First time stalling. Hoping this is the right thing to do

The day is finally here when Starburst gets looked at by my normal vet. This vet saw me through cancer (and radiation treatments) of my beloved Rahasia 10 years ago as well as the death of my first 2 dogs within the last 2 years (age related). He knows how I work, that I told him years ago that I won't do radiation or other extreme measures for my pets anymore, not because I don't care, but because I didn't think the quality of their lives was there. I am a bit nervous, as a result, that he may think I am getting to that line today. I have a list of questions and want recommendations on supplements/hydration options from him but I hope I get across to him that I am trying to get the DM under control to see how her other numbers then pan out....basically I think some of her kidney values are from stress from the super high glucose numbers. I am trying to figure out if some of these other lab numbers (creatinine jump from 2.0 to 2.8 in a week for example) are from chronic issues (ckd, for example) or elevated from something acute (kidney infection) also. I am also wondering if this may be the start of cancer since her weight loss was so sudden when it happened (5 lbs in a matter of a few weeks), although her weight has stabilized since insulin/diet change. I'm just writing to get my anxiety out and please keep us in your thoughts today. If he thinks this is a lost cause I will be devastated.

 

Let us know how it goes. If you are having Bloodwork done, ask for a copy of the labs.

 

Like you, my vet is one that I've had for years (25). We've been through many happy and sad times together, and many crises. I trust her to tell me when/if my pet is suffering and facing no hope of a better future. Whether or not I choose to face the coming days/months/years with daily meds (and their cost) is a management issue and that decision is mine, and only mine, to make.

There are plenty of diabetic cats on this board who also have CKD. My Lola is one of them (creatinine of 4.9 on diagnosis, rose to 6.1 at one point, now down to 3.9). I know that CKD is fatal and it will kill her (unless something worse comes along). However, today is not that day: Lola's managing fine with renal diet, daily fluids and meds/supplements. Her quality of life is just fine. As that changes, my vet and I will face the tougher times together. She's my partner in this.

I hope that your vet recognizes your level of care & commitment and supports you entirely in that. (If he doesn't, you're certainly free to shop around to find one that does.) Good luck.

 

I understand that it is my decision and also have seen that there are several ckd/diabetes cats on here that are managing well, and that's wonderful. Starbursts lab work and her high glucose values doesn't seem to follow that trend (from what I have gathered she is quite anemic and low potassium/high phosphorus for a creatinine count relatively low....also a significant change in her creatinine and anemia in a week) so I'm nervous I'm going to learn of something else going on in addition to ckd/diabetes. Basically I'm not following my own advice of crossing bridges when I get there. Anyway, thanks for wishing good luck, it's appreciated.

 

Vet visit went well. He wants me to up prozinc to 2 U starting tonight (she tested at 618 at +5 from am shot, did mention stress is likely impacting it). Starburst received more fluids today, I am to order the freestyle libre ASAP (likely Monday because they are now closed for the weekend). He feels we need to get the glucose down before worrying about anything else. If she doesn't start responding to the prozinc within a week or two he wants to go to glargine.

 

My kittie was on ProZinc and I switched him to Levemir about 5 months after the initial diagnosis. I am so glad I did as he is doing much better on it and his BGs levels are much flatter. I order it from Marks Marine Pharmacy in Vancouver (if you’re in the States, they can ship). Best of luck with everything you and Starburst are going through. It’s such an emotional roller coaster. I’m glad to hear you have an amazing vet you really respect and trust.

 

Oh good I'm glad you're raising again. I suspect you will be closer to 3.5-4 before you see a real impact. Although only giving it a week is expecting a little much.

 

If her numbers start going down and moving he's fine with continuing prozinc, but he prefers starting with glargine (the ER vet prescribed prozinc). If she's still in the black he wants to switch her. But she's starting tonight in low 400s and her shot will be in 20 minutes so crossing fingers it isn't a fur shot

 

ProZinc is a very good insulin. I think you just haven't found your breakthrough dose yet

 

@JanetNJ can you take a look at starbursts ss? I hope to get a freestyle libre on her soon to get more readings but with where she is mid-cycle (+6, 524) would you recommend I go up to 2.5 tomorrow morning since that will be 3 cycles (assuming her pmps is in the black or red)? I wonder if stress from the vet visit and difficult dosing last night could be still impacting these values

 

Maybe wait one more day.... If it's still high, yes. I don't know how difficult your cat is to test, but if you can, try to get a before bed test as well.

With this high of numbers get some ketone tests when toy can, too. Does he eat ok?

 

Thank you, I am planning on attempting a reading sometime between +3 and +6 tonight.
I am doing ketone tests, did one this morning (negative). Her appetite is great....she is back to acting normal, though thirsty and urinating a bit more than normal. I thinks she's been high glucose for a while based on how normal she's acting now. She's holding weight since I transitioned her to wet food.

 

I am glad the vet visit went well. I agree with Janet about the dose will need to be closer to 3.5 or 4 before you will see impact. And only a couple of weeks is not long.
I’m glad you are testing for ketones.
Hang on there.

 

Starburst is tentatively scheduled to get the Freestyle libre on late tomorrow morning and I hope that goes well....we are at the point that I can't get her bg reading now at all. She bled fine a few weeks ago but today I had to heat up the ear with a compress and although that worked earlier, it didn't now....and she's thrashing, biting, fighting. Earlier today my son helped hold her and it went well and fast....at her +11 (treated as PMPS) she fought it but I was able to get a reading....this time nope, she's straight wild. If the freestyle doesn't work I'll have to just shoot blind and hope that she can be desensitized. hope it works

 

@JanetNJ I think I should've waited until she got the libre placed on her before bumping up to 2.5 but I thought I'd be able to get readings tonight and tomorrow, now I doubt it. If I can't get a AMPS in the morning should I just do a 2 or go ahead with a 2.5? She should get the libre on at +5 of AM shot if all goes well. She doesn't act hypo at all but honestly other than higher water intake she isn't acting hyper either so I don't know if that is any sort of indicator. I'm driving blind here.

 

You have been doing fine getting tests. I’d do the 2.5 for sure.

 

@JanetNJ thank you again. She has a Libre on now and I have taken a reading regularly and there is definitely a pattern and curve. If I am absorbing all this info right I think she should get another 0.5U increase soon, but I wonder if I should wait a bit or increase tomorrow morning. Would you recommend I wait a few more cycles or increase in the morning if I don't see greens/blues tonight and she seems consistent with yesterday/night's trend?
She seems to track @ 20 mg/dl lower today so far (too early to see if that will be consistent). Is it typical for the morning nadir to be so different from the evening nadir (+9 vs +5)? Thanks

 

It's not unusual to run differently in both cycles. I Would wait another day then raise. It was nice seeing those yellows.

 

Thanks, will do! It really was nice seeing yellows for the first time.

 

I'm curious to

see if it goes down tonight too

 

She seems to be tracking higher so far, I so want her to hit the cool colors soon. When I do increase do you think it should still be 0.5u or 0.25u?

 

@JanetNJ now that she is in purple and reds are her health risks (like for seizures, dka, and ketone development) less than when she was in the black or is it one of those things that she is high risk for those health risks until she gets in blue/greens. I would like to give her a fat 2.5 this morning as no yellow last night. When I do increase (assuming either tonight or tomorrow) should it be still 0.5 or 0.25 at this point?

 

Well the purples are definitly better than reds and blacks.


I would continue to raise by 0.5 until you start seeing blues. You could raise it tonight.

 

After upping Starburst's insulin dose to 3 units last night, we have our first BLUE!!! I am so happy! I was so defeated until earlier this week and finally seeing progress. Thank you all for your help (especially @JanetNJ )

I think she may bounce off of this (she is napping now, so no real behavioral change), so I'm trying to be prepared for that. I will be checking her Glucose every half an hour until we hit nadir but I just hold her dose at 3 for a few days at least if she bounces, right? The only way I decrease at this point is if she goes hypo I believe.

 

Hooray!!!! Yes hold this dose. . And you're right he may bounce... But so nice to see that blue. First pink preshot too

 

@JanetNJ The libre stopped reading this afternoon and I am not confident that I can get BG readings, I don't even want to attempt it at this point. I plan on contacting the vet to get the second sensor on her by Tuesday hopefully. I hadn't planned on increasing her dose until after she gets fitted again in case she bounces anyway. Considering her readings prior to the libre stopping, do you think we are likely to go hypo if holding the 3 unit dose through Monday? I think it should be ok but wanted to check with those that are more knowledgeable on this.

 

I think 3 is a safe dose

 

@JanetNJ we have a new libre on (I hope this one lasts at least as long as the last one did). If Starburst doesn't get down into the 100s today I want to increase her dose either tonight or tomorrow. Should I increase one more time by 0.5 or do you think we should go with 0.25 unit increases from here on out? Thanks as always for your insight

 

I'd do 3.5

 

@JanetNJ thank you. She ended up tracking lower than I thought she would for most of the day/night but I did up it to 3.4 (using U100 syringes so easier to measure 3.4 than 3.5). Hoping she doesn't get too low.

 

Looks like it def didn't go too low

 

Huh? 3.5U would be "on the line" (if your syringes have half unit marks)...there's no syringe that would have a mark at 3.4U so that should be a lot harder to measure.

Could you explain how you're measuring (or take a picture)?

 

@Chris & China (GA) I used the conversion file you guys have on here. Prozinc is u40 insulin, I'm using U100 syringes. Conversion of x2.5. 2.5x3.4=8.5, like in the image if the file that was shared in a previous post about syringes (my gal was reacting to the long and thicker gauge needle that came with the prozinc kit, 6mm 31g needles only available for u100 without a prescription).
https://linksharing.samsungcloud.com/74lFKPGIjEGO

 

No it didn't....I think she may have been trying to bounce a bit as yesterday was lower than she had yet been for such an extended amount of time. I think I will be up late tonight just to make sure she's OK.

 

Oh OK! That makes sense then!

Yes, the thinner needles can be a lot more comfortable. There are some U40 syringes with 31 gauge needles if you're interested but as long as you're using the chart, there's no reason you can't continue doing exactly what you're doing!

 

@JanetNJ based on how Starburst has gone yesterday and today I am planning on raising her dose again on Saturday (@36 hours from now) since the duration seems to be minimizing and we still can't tap lower than upper 100s at nadir. Due to the syringes I'm using I can really only increase in 0.2 units. She's at 3.4 now....if her numbers are similar tomorrow to today would you recommend I go to 3.6, 3.8 or 4.0...or am I splitting hairs now?

 

Not sure. Let's see what the numbers do tomorrow.

 

Are you planning on learning to test with a regular meter? Having Libre installed every couple weeks seems expensive.


Of you don't see any numbers in the blues in the next Couple days id do 4

 

She did hit blues last night, will see what happens. Thanks for your dosage suggestion. Barely was over 200 this morning and looks to be currently plateauing at the height of her peak in the low 200s.

 

Good! Maybe hold this dose a couple extra days and we can reevaluate.

 

Does this curve seem concerning to you? Should I give her MC food now or just play it by ear?
https://linksharing.samsungcloud.com/8KLYpaX9OWir
I posted another thread about it as this one was getting long.

 

@JanetNJ I'm really confused with how different this cycle has been. I'm stalling and can continue to stall until she rises above 200, but I'm toying with reducing it a touch. Do you think I should still do 3.4 when she gets over 200 or reduce it to 3 or 3.2?

 

We have stalled for an hour, she is at 189. My cats are all looking at me like they are going to murder me in my sleep if I don't feed them soon so this is my plan- Give her minor reduced dose of 3.2 instead of 3.4, give her food that is ~8-9% carb (she had lower carb this morning) and not sleep tonight. OK, good....talking to myself now on forums, I have completely gone mental.
Anyway, does that sound reasonable?

 

It's OK if you want to reduce a little.