Introducing Scooter

Discussion in 'Welcome to the Group - Post an Introduction Here' started by Jeff Phillips, Dec 9, 2016.

  1. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    Hello,

    I have a 17 yo male kitty that has had hyperT since 2012. It has been under control until he was diagnosed with diabetes at the end of August 2016.

    His T4 levels that were controlled on 5mg of methamazole a day now requires 18mg to stay within the 2-4 range.

    It went haywire when he acquired diabetes and have been struggling to get him regulated. The vet started him on 1 unit of vetsulin and said recheck him in a month. Well he started to get dehydrated so I bought a test kit and tested him for 12 hours on 1 unit and the high was 500+ and nadir was 338. Not good (had a diabetic cat years ago that went in remission) so asked the vet if I needed to increase and she said no. Well I did and got his nadir doen to the 150 range but the high has still been 500-600.

    When his t4 dropped to 5.3 on 15mg of methamazole his insulin needs changed again. I noticed he was drinking alot more and peeing it right out. I went from 3units to 4.5 as recommended by a different vet we visited that has more experience with cats and i now have Scooters levels back down to a nadir of 140-160 but highs still hit 600+.

    Is this normal? I have been to two vets and they have no experience with treatment of 2 endocrine issues at the same time.

    He went from like 10 bs to 7.3 since September but hasn't lost anymore but hasn't gained it back yet.

    Diet is friskies pate and fancy feast classic. He grazed on hard md until 2 days ago when I decided to try something different.

    Is there something im doing wrong? His curves thst i have done the past 3 going on 4 days every 2 hours has gradually kept him below 300 for 5-7 hours out of a 12 hour period.

    Thanks
    Stressed Jeff and Scooter

    I attached a recent curve
     

    Attached Files:

  2. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
  3. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
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  4. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Jeff,

    Welcome to you and Scooter.

    The Hill's m/d kibble is still fairly carby. The Friskies patés and FF classics should be OK (although we suspect some of the FF Classic formulations may have changed recently as some cats seem to be running higher on them lately - see the discussions about this on Feline Health).

    The bucket-shaped curves you've been seeing on Vetsulin with a food that's not low enough in carbs are fairly typical. Vetsulin hits fairly hard and fast in the early part of the cycle, keeps numbers down for a few hours then they tend to shoot back upwards around the +8 mark. (Note: some cats do fine on Vetsulin and may get a longer duration of effect from a dose but they tend to be in the minority.

    Important Safety Note: With the recent food change be very vigilant with your testing over the next few days; BG numbers can drop significantly over several days as the effects of higher carb food leave the cat's system and the dose you're currently giving may need to be reduced (and more than once).

    I've no experience with hyper-T so this is just a very general suggestion: it may be worth asking your vet whether a longer-acting depot insulins - Lantus or Levemir - might be a better fit for Scooter.

    For general and Vetsulin questions Feline Health is a good place to start posting. However I also think it might be a good idea for you to also post a thread on the Lantus & Levemir support group's board asking any members whose cats have hyper-T to share their experience of using an L insulin for the diabetes alongside the treatment for hyper-T, and what you might expect or need to look out for if you were to switch.

    Here's a link to the L&L board:

    http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

    It's a very busy board so I recommend that you set the "?" prefix against the subject when you create the thread so that the experienced members on L&L will be able to see that you need help with a specific question.

    At the top of the L&L board there are a lot of educational stickies where you can learn about how depot insulins work. Don't be shy about asking questions! :)


    Mogs
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  5. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    Thank you Mogs,

    Glad I found this group because I will find more real world experiences than what any vet could tell me. Both vets recommended Hills M/D but doing more research and a page I found by DVM Lisa Pierson, all that my vet told me has been misinformation.

    This site was recommended by Linda over at the hyperT forum.

    Thanks again guys and it will take some time before I can use this site to it's full potential but you have pointed me in the right direction.

    Thanks

    Jeff and Scoot
     
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  6. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    If you need info just post a question on Feline Health. We'll be able to point you to the right resources to help you with the learning curve.

    I'm glad you've found catinfo.org; it's a great resource.


    Mogs
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  7. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Nice pic of Scooter, Jeff; he's a handsome boy. :)

    How are you both doing today?


    Mogs
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  8. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    Thank you so very much for asking He is doing better today. Actually gave him 1. Unit of vetsulin last night cause his sugar didn't drop below 300. He was not happy at all. Today he stayed below 300 for a few hours with most below 200 and above 150. So far so good tonight. Not sure all the surf terminology yet and the + numbers.

    I actually talked to the vet yesterday morning about a longer lasting insulin when I showed him all the curves I had. He is always over 600 now but 4.5 units takes him down. The vet said I could give 1 unit at the peak drop. That is at 5 hours with Scooter. Not sure how this messes up his schedule but he is happier when his levels are down.

    Not really sure if 4.5 is too high. Never went hypo at all but there are a few fast drops from 6 to 8 am or pm. Shots are at 6 and 6.

    Not sure how the insulin works but wondering is his body adjusts to the increased dose. He never hit 600+ as much on 3 units. But he has lost weight so im feeding him more at preshot. High protein pate.

    He did sneak some of my other babies proplan natural dry kibble. 45gr protein and no grain. Not sure what that does to him.

    Again Mogs thanks for checking on Scoot

    Jeff
     
  9. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I think the 4.5 dose might be too high. Between a possible too-high dose and Scooter's body currently not being used to running in the healthy BG range it is possible that his body is releasing stored glucose and counter-regulatory hormones to fight the effects of the too-high dose; it's probably that which has kept him from becoming hypoglycaemic - so far ... My understanding is that if his system becomes exhausted from this effort Scooter could go into a very serious hypo.

    The body's protective measures are quite likely why Scooter's preshot BGs are getting higher. Too much insulin can look like too little insulin; in both situations BG numbers go high.

    Another pointer to the dose potentially being too high is the fast drop you're observing in the early part of the cycle. Such sharp drops can also trigger the body's protection mechanisms and therefore feed into BG numbers rebounding into higher ranges (what we refer to here as 'bouncing').

    I don't know how the thyroid issues might affect matters but BG drops of over 400 points between preshot and nadir are MASSIVE - even by Vetsulin standards.

    Scooter's not getting enough insulin to use food properly, hence the weight loss (and the hyper-T won't help either). Glucose can't get into the cells to provide enough energy to support normal metabolic functions. Essentially at a cellular level unregulated diabetics are actually starving; even though they may be eating plenty their bodies can't properly benefit from the nutrients they're consuming. We normally suggest that unregulated diabetics who are underweight be given more food while work is done to improve their BG levels. With hyper-T in the mix I'm sure that maintaining weight must be even trickier but I've no experience of dealing with that condition so I don't know anything that might help on that side of things.

    Would it be possible for you to set up one of our spreadsheets for Scooter and for you to post his BG data and dosing history in it? It would assist both you and us to get a better idea of what's going on with Scooter's current dosing and hopefully enable us to suggest things which might help.

    The spreadsheet is essentially a grid where you fill in the date, doses and BG test results. It allows you to see a cat's data over multiple 24-hour periods at a glance and this makes it easier to identify patterns in the response to the insulin and dose being used. Putting a link to the spreadsheet into your forum signature will allow other members to also see Scooter's data and hopefully make more helpful suggestions on ways to improve his regulation. Here are the links you need to get going:

    FDMB spreadsheet instructions

    Understanding the spreadsheet

    FDMB Jargon Buster

    If you get stuck just holler and we'll find someone to help you with setup.


    Mogs
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    Last edited: Dec 12, 2016
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  10. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I wanted to reply to the above in a separate post because it really worries me from a safety perspective.

    Some background:

    Vetsulin has two constituents: amorphous and crystalline insulins. Note: each constituent has its own peak period of effect. The amorphous insulin which kicks in within the first few hours post-dose has the most powerful BG-lowering effect and usually drags numbers down from high levels to a nadir typically somewhere between +3 and +5 hours after the dose was administered. The crystalline fraction isn't as powerful in effect. It starts to exert effects any time after +6 hours and reaches its peak of effect between +7 and +10, the idea being to go somewhere toward extending the effective duration of the dose before it finally poops out and BGs start sailing upwards again. Note that there can be a second dip in BG numbers from the crystalline insulin but its effects are not typically as pronounced as that for the amorphous insulin.

    I am really very concerned about your vet advising you to give extra insulin at +5; it's right in the middle of the time when Vetsulin's effects are at their strongest for starters, you'll end up juggling multiple nadir times at all manner of points in each cycle. I honestly worry that it won't do anything to help Scooter's BG much and I think it could put him at greater risk of an adverse event.

    In some cats Vetsulin peters out by about +8 hours after the dose has been given but there's no guarantee that numbers won't continue to drop later in the cycle sometimes. Very, very few people may attempt to dose Vetsulin every eight hours but to the best of my knowledge that would require really intensive BG monitoring for safety.

    If it were my cat I would not be one bit comfortable giving doses of Vetsulin mid-cycle in the manner advised by your current vet. I don't think it's safe, and I don't think it will help improve Scooter's regulation. (Note that other members may take a different view.)

    (Note: There are some members here using advanced techniques to manage BG levels for 'special needs' diabetic kitties using both gentle, long-acting insulins plus some very short-acting bolus insulin treatment to help numbers down at some points in a cycle but they are very much the exception, not the rule - and to the best of my recall they don't use Vetsulin as one of the insulins.)

    I wish I knew more about hyper-T and how it might affect regulation but just looking at the BG regulation side of things if Scooter is already getting too much insulin adding more insulin would be both unhelpful (driving numbers up, not down) and potentially dangerous (greater risk of unexpected hypo events).

    Questions:

    Can you let us know how much Scooter weighs and confirm that he is currently underweight?

    Can you tell us what dose Scooter started at?

    Can you tell us how quickly Scooter's dose was increased - and also how big the dose increases were (e.g. quarter / half / full units)?

    Also can you tell us what diet Scooter was eating at time of diagnosis and what he is being fed now?


    Mogs
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  11. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    Thank you Mogs!

    I actually reduced his dose this morning to 4 units because I didn't feel good about his numbers after reading some info on this great site. What you said makes perfect sense. Is it okay to drop him to 3 units tonight?

    He has only been on 4.5 since December 5. He was on 3 for all if November when he was pretty regulated. Rarely went over 515 preshot. When his t4 levels came into range his blood sugar spiked. Im starting to think he should have been dropped to 2 units instead of increased to 4 for 2 days then 4.5.

    I will download and post on the sheets at work tomorrow.

    So glad I found this site for Scooters sake!

    Thank you for your knowledge.
    Jeff
     
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  12. Jeff Phillips

    Jeff Phillips Member

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    Dec 8, 2016
     
  13. Jeff Phillips

    Jeff Phillips Member

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    Dec 8, 2016
    Oops I didn't know how to respond to a quote and actually added to your original post above..

    Still learning
     
  14. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    You aren't the first to do that, Jeff, and I very much doubt you'll be the last! :D

    I don't think you'd have much to lose by trying the 3.0 IU dose tonight. Do you test Scooter for ketones regularly? Is he eating well?


    Mogs
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  15. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    BTW when posting:

    1. If you don't want to quote anything just go to the text entry box at the bottom of the screen and start typing.

    2. If you want to quote a full post click on the "Reply" option at the bottom right hand side of the post in question. The full text of the post will appear in the text entry box and you can type your comments below it.

    3. If you want to quote only part of a post click and drag your mouse over the text you need so as to highlight it. A little black "Reply" tag will appear on the screen next to the highlighted text. Click on the black tag and only the highlighted text will be quoted in the text entry box. Add your comments below the quoted text.


    Mogs
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    Last edited: Dec 16, 2016
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  16. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    I don't test for ketones (scoopable litter and he doesn't care for me to mess with him when he is going potty) He eats as much as I let him. He just ate some tuna and a some kibbles of proplan true nature. He has been on a strict 4+ oz of wet fancy feast or friskies pate at 6am and 6pm before shot. I come home for lunch and usually give him a wet food snack. He always meets me in the kitchen and if he ever stops something is wrong.

    I will do 3u until I take him down to 2 u. How long do I need to keep him on 3 before a change?

    Honestly looking back at my records 2 or 2.5 was a good dose. Not sure why it was passed over. Vet said keep him on 3 and I did.

    Thank you for the posting info that will help tremendously.

    Jeff
     
  17. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    If you can get that data into a spreadsheet, Jeff, we can have a look at it and help you to interpret it.

    Here's a helpful general guide to Vetsulin:

    FDMB Vetsulin/Caninsulin Guide

    Be sure to allow about 30 minutes after the preshot feed before giving the insulin to so that it has something to work on. Also, it might be worth trying to give Scooter a snack of his regular food at about +1.5 after the dose was given to see whether it might slow the drop and perhaps even out his numbers a bit.

    Here's another link for you. It explains how the body responds when a dose is too high or when the dose drops the BG too hard and fast. I hope it's helpful to you.

    http://petdiabetes.wikia.com/wiki/Somogyi_rebound


    Also here are some general links about hyperthyroidism and diabetes:

    http://www.caninediabetes.org/pdorg/hyperthyroid.htm

    http://www.diabetesselfmanagement.c...s-information/thyroid-disorders-and-diabetes/


    It seems from the two articles above that there is significant impact on blood glucose control when the two conditions are comorbid.

    I do wonder whether a change to a gentler, longer-acting insulin like Lantus or Levemir might help Scooter better. As I mentioned yestereve, in cats who metabolise insulin quickly lente insulins like Vetsulin can poop out too soon (my Saoirse would metabolise insulin very quickly so I'm familiar with this effect). The L insulins are depot insulins. With successive doses they build up a 'chemical tank' of insulin in the body which releases gradually thus extending the duration of benefit. (They are used as basal insulins in humans.) Because of the depot the cat benefits from more continuous insulin availability. Treatment starts at a relatively low dose, it's held for a number of cycles (with appropriate daily BG tests to make sure it's safe and to assess efficacy and duration) and adjusted in small increments - typically 0.25 IU. By titrating the dose upwards in this slow, steady fashion it is safer for the cat and there is less likelihood that a 'good dose' will be skipped over. You can learn more about the L insulins by reading the forum stickies at the top of this board:

    Lantus & Levemir Insulin Support Group

    With regard to testing for ketones, you might try placing some plastic food wrap over one of Scooter's 'favourite spots' in the litter tray and pushing it down a little to make a well. If it works it's a handy way to catch a little bit of urine for testing. Alternately you can get blood beta ketone meters which work in the same way as a glucometer. The strips are a bit pricey but the ability to do spot checks for ketones without the aggravation of trying to collect urine samples makes them a well worthwhile investment. If you are going to reduce Scooter's insulin dose I strongly recommend doing ketone checks to protect him from the risk of developing DKA (which can put a kitty's life at risk and it is very expensive to treat.) For further information, here is a forum sticky about DKA:

    DKA and Ketone Meters


    Mogs
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  18. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I'm far from an expert on HyperT in felines but in humans it speeds up metabolism so it would make sense that the Vetsulin may be pooping out even faster in Scooter due to the HyperT. A longer acting insulin might be the ticket to better control with Scooter.
     
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  19. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    It most certainly does. My mother developed hyperthyroidism. The weight just fell off her and she used to shake so badly that if she rested the back of her legs against the pew in church on Sundays the whole thing would shake along with her. :oops:


    Mogs
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  20. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    https://docs.google.com/spreadsheets/d/1hNxlHf3NGbWe1ZpUfBYBnnqvmgCUhqctl0ptcynsFE0/pubhtml

    Mogs you have been a godsend to Scoot and I.

    I actually reduced to 3 tonight and you can see by the spreadsheet that he is lower at 8pm than he has been in a long time. After looking at the spreadsheet I was able to see the pattern that was emerging, the more insulin he was given the sudden drop must have kicked his system in protect mode even though he never went hypo. What is sad is that I have gone to 2 different vets for info and they both said increase the dose to 4 and then 4.5.

    Scooter was on a violent path on 4.5 and if I went back to the vet they would have probably said increase. One vet told me to keep him on this dose and give it a week to stabilize. It never would have stabilized and you were correct in your statement that his body would wear down fighting the drop and one day I would come home and find him dead from a seizure induced by hypo.

    Great info you sent on hyperT. Hopefully the thyroid is under control now. It was high normal on Nov. 26 and he goes for more bloodwork this Friday.


    praying this is what he needs. Thank you again and let me know if I posted the spread sheet properly.

    Jeff
     
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  21. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Jeff,

    Great job on the spreadsheet; isn't it a wonderful tool!

    I need to hit the hay right now (have taken sleep meds and need to get my civvie to the vet in the morning) but I'll reply again later.


    Mogs
    .
     
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  22. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Jeff,

    I've been looking at Scooter's data again and there is a strong pointer to his just metabolising the Vetsulin very, very quickly. If you look at the colour coding you'll see that he starts in the blacks, drops for a few hours then most of the time the blacks are back by +8 hours after the dose was given. It very much looks like the Vetsulin is completely pooped out the majority of the time - and for his latest data the 'start black, drop, return to black' seems to be independent of dose.

    I note on the 1st December Scooter stayed high and flat in the black range all day. I wonder whether you might have given a fur shot that morning? The only other noteworthy change that day was the increase from 3.0 to 3.5IU but he did see some BG lowering effect from the Vetsulin in all later cycles.

    After reviewing Scooter's data my own thoughts are that, while there may possibly be some element of rebound in Scooter's preshot and late-cycle BG levels, the Vetsulin just doesn't have sufficient duration in his body to keep his blood sugars out of high numbers for nearly half the day (from preshot to +2, then from +8 till the next preshot - c. 6 hours out of every cycle). That's about as clear an indication as you can get that Vetsulin is not an effective treatment choice for Scooter. Spending that much time each day in very high numbers will be impacting Scooter's ability to utilise his food properly and maintain weight, it is not doing any good for his internal organs and nervous system, and it increases his risk of developing ketones.

    We work on a peer review basis on this board where many members offer their observations and suggestions to other members seeking help. I'm tagging @MrWorfMen's Mom and @Tuxedo Mom to see whether they might have a look at Scooter's data and give you some additional feedback. (Their interpretations and suggestions may be different to mine.)

    Based on Scooter's data, my thinking is that you could try tweaking the 12/12 Vetsulin dose till you were blue in the face but Scooter would still most likely spend half the day completely unregulated; you'd be on a hiding to nothing because the Vetsulin just doesn't last long enough in his little body. While it is true that some people may use an 8/8/8 Vetsulin dosing schedule instead of a 12/12, it would make treatment much more difficult and you'd still probably see wide swings in BG during each cycle because that is in the very nature of the insulin itself. Throttle-break, throttle-break isn't kind to any engine - mechanical or biological.

    If Scooter were my cat I would show my vet the spreadsheet data and ask for him to be treated with a gentler, longer-acting insulin, i.e. Levemir or Lantus. Because of the depot nature of these insulins they typically have greater duration of effect in cats and should provide benefit throughout the cycle when dosed on a 12/12 schedule. With longer duration the hope would be that gradually Scooter's BG levels would move into a healthier range. Also there would be far less likelihood of Scooter having wide swings in BG level between the high and low points of the cycle.

    If we assume that the data for 1st December 2016 is where Scooter's BG would be without insulin (maybe due to the thyroid issues?) it is possible that he might need a significant dose of an L insulin to keep him regulated. Because of its formulation, Lantus can sting when administered - especially at higher doses. Levemir has a different biological mechanism of action and does not sting. Therefore Levemir might be a better choice to consider for Scooter.

    I have attached below a PDF of a peer-reviewed, published study on the treatment of diabetic cats with Lantus and Levemir. One of the authors, Dr Rand of the University of Queensland, is a world authority on feline diabetes. It might be helpful to you and your vet.

    In the meantime I think you may need to find a dose to give Scooter that keeps him in reasonable numbers for part of the cycle but which doesn't take him too low and put him at risk of a hypo. With such high preshot BGs I think reducing the dose would likely make matters worse (pending data to the contrary from today's cycle). Perhaps somewhere between 3-4 units? (@MrWorfMen's Mom, @Tuxedo Mom: do you think this is a valid and safe suggestion? I would welcome your input here.) I still think the 4.5IU is a tad too high because of the double-digit nadir you saw on 7 December 2016. The FDMB Vetsulin guide suggests aiming for a nadir in the low 100s (as measured on a human meter - aim a bit higher on a pet-calibrated meter) so that there would be a reasonable safety buffer in case Scooter might for some reason run a bit lower than usual in any given cycle. If you feed a mini-meal at +1.5 hours as suggested in the Vetsulin guide it might slow the drop a little and perhaps go a little way to helping Scooter's numbers not to head skywards quite so quickly as the dose starts to wear off. (Worth a try.)


    Mogs
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    Attached Files:

    Last edited: Dec 12, 2016
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  23. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Just had a peak at Scooter's data and I have to second all of Mogs' theories/suggestions. It definitely looks to me like Scooter is metabolizing the Vetsulin so quickly that it is gone by +8 hours post shot. With a HyperT cat and the inevitable battle to keep their weight up it seems to me that getting Scooter onto an insulin that would give him longer lasting effect would be key. Diabetics lose weight too when not regulated so getting the diabetes under better control is key to being able to get some weight back on the little guy.

    I too would recommend Levemir over Lantus although Lantus would be a good second option. I have a high dose cat and the sting from the Lantus was why I switched from Lantus. After switching I also noticed my girl's demeanour and energy levels were better. I also think Levemir tends to have a bit more staying power over Lantus but that could just be my kitty's individual response. Many vets are not familiar with Levemir (mine didn't even know what it was) for kitties but if you use the document Mogs provided as a reference, it should give your vet the info they need.

    Dose wise, I'm inclined to think 3u was a better dose for Scooter than the 4.5u. I don't see any data for the lower 2u to 2.5 you mentioned above. You didn't try 3.5u for any length of time so that might be even better but I think he's bouncing from those massive BG drops and his quick run back up to high numbers before his next shot. Eventually his reserves will get tapped out and he could end up going too low on the 4.5u. All that bouncing up and down is hard on Scooter so anything you can do to get him into smoother less dramatic cycles would be ideal.
     
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  24. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    @MrWorfMen's Mom -

    Thank you very much for answering the tag, Linda, and for your input.


    Mogs
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  25. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    hank you
    Thank you Mogs
    I believe it was a fur shot, good eye and I did notice wetness but did not want to administer another dose.
     
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  26. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    Mogs thank you for the time you have taken to help us! Scoot and I really appreciate it. My daughter was laying under the live plantable Christmas tree we get every year loving on Scoot. Scooter has always been an indoor cat and hates to go out but he sure loves trees.
    Tonight at +2 he is 372 on a slow curve downward on 3 units. His high level must be right at 600 or just above cause +1 he was 478. He was feeling much better this morning cause he meets me every morning in the kitchen but this morning he was headed to the bedroom to get me meowing that he was hungry for his wet food.

    I sent an email to the vet stating I had additional curves and Scooter needs a longer lasting insulin but no reply yet. I might need a new vet. She is the same vet that told me I test him too much and that people don't test as much as I do him. That's just nonsense because when Frisky was on humilin insulin in early 2000 I tested every morning before shot. Thats how I found one morning his bs was 80. He went into remission and lived to an old age of almost 20 when he died of natural causes.

    I really do appreciate your quick response because ultimately it saved Scooters life and took a little stress off me in the process.

    I looked at Saoirse's spreadsheets and he is better regulated than my Scooter and that's what Im working towards. I am so scared of organ issues because of the diabetes. He has been hyperT since 2012 and all bloodwork came back excellent including pancreas, kidneys, liver, etc.. but that was right when he was diagnosed diabetic at the end of August 2016. Hopeful the new bloodwork will show the same or close to the same. As you have seen he stays yellow, red and black often and some in blue and less in the repair green.

    If my vet doesn't get back to me I have another that has been recommended.

    I can't thank you enough from the bottom of my heart for the guidance you and other members on this site have done to help me understand this better.

    And I tried to quote certain statements and messed up again. I will eventually get it right. Lol...

    Jeff
     
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  27. Jeff Phillips

    Jeff Phillips Member

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    Dec 8, 2016
    Thank you Linda!
    I have some data from September 1-October 31 that I plan to enter in the spreadsheet but not as detailed as recently. I did a few curves but mostly checking preshot, +3, +5 and +7 when it was on its way back up regardless of dose. I think a longer lasting insulin will help Scooter better. The hyperT is under control again but he lost so much weight and his back is boney. Hasn't lost anymore and might be gaining a little back slowly but with the tight window for his body to actually use the insulin to feed his cells, I don't see major weight gain in his future. He got hit hard when diabetes kicked in and I didn't catch it in time and when his bloodwork came back his t4 levels were around 9 and they should be 2-3. Now the were 5 last check. A little above high normal but his methamazole was increased some and it should be within now. He was controlled on .25ml twice a day or 5mg a day to now 17mg a day. A major increase.

    Thank you again Linda and I appreciate your interest in Scooters health. I have contacted my vet on a longer lasting insulin but probably will be changing vets soon.

    I can't thank y'all enough!!!!

    Jeff
     
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  28. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    That's quite the increase in methimazole and his levels are still a tad high but indeed much better. I just did a little search and found out that a kitty who is HyperT prior to diabetes Dx, often has developed insulin resistance as a result of the HyperT. This means the pancreas is still working just fine but the kitty can't utilize the insulin properly. If the HyperT can be brought back to normal levels, then the diabetes can go away. It's a different situation when the diabetes is the primary ailment. So it appears that if you could get Scooter's HyperT under control, there may be a chance that the insulin resistance will go away. The video I found by a vet endocrinologist is HERE.
     
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  29. Jeff Phillips

    Jeff Phillips Member

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    Dec 8, 2016
    You are so awesome, I've been looking all over the web for info on both conditions combined with no luck. It's weird how his thyroid was under control and all of a sudden his methamazole more than doubled. Also his t4 was under control on 5mg a day when the diabetes began treatment. A month later t4 was run and it hit 9. Dose was increased to 10mg a day with a drop in T4 levels to 8. Then it was increased to 15mg a day and he hit 5.3. Increased to 17mg a day and rechecking this Friday.
    Vet can't figure that out and either can I. Im checking him every 2-3 weeks for T4 levels because if that reversed a 17mg hit on his kidney and liver can't be good.

    Little guy is in good spirits though.

    Jeff
     
  30. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    Have one question about food.
    Right now his levels are 250 and dropping on a gradual curve which will peak at 11:00-11:30ish.

    He wants a tuna treat now. Do I give him some or wait till +6. Does it matter? How much does this affect his levels when the insulin is bottoming out?

    Still working on tagging Linda. Im still in learning mode.
     
  31. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Sorry Jeff. Just seeing this now. Feeding times are a bit of an individual situation so there are no Feed at +X hour etc. guidelines except for pre-shot meals and no feeding two hours before the pre-shot test. Some folks allow their cats to graze while others have fixed feeding times. Some feed twice daily, some four, some six. The decision about feeding times is one of convenience/ablity for you and how kitty reacts to insulin. Sometimes kitty can get adamant they WANT food NOW and it's no where near normal meal/snack times so we test to see if we can pinpoint the reason for kitty's insistence.... are they dropping low or very high. Both low and high BG can make kitty extremely hungry. This is something you just have to play by ear in the beginning and come up with your own formula and it helps to make notes so you can refer back to see how BG is being effected by meals of different foods and at different times in the cycle. So if Scooter wants some tuna earlier than +6 give it him and make a note of it so you know his +6 was food influenced and by what.
     
  32. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    I gave in and gave him some tuna at +5 when his levels for the night hit 240(lowest). Good thing is that the rapid drops and spikes are gone and his preshot level this morning was 566 so his nadir should gradually come down to where it was in November around 100-150. First time in about 2 weeks it has been under 600+. All our 5 kitties are free feeders that age from 12 to 18. Rootey the 18yo is in great health and gets upset if I pick up the food. Scooter does too but he prefers wet food or occasionally tuna.

    Thanks,

    Jeff
     
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  33. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Glad Scooter got his tuna fix. There is nothing harder than staring into those soulful pleading eyes when they want food and you don't want or can't feed them. Went through that with my girl this morning in that 2 hours prior to AMPS test and man can she talk up a storm when she wants food and doesn't get it! I spread out my girl's daily rations in six helpings, 2 full size meals for shot times and 4 small snacks. She's pretty routine about when she wants food through each cycle so if she gets antsy early, it's my cue to find out if she doing one of her cliff dives or calling my bluff because she is running high.

    I have an 18 yr. old too but I'm a bit concerned about him right now. He is a bit senile and has gotten very fussy about food and not eating as well as I'd like. I've been poaching chicken breasts for him and I'm beginning to wonder if some of his stubbornness with his cat food now isn't a product of my spoiling him.:woot:
     
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  34. Jeff Phillips

    Jeff Phillips Member

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    Dec 8, 2016
    Haha I completely understand cause all our cats have been with me from 3 months to 18years so they have had plenty of time to train me. Lol
    Spoiled is an understatement but haven't started chicken breasts yet because once I did as a meal they would never eat anything else. Rootey more or less thinks she deserves what she wants when she wants it and can be picky at times. She is the alpha female and Scooter is the alpha male. Even though Scooter has lost weight and doesn't play as often as he used to nobody challenges his position. If they get picky about food as I learned with Rootey, make sure they eat. Rootey had fatty liver in 2014 and again early 2016 but was able to catch the signs and syringe feed her with A/D and 2 days later she was eating on her own again.
     
  35. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
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    No worries about making sure my old guy eats. This Mama has been known to buy steak and cook it up for him on his fussier days.:D While some of my friends think I'm totally nuts, I just don't think it's possible to spoil them too much. I get so much more back from them all than I give them!
     
  36. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    They sure do give so much back. Therapeutic in a wayI share steak but haven't grilled one just for them yet. It's a shared treat.
     
  37. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Jeff,

    Just checking in to ask how Scoot's doing today.

    :bighug:


    Mogs
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  38. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    Thank you Mogs he is doing better on 3 units. In blue but no green yet but has stopped drinking and peeing considerably which is a good thing. Still drinking the same though.


    vet hasn't returned my calls for a longer lasting insulin yet. Probably stopping by a new vet on the way home tomorrow.

    Thanks bunches Mogs:)
     
  39. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Jeff,

    I am glad to hear that Scoot's doing better; the reduction in PU/PD symptoms sounds encouraging!

    When you get a chance could you update Scooter's spreadsheet BG data, please? I'm really keen to see what his BG is up to.

    Fingers and paws crossed for you to get the right veterinary support today. Be sure to let whichever vet you consult know about the improvements you've observed in Scoot's clinical signs since adjusting his dose as well as showing them his BG data. Looking forward to hearing how you get on.

    :bighug:


    Mogs
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  40. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    Hi Mogs

    I will update Scooters spreadsheet today. His curves look better now that he is back on 3. (Actually 3 to 3.2) u40 syringes are hard to get exact for me. I wanted to post after I had a few days on 3. By information you sent me I believe he could be bumped up a little.

    His high has been 576+-, nadir varied but is around 200 and the mid point is around 300. He stays at 220-240 for a longer time and there is no immediate spike upward after his lowest point like there was previously. Woohoo! He has gone back to laying on the floor next to me when I do my T25 workout so he feels much better:)

    But yes I believe you are 100% correct that Scooter would be better off with a longer lasting insulin.

    Thanks bunches Mogs you have been an awesome help to Scoot and a bonus that I can actually sleep better.

    I will try and update at lunch. The curves aren't as thorough but they hit a bunch from 0- +6, +7. I plan on a good 12 and 24 hour this weekend.

    Jeff
     
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  41. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Oh, boy! do I know what you're going through, Jeff. :bighug: I'm glad that both you and Scoot are starting to feel better. It shines from your posts how much you love your boy. :)

    That's good to hear. :)


    Mogs
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  42. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    PS: Please give your little fella some fusses from me. :bighug:


    Mogs
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  43. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    He is a special boy indeed. Im in engineering and one of our drainage projects in jan 2000 a little itty bitty 6 month gray thing came out near the interstate meowing and hopped in my truck. I went to the store to get him some food and the rest is history. Rofl
    He has been with me through a divorce in 08 and just about everything else. He liked to play fetch when he was younger but now prefers the laser.

    They do have a special place in our hearts.
     

    Attached Files:

  44. Critter Mom

    Critter Mom Well-Known Member

    Joined:
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    Awwww! They really do choose us! :cat:

    (((Scooter)))

    I'm glad that Scoot has been there to help you through the tough times, Jeff. :bighug:

    I developed PTSD after a car accident in 2006 and my life just completely unravelled; I lost everything. I went though years of misery while the litigation related to the accident was ongoing. Between that and the effects of the illness itself I honestly don't think I'd still be here were it not for Saoirse's love and companionship; she gave me a reason to keep living. This is going to be my first Christmas without her physically here with me ... :(

    It's a great photo of the two of you! Both Saoirse and Amadán, her brother, would stretch up like that looking for their nosh. I miss being able to see their little faces looking up at me, though I can still vividly picture them doing so in my mind's eye.

    Saoirse and Amadán are without a shadow of a doubt the two greatest loves of my life (and I say that as someone who absolutely adored her father). I was thrilled when the lady who ran the rescue shelter where I first met them agreed to let me be the one to adopt them. I already had two rescues, Tara and Psycho Fatboy the Third, whom I was completely dotty about but there was just something about Ammie and Saoirse that captivated me even more. When they came to make their home with me I spent the first few nights sleeping on the sofa so as to reassure them and not rattle the incumbent kitties too much. On the morning after their second night with me I found the two of them parked right on top of my heart, staring intently at my face, waiting for me to wake up. From that moment on they entwined themselves around my heart and my soul, and there they will stay forever. (((Saoirse and Amadán)))

    Aren't we truly blessed to be loved by these magnificent creatures! :)


    Mogs
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  45. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I love hearing all these "true" love stories. We are indeed blessed to have these furry bundles of love in our lives. :cat:

    So happy to hear the lower dose is helping Scooter (and his Papa) feel better! :D
     
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  46. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    https://docs.google.com/spreadsheets/d/1sWDKEa-WUHSFnvLA3y9fdl0_FtegaVtOUJzwf6ZPZHk/pubhtml


    Im so sorry about your babies, I was unaware that they are not here in physical body.:)
    You have had a rough time and I know all the furbabies helped you through the worst:) and are still watching over you.
     
  47. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I work on the principle that Saoirse's spirit is still here beside me. I still spend the whole day talking to her; I just can't cope with the thought of being completely without her. (((Saoirse)))

    It is beyond dreadful to be physically parted from our little ones but, as incredibly painful as it is, there is something that could be worse: never having had the chance to share their lives; to love and be loved by them.


    Mogs
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  48. Jeff Phillips

    Jeff Phillips Member

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    Dec 8, 2016
    I couldn't have said it better myself Mogs.

    Jeff
     
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  49. Jeff Phillips

    Jeff Phillips Member

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  50. Critter Mom

    Critter Mom Well-Known Member

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  51. Critter Mom

    Critter Mom Well-Known Member

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    Hi Jeff,

    Just had a quick gander at Scoot's spreadsheet.

    I see you've nudged the dose up to 3.25IU Vetsulin and that Scoot's now spending part of his cycle in a range that's probably under the renal threshold (varies from cat to cat but is typically somewhere in the 200s). Is Scooter drinking and peeing any less since you tweaked the dose? Also have there been any changes in his appetite; in particular is he a little less hungry by any chance?

    Also did you hear anything back from the vet about the possibility of switching your boy to a longer-acting insulin? Scooter's responding well to insulin, it's just that the Vetsulin doesn't last long enough. An L insulin should make a big difference.

    What's Scoot's form like today? Improving, I hope. And I hope you're sleeping a bit better, too. :)

    (((Scooter)))


    Mogs
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  52. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    @Critter Mom @Jeff Phillips, I just noticed we are still on the Welcome board and this thread is getting rather lengthy and we try not to discuss dosing etc. on this forum. I'm sure one of the moderators will be telling us to move our discussions and advice to either Health or the Vetsulin forums very soon. So Jeff, when you next post, can you start a new thread over on Health HERE or in THIS forum for Vetsulin users. We can take a link of this thread and plant it there so we keep continuity. :)
     
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  53. Jeff Phillips

    Jeff Phillips Member

    Joined:
    Dec 8, 2016
    He is drinking around the same amount just not peeing it out. Yes I don't use the tech terms. Heehee.

    His appetite is not huge at 400-600 level but when it drops he is really hungry. I feed him a snack at +5 to +6 of his protein food. I slso see him grazing some. I know that's not ideal for control.

    What I noticed on the .25 increase is he stays below 200 longer but never drops below 150 like he did in November.

    You were right that 4.5 was too high. You can see that at his new +1 and +2 levels, also the drop is not as quick and the spike after peak doesn't skyrocket. Its gradual.

    Im taking Scooter in to the vet tomorrow at 9am for T4 level test and she said we could talk about maybe using prozinc. Not sure but what I read this is along the same lines as vetsulin.

    All in all he stays in the middle of the floor out in the open, in the kitchen or under the Christmas tree. He normally hides behind the couch when he feels ill.


    What are your thoughts?

    He does need a longer lasting insulin to keep him below 200-250 longer. I have the spreadsheet printed out and updated to take with us tomorrow.

    Scooter hates the vet. Lol

    Jeff
     
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  54. Jeff Phillips

    Jeff Phillips Member

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    Dec 8, 2016
    Yes
    Thanl you
     
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  55. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    We'll keep an eye out for you Jeff. :)
     
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  56. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Jeff,

    If it were my cat in this situation I'd hold out for one of the depot insulins - Levemir or Lantus (unless your vet can provide indisputable clinical evidence to prove that L insulins are contraindicated for Scooter). If my current vet was unwilling to prescribe an L insulin I think I'd try to find a vet who was willing to work to provide a better treatment for my kitty's diabetic needs.

    Prozinc is another in-out insulin like Vetsulin. The dose goes in, it gets used up within 12 hours, and another dose is given.

    Prozinc is supposed to have longer duration in cats than Vetsulin but consider the speed with which Scooter's metabolism is eating through each dose of his current in-out insulin: it is pretty much completely G.O.N.E. by +8 (even though in an 'uncomplicated' cat it's supposed to give another - less powerful - spurt of BG-lowering effect between +7 and +10).

    My concern would be that, while Prozinc may possibly provide a little bit better cover, in a cat whose metabolism is faster than average it would still be very likely to peter out well before the next dose was due during which time BG levels would skyrocket again. Also with Prozinc there could be wide swings in BG over the course of each cycle (as is the case currently with Scooter's response to Vetsulin).

    Conversely with a depot insulin like Levemir or Lantus the 'tank' of insulin in the kitty's body would provide more continuous BG-lowering effect and therefore offer the best chance of the kitty having enough insulin available in the body to provide better regulation 24 hours a day - and smoother BG levels overall.

    Prozinc could prove to be a 'less bad' treatment option than Vetsulin whereas one of the L insulins should, in theory, be an effective treatment option much better suited to Scooter's particular diabetic needs.

    My two penn'orth.

    @MrWorfMen's Mom - Your thoughts, Linda?


    Mogs
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    Last edited: Dec 16, 2016
  57. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    This is very important information to draw the vet's attention to, Jeff; it's further evidence in support of a switch to a gentler-acting insulin which is less likely to produce wide fluctuations in BG levels throughout the course of the day.

    The whole purpose of giving insulin treatment is to make Scooter feel better. Between your BG monitoring and your observations of Scoot's clinical signs you have been able to identify a direct correlation between less violent swings in BG levels and definite improvements in Scooter's quality of life. Your vet should very much take this into account in your discussions about Scooter's treatment needs going forward.


    Mogs
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  58. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
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    I had the opportunity to help another member who was using ProZinc for her cat and while it is somewhat gentler in it's action than Vetsulin and works wonderfully with some cats, it can and does produce wild fluctuations in others. I think with HyperT in the mix, which in your case with the HyperT preceding the diabetes, could be causing insulin resistance, it makes your situation similar to mine with my high dose IAA positive cat. You are better off using a longer lasting insulin with any insulin resistance situation so that there is definitely 12 hour coverage and that little backup depot to ensure duration as well as keeping readings on a more even keel. I vote Levemir or Lantus too. :)
     
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  59. Critter Mom

    Critter Mom Well-Known Member

    Joined:
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    Of the spreadsheets I've seen for kitties on Prozinc I've always been struck by the number of them who have such a response; so many seem to have high BG at preshot. Given that Scooter's BG heads for the stratosphere as soon as his insulin dose wears off. Based on the data from the AM cycle where the fur shot happened that sky-high level would appear to be where Scooter's BG baseline would be were he not receiving any insulin at all. I cannot see Prozinc being of that much benefit to Scooter. Most likely it would still leave him unregulated and at very high BG levels for part of the day, just not for quite so long; hardly the ideal insulin choice for him when there are more suitable options on offer.

    Jeff - keeping fingers and paws crossed here that your vet will be open to prescribing a depot insulin today for Scoot. As discussed earlier in this thread, because it doesn't sting and many cats seem to have brighter mood and better energy when being treated with it, I think Levemir would be the one to go for as a first option for Scooter.

    To aid your discussions with your vet I'm uploading the PDF of the Roomp-Rand published study on the treatment of diabetic cats with Lantus and Levemir. If you print out a copy and take it with you to Scooter's consult today it may help you in securing a prescription for one of these gentler, longer-acting insulins.


    Mogs
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    Attached Files:

  60. Critter Mom

    Critter Mom Well-Known Member

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  61. Jeff Phillips

    Jeff Phillips Member

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    Thank you Mogs:) I started a new thread but haven't learned how to tag you yet. Its under health and labeled Scooters multiple endocrine issues.

    Look forward to your continued guidance over there.

    Hopefully my vat will see what we see and gives him something to better level out his levels. He is acting better but the roller coaster ride of his levels can't be good.

    Jeff
     
  62. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Jeff,

    If you look at post #60 above (post number is on right hand side of screen below the text) you'll see I've included a handy clickable link to your new thread on Feline Health. We know where to find you! :D ;)


    Mogs
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