NEW MEMBER 2/9/20 - My vet wants to increase to 3 units, and I am worried that it is too much!

Discussion in 'Feline Health - (Welcome & Main Forum)' started by NiandraLaDes21, Feb 9, 2020.

  1. NiandraLaDes21

    NiandraLaDes21 Member

    Joined:
    Feb 9, 2020
    Hi everyone,

    I am a newbie, and I need help figuring out this insulin dosage with Prozinc. I feel I don't know what I am doing. I am not as clueless as the beginning, but I am slowly learning, especially after having come across this forum a couple of days ago. My cat Chia is 11 years, 19 pounds (body condition is a 6 or 7....he has a large frame and muscular) and diagnosed diabetic in October 2019.

    On Wednesday 2/5/2020 after getting the results of my cat's fructosamine, my vet told me that Chia's insulin needs to increase to 3.0 units. I am scared this is a big jump from 2.0 units, so I only increased it to 2.25 units that Wednesday evening to see what it does. His AMPS/PMPS since the dose increase are lower now....maybe too low from what I am learning in this forum. In fact, I am thinking that I am supposed to skip his insulin dose tonight if it is still below 200. I am doing Chia's first blood glucose curve today. I understand I am supposed to wait 7 days after the change in dosage, but I gave him insulin this morning with a AMPS of 78. I figured I may as well do the BG curve so I can monitor the effect of the insulin dose.

    Background on Chia's diabetes diagnosis. My cat Chia had a case of pancreatitis in late September 2019 and was diagnosed as diabetic in October 2019. He was severely dehydrated and not eating . They had to put a feeding tube and spent a few weeks at the vet. He recovered, but the vet told me he needed to be on insulin. She recommended 2.0 units of Prozinc every 12 hours.

    Prior to Chia's diagnosis, he was already on a raw food diet. I give him Bobcat' s Raw Foods (from a local business here in Texas) and also Stella and Chewy's dehydrated raw food that is reconstituted with water. I used to leave extra food for both my cats since v they tend to be grazers, but now I am checking his portion size to make sure he is not overeating. I also used to give him this cheese popcorn from Trader Joe's whenever I was snacking on it (he would beg for it....he seems to like corn and breads....i have to make sure such items are out of reach from him), but since his diagnosis, I no longer give him popcorn or other human food. I believe the popcorn was what triggered the initial pancreatitis because I had given Chia some a couple of days prior to his getting sick. I hadn't had that popcorn in a while and that was the only thing that changed prior to his getting sick.

    When Chia was at the hospital with a feeding tube, they gave him a prescription diabetic canned cat food (Purina DM, I believe). Since returning home, I have put him back on his raw food.

    I started testing his BG at home in November 2019 when I bought the AlphaTrak2 the vet recommended. I wasn't that consistent with checking. I was merely keeping track of the numbers to show the vet. I also think I wasn't as consistent with the 12 hour window now that I look back at my readings.

    Chia had another bout of pancreatitis in mid-January 2020. He wasn't eating like normal and he was in pain. The vet gave me some meds to help get him out of pain and back to eating (cerenia, Bupernex, mirataz). I took Chia for a follow-up visit on Tuesday 2/4/2020 and they did some bloodwork. On Wednesday, 2/5/2020, the vet told me Chia's fructosamine was too high still and recommends increasing his dose to 3.0 units. I only increased to 2.25 units because of my concern of it being too much of a change.

    For the past couple of weeks, I also have been trying to give him smaller meals throughout the day rather than 2 large meals. On the days I work, I separate the cats and give him one large meal. Then I give him 2 smaller meals in the evening. I am looking into investing in a times feeder for when I am at work.

    Any advice on what I should do? Here is his spreadsheet. Thank you so much for whoever created this template. It is very helpful!
    https://docs.google.com/spreadsheet...ufU0t7228kEIG7gLPk5KNKL3sZI/edit?usp=drivesdk
     
  2. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Welcome to FDMB!

    Wow, congratulations on taking control of this situation. I am so glad you decided not to give 3.0U and only increased to 2.25U. Even that might be more than Chia needs, so it is a really good thing that you are testing! I am not familiar enough with Prozinc to give any dosing advice with that insulin, but here are a couple of general observations from your spreadsheet:

    1) I'm glad that Chia was (apparently) moving up this morning and was in safe numbers all day, but in general, I wouldn't shoot 78 on an AlphaTrak without a lot more data than you have. You've been doing a great job getting the pre-shot numbers, but you want to get more tests in between shots, to get an idea of just where a particular dose is taking him.

    2) From the numbers you do have, I'm willing to bet that Chia is spending a lot of his time "bouncing". That's what we call it when a diabetic cat hits an (unfamiliar, to him) low number, his body reacts by dumping sugar into the blood, and the BG numbers zoom back up. That's bad enough to have to deal with, but the real problem is that a really bouncy cat can spend up to three days bouncing after a single low :eek:. Which means that not only will you have to get very lucky to even see that occasional low number with just a couple tests per day, but also, the vet's fructosamine test will show too-high levels, and you'll get a recommendation for a dose increase, even though the current dose is perfectly capable of bringing the BG down. It's the cat's body's reaction that's the problem, and the fix for that is time and patience, not more insulin. Anyway, looking at your spreadsheet, not only did you get the 78 this morning, but an 82 a couple weeks ago, and lots of scattered blue numbers throughout. Again, I'll have to defer to those who know Prozinc better, but it sure looks like Chia is getting enough insulin, he's just a bit bouncy.

    OK, that's a couple of dense paragraphs of info, so I'll stop here for now. Again, welcome, and good for you for trusting your instincts on that 3.0U dose!
     
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  3. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Sorry, I forgot a really important question: during Chia's pancreatitis attacks and hospitalizations :(, was he diagosed with ketones or ketoacidosis/DKA?
     
  4. NiandraLaDes21

    NiandraLaDes21 Member

    Joined:
    Feb 9, 2020
    Thank you for explaining bouncing more clearly for me. That makes sense. I was wondering about that. Yes, it seems his numbers are everywhere and he is bouncing a lot. I will see what his PMPS reading is tonight and see if I need to skip his dose. This is definitely tricky, but I think I am slowly absorbing this new information.

     
  5. NiandraLaDes21

    NiandraLaDes21 Member

    Joined:
    Feb 9, 2020
    Hmmm....good question . I want to say no, but I am not 100% sure. This recent bout in mid-January I am pretty sure is a no. But the initial one in October 2019, I am not sure. I will call my vet tomorrow and ask more specific questions about his ketones. I need to start testing for ketones at home. I haven't been doing so.
     
  6. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Right, that's why I was asking! That's always a good thing to do with any diabetic cat, but particularly one that has already had ketones. Also, if he did happen to have been in DKA recently, it may affect some of the advice we give here on insulin and food.
     
  7. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Nindra, you are so smart to be cautious of such a big increase in dose. I'm a ProZinc user as well, and I had help from a very experienced member when I started. What I'm going to tell you is what she told me.

    Yes, I agree with Nan that Chia looks to have been bouncing a bit. Here's why the mid-cycle tests are so important. You don't change doses based on pre-test numbers, you change besed on the lower, mid-cycle numbers. Look at all those lovely blues you have today. I wouldn't up that dose at all. Hold steady at 2.25 and watch the numbers. Be prepared if his mid-cycle numbers come down, you may have to reduce dose. And be wary of giving him any insulin at all if his pre-shot test is below 150-200. Depending on the pre-shot number, you may want to stall, give a lower dose, or not dose at all. Stalling is exactly what it sounds like. You test, get too low a number, and wait without feeding for 20 minutes, then test again to see if the BGL has come up high enough to inject. You can stall multiple times if your schedule allows.

    You're smart to do more smaller meals as you can, and timed feeders are awesome. Two giant meals twie a day is what most vets recommend, but it's not good for regulating blood sugar. Just make sure you pull up any uneaten food 2 hours before test and injection time. This will give you a more honest BGL (not one pumped up by eating) and make sure Chia is hungry enough to eat when he gets his insulin.

    You are taking awesome care of Chia. You rock!
     
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  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome to FDMB!

    You have great instincts! Increasing a dose by 1.0u would be a very big increase. We typically increase by 0.25u.

    The one think I'd strongly encourage you to do is to start getting some tests during the both the AM and PM cycles. Without any spot checks, you have no way of knowing how low a dose is taking Chia and if low numbers are what's contributing to bouncing.
    With Prozinc, the pre-shot numbers tell you whether it's safe to give a shot. The nadir (lowest point in the cycle) lets you know if you need to reduce the dose or if an increase is needed.

    One additional thought. The dosing methods we use are based on a human meter. The strips for an AlphaTrack are very pricey. You may want to consider getting a human meter and paying way less for your strips..
     
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  9. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    Thank you for your tips. Chia's PMPS was 149. I didn't stall and retest though. I will remember to do that next time. It did decrease from his +10 reading and he was definitely vocal about being hungry! I will do a mid-cycle this evening before giving him one final small meal. I will be making sure to take more mid-cycle readings. Looking at everyone else's spreadsheets is giving me a better idea about insulin dosage. I still have lots to learn though! There is a beauty to all these spreadsheets I am seeing. It is a peak into everyone's journey to their furrbaby's better health!
     
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  10. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    I had no idea you could use human meters until I came across this forum. Yes, the AlphaTrak2 strips are very pricey. I will look into a human meter. I am going through a ton of strips with all this testing! Thank you for the advice. I will be doing more mid-cycle tests, too.

     
  11. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    The pro side to using an Alphatrak is it does give you more accurate BG readings, since it's calibrated to feline blood.
    The con is that the Alphatrak test strips are pricey and you can't buy them just anywhere. Although, ADW Diabetes carries them.

    The pro side to the human meters is the cheap test strips and the documents here are all written for the human meters.
    The con side to the human meters is their accuracy and depending on the meter, the bigger blood drop needed.
     
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  12. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    That is a lot to consider. I will probably continue to use the AlphaTrak2 for a while since I have 2 more bottles of strips to use. Maybe once I regulate Chia's diabetes, I may look into the human meter.

     
  13. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    John Frusciante fan?
     
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  14. NiandraLaDes21

    NiandraLaDes21 Member

    Joined:
    Feb 9, 2020
    Chia's PMPS was 149, so I am skipping his shot tonight. I will be taking a mid-cycle test in a few hours and see what that does. I am excited with this new knowledge. When I look at all the pre-shot readings I took, I can see all the bouncing going on since he has started on insulin. There were many times I gave him insulin when his pre-shot was in blue and green. Now I need more mid-cycle data to see what the insulin dose is doing. Thank you for all the helpful information everyone. I am truly feeling more empowered to care for Chia. Knowledge is power!
     
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  15. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    Haha, yes! Are you?
     
  16. Juls and Billy

    Juls and Billy Member

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    Dec 28, 2019
    Just popping in again to say that you are completely and totally awesome! The more you know, the easier it is. Chia is in excellent hands.
     
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  17. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    He's a bit too atonal for my tastes.
     
  18. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    I get that. I love his guitar work.
     
  19. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    Thank you for the encouragement!
     
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  20. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    @Deb & Wink -
    I don't agree. Human meters are accurate. If they weren't, they would not have FDA approval. As long as you test consistently with the same meter, there isn't an issue. Human meters were around before pet meters and people continue to use human meters with no problem. As for the amount of blood needed, this varies by meter. Some take more; some take less, as Deb noted. You need to do a bit of homework to find the amount of blood.
     
  21. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    FDA 'Approval' you say?
    Well you may be interested in this article on how many of those FDA approved meters failed independent testing.
    Are Blood Glucose Meters Accurate? New Data on 18 meters. Article is from 2017.

    Comparative Accuracy of 17 Point-of-Care Glucose Meters article is from 2017

    Accuracy evaluation of contour next compared with five blood glucose monitoring systems across a wide range of blood glucose concentrations occurring in a clinical research setting.
    article is from 2015

    Do Currently Available Blood Glucose Monitors Meet Regulatory Standards? from 2013
    "Several articles have concluded that BGMs in the marketplace may not consistently provide accurate results in accordance with the regulatory standards that led to approval. "
    " The FDA does not conduct an independent evaluation of the device and relies on data generated and submitted by the manufacturer. There are limitations to the data received by the FDA and on how the FDA can review the data."

    We already know that the components of feline blood differ substantially from human blood. We are in essence using the human blood glucose meters "off label" in our diabetic cats. With data collected over years on an informal basis.

    It's a delicate balancing act. For some people, it's being able to test their cats affordably with a human meter vs less testing with a pet meter. Your choice. Always.
     
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  22. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    Although pet and human meters are essentially the same and have the same inherent accuracy, pet meters give a more accurate BG since there is a different distribution of glucose in the blood constituents in animal blood compared with human blood. Pet meters, which are really just human meters, use an algorithm to account for this different distribution.
    https://www.wellion.eu/en/animals-diabetes/why_a_special_blood_glucose_meter/blood_different/

    However, with ost human meter, the difference is relitively small especially with human meters reading a little lower than pet meters. That difference doesn't really affect dosing and BG control. I have been using human meters since I began the journey of being a diabetic cat caretaker over 15 years ago.
     
  23. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    I'm also a bit uncomfortable with calling human meters "inaccurate" (even if that is, technically, the right way to describe them). I've seen my share of "wonky strip" readings from both pet and human meters here, but I don't think I've ever seen anyone having problems with a human meter where they were giving such unreliable readings that I worried about the decisions being made.
     
  24. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    I called my vet and he was not diagnosed with ketones or ketoacidosis/DKA ever.
     
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  25. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    That's great-- it's much easier without having that to deal with. Still a good idea to test for ketones regularly, of course!

    How is he doing today?
     
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  26. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    I didn't give him an injection yesterday PM because he was in the blue range. I took a couple of mid-cycle readings and his AMPS was in black so I gave him 1.75 units. I was able to come home during lunch and his +5 was in the yellow. I just got home. I am about to check his PMPS soon and see how he is now.
     
  27. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Good to know? Very good!

    With Prozinc and a pet meter like the Alphatrak, I wouldn't dose at those low numbers you are getting, like the AMPS of 78 on 2/9/20.

    Try to keep closer to a 12/12 hour schedule for the dosing with Prozinc. That consistency in the dosing schedule is important. It may mean you get up the same time on the weekends as you do for work during the week. (I can hear the groans already. :()
    Pain can spike BG (blood glucose) numbers.
    Raw food is a good choice for a diabetic.
    Any access to "contraband" from other pets in your home or people food? (besides the Trader Joe's cheese popcorn, which you have stopped sharing.)
     
  28. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    No access to contraband food from the other kitty Tiggy. She gets the same type of food. No other human in this household either.

    Chia's PMPS is 165. He was stressed more about me pricking him and was fighting me a bit. I hope it is an accurate reading. I am doing a 20 minute stall and will check again. So if still under 200, I skip the shot right?
     
  29. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Yes, if under 200 with the stall and retest, skip the shot for tonight. Pick things back up in the morning.

    Expect a "bounce" from a skipped shot. Higher BG's because of no insulin.
     
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  30. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Would you update your user profile Signature with a bit more data please?
    Your first name, cats name age and sex, diagnosis date, insulin used, meter used, any other health conditions. Then last but not least, the SS.

    250 character and 2 line limit on the signature.

    You can shorten the name on the ss to make everything fit better.
     
  31. NiandraLaDes21

    NiandraLaDes21 Member

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    Feb 9, 2020
    Still under 200 after the stall so I am skipping his insulin shot tonight.

    I will update my user profile Signature with more data as soon as @Marje and Gracie edits my spreadsheet link.
     
  32. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    OK Lots of kitties stalling tonight, and then skipping.
     
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