Vet wants to jump up to two units

If anyone here saw my FB post in the Feline Diabetes group knows that Jasper a few weeks ago just went through DKA (again), Pancreatitis, & a bladder infection. Thankfully he is doing much better! But we are still trying to figure out his dosing...for the last two weeks the vet had wanted to try 1 unit once a day. His numbers are mostly in the 300's with a couple 400's (3 times he was under 300). But when I took him in for a checkup today she wants me to try 2 units tomorrow, just the one dose. And see how is numbers are that day. She only mentioned doing it the one day and if I remember correctly you only increase the dose by .25 and you wait a couple days to see if the dose works or not.
I feel a bit flustered since I have tried both 1 unit and 1.5 units before and not sure if I need to keep going up? I'm a little hesitant to what the vet is saying even though I know she has good intentions.
I have not updated his numbers honestly because I am having a carpal tunnel flare up and at the moment do not want to update them. I'll try to get around to it tomorrow, school work always gets to me sometimes.

 

Hi there, Sarah. So good to hear that your kitty is on the mend! That must have been stressful for you ... (You're testing for ketones regularly at home, too, right?)

Can't say as I blame you for feeling that way; full unit increases can be problematic. But I hesitate to speculate on where you might want to go with Jasper's dosing without reviewing what his numbers have been since 3/30 - so will look forward to seeing them tomorrow, hopefully. (If your carpal tunnel settles down enough to allow you to plug them into his SS - gee, I know how painful that can be!) Would be a good idea to get thoughts on this from @Rachel and @Sue and Oliver (GA), too.

 

Hi Sarah! Sorry, I was out like a light last night. Been a rough few days at work...I was exhausted!

Yeah, full unit increases aren't great. We increase by 0.25 or 0.5 at most. You can skip over a good dose for Jasper if you increase too much.

I'm also hesitant to give advice without knowing the last few weeks of numbers. I see by your SS that up until 3/30 he was sticking in the pinks, reds, and blacks, yes?Has that continued? Have you gotten any lower numbers? What does have you been giving?

I hope the carpal tunnel feels better!

 

Thank you! I found my brace last night so I slept with that on and my wrist is feeling a bit better now. So I did get his spreadsheet updated as well on here and I did only dose him the one unit this morning. I don't want to jump on that one whole unit as my vet suggested.

Sarah

 

I'm kinda assuming that where the dose #s are missing in your SS (rather than where you plugged in a zero), that this means that the dose remained the same as the last (previously noted) dose that appears on the SS above those blanks. Is that a correct assumption?

 

Just trying to clarify things:

If I am reading the spreadsheet correctly it looks like you are only dosing one unit once a day???

Is your vet asking you to do 1 unit twice a day or 2 units once a day or 2 units twice a day???

If you are only doing one unit one time daily then doing 1 unit twice daily at 12 hour intervals would make the most sense since Prozinc/PZI does not last 24 hours.

 

Hi, Your only giving it once a day? So that means the blood sugar will be rising and be high in the morning?

I'm just trying to understand the vet rationale on timing. Is the insulin your using a once a day insulin?

 

Looking at your updated SS, I have some questions/comments:

(May seem a stupid question, but ...) Did ALL of Jasper's repeat labs (assuming vet did this) show normal #s (except for blood glucose, obviously)?
Was he retested to make 100% certain that the UTI has cleared? If so ...Keep in mind that when your Jasper was dealing with a "Triple Threat" (DKA/pancreatitis/UTI) all at once, it makes sense that his #s would be spiking really high. This concerns me though (did you do it this way?):

Once a day dosing on PZI usually doesn't work very well. So if you were doing the dosing the way the vet had recommended, this could factor into the mystery of the high & flat #s you're seeing at present. Also ... IF Jasper's DKA/pancreatitis/UTI are all cleared up, the possibility exists (mind you, we don't know this for sure) that the dose may actually be more than he needs. (Too much insulin can cause numbers to keep running high and flat through a cycle.)

If your vet's original dosing decision (when Jasper was first diagnosed) was based on a BG test done in-clinic (and other dosing decisions were made based on in-clinic BG levels) here's another thought: Is not at all uncommon to see a kitty spike "stress hyperglycemia" BG#s; i.e. cats can spike #s that are WAY higher than you'd get when kitty is calmer - like at home where he feels secure and comfortable. So it is conceivable - again, IF all the other medical complications have been cleared up - that he could be getting a little too much insulin, rather than too little.

Just some food for thought as we try to sort out the whys and hows of Jasper's most recent BG#s ... you can fill in the blanks for us (re: repeat labs confirmed that all other problems are resolved/if vet historically has based dosing recommendations on in-clinic BG#s, etc.), and maybe - with multiple sets of eyes looking this over - we can figure something out. - Robin

 

Also ... did vet look in Jasper's mouth, to make sure there's no dental disease going on? (nflammed gums, bad teeth, etc) As this can certainly help keep the #s up there @ higher levels.

 

Whoa, lol thank you guys!

Yes the vet actually has me only giving him 1 unit once a day! (I should have typed that into the SS, sorry). I thought it was funny at first but hadn't had time to post in here so I went with her recommendation. His teeth should be ok-he had 13 teeth removed back in...I believe October. She ran a fructosamine yesterday and I cannot recall what it was but she told me a set of numbers will probably be a little higher than normal because of what he just went through and they were. They were on the 'low' end of the high scale. Agh I wish I remembered what it was....
She did not mention about checking for UTI =/ we went for that check up yesterday and checked his belly and his heart, didn't say anything was abnormal and ran the fructosamine test.

I do believe since moving from Japan and going to this new clinic we ran a curve at home since we were already testing ourselves and based on that had us start out I believe at 1 unit twice a day. This was last summer but I do believe that is where we started.

 

Well I'm confused.

Did the vet say give it once a day thinking you knew to split the dose and give it twice? You have given 2u twice a day. And 1u twice a day. Then many days where nothing is entered.

I'm a little concerned since there has been DKA it very possibly it will happen again.

 

The only reason I mention getting actual lab confirmation that the UTI is completely cleared (and this may mean they run a culture), is that some time back, my vet "assumed" that the first-choice antibiotic had worked to clear Bat-Bat's UTI - and it hadn't. In fact, it didn't clear until after the third antibiotic they tried on her; her UTI-bug was that antibiotic resistant!

What do you mean by "Should be okay" - ??? Did the vet do a thorough examination of his teeth & gums recently? I know I may be sounding kind of like a bulldog here, Sarah - and I know that you are doing the best you can! But I have learned some lessons (the hard way) about veterinarians and feline diabetes: So many of them have so little real education about it that it's almost as though you need to train them! (Most only get the equivalent of ONE hour of instruction on feline diabetes in vet school ... and I've no doubt that you've spent many more hours than that reading/learning about the disease already!)

Sarah, I guess my point in telling you all this is: Don't be afraid to speak up & question your vet*. "Doctor, did you run a culture on Jasper's UTI to make 100% certain it's cleared entirely? Did you check his mouth for any ongoing inflammation of the gums, Doctor?" I used to hesitate for fear of offending the doc (always assuming they must think these things through more thoroughly than I do). And what I found out is: The don't always think of everything, unfortunately.

*And any vet who gets huffy when you ask those good questions? That's your clue to ... find a new vet.

 

Before the appt was over I double made sure that it was the 1 unit a day in the morning and nothing at night and she said yes.
Agh I wish I posted in here sooner now....

 

Once a day dosing is really not effective: Protocol for ProZinc/PZI

 

But here's the good news, Sarah:
You can get this turned around for Jasper.

So please don't beat yourself up! We'll help you as best we can, ok?

 

He was given an anti-biotic when he was at the vet for 3 days and she said it would last two weeks. But I do have Orbax here at home as well! I keep that and potassium on hand just in case.

The check up yesterday I do not recall her checking his teeth but I think they were checked on when he had an appt on the 30th of March.
Lol no!! It is completely OK! I really appreciate all of the help and trying to help me figure all of this out.

I feel bad now though, I hadn't even thought of asking about the UTI when I was there yesterday. =/

 

Thank you so much Robin! It's hard not too sometimes since he has had Diabetes for some time now and feel that I should be dang near an expert at this! I get so caught up with school that I never realize that his numbers would be running high for an extended amount of time until something happens. I don't always keep up with the SS and always when I do punch in those numbers that I am like well...holy crap he's had a ton of terrible numbers here.... =(

 

Sorry, about peppering you with so many questions, but: What was the date when Jasper was in-clinic for 3 days? And it sounds like the antibiotic given in-clinic may have been the injectible, Convenia. Is that correct?

 

I'm not familiar with PZI. And didn't use Prozinc for long. The people here who do I'm sure will advise you, but I'm only using common sense here would be to split the 1u you give now to .5 every 12 hrs and take it from there.

 

Yes! I forgot about my receipt and he was given that plus she gave me a pack of 4 pills of the Cerenia as well that I am still currently giving him once daily (last week) and this week only two tabs per week. So two tabs this week and two next week than he will be done.

Oh and it does look like he did have a urinalysis! But I don't recall any problems...or I am sure I would remember. Seems I cannot remember everything... =/

He was in the clinic from the 4-6th but he did go to an ER clinic overnight on the 2nd (in Virginia when I was visiting a friend, thats when I noticed he was a bit lethargic and not eating), and on Sunday after coming back to NC took him to the local ER clinic but the vet felt he was well enough to go home for the night after she gave him regular insulin and fluids and get him to the regular clinic in the AM.

 

Thank you thank you! He had the 1 unit this morning so I will go ahead and give him the .5 unit this evening.

 

Please do get a pre-shot BG test tonight before dosing anything, because:

- You don't want to shoot Jasper if BG# is less than 200.

- His BG# will probably be higher than 200, however - if it were less than 200, you can stall (and do not feed yet): Wait about 15 to 20 minutes, then retest for a rise in BG (as kitties' BG#s will often rise in anticipation of a meal). Sometimes it takes 2 to 3 "stall & withhold the food" sessions before the BG rises enough to dose safely.

 

Oh yes of course! I always check his BG before giving insulin! I am curious though that if his numbers were lower than 200 why not give him some food and test again afterwards to see if it went up? I'm sure this is a dumb question and sure that there is a reason behind it...

 

Because you don't want his blood glucose to be influenced by the food. It's the same reason why you do not feed in the 2 hours before shot-time - if the food raises BG for your cat and you shoot after that, you risk giving the cat too much insulin based on artifically-inflated BG #s. Get it?

P.S. There are NO dumb questions! (Curiosity is the calling card of a deep-thinker!)

 

Oh my! I did not know that! Or not giving him food two hours before checking his BG.....crap....I suppose still starting him at .5 units twice a day for a couple days is still a good idea and be sure not to feed him two hours before feeding time. Correct?

 

That's correct. The only time you would feed within that 2-hour window would be IF you were in the middle of an actual hypoglycemic event (where you need to bring extremely low blood sugar level up, because the "hypo-zone" can be dangerous. So here are three docs you should read through now (feel free to ask us any questions you may have ) :
Protocol for ProZinc/PZI
Hypo links - be prepared just in case!
Are you testing your cat for ketones? If not - DO IT!!!

 

Thank you Robin, I just posted under the general health board if that is the correct place? I checked Jaspers ketones and he has ketones....I don't know what to do. He just had DKA two weeks ago. It's hard to pay these bills and break the news to my husband when he just wants me to put him to sleep.

 

Well, you've gotten tons of good advice! I agree. Let's start at .5 twice a day as long as the number is above 200. After a few days, we'll see if that is working out well or if we need to raise the dose.

Do you have any other questions? That's what we are here for and I want to make sure I didn't miss anything!

Also, remember you are the best advocate for Jasper. I've found that my vet respects me more because of all the questions I ask. I read up and research and then when I go in, I start asking questions using their lingo. When Oreo had crystals, my first question was "struvite or calcium oxalate?". My vet knows that I know what I am talking about and that I will continue to ask questions and he seems really good with it. He knows that he can give me info and I will understand it. So ask as many questions as you can at the vet...if they don't like it, time for a new vet!

 

@Rachel , @Tuxedo Mom @Woodsywife - Oh, dear! Is it possible that Sarah's vet did NOT test Jasper for ketones yesterday (and/or didn't TELL her to be testing for ketones??? Good grief....) She is at ER vet now, apparently - and posted on Health:
Moderate Ketones Help!

 

@Hine87 - Sarah, I am thinking good healing thoughts for you and Jasper, knowing (from main Health thread) that you've gone to the ER vet.
Have all of my fingers & toes crossed for you ... please let us know how things are, whenever you can.
Sending you hugs -

 

Thank you all so much! I wish I could hug all of you! Virtual hugs will have to do! We just got home, he does have ketones she said he has '2+' so I guess right there in the middle like his strips showed me at home. I checked Jasper's BG before we left and he was 400-when at the clinic he tested at 360. The vet gave him fluids and sent us home until we get to the clinic tomorrow. I'll be calling first thing when they open. I went ahead and gave him his .5 unit of insulin as well. Hoping for the best tomorrow.

Robin-She didn't test for ketones I suppose I need to be on top of this and get to checking more often-although thinking about it I wonder why she didn't check it if he just had DKA?

 

Posting the same info from your other post:

Without going through all your posts....it is critical that you be home testing for both glucose levels and ketone levels. Jasper has a history of ketones/DKA and it is imperative that his levels..both glucose and ketones..be monitored very closely. In your other post you said your vet was only wanting you to do shots 1 unit one time a day. You MUST do shots every 12 hours and test the glucose levels. you were doing 1 unit once a day. MY suggestion as long as you are able to monitor carefully...would be to do 1 unit TWICE a day...every 12 hours


This is only my opinion and hopefully others will weigh in with their opinions.

 

Please don't beat yourself up, Sarah; is not your fault that your vet is, um .... (excuse me for saying it but I just can't help myself) a moron!

Fortunately, what all of us learn, thanks to the many wonderful & supportive members/ advisors here @ FDMB is that we can all become our kitties' "best practices" advocates where treating feline diabetes is concerned. Of course, this means you end up having to learn a LOT of new stuff; however, you'll probably end up better educated about this subject than your vet as a result! Might be a good idea to start thinking about finding a vet who knows more/ is more on-the-ball ... @BJM has a great list of "Vet Interview Questions" that you might want to take a look at: You'll find that you can click on that link in her signature.

Good job giving the 0.5U tonight. Keep an eye on Jasper (keep checking those ketones, daily for a while until they clear) and keep us posted!
- R

 

It's okay that you just shot the 0.5 tonight, btw ... but @Tuxedo Mom has a good point here, so let's see where he is on his AMPS # in the morning, and we can figure out what you should dose for tomorrow morning's shot at that time. (@Tuxedo Mom will you be able to be around for this? May be too early for my time zone ...)

 

Thank you! I read that a lot of vets just don't seem to know or care? I feel like she doesn't know =/ She was on board with me when I told her I didn't want to feed the prescription junk and let it be. When in Japan they kept trying to force me to buy it...same brands they have here but smaller bags and triple the price. No way! I will be checking his BG again before I go to bed so fingers crossed, I would like to see some good numbers for once!

 

Good; that's the spirit, Sarah - you can do this!

 

Vet Interview Topics compiled from FDMB.
Also see the Secondary Monitoring Tools in my signature and do the dehydration checks. Uncontrolled diabetics can become dehydrated easily, which further concentrates ketones.

With the testing you are doing, you will be able to develop a sliding scale. So far, when he has a pre-shot test over 400 mg/dL, 1 unit appears to be safe. When he is closer to 300, 1 unit kept dropping him over the next 12 hours, so a lower dose would be appropriate then, possibly check 0.5 units the next time you've a pre-shot near 300 mg/dL.

 

Oh my. I'm just catching up here. Sorry to hear about the DKA.

Everyone here will help you through this. FD is treatable and manageable once you know what to do.

Is he eating and drinking enough? I don't know if this would be too much for you right now, however fluids can be done at home if your up to it. It would flush the ketones and keep him hydrated, while saving you some ER visits. It is something to consider.

 

For some reason the post I tried posting last night and it didn't post. I just checked Jasper's numbers and he was 89! I also caught him going potty and he only has trace ketones now but will still call the vet after I drop my son off at school.

 

Thank you for these tips! I wrote them down so I wouldn't forget.

 

Yes! He has been eating and drinking fine, no symptoms or anything until I randomly checked his ketones last night. I'm keeping that bottle out from now on so I can remember to test him. When I take Jasper back to the vet I will for sure be asking about being able to do fluids at home-I cannot keep trying to afford these ER visits, he's already had three this month!

 

Whoa! 89? What a great number! I definitely agree on calling the vet anyway. It's good to just be sure all is well. And great job on getting a ketone test in! Definitely something you want to keep up with for him.

 

I was surprised as well!!! I was waiting for another 400+ ...
So I'm stalling right now and checked him a couple minutes ago and he was up to 95. Out of strips and will be picking some more up here-Jasper is going to have to wait until I get back to see if he can eat!

 

It's now 0912 and just got home from dropping my son off at school and bought some more strips. Jasper went from 95 before I left down to 92. I'm not sure what to do now?

 

I would not shoot that low. I think he should be in the 180-200 range. Will you be home today and can "chase" the number? Test every hour or so until he starts to rise and is near 200. Then give a tiny dose - maybe 0.5 and let out a few drops.

My thinking is that if you skip completely, he may jump up, and with ketones, you don't want that. If you can chase his number and shoot a tiny dose and keep him in good range today, it would help with ketones.

 

I would not shoot. Remember last night at ER you said they gave some insulin. THEN you gave .5u when you got home.

Sorry for being blunt now. You are in panic mode and reacting. Please take a breathe and calm down for Jaspers sake. From what I just read no more insulin until tonight when you test. Then post it for advice. Should only be getting insulin twice a day.

He will have lows and highs but you can't dose just whenever.

 

Thank you! Actually the ER vet didn't give any insulin, I was a little surprised actually. She only gave him some fluids but I did dose him myself after I got him with the .5 units. His vet did recommend not dosing at all today but I haven't had a chance to check his numbers since 1030 (hectic day) and when I checked than he was 126. I will be checking here shortly though, wanted to get all these posts checked first. =)

I was able to get the vet to show my how to administer fluids if I need to and bought myself a bag and some needles for it, just in case but hopefully I won't need it.

 

OK! I checked his BG and he is 323-it's 1PM here now so should I dose this late in the day or wait until the evening dose?

 

Does he still have ketones today? Clearing this level of ketones isn't usually done at home. But the key is more food calories (or IV glucose), more fluids and more insulin. Ketones mean that sugar isn't getting into his cells to be utilized so his body is breaking down fat stores because the body can't utilize sugar. It's a complicated metabolic situation.

I disagree very much with once daily dosing.

You need someone very experienced with working with ketones in order to manage this. The rules are completely different when ketones are involved.

 

I would shoot and give lots of food with some water mixed in as long as he is eating. But you don't want to shoot again until you have gone enough hours for the Prozinc to wear off. Can you check his sugar every couple of hours until this issue resolves? Did you already shoot? If so, how much did you give?

 

I never did give the insulin! I was back and forth with it. When I checked ketones this morning it was only a trace and he was given more fluids at the vet and he has ate a couple times already. I have fluids here at home now and know what to do! (woohoo!) It is probably about time to check him again and see where he is at though. That has been the consensus though on giving him the two doses a day. Not sure why she is still pushing for the one dose a day?

 

If it has been more than 12 hours since his last shot, and he is at 323, you could give him insulin. Are you near the usual pm shot time? The trick is to be available 12 hours from this shot to give him another.

Have you been giving one unit? Help us with the sequence of the low level he got recently.

 

Have you checked more sugars? We would like to know what his sugar is right now.

 

OK! I normally give him his shot at 8 so with it being 1 I wasn't sure. I ended up not giving it to him so now at this point I will wait until normal shot time. Last night I gave him .5 units and figured I would be dosing the same tonight? I checked his numbers...around 4 (pushing 5 possibly) and he was just over 330.

Sorry guys! I have just been swamped with work as well and my 5 year old has early release today so it has been hectic for sure.

 

I think 0.5 should be okay but I would plan on getting a before bed test, just to be sure he isn't dropping low fast.

 

I will! Thank you Sue! I'll post in the AM the results! =)

 

I'm glad to hear that Jasper's ketone levels have come down.

Big mistake. It is even more important to monitor ketone status in any ketone-prone cat; quadruply so for cats with a history of DKA. That Jasper is still recovering from a recent bout of DKA makes this an even greater error on the part of the vet.

WRONG!!! Of course all diabetic cats not in remission require insulin but it is even more critical for a cat throwing ketones to receive sufficient insulin for their metabolic needs (even if it's necessary to temporarily increase the dietary carb load in order to administer the insulin safely).

You are right to be concerned: it demonstrates a lack of understanding/experience of appropriate and effective feline diabetes treatment on the part of the vet.

I strongly recommend that, if at all possible, you really need to find a new vet with a much better handle on feline diabetes and who is truly knowledgeable about its associated complications - especially ketosis and DKA. If that's not an option for you then I recommend in the strongest terms that you post here for input regarding Jasper's treatment so that you will have the combined experience of the members here to help you identify shortcomings in your vet's understanding of how to treat diabetes and manage ketone status successfully. Take the input from here and discuss it with your vet as appropriate.


Mogs
.

 

Very helpful information about ketones here:

The Hows and Whys of Ketones

Forum sticky about DKA


Mogs
.

 

Hi Sarah! Glad to hear that Jasper is doing okay. I agree with Mogs...time for a new vet.

I'll be around early in the AM. Around 5:30-6:30ish CT. I'll check in on you then to see how the evening went!

 

Oh my thank you Mogs! I really had no idea about that...I'm feeling bad now that I waited to give him insulin until the evening. But I suppose at least he did get a dose where as the vet didn't want me to give him anything. I will start searching around for a new vet. I know there are a few other places around here but now to find one with a knowledgeable vet about feline diabetes. But in the meantime I will be posting regularly here! I will also get Jasper's SS updated here in a moment as well!

 

Updated =)