Seeking input on a difficult choice (insulin or not)

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SusanandOwen

SusanandOwen

Member Since 2013
I have posted here a few times about my cat Mac, whose BG is routinely right around 200, plus or minus about 10-15 pts. We were hoping that his numbers would come down some after his dental procedure (3 weeks ago) and being put back on a stricter low carb diet ... but that hasn't happened.

At his follow up appointment, the vet was really pleased with Mac's overall condition. He had gained back the pound he had lost when we tried putting him back on the strictly low carb food (which he pretty much refuses to eat,) his mouth looked great and he seemed happy & healthy in every way. However, the vet still feels that Mac would benefit from being put on insulin. The vet said, "why not let him enjoy the foods he likes (FF marinated morsels, mostly, along with the zero carb dry which he picks at throughout the day) and just give him the shots," likening it to a guy being told he can't have a beer or food he enjoys."

This vet uses ProZinc and suggested that 1u BID would be a "very conservative" dose.

I expressed my concern(s) that due to my work schedule, it would be very difficult for me to keep him on a 12 hour dosing schedule, although I think we could get close enough to manage. However, there is *no way* that I will be able to routinely monitor him at other times to assess his response to the insulin during the day. And since he routinely stays right at that "no shoot/shoot with caution" BG number, I really worry about a hypo, even on just 1u.

The vet - who is a feline specialist with almost 20 years of experience, and who I believe is very competent - said that he does not advocate testing at the time of insulin administration (because it won't take effect for hours) and wouldn't worry about routinely testing during the day. He did say he felt there was value in trying to determine the nadir, but that at 1u he would have no concern about causing a hypo.

Vet also quoted the approach used at UCSF Medical Center's diabetes program which has an extremely rigid protocol for (human) insulin therapy - which is extremely successful. Yes, it's in humans, I know, but I am in the medical field myself and I would agree that they are one of the top programs.

So ... sorry for the novel... but if you had to choose one approach or the other for your cat... what would you do?

A. Put the cat on insulin (1u BID, Prozinc) as suggested by the vet (with either zero testing, or only AMPS/PMPS) ... even though the cat's BG is going to be ~200 at those times.
OR
B. Choose not to put the cat on insulin, and monitor weight/appetite/5Ps

For the sake of this discussion, please assume that getting someone to come in during the day to do the monitoring is not an option at this time.

Thanks in advance for any thoughts you are willing to share.
 
Prozinc is a U-40 insulin so......using the conversion chart and U 100 syringes with 1/2 unit markings you could start him on 1/2 unit of the U-40 which would pull up to 1.25 units in the U -100 syringes. Using the conversion chart you could even start him on .20 of a U 40 unit which would be a real tiny dose. Maybe also start it on a weekend when you could monitor more. A .20 dose of Prozinc would pull up to 1/2 unit mark in the U 100 syringe.
 
Drat it - I wondered how he was doing and was hoping he had dropped BG. Whats his levels been like the last week?

A few thoughts - What about fancy feast flaked? I would try a variety of low carb wet and dry first to see if you can get him eating any of it. You want him eating normally. I have 3 cats and I wanted them to all eat the same food and they are picky so I bought literally 2 cans of everything low carb wet (and if I were you I would try dry too) until I found something they would consistently all eat. (need 2 cans because sometimes they will eat the 1st can and turn their noses up at the 2nd)

But I would also get some urine glucose strips and see if he is spilling glucose into his urine at these levels. If he isnt , or if its trace, you might get away with leaving him at these numbers.

Wendy
 
i'd go with option A myself but maybe consider 1/2 a unit to start with since testing will be minimal.

fwiw, my cats are rarely if ever shot on a 12 hour schedule and we've used the old PZI by Idexx and now lantus and in all honesty, with my type 2 diabetic, i don't notice much difference at all as to whether he gets his insulin at 10 hours or 13 hours. with my type 1, sometimes she is unshootable if the shots get too close together but i deal with that when it happens. by knowing your cat and knowing the meter is your best friend you will know what to do in situations like that. i just don't think the 12 hour regimen is a must do, especially when doing something is better than doing nothing and there's a life at stake.

also, i don't do any mid day testing thru the week. just on weekends or the occasional holiday if i'm blessed to have an extra day off work. in the beginning i made sure to do more of it on the weekends when i was home but now that both kitties are very well regulated, i only do occasional mid day testing on the weekends.

it may not be ideal in some eyes but my type 1 has been diabetic since 2006 and is running 90-150 most days and my type 2 is running 65-110 most of the time and most of that is spent in the 80's and 90's so it's working for us
 
Feeding him higher carb while giving more insulin seems odd to me. Would you tell a human diabetic to continue eating donuts and just increase insulin usage? You have a chance to get him into remission if his numbers are lowering. As others have suggested, using the conversion chart and U100 needles give you lots of options under one unit.

Lots of people here work days (and nights) and work around their schedule. ProZinc is more flexible than some other insulins as you can shoot early or later if you have to. Many people get their midycle number at night, and not every night but every so often.

If he were mine, I would find a day or night when I could get some midcycle numbers and see about lowering the dose. If you want specific advice on dosing with ProZinc, come over to the PZI forum. You might check out some of the threads there and see how people are managing with odd schedules and odd kitties. :mrgreen:
 
Wendy&Tiggy said:
Drat it - I wondered how he was doing and was hoping he had dropped BG. Whats his levels been like the last week?

A few thoughts - What about fancy feast flaked? I would try a variety of low carb wet and dry first to see if you can get him eating any of it. You want him eating normally. I have 3 cats and I wanted them to all eat the same food and they are picky so I bought literally 2 cans of everything low carb wet (and if I were you I would try dry too) until I found something they would consistently all eat. (need 2 cans because sometimes they will eat the 1st can and turn their noses up at the 2nd)

But I would also get some urine glucose strips and see if he is spilling glucose into his urine at these levels. If he isnt , or if its trace, you might get away with leaving him at these numbers.

Wendy
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Sigh. Yeah... I was really hoping the numbers would come down, too. But I promise you - I have tried every.single.low.carb.canned.food I could find over the last few weeks, without much success. (And this is by no means the first time we've tried to get him to convert to low carb food.) He's been right around 190-200 all week.

For a few days, mixing it with the (zero carb) dry food got him to eat pretty well. Then he just turned his nose up at it and gave us a really hard time about eating anything at all. He lost a little over a pound between the associate vet saw him and when he went in for his dental. We had a bit of a miscommunication with Vet #1, who is an associate in the practice - she saw him for his regular check up prior to the dental, and told us she wanted him to lose 2 pounds, so I didn't get as aggressive with the food situation when he was eating poorly (he was still pretty darn fluffy.) When we saw the senior vet, he told us he did NOT want Mac to lose any weight and to try to get him to gain it back, fearing it was an indication of the onset of much more serious diabetic problems.

I told him at the time I was quite sure I could put the weight back on him pronto if I could give him the FF he likes - which is exactly what happened. When he went to the follow up after the dental, he had regained all the weight he'd lost... plus an ounce or two, LOL. The vet said that given how easily he put the weight back on, he was rethinking his concern about the onset of more serious issues, because he's clearly able to utilize the calories he's getting. But he still feels like the insulin would be the right thing to do. The only time he's ever had sugar in the urine was at the vet's at the time the dental was done - and his BG reading was over 300. He was unbelievably stressed there that day; it was *really* busy and he was there for the procedure, so was getting IVs, anesthesia etc. Even the pre-meds for the anesthesia made him upset and sick :( He hasn't had a problem with any sugar in the urine since then, as far as I can tell.
 
Hope + (((Baby)))GA said:
Prozinc is a U-40 insulin so......using the conversion chart and U 100 syringes with 1/2 unit markings you could start him on 1/2 unit of the U-40 which would pull up to 1.25 units in the U -100 syringes. Using the conversion chart you could even start him on .20 of a U 40 unit which would be a real tiny dose. Maybe also start it on a weekend when you could monitor more. A .20 dose of Prozinc would pull up to 1/2 unit mark in the U 100 syringe.
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That's a very interesting idea... thank you. I may just try that! For sure I would be happier with reducing the chances of a hypo while still trying to get that BG down some. :)
 
LynnLee + Mousie said:
i'd go with option A myself but maybe consider 1/2 a unit to start with since testing will be minimal.

fwiw, my cats are rarely if ever shot on a 12 hour schedule and we've used the old PZI by Idexx and now lantus and in all honesty, with my type 2 diabetic, i don't notice much difference at all as to whether he gets his insulin at 10 hours or 13 hours. with my type 1, sometimes she is unshootable if the shots get too close together but i deal with that when it happens. by knowing your cat and knowing the meter is your best friend you will know what to do in situations like that. i just don't think the 12 hour regimen is a must do, especially when doing something is better than doing nothing and there's a life at stake.

also, i don't do any mid day testing thru the week. just on weekends or the occasional holiday if i'm blessed to have an extra day off work. in the beginning i made sure to do more of it on the weekends when i was home but now that both kitties are very well regulated, i only do occasional mid day testing on the weekends.

it may not be ideal in some eyes but my type 1 has been diabetic since 2006 and is running 90-150 most days and my type 2 is running 65-110 most of the time and most of that is spent in the 80's and 90's so it's working for us
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Thank you, I appreciate that information. I am definitely not going to be home on a perfect schedule and it's good to know that others have had success managing on a less than ideal routine!
 
Sue and Oliver (GA) said:
Feeding him higher carb while giving more insulin seems odd to me. Would you tell a human diabetic to continue eating donuts and just increase insulin usage? You have a chance to get him into remission if his numbers are lowering. As others have suggested, using the conversion chart and U100 needles give you lots of options under one unit.

Lots of people here work days (and nights) and work around their schedule. ProZinc is more flexible than some other insulins as you can shoot early or later if you have to. Many people get their midycle number at night, and not every night but every so often.

If he were mine, I would find a day or night when I could get some midcycle numbers and see about lowering the dose. If you want specific advice on dosing with ProZinc, come over to the PZI forum. You might check out some of the threads there and see how people are managing with odd schedules and odd kitties. :mrgreen:
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Well, if you can figure out how I can just tell Mac that he needs to eat the low carb stuff he refuses, I'm all ears. He's getting the higher carb food because that is all he will eat; he refused over $300 of the various low carb foods we tried -every single one we could find - and he lost over a pound in one week in the process. And unfortunately, his numbers are NOT lowering - they are steady ~ 200 with no insulin at all; we're not increasing a dose so he can eat a higher carb diet.

Mac's been in remission for almost 7 years since he was diagnosed originally in 2006 with numbers in the high 400s. He has never been on insulin; the diet change from dry food to canned got him down to around 110 or so very quickly, and he's been in that range for years. Recently he's crept up from there to 190 or so, and it seems like that is where he's staying on the current program. That is why the vet is recommending we finally think about giving him insulin.

I do like the idea of giving a smaller dose, though, and I will check out the PZI forum. Thanks.
 
I assume someone has given you Dr. Lisa's site on transitioning difficult kitties: www.catinfo.org

And it probably couldn't be this simple, but we found that the texture of the pate was the issue for Oliver. Once we chopped it up and added some warm water to make a gravy, he was okay with it..
 
Sue and Oliver (GA) said:
I assume someone has given you Dr. Lisa's site on transitioning difficult kitties: http://www.catinfo.org

And it probably couldn't be this simple, but we found that the texture of the pate was the issue for Oliver. Once we chopped it up and added some warm water to make a gravy, he was okay with it..
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I wish it could be that simple. While I am always looking for ways to get Mac onto a low carb canned food diet, we've been trying unsuccessfully for almost 7 years now. Trust me when I tell you that I would do just about *anything* to keep Mac off insulin, as frankly I think it is going to be extremely difficult for us to manage that for him without putting him at risk.
 
Ok then small dose of PZI it is. Given that he isnt spilling sugar into his urine (i would still check a few times if I were you) I think a small dose (even if you arent on a 12 hour schedule) will be enough to bring him low enough to be healthy but not too low to worry about testing all the time. I would still test preshot and do spot checks when you can though.

I have seen a few vets saying they are happy as long as the cat is under 200 - insulin or not.

Sue is pretty experienced in PZI - as is Carl & Bob so they may able to advise a small dose.

Wendy
 
But keep an eye on his 5Ps.

And maybe set the alarm occasionally for a mid night test. If he starts to drop low you want to catch it so you can tweak dose.

Wendy
 
Then I'd try the U100 needles and the conversion chart. On a day when you can be around to check on him.

Here is the conversion chart:

http://www.felinediabetes.com/insulin-conversions-printer.htm

You want U 100 needles with 1/2 unit markings. You may have to ask at the pharmacy but they do carry them.

Is he still on antibiotics from the dental?

With numbers in the 200s, I would start with a tiny amount like .1 or .2 and see what it does.
 
Hi Susan,

I agree with some of what your vet said. Yes, 1u is a conservative dose. But a cat can go hypo on one unit. I think going with the U100 syringes and the conversion chart would be your best bet. That way you can shoot .4 or .6 and line up with a mark on the syringe. It might be enough to get the numbers down to "normal".

What type of meter are you getting these numbers on? I just want to make sure it's a human meter and not a vet meter like an Alpha Trak.

I pretty much completely disagree with this however:
The vet said, "why not let him enjoy the foods he likes (FF marinated morsels, mostly, along with the zero carb dry which he picks at throughout the day) and just give him the shots," likening it to a guy being told he can't have a beer or food he enjoys."
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My Dad has gout. The doctor told him to quit drinking beer because it would cause flare-ups and the need for more meds. My Dad decided "nope, not going to do that. Then he complained about the gout pain. I told him to shut the hell up and quit drinking beer. A diabetic person isn't supposed to eat sweets. Unless their "sugar" goes low. Then it's a great thing to eat. But they can choose to disregard their doctor's advice, and then might have to up their insulin to compensate, or be hyper-glycemic and deal with the other health problems that can cause.

Sort of like where you're at with Mac. He refuses to eat diabetic appropriate food, so you'll need to "add meds" to compensate. 200 isn't a terrible number, but it's above normal and long term, it's not good for him. If you aren't able to get him to eat low-carb food, then you'll just need to give him a tiny bit of insulin to give him the best chance at having the longest and healthiest life he can have.

My cat Bob is currently a diet controlled diabetic, and has been for 20 months or so. But there's no doubt in my mind that the low-carb diet he's been on since he was diagnosed is the reason he's still in normal numbers. If I were to feed him dry food, or high-carb canned food for any length of time, he'd relapse and need to go back on insulin. I don't want to re-live that whole nightmare if it's at all avoidable.

I guess I would try a small dose of insulin, and never give up trying to convert Mac to low carb food?
 
Thank you all. I think it most likely does make sense to go with a very small dose, and see how things go.

Carl, I am using a human meter (Bayer Contour)...

I appreciate everyone sharing their thoughts.
 
Wendy, I'd recommend starting low, like .4u (1.0u in a U100 syringe). It's much better to start low and increase if needed.

And no matter the dose, test at +3 and +6 to see what happens. I'm not a big believer that it takes a while to see results. Not with Prozinc at least.
 
Carl & Bob said:
And no matter the dose, test at +3 and +6 to see what happens. I'm not a big believer that it takes a while to see results. Not with Prozinc at least.
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OK, at the risk of going round and round the same bend again...

Carl, if you could not test at +3 and +6, would you give even that amount of insulin?
 
Not Carl, but I would not give any amount until you can be home to monitor. Once you see how he reacts, then you will be more comfortable shooting and leaving.
 
Susan,

I might, but would never advise anyone else to. I would start insulin on a day that you could be around to get test during the first half of the cycle. Probably, in my case, a Saturday and Sunday, so that I could get a couple days of data and get an idea of the effect of even a small dose.
With that data, you'll have a better idea of what to expect when you can't be around to test.
 
Sue and Oliver (GA) said:
Feeding him higher carb while giving more insulin seems odd to me. Would you tell a human diabetic to continue eating donuts and just increase insulin usage? You have a chance to get him into remission if his numbers are lowering. As others have suggested, using the conversion chart and U100 needles give you lots of options under one unit.
Click to expand...

This reminds me of an episode of "It's Always Sunny in Philadelphia" where Mac (same name! :lol: ) shoots himself with insulin so he can keep eating whatever he wants (specifically chimichangas). This is the only clip I could find of it, but the whole scene is hilarious!

One suggestion about the wet food that I found works amazingly well with my cats is to "put a cherry on top" of their food. For example, my cats absolutely go berserk over the chicken Tiki Cat, however it's much too expensive for my pocketbook to feed for every meal. So, instead, I feed them the cheap Friskies as a base and sprinkle the Tiki Cat on top. I end up only using one 3oz can of Tiki cat a day (and three 5.5oz cans of Friskies) instead. You could try a low carb food with the higher carb FF morsels on top and it might work?
 
Carl & Bob said:
Susan,

I might, but would never advise anyone else to. I would start insulin on a day that you could be around to get test during the first half of the cycle. Probably, in my case, a Saturday and Sunday, so that I could get a couple days of data and get an idea of the effect of even a small dose.
With that data, you'll have a better idea of what to expect when you can't be around to test.
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Thanks, that makes sense. Sadly I am not routinely home on weekends (or might be home but on call, so not necessarily able to be around for sure at +X) but one of these days maybe I can get someone to cover me so I know I'll be around to test.
 
KPassa said:
Sue and Oliver (GA) said:
Feeding him higher carb while giving more insulin seems odd to me. Would you tell a human diabetic to continue eating donuts and just increase insulin usage? You have a chance to get him into remission if his numbers are lowering. As others have suggested, using the conversion chart and U100 needles give you lots of options under one unit.
Click to expand...

This reminds me of an episode of "It's Always Sunny in Philadelphia" where Mac (same name! :lol: ) shoots himself with insulin so he can keep eating whatever he wants (specifically chimichangas). This is the only clip I could find of it, but the whole scene is hilarious!

One suggestion about the wet food that I found works amazingly well with my cats is to "put a cherry on top" of their food. For example, my cats absolutely go berserk over the chicken Tiki Cat, however it's much too expensive for my pocketbook to feed for every meal. So, instead, I feed them the cheap Friskies as a base and sprinkle the Tiki Cat on top. I end up only using one 3oz can of Tiki cat a day (and three 5.5oz cans of Friskies) instead. You could try a low carb food with the higher carb FF morsels on top and it might work?
Click to expand...

Thanks ... the clip was hysterical!

Sadly Mac is wise to the "cherry on top" approach and will carefully pick out and eat JUST the tasty cherry... but thank you anyway for the thought!
 
Wendy&Tiggy said:
so whats your plan Susan?
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Sorry for the slow response, Wendy; I was away from my computer this weekend.

I am going to speak to my vet about the dosing recommendations that were discussed here, and then make a decision. It will be May before I can begin insulin, if we end up going that route, as I am just not otherwise going to be able to monitor Mac, and I am not comfortable injecting him without monitoring.
 
It will be May before I can begin insulin, if we end up going that route, as I am just not otherwise going to be able to monitor Mac, and I am not comfortable injecting him without monitoring.
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We wouldn't be too comfortable with that either, Susan :smile:

How do his numbers look? Is he doing okay? Are the 5 P's in place?
 
Carl & Bob said:
It will be May before I can begin insulin, if we end up going that route, as I am just not otherwise going to be able to monitor Mac, and I am not comfortable injecting him without monitoring.
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We wouldn't be too comfortable with that either, Susan :smile:

How do his numbers look? Is he doing okay? Are the 5 P's in place?
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Carl,
I am not testing him that frequently right now (because I am not home to do so) but his numbers have been uniformly ~180-190 when I have pulled them. By all accounts he is perfectly happy and acting fine, although he has put on a bit more weight since he is home with my husband and in my absence, it is treat city all day long.
 
You might find it helpful to check my signature link Secondary Monitoring Tools for tips on urine testing for ketones which may be a warning sign for diabetic ketoacidosis (DKA)

If his blood glucose is below 240 (about the renal threshold), he is unlikely to spill glucose in his urine.

Water and food consumption may be measured and urine output as well, plus behavior.
 
BJM said:
You might find it helpful to check my signature link Secondary Monitoring Tools for tips on urine testing for ketones which may be a warning sign for diabetic ketoacidosis (DKA)

If his blood glucose is below 240 (about the renal threshold), he is unlikely to spill glucose in his urine.

Water and food consumption may be measured and urine output as well, plus behavior.
Click to expand...

Thank you for the suggestions. Unfortunately, unless they can be done long distance, they aren't going to happen anytime soon.
 
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