Change insulin dose against veterinary advice?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Amanda Guimarães, Nov 22, 2020.

  1. Amanda Guimarães

    Amanda Guimarães Member

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    Nov 14, 2020
    (Posting here as advised by another user, since I have not received answers in the Prozink forum)

    I went to the vet this Thursday and the nurse+vet said me that I should give the full 1.0 unit insulin even if my cat test is 92. They said me that he should not be lower than 72 (US numbers), in which case I should proceed with the hypoglicemic measures, wait one hour, and shot the insuline. They justified saying that the insulin dose was very low so there was no danger. They said me it would be bad to skip the insulin because it could give a too high blood result later on.

    I am taking his first glucosecurve right now and I am worried. The first glucose test was alright, so I gave the insulin shot. I am taking measures for the glucose curve every two hours according to the veterinarian scheme. It´s been 4 hours and he´s got hyploglicemic numbers, so he has gotten more food now - he is eating. I will test again soon.

    Last evening I took his glucose number and it was 146, so I followed the veterinarian advice and shot the insulin. But it didn´t feel alright, so I stayed awake longer (I normally sleep by that time) and just watched the cat, even if he had eaten a lot. 4 hours after the shot I tested again, finding it was even lower. I served him more low carb wet food, he refused to eat but meowed at me! So I served him a bit of dry food he had before, mixed with the low carb food, and than he ate everything. This took all of the night....

    --> According to the veterinary I should never skip the insulin if it´s higher than 92; to not cause a higher blood result later on. But I´ve got two hypoglicermic numbers already? Do you think it´s safe to not give the insulin if it´s lower than 180, as you reccomend in here?
     
  2. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    If it's under 180 wait without feeding for 30-60 min and see if the number goes up. As I said in the other thread, I feel your dose has become too much. And would lower it.
     
  3. Amanda Guimarães

    Amanda Guimarães Member

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    Thank you @JanetNJ! It feels safer, yes!

    I am just worried about not following the veterinarian reccomendation. I wonder why they reccomended me a much lower number as a referense before the insulin...
     
    Last edited: Nov 22, 2020
  4. Critter Mom

    Critter Mom Well-Known Member

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    This blanket assumption is false.

    The only dose that's safe is one that isn't too high for the particular cat. Cats can have symptomatic hypos on lower doses than 1 unit of insulin.

    The greater danger comes from low numbers. High BG levels are harmful but the damage they do takes time (DKA excepted). Hypoglycaemia can kill - quickly. As the saying goes at FDMB: better too high for a day than too low for a minute.

    It is normal in the early days of the regulation process for kitties to spend some time at the beginning and the end of each cycle in slightly higher numbers. Also some kitties 'bounce' to higher numbers when they start hitting lower BG numbers - even when those numbers are perfectly safe - because their bodies have become accustomed to running in a higher range. (This morning's pink preshot may be bounce-influenced from a lower number yesterday.) The regulation process is gradual and can't be forced. The body needs time to relearn how to run in better numbers. As treatment continues the goal is to see a kitty's body become more familiar with healthier BG levels, leading to the kitty spending less time in higher numbers, and possibly even achieving remission.


    Mogs
    .
     
  5. Critter Mom

    Critter Mom Well-Known Member

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    It's quite a daunting prospect, but your ultimate guide should be Severino: his BG readings can't be argued with and they will tell you whether or not he's on a safe dose. :)


    Mogs
    .
     
  6. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Hi Amanda. Don't worry about not getting an answer in the Prozink forum. Some forums are the fast lane and the volume of posts can often mean yours will quickly sink to the bottom and out of sight. I'm out of the loop on medical advice but the members who replied to you know what they're talking about.
    Hope you both have a good day.
     
  7. Amanda Guimarães

    Amanda Guimarães Member

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    Hey everyone <3

    @Noah & me (GA) thank you for your kind remark.
    @Critter Mom thank you for your careful answer and suggestions.

    It feels to refreshing and nice to be able to have your support in this forum!! Thank you so much for doing this!
    I have quite a long time experience with rescue cats and I am honestly to tired of suspectful veterinary advice. From my teen years until last year, my mom had Cat Gil, who was also diabetic; he died last year - 20-years-old - he was rescued when he was 10. It was alright in the end and he had a nice life, but I wish we knew about this forum than!
     
  8. Critter Mom

    Critter Mom Well-Known Member

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    Gil was a lucky kitty. So is Severino. :)

    :bighug:


    Mogs
    .
     
  9. SashaV

    SashaV Member

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    Apr 25, 2020
    You will get a response in the prozinc forum, but those who are advising is in the US. So @Deb & Wink is on at 1 at night our time, so just hang on!
    If you ever have an emergency you need to use this forum, and do a 911 tag.

    Most of us, one way or another is doing something against the vet's opinion or advice. I was told not to test for example...
    The most important thing is to find a vet who's wants to learn with you, who knows the basics, a vet on your side.

    I'm doing my own thing, my vet know what I'm doing and has access to my spreadsheet, but I'm only following her advice if it makes sense to me. Trust in yourself and your gut feeling, you're most likely right :bighug:
     
  10. Amanda Guimarães

    Amanda Guimarães Member

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    Hej @SashaV, tack så mycket för svaret!

    It´s definetely reassuring! Not easy to go against veterinary advice.

    I was also advised to not test daily, just watch for symptoms...
    But that´s the next chapter to think about - probably going to make a new post sometime soon asking you all some questions about daily testing :)
     
  11. Amanda Guimarães

    Amanda Guimarães Member

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    @Critter Mom thank you <3 Here is RIP diabetic Cat Gil, in 2015 :)

    [​IMG]
     
  12. Amanda Guimarães

    Amanda Guimarães Member

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    Here´s Severino :) I think he looks like the Grinch :p
     

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  13. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    I think Severino is BEAUTIMUS! :bighug:
     
  14. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Years ago with our first sugar cat our vet said "well clearly this approach isn't working" and everything changed for the better. Her dad was a vet as well and she is now a close friend. Not everyone gets that lucky.
    Question authority.
     
  15. Amanda Guimarães

    Amanda Guimarães Member

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    Nov 14, 2020
    We are almost done with his first blood curve and we got a 5.5.mmol/L (99 in the US) right now. He got his food now but he wasn´t very interested!

    I would give him insulin on one and a half hour, let´s see!
     
  16. Critter Mom

    Critter Mom Well-Known Member

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    That is such a good photo. His expression! Visions of him thinking:

    "Where's dinner? Don't think much of the service round here." :rolleyes:

    :D


    Mogs
    .
     
  17. Amanda Guimarães

    Amanda Guimarães Member

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    Nov 14, 2020
    hahahaha a bit like that!!!

    Measured his glucose an hour ago - 5.5 (99). His insulin is due in one hour, I will measure than before and see how it´s...
     
  18. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    I might try 0.75 on the next shot. 1 unit brought your kitty down too low earlier.


    Another option since he's at such low numbers (trying for remission I hope) is to do a bit of a sliding scale. Like 0.25 if over 130 0.5 units if over 150 and 0.75 of over 180. Not everyone is a fan of sliding scales but I think they can sometimes work.
     
    Last edited: Nov 22, 2020
  19. JanetNJ

    JanetNJ Well-Known Member

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    Post when you get your next preshot number. :)
     
  20. Amanda Guimarães

    Amanda Guimarães Member

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    Nov 14, 2020
    Thank you @JanetNJ ! Just measured, we got 6.1 (110).
    Going to give him more food now, but he ate some low carb food one hour ago.
     
  21. Critter Mom

    Critter Mom Well-Known Member

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    Just to clarify, did you feed Severino 1 hour before getting the 6.1/110 reading?

    Please don't feed Severino just yet, Amanda.


    Mogs
    .
     
  22. Amanda Guimarães

    Amanda Guimarães Member

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    Hej @Critter Mom,

    sorry about the confusion. Because he needs to put some weight, the vet said that he should have food available when we asks for it.
    I read your message just after giving him some more food as he asked. Yes, he ate 1 hour before getting the 6.1 reading.
     
  23. Critter Mom

    Critter Mom Well-Known Member

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    The reason I asked you to withhold the food is that for safety the preshot BG should be taken after a 2 hour fast. Given Severino had food 1 hour before the 6.1/110 reading you'd have been able to get a fully fasted BG reading after one hour. Now that he's eaten again it will be 2 hours before a reading can be taken that isn't food-influenced. I'm tagging @JanetNJ to draw her attention to the 6.1/110 reading at the end of the curve. I think she would be best placed to discuss dosing for this evening.


    Mogs
    .
     
  24. JanetNJ

    JanetNJ Well-Known Member

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    the reason
    we say no food two hours before the preshot test is because it will raise the number. Then you will think it's safe to shoot, but when the food number wears off he could go too low. Other than the two hours prior to the preshot test he can eat as much as he needs. 110 is too low to shoot. Stall and let's see if the numbers go up
     
  25. Amanda Guimarães

    Amanda Guimarães Member

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    @JanetNJ @Critter Mom thank you so much, didn´t know at all about this information! His food is 100% protein, does it influence his readings in the same way?
     
  26. JanetNJ

    JanetNJ Well-Known Member

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    ANY food can raise numbers. Low/no carb does not raise it as much.
     
  27. Amanda Guimarães

    Amanda Guimarães Member

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    Nov 14, 2020
    Thank you! So you advise me to wait two hours, do a new reading and than give him the insulin if necessary?
     
    Last edited: Nov 22, 2020
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  28. JanetNJ

    JanetNJ Well-Known Member

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    Looks like your cat is trying to get off insulin. Wouldn't it be amazing if he went into remission. My cat was in remission with no shots for a full year, it was wonderful.
     
  29. JanetNJ

    JanetNJ Well-Known Member

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    Wait an hour or two and let's see what the number is.
     
  30. Amanda Guimarães

    Amanda Guimarães Member

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    @JanetNJ took a reading again, one hour after, and we got 6.8/122
     
    Last edited: Nov 22, 2020
  31. Amanda Guimarães

    Amanda Guimarães Member

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    Do you think we should give him a 0.5 unit? :)
     
  32. JanetNJ

    JanetNJ Well-Known Member

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    Can you monitor overnight? If not I might do 0.25
     
  33. Amanda Guimarães

    Amanda Guimarães Member

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    @JanetNJ thank you! Unfortunately I am not much able to monitor overnight as I need to work (even if it´s from home) the whole day tomorrow. I will be awake for four hours from now! I guess I will go with 0.25! <3
     
  34. JanetNJ

    JanetNJ Well-Known Member

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    Better safe than sorry since the numbers have really dropped.
     
  35. Amanda Guimarães

    Amanda Guimarães Member

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    Thank you so much for all of your support today <3 <3 <3

    He ate a bit and I just did a last day´s measure for his glucose and got 158. Time to sleep! :) Better safe than sorry!
     
  36. Deb & Wink

    Deb & Wink Well-Known Member

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    Even cats on a small 1U dose of Prozinc can become hypoglycemic.
    The meter you are using is a pet meter, so you should be a bit more cautious when your cat Severino has low BG numbers at the pre-shot test.

    We have a saying here "Better too high for a cycle, than too low for a moment." This saying is comparable to your "Better safe than sorry."
     
  37. Amanda Guimarães

    Amanda Guimarães Member

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    Thank you everyone for your support yesterday :) His blood was actually still quite low this morning and wasn´t much different than when we went to sleep. Because it was still lower than 180, I give him 0,75 this time. Contacted the veterinarian this morning, they said I will get an answer later today.
     
  38. SashaV

    SashaV Member

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    Apr 25, 2020
    Another thing Amanda, if at all possible it would be very helpful if you could test more.
    Specially when you're shooting so low.

    Any reading lower than 68 on a pet meter is a reduction. And we have no way of knowing if Severino is going lower without testing.
     
  39. Amanda Guimarães

    Amanda Guimarães Member

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    @SashaV thank you! How often should I test?

    I am currently doing pre-shots testing; before having food.

    What do you mean by reduction?
     
  40. SashaV

    SashaV Member

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    Really as often as you can.
    Nadir is when the cat reaches the lowest point, and that varies with every cat. Mauers is lowest at +5 or +6.
    We usually say that a +2 shows where the cat is heading, Mauer is always higher at +2, so I do a +3.
    The point is, you can't test too much. Take a look on others spreadsheets and see how often they test.

    What worries me is that your cat is a new diabetic, and is already blue and green, and that freaking awesome!!! but it also means you need to be more careful.
    You might be closer to remission than you realize, and that would be awesome but dangerous if you don't test.

    A reduction is a reduced dose of insulin.

    And by the way, I'm also relatively new, so its just my opinion and thoughts so I don't have the experience to back it up.
     
  41. Amanda Guimarães

    Amanda Guimarães Member

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    So I need to start working but I will see what I can do! @SashaV your message came in the right time. We are 3 hours after his insulin and yesterday, doing the glucose curve, I saw a dramatically lower point at +4.

    I tested right now and...tcharam! Lower than 4 :-( He is eating right now.

    So odd, he was playing around...no symptons at all. But he is eating ravenously right now after I served more food!

    (He normally asks me for more food from time to time. Not today!)
     
  42. SashaV

    SashaV Member

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    They rarely get symptomatic when they're low.
    I'd say, whenever you get a neon green it's time for help. And you're already close at +3.

    So if I were you, I'd start preparing for a long day, get your hypo-kit out and test again in 20 minutes. Make a new thread with his +3 BG reading and put a 911 tag on it.
    Not to worry you, but to be on the safe side. I'm not competent to guide you through a hypo, you'll need the old-timers for that. Put a link to this thread.
    He hasn't reached his nadir yet, so you're going to need some help..
    @Bron and Sheba (GA) is in Australia and might be able to help you?
     
  43. SashaV

    SashaV Member

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  44. Amanda Guimarães

    Amanda Guimarães Member

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    Thank you @SashaV . It´s not the first time he gets this lower numbers :-( I am doing as advised by the veterinarian, he got more food with "druvsocker" on it. Going to test again soon!
     
  45. Pookie

    Pookie Member

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    By way of reference, my Lola was diagnosed and received her first shot of Prozinc on September 14. She had her last shot the morning of October 18. It appears that changing her diet to low-carb, wet food might be what it takes (at least for the present) to eliminate her need for injections. (Unfortunately, she's still battling an infection, and now the side-effects and after-effects of the antibiotic, which pose a threat to remission.)

    It was recommended to me that one day I test at +2, +4, +6 and another to test at +3, +5 +7, to help us see at what point during the day the Prozinc was at its most effective (making her BG reading its lowest). (For Lola, it was pretty consistently at +5.) That way we could determine how low she was dropping during the day and 1) keep her safe if the number dropped too low (hypo), and 2) determine when it was appropriate to reduce her dose (and 3) when it was appropriate to do an Off-The-Juice trial).

    I was also told that sometimes numbers get lower during the night than during the day, so tests during the evening hours are a good idea, too.
     
  46. SashaV

    SashaV Member

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    This low is low. It's too low for a new diabetic owner to deal with alone. That's why you need help, to keep him safe.
    Honey might be easier to deal with. Keep him a bit hungry so you can push him back up with food.
     
  47. Amanda Guimarães

    Amanda Guimarães Member

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    @Pookie thank you, that´s so helpful!

    Severino needs to put some weight and he is a quite hungry cat; I was advised by my vet to give him food when he asked for it. He asks for food 3x every morning, 1 time in the afternoon. He gets his final food dose at 19:00 and than he doesn´t eat until the morning. I am a light-sleeper and have woken up before to feed him; in September. But right now he doesn´t want to eat in the evening, even if I let food available. He sleeps all of the 8 hours with me and my partner, between us, like a baby!

    I have been worried about giving insulin in the evening because of that but the vet said I should not worry. More as I read, more worried I get.

    Can I give two different doses to the cat? I call the clinic this morning and shared all of the data; they said me that my veterinary is off today but that someone else and the nurse that knows Severino and has experience with diabetes would look and advice; but they said I should not change the dose meanwhile.
     
  48. SashaV

    SashaV Member

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    We usually shoot the same units in the AM and PM cycle. Usually! Every cat is different.

    And at some point you should worry. You're cat is doing great, and insulin is a very very powerful drug.

    I'd listen to the people here, instead of your vet. These people do nothing else than diabetes, your vet might only see to diabetic patients a year..
     
  49. SashaV

    SashaV Member

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    Amanda, did you get a new test?

    Even if it's higher, you're still not out of the woods.
    Could you please make a new thread with the 911 tag?
     
  50. Amanda Guimarães

    Amanda Guimarães Member

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    @SashaV we ate quite a lot right now, with honey and a bit of druvsocker. His test right now, a half an hour after he ate, is 6.2.
    I will keep monitoring
     
  51. Amanda Guimarães

    Amanda Guimarães Member

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    I think since it got higher I will wait to do the 911 thread, I will create one after I have done some more readings. I will taking from time to time.
     
  52. SashaV

    SashaV Member

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    The honey only lasts for a short time. He will drop again, that's why the new thread with the 911 tag.
    You need experienced eyes on this, no one knows whats going on in this thread.
    Rather be in front of the situation. You'll need help, and the most of those who's able to help is already or about to go to sleep.
     
  53. Pookie

    Pookie Member

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    Lola started at 1u twice a day. After 10 days she went to the clinic for a curve (I wasn't home-testing at that point) and my vet's colleague told me to increase her dose to 1.5u twice a day. I knew in my gut that this increase was too much, but I did it anyway because I trust my vets and because I never went to vet school, did I?

    The increase made her sick and I decided I needed to do my own testing (not at the clinic where she gets stressed out - which probably raised her BG). It wasn't until she was very, very sick (she stopped eating entirely - the only thing she would eat were the Friskie's treats, which are super high carbs, but which I fed her anyway because I knew she needed food). (I also instinctively lowered her dose because I knew the 1.5u was too high.)

    Fortunately, at that time I received my glucometer and I found FDMB. I learned how to get samples from her ear (because trying to get them from her paws was rubbish!). And I could see in real-time how what her BG levels were and how the Prozinc was affecting them. And I learned about the proper food for a diabetic cat and how dreadful that high-fiber "diet" food had been for her. Lola started responding quickly to proper care and one day when her BG dropped below 90 one day her dose was reduced to .75u.

    I hate to think what would have happened if I had continued to follow the vets advice. At the very least it would have involved a trip to the emergency vet, but it might have led to her death.

    I've known my vet for 25 years and trust her implicitly. Twenty years ago she helped me with my first diabetic kitty. She knows her stuff about diabetic cats. When her colleague recommended increasing to 1.5u, it was because my vet was out on medical leave. I have since spoken to my regular vet about that increase and she said the she would have made the exact same recommendation (which, yes, makes me a little uneasy). Had I been testing at home at that time I would have had the benefit of "real" numbers, not ones inflated by stress from being at the clinic among strangers and barking/whining/crying dogs. And under the guidelines here any increase would have been only .25u, not .5u (which 50% increased her dose by 50%).

    I, too, am not qualified to help you through a hypo event. You should read this (be aware that the numbers cited therein are for readings taken from a human meter where the "danger" zone starts at 50. The "danger" zone with an AT2 starts at 68 (the bright green numbers on your spreadsheet.)

    How to treat hypos - they can kill

    When Lola had her low BG episode we used small bits of food (and a LOT of testing) to get her back to safe numbers (but not send her sky-high).
     
  54. SashaV

    SashaV Member

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  55. Amanda Guimarães

    Amanda Guimarães Member

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    @SashaV I made a new thread <3
     

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