Advice please

Couldn't get the AMPS this morning (nothing unusual there) but just got a 7+ reading of 34.6 (623) and Bob not due his evening shot for another for and a half hours.

He's only eaten one packet of Animonda chicken (100g) and an 85g tin of Almo Nature chicken and prawn since this morning.

Should I incrementally up the dose - vet said to stick to 2 units but they were only feeding him minimal dry food for the two days he was in hospital.

I'm besides myself here

 

This is from the advanced techniques guide for using ProZinc. You have only been using it a short time but Bob's numbers NEED to come down:
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INSULIN RESISTANCE/ GLUCOSE TOXICITY: Worth knowing about

If, after months on insulin, your cat’s diabetes still remains unregulated, glucose toxicity may be something you should discuss with your veterinarian. If you have followed all the recommended treatment steps to the letter, and your kitty’s numbers remain high, it’s time to rule out any and all conditions that may be complicating and impeding your cat’s progress toward good blood glucose control and better health.

The following brief explanations (italicized excerpts) about insulin resistance, glucose toxicity and the effects of carbohydrates and obesity in relation to type 2 diabetes (which is the type most diabetic cats have) are from Dr. Lisa Pierson’s Catinfo.org website:

Type 2 is characterized by two problems. The first, as in Type 1, is a diminished ability of the pancreas to secrete insulin. The second issue is one of insulin resistance. In other words, the receptors on the cell wall that would normally open the door to the cell to let the glucose in when insulin 'knocks', stop 'listening' to the insulin. The cells 'resist' the signal that the circulating insulin is sending and the glucose is not transferred to the inside of the cell, resulting in an elevated blood glucose (hyperglycemia) and cellular 'starvation'. The elevated blood glucose, in turn, sends a signal to the pancreas telling it to secrete more insulin. The elevated insulin may somewhat override the insulin resistance resulting in more glucose entering the cells, but eventually the pancreas can become exhausted or 'burned out'.

Glucose toxicity results from chronic hyperglycemia. Glucose toxicity wreaks havoc on the entire body - especially the pancreas and its insulin-producing cells. A vicious cycle then ensues as the insulin-producing cells are damaged resulting in less insulin being produced.


This is how we use this concept on the forum: If your cat has been on ProZinc/ PZI for quite a while, remaining in “high and flat” BG numbers throughout his/ her 12-hour cycles at the current dose, the dose may need to be increased every 6 cycles by a small amount, until you reach what we call a “breakthrough” dose.

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I'm at a loss for what to suggest because:

• You have evidence on your SS of Lantus giving nice numbers on March 03 and then he's up into blacks.
• You have very little night time data.
• He also eats kibble which is high carb and if he's particularly carb sensitive that could wreak havoc with his numbers.
• You're on your third insulin in three months (at various doses for each) and that also complicates the picture enormously.
• He's had a respiratory infection which can cause BG control problems.
• He's an outdoor and a fractious kitty.

This is a situation that cries out for some stability. It might not be possible but this would be the ideal prescription:

• Choose an insulin and give it 6 months - Lantus is your best bet but you could try to make ProZinc work
• Eliminate all dry food from his diet if Lantus and follow one of the dosing methods to the letter - any dry food restricts you to SLGS and he probably needs the more aggressive dosing of TR to get his numbers down.
• If sticking with ProZinc reduce the dose to 1 u to start and increase the dose by 0.25 u after 6 cycles (or less as you get more data - we can advise). Reduce the dry food to a miniscule amount of his diet.

There are many factors at work here and it greatly complicates things. You control the insulin you use and the food you feed. We can help with dosing. Unfortunately, Bob might have other issues making control more difficult. I can't advise on that.

I hope this helps.

 

Hi Tilou
I remember you from when you first came to the board and posted in the main health forum, which is where I tend to confine myself, just occasionally looking at the ISGs that I have some experience in.

I'll leave the dosing experts here to answer your specific question today, but I just had a look at Bob's ss and see that he's still fluctuating rather a lot. I don't know what else has been discussed since I saw you on Health, or what your vet(s) may or may not have said, but fluctuations like this do make me wonder if there may be an underlying condition that can manifest itself this way - acromegaly, for example. By no means saying that this is the case here, but worth asking your vet if there could be something of that kind going on.

Meanwhile, I hope others will chime in with some dosing ideas for you.

 

Thanks @Kris & Teasel - we cross posted and you have said very comprehensively what I would have liked to say!
Tilou, this is all rather difficult I know, but I agree with Kris that a period of stability on one insulin and one dose would help to clarify the rather muddy waters.

 

Thanks for the comprehensive replies - it's always much appreciated.

I am worried about the continuing high numbers as I don't want Bob hospitalised again - he really doesn't cope very well with being confined and his temperament since his return had reverted back to the feral kitty we adopted 12 years ago.

As we have a control blood test appointment in 10 days with the vet, I'm going to stick with Prozinc (plus it cost €50 that I'm loathe to see go to waste, as we don't pay for Lantus as DH uses it!).

I'm going to adjust Bob's food. I've just cleaned up his tea (fresh fish, to try and avoid giving him any commercial low carb) that he's just thrown up immediately after eating it.

I confess to not being a patient person and like to see quick results, but am now wondering if the reason the vet told me not to test Bob's BG was so I wouldn't see these high numbers!

I'm exhausted and DH is unwell, so it's very difficult at the moment.

 

I do sympathise, this isn't easy at the best of times.

Adjusting Bob's food to cut out the dry is definitely one thing you can do, or at least try to do. BUT remember that if his numbers are going through one of those intermittent spells of being low, you may have to be cautious with insulin dose. Cutting out the dry should automatically get numbers down at least a bit, so keep an even closer eye on bg now and see what happens.

Have you identified what it is that makes Bob throw up? Is it a particular food, or is it during a time of very high numbers? Try to keep a log of this if you can - it's important that he eats and keeps his food down. It may be that a diet of mostly plain blandish food like chicken is best for a while, but remember to add a complete food (in jelly, not gravy) that he likes, for proper nutrition. I think you were previously feeding a complementary/supplementary food, amongst others, so look out for "complete" ones. A balanced diet will help with overall health while he's battling the diabetes.

It will be very interesting to see if cutting out dry makes a difference. These very high numbers are very concerning, and with the fluctuations as well, won't be making poor Bob feel great at all. Presumably you will show your vet the ss when you next visit? I think some time spent looking closely at it together might help to point a way forward.

 

I've just feed Bob some chicken and so far so good.

He's a very basic eater and always used to have the same Carrefour sensitive sachets day in, day out. I've tried him on all.the recommended low carb complete wet food recommended on the forum (that we can buy here in France) and the only one he'll eat is Animonda Integra Diabetic chicken or beef. He won't touch the rabbit or salmon flavours. He also eats Almo Nature complementary tins of chicken and prawn. And that's it. I complement this with fish and chicken that I cook for him.

I will be taking the ss to the vet. She's a new vet and I've kept her informed of his numbers all along. She didn't want me to home test him for the next 10 days, just stick to the 2ui and two meals a day.

Also she is of the "dry food only" school of thought and physically shivered when I told her I feed Bob wet food. She gave us free sample packets of Hill's Metabolic, which is what they'd been solely feeding him for his two day stay and said to feed him that. I told her I have Royal Canin Diabetic kibbles (sold to us by the old vet!) and she said I should use them for the two main meals

Bob does love his kibbles but I only leave a modicum of them (about 10g) down at night - and our other cat eats them if he gets to them first!

I'm going to have to reassess our whole regime methinks

 

I take my hat off to you! You're doing the very best you can in trying circumstances. Do remember to look after yourself too - the more than occasional treat in the form of wine, chocolate etc can help to keep you sane!