Switching from vetsulin to prozinc: Part 10

It's been about two weeks so starting a new thread.
http://www.felinediabetes.com/FDMB/threads/switching-from-vetsulin-to-prozinc-part-9.173642/

Today is Smokys 6 month anniversary since his diagnosis of FD. He goes back to the vet today for a recheck. She wants to see how he's doing on the steroid so far. It's been a week since our big move and still have a bit of unpacking and organizing to do yet. March 6 AMPS was 162 he didn't have the budesonide last night so maybe that's why? I gave him 1 unit and will check later to see how he is doing.

 

Is this the (bossy) diabetes vet? It'll be interesting to see what she thinks of his recent lower BGs and their possible connection to the budesonide.

 

Yes it's the pushy vet and she has given up on me I think. I stand firm in what I can do for treatment options for Smoky. I won't put him through countless tests and blood work every couple of weeks. She has already told me that I am doing far more for him than most pet owners.

 

Stand your ground, Lisa.

 

OK so I took Smoky to the vet. She asked me if I just wanted the recheck done. The vet is the one who told me I had to bring him in to get a refill called in. I'm sure she would have ordered blood work if I had let her. I would have had a $250 bill instead of $40 plus another $40 for the steroid. She is trying to get the budesonide compounded into a liquid. He is having a very hard time with swallowing the capsules.
I just updated Smokys SS and his BG is in the blue so happy about that. I'm giving him the steroid tonight. I'll post a little later about details from the vet visit.

 

Smoky's numbers are looking so good!

 

I agree! He's doing really well. The budesonide must be part of the reason.

 

Update on vet visit for Smoky: The vet was amazed that his BG numbers were so good except for a few pinks. She actually asked me if I brought a copy of his SS for her to look at. apparently he is improving with the budesonide. His stools are more formed and there are a lot more of them. I also noticed his urine balls are half the size that they were.


The vet said that all of that is a good thing as it usually means he is getting more nutrition from his food. He gained almost half a pound since the last visit and is now at 8 lbs 15 oz. She is calling in a refill for me for the budesonide in a liquid instead of the capsules.

 

This is great news, Lisa!!! Did you tell her that most of the SS numbers are from a human meter? Half a pound weight gain is significant in a kitty. I'm so pleased for you and Smoky!

 

Well Kris, I didn't actually tell her what meter I used most of the time.
I did tell her I used a human meter on the days he was in hypo numbers. She saw the 28 and thought it was an AT2 reading!
I had asked her what numbers I should be looking for with PS and nadir and she gave me a blank look. She just said 100 to 300 are good numbers but didn't say for what.

 

We know how to read/understand numbers better than most vets. Sue often said to aim for low 200s at PS and low 100s or high double digits at nadir as a general guide to good numbers.

 

Smoky's numbers are looking great! Good for you for standing up to the bossy vet and being your boy's best advocate

 

Looks like another 1 u tonight, right?

 

I was just wondering about what dose to give him tonight

 

I usually have a no shot number if BG is under 150. I know the steroid will raise it some though. Now I feel like Susan did with dosing Timmie last night.
I will give him the 1 unit for tonight and test him before bed.

 

You gave him 1 u on a PMPS of 165 on 02/22. 158 and 163 are essentially the same.

 

Smoky ran and hid after I gave him the steroid. He really has a hard time taking the capsules.

 

I'm sorry. Capsules can be really difficult for cats sometimes

 

I'm not sure if this has been suggested... When my angel kitty, Bubba, was in congestive heart failure he was on a lot of pills. A huge potassium pill at first then switched to gel. I would cover the pill in his pate. Angle it long ways so it didn't go down sideways. I would then "shove" it (very gently) into the back of his mouth and he swallowed it down much easier. I would do this from behind, leaning over him. I would gently raise his chin and kiss his nose while he swallowed the pills. His other pills, I would wad up in a chunk of pate and wipe them into the back of his throat and he swallowed them with no issues, with a kiss on the nose every time. By the end he was a pro at taking pills. Idk if Smoky would allow this method or if it would work but it might be worth a try.

 

When you get the budesonide in liquid, Lisa, dab a bit on your finger and taste it to see if it's bitter or not. I always do that with pet meds so I know beforehand what I'm up against. That little taste won't hurt you.

 

I finally got the pill gun to try with Smoky.
He is usually easy to give pills too. Thanks Kris for the tip about taste testing meds.

 

I picked up the budesonide in liquid form.
Smokys PMPS was 215, am was 234 so I guess I shld have given him 1.5U for am.
I'm thinking that the 1.5 unit dose wld be good for tonight. I don't usually give him the steroid until right before bed.

 

How did it go with dosing the liquid form of budesonide?

 

It was better than the capsules. He tried to kick my hand away. The pharmacist said to bring it back if it needs more flavoring. It does taste a bit tart but not bitter.

 

How is it going with the liquid budesonide?

 

So far, so good Kris. He is still eating me out of house and home though.

 

Good news - let him eat! Must be feeling better.

 

Should I be looking for PS in blue or are PS in yellow ok too?

 

I think I read somewhere that it's believed that anything under 250 allows for healing. And below 250 with nadirs in the safe greens is considered regulated.

 

March 12: Smoky AMPS was 254 and I am thinking of trying 1.8U this morning. Is that too much? I can test him later plus trying to figure out what dose to give for the curve tomorrow.
Smokys +4 was 120, shld I check him again before PMPS?

 

If you're home today, try 1.8 u. Should be OK. How is he generally?

 

He fights me sometimes about having his BG tested. He is not one of those kitties who runs to the testing site. He is very food and treat motivated but still resistant to the testing aspect. I gave him the 1.8 units and he ate about 6 oz of food this morning.

 

Poor Smoky does have to take quite a few meds. We have only been at our new place two weeks today so the cats are still a bit stressed out yet. He is being more sociable and has a very good appetite.
I noticed that Teasel seems to be doing well on the Lantus the second time around even though it's still early days yet.
Going to go grab a nap before his next test, didn't sleep much last night. Maybe DST having an effect.

 

Smoky's BG was 167 for PMPS. I'm giving him 1 unit tonight but no steroid. I don't want it to influence the curve on Monday.

 

March 13: Smoky BG at 273 using Relion meter and 353 using AT2 meter. I want to dose according to human meter as that is what I use for day to day. Any advice on dose for am? I'm thinking I should try 2 units since I am home to monitor today.

 

Yes, try the 2 u dose. You know what to do if he starting going too low.

 

Yep I just bought him some HC food yesterday. We are expecting a big snowstorm in southeastern Pennsylvania on Tuesday. I'm hoping our power doesn't go out. I worry about that with the insulin needing to be kept cold.

 

Unless the power is out a very long time your fridge should stay cold enough inside to keep the insulin at a safe temperature.

 

We are getting that storm too tonight. Keeping things cold shouldn't be an issue. If the power goes out fill a cooler with bags of snow to make an insulin fridge so you can keep the fridge closed.

 

But you don't want to accidentally freeze the insulin.

 

Smoky dropped down from 353 to 156 in 3 hours. Yikes! I think that might be a bit of a drop in BG.

 

It is a big-ish drop. He might do a little Smoky bounce after this.

 

LIFE got in the way of the curve again. We're trying to prepare for the upcoming storm which is supposed to be 14 to 18 inches here. I did manage to get a few spot checks in though.

 

Snow apocalypse prep takes precedence. I like those blues - and on an AT meter!

 

Smokys BG numbers for today: AMPS- 273 on Relion meter, 353 on AT2 meter.
+3 at 156, +5.5 at 101, +8.5 at 172,
PMPS- 181 on Relion meter, 116 on AT2 meter. Am I missing something here? Smokys BG dropped again, is that normal?

 

Here's my next question: 116 is too low for a shot but I'm giving him the budesonide tonight. I know that will raise it somewhat but not sure what to do now.

 

Could you try stalling up to an hour in 20 minute increments without feeding to see if he gets closer to your OK to shoot number? Something I did with Teasel a few times was just feed him, wait about 45 minutes, test his BG (which would by raised by food) and then give a reduced dose.

 

He didn't eat too much today and was extremely hungry. I gave him some food about 30 minutes ago. I thought maybe he could skip tonight and start new tomorrow. I cld also give him half a dose of the steroid as I don't want to skip that again. What do you think? I may also have to give him his am dose earlier than usual with the snow coming and getting to work earlier

 

Yes to all, Lisa. You have to do what works for you. Smoky will be back in blue and yellow very quickly. He looks darker on his back in your new pic. Is his coat growing in some?

 

Yes his coat has almost grown back in Kris. He still has some hair coming in on his side where he had the ultrasound done. My camera on my phone isn't great, I think I need an upgrade.
The snow forecast is now up to a possible 23 inches here.

 

Now I'm starting to worry about all of you in the storm zone! Stay safe and keep us posted! When is it supposed to hit?

 

8 to 9 inches tonight and then around 12 inches tomorrow. They upgraded the storm now, 23 inches between 8 pm tonight to 8 pm tomorrow.

 

You were right Kris, I should have given him a reduced dose. Smokys BG is at 295 on AT2 meter 14 and a half hours since his last shot. He will be in pinks in the morning and I still need to give him half a dose of the steroid yet.

 

Not to worry, Lisa. Something to try next time (ie., feed, wait a bit, test, give reduced dose).

 

It's all data!

I'm keeping all of you in the path of the big snow in my thoughts!

 

Data gathering, data gathering. Enjoy the snow!

 

March 14, Smoky's AMPS was 230 which surprised me. I skipped his shot last night since his PMPS was 116 on AT2 meter and 181 on Relion meter. I found that unusual since the pet meter usually runs higher.
I gave him 1.5 units this morning which I've done before but worried since I am at work today.

 

Not bad for no insulin in 24 hours!

 

That's very strange...I've never seen a pet meter lower than a human meter. I don't know enough about the AT to make a stab at why it was lower...but maybe if it does it again check it on yourself to see if it is lower than the human meter on you?

 

Maybe a wonky AT strip?

 

I thought that too so tried a second strip with same drop of blood. Second test read 125.

 

I made it into work but it will be tricky getting home after work. I'm just glad it will still be daylight when I leave work. I have a 4 wheel drive car and only live a mile from work but you never know.

 

I hate driving in snowstorms even though they're a fact of life here and we have plowing/snow clearing infrastructure galore. I hate freezing rain even more.

 

We have snow, freezing rain, high winds, and drifting snow. Yuk!

 

We have a slushy here lol. Seem to have gotten more sleet / freezing rain than snow.

 

We so rarely have snow/ice here that a few years back when we did...well let's just say EVERYONE slept at work. Kids were stuck at school with teachers, the interstate was completely closed down by wrecks, and people were stranded in their cars. Terrible!

 

Smoky BG at 169 for PMPS at 13 hours since am shot. I gave him half a dose of budesonide last night and skipped his shot. His BG was 116 last night. I'm trying to think what is a safe dose to give him for tonight. Maybe 1.5 units or just 1 unit? I'll be giving him his pm shot late today, 13 and a half hours since his morning shot. Is it OK to do that or should I skip his shot tonight? I'll be giving him his regular 1 mL of budesonide as well.

 

Did you already feed him?

 

You've given 1 u in the past on a similar PS numbers. Why not stick with that? I think you should give the shot late rather than skip it. If he's lower tomorrow AM because of it you can dose - or not - accordingly. I think the positive effect of budesonide on his IBD is bringing his numbers down.

 

Yes I did feed him already. His BG is high enough for his shot. I was just wondering how much to give him.

 

Thanks Kris, I was thinking about the steroid bringing his BG up so wasn't sure what dose to give given that factor.

 

Yes, the steroid can bring his BG up short term after a dose but overall a reduction in inflammation should cause BGs to trend downward.

 

Seeing the positive effect it has on Smoky I'm wondering if it would make a difference in Chuck... I think I'm going to write it down and ask our vet about it next wednesday.

 

I never heard of a pancreas booster. I'll have to check into that. Smoky didn't do well on regular steroids so my vet recommended budesonide for him.

 

I saw it on this forum and did a bit of research into it. A lot of the reviews are good and claim to make a difference in pancreatitis pets. I figured it is worth a shot to help support Chuck's pancreas.
ETA: here's the link to the thread: http://www.felinediabetes.com/FDMB/threads/exciting-supplement.173867/#post-1916642

 

Why not, right? Anything that might help!

 

OK I'm confused again. I thought the goal was for his BG to go down over time. Smoky's BG is all over the place it seems as though there is no pattern to it. I'm giving him his shot soon and it's hard to figure out a good dose to give him with the steroid in play. I'll need to look at the meter and see what his BG was on Wed night for PMPS.

 

That definitely is the goal Lisa. Generally speaking, I'd say the goal is to get the cat regulated...yellows at preshot and high double digits at nadir. Then maybe OTJ...but regulation is the overall goal as that should be obtainable and remission isn't always.

Scanning over Smoky's SS, I see that his AMPS has generally been higher than his PMPS. As his numbers have come down, he's stayed fairly consistent that way. His numbers are really NOT bad. They're in yellows and blues most of the time, which is lovely. And if you just let your eyes scan the colors, you can see they get lower as you go through the SS.

The steorid just DOES make it harder. He's actually doing really well with it...lots of kitties on steroids are in the pinks and reds and we just have to dose around it. That tells me it probably is helping him and he's feeling better...thus having lower BGs.

190 is darn close to 200...looks like you gave 1.5? I think that was a great choice. Giving 1 on a 150/160 has gotten you good numbers in the morning...1.5 on a 190 should get you another good AMPS (maybe even a bit lower!).

I'm not sure if this clears anything up for you at all...does it?

 

Actually it does help me out a bit. Thanks for the info. The steroid is to help him with the IBD and the inflammation from that. Are blue PS's a bad thing or should I be trying for yellow BG numbers? The budesonide tends to raise his BG in the am.

 

Blue preshots are good. Basically you want 2 shootable numbers but if you're getting that you want those lower preshots that you can still shoot. So the budenosiude is affecting AMPS? When do you give it again?

 

Smoky get the steroid in the PM and the effect almost always shows as a higher BG in the AM.

 

He's doing well, Lisa. Given the variety of health concerns you're working around there's very good progress showing on his SS.

 

I was not able to get a big enough blood sample this morning so I skipped his shot. I didn't want to shoot blind or keep sticking him a bunch of times. It's rare that I can't get a blood drop.

 

It'll be OK. He's very good about picking up where he left off.

 

Smoky was 160 for PMPS! That's 24 hours without insulin. I think I will try the tip Kris gave me she tried with Teasel. I fed Smoky and can wait 30 minutes and see if his BG is high enough to give insulin. Or shld I just give a reduced dose and if so how much? Keep in mind though I'll be giving him the steroid before bed which does raise his BG.

 

This is a good time to try the feed/wait/test thing. When I did it I was successful. The first time I lowered the dose 0.5 u and the second time only 0.25 u. Both times he was absolutely fine.

Look at Jan. 16 and Jan. 22 on my SS where you see "note" in red near AM and PM shots.

 

How long did you wait after feeding to test again?

 

Both times I waited 45 minutes but you could probably try a half hour.

 

It's been about 35 minutes now so I can go and test him again. I checked his BG after 40 minutes and it only went up to 167. I think I will just give him 0.75 units and see how he does on that.

 

Hi Lisa,

I suggest that you put in the actual BG just before shooting on your SS. You can add a note about waiting, etc. It will be helpful if this happens again.

 

I tried a new food for Smoky from Dr Pierson's newly revised list of low carb canned food. I gave him the FF roasted turkey for dinner last night. I don't know if it was the food or not but his BG shot up into pink numbers for AMPS. It was 332 for am and 212 for PMPS. I gave him 1.5 units last night and thought about giving him 2U for am shot this morning.
I gave him 1.5 units on 2/26 in am with a BG of 321. He went down to 97 in 2.5 hrs which seems to be a pretty big drop. I am home to monitor today. Any ideas on dose for am would be appreciated.

 

Hi Lisa,
It's possible that he dropped lower overnight and the pink is a bounce number. I wouldn't increase the dose to 2 u in case it is - adding fuel to a fire. It's hard to say with the food but, given the choice, I'd vote for an overnight low. I suggest you stick with 1.5 u and if you want to experiment, feed him that FF today when you can measure BG afterward - maybe a mini curve.

 

Thanks Kris,
I was just about to give him his am shot. He was actually at the 332 at +11 hours so may have been higher at +12 hours. I will try the mini curve tomorrow as I have to pick up some more food for him today.
I'll stick with the 1.5 units for am and do a few spot checks today. Thanks for your adviceI see that Teasel has been doing fairly well over in Lantus land

 

We were "talking" over on the other person's thread so I thought I'd come here to ask if you tried the same roasted turkey FF today.

 

You know I didn't even realized we high jacked someone's thread. I didn't try the FF roasted turkey today yet. I just finished my " shopping" list for smoky and am going to the local Petsmart soon.

 

I am planning on giving him the new food Monday morning when I can also get in a mini curve.

 

March 20, Smoky back to yellow numbers again. AMPS was 228 so I gave 1.6 units for am. I forgot in my small town most of the stores close at 7 pm on Sunday. I can only get the FF roasted turkey and other specialty foods at pet stores. I found some Beyond grain free pheasant and sweet potato to try for his breakfast. I looked at the ingredients after I gave it to him. It has chicken and chicken broth in it which will probably irritate the IBD. Why would the company put that in there when it is supposed to be pheasant and sweet potato. I will check his BG a few times today and watch if he has any flare ups from the IBD. It's so difficult to find food that is completely chicken and fish free.
Smoky has also started to go under the bed or in a box of blankets in my closet after meals. I'm not sure what to think of this as it is a recent behavior with him over the last week.

 

I hope he's OK. One note, though, sweet potato is carbs. His PS is not bad at all, Lisa. Re the hiding after meals: is he showing any signs of stomach upset or nausea after eating?

 

It's hard to tell sometimes with him. I haven't given the cerenia to him lately.
I have been trying out some new kinds of food due to food allergies and the IBD over the last two weeks. What symptoms should I be looking for?

 

He does seem to be a little nauseous I think. He was hanging his head over the water bowl over the weekend. He doesn't hesitate to start eating but hasn't been eating much of his food once he starts eating. How long after a meal should I wait to give him the cerenia?