Switching from vetsulin to prozinc: Part 6

http://www.felinediabetes.com/FDMB/...-to-prozinc-part-5.171013/page-2#post-1875845

Guess it's time to start part 6 of this thread. Smoky seems to feel the worst a short time after eating.

 

Isn't that how pancreatitis behaves sometimes?

 

I think so but he is always looking miserable. It's just worse after he eats. I answered your other post on my other thread .

 

Yes, I saw your other post. I'm wondering if Smoky is like @Carol & Murphy 's kitty who needs ongoing management of his various issues.

 

Oops I posted on part 5 again instead of part six.

 

Saw it.

 

I'm going to get smokys shot around now. He ate nearly a full can of FF so think he is OK to get his pm shoot.

 

Smoky was laying on bed with me purring up a storm. He is curled up in his kitty condo singing away in there. I think maybe the cerenia and bupe are kicking in.

 

Was this his regular schedule for meds or did you decide to give them because he wasn't feeling well? Did you end up giving him 1.4 u?

 

The cerenia he gets every three days but the bupe I gave him because he was feeling bad.

 

That certainly suggests that he has pain.

 

Unfortunately, my vet will only give me premeasured syringes and only enough for 10 doses.I can't give him different doses on an as needed basis. At Carol and Murphy suggested asking my vet for certain meds that may help smoky out.

 

Yes, I recall that you had pre-measured doses. I think some vets are reluctant to prescribe it more freely because it's a narcotic. Your vet might not be willing to prescribe meds to be used as needed whereas Carol's seems to do that for her. Very frustrating and worrying situation for you. I hope you're able to talk to your vet tomorrow.

 

I may take him for a consult with another vet that is at an animal hospital that is very modern. The vet at cat clinic seems very knowledgeable. She has limited facilities and may not be able to treat smoky with all his various health issues.

 

Sometimes a new take from someone else can be beneficial. Check to see if the other place has a veterinary internist on staff - might be worth a referral because Smoky is so complicated.

 

I'm not able to take him to an internist due to high costs associated with them.
I spoke to a specialist who said they might have to do an endoscopy to find out. The vet didn't recommend that being done with smoky being so underweight.
I will call my vet back again in the morning and ask about having blood work done to check for parasites and also to ask about meds that Carol mentioned in her posts.

 

The endoscopy might be to look for inflammatory bowel disease. Yes, it might be more risky because anesthesia is required. You can only do what your budget will allow, Lisa. Blood work and maybe a different protocol with meds would be helpful. If he's comfortable he might eat more and would certainly have improved quality of life.

I see his nice blue AMPS and your 1.5 u dose on the SS. Looks good!

ETA: Re parasites: Mine had to be treated for tape worms because they were exposed at the stable where they were born, probably from eating a mouse that was a carrier. If a cat is young and healthy they can cope better with untreated tape worms but it's hard on them if they have health problems. Maybe your vet is considering that.

 

I'm on my way to march right now, but will get back to this thread tonight - hang in there, Lisa. I know it is tough

 

Smoky was up a little bit from this morning and last night.
PMPS was 195 but I'm not sure how low he goes during the day. I'm thinking to give him 1.4 units tonight and check him later before bed. The ultrasound he had done in Oct was the time I found out about the triaditis and probable IBD.

 

183, 181 and 195 are within meter variance (+ or - 20%) so essentially the same. You could give 1.5 u tonight but it's your call.

 

I gave him the 1.4 units tonight. The cat clinic called back and I have an appointment for Tues afternoon for blood work and to discuss possible treatment options.

 

Smoky seems to run higher in the morning and lower at night. I haven't done a curve for a little while so think I will do one tomorrow. I will have current BG numbers to show the vet that way.
I'm going to use the AT2 for that but usually use both the Relion and AT2 meter for the AMPS and PMPS readings.
Is that a good idea or not?

Smokys BG went up from last night, was 237 for am. I thought about giving him 1.6U or wld it be better to stick with the 1.5U and test at +4 and +8 to see how low he goes?

 

What exactly is the goal for Smoky as far as preshot BG's go? I have heard that numbers under 150 are healing, would that be preshot numbers, nadir, or in between there somewhere?

 

Your vet will want curve numbers from the AT meter for sure. Using both meters daily for AM/PMPS uses a lot of very $$$ AT strips. What you'd have to do is carry the two different reference ranges (AT and ReliOn) in your head or noted somewhere if you want to save money on strips. The readings will diverge by greater or lesser amounts depending on how high or low the BG is. It's rather like choosing to use Fahrenheit or Celsius for temperature but not both at the same time.

Your choice I think. He might have given you a blue AMPS if you'd given 1.5 u last night but who knows? You'd be able to get good data for the higher dose because you can test today.

When you're giving insulin that works like ProZinc, the BG numbers will (hopefully) follow that ideal smile-shaped curve with higher AM/PMPS and a gradual dip to a nadir that's around 50% of the PSs. To keep them in healing numbers 24/7 you'd want to see around 150 PSs and around 75-90 at nadir.

Insulins like Lantus might give you a flatter "curve" where BG is closer to nadir value for more hours in the day.

 

I only use both meters for AMPS and PMPS on curve days. I wld love to be able to use the AT2 all of the time but it's not cost effective for me to do that. I gave him the 1.5 units and will check at either +6 and +8 or +5 and +10. The curve tomorrow should also tell me if the prozinc is still working at full effectiveness or not.

I'm not sure about using Lantus since it is a depot insulin and doesn't offer much leeway where injection times are concerned. I have heard that if you give shot early it acts as a dose increase or if given late acts as a decrease in dose. Or maybe that is backwards and it's the other way around.
I need to get a few hours sleep and set an alarm to get up and test him later. I've been so worried about it lately that I've only been sleeping. 4 or 5 hours a night.

 

This is correct.

 

Smoky was 150 at +4 hours after shot.
I'll check him again at +8. You were saying in your post that around 150 is healing numbers plus nadir at 75 to 90. How do I figure out a no shot number if goal for PS is about 150? Isn't that too low to give a shot?

 

It's too low to give a shot until you have a lot of data on dosing at those levels. I'm at the point with Teasel now that my "no shot" number is around 8 in world units (145-150 in US units). If he was more predictable in his responses I could certainly find a dose that I could give at that number regularly. As it is, he hits 8 only occasionally so I have to figure out a dose that might work for that particular day. There are examples of this on his 2016 SS.

A broader definition of regulation that I've read here quite often is PSs in the low to mid 200s and nadir in the low 100s or high double digits. Also, what "healing numbers" are we talking about? Maybe it's for the pancreas. For kidneys renal threshold is stated to be around 230 - 250. That's the level below which kidney damage is minimized.

 

I guess it would be both pancreas and kidneys. I didn't think about the threshold for kidneys yet. I also have to check him for ketones again, especially since he has a decreased appetite. Thank you for the info. I hope to one day be more knowledgeable so I can help out others more than I can now. I'll be checking smoky again soon and will update his SS.

 

You've helped a lot already, Lisa. Another nice blue I see.

 

Thanks Kris
Yep another blue, so far so good.
It will be interesting to see what his PMPS is later on tonight. Smoky was same BG as last night: 195 so I'm guessing that's a good thing.

 

Another nice blue! Good dose I think.

 

Smoky got into some dry kibble my roommate left down. Why does this have to happen on a day I wanted to do a curve? She said it was five minutes and he is hungry this morning. I tested him about 10 minutes after he got into the kibble. His AMPS was 249 with Relion meter and 289 with AT2 meter. I am using the AT2 for the rest of the day. I thought about giving him 1.6U since I am doing a curve or should I stick with the 1.5U? Anyone have any thoughts on that?

 

You could go two ways: stay with 1.5 u because it's been the typical dose for several cycles or you could go to 1.6 u to see what this higher dose does for him. The kibble clouds the picture though. Is this a curve for your vet?

 

Yes it's for the vet.

 

My roommate doesn't think he ate that much of the kibble. He doesn't normally want to eat dry food anymore. I thought I wld try 1.6 units and see how he does since I am home all day to monitor.

 

That's a good idea. He'll need a dose in that range to get into green again. Those greens are scary but are a good thing. How's he feeling overall?

 

His appetite is slowly getting better. I asked the vet about giving him cerenia every other day and she said that was fine. I plan on asking her about some other meds that @Carol & Murphy suggested to me. He seems more perky the last few days. It's probably because I have a vet appointment tomorrow. if he acts better he might think he doesn't have to go.

 

I think giving the cerenia every other day - even increasing that to 3 days on, one off, will really help Smoky. At least I hope so, Lisa

 

Ah, yes, the white coat syndrome is kicking in. Good that he's feeling better and that you can use the cerenia more frequently. I get the impression from my reading here that these meds are needed to keep some kitties functioning better over time. Quality of life thing ...

 

Thank heavens for your expertise, Carol!

 

Thanks Carol,
I will ask my vet about that, I thought the same thing, guess great minds think alike. the denamarin is helping him quite a bit as well. I still have the bupe and have given it to him on occasion when he has a flare up. He also has meds for appetite stimulant.

 

My vet said the only hesitancy with daily cerenia is the cat can develop tremors - but it seems very unusual and studies have shown that even daily cerenia is safe. And if it happens, the tremors go away when the cerenia is stopped. Seems to be dose related - Murphy gets 4 mg (1/4 16 mg tablet) once a day for 5 days, skip a day, repeat. Although if he is having some GI issues, I will continue the cerenia until it seems to be resolved and go up to 8 mg when he seems to be having issues.

 

Smoky gets 1/4 tab of a 16 mg tablet too.
My vet told me to give him a 1/4 of a tab every 3 to 4 days. He has frequent nausea though so want to ask vet about ondansteron and urosodiol.

 

I think I would push the cerenia and see how that does in improving nausea as well (ask the vet)

 

OK thanks Carol, will do.
I'll keep everyone updated after his visit with the vet tomorrow.

 

OK just have to check Smoky a little later for his PMPS. I used the AT2 meter today to show my vet tomorrow. I used the Relion and AT2 for am and will do the same for pm. I have been using the Relion to determine his dose so that's why I used both for AMPS and then for PMPS later on tonight.
Check out his SS for today's BG numbers. I can also post on here later.

 

Looks good an uneventful, Lisa. You could try a little boost tonight.

 

By a little boost you mean...?

 

Maybe 1.75 u using a U40 syringe or even a 1.8 u with a U100? At least you'd have a reference line to go by on the U100.

 

I'd rather give him the 1.75 with the u40 since I can't be here to watch him tomorrow. Getting ready to test him now, are those good numbers he had with the AT2 meter?

 

Those are fine but they do indicate that a small increase is in order. The AT reads higher than your ReliOn and I'm taking that into account. You can give 1.75 u but if you're concerned because you're at work tomorrow you can stay at 1.6 u. It would be nice to see some (safe) greens soon.

 

Would he have been in green numbers with the Relion meter maybe? I just updated his SS now with his PMPS from both meters.

 

I'm debating between 1.75 and 1.8 units for tonight. I'll have to wait and see what he is in the morning. How much of a difference is it between 1.75 and 1.8?
I mean how much of an increase is it from 1.6 to 1.8?

 

That's only a 12.5% increase but it should be enough to move his BG a bit. Your call.

 

I can try the 1.8 units tonight and see where he is at with that. I can do a +2 before bed. You have been great with all your help and Smoky and I really appreciate it..

 

You're welcome, Lisa! You've learned a lot and are now out on the forums paying it forward - feels good to help.

 

No, I don't think so. The blues from today are too high to translate into greens on the lower-reading ReliOn. FYI - the two types of meter tend to read closer together at low numbers and further apart at high values.

 

Smoky decided to come up on the bed with me and hang out. He is comfortable, me not so much. What to do?

 

Hurray! He's hanging out with you - nice to see.

 

Yep but I suspect he will be mad at me later when he gets his Cerenia and Denamarin. Not to mention his before bed test. Smoky was 148 at +3 after pm shot using Relion meter. PMPS was 195-( Relion) I gave him a before bed snack of 1 teaspoon gravy food and 1 oz of FF chunky turkey to ward off too much of a drop between now and +7 which is usually his lowest point. I hope he doesn't have a higher BG in morning now.

 

I'm thinking Smoky may have dropped too fast overnight. His +3 using Relion meter was 148 and AMPS was 280.
I guess the 1.8 unit dose might have been a little much it's about 30 minutes before his am shoot. Any ideas? Maybe I'll try the 1.6 unit dose for am?

 

Yes, try the 1.6 u because you're at work today. I think you're referring to the +3 last night, right? Actually, the drop from your (ReliOn) PMPS of 195 to 148 at +3 isn't bad at all. Here's the way I'm reasoning it out: assuming that nadir is +6 (-ish) and a good nadir value is about 50% of PS, or around 100, halfway to nadir you'd expect BG to be around 150. Those numbers from last night are almost bang on.

You have a slight elevation this AM that's likely a mild bounce. All things considered, Smoky's BGs are good.

 

Thanks Kris,
I can understand it the way you explained it. Yep, the +3 is after pm shot. I did give him the 1.6 units this morning.

 

Can't help myself, Lisa - old retired teacher here. I spent decades explaining stuff!

 

Fingers crossed your vet visit will go well.

 

Smoky was 181 for PMPS. The vet visit went well, she just gave me a few options to treat his IBD and did a basic CBC. The vets office will call me with results in a day or so. I'll post on here a little later with the suggestions she gave to me. I picked up more Cerenia for him and another vial of prozinc ahead of time.

 

I'm glad it went well. Have you decided on his dose tonight?

 

I was going to try the 1.6 units again or maybe 1.75U. I wish there was a measurement for 1.7U. I was just going in to kitchen to draw up his dose.
His vet was impressed with his SS but said she thought the 1.6 units was too much. I'm trying to get him into safe greens but would that be for nadir? I know you explained that to me already but how do I get there?

 

You can actually eyeball half way between the 1.6 u and 1.8 u marks on the U100 syringe. I do it all the time. Easier with practice. Just turn the plunger slowly like a screw until you see only a tiny bit of space between the plunger top and the mark on the barrel.

Not sure why your vet thinks that 1.6 u is too much ... ? Yes, you want safe greens at nadir which means the PSs will probably be blue. You get there with gradual dose increases and hope that there's no diving too low at nadir. No rush to get there.

 

She thought it was too high because of the slight bounce in the am following the curve. I used a u40 syringe with half markings to eyeball the 1.75U dose for tonight. Thanks for the tip for measuring out 1.7U dose on the u100. I'll use it for next time, already had the 1.75U drawn up.

 

Hey Kris! Old teacher here too!

Well as we know bouncing happens. I think 1.75 is good...looking forward to seeing what it does!

 

My vet suggested giving budesonide to treat Smoky's IBD and then told me it would be a long term treatment.
The second choice she offered was chlorambucil, also a long term treatment, but she said it can suppress bone marrow. Smoky would need to be monitored closely by his vet. He wld also need periodic blood work done to (1) make certain the meds were working and (2) there were no adverse side effects.

I did some online research which stated that the chlorambucil shld be used as a last resort. Antibiotics can be used as a treatment option along with a med like Metronidazole

 

Is is just me or does Smoky seem to need a higher dose in am and a lower dose in pm? I ask because he has higher BG's in morning and lower at night. I gave him the 1.75U last night and he appears to have a slight bounce this morning.

 

Many cats run lower at night, Lisa. If it's a bounce this AM, it's slight. I'm used to Teasel's Olympic level bounces. Your AMPS is within meter variance of being the same as yesterday's PMPS. However, you're at work today so 1.6 u will give you peace of mind.

 

I gave him just over 1.6 units this morning. It's hard to eyeball the 1.7 on the u100 syringe.

 

Yes, it is but you'll get better. I put the syringe under the bright light of my desk lamp and make sure there's a white background like a tissue or piece of paper.

 

Wow! Just saw your "no shot" Lisa. How it going overall? We haven't "talked" for a bit.

 

I see budesonide mentioned quite a bit here. Is it less risky than chlorambucil even though it's long term?

 

According to my vet the bude wld have to be used long term as well. That is contrary to everything that I have heard on this board. They're both risky but I don't like the side effects of either one. I thought about tagging @Carol & Murphy since her kitty had the same diagnosis of triaditis. I should also create a new thread asking about these meds on the main health forum.

 

Smoky seems much better now that I am giving him the cerenia more frequently.

 

Luckily, Murphy has not needed an immunosuppressive drug, so I don't have experience with either one. Luckily, using the ImmuneIQ information (linked on his spreadsheet) and trying to limit exposure to the allergens indicated there, he hasn't needed anything else. What kind of symptoms is Smoky having? I'm glad to hear that the cerenia has helped. I strongly urge you to look at the ibdkitties website -and also post on their Facebook site - lots of very experienced people there to guide you

 

His vet is concerned that he is having trouble with malabsorption issues.
He is having a lot of problems gaining weight and has foul smelling poop. The texture is formed but soft and lighter brown in color. Smokys vet thinks his food is passing thru his intestines too quickly. She told me that he is probably not getting much nutrition from his food. He is now eating anywhere from 4 to 5 cans of FF per day.

 

Is there any treatment for this problem like very high calorie food, etc. (one he can tolerate of course)?

 

pancreatic enzymes?

 

His options are either budesonide which is a steroid I believe or chlorambucil. I believe the vet said that is an immunosuppressive drug. He wld have to have to be monitored closely though. His vet said she didn't think he needed pancreatic enzymes.

 

Yeah, you are right - after i wrote that, I realized I was wrong. I wonder about digestive enzymes though (OTC) - they are different from digestive enzymes. But he's gained weight recently, right? He must be absorbing something. It's all so difficult - balancing all of these different issues

 

Yes he went from 7.5 to 8.6 lbs although has not gained any additional weight in the last month.

 

Smoky PMPS was 190 after no insulin for 23 and a half hours! Is that a good BG and now I'm not sure what dose to give him.
. I'm thinking about giving him 1.6U since his BG may have gone up a little bit more in another half hour.

 

That's excellent, Lisa! Yes, maybe try 1.6 u. He was low enough for NS this AM but not scary low. ProZinc is in and out so it's fair to decide the dose based of his PMPS. You can test before bed. If that scares you, try 1.5 u? He's responding so well to the insulin these days. It would be great to see some safe greens. I think he'll get there, maybe sooner than you think.

 

I feel pretty comfortable giving him either the 1.5 or 1.6 unit dose. I'm just a little nervous about giving a higher dose since he hasn't had any insulin in almost 24 hours.

 

I know you're concerned about his inability to gain weight. It might take more time. How is he feeling overall with the Cerenia? Did your vet OK it to be used as needed?

 

I think he'll be OK. You have to go by his PMPS. Test him before bed. If he's a NS again tomorrow morning, the dose will have to come down more tomorrow night.

 

The vet said to give the cerenia as needed. I'm giving him 1/4 tab every other day plus the denamarin. Also, the bupe if he needs it. I gave him the 1.6 units for tonight. He is pretty hungry today. He ate two cans for breakfast, one for lunch, and two for dinner so far.

 

I can test him at +2 tonight, is that enough time after shot for his BG to be affected?

 

Just keep feeding him. He doesn't sound like a kitty who eats a fair bit and then vomits. Those meds seem to be helping him feel better which is so important to his quality of life.

 

If he's going to dive, a +2 should give a hint. Does he get food in his feeder overnight?

 

I usually give him a half can in his feeder and set one timer for 3 hours before his testing time. The next one is set for one hour later after that. He can eat for one hour and then it goes to the next compartment which is empty. I can make sure that he doesn't eat for 2 hrs before his BG is tested.

 

Good plan. Being able to eat small meals through the night should keep him in safe numbers.

 

Smoky at BG 184 at +2 after pm shot.
I put 1/4 can of food in his feeder for 2 am and one for 4 am my time. He is eating a before bed snack now, another 1/4 can of food. So that would be a +3 snack now, and a +6 and +8 snack for overnight.
So no food after +9 hours after pm shot.