Started Prozinc August 1 after 6 years with Lantus

Bella is a 17 yr old, diabetic with CKD, Dental disease, Pancreatitis and now a potential heart issue (echo scheduled on 9/2). For the past 18-24 months, it has been impossible to regulate her on Lantus. No matter what we did, she would drop fast from the 500s into the 100's and back up again all within 5 or so hours. I worked with FDSG to introduce using Novilin R and even with that, we could not regulate her. Her dental disease may have played a part. Additionally, she was diagnosed with pancreatitis in March - but we thought it had passed because she was eating well and not vomiting (without meds).
But on 8/16, things took a turn. Bella was very ill and not eating. I took her to ER where she was put on fluids, pain meds and she started to eat. Great! After 24 hours she came home.. But on 8/19 she took a bad turn. This time, her ketones were at 4. She never had ketones before so this was a shock. She went back to the hospital for 2 days. There there did an ultrasound and luckily this was all pancreatitis according to the report. There was some fluid noted around the pancreas due to the inflammation.

In the last 12 hours of hospitalization, they were unable to handle her and her glucose was over 700 and not coming down. Luckily she was still eating. They told me to come and get her and be prepared to EU if I couldn't get her glucose controlled.

The first 24 hours home were awful. Her ketones jumped to 6.5! But by some miracle I got those down and am starting to see some normal glucose patterns!!! My vet and I closely monitor her through a Freestyle libre. It is not accurate but provides good directional data.
Initially, Bella would only last 6 hours under 400 (500+ according to a handheld). My vet would direct me to use Novilin R when she was very high at the end of a cycle to attempt to keep her numbers from skyrocketing. This has worked! I was using R almost 2x/day - but haven't had to use any in 3 days! I am not only seeing very high numbers for approximately 4 hours each day (beginning/end of each cycle.

ISSUS - I continue to see sharp drops and increases - 250 to 300 point swings at the beginning/end of a cycle that happen over a 2 hour period. Is this normal? How can I "flatten" her curve more? If I increase the dose, she crashes - and the swing from high to low is just greater. I would love to get to a point where she is in the 150-250 range for 6 hours. Is that possible?

NEW ISSUE - just a few weeks ago, we noticed Bella was having some issues so I started monitoring her blood pressure. It was HIGH (over 200). Her heart rate was consistantly in the 170-185 range. She was on 62.5 mg of amlodipine. 1x/day.
When she came home from the second ER visit, her heart rate is always above 200 and we are having a tougher time getting her BP under 150. I spoke with my vet who initially thought it was the stress of the hospital visit - but it didn't come down. I persisted and showed a chart with all the measures from the BP machine. Finally a few days ago, we did bloodwork and an xray. She was slightly anemic (perhaps due to all the ER fluids). We did a small dose of Aranesp (we did this in early July when we saw her HCT drop slightly). At first I thought that could explain the higher heart rate. Additionally, she had been put on a higher dose of bupernex during the ER visit - so although unlikely the culprit it was possible. But the xray showed an enlarged heart as compared to an xray taken in early June. I am gutted. We have not had any signs - no murmur no coughing, nothing. Bu Bella does get 125-150 ml of fluids daily for her CKD. This has never caused an issue. In the ER she was put on a maintenance does of IV fluids (I think the rate was "16"). {Perhaps that was just too much. I don't know what to make of this but I am so upset and stressed thinking the ER visit caused a heart issue. It's been 8 days since I noticed the increase - and I don't see any change. It coincides with the higher BP too.

What is causing what? Is the anemia causing the enlarged heart which in turn is causing the BP and heart rate to go up? Does she suddenly have cardiomyopathy which is causing all of this? Now that we are seeing diabetes improvements, it's like getting kicked in the gut.

We have an ultrasound scheduled on Tuesday. I was hoping to get it done by a cardiologist but we are using a traveling ultrasound person who my vet knows (he's a retired IM with TONS of experience.)

Any ideas or thoughts on all of this?

Here is Bella's meds, etc

Prozinc - 1.25 units 2x/day (currently no Novilin R - but the dose was .25-.5units as needed)
Bupernex .2ml 3x/day
Zofran - 1/2 pill 3x/day
Amlodipine - 62.5 mg now 2x/day
(I stopped cerenia and Elura as both seemed to make her sicker and she's not needed them)
Normisol fluids - now 75ML/day

I stopped Porous One and Catney One when the pancreatitis popped up on the 15th because I was trying to ensure she would eat. The IM said her 4.6-5.2bloodwork value suggested it may be too early for a phos binder.
 
Hey @DianefromDallaa. Happy to see posted. Since you're new, it may get more eyes if you post in the Health Forum which has a lot more activity so your post should get more comments. You can just copy/paste what you've said here.

Also, the spreadsheet link you have in your signature here belongs to another group, the FDSG. You do have a spreadsheet that is the correct one for this board, but neither of them have had any testing data since June 1. People here will need to see updated numbers before they'll be able to give you much in the way of advice. Here's the link to the correct spreadsheet for this board. Bella's Spreadsheet (003) as of 072325.xlsx

I'm not familiar enough with Prozinc (especially with the occasional use of R) so I can't really help but I did want you to know that you had posted (since you said you couldn't find your post on the board in the Feline Diabetes group)
 
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