question about the treatment

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janettavigil

Member Since 2012
Hi everyone,
My cat Rusty (10 yers old) and I are new to the board and to this diagnosis. Rusty was diagnosed with DM just 3 weeks ago and put on Prozink twice a day after taking care of his ketoacidosis with two days on IV treatment . His vet has been steadily increasing the dose every week from 1nit to 3, that Rusty is currently now. We cannot bring his glucose down. I measure it myself at home with AlphaTrak 2 and take him to the vet once a week for the curve. His glucose still pretty high: 491(am before the shot); 416(+3 hours); 402(+6h); 468(+10h) and his lowest reading is 3 hours after the evening shot - around 300-400. I switched him on wet food Fancy Feast Classic and feed him whenever he asks for food. It seems to me that Prozink doesn't work. I am worried that its taking so long to regulate him. My vet was saying at the last visit that we have to try to increase the dose before we change the insulin. We are going to see him tomorrow and I didn't noticed any difference in his glucose numbers after the dosage being increased. Please advise. Janetta and Rusty
 
Welcome, Janetta and Rusty. Scary thing, diabetes. I hope it will help to know we all were terrified in the beginning. But the more you learn, the more in control you feel.

We encourage dose increases in the .25 to half unit range so you don't go over the ideal dose. Increasing as fast as your vet did can be an issue. But with his DKA history, I wouldn't suggest (as we sometimes do) to reduce the dose and see if he is rebounding. Here is some info on it: Rebound

Three weeks is not a long time in diabetes land, although it seems like an eternity to you and Rusty. Very few cats go into remission or are regulated until the 3-6 month point, at the earliest, unless it is a food change that makes the difference immediately. We like the Start Low and Go Slow approach - starting at one unit, monitoring carefully at home and increasing by that half unit if the numbers suggest that. I honestly am not sure what to suggest at this point. It is difficult to know if he is getting too much insulin or too little. And his DKA history makes experimentation an issue.

He is only eating low carb Fancy Feast (pâté not gravy) and has no access to sneaking higher carb foods? You give low carb treats? Are the numbers you posted from the vet? Do you see any other lower numbers at home? (cats can be very stressed at the vet and stress artificially rises glucose levels)
 
Hello Janetta and Rusty- Welcome!

Prozink is a good insulin for cats but you are right- the dose is way high for just three weeks. What was his initial BG level? I am asking because even the 1u may have been high to start with but might have been mitigated because of the DKA. Too much insulin also kicks them into higher levels the higher you go.

Okay- you have switched to FF classic (how long ago did you switch? Sneakers held onto carbs for a whole week and they made her numbers high until they left her system) and feeding him anytime is good- all except for 2 hours before his shot times. If you feed during those two hours you will actually have food spiking his numbers- my cat used to go up 100+ points with food if that gives you any indication and it just continues to go higher until the insulin kicks in.

Alpha track- expensive meter and expensive strips- how often do you test then? At the least you should be getting in 3 tests- at each shot time to find out the 'fasting' BG and once in the middle to find out how low Rusty goes. Do you get any other testing in besides those? And you don't need to take Rusty to get curves at the vet as you can do them at home with no vet stress as his numbers will rise and be inaccurate anyway and is considered here to be a waste of time and money- save the money to buy more strips! Or you can get a human meter that have less costly strips and use that instead.

Give Prozink time to work. I would suggest buying keto-sticks at a pharmacy- usually $6-9/50 to keep up with any trace of ketones in Rusty's pee. Since he has had DKA already that is a big flashing sign and you need to keep it in mind. The reason I am saying to do that is going up to 3u twice a day in just 3 weeks is very dangerous and I would actually start to lower the dose slowly- 2.5u BID for at least 3 days- maybe longer and stair step it down. But testing for ketones is extremely important during this time.

There are other people who use Prozinc- in fact a whole forum of them :lol: - who can tell you more about it. We only used it for a few months until we changed to Levemir.
 
Thank you for answering. Rusty's BG level at diagnosis was above 500. It did not changed much with the increasing dose of Prozink. He has been on Fancy Feast for about 2 weeks. I decided to get Alpha Trak so I can be in sink with vet's numbers of BG,though I understand the problem with BG level and stress. I also did not to do any calculations, since I understand you have to add 30% to human meter readings. I test 3-4 times a day - Rusty is still getting used to it and I am not always successful. I will eventually planning to change the glucometer.
 
Sue & Oliver,

Thank you very much for your feedback, although quite frankly I do not know what to do with this information. We have been relying on our veterinarian for dosage and insulin type and perhaps expect results more quickly than possible. You are not kidding about scary! And confusing too. I just learn about rebound. That is even scarier. He is on Fancy Feast Classic, as far i understand its a lover carb food. No treats. And his curve I think is on the flatter side as you can tell from my firs post. Today's data: 491(0), 250 (+5,5). I will be monitoring him closely.
 
I know that my advice was open-ended. :mrgreen: I am not sure what you should do; I am not a vet. I have seen lots of cats whose doses were raised too fast and they did better on lower doses. But the DKA makes lowering the dose as an experiment scary. If you would decide to do that, as Heather said, you would also want to monitor carefully for ketones.

The insulin is working. Your numbers today are not flat at all. Your nadir today is almost 50% lower than your preshot. But your preshot numer was high. If you can, get a number around 8-9 hours after the shot to see how fast he goes up at the end of the cycle. That information might help us figure this out.

All Fancy Feast isn't low carb. The ones with gravy are high carb. You want the Classic kinds.

A question that Heather asked - what is the timing of tests vs food? You want the test to be before feeding. Food raises blood glucose levels so you want a test that isn't influenced by the food.
 
Hi Janetta (and Rusty),

I saw you mention "rebound" but at this point, I would not worry a great deal about it. Your vet did raise the dose pretty fast, but so did mine, and my cat, Bob was also diagnosed "DKA" at the beginning. His dose went up at about the same rate, but I just listened to my vet and nodded my head a lot until I found this place. The real issue may not be that the dose is too high, but that it got too high too fast. When you increase a unit at a time, there's a good chance you will skip over a dose that works well. From my experience with Bob, and from reading a lot of other's experiences here, it seems that vets are very heavy-handed with doses, and don't realize that some syringes have half unit markings for a good reason! Protocol here for any insulin type is to increase in no more than half-unit increments, and only rarely that much at a time. Most increases are made in increments of .25u, and then the dose is held at that level for at least 3 days before thinking about another increase.

I agree with what Sue and Heather have said about testing for ketones. You know already how scary they are (not to mention the expense of around the clock vet care), and they can be deadly. If you decrease the dose at all, you want to be testing with the ketosticks daily.

I also agree with Sue's thoughts on today's numbers. The insulin is working, and Rusty's BG's fell by 50% or more today. It could be that a dose reduction will be needed, and Heather's idea of dropping to 2.5u is a good idea, provided you can test for ketones.

Does Rusty have any other "issues" right now? Is he being treated with an antibiotic for anything? Other than the DKA, and the two days of IV treatments, did the vet mention anything else as a problem besides the high BG numbers?

Carl
 
And about the meter- human meters usually read UNDER pet ones and most people here use them.

What you will find out is that you DON"T have the know what Rusty is at that moment. What you need is a dependable meter that you don't mind using strip after strip on that will show you the trends of Rusty throughout the day each and every day. All of our advice is given on human meters- which typically read 20-30 pts lower than pet ones. There are those who prefer the alpha track meter and use it. I just want you to know that there is a cheaper option available if money does become an issue with testing as much as you want.

Good that you are testing daily and doing multiple tests :-D . The easiest way is (in the morning) test a fasting (& hungry :lol:) feed and shoot the insulin- we call this AMPS. Feed during the day- grazing is better for the cat if you can and if you are home during the day test sometime in the middle of the cycle (at +6 hours from the AM shot) other people (like me) test at night. At +10 hours from AM shot take up the food so you will have a fasting level at +12 (which starts the PMPS time) where you test, feed, and shoot. Some people have an early shoot schedule- I do 5am/pm, so I get up and shoot at 5am for AMPS, I get an out the door at 7:30 (+2.5), come home in time for the PMPS, get a bed time test (around+4 to +6), and wake up at least once in the middle of the night and get a test then.

The more data we have the better knowledge we have on what our fur babies are doing.
 
Thank you so much Hmjohnston and Sue and Oliver! We got a good curve and nadir today for the firs time in three weeks: 250(+5) and 223(+7). It started going up @+9 to 380. He ate 30 min before that. Now I am thinking that 3U is too high. I will test him PSPM withholding the food for 2h. I also got ketone sticks ready. And i only give him FF Classic that is lower carb as far as I check.
 
Heather and Carl and Bob, thank you again. I adjusted a prozink dose to 2,5U for pm shot, so i dropped it 0,5U, since the afternoon an evening numbers were much better:250 (+5), 223 (+7),380 (+9).The last one was after eating (I have to deal with my husband, who was not supporting the idea of not feeding him when he is hungry). I will be also checking his ketones. I have one Touch Ultra meter that i was using on Rusty before I got AlphaTrak and i have a lots of strips for it, that are expiring by the end of October. So I will get some other human meter that requires cheaper stripes and still reliable. Any recommendations? And Carl, It seems that Rusty doesn't have any other health issues . His liver enzymes were elevated and the vet explained that its bc ketoacidosis and they will get to normal. I still have a lot to learn, I appreciate you all for helping and being so responsive and I know now that I have a great support.
 
Just so I'm not confusing you and your husband...
It's okay to feed him at different times between shots. The only time you shouldn't feed is in the two hours leading up to each shot, because you want that test number to be free from any boost to the blood glucose due to eating (it might lead you to think that Rusty needs more insulin than he really does). Most of us feed more than just twice a day. When Bob was on insulin last year, he got 4 meals a day. One at each shot time, and one about 5 or 6 hours after his shots.

As far as meters go, Walmart sells a brand called Relion, and there are 3 models which are used by many people - the Confirm, the Micro, and the Prime. I think the strips for the Relion meters are the cheapest strips out there. I use a Relion Micro with Bob.

Carl
 
Carl, I think I understand the reason behind fasted BG reading. Will try to implement it. Thank you for recommendations on BG meter, I will get it. How do you take the urine sample? Do I need a spacial litter box that advertised on the website? Thank you s much again.
 
With respect to getting a urine sample: If he is a 'secret' type of guy who likes to use the litter box in private, then you might have to try some special tricks (and there are lots!). However, if he pees while you are there its simple. If you are not grossed out by doing so, you can just hold the ketone test strip in the pee stream. If he is a low squat type of peer, you might need to use a spoon or ladle to catch a bit and then dip the strip. I think that Dr. Lisa has some great suggestions on her web site at www.catinfo.org. I'll check and post the specific link in a moment.
 
Although the fancy litter box is nice, you don't need it. Some cats cooperate and with the bean hovering nearby are unable to stop in midstream and the bean can use a scoop to get the sample. Some people scoop out a place where the cat usually goes and put saran wrap on top. It helps keep the sample fresh. Oliver would not pee with anyone watching so we bought aquarium gravel and put it in a cleaned box. We left him alone in the room and waited. He couldn't stand the clean box and would go. We could get the sample after because it wouldn't be absorbed by the gravel. (The sample does have to be tested a few minutes at most after the cat goes.)
 
I will let you know that Sneakers was quite startled the first few times I lifted the lid and stuck a spoon in there. it was like "!!!" & and expression was "Nasty little voyeur!" (This after she has been watching me go and bath for 10 years and she objects when it is her turn :lol: If you go the catch and test later way- the bottle says you need to test the pee within 1 hr- not a large window.

Meter- I use the Relion Micro ($15) and have the strips on auto order from ADW (use the link in shop icon page to give FDMB a small commission for sending you their way) for $72/250 strips and it comes out to $.29 cents each (the strip in ADW is called Arkray) and at the store it is $36/50- $.36 per strip. The newest is the Prime ($15) and the strips are like $9 for 50 so this one REALLY is the cheapest out there. But when I went I could not find the Prime or the strips but they might have been behind the counter, too.

Feeding- small meals through the day/night is good for them. Just pick it up 2 hours before shot time to get an accurate reading.

Good luck!
 
So I did the ketones test today on Rusty. Negative! No technical difficulties. He just loves fresh litter... so a little bit of litter and table spoon did the trick posting.php?mode=reply&f=28&t=81232#. I was not able to take too many BG reading today, since i was at work all day:
-431(+12) at 7am (2,5U the night before);
-276(+2,5)
-435(+12) at 7pm (3U in the morning).
So the numbers are still high. Even that decided to go back to 3U.
Hmjohnston thank you for miter suggestion, that sound very good. The BG readings today were taken with human meter.
One Touch Ultra.
 
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