Marley's Adventure - new to this with high numbers

Hello!

My wife and I are providing special care for our 11 year old male, Marley. His sister, Maddie is presently in good health so we're looking to maintain for her as well as hopefully get him in control.

Having cats in the past with kidney issues, we opted to keep them on an urinary health formula for the majority of their lives. Their diet was Purina Pro Plan Urinary Tract Health dry food and treated them on occasion with canned foods that were heavier on the gravy... they are both gravy lickers rather than wet food eaters. They've always seemed to prefer their kibble ... and yes it was always more convenient for us.

6/10/2019: Marley was diagnosed with Pancreatitis and spent a few nights in the hospital on IV fluids and they recommend we switched to a food that was easier on his digestive process. This is when we switched to Hill's Science Diet Sensitive Stomach & Skin, we also noticed that we had fewer piles of undigested food in random places throughout the house.

8/9/2019: Marley was diagnosed with Diabetes and spent a night at the hospital testing his glucose curve. Looking back, we noticed an uptake of water and wet litter content for about 2 weeks prior to the vet trip. At this point in time the vet said that it was probably easier to tune his insulin intake and keep the same diet as long as he ate very consistently. Was prescribed ProZinc, 2U once daily.

8/19/2019: Marley went back for anther curve. Vet said to continue 2U, once daily because glucose levels had not started to rise after 11 hours. Recommended that we consider switching to DM diet. Researched DM vs Hill's w/d and settled on w/d believing that it would benefit both cats more than DM... Nice marketing on Hill's part.

8/31/2019: Bought an Alpha Trak 2 because he seemed lazy would occasionally wonder around the utility room (litter boxes in here as well as a ton of other stuff) and howl. We watched multiple times, it didn't seem to be related to his litter box habits, just like he was lonely or bored, never shows signs of pain in litter box or accidents etc.

We bought the Alpha Trak 2 because we were concerned of his glucose levels dropping, when in reality they are not. In-fact, it appears that the Hill's w/d was actually causing a higher BG number than the sensitive stomach and skin dry food. We're still testing and trying to come up with some accurate numbers at this point though.

After reading this forum, we are working to switch them over to an all wet food diet ASAP. We want to see the numbers prior to involving the vet again. I know that Marley won't eat as well for them and they won't be able to obtain "everyday" average results. We're also certain that they'd just want to immediately up the dosage which as we've read would cause us more issues when we are working to totally change their diet.

We are not opposed to switching his dosing from once to twice a day or varying the dosing amount but we do want to have a conversation with our vet prior. We'd also like to see what happens after switching his diet over for a few days before making a lot of adjustments. As far as Marley's behavior, he seems pretty normal and based on testing ... when he does have slight changes, it doesn't seem to be because of his BG.

Concerns at this point:
- His curves seem to be significantly higher than others that I've seen on this forum.
- Will a diet of FF Classics cause him issues with Pancreatitis flare-ups? Are they easy for him to digest?
- Any advise is welcomed, we'd love to know if we are doing something wrong to get Marley well ASAP.

Other past history:
- Neutered as a kitten.
- Infected tooth removed more than 1 year ago.

Thank you all for the help!

 

http://www.felinediabetes.com/FDMB/threads/marley-here.218933/ from the Intro forum so that advising members can see my reply to your first message on the board.

I am tagging in more experienced members than myself regarding the dosing your vet has recommended to this point. Of course you want to do the best thing for Marley and get those high BG levels down.

@MrWorfMen's Mom
@FurBabiesMama
@Lisa and Witn (GA)

I have had no experience with Pancreatitis and I'm sure that others will chime in on your questions. I can provide a link to the Primer on Pancreatitis though, hopefully that will add more information to what you already know from your experience:
http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

 

Hi and welcome to FDMB. Kudos for being pro-active and starting to home test Marley. Your meter is your most important tool in keeping Marley safe and getting him regulated and on the road to better health. And it's great that you are transitioning him to a wet low carb diet. That too will help to get his BG regulated and under control.

The first thing I would do is start twice daily shots 12 hours apart. I'd suggest a dose of 1u twice daily. Cats have a fast metabolism and while it does happen, it's extraordinarily rare for a cat to do well on one shot daily. The insulin is only active in the cat's system for half the day putting kitty on a roller coaster of ups and downs or into a perpetual bounce (elevated BG) which is what it appears may be what is going on with Marley.

Insulin is a hormone that is active and needed 24 hours per day. It allows the cells to get the nourishment they need. Once a day shots means for half the day, Marley's cells are starving. And if that daily dose is more than Marley really needs, as soon as it starts working to pull his BG down, his body panics and starts dumping out more glucose (bounce) to keep the status quo it has become accustomed to, creating a vicious circlea and high BG.

ProZinc generally reaches peak action +4 to +7 hours post shot so getting mid cycle tests in that time frame whenever you can will tell you how low the dose is taking BG. The test before each shot tells you if it is safe to give insulin and we recommend no shot unless BG with your pet meter is between 225 and 250 until you get more data. Getting a before bed test every night also helps to fill in the picture of what is happening on a 24 hour basis and also ensures you can take action to slow things down if BG is dropping quickly on the night cycle. Our kitties quite often go lower at night than they do during the day so it is crucial to get some night time data to truly see what is going on and to see if a dose is working well or needs to be adjusted.

The FF pates should be fine for Marley. The important thing is to find food he likes and tolerates. There is really no reason for a special diet as there are lots of options to choose from if FF is not to his liking or doesn't agree with his tummy. I would make any food transition gradual to avoid a GI upset and to ensure you can gauge any need for insulin dose adjustments as often a change from high carb dry to low carb wet diet reduces insulin needs. In some cats, the diet change alone can put them into remission making monitoring during the diet transition absolutely crucial.

It can take a few cycles (up to six 12 hour cycles) for any bouncing to clear and for you to really be able to see how a dose is working for Marley so unless you start getting pre-shot tests too low to give insulin or BG is dropping too low mid cycle, hold the dose at 1u twice daily for the next 3 days. You should aim to keep Marley's BG no lower than 90 for the moment.

Normal range is 68 to 150 and any reading 68 or lower means BG is going too low and you need to take steps to bring BG back up with food. There are instructions HERE for dealing with low BG and THIS DOC tells you what supplies you should always have on hand just in case. Because you are using a pet meter and the test strips are not readily available locally, I suggest keeping a vial of strips in your hypo kit and swapping it out every time you get a new supply of test strips.

Keep the questions coming and feel free to post in the ProZinc forum especially for insulin specific questions. Look forward to seeing you there.

 

Linda has already given the same advice that I would give. One thing that is important is that you should reduce the insulin dose at the same time you change to an all canned diet. Removing dry food from the diet usually causes a significant drop in glucose levels. By also reducing the insulin dose and giving it twice daily, it will help get the glucose levels under control. When you test you should do it before feeding and giving insulin.

I have never used ProZinc so the members on the ProZinc forum can provide better advice. However, for new members we generally recommend setting a "don't shoot" number, usually a BG reading of 200. This means that if your reading is less than 200, skip the dose. As you get more data and learn how he responds to the dose, that number can be lowered. The reason for skipping the dose is to prevent hypoglycemia.

 

Hi and thank you all for the responses. I'm not sure when I should move this topic to the ProZinc forum though.

I actually stopped by my veterinarian's office tonight to update him on the fact that we are in-home-testing now and to show that the numbers were quite a bit higher than we experienced when they did the curve in-office. They originally wanted to run another curve in 30 days, but we wanted to be more proactive and started monitoring ourselves. Based on the numbers that we had prior to this evening he said that we could try a 2U dosing twice a day, but recommended that we start off with a 2U in the AM and a 1U in the PM dosing until we were comfortable with the numbers. I also explained that we were transitioning to a low-carb and all wet food diet.

Today both cats were exclusively fed FF Classics, they seemed to "pig out" on it this morning so I felt pretty comfortable not adding kibble but I had concerns that it may mess with their stomach. I did leave the remainder of the can in their bowls while I went to work. I came home to find happy cats and empty bowls.

I proceeded to test Marley's BG before I ran off to my son's soccer practice at what was now +11hr and found that he was at 121. At this point, I am pretty impressed that all we really did differently was to change food types.

Fast-forward 2 hours to +12.5, starving cats... I fed them a different flavor of FF Classic and immediately tested Marley again as soon as he walked away (about 5-10 minutes) and this time had a reading of 199. Needless to say, I didn't shoot.

Now, I plan to wait and test him again at maybe +15 and/or +17. I need to be easy on strips as I only have about 7 more until Friday evening, so I'm probably not going to be too willing to change up his dosage much until they arrive.

However, I am a bit concerned that if it was at 121 during the 11th hour, what was it really doing during the +4 to +7 hour period. Should I cut back the tomorrow AM dosage depending on the AMPS number?

Thank you!

 

I was looking at your spread sheet, wondering why you put his BG tonight of 199 in the +1 column. Also last night the BG of 472 is in the +1 column. They should go in the PMPS columns. His 8-19-2019 BG of 471 in the morning cycle should be put in the AMPS
column.
Above you say you might test at +15 or at +17. I think that might be confusing when looking at your spread sheet or if you post it like that.
The AM cycle would end at +11, the you begin with the PM cycle, put his pre shot BG in the PMPS column and start again with +1, +2, +3 and so on.
I am no expert, but I see some members suggested shooting 1 unit in the am and 1 unit in the pm depending on his pre shot number. I see your vet recommended 2 units in the am and 1 unit in the pm. I am not to sure about this but I would ask some members what they think about this. All the best with your kitty

 

I did that because I didn’t want to adjust the whole spreadsheet knowing that I was probably switching from a single dose to a twice a day dosing. Those are technically at the +13 hour or later. I was treating PMPS as a +12 hour column until I switch to a “normal” schedule.

His 8-19-2019 BG of 471 in the morning cycle is actually a +1 value. We didn’t have the Alpha Trak at that point and the vet had us shoot him after his breakfast and drop him off. Then they took that reading 1 hour after we gave his insulin. They did his curve that day. It should be in the comments for that line. Do I have it entered correctly after reading the background for that day?

Thank you!

 

Yes I see what you mean about the 8-19-2019 and it's correct. I am glad you will be dosing twice a day.

 

Great. Thank you for looking it over for us. We’re just trying to do the best we can for him. We’re a lot more comfortable now after a month with insulin and a week with the monitor. It really surprised us that he doesn’t even act like he feels the BG testing. Reading about testing made it sound like it would be bad and we’ve not had a single issue with it.

 

That's great, my cat doesn't mind it either, sometimes when he's sleeping and I test him he doesn't even move lol Are you able to test him at +2 to +7 at all.
You mentioned you were wondering what he was between those hours since he was 121 at the 11th hour. He could have been lower than 121

 

You can post in the Prozinc forum at any time. However, if you don't receive a timely response about dosing you can certainly post here in the Main Health forum also.

Regarding dosing 2 Units in AM and 1 Unit in PM I would rather see you dose evenly and see what Marley does for at least 6 cycles, that's three days. If you dose 1 Unit AM and and 1 Unit PM, with the additional low carb diet change, you would be helping to avoid any "too low" blood sugar levels. Better to be safe, and then if Marley does need more insulin, then you can increase by smaller increments than one whole unit, rather by 0.25 or 0.5 U, so you don't bypass a good dose. Cats are small animals and those one unit dose increases are big for them, going from 2 units to 3 units a day might be too much. You don't want to be at work, asleep or out at an activity and not know he's going into Hypo and be there to help him. We would rather err on the side of caution than pay the price of putting a kitty in a precarious situation.

Please read the stickies at the top of the Prozinc forum, it's all good information and will help you help Marley towards regulation.

@MrWorfMen's Mom

 

I can’t until the weekend or if it’s low enough AMPS that I’d only do a 1U and then another 1U in the PM, I’d be able to follow the PM shot up all the way up to +7.

The issue here is that I’m running short of test strips until Friday PM, but if he’s low in the morning I’d much rather cut back to a 1U dosing. That low result earlier was what makes me worry about what could have been happening before I tested.

 

I understand, I do agree with @Idjit's mom about dosing evenly for six cycles. I'm lucky enough that my vet always has the Alpha Trak strips in stock all the time. Marley is a very handsome boy

 

This is more of what we were thinking as well. So basically if his AMPS is over 200, feed and shoot 1U?

 

Yes, the abrupt low BG is a worry, sometimes the diet change to a low carb wet diet is enough to bring a cat into remission, Idjit was on insulin for 11 days with the diet change and has been "off the juice" for 15 months. Our vet also prescribed one unit once a day, and I found it was not the correct way to dose a cat.

Correct.
Many of us use a human meter for the reason of strip cost and availability, it's hard sometimes to keep a good supply of AT2 strips on hand, you never know when you might have a situation approaching hypo and need to test a lot. Plus, the AT2 strips are very expensive in comparison.

 

Another thing that you might not know and I learned here, sometimes too much insulin can look like not enough and vets just keep raising the dose. What is happening is "bouncing"

Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high: (possibly contributing to your kitty's high BG at the high dose he's on)
BG goes low OR lower than usual OR drops too quickly.
Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

 

That's amazing that you were able to turn your Idjit around so quickly. I was finding that after reading quite a few of the stickies and some post here that the vets may not know how to best treat diabetes as well as the collective resources at this site.

I was going to buy a Contour Next meter earlier today for the quick and reasonable test strips, solid reviews, and same amount of blood required as the AT2 I instead purchased 50 more AT2 strips since they were available for Friday delivery and 100 of the Insulinx strips that seem to be well liked by some AT2 users. Unfortunately the Inuslinx strips won't be available for a week but I should have enough AT2 strips remaining to ensure that they are accurate too. Does that seem reasonable or would you recommend just buying a human reader and getting it over with?

Thank you for the information about bouncing. Very good to know and well explained!

 

I would strongly recommend you DO NOT give the 2u dose recommended by the vet no matter what BG is and giving two different doses at AM & PM is just going to muddy the waters until you get Marley regulated. Insulin works best when dosing is done consistently at the same dose twice daily. Starting dose of ProZinc would normally be 1u twice daily so your vet prescribed double the usual starting dose but only once daily.

I would also strongly advise you withhold insulin if BG is 250 or less on the AT2 meter given the readings you got today. Chances are BG will be higher tomorrow. The drop today from 543 to 121 is a huge drop and will no doubt trigger a bounce to higher BG yet again. That lower reading of 121 today may be in part from the change of diet but could also be indicative of Marley's glucose reserves being taxed from the once a day dosing. It is therefore even more important to be sure to get a fasting BG in the AM making sure Marley has had no food for at least 2 hours prior to the test. You need to know the BG is not food influenced when doing pre-shot testing.

Given the readings today and the change of diet, if you decide to give insulin in the AM, I would suggest you drop the dose to 0.5u for tomorrow since you will not be able to monitor and are running low on strips. Make sure Marley eats a good meal prior to the shot and leave food available for him in your absence.

Insulin is not a medication...it is a hormone. While 2 aspirin might work better than 1 for a headache, more insulin can make thing worse. Too much insulin can lead to elevated BG and look exactly the same as too little insulin and this often leads vets to prescribe too high a dose which is what I think is going on with Marley.

 

Oooops, didn't mean to hit "reply". You are quite right about vets not being well educated with feline diabetes, and sadly we have lost kitties or been on the very verge because of inaccurate and just plain bad vet advice.

We were still floundering around learning to test when he just did his thing, and it wasn't a planned event. I am not complaining though.

There are members here who are more than versed in effective diabetic treatment, have had diabetic cats and/or offered guidance for many years. We are very fortunate to have them here. If you will follow that guidance I believe sincerely that you will see progress for Marley and keep him as safe as possible.

 

Okay, makes sense.

Do not give a 2u dose.
Do not give different size doses for AM or PM until regulated.
Do not dose if BG less than 250 at time for shot.

Food is always picked up at night, Marley's AMPS testing is always done after 6ish hours without food.

If his BG is >250, you'd recommend a 0.5u dose tomorrow AM at what point would you recommend a 1u rather than a 0.5u?

Thank you!

 

PM+5 ... or 17 hours after shot just added to spreadsheet at 383 and I'm going to bed. I'll check back in the morning. Thank you!

 

You just changed the diet so I would hold the 0.5u dose for at least 2 maybe 3 days and get what readings you can and then re-evaluate. Hopefully by then some of the bouncing will have dissipated and we can get a better idea of what BG looks like with consistent twice daily dosing. It's easier to start low and slowly increase than to try to guess how much to back off a dose that is too high and diet change can have a significant lowering effect on BG.
That 383 is not unexpected at all. It may continue to climb so don't be shocked if it's higher in the AM.

 

He was at 566, fed and then shot with 0.5u. I'll check him around the +8 mark and check, feed, and shoot (if his BG allows it) at +12.

 

Can you check any earlier than +8 today? If yes, then perhaps a +4 or +5 but if you can't test till +8 that is fine.

 

We're already at the +6 mark and I can't leave for another hour at best. I can definitely catch any hour that you recommend on the PM dosing but I'm down to 6 strips remaining until Friday PM.

 

Gotcha. Test when you get home, pre-shot tonight and a +2 or +3 tonight and based on that we decide if more testing is needed before tomorrow AM. I'll send more info a bit later today as I have to go out shortly.

 

I see Marley's BG has dropped about 100+ points by +2 which is a fairly big drop. I'd check again at +4 tonight and see how much more Marley has dropped. If she is continuing to drop a fair bit, feed her a snack of medium carb food to slow him down. He's high enough he has a lot of room to drop but if the bounce clearing, we don't want him dropping off too far.

 

I was actually just about to do the +3 test, but I'll postpone for another hour to make it a +4.

We really need to work on getting our food and snack supply situated. We essentially panicked when we saw the high readings after get the AT2 and reading about how bad the Hills food really are for diabetics... we looked at the databases of foods and read about the FF Classics and grabbed a bunch of those. Both of our cats seem to love the Turkey/Giblet, Salmon, and Ocean Whitefish pates... so we bought a ton more of those.

We also grabbed a couple cans of the FF Gravy Lovers in the case that we needed to bring him up quicker. We have quite a few cans of Royal Canin and Purina One sensitive stomach varieties left over but I'm not sure if these would classify as medium carb or not.

Thank you, we really appreciate your follow-up.

 

Sounds like you are very well stocked. The FF Gravy Lovers is considered high carb. Not sure about the RC and Purina. In case you haven't seen this yet here is a LINK to the food list we use here. Low carb is anything 10% or less. Medium carb would be 11 to 15% and anything 16% and above is high carb. You can always mix a bit of high carb and low carb together to make medium carb if need be. If Marley has dropped enough, you could use the high carb food tonight.

 

We're at +2=423, +4=462. Assuming we should stick with the 0.5u dosing tomorrow AM as well. Also, we're down to our last two test strips until tomorrow night... assuming USPS doesn't screw up the Amazon delivery.

 

Well it looks like things have slowed down for now so I think you can stop testing until AMPS. Give Marley some low carb food for a snack to hold him overnight and then get some rest. I would hold the 0.5u dose until you know you have more strips for testing should the need for more monitoring arise.

If per chance USPS should screw up, you could head to Walmart and pick up a human meter (Relion Premier). Never hurts to have a backup meter if you choose to continue to use the AT2. The other option is to pick up a vial of Freestyle Lite or Insulinx strips. They work in the AT2 meter and readings won't be 100% accurate but they will be in the ballpark. Works in a pinch.

 

He was a little lower the AM but still in the 500s.

We are grabbing a Contour Next One at Walmart right now, it seems pretty close on cost but slightly higher long term but seems to require less blood. If it's a poor unit, someone please chime up and we'll return it before we open it. We also have have Freestyle Insulinx strips coming next week from Amazon to compare to the AT2 strips.

 

Looks like Contour Next One takes a sample about double the size of the AT2 which may be problematic unless Marley is a good bleeder. Otherwise the meter is fine, I'd suggest perhaps a Freestyle Lite meter instead which then will allow you to use strips in either the human or pet meter. It takes the same small sample as the AT2. Just a thought.

The higher numbers may still be a bounce from the lower readings the other day. See how Marley does today and then we can revisit the dose.

 

Well I guess that one is going back. I could have sworn that I read it was 0.3 like the AT2. Freestyle Lite it is then. Thank you!

 

Contour Next requires a .6 ml sample; ReliOn Prime requires a .4, ReliOn Confirm or Micro if you can get one requires .3, Freestyle Lite requires a .3

one advantage of the Contour Next is that you have 60 seconds to apply more blood if there wasn't enough at first --

most others give you an error code and you have to insert a new strip, discard the one giving the error

 

Freestyle has the same "add more blood" option.

 

Did you get your strips yet or a new human meter? If so I think you can take the dose up to 0.75u and try that. Looks like Marley definitely needs a little more juice.

 

Yep. We have all kinds of goodies now. More AT2 branded strips, 100 Insulinx strips (which shows about 20 less on the control solution), and my mother had an older Relion Micro and some old strips but it showed 107 and 111 on the same control solution. The Relion strips were old, not sure if I trust them, I’d have to read around again but I was thinking the AT2 was typically lower in most cases so it makes me wonder.

 

Lower than what? It will typically read higher than any human meter and the difference will be greater the higher the BG.

 

I thought we read somewhere that the AT2 typically reads a bit lower than a human monitor or maybe that’s in my head.

 

the AT2 will display a higher number from the same drop of blood than most any human meter -- we did a direct comparison at the vet with her AT2 and my Confirm (same thing as the Micro, just slightly larger) --

if you want them, you can still get the strips for the ReliOn Micro from Walmart online -- they will show as ReliOn Confirm strips (not Prime, not Premier) -- those are the ones you would use, they aren't as cheap -- currently $14.95 for 50 -- as the newer ReliOns, but still cheaper than most any other human-meter strip

 

Nope. AT2 will read higher. Human meter lower. Normal range on AT2 is 68 to 150 while on human meter it's 50 to 120.

 

Awesome. I was mistaken about seeing it the other way around then.

The Micro still had the box and all so it said you could use Confirm strips too. I like that it’s a .3ml sample size which is the same as the AT2.

I originally just wanted the human meter as a backup, but maybe I should ask this instead. Other than cost is a human meter better and should we use one as primary rather than the AT2? My plan was to use the AT2 with Insulinx strips most of the time because I can get a ton of them pretty reasonably and just testing on myself and control solution they are pretty much the same (it was actually 12 different on average rather than 20 like I mentioned previously).

 

yes, I am so glad for the .3 sample -- initially I got a Prime and got error message after error message, could not get sufficient blood to make it work even though I once even nicked the vein --- eeek -- lucked out because they had just put the last Confirm meter on the Closeout shelf

my vet was initially skeptical about my using a human meter until we did the direct comparison test at her clinic, with her AT2 and my Confirm, plus she had the link to look at my spreadsheet; because Catcat was stressed (and she could see that from comparison to tests at home) there was quite a difference between the results there, but she noted that at lower values there's no more difference between, than the allowable variance for any meter (to be certified they have to be within 20% of lab findings)

 

Either meter is fine. Neither is superior. Big difference is that the AT2 with AT2 strips will provide readings closest to animal lab values. Pet meters are actually a relatively new tool and human meters were used before the pet meters came on the scene. In many cases of treatment methods/protocols, they've been developed using human meters.

The AT2 meter needs coding and we know of 8 different cat codes for the meter. There may be more. The strips (same as Insulinx/Freestyle) are batch tested to determine which code on the AT2 meter will give you the most accurate lab equivalent readings. The problem with using the Insulinx/Freestyle strips in the AT2 meter is that each new vial of the alternate branded strips may not result in the same degree of accuracy. You may have seen an average difference of 12 points this time but that may not be the case with the next vial of alternate strips. When numbers are running high it makes little difference....high is high. When dealing with low numbers, 12 points could be substantial. That said all meters have a variance allowance of 15% to 20% (depends on age of meter) which adds yet another variable to the use of the alternate strips in the AT2 meter.

As a long time diehard pet meter user, I eventually switched to a human meter but used my AT2 with AT2 branded strips to double check low readings.

The choice is entirely up to you and we can support either choice but most folks here use a human meter.

Happy to see that lower PMPS tonight. Heading in the right direction.

 

Good to know. we think if the numbers get closer to low or risky, we'll use the actual AT2 strips or use the human meter.

We've upped his dosing by .25u now as well after staying at .75u for 6 cycles. We're not noticing any change in litter habits yet, but he has been drinking a bit less since the change to wet food.

Side-note, we think he had his first fur shot last night. It's so hard to tell of a miss with small doses. He also seems to try to army-crawl a way now... he used be incredibly tolerant of the lancing device and the actual injection but he's been getting sneakier.

 

Make sure to rotate shot locations to avoid the development of scar tissue. Have you tried shooting while Marley has his head buried in his food bowl?

Fur shots happen to us all so just note it on your SS so you know if numbers rise unexpectedly. Don't forget to get mid cycle tests whenever you can. They are really critical to see how the dose is working for Marley.

 

We're always trying to bounce around in other areas of the scruff of his neck and been shooting while he's eating for the last couple days, it seemed to work well. Are there other areas that are just as easy on them?

We'll try to fill in some more mid-cycle tests tonight too.

 

Here's a pic of alternate shots sites.

 

Catcat seems to be less aware of the shot if I target somewhere in the mid-back to just behind shoulders -- I look for a loose part of his skin

 

Thanks, I can't imagine he'd tolerate some of those any better but he has surprised us with how well he's been doing. He's made what could be a stressful situation much easier than we could have imagined. We've been targeting looser areas of skin around the shoulder areas. He's got some extra baggage since he's down about 1.5# from 16# and some change.

 

We posted the other day in the Prozinc forum about dosing and now that we're past that, we have some observations and some general questions on how to make Marley more comfortable.

We see appetite loss, weight loss, drier skin, hair loss in two spots on his legs, may not be moving around quite as well.

Just the past 3 days or so, it seems like Marley doesn't have his full appetite. He normally gets tested, fed, and shot around 6-7AM. We feed him (and his sister) a whole can each of FF classics with 2T of warm water mixed up. Most of the time the bowls are pretty cleaned up throughout the day. We normally start the routine over 11-12 hours after the first feeding. If he wants a snack prior to dinner he gets 3-6 pieces of PureBites Chicken Breast & Catnip snacks. We normally pick the bowls up around midnight or so when we go to bed, that lets us have a 2 hour fasting number in the morning. Most of the time, the bowls are pretty much cleaned up (and we get walked on and woken some mornings around 5AM) but recently they've been 1/2 full or so. We've not been able to accurately weigh him, but he's definitely still losing weight. We've read a bunch of times that they often start regaining their weight once they are stabilized though.

He has always had dry skin, it's normally worse in the winter months when the furnace is running though. We've tried this fish oil and he hated it so we've used this spray in the past, we just used a waterless bath on him and have been applying the spray but want to make sure we take care of it as well as we can. We've also noticed the two spots on his legs that you can see in the pictures attached.

We're not certain but it appears that he may be having a little trouble moving around at times. We've read about Zobaline and neuropathy but not sure if that's what we're seeing or if it would even possibly be the best treatment.

Does anyone have any advice at this point that you'd be willing to share?

Thank you!

 

Marley's BG does seem to be a little better but the lack of appetite seems out of line with the improvement being seen. Are you checking Marley for ketones? Ketostix can be purchased at the local pharmacy and you can check his urine. Any reading over trace is cause for a vet consult. Some folks can hold the strip directly under kitty while they pee while others use a plastic spoon to catch a small sample. If Marley is shy about his bathroom habits, you can try putting some crinkled up plastic wrap in the litter box where he normally like to pee and see if you can catch a few drops in the plastic wrap.

When is the last time Marley had his teeth checked? Tooth issues can cause kitty to eat less and also higher BG.

Mobility issues could be associated neuropathy but it could be something else going on too. And the skin issues again could be something entirely separate. Have you changed foods lately? Food allergies can often show up as skin issues. Is Marley scratching more or is it just the patches of lost fur you've noticed?

 

We have Ketostix but haven't been able to get a clean sample. I gave him a tour of the fresh litter box about 20 times throughout the evening with no success though. He's not a big fan of changes in his litter box including different litter types. It's also harder to keep track of which cat is using it without isolating them for some time.

However, he seems to have a full appetite as of last nights meal and maintained some lower numbers. He also seemed to be eating as normal this morning as well but his AMPS was high again, I didn't expect it after the lower numbers at +6. I did leave his food out all night and found it cleaned up but I'm pretty certain that between both cats it should have been gone more than 2 hours prior to AMPS.

His teeth were checked at DX:08/09/19. He doesn't act like it's painful to eat, he's had two previously extracted so we've seen this in the past but will probably open his mouth and check again tonight to be safe.

Is there anything we should/could do as a preventative for neuropathy? Any supplements that may be recommended for that specifically or his health in general at this point?

We changed from the dry foods over to the FF Classics Poultry and Beef packs and haven't looked back, they both seem to enjoy those flavors. We've also been adding a few tablespoons of warm water and stirring them up to make a stew-like consistency. This definitely cut back on how much he drinks but the litter box is still wetter than pre-DX but a bit better than before insulin.

He doesn't really scratch or chew, he's never really acted like the dry skin bothered him much either. We don't notice any real changes other than the two spots and they don't appear to be red or irritated at all.

 

Glad to hear his appetite seems to have picked up. Just keep trying to check for ketones. It is indeed difficult to do with more than one kitty in the house. There are meters available that test for ketones as well as BG and you could consider that as an alternative if his numbers stay elevated. Glad to hear the water intake has decreased and the LB is a little less wet....both good signs.

Did the furless patches show up since the switch of food? Chicken can be problematic. Seems to be one of the main culprits where allergies are concerned.

You could try a supplement called Zobaline available on Amazon for the possible neuropathy and see if it helps at all. It's not a magic cure and most improvement will come from getting BG regulated however it does seem to help speed up the recovery for a lot of cats.

 

Just ordered a Nova Max Plus meter and ketone strips, we'll continue to try the plastic method but we'll have the meter as a backup.

The two patches showed up after the food change to FF, but I'm not sure they are related. I'm actually wondering if the front leg was from the vet shaving it, it's sad that I can't remember or didn't continue to notice.

Also, since we are feeding 2x daily approximately 12h apart, how much FF would you recommend at each meal? The AM feeding typically gets cleaned up, where the PM feeding is normally only 1/2-3/4 consumed in most cases.

 

Glad to hear you ordered a ketone meter. Well worth having a backup meter anyway and that will make checking ketones much easier. FYI - using the meter for cats, you don't need to worry about ketones unless you get a reading of 2 or above. I believe 2.4 is considered the point where a vet visit is needed but anything over 2 would be an alert to up water/food intake and careful watching.

Keep an eye on the fur spots. Food allergies can display as skin issues. And don't feel bad about not knowing if the one is from the vet shaving it.....it's hard to keep track of it all and we've all wished we paid more attention at one time or another.

While the vet may have told you to feed two meals a day, it's actually better to break food up into a couple of meals and snacks. Some of us feed our cats 4 time daily, some 6. Just split up the normal amount. Each FF can of pate (classic) is around 80 to 100 calories depending on flavour. I would guess if 16 lbs is a good weight for Marley, he'd need around 300-320 calories per day or roughly 3 cans give or take. An auto feeder is very helpful to be able to leave food out for a snack when you are out or overnight or alternately, freezing food into cubes and leaving them out to thaw for eating later is an option.

 

Ketones were at 0.3 when I tested him twice after running a calibration test. So we should be good there.

Fur spots, they are definitely from him over-grooming. He's not biting or scratching, just seems to be OCD about his legs being cleaned. I'm pretty sure this is neuropathy from what we've read, the Zobaline arrived and we started him on it this AM.

We've always fed two meals a day, unfortunately we're normally gone for 10 hours or better in the morning/afternoon. We're going to look into the auto feeders though. Right now, both cats only seem to be hungry enough for 2 cans/day each. Rarely they may ask for more and we give it, some days they are leaving some behind. 16# is a little high for Marley, they've told us that since he was like 3 years old. We don't let them starve, but we're surprised they only seem to want 2 cans per day each.