Bruce dx 36 days ago new to the board

BruceWayne

BruceWayne

Member
Hello all,


Our cat Bruce is a six year old male diagnosed a little over a month ago but we are new to the board.

Immediately transitioned to 100% wet food (fancy feast classic) upon dx. Vet started with 1 unit PZ insulin which he upped to 2 units 4/6/2022.


We followed our vet’s recommendations but hadn’t discovered this board until a couple of days ago and after doing a lot of reading I realize we haven’t been doing enough tracking so we have a lot to catch up on as far as data collection.

Doing our first blood glucose curve today and I’m very thankful for all of the information and support already provided through this website.


https://docs.google.com/spreadsheets/d/1bE0czBgp2QeA2w3GrgmSIMyOdkrcq7ynIOhqvFwOj4g/edit
 
Oh, and keep him on this dose and keep testing and putting the numbers into the spreadsheet so we can help you evaluate how he’s doing on this dose and where to proceed. If he’s on an all low carb wet diet and you can test at minimum before each shot and one additional mid-cycle test each day and night then you can follow tight regulation and can adjust insulin doses more quickly.
 
BruceWayne said:
We give him his first dose at 7am and we aren’t typically available for another test until we get off work around 5/6pm most days.
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That’s a long time alone on insulin. You have no idea what his BG is doing for all those hours. I hope that you can at least leave food out for him to try to keep himself safe or have a timed feeder to feed him small meals throughout the day (also to keep him safe.). Have you considered a Freestyle Libre sensor?
 
We are currently leaving food out for them. My wife only works 3 days a week so for the other four days she’s at home most of the day. I know it’s not ideal but unfortunately that’s where we are at right now. Reading up on the sensor now.
 
BruceWayne said:
We are currently leaving food out for them. My wife only works 3 days a week so for the other four days she’s at home most of the day. I know it’s not ideal but unfortunately that’s where we are at right now. Reading up on the sensor now.
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Nothing ever is ideal is it? . You two are doing a great job already and are educating yourselves on what you need to do. I am impressed. That should be enough days for you to get data on what Bruce is doing. Once you have a lot of data on your spreadsheet and can see patterns, you should be able to predict what he will do (I hope he will be one of the predictable diabetic cats anyway) and you are already leaving out food so that’s a wise precaution.
 
A few people who are away for a lot of hours at a time have a pet sitter or friend or family member stop by to either test or check up on their cats during the day.
 
BruceWayne said:
Immediately transitioned to 100% wet food (fancy feast classic) upon dx. Vet started with 1 unit PZ insulin which he upped to 2 units 4/6/2022.
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Welcome we usually increase by 0.25 units at a time not whole units
Going to tag
@Suzanne & Darcy to see if you should reduce since his BG dropped to 72
Also
@FrostD
Do you have syringes with half unit markings
Copied from the Prozinc / PZI sticky
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
@Bruce Wayne
 
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As Diane has shown above, if your kitty drops below 90 on the start low, go slow protocol then you need to reduce. I hope you all will be able to continue testing in the evening. This drop has me nervous. Definitely reduce tonight, but keep testing.
 
If there were subsequent tests after the 72 and he went below 65, I would reduce by 0.5U. He bounced, I'm just not sure from how low of a number.
 
Do you have a hypo kit set up, and ketone test strips? I can drop some links for you in a bit if not
 
FrostD said:
If there were subsequent tests after the 72 and he went below 65, I would reduce by 0.5U. He bounced, I'm just not sure from how low of a number.
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Yes. I was thinking this too…. Wanted to see how low he went - but earlier this afternoon we had bo idea. It would be safer to just go ahead and reduce by a half unit. You can always work your way up from there after you have more data. Today’s drop was startling.
 
Sorry for not updating the spreadsheet in real time. I have a lot of catching up to do.

tested him again in two minutes after the 72 reading (which was unnerving) and luckily he showed 99. We put his plate of fancy feast in front of him and he ended up eating some.

At +11 he showed 152

PMPS 207

I should have checked back on this forum for advice but I made the decision to drop it down to one unit.
 
BruceWayne said:
Sorry for not updating the spreadsheet in real time. I have a lot of catching up to do.

tested him again in two minutes after the 72 reading (which was unnerving) and luckily he showed 99. We put his plate of fancy feast in front of him and he ended up eating some.

At +11 he showed 152

PMPS 207

I should have checked back on this forum for advice but I made the decision to drop it down to one unit.
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Okay. Good. Well, now you can collect data on how he is doing on one unit and make gradual adjustments from there.

You should know about meter variance. There is always a meter variance of about 20% (although recently I heard Melissa saying that she thought the AlphaTrak meters had a variance of 15%). What this means is that, for any given drop of blood, you can test it and then retest (the same drop) again and get a different number that will vary by about plus or minus 20 percent. By the way, what you did in re-testing is good. Whenever you get an unexpectedly low or high reading on your meter, it's a good idea to re-test because sometimes you just have a bad strip. What you also did in feeding and retesting him with that low number was perfect. You need to keep retesting until you are sure that his BG is rising on its own (after the food wears off).
 
This is excerpted from the "Do Not Panic, or How to Handle Low Numbers Sticky Note." Here's the link to the whole thing, but excerpted below the link is the part about testing frequency and feeding during low numbers.

https://felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/

If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)
  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If numbers have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
 
So I need to clarify a few things:

Bruce was diagnosed 3/12.

Up until yesterday we were following the vet’s protocol for his treatment which was as follows.

switch diet to 100% low carb wet food (fancy)

Started on 1 unit of PZ twice daily (which i now realize should have been .5 with SLGS)

After two weeks we brought him in for a mid-cycle test at +7 which read 280 so the vet upped his dose to 2 units which I now realize was reckless. Chances are his reading was elevated due to the stress of being at the vet.

We decided to cancel his next checkup for the in-office glucose reading and do his tests at home to save money and save him the stress.

We gave him his first at home test 4/13 PMPS and he read 239. My wife is tentative about giving tests so I waited until my day off, yesterday, to give a full curve of tests.

i spent all day yesterday giving him his glucose curve and doing hours of research on the forum, both his low numbers and everything I was reading really scared me and I now realize we’ve been going about this all wrong and putting Bruce in danger. I am no longer following the recommendations of our veterinarian and instead of allowing him to provide dosing guidance I will be following the advice of this forum and asking him for feedback.

We do have a hypo kit

I just ordered ketone strips

We dropped him down to 1 unit last night after a PMPS of 207, was this the right move?
 
You mean... are you concerned that even 1 unit will be too much and that you should start at a lower dose? Are you using a human meter (ReliOn?) I just want to confirm.

Really, based on the curve that you did yesterday... which was not a bad curve and Bruce was not in any real danger yesterday since he did not drop below 50 (on a human meter)... I would not drop the dose down below 1 unit, if that's what you are concerned about. One unit may be dropping the insulin a bit low (again based on what we saw yesterday), but you can increase your comfort level. You will have to start the cycle count over again since you had a fur shot this morning (sorry about that.) @FrostD what do you think about the "new" starting dose.

By the way, you are doing a GREAT job caring for Bruce. I know that he's going to be one of the lucky ones who does really well because of your dedication and the way you are diving in and learning everything that you can. Hopefully, your wife will get a little comfortable with testing and these little bumps in the road at the beginning will be smoothed over.
 
I just wanted to ask... how is he doing for all this testing? Are you giving him a little low carb treat each time that you test? Do you have a particular testing spot set up where you will do most of your tests? Did you see the photograph of the ear and the spot that you are shooting for just outside of the vein that runs along the outside edge of the ear? Are you having any trouble getting blood. Really, it sounds like you must have a good technique or you wouldn't have been able to get all those tests yesterday.
 
Using relion prime.

I’m wondering if dropping down to 1.5 would be better and if 1 unit is too low to start at. Better to err on the side of caution I suppose and work up following the protocol.

he’s doing OK with the testing. He definitely wasn’t happy about it and spent a large amount of the day hiding under our bed. I’m also wondering if that’s why he dropped so low, because he was a little stressed out and didn’t come out to eat as much as he normally does mid day.

so far he has shown no interest in the two no carb treats we bought him, but he loves to be brushed so we’ve been brushing him before and after every shot and test as a “treat”.

I think I’m doing a pretty good job with the testing, although a couple times I didn’t get enough blood and had to poke him a second time for a sample. Yes, aiming for the outside of ear.
 
I would not drop to 1U due to risk of ketones/DKA. If you'd like more cushion, start at 1.5U.
 
We should know more tomorrow when I get to ketone strips. Is there an acceptable level of blood ketones? Or is any reading other than zero cause for concern?
 
FrostD said:
I would not drop to 1U due to risk of ketones/DKA. If you'd like more cushion, start at 1.5U.
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I am very glad you said this, Melissa! I too, wouldn't go all the way back to 1 unit. I would go with 1.5 and test. Based on yesterday, he should be okay. He was not in danger yesterday with those greens -- nothing under 50. I was a little worried that he'd keep on dropping though. I went to be a little worried about Bruce because you hadn't posted... my mind ran to all sorts of things like you having to take Bruce to the ER, etc... then I told myself how silly that was... that you were probably just testing and too busy to update the sheet, etc... so I was really happy to see the update this morning.
 
BruceWayne said:
We should know more tomorrow when I get to ketone strips. Is there an acceptable level of blood ketones? Or is any reading other than zero cause for concern?
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You got the blood meter? I used the Nova Max Plus. If you get anything 2 or under, I would just keep an eye out and not worry as long as he is eating well and seems normal in his behavior (no lethargy, vomiting, lack of appetite.) Hopefully, he is not ketone prone. Ketones do vary throughout the day as well. You can test at one time and get one reading... test later in the day or night and you will get another reading. If they seem a little high, try adding some water to his food for extra hydration.
 
BruceWayne said:
We should know more tomorrow when I get to ketone strips. Is there an acceptable level of blood ketones? Or is any reading other than zero cause for concern?
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Most cats baseline around LO to 0.8. Some ketone-prone cats tend to baseline higher than that (Suzanne's Darcy was one of them, but from what I've seen he was an exception).

When it starts getting close to 1.7 or so I raise an eyebrow because it may mean something is happening.l, want to be proactive with extra water and food. There are two studies out there:
Study 1: blood ketone reading of 2.55mmol/L or higher is 94% accurate in diagnosing DKA, and values below that are 68% accurate at ruling out DKA
Study 2: blood ketone reading of 2.4mmol/L or higher is 100% accurate in diagnosing DKA, and values below that are 87% accurate at ruling it out

They do fluctuate from day to day, that is normal. But again it's the trend, and if it starts getting close to that 1.7-ish
 
I'm just really going back to what Wendy told me. When Darcy got under 2, she said he was below the "worrying numbers." Can you link those studies. I had the WORST time trying to get my vet to pay attention to my blood ketone meter readings. I would take Darcy in there and tell them his ketones were high... they'd do a urine test and tell me it was all just fine and that they doubted my blood meter. I did a lot of research on it and was satisfied that the blood ketone meters were useful and accurate. But as long as he was hungry and acting normal, I didn't freak out (after the DKA/week in the ER/feeding tube it was hard not to freak out.)
 
They are here - https://www.felinediabetes.com/FDMB...oacidosis-dka-and-blood-ketone-meters.135952/

She's right, above 2 is when I do start to worry more. But the problem I have is that it can change so fast (Hendrick is a good example). So I like to recommend being more "alert" and a bit proactive a little lower. I do believe Darcy was part of that 6% of cats that the 2.4/2.55 wasn't exactly a reliable cutoff for

There's also a common saying here that ketones don't show up in urine til 2.4/2.55 and that is NOT what those studies say. I'm not sure where it came from (possibly the post I linked because it says something similar in there) but it does keep getting repeated a lot.
 
FrostD said:
I do believe Darcy was part of that 6% of cats that the 2.4/2.55 wasn't exactly a reliable cutoff for
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I wonder if it had anything to do with the acromegaly. Of course, Mr. Kitty is acro, too. But then we have things we just don't know about like size of tumor, activity of tumor, etc. What landed Darcy in the ER was an infection.
 
FrostD said:
So I like to recommend being more "alert" and a bit proactive a little lower.
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And yes... I would NEVER advise anyone to become complacent about ketones. I wasn't. The problem is, I used to take him to the vet like EVERY time (for a while) that he had high ketones. They just said... what do you want us to do? Sometimes I had them do IV fluids just for the day (poor Darcy.) I used to give him sub-q fluids a lot at home... but I honestly never saw the ketones budge much as a result... but I did them anyway.
 
Suzanne & Darcy said:
And yes... I would NEVER advise anyone to become complacent about ketones. I wasn't. The problem is, I used to take him to the vet like EVERY time (for a while) that he had high ketones. They just said... what do you want us to do? Sometimes I had them do IV fluids just for the day (poor Darcy.) I used to give him sub-q fluids a lot at home... but I honestly never saw the ketones budge much as a result... but I did them anyway.
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Yeah that is curious because I don't know what you do in that situation when they just baseline kind of high. Just sit on your hands and wait for DKA symptoms? I have no idea.
 
Suzanne & Darcy said:
You got the blood meter? I used the Nova Max Plus. If you get anything 2 or under, I would just keep an eye out and not worry as long as he is eating well and seems normal in his behavior (no lethargy, vomiting, lack of appetite.) Hopefully, he is not ketone prone. Ketones do vary throughout the day as well. You can test at one time and get one reading... test later in the day or night and you will get another reading. If they seem a little high, try adding some water to his food for extra hydration.
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I have the precision Xtra meter already for when I was testing my own ketones on a ketogenic diet a few years ago.

I just contacted Bruce’s vet and they said they did a ketone test for his urine March 12 and there were no ketones present.
 
Suzanne & Darcy said:
I am very glad you said this, Melissa! I too, wouldn't go all the way back to 1 unit. I would go with 1.5 and test. Based on yesterday, he should be okay. He was not in danger yesterday with those greens -- nothing under 50. I was a little worried that he'd keep on dropping though. I went to be a little worried about Bruce because you hadn't posted... my mind ran to all sorts of things like you having to take Bruce to the ER, etc... then I told myself how silly that was... that you were probably just testing and too busy to update the sheet, etc... so I was really happy to see the update this morning.
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Sorry to leave everybody hanging, I’m just getting used to all of this and I was pretty distracted testing and monitoring Bruce.
 
BruceWayne said:
Does anyone think it’s weird that his nadir occured so late?
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No, not really. When they drop lower or faster than they're used to (super cat-dependent definition of low and fast), their liver perceives it as a threat and dumps stored glycogen and counterregulatory hormones in order to spike BG back up. That also what you saw with this morning's preshot.

When they clear the bounces which can take 4-6 cycles, it is often a longer slide down with a later nadir. So he was very likely bouncing from a low the night or day before yesterday, and you caught the break.

Ketones can form very quickly. We recommend every other day-ish while unregulated, weekly-ish when regulated.
 
FrostD said:
They are here - https://www.felinediabetes.com/FDMB...oacidosis-dka-and-blood-ketone-meters.135952/

She's right, above 2 is when I do start to worry more. But the problem I have is that it can change so fast (Hendrick is a good example).
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clicking around in the Prozinc forum and I see a mention, ha

Yeah with Hen, he could be .3 one day and 1.2 the next. Sure kept me anxious! We haven't actually tested in weeks, with him so tightly regulated atm. I probably should toss a spot check in, maybe in particular after a reduction settles in. Because less insulin *could* mean more ketones, I suppose.

Not to alarm you @Bruce Wayne but in the 4 months I have been on this forum I have seen multiple times where DKA hit fast, hard, and was lethal. Posts like "well he wasn't eating or drinking past few days" and then boom -- GA. When Hendrick didn't want to eat one evening, and then again the next morning that was enough for me. Not waiting even a full day, nope, not this guy. Of course we didnt even know about DKA or ketones at the time, he was just two days out from diagnosis of diabetes.

We ran off to the ER where he was hospitalized for two nights for DKA and mild pancreatitis ($3400, oof). And today, he's good as ever!
 
I’m guessing this means he’s still bouncing.

Following the SLGS protocol so we’re holding off on the shot tonight
 
The spreadsheet isn't updated for me? It might be my phone being a pain.

I'm suspecting you'll want another reduction to try to get a dose you can shoot consistently but need to see spreadsheet. Glad about the ketones!
 
FrostD said:
The spreadsheet isn't updated for me? It might be my phone being a pain.

I'm suspecting you'll want another reduction to try to get a dose you can shoot consistently but need to see spreadsheet. Glad about the ketones!
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Hi Melissa it's not your phone , the SS hasn't been updated :cat:
 
Ok, the 1.5 actually didn't look too bad, but without quite enough data yet I would do 1.25U. Hopefully that way can shoot consistently. 1U is too low
 
FrostD said:
Ok, the 1.5 actually didn't look too bad, but without quite enough data yet I would do 1.25U. Hopefully that way can shoot consistently. 1U is too low
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Do you have a recommendation for the lowest number we should shoot at if we won’t be around to monitor at 1.25?
 
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