In a Bit of a situation here

Discussion in 'Feline Health - (The Main Forum)' started by G & I, Dec 9, 2017.

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  1. G & I

    G & I Member

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    Dec 8, 2017
    I recently joined this group and I am unsure where to post what and ask questions/seek advice and guidance. I am a bit of a quandary here and I realize we are not veterinarians but I have numerous questions. Maybe I should post over in the Prozinc Forum - again unsure

    Goma is an approximately 7 year old female who was diagnosed with diabetes approximately 6 weeks ago. She has been relatively healthy through the years but developed a bad skin condition approximately 8 months ago which is still not resolved although I suspect this is due in part to the diabetes. The vet I have wanted to try oral medications to bring her glucose level down. Was unsuccessful and decided to start her on Prozinc. They are using the minimal dose of 0.5 ml however only using once a day and not feeding her for many hours. The level drops and then they will feed her. Not sure why they are doing it this way and the language barrier comes into play. For the past 6 days they have continued to perform graphs that will of course show a decline in glucose levels after injection and then an increase. They are continuing to withhold food for 3 hours after injection. I am seeing morning levels over 700 now when previously they were around 360. From my visiting the Prozinc website it appears she should be on twice a day doses and be allowed to eat. She was approx. 5 kg but is now 2.33. She did have pancreatitis which is now resolved according to the specific blood test for that. Her liver levels are still very high but substantially lower then a week ago (1000 to 200).

    My situation now is that I am now being asked to bring her home and monitor her over the weekend and there will be no emergency person available. I gave her the insulin injection this morning about 0930 under the supervision of the vet but the last phone call I got stated the levels did not drop so I suspect I did not give the injection correctly. This was my first time giving the injection. But I am still going to have to bring her home shortly.

    When I ask the vet why he is not following the protocol laid out by the manufacturer he states twice a day injections are risky and he does not trust the information.

    I realize there is not much of a question here per se, however I would like to hear and would certainly welcome and advice or guidance as to how best to proceed. Being a weekend I am at a loss. This being my first experience with diabetes is really leaving me feeling most inadequate.
     
  2. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Frankly, it sounds like your vet does not know what he is doing. First of all, Prozinc should absolutely be given twice a day, once every twelve hours. It is an "in-and-out" insulin, and it does not last 24 hours. Second, give that baby some food! The only time food should be withheld is for two hours prior to shot time. This is so that a blood glucose test can be done prior to giving the shot to make sure it is at a high enough level to give it. You do not want the test result to be impacted by food, so you withhold it. It also helps ensure your baby will eat enough for you to give the shot. So, the order is test, give shot then feed. The AAHA diabetes management guidelines say that it is ideal to feed them four times a day (using an auto feeder if needed) but that free-feeding is fine if the cat is underweight. So, I would give her all the food she wants except for two hours before the pre-shot test. What are you feeding her? Low-carb wet food is best. If you have not seen it yet, there is a great cat food database to help you select foods (I am not sure where you are, this is the US food list), and a lot of info on feline nutrition on catinfo.org. It is very important to do home glucose testing. It is the only way to keep your baby safe. So, if you are not already doing it, I strongly suggest getting a meter now and starting right away. You will want to test before every shot to make sure it is safe to give the planned dose and to get mid-cycle tests when possible to see the impact the insulin is helping.

    You have come to the right place to get help. Unfortunately, it seems that the majority of vets know very little to nothing about feline diabetes. So, we all have to educate ourselves and help each other. Please ask any/all questions that you have. It would be helpful if you added a signature like you see under our posts. That way you do not have to repeat basic info about Goma each time you post.
     
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  3. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You've been given great info already. I agree that your vet doesn't know how to properly use ProZinc, which works well for many cats, and seems to have a limited understanding of feline diabetes treatment in general. Many of us here will say that if you're willing to take on your kitty's treatment yourself we can get you moving forward. Here's a summary of what you'd need to do:
    1. Learn how to test blood glucose at home - not as difficult as you think and gets a lot easier over time.
    2. Learn as much as you can about ProZinc. If you go to that insulin forum you'll see a list of yellow-coded info stickies about ProZinc. Start there.
    3. Start your kitty on a 1 unit dose AM and again PM.
    4. Implement a good testing routine so you can keep your kitty safe. We can help you with that.
    5. Switch your kitty to low carb wet food if she's on a different diet. Blood glucose monitoring will be important because a diet change alone can often drop BG levels.
    6. Post here and/or on the ProZinc forum for help as often as necessary. Ask a lot of questions. :)
     
  4. G & I

    G & I Member

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    Thank you for the quick response. I hope my signature is now approaching the appropriate level but will continue to edit. I have printed out the AAHA diabetes management guidelines in addition to the Prozinc Protocol I found here and have read and printed as much information as I can find from the Prozinc website. I have been torn apart the last few weeks with Goma's treatment regimen as it is completely in conflict with what I have been reading. Your response has confirmed that and I appreciate it more than I can express. So it is okay to feed her even with the high glucose numbers (over 700)? The vet has been saying it does no good as it all converts to sugar and drives the number higher. I have been reading that withholding food from a diabetic cat causes DKA. Her ketones have recently become a - in urine test with glucose being a +3.

    The vet has loaned me an AlphaTrac 2 meter which I have also ordered on line via my daughter in Florida since they will not ship it here directly for some reason. Are there other items I should be looking at in addition to the testing strips and lancets.

    In regards to food, she is currently eating canned Hill's Prescription Diet m/d and something in an aluminum tin called Specific FRW which I guess is Japan based.
    I am trying to get all my friends here on wet food. Have also been preparing chicken for them and Goma but have been afraid to give based on the vets warnings.

    I note there is a spreadsheet I should be completing and will endeavor to do so when I become proficient at making the readings in addition to being more literate in using the template I think I noted.

    Thank you again for posting. I am beginning to feel a bit less overwhelmed.
     
  5. G & I

    G & I Member

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    Dec 8, 2017
    I sincerely appreciate the response. I am more than willing to take this on as my only concern is for the health and well-being of Goma, The vet loaned me an AlphaTrac 2 meter which I will begin using in the morning prior to administering an insulin injection. This will be my first attempt at the glucose reading and only my second attempt at injecting the insulin. My injection failed this morning at the vet prior to bringing Goma home based on the glucose readings during the day the vet obtained.
    I will refer to the Prozinc insulin forum and review all info stickies and go back to the ProZinc site. The vet started Goma on a 0.5 dose and maybe I should stay there for now(?) Would testing every 2-3 hours be appropriate? Goma is currently on canned Hills m/d and another aluminum tin called SPECIFIC FRW which I guess is Japan based. I would like to get her on home cooked chicken which I have read is good for diabetic cats as it would be high in protein.
    Again, I thank you for the response and information. Will go to the ProZinc forum now.
     
  6. Kris & Teasel

    Kris & Teasel Well-Known Member

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    When you say 0.5 dose, are you referring to 0.5 units? On the syringe that would be at the half way mark before the 1.0 mark. If that's where she's been started, stick with that for now. She needs to be dosed twice a day though.

    Here's the recommended dosing routine:
    1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
    2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
    3. do extra tests on days off to fill in the response picture
    4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
    5. post here for advice whenever you're confused or unsure of what to do.
    The Alpha Trak pet meter is very good but the cost of the test strips is high. If you can afford it, stick with that meter. If you find it becomes too expensive over time, buy a human meter. Many/most of us use those to save money on test strips. It will read lower than the pet meter but we can help you interpret the readings.

    Getting a good blood drop from Goma's ear will be easier if her ear is warm. You can make an ear-warming rice sock: put 1/4 to 1/2 cup dry uncooked rice into the toe of an old, clean sock, tie it off and warm it in the microwave until it's quite warm but safe to touch. Hold it on her ear for 15-30 seconds. Some people fill an empty pill bottle with very warm tap water and use that to warm the ear. Here's a photo of the best location to poke:


    upload_2017-12-9_10-9-9.png
     
    Last edited: Dec 9, 2017
  7. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    Where are you located? Are you in Japan? I ask because some of our recommendations (food, testing supplies, etc.) will change depending on where you are and what you have available to you.

    The AT2 is a good meter, and it's great that your vet is loaning you the use of one while you get comfortable with testing! That said, many of us here find that using "human" glucose meters is more convenient, for two reasons: 1) the testing strips are usually much cheaper, and 2) it's much easier to get supplies from a human pharmacy than from a vet. Vets do not tend to like them because the numbers will be different than an AT2, but what we have found is that the most important thing to keep a cat safe is knowing what the "too low" number is on a particular meter. At the high numbers, it really doesn't matter much if a cat is "really" 500 or 700, so meter differences won't change how you treat.

    As for food: home-cooked chicken sounds like a great option! The main thing for feeding diabetic cats is to keep the carbohydrates low, so making your own meals that you know are high protein + fat is a good way to ensure that Goma isn't getting extra carbs. Always keep in mind, though, when making homemade food you are going to have to add extra nutrients to make it "complete". Just plain chicken lacks certain essential nutrients (taurine, etc.) that cats need, so if you're feeding that in anything but a short-term basis, it's not enough.

    Ketones are always a concern with a cat who is running high, and possibly not getting sufficient insulin and food. What does the "-" mean for the test you are using-- is it negative, or does that mean something else?

    Here's a link to the spreadsheet instructions.

    You're doing great so far! Breathe!
     
  8. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    See, I told you this was a great place. You're going to be smarter than your vet in no time.
     
  9. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Please note that if you ever give an injection, and you think it did not go in, do NOT give a second injection. We call these fur shots. You have to wait 12 hours until the next cycle. Before you know it, you will be an expert at injections. Always remember you are helping your kitteh get healthier.

    You are getting good advice from others.
     
  10. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Jul 6, 2017
    YES! When their glucose is high, their body is not able to 'use' the food so they are literally starving.. hence the weight loss. So, give that baby some food! If you have an appropriate low-carb food, the impact on blood glucose will not be much, and besides, they HAVE to eat. You need a different vet. :)
     
  11. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    I think there's something missing here. In Islander's intro he mentioned something about Goma being part of a group of ferals he's caring for, may cause a few more problems for him especially trying to stay on schedule. Please correct me if I'm wrong.
     
  12. G & I

    G & I Member

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    Dec 8, 2017
    Thanks for the response and guidance. With the chicken I will provide a supplement called Felo-Form which contains taurine and potassium for cats. Otherwise I am hoping the Hill's and other canned food will be okay for now though it is rather expensive here. Yes, I am in Japan and it is difficult at times to get items however I have a daughter in Florida who is providing assistance in obtaining items. I will attempt the spreadsheet in the morning (wait..it is morning here). Thanks for the advice on meters as well. Since I committed to the AT2 I'll see how the expense part goes and maybe go to the human meter for the reasons you provided. Now that I realize I can get help in reading correctly. In regards to the ketone reading - at one point Goma's urine test was reflecting a +2 in ketones and now reflecting a - which I am being told means 0. The glucose level in the same test has remained +3 throughout.
    Thank you again.
     
  13. G & I

    G & I Member

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    Dec 8, 2017
    Thanks for the post. I hope I can clarify this. Goma in addition to several others is part of a TNR program gone bad. I have taken Goma and the others in and they are now a part of my family. Since I am now retired, I can keep any schedule necessary and will certainly follow guidance you all are providing. There are other ferals that I have vaccinated and neutered or spayed and released that have decided to remain around the outside of my home, so I continue to care for them as well.
     
  14. G & I

    G & I Member

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    How right you are in both regards. What a great place. Wish I had found it weeks ago.
     
  15. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Keep in mind that the Hill's m/d food is 13% carbs. You can get lower carb, less expensive foods.
     
  16. G & I

    G & I Member

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    So is Hills prescription m/w and appropriate low-carb food I can give her as much as possible (beside the two hour window you mentioned previously). I feel relieved that someone else is expressing something I have been saying all along - "they HAVE to eat." Thank you
     
  17. G & I

    G & I Member

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    Thank you for that advice, I hope I will be an expert in both blood testing and injections sooner rather than later.
    Should have read this prior to replying to another post. Not sure what I can get here in Japan but will certainly be trying to find it in addition to some home made food.
     
  18. FurBabiesMama

    FurBabiesMama Well-Known Member

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    If that is what you have right now, yes, give it to her, but I would suggest transitioning to a lower-carb food as soon as you can (as long as you are testing). The 13% carbs in the m/d food will impact her glucose levels. I have actually used that food in the past when Mia's numbers were getting too low to help bring them back up some.

    The way I personally do it is that I feed my girls their wet food four times a day (every 6 hours), and what they have left from each meal stays out for them (I add a little water and stir it) until the next meal or until two-hours before shot time.
     
  19. G & I

    G & I Member

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    Once again, thank you. This is the food the vet supplied after I advised him I was under the impression Goma should be on a high protein low-carb diet. I had read somewhere that below 10 is okay but I need to get below 7 I think. I like your feeding routine and will attempt that.
     
  20. G & I

    G & I Member

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    Thank you for the timely information particularly in regards to warming the ear since I will be performing my first test in a few hours. Yes I meant 0.5 units. Would you recommend I perform two injections although the vet has her on one?
     
  21. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Prozinc dosing is every 12 hours. I do not know what that vet is smoking.
     
  22. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You have the option of leaving her at 1 injection a day and using this period to get used to testing and logging data. I'd make sure to get a couple of evening tests in too, even an overnight one if you can. I suspect that'll show that the ProZinc has worn off and there's little to no BG control for the overnight period. You can show the data to your vet. Cats metabolize insulin quickly, hence the need for twice daily dosing.

    We all, at some point, had to decide whether we wanted to let our vet guide us or begin to do things on our own. For every one vet that's knowledgeable about treating feline diabetes there are probably 100 or more who have little to no understanding. From what you've told us, your vet is in that category. If we're lucky, we have a vet that will work collaboratively with us in treating FD and we use their expertise to treat other kitty health issues. Only you can decide if you want to do that.
     
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  23. Nan & Amber

    Nan & Amber Well-Known Member

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    My vote would be for the generally-recommended twice-daily dosing, due to the recent positive ketone test and high BG numbers seen at the vet. But let's see how the testing goes, where Goma is on BG now that she's home and relaxed.
     
  24. G & I

    G & I Member

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    Okay thank you. I think at this point I need to clarify to everyone that they have been making a chart each day with a bg score prior to injecting then waiting three hours and seeing if the score goes down then giving food. It has made no sense to me at all as I would think that after injection and with no food for more than 14 hours of course the bg would go down. Then they were looking to see when it went back up. Since I know nothing other than what I have read, it appeared to me that they were reinventing the wheel in that the ProZinc guide already indicates the effectiveness range or time period or something to that effect. This has been going on for over a week with, from what I can see blood glucose starting at a higher level each morning. And I still don't understand the once a day injection when as everyone here has noted the protocol states twice.
    Sorry if this is getting confusing, I've got to get some sleep.

    I sincerely thank you for your candidness.
     
  25. FurBabiesMama

    FurBabiesMama Well-Known Member

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    An insulin injection should only be given after a cat has eaten some food. This sounds like they were giving the poor baby insulin on a very empty stomach.
     
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  26. G & I

    G & I Member

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    Exactly!!!
     
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  27. Kris & Teasel

    Kris & Teasel Well-Known Member

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    This is inviting a hypo incident! :eek: Once you're better rested and think about it more you might want to take your kitty home and try what we're suggesting here. There's nowhere to go but up! ;)
     
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  28. G & I

    G & I Member

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    I agree and will be given a second injection of 0.50 units tonight around 9:40 if bg readings indicate okay. Based on what I am seeing, I don't see where that will be a problem. Thank you for the response.
    Yes, I have brought her home and intend to take care of the insulin injections and monitoring myself. I will be meeting with the vet to discuss.
    Thank you
     
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