Reduction Needed? Remission? Please advise.

thaurermellon

thaurermellon

Member
I am still pretty new to the board and tried to make my signature with the sheets correctly but please let me know if I need to modify or change anything.

I started giving insulin 2 weeks ago. I started low with a 1.0 unit of Prozinc and then moved up to 1.5. I was still getting numbers in the mid to upper 200s, so I went to 1.75. After 3 cycles, he went down way too quickly for my liking and needed carbs.

The next day I missed the shot accidentally, so I skipped it. That night he got a 1.5 unit dose again and it was getting him into low 200s and nadir was 197. I gave him a 1.0 unit the next morning because I was worried since I would be at work and could not feed him (he is given food in his bowl but he is not always motivated to go and eat it). Tonight I gave another 1.5 unit dose and within an hour he started dropping rapidly. I have gotten it to level out in the low 100s AFTER feeding him tons of carbs, some honey, and even some karo syrup.

Do I need to reduce to a 1.0 unit? I'm at work tomorrow morning again, and I'm worried he could be going into remission. He went into remission once in the past and even a 0.25 unit for him previously was too much.

Advice? I think to be safe I want to give a 0.5 unit tomorrow since it's difficult for me to leave work and I work 30 minutes away.
 
Hello, Jessica, and welcome to the ProZinc forum! Paco really does do some diving in his BG numbers. In his case, it will be very important that he is fed snacks during the early portion of the cycle. Please tell me what he is eating? What kind of food? Is it low carb (ten percent and under) ?
 
So you have the Libre 3. Do you have a phone at home to keep track of his numbers when you are away? Do you have an auto-feeder to dispense food while you’re away?
 
With tonight’s drop to 87, he has earned a reduction down to 1.25 units. We need to slow his steep dives. Those steep dives will probably set him up to bounce. He does bounce a bit from not being accustomed to the lower numbers anymore. Now 87 is an extremely safe number for a cat and is within the normal range for a cat. We do not recommend using high carb food to bring up a cat who is at 87. The first thing to do is to give regular LC food in small amounts and to retest in 20-30 minutes. You keep doing this as often as necessary. Karo should be reserved for a cat who has dropped below 50. There can be exceptions to this, but only if it’s very early in the cycle and if the numbers keep dropping rapidly after trying the LC or MC — if numbers are not going up or stabilized. The goal for a cat who is at 87 should be to stabilize the cat with LC food to help them have a long surf in green numbers, if possible. We actually want them to stay in green as much as possible to help heal the pancreas. With the start low go slow method, reductions are taken when the cat drops below 90. We can try this for a few weeks and see if it is working well or if it would be be better for Paco to switch to another dosing method. I really hope we can get his cycles smoothed out.
 
Thanks, I just panic because in the past he doe drop quickly below the 50 mark as well and with his decline last night, that's what it seemed to be doing.

I did give him a 1.0 dose this morning because I hadn't read this post yet, but especially since I am away from home and can't make him eat, I feel more comfortable with that dose.

His foods include: freshpet chicken and beef, Friskies's chicken pate, and I've currently added some hamburger to his diet because he has been refusing to eat more than a small portion of his freshpet, and with his kidney disease I don't want to give him too much of the friskies. I'm hoping to get him back into freshpet, since previously he was eating about 125 calories of freshpet a day at least.

I do have a dispenser which has Dr. Elsey's clean protein dry in it. He also has a wet food feeder that I've started putting Friskies in to tempt him. However, yesterday he did not eat his Friskies at all. Lately he has not been wanting to eat much during the day when I am gone. I've been trying not to give him dry food, but do you think it's more important he eats during the day when I'm gone, or that he stays away from the dry?

My attempted schedule was him for food was 5am with food left out for him to munch on whenever, 5-8pm additional small meals (but he tends to eat at 5 and then stop) and then another round of meals around 10-11 pm before I go to sleep. I've left food out over night as well but he tends to not go to it.

And yes, he has his own phone that keeps constant readings on him. However I just got the Libre 3 on him this Monday night. Before I had the Libre 2 and had to scan him.
 
thaurermellon said:
My attempted schedule was him for food was 5am with food left out for him to munch on whenever, 5-8pm additional small meals (but he tends to eat at 5 and then stop) and then another round of meals around 10-11 pm before I go to sleep. I've left food out over night as well but he tends to not go to it.
Click to expand...
I am not sure I understand this, sorry. What are your shot times (and your time zone?). Is his shot at 5 a.m?
 
I do think it’s important for him to eat something while you’re away. It would be nice if it was wet food, but the Dr. Elsey’s Clean Protein dry food (is it the chicken?) will have to do, I suppose. I hate to see a cat with kidney disease eating dry food since it’s so dehydrating, but again, he must eat.

How are his kidney values? Do you have his bloodwork? Does he receive regular sub-q fluids for hydration? Is he at that stage yet? Is his appetite poor? It sounds like it is. Perhaps he is nauseated and would feel better and eat more if he was receiving an anti-nausea medication like Ondansetron (or Cerenia works for some cats, but it’s better for vomiting.) I am sure you know that he should be eating a low phosphorus diet. The Friskies is not low phosphorus. Even the doctor Elsey’s isn’t really that low. The Young Again dry foods have less phosphorus I have never checked the FreshPet foods for their phosphorus levels.
 
I think it’s okay to try the 1 unit dose and see how it goes. Hold it for seven days. Today would be the first of 14 cycles. With so many high numbers, it’s important to test for ketones. We don’t want to risk a life threatening DKA. He has never had DKA has he? You should either get the leto stix and try to catch him using the litter box or get a blood ketone meter to test a drop of blood from his ear to see if he has ketones. I used a Nova Max Plus blood ketone meter from ADW Diabetes Supply. There are a few others that are available.
 
I agree which is why I’m not really happy about using Friskies. I have used it and kept him at a stable stage 3 for about a year, but only for his meds (1/3 can a day). He doesn’t have an issue eating. When offered the carb foods last night he ate plenty. He is mostly just become finicky with eating what he currently has offered (fresh pet). I also have a kidney dry food I can use instead of Dr. Elseys.

He unfortunately has always preferred larger meals over small meals so it’s hard getting him to eat consistently throughout the day. I’ll
Try to upload his lab work sometime soon.

In the document I have his ketone tests from recently down. This last Saturday he was 0.1 so he’s been doing much better since he was initially diagnosed because of his blood work showing ketones at 1.0.

I was giving him sub q fluids but he started to not tolerate it and having him switched to Freshpet has immensely improved his hydration. He also gets hydra care and is very good about drinking during the day.
 
If his phosphorus level is above 4.5, you will want to get it down to help spare his kidneys. You can always just add a phosphorus binder to the foods to help ensure that his blood phosphorus levels won’t get too high.
 
I really don’t think the 1 unit is going to be enough for him, but I didn’t want you to stress too much over it. I hate to see all that black on his spreadsheet. He should be getting the same dose morning and evening (with the exception to this being if a one-cycle reduction is taken due to BG being lower than ever before charted.)
 
Suzanne & Darcy said:
I really don’t think the 1 unit is going to be enough for him, but I didn’t want you to stress too much over it. I hate to see all that black on his spreadsheet. He should be getting the same dose morning and evening (with the exception to this being if a one-cycle reduction is taken due to BG being lower than ever before charted.)
Click to expand...
Unfortunately I'm noticing even a 1.2 UNIT dose isn't doing much. My concern is with my work cycle. Do you recommend keeping him on the 1.2 for the week? He's been HIGH almost all day today and yesterday. Like I said previously, I leave food out for him during the day but he does not always eat it. I had previously given him 1.5U so I'm not sure if this was a fluke.

I've also been able to reduce his Friskies over the last day. He's been eating a little bit more of his freshpet (previous diet) and if he needs any extra calories before his shot I have some hamburger I can add to his food.
 
Last edited:
What kind of syringes are you using? If you are using the U-40 syringes that are typically used with ProZinc, then your doses would be in .25 increments (1, 1.25, 1.5, etc.) If you are using
U-100 syringes with the conversion chart then you would have doses like 1.2, 1.4, etc. so I am confused by the dose amounts on your spreadsheet and how you are measuring them.
 
Suzanne & Darcy said:
What kind of syringes are you using? If you are using the U-40 syringes that are typically used with ProZinc, then your doses would be in .25 increments (1, 1.25, 1.5, etc.) If you are using
U-100 syringes with the conversion chart then you would have doses like 1.2, 1.4, etc. so I am confused by the dose amounts on your spreadsheet and how you are measuring them.
Click to expand...

I am using a U-40 syringe, but it's only marked with full units and half unit measurements. So I am approximately doing between 1.2- and 1.25 by going to half way between 1 and 1.5.
 
If we are going to follow the Start Low Go Slow dosing method, which gives us a clear parameters to follow, regarding reductions and increases. The dose should be 1.25 units. If there is an unusually low preshot then an adjustment can be made.
 
We should hold the 1.25 unit dose for seven days (14 cycles) unless ketones are high and then we would be more aggressive with the dosing. This 1.25 dose would be the same for both a.m. and p.m. doses.
 
Suzanne & Darcy said:
If we are going to follow the Start Low Go Slow dosing method, which gives us a clear parameters to follow, regarding reductions and increases. The dose should be 1.25 units. If there is an unusually low preshot then an adjustment can be made.
Click to expand...

like I said it’s approximately halfway. So I’d say between 1.2/1.25. I can mark 1.25 on the sheet if that’s easier but it technically is somewhere in that range.
 
thaurermellon said:
like I said it’s approximately halfway. So I’d say between 1.2/1.25. I can mark 1.25 on the sheet if that’s easier but it technically is somewhere in that range.
Click to expand...
Yes. In order to avoid what looks like different doses, it would be good if you could use 1.25 to avoid confusion. There is an actual dose of 1.2, 1.4, etc., but it is only measured with the U-100 syringes. Obviously, we know that a 1.25 unit dose is measured when we just “eyeball” between 1 and 1.5 units. The only way to actually measure 1.25 exactly the same each time would be to use digital calipers. Most cats don’t need that if we just do our best to get between those two marks on the barrel.
 
thaurermellon said:
leave food out for him during the day but he does not always eat it. I had previously given him 1.5U so I'm not sure if this was a fluke.

I've also been able to reduce his Friskies over the last day. He's been eating a little bit more of his freshpet (previous diet) and if he needs any extra calories before his shot I have some hamburger I can add to his food.
Click to expand...
I think if his blood glucose drops low he will become hungry and eat something. What kind of food are you leaving out for him during the day? You should, if you can afford it, get an automatic feeder to open at certain times to give the FreshPet.
Does the FreshPet have different flavors?

Which is lower in carbohydrates? The Friskies or the Fresh Pet? The FreshPet is the lower phosphorus? Is Paco underweight? How is Paco feeling these days? Is he active? I know you are worried about him. It’s very frustrating, too, when we give our cats insulin and seem to get very little response. I understand. And you also have the extra worry of being away at work for so much of the day.

Will you be home on Saturday and Sunday? I hope you have a good day, Jessica.
 
I just looked up this food:

Freshpet® Vital Cat Food - Grain Free, Chicken & Chicken Liver, 1 LB.
It is listed as 15.71 carbs on a dry matter basis. That’s too high for a diabetic cat and will serve to raise BG. That would be a medium carbohydrate food that we might to raise BG if Paco’s BG dropped too low.
 
The Chicken and Beef roll is even higher in carbs at 22.73 percent so that’s definitely high carb and will raise BG quite a bit and make ot very difficult to regulate his BG. If he’s eating mostly HC foods, he will need more insulin. Another problem with these HC foods is that the carbs will wear off after about 2 hours and then his BG will potentially drop by quite a lot unless he eats more of it. So he could go up and down quite a bit. It’s better for them to eat lower carb food (10 percent and under) because it won’t spike the BG and helps to keep numbers fore stable.
 
He's been very stable with his kidney function on freshpet, so I hesitate to change it a lot. I know vets are not very knowledgeable about nutrition, but I know my vet told me to prioritize his kidney disease over his diabetic diet. Friskies has too much phosphorous. I am trying to switch him to Weruva which has lower phosphorous and carbs than the Freshpet.
 
Suzanne & Darcy said:
I think if his blood glucose drops low he will become hungry and eat something. What kind of food are you leaving out for him during the day? You should, if you can afford it, get an automatic feeder to open at certain times to give the FreshPet.
Does the FreshPet have different flavors?

Which is lower in carbohydrates? The Friskies or the Fresh Pet? The FreshPet is the lower phosphorus? Is Paco underweight? How is Paco feeling these days? Is he active? I know you are worried about him. It’s very frustrating, too, when we give our cats insulin and seem to get very little response. I understand. And you also have the extra worry of being away at work for so much of the day.

Will you be home on Saturday and Sunday? I hope you have a good day, Jessica.
Click to expand...

Paco is not underweight. He is acting fairly normally, but he's always been a very 'lazy' cat. I watched him today on the camera while I was gone, and he did not wake up even when my pet feeder called him. He's just not super interested or food motivated during the day unless someone puts food directly in front of him. He does have an autofeeder. That isn't the issue. It's more his motivation to get up and eat. Yesterday when I stayed home he ate during the day because I fed him. After you mentioned how many carbs freshpet has I am working on switching him to Weruva. In the past he had a bad spell of diarrhea with one of the types of weruva so I was hesitant to switch him when he's going through so much. However he's had small portions of Weruva (press your lunch) and he hasn't had any bad reactions yet. He honestly hasn't been eating his freshpet lately, so that hasn't been his big issue.

I had lower numbers with him today and he stayed below 400 for 8 hours. I'm hoping if I avoid the freshpet and other high carb foods, the dose at 1.25 might help him level out in the next week.

Yes, I will be home on weekends.
 
thaurermellon said:
He's been very stable with his kidney function on freshpet, so I hesitate to change it a lot. I know vets are not very knowledgeable about nutrition, but I know my vet told me to prioritize his kidney disease over his diabetic diet. Friskies has too much phosphorous. I am trying to switch him to Weruva which has lower phosphorous and carbs than the Freshpet.
Click to expand...
Yes. I feed Weruva to my cats. Have I sent you this list yet?
https://www.bizave.com/foodlists/Weruva Low Phosphorus.pdf
 
thaurermellon said:
Paco is not underweight. He is acting fairly normally, but he's always been a very 'lazy' cat. I watched him today on the camera while I was gone, and he did not wake up even when my pet feeder called him. He's just not super interested or food motivated during the day unless someone puts food directly in front of him. He does have an autofeeder. That isn't the issue. It's more his motivation to get up and eat. Yesterday when I stayed home he ate during the day because I fed him. After you mentioned how many carbs freshpet has I am working on switching him to Weruva. In the past he had a bad spell of diarrhea with one of the types of weruva so I was hesitant to switch him when he's going through so much. However he's had small portions of Weruva (press your lunch) and he hasn't had any bad reactions yet. He honestly hasn't been eating his freshpet lately, so that hasn't been his big issue.

I had lower numbers with him today and he stayed below 400 for 8 hours. I'm hoping if I avoid the freshpet and other high carb foods, the dose at 1.25 might help him level out in the next week.

Yes, I will be home on weekends.
Click to expand...
Oh yeah. I think we talked about Weruva and diarrhea on another thread. Or it could have been some other member.
 
I just looked at Paco’s spreadsheet. Hooray for a stretch of yellows today! I hope he won’t bounce too much from the yellow.
 
Suzanne & Darcy said:
I just looked at Paco’s spreadsheet. Hooray for a stretch of yellows today! I hope he won’t bounce too much from the yellow.
Click to expand...
Suzanne & Darcy said:
Oh yeah. I think we talked about Weruva and diarrhea on another thread. Or it could have been some other member.
Click to expand...
I have seen that list and tried to get him on Weruva a while ago but yes… it made him sick. I think it was the BFF line so I’m hoping the press your lunch is ok.
 
thaurermellon said:
I was happy about that too but now I’m worried I might have missed his pm shot. I didn’t feel any moisture but it felt cold so I’m wondering if it didn’t get under his skin.
Click to expand...
Oh no. I hope not. If you didn’t smell insulin on hos first or feel wetness it’s probably okay. Either way, we will get him back on track.
 
Suzanne & Darcy said:
Oh no. I hope not. If you didn’t smell insulin on hos first or feel wetness it’s probably okay. Either way, we will get him back on track.
Click to expand...

I had to start using his glucometer today because he hasn't dropped below the HIGH. I think the lowest I saw was 454. He's I think over 600 right before his pm insulin (Glucometer just says HI and I know it reads into the 500s). I shaved a portion of his fur so I know for sure the shot is going in tonight. I'm wondering if he's so high that the insulin did go in, but I just didn't get any readings on my freestyle libre. I plan to check him at +3 since he's usually dropped a bit by then. If he does not drop below the 400 again before morning, should I consider increasing his dose to 1.5U ?

I did check his ketones this morning and they are only 0.2 so not much higher than last weekend. I'm a little worried about him being HIGH for several days in a row constantly though.
 
@Suzanne & Darcy If you get a chance could you take a peek at Paco's spreadsheet. I started the 1.5 U dose and for some reason his BG levels are higher on it. I haven't changed his feeding schedule (he is freefeeding durng the day when I'm at work a certain amount of food).

He actually had a great curve today, though it might be partially because he didn't go to eat from his feeder during the day. But at least his numbers were out of high.
 
Last edited:
Well he actually had a nadir of 200 today and a long stretch of yellow numbers. That is an improvement. You have not seen nadirs that low for a while. He had some blue nadirs a while back when he was on 1.5 units.
 
It looks like yesterday he was bouncing from the yellow numbers. Also, sometimes you will see a brief period of higher numbers after an increase.
 
Unfortunately Paco's ketones are now at 2.9 so I am calling the 24 hour vet here. Currently on hold. Would you recommend increasing his dose after he gets that under control? I was worried about increasing it since I'm gone, but I think the risk with the ketones is probably the greater one. @Suzanne & Darcy
 
You must log in or register to reply here.

Similar threads

Chellie
Advice on Increasing Dosage: Newly Diagnosed Cat
Replies
5
Views
222
Chellie
Chellie
Youde
Should I skip a shot?
Replies
16
Views
418
Suzanne & Darcy
Suzanne & Darcy
Buddyboy14
  • Locked
Possible Remission?
Replies
12
Views
308
Diane Tyler's Mom GA
Diane Tyler's Mom GA
Buddyboy14
Remission help
Replies
2
Views
109
Bandit's Mom
Bandit's Mom
Cindy & Ivan
When to stop insulin
Replies
22
Views
528
Bandit's Mom
Bandit's Mom
Back
Top