New member 02/17/21

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Hailey K

Hailey K

Member Since 2021
Hello everyone, sort of new to all of this but have just stayed on the sidelines watching and taking notes... Our boy Toby was diagnosed back in October, he is 6 years old, he is currently on 5.5 units of prozinc and he is NOT regulated. We are in the process of switching him and my other 2 non diabetic cats to strictly friskies Pate. Right now he is getting 1 can before AM shot and 1 can before PM shot and seems like he is catching on quickly as to when his new meal times will be. I will also be adding in the canned food in the afternoon. Starting this weekend they will all be switched over to strictly wet and will no longer have access to their dry food. I have not been home testing except for BG curves every 2 weeks. However I will be starting to test daily (before shots) starting this weekend also. It about time we made a change for the better and hopefully on the path to lower BG numbers and lower dose of insulin! Thanks for taking the time to read and looking forward to joining the discussions.
Edit: we are from Alberta, Canada, to add I have the alphatrak 2 meter, we are waiting for the weekend so I can be home with him all day to monitor closely
 
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Welcome!

When you get a chance, can you read through this post to set up your spreadsheet and signature?

Also, please please please do NOT make any more food changes before getting at least 3-5 days of BG testing data. That is a fairly high dose of ProZinc, and a switch to low carb food could have drastic results. The BG could drop too low and cause hypoglycemia, which can quickly become fatal. The post I linked above also covers hypos and the home toolkit recommended to hell treat them if they do occur.

For now I recommend:
  • Get whatever data you have in the spreadsheet (curves.yoive done, the vet has done, etc)
  • No more food changes
  • Make sure the shots are 12 hrs apart.
  • Remove food 2 hours before each shot time (so that the test you do before the shot isn't influenced by food)
  • Test before each shot and record in the spreadsheet. The sooner you can start doing this, the better. I'm a bit concerned about how high that dose is.
Does Toby have any other medical conditions.you know of? Any history of ketones or DKA?

Tagging @Deb & Wink since she knows a bit more about ProZinc than I do and can hopefully help guide through food and dose changes.
 
Hi thank you for the reply. So should I just begin withholding the dry food for the 2 hours before the shot ? I have one diabetic cat and 2 non. So there is always dry food left down as of right now.
 
Hailey K said:
Hi thank you for the reply. So should I just begin withholding the dry food for the 2 hours before the shot ? I have one diabetic cat and 2 non. So there is always dry food left down as of right now.
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You only need to start withholding once you decide to start testing. So if you plan to test tomorrow morning, you'd remove it 2 hrs before test and shot time tomorrow. The order for ProZinc is test - feed - shoot, and they can all be done at the same time (for some other insulins, you have to wait before shooting).

Most of us use automated feeders to make it easier :)
 
He has not had any ketones or dka. Just always high BG levels. He was just at the vet for a recheck last week to check for all that as well as his fructose levels. All was normal. His last curve 2 hours after shot was 24.2 then 2 hours later was 21.9, after that he started going back up. 2 weeks prior he was 23.1 and then down to 17.9 and then back up. So his numbers got worse in 2 weeks even though the dose was upped another .5 units... it’s not making sense. This weekend i am supposed to do another curve and I hope to see improvements since he has mostly been eating canned food and since he was increased another .5 units
 
So let him still have access to the dry food even though it’s not low carb dry food? We feed orjen “fit and trim”. Just until I can get a few days of proper numbers from him ?
 
Hailey K said:
So let him still have access to the dry food even though it’s not low carb dry food? We feed orjen “fit and trim”. Just until I can get a few days of proper numbers from him ?
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Correct. The dry food will be keeping his numbers high BUT it's also keeping him safe. It's better he be high for a few more days than drop too low.

I'm not sure if you've seen this yet, but here's a database of cat food that lists carb content as % of calories. Low carb we define as under 10%, most of us feed canned food around 5% or so.

The hypo toolkit linked in posts above requires medium and high carb food. Medium carb is around 15%, and high carb around 20%.
 
Hailey K said:
He has not had any ketones or dka. Just always high BG levels. He was just at the vet for a recheck last week to check for all that as well as his fructose levels. All was normal. His last curve 2 hours after shot was 24.2 then 2 hours later was 21.9, after that he started going back up. 2 weeks prior he was 23.1 and then down to 17.9 and then back up. So his numbers got worse in 2 weeks even though the dose was upped another .5 units... it’s not making sense. This weekend i am supposed to do another curve and I hope to see improvements since he has mostly been eating canned food and since he was increased another .5 units
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We'll get it figured out! Will just take a few days' worth of data to make sure we do things safely. High carb dry food can really mess with things, even in small amounts.

As an FYI you may find the AlphaTrak gets pretty costly for strips. A lot of us use human meters. There are minor differences between the two and vets tend to prefer the AlphaTrak because it's pet-specific and usually what they have in the office, but the human ones work just fine for our purposes (and are cheaper).
 
Gosh sorry it's late - some more info:

We recommend testing for ketones. You can do it with urine test strips (such as Ketostix) from any pharmacy, or there are blood ketone meters if it's too hard to get a urine sample (or to know which cat left it).

From what I've gathered, it's a good idea to test weekly at minimum. The "recipe" for DKA is usually: not enough insulin + not eating enough + underlying infection/systemic stress. Since Toby isn't regulated, he meets the first part of that. If you notice he's eating less or perhaps has an infection, I'd test more frequently.

This post covers ketones and DKA.

The spreadsheet has a tab for labs, any data you have there also helps.
 
That’s what I was worried about with him being on such a high dose that if I just took the dry away that he would crash hard! Thank you for confirming that. I have seen the list for the foods, he’s been having wet food with his shot both AM and PM and it’s a friskies Pate. I’ll be sure to pick up a few higher carb ones in case of emergency. I’ll try to get on starting a spread sheet tomorrow. Thank you so much for your help and look forwards to chatting again.
 
The spreadsheet looks very difficult to get started as I don’t have access to a computer only my phone. Would I just be able to post his numbers here once I start the testing ?
 
The spreadsheet looks very difficult to get started as I don’t have access to a computer only my phone. Would I just be able to post his numbers here once I start the testing ?
 
Hailey K said:
The spreadsheet looks very difficult to get started as I don’t have access to a computer only my phone. Would I just be able to post his numbers here once I start the testing ?
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It can be difficult to setup the SS on a phone. However, once set up it is easy to fill out on a phone. There are caretakers here that can set one up for you. I will start a topic to get you help.
 
Thank you I appreciate it. I was going to attempt it today but I’m worried about messing things up lol
 
I took my first test for his PM shot. Food was withheld for 2 hours his number was 14.8 ... this is the lowest I have ever seen it ! He was given his shot and can of friskies Pate. Should i re-test in 2 hours ? Do I continue to withhold the dry food until next test ?
 
Hi Hailey, I have set up your spreadsheet and signature. When you can, could you input any BG data you have, as well as whatever insulin you have given Toby from Jan 1, 2021?

It is a great idea to switch Toby from HC kibble to LC canned. However, as Melissa mentioned earlier, a change to a low carb diet can significantly reduce numbers and insulin requirements. We have had cats go off insulin with just a diet change. Therefore, the food transition has to be done gradually and with close monitoring of Toby's BG in every cycle. And you are on a pretty large dose.

I am not familiar with Prozinc but the benefit is that it is not a depot insulin. So it may be easier to adjust the dose on a cycle-to-cycle basis unlike depot insulins like Lantus and Levemir.

When is the last time that Toby was fed dry food?

And yes, please test 2 hours after tonight's shot.
If you can input the data you have in the SS between now and then, it would be great!

Since you are seeing new low numbers and there is a food change involved, it would be safe to not shoot below say 10 mmol. If you get a reading below 10, please post here and ask for advice.
 
I gave him a few temptations cat treats just before the 2 hours and wasn’t sure last he had any dry since it is just free fed. I’m still trying to make sense of the spreadsheet and where I input the information. Do I continue to withhold the dry food for the next 2 hours as I wait to do next test?
 
Temptation treats are way to high in carbs, as is most dry food. Feeding high carb and then giving insulin is like running an hour on a treadmill and then eating a tub of ice cream or a whole cake! :-)

Withhold the dry for now and let us see where he is at +2 (2 hours from the shot).
 
Okay sounds good. He will only have whatever is left in his bowl of wet food. I know the temptations are bad I just wanted to make sure he had something in him before I took away the food because I’m unsure of when he ate any dry last.
 
Do you have any BG data before tonight's shot? 14.8 is not very high as far as BGs go. I'm wondering how he got to as high a dose as 5.5U.

Before he was free-fed Orijen kibble? When did you start the Friskies Pate? Now you feed 1 can in the AM and PM and the Orijen is free-fed?

Btw, do you have any canned food that is higher in carbs? Gravy based?
 
The 14.8 will go in the "PMPS" (PM pre shot) column for today. The next test in 2 hrs will go in the "+2" column to the right of the PMPS one.

It would be great if you could note in the Remarks column anything you know about his eating habits as well, such as when you gave wet vs dry, how much, the treats, and roughly how much he ate. Just helps us with a more educated guess when we do the food and dose transition.
 
Because I have been testing pre shots, only testing my vet wanted was BGC’s every couple of weeks I will update the sheet for his last 2 curves to give you an idea of what his numbers have been, give me a few minutes to get the data imputed
 
So after the next test I can put back down the dry food? Also I won’t be able to test again until tomorrow PM!
 
Hailey K said:
So after the next test I can put back down the dry food? Also I won’t be able to test again until tomorrow PM!
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If you have multiple cats that are free fed dry food, have you thought about switching to a low carb kibble like Young Again Zero or Dr. Elsey's Cleanprotein (chicken)? They are both low in carbs and Toby can be free-fed on them.
It is good to feed some wet food to all your cats from a hydration perspective. Cats get their water mainly from food. Dry food deprives them of that.
 
I won’t be able to tomorrow as I work and don’t have enough time to withhold the food for 2 hours before giving his shot. This coming weekend Saturday and Sunday I will be able to do both AM and PM pre shots and withholding food. I imputed the other data to the spread sheet.
 
Hailey K said:
I won’t be able to tomorrow as I work and don’t have enough time to withhold the food for 2 hours before giving his shot.
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Will you be able to get a BG reading just before the shot? Even if you are not able to withhold food?

Hailey K said:
I imputed the other data to the spread sheet.
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Can you also please enter the insulin you have been giving every day from 01/01 in the U column? AM and PM. If you have the data. Thanks!
 
Yes we just discussed getting the doctor elsys for a smoother transition for my other non diabetic cats. I know to get the chicken one. I was advised up higher in the conversation not to take away the high carb food just yet until we can get a couple days worth of numbers incase he goes too low being on such a high dose of insulin. I can take the preshot number tomorrow, just no dry food will be withheld over night
 
Hi Hailey and Toby
If you are unable to test again until tomorrow I would put the dry food back down for Toby because we need to make sure he is safe. I think @Bandit's Mom thought you would be able to test frequently from now on but if that’s not the case, I would put the dry food back down.
You need to be testing frequently when you do the transition to low carb diet over a few days, to keep Toby safe.

How did Toby reach 5.5 units
 
Quick point of clarification - you do not have to withhold low carb food during the cycle to test, only before preshots. So if you're going to test at say +6, it doesn't matter if he's eaten at +5.5 or whenever. We want to see his BG pattern on a "normal" day.

<Deleted, similar to what Bron said about the dry food and frequent testing>
 
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Hi Hailey.
Just to clarify..... if you are unable to test any more tonight, please put down the dry food again for Toby to eat and whatever else you have been letting Toby eat until such time as you can test frequently during the cycles.
A couple of cycles on his current food would be good to see before you start to slowly changing over to a low carb diet.
Please make sure you are posting and getting guidance when you do the change over which should take a few days. We need to make sure Toby is safe.
.
 
And please try and get as many tests as you can. That test 2 hours after the shot tonight would be good since that was his lowest pre-shot.

Also, please test before giving him his shots.
 
I just did his second test he is now at 20.8.... I thought this number would have gone down not up ? I’m confused
 
Hailey K said:
I just did his second test he is now at 20.8.... I thought this number would have gone down not up ? I’m confused
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He must have gone lower than 14.8 in the day and is now "bouncing".

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Hailey K said:
I have also completed his spread sheet after getting my numbers so mixed up, I fixed it now though... I hope lol
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Great! Could you input the +2 number as well? In the PMPS +2 cell.

You don't need to say "prozinc" in the U column. Just the number of units. Have corrected that in your SS.
 
Oh jeez this is A LOT to take in. Okay I have a game plan and would like to know if this is what I should be doing in the next coming days..... tomorrow AM I can test pre shot but food won’t be withheld the 2 hours prior, he will have access to high card dry during the day, PM I will withhold food for 2 hours and pre test again followed by shot and test again in 2 hours (same scenario as tonight).... Saturday AM &PM I can withhold food and pre test before shot. My question is during the day Saturday should I be testing every 2 hours between the AM and PM shot ? And should I be withholding his high carb dry food during that time as well ? Or do I let him have access to high carb between testing every 2 hours ?
Side note when I do a “normal” curve on Toby I never withhold the high carb dry food, I have to do a curve this weekend to “please” my vet, just want to know which route I should be taking.
 
Firstly, you shouldn't have to please your vet. He works for you :-) And he has not been advising you correctly. But we have seen this with several vets. Their treatment for diabetes is to switch to high carb, expensive "prescription" food and give the cat insulin without testing! I presume a food trial was never done for Toby at diagnosis? We usually recommend making a food change to a low carb canned food to see if that can regulate BG before starting insulin.

(a) Till you can test regularly, do not withhold the dry food.
(b) Till the weekend, get as many tests as you can - and most definitely before shots (AM and PM)

However, at some point, you will need to start withholding the dry food and getting more tests to see how that affects Toby's BGs and reducing his dose accordingly. Are weekends the only time you can get test during the day? Even just 1 test 2 hours after his AM shot?
 
I come home quickly in the afternoon Monday- Friday to let the dog out so I could test then but that’s about 6 hours after the cats AM shot... not sure if that’s good enough. Saturday and Sunday I am home all day though. No food trial was ever done on him. His numbers were very high 500+ I believe and he was extremely skinny. He was immediately put on 2 units Prozinc the following day after the vet did their own BG curve. How often do you consider regular testing ? Is that just preshot testing ? Or more often than that ? Maybe im jumping the gun a little bit and trying to predict how the following days will be like. I’ll just start by taking it one day at a time with the help of you guys lol
 
Well, a +6 is better than no mid-cycle tests, so I would start getting that from tomorrow if you can.
(And you could look at switching to a human meter. Testing regularly with AT can be quite expensive! I know folks in Canada find the Bravo meter and strips to be quite cheap.)

We usually test pre-shot and at least one test between shots. Usually a test at +2 will tell you if the BGs will go lower in the cycle. If the +2 test is lower, we try and get another test later in the cycle. It differs from insulin to insulin as well.

I will ask @Deb & Wink to weigh in here, but I'm wondering it it makes sense to remove the dry food and reduce the dose to half (or so) and see where it gets us. Let's see if we can come up with anything till Saturday. Till then continue as you are.
Just get the pre-shot tests and +6 in the day and +2 at night. Does that sound doable?
 
Hailey K said:
How often do you consider regular testing ? Is that just preshot testing ? Or more often than that ?
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Generally speaking for ProZinc and a low carb diet, these are the tests we like to see:
  • AMPS and PMPS, food withheld 2 hrs prior. Every day, every shot. These tests tell you whether it's safe to shoot.
  • Usually +2/+3, ideally after both shots but for many this isn't possible with work. Realistically, a "before bed" test is what most people do. These tests tell you how quickly the BG may be dropping, and if you need to maybe keep testing or keep a closer eye on the cat. Note: the more data you have, we'll know which (+2 or +3, maybe even +4) is best. For example, my cat shows no difference at +2, but if I check +3 I get a very different result...so I do a +3.
  • Any mid cycle tests you can get, any time. So if you come home for the dog, test. Randomly think about it while watching tv, test. These tests help us figure out when the onset is, nadir, and the duration. Dosing is based on nadir.
  • Curves - only needed if you can't test often. So if the best your schedule allows most days is AMPS, PMPS, and a "before bed", will probably want to do a curve once a week when you're home.
Big BUT coming - the high carb food changes this. Whenever a food change is made it's best to be home all day.

I see Bhooma tagged Deb, she really will be best to help you through the food transition. In the meantime, do what she said - continue exactly as you are, aim for AMPS, +6, PMPS, +2. Any other tests you can fit in are a bonus and will help.
 
I will definitely be looking into a cheaper meter and strips. That sounds very doable. It’s unfortunate that I can’t be home during the week to do more frequent tests, but what can you do. I will touch base with you guys tomorrow and see where we are at. Thank you !
 
Even with HC dry food still in the picture, Toby had a very good drop from the pre-shot to the +6. Yellows are good. Still safe. You want to pay more attention when the BG levels get down into the blue and green colors.

Keep the food the same for now. Please do not switch to all low carb (LC) food just yet.

Hailey K said:
I’ll just start by taking it one day at a time with the help of you guys lol
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One day at a time is a good plan Hailey. Breath, remember to breath. Nice deep calming breaths. Mindfulness breathing.
Hailey K said:
I come home quickly in the afternoon Monday- Friday to let the dog out so I could test then but that’s about 6 hours after the cats AM shot... not sure if that’s good enough.
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You do the best you can Hailey. Most cats on Prozinc have their nadir around +6. So yes, please test when you come home to let the dog out.
I think you need a plan in place in case Toby is low at that +6 point, and you have to head back to work.

Here is one possible plan.
If Toby is >200 (11 mmol/L) at nadir (your +6 test time), leave some regular food out for him, the wet Friskies. Many cats will seek out food when they feel their BG levels dropping. Hopefully, there is a place you can leave the wet food where the other cats won't steal it. You many need to confine Toby to a room by himself.
If Toby is <200 (<11 mmol/L) but > 120 (8.3 mmol/L) at nadir ( or your +6 test time), give him a little bit of wet food (teaspoon or so), a couple of temptations dry treats, and leave out some dry food for him.
If Toby is <120 ( <6.6 mmol/L) at nadir (or your +6 test time), you need to carb him up as much as possible. Don't worry about any higher numbers or a bounce.
You're goal at that point is to keep Toby safe
If Toby is <68 (<3.7 mmol/L) on your Alphatrak, call in sick or take Toby to a vet ASAP. Without you there to monitor and bring those BG levels back up, you are risking hypoglycemia.
Those recommendations will change, as you are able to gather more data and add them to your SS. Eventually you will learn to shoot lower and lower BG levels.

The HC dry food will be keeping his BG levels high. But for now, you need to get good with testing, gather more test data, and then we'll see about changing more of the food to the LC food. It's not ideal, but we don't live in an ideal world.

Alphatrak reads higher than human meters. There is no direct comparison. Throwing that fact out there, so you know for when you switch to a human meter.
 
Hi Deb thanks so much for your reply that all makes perfect sense to me so far. I just did PMPS and it was 11.6 in two hours I will take another test and see where we are, in the mean time I am still withholding his dry high carb food. He had his shot and can of friskies.
 
One question though. So after I give him his AM shot and give him his can of friskies when I leave to go to work I shouldn’t leave any dry food down and just wait to see what his numbers are 6+ ?
 
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