Need help with insulin dosage

My cat Rocky was diagnosed with diabetes the beginning of June this year. The vet started him on 2 units of Prozinc twice a day and Hills DM dry food. After about 3 weeks with not much improvement she increased his dosage to 3 units twice a day. Still no improvement. She upped dosage again to 3.5. Against her recommendation I changed out his food to low carb Fancy Feast and his BG dropped dramatically. So much so that I feel he needs less insulin. I dropped the dose back down to 3 units. I know I should have consulted my vet, but since she doesn't bother to call me back and is at odds with the food I feed him I would like some advice. I live in a very remote area so it is difficult to get to another vet and the trip totally stresses out my cat.
I have posted his spreadsheet below. His BG before I changed his food was regularly in the high 300 to 400 range and rarely dropped below 200. I started him on FF on July 13 and now his BG is regularly in the mid 100's. Yesterday 3 hrs post injection his BG was 57 and I got a little worried so I gave him a little Karo syrup and fed him earlier than usual. At 8:00 pm when I usually give him his evening insulin his BG was 141. I decided to skip his evening injection and this morning his BG was back up to 382 about 1/2 hr after his meal. I gave him his insulin early and only gave him 2 units. I will continue to monitor him closely today. I'm wondering if I backed off on the insulin too much.

 

I'm glad you dropped the dose to 2 u. The Fancy Feast is low enough in carbs if it's the pate variety.

It would help us to help you if you set up the spreadsheet we use here. The colour coding allows us to see at a glance how the BG levels are. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. 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.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. 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.

Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

I see you gave 1 u on a PS of 88 this morning. I recommend that you get more tests because that PS was actually too low to give insulin. I also suggest you change your spreadsheet to the colour coded version we use here. It's so much easier to spot patterns at a glance. I gave you the link above.

The very low PS this AM might have been from the 2 u dose you gave last night on a PS of 123. That 123 was also too low to give insulin at this point. The "no shot" BG can be lower as you learn your cat's responses based on a huge volume of data. I would suggest no shot for anything under, say, 150 right now and a reduced dose for anything between 150 and 200.

 

Recommended reading: http://www.felinediabetes.com/FDMB/...prozinc-pzi-insulin-for-diabetic-cats.164995/

 

You should able to see my spreadsheet now. We have cut way back on his dosage and his numbers are really good. I was tossed up about giving him an injection this morning but after reading your post I will hold off. I have read that some cats will go into remission and would like to know how to know if this is happening with Rocky. He also has neuropathy in his hind legs and wonder if that will get better or if there is anything we can do to help him get better.

 

Yes, those blue PSs are nice but we need to see mid cycle tests to properly assess the dose. Good BG control will help hind limb neuropathy over time. Many people also give a B12/folate supplement called Zobaline. It's formulated for cats and is available online.

 

By mid-cycle do you mean 6 he's after injection? I have been trying to get the midday reading but I was out of town and my husband dropped the ball. Rocky's BG has been coming down steadily since early this morning without an injection. It's now at 107. I will try the zobaline. Thanks for the help. My vet is no help at all.

 

The mid-cycle tests can be anywhere between the two shots, but most people find +4 to +7 to be the most helpful range since that's usually when cats are lowest. Sorry to hear your vet isn't much help.