Urgent, out of town, need help ASAP

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codyraja

codyraja

Member Since 2014
I posted this on the prozinc page. Adding it here to get more traffic:

I am out of town and need help. I have not kept a spreadsheet in years, so I will try to summarize:
Cody, 17, diabetic since 2014, usual dose is 1.6 - 2 units prozinc, adjusted based on BG. Also on Gabapentin and metacam.

For the last few weeks, Cody’s Pre-shot bg, especially AMPS, has been high, 400-500s. We are almost never able to get a mid-cycle bg, but at +3 his bg is usually only down by about 100. But if I increase his dose (I work in .2 increments) he’s pre-shot numbers are too low, so we stay around 2units.
I’ve been gone since Monday night and my husband is at home. He’s good with testing and shooting. I’m sure there is some stress from me being gone, but Cody is very close with him too. Hubs called last night worried that Cody’s numbers are all over the place:

Tuesday pmps 400s, 1.6u
Wed amps 45, no shot
Wed pmps, meter read “high”, 2u
Wed pm+2, 484
Wed pm+11, 64
Thurs amps, 50, no shot
Thurs +3, 141

MIL is staying with him today while hubs is at work. He’s really weak/wobbly lately, with good and bad days. Hubs says he’s moving pretty poorly this week. Pee and poop normal, pretty thirsty. All he’ll eat lately is Inuba Churru puréed treats and Origen freeze dried treats. He gets 3-4 churru tubes at meal times and lots of treats throughout the day. He also gets chicken/fish from our dinners.

I have told hubs to reduce his dose...assuming he’s back in the shooting range tonight. But what could be causing such a huge drop in BG on his normal dose? Is it odd that his bg is still dropping at +11/12?
Any other ideas what to do besides reduce dose? thanks!!
 
  • Could be Cody's poor appetite.
  • Doesn't need as much insulin.
  • Husband is feeding him differently than you would.
  • Trying to go OTJ and you have not been testing as much to catch lower BG numbers.
How did you come up with the custom dosing?

The 2 kinds of treats Cody is eating are not nutritionally complete. Could be contributing to his wobbly condition.
Neither are those Inuba Churra treats low carb. Contain tapioca (starch).
Which Origen freeze dried treats? Which flavor?

Is Cody eating well?

When are meal times in relation to these BG readings? In other words, put the meal times into the + hour format.
 
Thanks, Deb. We are not trying to go OTJ. These low numbers are new this week. Custom dosing is based on our experience and consultation with our vet. He is given breakfast and dinner at shot times and treats/small meals throughout the day whenever he asks. I know that the treats are not nutritionally complete, but he has really turned up his nose at everything else and I just want him to eat. I just ordered tiki mousse and will give that a try.

Even when his appetite is down, I’ve never seen a 400+ drop. If his BG is over 300 tonight, I was going to have my hubs give him 1 unit and see how that goes. Any thoughts on that approach?
 
Not saying you are deliberately trying to go OTJ.
I'm saying that Cody may be telling you he is ready for less insulin than you are giving him.
I'm saying Cody's insulin needs have changed.

You could have your "hubs" give Cody 1U tonight. May still be too much. Monitor closely, of course.

With those doses you are giving, looks like you use U100 syringes to dose the U40 insulin. Using the conversion chart.
U40 insulin times 2.5 = dose to draw up in the U100 syringe. So 1U Prozinc in a U100 syringe would be 2.5U.
Could your husband have grabbed some old U40 syringes? And is measuring with those?
Could you have your husband take a picture of the syringe, with the insulin dose drawn up and send you a picture?
To double check that he is drawing up the correct amount.
In the correct syringes. Orange cap for U100, red cap for U40 syringe.

400 point drop is a lot.
Usually, when a cat drops that much, the dose is way too high.
You are looking for a 50% drop between pre-shot test and nadir.
484 to 64 is a 86% drop.
 
You may not be trying to go OTJ, but Cody's pancreas may have other ideas. I wonder if your husband is feeding less of the high carb treats. Deb knows more about dosing than I do. If it were me, I'd reduce to 1 unit for 3 days (assuming pre-shot BGL is high enough to inject) and see how he is doing then.
 
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Just because the +3 was only down around 100, doesn't mean that the BG levels did not keep dropping, and dropping and dropping later in the 12 hour dosing cycle and then rise back up really high before your next test.

In point of fact, that is exactly what it looks like happened on Tuesday PMPS to Wed AMPS and the BG levels probably kept dropping for the rest of Wed AMPS. Then again on Wed PMPS to the +11 and Thursday's AMPS he was still dropping.
codyraja said:
Tuesday pmps 400s, 1.6u
Wed amps 45, no shot
Wed pmps, meter read “high”, 2u
Wed pm+2, 484
Wed pm+11, 64
Thurs amps, 50, no shot
Thurs +3, 141
Click to expand...

I seriously think you need to adjust the "sliding scale" dosing you are using.

Personally, if Cody were my cat, I'd only give him somewhere around 0.5U of Prozinc for Thursday PMPS IF and ONLY IF his BG is high enough. Then reevaluate for the next shot.

What is your current threshold where you give Cody insulin? 200? Lower? Higher?
 
If Cody is dropping so much, that you can't give him his 2 shots a day because of BG levels too low to shoot, it's time to find a dose low enough where you can do that.
 
Cat's can do strange things. His little pancreas could be spitting out a little insulin to confuse everyone. I have seen my Callie do the same thing. I would lower his dose until you get to more consistent numbers..
 
Thanks, everyone, I really appreciate the support. We have used u100 needles for years...but that was my first thought too. I had him send me a pic of the needles and they are the right ones, orange caps, u100. We are going to get him on a better food and stick with 1 unit for several days to see what that does. It’s probably time to resurrect the spreadsheet too.
Side question...I know the churus have tapioca, but does that necessarily mean they are “high” carb? The contents list 91% max moisture and 7% min protein. Doesn’t that only leave about 2% for carbs? Thanks!
 
codyraja said:
Side question...I know the churus have tapioca, but does that necessarily mean they are “high” carb? The contents list 91% max moisture and 7% min protein. Doesn’t that only leave about 2% for carbs? Thanks!
Click to expand...
No you have to subtract the moisture content to find the percentage of carbs.
Try 22% carbs on a dry matter basis.

codyraja said:
It’s probably time to resurrect the spreadsheet too.
Click to expand...
Yes.
 
codyraja said:
Side question...I know the churus have tapioca, but does that necessarily mean they are “high” carb? The contents list 91% max moisture and 7% min protein. Doesn’t that only leave about 2% for carbs? Thanks!
Click to expand...
For whatever reason, this calculation method doesn’t seem to give an accurate estimate for calculating carbs with treats. Using the numbers on the bag, Purebites freeze dried salmon treats which only contain salmon are 22% carbs, so obviously not accurate :rolleyes: Chewy reports some of the churus as being 1.7% carbs (although I’m not sure on what basis), and the chicken as being 5.5% dry matter basis, so as long as you don’t notice them causing blood sugar spikes in your specific cat, they’re likely fine
 
Sarah&Soph said:
Chewy reports some of the churus as being 1.7% carbs (although I’m not sure on what basis), and the chicken as being 5.5% dry matter basis, so as long as you don’t notice them causing blood sugar spikes in your specific cat, they’re likely fine
Click to expand...

As the main food? Her cat basically only eats treats.
 
So .... Cody is elderly, a long-term diabetic, not eating well, weak and wobbly, with BG values suddenly erratic for him. You rarely get mid cycle tests. And he’s on Metacam also.

OK, here are my initial thoughts, in no particular order:

1) Are you testing for ketones? Does Cody have any history of ketones or diabetic ketoacidosis (DKA)?

2) When’s the last time you ran a blood panel on him? In addition to other numbers, I’m particularly interested in the kidney values (given his age, inappetance, and history of Metacam use) and his phosphorus and potassium levels.

3) Is he losing weight?

4) What are his other known medical issues? (I assume there’s something given the Metacam and gaba).

5) Is he vomiting? Doing any lip smacking?

6) How long has he been on Metacam and at what dose?

Sometimes dosage needs change quite abruptly even in long term diabetics, which is why those mid-cycle tests are so important, especially right now. There are other medical conditions that can affect exogenous insulin needs, so any time a long-term diabetic suddenly needs less insulin, it’s worth taking seriously.

It might be as simple as his limited food intake has lowered his insulin needs and his “usual” dose is now an overdose that’s thrown him into a hypo/bounce cycle. It’s also possible there are other variables going on. Especially given the weakness/ wobbliness and lack of appetite, I’d strongly encourage you to get Cody in for a vet check and bloodwork as soon as possible.

edited to add: I’d also pick up some ketostix and check for ketones, for good measure.
 
Hi cocyraja, I simply wanted to make you aware of this.

All the "Sticky" or pinned posts in the Prozinc forum have been updated and there are a couple of new ones.

Highly recommend that everyone using Prozinc or helping those using Prozinc read them thoroughly.

I'll be doing that myself. Been expecting this for some time. Came about a week before I thought it would.
Thanks Marje, and Robert, and especially Djamila for the Modified Prozinc Method. You folks are FANTASTIC!
 
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