Dixie's Dosing Thread

Discussion in 'Prozinc / PZI' started by FarmKitty, Aug 21, 2020.

  1. FarmKitty

    FarmKitty Member

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    Aug 19, 2020
    Hello! I didn't want to post again so soon but Dixie's numbers were very low at 6.6 (119) during her PMPS. We stalled for 30 minutes and then it was 7 (126). These numbers were verified with two meters (Nova Max Plus and Bravo). So we just fed her and skipped the shot.

    This is the second time this week that her PS numbers has been low. Her vet appointment is 1 week away. She didn't show signs of ketones (Nova Max Plus said 0.3).

    Could this be an indicator that her dose (1 unit) is too high? Her spreadsheet is up-to-date.

    Edit: Some extra info: She is very consistent with eating all of her breakfast and dinner. Also, my partner and I both work from home so we can monitor her very closely if it is recommended that we give her shots with a low PS number.
     
    Last edited: Aug 21, 2020
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  2. Panic

    Panic Well-Known Member

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    Hello Dixie's caregiver! If you'll give me a few minutes to boot up my laptop and peek at Dixie's SS I'll comment :)
     
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  3. Panic

    Panic Well-Known Member

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    To start, I want to let you know if you have anything time-sensitive to please post in the Main Health Forum - as you can see with your other post, the Prozinc ISG forum isn't very active since the majority of the kitties here are on Lantus, but the Main Health is always bustling with helpful people, so try to get eyes on stuff over there as well in case no one that frequents this section is online. :)

    A refresher on the Prozinc SLGS protocol should help you:

    How to handle a lower than normal preshot number when following SLGS:
    When you stall feeding and retest at a low pre-shot, it will be beneficial both to you and the members here if you add it to your spreadsheet. For example, if Dixie's pre-shot is 110 and you stall feeding 20 minutes and she re-tests at 130, you should put in the AM/PMPS cell: 110, 130 (+12.20). You will have to manually color the cell if you do this; I would color it based on the lowest number. You also want to put in the remarks section stalled 20 min, etc etc so YOU can look back and see what you did. It's all about gathering data and basing doses off of Dixie's experience. You're doing good with the remarks so far, just add them to the cells as well so it's easy reading for those looking to offer advice. :)

    As you can see above, numbers between 150 and 200 have three options: stalling and retesting is recommended first if your schedule allows it. I think introducing token doses (which are 10-25% of usual dose, so in Dixie's case of 1u would be .10 to .25u) will help you get the courage to still give insulin when she drops a little lower. Eventually you'll lower the no-shoot number from 200 to say, 180. 150. Etc. I think it's fine that you skipped this morning, though the evening of the 18th it might have been nice to at least done a token dose.

    If you DO decide to give a token dose or full dose on lower pre-shots, make sure you're going to be there to monitor and get a +2 in. +2's are great indications of what the cycle is about to do. Try to get one every cycle if you can.

    As for Dixie needing a reduction ... hmmm. I am not sure. She's kind of in the middle with those nadirs:

    I'm going to ask @Deb & Wink 's opinion on this. I would REALLY like to see you kick the DM dry, if you haven't already. It's high-carb. We use this chart from Dr. Lisa Pierson to determine low-carb food options for our kitties. Anything under 10% is good, ideally under 5%. We most commonly use Fancy Feast Classics or Friskies Pate but anything under 10% is acceptable. By using dry food (and a high-carb food at that) you're elevating her BG numbers. If you do remove the dry make sure you're monitoring her, as it drops the BG noticeably when it's removed.

    Along with that, I recommend getting some emergency medium- and high-carb wet food for potential hypo events. Medium-carb is around 11-17%, high-carb is 18%+ . PM Dry is 18% but dry food isn't helpful in a hypo event, it takes too long to hit the system. Here is our hypo tool kit, everyone should have one yesterday!

    One more question - as indicated by your signature, is Dixie only getting two meals a day? Two meals is very hard on the pancreas, especially diabetics. Small meals throughout the day (mainly at the first half of the cycle) are helpful. Bulk of the meals at breakfast/dinner, then a few "mini" meals, usually at +2 and a couple more times. That includes the night-time cycle. ;)
     
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  4. FarmKitty

    FarmKitty Member

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    Thank you so much for the reply! I will update her SS soon with your suggestions. I will also start doing the +2 tests, although I might hold off on that for a few days because we are really bad at testing her ears right now and they are all bruised :(. It takes a lot of pricks to finally get a good blood sample. I know that we will get better at it.

    The reason she is on the DM dry is because the vet said that her teeth are really bad. She has gingavitus and she is missing all of her canines. Although now that I have looked through the forums, it seems like the DM dry is not very popular and that dry food isn't recommended for cleaning teeth. I just got some Vibrac C.E.T. Poulty Flavour toothpaste today so hopefully that will take over for the dry food. Also, I am open to feeding her gizzards and stuff like that... although I'm not sure if she could chew through it without her canines!

    Another reason I like feeding her the DM dry is because we have a good routine down where we 1.) feed her wet food and she eats most of it 2.) put 1 tbsp of dry food in bowl 3.) she goes back to the food bowl 4.) we give her the insulin shot 5.) she licks bowl clean. Before this, she would run away when we tried to give her the insulin shot and she would often leave 1/3 of her wet food. I will look into dry foods that are low carb (if that even exists), or maybe I could replace this step with the gizzards.

    I will definitely look into getting some medium/high carb wet foods! I have corn syrup ready, but I haven't stocked up on any other wet foods. I will make an effort to get the hypo tool kit ready.

    It's funny that you mention Friskies Pate because that is what we were feeding her before the diagnosis. I still have a case of it left. I have already ordered more Purina DM wet food because I would like to get her a bit more stable before switching over to another less expensive wet food.

    And yes, Dixie gets two meals a day because that is what the vet initially recommended. The vet wanted to make sure that she was eating with each shot. I am definitely open to feeding her multiple times a day though and maybe getting one of those automatic feeders. I'm not sure how much to feed at each time though... if there is a page or forum post on that then I would be very interested in reading about it.
     
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  5. Panic

    Panic Well-Known Member

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    Aww poor Dixie! Advice if you aren't already doing it: only prick the edge of the ear, not the veins, and use neosporin ointment with pain relief. Holding the ear to stop bleeding also helps prevent bruising. <3

    Do vets still believe that myth? They should know better than anyone dry food doesn't clean teeth any more than hard food cleans ours. :rolleyes:

    Hmm has Dixie ever had a dental? Teeth issues can elevate BG. Food won't fix gingivitis. I'd be curious to see what the Main Health forum could recommend to help you out with since she has gingivitis. Would you consider posting there and asking about it? They might have some good advice there for her - lots of diabetic kitties have to get dentals.

    There are currently only two low-carb dry foods available - Young Again and Dr. Elsey's. They're expensive, but they are low-carb. If she were down for another goody that might be better for her. Course getting the shots are top priority and we want her to eat!

    That is excellent! The is little difference between DM wet and Friskies Pate, they are both roughly 5-6% carbs (unless you're using DM Savory Selects - that's higher carb!). It can take months before kitties get "stable" so I wouldn't hold off on a food switch in hopes of better numbers. That's just my thoughts on it though!

    Some vets lump cats and dogs together with the two meals a day thing - that's better suited in dogs. Bad advice for cats. And unregulated diabetics are very hungry - they need at least twice as much as normal. I don't think there is a page on it (wish there was!) but this page touches on feeding kitties "as much as they want". Kind of depends on the cat, but in terms of a 3oz Fancy Feast can, I was feeding one whole can for breakfast/dinner and half a can at each mini meal. She was eating something along the lines of 12-15oz a day, 2-3 cans of FF per cycle! She was incredibly underweight though (only 4 lbs) so she may have been a more extreme case.

    If you want a pet feeder, do snag one soon, Amazon is selling a popular favorite for about half off! The 5-meal feeder is excellent :)
     
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  6. FarmKitty

    FarmKitty Member

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    We've been going closer to the vein to get anything to come out... but we will try doing it closer to the edge of the ear and see if that works out. I've heard about the neosporin oitment although I haven't looked into it yet. I'm assuming it isn't good for them to lick off right?

    Dixie has never had a dental. Her canines fell out around 8 years ago and back then the vet said that they didn't know why they were falling out and they her gums looked healthy. She has only gone to the vet a couple times in her life, so I'm not sure how her teeth got to this point. We adopted her a little over a month ago so she will definitely be getting more checkups now :bighug:. Our recent vet said that her gingavitus was bad and that she may need to get teeth extracted although there is no way to tell unless they are actually doing the procedure. I will definitely post on the main forum to get more info though!

    I will look into spreading out her feedings as well. That amazon feeder looks great, although since I am in Canada everything is always double the price up here :facepalm:. Dixie used to be on the larger side.. maybe 16 lbs. I think she is a ragdoll mix but we have no clue because she was found as a stray kitten. She was on 1-2 cans a day of wet food and unlimited dry food and she ended up losing weight (I guess due to untreated diabetes). Right now she is 10 lbs and the vet said that is a good weight so we have been feeding her 200 calories + freeze dried chicken snacks and she is maintaining her weight. If I were to spread out the meals, I would probably still keep to 200 calories a day because I don't want her getting overweight again!
     
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  7. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    It's likely that 2 things are keeping Dixie's BG numbers high.
    1. the dry food
    2. the persistent inflammation/infection in her mouth with the gingivitis

    The risk with keeping Dixie's food intake low, is that ketones could develop. That happens when the food and/or the insulin is not enough and your cat starts to burn body fat and muscle tissue to provide needed energy. Ketones are a toxic byproduct of that tissue breakdown. There are urine test strips (keto sticks) and/or blood ketone meters to test for this. Please seriously consider one of these methods for Dixie, ASAP. I see from your SS that you have the Nova Max Plus meter, which has special strips for ketone testing. It would be best to test Dixie for ketones at least once a day.

    The additional risk is the gingivitis. Ketones can go too high and lead to DKA (diabetic ketoacidosis) which is life threatening. The classic setup for that is not enough food + not enough insulin + infection/inflammation. Very expensive to treat, with a multiple day to a week or more stay at a 24 hour emergency vet.

    Worry about Dixie's weight another time would be my recommendation. Getting her diabetes regulated and making sure she is getting enough food is more important at this point. Plus the daily check for ketones.
     
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  8. Panic

    Panic Well-Known Member

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    The capillaries in the ear will take a while to form, then it'll get easier, promise. You'll find that one ear will probably bleed easier than the other. Also use larger gauge lancets if you're not already. 30 gauge is a good starter size. It's tempting to go for the vein when you're not getting blood but as you've seen, it's not a good idea. The sweet spot is the easiest area but don't forget you can go all the way around the edge of the ear (mostly upper edge), not JUST the sweet spot.

    [​IMG]

    Yes please do post, I'll keep an eye out because I'm curious as well! The need for dentals can raise BG in cats and can get unavoidable. It can and will knock kitties out of remission. Be good to see if something needs to be done for her.

    Oh shoot, always forget about that in Canada ah!
    Does Dixie look to be a good weight to you personally? If she really should weigh a little more I'd offer her more food, like Deb said. Sometimes a vet's perception of what a cat SHOULD weigh isn't always realistic for the cat ... my vet wanted my girl to hit 10 lbs but she's always been a small cat, I knew she wasn't going to hit that number without being overweight. And you never want to restrict food from an underweight cat. If she is underweight for her size anyway. :p
     
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  9. FarmKitty

    FarmKitty Member

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    Aug 19, 2020
    Is her food intake considered low if I am feeding her enough to maintain her current weight (10lbs)? I just used one of those online calculators and it said 200 calories so we have been doing that. I don't mind increasing her food if that should be done though! As far as what weight she should be, I really have no idea. She is my first cat. She isn't bony at all, and she has long hair so it is hard to get an idea of what her shape should be. I was just going off what the vet said.

    dix1.jpg dix2.png

    I have ketone blood strips and also keto diastix (although I haven't used those yet). The Nova Max Plus showed no ketones (0.3). I am glad I ordered them in and I will keep up the testing!

    I will start a toothbrush routine very soon and will double-check with the vet this week to see what they say about a dental.

    As far as the food, I will start to transition away from the dry stuff ASAP. Maybe I will treat her with the friskies pate or some dried chicken. Or maybe she will now just put up with the injection :D

    Also thank you for the ear picture. I think I have been misreading the whole 'edge' thing. We will try going around the edge tonight! Our lancets are 28 guage and we are trying a mix of lancing devices and free-hand.
     
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  10. Panic

    Panic Well-Known Member

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    Wait, I have to correct myself. 26 gauge is better to start with than 30, oops! The smaller the number, the bigger the needle. If 28 gauge isn't doing it, try 26.

    Ah, a fluffster! Those are tricky to tell. 10 lbs is a bit of the standard cat size, with females being more in the 8-9 lb range, but that's all relative. I have an itty-bitty-looking female who's actually 11 lbs. :rolleyes:
    [​IMG]
    The photos won't help for a fluffy cat but maybe the info on helping you gauge will be more useful.

    Oh wouldn't it be nice if she's so happy with the Friskies she'll let you poke her without fuss!
     
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  11. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Any kind of pure protein is fine as a treat for your kitty Dixie. So if you have some plain cooked chicken, that would work well as a treat too. Treats don't have to be freeze dried. Even some cheese or egg would be ok. If she likes those kinds of things. No waffles or pancakes though, too many carbs in those for a diabetic cat.

    The smaller the number on the lancet, the bigger the pin to poke with. Counter intuitive I know.

    Try to feel through her thick fur, around the ribs. Do you feel a layer of fat over the ribs?
     
  12. FarmKitty

    FarmKitty Member

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    Aug 19, 2020
    Judging by that body condition chart, I would say Dixie is a 4-5. She does have a layer of fat over the ribs (described in that body chart), and she has maintained her 10lb weight with the 200 calories of food she was getting (Purina DM Wet 60g and 1 tbsp Purina DM dry both twice a day). I have almost transitioned her off the dry stuff and have successfully replaced it with the Friskies wet. I think she doesn't really care about the dry food and just enjoys the concept of getting fed something twice LOL. The insulin shots are so easy now. I will have her off dry food completely be the end of the week. Thank you both for recommending that... I think I was a bit stuck in the way of thinking that if something works then don't change it!

    To avoid ketones, how much extra food should I add to her diet? 50 calories more a day? Based off of what I see other people doing here, I might add extra feeding times early on in her cycle. Also, I think splitting her food up throughout the day would be beneficial because she has been throwing up a handful of times which I think may be related to her eating too much too fast.

    I will start testing her pee for ketones daily. She doesn't care at all when I come at her with my spoon :D

    She was 151 (8.4) during her PMPS last night so we tried the first 'token dose' and it seems like her numbers shot up because she was in the pink values for the first time today.

    I have a vet appointment tomorrow! I'll get to show off my charts :bookworm:
     
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  13. Panic

    Panic Well-Known Member

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    Yes, please feed her multiple times a day! It's very hard on them otherwise. The two times a day rule is meant for dogs, not cats. A good rule is to start mini meals at +2 and then a couple more times at least before nadir.

    If you think Dixie doesn't need more calories you can just give slightly smaller breakfast/dinner and use what would have been given then during snack time. The rule is to give 20 calories per lb to maintain weight, but new diabetics often need more than that (at least double) until they're better regulated.

    Let us know what the vet says about the gingivitis issue!
     
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  14. FarmKitty

    FarmKitty Member

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    The vet was onboard with what we are doing :D and couldn't really give us much useful diabetic info other than what we already know. Dixie was diagnosed with a bacterial ear infection so we will be treating her with ear drops for the next couple of weeks!

    As for her gingivitus, the vet showed me and it looked pretty bad. It was a thick red line around almost all of her teeth and some teeth had some grey marks. I asked if brushing her teeth would hurt her and the vet said yes and that is was best to avoid that until after having a dental.

    I have the option of getting her dental done at our vet or picking from a couple of places that specialize in animal dental procedures. My regular vet said that the specialist would be much better than him so now I am leaning towards the specialist haha. Unfortunately, it looks like it will be big bucks. My vet is quoting $1700 for the procedure + $900 for the ultrasound and bloodpanel... and that isn't even including teeth extraction ($78 - $250 per tooth!) or IV fluids. I can't imagine what the specialist will charge :nailbiting:. From snooping around the forums it seems like these prices are pretty crazy, but maybe it is because I'm in Canada.

    I will take some time to think about what the best place to go for her will be, but I definitely don't want to wait too long.

    Her PS numbers seem to be hovering more in the blues now so we have been a little bit more aggressive about giving her shots. Her PMPS tonight was 8.7 (157) so we gave her a 50% token dose. I know this goes against the SLGS method, but I don't think stalling and changing her meal times each day would work for me, and I don't want to skip all of her shots! I guess this is just the process of determining her normal PS numbers. If what I am doing seems wrong or too aggressive then please let me know.
     
  15. Panic

    Panic Well-Known Member

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    Wow! Poor Dixie! :eek:

    I would ask in the Main Health forum about those prices - I know Dixie needs a lot of work but that still sounds really expensive! There's a lot of Canadian members so perhaps someone can confirm if that's standard pricing or if they know somewhere else to go.
     
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  16. Deb & Wink

    Deb & Wink Well-Known Member

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  17. FarmKitty

    FarmKitty Member

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    Thank you both for the dental info. I'll start researching that and get her an appointment!

    Dixie's numbers have gone rather low the last few days. She went from 191 (AMPS) to 65 (AMPS+2). It was my understanding that switching to feeding her +2 meals would slow down the drop, but instead it's almost as if it increased the drop? I have given her 2 dose reductions in the last two days!

    If someone could check my spreadsheet I would greatly appreciate it. Thank you.

    (Also sorry for the lack of data... it is still extremely difficult to get her ears to bleed! I wrongly thought that since her PS values were so high that there was no way she would be going this low... good thing I checked!)
     
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  18. Panic

    Panic Well-Known Member

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    Wow, congrats on the reductions!

    It's entirely possible that Dixie onsets at +1 instead of +2 ... you could get a +1 and check if you see a dip. If so you'd want to switch snack time to then. Great job so far!
     
  19. Deb & Wink

    Deb & Wink Well-Known Member

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    Very good thing you checked! VERY GOOD!!!!

    Has Dixie's appetite been good? Eating her full meal after the pre-shot test and the insulin shot?
     
  20. FarmKitty

    FarmKitty Member

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    Hmm I will start getting a few +1's in and see what's up.

    Dixie's appetite is very good. She eats her full meal every single time (I am very lucky).

    The only change I have made to her diet recently (besides switching to 4 meals a day as mentioned in her SS) is changing her off of the dry food and moving just to wet. This was done gradually by giving less kibble each day and replacing with wet. I think she has been completely off of dry food for 9 days now. She used to be on 200 calories and I just calculated her new calorie count and it is 180. I didn't intend to reduce her calories at all... I just underestimated how her dry food had more calories than the wet. Oops! I will transition her back up to 200 cals (she will like that hahaha).
     
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  21. Barbara

    Barbara Well-Known Member

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    [QUOTE
    The reason she is on the DM dry is because the vet said that her teeth are really bad. She has gingavitus and she is missing all of her canines. Although now that I have looked through the forums, it seems like the DM dry is not very popular and that dry food isn't recommended for cleaning teeth.
    [/QUOTE]

    I have the proof that dry food is NOT good for their teeth....I just had all 5 of my cats teeth cleaned. The 2 with the worst teeth, loosing 5 each are the youngest that were born feral & the rescue that had them before me only fed dry...try as i might I have had an awful time getting them off it. The 3 that eat wet food had much better teeth!

    Well, I obviously don't know how to shorten the quote but you get the message!
     
  22. Panic

    Panic Well-Known Member

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    This is interesting! While dry doesn't clean teeth, wet doesn't promote dental health either. In fact, both dry and wet food produce dental tartar, dry just doesn't produce AS much as wet. So I've read anyway. :confused:

    I started adding Plaque Off to all my cats' (and dogs) food! As long as the animal doesn't have any thyroid issues, it's a really neat supplement. There's been rumor that it lowers BG too.
     
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  23. Deb & Wink

    Deb & Wink Well-Known Member

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    You might even consider giving Dixie a few more calories. If she needs to gain some weight back that is.
    Unregulated diabetic cats don't process the food they eat as well, so need more calories, more food intake to balance out the poorer use of the food they do eat.

    Dry is higher in calories, more calorie dense, per ounce. Wet is just about always lower in calories. Except for some high calorie "rescue foods" like the Hill's A/d.
     
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  24. Barbara

    Barbara Well-Known Member

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    Add to that the 3 with better teeth are older....the 2 younger ones are siblings & were born feral but I got them when they were about 3 months old....to try to tame them enough to adopt...6 years later here we are! LOL! I've never heard of Plaque Off, where do you find it? I suppose them having worse teeth could just be coincidence, I just found it interesting.
     
  25. Panic

    Panic Well-Known Member

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    Sounds like a successful adoption to me! :woot:
    I get it from Amazon, seems to be cheapest there. Just purchased a larger container of it - with 4 cats and 2 dogs getting it every day it made more sense, plus it was cheaper to get the big one. :p There is a cat-only variety with Brewer's Yeast added to get the cats to eat it - I think that is the one rumored to lower BG. My cats use the cat/dog variant and they don't seem to mind the taste.
     
  26. FarmKitty

    FarmKitty Member

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    Feeling a bit down because Dixie's numbers have risen since her dose was reduced. I wasn't testing her Nadir at all this past week and SLGS says that we need to know her Nadir before we can increase the dose... oh well lesson learned. I hope this isn't doing too much damage to her :(.

    She has two vet appointments lined up this week. One is to learn how to clean her ears because her bacterial ear infection isn't going away. The other one is a pre-exam to get her ready for a dental. I'm happy that I have started the dental process, but this will definitely be a rough week on her.
     
  27. Deb & Wink

    Deb & Wink Well-Known Member

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    Set an alarm to get you up at night? Would that be possible? Doesn't have to be every night cycle, but now and then.
    Drink a big glass of water before you go to bed. Then, when you get up to use the bathroom you can take a BG test for Dixie. ;)

    Hang in there. Dixie will get better. It takes time.

    You could try a very tiny increase in the dose. What we would call a "fat" dose. Slightly above the half unit mark on the syringe. So you would record that as a 0.5F on the SS in the dose column.
     
  28. FarmKitty

    FarmKitty Member

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    Thank you for the encouragement. Dixie's ears have finally learned to bleed! It is so easy to test her now!! So I will be able to gather lots of data :D

    I started giving her 0.5F units, and then raised it to 0.75 units because her nadirs were high. The 0.75 unit made her drop below 5mmol/L so she is back to 0.50 units...

    I 'feel' like she needs more insulin because her numbers looked better back when she was on 1.0 unit. The +2 tests are also higher (and they are all taken before her +2 snack so that isn't a factor). But I can also see that the 1 unit sometimes made her AMPS and PMPS on the lower side, and I definitely don't want her going into hypo!

    Dixie is has been a bit slower the last week. Maybe it is the vet visits and house reorganizing. I hope it's not from her BG levels.

    Thank you again for all the help.
     
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  29. FarmKitty

    FarmKitty Member

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    Another good update: I just got back from a new vet for Dixie's pre-dental checkup. The vet couldn't hear any lung sounds and doesn't think she has asthma (yay!). She thinks there could be a grade 1 heart murmur (previous vet thought grade 1-2), and she isn't concerned about it for the dental. Regarding her teeth, the vet said that Dixie has mild gingivitis and might not need any extractions. I picked this vet because she has an interest in dentistry and has done a lot of operations.

    Only health concerns at the moment are her ear infection (which was a bacterial infection that turned into yeast infection). The vet mentioned that diabetic cats have lots of inflammation, and that ear infections could be a result of skin inflammation because cats should rarely get ear infections. She mentioned something about how it could be food related or environmental related or something like that.

    Additionally, Dixie has had some bowel problems the last two days. She seemed lethargic the whole day and then pooped in her litter box, but she ended up dragging it all across the floor o_O. Maybe she was constipated? The vet today said that she had some hard stool stuck in her colon so I will need to just wait and see what happens. The vet said that if this keeps happening then I will need to start sprinkling PEG powder into Dixie's meals.
     
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  30. Deb & Wink

    Deb & Wink Well-Known Member

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    Dixie did earn a dose reduction when she dropped < 90 mg/dL and using the SLGS dosing protocol.

    Yes, a little bit of PEG powder (aka Miralax or generic form is polyethylene glycol 3350) does wonders for constipation. Tasteless, odorless, but does cause the food to get "gummy" quickly if the food isn't eaten all at once.

    My civie (non-diabetic) Dancer gets the Miralax daily. 1/8 teaspoon in the AM plus 1/8 teaspoon psyllium husk fiber AM and PM. She has rock hard poops otherwise. Took a bit of experimenting to find the right dose. If I try to cut back, her stools get too hard again.
     
  31. FarmKitty

    FarmKitty Member

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    Aug 19, 2020
    Thank you for the info Deb. I think Dixie's poops are turning out to be okay now... although it is hard to say! I've only had her for a few months now so I'm not sure what the typical cat poop texture should be :D. I will keep an eye on her litter box.

    @Panic thank you for the advice on doing small meals throughout the day. I have a Petsafe 5-feeder now and have started feeding 6 meals/day of the Purina DM canned (will switch to Friskies pate). I've also upped the food to 200g (225 cal/day), since Dixie leaves a bit of food behind in the automatic feeder.

    Here is her schedule:
    • AM shot time: 60g
    • AMPS +2: 20g
    • AMPS +4: 20g
    • PM shot time: 60g
    • PMPS +2: 20g
    • PMPS +4: 20g
    Does this schedule look good? Or do you think I should change the times or add another feeding time? Dixie has adapted to the automatic feeder very quickly!

    Also, how will this affect my BG tests throughout the day? Since the feeding times are 2 hours apart, should I try to test right before her meal times? Or is it ok if her spreadsheet has food influenced values?
     
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  32. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Excellent! :D

    You could throw in another meal at +5 if you wanted, I always gave at least 3 mini meals but I don't think there's any recommended minimum.
    Don't worry about the mid-cycles being food-influenced, we just don't want food affecting pre-shot numbers. Take those mid-cycles whenever. :p
     
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  33. FarmKitty

    FarmKitty Member

    Joined:
    Aug 19, 2020
    Dixie's numbers have been on the rise lately. It sometimes seems like the insulin isn't even doing anything.

    I'm trying to come up with some possible explanations:
    1. I haven't scheduled her for a dental appointment yet to deal with her gingivitus (which my new vet says is a medium case)
    2. Increased her calories from 180 to 230
    3. Changed from 2 meals a day to 8 meals per day
    4. Changed her food from Purina DM Canned to Friskies Chicken Pate and Friskies Turkey&Gibblets pate (I think it might have more carbs)
    5. Changed litter from paper to clay
    6. She has been waking up during the night meowing in a sort of weird disoriented baby-talk type of meow that lasts for 30 seconds (typically, she will only meows at breakfast/dinner time)
    7. She has a yeast infection in her ears again that I am treating with Surolan ear drops. It looks like it has cleared up again so I will stop in a day or so.
    8. When I draw up the insulin, I will squirt the excess back into the insulin bottle (without removing the needle). Maybe this is contaminating it? (for the first week or so I was removing the needle first... ugh)
    9. I keep her insulin bottle near the front of the fridge. My fridge has issues with freezing stuff if it gets pushed to the back, so I have a freezer thermometer in the fridge next to the insulin. I think it said it was nearing 0C sometimes, but I don't know the accuracy of the thermometer. I reduced the temperature setting on the fridge. I have never noticed her insulin bottle freezing though.
    Do any of these seem like likely explanations? I was going to prioritize making her dental appointment but is there anything else I can do?

    If her numbers are higher like this, then is it causing her a lot of damage? I want to do anything I can.

    I think I will raise her ProZinc does back up to the original 1.0 units tonight.

    Thank you.
     
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  34. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yes, agree with your thoughts to increase the dose back to the 1U dose. Dixie needs to get back into some better BG ranges, those blues and greens.
    With the completion of the food change to low carb, there is no reason to be so cautious with the dose we had you reduce to. So my recommendation is to increase by 0.25U so back to 1U (from the current 0.75U).

    I'd get a BG test when she does this. Just to double check that her glucose levels aren't dropping low.
    The yeast infection is the likely culprit for the higher BG levels. Or the need for a dental could be contributing some to the higher BG levels. Those BG readings can be caused by a number of factors. So it's hard to pin down the reason.

    Does the insulin still look good? Still uniformly cloudy when you have rolled it? No floating particles? ( You may need a magnifying glass to see this, if your eyes are bad like mine.)

    How old is your bottle? Prozinc does degrade faster than some of the longer duration insulins. Manufacturer says 42 days I believe, counting from the day the rubber seal at the top was breached (the first time you used an insulin syringe.)
    Has the bottle ever seemed too cold when you took it out of the fridge? Was it ever kind of "slushy" or "thicker" than normal? Any signs of "frost" on the bottle itself, or some of those "snowflake" patterns on the bottle sides or bottom? That would say the insulin was too cold.

    The lower carb food and more calories is unlikely to be the reason for the higher BG levels overall.
    WHEN you feed can make a difference. We suggest that you try to feed the bulk of the food before +6, as the insulin gets "used up" by the food eaten earlier in the cycle. Feeding later in the cycle will usually raise the BG levels more and faster.

    I can't see the litter making any difference. Unless you changed to a litter that has wheat or corn in it (Swheat Scoop is one such product.) and your cat is eating the litter.

    Numbers that are higher, for extended periods of time, do cause slow and gradual long term organ damage. I won't lie to people about that or try to hide the truth.

    It's one reason we press people so much to learn to home test the BG's and ask for more testing. The better you can control the BG levels, the less damage the excess glucose will do to the tissues and organs and nerves. The less sugar rich (no glucose spilling into the urine) the kidney and urinary tract system is, the less likelihood of UTI's or kidney damage. The more time that Dixie stays in those blue and green colored coded range BG numbers, the better for her body.

    It's very possible that Wink's first adoptive family ignoring his diabetes symptoms for so long caused his heart damage. So even though I got him on a low carb diet and managed to get him OTJ (off-the-juice, insulin being the "juice") fairly quickly, the damage was done before I ever took him in as a foster cat. We'll never know for sure.
     
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  35. FarmKitty

    FarmKitty Member

    Joined:
    Aug 19, 2020
    Thank you for the advice about ditching the S/F dose changes. I think the step back to 1.00 has really helped her.

    My bottle of ProZinc is 93 days old, and it does have those "snowflake" patterns on the sides of the bottle only (not the bottom):

    test.jpg

    However, the consistency still seems to be the same.

    Also... Dixie's numbers have suddenly jumped down to the blues!!! She even spent two cycles entirely in the blue/green range (I can't believe it!!). So I guess the insulin is still working. She has another ear infection at the moment, so it will be interesting to see if her numbers jump up to the pinks like her last infection.

    I have decided to switch from SLGS to MPM, and I am also lowering her preshot safe range quite a bit because I think my method of using a sliding scale wasn't working very well (although it did give me the confidence to slowly lower the safe range).

    I am still scared that maybe she will dip a bit too low (such as when I gave her a full dose at 99 (5.5)), but I have the hypo kit ready and she sits next to me all day so I think I am ready to handle any situation she throws at me.
     
    Last edited: Oct 23, 2020
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  36. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    MPM dosing method it is then! Glad you have the confidence to try that and have learned a lot about what the pre-shot range tells you about Dixie.

    Dixie is spending good amounts of time in the blue BG ranges. That sure does help to give her pancreas a rest. Bet it makes her feel better too.

    So what is your "decision point" BG pre-shot now? I see you shot the 1U dose with that 5.5 (99 mg/dl) yesterday. Do you go lower than that?

    Did Dixie stop laying in the new, fresh, unscented litter in the litter box? And finally use the new litter?:cat:
     
  37. FarmKitty

    FarmKitty Member

    Joined:
    Aug 19, 2020
    I gave Dixie a 1U dose at 92 and she did fine. According to the MPM sheet, I can go down to 50. I would only shoot this if I had more data and I was awake to test her throughout the cycle. Luckily, these low PS values have been in the daytime!

    Yes, Dixie used the new litter and hasn't laid in it since. However, I have noticed some issues she has with her litter:
    * She lays on her litter mat every day
    * She dragged some poop across the floor the other day, which has only happened once before
    * Vet mentioned she had some hard stool stuck in her colon during her last visit
    * She sometimes stares into the litter box

    However, on the other side:
    * She still uses the litter box several times a day like normal (still peeing a bit too much)
    * The litter box is right across from her feeding station, and she seems to only lay there if she is ready for breakfast/dinner
    * The litter box is in the kitchen which has cold tiles and I never see her lay on the tiles, so she might just be trying to avoid that
    * I am in a small one-floor apartment so it isn't like she needs to stay next to the litter box in case she can't make it in time

    I've read that cats can show certain health problems in this way... so I think I will move the litter mat and see if she still lays there. I'm guessing that would reveal a lot!

    (Also, I know it isn't great to have the feeding area near the litter box, but I am working with what I have I separated her food/drink/litter as much as possible and it seems to be working!)
     
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  38. FarmKitty

    FarmKitty Member

    Joined:
    Aug 19, 2020
    Dixie has been spending a lot of time in the dark greens :D. However, some cycles she will stay in the yellows the whole time and it seems as if the ProZinc has no effect.

    Does this seem like bouncing? Or does it look more like an issue with the injections?

    Edit: I just tested Dixie and it seems like even though she was in the yellows at PMPS+3, she actually ended up in the green at PMPS+6. I'm glad I got that test, because I was usually assuming that she was staying in the yellows if she had a yellow test. I wasn't very good at getting extra tests during her other cycles where she had yellows (because I assumed she would be safe), but now it looks like I need to make an effort to get more data!
     
    Last edited: Nov 8, 2020
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  39. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    More data will be good! Our diabetic cats can surprise us, and drop into lower BG numbers during the cycle.

    Now that you know, and will be getting more tests, hopefully Dixie will show you some more green BG numbers at mid-cycle.
    Dixie seems to be doing well on the 1U dose for now. Not quite ready for a reduction though, since she hasn't dropped below 50 mg/dL (2.7 mmol/L) yet. But she has gotten close to a reduction point a couple of times.

    Since you switched to the MPM dosing method, she has been doing well.

    Is the roof construction completed? Or is Dixie's appetite at least more consistent, if the workmen are still around?
    I see from notes on your SS, in the Remarks column, that she isn't eating well still.

    How is she acting when she won't eat? Sniffing at the food and walking away? Or something else?
     
  40. FarmKitty

    FarmKitty Member

    Joined:
    Aug 19, 2020
    The roof construction was only for a couple of days, so that isn't an issue for her anymore. Today, she just didn't want to go to the PetSafe feeder when it triggers (whereas usually she will go to it immediately). My partner was giving her tests and then that seemed to trigger her to go check out the feeder, and once he had to lure her with a chicken treat. It seems like she ate most of her food though (I was originally incorrect with my remark I wrote for today because it turns out she was eventually eating).

    She is also getting to be a lot more difficult with her main meals of the day. I usually feed her 40g, wait for her to finish, then give her an extra 10g and give her the shot. She used to be a perfect little angle with this method! Now, she'll eat maybe 20-30g and then run under the bed... I have to keep picking her up and placing her in front of the feeder (where she will usually eat more). Sometimes we give her a chicken treat on top of her meal to entice her, but now it seems like she expects it (which I don't want to encourage!).

    I feel like it isn't nausea related because if I pick her up and put her in front of the feeder, she will start to eat again.

    I wonder if maybe the shots are hurting her since we have let her fur grow in over her shaved patch. I will shave the squares back into her so maybe that will make the shots go smoother (and less chance of her running under the bed :nailbiting:).

    Edit: I just had a thought... since Dixie is now considered regulated, then I would guess that would reduce her appetite (she was pretty ravenous when we started the insulin!). How much food should I make sure she eats at shot time? Is there a minimum I should aim for?
     
    Last edited: Nov 9, 2020
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  41. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yes, when a diabetic cat gets into more normal BG numbers or becomes regulated, their appetite does diminish.

    There is no minimum food amount you should aim for, before you give Dixie her insulin shot. In fact, there is an old thread somewhere that explains why it's a bad idea to skip the insulin shot if your cat isn't eating. Mainly having to do with ketones being produced from not enough insulin and not enough food.

    I think that many vets talk about only feeding twice a day, at 12 hour intervals, to make sure your diabetic cat is hungry at shot time. We don't advocate that here, as we know that mini-meals work well for most diabetic cats. If you don't already, taking up any food about 2 hours before shot time leaves time for your cat to be hungry and it helps in having that non-food influenced pre-shot test.

    Since Prozinc doesn't onset until about 2 hours after the shot, as long as there is food available for Dixie, she should be fine. Many cats will in fact seek out food, when they feel their BG levels dropping low.

    I remember when Wink went from eating around 11 ounces of food a day, to around 5-6 ounces. He was unregulated when I first fostered him and on a really high carb diet. Took a while, but getting him on a better diet helped to get his BG levels down, and that helped diminish his ravenous appetite. The lessening of his appetite didn't happen all at once, but was more gradual. That same gradual effect is probably why Dixie is not eating as much.
     
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  42. FarmKitty

    FarmKitty Member

    Joined:
    Aug 19, 2020
    Thank you for the info about eating! I didn't realize that it wasn't necessary that they finish all of their meal at shot time. I have stopped worrying about Dixie finishing her meals and things have just sorted themselves out. She often goes back to eat her main meal after an hour, otherwise I just scoop it into her next meal :) Dixie's appetite seems to vary depending on the day. Some days she isn't that interested and leaves bits behind, but other days she will lick every bowl clean, so now I am not too sure if her appetite has diminished or not.

    Dixie has been getting pretty low lately. She has hit 2.7 mmol/L a couple of times but she hasn't dipped below that so she hasn't technically earned a dose reduction. I am wondering if I am doing the right thing? Is it ok for her to hang out in the dark greens for so long?
     
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  43. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Those dark green BG numbers are what we call the "healing numbers". They give the pancreas a rest and a chance to heal.

    So yes, it is fine for her to hang out in those dark greens for as long as you are able to keep her there. We sometimes call it surfing, because the cat's BG levels are "riding a wave", holding steady and in the greens.
     
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