NEW PRO ZINC USER HELP/Newbie with Lots of Questions

Hello, thanks for being here, I could certainly use your help. Sorry this may be a bit long, I'll try to keep it as concise as possible.

My cat is a 12 year old Russian Blue male (his name is Eukanubo (long story about that). He was diagnosed in October 2009 when he was peeing outside his box. His sugar at the time was in the 400s. Curiously, he had a UTI in April, his sugar at the time was fine. At any rate, he got diagnosed two days before I had to go on a 2 week trip, so I left him boarded while I was away, so he could get regularted. When I got back, his glucose was on the 170s, so the vet said to hold off on the insulin but to keep testing him. At the time, he was getting Vetsulin 1 unit twice daily. They taught me how to test him, and his readings were on the 170s to about 220s, the vet didn't want me to give any insulin until it was 300s. So for the next 3 months, I check regularly, sugars are less than 300s, but I'm noticing the cat is losing weight, eating and drinking, so after this went on for a while, I finally took him to the vet with my meter so we can check it at the same time. It turns out that while my meter was reading in the 200s, theirs was in the 400s, they even checked with another meter and with a blood draw. No longer poor kitty was losing so much weight! So, it's insulin shots for him only that since Vetsulin was discontinued, they gave me a vial of ProZinc, and I've been faithfully giving him shots twice a day, and they gave me a new meter for free, so he is being tested regularly. There's only been a couple of occasions in which his sugars were low enough that I would skip his insulin, but he is consistently running in the 300s, sometimes in the 400s. He's now been getting insulin for 3 weeks now. For a while there, it was a struggle to get him to cooperate with the ear testing and the insulin shots, so I thought the high sugars were from the stress, but now he's doing much better with the testing, but the sugars still seem high to me. I've tried doing a curve, testing him at several times a day, but it seems that the insulin barely touches the sugar readings. He is on dry Hill's Prescription M/D, and I've read the comments about wet food being better. He's a free-feeder.

Clinically he looks much better. He's put on a little weight, and is definitely more perky and playful that he's been recently, although he's still have had a couple of times in which he peed outside the box, and still drinking lots of water.
I have a spreadsheet with Google docs but don't know how to post it here, help?

So, here are my questions,
Should I expect his sugar to get better in 3 weeks of insulin, or would it take more time?
Should I switch from free-feeding to only feeding twice a day?
Should I change his diet first, then try to switch to twice a day feeding, or should I increase his insulin dose?
If I should do all of the above, in what order should I proceed? I'm mostly concerned that since I'm gone for the day, his sugar could drop and if I restrict his food to twice a day, he may get hypoglycemia when I'm not around.
How can I figure out if my injecting technique is adequate?
I feel comfortable with the vet, she is always very willing to answer my questions, my only concern is that I don't feel as comfortable as she seems to be with a glucose in the 300s. Incidentally, I'm a physician, but I'm well aware that what I know about human diabetes and management wouldn't apply to my cat, so I feel as unfamiliar and lost as any other newbie. What else should I be asking the vet or at this board?

Thanks so much for any feedback!
HB

 

Re: Newbie with Lots of Questions

Hi there

Welcome to the FDMB!

If you could EDIT your subject line to include NEW PRO ZINC USER HELP that will help.
I'm going to cross post your thread in the PZI forum which includes ProZinc.

 

I haven't been doing this long enough to give you advice, but my Max has been on ProZinc for about two weeks now, and with a diet change, his numbers are so good he hasn't had insulin in a few days. I attribute that to diet change, 2x a day wet from Binky's list. I'm sure someone who knows more will show up with good advice for you! I do know if you change diet to wet you have to really monitor the bg #'s, as the cat will need less insulin.

 

Hi HB, and welcome!

A couple of questions and some comments: First, what is the cutoff point you are using, the number where you don't give a shot? Second, what was the starting dose on each insulin and how were increases made?

He is on dry Hill's Prescription M/D, and I've read the comments about wet food being better. He's a free-feeder.

And this dry food is impeding your progress. Please read http://www.catinfo.org for the basics of feline nutrition, then you can consult Janet's charts to help you make a change to a better diet. And be aware that the phony "prescription" foods are made with poor ingredients. You can do better.

So, here are my questions,
Should I expect his sugar to get better in 3 weeks of insulin, or would it take more time?
Should I switch from free-feeding to only feeding twice a day?
Should I change his diet first, then try to switch to twice a day feeding, or should I increase his insulin dose?
If I should do all of the above, in what order should I proceed? I'm mostly concerned that since I'm gone for the day, his sugar could drop and if I restrict his food to twice a day, he may get hypoglycemia when I'm not around.
How can I figure out if my injecting technique is adequate?
I feel comfortable with the vet, she is always very willing to answer my questions, my only concern is that I don't feel as comfortable as she seems to be with a glucose in the 300s. Incidentally, I'm a physician, but I'm well aware that what I know about human diabetes and management wouldn't apply to my cat, so I feel as unfamiliar and lost as any other newbie. What else should I be asking the vet or at this board?

Re your questions:

There is no set time for progress, every cat is different. If you have detailed test data for us it would be easier to make a guess here.

You can continue to free feed, but get rid of the dry food.

First, read the catinfo site and give us more details. You should be switching the diet as soon as possible and before any increase is made, in fact, you may want to decrease during the change. The catinfo site has good advice on changing diet from all dry to canned or raw.

The thing you must do is learn all you can absorb about FD and its treatment. Once you have the basics down you can fine tune your questions. Start with our FAQs and read some of the newbie threads on this board for openers.

 

ditto from me! Soccer has been off insulin for a few days. We changed his diet when we started the insulin. The change in diet has done wonders.

 

Welcome!

Free feeding is the best policy for ProZinc and free feeding should be the objective when using ProZinc [or other longer lasting insulins]. You should not restrict feeding to twice per day. Cats should eat 10-20 small meals per day. This is absolutely 100% possible with wet food. I add water to our wet food which helps it stay out longer. Some freeze it into cat food cubes and leave them out. Some use timed feeders.

But unfortunately, you really must get rid of the dry food. You do not need to use the prescription diets [in fact they have very average ingredients and some do not have low enough carbs].

Look for foods your kitty will eat that are less than 10% carbs as %Kcal from Janet & Binky's list here:
http://binkyspage.tripod.com/canfood.html

You will need to keep a very close eye on your kitty's BG levels while you transition because their insulin needs will almost certainly drop once you get them off the dry/junk food. You should not up to insulin if you are going to change to a low carb wet food only diet immediately.

Also you may want to read the sticky in the PZI forum about using u-100 syringes. I'm hoping you are ultimately going to need less than 1u per day and to make the dosing changes required, using the u-100's really helps.

Hopefully, you are not aiming for the vein [but rather you are aiming for the sweet spot between the vein and the edge of the ear] when you home test right?

Help with the spread sheet can be found in the Tech forum. There are complete instructions. Basically, you just "publish" it or make it "public" [viewable not editable] and put the link in your signature here.

There is actually quite a bit about human DM care that translates well to cats. Diet being the #1 - and exercise even help with cats too. I was just reading last night about a recent human study that showed omega-3's help with insulin sensitivity and I was going to try to find it and post in another forum here.

Feel free to join us/post over in the PZI Insulin Support Group any time.

EDIT: [just looks at your SS]In the interum, while the numbers are high like they are, you may want to get some ketosticks and be testing your kitty's urine for ketones - just to be on the safe side. Once the numbers get under 300 then ketones are not such a concern. But I'd get moving with the low carb wet food ONLY diet ASAP - it should make BIG improvements fast.

 

We did the same, diet change and insulin together. I knew that could be sticky, thank goodness for home testing! Hope Soccer keeps improving

 

Thanks for all your responses. I was able to figure out the spreadsheet thing, so I hope that's helpful.

What is my cut off point? The vet said 300, and not to give insulin if any less than that. It seems to me that's a big high but I don't know for sure. At any rate, he's had only a couple readings below 300, so I would have given the insulin regardless.

Vein vs sweet spot: I don't always know, since at first I was trying to do the sweet spot with a free-hand lancet, but after a while, he really started to fight me on this, so now I'm using the lancet pen, which is much easier for him, but it seems less accurate, sometimes I hit it on the first try, sometimes I have to try a few times and sometimes it's a matter of getting blood from somewhere. Does that makes a big difference in the reading?

As for wet food, now the question is, which one? I read that food chart and the number of choices is overwhelming. I looked a few of this online and they recommend around 3 cans a day, which seems like a lot to me and will add up money wise. I also forgot to mention that I have another cat, a 5 year old female domestic shorthair, who is supposedly still eating her original food (dry Iams weight and hairball control), but seems to be eating a lot his M/D food. She has had always a big problem with vomiting undigested food and hairballs, and no (dry) food has been able to solve this problem, although she is very healthy and strong otherwise. So, ideally, I'll try to find a wet canned food that will be eaten by both, keeps his glucose under control, and will not cause the vomiting in Molly (the other cat), sounds almost impossible, any suggestions on how to try to make the food transition?

Thanks
HB

 

Generally a PS of 200 is a safe cut off point for beginners and luckily you are not giving a ton of insulin. As you get a little more experience, get to feeling more comfortable and get the dose more squared away that number will drop. When the nadirs start getting under 100 you need to be paying a bit more closer attention. Of course any number 40 and below is hypo zone and you need to be taking action at that point [Kayro etc + monitoring]. Even any number at 50 one might be taking hypo light treatment steps [a little high carb or even dry food + monitoring]. Make sure you are familiar with the How to Treat a Hypo document.

Vein vs sweet spot should not make a big difference in the readings but it is more about making sure you do not over damage the vein. It can take some occasional punnishment but not all the time. Also make sure to apply pressure after testing for about 30 seconds.

In the ideal world you would choose a GRAIN FREE food option. The Wellness grain free foods [particularly the Turkey and Chicken] are liked by many here. Budget is sometimes another concern with food and there are coupons online for Wellness [just google "Wellness coupon"]. And Wellness is available at most pet stores. And finally it is important that your cats actually like the food. A number of the the Merrick ones are good too but H will not eat them :sad: .

Deep combing/grooming at LEAST once a week should help with the hairballs. I made instructions on how to achieve this for long hairs but there was some input about how to achieve this for short hairs too. Please let me know if you would like me to dig up my instructions for this that I had committed to the old board here. If they are still barfing [just food] more than once every couple months then you might want to investigate to see if other things are going on. A low carb, gran free, wet diet is optimal for all cats.

The food transition should be at least over a few days. Just progressively mix in the new stuff and phase out the old.

 

Tips for transitioning to wet food: http://www.catinfo.org/TipsforTransitio ... -18-09.pdf

If your other cat tends to be a piggy, you may need to feed measured amounts at "meals" (as many meals a day as you can manage), while you stand guard to make sure each cat eats enough. My two are that way. If she isn't a piggy, some combination of frozen cat-food cubes, timed feeder, and water added to the food should suffice to get both cats fed appropriately.

As far as I'm aware, readings won't be different if you get the blood from the vein or from the "sweet spot." I too seldom am sure exactly where I'm getting the blood from. Once in a while I have hit such a gusher that I think I must have hit the vein directly. But I've never seen a variation in readings that I can attribute to the exact source of the blood. My general impression is that the principal reason for recommending the "sweet spot" is that it is a relatively easy and reliable place to get the blood, which is helpful to many newbies. It doesn't sound like that is a problem for you, though. (Another reason for avoiding the vein is so that it doesn't scar up and stop carrying blood, which could cause its own problems. The occasional accidental prick right on the vein shouldn't be a difficulty, though.)

Which food? Really depends a lot on what you can get locally. One of my cats vomits (and his asthma gets active) on a number of foods, but he does beautifully on Wellness Chicken, which is one of the grain-free flavors and has good numbers for a diabetic. Merrick also has several flavors that work well. Grammie's Pot Pie and Turducken are our current favorites. (Merrick Cowboy Cookout is about the best nutritional makeup of any commercial cat food, but it is beef-based and beef is a problem for many cats, including my vomiter/asthma kitty.) This is an area where ECID (every cat is different); what works for my kitties won't necessarily work for yours, though it may be worth trying.

Oh, amount of food: What the manufacturers recommend is often much more than a cat really needs. Of my two, one needs maybe 4 oz a day of Merrick, which is somewhere in the region of 115-120 calories. The other needs maybe 5 or 6 oz of Wellness, which is in the region of 220 calories. They weigh 9 and 10 pounds, both indoor, both about 5 1/2 years old, similar activity levels. Obviously, their metabolisms must be very different.

I can't advise on dosage or cutoff point, since we're not on insulin (luckily). Diet did the trick for us. I'm sure others will make recommendations there.

Welcome to FDMB.

 

Oops forgot to answer your how much food question. There are a couple ways at it but the way I've seen the vet books go about it is the MER/DER way.

I've actually created a google spreadsheet that you can save to your own computer then use [in excel or other, or upload into your own google docs] for yourself located here:
https://spreadsheets.google.com/ccc?key ... nhPTXBEUUE

Or, assuming your kitty is currently at it's ideal body weight, if you tell me your kitty's weight [and perhaps the activity level - indoor or outdoor etc] then I can run the calc for you.

But importantly all the ways of calculating are just approximate guidelines and should not be taken as an absolute. Ultimately, how much you feed is what it takes to reach and maintain your kitty's ideal body weight.

 

One of my non-diabetic cats is a vomiter with a sensitive stomach, and she upchucked all the time on dry Iams, hairball or regular. In the two weeks that we've been switching over to wet, (she is still eating some kibble, but not much, she's resisting the change) I have yet to find vomit anywhere. This is shocking to me and further proof that wet is better for the cat's needs.

The list of foods was overwhelming to me, too. I looked first at brands I knew were available, and then bought about 5 flavors of three different brands. That made it less overwhelming to me, to say, okay, Friskies--what can they have of that, then moved to 9 lives, and so on. My brain was able to sort it out better that way. I made a list that way, and from that, I'm making a list of the brands/flavors they will eat. Hope that helps!

 

Thanks, again!

I went to the local grocery and bought a few cans of Fancy Feast and Friskies. I got home, opened up a FF one (the white meat chicken fare), I put a little on a spoon, and he gobbled it up and wanted more! So I mixed it in with the dry food, he ate a little more of that as well. The other cat, Molly, seemed a little more wary, but she did eat her spoonful as well. So many flavors, so little time! I forgot to mention that lately, Eukanubo has been exhibiting an unusual interest in human food, something that he never cared about before. It seems that poor kitty was starving! I bought some Karo just in case, although I had some maple syrup on hand just in case. So, it seems that I'm on track so far, now, if only his sugars would normalize!
Thanks
HB

 

When they are out of control hyper diabetic they eat a LOT. They will even eat TONS and lose weight. So yes, here's hoping things turn around for you guys quickly. Keep us posted in PZI of your progress.