Can't get sugar levels down... help appreciated!

Discussion in 'Prozinc / PZI' started by Jennifer & Splunk, Jan 23, 2020.

  1. Jennifer & Splunk

    Jennifer & Splunk Member

    Joined:
    Apr 16, 2017
    Hi Everyone,

    It's been a while since I posted here, as Splunk has been in remission for almost three years.

    Just a bit of history: Splunk is a 17 y/o neutered male. He has a history of pancreatitis, maybe IBD, diabetes, and kidney disease. He was on insulin a couple of years ago, and went beautifully into remission after a few months... thanks in no small part to the community here.

    Last November, he had a bad episode of pancreatitis, and ended up in the emerg for several days. An ultrasound at the time showed generalized inflammation in his pancreas and intestines, as well as suspicious abdominal fluid, and enlarged lymph nodes, making the vets suspicious of cancer. I refused to put him through surgery to confirm this suspicion -- he's too delicate for that -- so we treated the symptoms at home. Against the odds, he bounced back well, started gaining weight, and then had another, less severe bout of pancreatitis about a month later. He bounced back from that too, and then a third bout at the beginning of January set us back again. Seems he's recovered from the acute pancreatitis, but as part of this process, I tested his sugar and found it to be 34 mmol/L (in Canada, here), so we rushed to the emerg again. No DKA, thank goodness, and he was sent home with ProZinc, which worked very well last time.

    At home, he is still on Cerenia (anti-nauseant) daily, Mirtazapine (appetite stimulant) regularly (every 1-2 days, depending on his presentation), a potassium supplement, B12, and is getting about 60mL of fluid daily. We haven't given him more than that, as he has a heart murmur, and we don't want to cause fluid overload. He's tolerating the 60mL well.

    For food, he's free-feeding on Fancy Feast pate. I know FF isn't good food, but it's what he will eat, and he's gotta eat. At the height of his pancreatitis he dropped to 6.25kg, then gained back to 6.95, and is now at 6.78, and hasn't been able to gain weight for about a week.

    Per the emerg vet and in consultation with my own vet, I started with 1u of ProZinc, q 12 hours. This didn't get his sugar levels down enough, so I went to 1.25. Still not good enough, so now I'm at 1.5u every 12 hours, and honestly, it seems to be getting worse. For the past two days, his morning pre-shot sugar has been "HI" on the AlphaTrak 2 with FreeStyle test strips. His sugar has been getting down to about 20 at the 8-hour mark, but today it's 29. I'm just not sure what to do any more... we need to get this sugar down. I've been testing with Ketone strips every day or two, and so far they're negative. Splunk's clinical presentation isn't awful; he's drinking and peeing a lot, as you would expect, and is slightly wobbly, but he's fairly engaged, and seems in reasonable spirits. The wobbliness may be due to the fact that his potassium has been low.

    Not sure if we need to try a different type of insulin, or change his feeding routine, or do further testing... or what. Any help would be so very much appreciated. I've been out of this feline diabetes world for a couple of years, and this time around is really different than it was last time, so I feel out of my depth. I'm scared to leave the house or sleep, because I'm worried he's going to go into some kind of crisis while I'm not present.

    You should be able to see Splunk's new spreadsheet in my signature, but in case that doesn't work, here's a link:

    https://docs.google.com/spreadsheets/d/1qQqKJx17TNuZ91i_feTa2G-_fRV3AC47xOYysfWccog/edit?usp=sharing

    Thanks for reading, and all the very best to you and your kitties,

    Jennifer & Splunk

    P.S. Just heard from my vet, who thinks the problem is that I'm being too conservative with the ProZinc; she recommends increasing to 2.0u q 12 hrs. I'm a cautious sort, so I'll probably go to 1.75 first. Thoughts?
     
  2. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Hello Jennifer and Splunk!

    First off, I'm a newbie, so take what I say with a grain of salt. Personally, with the pancreatitis, I think your vet may be right about Splunk needing a higher dose. I also think you are wise to increase slowly by .25 increments. Give it at least 3 12-hour cycles before changing again, so Splunk's body has time to adjust. You have to give the pancreas a break so it has time to heal, and the higher dose might do that. Keep up the home testing, and try to get a +5 and +7 reading when you can. Yes, most cats start around 1 to 2 units twice a day, but some kitties need more. Every Cat is Different. I imagine every time they fall out of remission is different too.

    Fancy Feast Pates can work great. Lots of folks on the board feed them. I am absolutely sure that's what's gotten my Billy headed for remission.

    I'm sure you know this, but I'm going to say it anyway just to double check. Free feeding him is not a problem, as he's not trying to lose weight, but are you picking up the food 2 hours before injection time? Holding food for those two hours will make sure the BGL test isn't pumped higher from him having recently eaten.

    I will tell you that this ProZinc forum is quiet right now. Do post on the Feline Health (Welcome and Main Forum) if you want more eyes on your post.
     
  3. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Welcome back but I’m sorry Splunk didn’t stay in remission.

    Did you retest that 97 a.m. cycle 1/16? That number doesn’t really fit. I would like to encourage you to try and get at least one other test each cycle besides the PS. The BG can start at 400, be at 40 by midcycle, and then soar to 400 again by the next PS. Any extra tests to help put the pieces of the puzzle together are always great.

    Any time you have all nadirs over 300 at a specific dose, I’d suggest you increase by 0.5u.
     
  4. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hi, I simply wanted to make you aware of this. Posting this in your most recent thread.

    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!
     
  5. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013

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