*Maddox* Restarted insulin after vet said to stop due to ketones. Could use some help regulating.

Hi All!


My cat Maddox was suspected of diabetes and started on Prozinc, but then developed hepatic lipidosis. The vet wasn't sure if the Prozinc caused his blood glucose to drop to 124 or if it was due to his poor eating. We stopped insulin to focus on the hepatic lipidosis. On 5/3 his labs improved, but his fructosamine test came back high, and the vet suggested he might be prediabetic and recommended a diet change without insulin, and told me to discontinue insulin because he seemed hypersensitive.

On 5/16 I posted on the FB group because his home test showed up for ketones (more than trace closer to small-med) and with the helpful support of the group started him back up on 1 unit prozinc. (He was originally RX'd 3 units of prozinc due to his large size/weight.)

Now that it's been a few days I guess I'm kind of lost in knowing if he's heading in the right direction on this dose? Especially since this isn't even his original RX'd dose. The ketone strips are getting lighter each day and the last one I did got down to trace so I'll keep testing. But any insight is SO appreciated because I def don't want to be giving him too much/too little insulin.

Just a note: both my cats are diabetic and the spreadsheet has both so this post is for the Maddox tab.

 

@Bron and Sheba (GA)
@Wendy&Neko
@Chris & China (GA)

 

Tagging @Suzanne & Darcy since she is familiar with Prozinc since that's what Maddox is on
You also need to be testing more often for both cycles like I suggested for Miki
Please read all about prozinc here


https://felinediabetes.com/FDMB/forums/prozinc-pzi.24/

 

@Bumblebee
Since Miki is on lantus I suggest you read all the yellow stickys
Especially the 2 Dosings Methods to follow
I'm no expert but one thing I can tell you he is in this dose way way too long
You also need to be getting more tests in during the day cycle and especially the night cycle
It looks like you didn't test some AMPS because they are blank but gave insulin and did not test after them
With lantus we adjust the dose by how low the cat is dropping which is called the nadir.
You will never know this since you are not testing enough for both cycles
I tagged a few experienced members for you to look at your SS and look at the dose you have been giving.
On your spreadsheet you have a ? Where it says TR or SLGS that's were the 2 dosing methods come in

Please read all the yellow stickys here about Lantus
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

 

Which Royal Canin is he eating? Wet or dry? The Savory Selects is 10% carbs so a little higher carb than most people feed. I'm trying to get an idea of his carb intake. Is he eating back on his own and over the hepatic lipidosis?

It was a good idea to restart insulin and I'm happy to hear the ketones are fading. It's be helpful to us if you put the ketones test results in the Remarks column of the spreadsheet, so we know they are happening and improving.

3 units was way too high a dose to start on! With dry food in the picture or higher carb, 1 unit is a better starting dose. It also means following the SLGS dosing method.

Is it possible for you to get any BG tests after PMPS? Maybe even a +2 or before bed test? We don't have any data about what's happening at night and many cats go lower at night. To figure out how he's doing on a dose, we have to see how low it's taking him. It's possible the higher numbers are due to bouncing from numbers we aren't seeing.

 

@Wendy&Neko
I meant to tag you for her other kitty that is diabetic Miki ,sorry about that
Can you please read what I wrote about being on 1 units for so long
Thank you

 

@Bumblebee
Hi I think you should add to your title that Maddox and Miki both diabetic only because they might just think it's Maddox even though you put at the end of your post both my cats are diabetic, so members can give you advice on Miki
Tap on Thread Tools to the right ,then tap on Edit Title and add it ,then tap Save

 

@Bron and Sheba (GA)
@Chris & China (GA)
@Bandit's Mom

Can you please read what I wrote about being on 1 unit for so long
Thank you

In case no one noticed both her cats are diabetic , spreadsheet is for both of them in her post

 

@Bumblebee are you able to get some tests in during the pm cycle so we can see how well the dose is working? Just one each cycle would be helpful
@Bandit's Mom, can you look at the SS and q see if it is one of ours please?
@Suzanne & Darcy could you have a look at the dose of Prozinc and see what you think about increasing please?

 

It would be very helpful if you can get at least one test during the PM cycle. Without that information, you're missing half of your data. If you can get a few tests during the PM cycle, we'll be in a better place to make suggestions about dose.

 

@Diane Tyler's Mom This post is about Maddox. I think it might be confusing to add another cat into the same conversation at this point.

 

I also agree that you need at least one mid-cycle test for both the a.m. and p.m. cycle. We need this information. It looks like Maddox needs an increase, but I would like to see a p.m. test at some point. You are right at the point now where an increase is due as long as he’s not having any unexpectedly low numbers that we haven’t spotted yet. How are the ketones? That information will help determine the amount of the increase.

 

Wet for royal canin glycobalance. Yes, he’s eating on his own and the labs were a huge improvement. He's needed an anesthesia cleaning for his teeth due to bad gingivitis but my vet wants me to wait a couple months for him to fully recover from fatty liver, so maybe he's not completely past it but improving.

He's 27lbs, not sure if that's helpful for the dose. It's so stressful because I need to keep him eating since he just had fatty liver, but the stuff he likes is the epigenin dry/savory selects wet/etc that's not as low carb. I do the PM dose at 10 pm so I couldn't do a second test during the week, but I can now that the weekend is beginning. Halfway for that would be 4 am but I can definitely aim for 12 am or 1 am to get some data tonight.

The ketones I just tested from the at-home test strips, I have pictures but I'm not sure how to attach them here.

 

Thank you all for the responses so far. I'll try and get the PM cycle BG test tonight. I definitely could use advice on Miki too but can make a second post if that's confusing. This has been so stressful, I want to crawl under a rock. Neither one of them seem regulated, I'm going through so much litter each week since they're still drinking so much and it's completely beyond exhausting having two diabetic cats. They are my whole heart tho. You all are amazing for doing this.

Eventually my goal is 100% to get them on the same insulin if at all even possible but that can be in the future. The pet hospital put Miki on Lantus and figured out his dose thru a multi-day hospitalization. Then when Maddox got diagnosed a couple months later, my normal vet said he has zero experience with lantus and can only prescribe prozinc. So that's how I got here with two different insulins/syringes to keep track of.

 

To post a photo, you can copy and paste the photo

 

Initial ketones a few days ago:


This morning's test (closer to trace):

 

Thank you!

 

Thanks for posting the photos. That is an improvement which is good.

How much food are you feeding now? For hepatic lipidosis DKA and ketones…the treatment is to feed as much food as possible. We recommend feeding 1 and a 1/2 times as many calories as he would normally eat.
And I think he need an increase in dose up to 1.25 units BUT I would really like to see a couple of tests taken sometime during the cycle. Do you think you could manage that? It’s important we get the dose and the food right so he can improve.
If you also want help with Mimi, I would start a different thread as it is too hard trying to juggle two diabetics on one thread

 

That's helpful to know. I'll offer cans every couple of hours and have been leaving some dry epigenin for him. Ok I finally got a 2nd cycle bg test! PMPS +4 319. So weird that he's staying so high. His first few days on prozinc he dropped into the 100s right away but perhaps it was due to the fatty liver disease and not eating enough.

 

Well done getting that test in
He could be bouncing after dropping low overnight. Bounces can last for up to 6 cycles so I’d keep trying to get extra tests in.

 

@Bumblebee

I would start a separate thread for Miki who is on lantus and ask for advice
It looks like he can use an increase
@Bandit's Mom
@Suzanne & Darcy
@Wendy&Neko
@Bron and Sheba (GA)

 

14% carbs - still too high for a diabetic, but better than the dry food. 14% is what we consider medium carb.

Good to see ketones coming down. If you could put a note on the spreadsheet Remarks column showing ketones = trace, or whatever the test results are when you do them, then we'll know you are testing them and stop asking.

 

Great idea on the ketones note, will do. I wonder if the 14% is what’s spiking him then. He’s drinking like crazy and peeing a TON. I think those are big signs that he’s unregulated and feeling dehydrated.

I’ll look for the carb content on the purina dm savory selects too. Will try to give more fancy feast if he’s willing.

 

@Bumblebee
I would start a separate thread for Miki since you said you could use some advice on Miki ,who is on lantus and ask for advice
It looks like he can use an increase
When you have questions about Maddox or need advice I would start a post for him
When you need advice about Miki do a separate post for Miki


@Bandit's Mom
@Suzanne & Darcy
@Wendy&Neko
@Bron and Sheba (GA)
@Sienne and Gabby (GA)
Thanks ladies
She said
Just a note: both my cats are diabetic and the spreadsheet has both of their names on it

 

Are you able to get some tests in during the cycles for both cats? At the moment there are very few tests and we need to see how far down the doses are taking the cats for us to be able to give dosing advice.

 

@Bumblebee Are you using different types of syringes for each cat? Just wanted to check. It’s hard enough having two diabetic cats, let alone one cat on a U-40 insulin and one on a U-100 insulin. It’s very important that you don’t get those syringes mixed up (they’re not interchangeable).

I’d try to get both cats on the same insulin if you have the opportunity. It will make life much simpler all around.