New spreadsheet data, poorly regulated on Prozinc. Please help with next steps!

Our cat was diagnosed on 8/9/17. After a few days of noticing excess thirst and finding puddles of urine around the house we took him in to the vet and his BG was 535. He was also diagnosed with a UTI and got a course of antibiotics at that time. No ketones noted at that time. Here is the timeline after that:

-Prozinc, 1 unit 2x daily which we started on 8/11/17.
-Symptoms initially improved but worsened by 8/19 with excess thirst, peeing. Discussed w/vet by email, Prozinc was increased to 2 units 2x daily on 8/21
-Symptoms improved again for about a week and then returned. Vet said to increase to 3 units 2x daily- 8/28
-Symptoms improved again for about 10 days and then returned. Vet said to increase to 4 units 2x daily- 9/14
- Of note, no glucose testing was done during this period

During this stressful process we became pretty worried about hypoglycemia and also wanted to look into other options for control, such as diet. We have asked our vet about diet control as well as home testing but she has not been as supportive as hoped. Our cat has always been free fed dry food but we realize now after doing our own research that he needs to be switched to wet food on a schedule. As we had already started insulin though we have started home testing so that we can safely make the switch to wet food. So, I have a few questions now that we have our first spreadsheet data.

1. It seems that our numbers fluctuate quite dramatically over the course of the day. Is he on too much Prozinc? The drop to the 30s was scary mid-day but he was completely asymptomatic. Do we need to try a different insulin? Or should we make the diet changes first and see how he does with Prozinc?

2. Re: making the switch to wet food. Our cat has always been free fed dry food so we don't know how he will take to wet food. Should we first try mixing wet and dry or should we try to make the change to wet cold turkey and see how he likes it? I know this will also depend on how he likes the wet food but I would love advice on how to actually start the change. Also, should we try to get him on more of a schedule of eating twice daily rather than being free fed before we even introduce the wet food?

This has all been really stressful, especially with two very young children at home. We are financially stretched quite thin with these added expenses. We are trying to give this a really good shot to get things under control but we are at our wits end! Any advice would be much appreciated!

 

YES!!! A drop into the 30's is way too low!! If it weren't for the high carb dry food, you may have had a tragedy on your hands. Even if they don't show any outward symptoms, if the blood glucose is too low, the brain is being deprived of glucose...which it needs to survive.

ProZinc is a good cat insulin so I don't think there's any reason to change. We usually suggest trying an insulin for at least 4-6 months (while using our methods) before considering a change.

It's usually best to switch slowly to avoid problems with upset tummies and diarrhea. Try no more than 25% wet food for the first day or two, then gradually increase the amount of wet until that's all he's eating.

It's actually better for a diabetic to eat several small meals a day instead of 2 big ones. Most of us feed every 3-4 hours.

It's important that you take all food up for 2 hours before shot times so that when you test, you get a number that's not influenced by food. After you get the "pre-shot" tests, you can feed several times throughout the day.

I strongly encourage you to drop his dose back to something like 2U while you're getting him onto a low carb canned diet and continue testing to see how he does. If he drops below 50, that's your "Time to act" by feeding him something high carb (like Fancy Feast Gravy Lovers) or adding a few drops of Karo/honey/syrup to his food

We never do dose increases in whole units like your vet has. We do increases in .25 unit increments so we don't bypass what could be a "perfect" dose. You can get syringes with half unit markings at American Diabetes Wholesale. They don't make them with .25 unit markings so we have to eyeball those .25 unit dose adjustments.

 

Hello and welcome,

Chris and China has addressed your issues so I just wanted to pop on and give your some moral support and also say that I free fed Tempest as that's what she's used to and lifted the food 2 hours before amps and pmps, it really doesn't have to be so regimented as long as you remove food for those two times.

At night to save me getting up extra early I'd only put enough food out that was finished well before the 2 hour mark and during the days I worked I'd leave enough that she could eat until I got home. My test times were 8am and 8pm so it worked out really well and Tempest never felt (starved).

It looks like kitty is responding well to the prozinc. High carb food does offset the insulin so it can look like it's not doing anything. The more carbs in the food the more insulin kitty will need to bring the numbers down. But I'd definitely not switch immediately, do it slowly and lower your insulin dose as well. This is where you absolutely must test to make sure the insulin is the right amount.

Looking in your SS you can see how kitty went really low then at pmps the number went really high. This is because kitty's body reacted to the really low number and the body then releases stored glucose (to save itself) which drives the numbers artificially high. This is called bouncing. It's not a reflection on whether the insulin is working because it actually is, but is too much. The goal is to find a dose that evens out the bouncing so that amps and pmps are more level numbers without dropping into hypo numbers in between.

 

Hi. I cannot believe the dose was increased from 1 unit to 4 with no glucose testing being done. These vets continue to horrify me!

The current dose is very high. I agree that you should drop the dose at least in half, start low-carb wet food and keep up the home testing. Also, be aware that once a bounce has been triggered (such as by that 30), the numbers will look a little crazy, sometimes for a few cycles afterwards. It is best not to jump up in dose during that time. Allow things a few cycles to smooth back out. Unfortunately, bouncing is something I have become all to familiar with since my Mia is very prone to it. She does not even have to get super low for it to happen. So, I have had to learn a lot of patience with the numbers, and I have to remember to watch the clinical symptoms, too.

My girls always free-fed on dry food before this. Now, I have them on all low-carb wet, and I feed them four times a day. The AAHA guidelines say four times is best but free-feeding is okay if your cat is underweight. Just be sure to take the food up two hours before shot time so your pre-shot test number will not be influenced by food. The conversion from dry to wet (and finding a wet they would eat enough of) was a little rough, but I feel so much better with it behind us.

ProZinc is a good insulin, and you really have not been using it very long. With proper dosing and diet, it may work out great for you.

 

Thanks for everyone's advice so far! His glucose this AM was 455. We went ahead and made the switch to 2 units of Prozinc. Unfortunately we work full-time so it's hard to do frequent full glucose curves but we should be able to at least get a +6 and +8 in addition to the pre-shot tests. Given our schedules it is not possible to be home for 3-4 meals a day, so we will have to figure out a system for leaving out enough food but not so much that he is eating in the 2 hours before his shots. We will start with 25% wet food tonight. Is there a sliding scale chart somewhere I can use to dose his insulin based on the sugars we get as we make this change?

Also, any suggestions to prevent him peeing all over the house? We have two litterboxes for him but once we got the second box he just stopped using the first altogether. If the one he uses gets full he just starts peeing on the floor rather than going to the other box. This has been one of the biggest issues as we have a toddler and an infant who are both on the floor a lot.

 

There is no need to do frequent full curves, getting a couple of mid-cycle tests in addition to your pre-shot ones is great. Maybe on some weekends you can grab mid-cycle tests at different times than you are able to during the week so that you can begin to get more of a picture of the full cycle.

This is where an auto-feeder would come in handy. Several people use them. You can have it turn to an empty section two hours before shot time.

 

Hi there, please see our updated spreadsheet data. I dropped Meow's insulin yesterday (10/3) to 2 units twice daily as suggested and we started the transition to wet food. He loves the wet food which is great news! Unfortunately despite going to 2 units he continues to have very low sugars 6 hours after his AM insulin shot. Today his glucose was in the 30s for about an hour and slowly improved after giving treats and FF gravy lovers. His pre-shot insulin tonight was 133 so I held his insulin altogether- is this appropriate?

What do you suggest next? If his sugar is over 200 in the morning should I go down to 1 unit of Prozinc? Or should I give the 2 units we've been giving?

 

Lime green = reduction. Usually with prozinc we reduce by .25u. You've hit some very dangerously low numbers, followed by bounce cycles.
When you aren't at a shootable preshot you can stall for 20 mins, retest without feeding, see if Moew is rising. You can stall and stall and stall, but don't give any food. There have been many times when we were in the 100's and because of time constraints I didn't give insulin. There's some very handy info over on the prozinc forum. http://www.felinediabetes.com/FDMB/forums/prozinc-pzi.24/ as well as protocol for use http://www.felinediabetes.com/FDMB/...prozinc-pzi-insulin-for-diabetic-cats.164995/ Be sure and read the stickies at the top. You can always post over there too
Tagging @Yong @Kris & Teasel @Djamila @Rachel I'm sure these guys and gals can give you better advice than I will ever be able to.
If no one gets back to you about dosing, I might go with 1u unless you're going to be around to monitor. If you are then I'd try the 1.75u since you guys have earned a reduction. If you go with the higher dose, try and get a +3 +4 in so you can steer with food and prevent another hypo situation if you run into trouble.

 

That was quite the drop yesterday!!

You may see a much higher preshot number in the morning because of dropping so low and with skipping the PM shot. This "bouncing" is normal when hitting such low numbers and may last a few days. MY thought is that with the transition to low carb wet food and the big drop that you got to reduce the dose down even further...possibly 1.0 unit...and see where that dose takes your kitty. Some kitties have had huge reductions in insulin needs just from changing to a more appropriate food. If the lower dose does not seem to be keeping the numbers down after a few days, then you can always increase back up slowly. Best to be safe, especially with the diet change added into the picture. Hopefully others will weigh in with their thoughts on what dose you should be working with at this point.

 

Id go down to 1 unit for a while. So glad you caught that hypo number! Reducing the dose may help quell the bouncing. Once he's not a roller coaster hopefully the preshots will come down and the inappropriate peeing will stop. He's just letting you know he feels crappy.

Make sure you use a pet specific cleaner or the peeing will continue. My personal favorite is Anti Icky Poo Unscented which I get on amazon.

 

I agree with Janet. I would drop in half to 1 unit especially since you just switched to low-carb wet food.

 

Thanks so much! His pre-shot glucose this morning was 344, not as high as I expected after holding his insulin! We gave 1 unit of insulin. This is also his first day of 100% wet food as we have been making the change gradually so we will see how his sugars settle out over the next couple days. Thanks for all the advice and support!

 

I like what the other's have suggested. Grats on the reducie! Looks like the complete wet food diet may be helping a lot so be sure to keep testing so Meow stays safe!