First Curve and Little Appetite

Hey All. I am new here and still haven't quite figured out the signature thing. My boy is 12, was diagnosed about 3 weeks ago. He is on one unit ProZinc two times daily. Have switched his diet. In the beginning he was somewhat cooperative with new food, will now only eat fresh chicken breast. That's basically it. His neuropathy is quite bad, and he's not moving around much at all. His numbers have been generally in the high 200's to mid/low 100's, so not bad. But his fructosamine for the same two weeks showed totally elevated BS, much different than home tests. Anyway, any thoughts, advice on the curve, eating...I'll take it. Thanks.

 

Hi, I am new at this too, as Gus and I are on our 16th day, but they have a lot of great links to various food kinds on this website. You may have to look around a little, but they are there.

 

Hi and welcome

First of what is your and your kitties name?

Can I ask what you switched his diet from and too. Sometimes it can upset their tummy's. Does he seem nauseous ? Licking lips, grinding teeth, walking up to food and then turning away? When you give him the chicken breast does he enjoy it? Are you able to give him enough for him to maintain his weight?

With regards the blood glucose. It sounds like you are testing him at home. Could you perhaps list out the recent readings? Have you done a curve yet at home?

Are you testing for ketones with the urine dips sticks. I would recommend that you do this whilst you are still getting him under control.

Have you read the prozinc protocol we follow on the forum.
http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/

Not sure about the fructosamine test. Hopefully someone else can advise.

 

@Sue and Oliver (GA) may be able to offer some advice

 

Hi,

I am not sure about the fructosamine test either. It gives an average of the blood glucose values over the past few weeks. If some of that time, he was not yet in lower ranges, then it could be reflecting that. What meter are you using? Some people have found meters with "true" in the name run lower than other ones.

He does need to eat. He may be lower than usual if he is not eating well. This thread has some great suggestions for getting a reluctant cat to eat

http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

as does this vet's website: www.catinfo.org She also has a great food list.

For reference. We consider a cat regulated if they are in the lower 200s at pre shot and in double digits at nadir (usually 5-7 hours after the shot for ProZinc) but not below 40 which is approaching hypo territory. We suggest that new diabetics not shoot under 200 until they have more data. So his numbers do sound pretty good. I would just work on getting him interested in eating.

 

Fredo! Yes, Phlika29 things are very bad right now, and i'm basically trying to just trust. Both my vet (he's a cat specialist) and I are completely flummoxed. Right before last night's ProZinc dose at midnight his BG was 285. but this morning, 12 hours later, it was down to 112. and then an hour later (no dose yet) a retest was at 84. No dose now, too dangerous. It has been going this way it seems since i started monitoring just a few days ago. A couple days ago we actually skipped a dose because he was at 160, and then he had skyrocketed to 315 12 hours later. Yesterday, 162 in the am, one dose, and BG 281 twelve hours later. His numbers are all over the place and it just doesn't make sense. But the fact that he is so low this morning, after no dose for 12 hours, and a reasonable amount of food is pretty confusing and concerning. I am giving him quite a bit of chicken breast. And occasionally some egg. He eats them all up. But he almost seems like he is shutting down. I have to literally bring the food to him, or him to the food.
The only thing my vet has suggested is possible changing to Lantus, but he finds it even less reliable than ProZinc. All I know is that Fredo is my heart, but I can't live like this much longer.
(and regards to diet, changed him from FF higher carb wet & Hill's K/D - because of very slight kidney issues, to FF higher pates or weruva, or wet DM and the occasional teeny serving of DM dry - which he is no longer eating)

 

Aha. Now your numbers make more sense. If you are getting a number too low to shoot for a pre shot with Prozinc, it means the dose is too high. The insulin is lasting longer than it normally does. So I would reduce the dose to .5 (or even .25) if you are concerned the next preshot you get over 200. See what that dose does. You are looking for a smile curve - from a pre shot down to a lower nadir and then back up for the next preshot. Our theory is to start low and go slow. So you might go with the lower dose, see what he looks like midcycle and see what you get for the next pre shot. Hopefully it will be high enough to shoot. If he is sitting in higher ranges after 3 cycles or so, raise by .25 on a cycle you can monitor. Once he starts to eat better, your numbers may rise but that is fine. Your vet started with a logical low dose but it seems too high for Fredo with his eating issues at the moment.

I think the ProZinc is working great - a little too well. If he will eat the chicken and egg, I would keep feeding that, try some of the pates along side and see if he will try them. My kitty did not like the consistency of the pates so I add a little warm water and make a gravy. He likes that much better. Another thing to try is to put the chicken in the wet food and mix it up.

I would also start testing daily for ketones. Not eating well can sometimes lead to DKA if it is combined with any kind of infection. That doesn't sound like Fredo's issue but it is safest to keep on top. You buy ketone strips (just like humans use) and stick in his urine strip. If he won't let you do that, we have ways….

The ProZinc protocol is in my signature and may be helpful.

 

Yes, vet suggested a switch to lower .5 dose today, but after retest at 84 this morning we agreed I should wait and retest tonight before giving new dose. I know generally ProZinc tends to reach its nadir around 6/7 hours, but with Fredo it seems to be lasting really long, maybe because of dosage. I have literally tried all those things and everything with the food (except the forti flora or cheese, will try next) but he had a really good day a couple days ago, and ate some canned food a few times. it's just gotten much worse in the last 24 hours. and it has been like that a lot, good day/bad day. but this is the worst i've seen and i'm scared. will keep feeding him the chicken and egg. and i'm not planning on leaving apt for more the 15 minutes today. but i don't know how much longer i can realistically keep that up. thank you so much for your help, i have begun to feel like there is no hope anymore. i've never seen him like this. and i love him so much, it's hard.

 

Fredo. Cute name

I would listen to @Sue and Oliver (GA) she has a great deal of experience with this insulin. I like her idea of trying a lower dose. That way you hopefully would be able to shoot every twelve hours as long as you are monitoring him.

It could be that he is having something like a pancreatitis flair. My cat didn't eat, move or drink when he had one. I found that pain relief, and anti nausea medication, additional fluids and assisted feeding helped get him through but he seemed like he wouldn't make it.

 

yes, definitely lower dose seems the way to go. will test before dose tonight. RE: pancreatitis, did you have to have vet assess? he seems to be tiring of chicken now too.

 

For that signature thing!

When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback without having to go look in all your past posts.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

And welcome to FDMB!

 

Yes the vet diagnosed by assessing him physically and also sending a blood test -spec fPL -off to the IDEXX lab. You can also treat the symptoms but please don't leave it if your cat is not eating or drinking. They can go down hill very fast. I would go back to your vet and discuss the symptoms.

If he isn't moving much it maybe because he is in pain. How is he sitting? In a meatloaf position, eyes down?

Does he seem nauseous as I described above? Then an anti nausea may be called for.

Is he dehydrated? If you pull his skin up on his neck does it fall straight back or stay up?

In the meantime you could try to syringe some water carefully into him or add it to his food. I use a 5 or 10ml oral syringe and very slowly put the syringe on one side of his mouth and aim it to the other side (not down the throat).

Other things to consider if not moving about is whether he has low potassium levels-vet blood test- or diabetic neuropathy which is helped by vitamin b supplements MethylCobalamin.

I think you need to address the eating so that you can keep giving the insulin. When diagnosed did he have dk?

 

yes, the neuropathy is bad. just got the xobaline (methylcobalamin), but since he is already so traumatized right now, i don't really want to add shoving a pill down his throat right away. would like to get the eating first. his position is generally on his side, sometimes meatloaf, but paws tucked in a lot of the time, which is not his norm. and if he's not asleep, he often has the very upsetting eyes down. he did not have any ketones when we tested him last a week ago at vet. and he is still drinking occasionally, tho not like in the beginning. but skin still goes back. i will suggest pancreatitis possibility. he had issues with that many years ago. he's generally been a healthy boy, but then occasionally has had really weird bouts of difficult to diagnose "stuff".

 

i literally can't take anymore. i suppose that's normal. but i just don't know what to do. i will test him in an hour so i can give dose. but we've had 3 vet visits back and forth in a week, with nothing new conclusive and today he just really seems to be going downhill
.

 

well sure enough @Sue and Oliver (GA), just tested and he was up to 337! gave him .5 dose. fingers and paws crossed. hoping this is why he has been so difficult, lethargic, and sad today, the huge swing. @BJM do i need to do the google docs thing, or can i just update signature info as you suggest?
thanks all. i literally don't know what i would do without this forum right now.

 

The signature provides details which help us interpret the numbers on the spreadsheet and give you feedback, so both are helpful to us.

 

Hi Miss Kitty,

My Saoirse had major eating problems just after she was diagnosed (she has pancreatitis as well as diabetes). Saoirse was also terribly lethargic and felt awful during the early stages of treatment. I know how scary it is trying to give insulin and trying to manage eating difficulties at the same time, and I don't know what I'd have done without the emotional support I received here. You've already received some great information from other members, but I just wanted to send you a .

 

Hi, any update? How are things going today? Don't give up - it is overwhelming but you can do it!!!

 

Hey Nicole,
You are so sweet. Things are a little better today, he jumped up on bed to wake me this morning! Yesterday he barely moved. So we are taking it easy, trying to see if we can get Fredo's appetite back on its own or if we might have to use a little mirtazapine tomorrow. (I've used this once before with him and he did not like, but it worked. Still it ascares me a bit.) He will happily eat chicken or turkey, but still no canned food. The good news is I have gotten him off dry. Ha, small victories.
Last night after skipping morning dose because he was too low to inject, he skyrocketed to 337. So he got .5 around 8pm. This morning he was at 242. Not great, but we are going to stick with .5 for a little bit to see if things can even out. again, appetite is most important now, so no curve since we just started this dosage. He's not great, but better and more alert than yesterday. I got the forti flora too, so we'll see if that works. He's no fool. He keeps licking the parmesan cheese off the top of wet food. Thanks so much for checking in, it really helps, as I'm sure you know from your own experience. Love to Baby.

 

Be very careful about skipping the insulin shots if your kitty is not eating. It can make things worse and lead to DKA (diabetic ketoacidosis), a life threatening, vet hospital emergency stay for days.

If kittys appetite does not improve, you may need to force feed or get a feeding tube installed.

Please let us know how things progress with Fredo.

 

to be clear, he is eating, just super finicky. no actual cat food, just chicken or turkey. and i mostly have to bring it to him. but he eats a decent amount. have any of you ever used mirtazapine to fire up your kitty's appetite? a feeding tube would be further than i feel comfortable going.

 

There are two appetite stimulants commonly used in cats, mirtazapine (an antidepressant) and cyproheptadine (an antihistamine). The appetite stimulant effect of mirtazapine may last longer but it carries the risk of inducing serontonin syndrome, a potentially life-threatening condition. Saoirse was given one dose of it and she became really aggressive and crazed with hunger (I didn't know about mirtazapine's side-effect profile at the time). I've been prescribed mirtazapine myself, and I found it quite a harsh medication (I also had a bad reaction to it). I asked our vet to prescribe cyproheptadine for Saoirse because it had a more acceptable side-effect profile. It worked very well for Saoirse: she was very keen to eat but not crazily so, and the only side effect she had was a little drowsiness shortly after taking the medication but which quickly wore off. A tiny dose of cyproheptadine went a long way (c. 1/8 of a 4g tablet helped Saoirse to eat for at least 8 hours but up to 24 hours. Saoirse weights c. 10lb.) Between the cyproheptadine and ondansetron (an anti-nausea medication) I was able to successfully nurse Saoirse through a pancreatitis flare at home last year.

For information, cyproheptadine is given to counteract serotonin syndrome.

 

yes, Fredo had 1/4 tablet of the mirtazapine once before years ago and was very agitated. but it worked and made him eat. i told my vet about my concern so they cut into 1/8 a pill this time. do you know what the dosage you gave Saoirse was? and fredo is in the 14-15 pound range.

 

I can't remember exactly what dose mirtazapine Saoirse was prescribed, but I do know it was the tiniest dose I could give her (by default I'm extremely conservative with all medications she receives).

FWIW, I had to feed Saoirse exclusively on home-poached chicken breast and the broth from the poaching for well over a week when her inappetence was at its worst. It was the only thing she could tolerate with the pancreatitis problems.

 

that's so good to know Aine. I have been worried about it. But chicken, dried chicken treats, turkey breast, and ground turkey seem to be it right now. and my eggs if i am eating them. ha. I just can't stand how lethargic and sad he feels. This is no quality of life, and I am having a hard time believing it will get better. Everyone is so supportive, but it seems that everyone here spends there entire life testing.

 

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

Hey BJM I couldn't figure out how to rename the spreadsheet in my signature, just copied the link.
Wanted to give a heads up to all that have been here with me that Fredo's BG was 199 last night pre-dose of .5 ProZinc, and 202 this morning pre-dose of .5. i am hopeful that we may be onto the right dose, at least for now. No curve yet, as we just started him at this dose. His eating "issues" continue. To be clear, he will eat. It just has to be only fresh chicken or turkey (or my eggs) and I often have to bring it to him. But he has been more "alert" and come up onto the bed to cuddle the last couple mornings, which feels like the greatest thing ever. Trying to remain optimistic.

 

We can't access your spreadsheet. Looks like you missed the Share Options. This needs to be set to "anyone with the link" so that we can see it.

 

i think i've fixed it. let me know. (haven't made an entry yet tho).

 

Yes, that was it! Let us know when you have some data on your SS. Even making some notes over in the right most column can be helpful.I kept track of what Wink was eating, any meds he got that day, if he was feeling off and anything special going on that would help people to understand those SS numbers.

 

“Things are a little better today, he jumped up on bed to wake me this morning!” (AWESOME) it IS baby steps sometimes!!! Yay!!!
“we might have to use a little mirtazapine tomorrow. (I've used this once before with him and he did not like, but it worked. Still it ascares me a bit.)” NO need to be scared … just a lil jumpstart for him!!! Again… YAY!!!
“The good news is I have gotten him off dry. Ha, small victories.” This is a HUGE victory!!!! YAYYYYY for you both!!!! <3
Not sure about dosing, etc. we are on Lantus but he has interest in some food and for today --- that is what we celebrate.
**And to comment on your reply “everyone seems to always be testing” that isn’t the case, it is just new for you & seems overwhelming!!!!
YOU got this!!!! Heck we don’t give up on humans who are diagnosed with Diabetes – it just takes time to figure it all out … and WE (yes .. FDMB & YOU (((WE))) are going to get through this!!!)))
You will look back soon & say… WHO was that lady who was freaking out/questioning … you will be doing things blindfolded with a happy cat GIVING advice!!
Yes, YOU!!! lol
Hugs and love for well wishes for (((Baby)))!!

 

If you'd like that long spreadsheet link referenced by just Fredo's Spreadsheet, you can edit your signature like this:
1) highlight and cut the link
2) enter the text you want to display
3) highlight that text
4) click the chain link icon and paste the link in the box that comes up

 

it was such a stressful day for us both today. he finally just ran and hid from me. that was tough. i took a BG reading around 5:45 before i had to go out and he was up to 292. i am actually afraid that for all my concern of him not eating, i may actually be over feeding him (the chicken, turkey, freeze dried chicken...). i'm constantly on him to eat. i keep thinking maybe he's getting too low. and clearly not the issue. i dosed him when i got home about half an hour ago. did not take another reading. right now i think we both need a little calm, and since he was so high before, i knew it would be okay. as of now he is only getting .5 ProZinc and my main focus is getting us both a little calmer. so we had a good brushing, grooming, just hanging session. i know his BG is higher with this lower dose because he is drinking and peeing more. now if only he would eat like a diabetic cat! ha.
anyway, does anyone have any idea what might be the "right amount" of food, ie chicken breast, turkey etc...by weight, that i should be feeding a 14-15 cat (he's a big cat, not just heavy, big, maine coonish, long hair big). thanks again for the support. i really want to avoid giving him the pill. waiting another day.

 

Fredo had a slightly better eating day yesterday, and just seemed more alert, tho his numbers were much higher than i would like with this new lower dose. 296 preshoot this morning and 271 6 hours later. flummoxed. also, he has diarrhea today for the first time. wondering if adding FortiFlora or EVO dry (yesterday, to help with eating) might be the cause. hoping that's what it is. any thoughts from anyone else if they've had diarrhea result from either of those things?
ps left message for Vet. i am hoping not to have to take him in, as i now have the full on flu.

 

Cat Info has a section on obesity which discusses how much to feed.
Also, the panreas makes digestive enzymes in addition to insulin. If those aren't being made in enough quantity, diarrhea can be the result.

 

going to take out the EVO and see if that corrects it first. I know change of food can also have an effect.

 

Saoirse didn't have diarrhoea after Fortiflora, but it did make her nauseated.

 

Help guys! Fredo is super agitated and keeps going in litter box with nothing but a little diarrhea coming out. he is pacing and acting strange
could this be hypo? what?

 

i just took a read 111. not crazy low, but low for him. i gave him some ff, the kind with gravy and he scarfed it up.

 

Hi misskitty,

How is Fredo now? I'm fairly new to this forum, but they've helped my kitty so much and saved her life one night. I'm not experienced enough to give you advice, but here is how to get someone experienced to see your post right away:

Start a new thread (post) in the Feline Health Forum-- when you name the thread, select the "911" prefix. Then start the name of the thread with "Help! the date, and the problem"

Also, copy the link to this thread at the top of your new thread. (don't worry if you can't do this right away, just get your help message out there now)

Do this whenever you need immediate help and also when you are posting for general help. It's better to start new posts for each day, with current headings so the experienced people scanning will see yours, and see the date.

All my love to you and Fredo-- I know what you are going through. Don't give up, the people on this forum are lifesavers, literally.

Martha

 

thanks Martha. he is okay. quiet today. probable UTI on top of all the other stuff. and we are testing for pancreatitis.

 

It is possible to be partially obstructed with other fecal material flowing around the obstruction to be excreted.

 

@Sue and Oliver (GA), after a rough a couple rough weeks in many ways, including a late night Vet hospital trip for a possible UTI (for which he is being treated with an antibiotic), Fredo has been doing a bit better the last couple days. He is eating a mix of Friskies Special Diet canned, some DM, and some chicken breast. In the last couple days his BG has held pretty steady Pre-Shoot AM & PM in the high 100's. I know you suggest not dosing below 200, but my now that Fredo is only getting .5 ProZinc my vet does not want me to skip a dose, and while i really don't want to,as this seems to be good right now, I am also incredibly paranoid about a hypo attack. My vet feels pretty confident that .5 should not induce a hypo attack with these BG #s. Just wondering your thoughts on this. How do you ever not worry 24/7 and have your life back?
(also, i know everyone says no food before test, but i have to feed him a 5 or 6 pieces of chicken while I test...)

 

The lowest glucose between shots, or nadir, is roughly +5 to +7 hours after you give ProZinc. You need to test in that period to monitor the dose effectiveness and safety. And since cats can and may recover pancreas function, it is possible to develop hypoglycemia on just 0.5 units. All it takes is the pancreas starting to put out insulin again and down it goes.

The lowest he can go before you intervene is 50 mg/dL on a human glucometer. Getting a before bed test is good to determine if you might need to stay up and feed to steer the glucose numbers or can go to bed.

Also, if you test within about 15 minutes of those chicken pieces, the number is less likely to have been influenced by them.

 

oh that's good news. yes, i test within about two minutes. i usually dose around 9am/9pm. and i have not done a curve yet because we wanted to wait until a solid week at this dose. also he is getting less easy with the testing unfortunately, not more, so i am getting more anxious. never a good combo.
we use an alpha trak2 so i'm not sure what the low number might be on there.

 

and he had a good amount to eat tonight, so i feel on the safer side.

 

See my signature link Glucometer Notes for AlphaTrak reference numbers and info on how meters work.
You want to stay above 68 mg/L on the AlphaTrak.

You don't need to do a curve, just get some tests in the +5 to +7 range to see how low he goes. The nadir can vary from day to day, so get a test (or two) at different times each day that you can. You need to be sure he isn't going too low.

 

we started at 195 this morning and now a +6 of 155. will pick a slightly different time or two tomorrow for another nadir test.

(and of course i woke up and made sure he was okay like every two hours last night because i'm insane. he was fine. i swear he kept looking at me like i was crazy.)

 

I am so glad that Fredo seems better-- it sounds as if you are getting a handle on it. I've been thinking about you guys. I obsessed over not being home to test at the nadir all the time. A couple of times I knew I couldn't be home, so I skipped a dose or did what we call a BCS- or Big Chicken Shot. I don't recommend you do this now especially now that he seems to be stabilizing, but I want you to know you will start living a normal life again, without constantly worrying about his BG, when you get him stabilized, and know his patterns. Hugs to both of you, you are doing a FANTASTIC job!