Newly Diagnosed-Help!

Hey everyone.

First I wanted to say that I absolutely love this site. I'm two months into treating a newly diagnosed kitty, and this site has been a saving grace to helping me learn about feline diabetes.

Lucy is a 14 year old tortoise shell domestic short hair kitty with an attitude (some call it toritude). I've had her since she was 5 weeks old, and was heart broken to learn that she is a diabetic. She had the classic symptoms: extreme weight loss, profound polydipsia/polyuria, and was tired all the time. I was worried that she was in renal failure, but thankfully all of her lab work was excellent except for her blood sugar. As strange as it sounds, I was happy to get a diagnosis of diabetes rather than renal failure since I can manage it easier.

The first two weeks on Prozinc went fairly well. Although her BS numbers were not ideal, I was seeing less polydipsia/polyuria, and her coat seemed to be looking better. Now right around the same time that she was diagnosed, I adopted a new kitten who brought a nasty upper respiratory infection into the house. Of course Lucy got it and things quickly went down hill. Long story short, Lucy stopped eating, became very dehydrated, and ended up in the hospital for a night. Thankfully, she has recovered and I have been focusing on getting her blood sugar regulated, which is what lead me to post this.

Another important thing to know about Lucy is that she will NOT eat wet food. She will lick the wet food, but will not eat it. I haven't given up hope that she will switch over to wet food and will continue working with her to convince her to change, but for now she is eating Purina DM dry food.

Before the illness, I followed the vet's prescription of 2 units of insulin twice a day, but wasn't seeing very much success in keeping her numbers low. After the URI, the emergency vet suggested that we start over. So I reduced her dosage to 1 unit twice a day with food. After a week of doing this, I still wasn't seeing ideal numbers, so I consulted with the vet and we decided to try 1 unit in the morning and 2 units at night since it seemed her night time numbers were trending higher. While I've seen some progress, I am still not sure that her dosage is right (although I'm new at this, so maybe I'm just expecting too much too soon.)

I have attached her spreadsheet in my signature in hopes of getting some advice from some of the seasoned diabetic caregivers out there. I am primarily using the AlphaTrak 2 to home test, but I find that the strips are too expensive, so I'm slowly converting over to a Relion Prime meter with less expensive strips. MOST of the numbers on the spreadsheet are from the AlphaTrak 2 though.

Yesterday was her best day yet, with her BS holding in the 200's. I was afraid to give her 2 units yesterday evening in fear of her going hypoglycemic, so I only gave her one unit. This morning, we are back up to 509. As you can see from the sheet, her BS tests seem to be so inconsistent.

What advice can you guys give to help a newbie out?

 

Hi,
Can't give dosing advice but it looks to me like your little tortie may be a bouncing tigger cat.

Just taking the numbers at face value as I can't see notation as to what reading is what. The human meters will test lower than the alpha track and these two readings are not really comparable.

You see that blue on 6/17 then she shot up to black and stayed up in the clouds for a bit (a bounce can take up to 6 cycles to clear) and she was back down to blue on 6/20 and then right back up to black for another 4 cycles and there is no tests in the evening of 6/22 so we will not know for sure but there is the black on the 6/23 AMPS.

So on the 29th there was Lucy's blue in the evening and then this morning - black again in the morning!

Can I ask why you went from 1 to 1.5 to 2 units within 3 cycles? I use Lantus so am not familiar with dosing requirements on Prozinc, so if this is a rude question - please ignore

Have you tried some of the lower carb dry foods? Young Again or Dr. Elsey's? That may help her numbers as the DM is pretty high in carb while you are trying to transition her. The only caveat I have on moving to a lower carb diet - you need to test consistently - her numbers can drop quite dramatically and you don't want a hypo situation.

 

Hi Tracey,

I don't think that's a rude question at all! I will check out those foods as well. The 1 to 1.5 to 2 unit adjustment was during a really bad day for Lucy. She actually went over 600 that day (I'm not sure why it wasn't recorded on the spreadsheet), so my regular vet advised the dosage change. The regular vet has made some suggestions that I don't really understand, so I have been consulting with a different vet who has much better at helping me with the dosage. Right now, we are thinking Lucy may be a 1 unit/2 unit kitty, so we are trying that for a little while.

I like your comment about how she is a bouncing tigger cat. That describes the situation perfectly. Another variable that I haven't really considered is that she still may have not completely cleared the upper respiratory infection yet. The symptoms are gone, but I've seen some research that says the unseen effects of a URI can linger for about a month. I've also read about the smogyi effect and wondering if I'm seeing that too. The Prozinc is supposed to be a 12 hour insulin, but I've often seen that it doesn't last long enough to keep her number down consistently.

What is an ideal BS range to strive for to be considered regulated?

I am open to all advice!

 

The range depends on the meter you are using. Pet meters I think is 68-150, human is 50-120. You are looking for healing greens and blues on the spreadsheet. Lots of pet parents use the human meter for regular testing and then a pet meter for curves for the vet. My vet told me to get a human one - never even suggested a pet meter.

I know those blacks are a little scary. The problem with just bumping up the dose too quickly is that you don't give the insulin time to work and for Lucy's body to figure out what it is doing. Patience is key here. There is a reason we say it is a marathon not a race. I am afraid most vets are in a "dosing" mind frame when they talk about insulin - which in most cases leads to bad decisions. Insulin is a hormone - not a drug. So you are not going to get a Y outcome if you do X dose. There is a complex dance going on inside Lucy and we need to give her time to tell us her story. Human hormones are just as complicated.

Have you read the sticky on the protocol we use here for Prozinc? There are guidelines for dose increases. I hope someone with more experience comes along to give some guidance on dosage. You may want to change your title to include "dosage advice needed".

How is Lucy eating? With her numbers being high and a possible residual infection you may want to test for keytones. DKA is not a scenario you want to miss.

 

Hi Jason! I'm looking at your SS on my phone from work so I can't see it all at once...but it looks like bouncing to me.

I know you said you're trying 1 unit AM and 2 PM but I'm not sure I'd do that...consistency in dose usually works better. Especially considering that lower preshot you got last night! I can't give dosing advice right now...I really need to look at your SS on my computer. I'll definitely check tonight when I get home. And most likely someone else will be by before then too. We're not as busy during the day but someone is around mornings and evenings usually! I just wanted to respond and say hi and we'll definitely be able to help with some dosing ideas.

 

And I'm home! Okay after looking at your SS on my computer (ah the joys of seeing more than one column on the screen at a time!), my thought is to maybe drop back to 1.5. It looks like 1 unit was getting you some good drops, but not into greens. It looks like then you tried 1.5 but only once...then went up to 2 units. And since then, you get some high numbers and some low numbers. I think trying 1.5 consistently for a few cycles would be good...and if you can get some mid cycle numbers, that would be super helpful (you've been great about getting those when you can!). 1.5 may not be enough, but I think sticking at a consistent dose for a few days would help as stable doses might help Lucy stabilize out somewhat. Then if needed, we can raise the dose again.

I know you said you wanted to try 1 in the AM and 2 in the PM, and you certainly can if you think that's best (you hold the syringe and you have to make the decision!). The reason I would try a consisten 1.5 is because we've found here that most kitties respond best to consistent doses. Plus, looking at your SS, you get those lower preshots (not too low, just lower than you're used to) sometimes and then drop back to 1 unit (which I would have done too) and then it just continues with Lucy bouncing around.

Also, has anyone told you about our no shoot suggestion? We suggest new members not shoot if below 22o (on a pet meter) or 200 (on a human meter). If you get a number lower than that, try stalling WITHOUT FOOD for about 15-20 minutes and retest to see if the number comes up enough.

What other questions do you have for us?

 

Welcome Jason and Lucy!
I agree it looks like she's a little bouncy and she does give some hints that her "ideal" dose (which can change around, so it's not set in stone) might be between 1.0 and 2.0U so with jumping almost whole units each time, you may be missing it. Don't feel bad, a lot of Vet's tend to think in terms of whole units, while this works for us humans it doesn't work so well with our little kitties (even the big ones ).

We also have a saying about treating FD, it's a marathon, not a sprint. Seems a lot of people don't see big improvements in BG numbers in first 2 months or so. Maybe it's mostly been members I come across . I do like the suggestion of testing for ketones, just to be safe. You can pick up test strips for a few dollars at any place that has a pharmacy/diabetic supplies.

Also, have you read this article: http://catinfo.org/docs/TipsForTransitioning1-14-11.pdf
Do your syringes have half unit markings? They are super helpful with making smaller dose adjustments. We recommend dose changes be done by 0.25U or 0.5U.

Lastly, if you wouldn't mind looking at some suggested info to add to your Signature, it will help us going forward

Feel free to keep asking questions. We'd love to help you and Lucy

 

Hi Jason and Lucy!
Any updates? Noticed SS hasn't been updated since 4 July so was getting concerned . Any luck on transitioning to wet food?