Toofy - Dosing advice

Discussion in 'Prozinc / PZI' started by Christina & Toofy, Mar 21, 2021.

  1. Christina & Toofy

    Christina & Toofy New Member

    Joined:
    Mar 14, 2021
    Hello everyone,

    This forum has already been invaluable to me for reading and knowing what to push the vets for and what to avoid from them. I've been feeding my cats a raw (prey model--whole food as much as possible) diet since 2005. I had no experience with diabetes until my little 13.5 year old girl was diagnosed a couple of weeks ago. Her spreadsheet is in my signature, and I'm just curious if I'm being a little too tentative in increasing her dosage? I started out SLGS, but now I'm aiming for the Modified Prozinc method.

    I was being careful at first, but now she's settled back into being at home and eating a normal amount of her normal raw diet, rather than random canned food and a mix for a while when her appetite was coming back after her vet stay.

    Fwiw, I don't expect her to go into remission, and I suspect it's just her body wearing out. But I'm hopeful she has some more time left to be her silly chatty self with the help of insulin supplementation. Looking at her now, 2 weeks out from her initial crash and DX, you'd never know she'd been so close to slipping away if not for her four little shaved legs and neck.

    If you're interested in the background of her diagnosis and DKA episode that immediately followed, it's all below (and pretty long):

    The first vet was very unconcerned about her numbers when I first brought her in. She had gotten lethargic and stopped eating that morning, plus her breath smelled like acetone--which no one but me seemed concerned about. Her labs were pretty good (slightly elevated BUN) but she had a BG of 398. They sent me home with Vetsulin, instructions for 1 U (2x daily) and come back in 2 weeks. I mentioned she wasn't eating, but they seemed confident she would start again.

    She didn't. We ended up at the ER about 30 hours later after she was just getting worse, and I'd moved to assist feeding by hand, and then syringe, but not nearly enough, and her not peeing for two days. She would just sit over her water bowl and soak it into her fur and sip a little. The ER detected a likely UTI, said that was probably why she didn't feel good, and sent her home with antibiotics and Gabapentin, and instructions to stay with the same insulin instructions.

    It wasn't what I was hoping for. 24 hours later I called the ER again (every ER trip was at 2am of course) and made it clear I wanted them to do something to actually help her, because she was still getting worse, and after spending plenty of time on this forum, I was sure she was in some stage of DKA, even though they said she wasn't showing the numbers or going acidotic.

    That time they kept her--she was finally getting dehydrated, electrolytes were getting out of balance, and her BG was still high. The next morning they added some pancreatitis inflammation to the mix and ketones finally being detected in her blood, though she never did go acidotic. They gave electrolytes and switched her to Prozinc. They delayed another day before finally putting in a nasal feeding tube and using a fast acting IV insulin. She was on fluids the whole time, and finally by day 3 at the ER she was perking back up and eating on her own, and her urinalysis came back clean, but they kept her one more day to try and get her BG regulated with her eating on her own and going back to Prozinc, which didn't happen.

    At that point we were all comfortable with me taking her home and working on that myself. I brought her home that evening, just before she was due to eat/get a shot. They'd bumped her up to 2U that morning for the first time, but when I tested her before her meal, she was at 132. I called them, because that felt really low for a repeat, in the evening, of that new dose level, especially with the change to being more relaxed at home. They said to keep with the dosage. I tested her around +6 and she was 32. I called them, explained that this was what I was worried about, but couldn't accurately gauge her symptoms, because I'd also given her a dose of Gabapentin. She was stumbling and would get into my lap and then not be able to hold her head up. They said bring her back.

    I put a little honey on her tongue, took her there, and waited. After a couple hours they said she'd eaten very hungrily, and her BG was up to 89, so I brought her home after telling them I'd be reducing her dosage the next day and working our way back up. At that point, they just let me dictate how I'd dose her, and they didn't charge me for that visit, which pretty much told me they knew their own advice hadn't been great.

    Since then, she's back to eating raw with no canned, and she's always hungry again. She was very hungry before her diagnosis too, which I realize now was the early signs of this. I assume with her numbers staying as high as they are, she's still loosing a lot of her calories, though she has alredy put back on some of the weight she lost at the vet's. But even with those BG numbers, she's perky, aside from the few times her BG has dropped into less scary high numbers--then she's a little subdued and sleepy, which sounds common. She's gotten much better with blood tests now that she knows she'll get tiny pieces of freeze-dried meat during them.

    I feel like the Relion meter is testing higher than the True Metrix was, but that one threw so many E-0 errors due to her blood not fitting in the narrow hematocrit ratio it operates in, that it was making half the strips I bought useless and making the whole process one big gambling ball of stress. The Relion hasn't thrown an error yet, which is great, but I have retested a couple of times when I've gotten Hi readings, and then gotten lower ones immediately after (once 471, once 517). So I know there's some wiggle room in there.

    Thank you to anyone who may have some thoughts or advice on how we're proceeding. ;)
     
  2. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Welcome! I would just follow the Modified Method as it's laid out. Right now she clearly isn't getting enough insulin, which is a contributing factor to DKA. The fast you can get her to a good dose, the better off you'll be - which is where the Modified Method helps. The other factors in DKA are infection/inflammation and inappetence...both of which could happen if she has another pancreatitis flare.

    Do you test for ketones at home?
     
  3. Christina & Toofy

    Christina & Toofy New Member

    Joined:
    Mar 14, 2021
    Thank you--and yes, I have the urine strips and I've been using those, even though my understanding from the vet is that they didn't show up in her urine previously, just her blood. I don't have a blood ketone meter. So far nothing on those.
     
  4. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Ok that's good! They can come on quickly. Most of us test weekly, but with a recent DKA and pancreatitis I'd do it as often as you can. Rough couple of weeks for you and Toofy :(

    Will your vet give you supplies to treat pancreatitis flares at home? Fluids, pain meds, anti nausea? I now have a set of supplies at home.

    DKA is always a vet trip, but bring able to manage appetite and inflammation at home will hopefully help keep you out of DKA territory.
     
  5. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    I find the blood ketone meter much easier, ADW Diabetes often runs a sale where if you buy 10-15 ketone strips they'll give you a free meter
     
  6. Christina & Toofy

    Christina & Toofy New Member

    Joined:
    Mar 14, 2021
    I'll have to keep a look out for that deal. I've been urine testing every day or every other day since she came home. It does require a little luck, lol. I'm pretty amazed they couldn't detect anything in her blood at first when her breath smelled so much like nail polish remover. Fortunately there's been no sign of that since she came back.

    I have cerenia and gabapentin on hand, I asked for that from the ER. We agreed it made more sense to pick up fluids from the first vet she went to, but I haven't grabbed them yet. So far she's drinking and peeing plenty, which would fit with the higher blood sugar, and I get her to drink even more by giving her a watered down treat when she gets her shot. Her fur isn't crunchy by her butt anymore, so the glucose concentration was likely even higher when she first showed dramatic symptoms and first came home. She's also grooming herself well again.

    That first week was brutal, but I think both she and I feel almost normal again for the time being. ;) I'm planning to raise her dose to 2.5u tomorrow morning and see what happens. I'd do it tonight, but I'd rather only have to get up for the nadir test. :rolleyes:
     

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