Slowly learning, dosage seems to go down

Discussion in 'Feline Health - (The Main Forum)' started by TravisCat, Mar 1, 2018.

  1. TravisCat

    TravisCat Member

    Joined:
    Oct 23, 2017
    I found these forums last year when Travis was diagnosed, but I've never posted in them. Mostly, I've let my vet be my guide (they're the expert), but I'm starting to worry that I'm not doing enough. There's a lot that's happened, so I'll try to be brief, yet thorough. :)

    Travis started ProZinc and a diet of Purina DM when first diagnosed. We took him to get his BG checked every other week, then monthly. Starting out, he was a 17 pound cat. They slowly upped his insulin levels until he was at 3 units. He also lost some weight, as I gave him less food, and the vet wasn't happy about that. My argument was that he needed to lose weight, as that's probably part of his problem. Their argument was that it was a bad sign when having diabetes to lose weight. At that time, I started to do more and more research and just felt like I wasn't doing enough. I suggested to the vet I get a BG monitor, and she seemed hesitant (she only had dog owners that did that), but agreed to let me do it if I didn't change dosage on my own, didn't go overboard on checking, and gave her the numbers as updates periodically. I also changed his food, because DM was so expensive, and from what I read, wasn't the best for him. I put him on EVO dry food. When I switched food, after a month, he gained a lot of weight, and his insulin need went up to 5 units! UGH! I figured out that he needed less food than the DM. I promise I read the bag, but he's a big cat, so I gave him the upper amount. Since then, I've lowered his amount to something appropriate, and he's lost weight again. As his weight goes down, so seems his insulin needs go down. I started doing AMPS and PMPS readings during the weekdays, and ps, 1+, 4+, 8+ on weekends. I could see he needed less, and I started giving him 3. A month later, I notice that 3 units seems too much, so I start giving him 1 1/2 units. When I gave the vet my update about 1 1/2, she did not really like that I changed things on my own. She also politely tried to indicate to me to be careful I wasn't being hyper vigilant. She wanted me to give him 2 units since I don't see him being shaky or wobbly.

    Here's the reason for my post... I didn't want to give him 2 units - that seemed too much for him at the moment. So, I've been giving him 1 unit. His pre-shot readings have been in the lower 200s. My vet said the typical curve should look like this: ps - low 300s - 1+high/mid 200s - 4+mid 100s - 8+mid 200s. When I see low 200s for ps, I feel like I shouldn't give him a full dosage. Over the weekend, I checked him, and he seemed to stay in the 200s through the day at 1 unit. For two meals this week, I tried no shot, and his ps always stays in the low 200s (around 218). I work, so since I can't do a curve on a weekday, I asked my Mom to come over and test him today. This morning, he was 194 ps. I gave him 3/4 unit. At 1+ he was 233 and at 4+ he was 234. I'm so confused! Just when I thought I was getting things adjusted, his curve seems backwards. I will add that my husband thinks he's acting a bit strange because he's been jumping up on counters and tables to try and find cups of milk and food, which he has done before occasionally, but more so lately.

    I'd appreciate any wisdom. I really want to do what's best for him and understand these things better. I know it's not really an excuse, but I work full time and have two kids - and though my learning has come a long way, I just feel like I'm still not doing all I should.

    Thanks in advance,
    Desiree
     
  2. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
  3. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yes, please do set up a spreadsheet and enter all the BG data you have. It'll make it much easier to see what going on. :)
     
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  4. TravisCat

    TravisCat Member

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    Oct 23, 2017
    I'll definitely work on that tonight.
     
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  5. TravisCat

    TravisCat Member

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    Oct 23, 2017
    I finished the spreadsheet this morning. Eye opening when it's laid out like this. I write things in a little notebook, and it's hard to decipher what I was doing on occasion. I only put in how many units administered on the spreadsheet if I had a ps reading - otherwise you can assume I gave him the dosage of the time.

    As an update to his current status, I came home yesterday and found he'd thrown up every ounce of his food. I didn't give him insulin last night, he ate half his food and threw it all up an hour later. This morning, same thing (only I don't know if he's thrown it up yet). No insulin last night or this morning though. He has done this twice before, and it only lasts about 2 days. The first time, I completely freaked out and the vet took him and kept him for a day. They ran a ton of tests and said nothing unusual on them. It also seems like he does this when his numbers are looking good. Not always when they look good, but that's the trend my husband and I notice.
     
  6. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Isn't it though! You can see why we like this spreadsheet - a ton of info at a glance. :)

    It would help us a lot if you put the dose in anyway. If someone looks at your SS and hasn't read this part of your post they'll think no dose was given.

    Be wary of this in a diabetic cat. No food plus dehydration from vomiting plus no insulin can be a recipe for development of ketones. I suggest you buy some urine ketone test strips at any human pharmacy and try these tips to get a urine ketone test done - ideally today;
    • put the end of the test strip right in his urine stream as he's peeing
    • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
    • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
    Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

    Re his BG numbers: It looks like 1 u is fairly good but might be a tiny bit too low. Our recommendation would be to eyeball 1.25 u. If your syringes have half unit marks it won't be that hard to do, especially with practice. Vets don't recommend quarter unit changes but we see all the time how a small fraction of a unit can have a big effect. As long as his pre shot BG is above 200 it's safe to give his full dose. If he vomits you can wait a half hour or so to see if he'll eat maybe a couple of teaspoons of food. If he keeps that down you can give the full dose because ProZinc is slow-ish in onset.

    Re food: Have you changed his food recently? Is he one to eat too much too quickly? Is he showing signs of nausea - sniffing food and walking away, licking lips? Is his belly tender when you press gently on it? That can be a sign of a possible pancreatitis episode and they can cause vomiting, nausea, etc.
     
  7. TravisCat

    TravisCat Member

    Joined:
    Oct 23, 2017
    Thank you! I'll look for the strips tonight. He is the type of cat who doesn't go all day and then goes bucketloads!

    Okay, I felt like if his pre-shot BG was in the 200s, then I was going to make it go too low. I felt like I'd read somewhere not to give them a dose if they were in the lower 200s, which is what gave me pause.

    I haven't changed his food since October. I haven't noticed him eating too fast. Even though he's only eating half the bowl, he still follows me around asking for food. He looked a bit unhappy last night (we could tell he didn't feel super great), but he looks bright eyed and bushy tailed this morning. If he still doesn't eat tonight, would you think giving him a can of Fancy Feast would help?

    Speaking of food... I read the post about dry cat food that's pinned. I have a ton of Evo left (two large bags!), but if it will make my dude get better, I'd switch him in a minute. It makes me nervous switching foods, but he's at a pretty low dose so it might not matter.
     
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Removing all dry food might well impact his BG so testing more will be important. Are you feeding any low carb canned food at all? That really is best but you'd want to do the switch very gradually over a week at least. Friskies and Fancy Feast pates are fine for diabetic cats. I don't know the carb level of the EVO but most dry kibbles are too high.

    The no shot number if you're using a human meter like yours is below 200 until you have a lot of data on your spreadsheet. Once that's in place you'll be able to carefully lower than number.
     
  9. TravisCat

    TravisCat Member

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    Oct 23, 2017
    No wet food, but he does love it, so he would probably like my switching it. Evo has 8.4% carbs.

    This has been immensely helpful!
     
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  10. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Is that 8.4% carbs as fed - ie., as a percent of calories? If so, that's good.
     
  11. TravisCat

    TravisCat Member

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    Oct 23, 2017
    Yep. Someone on your message board had contacted the company and got them to write back and tell her the as fed content and she posted it. :)
     
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  12. TravisCat

    TravisCat Member

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    Oct 23, 2017
    Update on Travis. I said in one of my last emails that he wasn't looking so good Thursday evening. Friday, after I got off work, he looked a bit worse, but he hadn't thrown up during the day. On Saturday morning, my husband woke me up to say he didn't look well at all. So, I called my vet and got him in within the hour. They drew blood to test for pancreatitis, and he said the blood looked cholesterol-y (?) which indicates that might be what his problem is. I'll know more on Monday. He then took a urine sample and found ketones. So, he thinks Travis has both problems. He explained to me that I needed to give him insulin, even if he hasn't eaten, as that's what's causing the ketoacidosis. I feel terrible. He gave him an appetite stimulant and anti-nausea meds, as well as some fluids. He looked the worst Saturday night, but this morning much, much better. I have switched him to Fancy Feast (the vet said it would be okay not to do the transition thing, since he really hasn't been eating). It's been good. Yesterday, when he was feeling so terrible, I put out a can's worth and he just nibbled on it the whole day. I also bought him some chicken baby food (pure chicken and broth) as the vet recommended. The vet wanted me to also give him 2 units and keep giving him insulin to get him over the keto. Here's my question though. I feel like 2 units has made his readings look pretty good Saturday and this morning, but tonight he's 56 PMPS. I just fed him after checking. Should I wait a bit and test again? Should I definitely not give him anything since his ps was 56? Now I'm nervous NOT to give him a shot.

    A note about this weekend's episode. He used to look a bit off every now and again in the few years we've had him (throwing up and that), but he only would do it for a day or two. Then it seemed worse and we took him to the vet. That's when he was diagnosed with diabetes. Since the diagnosis, he's had three episodes with all these same symptoms. The first one, was over the weekend, and we took him to the vet just as he was getting over it on the Monday. The second time he got over pretty quickly. This time, not so quickly. So, it looks like this is going to be a reoccurring event for my big guy. :(
     
  13. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Was he in full blown ketoacidosis (DKA)? If so he NEEDS insulin. Tonight's PS is awfully low but it's risky to skip insulin. Do you have any higher carb food at home - eg. wet food with gravy? If so, I'd feed a meal of that and give a reduced insulin dose, say .5 u (1 u if you're prepared to monitor closely) tonight. Test him again at +2 to see its effect.

    If you go back up to my post #6 I mentioned the dangers of ketone development and described ways of testing his urine for ketones. I'd do that daily for quite a while.
     
  14. TravisCat

    TravisCat Member

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    Oct 23, 2017
    UGH, I'm glad I said something. I gave him his meal about 2 1/2 hours ago and just now tested him. He's up to 99. I'll give him some cat treats and insulin. He didn't say ketoacidosis, he just said he has ketones in his urine. However, he did say he might have a couple of issues and would be touch and go. He definitely looks so much better than yesterday, but yesterday was pretty bad. I understand a little better about the keto thing - which is why I was freaked out about not giving him insulin, but I didn't dare give it to him with 56 reading. What you advise makes lots of sense though. THANK YOU so much for the help!
     
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  15. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Make sure you show the dose in the proper time slot on your spreadsheet. How long past your usual shot time will it be? I ask because that could affect tomorrow AM's dose time if you're more than an hour late.

    What dose will you give? I suggested 0.5 u or 1 u. Please try to get a test 2 hours after the dose because you'll be injecting on a lower than usual pre shot number.
     
  16. TravisCat

    TravisCat Member

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    Oct 23, 2017
    Okay. I normally give shots at 7:30. I actually fed him and gave him just over .5 (tried to aim for the middle of your advice!) at 9. Will test at 11 and see what happens. I think I fixed the sheet to reflect this better. :)
     
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  17. TravisCat

    TravisCat Member

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    Oct 23, 2017
  18. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    That pink this AM is a rebound ("bounce") from those greens. Stick with the 2 u dose for now. :) Urine ketone testing is essential right now. He's in a vulnerable state wrt ketone development.
     
    Last edited: Mar 5, 2018
  19. TravisCat

    TravisCat Member

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    Oct 23, 2017
    I talked to the vet this morning. This is the other vet in the practice. Wow, I'm sticking with him from now on, as he didn't discourage me from more monitoring like the other one did. Anyhow, he said that he has pancreatitis. The value is 39, which he said is 10 times more than normal. He agrees that this is probably what has plagued him periodically for a while now. :( And that we'll just have to manage it the best we can when he gets it. I'm currently trying to see if my mother can come over during the day to get a midday reading.

    So, you think this is a rebound from that 56 reading last night? I thought the values on Saturday looked pretty good.
     

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