Need input from experienced folks, please

Hi. I initially posted on the main forum but wanted to post here as well since Prozinc is the insulin Mia is on. Any thoughts you could share would be greatly appreciated. Thank you!

Here is the post:
http://www.felinediabetes.com/FDMB/...houghts-from-experienced-folks-please.186479/

 

Hi there, FurBabiesMama (I'm sorry, I don't remember your name ). I read through your post out on Main. Thanks so much for linking that. It looks like that is focusing on a food discussion, so I'll just post about dosing over here. That blue mid-cycle you got when you lowered the dose is pretty common. I don't know how to explain it, but I see it quite frequently that someone lowers the dose, the kitty gives a good cycle or two.....and then goes right back to where they were. It kind of gets our hopes up, but then doesn't quite work out.

As you mentioned, you did slow, steady increases, but they might have actually been a little too slow and led to some insulin resistance. There is a sweet spot on the dose increases that differs a bit from one cat to the next. You have to move slowly enough to give them time to adjust, but fast enough to stay ahead of them.

So assuming that you keep the food steady, and stay on prozinc, I would recommend moving forward with some increases every six cycles (three days) until you start to get some wonky numbers, and then post again and we can see if you need to move slower than that. Quite often the wonky numbers are just a matter of timing (if you stall without feeding, they catch up), but sometimes adjustments need to be made.

Now, if you change food, you may need to adjust that to accommodate the shifts in carb/protein, but monitoring will let you know what you need to do.

I think a good thorough vet visit is a great idea. It sounds like you may be seeing some symptoms of IBS, pancreatitis, or dental issues. So having the vet run labs and give a careful look at the teeth will be important. And if she hasn't had a cleaning this year, I would suggest getting one, even if the vet says everything looks okay. Problems can hide under their gum line and can't be seen until they are asleep and can do the x-ray. Secondary health issues are quite often the cause of unresponsive numbers, so trying to figure that out might make a difference. I'm on that little scavenger hunt myself these days with my kitty.

Also, if you aren't already, make sure you're checking for ketones with the fussy eating. They can sneak up quickly.

Finally, once you have sorted the food situation, gone through a full exam at the vet, and tried some increases, if you're still not seeing any change, then yes, I would recommend looking at a different insulin. Sometimes it's just a matter of matching the cat with the insulin. However it's strongly recommended to just make one change at a time, so that's why I would suggest holding off on the switch until the other things are settled.

Whew! That was a lot. Please let me know if you have any questions or need more explanation about any of that!

 

Now, this is a new concept for me. I did not know I could be moving too slow. Early on, her issues were all with bouncing, so I was focused on preventing that. Crap.

I have had her on 1.75 for three cycles, and I was planning to go to 2 in the morning. I could start the 6 cycle doses you recommend from there. I do not really think I need to sit at 1.75 longer then the three cycles. (Let me know if you disagree.) I really just dropped down there out of desperation to mix things up and see if I could get a response of some kind. I will sit at 2 for three days then go up in .25 increments every three days from there.

I hate to drag the poor baby to the vet, but I guess I need to - if nothing else, it would put my mind at ease if everything turns out okay.

Thank you so much for responding.

 

Please don't feel badly about the rate of increases. It really does vary from one cat to the next, and the only way to know is to experiment. Like so many things about this dance, we can't know if we did it "right" until afterwards. So then we just move forward and try something else! If you do the quicker increases and she starts bouncing like a ping pong ball, then we'll know that the slower increases were actually better!

I agree that there's no need to stay at 1.75 any longer. Moving to 2u in the morning sounds good to me. The protocol actually says you can move every 3-6 cycles. I went with six since you said Mia has been a bit bouncy in the past. If you look at the numbers and think an increase should happen sooner than that, it's okay too. Then just slow down if she dives.

And I agree so so so much about hating to take them to the vet! Mine was just there a little over a week ago, and he's going to need to go back. His numbers aren't going to come back down until we figure out what's ailing him, but that will require more testing and I just hate seeing him so stressed out! The vet has offered something to calm him before his next visit, which is great, but I wish he would offer something to calm me too!!!!

 

Amen!

Mia has an appointment for tomorrow afternoon. So, we shall see...

 

We could all use some calming things before those darn vetty bean visits! Let us know how yours goes...I think a vet visit is a good plan at this point.

 

@FurBabiesMama - any news from the vet? Did Mia's teeth check out okay?

 

@Djamila We will not have the test results until early next week (complete blood count, biochemical profile, pancreatic lipase immunoreactivity and urinalysis) since we went on Friday afternoon. She does have gingivitis though, stage 1. So, a cleaning is probably in the near future. It would be great if it was just the dental causing the high, flat numbers. I will take that over the other options I can think of.

Thanks for asking.

 

I still have Mia's previous insulin vial. I decided to try giving her a dose from it to see if there was any difference, and she got down to 193. She has been living in the 300s consistently. Maybe that was a fluke, but it sure makes me think something could be wrong with the other vial. I will continue shooting from the old one and see if this keeps up.

I do not know why the insulin would be bad. It is never out of the frig for more than 5 minutes, and it does not look cloudy. Hmmm...

 

I'm not quite sure what you mean by that. Do you mean "it does look cloudy"? Prozinc should be cloudy when it's been rolled to mix it. If you look at Caitlin M's thread, she just posted a picture of her prozinc bottle. That's what it's supposed to look like.

 

Our Prozinc is not clear, it has a milky appearance (just like Caitlin's). 'Cloudy' may not have been the right term to use, but it is the one the vet used when I was asking about whether it could be bad. I believe what he meant was even more cloudy than normal and/or inconsistent cloudiness.. you know, like something is in it or whatever. Anyway, ours does look like the picture she posted.

 

Ah, that makes sense! I'll be curious with you to see if there is a difference between the two vials. It will be great if it's that easy of a fix for those high numbers!

 

Hi. Mia's blood tests and urinalysis all came back good - no problems (other than the glucose being high, but that is no surprise). She will be seeing the dentist next Tuesday.

 

So glad to hear that her bloodwork all came back good! Please forgive me if I'm forgetting something, but it looks like Mia handled the increase from 1.75 to 2u well, so are you ready for another increase? Or is there a reason to stay at 2u?

 

Glad to hear things came back good!

 

It's a little strange, I know, but here's the story. I was gradually raising her dose (very gradually due to issues with bouncing in the past) and had recently started to see her numbers staying higher, I got as far as 2.75 but was seeing pretty much the same result no matter the dose. We are pretty much living in the 'pink' land of the 300s regardless of whether the dose is anything from 1.75 to 2.75 (where in the past the lower end of that could get her in the 100s or below). So, I just went with 2u until I could get her into the vet to try and determine what is going on.

On a call today, the vet asked me to go to 2.5 (which I did w/the pm shot) and try to stay with that for as much as two weeks. I am hoping the dental ends up helping things. Something is definitely going on with her, not only based on the numbers, but she just is not feeling great.

 

Oh, I'm so sorry she's not feeling well. That's even more important than the numbers. It's so hard on our mama-bean hearts when our cats aren't feeling their best. I think the increase to 2.5 is a good idea. And her dental is only a week away.

It may be that the dental is all she'll need, there may be something else, or it may just be that she's a high dose kitty, and that's why you haven't seen any change as you went up to 2.75 - she might just need more than that. There are cats on here with incredibly high doses. Kitties just need what they need.

Hopefully it's just the dental though. That being said, if you don't see a change fairly soon after, I think it will be important to talk about some next steps to get her out of the pinks. They are likely at least part of what's making her feel poorly these days.

Please keep us posted on how she's doing with the increase, and with the cleaning next week. Sending vines for good health between now and then.