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Newly Diagnosed: Frustrated

Discussion in 'Prozinc / PZI' started by DiabetesSucks, Sep 10, 2019.

  1. DiabetesSucks

    DiabetesSucks New Member

    Joined:
    Sep 10, 2019
    Greetings everyone! New to posting but I've been reading this forum since one of my cats was diagnosed a couple weeks ago. His name is Bengal Beast and he is a 14yr old neutered male shorthair, indoor his whole life. Always been healthy until early August when the standard symptoms of diabetes began.

    After a curve in the vet, he was started on ProZinc @ 2 units twice a day. He's 14.5 pounds, down from a high of 17. Unfortunately, he's a dry food addict, and was fed Blue Wilderness (which I thought was good high protein food). He has transitioned to Purina DM dry, not ideal, but he is proving difficult to get on wet food.

    I purchased an AlphaTrak2 and have been home testing since day one. So, after 2 weeks his glucose readings have stayed steady in the 300-400 range with a few spikes in the 500s. I did a home curve and the 2 units brought him down to 170 nadir.

    So, I ran out of strips over the weekend and started a new pack code 37. I had a AMPS of 650...and a PMPS of 625... previously never above 500. Then the next day an AMPS of 405 PMPS of 345. Now, today, AMPS of 415 and PMPS of 685! I immediately retested the other ear and got 605. I am very frustrated with this. I did a control solution test and it was within range. What is going on?
     
  2. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    You are right, diabetes sucks! Good thing though, it's treatable and you have found a good place for information and support while you learn the steps to the sugar dance.

    I can certainly understand your frustration with the high BGs you are getting when you test. And I suspect that Bengal Beast is bouncing from the 2 Units 2X day.

    Let's begin at the beginning with a little housekeeping though, so we can all see BB's information when you post without having to go back through previous posts as we go along.

    Create a signature and then a spreadsheet so we can also see the insulin dose and testing results you have so far.

    Setting up your signature (light grey text under a post). Here's how:
    click on your name in the upper right corner of this page
    click on "signature" in the menu that drops down
    type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what he eats/any other meds or health issues he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.

    Set up a spreadsheet like the one we use here. You will see how the trends and patterns emerge, and members can review his progress before offering suggestions or advice:
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
    http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

    We will then get to see when you are testing in relationship to the injection times, the mealtimes etc. You can use empty cells to insert information such as a meal, how much etc. or put that into the comments section to the far right of the grid.

    Back to "bouncing":
    Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high: (possibly contributing to your kitty's high BG at the high dose he's on)
    BG goes low OR lower than usual OR drops too quickly.
    Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
    Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
    These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
    Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
    Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

    I will also refer you to the yellow tagged stickies at the top of this forum. You will read that a usual starting dose of Prozinc is one unit. It could very well be that the 2 Units is too high and BB is constantly bouncing from the high dose, a drop in BG and a bounce. My concern is the part "Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing."
    You are home testing, but not understanding yet what may be going on, you are just seeing very high numbers.

    I am tagging an experienced member that can advise further on the issues.
    @MrWorfMen's Mom
     
    MrWorfMen's Mom likes this.
  3. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Hi and welcome to FDMB the best place you never wanted to be.

    First of all, I love your handle! I agree with the sentiment but it is also quite treatable and we can help you get Bengal Beast (love that name too!) on the path to better health. Secondly, kudos for home testing. That is the best tool you have in your arsenal to get Bengal Beast regulated and keep him safe.

    On the meter front, nothing you are seeing is out of the ordinary. BG is not static and can fluctuate quite a bit in an unregulated cat. The chance of getting the same and sometimes even close readings for both AMPS and PMPS are pretty much nil. Even in a regulated cat or a non-diabetic cat, two readings 12 hours apart are not likely to elicit the same result. Unregulated diabetics will tend to have a wider spread in their readings than a non diabetic or regulated diabetic.

    As for the PMPS of 685 followed by a retest of 605 is actually within meter variance. All glucometers including human ones have variance allowance of between 15% to 20% depending on the country and age of the meter. The AT2 being a pet meter modeled on an older human meter we assume has a 20% variance allowance. So the first reading of 685 could in reality be anywhere between 617 and 753. It's unusual to get a spread that wide most of the time and it could be that you had a wonky strip but it does happen.

    I can relate to the dry food addict issue. Got one here that thought wet food was waste to be buried (even tried to bury her brothers' food:rolleyes:) until over 2+ years into our diabetic journey. She finally decided to try it one day, probably out of hunger desperation and I never looked back. There are tips for transitioning a kibble cat to wet food on https://catinfo.org/ Just scroll down a bit to see the transition tips.

    The Purina DM kibble is about 18% carbs which is too high for a diabetic. We recommend foods that are 10% or less and most feed 6% or less. The good news is that in the US there are a couple of low carb dry food options and both will send you samples to try. There is Young Again which is available online only and Dr. Elsey's which is available at specialty pet stores or online.

    We are extremely data oriented here and we have a great colour coded spreadsheet that you can use to track your readings and see Bengal Beast's progress. It's easy to use (colour coding is automatic) and it resides on Google docs so anyone here helping has access to view the sheet.
    The instructions for setting up the spreadsheet are HERE and THIS document tells you how to use the sheet. If you have any problems setting up the spreadsheet, just holler and we'll help.

    Oh I see Lou types faster than I do :woot:;) and has covered a lot of this already.

    I agree the starting dose of 2u is higher than we would recommend and Bengal Beast isn't a huge cat so bouncing may very well be part of why you are seeing those high readings. If you can plot in the last week of data for us we'll be happy to have a peak and see if we can offer you some suggestions to get those numbers down. :)
     
  4. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    An addendum:
    Here's the basic testing routine we recommend: (do what you can on work days - before bed is useful along with the essential pre shots)
    test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
    test at least once near mid cycle or at bedtime daily to see how low the BG goes
    do extra tests on days off to fill in the response picture
    if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
    post here for advice whenever you're confused or unsure of what to do.

    And:
    New? How You Can Help Us Help You!
     
    MrWorfMen's Mom likes this.
  5. DiabetesSucks

    DiabetesSucks New Member

    Joined:
    Sep 10, 2019
    Thank you for the welcome and info filled replies. I will get a signature and spreadsheet set up soon (I am a working father of two elementary age boys, so free time is premium). I suspected bouncing, but he had been on the 2 units for 2 weeks and never tested higher than 450, then boom 600+ 3 times in the past few days. Is that normal?

    I wish I had time this week to do another home curve with 1 unit or 1.5 units and see what his numbers do. Weird thing is he looks better than he did at diagnosis but definitely is still weaker with polydipsia and polyuria. I was hoping for better results after 2 weeks. It has been very stressful and time consuming, but I love him and will keep hope alive.
     
  6. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    We understand the busy lives our members have, and adding the care of a diabetic cat can be a strain. Hopefully we can help relieve some of the strain and lift a little worry off you shoulders.

    Re: a curve. Test during the work week when you can, get that before bed test too. Then on days off, try to test at different intervals after the injections..on the spreadsheet you will see +1, +2 etc.that's one and two hours past the injection. That gives you the same information as a curve, but over a longer period, not just one day. And every day, every cycle between shots can tell a different story.

    Two weeks is not a very long time, Beast was probably diabetic for much longer than you knew, before dx. and it's going to take time to see if the pancreas can heal and get back into action by itself (remission) or if he's going to require insulin for regulation. He's unregulated and that's why the excessive peeing and drinking. And probably excessive hunger too.
    Diabetic treatment is a marathon, not a sprint and we advise and support patience.

    At what times every day are you testing him?
     
  7. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You've got lots on your plate and the early days of feline diabetes can be a steep learning curve. We have a saying around here that this is a marathon not a sprint. Some cats get regulated fairly quickly and others take a bit of time. The first few weeks can be stressful because you hang on every number and struggle with a new routine but it will all become second nature in no time as you start to understand the nuances of those numbers which on their own don't tell you much but when viewed as patterns, start providing clues as to how to best help your furry four footer. Each reading provides a picture of one moment in time. Once you collect some data over time, you will start to see a movie that makes this easier. We're here to help in any way we can.
     
  8. DiabetesSucks

    DiabetesSucks New Member

    Joined:
    Sep 10, 2019
    Schedule did not allow for signature and spreadsheet work today. I reduced his dose to 1.5 u this morning. The PMPS was 417, which is still high but certainly an improvement from the 600s. I kept him at 1.5u for tonight's dose.

    One issue is Bengal has never been one to sit and eat a meal. He begs but only eats three or four mouthfulls at a time, then walks away. He's been this way his entire life. He is just a natural born grazer. I have been waking up early to pull his food 2 hours before AMPS, but there is no telling what impact food is having on his BG. I have been looking more for signs of a let up in his excessive thirst and urination, but that has not been any better yet.
     
  9. JL and Chip

    JL and Chip Member

    Joined:
    Dec 28, 2009
    One thing I've done for years is open a new vial of test strips when I get down to two strips in the old vial. I test using the last strip from the old vial, then immediately recode the meter (if needed) and retest on the a strip from the new vial, often using the same drop of blood. Although not foolproof, it does give me a clue as to whether a wild variation is due to the cat or the test strips.

    Also, my AT meter can give occasional wonky results depending on if I get too much or too little blood on the strip. Just something to keep in mind. You'll get a better feel for what is "normal" for your cat and meter after you've been testing for awhile. I'm data driven and used to get hung up on why (as you experienced) I'd get different results minutes apart or different results from one ear vs. the other. As others have said, it happens. Sometimes it's the strip, sometimes the amount of blood, whatever. Also remember that the feline body is a dynamic system and the BG is an approximate value that reflects a snapshot in time. It will vary. It's supposed to! :)

    I'm pleased to see that you're being proactive and engaged in treating your cat. Diabetes can be daunting at first, as is anything new, but soon it will all become more familiar and comfortable and just another part of your normal daily routine.

    Keep up the good work!
     
    MrWorfMen's Mom likes this.
  10. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    It's fine to allow Bengal to graze. The only time BG testing needs to be done without food influence is pre-shot. Most of us either allow free grazing or feed multiple small meals each cycle. Grazing or small meals through the day are better for kitty than two big meals twice daily with shots. It helps to stabilize BG and help keep kitty from getting hungry between meals.
     
  11. Las

    Las New Member

    Joined:
    Friday
    Sierra is still at the vet & they have been testing her. I have an appointment at 4:30 PM to discuss bringing her home today. I plan on running by W/M & purchasing a Relion test meter & strips & lancets & taking those out with me & ask them to show me how to use the meter so I can start my own chart for her at home. I bought several kind of canned cat food to have on hand. So I'm heading out right now. Will post an update ASAP. Thanks so much!
     
  12. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    @Las You have posted this on a thread begun by DiabetesSucks. I am copying and pasting this in a reply to you on the Introduction forum in the thread you have created there.
     

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