PLEASE HELP! Hard to regulate newly diagnosed

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Kerry 235

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I'm overwhelmed. I need to make decisions about what to do and really appreciate any information that might help.

Domino is 13yrs 8mo male cat, diagnosed in October 2015. He was started on 1 unit of Prozinc at the same time that his food was Hills Metabolic diet (dry) 1 cup per day. Before getting the diabetes diagnosis, this food was increased from 5/8ths to 1 full cup because we were thinking that his vomiting was maybe due to not getting enough food (we had finally got him to lose the weight on this diet). At the time of his diagnosis, his BG was 544 and later a fructosamine was in the 800s. On 1 unit of Prozinc and 1 cup of Hills dry metabolic, his numbers were still high and after almost a month it was increased to 2 units. At 2 units his BG was still high, and it was increased to 3 units at the same time that we changed the food to Hills MD/glucose/weight management and also changed it from 1 cup to 5/8ths cup (which I measure as slightly under 1/3rd cup in the AM and again in the PM). Also, he wasn't on 2 units very long before we increased to 3 units. By mid-December (at the time of this increase), I was finally comfortable doing the shots and know he was getting all the doses (prior to that I had trouble with my technique and the fur would be wet sometimes).

On 3 units there was basically no change in his fructosamine, so it was increased to 4 units and again no significant change (over 600). The vet says increasing to 5 "would be a lot" and says I can do this, or stay at 4 units, or switch from Prozinc to Lantus. The question I had about a possible Somogi effect wasn't answered. I bought an AlphaTrack glucometer but haven't been able to use it… I tried. I had also tried-- REALLY tried-- switching to wet food but he wouldn't eat it, so that's clearly not an option.

He's been on 4 units for 2 weeks and the fructosamine is 636, but a BG at the vet was 265 at 9 hours after a shot was given. The fructosamine at 3 units was 617 and at 2 units was 625.

I'm attaching a spreadsheet that I've used to help me keep track… I've been managing a complicated work/school schedule and making a lot of sacrifices to get home in the 12 hour mark on my early/late days.

Also: Domino had bloodwork to check organ function and everything came back just fine! There are no ketones…! I've recently begun to use the urine tests strips, but all of which have indicated glucose.

I'm fearing the worst more and more everyday. I wonder if my impatience and lack of knowledge in the beginning contributed to missing the right dose. I really don't know what to do (still). Should I switch insulin? Should I "start over" on Prozinc?
 

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Fructosamine only gives an average, not the peaks and valleys. While the peaks may be alarming, its the glucose lows you have to watch like a hawk, as too low can be fatal, quickly.

The food you're giving may be part of the issue. Take a look at Cat Info to see what Dr Lisa Pierson suggests in feeding cats. If you want to make a change in the food, you'll need to be home glucose testing for safety as the glucose levels may drop 100-200 mg/dL and the insulin dose may need to be reduced 1-2 units. This varies with the individual cat.

We highly, highly advocate home blood glucose testing. It is more accurate than urine testing and gives you and idea of what is going on right then, not just the period since the previous void. You need an inexpensive glucometer, matching test strips, and lancets labelled for alternate site testing (26-28 gauge). Check YouTube for videos of home testing blood glucose, practice on a piece of fruit, practice on yourself, then practice testing your cat.

I took a look and your spreadsheet wasn't helpful to me in terms of giving you feedback.

So, can we get you started using our grid to record your notes and, eventually, glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning, pre-shot, test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening, pre-shot, test)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

It is merely a grid for storing the info; no math required.
 
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Thank you! I bought the feline glucometer: AlphaTrack. I even took a day off of work to hope to create a glucose curve, but it didn't work out. I felt like I was scaring him. I'm going to try again. I'll practice on myself first and hopefully I can get samples from my cat. Thanks for the spreadsheet!

If I can't do it, should I bring him to the vet for the day so they can do it? I think that would affect the results because of stress.

I guess the idea is that being able to create a curve will answer all my concerns? That we could figure out if it's the Somogyi effect or insulin resistance?
 
A curve, or even just spot checks during the likely nadir period will help you see how the insulin is working, or not.

Testing:
1) Always test before giving insulin to make sure it is safe.
For now, your no shot level is 200 mg/dL on a human glucometer (230ish for pet-specific meters); this will lower as you collect data around the middle of the cycle to know how low he is going.

2) Mid-cycle tests between shots - whenever possible, test around the nadir (lowest glucose level between shots) for your insulin, to see how low he's going. For ProZinc, this often falls between +5 to +7 hours after the shot. Some folks do this on weekends or set a clock for the middle of the night to get this test done as it helps determine dose adjustments. This number should be above 68 mg/dL for pet-specific meters.

3) A before bed test is helpful in determining if you need to break out some higher carb food and steer the glucose level or go to bed with some peace of mind. Steering means giving 1-2 teaspoons of high carb gravy, waiting 30 minutes, and re-testing (repeating as needed) to make sure the glucose stays above 68 mg/dL on your AlphaTrak meter.
 
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Hi! BJ has already given you lots of good info, so I just wanted to c hime in. :) Testing on yourself is a great idea...when I first learned to test, I brought my glucometer to work and asked my friend who is diabetic to help me figure out how it worked. I went from there to watching videos on youtube to see how to test a cat. All these things helped..especially when I sat on the floor and looked up at my cat on the couch...she had a lamp behind her and I could see the vein in her ear. That helped me find the "sweet spot".

When you can test at home, that will help you figure out a good dose...I also think it will make you feel better. It'll show all the numbers, rather than just an average which isn't really helpful.
 
I have exciting news this morning: I got him to eat some canned food!! I'm really surprised but so happy-- I've tried it before but this time I put a treat that he's crazy for in the mix… it still took him time to accept it, but it worked! For now, I just wanted to see if he'd eat it. I'm going to ask the vet about switching to canned food and starting over on Prozinc. I don't want to upset him while he's getting used to new food so maybe I'll use the time to practice the glucometer on myself and then when I'm confident with that, and confident that he's eating the canned, then I'll do home testing.
 
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It sounds like you have a good plan, going forward. Adding a treat to the wet is a good idea. Some people also add some warm water to the pates and make a sort of soup. My kitty doesn't like the texture of the pates, but if I make it a little soupy, he gobbles it up.

You can get yourself and your kitty ready for home testing this way:

First, pick a spot where you plan to test. Take him there, praise and pet him him, give him a special treat and let him go.

The next time, add messing with his ears, praise, pet, treat and release. After he sits for that, add warming his ears. (Some people use a rice sack: a thinnish sock, filled with raw rice, knotted and warmed in the microwave until very warm. Some people put very warm water in a pill container) . Either way, hold it up to his ear, pet, praise, treat and release.

Finally, after you've tried the lancet on yourself or an apple or someone else and know how it works, add the click of it to the process.

Finally, add poking. Be sure to give a treat, successful test or not

As Rachel says, practicing with the meter helps first. Knowing how to get the strip in etc really helps.

We say three tries, treat for kitty and bean and rest. Sometimes you don't get blood the first or even second time. But poke firmly and confidently. Also, 25-27 gauge lancets can really make a difference. The 30/31 gauge used for humans can be too thin at first for cats.

Let us know how it and the food change goes. We will be really anxious for you to home test. Changing the food over can lower the levels by quite a bit and you are shooting a big dose. So I would go easy on the wet (maybe one meal a day) until you are confident testing. Normally we say don't switch foods until you can test, but I know you have had trouble getting him to switch. If the testing is taking a while and he is eating the wet food well, you might lower the dose a bit, just to be on the safe side.

Let us know how we can help and don't give up. We would love to help you help your Domino.
 
I think you are on the right path to home testing, setting up a spreadsheet and switching to wet, low carb can food. Those three things are the main things to start right away so you will be informed, kitty will be safe and you will be in control. Here is some additional information on those three things. Please read as much as you can, several times over, and eventually it will sink in. There is a huge learning curve at first but it will all come together in a very short time.

Also, I am going to give you a list of things to try if your kitty is having a hard to time to eat. I know Domino is eating but maybe some of things he will like as you transition. My cats love Bonita Flakes which is shredded fish and can be found in an Asian market. I just sprinkle that on top of foods and they gobble it up. Also as you transition, you may want to consider taking about four days to transition at 25% at a time so Domino doesn't get an upset stomach.

How to get Kitty to Eat

1) Chicken Broth or Beef Broth (no sugar added); could be made from bouillon cubes
2) Tuna or tuna broth/juice
3) Parmesan cheese sprinkled on food
4) Bonita Flakes sprinkled on food (get from Asian Market or possibly some local food stores)
5) Boiled chicken shredded or pureed
6) Baked/broiled/boiled Salmon, White fish, etc.
7) Warm up regular food in microwave
8) Florti-Flora sprinkled on food (get from vet)


Spreadsheets: Our spreadsheet instructions are here. If you look at the signatures of the members here, you will see a link to their kitty’s spreadsheets. We keep track of all our tests. This is basically a place to collect data and help you to determine patterns, doses, etc. It also aids those that may be helping you to better understand your kitty. To further my knowledge on diabetes, I would make it a habit to read other kitty’s postings and spreadsheets. Even though they are all different and will be different than your kitty, it was still invaluable information.

Food: There are many reasons why we are here but one is due to feeding dry cat food which is high in carbs. You will want to consider changing your food to wet, low carb food. It is recommended to feed food that is under 10% carbs and I found with Merlin that right around 4-5% worked for him. Here is a list of cat food to choose from food chartyou will note that the food with fish are lower in carbs however it is recommended that you only give fish once a week due to its mercury content. Many use Fancy Feast, 9 Lives, Friskies, Wellness, Werurva etc. This list can also be found in www.catinfo.org If you are already giving insulin and you have not transitioned to wet, low carb cat food, be sure to test while you are transitioning. This is because by changing to low carb food, it could decrease your kitty’s number by 100 points or more. One last thing, many of us add water to the wet food so your kitty is getting plenty of water to flush out the toxins and to keep them hydrated.

Hypo Kit: Always good to be prepared for possible hypo events (low blood sugar) which means that your cat has reached dangerously low numbers. It can be fatal, hence, the importance of home testing and collecting data in a spreadsheet. In each of the Insulin forums are stickie’s labeled Hypo Links. Here is one: How to Handle a Hypo. Please print and post on your refrigerator so everyone in your household is aware of hypo symptoms. You will want to create your hypo kit that would include and not limited to; extra testing strips, honey/karo/maple syrup, high carb food, medium carb food, vet information, etc. Hopefully you will never need it but probably at some point in time, you will need to deter from going too low.

Treats: It is always nice to have treats available for your kitty especially when testing or when they decide not to eat. I like using Pure Bites. I have found it at Petsmart and other pet stores. It is freeze dried and the only ingredient is the meat i.e. chicken, duck, etc. If your cat likes it, then I would go to the dog section where it is cheaper than the cat package. It is bigger chunks but no problem in breaking it up. Another option is to use Bonita Flakes where you can find at your local Asian market. There is a link here somewhere in this site that has a list of low carb treats.

Home Testing: Here, we all home test and congratulations to you for wanting to home test too. It is mandatory to understand how your kitty is reacting to the insulin and the dose. You will want to test before each shot and some additional test in between the 12 hour cycle when you can. The main reason to home test is to keep your kitty safe and to find an effective dose. Find a place in your home where you will always perform the test and give lots of hugs and treats before and after testing. There are many videos showing you how to test. Hometesting Links and TipsHere is a picture of where you test on your kitty. http://s106.photobucket.com/user/chupie_2006/media/testingear/sweetspot.jpg.html

Here is another good link on Home Testing:http://www.felinediabetes.com/bg-home-test.htm
 
Thank you all for the info! It's going to be a process for me to become familiar with it all.

Right now I'm trying to muddle through the chaos of decisions. I'm going to try to do a glucose curve at home this weekend, by which time he will be fully transitioned to wet food. I'm not confident I'll get the curve done, but I will try my best. Realistically, I don't think I can plan to rely on doing a curve this weekend in order to effectively rule out Somogyi effect.

Today I spoke to the vet and initially we were thinking of starting over on Lantus, but after further discussion decided not to. The vet said to continue on 4 units of Prozinc and do the switch to wet food. I did his evening shot and split his food between wet and dry as best as I could, erring on the side of giving too much food rather than too little. Honestly, I am concerned the vet is saying to keep the dose at 4 units and change the food. I'm wondering if we want to "start over" on Prozinc with the new food… maybe not at 1 units but at 2? I'm basing the idea of "(re)starting" at 2 units because while on dry food that's when we saw the most improvement. The increase to 3 and 4 units didn't show any improvement (Fructosamine tests).
 
Maybe not do a curve this weekend but concentrate on getting the preshot numbers- so if the new food drops his levels, you can reduce the dose if needed - and a number 5-7 hours the shot (so you know how low the dose takes him). That takes the pressure off your having to test so often, but can keep him safe.

How are you feeling about the testing? Did you get the larger gauge lancets? Have a rice sack or pill vial ready to warm his ear? Have you looked at his ear with a flashlight so you know where to poke? ( you are aiming for the little capillaries that run off the fatter vein which runs up and down the side of his ear.). This is silly, but some people sing while they test at first - there is a version of the Hokey Pokey song going around that uses Pokey, Pokey instead.... It could settle you and the cat if sung softly......
 
Thanks! I've been focusing on food today: the switch to wet will be Fancy Fest or Weruva. I don't trust Hills "prescription diet" anymore.

I think that's a good idea about the testing... I am nervous... I'm leaving work early to get the new supplies... the food, the lancets, something to warm his ear... I'll be watching the videos when I get home

Can I ask what the initials "OTJ" mean? Sorry about your Oliver.

I'm worried about Domino's kidneys... after the vet had told me that all the bloodwork to check organ function was "good," just yesterday she sort of randomly mentioned that his kidneys were "borderline"... I'm guessing that means borderline failure, but she didn't say directly... I still have to hold out hope that the changes to get him properly regulated will make things better
 
OTJ is off the juice, or in remission. Thanks, Oliver was a sweetheart - a big Maine Coon. We, like everyone, were devastated to get the diabetes diagnosis, but it turned out to be the easy part. The heart disease and his age were the parts we couldn't control.

It's hard to know about the kidneys. My understanding is that if a cat is diabetic, then their kidneys will be compromised to some extent, but if their levels improve, the kidneys can improve. If I were you, I'd put that on a back shelf and concentrate on the diabetes. You have a great attitude and determination, and often, that is the most important part of this sugar dance.
 
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