High Pre Shots with high +2 , +4.5, +5.5, +6.5, +7.5

My cat is Darwin, he's a 9 Year old DMH Tuxedo cat, and he was diagnosed in 2016.

We switched to PZI in Octoberish, however when we switched from human insulin, to PZI, we were never told that we had to switch from U-100 needles to U-40, the insulin we got from Banfield came in a blue prescription bottle, without any instructions and it didn't say anything on the bottle, so when we were initially told to "make sure we use the u-100 needles," we did.

Because of that, Darwin has never been getting the proper dose of insulin, until literally two days ago, when I became frustrated once again that he was having obvious symptoms of hyperglycemia.

Two weeks ago, Darwin was in DKA, he was in the hospital for 36 hours and was released because he started eating on his own again and his blood sugar had come down reasonably, though he still had ketones present, but at $3300 we couldn't afford to keep him in the hospital any longer.

He seemed a lot happier then he did when the DKA onset, as he had a concurrent Upper Respiratory Infection, which has since cleared, and has put on 1.3 lbs, back up to 10.7lbs as of one week later when we took him for his blood glucose curve, and they said he still wasn't being regulated well, which was the tipping point of my frustration resulting in me digging through everything to figure out why my cat seemed to be the only cat on the planet that didn't have SOME improvement with PZI, so I finally found the conversion chart for U-40 to U-100 syringes, and I'm wondering if it's just going to take some time for him to get down to a normal level or if I need some help.

Firstly, Darwin seems to be constantly hungry (Another thing that sent me looking because it was upsetting me that his body wasn't absorbing nutrients appropriately). Now, that being said, we're currently on our second 12 hour cycle of having the correct dosage of insulin with the U-100. He's on 2.8u U-40 / 7u U-100.

I've done my first BG curve, and he's currently eating 5.5oz Purina Pro-Plan Turkey and Chicken, I'm trying to limit it to 3oz pre-shot, and 1.5oz more +6.

For the first pre-shot measurement he was 444 mg/dl
+2 284 mg/dl
+4.5 282 mg/dl (So I immediately took a second sample at +4.5 209 mg/dl)
+5.5 190 mg/dl (Immediately checked a second time and got 190 mg/dl)
he ate the rest of the 1-2 oz left of the 5.5oz can at around 10:45pm
+6.5 239 mg/dl (2nd +6.5 258 mg/dl)
+7.25 269 mg/dl (2nd +7.25 279 mg/dl)
+8 336 mg/dl
+9 499 mg/dl
+12 527 mg/dl <- Also the AM preshot


Fed Darwin ~4oz of Purina Pro Plan True Nature Ocean Whitefish and Salmon Entree
+1.5 372 mg/dl
10 min after +2 287 mg/dl


I'm craving input on what I should change / do to help Darwin get to normal blood sugar levels... I'm home most of the time currently.

I'm super terrified of him going into DKA again.

I'll keep replying / updating with added BG measurements as I take them every hour or two. I don't know which the board prefers

 

Welcome! We can help. Congratulations on home testing

Aside from the dosing issue caused by lack of proper info on using U100 syringes, it can take time - sometimes a lot of time - to get a cat responding well to insulin, any insulin. Darwin is by no means the only cat who needs more time.

He's hungry because he's not yet regulated. This will improve once he's more consistently in lower numbers. There's no need to restrict food too much but feed low carb canned and keep meals smallish and spread out through the day.

I understand the fear. I went through it with my cat. It's a complication that generally develops when a cat has poor BG control, is dehydrated (high BG, vomiting, excessive urination can contribute), is not eating enough and/or has a concurrent infection. It's far less of a worry (although not impossible) in a well hydrated cat who's eating well and has proper insulin dosage.

Curve Analysis:

• classic PZI "smile curve"
• ∆BG between AM preshot and nadir is within range (nadir about 50% of preshot BG) but a little large
• nadir around 5.5 hours - typical of PZI
• duration (time at which PM BG rises to AM preshot value) is about 8.5 - 9 hours but might be distorted by beginning of BG rebound
• dose increase is needed to displace the whole curve downward by about 100 points.

This is a wonderful graph, Alex, and makes an excellent teaching tool for curve analysis. We use a spreadsheet here that's viewable by all members and it's what we look at before offering advice. The advantage of the SS is that many days/weeks of data are shown at one time so we can look for patterns and trends. I recommend that you set one up:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Darwin is showing a good (but sensitive) response to PZI based on the shape of the curve, nadir, ∆BG, etc. The steep rise in BG that begins at 8 hours could suggest that the PZI lacks duration but I think it's more likely that Darwin is "bouncing" up to higher PM preshot numbers in reaction to: 1. a fairly steep drop from AM preshot to nadir; 2. a nadir BG that's lower than his body is accustomed to; 3. both factors. What we call bouncing is his body's response to a perceived "dangerously low" BG range. Processes that mobilize glucose from a stored form in the liver (glycogen) raise the BG as a protective measure. The response can be overblown and raise BG too high.

Here's what I suggest:

1. set up a spreadsheet so we can see all of your BG data for Darwin as you get him on track
2. stick with this dose for two more 12 hours cycles to get "baseline data"
3. post on here for advice as often as you like
4. when a dose change is needed do it in 0.2 u increments because you have U100 syringes.

Does this help? Any other questions/concerns?

 

Thank you very much for your expedient and thoughtful response, it is very consoling and helpful.

I too was wondering if his BG was bouncing, but I couldn't find clarification for if it could happen without him actually going into dangerously low BG levels.

I want to add that I'm using a OneTouch UltraMini w/ OneTouch Ultra Blue Test strips and 30 gauge lancets. I don't know if that changes the numbers at all -- up or down.

Luckily, he doesn't mind being tested at home, which I've also just recently started. I certainly hope his body can get used to the PZI and eventually show some better numbers.

I will start the spreadsheet today!

One last question, do you know if the Royal Canine Glycobalance DRY FOOD, is okay to free-feed/free-choice feed at all times due to it's supposed low carbohydrate level, as suggested by my emergency center vet? On the contrary most places say to completely cut dry food, which makes sense in relation to it having low moisture and high carbs, just want to know what anyone thinks about that one.

 

We all recommend a diet of canned low carb food. All dry food is too high in carbs, including those sold as prescription dry food for diabetics. There are very few exceptions. One is an American brand available online called "Young Again Mature Zero" and some people also feed Evo kitten kibble (purple bag). Many people use timed pet feeders so that small meals are available frequently through the day and night.

 

Most people here use a human meter and what I said about your curve still stands. The most important thing to remember with a human meter is that the "intervention needed" number for low BG is 50. High is high.

If you're having success getting blood from Darwin's ears with the 30 G lancets, keep on. Sometimes a larger 26 - 28 G is easier to use. They're often labelled "for alternate site testing" at a human pharmacy.

 

Welcome!
Kris has given some great advice, as she always does . She is one of the people that help me with my boy. Good idea to plot the curve because it really allows you to visually see the "smile curve"! Just wanted to chime in about the RC dry, as I started Maury on the Purina DM dry (just Purina's "diabetic" formula), the estimated carb content is 24.67% - 30% (High carb) depending on which formula you use and that's also based on the not-so-accurate Guaranteed Analysis information provided by the company. Purina DM is still medium carb with a range of 15%-19% (even if their bag says 18%).

You can check out Maury's SS and when I started reducing the DM dry, his numbers started to improve. I am starting Young Again Zero and already seeing tiny effects of introducing it . The YA food is listed as <1% carb but I have seen people mention it could be as high as 5%, which is still waaaaay better than the RC or Purina. If you decide to change his food, continue to test him. Do not change insulin dose and food at the same time. Baby steps, one thing at a time . It will help a lot since you are home testing.

Also, you don't need to test him every hour or two on a daily basis. As other members post you can look at their SS (spreadsheet) too and get an idea of how often to daily test. I am still a newer member but I will try to help where I can . ASK ANYTHING HERE

 

Hello Alex! Yes, it looks like Kris has covered the basics with you.

Basically, I just wanted to pop by to say Welcome and to reiterate that some cats just take awhile to get regulated. The bouncing can be caused by the cat going lower than they are used to...not just dangerously low numbers.

What other questions do you have that we can help with?

 

Have you set up Darwin's spreadsheet?

 

Welcome!

I'm sorry you've already had a DKA episode and about the wrong syringes for ProZinc But you'll find a wealth of help & support here!

 

Apologies, it's been a crazy couple of days... I lost quite a bit of sleep when I stayed up getting the hourly BG levels after learning about the syringe size / insulin amount issue for those 3+ cycles.

I missed most of the hourly BD draws I initially wanted to be able to do, due to having to sleep. I'll be able to get a good curve today though.

Darwin seems good, he's eating well, fluid intake seems appropriate and eliminating in the litter box.

He's still getting hungry between meals, but it doesn't seem to be as dire to him as it was day 1.
Rather, he might complain for food for a little bit, but if I don't give in he'll jump up in my lap and sleep on me and purr.

I'm finding it really hard to keep him perfectly on schedule with his insulin shots exactly 12 hours apart, I'm going to see if I can't recruit my brother to help me out, though he doesn't much care for Darwin...
Additionally, when my personal schedule becomes less fluid, what is the best way to move his dose around? For example, it's at 11am and 11pm now, and let's say I needed to move it to 8 AM and 8pm.


I'm working on that spreadsheet now, I keep getting interrupted and sidetracked. I'll try to get it posted asap.

 

Sleep is such a pesky thing, isn't it?

We suggest that when you need to move shot times you do it 30min at a time. That way the insulin dose has cleared so you're not overlapping which will act like a dose increase. It takes a little longer, but it's definitely safer.

 

Are you just feeding the two meals a day? I added a "lunch" for my boy, which helps hold him over a little better (unless I have to stall).

P.S. Are you going to get a picture of Darwin as your avatar?