Vet started us off at 2 units of PZI, twice daily

Malakai just began insulin on 8/18/16. He was hospitalized for three days initially, in order to begin treatment. When we picked him up from the vet, he instructed us to give him 2 units of PZI insulin, twice daily. I also test his blood sugar twice daily. At first, his levels have been jumping all over the place (between 227 - 404). This morning though, he was at 155 (lowest he's ever been). I still gave him the 2 units of insulin (even though I was questioning whether or not I should, in my head). This led to a severe hypoglycemic episode. He lost control of his bowels, vomited, and had seizures. I rubbed Karo syrup on his gums and we rushed him to the emergency vet. They put him on catheterized him and put him on IV. He will be hospitalized overnight. The vet said that he stopped seizing once they put in the IV fluids. It was one of the worst things I've ever gone through in my life and cannot stop crying or feel riddled with guilt. I am having flashbacks of his seizures.

But regardless, it sounds like 2 units, twice daily was way too high of a dosage to be giving him. Can anyone shed some light on this situation? My vet told us to bring him back in two weeks, at which point we would drop Malakai off for the day, so that the vet could test him and re-assess the dosaging. I'm wondering why we weren't told when NOT to dose. We were told about hypoglycemia levels, and that it was a danger of insulin therapy.

I just feel so lost and so sad.

Any thoughts or advice would be greatly appreciated.

 

Hi Anna - initial dosing guidance from the manufacturer is based on weight (or ideal weight), how much does Malaki weigh and what was his glucose level when diagnosed?

 

He weighs around 15 lbs, though has lost some weight. His glucose level (when we hospitalized him) was 477.

 

I should add that while hospitalized (and beginning treatment), his levels remained in the 400's. This might be why the doc prescribed the 2 units right off the bat.

 

It is at the higher end of the manufacturer start dose but within the dose range for his weight, I have noticed vets tend to start at the higher end of the recommendations but we have seen many cats reacts quite quickly to their insulin and need a dose reduction fairly soon after starting insulin. Vet stress can push the numbers up considerably which is why home testing is so important as you get a much more realistic picture of how the cat responds to the insulin. My cat only had two curves at the vet and they then agreed home curves were a better way to go as she went on hunger strike the first time and I had to take her hone to feed and give her insulin, and the second time she stayed high for most of the day. Once you have your spreadsheet up and running the more experienced PZI users can have a look for you.

 

I agree that you can gain control by home testing. Then you'll know whether the dose you are planning to give is appropriate for the preshot levels twice daily, and you can see how low the insulin takes him by getting some midcycle tests.

Vets too often overdose based on levels they get in their office. Cats are usually very stessed at the vet, and we know stress raises levels, reported here by owners, often by 100 points or more. The the dose based on those levels is too high once you get the cat home and he relaxes.

The protocol we put together for ProZinc is in blue in my signature. We suggest starting at one unit and raising the dose slowly, as and if needed, based on your home testing. You seem uncomfortable with the idea of waiting weeks to have the dose evaluated. Your instincts are right on. Diabetes is a home regulated disease. Just as with humans, doses can be adjusted and reviewed daily, based on testing at home.

I am so sorry your kitty had a hypo. But you can begin to feed confident about his progress and safety by testing him. You can send your results to the vet, but I urge you to start keeping track of his levels at home. We all felt completely overwhelmed at first. The best way to take control is to learn about this disease - how to test, what to feed and how to adjust dosing. We'll be glad to help; someone helped us.

 

Hi Anna! You've gotten some great advice already, so I just wanted to offer some encouragement. I know how lost and sad you feel at the beginning of this sugar dance, but you are NOT alone. We're here and we want to help you through this. We've all been there and we'fe felt what you feel now...and look at us now! We laugh and joke and help our kitties get better. You'll get there too...it's a steep learning curve, but it's fast too. You learn quickly and before you know it, you feel in control and happy again!

 

Thank you, Rachel. Your encouragement means a lot. This has been a roller coaster, and I just can't wait for things to even out a bit. Do they ever?

 

Sue, your link about PZI is *VERY* helpful. Thank you. I also really respect that it's an overall conservative approach. Changes are done gradually and doses adjusted based on the animal.

 

Things do even out. It just takes a bit of time to figure out what works for your specific cat. Once you do that, regulation usually follows and that helps a lot. There are just a lot of things to try, and every cat is different (ECID)! Take a look at some of the threads around here...it'll help you to see that people learn pretty quickly and you will too!