Maybe Not Moving

Discussion in 'Prozinc / PZI' started by Greg and Goma & Friends, Jan 18, 2018.

  1. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I was unable to get any tests performed during yesterday's early cycle. However amps and pmps were virtually the same. Pmps +7.5 was 414 (will update ss later) and I suspect by her actions it will be higher by amps. I think I may start moving to the 2.75u previously suggested but would prefer the fat/skinny route. I do not have syringes with half marks so this is going to be difficult either way. Any suggestions as to markers on the syringes that may be used as reference points?

    Also she is really scratching herself again though I've not changed anything. She's also started sneezing and sniffling occasionally. We are going to the Vets in a couple of hours for scheduled subcutaneous injection. Unfortunately they are not"hands-on" types and have been no help with the skin issues other than stating its the diabetes. Any thoughts or suggestions on this part would be very welcome.
     
    Last edited: Jan 28, 2018
  2. FurBabiesMama

    FurBabiesMama Well-Known Member

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    It will be pretty hard with out anything but whole unit markings. You just have to aim for between what you have been giving and the 3 unit mark . (I know, that isn't very helpful. Sorry.) I have seen some people recommend filling a syringe with colored water to the point you want then using that as a guide each time you fill a syringe. That means you still have to 'guess' when you do the colored water one, but maybe it makes it easier after that to have something to compare.
     
  3. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Okay- Thank you. These tired old eyes will get a work out.
     
  4. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Can you get some of the 1/2 unit ones? I have them and they do make it easier to do partial unit doses. They do have even smaller markings though.. at least mine.
     
  5. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I’m going to check into the 1/2 units with the Vet today but probably won’t get much help from them.
     
  6. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Could your daughter send you some?

    Re skin issues: I don't think that skin issues are a given with diabetes. Some cats will have poorer coat quality, dandruff, etc. but not necessarily itching. Itching is more often associated with an allergy, either food or environmental.
     
  7. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I agree with your skin assessment but working with this Vet is hard at best. I have another cat with similar itching problems that they have performed skin tests, blood tests, X-ray with no resolution in almost a year.

    I’ll see if my daughter can ship internationally in regards to syringes.

    Do you agree with my thoughts on increasing dose now. Still have not done amps. Am at Vet now with Goma and other cat.
     
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That green from yesterday is a sign that you should stick with 2.5 u for a few more cycles. That non-bounce cycle showed you what this dose is capable of doing, as it did on 11 Jan as well. The other pinks, reds, etc. are bounce-inflated.
     
  9. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Thanks so much. Sticking with 2.5u for now. I’ll learn...
     
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  10. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    You all just may need to take turns with a 2 X 4. Goma gets Two Turns
     
  11. Djamila

    Djamila Well-Known Member

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    Can you get u100 syringes where you are? They are the syringes that human diabetics use. We have a conversion chart so you can dose Prozinc using those, and they enable you to make very small changes with greater precision. It takes a little bit to figure out the conversion, but once you have it figured out, it's easy.

    ETA: Although I want to add that I agree with Kris that you should hold this dose a bit longer first - so the syringe information is just something to consider going forward.

    I also want to add that dosing on Prozinc is tricky. No 2x4's needed :):):)
     
  12. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I thank you once again. I had previously printed out the conversion chart just in case and will look into the u100 syringes.
    Okay - no 2 x 4's - (at this time).
     
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  13. Rachel

    Rachel Well-Known Member

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    Also, until you do get different syringes, you might want to look into those reading glasses they sell at pharmacies/Walmart...a lot of people find them super helpful to wear when pulling up insulin!
     
  14. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, I agree. It's also helpful to get them in a magnification that's higher than what you'd need to read in a regular way.
     
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Hang in there. She's still bouncing from that dark green. Bounces can take a while to stop in a volatile kitty. I could write a book about that .... o_O
     
  16. Critter Mom

    Critter Mom Well-Known Member

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    Perhaps get a cheap 'n' cheerful jeweller's loupe to see the syringe markings more clearly, e.g. something like this:

    http://www.ebay.co.uk/itm/New-30x-6...640339?hash=item2f125e6a13:g:nE0AAOSwx2dYEw1c

    Provided there are no contraindications (e.g. high blood pressure) the anti-histamine Piriton (chlorphenamine, also called chlorpheniramine) can help with sneezing and mild allergies. See:

    Mar Vista Vets Pharmacy Centre - Chlorpheniramine

    From the above web page:

    Main side effect is drowsiness but starting at a low dose can ameliorate this.


    Mogs
    .
     
  17. Djamila

    Djamila Well-Known Member

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    @Critter Mom - Mogs, I'm going to start referring to you as The Pharmacist :):bookworm::cat:
     
  18. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, Mogs is a font of information! :smuggrin:
     
  19. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Goma was prescribed with the anti-histamine Polaramine (dexchlorpheniramine) which I guess is the same. Side effect noted is drowsiness. She will be on this twice a day. Hope this works, I believe all these factors are contributing to her discomfort.

    Thanks for finding this and posting. At least I now have some verification that we are in the right ballpark. You truly are a gem..
     
    Last edited: Jan 19, 2018
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  20. Djamila

    Djamila Well-Known Member

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    It's morning for you now isn't it? I'm hoping Goma gives you a nice cycle today. She's been taking her sweet time to get back to work after that green! Tell her if she doesn't show another pretty blue or green soon you're going to have to do an increase. Sometimes just the threat is enough to get them back on track. ;):confused::rolleyes::smuggrin:
     
  21. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Still high, holding on to hope she will return to the soothing numbers, but this go around is getting long. How many cycles can I allow this to go on? It is 1:00 pm here. I gave her injection about 2 hours ago. Will do a check in about an hour or two.
     
  22. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Thanks - I'm holding on to hope this will stop soon.
     
  23. Djamila

    Djamila Well-Known Member

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    We usually say six cycles to clear a bounce, and if she's still stuck up high you can increase on the 7th cycle which if I'm counting right, would be tonight. However, occasionally they can come down quickly on that increase, so you'll want to be a bit careful. Since her 7th cycle is at night, you may want to wait until morning - up to you though.
     
  24. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    If I don't see anything by +7.5 will plan on increasing in the morning when I can be sure to monitor her. Have gone out today to clear up everything so I can be home the entire day tomorrow. I do plan on using small increments up to 2.75u rather than jump to the 2.75 immediately. Perhaps that will mitigate a larger drop. I am actually starting to doubt I am giving the injections correctly with so little movement.
     
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  25. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Indeed
     
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  26. Critter Mom

    Critter Mom Well-Known Member

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    Saoirse had problems with sneezing so our vet prescribed it for her. It really helped her. I hope that Goma's medicine will help her to feel more comfy.


    Mogs
    .
     
  27. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    What brand are your syringes? I am going on line to order with a company that ships international. My daughter checked with the post office and they said she could not send herself but some companies can. Go figure...but I'll make something work.
     
  28. FurBabiesMama

    FurBabiesMama Well-Known Member

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  29. Greg and Goma & Friends

    Greg and Goma & Friends Member

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  30. Djamila

    Djamila Well-Known Member

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    Do you have a Seiyu near you? It looks like they are owned by WalMart, so I wonder if you could get the u100's there?
    I agree - if you're going to do the baby steps, a steep drop is unlikely. That sounds like a good plan. I was really hoping she would show a better response on that last cycle. Okay, up she goes then! Time to get those better numbers back in her cycles!
     
  31. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    In looking through the last two cycles, she appears to have leveled off with virtually no difference in the last 18 hours. Could this be a sign that this bounce is over and a drop could now be expected overnight at the same dose which I have already given? Should this occur, I would need to revisit the thought of an increase correct? I wholeheartedly agree she needs to bet better numbers back.
     
  32. Djamila

    Djamila Well-Known Member

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    That's an interesting question!!! One well-observed pattern is that a flat yellow cycle often precedes a reactive cycle. So I suppose since Goma runs higher than yellows, that in her case perhaps a flat red cycle could be a similar indicator! Hmmm.....we'll have to wait and see, but now I'm quite curious!

    And if she does respond tonight, then yes, you'll need to reconsider the increase. Although, I would also factor in how much she responds. If she is still in the mid to high blues, I might go ahead with the small increase anyway as I'd like to try to start pushing those pre-shot numbers down a bit if we can. If she ends up in a low blue or green though, it's probably best to hold a bit longer.
     
  33. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Okay, if I do a test in the next hour (this would be a +2), it might give me an indicator if I remember what I've been told correctly. I will probably be asking for advice in the morning (wait..it is morning)...later in the morning... Thanks for the pointers again.
     
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  34. Djamila

    Djamila Well-Known Member

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    Wait..I'm so confused! It's morning there now? I thought it was nighttime?!?! That silly date line makes everything so complicated!

    ETA: Okay, I just googled it and now I understand! :D
     
  35. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Didn't mean to confuse you. One of us(meaning me)being confused is enough. 12:30 am here now.
     
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  36. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    It appears that there still is little to no movement through pm +7. Will be giving slight increase so I think I would record in the spreadsheet as 2.5F. On the syringe I will be move the plunger down just below the #2 so there is a bit of space. Currently I have the plunger at just on the bottom of the 2 with no space. Unless, of course, there is some unexpected change at amps.

    She did throw up a bit about 1/2 hour ago. Just fluid. She appears okay at this time. Gave her small amount of food and she held it down, so fed her breakfast which she finished quickly. It is now almost pm +7.5 (0630 local time)
     
    Last edited: Jan 20, 2018
  37. Critter Mom

    Critter Mom Well-Known Member

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    @Djamila -

    Idiot questions from someone who's never used Prozinc:

    • For those caregivers who are in a position to test sufficiently frequently, have any Prozinc users ever used food manipulation/curve steering in order to enable larger doses of insulin to be given to kitties who are spending a lot of time in higher ranges but then dip a lot lower on occasions (as Goma is doing here)?
    • Can strategic feeding of appropriately carby, well-timed 'snacks' in the early part of the cycle slow down steep drops and help level a kitty out overall?

    (Trying to learn here. I have no idea whether or not the above are feasible/safe.)


    Mogs
    .
     
  38. Critter Mom

    Critter Mom Well-Known Member

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    Just noticed from your spreadsheet that you've recruited another one of your kitties to help Goma. I had to smile because I felt compelled to test my civvie, Lúnasa, to make sure her BG levels were OK (and to get some sort of idea of what BG regulation looked like in a non-diabetic kitty). There's no denying it; I am a dyed-in-the-wool helicopter parent. :oops:


    Mogs
    .
     
  39. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I have become the same. If I hear a cough, sniffle, sneeze or one of the group seems out of sorts I am all over it to the point I probably irritate them.
     
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  40. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, some people will try this with varying degrees of success. The carb sensitivity of the kitty can factor into how successful it is.
     
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  41. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Goma appears to be getting stuck in these higher numbers. A small increase to your best estimate of a "fat" 2.5 u at her next dose is worth a try.
     
  42. Djamila

    Djamila Well-Known Member

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    Yes, it is certainly possible. Honestly, most people on prozinc either go into remission so quickly they don't need to learn that trick, or they make the jump over to L/L so quickly that they learn it over there. I think in this situation though, it may be something to consider. scs_islander is certainly a skilled enough caregiver to learn the technique - so it would just be a matter of being okay with the potential added stress of feeding the lower numbers. Scs (I'm so sorry, I don't think I've learned your name! :oops:), it's basically just like what you did on 1/4 during the PM cycle, only more intentionally. Mogs' description is basically what you do - raising the dose and then through some experimenting, figure out what arrangement of food, timing, and portion size Goma needs in order to stay away from the lime greens, but have more time in numbers that are near that. It's a more vigilant process than the current approach. Many cycles would be just fine, but there would be more cycle when your intervention would be needed. It may be something to consider though if those PS numbers don't start moving soon.
     
  43. FurBabiesMama

    FurBabiesMama Well-Known Member

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    I am glad she liked it! I hope she enjoys the broth, too.
     
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  44. Critter Mom

    Critter Mom Well-Known Member

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    I've lost count of the number of times I've felt the need to apologise to my little ones for exactly that reason! :oops: That said, if I hadn't perceived myself as being an out 'n' out pest and been less respectful of Saoirse's 'personal space' and a bit more helicoptery she might have been diagnosed sooner. Can't win. :rolleyes:


    Mogs
    .
     
  45. FurBabiesMama

    FurBabiesMama Well-Known Member

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    I just bought a selection of Weruva foods with varying carb content for this very purpose. It is starting to dawn on me that this may be the right approach for Mia. I have come to believe that I have to assume a little risk to make progress with her. When we finally started getting good numbers, there was a period where she ended up going low every several cycles. I was nearly certain the dose was not too much, it had been very slowly worked up to and any less was just not enough. When it would happen, I would give her m/d kibbles to steer her up. It seemed that during those times, giving the carbs not only served to raise her up to stay safe during that cycle, but it also seemed to prevent (or very greatly reduce) the bouncing I expected to see. With her tendency to bounce, I really need to hold a dose to the extent possible, adjusting with PS values (unless absolutely necessary) is just not a good idea. So, I think deliberate carb management may be a valuable tool for me to try. That is why I wanted to 'arm' myself with varying degrees of carbs. Mia would not really eat the FF higher carb foods I tried, so I was always stuck with using the m/d kibbles which are really higher carbs than I need sometimes, and I think she may actually be allergic to something in them. I hope she likes the new foods, and I hope I am right about this. I guess I will find out. This is all an ongoing science experiment for the most part anyway! :)
     
  46. Critter Mom

    Critter Mom Well-Known Member

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    It would be great to follow your progress if you do go for such an approach. Perhaps you'll give us all a heads-up if and when you start. :)


    Mogs
    .
     
  47. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    For today, I have given the 2.5u(F) following the amps of 354 and see where that takes her. I appreciate your undeserved confidence in my skills as a caregiver and will just have to handle the stress. The ends more than justifies the means. Just need to figure out what are higher carb foods and have everything in place prior to beginning the approach being suggested. Totally on board with it, just want to have all of my ducks in a row (or cats as it may be). Been clearing out all the higher carb foods. I do have the FRW from Specific and the Hills M/D and (shudder) some dry diabetic prescription diet from Hills as well. Would all these provide the appropriate level of carbs to turn her around? Thus far, I have been able to use these successfully when the unintentional drop occurred. If I am going to approach this intentionally I want to be sure this is enough.
     
  48. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I want to ask general question - I have been giving the injections on one side of Goma due to her skin condition on the other. Previously when I attempted, it was obvious it was painful due to the condition. The condition is clearing somewhat and I have just today given the injection on the opposite side. My question is, I guess, pretty dumb, but if you continue to give injections in the same general area does it become somewhat sensitized to the insulin?
     
  49. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Have given a "fat" 2.5u to see if this will get her moving. She has slowly dropped from red to purple and I hope a gentle nudge will move her along. If not, I will be going to a "skinny" 2.75 and then 2.75 firm. In this case scenario, is one cycle enough or should I be allowing two or three?
     
  50. Djamila

    Djamila Well-Known Member

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    Oh Goma....:rolleyes: She's just messin' with us now! Giving that lower AMPS number right as you do the increase....Last time she did this was on 1/17 and you ended up with a green....keep an eye on her today. :cat:
     
  51. Djamila

    Djamila Well-Known Member

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    As for the foods, your usual food is probably under 6%, is that correct? M/D is around 13%, and the Hills dry is....I have no idea really....high though, I assume. Do you have any idea the carb level on the FRW? I don't think I've heard of that one.
     
  52. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Not a dumb question at all. Many people use a relatively small area but vary the injection site a little within it - eg, the scruff area. If she’ll let you use her sides you have a much larger area to work with.
     
  53. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I hope I have not made a mistake here. I'll be watching. Will be checking @+2 in the next 25 minutes.
     
  54. Djamila

    Djamila Well-Known Member

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    Definitely not a mistake! She really needs more time in the good numbers. That pre-shot just makes me more hopeful that maybe she'll find her way back towards the blues/greens again. :)
     
  55. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I am using the export version of FF (Mon Petite) which we figured was about the same so I am guessing the carbs is 6 or under. I think the FRW was higher than the Hills M/D if I remember correctly, but will have to go back to my previous posts to find it for certain.
     
  56. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Should this go bad, would a reduction back to 2.5 be the right thing to do? You all may not be available at that time of day(night) so I am just checking in now.
     
  57. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If she gets to nice dark green and doesn’t need heroic efforts with food intervention to keep her from going lower, keep the dose. If she dives into lime green numbers you should go back to 2.5 u.

    Sometimes a cat will have a short-lived exaggerated reaction to a small dose change and then will settle into more usual numbers. This is one of many patterns that can become evident as you build your BG data base.
     
  58. Djamila

    Djamila Well-Known Member

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    Honestly, I wouldn't really want to see a reduction right now unless it's absolutely necessary. If she goes lower today, she'll be high and flat again, which means you can most likely hold this dose for at least another cycle or two while she bounces. I'll be surprised if she goes below 68 (although sometimes they do surprise us!), so odds are you won't need to worry about it.

    Maybe it'll just be an invitation to try feeding the curve! Below is a link to a long discussion. The good stuff starts at Jill's post #15. The only difference I take with it is that I am quite averse to using medium (MC) or high carb (HC) foods to feed the curve. If it can't be done with low carb regular food, I think the dose is too high. I don't even like MC or HC foods for mild hypos (although they do of course have a purpose for if the numbers continue to drop. )

    From the reading I've done about diabetes, and from studying spreadsheets here, I believe that giving a cat carbs throws things off for several cycles after and creates even more bouncing in many cats. However, most people around here use them freely whenever a cat hits a lime green number or to manage the curve as you will read in the linked discussion.

    http://www.felinediabetes.com/FDMB/threads/8-10-tashie-pmps-high-questions.101989/#post-1087990
     
  59. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    +2 is at 416 . Tested three times (1) 458 (2) 345 (3) 416.
     
  60. Djamila

    Djamila Well-Known Member

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    Boo. :( Still a lot of hours to go though. She may yet find a blue for you.
     
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  61. Critter Mom

    Critter Mom Well-Known Member

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    I've seen this phenomenon on several insulins. Why is this the case? Counter-regulatory measures to try to keep to the familiar homeostatic 'setpoint'?

    I've often noticed that when a kitty first gets insulin it may have a few good days and then numbers start edging up again, and then a dose increase is needed soon after.


    Mogs
    .
     
    Last edited: Jan 20, 2018
  62. Djamila

    Djamila Well-Known Member

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    Sigh. Okay, Goma. You can do better than this!

    And in answer to your earlier question (sorry I missed this before!), you can move the baby steps as quickly as you'd like since normally you'd go straight from 2.5 to 2.75 in one cycle. I wouldn't hold each one for three cycles - two at the most, but just one is fine. Up to you.
     
  63. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Okay thank you for the clarification. I have already given the fat 2.5 tonight. I am finding these last couple of cycles eerie. Really uncomfortable not seeing any movement whatsoever. Prefer not changing doses at night cycle as I may get a deep sleep (in my dreams)...Will take a look in the morning... at around +7 (6:00 a.m. my time).
    If no action again, will increase next increment.
     
  64. Djamila

    Djamila Well-Known Member

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    You could go ahead and move straight to the 2.75u and see if you can bump her out of this stuck place. Sometimes they need a firmer nudge than others.
     
  65. Critter Mom

    Critter Mom Well-Known Member

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    Wise move. :)


    Mogs
    .
     
  66. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I may do that. We have a vet visit which I never look forward to anymore, but she continues to have subcutaneous injections for liver and pancreas support. Has been reduced to every other day with me giving meds on the off days. Since Saturday was an off day and Sunday they are closed, it has been two days so I have to go.
     
  67. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I can always hope right?
     
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  68. Critter Mom

    Critter Mom Well-Known Member

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    Sorry to hear about you two having to traipse to the vets so often.

    When you get a moment, it would be really helpful if you could add some details of Goma's meds and sub-q injections and what they're for to your signature line. It'd also be handy if you could make brief notes in the Remarks column of when she gets her treatments. Every little bit of information helps build a better picture as so many things can influence how an individual kitty responds to its insulin.


    Mogs
    .
     
  69. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Any chance you could give sub q fluids at home? Many people here have done that, and it may make life a little easier for you both.
     
  70. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Great Idea! However, I don't think they will allow me to have the vials of medications that are in the injections. If it was just the lactate fluid I could do that as I have done it in the past for others in my care. I will get firm information regarding the medications that are included (plus vitamin c, b12, potassium and calcium) and see if they can be put in her food. Some I am already doing so I need to get a clearer picture of the sub q fluids. Thanks for the suggestion - much appreciated..
     
  71. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    UPDATE - I have moved directly to 2.75u beginning with this mornings injection about 13 minutes ago (11:00 am Japan Standard Time). While the amps was high, I attribute part of it to the vet visit and sub q fluid injection (and then waiting for the bill - That part even stresses me). Then home, cleaning of the skin irritation points prior to the amps test. Have cleared matters outside the home so I can be here throughout the day. I am really hoping this gets her moving downwards again.
     
    Last edited: Jan 21, 2018
  72. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    I regret being so remiss in providing all necessary information. As I gather more from her medical history I will post somewhere in the spreadsheet as I have now reached the limit in the signature line. Kindest Regards.
     
    Last edited: Jan 25, 2018
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  73. Kris & Teasel

    Kris & Teasel Well-Known Member

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    She seems to have some (possible) glucose toxicity built up, barring any other infection/inflammation issue. I suggest you go to 3 u next AM injection. It's not uncommon to see some action at a dose and then a relapse to higher numbers until you get closer to her good dose range.
     
  74. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    That was my plan initially this morning and I started to post but changed my mind when I noted the stuck numbers coincided with the antihistamine. However, it is more likely as you say - I am having a blood test performed in the morning at the vet to see where her wbc is (it was sky high last week) and also ALT. With the antibiotics she is on I am hoping the infections or whatever else is going on is cleared up. I will go to 3.0u. Since she was (and still is) in those high numbers can the glucose toxicity build up be overcome? Is there a guesstimate of a time frame if so?
     
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  75. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    The way through it is by careful dose increases and not lingering too long at an ineffective dose. Sometimes the toxicity reduces quickly when you reach a good dose and the BG can drop sharply. Toxicity can recur any time a cat who's prone gets stuck in high numbers, whatever the reason. It's more difficult to sort out all the factors when there are several things going on at once.
     
  76. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Okay Thank you
     
  77. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    If you go to 3 u tomorrow AM and after 3 cycles at that dose there's not much improvement in BG put it up to 3.25 u at the 4th cycle. Three cycles, then 3.5 u and so on until you see blue and hopefully green. Your goal is to break the toxicity before it's too entrenched.
     
  78. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    And if we are able to break the toxicity is there a time when dosage can be reduced?
     
  79. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You'll know it when you see that a dose is dropping her lower than what you want or dropping her too quickly - ie. all the signs of a dose that's too high. At that point you'd reduce the dose slightly, collect data and go from there. One thing that can take a while to truly understand is that the good dose is a range rather than a set amount and a cat can move up and down within that range. The good range can also change over time. It's extremely rare to find one dose that gives ideal BG numbers day in and day out for the long term. It's a moving target.
     
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  80. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    I guess what I really want to know is does the cat become dependent on the higher dose?
     
  81. Kris & Teasel

    Kris & Teasel Well-Known Member

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    No, it doesn’t work that way because insulin is a hormone and not a drug. They need as much insulin as they need at a given point in time and that can fluctuate or stay relatively stable. Giving insulin doesn’t suppress the body’s ability to produce its own from all that I know and have learned. It allows cells to get glucose from food they way they should and in cats there’s a possibility for the pancreas to heal to some degree.
     
  82. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    Thanks. I felt that I understood insulin worked the way you describe but - well - I'm having a senior moment I guess. Gave 3.0 this morning, but still do not see any movement. I am wondering if the vial of ProZinc has somehow gone bad after 6 weeks. I know it shouldn't but it just seems so odd that I have not seen any appreciable movement in numbers in a long time even with dose increases. Again - appreciate your taking the time to respond.
     
  83. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    If your vial has been stored in the fridge and handled gently (rolling, not shaking before use) it should be good for a few months. The other thing to consider is that one or another of Goma's health issues might be flaring and raising her numbers. The usual culprits are bladder or dental infection. She's being treated for a variety of health issues and that makes everything more complicated.

    Another endocrine disease that is treated similarly to diabetes is hypothyroidism where replacement hormone is dosed to a level that raises the blood thyroid markers to the desirable range. The replacement hormone dosesn't suppress the body's production of thyroid hormone but replaces what's missing. Isulin treatment is similar in that respect.

    Let's see what some other the other ProZinc folks think: @Djamila @Rachel
     
  84. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Barring another issue clouding the picture, keep the 3 u dose tonight and tomorrow morning then raise it to 3.25 u tomorrow night. Three cycles, raise dose by 0.25 u, three cycles raise dose by 0.25 u. Do that until the numbers improve. It seems aggressive but it's the best way to get ahead of the toxicity if that's the complicating factor here.
     
  85. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    I agree with Kris that this is most likely either (A) glucose toxicity or (B) the other meds/medical issues inflating her number. Either way, the "remedy" is to increase the dose. My cat gets pancreatitis and when he has a flare, I have to increase his insulin until the flare subsides. That's why on my spreadsheet you'll see his dose flow up and down between 2u and 3u as his health issues change. So if one of Goma's other issues is causing the trouble, you'll need to keep increasing until the insulin is sufficient to counterbalance it. And if she's having a little toxicity, you have to increase the dose to "break through" the stuck-ness.

    On her other meds, are any of them steroids?
     
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  86. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    I agree with Kris and Djamila! We see a lot where another medical issue can cause high numbers. Cats who have more medical issues are complicated...and the usual remedy is to dose around their other issues. Oftentimes that means they are on a higher dose than kitties who only have diabetes. And that’s okay because it’s what they need. I think the aggressive increases are the way to go. If it’s toxicity (which is definitely a possibility) or other medical issues that’s how you solve it.
     
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  87. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    We had a vet visit today and blood test results were much improved to the extent that she will no longer be needing subq injections every other day. WBC was within normal range as were most other areas. The liver issue seems to be resolving itself now as well. The meds she is on now are included in my signature. The only real visible issue we have now is the ongoing skin problem that we are slowly getting to heal. She still scratches the area on top and sides of her neck but with twice a day cleaning we hope to stay ahead of it.

    She is on antibiotics and has been for quite some time. Previously she had been prescribed steroids for an extended period but that was stopped long ago. I am wondering if probiotics would help her. Goma is definitely feeling better and continues to regain her weight. Another area I think I need to look at. I have been feeding her quite often to encourage the weight gain, perhaps I am overdoing it. I do not want to give her large amounts in fear she will eat so fast it will make her sick. But she does get more than I would probably feed her if she were at her ideal weight. Just trying to figure everything out.
     
    Last edited: Jan 26, 2018
  88. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    No steroids to my knowledge. The meds listed in my signature line are all she is on. As mentioned in my response, she was given them previously for the continuing skin problem but was gradually taken off at my request due to what I perceived as a non rational approach to the problem yielding no results and opening the door for potential problems down the road.
     
    Last edited: Jan 26, 2018
  89. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    I may have to go a 4th cycle if possible.
     
  90. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yes, you can do this if starting a new dose in the AM is better for you.
     
  91. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    So glad to hear the positive report from the vet! What great news!

    I agree that a probiotic might be a good idea since she's been on antibiotics for awhile. s. boulardii is the one that is most often recommended around here. Here is one that I've used, and I've also heard good things about Florastor brand if either of those might be available to you.

    https://www.amazon.com/dp/B00E0NDTP6/_encoding=UTF8?coliid=I2ZSDA2QREOPF6&colid=2FJ85LO4ON0NC&psc=0

    Steroids are a frequent cause of FD, so if at all possible, you'll want to keep her off of those in the future. If there is no other effective treatment, then there are folks around here who have learned to dose around them (higher doses of insulin to counteract), but it's just best to keep her off of them if you can.

    As for food, is she getting over her goal weight? If she's still underweight I'd say keep feeding her what she wants. When she reaches her goal weight, then you can start to control her portions more.

    Fingers crossed the dose increases get her moving again soon! :)
     
  92. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    I will check into the availability of the probiotic you referred to.

    As for steroids, I have never been a big fan of their use and approach them as a last resort option.

    Goma is still underweight and needs another 3-4 lbs to return to where she was long ago. I have been spending a lot of time on line trying to find specific information about the carb level in the mon petite food I have been giving her with no luck. While it appeared to be the same as ff classic seafood pate, I just don't want to leave any stone unturned to determine the continued high numbers. She still eats three cans of this each day accompanied by some home cooked chicken breast. Would probably eat even more if I let her. I was considering reducing the amount to the calorie level she should have each day which is about 2.5 cans minus the chicken. However, if she can be allowed to eat as much as she wants minus the two hour window I'll let her, but think this may be affecting her numbers to some extent (not a lot I recognize). I used to leave food out all the time and still do for other cats but if I left it out for her the bowl would be perpetually empty.
    Will be looking hopefully to better numbers in the days to follow. 3.00 today and tonight, and then 3.25u in the a.m. if needed.

    Her energy level is still fluctuating with good days and bad. I am waiting to receive the order of Zobaline to see if that will help her as well.

    Thanks for the thoughts and additional information.
     
    Last edited: Jan 26, 2018
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  93. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    You're doing very well in a complex situation. Most of us here would say let her eat as much as she wants but in small meals spread out over the day, except for the 2 hour PS test window. In my book, eating well trumps any small effect food might have on BG at various times in the insulin cycle. It's a blessing to have a cat who eats well - that's a huge plus for you.

    Do the best you can with carb level, avoid the gravy style foods but don't fret too much. It's like many other things that owners have to dose around. We can only work with what's available to us. This is a balancing act and it's a marathon. You have to find the best path you can sustain over time while getting Goma's BG to decent if not perfect levels.

    Her energy will fluctuate for any number of reasons, BG included. My cat is doing fairly well over all but still has days where he's a little lacklustre. Goes with the territory I think ...

    It's very helpful to step back periodically, review the SS, see that there's true progress and think about what you can reasonably manage with your own life and other constraints. Your goal is to optimize her treatment within those parameters. :)
     
  94. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Jul 6, 2017
    You may want to reach out to the Purina and request the info on the food. I did a 'chat' on their site once to ask for information on a food, and they said they would get back to me. It took several days, but they did email me back with the requested info. Dr Pierson gives you the questions to ask to get the correct information back:
    “I would like to know the percentage of calories that come from protein, fat, and carbohydrates.” (metabolizable energy (ME) profile)
    “How many milligrams of phosphorus are in the food per 100 kcal?”

    This is from here: http://catinfo.org/commercial-cat-foods/#Contacting_Pet_Food_Companies_
     
  95. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    Thanks for expressing this option, (reaching out to the company). I'll try to do that in the next day or two, time permitting. I needed to read that information again from Dr. Pierson and I am appreciative that you have pointed me back in that direction.
     
  96. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    While Goma is still so underweight then it's OK to feed her as much as she wants when she wants it (with the exception of the 2 hour fasting period before each preshot test). Remember that she is likely to be losing some of the calories she eats as glucose in her urine. For general background information, here's a post by Meya on the importance of getting enough calories into a kitty:

    http://www.felinediabetes.com/FDMB/threads/underfeeding-as-a-trigger-to-dka.179520/

    Just as getting enough insulin is important to a diabetic, so is getting enough food to meet the individual cat's needs. If the extra food does affect her numbers a little, remember that the insulin dose can be adjusted as needed. The patience part is, of course, the trickiest thing for us mere bipeds! ;)

    I was glad to read that Goma's most recent blood test results are good. :)


    Mogs
    .
     
    Last edited: Jan 27, 2018
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  97. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    I am at the point of feeding her every 2-3 hours but can't seem to satisfy her completely. Rarely is there any food left even if I add more. I'm just glad she has not tired of the sole choice I have been able to find. I just want to ensure she is truly getting the necessary balance of nutrients but it is difficult without knowing what is really in the can.
     
  98. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    It appears that I may have been approaching this all wrong with too low carbs for a severely underweight cat. From the readings this could be contributing to the previous swings and high numbers at both ends of cycles. Am I getting (reading) this wrong or would it be beneficial to include some higher carb foods here. There has been no movement in days regardless of dosage increases. Today is no different and I have to admit I am becoming more confused, discouraged and frustrated by the minute. I also never claimed to be the smartest person in the room .
     
    Last edited: Jan 28, 2018
  99. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yes, this is a very difficult and frustrating disease to treat when you have a cat that doesn't follow the rules. You could try feeding a slightly higher carb food to see if that helps. It's true that diabetic cats who are substantially underweight can be more erratic in their responses to insulin. You would dose around any effect the higher carb food has on BG levels.

    Have you tested her urine ketones regularly? That's important because she's been in higher numbers for a while.

    It's a small gain but her SS shows far more numbers in the 300s and 400s and almost no 500s or 600s as you've raised the dose. You had some hopeful action around the 2.5 u dose level but then she became stuck. Aside from her other health issues, she's likely struggling with glucose toxicity. It's a common problem and you have to be more aggressive with your frequency of dose increases - no more than 2 days (4 cycles) at a dose for now, something you've only begun recently. It's possible to raise the dose by 0.5 u for a while until you see some better numbers. That's not a large % increase and it might help to get her moving more quickly.

    Many people worry when the insulin dose has to be raised beyond what they thought was "reasonable". Many unregulated cats are insulin resistant until a certain dose range is reached that seems to wake them up and they start to respond better. I don't think you're there with Goma yet.

    On another note, given the difficulty you had getting a fresh vial of ProZinc last time, I suggest you get whatever process you need to activate going soon so you aren't caught with no insulin. :)
     
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  100. Greg and Goma & Friends

    Greg and Goma & Friends Member

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    Dec 8, 2017
    I may start giving her a small portion of Hills m/d. I had the Vet do a urine test on the 17th which was negative for ketones and I did a home test on the 24th also negative. Did another today but had to push the stick into the litter and still saw negative. I have been doing these pretty regularly.
     
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  101. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I don't believe that thread is advocating for adding more carbs. Instead as i read it, the recommendation is to make sure to be looking at calories, protein, and fat - not just carbs when choosing a food to ensure that the cat is getting sufficient calories, and not just obsess about the carb level. Many cats do fine up to 10% carbs, while some folks in an effort to control BG will only feed their cats 0% foods. Sometimes 0% carbs is also a lot of water and fat, and not much protein which can contribute to being under nourished. Hills MD is 13%, so I would be cautious if you decide to introduce that into her diet. That being said, I know you are somewhat limited in food choices, so whatever you have to do can be dosed around.

    I agree with Kris that if you don't start seeing some movement in the next cycle or two, your next increase can safely go up by 0.5u. Goma was making some good progress, and she'll get back to it. But it is oh-so-frustrating when a kitty gets stuck like this. Hang in there! Sending healthy vines to little Goma!
     
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