Dosing advice - newly diagnosed

Nini

Nini

New Member
Hi all,

First off I want to say I'm so glad this forum exists. My vet has never had a cat with diabetes before so everything is a bit of a mess. He is now going on seminars and training courses with his nurses but that doesn't immediately help my little kitty.

Her name is Pepper and she's 14. She was diagnosed 5 weeks ago and we started her on Prozinc for the first 4 weeks. Started on 0.5u and steadily increased up to 4u with 0.25 and 0.5u increases after a few days. I have put the numbers I have to hand in the spreadsheet in my signature (hope it works), just in case this adds any value.

She does not like needles and it was a bit of a hit and miss so we decided to go for the Caninsulin VetPen which is a godsend, she doesn't even know she's getting an injection. At this point, I also purchased a AlphaTrak2 after reading in this forum how important home testing is (Thank you!!)

However, the Caninsulin does not seem to have any effect on her glucose readings. I know it is still early days, we started on 2u because her Glucose was at close to 40 (700 in US) on the 9th of June and are now at 3u but last night, both readings PS and 2 hours after were so high, the Alphatrak couldn't read it.

Testing is a bit hard because we need to both be home and we both work full time but we do what we can.

She refuses to eat any form of wet food other than boiled chicken (Don't know if that's any good for her so have not been feeding it) and the only thing I could get her to eat with lower carbs has been the Hills M/D dry food. But this has also not made a difference in the last week. Maybe too early?

Anyway, I thought I would write a little book for you all and see what your thoughts are. If there is a best time to test her glucose, please let me know and I will try and fit it in. I am usually out all day between her 2 shots but I have a few holidays coming up and might be able to get more tests in there.

Thank you for reading all this and thank you for giving people such great advice on this forum.

Nina
 
Hi Nina and Pepper, welcome to FDMB. We want to get the answers you need to help pretty little Pepper and get her to better BG numbers. Nobody likes seeing those high numbers and I'm sure she doesn't feel very well right now.

It's fantastic that you have created the signature and set up the spreadsheet (it works!). Every bit of data is useful. I am not a Canninsuln/Vetsulin user, but I do know that you should test before every injection, and as well as you can between injections. Pepper's numbers are high now, so there isn't the same danger of a hypo that there might be with other kitties, but it's a good habit to get into now. The experienced members will want to see that data, and this will help keep her safe as she responds to treatment and the numbers come down.

I know it can be a challenge to change the diet, and you are trying. Some cats are very hard to transition but that dry food that she will eat is just contributing to the high BG. The Hills DM food still has too many carbs, unfortunately. She can have plain poached chicken, it's low carb and it's a start. It's a good treat for before and after testing too. However, it's not a nutritionally complete alternative for the long term. You could chunk up the cooked plain chicken and gradually add some water, to make it more moist like canned food, then perhaps add a very small amount of a low carb chicken based canned food. Maybe sneaking it in will help?

Here is a link to some information about supplies in the UK:
http://www.felinediabetes.com/FDMB/...-vit-b12-and-other-need-to-know-stuff.137376/
and a link on transitioning from dry to an all wet diet:
http://www.felinediabetes.com/FDMB/threads/transitioning-your-cat-from-dry-to-wet-food.956/

Another fairly new UK member is working with her cat (another dry food lover) using raw meat and a supplement. This may be something for you to consider. Here are links to threads that @Zee has posted regarding her struggles to her her kitty Mum toward a better diet. Other members have offered some suggestions along the way that you might find helpful.

http://www.felinediabetes.com/FDMB/threads/fancy-feast-or-equivalent-in-uk.213712/
http://www.felinediabetes.com/FDMB/threads/raw-food-dangers.213419/
http://www.felinediabetes.com/FDMB/threads/am-i-feeding-the-wrong-food.215384/

We offered Idjit chunks of raw chicken breast and whole raw chicken gizzards/heart just to see if he recognized it as "food". He did, but this cat is a champion eater. So we made the decision to transition to raw with a complete nutritional supplement
Whatever low carb wet food you can get her to eat, the better to help bring down those blood sugar numbers. If raw food works there are other members beside myself that can offer more information on the process and what works for us.

Please read the yellow tagged stickies at the top of this forum, very valuable information here. I know that you will get responses from the experienced Caninsulin/Vetsulin users today.

Very best wishes going forward Nina, this truly is the best place for you to be right now to learn how best to help Pepper and work with your vet as you both learn. :cat:
 
Hello Idjit"s mom :)

Thank you so much for your reply and for taking all that time to write back. Your information has been very useful and you are right, Pepper is not feeling her best the last couple of days. She's back to how she was when she was first diagnosed which is a setback but I have hope that we can sort this out soon.

Regarding her food, I've been feeding my dogs raw for 10 years but have never managed to convert any of the cats (there are another 2 kitties here). I won't give up trying though, not with the wet food either. I know the dry MD is still bad, this one has 18% carbs but the one she used to eat had 43% (shocking) so it is at least a slight improvement until I can convinced her to eat wet food again. She used to love it but has gone off it.

I will definitely try your suggestion of mixing the chicken with water and then canned food to see if that helps. I did not even think of that so thank you very much for that tip. I really appreciate it

Best wishes to you as well, and thank you again for your lovely reply :)
 
Hello and welcome to you and Pepper. Pepper is a beautiful little girl!

I can completely relate to the frustration of having a kibble addicted feline. My extra sweet girl refused to ackowledge wet food was edible from kittenhood until 2 plus years into our diabetic journey. Ultimately, our kitties have to eat so if kibble is what Pepper likes right now, let her have at it but keep trying to get her to accept the wet food as well. Right now with those high BG numbers, I don't think switching her to an all wet diet is necessarily the safest thing to do. I think we need to figure out why her BG is so high and determine the optimal dose of insulin for Pepper at this time. Diet change will need to done slowly and carefully.

With our diabetic kitties we worry about ketones. With high numbers like Pepper's we worry about ketones even more. Ketones can lead to DKA which is a very serious complication of diabetes so it's very important to test Pepper for ketones regularly while getting her BG under control.
You can get Ketostix at the local pharmacy and test her urine if she is not shy about her visits to the LB. Some folks are able to hold a plastic spoon or small ladle under kitty's butt and catch a few drops of urine to test while others put scrunched up plastic wrap strategically in the LB where kitty prefers to pee hoping to catch a few drop of urine to test. This of course is a bit more problematic if Pepper has any furry siblings. There are glucometers that can be used to test for ketones as well and if you cannot test Pepper's urine, I encourage you to seriously think about getting a meter to test her. With the Ketostix any reading above trace means a call to the vet for advice or a vet visit. On a meter ketone test, any reading over 2.4 indicates ketones are in the picture and a vet consult is needed.

Idjit's Mom, Lou has already touched on testing before every shot and when possible, at some point during each 12 hour cycle. The test before giving insulin tells you if it is safe to give insulin while tests taken after the shots tell you how much the dose is dropping BG and those are crucial to determining optimal dose.

It's more of a challenge to get mid cycle tests when you are working outside the home but sometimes scheduling shots around work hours allows you to either grab a test a couple of hours after giving insulin before you leave for work or as soon as you get home a couple of hours before the evenng shot is due. All data helps and provides clues as to how the insulin is working. More mid cycle testing can be done on weekends. We also strongly suggest getting a test before bed every night as many if not most cats go lower at night than during the day.

You are not the first to need 2 folks to test but with a little bribery (carb free treats after testing and before if need be), you will probably be able to test with only one person. May take a wee bit of time, but most kitties eventually calm down and accept testing much better than we expect they will. Another new member was in the same boat and within a couple of days, managed to get her kitty to co-operate much to her surprise.

You mentioned originally using ProZinc and then switching to Caninsulin. While the best insulin for your cat is the one that works, ProZinc tends to be a more gentle insulin and in many cases, provides much better duration than Caninsulin and duration issues can contribute to higher BG.
We recommend dose adjustments of 0.25u which is not possible with the Caninsulin Vet Pen because even dose changes of 0.5u can sometimes be too much. The confounding part of this is that too much insulin can look just like too little so making small dose changes every few cycles rather than larger ones ensures you don't bypass the best dose for your cat.

If you can share a bit more info about the insulin types and dosing history so we can understand how the doses were adjusted and how frequently, it would be helpful. I'd also strongly recommend checking for ketones as soon as possible.

Let's see what we can do to get your beloved Pepper on the road to feeling better.:)

And you thought you wrote a bookl! ;)
 
Hello Linda,

thank you very much for your reply. Yes I thought I wrote a book but you ladies clearly know how to write a book, and I have more to learn than I thought ;)

I should have mentioned that I do test for Ketones and have the test strips at home. My vet gave me those when she was diagnosed, he at least knew that we need to test for this. Pepper has no shame so she lets me put a little cup behind her while she pees in her box, so I can collect some urine. She just gives me that "why, mother??" kinda look lol. So far, all ketone tests have been clear and I test once a week. Should I test more often?

Regarding the food, I have not given up yet. But like you say, I rather she eats something than nothing at all. And I agree that getting her dose right is more important at this point. If she ever accepts wet food, I would monitor her closely and lower the dose if needed. She doesn't really eat a huge amount and she's a grazer luckily, so will eat around 4 small amounts of food throughout the day, and usually once at night.

We did not test her last night because from her behaviour, I knew that her glucose was high, and I didn't want to torture her needlessly. We put her dose up to 3.5u last night. I unfortunately only have what's in the spreadsheet. I didn't have the AlphaTrak until we started her on Caninsulin, but while she was on Prozinc, her levels were never below 20, only once at 17.8 when she was at the vet all day for tests and didn't eat. That was the lowest they got her to. Only when we put her on 4u of Prozinc twice a day was there any reaction. And the dosage was put up by 1/2u at a time, from 0.5 to 4u twice a day, usually staying with the same dose for at least 3 days and monitoring for change. But there was none until 4u as per the spreadsheet. I could only take her in once or twice then for the vet to test her bloods so we are in much better position now I think and this weekend, we can do some tests during the day.

I hope she will have a positive reaction once we get to 4u twice a day, like she did with the Prozinc. Fingers crossed.

Thank you both for your help, I really hope we can get Pepper sorted, she's the best cat I ever had (don't tell the other 2)
 
Hi Nina. I feel for you.. I have a junkie for a cat so know how hard it is.. I’ve thrown more wet food than I’d care to list on here.. however although not completely transitioned madam now has a couple of meals of raw food! I’m not a hundred percent sure I’m feeding absolutely the perfect diet but am doing my best... Madam still has some dry food... I’ve had to slightly take the pressure off myself in order to stay sane... I know we all strive for doing a ‘perfect’ job of being cat parents - but sometimes it can become all too much.

Mum is overweight, her levels fluctuate, but she seems content and ok in herself... good enough for me...
 
BTW - I mix 3 types of low fat mince (human) beef, turkey, pork and add Felini complete supplement and a bit of wild salmon oil... she loves it...
 
So glad to hear the vet recommended testing for ketones. I am impressed because it's quite rare for vets to suggest ketone testing. And how lucky you are that Pepper isn't a shy girl. While her BG is so high, I'd test daily just to be on the safe side. Ketones can start and progress quickly so catching them sooner rather than later makes treating them so much easier. Testing for ketones immediately is a must if Pepper's appetite drops or you notice her becoming lethargic or hanging over her water bowl constant.

Since the only BG testing done while Pepper was on ProZinc was done in the vet's office, I have some concerns. Our kitties typically get very stressed out at the vet. Many are stressed by the travel to get there and then all the handling by strangers not to mention all the different sights and sounds can raise BG by 5 to 6 mmol. and sometimes even more. This in turn leads the vet to think BG is higher than it normally is in the home environment and that the insulin dose needs to be increased when often it does not. Too much insulin can look just like too little so the insulin increases set up a vicious circle that is hard to figure out.

Given dose increases were done in 0.5u increments and how early it still is in your journey, I have to seriously wonder if that 4u of ProZinc wasn't too high. That is a high dose for a kitty just over a month past diagnosis. I wouldn't do any more dose increases right now and give Pepper time to get used to this dose. Check her for ketones daily. And get a pre-shot test before every shot as well as a before test every night during the week. On the weekend try to grab some more tests during the middle of the cycle to see what Pepper is up to. You need to know how low a dose is taking Pepper. Blindly increasing the dose based on pre-shots is not safe.
 
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