New Member, 6mo post-Dx, can’t regulate, please help

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Jay Dee, Apr 24, 2021.

  1. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Hi! I'm Jill and my sugarcat is Snuggie. We are new members on the board, but have been part of the FB commuity and other diabetic support groups over there as well - but only since 2/1/2021.

    Snuggie was Dx 10/27/2020. Symptoms were excessive thirst and frequent, high-volume pees. We tried to control it with food first (Purina DM wet and dry), to what i thought was no avail, but was not testing during this time. We had an Alphatrak on hand but needed to acquire the strips, control solution etc. We had been feeding him Hills k/d wet due to a past elevated SDMA (altho his BUN/crea etc were normal).

    I took a few mid-day readings and they were high (500s), and we started ProZinc on 12/21/2020 at 1 unit 2x daily. I sitll didn't know the need for preshot testing or low carb food. His midday numbers were still in the 500s. We increased to 2 u.

    2u still didn't show good numbers (at midcycle anyway). I knew enough from a past diabetic kitty to do a curve but didnt know about upside down curves. His numbers went from preshot low 500s to over 600. We increased to 3u.

    I then found the FB groups and did a dose reset at 1 and also switched him to Fancy Feast pate and pulled his dry food except overnight until i could get some better dry. I did another curve at 1. The numbers were still in the blacks and the vet advised me to go back to 3...

    Then he got very lethargic and wouldn't eat. We took him in on 2/27 and his BUN/Crea were sky high and his phosphorus was off the chart. He also had a UTI. They gave him convenia and sent me home with fluids. THe next day he had a BG of over 700 and was really in bad shape. Vet advised to jump him up to 5u.

    Two days later he was unable to walk or hold his head up. We rushed him to the vet and he had critically low potassium. They added potassium to his fluids and we started renaPlus. At this time I switched his food to low carb-low phosphorus stuff (Weruva BF PLAY).

    He was constipated too, and when he finally went, his BG that evening dropped. He had a vet appt the next day and his kidney values were much imroved but he had lost 2 lb in 2 weeks. We had a few scary moments on 5u, where i tested over night and i decided to drop him to 4u. He did really well on 4u... until he didn't.

    I increased to 4.5 then 5, took hm back to the vet on 4/1 and they confirmed another UTI. We upped his dose to 6u, and sent the urine in for culture and sensitivity. The lab was unable to culture his urine so we started him on Orbax. I was expecting to see his BG numbers plummet but they didn't.

    I started dropping him - from 6 to 4 then from 4 to 2. I'm still seeing VEY high numbers with relatively flat curves. I am now at 2.5 u and am wondering what to do. I had so little data early on annd really did things wrong. I'm not sure if 1u was too much or too little, if i should be increasing or decreasing, if i should start over at 0.25 since so many of his issues have resolved... or try switching insulins, or testing for acromelagy.

    I'm at a loss and the FB group strongly suggested i join here for help. He has an appt on 4/29 and i'm almost out of ProZinc. i will ask for a cystocentesis urinalysis with full culture and sensitivity again. i am going to ask that they send his blood to IDEXX or Antech for analysis since the vet usually does in-house. I live in a small town with only a few vets - i trust this one and he is open to my home testing and adjustments annd other suggestions i have, but i am balancing advocating the best for my cat vs sounding like i'm telling them how to do their job. I don't have too many other options and certainly no specialists nearby. Snuggie does'nt do well in the car either so i prefer to try to stay local.

    THANK YOU for reading this far and THANK YOU in advance for any and all help that i hope to get here!
     
  2. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    I should add that he is now back to his normal weight of 11ish lb plus/minus and stable, altho his hunger is still pretty crazy. I feed him dry overnight only and it's a mix of Dr Elsey clean chicken protein and Young Again Mature Zero LID with the goal of fully transitioning to the YA MZ LID.
     
  3. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hi Jill sorry no one has gotten back to you yet.
    I will tag a few members who are familiar with Prozinc

    @JanetNJ

    @Deb & Wink

    Thank you ladies
     
  4. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Jill while you are waiting for a reply please fill out your signature , it is at the end of everyones post in gray just so we don't have to ask you the same questions over again. Go all the way to the top and click on your name
    Make sure your signature is up-to-date
    .
    • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback. There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add info we need to help you:
      • Caregiver & kitty's name
      • DX: Date
      • Name of Insulin (do not include dose or frequency)
      • Name of your meter
      • Diet: "LC wet" or "dry food" or "combo"
      • Dosing: TR or SLGS or Custom (if applicable)
      • DKA or other recent health issue (if applicable)
      • Acro, IAA, or Cushings (if applicable)
      • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
      • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
    Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.
     
    Last edited: Apr 25, 2021
  5. SashaV

    SashaV Well-Known Member

    Joined:
    Apr 25, 2020
  6. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Jill and Snuggle and welcome to the forum. I am sure we can help you. I’m sorry you have had such a difficult time.

    I’m glad you got rid of the high carb dry food. It is very hard to regulate cats when they are eating that.
    So at the moment you are feeding mostly low carb wet food with some dry overnight. Is that right? Is the dry a low carb variety now?
    Are you feeding before the shots and giving snacks during the cycles?

    I see you dropped the dose to 2 units a few days ago. Why was that?
    Are you testing for ketones? If not I would strongly advise that you buy some Ketostix from a pharmacy or Walmart and start testing the urine for ketones every day.
    Reducing the dose that much can be risky and can leave the door open for ketones

    The dose has been increased and decreased in larger amounts than we advise. It’s possible he has gone past the best dose.
    One thing I would start doing is to test during the pm cycle. At the moment there are very few tests done during the pm cycle and it is just as important as the am cycle.
    Do you think you could get a couple of tests in during each pm cycles so we can see if he could possibly be dropping at night and bouncing?

    I have to feed my family now so will post this and get back to you a bit later once I have had a chance to reread your introduction.
    I’m sure we can help you. It may take a few days to find out all about him and figure out a plan. If you can answer any questions I have asked, I’ll get back to you a bit later.
    Bron
     
    Gill & George likes this.
  7. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi again Jill,
    I would definitely not recommend starting over again at 0.25 units. It rarely works, it puts the cats at risk of ketones and can produce glucose toxicity.
    There is one FB page that advocates resetting the dose, and the CG usually ends up here with either a cat who has ketones or they don’t know what to do as the reset didn’t work.
    I see in your information you are giving sub Q fluids and Zobaline. Does Snuggles have any neuropathy?
    I think I would be inclined to look at swapping to Lantus or levemir insulin as you have had him on Prozinc for over 6 months and it is not working. Amd this is a good time to do it if you are at the end of the Prozinc
    Levemir and Lantus are both similar depot insulins and are both recommended for cats. Levemir may be better as Snuggle is on a higher dose....Lantus can sting some cats at a high dose.

    You mention you are going to change to a human meter when you find a good dose. I would recommend you do the change now. It will be a lot cheaper for you to use a human meter and our 2 dosing methods are based on the human meter. We have dosing methods for Lantus and Levemir but here is the Prozinc dosing method for now.
    https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

    I would also think about getting the Acro test done. At least then you will know if he has Acro or not and if he is, that is good knowledge to have moving forward with dosing. We have a very experienced Acro person here @Wendy&Neko who will be able to help you if it turns out that way. I would also get the IAA test done as well while you are getting the Acro test done.
    So here is what I would do
    • Feed an all low carb diet
    • Offer snacks during the cycles as well as the preshot meals
    • Make sure you start getting some tests in during the pm cycle. At the least, get a before bed test in. If that test is lower than the preshot BG I would get up and test again later.
    • Test daily for ketones
    • Change over to a human glucose meter now.
    • Look at swapping to Lantus or Levemir insulin
    • Post daily and start increasing the dose as per the dosing method and don’t chop and change the dose.
    • Get an Acro and IAA test done
    • Ask lots of questions...we are very happy to help you get Snuggles sorted out.
    Bron
     
    Last edited: Apr 25, 2021
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome to FDMB!

    As much as I hate to say this, I think some of the FB groups have not been providing you with stellar advice. There seems to be the notion that any time some of those groups see a higher than a 1 or 2 unit dose, they tell the caregiver to drop the dose and start over. From the time I've been on this board, The kitty ends up going back to high numbers and you start the ratcheting up of the dose all over again. Frankly, if the dose is too high, your cat will let you know by the numbers dropping (and you reduce the dose). On the other hand, if there's not enough insulin, you risk DKA developing. You can deal with dropping numbers if you're home testing. You can't deal with DKA at home -- it's a legit crisis.

    That said, I agree with Bron -- Snuggle needs more insulin, not less. I also agree with almost everything she noted in her bullet list. (I'm not entirely sure what she meant by giving a snack at pre-shot times since you'll be feeding Snuggle after you get your pre-shot test.) Also, do not feed your kitty in the 2 hours prior to shot time (unless you test and find numbers are low).

    If you are feeding dry food over night, would you consider an alternative? You can make "catsickles" with canned food. You mix the food with water and freeze it in portions. I would use an ice tray. You can either leave the frozen chunk out and it will defrost for a snack. Or, you can get a timed feeder and either leave the frozen chunk out in that or put canned food + water in the timer slot. My kitty would lick the frozen food until it was gone and it didn't really serve the purpose of a midnight snack so I used a timed feeder.

    Also, if your vet didn't mention it, adding water to Snuggle's food will help with the kidney issues. FD is hard on the kidneys all by itself. Water is good for the kidneys. It's also why it's important to work at getting Snuggle's numbers better regulated.
     
  9. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Hi all and thank you for the replies.

    I have a signature set up and thought it was automatically attached but I’ll get back onto my computer and see if I can fix it. Here is a link to his spreadsheet -
    https://docs.google.com/spreadsheets/d/1ROHT9FunM-0yMTBj8_UY9TmZwDy0W5IwQjSzlZALZ0A/edit

    all his food info etc is in my profile but a recap:

    no history of ketones but I do have strips and will check.

    I’ve not done pm cycles bc he was going thru so much and his PMPS are so high I wanted to give him a break but will start

    he may have had a hint of neuropathy but it comes and goes - the vet and I are working together to see if it’s that or muscle weakness from CKD. I’m giving him 2 Zobaline tabs daily

    I add chicken broth (homemade nothing added just water and chicken) to his food but overall his Weruva foods are very watery

    i test feed shoot. He wants food every 2-3 hrs and since he had lost so much weight vet said feed him when he’s hungry. He’s maintaining between 10.6-11 lb daily now.

    yes from 8am - 11pm or bedtime it’s all wet (I do pull food 2 hrs before shots). Overnight it’s Young Again Mature Dry Zero LID.

    I’ll look back to be sure I answers all the questions and will try to work on my tech issues soon - thank you!
     
  10. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Ok I see my signature on my replies from my end but I guess no one else can see them?

    We didn’t go right from 6 to 2. I backed off to 4 because he had a really good run at 4 in mid March. I stayed there for a week and the numbers didn’t look any different. Yes a different FB group suggested going back to 2. Yes they were also the ones who suggested the initial dose reset in Feb to 1. I was hesitant to join this forum because of all the technology- I’m intimidated by the forum format and I’ve literally given all my energy to caring for this cat and his sister who has her own set of issues. I’m exhausted. I’m overwhelmed. I’ve given up my own hobbies. I’m scared I hurt my cat trying to do the best for him. My mental health is crap and I have near daily migraines. I’m lucky I work from hone and have a flexible schedule that allows me to test frequently but I can’t always do all the tests. I don’t know if I should fiddle with the incremental doses of ProZinc or switch. If I switch I know my vet has been resistant. I don’t know if I’ll be able to get Lantus quickly in my small town without paying an arm and a leg til I can learn the ways to get it for less.

    and a question - my vet said if 6u doesn’t do anything then we can just assume he’s insulin resistant and give him some oral meds... thoughts? I’ve heard the oral meds are hard on the pancreas. I do want to test for acro but what can I do if he IS? Is it worth the money? Are there treatments? Someone on another board told me it means he has a tumor and he’s need radiation.
     
  11. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @Wendy&Neko
    Hi Wendy could you please take a look at Snuggies SS for Jill
    her intro #1. She's really having a tough time

    Thank you Wendy
     
  12. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I think you are talking about the info you have in your profile information page.
    It has to be at the end of your posts in gray, do you see mine

    Just follow the instructions I gave you above in post above #4
    The numbers are on the right hand side

    If you have trouble ask, we have 2 members that can help you
    I also tagged @Wendy&Neko
    for you she had a kitty that was acro
     
  13. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Hello and welcome. Bron has given you lots of good tips. Since you are in the US, there is a cheaper way of getting Lantus or Levemir than buying at a local pharmacy. People here buy from Canada. See this post: Buying insulin from Canada. Your vet needs to write a prescription that you then send to Marks. I would also strongly recommend Levemir vs. Lantus, in case he does need the higher dose of insulin.

    Speaking of which, one of my favourite sayings here is "a cat needs however much insulin they need". I've seen cats with way more than 6 units, so don't worry about being on too high a dose if it hits a certain number. Go by what the blood sugar numbers tell you. Many cats go lower at night, hence the importance of those night time tests. A before bed test if it's at least 2-3 hours after PM shot time is a good place to start. If he's going low, the dose is too high. If not, he needs more insulin. Speaking of which, his current dose is way too low. I'm worried about the lack of appetite you mention on the spreadsheet. Worried that DKA may be brewing. I'd hurry on getting those ketones tests, and would test every day while he is in such high numbers. And I'd increase back to at least 4 units right away.
    I get that, most of us here do. :bighug::bighug::bighug: Once you've started getting him better regulated, it will get so much easier. Right now you've been getting conflicting advice, and some of it from groups who have no experience with cats that need higher doses. I remember being very confused at the beginning too. My girl needed higher doses, she was hungry all that time, drove me crazy. Turns out she had two secondary conditions that meant she was harder to get regulated. In her case it was acromegaly - a benign pituitary tumour that causes excess growth hormone to be output and causing the diabetes, and IAA or insulin auto antibodies - sort of like an allergy to the injected insulin. About one in four diabetic cats has acromegaly.

    For me personally, I had to set aside some me time every day. For me it was exercise, but whatever it is for you, set aside at least an hour a day that isn't about cats and is all about you. :bighug:
    First steps first, start with the tests. We also have some cats that just have IAA. There are multiple treatments for acromegaly, if you want to proceed with treatment. Some people treat just with the insulin dose they need. There are a couple oral treatments, one reasonably priced called cabergoline that a number of people here use. One called pasireotide that will cost you an arm and a leg and no one here has experience with cause it's too expensive. Radiation is another option, my girl had stereotactic radiation therapy (SRT) at Colorado State University, so not too far from you. Surgical removal of the pituitary gland is another option, though available in even less locations than SRT, and more costly.
     
  14. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Thanks everyone! I really appreciate it.

    - I just re-fiddled with my signature. I see other people's but I DO NOT see mine even now. This is giving me a bigger headache than Snuggie's BG numbers (LOL)
    -** he is alert today and acting like his usual self, his eyes are bright and he's interested in what i'm doing.
    - Lack of appetite - he eats usually every 2 hrs when i work from home. On weekends our schedules are all off, so he snoozes past 'mealtime'. I recently purchased an elevated food dish for him and he seems suspicious of it all the sudden, but will eat when i put the bowl on the ground. His appetite kicks in in the evening when we are on our more regular schedule. Last night he ate like 1.5 cans btwn 4pm and 11pm. This morning at his first meal he ate 3/4 of a can. So, i'm not TOO worried.
    - he did vomit this am and yesterday am. hairballs and white mucous. I realize this is another sign of possible DKA, but again he is acting fine and nothing out of ordinary. I have the ketone kit ready to go and have saran wrap where he usually pees. My office is literally 8 feet from his favorite litter box so i should be able to catch it fresh :)
    - Please tell me what test to ask for and where to send it etc. My vet may not know there's a test for acro/IAA so i want to be prepared with ALL the info on Thursday.
    - oral meds - i'll ask which one he gives and hopefully it's the one ya'll mention the board has experience with :)
    - OK i can start the Freestyle Lite today. How do i keep his old AT2 history for reference on the spreadsheet - do i start a new fresh one and link to both?
    - i am going to start daily walks again and next week will go back to the gym to force myself out of the house and for "me" time for that hour. Trying to work out at home usually leaves me feeling guilty about what I'm neglecting. Now that the weather is nice, i'll be heading out on the motorcycle too, which is a great form of therapy for me.
     
    Bron and Sheba (GA) likes this.
  15. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Few more questions - I just read through the AAHA guidelines and two things stood out to me -
    1) spot checking is not encouraged and a full BGC after 7-14 days of a dose adjustment is the only way to see if a dose is working
    2) the human client is ok to decrease or skip doses but not recommended to increase dose w/o veterinary consult

    I was hoping to use the AAHA guidelines to support my home testing and and adjustments. I really don't want to say to my vet "oh this group that i'm on said to" (my hubby is already giving me crap for that) and i know that's a concern expressed by many here.. Also = I can see my signature when i'm logged in but not if i'm logged off.
     
  16. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    This is what is supposed to be showing in my signature:
    Jay Dee (CG) and Snuggie. Dx 10/2020. ProZinc. AlphaTrak2. Mostly wet. Custom/panic. CKD. Link to Spreadsheet.
     
  17. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
  18. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I can see your signature , thanks, the freestyle light is a human meter am I correct ?
    If so, sorry I forget if it is, by the way your spreadsheet is not up to date

    Once you update it, you said you can start the freestyle light today
    When you do start it just put a blank line above the date you start it and
    Put. Switched to Human Meter
    Also with a human meter the color coding above has to be changed in one of the cells
    I can ask someone to do it for you once you start using the human meter
     
  19. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    So my spreadsheet is for AT2 only so far. I don’t have any readings from the F/L but I have it ready and will be doing my +6 with it in 45 min (1:45 MDT). What do I need to update? I’m so confused. I’ve used AT2 Pet since we started this. The spreadsheet is using the pet meter / feline template. Do I need a new spreadsheet for the human one? I still don’t know what I’m supposed to update based on your post...
     
  20. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I have never read the AAA guidelines, but I do know one thing we all spot check our cats everyday to see how low the insulin is taking them, just not doing a curve

    If it wasn't for this group my cat would not be in remission right now
    They taught me when I should increase or decrease , taught me everything I know

    I printed off tons of info from this group to show my vet that they do know what they are talking about, how they have so much knowledge about DKA ,ketones,
    the list goes on.

    She was so impressed when see read everything
    She let's me do what I wanted when Tyler needed insulin
    I used the Relion Prime human meter and showed her what all the color coding meant . There are so many vets out there that have no clue about diabetes
    I'm not saying all but most of them don't
    You can try to explain to your husband about this.
    Relion Prime from Walmart is 9 dollars
    17.88 for 100 test strips
    There is also the Relion Premier
    You go thru a lot of test strips ,that's why most of us use this meter
     
  21. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Why don't you start the new meter tomorrow morning
    No you don't need a. new spreadsheet , the numbers all the way up top that shows the color coding just need to be changed for the dark green and neon green that's all

    Your SS is only filled in up to 4-22
    Did you test on the 23rd , 24th ?

    The Freestyle is a human meter correct?
     
  22. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Thank you! Because my kitty has been to the vet so much he can’t always see the one that seems more accepting of my home testing and adjusting. So I just want to be prepared. One has between the lines suggested it may lead me to panic myself and just bring him in for a check at the vet after a week or two at a new dose. No thanks!

    as for meters- we had the AT2 pet meter onhand from a previous diabetic which was fine when I didn’t know I needed 4 tests per day lol! I bought the freestyle lite human meter bc I’d heard it doesn’t need much blood and my kitty doesn’t like to bleed. This is more important to me than cost but the AT2 strips were killing me. I have two meters on hand now so while i know the relion meters and strips are cheaper, I really don’t want a third plus with how little blood he gives me id probably waste a lot of strips
     
    Last edited: Apr 28, 2021
    Reason for edit: Clarity
  23. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I can tag 2 of our members to fix the color coding for you
    I would start with the human meter tomorrow morning if I were you
    They will also add a line above the day you start using a human meter stating
    that you started to use one
     
    Jay Dee likes this.
  24. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    ahh got it - yes the freestyle lite is human. I have tests in there all the way up to this AMPS. I don’t know what’s going on with the spreadsheet then. I’ll figure it out, I am trying to interpret the gray ketone result on my relion strips and have a migraine. This is really so overwhelming
     
  25. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    That's fine , I used the Alpha Trak too in the beginning, the price for the strips are crazy. That's why I switched. Do you want to start with the human meter tomorrow am
     
  26. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Thanks for your help -
    Much appreciated!
    Sorry if I am sounding short and our posts are overlapping, it’s from not feeling well. God I sound like a real basket case
     
  27. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Yes I will finish out today on AT2, and start human tomorrow. I also read to go back up to 4u - when do you suggest I do that?
     
  28. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Sorry about the migraine, I know it's overwhelming in the beginning
    It will get better
     
    Jay Dee likes this.
  29. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Thank you!

    4/23: AMPS 549
    +6 582
    PMPS 603
    2.5u am and pm

    4/24: AMPS 594
    +6 557
    PMPS 569

    2.5u am and pm

    4/25: AMPS 524
    +6 618 what the actual heck
     
  30. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I see that Wendy suggested to go back to 4 units right away, so do it for the PMPS
    Once you get the spreadsheet up to date ,that's weird let me know, tag me I will keep checking tonight , then I will ask someone to change it for you and state that you
    Changed to a human meter, don't worry about it
    Go rest and try and get rid of that migraine
    I don't know if you know how to tag someone
    When you want to tag a member you would put
    @Jay Dee
    @ then start to type the first couple of letters of the members name and you will see
    a list of names pop up, hit on the one you want
    You will know if you did it right if it shows up in blue
    I always tag the person on a separate line
     
    Jay Dee likes this.
  31. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Diane Tyler's Mom

    thank you! Did the tag work?
     
  32. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I have no idea why you can't fill these in on your spreadsheet but we need them, are you going into your Google docs to fill them in, you can't tap on your spreadsheet at the end of your posts to fill them in and yes the tag worked
     
  33. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Keep the AT readings in your spreadsheet, all data is good data. Just leave a blank line between it and the Freestyle readings. Tagging @Bandit's Mom who can help you convert the range for going to a human meter.

    The tests you want are only done at Michigan State University. You want the following:
    https://vdl.msu.edu/Bin/Catalog/Catalog.exe
    Search for code 20005 for acromegaly or IGF-1 test. Positive is over 92.
    Search for code 20031 for IAA test.
    A result > 20% is considered positive for IAA.
     
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  34. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    After you get them filled in tag
    Thanks @Wendy&Neko , she is having trouble filling in the BG for the 23rd, 24th, and 25th , Don't know why
    I was going to tag @Bandit's Mom also to make the changes for her add when she switches to the human meter, I told her to start using the human meter tomorrow morning
    I also told her to give 4 units for PMPS like you stated in #13
     
    Last edited: Apr 25, 2021
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  35. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Diane Tyler's Mom ok pls check the spreadsheet now. i think i had the wrong URL link. i had issues making my FDMB spreadsheet the other day and had a zillion links :)

    @Wendy&Neko thank you! i'll need all the math help i can get :)
     
  36. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    OK great the numbers are there now, so start tomorrow morning and we will ask @Bandit's Mom to make the changes for you can ok
    Hi Bhooma @Jay Dee will be switching over to a human meter on 4-26 AMPS
    Would you please convert the range for it, also add the line above stating she switched to a human meter
    Thank you Bhooma :bighug:

    Edit, Bhooma @Chris & China (GA) already made the changes for Jill, :cat:
     
    Last edited: Apr 25, 2021
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  37. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Diane Tyler's Mom can you check my spreadsheet again? I just typed in “4” for my dose tonight to see if it is updating automatically...
     
  38. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Yes it says 4 units
     
    Jay Dee likes this.
  39. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
  40. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I can do the SS switch for you in just a few minutes as Bhooma will be on much later.

    I’ll send you a private message to your Inbox. Give me just a few minutes to write it and look in the upper right corner of this page at “Inbox”. When the message is there, you will see a number. I just need to get some info from you to do it and it will only take me a few minutes.
     
  41. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Spreadsheet updated!

    So glad to see you're here now! Hopefully we can get Snuggie feeling better!
     
  42. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Chris & China (GA) thank you!! I’m so glad I’m here now too. Thank you for all your help!!
     
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  43. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    All - since his max dose was 6 and his last good dose was 4, is going from his current 2.5u to 4u at his next dose considered fast tracking an increase? Or is fast tracking anything beyond a max dose?
     
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  44. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Going back in dose is neither fast tracking or an increase, it's returning to a dose that showed some good numbers after a reset that shouldn't have been done. I'm pretty sure you'll be going up to 6 units, but I'd like to see a couple nights with data just to confirm.
     
  45. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Wendy&Neko ahh ok thank you!! Not sure how much ProZinc we have - may only be able to get a few cycles at 4
     
  46. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Thank you @Chris & China (GA)
     
  47. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @Jay Dee Hi Jill down the road if Suggie does need higher dose of insulin
    don't forget to check out Marks Marine in Canada for Levemir.
    You would still use your syringes to draw the insulin out of the pens like you do with the vials


    With higher doses of insulin we suggest Levemir over Lantus because at higher
    doses Lantus could sting.
    Buying it from Canada will save you money


    [​IMG] [​IMG] [​IMG] [​IMG] [​IMG] [​IMG]
    [​IMG] Levemir 5x3ml (Flextouch) CAN (temp. gauge. ice pack, express-air mail) Brand 100iu/ml 15 ml $169.99 USD
    [​IMG]
    [​IMG] Levemir 5x3ml (PENFILLS) CAN **CARTRIDGES** (temp. gauge. ice pack, express-air mail) Brand 100iu/ml 15 ml $169.99 USD


    [​IMG]
     
    Last edited: Apr 25, 2021
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  48. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
  49. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
  50. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @Jay Dee no problem, I hope Snuggies numbers start to come down , we will just have to see how he does, you can always tag for help.I'm glad your spreadsheet is all ready fo go tomorrow when you use the human meter
    He looks like a cutie , how old is he
     
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  51. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Diane Tyler's Mom thabk you! We think he’s around 15
     
  52. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    It looks like you just increased Snuggle's dose If you are going to stick with a 4.0u dose, please stick with the dose. And, please get a before bed test EVERY night. If you don't test during the PM cycle, you're missing half of your data. Many cats experience lower numbers during the PM cycle. It that's the case with Snuggle, it may go a long way to explaining the higher numbers.

    What does "Custom/panic" mean in your signature?
     
  53. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Sienne and Gabby (GA) someone suggested I go back to 4 and thinks I will need to increase to 6. I don’t know who to listen to anymore: I’m about ready to leave and just figure this out on my own

    I’ll stick with 4 til 4 doesn’t work

    custom was an option I saw. Panic is that we have been treating a few other things ans he almost died a few times
     
    Last edited: Apr 25, 2021
    Reason for edit: Further info
  54. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Fast tracking is where we take the dose up a little faster when the BG is over 400 all the time. For example, instead of waiting six cycles, we might increase after four or we might wait six cycles but increase by 0.5u instead of 0.25u. There are different ways to do it depending on the insulin and the cat and that’s why it is really, really important to work with someone who is very experienced at it. Fast tracking also involves very closely monitoring.

    As Wendy said, taking him back to 4u is just getting him back to a dose he was at before and shouldn’t have been reduced from.

    We have a dosing method for PZ on the PZ insulin support group so I suggest you read through all those files. It will give you some guidance on how the dose can be increased (fast tracking is more aggressive).
     
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  55. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Marje and Gracie thabk you: I’m on info overload at the moment. My cat literally had like 5 things wrong with him at once and was at ER vet once. I’m not sure picking 4u and just sticking with it is right but he’s at 4 now and I’ll test a few times and stick with it for a few days til I see if it’s working. I think I need a few days to absorb all this info and talk w my vet.
     
  56. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    We won't keep him at 4U if he proves he needs more (which he probably will) but with all the dose changes and all the medical stuff he's been through, we just want to get a stable baseline for how he is doing NOW. When it comes to feline diabetes, things that happened a month ago can be very old news and have nothing to do with what's going on now.

    Hang in there. We're all going to do everything we can to help!
     
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  57. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Just remember that we are very accustomed to seeing these kinds of situations which means we have your back. If you are testing and we see it’s too much insulin, we will let you know. If it’s too little, we will also let you know. I suspect, for many reasons, that the dose will need to go up but...baby steps.
     
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  58. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @Jay Dee
    Hi Jill just checking in, please don't leave, I know you have been told to change the dose many times by a Facebook group, which was wrong. Please stay and listen to @Marje and Gracie
    @Chris & China (GA)

    @Wendy&Neko

    they will help you, when you see the 4 units isn't doing much please tag them and ask for advice. Like Wendy said you may have to get him checked for Acro
    She gave you the codes and info in #33 above.
    I assume Sienne didn't read your first post above and didn't see what the Facebook forum gave you wrong info about dosing.
    So please don't leave ok ♥:bighug::bighug:
    Did you happen to test for ketones yet
     
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  59. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I see Wendy gave you the info below if you need to check for acro




    The tests you want are only done at Michigan State University. You want the following:
    https://vdl.msu.edu/Bin/Catalog/Catalog.exe
    Search for code 20005 for acromegaly or IGF-1 test. Positive is over 92.
    Search for code 20031 for IAA test.
    A result > 20% is considered positive for IAA.

    If you do switch to Levemir just post and tag Wendy, Marje or Chris and they can advise you what dose to start with

    Jill if possible after you test his PMPS can you then test maybe @+ 3 and then @+6
    Same goes for the AMPS
    Hang in there ok :bighug:
     
    Last edited: Apr 26, 2021
    Jay Dee likes this.
  60. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    I’m still here. Had to take a break last night, I spent all day pouring rhru all the info and advice on here and had a meltdown.
    I did a PMPS and a +3 last night. A PM+6 is 2am my time and I have a full time job but if it’s absolutely necessary as a baseline I can do it on occasion.

    I guess my next crisis is how the heck do I tell my vet that I made these sh!tty decisions to drop his dose without consulting him? As I mentioned he’s super supportive of my home testing and seems to support dose adjustments but in my mind if numbers are high and flat at 6, may as well see if they improve with less insulin. I guess if we go back to 6 or more I’ll hear the “I told you so” and why I should just listen to him. But going back to 4 sounded reasonable. It’s the drop to 2 I may have a tough time explaining.

    I tested for ketones yesterday and the strip turned gray all 3 times. He was his usual self tho and his appetite was fine, no vomiting, same today but I’m set up to do it again.
     
    Last edited: Apr 28, 2021
    Reason for edit: Clarity
  61. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Remember your vet works for you. You don’t have to be afraid to be honest with him. If he says, “I told you so”, then tell him you agree and now it’s time to focus on moving forward to help Snuggie. Then move on to the next question or discussion :)

    No one should beat you up for doing what you thought was best for your baby. You are certainly not the only one that has ever done what we call a “rebound check”. Many new members, especially coming from the FB group you were in (not the one associated with FDMB) have done it. Now we just focus on helping Snuggie towards regulation.

    We know it’s a lot at once; we try to not dump it all on you but there are things that just have to be read and learned from the get-go. We are a great support group and you can let us know what your questions are and whether you are getting overwhelmed. However, the bottom line is you are still his primary source for helping him improve. That’s a lot of pressure but we’ve all been there and you will be surprised where you are in what you’ve learned here and how much more at ease you are when you look back in a month.
     
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  62. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hey Jill it's ok to have a melt down, I understand
    Yes if on occasion it would be helpful to get that @+6 at night
    When you say the strip turned gray , so no ketones
    I never had to test for them did you follow the instructions on the bottle and check exactly 15 seconds later and compare the color on the strip to the colors on the bottle
    I don't see gray
    .

    [​IMG]
     
    Last edited: Apr 26, 2021
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  63. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Thank you @Marje and Gracie
    I feel so bad for Jill and Suggie
     
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  64. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Diane Tyler's Mom @Marje and Gracie
    Thank you both! I did read thru the dosing guide and a bunch of other stuff and my head was just spinning. I’ll reread a few more times to let it all sink in.

    We did the ketone thing again today - an obvious negative so that’s a relief.

    Switched to the human meter today. Low 400s AMPS and AM+3.

    I called the vet and they don’t stock Levemir, so I’ll discuss the change at his 4/29 appt. If we decide on the switch, I can at least buy a bottle of ProZinc to tide him over til it comes in. I can’t return it for any $ but they will accept it as a donation, so at least it won’t go to waste.

    But - should I wait until we see what the 4u and possibly more do? And/or to see what the acro and IAA test results are before committing to the switch?
     
  65. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Great job getting that +3 last night, that's enough to tell us he wasn't dropping low the rest of the night. Usually you'll see a much larger drop early on if that is going to happen.

    Vets don't generally stock the human insulins (Lantus and Levemir). They give you a paper prescription that you take to a human pharmacy. If you decide to fill the prescription in Canada (Marks is a real bricks and mortar pharmacy - 25 minutes from where I live), you just fax/scan and email the prescription to them. They have great customer service and can help you through it. In the mean time, phone around local pharmacies for pricing, I have heard of some people being able to get a single pen to tide them through. Or check out our Supply Closet forum where people are getting rid of supplies they no longer need.

    We should know within a few days what 4 units is doing for Snuggle. This isn't a rush, we can wait on the decision. However, if for any reason he needs larger amounts of insulin, I think you'd find the other insulins will do a better job.
     
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  66. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Glad there are no ketones!
     
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  67. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    If he were my cat, I'd ask my vet for a script for Levemir and send it to Marks ASAP so they can get it on it's way to you. It can take a little longer to get to you on the first order...7-10 days (sometimes sooner). Refills will come faster.

    I know you're running low on ProZinc so you may have to buy another vial just so you have insulin to give him while the Levemir is shipped (or you could buy the Levemir from a pharmacy here in the US but that's going to cost you several hundred dollars ($300'ish). If you do get Levemir filled here, take a picture of your prescription before you take it to a pharmacy. That way you'll have it to send to Marks in Canada.
     
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  68. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    YOU GUYS!!!! something just donned on me. When we adopted him at ~ 2 yrs old, the shelter said “you don’t want him, he’s got gingivitis” (I know, right??) ... and I was organizing his med folder the other day and it seemed we gave him a round of antibiotics maybe every other year (i complerely forgot what they were for til now) and I know we did a few dentals. He was on Royal Canin Oral Care dry food and Hills Oral Care before the diabetes Dx, and we used to give him CET Dental chews with kitty toothpaste on them. He had a nasty habit of chewing things like electrical cords, wood furniture, and shoes (the latter earning him the nickname Jimmy Chew)... We usually had the vet check his gums and his last vet in CA said he was super impressed and even said we could hold off on the dental before we moved to Utah. His checkup here before the diabetes Dx also was good with respect to his teeth ...

    Since the diabetes Dx, obviously we changed his food and treats, I don’t know what toothpastes are safe, and I can’t find CET chews to save my life (they may not be good anyway). He lost interest in his gum massaging worm toys (and my shoes, thank goodness) since the Dx too. He never chewed his dry food but he LOVED those chews. He doesn’t seem to be in pain when he eats now, and he chews his PureBites with enthusiasm...

    We do massage his gums with the kitty toothbrush but no paste.

    Im hesitant at this point to do any anesthesia for a dental due to the CKD values and unregulated blood glucose, and he’s been on 3 kinds of antibiotics in the last month, but could this be part of his whole issue?? Maybe none of the antibiotics deal with gums (convenia, clindamycin, Orbax)?? I looked at his gums today and they are decidedly more red than pink near the teeth.

    also - any recommendations for what’s safe for him tooth-wise?

    (in other news, his +6 today was 350 and he actually played fetch with me - running down the hall - with more energy than he’s had in almost a year.....)
     
    Last edited: Apr 26, 2021
    Reason for edit: More info
  69. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Absolutely! Dental disease can cause all kinds of trouble, including insulin resistance. Also, it sounds like he may have some painful teeth too and pain can raise the BG too.

    If his teeth are in bad shape, he really needs a complete dental (which should include pre and post dental x-rays). Once the tarter is on the teeth, there's nothing you can use to get it off. It must be "chipped off" with dental instruments.

    Once they're clean, you can help keep them that way by "brushing" with plain old water. Take a piece of wet cotton gauze and rub it along his gumline to help remove the plaque.

    Another option is to give him chicken wings, necks, kidneys, livers, gizzards or hearts to chew on. Cats in the wild keep their teeth in good shape by grinding and chewing against bone, sinew and cartilage. Chicken "innards" are fibrous so have to be chewed well which helps break up the plaque on the teeth. Chewing on raw bones mimics the scraping that helps break off the plaque before it can get too hard to clean without another dental.

    WOO HOO!! Great to hear he seems to be feeling good today!
     
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  70. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Chris & China (GA) daaang! Ok I will mention this all to his vet on Thursday. Could this reverse any insulin resistance or should I just continue on w the plan to switch to Levemir?

    also - any concerns for anesthesia as a kidney cat & unregulated diabetes?

    i massaged his gums good today so I wonder if he was trying to tell me something. It was literally 30 min later that he was playing
     
  71. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    It's possible, but I'd go ahead and plan on switching either way. I think the L insulin's seem to work better for most cats (but I'm a little prejudiced since it's what I know best)

    Ahhh....and there's the problem....a lot of vets won't do dentals unless the cat is controlled....but without the dental, it's almost impossible to get that control they want!

    Newer anesthetics are much safer than the ones they used to use and a vet should always do routine bloodwork before anesthesia to make sure the kidneys, liver, etc. are all working well enough to tolerate the anesthesia. China had her very first dental at age 15 and had 8 teeth extracted. Was eating later that evening. There are lots of us here who've had dentals done on our older cats and they do great. Will it guarantee to bring the BG down? No...but as least you'll know your cat isn't in tooth pain. Quality of life is important too...who wants to live with a toothache?

    I had to go over an hour away to find a vet who could do dental x-rays. Some vets consider cleaning just the visible surface of the tooth is good enough but teeth are like ice burgs....2/3rds of them are under the gums where you can't see what's going on without x-rays.

    Here's some good information on dental procedures
     
    Last edited: Apr 26, 2021
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  72. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Chris & China (GA) THANK YOU! I will definitely inquire about all of this on Thursday. Hehe yea my dad was a dentist so I can relate to the iceberg comparison!
     
  73. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Alflaxalone (aka Alfaxan) is a more recent anesthesia that keeps the BG from falling after the procedure. Checking labs before the dental will let them know if there is any issue with the kidneys.

    Clindamycin is an excellent antibiotic for the mouth.
     
  74. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    That's such good news that he was playing fetch with you, it makes me happy!
    Love seeing those pinks :cat:
     
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  75. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    Got a red at PM+3.5 but barely - we forgot to heat his fluids so had to give them at the same time as his insulin today - which we try not to do (usually 2 hrs apart or more).
    Plus usually I can get the fluids and insulin into different sides but I think we kind of overlapped today - so I’m not sure he’s getting the best insulin bang for buck tonight. I’ll try to get a PM+3 and +6 tomorrow!

    YES he had pushed a toy down the top step and when I got it he was interested - figured I’d toss it and see what happened. I was so encouraged to see he wasn’t even walking “wonky” in his back end
     
  76. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Diane Tyler's Mom @Marje and Gracie @Chris & China (GA) @Wendy&Neko

    ok - we have some data at 4u (injected too close to fluids injection area last night so may have interfered w insulin absorption).

    what are your thoughts so far? Should I try for that PM+6 tonight? (I didn’t want to waste it last night considering the issue we had)

    no ketones today either and he’s acting fine...

    I’ll be busy this evening but will check when I can. Thanks for your help and advice!!
     
    Last edited: Apr 27, 2021
    Reason for edit: More info
  77. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Stick with the 4U dose tonight....You don't necessarily need to stay up until +6...if you can get a +2 or +3 before bed, we can usually tell if you really need to plan on setting an alarm to get more tests.

    It would be good if you'd try to get some tests at other points in the AM cycle too. Maybe one day get a +3, +7, another day get a +2, +5, +8...just look for big patches where there's a lot of white and get a test.
     
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  78. Jay Dee

    Jay Dee Member

    Joined:
    Apr 22, 2021
    @Chris & China (GA) thank you! I’m super tired tonight so will get a bedtime one. I expect he’ll be in the 300s again...

    And you answered my exact next question :)

    thanks!!
     

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