Relative Newbie--Dose Advice

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Michelle and Schatzie

Michelle and Schatzie

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Hi Everyone! This is my first time posting here. Some quick info about my cat, Schatzie. Schatzie has asthma which is treated with a Flovent inhaler. However, Fall 2016 her asthma got worse and we had to start her on prednisolone in addition to the Flovent. She had been on it in the past and her BG numbers were always fine so we hoped that would be the case again, but unfortunately not. After raising her prednisolone dose to 7.5 mg a day for 12 days in late December/early January Schatzie became diabetic. I didn't notice until February, when I realized she had dropped from about 11.2 lbs to 10.6. Her initial blood work showed her BG at 380. The vet was hopeful that tapering her off of the pred would land her in remission and so we held off on starting insulin for a few weeks. After getting her off the pred her BG was at 280 and so we started her on Prozinc on 3/25.

We started at 1 unit twice a day. I didn't start home testing right away (was waiting to receive my Alphatrak from Amazon), but I tested her urine with the ketostix and it consistently showed glucose (between 250-500), but no ketones. After a week the vet suggested raising Schatzie's dose to 2 units twice a day. I didn't want to raise her a full unit right away and so went with 1.5 instead. I received my Alphatrak a few days later and my first check at +3.5 showed a BG level of 55! So we reduced the dose right away and have been playing with it since.

My question--I'm uncertain what I should do with her evening dose. I currently have her on .5 unit, but I can't tell if this is too much or too little based on her morning numbers. Some mornings she is in the mid-to-high 200s, but every now and then she pops up to the 300s (this morning was 365). I can't tell if she is bouncing and needs a reduction or if she needs more insulin. Also, it seems like she has an early nadir--normally around +4.

I'd love if someone would check out her SS and let me know your thoughts!
 
Hi Michelle! Welcome! Thank heavens you didn't do that 1 unit to 2 unit increase. What is it with vets, anyway? Your girl is a bit of bouncer so it's harder to judge the effectiveness of a dose, especially if you look at the pre shot numbers. It's better to give more weight to the middle section of the spreadsheet. Your evening tests aren't that different from your daytime tests.

Why not try some consistent dosing for a while to see if things settle more? Sliding scale dosing can work well once you have a lot of data to know your kitty's responses. At the beginning of testing, the fewer the variables, the better. I suggest you try 1 u both AM and PM for a couple of days. It seems you're able to test during the day so aim for at least one test in the +5 to +7 window and at least one before bed test in the evening. Don't be afraid of dark green numbers if they pop up. Just post here for advice if you feel anxious.
 
Hi Michelle and welcome to our forum!

Wow I'm glad you didn't raise to 2 when your vet suggested it! Also very glad you caught that 55...and you did exactly right reducing the dose!

Kris's suggestions are exactly what I would go with. Some consistent dosing to see where you get could help make the picture clearer for us all.
 
Thanks for such a quick reply, Kris! I'm so glad I didn't go to the full 2 unit dose too--luckily I had done a lot of reading here at the feline diabetes site and knew that this seemed like such a big increase. I go to one of the (supposedly) best vets in Brooklyn, but apparently that isn't reflected in their knowledge of feline diabetes. My vet didn't even recommend that I home test--although she's completely on board with it now that I am.

I will definitely give consistent dosing a try. I got too eager and jumped the gun with the sliding scale dosing!

I've been on spring break this past week and so have been able to grab a lot of mid-day tests. Starting next week I'll only be able to do this a couple times a week on my days off (I teach part time at a community college), but will definitely keep it up.
 
Thanks as well for your reply, Rachel. Looks like I should have followed the vet's advice on this one--after the 55 she suggested returning to 1 unit morning/evening, but I got nervous when I saw that high morning number on 4/8 and dropped down to .5 units.
 
Michelle and Schatzie said:
Thanks for such a quick reply, Kris! I'm so glad I didn't go to the full 2 unit dose too--luckily I had done a lot of reading here at the feline diabetes site and knew that this seemed like such a big increase. I go to one of the (supposedly) best vets in Brooklyn, but apparently that isn't reflected in their knowledge of feline diabetes. My vet didn't even recommend that I home test--although she's completely on board with it now that I am.

I will definitely give consistent dosing a try. I got too eager and jumped the gun with the sliding scale dosing!

I've been on spring break this past week and so have been able to grab a lot of mid-day tests. Starting next week I'll only be able to do this a couple times a week on my days off (I teach part time at a community college), but will definitely keep it up.
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If you can do the extra tests today and tomorrow we should have a good idea about the dose by the time you're back at work next week.
 
Kris--great. I'll do the tests over the next two days and post again.

Rachel--that's doesn't surprise me at all! We teachers definitely believe that "knowledge is power" and so are willing to go the extra mile to do the research, home BG testing, etc. to try to find a solution!
 
Hi and welcome! Are you using u100 syringes? I agree with Kris and Rachel about the dose increase, but I might suggest baby-stepping the evening dose to something about .75 for a couple of evenings, and then getting to the 1u. A few nights back you had some lower blues on .5 and .7, and may have been a bit lower an hour later, that's why I'm suggesting a slower increase, and monitoring that +4 if you can stay up that late.
 
Djamila said:
Hi and welcome! Are you using u100 syringes? I agree with Kris and Rachel about the dose increase, but I might suggest baby-stepping the evening dose to something about .75 for a couple of evenings, and then getting to the 1u. A few nights back you had some lower blues on .5 and .7, and may have been a bit lower an hour later, that's why I'm suggesting a slower increase, and monitoring that +4 if you can stay up that late.
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This is why we have peer review! :)
 
I've been using the U-40 syringes and attempting to eyeball the dose for anything under 1 unit (which probably also hasn't helped much in terms of consistency). I was planning on picking up some U-100 syringes today if I can find them, otherwise I'll order them online.

I just checked Schatzie at +3.5 and she was at 91. She really dose seem to hit her nadir earlier than a lot of kitties--around hour 4. I'll check again around +5.
 
Michelle and Schatzie said:
I've been using the U-40 syringes and attempting to eyeball the dose for anything under 1 unit (which probably also hasn't helped much in terms of consistency). I was planning on picking up some U-100 syringes today if I can find them, otherwise I'll order them online.

I just checked Schatzie at +3.5 and she was at 91. She really dose seem to hit her nadir earlier than a lot of kitties--around hour 4. I'll check again around +5.
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The U100s used in conjunction with the conversion chart give you a lot more fractional dosing options.
http://www.felinediabetes.com/insulin-conversions.htm
 
I live in Brooklyn and don't have a car so unfortunately no access to Walmart. But there are several pharmacies nearby that might have them. If not, thanks for the links to where I can order them online.

Also, I love your picture of Sam in the sink--Schatzie's a sink-loving cat too!
 
Well, in a completely unexpected turn of events Schatzie's PMPS was 191 on the Alphatrak! Since she's never had anything this low before for a pre-shot (and it's well under the 225-250 no shoot number listed on the Prozinc protocol for beginners) I've made the decision to not give her a shot tonight. We'll see what the morning brings...
 
Michelle and Schatzie said:
Well, in a completely unexpected turn of events Schatzie's PMPS was 191 on the Alphatrak! Since she's never had anything this low before for a pre-shot (and it's well under the 225-250 no shoot number listed on the Prozinc protocol for beginners) I've made the decision to not give her a shot tonight. We'll see what the morning brings...
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Good choice for now. Keep on logging data so you can learn her patterns. Eventually you'll revise the no shot number downward. Safety is always the number one priority.
 
I think that was a good decision. We have many folks here who shoot lower than that, but they also have tons of data behind that decision. Good news is that you know Schatzie is doing well and is in good numbers!
 
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