Unexplained Glucose Change

s4s

s4s

New Member
Hi, first post here, so apologies if this isn't the most clearly written description.

I have a diabetic cat (named kitten, well over 5yrs age) that we've been treating for a few months now, and we can never seem to get consistent results. We're just not really sure what we can do now to improve his health.

He's been on prozinc for about a month now, this was after we weren't able to get it under control with 2x4 units of caninsulin. Twice a day we feed him 1/2 can of Hills weight/glucose management, and 1/8 cup of Hills weight/glucose management dry food. We're currently dosing him between morning and evening, between 3-6 units depending on what our glucose readings have been in the previous day or 2.

We just did a curve last saturday, and it sat at 18 throughout the entire day, even before & after feedings. We gave him a higher dosage to bring it down to 9, and then lowered the dosage again for a few days. Problem is the next day it shot straight back up to 18 again, even on the same amount of insulin that had previously kept him at 18.

Is there something we're doing completely wrong? Is there any possible explanation on why his glucose levels won't stay consistent?

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UPDATE
https://docs.google.com/spreadsheets/d/1sYDxeIqVA_N_lqqkXuDVd2zJOzSscvlb5Z8pqd_q6IY/edit?usp=sharing
 
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Hi s4s, and welcome to you and Kitten! First of all, great job doing home testing. That is such an important tool in helping our cats feel better and improve their health!

We use a spreadsheet here that really helps with figuring out what's going on with a cat. You can click on the blue text in our signatures if you want to see examples of them. I'll share the link with you in a second so you can get one set up and we can see what's going on. Once you have it linked and input some numbers, the color coding happens automatically and it becomes a great tool in getting this all sorted out.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

If you have any trouble getting it set up, just ask and we can find someone here to help you. We have some great tech-savvy people around.

There are a couple of things that stand out to me in your description. First is the food. Hills dry food is super high in carbs, so you'll want to stop feeding that as it will make Kitten's blood glucose (BG) higher and his insulin responses harder to predict. Carbs really mess with diabetics. It's okay to leave out wet food during the day, just add a little extra water to it to keep it from drying out.

The other thing that stands out is that it sounds like you're dosing Prozinc like it's Caninsulin. Prozinc does better on a more consistent dose, with dose changes based on the nadir (lowest point in the cycle), not based on the pre-shot number. Once you get the spreadsheet up, we can try to recommend a dose to try for a few days, and see if the consistent dose will help Kitten start to feel better.

Please ask as many questions as you have! There is so much to learn with all of this, and we are happy to help!
 
Thanks for the info, i'm working on filling in the spreadsheet with my current information. I have a few other questions as well:

- We had tried a consistent dose of ProZinc for a while. We upped the dosage from 6u daily to nearly 10u daily, and his BG stayed near the 18 mark with few exceptions.

Is there any reason for this, or must there be some error we're making?
If the cat gets into something and gets an elevated BG, how should we bring it back down? Would we up the dose a small amount for a week, give him extra insulin once or twice, would we temporarily use a different kind of insulin (such as caninsulin)?
 
He stayed at 18 for his pre-shot numbers, or stayed at 18 throughout the curve?

Do everything possible to avoid him getting into something that might raise the BG as it's not as simple as just giving more insulin. It impacts how they feel for several cycles and can make the responses "bouncy". Managing the food situation is the most important thing you can do to help your cat heal. Many many cats get on a low carb wet diet and go into remission. I can't overstate the importance of that aspect of treatment.

As for the dose, it could be that he was getting too much insulin which can cause inflated numbers for awhile (followed eventually by a hypo), or it's possible that he's got a high dose condition (IAA or Acromegaly), but it's too early to worry about that at this point. Prozinc doesn't respond the way you're describing. You can't just give more because he ate too many carbs, and give less when he's eating healthy food. It's a hormone and it has an impact on other aspects of health beyond just changing the BG number.

At the top of this forum there are some threads with a yellow icon that says "sticky". Those contain some really helpful information about dosing prozinc. There are also some articles on the main Feline Diabetes page that just explain diabetes and insulin and all kinds of things. Reading those can really help start to make sense of all of this. It can feel like a lot all at once, but we're here to help!
 
The food you are feeding is super high in carbs and probably the reason the insulin is not working. It's like feeding a diabetic person donuts all day. There's a food list in my signature. Choose foods under 10 percent carb (under 7 is even better). If you change food I would test often and lower the dose as the numbers will most likely drop.
 
AM/PM Food:
1/2 can Hills Weight/Glucose Management wet
+2 hours 1/8 cup Hills Weight/Glucose Management dry

Insulin/Readings:
https://docs.google.com/spreadsheets/d/1sYDxeIqVA_N_lqqkXuDVd2zJOzSscvlb5Z8pqd_q6IY/edit?usp=sharing

Update:
-Vet advised that Hills was used because it has a particular glycemic index - my understanding is that it's used because its tested, consistent, and "predictable".
-Kitten had a sudden behaviour change. He's been less interested in food lately, drinking & peeing less, glucose levels aren't drastically different. He previously had severe urinary obstructions (aftermath of food change, weight loss, etc. likely cause for diabetes), so we took him into the vet and had a blood lab. Vet couldn't see any issues.
-Vet said case was complicated and referred Kitten to university clinic in city. Taking him next Thursday. It's ~2 hours each way, university vet suggested we get some depressant/tranq to help keep him calm. For the 10 minute drive to normal vet, BG shoots up 15-20 points normally. No idea what it's going to do with 4 hours of driving.
-All cats have been throwing up recently. Might be sick?
-Kitten has completely lost interest in wet food. Been having to do more to get him to eat, mix with dry, mix with salmon.
 
- Vets say that because that's what the Hill's sales reps tell them. The dry food is too high in carbs and is a contributing factor in the high numbers.
- Cats have about a six month window in which their odds of going into remission are quite high. After that, while remissions happen, they are much rarer. I would recommend dealing with the food issue now to give Kitten the best chance of healing.
- Please test for ketones. Given the high numbers you're seeing, a disinterest in food and lethargy are key indicators of DKA which can be critical very quickly. If you cannot get a test at home (you can buy the strips at any human pharmacy and you just stick them in the urine stream while Kitten is peeing. If he is too private to let you do that, we can share some tricks for getting it done. Do not wait and see on this. We lose kitties here far too often because of DKA.
- If you are going to go to the trouble and expense of seeing a specialist, you might consider asking for Kitten to be tested for the high dose conditions. Normally we might not recommend that so early since you haven't given the protocol here a try yet, but again, if you're going to pay for the specialist anyway, might as well get it done now.
 
- I'll try finding a new wet food for him to use based on the chart: https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
Although he has been avoiding wet food, and it's steadily taking more effort to make him eat it. The chart doesn't contain any recommended dry foods. It does concern me because he has a history of urinary obstruction, but the cats gotta eat, and we're running out of tricks.
- I'm not sure what "high dose conditions" are, but i'll ask the specialist next thursday.
- I'll see if I can pick up a box of Ketone strips. Although I'm only with the cat for a day or 2 every week. My folks who are watching him weekdays haven't had any luck getting urine samples. At a quick glance, it looks like you can test for ketones with blood tests as well?
 
-Yes, there are blood meters that do make it easier to get a ketone test. The strips are a little expensive, but much cheaper than treating DKA!
-High dose conditions: http://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/ The stickies at the top of that forum explain the different conditions.
-Normally we don't recommend testing until a kitty is over 6u and all appropriate care is in place (dental issues resolved, regular home testing, consistent and appropriate increases in dose, low carb wet food, etc.), so it's not that I'm all that concerned that Kitten has one at this point - just figuring if you're gong to drive all that way, might as well ask about getting the tests done.
- a few things to help make the wet food more enticing:
-Fortiflora is a probiotic which isn't great at being a probiotic, but it's super good at getting cats to eat. It acts as a flavor enhancer and lots of cats love it!
-Bonito flakes - you can buy them off amazon or most grocery stores. Thin little freeze-dried flakes of fish that cats love and if you put them on food, they'll usually eat more.
-Brewer's Yeast or Nutrtional Yeast - not the same as bread yeast - these are often in the health food section or the bulk section of grocery stores. Sprinkle on food. Cats love it.
-Parmesan cheese - the cheap powdery kind works best I've heard - my kitties don't like this one so I don't know much about it
-Tuna juice - the water that you drain off the can of tuna - pour a little on top of canned food
 
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Regardless of other problems detailed below, Kitten has so far (1 feeding) taken a liking to Blue Wilderness (3% carbs reported by food report). A quick Google shows a few issues with the brand, numerous quality issues and some consumer reports of sickness resulting in death after switching to the brand, as well as a buy-out by General Mills. Does anyone have a negative opinion of Blue Buffalo? Thought I'd send a quick email to them asking them for an updated TNA and a reply on the consumer complaints.

In other news it seems like our cats have been passing a disease between eachother recently. As a result Kitten has stopped drinking, we have a vet visit planned as a result.
 
Unless you make the food at home, you'd be hard pressed to find a commercial food that doesn't have complaints and recalls. I think writing to the company was a great way to approach this, and hopefully they'll have a helpful response.
 
Do you add water to their food? That might help them get some water in even if they aren't drinking.
 
Good news first. Turns out my cats did just catch the bug. After a few days Kitten was back to eating and drinking normally.

But It's been a couple more weeks now. We went to a referral appointment in the city. They did a blood workup, urine test, fructosomine, etc.

They classified Kitten as uncontrolled. They asked us to change back to Hills / prescription diet, vary the injection sites, reduce Kittens insulin to 3u per shot (6 daily), and do a curve in 2 weeks (that's today).

We're still giving him 5.5u per shot (11 daily). However I did my first test, and hes still at 24.7 (at the vets, this is typically 33+, so the 25 is lowballing it).

Vet said they hoped varying the injection sites would solve the issue. And our next step would be to test for pancreatitis. After that they suggested using a freestyle libre. But really they havent given us any direction on how we might actually get his BG down. this is starting to feel absolutely ludicrous
 
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Having a difficult to control diabetic is very hard. I'm almost three years into this FD thing and my guy is still challenging. Some important things to know:
  • what he eats is very important: NO kibble - low carb wet food only
  • any other health issues will complicate the regulation process a lot (IBD, allergies, dental infection, etc.)
  • keeping up a regular BG testing routine at home is key to assessing insulin doses and making necessary adjustments
  • relying only on vet testing, days in the clinic for curves, etc. can be counterproductive, especially because of vet stress inflated BGs on which dosing decisions are made AND the vet's recommendation to feed high carb kibble
  • there's no such thing as "set and forget" insulin dosing, especially with a challenging kitty - constant appraisal of dose/BG relationships over time with necessary small dose changes at appropriate intervals is how you make headway with these guys
  • FD is a very dynamic disease and so too is insulin action and requirements - many owners and even some vets don't appreciate this fact.
I think vets are well intentioned but lack experience treating feline diabetes or else they look at it like they do with canine diabetes. Dogs and cats are very different in their responses to insulin. Cats are notoriously complicated in the functioning of their endocrine system. I've even had my horse's vet tell me that.

Many of us here will tell you that once we made the mental/emotional leap to take FD treatment into our own hands and tried the FDMB way we made huge strides. If you have a vet that will work WITH you that's ideal. We know how hard it is to make the leap. Give it some thought. :)
 
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