New members, on Prozinc

Discussion in 'Feline Health - (The Main Forum)' started by Julie & steve j, Dec 8, 2018.

  1. Julie & steve j

    Julie & steve j New Member

    Joined:
    Dec 8, 2018
    Hello everyone

    We have a wonderful black/white male called Benny, got him from RSPCA about 5 years ago, he's aged about 8-9 now. In September he was diagnosed diabetic after we noticed him drinking/weeing more than normal.

    The vet started us on Caninsulin at 1, then 2 units. His numbers early on were low twenties, dropping to about 9-10 briefly. By the next curve he was twenties to mid teens at best and we changed insulin to Prozinc and 3 units. Since then his numbers have continued to increase, and so's the dose. We've gone through 3.5, 4, and now 5 units since last Monday when his numbers started late thirties down to mid twenties and back up.

    Early on we struggled with him a bit, and he wasn't his normal active loving self. He lost just over a kilo in a month. More recently we've started to see an improvement in his general manner, he's interested and wants attention like he always did, and he's even started to put a little weight back on (although with what he's eaten recently, that's not too surprising). But at the same time as we went to 5 units his water/food consumption has suddenly doubled.

    Once we went onto Prozinc the vet recommended monitoring his consumption accurately, and for a while he was drinking between 250-300 mls of water on good day, and maybe 300-350 on a worse one, which we expect as normal. This last week he's drunk around 600mls every day.

    For food he generally eats biscuits, our main brand has been normal Purina. He's a bit of a grazer rather than twice a day, and in the past we've pampered to it a bit too much and kept his food topped up. He's also fussy and if you put wet pouch down he'll only lick the jelly out of it. So the other change we've made this week is to buy some Purina Diabetic biscuits and to try and stick to the recommended amounts, eg. about 80g for his weight. Again, like the water he'll have eaten all his first batch of 40g in about 5 hours, and I'd guess if we put the other 40 down now it would be gone well before bedtime and he'd then be up through the night wanting more.

    Sorry to go on, but has anyone been in this position? From the initial upsurge in everything we thought we were really getting somewhere in the last few weeks (albeit his numbers were increasing), but this week's just been consistent loads of food and water, very disheartening.

    Thanks

    Steve Jackson
     
  2. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Hi welcome Julie, Steve and Benny! I think a change in food will help a lot as dry is very high in carbs. The best is a low carb wet food and we can help you with the transition. Also, are you home testing? It’s easy to do and very important especially while transitioning to a lower carb food as that can lower Benny blood glucose significantly. Where are you located (country) that will better help us recommend a food, meter, etc. I’ll tag a few prozinc users to help too. @Rachel @Djamila @Kris & Teasel
     
  3. Candy&Company

    Candy&Company Member

    Joined:
    Sep 12, 2018
    When you say he'll only lick the jelly... will be come back to lick more? My Fena is like this. She'll lick the moisture/good stuff out, and leave all the meat bits. Have you tried adding in hot water (kettle steaming but NOT boiling), and stirring it round and round, mashing the meat bits on the bottom of the bowl with a spoon?

    Generally they'll come back and eat more - eventually getting the bits too.

    Plus constantly adding a little bit of water to the food, even from first opening the pouch and putting it in a dish - gets them water.

    Diabetics are usually always hungry, but with dry food they'll go for the water bowl ALOT - if you can transition fully to wet, adding water to it at every stage (when it goes in the dish, after they eat from it a bit, etc) it'll help. But what you're experiencing is normal.
     
  4. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Hi Steve, Julie, and Benny! It definitely sounds to me like Benny is unregulated right now. That's pretty normal at the start (I know he's been on insulin for a bit, but Caninsulin doesn't usually do well with our kitties...some do great on it, but most of the time it isn't long enough lasting in cats to keep them regulated). What dose of Prozinc do you have him on now? Still 5? Do you test at home? That will help us figure o ut what's going on and help you get a good dose that might help Benny feel better.

    My guess is that you may have just jumped up too quickly. We don't often switch doses by whole units at a time. We usually do 0.25 or 0.5 at the most. If you can get some tests in (both preshots and mid cycle tests...whatever you can get) we can definitely get a better idea of what's happening. And as you get a better dose, Benny will feel better...he'll drink less and eat less too.

    We CAN help you. Yes, we've been in a position like this before, and we've helped plenty of cats get to feeling better over time!
     
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  5. Julie & steve j

    Julie & steve j New Member

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    Dec 8, 2018
     
  6. Julie & steve j

    Julie & steve j New Member

    Joined:
    Dec 8, 2018
    Thanks everyone for your replies, much appreciated. I sense, especially from the times involved, that most of you are in America? We're in England, North West.

    Rachel - definitely unregulated yes, we've done about 5 glucose curve tests at the vet now, usually about 2-3 weeks apart, and his numbers have increased each time. We inject at 8am and pm, take him in after the first one and he spends the day there, on blood tests every hour. The last time his first number was about 38-39, although that did drop to mid/high twenties later in the day. Stress probably played a (small) part in that, he's no fan of car journeys.

    The vet's line has been to increase the injection amount, and we've gone up in half units until this last time when we straight from 4 to 5. Now been on 5 units for 5 days and his water/food consumption has pretty much doubled this week. We don't do home testing yet, it's something we aspire to but we had some trouble with the injections for a while, getting a bit more used to them now, and we reckoned that although it's not a true reading we were happy to let the vet do the readings at the curve tests for now. Obviously in the future we want to be able to carry out our own random tests.

    I can pretty much remember the approximate numbers of all the curve tests he's had to date, if that'll help any?

    Sharon - thanks for that. It makes a lot of sense, he's just so fussy though and especially since the diabetic diagnosis we've been conscious of the importance of him eating. Maybe more so with the original Caninsulin than this slow release Prozinc. The vet wanted us to keep to his regular diet as much as possible, which means regular Purina biscuits, but we've just changed to their Diabetic biscuits, not with any outstanding success healthwise so far, although he does like them.

    Candy - yes he just licks the jelly out and leaves the chunks looking like a dessicated prune! I'll definitely try your suggestion of adding the water and see what happens.

    Thanks again everyone, I'll try and update soon.

    Steve
     
  7. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
  8. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Yep, we're mostly in America. I'm down South in Central Time (it's 7:20 PM here for me). On the weekends, I'm later, but during the week, I'm usually on fairly early before I head to work, so I'll see anything you post at my nighttime and be able to respond when I get up. We've had plenty of members across the pond before, and we work through it fairly easily with just delayed responses on both sides. :)

    Yes, any numbers you can give would help. If you remember the numbers from the vet, it would help us most if you gave us the info in this format:
    AMPS (number before morning shot) and amount of insulin given, +2, +4 etc (+however many hours after AMPS and the BG level at that time), PMPS(number before evening shot) and amount of insulin given. With the different time zones, we do +number of hours after shot to keep from being too confused. Remember that his numbers will surely be higher at the vet due to vet stress...but they'll still be helpful!

    Since you're interested in testing at home soon, I'd like to suggest a good way to start getting ready. Pick a spot you want to test (I used a towel on the floor by the fridge, some use the back of the couch, etc) and take Benny there many times throughout the day. Touch his ears some while there, then make a big fuss over him and give him a special treat he likes (freeze dried treats work great). Do that a lot and he'll get used to going there and having his ears messed with and then getting a treat! By the time you start testing, he'll be a lot easier to work with since he's used to this being a good place.

    And a quick plug for testing. I know it's a scary and hard at first (TRUST ME I never thought I'd be doing it!) but it's super important. It will give you so much more control over his diabetes and help us help you to get him regulated and back to his normal, happy self. It'll really make a HUGE difference. They get used to it pretty fast most of the time and a lot of them come running for tests or even remind us when it's time! With the amount of insulin you're giving, it makes me nervous that you don't know his BG levels before a shot. I totally get why you haven't started yet, but I have to voice my concerns...please don't think I'm trying to force you into something. I just need to make sure I stress why it's important.

    And a note on food though Sharon has already given you great info. I wouldn't change it again until you're home testing. You don't want to go too low in carbs until you can be sure that it doesn't make his BG drop a ton and you still give the same amount of insulin (we've seen BG drop over 100 points overnight from a food change!).

    Please feel free to post in the Prozinc forum as well! You'll get more responses there since most of us who use it hang out there most of our time on the forum! Welcome again and we're so glad you're here...please ask tons of questions! That's why we're here!
     
  9. Julie & steve j

    Julie & steve j New Member

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    Dec 8, 2018
     
  10. Julie & steve j

    Julie & steve j New Member

    Joined:
    Dec 8, 2018
    Thanks Rachel

    I understand why you're concerned about the high dose (hypo), but in truth his numbers are too high for that to be an issue.

    The only numbers we have so far have been from vet curve tests, so we don't know the pre or post shot number. Although in the morning he's usually having his first test less than an hour after the injection, so the number won't be too far away (albeit stress affected). All the below was done on vet recommendation, we wouldn't make any changes without consulting him (yet).

    His first ever test at the time of diagnosis mid September started at about 22, and went down to 8-9 at its best before returning to high teens by the end. We were put on 1 unit of Caninsulin.
    Second test was mid twenties down into mid teens and back again, no single figures. Raised to 2 units.
    Changed to Prozinc on vet recommendation and from a single reading of about 25 we went to 3 units of PZ.
    Next curve was much higher, started 32 came down to 20ish back to late twenties, raised to 3.5
    After a couple of weeks we went up to 4 units, as it was obvious nothing was changing and his consumption was higher. It was around this time we started to monitor water/food intake more accurately.
    Most recently, last Monday, he had another curve, started 39 came down to mid twenties back to early thirties, we raised to 5 units.

    Thanks

    Steve
     
  11. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Steve, waving to you from Surrey!

    If the blood glucose levels increase as the dose increases, this can often be a sign that the insulin dose is too high, not too low... I know it sounds odd, but it is not at all uncommon for this to happen...
    We had a UK cat here whose vet had increased the dose to 6 units on the basis of seeing high numbers. At that point the caregiver started to get concerned. Once the caregiver started to test blood glucose at home it very soon became apparent that the dose was too high. She dialled back the dose, and over a period of about 10 days (or thereabouts) that cat was actually off insulin completely. The vet was amazed... It was a particularly dramatic example of what can happen, but many cats do need less insulin than the vets prescribe....

    Eliz
     
    Last edited: Dec 9, 2018
  12. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Steve, the paragraph above looks to be exactly the kind of thing I was describing in my previous post....

    Did anything else happen after your cat was started on insulin that could have caused the increase in blood glucose? For example, did you change the food at all...?

    Eliz
     
  13. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Steve, @Julie & steve j , just in case you're interested, I've found the thread about the UK cat who came here on 6 units and who clearly didn't need that, and instead sailed into remission. It's a long thread, and the particularly pertinent bit of the story starts at comment 74 where the caregiver, Fiona, brings her cat home from the vet. At that point the vet has given 6 units of insulin before the cat went home...
    Of course, some cats DO need large doses, but alarm bells can ring here when a cat's dose is increased too fast, or with too little data to support that dose increase...
    New to this forum and have a few questions

    Eliz
     
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  14. Julie & steve j

    Julie & steve j New Member

    Joined:
    Dec 8, 2018
    Hi Elizabeth

    Thanks for that, a very interesting read.

    We're fairly new to it too, just a couple of months, our knowledge isn't huge. My only understanding of it was that insulin controls it, and the only way to get it controlled was to increase until you hit the right amount.

    Have to say, he was a lot happier on 4 units than he is this week on 5. I'm hoping to speak to the head vet tomorrow, but might think about reducing back to 4U tonight?

    We're certain he's always high rather than low, but haven't got home testing to prove it. Every curve since the first ever one, he's not been in single figures. In the last few he hasn't been below 18, and usually high twenties/thirties.
     
  15. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    The blood glucose (BG) numbers at the vet are most often quite high because the cat is stressed. Stress raises BG for most cats. Home testing allows you to see how your cat is doing when he's relaxed. Also, there are patterns of responses - sometimes a cat will go low for one cycle, and then stay high and flat for a few cycles in response to that low number. If the vet curves are on one of those high flat days, it looks like not enough insulin, when really it's a reaction to going too low (too much insulin).

    While it's quite possible that your kitty really does need a high dose, testing at home will help sort out what's going on.
     
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  16. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Yes, it's very important to find the 'right' dose. But it's all too easy to increase too fast, on too little data, and actually go past the dose that works best.

    As Djamila says above (emphasis mine), "The blood glucose (BG) numbers at the vet are most often quite high because the cat is stressed. ...Home testing allows you to see how your cat is doing when he's relaxed. Also, there are patterns of responses - sometimes a cat will go low for one cycle, and then stay high and flat for a few cycles in response to that low number. If the vet curves are on one of those high flat days, it looks like not enough insulin, when really it's a reaction to going too low (too much insulin)."

    We so often see vets prescribe too much insulin. Over the 12 years I've been here I've seen it time, and time, and time again. It's immensely frustrating...
    There must be a lot of cats out there who are on more insulin than they need, or are on insulin when they don't need it at all. And sadly, there will certainly be cats who die as a result of overdosing. The body can't cope with that indefinitely. At some point the body's glycogen stores will become too depleted to be able to provide a safety net and the cat will succumb to hypoglycemia. Or, the persistent high blood glucose levels will lead to other problems, such as DKA (diabetic ketoacidosis).

    The fact is that most vets actually deal with relatively few diabetic cats, and, it has to be said, many don't have much real hands-on experience with feline diabetes apart from doing fructosamine tests and occasional curves. (Although, thinking about it now, there are occasionally times when vets do have more direct experience and it just isn't helpful. For example, the vet who diagnosed my cat suggested I have him put to sleep because, "looking after diabetic cats is so difficult", and it would be "like having a two-year old around the house all the time". And she referred to her main practice nurse who wasn't managing her own cat's diabetes after nearly 6 months of trying. I looked across at the practice nurse who was nodding in agreement... I declined the offer to have my cat put to sleep. Instead, I got online and started learning, fast! ...Oh, and I got a new vet, haha!)

    Vets can seem to treat diabetic cats as if they are small dogs, but the two species are vastly different in terms of how diabetes affects them. Most vets are generalists and can't know everything about every species; they're also busy people and can't keep up with the latest developments and research. For example, many UK vets still prescribe dog insulin (Caninsulin) for cats even this goes against the RVC's recommendations and the current guidelines from the ISFM (International Society of Feline Medicine.) And they usually suggest higher carb diets than is recommended also.

    Many vets also seem to have a lack of awareness about remission, thinking it's something that happens only occasionally, when we see it happen a heck of a lot when cats are given appropriate treatment. The RVC's own remission research has found that a third of "diabetic cats in the general population" can go into remission, and that chance increases when cats receive optimal care.

    Steve, it may indeed be that your cat needs a high dose of insulin. But, statistically (in my humble view), the more likely possibility is that the dose is too high.
    Fortunately, it is not hard to find out the truth of things. You have the power! If you are willing to hometest you should very soon be able to establish whether the dose is too high or not. And if it becomes clear that it is not actually too high, and you can rule that out, then you know you need to look elsewhere to find the cause of the high blood glucose levels. It may be that your cat is just a high dose cat, or it could be that it has a condition such as Acromegaly (tumour on the pituitary gland) for example.

    Given the high and escalating blood glucose levels, I do strongly suggest that you monitor your kitty's pee for ketones. In diabetics ketones can be very dangerous, and can quickly escalate into the potentially lethal condition, DKA.
    The test is simple and involves dipping the end of a ketone test strip into a drop of pee, timing it for a given number of seconds, and reading off the result. Anything above a 'trace' result is a reason to talk to your vet ASAP.
    Crumpling clingfilm loosely in the litter tray (over the litter) is often an easy way to catch a little pee sample. Or, if you use clumping litter you might be able to just push the test strip into a fresh pee clump.
    Ketostix or Keto-Diastix should be available from most pharmacies. Ketostix just test for ketones; Keto-Diastix test for ketones and urine glucose, which could be useful since you are not yet testing blood.
    There is more info on testing pee with Keto-Diastix on the Sugarpet website here:
    http://www.sugarpet.net/urine.html

    Be aware though that not all ketones are detected by the strips, so also have an awareness of how your kitty's breath smells. It should smell like normal cat breath(!). If you notice a smell that is fruity or like acetone that can also indicate ketones.

    Eliz
     
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  17. Julie & steve j

    Julie & steve j New Member

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    Dec 8, 2018
    Hi Elizabeth

    Thank you so much for replying in such detail, sorry we've been a while coming back. It was so kind of you.

    We reduced to four units on Sunday, and have stayed at that since. We went back to the vet Tuesday; he'd been speaking to the Prozinc vets who recommended we stay on 4 and do another glucose curve at the end of next week. His one-off number when tested there was 35.8, which was as expected and probably at least partly stress affected. It drove home the good suggestions above that we have to start home testing, which we're going to get ordered as soon as we can.

    So that's where we are at the moment.

    His water consumption has gone down slightly. What prompted us to register in the first place was that he was drinking well over 600-650mls each day that week. Since reducing he's been between 400-500mls, so I suppose that's a start.

    We're now monitoring his diet a lot closer, only giving the diabetic Purina in the stated amounts, plus some jelly canfood with a drop of water stirred in, and a bi of tuna every now and then. He's generally eating fine, just wish he'd drink a bit less.

    I think we have to stick with it until the curve test, after which if his numbers are still as high as expected I imagine they'll recommend we increase dosage again.

    Thanks

    Steve
     

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