Should I get a 2nd opinion?

[PaigeE]

Hello! I have an 8 yr old neutered male named Leo who was diagnosed as diabetic at the end of October ‘22. We took him to the vet because he was losing weight (was not previously overweight) and in hindsight noticed the excessive thirst, urination, and appetite. In the days before his diagnosis we noticed the first signs of neuropathy (walking low to the ground). He presented with a 448 and since then it’s been vet visits every 2 weeks doing spot checks and curves, increasing the dose. My husband and I have worked hard to over haul his diet and give him his shots religiously. Not exactly every 12 hours but pretty darn close considering I don’t have a regular work schedule.

We had taken him to the vet at the end of December for a spot check and his glucose was 241, down from 340 it was 2 weeks before. We had upped his insulin dose from 4 units to 5 units during those 2 weeks. Feeling optimistic, they held his dose and we went a month before coming back for a glucose curve. Did the curve, numbers are all 350-400 and so we upped him to 5.5 units. Took him back 2 weeks later, which was today, his blood sugar is 351.

I had indicated during the appointment that during the last 2 weeks his neuropathy has slightly, but noticeably improved. Instead of laying flat on the ground while eating, he often will hold himself up some and even will have his bottom up off the floor like a normal cat. He can walk a little further than he could without sitting down. We had started giving him the Zobaline but I know his blood sugar needs managed to have a chance to fully heal his neuropathy. Basically the vet said to hold his dose and come back in 3 months. Even though he seems to have improved- he eats and drinks like a normal cat, he seems happy, he’s getting around a little easier, I’m concerned his blood sugar is still not managed. Should I get a 2nd opinion- maybe there is a reason he’s resistant to the insulin? Or ride it out as the vet is suggesting? I feel so lost and i don’t know what to do to get our boy better!

 

[Larry and Kitties]

I would go to Walmart and get or order on-line a Premier blood glucose meter and measure BG at home since vet stress can substantially elevate BG. You can get a meter for $10 or so and extra strips are $9 for 50 strips.
Mosty of us record or BGs and other info in a spreadsheet viewable by others. See: https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
Someone can help you create the SS.

What insulin are you using and what are you feeding? A low carb canned food is best and the commercial Fancy Feast or Friskies pate are fine.

 

[Bron and Sheba (GA)]

Hi Paige and Leo and welcome to the forum!
No I don’t think you need a second opinion.
Larry has given you some good advice.
When you get the testing equipment, you will also need lancets to prick the ear… ask for size 26 or 28 gauge (and box of 100) And get some cotton rounds to hold behind the ear as you prick.
I agree that you need to start home testing the blood glucose(BG) yourself as a LOT can happen between vet visits. A lot can happen in a day or a 12 hour cycle.
Home testing is the best way to keep Leo safe. I know it sounds scary, but it really isn’t and Leo won’t hate you but will settle down very quickly. I will send you a link to look at the hints and links for home testing. Expect a few failures in the beginning. That is normal. But I can promise you, you will get it and it will completely change how you manage the diabetes and insulin.
We get so many people here who are lost like you and don’t know what to do. We can definitely help you get Leo sorted. It is possible Leo is getting too much insulin. We will be able to see that when we can see some of his BG data.
Hometesting lets you see how low the dose of insulin is taking Leo each cycle. And dosing is based on how low the dose is taking Leo, not a random test once every so often. Cats can bounce (go up high)for a few reasons and if you are visiting the vet during a bounce and increase the dose, this can be dangerous….and cats get stressed at the vet which also increases the BG.
Here is a definition a in bouncing from The Basics on the Lantis page

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

And here is the link to home testing.
HOMETESTING HINTS AND LINKS

Let us know what insulin and dose you are currently giving please. And are you using a syringe or pen to give the insulin.
Have you been increasing in 1 unit increments? We recommend increases of 1/4 unit (0.25 Units) not 1 unit increments so as not to go past the best dose and it is safer for the cat.
I am also going to give you the link to HELP US HELP YOU which has information for new members. If you could set up the signature and tell us all about Leo that would be very helpful. The signature appears below all your posts so that anyone helping you can read about Leo and doesn’t have to try and find it in previous threads.
Also if you would like to set up your spreadsheet we will be able to help you with dosing. All the Bg data goes into that. If you need help with that I can get someone to help you with it, no problem.

What food are you feeding Leo and are you giving snacks during the cycles? A lot of vets say don’t feed during the cycles but we advocate giving snacks during the first half of all cycles. The cat is much happier and it is better for the pancreas.

Have you been testing for ketones in the urine? If not I would buy a bottle of Ketostix from Walmart or a pharmacy, collect a urine sample and follow the directions on the bottle, making sure you read the result exactly 15 seconds later. If thee is more than a trace of ketones in the urine, tell the vet. If the test is negative, I would test a couple of times a week until Leo is in better numbers.


There is a lot more I could tell you but I don’t want to overwhelm you.
You have come to the best possible place …this is a very knowledgeable and supportive forum and you will get a lot of great advice and support here.
Bron

 

[PaigeE]

I would go to Walmart and get or order on-line a Premier blood glucose meter and measure BG at home since vet stress can substantially elevate BG. You can get a meter for $10 or so and extra strips are $9 for 50 strips.
Mosty of us record or BGs and other info in a spreadsheet viewable by others. See: https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
Someone can help you create the SS.

What insulin are you using and what are you feeding? A low carb canned food is best and the commercial Fancy Feast or Friskies pate are fine.

I actually have meter already! But have only been successful a couple of times to get a reading. He tolerates his actual insulin shots really well (give them to him while he is eating, doesn’t even notice) but getting a BG reading has proven much more difficult! The biggest takeaway I’m getting so far is to definitely get on top of that and eventually it will be easier and he will be more tolerant.

We give him ProZinc, 5.5 units every 12 hrs. The majority of his diet is the Tiki “After Dark” and the Sheeba pate. I do give him a small amount of kibble (maybe 1/4 cup) of Tiki “Born Carnivore”

I appreciate your response! It’s been overwhelming and so happy I found this message board!

 

[PaigeE]

Hi Paige and Leo and welcome to the forum!
No I don’t think you need a second opinion.
Larry has given you some good advice.
When you get the testing equipment, you will also need lancets to prick the ear… ask for size 26 or 28 gauge (and box of 100) And get some cotton rounds to hold behind the ear as you prick.
I agree that you need to start home testing the blood glucose(BG) yourself as a LOT can happen between vet visits. A lot can happen in a day or a 12 hour cycle.
Home testing is the best way to keep Leo safe. I know it sounds scary, but it really isn’t and Leo won’t hate you but will settle down very quickly. I will send you a link to look at the hints and links for home testing. Expect a few failures in the beginning. That is normal. But I can promise you, you will get it and it will completely change how you manage the diabetes and insulin.
We get so many people here who are lost like you and don’t know what to do. We can definitely help you get Leo sorted. It is possible Leo is getting too much insulin. We will be able to see that when we can see some of his BG data.
Hometesting lets you see how low the dose of insulin is taking Leo each cycle. And dosing is based on how low the dose is taking Leo, not a random test once every so often. Cats can bounce (go up high)for a few reasons and if you are visiting the vet during a bounce and increase the dose, this can be dangerous….and cats get stressed at the vet which also increases the BG.
Here is a definition a in bouncing from The Basics on the Lantis page

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

And here is the link to home testing.
HOMETESTING HINTS AND LINKS

Let us know what insulin and dose you are currently giving please. And are you using a syringe or pen to give the insulin.
Have you been increasing in 1 unit increments? We recommend increases of 1/4 unit (0.25 Units) not 1 unit increments so as not to go past the best dose and it is safer for the cat.
I am also going to give you the link to HELP US HELP YOU which has information for new members. If you could set up the signature and tell us all about Leo that would be very helpful. The signature appears below all your posts so that anyone helping you can read about Leo and doesn’t have to try and find it in previous threads.
Also if you would like to set up your spreadsheet we will be able to help you with dosing. All the Bg data goes into that. If you need help with that I can get someone to help you with it, no problem.

What food are you feeding Leo and are you giving snacks during the cycles? A lot of vets say don’t feed during the cycles but we advocate giving snacks during the first half of all cycles. The cat is much happier and it is better for the pancreas.

Have you been testing for ketones in the urine? If not I would buy a bottle of Ketostix from Walmart or a pharmacy, collect a urine sample and follow the directions on the bottle, making sure you read the result exactly 15 seconds later. If thee is more than a trace of ketones in the urine, tell the vet. If the test is negative, I would test a couple of times a week until Leo is in better numbers.


There is a lot more I could tell you but I don’t want to overwhelm you.
You have come to the best possible place …this is a very knowledgeable and supportive forum and you will get a lot of great advice and support here.
Bron

Oh my gosh, thank you! I was feeling very overwhelmed this morning so having this place to go has made me feel more hopeful again. I appreciate your time to welcome us and give some beginner info! I’ll definitely go change my signature with Leo’s info as to be helpful while I’m asking for guidance.
So I do have a meter, however I have only been successful twice getting a reading. He’s very good for his insulin shots but is not as compliant for the ear pricking. I have already gone over to the page for the tips on home testing and have a few ideas already how I can be more successful and excited to put it into practice. Luckily he is a forgiving boy and is fine after a few minutes, even after failed attempts!

So when he was first diagnosed the end of October they started him on 2 units of ProZinc. We were going back to the vet every 2 weeks and each time they increased his insulin by 1 unit until we got to 5. After 2 weeks of being on 5 units his BG at the vet was 244 so we kept it at 5 for a month. Went back the end of January and the curve showed his numbers were high so increased it to 5.5 units. He’s been on 5.5 units for 2 weeks and his BG at the vet today was 351, 6 hours after his dose.

I give him the Tikicat After Dark or Sheeba pate for both his meals. I do offer him a small amount of kibble (maybe 1/4 cup or Tiki Born Carnivore) in between breakfast and dinner.

Also, he did have a urine culture 2 weeks ago. Would that show ketones? Either way I will surely get a test kit! His drinking and urinating have significantly decreased since diagnosis which has been a positive sign.

Again, thank you and I’m so looking forward to the help! I’m definitely going to get a spread sheet set up so I can get some insight. I love my vet and I think they are doing their best. I just want to see my boy get better! Definitely going to read some more about the home testing and going to go into dinner tonight confident that I WILL get a reading on him!

 

[Bron and Sheba (GA)]

Great you have a meter. Can you tell me is it a human or pet meter? Both are OK but our dosing methods are based on the human meter and human meters are a lot cheaper to run…ie the test strips are a lot lot cheaper.
Some of the tips I found most useful were….chose a testing spot and stick to it. Always give a treat every it you are unsuccessful. If he won’t stay still, try giving him the low carb treat as you test to distract him. If he doesn’t like his ears being touched.try desensitising him by taking him to the spot multiple times, touch/ massage his ears…don’t test… and give a treat. If you are still unsuccessful let us know and will help you further. We recently had a lady here who was sure she would never be able to test….that was three months ago…she is now a champion tester and her kitty is almost ready to go off insulin….so believe in yourself!

As far as the food goes….the Sheba pate is 3% carbs, the tiki after dark I can’t find on our list..but most tiki is 0% carbs. Maybe someone else will chime in and tell us. The Tiki born Carnivore would be high carb food as there are only a couple of low carb dry foods available.
However don’t change the food around at all until you are testing the BG OK as changing to a low carb diet completely can drop the BGs significantly. We will help you with that a bit later.

Also, he did have a urine culture 2 weeks ago. Would that show ketones? Either way I will surely get a test kit! His drinking and urinating have significantly decreased since diagnosis which has been a positive sign.

Yes it probably did have ketone result in that…can you get a copy..always ask for all copies of all tests to have at home. And you can post them here too. Regardless of the result, I would still test for ketones at home. We don’t want to see any ketones and unregulated diabetic cats can be prone to them…not all but some.

So when he was first diagnosed the end of October they started him on 2 units of ProZinc. We were going back to the vet every 2 weeks and each time they increased his insulin by 1 unit until we got to 5. After 2 weeks of being on 5 units his BG at the vet was 244 so we kept it at 5 for a month. Went back the end of January and the curve showed his numbers were high so increased it to 5.5 units. He’s been on 5.5 units for 2 weeks and his BG at the vet today was 351, 6 hours after his dose.

I love my vet and I think they are doing their best. I just want to see my boy get better! Definitely going to read some more about the home testing and going to go into dinner tonight confident that I WILL get a reading on him!

I am sure you love your vet and that is great. Sadly a lot of vets don’t know a lot about feline diabetes or they don’t see many. And some treat like little dogs but cats have a much faster metabolism than dogs and need to be treated differently. And vet have so many different animals and different diseases to treat. Feline diabetes has advanced a lot in recent years and many vets have not been able to keep up with treatments etc. However your vet chose a great insulin for Leo so that is good! We would have recommended starting with 1 unit not 2 and we would have gone up in 1/4 unit increments. If he was bouncing on the days he went to the vet or was stressed he may not have needed an increase. That is why home testing is so good.
With testing you need to test before every dose to see it is safe to give the insulin. Then try and get at least one test in during each cycle to see how low the dose is taking Leo. If you work you can do that in the evening cycle….more about that later.
I think the first thing to do is get the testing up and running, the spreadsheet and signature up and running and go from there. We are here 24/7 so keep asking questions …we are very happy to help.
I’m going to tag @Suzanne & Darcy as she is a Prozinc user so she can meet you. Not sure when she will be online.
I’m so glad you found us…
Let us know how the testing goes.
I’m also going to tag @Melinda and Kitkat as she may have some more tips on hometesting for you.
Below are links for Prozinc users
Bron

PROZINC BASICS

PROZINC DOSING METHODS

 

[Melinda and Kitkat]

I actually have meter already! But have only been successful a couple of times to get a reading. He tolerates his actual insulin shots really well (give them to him while he is eating, doesn’t even notice) but getting a BG reading has proven much more difficult! The biggest takeaway I’m getting so far is to definitely get on top of that and eventually it will be easier and he will be more tolerant.

Hiya Paige and Leo, So happy you find this site! It's a godsend. A huge step forward to understanding what is going on! And so glad you got the meter and are giving it a go. Hoping some of the tips in the link about testing will help out. I had quite the time with my kitty to get good tests, and it sure took alot of practice and many strategy changes. I had to find what worked best for him. And you will get there too, and you will find what works best for Leo. If you can explain a bit about the stumbling blocks with testing we can surely offer up some additional suggestions, a few here have some innovative ideas. And we can help you fine tune your strategy.
I found the first thing (and possibly the biggest) was that I needed to get over a big fear that my testing was painful or traumatizing him, he sure made a big fuss about it! Cats!!! Drama queens! The second big thing is to go at Leo's pace, remember he is now in the learning stage, just like you. He will pick up that you are helping and come around. Also be patient with yourself as well, sometimes a kitty will really try you. Keep us posted and ask questions, let us know where any troubles lie, I will watch for your updates

 

[PaigeE]

Hiya Paige and Leo, So happy you find this site! It's a godsend. A huge step forward to understanding what is going on! And so glad you got the meter and are giving it a go. Hoping some of the tips in the link about testing will help out. I had quite the time with my kitty to get good tests, and it sure took alot of practice and many strategy changes. I had to find what worked best for him. And you will get there too, and you will find what works best for Leo. If you can explain a bit about the stumbling blocks with testing we can surely offer up some additional suggestions, a few here have some innovative ideas. And we can help you fine tune your strategy.
I found the first thing (and possibly the biggest) was that I needed to get over a big fear that my testing was painful or traumatizing him, he sure made a big fuss about it! Cats!!! Drama queens! The second big thing is to go at Leo's pace, remember he is now in the learning stage, just like you. He will pick up that you are helping and come around. Also be patient with yourself as well, sometimes a kitty will really try you. Keep us posted and ask questions, let us know where any troubles lie, I will watch for your updates

I am so emotional from all the responses I have got so far which have been so thorough, kind, and caring! I wasn't feeling so optimistic after out vet visit today. We have been at this for almost 4 months and can't say at all he's regulated I felt like I needed to do more than just show up to the vet and I KNOW I am in the right place.

I'm happy to report I got a reading on him before his dose this evening! One of the things that stuck out to me on the tips page the most was, you just have to go into it saying, "I'm going to get this done" and that the cats sense your energy. And my cat is allll about the drama lol. Last time I had managed to get a reading, I was attempting to give him his dose before work and he wouldn't eat. We had just upped his dose and there was no way I was giving him a shot without knowing his levels but I had to leave for work! And I got it done! So I took that energy into it this time. What I would say with Leo is while we are at the vet he freezes, so they are able to get readings from him no problem. At home... different story. I had started making a point to rub his ears during regular petting to get him used to it. He is a lovely boy and happy to be touched so getting in that first prick isn't that difficult. It's the aftermath lol. After he is poked he tries with all his might to get away from me. And I'm not always successful in poking the right spot and getting blood the first time (but have been reading up and trying different locations). While he's not overweight he is just a big boy and even with his neuropathy can easy squirm out of my reach. Once he gets to that point I feel like I would have to use so much force it would physically hurt him in order to restrain him. So I'd say the biggest obstacle is being able to keep him restrained long enough to get the blood on the strip after he realizes I've pricked him. He won't take any treats after either but it doesn't take him long to forgive me. I think you're right and he is just afraid like I am! I am motivated to keep trying and get our technique down pat though.

 

[Melinda and Kitkat]

I had started making a point to rub his ears during regular petting to get him used to it.

even with his neuropathy can easy squirm out of my reach. Once he gets to that point I feel like I would have to use so much force it would physically hurt him in order to restrain him.

Sounds like you a doing a wonderful job with leo, get him used to ear rubs as a good thing and showing the patience needed to bring him around
I completely agree that trying to pin him forcably once he's just had enough of it is not something you really want to do. It's like teaching a 3 yr old it's a fun thing, even though they throw their toys at you in the start and cry. right? This, with time, will be overcome
Curious which meter you use? Different strips draw in blood differently, is it a wicking strip? Some need larger drop as well, and make beeping noises that can trigger a cat to flick it's head away.
Lancing device or freehand poke?

 

[Bron and Sheba (GA)]

When testing try this:
Get everything ready…the test strip and the meter, the food/treat.
I timed how long I had after I pushed the test strip into the meter and found if I pushed it in, I had time to prick her ear, get the blood visible and then put the strip to the blood before it clicked off.
So I got everything ready then kneeled done and then sat back on my heels.
I then put Sheba between my knees facing the same way as I was, so that if she tried to back away, she backed into my body. And I put one hand gently against her chest.
I pushed the test strip into the meter…I then put the plate with the treat in it in front of her and while she had her face in the plate I pricked her eat and got the blood test.

 

[PaigeE]

When testing try this:
Get everything ready…the test strip and the meter, the food/treat.
I timed how long I had after I pushed the test strip into the meter and found if I pushed it in, I had time to prick her ear, get the blood visible and then put the strip to the blood before it clicked off.
So I got everything ready then kneeled done and then sat back on my heels.
I then put Sheba between my knees facing the same way as I was, so that if she tried to back away, she backed into my body. And I put one hand gently against her chest.
I pushed the test strip into the meter…I then put the plate with the treat in it in front of her and while she had her face in the plate I pricked her eat and got the blood test.

So I was just able to get a reading on him and haven't given him his AM shot. I do use a pet meter (already bought one) and his BG is 163. I'm not sure what the equivalent is on a human meter but the lowest I have ever seen his sugar levels since he's been diagnosed. The next question is... how much insulin do I give him? the 5.5 seems like a lot since his levels aren't that high? I guess that's the next question, is how to know how much to give him bases on his reading! Dr has only ever had me give him the same amount every time.

 

[Jacques and Pumpkin]

Hi Paige, welcome to the forum! I’ve been chronicling my journey to get Pumpkin used to testing over here: https://felinediabetes.com/FDMB/threads/lancing-from-back-of-ear.273840

It’s been two weeks and I’ve gone from thinking it was never going to happen to having a system I think could work for us.

I noticed you had challenges with getting the meter on the strip after pricking. I had the same problem. Two things that helped me:

• Switching to a meter that takes a 0.3 uL sample. If you’re using the AlphaTrak, it’s one of the 0.3 uL meters. I’m using the FreeStyle Lite which works exactly the same way but is calibrated for humans to match the guidelines on this forum. I think the AlphaTrak is just a FreeStyle Lite calibrated for cats. The test strips aren’t cheap, but it’s worth it until I can start getting more blood. I’ll probably switch to a cheaper meter when that stops being an issue.
• Using my finger to take the blood drop off the ear. It’s much easier to get a finger in there than a weird and scary machine. If you think about it, human diabetics let the blood drop well up on their skin, so your skin isn’t going to invalidate the test or anything.

Good luck with the testing! There are going to be ups and downs as you and Leo figure out a system that works for you, but it’s such a relief when you can start seeing what’s going on with your cat.

 

[Diane Tyler's Mom GA]

As far as the food goes….the Sheba pate is 3% carbs, the tiki after dark I can’t find on our list..but most tiki is 0% carbs. Maybe someone else will chime in and tell us. The Tiki born Carnivore would be high carb food as there are only a couple of low carb dry foods available.
However don’t change the food around at all until you are testing the BG OK as changing to a low carb diet completely can drop the BGs significantly. We will help you with that a bit later.

Sharing it here for easy reference (only including the "dry matter" chart since it's the one to follow): This was sent by Tiki Cat

As Brin said don't change what you are feeding now until you can collect more data

 

[Larry and Kitties]

I'm not sure what the equivalent is on a human meter but the lowest I have ever seen his sugar levels since he's been diagnosed. The next question is... how much insulin do I give him? the 5.5 seems like a lot since his levels aren't that high? I guess that's the next question, is how to know how much to give him bases on his reading! Dr has only ever had me give him the same amount every time.

You are correct in the 5.5 units is too much with a PS of 163 based on the info you provided.
Since you have little BG data I would give 1 unit thought 2 units may be acceptable.
Dosage is determined based on history of doses and BGs. Since you are using a pet meter you really do not them lowest BG between shots to go below about 68. Practice is to slowly increase dose by ¼ unit increments untill you get the lowest BG to be a little above 68 with pet meter.

 

[Diane Tyler's Mom GA]

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

 

[Diane Tyler's Mom GA]

Do you have a hypo kit set up just in case you need to bring Leo's BG up
Such as
med and high carb wet food and some honey?


Fancy Feast Gravy Lovers Gourmet Beef Feast in Grav
20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods
And some honey in the house

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.

 

[Bron and Sheba (GA)]

I dont think that reducing the dose from 5.5 to 1 unit is the correct thing to do. We have very little data but reducing the dose that much can leave the door open for glucose toxicity and ketones. Reducing the dose back to 1 unit and starting again is rarely a good idea.
If the preshot BG was too low you could have stalled, not fed and tested again in 20 minutes to see if the BG was rising.
If you feel more comfortable reducing the dose, I would go back to maybe 4.5 U. Getting tests in during the cycle will give us valuable information.
Keep testing so we can see what is happening to the BGs and get an idea of the best dose for now.
I am going to tag @Suzanne & Darcy and try and contact her as I would like her to have a look as she is a prozinc user.

 

[PaigeE]

Sharing it here for easy reference (only including the "dry matter" chart since it's the one to follow): This was sent by Tiki Cat

As Brin said don't change what you are feeding now until you can collect more data

Thank you for the info! I will definitely be keeping his diet the same but happy to report I have been more successful at readings at home since being more determined to get it done! I am very determined to get some more at home readings so I can have enough info to paint a better picture of his situation and get some advice from you all. Thank you so much for assisting me and Leo on our journey!

 

[PaigeE]

Do you have a hypo kit set up just in case you need to bring Leo's BG up
Such as
med and high carb wet food and some honey?


Fancy Feast Gravy Lovers Gourmet Beef Feast in Grav
20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods
And some honey in the house

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.

I do have honey in the house and some high carb dry food that he really likes, but not any med carb wet food. Will be sure to get some! So far have not noticed any signs of hypoglycemia but I know that that can change at any moment! Definitely getting some of these items on my next grocery run. Thank you!

 

[PaigeE]

I dont think that reducing the dose from 5.5 to 1 unit is the correct thing to do. We have very little data but reducing the dose that much can leave the door open for glucose toxicity and ketones. Reducing the dose back to 1 unit and starting again is rarely a good idea.
If the preshot BG was too low you could have stalled, not fed and tested again in 20 minutes to see if the BG was rising.
If you feel more comfortable reducing the dose, I would go back to maybe 4.5 U. Getting tests in during the cycle will give us valuable information.
Keep testing so we can see what is happening to the BGs and get an idea of the best dose for now.
I am going to tag @Suzanne & Darcy and try and contact her as I would like her to have a look as she is a prozinc user.

So I have my spreadsheet updated what I did for the day. I didn't feel like giving him 5.5 U was appropriate for how low his BG was in the morning so I gave him 2.5. Again, not sure if this was the right dose but I used my best judgement! Had a busy day today but was able to get his PM preshot and it was 355. Again, was not sure what the appropriate dose was so I gave him the 5 U. That is the thing I'm most confused about! Is his BG low because his dose is working, or dose he need less when his BG is that low? I know it's a learning curve! Tomorrow I am going to be home all day so I plan do to do an at home curve to get some better data. So far I have been successful every time I have tried to get a reading so hopefully he will tolerate more than 2 a day! I'm sure even a couple more data entries will be helpful. I will keep you all posted and again... so grateful...more than I can say... with having you all help me! I know there are no black and white and for sure answers at this point and I really appreciate the guidance.

 

[Suzanne & Darcy]

Hi!! Please see if you can get a mid cycle test tonight at some point- perhaps a before bed test? I would like to see a lower dose and a more consistent dose while you begin to gather data via testing. We need to see what his nadir is, in order to know if the dose is safe. I’m extremely nervous about the 5.5 units and how it was arrived at — with whole unit increases and suggested doses based on a spot check done at the vet which could be high for several reasons that others here have explained, I think. I’m falling asleep now, but I will be back tomorrow.

 

[Suzanne & Darcy]

I'm wondering what your preshot will be. Post here if you have any anxiety. As I said, I am uncomfortable with the 5.5 unit dose and how quickly it was arrived at... I do think you need to drop that dose down. I'm still pondering by how much and would like to see the preshot number to make sure it will be a safe dose. Tell me, your kitty doesn't have history of DKA or ketones?? I'm new to this thread so I just want to make sure because that's a consideration. Also your ability to monitor/intervene today? It sound like you're really doing a great job on the testing and really ramped up quickly on that. That's impressive.

 

[PaigeE]

Hi!! Please see if you can get a mid cycle test tonight at some point- perhaps a before bed test? I would like to see a lower dose and a more consistent dose while you begin to gather data via testing. We need to see what his nadir is, in order to know if the dose is safe. I’m extremely nervous about the 5.5 units and how it was arrived at — with whole unit increases and suggested doses based on a spot check done at the vet which could be high for several reasons that others here have explained, I think. I’m falling asleep now, but I will be back tomorrow.

Okay so I'll try to give the quickest run down of how we got to 5.5 U.
10/19/22- Leo is diagnosed w/ BG level being 448. They did a full chemistry profile, complete blood count, thyroid hormone level, and urinalysis. All the results came back normal except it was found he had a UTI w/ he was given Cefovecin 14 day antibiotic injection to treat. Started him on 2 U of Prozinc every 12 hrs.
10/27/22- Spot check shows BG 402. Increased to 3 U.
11/10/22- Glucose curve. I actually don't have the #s for this and will have to get a copy from my vet (not in his ePetHealth chart either) but they increased to 4 U
12/07/22- Spot check shows BG 328. Increased to 5 U.
12/21/22- Spot check shows BG 241. Did not increase his dose and kept it at 5 U
1/26/22- Glucose curve at vet. 394 (30 mins after dose), 404 (1.5 hrs), 364 (3.5 hrs), 346 (4.5 hrs), 352 (5.5 hrs). Increased dose to 5.5 U. Performed a urinalysis to make sure he doesn't have an infection still, nothing found in urine.
2/13/22- Spot check, BG is 355. Vet does not say to increase dose. Says to hold him and come back in 3 months.

Should note that all these numbers are according to the pet meter. If there is a way I can recalibrate his tester to make it easier to give you all info, I surely will! This is what I have for now though. We usually give him his meds at 9 am and 9 pm which seems to work the best for our schedule. What I am getting that is, for now, I should keep giving him what we have been and keep collecting more data and to see if his dose needs adjusted. I am going to be home all day today so I will be monitoring him and trying to get some more tests. He actually just sat in my lap today and didn't even try to run away (even if it took me a couple pokes to get him!) so I'm starting to feel more confident. And hopefully can get some after his PM shot as well!

 

[PaigeE]

I'm wondering what your preshot will be. Post here if you have any anxiety. As I said, I am uncomfortable with the 5.5 unit dose and how quickly it was arrived at... I do think you need to drop that dose down. I'm still pondering by how much and would like to see the preshot number to make sure it will be a safe dose. Tell me, your kitty doesn't have history of DKA or ketones?? I'm new to this thread so I just want to make sure because that's a consideration. Also your ability to monitor/intervene today? It sound like you're really doing a great job on the testing and really ramped up quickly on that. That's impressive.

I just made another reply showing the quick rundown of how we got to 5.5 U, but this morning his preshot was 252 after giving him his 5.5 last night. I am definitely starting to question the dose, or if he has something else going on maybe? Which is what brought me here! As far as I know he doesn't have a history of ketones and his urine has been tested twice the past couple months, but I am going to get my own testing kit for home. And as far I know no instances of DK. I feel silly now that I haven't been testing him regularly at home and just relied on the vet test, but totally committed to at home testing now!

 

[Suzanne & Darcy]

Be careful to monitor today. Please try to get a +2 or +3 to see if he’s dropping much. I would advise giving a snack of 1 tsp wet food at +2 and go from there (meaning you probably will want to give another tsp. Of food at +3 or +4 depending on numbers.

 

[PaigeE]

Be careful to monitor today. Please try to get a +2 or +3 to see if he’s dropping much. I would advise giving a snack of 1 tsp wet food at +2 and go from there (meaning you probably will want to give another tsp. Of food at +3 or +4 depending on numbers.

So I just got his +2 reading- 182! He did get his PM shot at 10 last night and AM shot at 11 so insulin wasn't exactly 12 hrs apart. I gave him some food as suggested and will go for another reading in a couple of hours

 

[Suzanne & Darcy]

Okay so that 61 is an automatic reduction. Please do not shoot 5.5 units tonight. Did you get a test in after the 61? The procedure is to feed high carb food (not dry) and retest in 20 minutes and possibly keep going until BG stays up in its own. You must test for 2 hours after the last HC food is guven to ensure the BG stays up and doesn’t drop bacteria down. Please let me know what happened.

 

[Suzanne & Darcy]

And reduce the dose regardless of the PMPS reading. I was very uncomfortable with the dose this morning, but I was hoping for the best. By the time you posted you had already shot the dose.

 

[PaigeE]

And reduce the dose regardless of the PMPS reading. I was very uncomfortable with the dose this morning, but I was hoping for the best. By the time you posted you had already shot the dose.

So I had given some high carb food and just retested and he’s up to 84 right now. Next time if he gets that low I will make sure to rested sooner but he was on the couch with the the whole time! I will post again when I get another reading especially before his evening shot. Hopefully can figure out what to dose to go down to!

 

[Suzanne & Darcy]

I recently saw a post by one of our moderators who pointed out to another member here that her diabetic kitty had, on more than one occasion, been sleeping peacefully when she tested her and found her BG in the 30s. The point being that you cannot always tell by observation that their BG hasn’t dropped too low.

 

[Larry and Kitties]

The point being that you cannot always tell by observation that their BG hasn’t dropped too low.

A couple of year afo at evening treat time Nala did not come out. I found her in a cat tunnel making strange noises. I tested her BG and the meter showed Lo. She recovered fine with kero mixed with canned and administered by syringe .Nala went into remission shortly afterwards.

 

[Suzanne & Darcy]

Anyway, I will be home in a few minutes. Will you be available to talk?

 

[Suzanne & Darcy]

I would like to go over some things with you and find out what time your evening shot time is and be around to find out his BG etc…. Got to drive again now … back in a few.

 

[PaigeE]

I would like to go over some things with you and find out what time your evening shot time is and be around to find out his BG etc…. Got to drive again now … back in a few.

I will surely keep that in mind going forward! I assumed, incorrectly, that low blood sugar only came with all the scary symptoms you read about associated with hypoglycemia. I’m so glad I listened to my intuition that I needed more help than the vet was giving and came here. But yes I am home and available to talk if you have time and would very much appreciate your help! Tonight he’ll get his PM shot at 10

 

[Suzanne & Darcy]

I will surely keep that in mind going forward! I assumed, incorrectly, that low blood sugar only came with all the scary symptoms you read about associated with hypoglycemia. I’m so glad I listened to my intuition that I needed more help than the vet was giving and came here. But yes I am home and available to talk if you have time and would very much appreciate your help! Tonight he’ll get his PM shot at 10

And you are on Central time, correct? Or eastern?

 

[Suzanne & Darcy]

Can you tell me how much time elapsed between the 61 and 84 readings. Was it one hour as I see on the SS? And how many minutes until +8 or has it passed? What kind of HC food did you give after the 61?

 

[PaigeE]

And you are on Central time, correct? Or eastern?

Oh sorry didn’t think about that! I’m in Ohio so Eastern time

 

[Suzanne & Darcy]

Oh sorry didn’t think about that! I’m in Ohio so Eastern time

Okay, good. I'm on Eastern Time as well. So you are only about 2 hours and 15 minutes from shot time. It would be great to get a +10 and see where Leo is. No food after the next 15 minutes (unless he has low BG, of course). We need him fasting for two hours before his PMPS so that we know the number is not "food influenced" He may be bouncing though.

 

[Suzanne & Darcy]

When you can, please click the links below: This is from the ProZinc forum.

Essential Hypo Reading: Hypo toolkit link and HOW TO TREAT A HYPO

• Hot Tip: Print BOTH of the above documents out; the first is a great shopping list - and we strongly suggest you post “How To Treat A Hypo” in a prominent place (like your refrigerator door).

 

[PaigeE]

Okay, good. I'm on Eastern Time as well. So you are only about 2 hours and 15 minutes from shot time. It would be great to get a +10 and see where Leo is. No food after the next 15 minutes (unless he has low BG, of course). We need him fasting for two hours before his PMPS so that we know the number is not "food influenced" He may be bouncing though.

Okay I will see if I can get the +10! I have been successful so far so will make sure he gets no more food till his PM shot. It was an hr between the 61 and 84 and I got a 93 an hour later I need to put on the spread sheet. I gave him some of the fancy feast, the gravy lovers one I believe it is I saw that was high carbs and that’s the last he’s ate

 

[Suzanne & Darcy]

Here is the whole sticky note from the ProZinc forum that I excerpted above. There are other helpful sticky notes there as well. It contains a lot of useful information.

https://felinediabetes.com/FDMB/thr...-the-prozinc-basics-please-start-here.164995/

 

[Suzanne & Darcy]

A couple of year afo at evening treat time Nala did not come out. I found her in a cat tunnel making strange noises. I tested her BG and the meter showed Lo. She recovered fine with kero mixed with canned and administered by syringe .Nala went into remission shortly afterwards.

Thanks, Larry. You've been around the block a time or two with many diabetic cats! You have a lot of experience.

 

[PaigeE]

Here is the whole sticky note from the ProZinc forum that I excerpted above. There are other helpful sticky notes there as well. It contains a lot of useful information.

https://felinediabetes.com/FDMB/thr...-the-prozinc-basics-please-start-here.164995/

I will familiarize myself and definitely will print that out for the fridge! Just explained to hubby what to do in case he is hypo and him seeing me getting BG readings all day has made him feel more confident he can do it as well! He is always afraid of hurting him. So I got his +10 reading and have the spread sheet updated and will make sure he doesn’t have any food until PM preshot. Can’t thank you enough for walking me thru this day.

 

[Suzanne & Darcy]

By the way, I've been wanting to say this for a while now... but Leo has the cutest face in the world! I love that photo!

 

[Suzanne & Darcy]

We usually give him his meds at 9 am and 9 pm

What kind of medication does he get at 9 a.m. and 9 p.m.?

 

[Suzanne & Darcy]

Oh by the way, on the Alpha Trak meter 68 is your "take action" number, meaning that you will want to give a teaspoon of high carb food such as gravy lovers and then retest in 20 minutes to make sure BG is up and then to keep testing every 20-30 minutes to make sure BG is staying up and not dropping back down. Depending on if it is going up, not going up, still dropping, etc., you will need to either keep giving HC food, switch to LC food, etc. But I just wanted to mention the 68. The protocols we have here are written for human meter numbers and the Alpha Trak reads generally higher than a human meter, so we have to take that into account. For a human meter, the take action number is 50... for the AT it is 68.

 

[Suzanne & Darcy]

I'm going offline for a bit. I have a sick foster kitten who won't eat sleeping in my lap. Other cats/kittens to feed right now (getting a bit late actually) but I'll be back before your PMPS of 10 o'clock. I have a two hour drive tomorrow morning to take one of my cats to a specialist in the morning, but I'll be around for a while.

 

[PaigeE]

I'm going offline for a bit. I have a sick foster kitten who won't eat sleeping in my lap. Other cats/kittens to feed right now (getting a bit late actually) but I'll be back before your PMPS of 10 o'clock. I have a two hour drive tomorrow morning to take one of my cats to a specialist in the morning, but I'll be around for a while.

Omg thank you! He is really a trip and has so much personality lol. Good luck with your foster kitties! Definitely will be super prompt with testing and back on here, again thank you so much!

 

[Diane Tyler's Mom GA]

@PaigeE
Hi Paige can you add to your signature the meter you are using and the date Leo was diagnosed and also name of the insulin.That's the first thing members will look at . He is adorable

 

[jayla-n-Drevon]

Cats have very little feeling in the top 1/3 of the ears and on the outside of the vein
I used to free hand a terumo tiny needle they are so sharp its fast! You can do this
You can get the terumo needles with no script at https://www.calvetsupply.com/
They have other supplies too