I am from UK and feeling very overwhelmed

Discussion in 'Welcome to the Group - Post an Introduction Here' started by Marlena, Dec 27, 2015.

  1. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Hi there, I am a "mum" of a 11-years old diabetic cat Rocky who had been diagnosed about 18 months ago. I managed to get him into remission twice, last time I started insulin injections very quickly and after one month we were able to stop and he was in remission for 6 months. Unfortunately it all came back last October but this time I find it really hard to regulate him.
    He has been overweight, always having wonderful appetite for all sorts of foods including vegetables! After last stressful event outside he stopped going out and I think his lack of exercise and eating too much contributed to the development of diabetes.
    After diagnosis I changed Rocky's diet to raw human quality home made one. His carbohydrate is only a little green veg which he likes very much. He gets 2 main meals with his injection and 2 snack meals before expected sugar drops. All at regular times and portions are size controlled. My first goal was to slim him down and he lost about 1.5 pounds over time and then he stabilized. The vet kept saying that he needs to loose weight and suggested veterinary diet full of carbohydrates but low in calories! I was horrified. His insulin is Vetsulin (Caninsulin) in a pen, easy to use.
    Rocky has had some blood testing like kidney, liver function, urine test. Normal results. He had high folate level. His IGF-1 level was 700 (400 normal, above 1000 is diagnostic for acromegaly in the UK).
    I have noticed one thing which worry me: even with his low BG numbers during the day he often keeps going to his water bowl and drinks a lot of water, specially after food. I am sure that in the past when his BG was low I couldn't see him drinking. I noticed he lost weight recently (almost 2 pounds) but can not be sure of exact number as weighting him at home is not always accurate.
    Another problem I have is his unpredictable BG numbers so not too sure how to adjust his insulin dose. He seems to be better regulated during the day, sometimes having much lower evening pre shot BG after 12 hours since am insulin injection and then high BG morning values. I have tried 3 options with low PM values: no insulin at all, token dose and slightly reduce dose. None of these made any difference to the AM BG values.
    I would be grateful if you could give me some advice.
     
  2. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    HUGS and WELCOME! I am on the way out with dog food bowls so don't have time to answer right now. I'll try to come back when the dance is done in a couple of hours. There's usually more of us online so please excuse the length of time it took to say welcome.

    More hugs,
     
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  3. elizabeth and gus

    elizabeth and gus Well-Known Member

    Joined:
    Feb 25, 2015
    Marlena,
    I don't have enough expertize to answer your questions but I wanted to welcome you. It would be helpful if you edit your profile to include more info in your signature eg. look at the previous post. You can view Gus's spreadsheet if you click on the link on the bottom of my post.

    I will call you tomorrow to help you.
     
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  4. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Pippin and Rocky. Welcome to the forum where you will be able to get loads of great advise and help. At the moment it is fairly quiet around here because of the Christmas season and many are on holidays, so bear with us if we are a bit slow to respond.
    First of all it sounds like you are home testing the BSLs. That is a great start to helping Rocky. Can you tell us what type of glucometer you are using please?
    It would be a great help for people who can help you, if you can set up a spread sheet. Here are the instructions. If you have trouble setting it up, post and we will help you.
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    That is good you are feeding a home prepared diet for Rocky. Do you add supplements to the food?
    Make sure Rocky does not lose the weight too fast....needs to be slow.

    caninsulin is not the best insulin for cats. It is harsh and does not last as long as many of the better ones. Can you ask your vet to change you over to Lantus, levemir, or Prozinc/ PZI? You will have a much better chance of getting him regulated and possibly back into remission with one of these insulins.

    Cats do need to drink when they eat. Do you add some water to the home prepared food you make? I do home prepared and always add water to the food. He may also be drinking more when his BSLs are higher. Does he seem dehydrated? Are his gums moist or tacky? Does his skin bounce back easily when you pull it up at the back of the neck or go back slowly?

    Cats BSLs do move all over the place before they are regulated. He could be bouncing back up to high numbers after dropping lower earlier in the cycle.
    The best thing you can do at this point is set up a SS for us to see what is going on .....put in any numbers you have already...it will help too....and ask your vet fro a change to one of the other insulins. This insulin is clearly not working for Rocky, so the vet should be happy to change it. Then come back here and we will tell you how much to give. Vets often start off with too high a dose. We like to start low and work our way up.

    I have a cat who came out of remissiom so I do understand how hard and frustrating it can be.

    Again welcome and we look forward to hearing from you again.:)
     
    Last edited: Dec 27, 2015
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  5. Georgie

    Georgie Member

    Joined:
    Dec 25, 2015
    Welcome Pippin and Rocky....
    Maybe he is dehydrated. Mine did that before.
    I don't know much else I am sorry but sending the good vibes to you.
     
  6. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Pippin. Welcome to you and Rocky from another UK member. :)

    It might be worth discussing different insulins with your vet. Under UK drug cascade rules vets can prescribe insulins other than Caninsulin if the latter does not work to keep a cat regulated. For example, Lantus (insulin glargine) is a longer-acting insulin and typically it does not drop the blood glucose as hard as does Caninsulin so it can be easier to work with when tiny doses are needed. With Lantus, you might be able to get a suitable dose that can be given safely twice a day. Unlike Caninsulin where the dose peters out towards the end of a cycle, Lantus builds up a 'depot' of insulin in the cat's body which then gradually becomes available - a bit like 'timed release' medications. It might be a possible choice to help smooth out Rocky's blood glucose levels.

    Prozinc is also available in the UK and is another possible. I've not used it myself but I know from reading here that it can be dosed on a sliding scale. (Perhaps other members with Prozinc experience could give Pippin some pointers on how Prozinc works at smaller doses, please?)


    Mogs
    .
     
    Last edited: Dec 27, 2015
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  7. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Thank you guys, I am very grateful for your comments and help.
    I know you need to see my spreadsheets but to be honest I found that bit very difficult to do and being in the state of total frustration as I am at the moment I just couldn't cope with it.
    My main concern: is Rocky's glucose bouncing? It is difficult to grasp this concept, at the moment I reduced his dose from 2 to 1.5 units and I see he is drinking a lot. I read a lot about reducing the dose if bouncing occurs and observing what happens but what I can see is Rocky drinking a lot and his BG goes up. My understanding is I need to wait 3 days before cat's pancreas and liver adjust to the new dose. The vet insist I need to reduce and wait 7 days!
    He doesn't seem to be dehydrated. His food is raw meat with supplements and lots of water in it.
    I will take him to the vet after New Year, I have already spoken with the vet about different insulin and she mentioned PZI. I am ready to change because it looks like Caninsulin is not working properly.
    I have to tell you that I read a lot about FD and treatment with insulin but there is still a lot I am not sure about. I will post his numbers but which day shall I pick (every day is different!). There is also a mention of "normal" BG for given cat when considering a change of dose but how do I figure out which number is his normal if we are getting different BG numbers every day? Maybe I just need to leave these questions for now as I have made up my mind about changing insulin and start from scratch.
    But I am still puzzled by his previous remission, was diabetic for a month only, treated with Caninsulin and in remission for 6 months!
    Once again many thanks to all of you for your support and lets hope that Rocky gets better regulated on new insulin. I am lucky (and he is too) that he is very cooperative and testing him and giving him shots is no problem, I would say he enjoys it!

    Pippin
     
  8. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    And one more thing: I forgot to thank you for welcoming me to the group! Where are your manners Pippin?!

    Pippin
     
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  9. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Pippin,
    I know how frustrating setting up the SS can be so I am going to tag someone who is a whiz at setting them up. I am not sure if she is around during the festive season so you might have to wait a few days. Getting the SS up and running is really important for people to see before they can really comment on what is happening and what to do about it.
    @Marje and Gracie . Hi (((Marje))), would you be able to help Pippin with her SS please, she is having trouble setting it up...thanks!
    You can post numbers every day. They will most likely be different every day....we all have the same issue with BSLs.....they rarely stay the same, because they are influenced by things throughout the day.
     
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  10. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Pippin and Rocky, welcome to FDMB. :bighug:
    (Waving 'Hi' from Surrey!)

    I see that others have already given you a lot of info.
    I absolutely agree that it would brilliant if you could set up a spreadsheet with Rocky's numbers. It would make it a lot easier to spot patterns/trends and to identify problems.
    (It might well be that Rocky's blood glucose is 'bouncing'. How often are you able to get mid-cycle tests, Pippin?)

    Just on the subject of food, this may sound strange (and it may not be relevant to your situation) but some cat's don't like a really low carb diet. Some folks here have found that their cats didn't do as well on a zero/almost-zero carb diet, and needed a diet slightly higher in carbs. So, although the general recommendation for diabetics is 'less than 10% calories from carbs' (and many cats do better at around 4% - 5% cals from carbs); reducing the carb content even further isn't always helpful.

    Eliz
     
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  11. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Thank you Eliz for your suggestion.
    Do you think I should start giving Rocky some more carbohydrate? I actually give him a tiny amount of psyllium husk in his food and a tiny bit of green veg few times a week because he absolutely loves vegetables! In humans 0% carbohydrate and high protein diet would spike BG considerably, the key here is to include a lot of fat. Maybe the same thing happens in felines? Rocky gets healthy fats every day so his diet is low carb, high protein and medium fat. I need to do some more reading about that.
    To answer your question regarding mid-cycle testing I can do it 3 sometimes 4 times a week so that should be ok.
    Thank you for your time, hope we'll "talk" again soon.
    I am in beautiful Suffolk and my real name is Marlena but for the time being my name is Pippin (until I know how to change it!).
     
  12. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    It's only an issue for some cats, Marlena. And we have no way of knowing at the moment if Rocky is one of those. I only mentioned it as a possibility....just so you knew about it (and in fact you sound very knowledgeable indeed!) Sorry if I headed the conversation down a 'side alley'... :rolleyes:

    Aha....
    Are you only getting pre-shot tests the rest of the time?
    If that's the case you may not be seeing the whole picture, and could be missing any low numbers that might be triggering bounces....?
    .
     
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  13. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    I'm using PZI for Bertie (Hypurin bovine PZI).
    It's a very long-lasting insulin and has worked very well for us.
    Because of the long duration - and overlap (if shots are given 12 hourly) - many folks find that a dose reduction is necessary. That's because each insulin shot gets a sort of kick up the backside from the preceeding shot.

    This may have been the insulin that your vet was talking about. Or s/he may have meant Prozinc. But there are currently very few cats in the UK on Prozinc, and all the ones I actually know about were prescribed it because they were on a Royal Veterinary College research project (where Prozinc was being trialled).

    Prozinc is a US insulin that's made especially for cats. It is now licensed for use in Europe (since 2014, I think). However, for some reason, vets seem not to be prescribing it. That may be because they simply don't know about it. Or perhaps they prefer to stick to Caninsulin because they have more experience of that...? If they would start prescribing Prozinc that would be a big step forward for diabetic cats in the UK!
    .
     
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  14. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Hi Pippin!

    Welcome to FDMB! I'd love to set a SS up for Rocky. I'm going to send you a private message to get some info. If you look in the upper right corner of this page, you will see "Inbox" and when you have s private message, it should have s number on it indicating the number of messages. Just click on "Inbox" and you'll see the message.
     
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  15. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Thank you Marje.
    Thank you so much, best regards
     
  16. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Hi Bron, many thanks for your help, I really appreciate!
    I think I was giving Rocky too much insulin and he was bouncing so I reduced and after 3 days I am getting much better numbers but I would like to carry on for few more days before I can see real picture. I have decided that I am going to the vets for a different insulin.
    Best regards, Marlena (previously Pippin)
     
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  17. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Thank you, I am just really agonising which insulin I should change Rocky to - big dilemma! At the moment I reduced Vetsulin and fingers crossed his numbers look better, few more days and I hope I will be know.
     
  18. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Eliz

    I read this with great interest. Does that mean that UK vets now have a choice of Caninsulin OR Prozinc after initial diagnosis, instead of being legally compelled to prescribe Caninsulin?


    Mogs
    .
     
  19. Sushi The Cat

    Sushi The Cat Member

    Joined:
    Oct 23, 2015
    Another Hello from the UK, Marlena! Welcome!

    I can see already that you are the most amazing Sugar Mum to your kitty!
    Lots of Love,
    Sara
    :bighug:
     
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  20. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Marlena,

    Glad to hear that Rocky's numbers are improving. I hope he's starting to feel the better for it. :)

    With regard to mid-cycle tests, is there any way that you would be able to regularly get an evening preshot test and also a 'before bed' test about 2-3 hours later? That can give you some bit better a picture of how a kitty is responding to a given dose. Granted, on average there may be a bit of difference between a cat's AM and PM number trends (e.g. many cats tend to have lower average BG levels on the PM cycle) but any mid-cycle data is very, very valuable indeed in terms of determining suitable insulin dosage, and it helps to keep your kitty safer.


    Mogs
    .
     
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  21. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Thank you Sara for warm welcome.
    Yes, I'd like to think I am a wonderful mum to my darling Rocky, we have this special bond and love each other a lot! But the whole FD thing is taking my life away from me, I am very stressed but I am trying very hard to be in control. My dear sister in US who is a member (Elizabeth and Gus) is supporting me as well as you guys - other members of this blog.
    Lots of hugs to you and your kitty.
     
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  22. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    No, I don't think so, they have to prescribe Vetsulin first and if there are problems they can change to different insulin.
     
  23. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Critter Mom,
    I have just been to the vet and discovered that my True You (Nipro) glucometer is giving me really low numbers against pets meter at the vets. The vet checked his blood as well and I will have results of that test later. At home I checked TrueYou reading against One Touch Ultra meter and again the difference in reading was off (13.2 v 18.7). Waiting for test results now and also for the vet's decision to type of insulin we need to switch Rocky to now. I am feeling positive that I can get better results from new insulin and new approach but I will need your help guys.
    I will post later as I have to go to work.
     
  24. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Marlena,

    Thanks for the update.

    It is to be expected that a human meter will read lower than a veterinary meter, but I'm a bit concerned about your True You meter - particularly if it is reading a good bit lower than the One Touch Ultra. I've read here some of the meters in the States that have 'true' or something similar in their model names are prone to problems when trying to measure a cat's BG levels. I'm tagging @BJM to see if she might be able to advise whether the same holds for UK meters with similar names.

    Looking forward to reading your next update.


    Mogs
    .
     
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  25. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    If the standard in the UK is that meters must read within +/- 20% of what a lab gets, then
    if 1.2 times the lower number is greater than 0.8 times the higher number, the numbers may be considered the same.
    So, lets check
    1.2*13.2 vs 0.8*18.7
    15.84 vs 14.96
    Yes, IF the +/-20% rule is applicable, then these numbers may be considered the same.

    Now Canada has a rule that meters must read within +/-15% of what a lab gets, and it is possible the UK has the same standard (you'll need to check on that), so lets check if it works for that.
    if 1.15 times the lower number is greater than 0.85 times the higher number, the numbers may be considered the same.
    1.15*13.2 vs 0.85*18.7
    15.18 vs 15.895
    No, IF the rule is +/- 15%, then these numbers are not the same.
     
  26. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    H
     
  27. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Critter Mom,
    It looks like True You meter is no good and One Touch seems to be much better but I find it more difficult to use as it needs bigger drop of blood. Another one I am considering is Freestyle Freedom Lite meter. There is also a serious issue with Vetsulin insulin, I am waiting for the vets suggestions tomorrow so we are going to start new insulin in next couple of days. I think Rocky had some Somogyi overswings with this insulin and is very difficult to regulate. I have a lot of questions before I start afresh so I have to post in a new thread and will be doing spreadsheets for you to see.
     
  28. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Marlena @Marlena ,
    Some folks have reported problems with the Freestyle lite meters. The problem people have observed is that the meter doesn't read accurately at high numbers. It reads them as lower than they actually are. This has meant that some folks thought their cats weren't doing too badly until they tested with another meter...

    It's a shame you're having problems with the One Touch meter. It's a great 'workhorse' meter. But yes, it does take more blood than some other meters. Have you tried putting a teensy weensy smear of vaseline on the ear before pricking it? It helps the blood to 'bead up' and stops it disappearing into the fur. Making two ear pricks close together can also produce enough for a test where one ear prick might not. And massaging immediately below the ear prick can 'milk' more blood out.

    Quite a few UK'ers have used the Accucheck Aviva meter. It's widely available. The test strips can often be bought for half the RRP on Ebay. And it requires less blood than the One Touch. :)

    Eliz
     
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  29. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Dear Eliz,
    thank you for info. If One Touch is good then I am happy to keep using it and see how it goes. I had initially Accucheck Aviva but one day it gave me really odd numbers and I thought it was not working properly so now I need to check that against control solution and if it is ok I can use that as well. Still working hard to try my best, it is a lot of work and commitment but my kitty is worth it!
    Marlena
     
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  30. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    I've used the One Touch (mostly One Touch Ultra 2) as my main meter for almost 9 years. Have tried others but always come back to this one.

    And I don't know if anyone has already told you this but the ear sort of 'learns to bleed' quite quickly, and that makes getting a sample much easier. Someone told me it's because of 'angiogenesis' (crikey, that's a long word for me...:smuggrin: ). The ear grows more blood vessels in response to the miniscule 'injuries' caused by testing. And more blood vessels = more blood. :woot:
    .
     
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  31. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hang in there, Marlena; you'll get there! :) As Eliz advises above, when new capillaries form at the edges of the ears it gets much, much easier and quicker to produce a good enough sized blood droplet for testing.

    BTW I've got an Accucheck Aviva as a backup meter. I haven't used it very often but I found it easy to collect the sample on the strip and it doesn't seem to need much blood.


    Mogs
    .
     
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  32. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Dear,
    I am back to this meter (Accucheck), it is easy to use. I compared it to other meters and checked my own blood , also checked with control solution - all good. The reason I change the meter was strange numbers of BG I was getting on a particular day - wrong decision! The numbers were : 8 am 20.9 (food and insulin given), +2 21.8, +2 21.3, snack, +2 21.4, +2 19.3, +2 19.7. I have never seen BG numbers like that before so I wrongly assumed that the meter was broken.
    Would anyone know what this strange curve meant?
     
  33. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Elizabeth,
    Thank you, I knew about ears learning to bleed. I have taken so many samples and should be very experienced but for some reason I really struggle sometimes. I guess I am still learning. I am very grateful for your advice. Best regards,
    Marlena
     
  34. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Hi,
    I am awaiting the vet's call regarding the new insulin for Rocky.
    I would like to try Hypurine bovine PZI which is 100u insulin. How can I find out all information and guidelines and protocol for its use? There is Dr Hodgkins TR protocol. How do you Eliz use this insulin?
     
  35. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Difficult with just one day's data, Marlena. The curve is 'upside down', granted, but trying to ascertain why is not straightforward. Sometimes with curves like that it can point to a dose being too high (numbers stay high and flat) but it could just as easily be that a cat with that type of curve on one day might have got into some higher carb contraband, might have been stressing about something - even brewing up a poop can elevate numbers if a cat is a little constipated! :eek:

    Have Rocky's numbers improved since?


    Mogs
    .
     
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  36. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Marlena,
    There is no specific established protocol for Hypurin bovine PZI.
    There are members here though who have a lot of experience with other PZI insulins and with Prozinc, which is sort of in the same family. And a member here, @Sue and Oliver (GA) , has put together a protocol for these insulins:
    Protocol for ProZinc/PZI

    There are 2 main differences between Hypurin bovine PZI and the PZI/Prozinc that our US chums use.
    1). Hypurin is a U100 insulin (the other PZI and Prozinc are U40 insulins, as Caninsulin is).
    2). Hypurin has a longer duration, and the duration of the shots usually overlaps somewhat. That means that the dose for Hypurin usually needs to be reduced. When I switched to Hypurin from the previous UK PZI insulin I was using (which is no longer available), I found I had to reduce the dose by half.

    I'm going to try to get another UK'er, Juliet @Dr Schrodinger , to chime in here, because she also has experience of Hypurin bovine PZI.

    Note: If you want to use an insulin that does have a long established protocol in kitties then it may be that Lantus/glargine would be a better option...?

    Regarding the Dr Hodgkins protocol.... Well, um...we don't recommend that on this forum. One of the main reasons for that is that Dr Hodgkins says that a cat on a low carb diet can't have a hypo. And that simply isn't true.
    And some folks who follow her protocol take their kitties into very low blood glucose numbers which, we believe, puts them at risk.
    We have had quite a few people come to this forum after running into problems with Dr H's protocol (and I tried it myself in the early days of Bertie's diagnosis.)

    Eliz
     
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  37. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I can attest to this personally. Saoirse had a symptomatic hypo after a massive drop in blood glucose levels during her emergency transition to wet low carb food from Hill's w/d Dry. According to my vets the lower threshold of the normal blood glucose reference range is 3.9mmol/L as measured on a vet meter. Saoirse was symptomatic at 4.3mmol/L; above the threshold.

    I also looked at the Hodgkins protocol when Saoirse was first diagnosed and it made me feel extremely uneasy. Apart from my unwillingness to accept Dr Hodgkins' assertions about hypoglycaemia risk my best friend and his mum are both diabetic so I have had some historical exposure to the condition and I've been with my friend when he has tipped over into hypoglycaemia. He had taught me how to spot the signs and I knew to give him some sugar water straight away. (I actually used to keep chocolate with me all the time when we lived near each other so I'd always be prepared if he went hypo while I was with him.) With that experience of the practicalities of diabetes with a human, there was no way on God's green earth I was willing to follow Hodgkins' recommendation not to administer glucose in the should my cat ever fall into hypoglycaemic numbers. I can understand where she gets her theory from, but sometimes there's a big gulf between theory and reality. Frankly speaking, I consider it utterly reckless to recommend that high carb intervention be withheld from a cat in dangerous numbers. I certainly would not put my cat in danger like that.

    My two penn'orth.


    Mogs
    .
     
  38. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Hi Marlena & Rocky! (& Pippin, too ;))

    My name's Juliet. I'm also a Surrey-based Britisher, and I also used Hypurin PZI for my Milo kitty.

    The numbers you list above suggest to me that the insulin didn't enter Rocky - do you think you maybe gave him a 'fur shot'? 1 or 2 units either side of 20 isn't much of a variation, and I wouldn't consider that to be a response to any insulin that you may have given him. He might just have been having a bad day?

    With respect to a Hypurin protocol, as Eliz alluded to, there isn't one, really. You start off with a low dose and see how the puddytat responds.

    Milo was on 3 units of Caninsulin twice a day when he switched to Hypurin - we couldn't get him steady on Caninsulin, and the Vet just wanted to keep increasing his dose. He had already crashed twice and I wasn't comfortable with the Vet's plans, so I asked he senior partner of the clinic to go through the 'cascade' system and prescribe Hypurin - having seen Elizabeth & Bertie do so well on it. We started him off on 1.5 units. Moving from a U40 insulin to a U100 insulin means learning how to load you needle with greater precision. Are you using the VetPen at the moment? Have you ever manually injected him? Your Vet can help you get used to the manual syringe & show you how to load the appropriate dose of Hypurin. Your Vet may also want to do Rocky's first curve in the clinic.

    I did Milo's first curves at home. His numbers were all over the place, and looking back at his numbers now, it took a good few weeks for his numbers to come down to a 'tightly controlled' level. I soon noticed that his evening preshot numbers were lower than his morning preshot numbers (Hypurin lasts a lot longer in the cat's system than caninsulin does), so after 4 days, I lowered his evening dose to 1 unit.

    I then started reading the Roomp & Rand protocol which you can find here: http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf. It's a protocol for glargine (Lantus & Levemir), but I found that Hypurin was lasting so long in Milo, that I thought I would give it a go, and monitor him really closely. (Not sure about the ethics of experimenting on your own cat, but nevermind!). I increased/decreased/held the dose as suggested by the protocol - including raising his evening dose to 1.5U again - and swiftly Milo responded. I kept his BG very low. So low that sometimes other people on here (very caring people, I might add!) got worried, but I only injected him on low preshot numbers when I was working from home, in the house all day, and could keep a close eye on him. Within another two weeks, he wasn't needing his insulin anymore. Next month he won't have had any for 3 years.

    The key is to monitor closely, look for patterns in BG numbers, and adjust the dose (in 0.5 unit increments) accordingly.

    When you hear from the Vet, and start the new insulin, post up your numbers and we will help if we can?

    Good luck!
     
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  39. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    I really am not sure about Rocky's numbers because the meter I was using was reading very low but I was not aware of that and was surprised that even with simingly low numbers he was drinking water. And that got me thinking something wasn't right. Took him to the vet's and he had really high BG. Now my meter is more compatible with vet's so his numbers today are as follows:
    7am 25.4, +6 5.3, food given, +8 9.4, +12 16.4, food and insulin, +15 7.what do you think about these numbers? I am going to get up at night and test after 6 hours.
    Dear Juliet,
    I can't tell you how grateful I am for your input!
    I am having trouble with my vet at the moment - she sort of agreed to PZI but she is slow acting! I am taking a letter to her and copy of your email and hopefully tomorrow I will have new insulin, fingers crossed!
    I am still using Vetsulin pen which is very easy to use but pointless if it is not working for my dear Rocky.
    I will keep you informed.
    All the best for you and your kitty.
    Marlena
     
  40. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    You're most welcome! It is terrifying, frustrating & heartbreaking all at once. I remember well!

    So, Rocky's numbers don't look bad, really, from that set of tests. He's down to 5.3 (a great value!) 6 hours after his morning shot. He goes back up to 16 before his evening dose, and then drops quite quickly to 7.
    What dose is he on? 2 units morning & evening?
    He's responding well. Do you have anymore numbers after the 7 at +15? Did he bounce back again?

    Juliet
     
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  41. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I'm glad to hear that you're planning to get a PM+6 reading.

    What do I think? OK, first a disclaimer: I am super-cautious and super-conservative in my approach to treating my own cat and that caution informs all observations and opinions I express on this forum. Other members may have very different opinions to mine.

    A 20mmol/L drop on Caninsulin is something I would pay a LOT of attention to - regardless of whether I was using a human or a veterinary glucometer. If measuring on an Alphatrak or other pet glucometer I would definitely be considering a dose reduction for safety reasons. Even if measuring with a human glucometer I'd still be uncomfortable with a Caninsulin dose that had that much of a lowering effect. If it were my cat I would prefer to see far less precipitous drops (they can be very hard on the cat's system) and nadirs that were in a range where there was a bit of a protective buffer against 'surprises' rather than risk a surprise dropping her into hypoglycaemic numbers. (A nadir of 5.3 on Lantus would be a different matter altogether.)

    My two penn'orth.



    Mogs
    .
     
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  42. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Dear Juliet, many thanks again.
    I am giving Rocky 2 units am and pm at 7.15 (around) with his shot. The numbers on this particular day don't look bad but unfortunately we don't have many days like that.
    Yes, I agree his numbers during the day don't look too bad but I am still concerned about high PSAM numbers which is going on for sometime and probably means there lots of time during 24 hours he has high BG.
    So 6 Jan 2016 PSPM 16.4, then food and inj, +3 7, +6 6.5, food given. 7 Jan PSAM 21.9, +6 12.6, +12 13.3. 8 Jan PSAM 26.4(!). Now I am thinking about this higher number this am - I have delayed his pm shot by half an hour and gave a little more food an hour later to try to delay insulin onset to see if it would make his am number better. I did not give him food at +6 at night because I did not want food to influence his am number. In the past I have had this pattern for sometime (much higher BG am and much lower pm). Asked the vet she said much reduce the dose. I have tried to reduce, give token dose, no dose at all and normal dose and I still have the same result. Unfortunately I have very different readings almost every day. Totally confused, am I doing something wrong or this insulin is not working very well?
    Marlena
     
  43. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Many thanks,
    From what I am reading Vetsulin is a very harsh insulin and causes these high drops and highs. Lower doses are not controlling Rock'y diabetes so he would be in high numbers all the time. I think now I have to stop trying to figure it out because I have made a decision to change him to Hypurin which should be available to me today so I can start tomorrow. Shall I start a new post? I will need a lot of help from you guys because I am desperate to get this right!
    Marlena
     
  44. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Hi Mogs,
    It is all very difficult. What works for one creature doesn't work for another. Nothing is set in stone. There are lots of theories in medicine which are just theories and they were never proved. But we still continue to apply medicine according to that theory and then we are surprised that it works in some patients but does not in others. We are left with making decisions and trying an approach which seems right to us. Our personality comes to light. One person would be very prudent and another likes taking risks. That's why we are so frustrated when dealing with FD because you don't know how your cat is going to react. We can only support each other. I am glad I found this blog. Wish me luck.
    Marlena
     
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  45. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    I saw a similar situation in Milo, too. High numbers, rapid drop quickly after caninsulin, bounce back high again. Caninsulin acts quickly & is metabolised quickly, too.
    I don't think it is possible to 'delay the onset' of caninsulin to achieve a lower morning preshot number. I don't think the difference between AM & PM preshot numbers are due the longevity or depth of caninsulin action, but simply due to a cat's biology. They are nocturnal beasts, they have evolved to hunt & eat more at night than during the daytime hours, and so at what we see as being the normal breakfast time for us (when our own BG is low), the cat will have high BG - it is, after all, their bedtime!

    Is Rocky allowed to graze? Does he have food left out for him all day and night? They will self-regulate to a certain extent if they have food to enable them to do so.

    I am very pleased that Hypurin is on its way! Rocky needs a much more stable level in his system throughout the 24 hour period. I can't imagine what a rollercoaster ride of BG might feel like, but it can't be good. :(
     
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  46. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
     
  47. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Dear Juliet,
    Again - thank you so much!
    Going to the vets this afternoon to pick up a prescription for Hypurin and lesson how to use syringes -hurrrra! That wasn't easy.
    I am full of hope and anticipation.
    Regarding feeding: Rocky is very greedy and would eat anything in any amount! With Vetsulin I gave him his meals with his shots twice a day and two snacks (smaller meals) 6 hours after the shots in the day and night, so at 1pm and 1am.
    Could you please give me some advice how to feed him now with new insulin regime.
    Many thanks, Marlena
     
  48. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Marlena, has the vet actually got the Hypurin in for you? Or are you going to get a prescription and buy from a pharmacy?
    If the latter then do be sure to get Hypurin bovine PZI, and not not Hypurin 'neutral' or 'lente'. (I recall a situation where a member was just given a prescription that said 'Hypurin', and the pharmacist was completely flummoxed!)

    Has your vet had cats on Hypurin PZI before? Or is Rocky the first?

    That should still be a good starting point, Marlena. (Do you get up at 1am to feed Rocky ? (Crikey!) Or do you have a timed feeder...? Or do you just go to bed very late...? )
    When you see how his body responds to the insulin you could adjust the feeding as necessary.

    What you are likely to find, when switching to Hypurin, is that the blood glucose drops more gently, and stays in lower numbers for longer before rising. You may also find that your pre-shot numbers get lower (because of the overlapping doses if given 12 - hourly). But it may take a few days to see this pattern. (And Rocky may well have his own individual way of responding to Hypurin: As we say around here, 'Every Cat Is Different' ('ECID'). ;) )

    If you find that you are frequently having to miss alternate shots because the blood glucose is too low to shoot, then you may need to reduce the dose (and therefore the effect of the overlap) so that you can shoot both am and pm.
    However very occasionally, especially if the cat still has some pancreatic function, a Hypurin cat may actually only need one shot a day. My cat usually has one shot a day during summer/autumn, and then 2 shots a day during the winter/spring.... :rolleyes: )

    Keeping fingers and paws crossed that Hypurin works well for Rocky. Will be following his progress with interest!

    Is there any chance that you could set up a Google spreadsheet with his blood glucose readings? We have a template for that here. And if you get stuck there are some smart techy people who can help you set it up. (But, unfortunately I'm not one of them.... :smuggrin: )

    Edited to add: You may be interested to see the spreadsheet that Juliet set up for her cat, Milo. (It's at the bottom of her posts, 'Milo's Sugar Scores'). Milo was very lucky and went into remission after just a short while on Hypurin.

    Eliz
     
    Last edited: Jan 8, 2016
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  49. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Dear Eliz,
    I have Hypurin!!! I got a prescription which I filled at my own work place - I am a pharmacy technician and the pharmacist I work with is trained to dispense veterinary meds so no problem with getting the right insulin.
    I will get going with the spreadsheets as well.
    And yes, I do get up at 1 o'clock in the morning to feed Rocky.
    Please keep your fingers crossed.
     
  50. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Marlena,

    Wishing you and Rocky great success with his new insulin! In answer to your question, it probably is a good idea to start a new thread on the Feline Health board about the Hypurin.

    Go n'eirigh an bothar leat!



    Mogs
    .
     
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  51. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Hi Mogs,
    I have started a new thread yesterday.
    Thank you XXX
     
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  52. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    De nada! :)
     

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