New Member, Not Much Progress 8mos Post-Diagnosis, Need Advice

Hey there, my name is Christian and my cat, Ramirez, was diagnosed with diabetes in February this year. He is 10 years old and the symptoms that led to his diagnosis were increased thirst and appetite while experiencing weight loss. I thought it was perhaps significant that his symptoms seemed to get much worse after I went out of town for 2 weeks to dog sit for my brother - his weight loss was very noticeable when I got back and prompted me to take him to the vet. We started treating him with a diet of RC Glycobalance alone for a month or two, when that wasn't working we started him on 2 units of PZ. I took him in about a month later and they increased the dose to 4 units. He still wasn't improving and when I took him in the next time the vet asked if I was leaving food out for him. When I said I was, he told me I needed to restrict his diet to 1/2 a can and 1/4 cup of dry food per meal (before I was feeding him 1 can and letting him graze on the dry food). This seemed pretty drastic to me, but his symptoms did seem to improve with this change. However, Ramirez became absolutely maniacal for food and got into a lot of contraband during this period of time. After probably another month or so of dealing with this difficult behavior, I asked the vet and he said I could feed him a bit more. This was when I brought him in for another test, and while he tested poorly (I forget the number unfortunately) I had gotten a fur shot that morning and when I explained that, the vet said his numbers were probably good if his symptoms were improving and that I could wait 6mos for another check up. I was reassured in the moment, but as time has passed Ramirez is still going pretty crazy for food, he's still drinking a lot and urinating a lot, and he still hasn't regained his normal weight from what I can tell. The symptoms do at least seem less intense than they were originally though.

After doing some research I discovered this forum and found a lot of information that was at odds with the vets recommendations, in particular relating to diet and dosing of insulin. I was hoping to just follow the vets advice but now I'm concerned that this may not be the proper treatment and that I may have been going down the wrong path. I have purchased the equipment to do blood glucose tests at home so I will soon be able to get a better idea of what his condition is actually like. I am wondering in the meantime what I should know given this situation and how I should proceed in getting him on the right diet and finding a proper dose. As of now, I'm feeding him 3/4 can and 3/8 cup of RC glycobalance and shooting 4 units PZ.

 

WELCOME TO FDMB and we are so glad you found us! I cant count the number of times I've read these same words. Unfortunately Vets dont get much training /learning when it comes to feline diabetes. I know know its hard to go against a vets advice. (Of course it is, they are the ones with letters after their names.)
Here, theres not only a wealth of information but many people, over MANY years, with practical advice . We live feline diabetes 24/7/365.

Are you home testing Ramirez's blood glucose? If you are, then I would start weaning him off ALL that dry food SLOWLY. The removal of dry food can drop BG levels to dangerous levels. You NEED to be testing before you remove the dry food.
*Dry food (including the prescription kind) are packed with carbs. Carbs FEED diabetes. Its like throwing gasoline onto a fire.

We are DEDICATED to helping all the kitties that find us, become healthier and happier.

WELCOME TO OUR FAMILY

I'm going to direct you here to help you get acquainted with how things work around here. PLEASE pay special attention to the,
Profile/Signature section. This will help us help you more efficiently.

We look forward to getting to know you and Ramirez!
jeanne

 

BTW Most of us feed Fancy Feast pates or Friskies pates. They are all 10% or lower in carbs. Many here feed a raw diet that as well is a good source of food low to 0 carbs.

 

That's a big jump from 2 units to 4 units – in effect, it is doubling the dose. It is recommended here that increases be no more than 0.25 units because it is so easy to go right pass the proper dose. It could be that the dose is too high or if you need to increase it. Hometesting will give you the answer.

The RC Glycobalance is too high in carbs. But switching to a low carb diet is not advised until you are testing. And then the switch has to be done slowly. Just cutting carbs can drop a cat's numbers overall by up to 100.

An unregulated diabetic cat does not process their food properly so they are always hungry. Feed a meal at shot time, then feed small snacks throughout the cycle. Pick up any food two hours before the next shot so that the test at shot time is not carb influenced.

Tagging a few Prozinc people for you.
@Deb & Wink
@Panic

 

Hi Christian,

Welcome to FDMB. I think we will be able to help much more once you have a few reading at home, but can I just ask how big is Ramirez? The usual initial dose takes into account the cat size, so that is why I am asking.

My cat Hercules dropped his BG quite a lot when we moved from the purina diabetes prescription food to a low carb food. He still needs insulin and he is a bouncer, which means every day is different.... Meassuring blood glucose levels at home was a really game changer, but nerve racking to begin with! Do ask anything with you are struggling, people here not only have good knowledge but the are amzing at cheering us up through the maze of feline diabetes.

 

The key here is to get a handle on home testing Ramirez's BG levels, so you can see what is going on, before you even think about changing the diet. That is so you do not cause him to drop too low, and experience hypoglycemia. We really are data driven here, so need to see some home test data to make recommendations for you.

Have you seen the Sticky New? How You Can Help Us Help You! yet? Getting some info set up in your user id signature will help us to help you better.

Deep breath, hold, release, deep breath, hold, release, repeat as needed. You've found us now and we've got your back.

 

GOOD LORD I forgot to add that link! Thanks DAeb!

 

Don't be like me and forget to do this! Very important. I'm finally remembering not to give in when he asks for food at that time.

Tip: I gave my cat a "fix" of catnip tonight to distract him from wanting to eat during that 2-hour NO FEEDING window before shooting insulin. Worked beautifully! He was so HAPPY/Wasted/Drunk...!

 

Thank you all for the warm welcome! I meant to respond last night but my power went out unfortunately. I bought an alphatrak 2 so I'm going to try to test him today. I agree, I want to be monitoring his levels before making any changes. I've read up on the material here about hypoglycemia so I am aware of the risks now.

Thanks for the link Jeanne and Deb, I will read that thread and add the relevant info to my profile/signature.

I don't know what his normal weight is off the top of my head. The weight listed on my most recent invoice from the vet is 5.2 lb, but I think he has regained some weight since then. That reminds me, I need to order a scale. He is a pretty big boy though, at least he is larger than his "sister" Thea.

After reading through some of the material here, that is one of the things that raised my concern. It seemed like quite a big shift compared to the smaller adjustments talked about here. Are there U40 syringes that mark off 1/4 units? Thanks for the idea of feeding occasionally during the day, Ram will be happy about that!

 

There are no insulin syringes that measure in 1/4 units. Not U40 syringes, not U100 syringes. The closest available are ones that have 1/2 (0.5U) unit markings.
You eyeball, or do your best to measure in between the lines.

 

A little update: I was able to get a test mid-cycle yesterday and today, and I've started my spreadsheet. I'm having trouble with the AMPS and PMPS, he is very cranky about the ear prick and riled up cause he's expecting food. I'm sure I will get the hang of it soon, as he gets used to it. In terms of his numbers so far, I've gotten to the bottom of the vial of insulin I have and I think it might have lost some potency. A new one just showed up today so I will be interested to see if there's a difference. Thanks again for the words of encouragement, I am definitely feeling more optimistic about all of this.

 

Bribes. Use bribes, to get him to accept the testing.
Any kind of pure protein treat is fine. Fresh or freeze dried. Meat or cheese or egg if he likes that.
Brushing, pets, play time are all non-food alternatives to using food to get your boy Ramirez to accept the testing process.

Break the testing down into little steps. Do those steps a dozen or more times a day. Maybe not poking the ear every time, but getting Ramirez more used to the "process" of getting his ear tested.

New vial of Prozinc. Please note that in the Remarks column, on the far right of the SS.
Sometimes, new vials can be more potent. Depends on how long you had the old vial open.

Context. Those pre-shot tests provide context for the mid-cycles BG tests. Right now, we have no idea how high (or low) Ramirez started the 12 hour cycles.
So you might want to monitor more closely, especially near mid-cycle.

 

If you've not done so already, there's information on the Prozinc forum on dosing methods.

 

Welcome!!! You've come to the right place I'm new here too and the people here are AMAZING. I trust the advice here over my vet any day. I am also new to at home testing and my boy made it very hard for us but there are some fabulous tips around. What has absolutely helped me is that I have some freeze-dried salmon treats that I give Mo after every test, so now he associates testing with a treat. Every time he hears the zip of the testing kit, he comes running! He just needs to get used to his new normal. It definitely gets easier, I promise, even right before meal times

As mentioned by someone else before, slowly transition your Ramirez onto wet food only. It helps with their fluid intake AND is low in carbs if you choose the right kind. I have started Mo on Fancy Feast Classic Pates and in the last week his numbers having come down just by changing his food!

There is so much useful information on here which can be a bit overwhelming at first, but I'm sure you'll get the hang of everything. Feel free to ask for help! I'm not sure I'll be able to help as I'm still new to all of this but everyone here is so helpful and understanding.

Welcome

 

Thanks for the tips! I have some salmon fillet treats and they are working well as a bribe. I can only do the prick while he's eating a treat but I suppose that's good enough for now. He gets very upset otherwise, growling and swiping at me just for rubbing his ear to prepare. I will do more dry runs with him and break down the process.

Noted on the SS, will keep that in mind for future vials. I got an AMPS and mid-cycle today so I'm getting on track. Thanks for all the info Deb!

 

So I have been gathering data for a little over a month now. I'm still trying to get more consistent with successful blood tests, but at least I have been improving. As can be seen from the numbers I got from 11/17-11/20, I was concerned that something may be interfering with the insulin. I scheduled an appointment with the vet to make sure he didn't have an infection or anything. There were no signs of infection, and the vet suggested I increase the dose by half a unit this time. I explained that I wanted to cut dry food first and go from there and after a brief discussion he was pretty amenable to that.

I am still a bit confused and concerned that his numbers don't appear to be responding to the insulin though. The vet didn't have much to say about the insulin not having an effect, aside from asking if I was sure that I shot it correctly. I know that shooting under the scruff isn't the best spot, but it's the most consistent place for me to shoot. I have trouble tenting his flank but I've started to try to shoot there occasionally and see if it makes a difference.

Lastly, I plan on reducing his dry food now from 1/4 cup to 1/8 cup at mealtime and after a week or two remove it entirely.

If anyone has additional suggestions or insights into this situation, I would really appreciate it!

 

Did you have any further progress? Do you continue measuring?

 

Thank you for the response. I was a bit discouraged with the lack of a response so I had stopped updating the spreadsheet (I have since updated it now), but I've been testing. I had a very difficult January so I was more focused on making sure that it was simply safe to shoot the insulin. I am in a much better frame of mind now and have resumed monitoring his BG more closely. Now it seems that sometimes his BG doesn't come up as much as it used to at the end of his cycle. On 2 recent days he had a PMPS of 131 and 192, his lowest PMPS's so far. I am happy to see lower numbers, but also curious whether this is normal. Thankfully I have a pretty well established routine now, so I am going to be more diligent about monitoring him and keeping the spreadsheet updated from now on.

 

Chin, we are new here and i have to say that i felt so lucky to have the chance to get advice from people who are past my level of beginner understanding/lack of understanding of what is happening. I am sorry you got discouraged but from what i noticed in this group people are extremely helpful and it seems much more probable that it was lack of luck that nobody noticed your messages than anything else.

I am really no wise man regarding the feline diabetes since we are dealing with it for less than one month but i couldn't help but notice that you are measuring only AMPS (morning pre shot), AM +6 and PMPS (evening pre shot). What helped us a looooot to understand what is happening with Chico was to make a BG (blood glucose) curve. You can see it on the 30th of January in Chico's spreadsheet. We measured AMPS and the every 2 hours until PMPS. Only than we understood what nadir, when was it and how to recognize it, we saw that during the cycle he got some nice colors not. If we were to just measure pre shots we would as well see only red and black. After making the curve we understood that Chico was nadiring (i am not certain it is a word) at around +5 hour and that if this happens it most of the time means that the insulin is too short action. Later on we understood that his nadir was moving anywhere between +3 to +5 and we understood that during the night he is nadiring in much lower values than during the day.

If anything do this for yourself to understand if there is a problem with the insulin, if Ramirez is reacting to the insulin at all and maybe consider changing to another insulin. We transitioned 3 cycles ago from Caninsulin to Lantus, still in transition phase but we were really looking forward to switching from caninsulin which was clearly not having sufficient action.

 

I don't know Prozinc insulin but here is a link of some information in case you haven't read it yet

https://www.felinediabetes.com/FDMB...-the-prozinc-basics-please-start-here.164995/

 

Thank you so much for this reminder. I had planned on doing this initially but I was waiting until he was more used to the blood tests since he was pretty hostile about it, swiping at me and trying to bite me. He has finally gotten much better about it in the past few weeks so I'll see if I can do a curve tomorrow and get that info.

I agree, and I realize now that there probably wasn't much to interpret anyway until I get a BG curve in.

 

i will try to follow you tomorrow good luck

 

Hi Chin,

I'm sorry that you didn't get a reply the last time you posted. Sometimes the board can move quite fast and, as threads are answered and added, older posts move further and further down the list and don't get enough notice.

Some tips:

- If you haven't had a reply within a reasonable time, post a new reply to the thread with the word 'Bump.' This will 'bump' your thread back up to the very top of the board again.

- Sometimes when there are a fair number of replies to a thread members viewing the board may assume that you're already being helped by others who replied to you earlier. Creating a new thread for each new help request or question avoids this. You can post a copy of the URL for your previous thread in the first post so members will be able to check back if they need to.

- Setting the '?' icon next to the thread title will attract more attention to your thread and indicate to members that you're waiting for a response. You can then take down the '?' icon once you've got the help you need. (At very top of thread on right hand side of screen click on 'Thread Tools' to make changes to your thread titles.)

I hope the above helps you get more timely replies in the future.


Mogs
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It's really nice that you're looking out for Chin and Ramirez.


Mogs
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We struggled a lot with managing to do the tests as well, for a while he seemed so stressed around it, so i really understand you don't want to overdo measuring when he is stressed about it. Last few days it is getting better, he even comes to us by himself (unless he is too hungry))))

what really helped was the rice sock, in the beginning he didn't want to let us put the sock on his ear but after a few more days he did and it works like a charm: the ear is warm much quicker and it is easier to get a good enough blood droplet

 

Hi Chin, Just wanted to send you a
I imagiine managing feline diabetes can be tough in the best of times, but being on top of everything else going on the world... ufff... is really tough!
We are here to cheer you on! and help you if we can. As marina said, there are so many thing that seemed so difficult to begin with that when I tought too far ahead I would have gotten overwhelmed. But slowly, slowly me and the cat have gotten used to the new routines, and if I just thing about one day at a time and cheer each low number I see, it goes better. Hang in there!

 

Great job Chin, i see you started doing the curve

 

Thanks for these tips, it's very helpful! I have trouble speaking up, asking questions and asking for help, so I need to work on that. It was hard for me to even draft my initial post here but I am so glad I did.

The rice sock is a godsend! Ram really did not like it at first either. But I just got his +2 test in for the curve today and it was one of the easiest tests yet.

Thank you for your kind words, understanding and encouragement. Indeed it's been a very difficult time. I have had to take up meditation and breathwork to deal with the stress and I'm so thankful to have found relief in that (in particular, the wim hof breathing method has helped me immensely). It is really helping my mind slow down so I don't get ahead of myself.

 

I was thinking that after you will have the curve done, you should post in the Prozinc group directly, i believe if it is similar to the Lantus group you will find a lot of experience with this specific insulin

 

We're glad you did too, Chin. The natives here are very friendly!

Please don't worry about asking questions: pretty much everyone who arrives here has more questions than you can shake a stick at, and we all like to help each other.

Glad to hear the testing is going better with the rice sock.


Mogs
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Some people also suggest humming some song that you like (and Ram doesn't hate... ) while you test.
The idea is that cats might sense your stress, but if you are humming, you may hide your nervousness, or even calm yourself...

Once you have data, things are likely to get better. Look at Hercules spread sheet, it was all reds and yellows when we started, and now (knock-on-wood / anti-jinx) is mostly green and blues after much learning and adjusting. It does take time and experimenting, but you both will get there!

 

Very nice work Chin i love that we can see how Ramirez is reacting to the insulin

 

Thank you for monitoring with me! I agree about making a post in the PZ group. I think that's probably my next step, along with getting some tests in during his night cycle.

 

Very nice curve, did you ask dosing advice when the PMPS was lower than usual? There are protocols about it: you stall without feeding and ask advice but i am sure there are way more experienced people that will tell you all of this and i definitely advice to ask in the prozinc group about it

based on your curve it looks like ramirez nadired somewhere between +4 and +5 hours. From what we noticed nadir changes (they say mainly until the cat is regulated).

the more you will measure the easier it will be to understand what does he need. Testig during the night is a great idea

what are your feeding patterns?

 

I agree with Marina that the curve looks nice! We were on prozinc before switching to Lantus, and you can have a look at Hercules spreadsheet from 2020 to see what he was doing. Actually I found really helpful to look at a bunch of cat's spreadsheets to help me understand what is "normal" and how do other people handle things. You can just snoop on everyone's spreadsheet over the prozinc forum under stealth

It looks to me that Ramirez might be a bouncy cat, like Hercs. So looking over night is a very good idea, because many cats go lower at night than during the day, and cats newly diagnosed which have not been in lower numbers before will shhot up after visiting green and blue numbers, which might explain the very high AMPS, despite good numbers mid cycle. That being said, I never managed to regulate hercs on prozinc....

 

I had 2 failed tests (not enough blood) on that PMPS last night so Ram and I started fretting. I forgot about stalling, and was focused on the no-shoot #. Last night would have been a good one to stall so I'll make sure to do that next time I get a similar number. I am definitely going to ask the PZ group for advice on dosage when seeing those numbers.

I'm feeding him 1 can of Fussie Cat tuna & salmon at breakfast and dinner, then 1/3rd a can at +3 and a small plate of dried minnows at +6. He also gets a few minnows as a treat after every test.

 

I know exactly how frustrating this can be, trust me but hang on, it is getting better. Now since we stopped torturing Chico with several pinches for one test he is coming towards us when he sees the kit

As well it is recommended to take several measures during the cycle, best would be to measure around nadir, for your to see how low he goes, as well this helps us keep our kitties safe. From yesterday you can see that Ramirez's nadir is before +6 (of course it can and most probably is changing, that is why it is important to measure as much as possible). That being said it is recommended to feed them before nadir, because after there is less insulin left to act and by feeding you increase the peak at the end of the cycle.

I checked here: https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf and it looks like it is low carbs. We are currently trying to control Chico's BG cycle with food intake. I won't be flooding you now with information, i just wanted to let you know that in the moment when you have more information about what is happening with Ramirez there are "tools" to help him get better

Good luck at further measuring

 

Hi Christian! Just wanted to let you know that your post/spreadsheet has been really helpful to me after I joined last week. I'm having similar issues (no progress since April) and similar numbers in my spreadsheet. Only difference is the food and insulin - I started on Lantus and recently switched to Levemir. I've also been discouraged because I just keep seeing red/black and I look at all these other posts with yellow and pink! It's been encouraging to me to see Ram's gradual progress. Keep at it, you keep me hopeful!! I also may try your breathwork tip

 

Chin, be sure to check your post over in the PZI forum too. I've been answering you over there.

 

I'm glad our experience is keeping you optimistic! I definitely understand the frustration of continuing to see high numbers. Ram's dose took his BG down too fast a few nights ago and now it's bouncing around again. It's been very helpful for me to just slow down and focus on one thing at a time. I'm sure your diligence will pay off and I wish you and your Minnie all the best!

 

Your boy does like his trampoline.




Mogs
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