Switching from vetsulin to prozinc: Part 7

http://www.felinediabetes.com/FDMB/...-to-prozinc-part-6.171694/page-2#post-1883268

The journey continues on:

 

How's Smoky feeling now? Hopefully the meds are helping him feel better, poor thing.

 

He is still a little nauseous but is doing better now. His AMPS was 144 and I gave him one unit this morning. I just tested him at +4 and he dropped down to 66! His appetite is coming back slowly.
I'm happy to see a BG number in the darker greens but it scares me that he went that much lower in 4 hours.
I'm wondering if I should check him again at +6 since he is still in the first half of the cycle yet.

 

I would check in 30 minutes. Did you give him some regular food? If he continues to drop and gets to 50 or below, give some gravy off HC food.

Very nice number, but a little early in the cycle.

 

Thanks Sue
I gave him some of his regular FF classics for lunch. I just picked up his bowl about 15 minutes ago. He ate two ounces of his food. Shouldn't I wait for the two hour window before testing again? Or test him in about 45 minutes? It would be a +5 hours.

 

You just want to be sure he is rising - whether it is from the food is fine. You don't want him below 50. Once you see he is rising, not falling, then you can relax and test whenever you want.

 

OK I will test again in 15 minutes. That will make it +5 since his am shot and 45 minutes after he ate his lunch. Is that enough time for the food to have an effect?

 

Yes, sometimes the food only takes 15 minutes.

 

I just tested him again and he was 58.
Giving him two teaspoons of gravy with food. FF gravy lovers

 

The gravy should bring him up. We don't want to see him below 50 so 58 is not bad. If he would just surf along for awhile in single digits (above50) that would be fine.

 

Should I test him again at +6 or will he be fine until his +8 test?

 

Just seeing this now, Lisa. I've been out. Lovely greens even if you're doing some nail biting. Did you do another test after the 58? You might want to for info gathering.

 

I just updated Smokys SS, 93 at + 6.5

 

Looks good. Nice cycle. You might reduce a smidge on the next cycle if you can't be around. Or he might bounce some...

 

Nice. Good thing you have those U100s around!

 

I'm off work today and tomorrow so I can watch him. Today is the first time I gave insulin on a lower number. If I had been working today I wld have skipped his shot this morning. I just have to wait and see what his PMPS is tonight now.

 

Again, not a deadly unsafe number, just one you want to be around to steer. It is good to push the envelope a little, shooting lower preshots - as long as you can test, will be there to monitor and steer and feel confident doing that. You have plenty of data to be a little more daring.

 

You're into "Advanced Dosing 101" now, Lisa.

 

I know Kris but it's kind of a little scary
Thanks @Sue and Oliver (GA) for all your help today. I'd rather Smoky be an FD free kitty but I'm so glad to be a part of the FD family too. Hugs to all those who have helped me on my journey.

 

I know it's scary, Lisa. Look how far you've come though in knowing how to choose doses, steer numbers and give advice to others. Amazing!

 

Smoky decided he's ready to start giving you those nice numbers!

 

Could be his PMPS was 209. Is that a little bit of a bounce. I'm thinking about what dose to give him tonight. Maybe 1.6 units again? I decided to give him a little less with his early drop today, getting ready to give him 1.5U

 

I like 1.5 u. Yes, that's an itty bitty teeny tiny bounce ... wish Teasel could see it.

 

Smoky is hanging out with me again tonight. love this pic of him snuggling.

 

He will be mad at me later when I give him the cerenia before bed.

 

How sweet!

 

Smoky's AMPS was 234 so up a little bit this morning. I don't know if I shld open new vial of insulin or not. The old one is about 90% gone and will be 10 weeks old this Wednesday. I would rather open a new vial on Sat night or Sunday morning since I am off work those 2 days and can monitor BG and see how he feels on it.

I'm thinking about giving him either 1.6 or eyeballing 1.7 on a U100 for am dose. He is feeling a little better and I should be getting the budesonide today or tomorrow so I can start him on that. I have been giving him the same dose so I don't know if he needs a little more to get him into those nice green numbers.

 

I see you gave him 1.6 u this AM. That's fine I think. I agree with you about waiting until your days off to start a new vial of insulin. If you can get through this week until next Sunday, I'd keep using the vial you have now. It doesn't look to me that it's losing its potency.

 

I thought I would check him at +4 and +8 today just to see how his BG does on the 1.6U dose after that tiny bounce he had. How are you and Teasel doing these days? Did you decide about going back to using Lantus for him again?

 

Yes, I thought his little bounce was cute compared to the Mount Everest types Teasel gives me. Teasel is fine. I'm still thinking about giving Lantus another try because it would satisfy my curiosity if nothing else. I knew nothing when he was on it at the beginning. It's very cheap here compared to the US and I can buy it over the counter - don't even need my vet's OK. I suspect he'd bounce like crazy on Lantus too. Like you, I like ProZinc's flexibility and "what you see is what you get" with a dose - no depot to think about.

 

OK so Smoky dropped even more today than yesterday. AMPS: 234, +4: 102
I swear my boy is trying to send me into a panic attack. Big question is shld I test him again at +6 or +8 as I had planned to do today. He ate 2.75 oz for breakfast, he is eating his lunch now.

 

Beautiful number! Yes, I'd test at +6 and +8 to see where he goes. You can worry about what dose to give tonight later after you have more data.

 

Just tested him at +6 and he was at 99.
He is eating a little bit of his FF chunky turkey. He doesn't look like he feels too well. Sleeping a lot and not eating too much. Maybe having a flare up of his pancreatitis.

 

He probably won't go too much lower but a +8 test is a good idea. I hope you get the budesonide soon. Have you given cerenia and/or pain meds today?

 

I usually give the cerenia at bedtime. I do have bupe on hand if he needs it.

 

I called the pharmacy and his prescription for the budesonide will be ready to pick up today. I wld rather give him that this afternoon so I can keep an eye on his BG today since I have to work tomorrow.

 

Smoky is laying on the bed with me again purring up a storm. OK he got up and wants his bowl, not happy that he has to wait. He is giving me the saddest look ever but he just finished eating 1 hour and 15 min ago.

 

Good that he's showing signs of wanting food.

 

I'm going to have to check him at +7.5 anyway. I have to leave to run a few errands.

 

OK his BG was 112 and test was done 1 and a half hours after food. He ate 4.25 oz of food so far today.

 

Smoky PMPS was 190 so I don't think that's too bad. I thought to give him 1.5 units tonight. Think that will be OK. Plus I don't know what the budesonide may do yet to his BG if anything.

 

That dose is fine. Such nice numbers ... sigh ... Has he received a dose of budesonide yet? Are there any side effects you need to watch for?

 

I picked up the budesonide but it will be hard to give him one of them. They are big clear capsules and you can see the loose powder like texture in them. I'm worried they will come apart in his mouth if he doesn't swallow one right away.

 

I'm going to go and give him his pm shot and then see about giving him the budesonide. well, he didn't have any problem swallowing them so that's a relief.

 

Do you have a pill gun?
https://www.amazon.com/Kruuse-Buste...=UTF8&qid=1485824672&sr=8-3&keywords=pill gun
These are very useful. I got mine from my vet.

 

I was reading up on any side effects for the budesonide. I don't have a pill gun, he is very good about swallowing pills.

 

I see that you've already given him pill. Good boy!

 

The common side effects for budesonide are similar to diabetes: increased thirst, drinking,and urination.

 

The budesonide made Smoky a little sleepy so we both took a cat nap.
I didn't give him the cerenia yet, poor guy has had a bad day already. I've been giving it to him three days on, one day off.

 

I think I read that the budesonide has to be given for a while to show a positive effect, right?

 

It probably does take a while for effects to show up. Smoky has always been extremely sensitive to meds, especially steroids. He has taken them quite a bit in the past, most antibiotics don't work all that well on him. I gave him the cerenia, he gets the day off tomorrow except for the budesonide.

 

I gave Smoky the budesonide and his BG went up slightly for AMPS: 287
I plan to give him the 1.6U this morning to keep him safe while I am at work.
I don't know how fast the budesonide takes effect but that is a big bounce from last night. Any ideas or thoughts anyone?

 

Yes, he's up a fair bit since PMPS but it's still a yellow. It might be the new meds but you'll need more data to know. Maybe it was a little bounce from his blue PMPS. How often is the budesonide given? Any after effects this AM from last night's dose?

 

It's given once a day preferably in the evenings as the med works the best at that time. I checked his BG before the budesonide was given. He was a bit more hungry today but that's to be expected from the new med. The vet suggested I check him for ketones again since his appetite has been down lately.

 

Lisa, you are managing so well juggling his meds and his diabetes. And his numbers continue to be good (anti jinx). Hang in there!

 

Smoky was 223 for PMPS. He gets his pm shot in about 15 minutes and his budesonide shortly after that. I'm trying to figure out if I shld give 1.6U again or maybe a 1.7? It wld appear the new med is raising his blood sugar and causing a little nausea.

 

I'd try 1.7 u because you're home to check before bed. Fingers crossed the side effects diminish over time.

 

I thought the 1.7 units might be better especially if the steroid is raising his blood sugar somewhat. I considered giving him 1.8U but thought that might cause a big bounce.

 

Best to go slow for now.

 

I gave him the 1.7 units and the budesonide. He didn't look like he swallowed it so I checked in his mouth. The pill was sitting in the back of his throat. I gave it a little push back and checked again and didn't see it anymore.
I see what you mean about getting a pill gun now. He doesn't usually have any trouble taking pills.
How do I know when I do a before bed test that the BG is accurate and not a result of the med?

 

He's getting sneaky with that pill!

 

You might want to order a pill gun. Re meds effect: I think you'll have to collect a bunch of data going forward to see if there's a new pattern of higher BGs developing.

 

Poor Smoky is sleeping a lot plus a big decrease in appetite. Steroids usually make you want to eat more. I have to call his vet in the morning and see if it is safe to give him an appetite stimulant.

 

You might post on the main health forum asking about others' experiences with budesonide.

 

I did post on health about meds used for IBD. Smoky was 297 at +3 after pm shot.
I'm not even sure about how to figure out what dose I shld give him right now.
I don't know whether to go by his preshot BG or by how much the budesonide may raise it during the cycle.

 

I see that he's into lower yellow this AM. I still think you need to gather some data over a few more days with the new med on board. You might find that it's a short-lived elevation of BG for the evening only and might end up giving more insulin for PM. Too early to tell. Meanwhile, do what you're doing and dose on the PSs.

 

I called my vet with an update on Smoky. She suggested skipping a dose of the budesonide for tonight. I told her his appetite dropped sharply since starting the new med. He also seems lethargic and has been vomiting up food.

 

Sounds like it doesn't agree with him. You'll know for sure if he perks up tomorrow.

 

Smoky's BG was 290 for PMPS.
He is almost into the pinks
Trying to figure out what dose to give.
I'm guessing 1.6 units would be a good one to give again.

 

I like it.

 

Saw your fat 1.6 this AM. Is Smoky feeling better this AM with no budesonide last night?

 

He was still a little out of it this morning.
I'll see how he is after work today.

 

I picked up a can of Tiki cat gourmet carnivore Beef Liver and Lamb food for Smoky. He normally hates any healthy food I give him so was a little suspicious when he gobbled it down.
I looked at the label and the sixth ingredient is dextrose anhydrous which i think is sugar.

 

If it's in sixth place it might not be enough to affect his BG. You'll be able to tell when you test. If he likes it and needs to eat more you might have to dose around it. Yes, we aim for low carb food but sometimes other factors have to be attended to.

 

Smoky PMPS was 151, it's been almost 24 hours without budesonide. Not sure what to do now about dosing.

 

You gave 1 u on a 144 on 01/29 and it proved to be a bit too exciting afterward. You have options: 0.5, 0.6, 0.75, 0.8 using either U40s or U100s. You're at home so maybe try 0.75 u?

 

I'm trying him on some new low carb canned foods. He seems to like the Wellness Core Beef, Venison, and Lamb formula so far...
It's hard to find food he likes that doesn't contain ingredients he is allergic to. He loves the FF but nearly very flavor there is has poultry by products in it

 

You're right although I'm trying to factor in the budesonide possibly raising his BG again. The vet said it wld take about two weeks for new med to affect his BG. I've already noticed that it seems to be higher while on the budesonide. The 0.75 sounds good to me, is a u100 better to use for that?

 

ARe you planning on giving the budesonide again tonight? If so then you're still in the data gathering stage for how it affects his BG. It's hard to make any definite dosing decisions because of that. If you just look at the PMPS then one of those doses I suggested would work. If you're trying to guesstimate the effect of budesonide, I don't know what to suggest. Maybe dose based on PS for a little longer as you gather data?

 

I was actually thinking along the same lines that you are, drew up 0.6 units for him tonight. Yes I am planning on giving him the budesonide tonight.

 

I hope he can get used to the budesonide over time.

 

It's tricky to measure 0.75 u on a U100 syringe. It would amount to a skinny 0.8 u. Estimating it on a U40 with half unit marks is probably easier.

 

I gave him the 0.6 units for tonight.
I'll get in a before bed test yet.
I gave him cyproheptadine and cerenia last night. I gave him the budesonide and will give him the denamarin in the morning.

 

That pink this AM is so atypical for him that it must be from the budesonide. You might need to just dose around it if it proves to be a helpful med for his IBD. How's he feeling this AM?

 

He is feeling a little bit better but need to give him the cerenia daily I think. I skipped a dose and he felt lousy.

 

Lisa, I think the meds can be as puzzling as the insulin dose. You are doing the perfect thing: keep data on when and what med is given and what reaction he has, both in terms of behavior, eating and levels. It is a big job on top of the diabetes, but I think it is paying you benefits in figuring out how best to work with the puzzle that is Smoky.

Remember to take time for yourself as you go through this additional stress.

 

Maybe if he learns to tolerate the budesonide its positive effects will reduce his nausea.

 

Smoky PMPS was 240, thinking about 1.6U for tonight? The budesonide seemed to raise his BG last night by his before bed test at +3.

 

Yes, 1.6 u looks good. Was he as ill/lethargic on the budesonide last night?

 

He didn't feel too great but he didn't get the cerenia last night. I'm giving it to him tonight and maybe the cyproheptadine for his appetite.I gave him 1.5U for tonight. He was somewhat lethargic last night but seems to be better 12 hours after the pill is given.

 

Hopeful signs that he might tolerate the budesonide after he's on it a little longer.

 

Smoky was 275 for AMPS. I'm wondering if I shld give him more insulin in the morning but am working all weekend.
I am thinking either 1.6U or 1.75 units for am?

 

You could give 1.75 u because you've done that on lower PSs before.

 

I gave him the 1.75U for am.
He lost weight again I'm really worried about that. He went down to 7.5 lbs back in mid August of 2016. His highest weight since then was 8.6 lbs. He is now at 8.2 lbs and should be at least 12 to 13 lbs.
It's been about five months since his diagnosis and 6 months since he lost all that weight. It's so frustrating.
I have tried everything to try to get him to lose weight. I've not really taken any time for myself. I'm the only one taking care of him. Sorry, guess I just needed to vent.

 

You're allowed to vent, Lisa. This is a very tough road and yours is tougher than most. Did the vet give you any idea how long before the budesonide should have a positive effect? If his IBD can calm down and his appetite improve that should help with his weight.

 

The vet told me 2 to 4 weeks to start showing improvement.

 

I was fairly sure that steroids need time to do their work. Cross fingers that you see steady improvements.

 

I can give him the bupe according to my vet while he is taking the budesonide.
He was standing all hunched up last night. Poor Smoky.

 

Poor boy. Is he eating and keeping food down?

 

He seems very hungry today compared to last night. He ate a 3 oz can for breakfast, a 3 oz can for lunch, my roommate gave him another 3 oz can late afternoon, he was still pretty hungry it would seem.
I gave him about 3 oz of a 5.5 oz can about an hour after that. He finally decided he was full and is now sitting on my lap.