New diagnosis and Prozinc

Discussion in 'Prozinc / PZI' started by wyojonesy, Jun 13, 2012.

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  1. wyojonesy

    wyojonesy New Member

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    Hi all, Im Amanda master to my fur child Bob. I adopted him last october age unknown, the vet in his initail visit aged him between 5-7. He was just diagnosed with diabetes yesterday. I took him to my vet after he hadnt eaten anything since monday morning (Bob is a cat who as never missed a meal) and was very lethargic. his initial blood glucose when i got him to the vet was 250. They kept him over night and gave him a 2 unit injection of Prozinc. This morning they tested again and his level was 326. He finally ate wet fancy feast classics at 11 today and went to the potty box. I am just concerned with his number going up. Any encouragement out there?
     
  2. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Hi Amanda,

    Glad to see you posting, Amanda. Check your pms. I am having trouble sending your copy of the spreadsheet to your email address.

    Several things sound unusual here. Most new diabetics are literally starving - they are not cats uninterested in eating. A 250 at the vet is not very high. We think many cats are stressed at the vet and their numbers can be at least 100 points higher there. Did your vet do a fructosamine test? It is a definitive blood test that will give you his blood glucose levels over the past few weeks and is not affected by vet stress.

    We urge new diabetics to start low and go slow - test at home to get a baseline number, and if it is above 200, to start with .5 or one unit twice daily. Test at midcyle to see how the insulin is working and how low the kitty goes to see how the dose is doing. I would hate to see you give 2 units at home until you have a home test to go on.
     
  3. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Okay. Sent the link to the first email you gave me.
     
  4. kse

    kse Well-Known Member

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    Has your vet checked Bob for ketones?
     
  5. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    That's a good question, Kim. I hadn't thought of ketones. That could go with the not eating.

    Amanda, we need more info. Does Bob has any kind of infection? Did the vet talk about ketones or DKA?
     
  6. wyojonesy

    wyojonesy New Member

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    As far a keytones, the vet mentioned they were on the high side. She hasnt mentioned DKA. What is DKA?
     
  7. kse

    kse Well-Known Member

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    I am on my phone ... Let me get to a computer so I can respond better. Is Bob still at the vet?
     
  8. wyojonesy

    wyojonesy New Member

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    Bob is still at the vet he most likely will have to stay the night again. They will be doing another reading at 3:30pm I go in a 5pm to chat with then vet and visit him. Is there any specific questions i should ask while i am there?
     
  9. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    That explains why he is at the vet's office. Ketones are most often treated by a vet. DKA is a scary condition which can develop if ketones worsen. Vets can treat it with fluids and insulin and antibiotics, if there is an infection. Here is some info on it:

    http://petdiabetes.wikia.com/wiki/Ketoacidosis

    This is sounding more like diabetes. Some diabetics develop ketones if they stop eating. It is very good news that he is eating and his blood glucose levels do not sound that high.

    How long is the vet planning to keep him? Can we help you get ready for hometesting once Bob gets home?

    Great catch, Kim. I hadn't made that connection.
     
  10. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Kim has had more experience with ketones so she can give you suggestions. You might take along a tshirt that hasn't been washed and smells like you to comfort him if he is staying another night.
     
  11. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    It sounds like i should be able to take him home tomorrow as long as he continues to eat. I would love and appreciate any help in getting set up for home testing. He has the blanket from my bed that he sleeps on at night in the kennel with him. The onset of lethargy and not eating was extremely sudden. Sunday night he ate all of his dinner (i already feed a wet food diet) and was playing and cuddling like normal. On monday morning he didnt want to get off my bed and did eat any of his breakfast and he usually comes running when he hears the can open. He didnt eat dinner monday night and didnt eat breakfast tuesday morning. I called the vet and had him to her office a 1 pm yesterday. He was getting alot of eye infections that were easily treated but then would come back in about 2 months. He was just finishing up another treatment for eye infection when he started the lethargy and not eating.
     
  12. kse

    kse Well-Known Member

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    Hi Amanda.... Ketones are very serious. It is not uncommon for newly dx diabetics to have ketones due to the lack of insulin in the body. There is a difference between having Ketones and being DKA. Ketones alone are serious, but when combined with additional builiding blocks (infection being one) DKA can develop. With DKA the blood becomes acidic and the is very dangerous for the kitty's organs. The fact that Bob is eating is a good sign. A lot of cats do not eat when they become DKA and that is a severe complication. I am assuming that the vet is giving Bob either IV or Sub Q fluids-- fluids are very important in battling DKA, as is eating. Many think that DKA only happens when blood glucose levels are extremely high-- 400 or greater--but, DKA and ketones can happen at much lower BGs, similar to what Bob is having. It is important to get insulin into Bob to fight the ketones. Many times "R" insulin is used to fight ketones. Once the ketones are under control, the R is stopped and a long lasting insulin is started--ie Prozinc, Lantus, or Lev. Do you know if the vet is using R insulin?

    R insulin is a short lasting insulin!

    Be sure to ask the vet what Bob's ketone levels are today. The levels can fluctuate and rise very quickly. I do not want to alarm you, but I think it is only fair for you to know that DKA is very serious and can be life threatening. That being said, MANY cats survive DKA. My cat, Kitty, was DKA and she survived and lived another year and never had ketones again. You might want to post additional questions or concerns about DKA and ketones in the Health section, as there are many here that have had kitties with ketones.

    Please let us know how Bob is today-- we are here to help you!

    Kim
     
  13. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Here is a shopping list for hometesting:

    A human glucometer. Any one that sips and takes a tiny sample is fine. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

    Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 26-28 gauge is good. Any brand will work as long as the lancets match your device.

    Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

    Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking.

    Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

    And some lo carb treats to give your kitty, successful test or not Lo carb treats


    And here are some links and info: Basic BG testing info And a video: Video for hometesting

    Hopefully the vet will give you a testing lesson before you leave the office. Also, sometimes vet push the AlphaTrak meter. It is much more expensive than the human meters as are its strips and they are not readily available. The vast majority of people here use human meters. They work fine because we are looking for trends and patterns - not exact numbers. So we figure it doesn't matter if our meters exactly match the vets; we just want to be in the same ball park. If you can get a meter tonight, you might take it tomorrow and compare it to the one the vet has.

    Do stay away from meters with True in the name. We have found them very unreliable as have human diabetics.
     
  14. kse

    kse Well-Known Member

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    In regards to meters--- many here have had poor results with some of the Freestyle meters. I used an Accu Chek Aviva and found it very reliable- the strips cost more than some others, but the reliability was worth it to me. You can buy the strips for the Accu Chek and other meters through ebay at considerable savings!

    Good Luck!
     
  15. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    Kim~ they do not have him on an IV yet they just have a bowl of water in with him. The vet said his level wasnt high enough to have him on IV. I think thats what she said, i was in shock yesterday when she called me so most of what i got was, diabetes, ketoasidosis, and need him to stay the night. When i go in this evening i will definately ask about his ketone levels today. Do you know what the "normal" level is for ketones. The currently only have him on the Prozinc insulin and not any "R" insulin.

    Sue~ thank you for the shopping list. I live in a fairly small town so i will check to night at the grocery store pharmacy to see what testing supplies they have.

    Thank you so much for the information

    Amanda
     
  16. Questions for the vet....

    Make sure and ask about ketones, and specifically if he's DKA
    Ask about pancreatitis, if any blood results indicate that could be a possibility
    Find out if, or how much, he is dehydrated. They may send you home with fluids you have to administer.
    Don't let them sell you any sort of prescription diet food, wet or dry. They are grossly overpriced, and anything made by Hill's is terrible food for a diabetic cat.

    Let us know what they say!
    Carl

    P.S. - my kitty's name is also Bob. Does yours have a tail?
     
  17. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    Carl~ my vet has already said she would keep him on the same diet right now and take away the dry food. HE is on Iams hairball control dry food and fancy Feast Classics like turkey and giblets ( thats his favorite) and chicken and beef. Thank you for the sugestion on questions. I have wrote them down on my list of things to ask the vet tonight. He does have a tail a rather long one. He is a maine coon and weighs 15 pounds.
     
  18. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Your vet is sounding better and better. It is a great idea to drop the dry and only feed wet. Fancy Feast classics are a good choice.. Another vet explains why wet is best here: catinfo.org
     
  19. kse

    kse Well-Known Member

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    Amanda, they can test for ketones by either a urine dipstick test or a blood test. Most vets that I have dealt with use the urine dipstick-- the levels range from negative, trace (5), small (15), moderate (40), large (> 40) ** the numbers are the middle range reading. In my opinion, anything above small is in need of fluid therapy-- the fluids help flush the ketones. Lack of, or insufficient insulin is a major player in the development of ketones. So, if Bob just started insulin this week, it is probably fair to assume that the Prozinc alone might be okay -- since he went form no or little insulin (diabetes) to the Prozinc--but, I would be sure to ask what his 12 hour curve looked like today. If they Prozinc is not lowering the BG, the R might need to be supplemented.

    There is a link at the top of the forum threads, where you can ask for starter kits for testing from FDMB, in the event you have trouble finding anything. I also have a few extra supplies if you need them (but, no extra meter!)

    Continue to ask quetions-- there are many here that can help you and Bob!
     
  20. kse

    kse Well-Known Member

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    Feb 10, 2011
    Be aware that when you take away the dry food, you will most likely need a reduction in your insulin dose. Many cats that are on dry food, that are switched to wet, can be maintained with diet alone. My Chewy, was a dry food addict-- when he quit eating dry and was switched to wet his numbers dropped drastically. He came off of insulin therapy in 6 weeks. He too is a Maine Coon!

    Good Luck.....stay on top of the Ketone situation, that is your biggest enemy at the present time.
     
  21. wyojonesy

    wyojonesy New Member

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    Update on Bob. The vet was not in the office when i went by. They tested his BG at 3pm and it was at 360. they gave him two more units of insulin at 5pm and he ate while i was there. I asked about the ketones and they said first they want to get the BG regulated... this sounds odd to me. I am hoping i can take him home tomorrow. I will be calling another vet in the morning he is the vet my mom takes all of her pets to and is recommended by allot of people and is only about 2 hours away from where i live. I just want him to feel better. Why is the BG going up even with insulin treatment? Could this be a "bounce" it shocked me that they started treating with 2 units right away... im just so upset right now :cry:
     
  22. I can understand them wanting to get the BG down, and fairly quickly, because although ketones can appear no matter what the BG is, they are more likely with higher numbers. If he was "DKA", the usual process as I understand it is to use fast acting insulin (sometimes in combination with the normal insulin), and to give it by either IV or intermuscular shots. In a bad case, they sometimes have a dextrose or other type of "sugar" IV drip going on at the same time.
    If they are just dosing him with Prozinc normally (sub-q), then he may be showing ketones, but not drastically, ie: DKA-like. DKA usually involves sub-q fluids because of dehydration, and many times a kitty who won't eat without being syringe fed and/or tube fed. So it sounds like things aren't "bad" at least not to that point.

    It isn't rare that they would give him higher doses than you might think are logical. In general, it seems that vets are more heavy handed when it comes to dose amounts. It sounds like they are doing whatever they can to force the numbers down in a short time frame. If they can do that, then his numbers once they let him come home would be lower overall, and hopefully they would advise that you lower the dose accordingly. Unfortunately, it sounds like you are stuck in that awful "waiting game" as they attempt whatever it is they are attempting to do, and you're stuck as an onlooker. Try not to get too stressed and upset (yes, much easier said than done, I know), and try your best to get them to explain things to you as they happen. Let us know what they are saying, and hopefully we can let you know if what they are saying sounds like it makes sense to us.

    Carl
     
  23. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    Thank you Carl, I wam one stressed out cat mom right now.
     
  24. Understood. My Bob was DKA the first week after diagnosis, and spent three days in emergency treatment with little to no "updating for dad". I didn't hear about all they did until the day I went to pick him up, and I was stressed just a tad too!

    Carl
     
  25. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    Another question, those of you how had your kitties started out on Prozinc, how long did it take for your cat to start having any signs of BG inproving? Im just worried with the number not going down but going up (250 initally at vet, 326 at 8am and 360 at 3pm today)
     
  26. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    I have this comment that some people make fun of me for - Breathe, Amanda, breathe. :D The vets seem to be doing the right stuff. I am assuming, along with Carl, that the ketones are not too awful as they don't seem to be treating them too aggressively. Once you can get more information from them, it will be easier for you to process and research and ask more questions.

    Imagine there aren't too many choices for vets in Rawlings. (We are "almost" neighbors - I live in Colorado Springs) Sometimes we ask if we have members nearby who can suggest a second opinion vet but I don't think we have anyone in Rawlings. We do have a member in Wyoming somewhere, but she hasn't been completely pleased with her vet.

    Just get ready for him to come home. Collect your testing supplies and practice with your meter. And breathe, Momma, breathe.
     
  27. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Re your last question. Everything is different at the vet. If the other cats are howling or a new dog is brought in, it raises Bob's stress level and that raises his bg levels. He is still not in dangerous levels. We have lots of kitties here who start out in the 400-500 range.

    If his numbers continue to rise, you can ask about adding a short acting insulin like R that could bring down his numbers.
     
  28. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    Great Update on Bob this morning. His BG was down to 190 and his is not showing ketones any more. Vet said he can go home at noon. She said to do 2 units twice a day and in two weeks he will go back in for a glucose curve. Thank you everyone for the good thoughts will keep everyone updated as the treatment progresses. Thanks again :smile:
     
  29. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    How wonderful Bob is coming home! But I have to say I think this is not good advice from your vet, Amanda. 190 at the vet could be below 100 at home. Two units is a large dose and he could easily drop too low and hypo. We would urge you to home test before you give a shot, get a number without vet stress and shoot low to start. You can always raise the dose if you need to, but once shot, you can't get the insulin out of the cat.

    If you test at home, you can do the glucose curve and send the results to the vet. It is likely to be much more accurate than a curve taken in the vet's office.

    I know we are only strangers on the internet, but we do see a lot of diabetic cats. And shooting two units blind is not a good idea.
     
  30. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    PS Be sure to get ketone strips so you can test for ketones at home.
     
  31. wyojonesy

    wyojonesy New Member

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    Thank you Sue I was thinking the same thing. I thought 2 units was alot even at the vet. I am going to the store before i pick him up to get testing supplies and will have the vet show me where and how to test so i can keep a very close eye on him at home. I am thinking of just doing 1 unit... its hard for me to go against the vets judgement but at the same time i feel like it may be putting bob in danger following her word. I am still going to be getting a second opionion from another vet. I called this morning and just waiting to hear back from him.
     
  32. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Oh good. When you get a number at home, post and we can give you some ideas on dose. Or if you have trouble getting blood, post. We all have tips that helped us in the beginning.
     
  33. sophie

    sophie Member

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    Jan 2, 2012
    Hello Amanda,
    just want to welcome you! Noticed that you're in Wyoming, I'm in California. When first starting out, I was totally overwhelmed by the diagnosis and amount of information needed to absorb. The members here were great and generous with their answers.

    Some of the diabetic supplies took 'forever and a day' to get to me from the East Coast. I found a couple of supply sources with warehouses in western US. Perhaps, you can use them:
    1. http://www.diabeticcorner.com tel: (951) 847 - 7022, when I called to inquire about Bayer Contour testing strips, I received them the next day!!! They cost fully 2/3 less than in my local pharmacy!!! Great place in case you cannot get to a store for immediately needed supplies.
    2. Amazon Prime - if you purchase the Prime account ($79 per year, first 30 days free, account won't be charged If cancelled within 30 days) Prime eligible items (not all items are eligible) will be delivered in 2 days with no shipping or handling charges. Most of my purchases came from Nevada, thus, avoiding both s&h plus, in my case, the almost 9% California sales tax.

    My best wishes, Sophie
     
  34. OK, I asked in Health but now I realize he got two units at the vet, right?
    Yes 2u is a hefty starting dose. When you pick him up, and they show you how to test, see what kind of number you get. Also , find out how long since the shot was given. That's good data to have. And ask when and how much he ate this morning. Then after you get him home you can see if his number dropped any "vet stress".

    Glad to hear he's well enough to come home today :)
    Carl
     
  35. Lori&Scout

    Lori&Scout Member

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    Jan 18, 2012
    To answer your question about how quickly you can expect an improvement, his pre-shot blood sugar (all things being equal) will probably be constant on average, but with random highs and lows day to day. You can't read into an individual number too much, but if it is low, be cautious giving insulin. HOWEVER, with a switch to an all wet food, low carb, diet, you should see a dramatic improvement in his numbers within a day or two. The last day my Scout got into the dry food was the last day I gave her insulin... Once her preshot numbers got down to around 200, I stopped giving insulin and just kept an eye on her numbers. Go ahead and check out her spreadsheet below to see how fast it went down! Hopefully the same will happen for Bob and he'll be diet-controlled or managed on a low amount of insulin. Fingers and paws crossed over here.

    Lori
     
  36. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    Got him home :) when i picked him up i asked what time they gave the shot and It was at 8:30am with BG of 190.when i was there to pick him up we tested his BG with a meter i got and it tested 143 while still at the vet at 12:30pm. Ill test him again tonight after he has settled down.
     
  37. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    New update, tested bob tonight he was at 127. Called vet and she advised to skip this shot and see where he is tomorrow morning for AMPS.
     
  38. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Good idea to skip. The long cycle most likely means the dose is too high. If you reduce the dose, you are more likely to get two preshots that are shootable - that's what you are aiming for. The number in the morning is likely to be high, but not a " true" number. It will be higher because he has been 24 hours since his last shot. Regardless of your number in the am, it would be wise to reduce. I would play it safe and do one unit. 1.5 might be okay, but it could also be too much.....
     
  39. wyojonesy

    wyojonesy New Member

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    Sugar this morning was 134. Skipping another injection. Will be monitoring him closely :)
     
  40. kse

    kse Well-Known Member

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    Great you are skipping! Just continue to test!
     
  41. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    Will be testing at +6 and PMPS. Im completely stumped as to how this is happening. Hoping all stays well :)
     
  42. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    This is puzzling. It is beginning to look like he will be needing very little insulin, if any at all. It doesn't fit with the ketone diagnosis. Although you can have ketones without sky high numbers, I haven't seen a kitty come home and immediately throw low numbers. It's good news - just unusual.

    Regardless, good job on skipping. We generally urge new diabetics not to shoot under 200 (in case you get a 200 number at pmps), but to wait 20 minutes without feeding and test again. We want to be sure the number is going up, not down and that he is safely in the 200+ range.

    For reference, the normal range for cats, off insulin, is 40-120 with the majority of the time spent in double digits. A regulated cat, on insulin, will run in the 200 range at preshot and in the 100 and below range at mid cycle, but not in the 40 range.

    Please post your number before shooting tonight. You are most likely going to need to shoot very little insulin, regardless of the number.
     
  43. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    I will definately be posting his preshot number. My vet also gave be a direct line for her so i can check in with her at the preshot times to see if 1 i need to shoot and 2 if i do... how much. You guys on here have definately been wonderful to have :) I cant say it enough but thank you to everyone for their insite and knowledge :) Like i said I will definatly keep updating :)
     
  44. Amazing. :)
    Do you know if Bob has ever been given steroids for anything?
    Carl
     
  45. sophie

    sophie Member

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    Jan 2, 2012
    Hello Amanda,
    perhaps, you may wish to ask your vet for copies of all laboratory reports. They are good to have in case you go away on vacation or if for any reason you have to take your kitty to another vet. I always do so. In my opinion, it's especially important in case of serious diagnosis like DKA. It's also good to look them over in case the vet overlooked anything. You can always post the numbers here and ask for opinions.

    Your kitty's numbers look awesome! I'm curious to know if your vet has ever seen such low BGs in the immediate aftermath of a DKA episode. Sophie
     
  46. Lori&Scout

    Lori&Scout Member

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    Jan 18, 2012
    When was the last time he had dry kibble? We've seen a lot of huge improvements here with diet change alone, hopefully that's the case here.

    Lori and Scout
     
  47. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    Hey everyone. Bobs numbers Are looking great :) he has not had a bg of over 143. I have taken him off of " open range" dry food. He was never "dka" but had traces of ketones that could have progress to something worse the vet said. I havnt had to give a shot since he has been home from the vet. I am hoping it can just be controlled with diet. It definitely is looking that way :)
     
  48. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    A quick update on Bob. He has been doing good i havent had to give him any insulin shots since i got him home. His numbers though have been gradually climbing. One question. Most people they dont shoot below 200. Is that on a pet specific meter or on a human meter? I have been testing on an Accu-chek aviva and the numbers in his spread sheet are the number that shows up on the meter screen. When do you guys determine when to give a shot and how many units? Thank you so much!
     
  49. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Dec 28, 2009
    Lots of people mini dose when the cat's numbers start going down. Here is some info on how it works:

    When your cat is consistently in numbers too low to shoot at shot time and in numbers in the 100 range and below during the cycle, you can consider micro dosing. This process should be guided on the forum by experienced members and will require more frequent testing.

    You may be shooting at times other than the 12/12 schedule, when the blood glucose levels rise enough to require a small dose of insulin. You will need to pick a number somewhere near the 150 range at which you will plan to shoot, being sure that the number is indeed rising. The dose at these low numbers will vary with each cat and its patterns, so advice should be solicited. But you may be considering doses below .25 and even considering a “drop” of insulin. At this point, U100 needles and the conversion chart will be necessary.

    It is important during this period to offer small frequent meals. You may want to experiment with the lowest carb foods to help bring down the numbers, staying away from seafood more than once or twice a week.


    You will need U100 needles and the conversion chart.
     
  50. wyojonesy

    wyojonesy New Member

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    Jun 13, 2012
    Thank you. I rechecked him at +4 and he was down to 115 with out any insulin. So ill just keep checking him. Thank you
     
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