Frustrated ..... could you look at my spreadsheet, any ideas

I think I have finally attached my spreadsheet, crossing my fingers. Payne is four and was diagnosed on
10/11/10 with the addition of IBD and suspicion of an infection. She was admitted to UC Davis with DKA
and spent a week in the hospital with most all tests run.

She was sent home with ProZinc 1 unit bid, tylosin, pred. and pepcid sid but she was still really sick and ran
trace ketones. She was back to the hospital 2X more, each time with DKA and a great weight loss. Our vet
then brought in a specialist who upped her PZI to 3 units and added 1 unit of Novolin bid on 11/8/10.

She was on Wysong's dry food but changed over to low carb canned. (who would have thought that Friskies
would be better than Wysongs?) Because of the pred. she is always hungry but the good side is she's gaining
weight! We shoot her religiously 12 hours apart and test her ketones 2X a day. Except for an episode 2 wks.
ago which we were able to treat at home (yah!) her ketones have been normal.

Yet her BG #'s are still really high, what am I missing? She had a fructosamine test a week ago that was
545. I feel as if we are doing everything and her #'s are not improving and yet she is good, doing all her
normal stuff and acting well, like a pain

What am I missing? any ideas would be most appreciated.
Nancy and Payne

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Hi Nancy,

We used PZI but a long time ago. I know nothing about R. I posted over on the PZI forum asking for eyes here. If you want, you can post over there also. They use your insulin and may have specific ideas for you. It isn't as busy as this board, but there is usually someone on every morning and evening.

viewforum.php?f=24

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Hi Nancy,
Sorry your kitty is struggling so. I am new to all of this, but my kitty is on Novolin N... Is this what was added to the PZI? We found that when he was mostly yellows and reds on the spread sheet with Novolin it was because it was too large a dose. I don't know anything about the PZI, but Novolin acts quick and is short in action.

I noticed you changed to wet food, and others have mentioned this could cause a kitty to need less insulin because wet has less carbs... does the timing of all the yellows and reds on the ss fit with this? Could it be that her infection is clearing up and needs less insulin...

Those are my thoughts, but like I said, I'm new to all of this and I really don't know anything but what we have been tru with the Novolin.

Amanda

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Hi Nancy,

Payne's bg numbers aren't really crazy high so take a deep breath.

Prozinc has a settling in period where their bg's can bounce around some until they get used to it. Some say 45 days which seems to hold true for us, I'm not sure why.

There is a saying here that this is a marathon not a sprint. Although we all want to sprint in the beginning.

It sounds like you are doing everything right. Come over to our PZI ISG and read the stickys for the Prozinc information and get to know us.

But Sue is right that PZI doesn't get alot of traffic all day so if you have questions that need immediate answers please post them in the Health forum.

Robin

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Hi Nancy, and welcome! Good job posting your SS (and doing the home testing)! I am not a dosing expert, and it would probably be a good idea for you to post on PZI Insulin Support Group (can be found on home page under ISGs). Sue linked your post to PZI, so people will probably be coming by later today.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Now that you are testing you do not need to spend the extra $$ on frutosamine tests.

You are doing an excellent job testing. My experience with the Davis folks is that they recommend testing the urine glucose level and regulating a cat based solely on that. I do not believe that is good advice, nor do their reasoning being this recommendation sound [that cats will become factious because of the testing and testing will wear their veins out - we do not aim for the vein when we test]. Don't get me wrong they are an excellent institution, but that little bit of advice I do not agree with.

Hopefully you've seen Janet & Binky's list:
http://binkyspage.tripod.com/canfood.html
Any wet food 9% carbs as %Kcal or below should be OK.

I am definitely not qualified to get into the dosing mix with both N and PZI being given.

Some folks have found that SubQ fluids have helped a little with the keytones [oops just saw you are already doing that]. At a minimum I would make sure to be adding water to the food. It should not be soupy but it should be much much softer. And again, thought I should know more about dealing with keytones, my ability to work that into dosing advice is limited. I think the general idea though is that keytones are a sign that the cat is not receiving enough insulin.

Does the Vet at Davis have a plan for potentially transitioning to PZI only somewhere down the road?

The sudden addition of more insulin does raise the potential for rebound to be happening:
http://petdiabetes.wikia.com/wiki/Rebound
But I'm not saying that's what is going on, just trying to introduce you to the concept. I can't identify anything in her numbers right now that tells be rebound is in fact happening.

Again, I'm not an N expert but it looks to my like she is getting some traction in the early part of the cycle which is what might be expected with the additional N. But then it wears off and the last part of the cycle at about +6.
http://petdiabetes.wikia.com/wiki/Humulin_N

Another idea too for you is to post in the Vetsulin/N forum and ask if anyone there has experience with PZI and N together. I've found that most here who have PZI experience but no ProZinc experience tend to [rightfully] shy away from giving ProZinc advice. But I have found them both to be pretty darned similar. So just beseech them [a past or present PZI and N user] if you find them to help you based on their old PZI experience.
viewforum.php?f=19

Also posting a new topic in Health with a title that explains your needs better such as "PZI + N advice needed" might draw an eye of someone with experience with both to your cause.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Hi, I agree now that you are testing you do not need to spend the extra $$ on frutosamine tests. I have no experience with the Insulin you are using, Baby Cakes was on Lantus & I LOVED it! Have you considered using Lantus?

Remember.. the diagnosis is new, you have switched the diet to low carb wet, started insulin & are now testing.. sometimes.. it just takes time :YMSIGH:

I would say keep doing what you are doing, consider Lantus & step over to the PZI forum to see if they have specific advice for you ;-)

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Nicole,
I think advocating Lantus without pointing out the disadvantages is disingenuous. Also advocating Lantus without knowing the whole cat is inappropriate. Lantus is not the solution for all cats. Further, the Lantus group is focused on just one style of using it and not all people care or can use it that way.

Nancy is in a real pickle right now with a cat that just went DKA with keytones. She's getting PZI with a booster. If she switched to on the the Ls she would most definitely need a booster. Are you willing/capable of overseeing that transition? Are you willing to take responsibility for any potential broken connections with the vets she is using if she decides to go against their advice? I'm not trying to be a jerk, I'm just trying to point out the issues and say that the blind Lantus recommendations are not the best thing for cats.

I know it goes on in here so much it might seem normal or OK but it isn't - at least in my book it isn't. I do not appreciate the additional stress it caused me to have people trying to proselytize me about other insulins when it turned out PZI was the perfect insulin for us. Newbies have enough going on and to add doubt in their mind about the PZI they are on is not helpful - or certainly was not helpful to me.

PZI users don't hit up Lantus newbies and try to get them to switch - it would be nice of the Lantus users would not do that either.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Gator, that post does seem unduly harsh for a simple suggestion.
The right insulin is the one that works for your cat. Being aware of the options is part of being a well informed caretaker of our kitties, even if a switch is not indicated at present.

Nancy I would also consider asking some of the high dose group for their assistance as they have used boosters a lot to help their kitty. Even though you are not a high dose user yourself, I know their experience and understanding of this technique could be a benefit to you guys. I have posted on that forum and asked for some eyes to have a look at this thread for you.

Hang in there..it is scary to have gone through all you have....but you are not alone here.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

hi there
first i must address the wierd tangent that came out of the blue here in this thread and actually doesn't even belong.....the jump on Nicole wasn't called for. she did nothing other than mention that there are other insulins out there and everyone, new or not, has the right to know there are other things out there, whether it's needed at this point in time or not. besides, she wasn't screaming LANTUS IS BETTER LANTUS IS BETTER, she simply mentioned it while actually advocating taking a little more time to see what's going to happen with what Nancy is already doing. so, embarrassing as it is to see this stuff again, let's move on.

now, back to the actual issue at hand. it is very early in your dance still in my opinion and it does seem to take prozinc a bit longer than pzi did to start doing much so you could probably give prozinc a bit longer to see if it's going to work. that being said, with the tendency for ketones in your kitty, i think being aggressive is wise.

how do you do your shots? in other words are you giving the 3 units of prozinc and the unit of N at the same time or are you spacing them out a little. most who use boosters give the main insulin at amps let's say and a few hours later give the booster insulin. that way you get more coverage thru the day. the problem with that is the timing has to be right because let's say you give your prozinc at 7 am and the N at 9, both will possibly kick in at about the same time and kitty could go too low so lots of testing should be done if the plan is to stick with this combination of insulins for a bit longer to see if they'll start working.

now, not to be advocating anything but moreso to explain so everyone understands why lantus or levemir does need to be mentioned in a high risk ketone kitty here, alot of people do use those longer slower acting insulins with boosters. why? because you can give your shot of lantus or levemir at normal time. a little while later you give your booster shot which brings kitty down dramatically. the beauty of the L insulins is that once that booster gets them down, the long lasting effect of the L's keeps kitty down for a longer amount of time....thus lower BG's for extended periods of time help ward off ketone development (assuming other ketone causing factors are also being taken care of, i.e. proper food, no infections, etc.....)

now with all that said, i loved my pzi that i used for 3 years so whatever insulin someone chooses to use is no biggie if you ask me. as long as each person is well informed about this disease, etc.....then onward ho

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Nancy, one other point that others have seemed to overlook is that Payne is on a steroid as a part of his treatment. Steroids can play havoc with glucose levels. I'm NOT saying to stop the pred. I AM saying that as long as the pred is a necessary part of his overall treatment, you must work your insulin dosing with knowing what influence the pred can have. ProZinc may be easier to manage this with. Reason? If the pred is being given once a day, you may end up needing to dose two different amounts....one shot being a little larger to help offset the steroid effects and the other shot a little smaller because the influence isn't as strong during the following 12 hours. Some of the other insulins do not lend themselves nicely to different shot amounts due to the way the body processes them. However, that is something you should learn about and listen to other members (regardless of the insulin they currently use) about their experience.

There are several members of the board who have had to deal with the combination of the necessary use of a steriod and the balancing act with concurrent insulin use. And yes, by all means, learn about the other insulins to educate yourself...even if you don't choose to change. Understanding the other insulins helps you to better understand your own insulin and how Payne utilizes it. This can be very important when you least expect it, which is one of the reasons the spreadsheets have become so handy.

Good luck and happy learning!!!

 

Re: Frustrated ..... could you look at my spreadsheet, any i

The recommendation in this case was "consider Lantus & step over to the PZI forum." Not just "I like Lantus."

It would be nice if one PZI newbie could come in without being jumped on about other insulins. It is the the point of a cliche. PZI users don't to that. PZI users don't surf Health for Lantus newbies and say, "I love PZI! Do you know about PZI?" There is no need for it. It is too easy to talk about the good and leave out the bad or to not really try to understand what's going on with the cat and bean. Newbies have a lot going on at first, their time is not best spent being 'introduced' to other insulins. I don't think it is harsh - I'm voicing my experience, and I did not appreciate it. I know others that have been less appreciative of it but I'm one of the only ones that will pipe up about it. As a newbie I was 1,000,000% aware there were other insulin options and I was researching them on my own. And it turned out all the recommendations and me having to explain why I was using PZI was just waste of resources. I don't think most understand the corrosive nature of the constant barrage of 'other insulin' advice is. I think if people could be more sensitive about this then there would be less embarrassment. And many times it's just not good advice or warranted. For the vast majority, there's better advice to be given to newbies than telling people to consider other insulins.

Cindy if you are going to talk about the good please talk about the bad. I know you can comment on the bad too.

enough said.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Unfortunately it is not enough said. The title of this post is "could you look at my spreadsheet, any ideas ". Nicole gave an "idea". She did not jump on anyone but she sure got jumped on for responding to the actual request.

I haven't posted here in a long time. One of the many reasons I haven't is the total disrespect here many times for other members. Nicole showed no disrespect but she was shown it. This post should not have become a "my insulin is better than your insulin" thread and it wasn't originally. This is not, or should not be about ego. It should be about diabetic cats and answering as best we can the requests for help and suggestions.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

exactly! thus Nicole did nothing worth being yelled at. duh!

simply put you are making this thread into something it is not so hopefully, given that a few of the posts have already been reported by others i see, rebecca can clean it up soon.

fwiw, you would do prozinc more good by not reading more into every thread with the word "lantus" in it then there is. it's embarrassing for prozinc if you ask me. this isn't a prozinc vs. lantus thread. this is a thread about helping Nancy learn ways to keep her cat safe from deadly ketones.

(eta: i see g edited his last post and asked that i post about the bad too. i'm not sure what bad he is referring to though so will leave it be)

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Susie,
What does "could you look at my spreadsheet, any ideas" have to do with "consider Lantus?" I don't see anything in that SS that indicates a switch to Lantus is warranted at this stage.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

and now back to the OP's original question please.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

I have to say as a newbie I appreciated all of the insulin suggestions so I could make my own informed decision. I feel as though you have taken this thread and turned it into a "I hate lantus people" diatribe which clearly is not helping. It was just a "I can't help you with too much as my cat is on Lantus" and not a " you must use lantus statement". Clearly you have your own issues with Lantus people and should post separately about it and not turn this thread into a rant.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

i don't necessarily think a switch to lantus has to be done yet either but noone said "switch to lantus". the word was mentioned that's all.

and "have you considered using lantus?" is indeed an idea. if we want to be nitpicky about wording.

btw, Nancy, are you still reading or has this put you off looking for help from hundreds of very experienced feline diabetic kitty owners? i seriously hope not despite the tangent. one thing i could suggest, even though it's going to be a pain, is that not too long ago FDMB went thru some software changes because we outgrew the old system this message board was on. over the last 4+ years i've been around these parts i know there has been alot of talk and use of and advice about boosters, with what all insulins involved i cannot say for certain. unfortunately the "search" function on the old board is broken so you would have to do a lot of reading and scanning but if you are interested, it might be something to look into (checking the old board for discussions of boosters). Here's a link that should get you in. http://www.felinediabetes.com/phorum5/list.php?7

 

Re: Frustrated ..... could you look at my spreadsheet, any i

I think this is the direct link that Cindy was talking about?:
http://www.felinediabetes.com/phorum5/r ... msg-219488

 

Re: Frustrated ..... could you look at my spreadsheet, any i

I am still here ....
I feel bad that my questions have led to people getting upset, this was not my intention ....
Even though I am a newbie I can take comments and look at them, although I feel as if I'm studying
for my college finals, without truly understanding the material .... all you people are my college.

My main fear is the ketones and DKA. This morning she tested low for ketones, so we are watching
her closely. I have read the material that Gator recommended (my favorite aunt is just like Gator!)
and even though I still don't truly understand it all, the vet that is mentioned a few times,
Dr. Nelson an endocrinologist at Davis, is the specialist my vet brought in who added the Novolin,
that stopped the high ketones.

Yes I feel as if the pred plays into this, we have a few more days and then we are going to start
decreasing the dosage. There is so much to learn, she has only been diagnosed for 7 wks. and
I plan on understanding it all but for that to happen ... we need to work together because I need
ALL OF YOU and yes I can take the bickering as long as I get what I need to keep Payne alive.

For now I am just learning and I am not going to change anything until the path is illuminated better
and you all are helping me do that. I need the Nicole's (sorry about this) and the Gator's to make
that happen. Thanks to all!
Nancy and Payne

 

Re: Frustrated ..... could you look at my spreadsheet, any i

there wouldn't be just one direct link actually, more like probably dozens. just saying that i know on the old board there were many discussions of boosters and posters that used boosters. sure is fun to read thru some of the old threads.

anyhow, since there is a little mention of boosters in this thread gator linked, sure, i'd read that one too but if you have the stamina for it, and the time, i'd see if i couldn't read thru some of the old stuff on the old board. the knowledge and experience that was there in the first several years of fdmb are amazing. so much of what we do now is thanks to those guys that laid the groudnwork for sure.

for that matter, since the search function does work here on the new board i'd probably do a broad search here too. "search" is in the upper right of the page.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Hi Nancy,
I am wondering.. did the pred use or the diabetes come first? When is the pred due to discontinue? Is this a lifetime thing? I don't know what you've gone through and tried, but I have a couple thoughts. There are many holistic sites out there that can offer information about holistic IBD treatments, if you should ever want to look into it. One of the most common "treatments" is a switch to raw food. IBD can often be considered an allergic reaction. Many cats are allergic to ALL plant products, even vegetables. The miniscule amounts of plant products like rice, glutens, starches, can all aggravate IBD kitties. If you are interested, there are a few raw suppliers, and you could make your own as well. I had a cat with IBD and diabetes that I adopted from FDMB who was instantly healed with a switch to raw, and though I will not claim it will work for yours, it might be worth a test of it.

As you can tell, you have an unusual case. Personally, I would be worried about using N and ANY other insulin together due to it's lengthy duration. By lengthy, I mean *as a booster insulin*. I do have rather extensive experience using R, so if you want to ever switch to that one, talk with your vet and I'll be glad to weigh in. Most of us who have used R have used it due precisely to its short duration. It's in and out in 1-4 hours, with as far as I know, only 1 exception (Jojo's Settledown I believe?). This is why so few of us have experience with N and any other insulin. Suzie and Spook used it I believe in conjunction with a compounded PZI in her acrocat.. but I do not know if she is around anymore.


I think it's a viable recommendation to keep in the back of your mind that there are some really good insulins out there, and that not all insulins work for all cats. There are many people on this board who have had their cats on 4 or more insulins throughout their diabetic lives. I don't know that there is enough time gone by to assume the prozinc is failing, but you should always be aware that if one insulin doesn't work, another might do exactly what you need.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

dr. nelson is the one who did the research on prozinc yes?

 

Re: Frustrated ..... could you look at my spreadsheet, any i

oooooo, looks like she is actually using R already, not N
viewtopic.php?f=24&t=31272 (at the bottom)

Nancy, is this what the booster insulin looks like
http://www.google.com/search?source=ig& ... r&aq=f&oq=

and not this
http://www.google.com/search?hl=en&rlz= ... =&gs_rfai=

there's a big big difference between R and N, that is why i want to clarify

 

Re: Frustrated ..... could you look at my spreadsheet, any i

.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

no wonder he doesn't like lantus lol

 

Re: Frustrated ..... could you look at my spreadsheet, any i

That is a huge dose of R. If in fact it is R, I would recommend backing off. You can always use a touch of r or so during the cycle, but if you are using R, that would be my suspect right there. We wouldn't start a known acrocat on that dose, to give you an idea how high that dose is.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

To clarify ....
Dr. Nelson was brought in during Payne's third case of DKA and almost dead and he did
not put her on ProZinc. But from the MOMENT Novolin R was added, she started to get
better. I try not to get hung up in who did what but what happened with Payne. If
the devil had a better suggestion, I would have taken it. Thanks for all your suggestions,
you are a wealth of knowledge, although the webmaster calling me a poor woman hurt

So to be clear .... Novolin R is considered a booster?

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Will someone with R and PZI [and hopefully keytone] experience please help guide this young lady and her cat? PZI is pretty much just like ProZinc - there might be some small differences. We/I would be more than happy to try to explain any of those potential differences to anyone with past PZI and R experience.

From my experience they seem to pretty much follow the Dr. Nelson plan [and who could blame them - he's literally written the book on endocrinology]. From what I gather, they were a PZI institution and now they are a ProZinc institution. That's just the way they seem to roll. I think Nancy taking control of the dosing [let alone home testing for blood and not just urine] is going to be enough of a shock to the system for one afternoon. Just my $0.02. Once you get your legs under you, you might find that you do want to 'considder' another insulin [or 'consider' the moon too], but for right now enough is enough. :smile:

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Yes it is a booster, the duration of R is far too short to be a basal (primary) insulin. in many cats, it is out of the system entirely in 4 hours, doing much of its work by +2. This us why you are seeing such steep early drops. In acros, high dose cats and ketone-prone cats we use it many ways. One good way to use it in a ketone-prone cat is "on demand". ie: numbers unmoving or a positive urine ketone test.
The way you are using it now make it difficult to side how the basal insulin is working. It is the basal dose rather than the R use that will need to be adjusted to keep the ketones at bay. Knowing your cat is dka prone is troubling, but something you will have to work with. Just know that the way it is being used now is quite possibly too hard of a hit at the beginning of the cycle. If your cat is bouncing off the steep drop of R by the time the nadir of the basal insulin rolls around, it is making it harder for the prozinc to work. My recommendation would be for you to do a 1/4u at the beginning of the cycle and get tests at +1, +2 +4 and +6. If the cat is flatlined at +6, give another 1/4u. Ketone tests throughout. If ketones return at any time, resume your 1u immediately. Deciding whether this R dose is too high is imperative to discovering where the workhorse insulin, prozinc, needs to be.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Carolyn is an excellent person for this, as are others i'm sure, but I can speak with certainty that Carolyn has experience with all of this stuff plus more and am glad to see her input on this case :smile:

i do have to say that it does make more sense using a booster with a p-type insulin now with it being R rather than N

fwiw, i'm thinking rebecca was thinking about your frustration levels with all of this. :smile:

 

Was frustrated, now is ketones have spiked! in over my head!

I had posted this under frustrated could you view SS but I now have a bigger worry!
This morning Payne tested small on the urine ketone strips, where she had none for two weeks.

Her AM pre-shot BG 247 and at +7 257 (3 u ProZinc 1 u Novolin R bid )but on the ketone monitor
her ketones have popped!
We figured her baseline on the monitor was 1.5 (healthy,showing no signs on test strips) but
taken at +7 her # was 3.8. She seems okay, usually when she runs high her eyes get glassy but
are not. Is the monitor telling me where she is going? and that will show up in this strips
later?

When she had an attack 2 wks. ago we gave her SubQ's and 1 unit Novolin, which turned her
around, what should I do? I have a call into vet but this is Davis She doesn't seem
dehydrated at all. I can't seem to get ahead of all this .....

 

Re: Frustrated ..... could you look at my spreadsheet, any i

You can always ask to have your vet paged if you know them to be in and it's a rush issue [which it sounds like this is]. I always asked their receptionist if that vet was even in [many travel the world for lectures and conferences] - they are very good about knowing schedules. Even when I was leaving them vmail or sending email - you can't assume they will get their messages if they are not in town. If they are not in, you can ask to speak with the "coordinator" for internal medicine [or any other dept you are dealing with] and explain that you need input and can they find an appropriate vet to speak with you. I've found "coordinators" to be the key to the business up there and to be caring and helpful. Everyone likes gifts of appreciation. :smile:

Unless your cat has heart issues LRS is generally not a bad idea.

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Anyone getting e-mail follow-ups to this thread?? She posted a new thread as well about ketones now. I'm thinking it's time to head to an ER vet to have them handle the ketones..?? :sad:

 

Re: Frustrated ..... could you look at my spreadsheet, any i

Moved to new thread on Health forum. http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=32327