Sweet Georgia Brown is a problem cat-child! Help!

Hey all. I'm Liz. My cat is Georgia. She is a 12 year old chatterbox and my best friend. In December she was diagnosed with diabetes, and she has been super difficult to regulate. Her glucose is regularly between 200 and 375, depending on the time of day. She's on 4 units of PZI twice a day. The frustrating part is that my vet said feed her only canned food twice a day and we may need to go as high as 12 units per dose, which I cannot afford; but another vet I went to for a second opinion says heck no, let her free feed on diabetic dry food to get regular carb intake (rather than peaks from feedings) and if that plus the 4 units doesn't do the trick, we need to change her insulin type.

These are two VERY different opinions and it is so discouraging. She's also having complications like UTIs and slight nerve issues. I want to get her regular - I don't want to give up, but I'm not made of money!

Anybody have thoughts on the above vet opinions? Also, Lantus? Might want to try that one ... is it pricey compared to PZI? Ugh, I just want her to feel better!

Thank you in advance ... I've been reading this forum for a while so it's time I introduced myself!

 

I will say------NO DRY Food. There are way too many carbs in dry food. Cats are obligate carnivores and don't need a lot of carbs. They need low carb wet food that is less than 10% in carbs. Two economical choices are Little Friskies Classic Pate (except Mixed Grill) and Fancy Feast Classic.

Free Feed or Twice a day------Squeaker's IM told me to let him free feed. Personally, I have never had a cat who ate a meal in one sitting, mine have always free fed.

Insulin----Lantus, while expensive, is a very good insulin. Between Lantus and switching to the Little Friskies Classic Pate, Squeaker went into remission in 2 months. So I only had to buy one vial; however, not all cats can achieve remission. But the better insulins and proper food offer the best chance. There are folks here who buy Lantus from a Canadian pharmacy and it is less expensive.

To help with the "nerve issues" you might want to try some Omega 3 added daily to food.

Are you testing glucose at home? You can use a regular, low cost human meter. I used the Relion Confirm Micro from Walmart and it served us well.

 

For safety, before you make any food changes, you must be home glucose testing. A significant change in carbohydrate content may drop the glucose 100-180 mg/dL and reduce the insulin dose by 1-2 units.

 

What PZI are you using and what do you pay for it?
Can you provide specific BG values and when they were taken after the shot? That way we will have a better understanding of what is happening to BG over time. Also, if the BG are taken at the vet note that vet stress can raise BG by 100 or more points due to stress.

 

What was your starting dose? How many increases have occurred since December and by how much? 4 unit is high for most cats and 12 units is too high unless there are other health issues.

You may have missed the optimal dose. Too much insulin can also increase glucose levels. When the dose is too high the body produces extra glucose to prevent hypoglycemia.

 

Going in the middle of both could be a better option.

No dry food. Instead of free feed and only 2 meals a day, how about more frequent scheduled meals?

Again no food change unless your home testing. It could go bad very quickly.

 

Well, each of the vets got some things right, and some wrong, it seems!

Your current vet is right about the diet. You should be feeding low carb, canned food only, no dry food. You don't need to feed a prescription food--there's a ton of commercial options that are the same or better quality than the prescription foods that cost less. Fancy Feast and Sheba pates are very popular grocery brands for diabetics, and Wellness, Weruva, EVO, and Instinct are popular premium brands. Friskies, 9-lives, and Special Kitty pates are also diabetic safe if you're looking for good lower cost brands.

As others have mentioned, if you're currently feeding dry food, do not remove it unless you're home testing and adjusting the dose down. Cats can see huge drops in their blood glucose when dry food is removed.

If she got up to 4u on a canned diet without dry, then I would change the insulin type. Prozinc does work well in many cats, but it doesn't work well in others. Your current vet was not wrong in prescribing it, but typically if you don't see good results within a few months, you should try one of the other recommended insulins that have a little better success rate (Lantus or Levemir). Lantus is pricy in the US, but if you order from Canada, you can get a 5 pack of pens for $170 after shipping--each pen will last you 2-3 months if handled properly, so that works to be less than $15 a month. All you need is the script from your vet.

As for feedings, diabetic cats do best with smaller, more frequent meals. Bandit eats 4 times a day--every 6 hours. When I'm not home to feed him, I freeze portions of the canned food and use auto-feeders for the cats--this has worked out great and is just as convenient as dry food, if you think your schedule will make frequent feedings difficult.

 

Welcome Liz and Georgia!

 

Thank you all for your input!

I do home test; she hasn't gotten a test at the vet in several months. I last measured her glucose last night about 4 hours after a dose of 5.5 units (what my current vet has prescribed; the new vet says 4). It was at 272. She used to be on Friskies twice a day, and then tiny bits of dry prescription food during the night for a snack (so I can SLEEP). It would be the same result - glucose is rarely below 200. I can't do more frequent real meals because I work full time and live alone.

I'm not sure what kind of PZI it is, but I do know my current vet compounds it, which I hear is abnormal? I pay around $130 for a 10 mL vial. So at 5.5 units, that bottle lasts just over a month. But I did update my current vet yesterday, and he pulled up some Cornell research that states a "high" dose of PZI is actually 1-2 units per pound of weight. For my 14 pound cat, that'd be 14-28 units per dose. And I CANNOT afford that in the slightest.

Which leads me to the big problem, guys. I'm getting conflicting information from my vets. My cat is soaking through her litter, sometimes leaking elsewhere in the house when she gets too relaxed. She is always hungry, and sometimes asks me for more food even when there is already food in the bowl - I wonder if she's going a little senile. I'm getting to the point where I love my cat to death and want to fight for her, but cannot afford to start all over with a new insulin and set of curves, let alone continue on the out-of-control path she's on. Would it be the most practical thing both for me and her quality of life to just let her go? I hate even bringing it up, but I'm at the end of my rope. I don't know how much longer I can do this, especially since I am alone and not made of much money.

I hope you guys don't throw pitchforks at me for bringing up euthanasia. I know this forum is for support and optimism. I just need some clear, objective opinions besides my own conflicted, saddened heart.

 

So sorry for your issues. It sounds as if the PZI isn't the right insulin for your kitty. Dry food even prescription dry is to high in carbs and will keep the glucose elevated. You must home test if you stop it. If you can use an auto feeder, you can use it at night. Some do allow wet food. And there are tricks to keep it cold (freeze, ice cube, cold ice packs). More frequent meals tend to work better. Most of us get insulin from Canada because it's cheaper, I don't know if PZI is one of them. There are solutions we can help with.

 

The excess urination and hunger are symptoms of unregulated diabetes. If you get her blood glucose under control, those will improve.

I truly believe she will do much better on a different insulin like Lantus. If you can't afford the $170 to get the 5 pack of pens from Canada (keep in mind these will last you a year or more, you won't be spending that much every month), you can order a single pen to get started--it's not as good a deal as getting the 5 pack, but it's a lower up front cost ($70 after shipping, I think?). A single pen will last you 2-3 months. Changing to Lantus will be less expensive for you in both the short and long term. Most cats on Lantus and a low carb, canned diet do not end up needing much more than 1-2 units of insulin. The highest Bandit's insulin dose ever was (and this was when was on steroids) was 1.5u, but typically he needed around 1u or less.

My cats eat every 6 hours, and I freeze portions of canned food and set them out in auto-feeders for when I'm at work or sleeping. If your cat won't sit and gnaw at the frozen chunk of of food like mine will, you can just leave that out over night. Or you can free-feed canned--I have a few friends that do this. They put out multiple bowls of canned food at night with a little water added, and their cats munch away at it whenever they feel hungry.

I would like to see the research that your vet pulled up, because 14-28 units is not a typical dose in a cat unless it has a high dose condition like acromegaly. I don't see any evidence that this is the case with your cat based on what you've described, but if your vet is suspecting a high dose condition there are tests for those. Bandit currently sees an internal medicine specialist at Cornell and their treatment recommendations for diabetics are exactly the same as here on FDMB--low carb, canned diet, Lantus or Levemir insulin, and gradual dose adjustments via daily home testing. I believe Cornell will consult with other vets for free, so you could ask your vet to contact them if he needs more information. The veterinary library at Cornell is also wonderful and I'm sure would be happy to provide information for him.

I understand that you're tired and exhausted (especially when you see your kitty getting worse!), but would you be willing to try out the recommended treatment for cats before you give up? It's not going to put you in a worse position than you are now. All you would need to do is get the script for the Lantus (which will be cheaper than the PZI even if you order 1 pen at a time from Canada), and get rid of the dry food. I've also attached an article on treatment of cats with Lantus for you to print and bring to your vet--it discusses diet and dosing details with Lantus. Bandit has been diabetic for 7 years now, and he's still doing great. The right treatment path makes a huge difference--literally the difference between life and death. You can do this--that's not just me being optimistic, I've seen diabetic cats in terrible condition fully recover once they start on the right treatment path. I helped treat a friend's diabetic cat that was unregulated, wasting away, and suffering from diabetic neuropathy so badly that he couldn't walk--her vet had him on the wrong food (dry prescription), insulin (Novolin), and she wasn't home testing for about a year. She changed the diet (Friskies canned), the insulin (Lantus), and started home testing. 6 months later he had nearly fully recovered from his neuropathy and was healthy and in remission. It's definitely worth it to try, in my opinion.

 

Thank you so much for your detailed answers, guys ... it really puts my mind at ease!

I called the new doctor and here's what we're doing. He has a cat patient who passed away and left behind nearly a whole bottle of non-compounded PZI. (My current vet is compounding it ... is that abnormal? Because the new doc says there's no need to compound and it's really weird that my current doc is doing that. Maybe it's because that means I'd have to purchase straight from that vet and deal with any outrageous markup they put on it...???) He let me have the old cat's bottle for free - bless him for that! - to see if non-compounded works better, since Georgia has shown some PZI response in the past to suggest it may work much better. In the next week and a half or so, if she still shows no improvement, we will talk about switching to Lantus. I think he just wants to exhaust the PZI option first, especially since it's usually cheaper. It's really comforting to know that not only does he care about my cat and my finances, but that he doesn't have his own head buried in his pocketbook! This really opened my eyes to how my old vet is operating, with "by the book" processes that are really just excuses for money ... yep, I'm switching!

I also realized the new doc and I had a misunderstanding. I told him I'd been feeding her Friskies, and I think he thought I meant the dry food when I meant the canned food! So he's like NOO if you're going to free feed her, make it at least the diabetic formulated dry! Now that we're on the same page, he definitely recommends canned Friskies or Fancy Feast or anything under 10% carbs. (My old vet, in contrast, insisted on the expensive prescription food - that I'd mainly buy through them - because of scientific proof ... heh ... nope!) I'm now feeding Georgia Friskies canned food twice a day, with bits of dry Hill's m/d at night so she can eat little bits at a time and doesn't wake me up too much for food (which I know sounds selfish, but trust me ... she is pesky as heck when she is hungry).

Georgia seems to be doing well already on this new PZI formulation. I already noticed after the first dose last night that she wasn't drinking as much water (maybe has to do with the canned food?) and seemed a smidge happier, sitting by me and being less adamant about more food, stuff like that. My problem now is that she is still dribbling urine a little bit from time to time. I woke up in the night to find a few small spots on my bed where she was laying next to me. It's not nearly as bad as it was when she first had UTI and sphincter problems back in April (WHOLE BOUTS of urine on my furniture, ugh!) but she's almost done with her nerve/muscle medication, so I really don't know what's up at this point. Any thoughts on this? When she had the UTI, we did two different antibiotics back to back because we weren't sure she responded to the first one, so the odds of the UTI still being there are UBER low. But I could be wrong! And no, it's not marking for attention - it only happens when she's laying down and really relaxed, almost like a kid wetting the bed. If she wanted my attention, trust me, she'd literally talk til she gets it!

I really appreciate you guys. Feels so good to have people to turn to who just GET IT!

 

The lack of good bladder control may be due to some nerve dysfunction from the diabetes. This can be treated with methylcobalamin (methyl B-12 vitamin). This specific form of B-12 has been shown to be helpful in diabetic neuropathy (a fancy way of saying nerve problems from the diabetes), along with good glucose control.
One product, specifically for cats is Zobaline. You can use generic versions (ex from Vitacost) of those ingredients ( 3 mg of methylcobalamin and 200 mcg of folic acid) and mix them up in those doses yourself, if desired. Just make sure there are no sweeteners of any sort in them.

 

Oh man guys. I'm a fool. I've misunderstood Georgia's insulin! She was on BCP-PZI, compounded by my vet. She is now on ProZinc. I had no idea that the first is pork and the second is human! Anyone have thoughts on this switch?

And thanks for the supplement recommendations! Should I check with my vet first before trying them?

 

BCP PZI is a good insulin and may work better than ProZinc since bovine (beef) insulin is closer to a cat's inulin that human insulin.
The only concern is variations in vial to vial of the BCP PZI.

I have used BCP PZI in the past and it worked OK and only changed to Lantus or Levemir because those were more readily available. On a per unit basis, U100 BCP PZI in a 10 ml vial is less expensive that Lantus and Levemir (purchased in USA) and ProZinc.

 

The B vitamins are water soluble and any excess is excreted through the kidneys. If there is any kidney (aka renal) problem, you may not want to do that.
While it is unlikely that they would cause a problem, it is certainly reasonable to ask your vet if there would be any harm in trying them in your cat.

 

There's no evidence that bovine insulin works any better in cats than human insulin--it's the duration of action of the insulin, not the source animal, that typically indicates good results in cats. BCP PZI actually has a shorter duration of action in most cats than the human recombinant Prozinc.

 

All I said was "may", Id\ not say it was better

 

Is this based n using ProZinc and bovine PZI on the same cats?

I did not see any difference with my Badger, I used both on him.

 

Hey all!

So Georgia has been on ProZinc for almost a week. She was on two units per dose, and we increased her to 2.5 last night. I have to say, I think there's a noticeable difference. She drinks less water, and her glucose readings are a lot more reasonable (not out of the woods yet). I like what I'm seeing! Except for the continued incontinence issues ... it's starting to worry me. I hope she's not sick again - after two antibiotics, she'd have to have a superbug!

The other thing about the BCP-PZI is that at my old vet, they were ordering it and then compounding it at their office before I picked it up. But it's my understanding that it comes compounded from the BCP company ... so why would they compound it at my vet? Can anyone make sense of that?

Also, Georgia is hungry ALL THE TIME. This isn't anything new, but now that she is on twice a day canned feedings with some bits of diabetic dry in between, she is still waking me up a lot! Anyone have any recommendations for affordable, filling, diabetic-approved snacks for cats? I made frozen treats out of chunks of canned food, but I'm worried she'll choke on them ... she eats fast ... because she's a beast ...

 

Freeze-dried chicken, shhrimp, etc work as low carb treats.
Come on over to the ProZinc/PZI section to post more questions and get feedback specific to your insulin.