newbie with questions-- update on Soccer

Hi, New here. I'm a vet but not in private practice anymore... So, I have a medical background. In any event, we went out of town for a week and one of our cats was not well when we returned. (We have a pet-sitter who says she didn't notice anything.) So, the cat's glc is 493. Liver and kidney fcn are fine (based on bloodwork). He's dehydrated and I'm giving him subQ fluids. He's eating lots (big, fat cat).

I picked up PZI and a glucometer (+ supplies). I purchased canned food (ick) and a bag of Wellness core. We have 5 cats so I need to figure out how to juggle feeding... I figure that I'll wean everyone off of the stuff they are on and give them Wellness (10% carb content). Soccer can have canned. I know he'll swipe from the other cats...

So, here are my questions:
1. I'm going to start with insulin twice daily. Should I change the food now or wait a week or so?
2. Worried about hypoglycemia a bit. Will feed twice daily. SHould I try to come home at lunch to check a glc? (that'll be 6hrs post-insulin)
3. I'm planning on starting with 3 units PZI, twice daily. SOund reasonable? Does anyone have good ctrl with once daily dosing?
4. Going to check glc twice daily for a week or so. At what point do ya'll stop checking as frequently?
5. The cat has lost weight along hind-end. Assuming good ctrl, when should I expect that to resolve?
6. Any tips? It has been so long since I practiced med.... Hope it is like riding a bike!

thanks!
Michele

 

Re: newbie with questions

Hi Michele and welcome

I'll answer your questions first

So, here are my questions:
1. I'm going to start with insulin twice daily. Should I change the food now or wait a week or so?
Yes if you are testing right away

2. Worried about hypoglycemia a bit. Will feed twice daily. SHould I try to come home at lunch to check a glc? (that'll be 6hrs post-insulin)
if you can, that would be best but not always doable

3. I'm planning on starting with 3 units PZI, twice daily. SOund reasonable? Does anyone have good ctrl with once daily dosing?

nope. start at 1 unit BID unless there are complications like no diet change/ketones/etc. Few cats are maintained on once a day, and you want to start at 1 unit because many cats on a low carb diet are maintained at a lower dose. However, if you want to be super aggressive you could start at higher than 1 but you'd be monitoring all the time and I don't think that is optimal for anyone.

4. Going to check glc twice daily for a week or so. At what point do ya'll stop checking as frequently?

nope. test prior to each shot and then spot checks throughout the day when you can. And you don't stop doing preshots as they can pull a fast one on you one day and if you aren't testing you could OD.

5. The cat has lost weight along hind-end. Assuming good ctrl, when should I expect that to resolve?

neuropathy and yes. see http://www.laurieulrich.com/jasper/ and you can give methyl b12 to help.

6. Any tips? It has been so long since I practiced med.... Hope it is like riding a bike!

Start by reading the faq (link a bit further up in the list on this forum) and come on back with more info/questions

 

Re: newbie with questions

Welcome! Fun to see a vet hanging around. Here are the answers I can help with:

I'm going to start with insulin twice daily. Should I change the food now or wait a week or so?
least at the nadir, changing food now is fine. Changing to wet lo carb can bring down bg levels overnight, so you need to stay on top of the numbers. See this website by a vet: http://www.catinfo.org

2. Worried about hypoglycemia a bit. Will feed twice daily. SHould I try to come home at lunch to check a glc? (that'll be 6hrs post-insulin)

I would leave out food or use a automatic feeder so your cat has access to food if bg levels run low. We tend to free feed even with wet food. Yes, you need to check the nadir. It may be anywhere from +5 to +8, and may change after a week or two, so you will need to do spot checks now and a curve after a week or so. The more data you have, the better.

3. I'm planning on starting with 3 units PZI, twice daily. SOund reasonable? Does anyone have good ctrl with once daily dosing?

We suggest 1 unit, twice daily when first starting. If you start at 3 units, you can be over the ideal dose and start a cycle of rebounding. (Wondering why you thought to start with 3 units. Cats aren't dosed by weight.) Nope, PZI only lasts 12 hours in cats (sometimes less, sometimes a little more) but generally, dosing once a day means the cat is on a roller coaster, going from lows to highs over a 24 hour period. The only time I know people dosing once a day is when the cat is close to regulation and only needs a "splash".

Hope that helps.

 

Re: newbie with questions-PZI

Hi Michele and welcome to FDMB.

I haven't used PZI so don't know it's specifics. However the ethos of this board regardless of the insulin is to start on a dose of no more than 1u BID.People often dose cats on their weight when in fact if they are going to it should be their IDEAL weight. Preference though here is still 1u.

It may be worth you cross posting in the PZI insulin support group too. I know they use sliding scales, but that's the extent of my knowledge.
My preference is Lantus or Levemir.

If your swapping to low carb food, I would do it now and NOT shoot more than 1u and get spot checks.

The lower carb food you give, the less insulin required.

Lucky was around 482 on dry food. A week later after wet only (3.4%carbs) she was 257-still a diabetic number but a darn site lower. This obviously then has a knock on effect as to how much insulin a kitty needs.

I'd have a look through some of the threads to get an idea of how we do things.

I'm not sure when the nadir for PZI is-hopefully someone will cmeon in.
You always check before giving a shot and then get your spotchecks (whilst having a life too )
It depends how long it takes to regulate your cat in respect of weight gain. Some are quick, others take a lot longer, some don't ever get properly reguated for various reasons-ECID (Every cat is different)

And definitely you dose BID. Once a day shots don't work with cats.

 

Re: newbie with questions

I was figuring 3 units bc a friend (practicing vet!) told me to.

I'm worried about that dose... that's why I came here. Even when in practice, when managing chronic illness, the clients seem to know more about the day-to-day management. I'll drop to 1 unit.

WHen I was in practice, we used ultralente twice daily. But, my friend tells me that 1) it isn't available, and 2) PZI is the standard now.

As for feeding, there is NO WAY I can leave out canned all the time. We have 5 cats + 2 dogs and it would be gone as soon as it was put down! The logistics of the feeding is going to do me in!

 

Re: newbie with questions

I agree with the others that the 3 units twice a day is going to be too much. We had some scary almost-hypo situations with Sebastian when we first started. At first, I was absolutely insistent that we couldn't test twice a day, but I'm so glad we started doing it. Sebastian started needing less and less insulin pretty quickly-- like his number would be 180 pre shot. No way we needed to keep our dosage up based on that!

We've put both our cats (one non-diabetic) on an all canned diet, and I admit it's messy and way more expensive than we'd like. I'm not sure how that could be managed with 5 cats and some dogs! Hopefully someone can give you advice on that!

 

Re: newbie with questions

Yeah, humulin U was great! I had Squeak on L but he didn't need it for long.

There are 2 kinds of PZI used around here: BCP and the new Prozinc. Idexx used to make one but has stopped.

Even better according to some people is lantus/glargine or levemir.

3 units is SOOO not the way to start unless you want the good potential for hypo, so I'm glad you questioned that.

My cats have their food and litterbox in the furnace room; we use a long door hook to keep it open just enough for them to go in and out but closed enough that our dog cannot get in. You may want to pursue something like that if possible.

 

Re: newbie with questions

You have already received great advice so far, so I won't repeat it.

I also have 5 cats and a dog. One recommendation I can give is to wean them away from free feeding. Mine are fed twice a day and despite their occasional protests angry(2)_cat they have not starved yet. :mrgreen:

Also, if you can, I also suggest changing the cat's diets over to a low carb canned food only. This probably will be a challenge in the beginning especially if they are used to dry. But by changing all of their diets, you will have a better chance of regulating your cats glucose levels and also lessen the chance of any of the other cats from developing diabetes.

 

Re: newbie with questions

thanks everyone!!

I figure that I'll leave out the Wellness Core for the time-being for everyone else. That way if Soccer gets to it, it won't be as bad as it could be. what's the deal WRT seafood? Just bought a case of canned tuna flavored stuff!

 

Re: newbie with questions

The thinking on seafood is that it has high levels of mercury and should be given sparingly. Also, sometimes cats get "hooked" on it and refuse other types of food. I feed it once a week or so.

 

Re: newbie with questions



here's Soccer.

Oh... I bought prozinc. Crazy expensive!

 

Re: newbie with questions

seafood is also high in phosphorous...which can be tough on kidneys. basically a species inappropriate diet

and BTW, Soccer is gorgeous

 

Re: newbie with questions

Hi there!

Welcome to the FDMB!

I was reading your thread and as soon as I saw the pic - I had to post!!
Soccer is gorgeous!!

I hope u stick around and become a regular poster, keep asking questions and read read read all you can!

 

Re: newbie with questions

What a gorgeous kitty!

 

Re: newbie with questions

Hi Michele,,

First, Welcome and thank you for having the good sense to know that, even as a vet, you might
not have all the answers when it comes to Feline Diabetes.

We have a vet here, Dr.Lisa, who is an expert on feline nutrition, and also several Vet-Techs.

There are hundreds of us cat guardians here all over the world, hundreds of cats treated, and many
years of collective experience.

493 is a diabetic number, but as a spot-check it's not as good as a fructosamine test. A single high BG can
be caused by infection. Are other symptoms present ? Drinking a lot of water and peeing a lot ?
I would be inclined to add a bit of B-Complex to the fluids. Diabetic cats need their B-Vitamins.

Can you be more specific. PZI Vet by Idexx manufacturing has been dis-continued. Some here use BCP PZI.
Both of those are U-40 insulins (BCP PZI is also available as U-100). There are also human insulins compounded
as PZI. There is a new Vetrinary PZI on the market ProZinc, (I think). Specifically, what did you 'pick-up' and
is it U-40 or U-100.

Insulins of choice right now are Lantus and Levemir, which are insulins for people. Some are seeing
remission with these insulins. We do not recommend Humulin N, nor Caninsulin/Vetsulin, although some
are successful with it. They are harsh with steep drops and not enough duration.

We test by pricking the ear...if you do not know how to do that, we have a video that shows how.

Almost any canned food is better than any dry food for ALL cats. Diabetic cats need low-carb food
with UNDER 10% of calories AS FED from carbs. Dry food is, well, dry.
Please read Dr. Lisa's article on feline nutrition.

Changing food to a LOW CARB Wet food can have a big impact. If you are going to change food, you could
see a good response in a day or two. But don't wait too long to start insulin if BGs stay above normal ranges.
The sooner insulin is started, and the pancreas is allowed to rest, the better chance you have of getting
diet control....aka 'remission'.

Diabetic cats are hungry all the time, so try to leave food out for kitty. Timed feeder or frozen ice-cube-sized portions
of canned food that can thaw. Can you confine kitty at a room where the other cats won't eat his food while this
all gets worked out ?

Test BG Before each insulin injection. The usual sequence is Test/Feed/Shoot.

Please start at 1 unit 2x per day. Kitty should be safe while you are at work, if BG is above 200, then a meal,
then shoot. Try to be sure the meal stays 'down' before giving insulin. If kitty is de-hydrated, there can be nausea
and up comes the meal. Try to wait about 1/2 hour after feeding, then shoot. Unless you are sure this cat
is not a barfer.

These are just procedures for a 'beginner'....as you get further into the Sugar Dance and have more experience/data,
you can adjust your procedures. As we say here ECID...Every Cat is Different.

Use this first week to perfect your BG testing...test before every shot. Then maybe next weekend, or a day home
from work, you can run your first BG curve.

It takes 3-7 days for insulin to 'settle' and for kitty's body to learn how to use this new resource. Stick with
1u BID for the first week. You might see numbers all over the place, or might not, during that time.

If you have questions about doing a BG curve, come back here for help.

Do not raise the dose based upon pre-shot number or spot-checks. You need to know the nadir number to make
dosage decisions. You can LOWER the dose based upon pre-shot or not shoot at all if under 200.

Keep records... we like to see data here. AMPS means AM Pre-shot BG number, +2 means BG two hours after shot, etc.

Nope. As stated by others. START LOW...GO SLOW. Start at 1u BID and raise SLOWLY based upon home-test
data and curves. Raises are usually .5u to 1u per dose. Wait a week before another dose raise.

Test before every shot....as long as kitty is on insulin. Spot check if you want to. Trying to find nadir is what
you need to do now. You won't have that data until you have done a couple of BG curves.

Weight loss goes along with un-controlled diabetes. Now if he's walking on his hocks...that's another issue.
Diabetic Neuropathy is best addressed by controlling the diabetes. As mentioned by another responder, Methyl-B12
can also be useful in conjunction with BG control.

We make house-calls !!! To teach BG ear-testing. What city/state do you live in.

PS.. He is GORGEOUS....could be a twin to my Smokey. Smokey was a steroid-induced diabetic who passed away
last winter from throat cancer.

 

Re: newbie with questions

Hi Karen,

I bought ProZinc U-40.

Getting blood won't be an issue. I used to do curves on client animals. Right now, Soccer feels cruddy so he'll cooperate (in fact, I drew blood from him at home for his CBC/chem and just dropped it off at the vet office!). I'll do ear-sticks for glucometer readings....

 

Re: newbie with questions

ProZinc is quite new. Glad that your practicing vet friend is on top of that.

Since ProZinc is so new, we will be very interested in your experience with it.

I imagine there is some discussion over on the Insulin Support Group portion of our FDMB board...under
the PZI sub-section. You might want to pop over there for advice on using ProZinc.

As for the expense, PZI Vet was very expensive, also. Like $130 for a 10ml vial of U-40 insulin.
(400 units).

But because of the long shelf life on PZI Vet, a vial lasted Smokey from 3 to 6 months, depending upon
daily dose. I basically used it until the last drop in the vial.

So hopefully, ProZinc has a long shelf life after opening....probably refrigerated, I would imagine.

Folks here who use Lantus or Levemir often get way more than the useful life out of it by refrigerating.
Mfg recommends discard after 28 days...but people carry it around with them in purses, etc, unrefrigerated.
So folks here refrigerate lantus and Levemir and get way more than 28 days before it starts to go bad.

 

Re: newbie with questions

Hello and welcome. It is great to see you introducing yourself to the community and looking for insight to help Soccer.

As you already know the ultralentes, you may be interested in having a look at a couple of longer lasting insulins as an alternative to shorter acting prozinc, Lantus and levemir.
They have been getting a lot of attention of late, and much success with regulation and remission.
With the loss of PZI and the new and still unknown "prozinc" ( that you have) having a long lasting insulin that is gentle on the cat's body is a great alternative.

Here is some info on the L's ( Levemir Demetir and Lantus glargine) for you to have a look at.
LANTUS & LEVEMIR: More Information

I would also encourage some spot checks for this fIrst couple of weeks to ad to your curve.
The lingo we tend to use is "preshot" or in the morning this would be "amps " and +2 ( for two hours after shot) +4 etc, followed by "pmps" ( evening preshot ) at your +12. The start the + hours after each shot again.
A curve would then look like;
amps
+2
+4
+6
+8
+10
pmps

Establishing onset, nadir and duration allow for dosing decisions to be tweaked in the future with the whole picture in front of you.

I would also suggest ketone testing as part of your daily routine while working towards regulation. Especially when already showing how crappy he is feeling.

I look forward to having you as part of our community and think Soccer is gorgeous

 

Re: newbie with questions

Being that it's new, I did not know if ProZinc is U-40 or U-100.

Many of us U-40 users prefer to use U-100 syringes. They are way cheaper, readily available from
ordinary pharmacies (if you run out on a Sunday when the vet is closed).

U-100 syringes are also available in a better selection of needle sizes and lengths.
U-40 syringes are only available in 28 and 28 gauge...we refer to them as harpoons.

Best of all, it makes micro-dosing with U-40 insulin easier.

I used 3/10cc capacity, 31ga, 5/16" 'shorts' for U-100 insulin for Smokey.
They can barely be felt.

You can dose U-40 insulin in U-100 syringes in .2u increments using the following simple math:
(we also have a reference table somewhere around here).

Number of U-40 units times 2.5 = the MARK on the U-100 syringe.
Examples:
.2u of U-40 times 2.5 = .5 MARK on the U-100 syringe.
.4u of U-40 times 2.5 = 1.0 MARK on the U-100 syringe.
.6u of U-40 times 2.5 = 1.5 MARK on the U-100 syringe.
.8u of U-40 times 2.5 = 2.0 MARK on the U-100 syringe.
1.0u of U-40 times 2.5 = 2.5 MARK on the U-100 syringe.
-etc-

If you hold a U-100 syringe up next to a U-40 syringe you will see that the "1" mark of a U-40
syringe lines up with the '2.5" mark on a U-100 syringe.

The lines on a U-100 syringes are closer together by a factor of 2.5 because U-100
insulin is 2.5 times more 'thick' than u-40 insulin.

The math is just to insure the same LIQUID VOLUME of U-40 insulin as you would in
a U-40 syringe.

 

Re: newbie with questions

Hi Michele and welcome.

Soccer is a handsome guy.

You've been given lots of advice, but the one thing that hasn't been suggested yet, I'll suggest:

With regard to feeding times and such - you may want to purchase timed feeders. This will ensure that the cats can get food throughout day/night and if you put it on the counter or out of dog reach - then the cats can free feed on canned food without issues.

Also add water to the canned food - it keeps it moist longer and ensures the cats get enough water in their systems.

 

Re: newbie with questions

Had NO problems checking BG when I got home from work. At 7pm it was 376. I gave him 1/2 can of cat food and then 1 unit PZI. However, at 9:30pm, he was having none of the ear prick. <sigh> Had to enlist a helper and Soccer was mad as hell. BG was 276. I'm going to give him a before bed snack because I'm neurotic about hypoglycemia. I hope I can get BG tomorrow am without help. No one else is up at 6am and I leave for work by 6:45... ugggh.

Thanks again for all of your advice!
Michele

 

Re: newbie with questions

Michele

what's your technique? I would sit on the floor, Squeak in between my legs and I'd use one hand to hld a rice sock in his ear to warm it, the other hand brushing him. I'd have my stuff ready and then poke him when relaxed. Didn't take long and could easily be sped up. Point is we were both relaxed...plus they really do get used to it, especially if there is a treat after Some cats remind their humans when it is shot time....they know the tests and shots make them feel better!

 

Just wanted to do a quick fly-by with an update and to thank all of you for your help yesterday!! I HAAAATE treating my own pets. It is so difficult to be objective!

Anywhoo~ here are Soccer's #'s
10am 493
7pm 376- gave 1 unit of PZI
9:30pm 276
5am 243- gave 1 unit PZI
11am 181

I've been feeding him canned (1/2 of a 6 oz can before the insulin) and (1/4 can in between times). I left out a little Wellness Core (dry but low carb) so that there wouldn't be mutany among the entire grp overnight. Thankfully, Soccer doesn't like it. Yesterday he wolfed down the canned but today he isn't finishing it. But, he's acting like he feels better (following me around, stalking my son's gerbil, climbing on the top bunk... things he hasn't done for several days and maybe more than that 'cause we were out-of-town for 10 days before that...). Should I worry about his appetite? Also, if his 6pm reading is less than 150, should I cut the insulin dose? I was planning on sticking with the 1 unit for a few days at least to get some semblance of a curve but I certainly don't want an episode. I'm so unfamiliar with PZI... wish I had ultralente, then I'd know what to do.

Thanks again!

 

I'm not qualified to advise on dosage or other more complex matters, but I do know that when numbers come down into closer-to-normal ranges, kitties tend to be less hungry (not starving, because their bodies are using the food correctly). As long as Soccer is acting fine and is eating a reasonable amount, you don't need to be worried about a reduction in appetite.

 

Things are looking good, Michelle.

Re the dose. You may want to go over the Insulin Support Group for PZI. It does not have as much traffic as this board, but they all use PZI and are comfortable with dosage help. A very general rule for new kitties on insulin is not to shoot under 200. But you are a vet. And if you are going to be around after the shot, the PZI board may have other ideas for you.

 

Looks like the PZI is working well for you. I used PZI Vet for nearly three years before switching Moochie to Levemir.

Regarding a no shoot point, my suggestion is that until you have a good idea where the peak is that you consider not shooting any insulin below a preshot of 150 and consider shooting a "token" dose if any (maybe 1/2 dose at the most) below 200.

There are a lot of us here who use or have used PZI so I'm sure you will find many opinions - that's mine .

 

Others have mentioned the shoot/no shoot line. I argue for being cautious until you have a bit of data, then lowering your line in the sand, so to speak. I also caution against shooting when the numbers are still going down until you have more data, otherwise you can end up with too much overlap.

Jen