Should I add a second dose?

Hi all,

I had been posting on the main board and someone recommended I post here as well since my kitty is on PZI. Would you mind taking a look at this thread and give input about adding a second dose? Much thanks in advance!

viewtopic.php?f=3&t=9173

Here's my relevant posts if you don't want to read the thread:

My diabetic kitty Ephalba has been stabilized on 1 unit PZI once per day for a couple months now. She (and all my other cats to the woe of my bank account) eat only grain-free Wellness. Her blood sugars have been consistently been 215-230 before her evening shot and I have not done a bg curve (testing is pretty traumatic on her and me and I haven't gotten up the courage). Right now she has a fairly strong acetone smell on her breath but it's the only symptom of ketosis I've seen. Her appetite is excellent, she's cleaning herself, usual activity level and no noticeable recent weight loss. I did miss her shot last night because I got distracted and then fell asleep on the couch. I am of course out of test strips but I'm going to get more this afternoon so I can't test right this moment but likely within the next couple hours. Will ketosis reflect in bg readings anyway? She had the same smell on her breath a few weeks ago and I called the emergency vet but they said not to worry if it was the only symptom I was seeing. Since it's happened again, I thought I'd post here and ask the collective experts. Thoughts?


I ended up taking her to the vet because I just didn't want to worry--it would have kept me up all night. Her ketones at the vet were +1, so not in the danger range, but they gave her IV fluids to make sure she was stabilized. I guess peace of mind had a $193 price tag tonight! I'm definitely getting the meter that reads ketones because it could save me a lot of money and stress. Makes me wonder why the acetone smell was SO strong though and her ketones weren't higher though.

Ephalba went to the vet today and they did a fructosamine test on her to get a picture of her bg for the past couple of weeks. I'd not heard of the test before the vet so hopefully it's actually useful and not a waste of money! I'm also going to do a curve this weekend so between those two pieces of info we should have a pretty good idea if we need to adjust her dose but I'm thinking it's likely. No ketone smell today, so that's good news, and she's gained 1/4 lb in two months, so I'm happy for that as well!

So, I got the fructosamine results back and it was 471. Vet said that indicated the diabetes is being managed well, but my research is showing the number should be below 400. Any thoughts on this?

To clarify, I'm not currently shooting twice a day, only 1u at night--the vet felt the result was good and wanted to wait until after the curve before making any changes. I'm a bit nervous about this because my instinct says to add 1 unit in the morning, but I don't want to end up with a hypo kitty either. What complicates matters is that it's pretty tough to get morning numbers too since it's just me and my dear sweet cat won't hold still for me enough to do it. When we do manage morning numbers on the weekend when my husband can hold her, they are usually right around 200, often between 175-200. Evening number have been reliably 215-230.

I'm doing a curve on Saturday. I think I have the general principles . . . do our usual morning routine, then test every two hours for at least 12 hours. Is that right?

Thanks again for the support--I'm feeling braver lately in dealing with all this and it's starting to feel more manageable. I'm also feeling a bit more positive about the diabetes diagnosis. While we were feeding high quality for dry (Wellness regular and core), four out of five kitties are now on low carb wet (working on the 5th but she is uber stubborn!) and I feel fortunate that we made a change while our cats are relatively young. It might sound a bit sappy, but Ephalba's sacrifice could have saved the rest of our herd from lots of health issues.

 

It is going to be really hard to give dosing advice until we can see how low your kitty is getting after each shot. Based off of your morning numbers, I would guess a slightly smaller dose (0.8 maybe) twice a day might give you better results.

 

Yeah, I'm going to repost after we do the curve on Sunday. Luckily not a whiff of ketone smell today!

 

Hi & welcome!!!

There is a fructosamine conversion chart I just learned, so that # isn't the same as #s we see on our meters. Here is the chart: http://www.sugarcats.com/infirmary/fructosamine.asp, it's more like a 300 average BG I guess.

Most people do need to give shots 2x day, since for most cats PZI lasts for less than 12 hours. That doesn't mean that you have to double your regular dose though, you could do a smaller dose 2x day rather than a larger one 1x day, that is what works better for most cats. Many cats though do start at 1u 2x day, with ketones around I couldn't advise you to shoot just 0.5u 2x/day, just mentioning it in general terms.

To make it easier on yourself if testing is tough, I wouldn't worry about doing a full curve in one day. Yes there are full curves - test before the shot and then every 2 hours until the next shot (+12). There are also partial curves, where you only test every 3 hours. And many people never do either, just get spot checks on different days to get a picture. It's a lot easier on you & kitty, and can give you just as good data.

While it's great to have full curve data, when testing is difficult IMO the most important data points (when rebound is not an issue - I don't think it is an issue here from the #s you shared) are the PSs and the nadir, when the insulin peaks. If I were you (unless testing magically becomes easy) I would focus on whatever testing you can do over the weekend around potential nadir times - maybe try a +5 and +7 one day, a +6 the next day, something like that. If you can get more data great, but I wouldn't freak yourself out over it.

There is also a clothespin trick that people swear by ... I can never find the link, but I will go hunt it down and post it for you. Supposedly it works wonders to settle down the kitties!!!

clothes pin trick: http://www.felinecrf.org/giving_sub-qs_ ... _peg_trick

p.s. really glad you went to the vets to check on the ketones - the fluids should help, and ketones aren't something to mess around with!!!