Need some advise...I'm still new to all this

My little kitty was diagnosed 5/8 and she was started on ProZinc 1 unit twice a day. Numbers wouldn't budge so we are now up to 4 units. Almost two weeks at 4 units and still getting numbers in high 300's and high 400's. I've only done a mini curve and even at 4-7 hours after injection still getting those high numbers. Today she vomited and is not eating like her usual self. I bought Ketone test strips but haven't been able to get a sample. Oddly her water consumption and urine output are down. I'm going to bring her vet today just to be safe but could it take this long to get numbers down? I'm wondering how high should an insulin dose go before you consider a different insulin?
I'm still new and I am home testing but haven't done the FD spreadsheet to get readings every hour. I thought mini's would help identify nadir.
I know I have to be patient but I'm concerned about the consistently high numbers . Do I just need to give it more time?
Thanks for any feedback. I'm trying

 

Hi Beenie, and welcome! I'm so glad to hear that you're trying to test for ketones and are going to head to the vet. Please keep us posted on how it goes!

It can certainly take awhile for the numbers to come down. It's great that you're home testing, and you certainly don't need to test every hour! If you can get the spreadsheet set up and input whatever numbers you have, we would love to take a look and see if there is anything we can suggest to help you get her numbers into better territory.

I'm guessing from your post that you have the link to the spreadsheet and it's just a matter of setting it up. If I'm wrong, just post here and we can give you the link, and if you have any trouble with it, we have members who can help you get it all set up. Once it's done, it's super easy and will help you (and the rest of us) find patterns and figure out what will work best for you and your kitty!

 

Hi Djamila, thanks for the info. Spoke to vet and decided to hold off taking her in as she ate and seems ok. I copied the spreadsheet and undated it with the info I do have. What do you think based on what I have? Give it more time? I will keep trying to collect more data. I tried at 11:45 am but was unsuccessful. Also waiting patiently for her to urinate so I can try and test her urine for ketones. I smelled her breath and I detected no sweet odor or anything like nail polish remover. She's hydrated and hasn't vomited except the one time early this morning.

In the meantime anything I can do to help with the weak hind legs? She takes a few steps than lays down like clockwork. Feel so bad for her...I want her to at least be comfortable until we can get her sugar down. She's been much better with testing. There was a stretch where she would not stay still. Now she's been really good about it. Today just couldn't get the blood flow, even with the warmed up rice sock or massaging the ears. Boy when the ears are warm/hot its super easy to get a sample. Cold ears...not so much

 

There is a form of Vitamin B12 that can help with the neuropathy (back leg weakness), but @Yong and a few others know more about that than I do. I know Zobaline is a popular version. There's more than one version of B12, so wait until someone else chimes in to confirm if that's the right one.

Great job getting the spreadsheet going!!! The increases your vet has advised are pretty big - we usually suggest 0.25u at a time. However, you've held the 4u long enough that I wouldn't advise you to drop down at this point. A couple of things I would suggest: try to get a pre-shot test before every shot. I know it's hard, and especially at the beginnning it doesn't always work, but we can't tell if a dose is effective without knowing where it's starting. The second thing is to try to get tests a little later in the cycle if you can. (Do you work during the day, or are you around?) A typical nadir on prozinc is between +5 and +7, so aim for tests around those times as often as you can.

In the evening, many cats respond differently than they do during the day, so if you can get in a "before bed" test, that will help to gauge if there is a difference between the two cycles.

I realize that basically what I'm saying is test test test and test. But really, that's how we'll know what do suggest for next steps.

I'm guessing that you'll need some more increases to get into better numbers, but we need a few more tests during that nadir, and a few more pre-shots to be certain.

As far as considering another insulin, Lantus is a great insulin, but since you've only been at this for a month, I would say to give this a bit more time. Plus, they'll really get on you about the testing, so this is a friendly place to hang out while you're getting more comfortable with that!

And isn't it a fun way to spend the day: stalking your kitty around the litter box? Hopefully she'll pee for you soon!

 

Hi Beenie and kitty or Beenie and her bean
The type of B12 you want for neuropathy is Methylcobalamin. Zobaline is specifically made for diabetic cats and many have great results with hit. Keep in mind, the best treatment to help neuropathy reverse is getting her numbers under control. My boy had neuropathy in hind legs and even effected his front paws . Even though he was never considered well regulated (can explain later ) his numbers were better than when first diagnosed and he wasn't bouncing as high, so by month 5, I think, was when I really noticed his improvements. His front paws were like 99% better and his hind legs were no longer fully on hocks. He's still a little lower in the back legs but this was my results with just getting his BG under better control.

If you talk to a Vet about B12 they'll probably say they can give injectable kind, which is Cyanocobalamin. This version is more helpful for uhh soft tissue is probably the best term I can think of . While it won't hurt her, it won't do much for her neuropathy which is nerve damage.

I agree with Djamila to hold off before thinking of switching. I didn't see any improvements until about 1 1/2 months . Come on over to Prozinc forum . And if you wouldn't mind setting up your Signature with some information about your cute kitty: http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

 

Welcome Beenie! Are you Beenie or is the kitty Beenie?

I'd like to just jump in and third that for now, I wouldn't switch. Lantus and Levemir are great insulins, but for now, since you're on ProZinc, I'd give it more of a shot (pun intended). It takes some time sometimes for the insulin to start working and with the large increases, kitty probably needs time to settle in a bit. Those extra tests (if you can get them) throughout the cycle will really help to tell you and us what's going on so we can see what we can do to help get those numbers down!

 

Hi Beenie, I see you are having trouble posting
http://www.felinediabetes.com/FDMB/threads/error-message.179158/#post-1980693
Has it been resolved? Any ideas anybody?

 

I could be wrong, but I think new members have to wait a certain number of minutes between postings. It is a spam defence.

 

Thanks everyone! Fingers crossed, this posts

Was able to test her urine, finally, yesterday...strip test negative! Numbers slightly improved at PS times last night and this morning. Will be around more tomorrow to try and get +5 and +7 testing. Last little tid bit that is an issue is she is eating still very ravenously which I expect but she takes in so much air her belly gets so distended. I give smaller meals more often to try and avoid this but she goes right to the other resident kitties food and takes what they don't eat. My two males eat very leisurely and she ends up eating some of their FF too. Again I'm sure this will improve but was wondering if anyone else's sugar babies have this problem. You can see how big her belly gets. Before her dx we had a full body xray done and the size of her abdomen blew my vet away. I'll upload the xray so you guys can see. It still continues to be a problem. Causing her discomfort.

Thanks again for all the information, I feel so much better already. Not in such a panic. I'm doing what I can but will do much better with testing and the rest is patience

Have a great Tuesday!!

 

Attached is her xrays side by side. The one on the left was taken 4.27.17 and the one on the right 5.4.17 after 12 hr fast.

 

Fantastic!

Maury did in the beginning. He was hungry all the time and it's because their bodies are starving. With uncontrolled diabetes their body can't properly absorb nutrients so keep trying the small meals throughout the day but stop food 2 hours prior to Pre-shot time (about 15-30 minutes before actual shot time) so the number is not food influenced.

I do still have to wonder if she's on too high a dose. She was diagnosed about a month ago and lots of kitties don't need more than 3.0U. Since she's negative for ketones and I don't think she has had DKA (if so please add to signature ), how would 1. You (what should we call you? ) feel about the suggestion and 2. How the other experienced members feel. If we did with Beenie, what we suggested for one or two other Prozinc members that were on higher doses, and start back with 1.0U twice a day and do small increases every 6 cycles? @Kris & Teasel @Djamila @Rachel @StephG

Beenie's Mum, don't feel pressured! It's just an idea I'm putting out there!

 

If it was my kitty I'd be tempted to try the experiment of reducing to 1 u BID as a start over. The dose can actually go up by 0.25 u every 3 cycles if there's no positive effect. A preshot test every AM and PM is important, along with mid day and/or bedtime tests.

This advice is counter to what the vet has recommended and I know that is usually concerning to the owner. However, all of us here on FDMB have been down that road and our kitties are better off for it.

 

I'm a little conflicted about this (and Beenie, I hope this discussion doesn't just stress you out!). Normally I agree with the recommendation to go back to 1 unit and hit reset on the process. This time I'm not sure that's the best course of action (although it may be). My thinking is that while there are big gaps in the data, the numbers that we do see are quite consistent, and indicate that there may well still be a higher dose needed. We aren't seeing any numbers that indicate drops or bounces which would hint that there is too much insulin.

They've held the 4u dose for 12 days already, and I would think if it was too much that something would have shown in the numbers if the dose was too high. My thought would be to stay at 4u for a few more days until we can see some more mid-cycle data, and then more likely raise than lower the dose.

I also worry that even with raises every 3 cycles, it would still take 18 days to get back to where she is right now. Factoring in that some of those raises might hit when the human can't monitor and would need to be delayed, it would likely be at least three more weeks to get back to where we are now. Since the kitty has neuropathy and ravenous eating, I'd hate to drag out the high numbers any longer than necessary.

I do realize this is unconventional, and I'm fine if everyone else thinks lowering is better. I would certainly support that as a safe and sound approach. I'm just not convinced that it's necessary given the data that we do have at this time. If however, Beenie (pretty please clarify if Beenie is your name or the cats name) gets more numbers in the next day or two and we find that there is more volatile data that we just haven't seen yet, then I would definitely support a decrease.

 

Here's a compromise: how about leaving the dose at 4 u until a curve can be done to properly assess it?

 

It's a tough call. One on hand I think we all agree the dose was raised by too much each time. On the other...at this high of a dose dropping makes me nervous!

I like Kris's suggestion personally. I think we need more data to look at before we can really decide. Maybe as much data as we can get this week and a curve this weekend (or sooner I'm not sure when you're available for that).

Another thought just to marinate on...I think if Beenie DID drop back, you could raise by .5 every 3 cycles if he's in high numbers.

 

I appreciate the suggestion on lowering but I'm going to take it one step at a time. My primary goal right now is more data just like you've suggested. After you guys can see a clearer picture I would consider reducing. Im hoping to work from home the next few days and get more numbers.

Thanks
Oh Beenie is my kitty. I'm Michelle!

 

Hi Michelle! Nice to meet you!

 

Hi. I tried to get what I could in today and two after PM dose last night. Any feedback on what I do have. I don't see much of a dip do I'm not sure what it means. Im certainly able to do more on Friday. Won't be home enough tomorrow. Just wondering.
Thank you

 

I can't say for sure based on the data you have since diagnosis BUT very good chunk today and last night! My gut is telling me she's on too high a dose and since increases were done in whole units, her ideal dose may have been skipped. Keep collecting data, please don't be discouraged by my thought . Hopefully, the others will chime in

 

Oh not discouraged at all. Any information/help I've been getting has me rather encouraged! Thank you so much. I called my vet's office today to order U-100 syringes as I was given the U-40's for ProZinc. Want to be ready with the right syringes when the time comes to make adjustments.

 

Do they have the one's with half unit markings? They make like so much easier . U-40s are given for Prozinc because it's a U-40 insulin. Do you have the conversion chart for using U-100 syringes with Prozinc? If not, here's the link: http://www.felinediabetes.com/insulin-conversions.htm

 

Have we suggested ketone testing strips too? You can get them at Walmart, I think in same area as diabetes supplies. Pick up a long handled metal/silicon/plastic spoon too, you can sneak it under her to collect a tiny sample to dip test strip in. Recommend weekly testing.

Wow my memory is not good tonight! lol. So essentially with my first post to tonight's question, I am still sticking with my very first post on your thread about kind of starting over. I'm sure 9 hours working outside in 90 degree weather / with humidity is playing a big part in lack of brain function!

 

Rest up. You've had a long day. I'll keep at getting those numbers.

 

Wow...great job with the curve! She did surf basically. It's hard to be sure because too much insulin can look like too little. And that yellow you got the other night is interesting (and nice to see!). I do think some more spot checks will help...can you get some the next few days?

I'm still conflicted on too little or too much...I tend to assume too much because of the raises in dose being so big, but I could be wrong...it's hard to tell because we do usually see something funky when it's too much, but with so little data, we can't (and we totally get why there's not much data! You're doing great on getting it now!).

Basically, I'm not helpful right now, but maybe get some spot checks while you can and we'll let it marinate some and see what we can come up with!

 

Thanks Rachel. I'm determined and Beenie was good yesterday with all the testing. Her ears sure are leaning to "bleed"! I'll be out most of today but should get good spot checks tomorrow and Saturday. Will keep at so we can make a decision.

Thanks and have a great day!!

 

Got the U-100 syringes just now at the pharmacy. My vet loves the idea of smaller increments. I sent him my SS link and is so on board with home testing, thinks its a great way to monitor future adjustments. Game plan is to keep getting numbers and I will call him Monday/Tuesday and will decide on new dose. Based on my data so far he strongly believes Beenie's does will go up because so far we haven't seen any dips at the +5/+7 times. He feels we would see that if it was bouncing. Either way he agrees with giving it a few more days, get more data, and go from there. One of my favorite pics of her

 

Isn't she a lovely girl?!

 

That's so great that you have a vet who is supportive! Yes, those are very high, flat, consistent numbers. Generally we recommend increases of 0.25u at a time, but the Sticky protocol does say that:

"If the cat is high and flat during the entire cycle, the dose could be raised by 0.5 units, as long as monitoring if possible.
Doses are best held at least 3 cycles, unless the nadir is too low. In that case, it should be adjusted down. NOTE: A cycle is 12 hours. So, when we say 3 cycles, we mean (3) 12 hour cycles."

Vets often suggest full unit increases, but those can so often cause bouncing, that I would suggest increasing by the 0.5, and then just doing a second increase after three cycles until you get to whatever dose the vet suggests. It just eases the transition a bit.

And that is a gorgeous picture of your sweet girl!

 

So good you have a Vet on board with you and loves small increments

She is beautiful! Love her french manicure paws

 

She's gorgeous! and I love the name, Beenie. btw, silly question: are you keeping the insulin refridgerated?

 

When I raised Chloe's dose by only .25, she had a huge bounce and may have gone hypo.

 

Roberta, thanks for asking for clarification about that!

Michelle is regularly getting mid-cycle numbers, so she can safely make different changes. She (and all of us) can see that during the middle of the cycle, Beenie is not responding to the insulin since she gets enough tests to see that.

Since you don't regularly test Chloe mid-cycle, there is no way to know how she is responding to the insulin, so yes 0.25 may have caused Chloe to have a hypo. The advice I shared from the protocol is only for owners who regularly get mid-cycle tests and know that the full cycle is high and flat, and that this pattern occurs regularly and not just because of a bounce. That suggestion to make a bigger increase is definitely not for anyone who doesn't get regular mid-cycle tests!

 

I did a curve with the Everpaw on June 3 and she was flat the whole time. You have to look at my Everpaw SS.

 

That curve did show Chloe staying flat through the cycle. However, that's just one day. Unfortunately, you need to get mid cycle numbers as often as possible...and on days you can't get a mid cycle, you want to get whatever you can in even if that's just a +2 or +3 at night. One cycle of staying flat could be a reaction to a bounce, could be a wonky cycle, could be anything. Without REGULAR mid cycle numbers, there's no way for us to know what Chloe does on a consistent basis.

 

Hello!! She is a cutie, thank you
Yes we keep the insulin refrigerated. I'll call my vet in the AM and we'll most likely increase her Tuesday AM when I can work from home and monitor her. I'm fortunate that I can work from home most days. Don't know how I'd do this if I had to be out of the house five days a week most of the day.
Feeling so much better that she is so cooperative with testing. I'm relaxed, she's relaxed, and now she comes to her "spot" when I take out the meter, rice sock, etc. Well she's in for the end game...a piece of turkey!! Luckily she's always been a foodie!! My two male cats sometimes don't even come around for treats. Not Beenie.

Fingers crossed this next increase we see some results. I can't wait for her to start feeling better.

 

It's great that Beenie is being so cooperative!!! And you are doing a great job of getting those scattered mid-cycles to give a nice picture of how she's doing. Now if that picture would only start turning a little toward the blues...

 

Good morning
Yikes I thought my meter was broken this morning (AMPS) it read "Hi". I checked manual and it said to re-test and I did and it still read "Hi". Means her BG was over 600!! My hubby forgot to load her feeder last night and I have two other cats (and feeders). One of the other feeders didn't turn for the second feeding so everything got screwed up food wise overnight. When I went to test her at 6:30am pre shot, she was upstairs which she never is at that time. She's hardly upstairs at all these days. She was licking her lips like she just eat so I'm sure she had some of my other kitties food (everyone is eating FF classics). Could it elevate her BG that much??
I was planning on going into the office today but I don't want to leave so I can keep an eye on her. She's acting fine. Once I discovered the whole food issue I gave her some FF tuna naturals which has zero carbs and her shot.

 

Any chance she got any contraband? That is a bit high, even for her. Also, is urine test today for ketones?

 

It's possible that her high BG was from eating food just before you tested but FF classics are low carb. Is there anything else she might have gotten into? It's great that all your kitties are getting low carb wet food. It's the best diet for all of them.

I see in an earlier post that you'll be conferring with your vet about a dose change. While she's in these high numbers getting in some regular urine ketone tests in important. I believe Yong gave you tips on this in an earlier post on this thread.

 

Is there any chance last night's shot was a fur shot? Since there aren't any mid-cycles or PMPS last night, it's just a guess, but the PM+3 was a bit high too and it makes me wonder if she didn't get the full dose last night at shot time. Or if there's any way she found some old higher-carb food somewhere?

I suppose it's also possible that without food she went lower than normal during the night and this could be a bounce. If you tested her right after she was licking her lips, the food likely wouldn't have had a chance to hit her blood stream yet. That usually takes about twenty minutes.

Regardless, I think this dose really needs to be increased soon. When are you talking with the vet?

 

I leave nothing out on the counters just because I know she'll eat anything. I was planning on calling vet today to confirm dose increase. I wanted to increase at tomorrow mornings dose time and that way I can monitor her throughout the day. I can do it tonight but I won't be able to get many spot checks overnight. I doubt she'll go hypo at this stage so maybe it should increase today. I will certainly test urine today. Think its ok to increase tonight vs tomorrow morning?

 

Oh and I do always rub her fur to confirm the insulin went in. I've done fur shots before so now I always check . I believe she got her full dose last night

 

Most of us prefer to increase in the AM.

 

Make sure you don't rub too vigorously. Insulin is a"delicate" molecule.

 

Spoke to vet, he said to go to 4.8 which is 12 on the U-100 syringe. He feels shes been running high for quite some time. So this is .3 higher than I thought we'd go. I'm confident in him so this is the route I'll go for tomorrow's new dose. These lines on the U-100 are tiny. Going to need the reading glasses for sure

Wish us luck. I'll get lots of spot checks tomorrow during the day and make sure she doesn't dip too low.

Thanks again !!!

 

Whew!! Ketone test- negative!

 

Always a relief to get that!

 

Yes, Michelle, make sure you are not rubbing the injection site much like Kris stated. It can effect how the insulin is absorbed . We had a couple members state they were doing the same and shortly after they stopped rubbing, BG improved a little bit as insulin was absorbing properly

 

Thank you and I will let the hubby know too! So when ever you guys say to dose in .25 or .50 increments how does that work with the U100 syringes? I seems like the easiest, based on the conversion chart, is to go .2, .4, .6, and .8.. Or maybe I have a different U100 syringe?


I'm going to increase her tomorrow am to 4.6 units.

As always thank you for the help

 

Yes a relief. Bit of a panic this morning with that reading but I've been spot checking and she's come down and feeling a tad perky today

 

For U-100 syringes, you'll do 0.2 increments

She's so pretty

 

Oh ok!

Thanks she's my little peanut...all 8 lbs of her.

 

Cutie pie!

 

How adorable!!!

 

Good evening!!
Day one on the new dose, 4.4 units. I thought her numbers ran slightly higher today which was the opposite of what I would expect. I didn't expect any change yet but she seemed just a tad higher than normal. We'll see how it goes over the next few days. I will hold longer than 3 cycles because I won't be able to test much mid day tomorrow and Thursday but I will be able to get numbers Friday and Saturday and go up if no improvement. Of course I'll reach out for your feedback based on her SS.

 

Keep up the ketone testing because of these high numbers. We'd say increase after 3 cycles if a dose isn't giving a positive response. The longer she sits in high numbers, the harder it can be to get her down. Glucose toxicity can set in which makes the cells less responsive to insulin. The way through that is regular, careful increases until you reach a sort of "breakthrough" dose.

 

Thank you! Will do. Certainly don't want that. I will post once I make a change and won't wait too long, I'll give it 3 cycles no longer. Thank you, thank you

 

Yes, keep posting here. Someone will help. You have U100 syringes so stick to increases of 0.2 u at a time because you'll be increasing often at first. This might not be what your vet would recommend but this is tried and true among the many FD kitty owners here. This will take time but you will get Beenie to a better place.

 

Yep, we're happy to help!!!