New Member {Erin and Dot} Seeking Guidance

Hello there all! I am joining this group coming from the Facebook partner page in hopes for more detailed and specific assistance with moderating my sugary baby. Please bear with me as I attempt to learn FDMB acronyms and get used to this whole feline diabetes lifestyle.

It has come to my attention that my vet may be lacking some insight into this diagnosis and I am looking to you pros for some guidance! If he is, in fact, incorrect, I would love to have some information to share with him or be better equipped to look for alternate care. I am torn in that this vet sees all 4 of my pets and is wonderful, but if Dot needs a "specialist", I will find one!

About Dot:
9 year-old male tabby, 10 lbs as of 2/22/21, regularly aloof and rarely affectionate but always present.

Food: Friskies Classic Pate variety packs, 5.5 ounce can once in AM, once in PM.

Pre-diagnosis symptoms:
Dot has always been food positive but we started noticing changes in his behavior. He became voracious and aggressive around food, often destroying containers, knocking over trash cans, stealing food, the works, he was obsessed.
- Weight loss became evident in the last 3 months, he lost 5 pounds since our last vet visit.
- Massive intake of water and urinating clear, excessively and often
- Distant and moodier than usual
- started urinating outside of the box on carpets around the house
- Rash on chest and left arm, then overgrooming

Current Symptoms:
- Seems to be putting on a little weight, but not obvious yet
- normal mood except in regards to food - still very crazy - eats rapidly, makes a mess of his face and the table around the food, taking full mouthful gulps, still trying to steal food and find it around the house.
- Rash is improving but present. We use antimicrobial healing spray and if he overgrooms day to day then put a cat healing shirt to prevent licking.
- Heightened thirst, but seems to be improving. Urinating in the box now, still large amounts of liquid.

Injection History - How'd We Get Here?:
Dot was diagnosed a little over a month ago. We started with AlphaTrak 2 monitoring for the first 2 weeks, no insulin, just testing and determining his baselines.

2 weeks later, started ProZinc BID at 2 units, twice daily. After seeing no changes in BG after 2 weeks on 2 units, the vet instructed us to move to 4 units, twice daily.

Today: Started 4 units AMPS, did a test 4 hours later to see how things were looking, it was higher! 460 AMPS to 490 4 hours later.

Our Current Routine:
Morning - take blood test, give insulin, canned pate meal. This has been 2 units of ProZinc BID for 14 days so far. 12 Hours Later...
Evening - take blood test, give insulin, canned pate meal. This has been 2 units of ProZinc BID for 14 days so far.

We increased to 4 units this morning, and will dose again in 4 hours.

Randomly, for data: Will occasionally test 4-6 hours after insulin to monitor progress.

Commentary:
You will see from the chart linked in my signature block (hopefully I did all of that correctly!) that his numbers with 0 (no) insulin look identical to those received while administering 2 units. The general consensus on the Facebook group was that its likely we started too high and are increasing too quickly. I would love to know what's actually going on here.

Also note! I have been doing a lot of reading and have seen mention of Ketones in urine many many times, this is not something my vet tested for and is not something that was even mentioned. If this is something all cats with diabetes need monitoring with, please advise!

Another note! I am prepared for Hypo. I have high carb canned foods, honey and extra test strips at the ready and know which emergency hospital nearby to attend if needed. I have not seen anything that would make me think we are coming close to that, but for those worried about the DOUBLE units - me too. I am watching.

My Thanks:
I am desperately trying to figure this all out, I read the main pages, I know, I know, breathe and I am. But part of feeling comfortable with this change for me is learning to understand everything and be able to adjust accordingly as needed. I don't feel like I have a grasp on this yet. What is supposed to be happening? What are the numbers supposed to look like? What changes am I supposed to see in his behavior and when will those start happening? So many questions. BUT I look forward to having this group as a resource and cannot wait to thank you all again when things finally get sorted out. I cannot thank those of you who take the time to respond enough. Thank you, thank you, thank you!

- Erin and Dot -

 

Hi Erin, and welcome to yourself and Dot.

Sorry you've not had a reply yet. I've not used Prozinc so I'm going to tag some members experienced with that insulin for you:

@Deb & Wink
@JanetNJ
@Shelley & Jess

I agree, especially with the vet's recommendation to jump from 2IU BID to 4IU BID. That's a really big dose increase. With the dosing methods we use here, adjustments are usually done in increments of 0.25IU, 0.5IU max.

You've definitely come to the right place to learn about how Prozinc works, to understand what to expect from treatment and have all your questions answered. For starters, there are some really good info sticky posts at the top of the Prozinc support group's board to help you start learning about Prozinc and how to use it. Here's a link to it:

Prozinc Insulin Support Group Board Index


Mogs
.

 

Yes you should be testing for ketones in the urine in unregulated cats. Your vet should have tested for them at diagnosis.
You will need to buy a bottle of Ketostix from a pharmacy or walmart and collect a urine sample from Dot. Dip the test strips into the urine and read it exactly 15 seconds later against the colours on the side of the bottle. Anything above a trace needs vet attention.

I also think increasing to 4 units is far to much.please don’t do it.
The starting dose is around 1 unit.
Always test before the shot to see it is safe to give the insulin and again around +4 to +7 to see how low the dose is taking Dot.
Feed a meal before the shot and give a couple of snacks during the first half of all the cycles.

Just looked at your spreadsheet. You have hardly any tests in during the cycle. For all we know Dot could be dropping low and bouncing up at the next shot time. please try and get some tests in during the cycles including the pm cycle as it is just as important and many cats drop lower at night.
Getting a before bed test done routinely is a good idea. If the BG is lower than the present BG you will need to get up and check it later on to keep Dot safe.

Keep asking questions. We are happy to help
Bron

 

This concerns me. The recommended starting dose is 1 unit twice a day. If it proves to be not enough we recommend raising in 0.25-0.5 unit increments. Going from 2 (already a high starting dose) to 4 units is scary to me.
Most cats never need a dose more than 3 units. Personally I'm afraid you might have skipped the right dose, or he could be going lower mid cycle, then bouncing up high for a few cycles. The only way to know is to consistently test mid cycle. Personally I would drop that dose back down to 3... test for a while including a mid cycle test. If you don't see the number drop, then do 3.5 for several days while testing... if mid cycle tests are still high, then do 4... NOt raising by more than half a unit at a time. There will come a time that you will reach his BREAKTHROUGH DOSE... at which point you could see the dosage needs drop quickly. For my cat it was when she reached 3 units. Before that she didn't see a number under 300 . a month later she was in remission for a year.

Now It sounds like he's been an untreated diabetic for quite a while... which could make him insulin resistant and he may actually temporarily need a higher dose then average, maybe even as much as 5 or 6 units... but you don't want to get there too quickly. PROZINC IS DOSED BASED ON THE NAIDAR (peek mid cycle number) RATHER THAN THE PRESHOT. So that is why it is so important to see how LOW he goes. you also will want to get a mid cycle number any time you can. Prozinc generally peeks around 5-7 hours after the shot. Some earlier, some later, but in general this is when they peek. So readings during this time would be particularly helpful.

Our Current Routine:
Morning - take blood test, give insulin, canned pate meal. This has been 2 units of ProZinc BID for 14 days so far. 12 Hours Later...
Evening - take blood test, give insulin, canned pate meal. This has been 2 units of ProZinc BID for 14 days so far.


Excellent that you are testing at home. And great job getting the spreadsheet up and running as well! Well done! And friskies pate is a fine choice. SO one note on that... YOu mentioned that he's currently underweight, but you are only feeding twice a day. Most find feeding several small meals a day is better. I always fed morning, afternoon, evening, and before bed. Just no food at least two hours prior to the preshot test. And since he's underweight, let him eat as much as he wants.

Your cat is very unregulated and the numbers are very high... this makes him more likely to develop ketones. It is something all diabetic cats should be mindful of, but particularly with numbers this high. I used a ketone BLOOD meter which works the same as a glucose meter. Some use ketone urine strips, but I could never seem to catch my cat in the box, so the blood meter was just easier.

 

any chance you have the bloodwork from when he was diagnosed that you could post?

 

@JanetNJ - Thanks, Janet.


Mogs
.

 

Yoowza! That's a VERY steep jump in the dose.

Please get another test today, in a couple of hours from your last test if possible.

I second what Mogs said. And I second what Janet said.

Just want to double check. Are you tenting the skin for the shot, and not poking the needle all the way through?

p.s. Great job on learning to home test. Now we just have to get you to fill in the books (mid-cycle tests) between the bookends (pre-shot tests).

 

Thank you everyone for the information and thank you for the question! The vet did not do any detailed blood work upon diagnosis, only listened to the symptoms and took a BG test using an AlphaTrak and concluded it was diabetes. What types of bloodwork/tests would be helpful to have done?

 

looking at the numbers it's clear she has diabetes... but usually it's diagnosed with a fructosamine test which gets the average bg from the previous 2-3 weeks. THe reason I asked about the labs is because I was wondering if the resistence might be coming from an underlying infection. I was curious what the white blood cell count looked like.

 

Thank you so much! Yes, I am tenting the skin. I accidentally poked all the way through both sides of the tent once and have been paranoid and double check visually that I am only through 1 level of skin before plunging.

we just did his morning dose - using the 3 units as recommended by Janet and I will be testing every3 hours throughout the next few days so we can see what his cycles and mid-cycles look like. I will be updating the spreadsheet every few days as we go and make another post in a few days with updated numbers.

I cannot thank you all enough! More to come soon...

-Erin and Dot-

 

Erin, I know it's a pain to keep the spreadsheet updated every day. But if you suddenly need help with an emergency situation, like low BG numbers, it's important to have the SS as up to date as possible.

 

That is a great point and a very good question. It is likely the vet will want to do testing once he is leveled out, he said results gathered

That is a good point, I can do that. I have an app on my cell phone where I track the numbers and then transfer them over but for purposes of getting the most out of this group, I will keep it up to date! Thank you!

 

Hi Erin wanted to let you know we cannot see the spreadsheet all of a sudden

 

That is bizarre, let me take a look and fix it!

 

OK it's good now