Overshot correct dose? Help!

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Mancat

Mancat

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Hi. So this is an introduction/question. My cat Nala (yes after the lion king) is 11 years old and will be 12 in late February. She is affectionately nicknamed Mancat because she's a petite kitty with a giant head and depending on her expression she can look like a disgruntled man. She was diagnosed with diabetes about 6 weeks ago. My name is Alisha and I adopted her when she was 8 weeks old and I've had her ever since. I found your site and all of the incredible people and information prompted me to sign up and ask my question because getting the dosage correct has been frustrating. I'm not mad at Nala by any means but I'm frustrated because I can't help her instantly and it takes time. That being said, here's my question:

I think my vet and I may have overshot the correct dosing for Mancat. I've spent hours reading the forum and noticed references to too much insulin having the opposite effect. Here are her stats and why I think the dose is getting too high.

Age - 11
Weight - 9.5 (she lost a lot rapidly which along with her increased appetite and urination led me to taking her to the vet and getting the diagnosis)
Food - Wet (she used to have urinary tract issues on dry food so last year she was switched to wet and has had no problems since then)
My vet tested her for all the usual conditions and she has nothing other than diabetes

Her original numbers as per the vet's curve were in the 600's. My vet started her out on 1 unit twice day of ProZinc. She encourages home testing so I immediately picked up an AlphaTrak meter kit which came with all the goodies I'd need for home testing. Two weeks later I did my first at home test and the numbers remained in the 500's. We increased the dose to 2 units, twice a day. Two weeks later I did another test. Her morning pre feed/pre shot was 326, her +3 was 249, her +6 was in the low 200's and from there it leveled out and slowly increased to 400 at +12 before her second shot. I'm thinking awesome, major improvement here. At this point my vet recommended 3 units, twice a day (this was 2 weeks ago from today.) I am currently doing her curve this morning and her pre feed/pre shot was 510. Massive spike. She has another couple hours before her +3 test today but I was worried. Here is where I start noticing some problems. First, I've read tons of posts where you guys don't recommend increasing by a whole unit like that. I could understand at first because her numbers were so high but 2 units seemed to be inching closer to good numbers. Second, I made a rookie mistake and when buying her wet food (2 weeks ago when we switched to 3 units.) I got her the gravy kind because I thought it'd be a nice change of pace. I just read this morning that the carb content is too high and could be spiking her numbers. I got it at Costco which also has the pate so I'm going to go switch it out later today. All the pate flavors in the variety pack are sub 10% carbs which I know is recommended. If I give my vet Nala's curve numbers today I know she will recommend 4 units twice a day but after everything I'm not sure that's right anymore. Should I get Nala on the pate and stay at 3 units and test again in 2 weeks? Or put her on the pate and switch back to 2 units and test again in 2 weeks since she was having improvement there. If I do the 2 units I can do the .25 increases that you guys say works the best.

Thank you so much for any help and sorry this was so long but I wanted to make sure I got as much information out as I could.
 
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Welcome Alisha and Nala! It's great that you are home testing and that your vet is on board with that. I haven't been here long enough to offer dosing advice, but I would say you should get the food changed before increasing the dose. Since you are using ProZinc, I'll tag @Robin&BB for you. She will be able to give you dosing advice. Good luck!
 
Thank you so much! Nala is like a lot of cats and get super stressed at the vets. She yowls like she's dying and starts panting. I'm so happy my vet prefers home testing. So far today's curve is looking like this:

0 - 510 (pre feed/shot)
+3 - 366
 
My cat, Colin, was on 5u 2x/day before I switched him to Levemir. We wondered if I had overshot with him too. With advice from the great people on the ProZinc forum, I lowered his dose and slowly raised it. It didn't help Colin, but maybe Nala will respond to it. Robin will be able to guide you. BTW, She sure is a cute kitty!
 
Hello and welcome to FDMB! It's great that you have done so much research into treating feline diabetes, and that you are home testing!

I don't use ProZinc so I can't offer any dosing advice, but there is a forum here for ProZinc users and I'm sure someone there will be able to give you advice.

Nala (or Mancat) is adorable! Keep us posted on her progress, please! :):):)
 
it is hard to know what is going on. Yes, we advise increasing by 0.5 units rather than one full unit. And sometimes, as strange as it seems, too much insulin can look like too little - causing high numbers. That said, there are cats who do require more insulin than others.

If she were mine, I'd go back to the low carb. And I'd get some more data - especially in the 5-7 hour range, to see if she drops late in the cycle.

Her numbers today certainly suggest the insulin is working with a big drop at +3 (we think a 50% drop at midcycle is a decent drop). If she drops into the 50%+ range 5-7 hours after the shot, the dose may not be too bad. If she drops really low (200 or below) then it is possible she is bouncing. Bouncing is when their body perceives a lower range that it is used to (it doesn't have to be in the 50-100 range, it just can be a big drop from the preshot number) and releases extra glucose. The extra glucose causes the number to bounce up high.

It is possible that she is getting too much insulin, but usually that pattern is a high and flat cycle or a cycle that plummets at nadir.

The protocol we put together for ProZinc is in my signature. And yes, I'd definitely post in the PZI forum. Everyone uses or has used your insulin and can help with dosing. It is also very helpful to look ath their spreadsheets and threads to see how they are doing.
 
Welcome to the FDMB Alisha and Nala!! This is the best place you never wanted to be!!

I don't use ProZinc (We use Lantus) but ProZinc is a good insulin for cats so I don't want you to be discouraged about that! It's great that you're home testing too! That will be the most important thing you can continue doing!

You have learned a lot already. First, low carb canned or raw food only, so you want to buy foods under 10% carbs. Here's a Short List of foods under 10% but there are others. If you've been feeding something higher carb, it's VERY important that you don't switch to a low carb food too quickly since you're already giving insulin. First rule here is we want to keep Nala safe!

Next, how often are you testing? It sounds like you're only testing every 2 weeks at home and that's nowhere near enough. At least your vet seems to understand that you'll get better results doing a curve at home than in the office!

Here we want tests before EVERY shot ...if this was a child, a human doctor would never tell you to give insulin without testing first, and it's the same with our sugarcats! It's the only way to know if they're high enough to give any insulin at all!

Then you want to get a mid-cycle test somewhere between +5 and +7 (5 to 7 hours after the morning shot) to see how low it's taking her (that's called the "nadir")....then another test before the PM shot and at least a "before bed" test at night.

By getting those tests in, you'll be learning how low the insulin is taking her and that's how we make dose adjustments, not by how high the Pre-shot tests are (although with ProZinc, the Pre-shot test results are more important than they are with some other insulins)

We have a great spreadsheet program that we use here that's every bit as important a tool as your insulin is. Here are instructions on setting up the FDMB spreadsheet. Before giving dose advice, the people here will always want to check your spreadsheet to see how she's been doing.

The AMPS is the AM Pre-shot test--PMPS is the PM Pre-shot test. After that, we use the "+ system"....however many hours since the last shot, so +4 is 4 hours after the last shot, +7 is 7 hours after....all the way to +11 and then the next cycle starts over

Now for your dose...again, I'm NOT a ProZinc user, but my feelings are that you may want to drop back down to no more than 2U twice a day and start getting those tests in every day. You're totally right that too much insulin can look like too little!! Without knowing how low it's taking her every day, it's possible that she's been going much lower during the day (or at night when a lot of cats go lower!) and then she's "bouncing" high again.

Bouncing happens when the blood glucose goes too low, drops too much quickly, or even if it just drops to a point that the body isn't used to being at anymore (or any combination of the 3). The liver releases store sugar and hormones to bring it back up quickly...they "bounce" high. It can take up to 3 days (6 cycles) for a bounce to clear, so if the days you've been testing were days she was bouncing, that's enough to explain the high numbers.

Keep asking questions! You're well on you way to getting Nala under the best control possible!....and with a little luck, maybe even into remission!!
 
Sorry I didn't post sooner! I just ran out to Costco to swap out her food. I double checked all the carb contents on the catinfo website again before going out and I'm stocked up on 3 months worth of pate which all runs around 8-9% carbs depending on the flavor. Pretty sure the gravy kind running at 20% is wreaking havoc.

Here are her current curve results (with reviewing your system)

AMPS - 510
+3 - 366
+6 - 466

I've been testing her every 3 hours. My vet did say to wait for 2 weeks to give her body time to adjust to the dose. In another thread I saw someone say it could take a few days to get the remaining carbs out of her system. I'll finish her curve today and repeat it again tomorrow and Monday since I'm off for the holiday. Should I go back to 1 unit twice a day and slowly build from there? You said no more than 2 so I'm not sure where my starting point would be. I'll take a look at the ProZinc forum, too.
 
Mancat said:
Sorry I didn't post sooner! I just ran out to Costco to swap out her food. I double checked all the carb contents on the catinfo website again before going out and I'm stocked up on 3 months worth of pate which all runs around 8-9% carbs depending on the flavor. Pretty sure the gravy kind running at 20% is wreaking havoc.

Here are her current curve results (with reviewing your system)

AMPS - 510
+3 - 366
+6 - 466

I've been testing her every 3 hours. My vet did say to wait for 2 weeks to give her body time to adjust to the dose. In another thread I saw someone say it could take a few days to get the remaining carbs out of her system. I'll finish her curve today and repeat it again tomorrow and Monday since I'm off for the holiday. Should I go back to 1 unit twice a day and slowly build from there? You said no more than 2 so I'm not sure where my starting point would be. I'll take a look at the ProZinc forum, too.
Click to expand...

Welcome. I certainly can not comment on insulin and dosage as I use another and still trying to get Smokey regulated.

I do suggest keeping a few cans of the gravy kind of food on hand. It's part of the hypo toolbox I've become way to familiar with lately. If you don't have that, then karo syrup, maple syrup or even little tube of cake decorating gel. Since its all new to both of you, be prepared for anything.

Keep us posted on your progress.
 
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