Cookie bouncing on ProZonc, did we miss the sweet spot?

Hello Everyone,

My sweet Cookie was diagnosed with Diabetes 4 weeks ago after unexplained weight loss and uncontrolled peeing out of the box. Vet did a fructosamine test d(in the 600s) and put him on PorZinc 1U twice a day, suggested increasing to 2U after two weeks, and then again to 3. I have made the increases more gradual at .5 intervals based on what i have read here, I still feel that with every increase his BG numbers are getting worse. My vet thinks the high numbers are due to stress induced by too much testing and said i should test less often.

I found similar posts here about this phenomenon where people increased too fast and missed the correct dose. What i did not see in these threads was how people fixed the issue long term, most of these threads just ended inconclusive.

• Is it possible we marched by our ideal dose? If so, how to do you reset the cats system? do you back down? by how much and how long?
• I have not seen any super-low values mid-cycle that would indicate he is reacting to low numbers
• What would indicate a switch to another insulin (Lantus?)
• Could the insulin be bad? I did have it in the door initially until I read here it should be stored in the back of the fridge, i also left it out once for 4 hours. What is the shelf live of ProZinC anyway?

Cookie is a DSH neutered male, 11 years old, adopted in 2011. Had megacolon surgery while at the shelter, on cisapride 5mg twice a day for two years, recently increased to 7.5mg twice a day, also chronic urination issues which have gotten worse with his diabetes. He has always been on low carb wet food only, wellness, Merrick bistro, fancy food classic and home-made raw with feline instinct mix, it's not a kibble type 2 diabetes that's easily cured with diet change.

Cookie has a ravenous appetite, tested negative for hyper-T so it's the diabetes that's doing this to him. I feed him 1/2 a can of wellness turkey or Merrick Bistro right before his shots, and then the other half at +2 and +4. He inhales hos food and is always hungry.

Cookie's spreadsheet is here:
https://docs.google.com/spreadsheets/d/1aKhCWEzcZ2EkiIMGy5loAI1sE_rrtA_sLYt0YPPsMtg/pubhtml

I'd appreciate your feedback on our spreadsheet and maybe something jumps out at you that I am missing

Thanks,

eva & cookie

 

Hi Eva and Cookie!

It sounds like you have a tricky cat! Great job reading up on things around here and taking some proactive steps to help your kitty.

If a kitty is on too high of a dose, you can "reset" simply by lowering the dose and then starting to raise again in smaller increments.

As far as your vet's comment that high numbers are caused by testing...uh....no How does Cookie respond to testing? Does it seem to cause him a lot of stress? I can tell you that my cat really hates being tested, but you can see from Sam's spreadsheet that test-stress doesn't cause high numbers. Now maybe if you poked him over and over and wouldn't let him get away it might raise his numbers a bit, but assuming you poke once or twice, get the test, give a treat and some love, and let him get out of there, I would say that the high numbers are just where he's at right now, and not the fault of testing. Testing is the best way to keep him safe!

I doubt the insulin is bad, although it's always possible. Lots of people have done exactly what you did - fridge door and occasionally left out. Insulin is fragile, but it can withstand a little abuse before it goes bad, and four hours left out isn't really bad at all. The sticky says that shelf life for Prozinc is around three months, although I'm just past month five on one bottle. I do think it's getting weaker though, so I wouldn't really recommend using the same bottle this long.

Ravenous appetite is a common side-effect of diabetes. Breaking his meals into smaller snacks is a great strategy. If he isn't overweight, you might also consider increasing his calories for awhile while his numbers are so high. Diabetics can't absorb nutrients from their food well, so they often need a lot of food to keep weight on and not feel like they are starving. If he is overweight, then you do need to keep his intake under control.

A couple of the Merrick bistros are high in carbs, though most are okay. Here is a link to the food chart so you can double check the flavors you're feeding: http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Now back to the insulin: switching insulin would be indicated if the insulin you're on isn't working after you've followed all of the guidelines and given it some time. Given the other health issues, and that this isn't diet induced, Lantus might be something to consider when you're ready to get a new bottle of insulin, but I think I would suggest continuing with Prozinc until you're vial is running out. That should be enough time to see if Cookie is responding or if a change is needed.

As far as missing the dose. That does happen sometimes with the big, one unit increases. However, I agree with you that we aren't seeing a lot of information that would indicate an occasional bounce, although as those black numbers are emerging more, there aren't mid-cycle numbers to be sure if those are bounce induced or not. You did have one yellow back at 2 units. And you've just recently reached three units without mid-cycles. So I think there are two big options here. One is to get some mid-cycle numbers on the three units and see if we get any hints of drops, then decide if you should raise or lower. The other option would be to lower back to 2 units for a few cycles, and start the slower increases (0.25) every three cycles, to build back up and see if you get any better numbers at a lower dose. The risk of lowering is that he's at high enough numbers that ketones are a concern. The risk of staying at 3 units is that it may be contributing to the higher numbers.

If you lower, and work your way back up every three cycles, you will know. If you don't lower and get more data, and probably in a couple of days try an increase to 3.25...if it's too much he's going to show a hypo at some point to let you know it's too much. And then you'll know that way too. Which means either option is pretty much okay. Honestly though, it doesn't really look to me like you missed the dose. It looks more like he needs more insulin. Please know that my thoughts on that are just a guess though. And also that most people prefer to lower the dose and raise slowly. I tend to be a bit more aggressive in my dosing advice, so it doesn't hurt my feelings at all if you want to ignore me!

 

Djamila has given you excellent advice. I think that Cookie likely needs more insulin. Although the 1 unit increases are large, you have a fair bit of data at the recommended starting dose of 1 unit and he stayed quite high. I'd like to see some mid cycle or late evening BGs at 3 u to get a better idea of what's going on.

 

Great job home testing, Eva!
You've gotten some great advice already so I will just ask if you wouldn't mind putting some information you listed in your post, in your Signature for Cookie. Along with the Spreadsheet link. Makes for easy access when you post again.

Here are the instructions: http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

Like Kris is thinking, he may need a little more BUT it also may not stay that way and he may come back down to average dose levels. Keep posting, ask any questions!

 

Thanks to everyone who responded so quickly, Djamilla specifically. What a great group this is!
As if my decision to post here broke the stalemate: just tested +7 and it was 119!!!! our first blue. So this tells me the insulin is working, will check again in an hour to make sure it's not dipping more.

Just lost my entire post, the app thought it was spam. Will try to figure this out after work.

eva & cookie

 

Huh! Well look at that! Maybe the dose is too high! Keep up with those mid-cycle tests the next couple of cycles. 531 to 119 is a HUGE drop. Definitely something to keep an eye on.

 

A bit of spreadsheet housekeeping: it would be helpful to have a link to Cookie's SS in your signature - the light grey text you see below our posts. Here's how to do it:

1. copy that link to your SS from your first post up above on this page
2. click on your name in the upper right corner then click on "signature" in the drop down menu
3. type something like "Cookie's SS" in the text box and highlight it
4. click on the little paperclip icon then paste the URL for your SS in the dark blue bar that appears and save
5. at your leisure, add other info to your signature by typing it into that same text box and saving it - have a look at our signatures for what to include.

 

Or if you prefer those same directions in video form

 

Wow! Cookie decided to make some progress today!