Transition to Prozinc dose advice

Discussion in 'Prozinc / PZI' started by Mopem'sMom, Jun 15, 2020.

  1. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    Hi,
    Some background info before my main question:
    Mopem was diagnosed last Thursday. On vet advice, we started vetsulin with a vet recommended dose of 4u in the AM and 3u in the PM. They administered the 4u at the vet's office the first day, but he didn't eat that night, and I had no way to home test (and had not been told the importance of that by vet) so in fear of hypo shock, only gave him 2u that night. The next few days were an uphill battle of trying to learn as much as I can, find a new vet while still fighting to get him what he needs from current (scripts for food, insulin, syringes, copies of bloodwork and urinalysis) and trying to manage home testing BG and dosing that doesn't kill my poor cat. After a long weekend, I've come to the following conclusions (please correct or advise if not correct):
    • He is on the wrong insulin. Based on budget, what I read here, and the advice of another vet (she suggested Lantus or Prozinc) I have decided to switch to Prozinc asap. I am waiting for the current vet to approve prescription and for it to ship so we are stuck with vetsulin for at least 3 more days
    • His diet, which we are transitioning from dry to wet is affecting his numbers big time. I have switched to Fancy Feast pate, with a spoon of Friskies with gravy to motivate him, and Meow Mix fish cups. I am waiting on the script approval for Hill's M/D dry food to ease the transition to all wet but this will be a process, especially since Mopem is in a multiple cat household and has extreme anxiety if he is in a room by himself.
    • I need to not obsess over his numbers, but I am being bombarded by well meaning friends who keep telling me the horrors of long tern effects of high numbers and bouncing on his organs. I honestly don't know how long he has been diabetic, looking back, symptomatic for maybe 2 months?
    My questions: 1. looking at his spreadsheet, his doses, and knowing his history and situation, what is the best dose going forward once I get the Prozinc? The recommended 1u to start? His numbers will be high and he's used to more insulin right now. 2. Should I gradually reduce the vetsulin doses regardless of BG numbers if I start with the 1u of Prozinc later this week?

    He has had such a bad start with all of this, I don't want to do more damage. I appreciate any and all advice. I have read the sticky's in this thread, and re-read them , but it doesn't all make sense right now, so I apologize if I should already know the answer to these questions.
    Thanks, Christine
     
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  2. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    Hello and welcome Christine! :)

    Hmmm. I'm not great with dosing suggestions and you've got a lot to consider. Keeping him on dry even while transitioning is going to make him need more insulin than once he's on wet completely.
    Let's try not to flip-flop his dosage (unless his pre-shot is unusually low) and stick to the same dose at AM and PM. I don't think he should be getting more than 2.5 units since you got a nice blue from that dose already.

    At this moment are you feeding him any dry?

    Usually when switching from Vetsulin to Prozinc you will maintain the dose, but again, a lot of elements at play because of the food and the varied doses given.

    Tagging @Deb & Wink and @JanetNJ to see what they think.
     
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  3. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    It’s fine to use the Vetsulin for now. Some cats do fine on it. My cat did good on it. Prozinc does tend to last longer for most, soA switch is not a bad idea, but don’t think you are doing your cat harm by using the vetsulin for now.


    Switching from a high carb dry to low carb can drastically effect his numbers. Please only give 1 unit so you run less of a risk of hypo while you transition and get good at home testing. 1 is the recommended starting dose... 4 is a crazy high starting dose and frankly is dangerous. if you feed all the cats low carb wet food he will not have to eat alone. I have six cats.
    It’s a marathon. We will help you. You are just starting out. It may take a while to get regulated.
    Your numbers are all over the place. I think you are seeing bouncing going on.... and I think you will see the numbers come down as you get him on a more appropriate diet. I think a few days of 1 unit will help you see what’s really going on. Then if a dose increase is needed, you raise it in 0.25-0.5 unit increments.
     
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  4. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    When you switch insulins, you take the current dose of whatever insulin your cat is on into consideration. You would not start him at 1U if he is getting more insulin right now, with the Vetsulin. IF YOU were NOT also doing a food change at the same time. A food change, to low carb food, can drop the BG levels 100 points or more overall.

    Dry food, even the Hill's M/d is higher in carbs than is good for a diabetic cat. The Hill's M/d dry is 15% carbs (per their website ), and you want 10% carbs or less ideally. When Wink joined my furmily, all the cats got switched to low carb wet food. Feeding Friskies pate style made it affordable.

    Did Mopem have something else going on, such as some ketones at diagnosis? Is that why your vet started him at 4U? How much does Mopem weigh? Ideal weight, underweight, overweight?

    Since you are pretty new at this whole diabetes dance, and new to home testing, you want to be sure that the pre-shot tests are >200 mg/dL before you shoot the insulin. That number can be lowered as you gather more data.
    So please, give yourself some slack, don't obsess over Mopem's numbers and keep Mopem safe with the home testing. Tell those "well meaning" friends to butt out for a bit, and let you get a handle on treating this disease. ECID. Every Cat is Different, Every Caregiver is Different, Every Cycle is Different.

    Wink was probably diabetic for several months before his owners DUMPED him at a kill shelter.

    p.s. Believe it or not, I already had this thread open and was writing my reply, when Elizabeth "tagged" me.
     
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  5. Panic

    Panic Well-Known Member

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    Great minds think alike? :woot:
     
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  6. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    Hi Panic,
    Thanks for responding. Did not get a chance to up date SS last night, sticking with 2.5u of vetsulin which seems to give a steadier set of numbers. He has access to dry, but I have not seen him eat any for about a day. However, that doesn't mean he isn't, it is out at night for him and his siblings. I'm going to transition that to the Hill's m/D for a while, he as IBD so food is a slow change for us. Everything I read says start at 1u of Prozinc, idiot vet (same one who said start 4u on vetsulin -long story) also said start at 1u but I'm waiting to hear back from good vet. Just thought I'd see if anyone else went through this transition and what worked. Thanks again for your advice- much appreciated
     
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  7. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    Janet- thanks for all of your advice. Frustrating part is waiting on the idiot vet to send scripts so I can at least get the low carb food. I will stick with the 1u when we switch over. Thanks again!
     
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  8. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    Hi Deb and WInk,
    Thanks for replying. I just got his urinalysis results from June 11th yesterday. It was negative for protein, ketones, bilirubin, blood, casts, RBC. He had a specific gravity of 1.014 which they labeled low (ref range 1.015 - 1.060) but just under low normal. He had a 6.5 pH but glucose was +3 (to be expected with his numbers?) TBH I have to look up what most of these results mean. From reading here I know ketones are bad and it seems he didn't have any. Mopem is seriously obese, he has always been overweight, but he currently weighs 24 pounds. He has gained a lot of weight over the past 4 months or so, so the original reason for bringing him for bloodwork was to test for rare possibility of hypothyroid (thyroid was all fine) He's getting FF pate, some Friskies shreds no gravy, and some FF flaked fish. I have the Friskies pate but he is not a fan. I need to do more low carb dry homework, I know Hill's isn't the best but it's better than the Purina Naturals he is eathing now. Although he seems to be staying away from it during the day- may be picking at night I can't be sure. I'm slowly reducing the amount of time the dry bowl is down and hope to eliminate altogether in a few months. Longer time frame than ideal but he has bouts of IBD and food changes need to be slow for him. Thanks again for the advice! It is much appreciated
     
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  9. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    There are some dry foods that are lower carb then the perscription one. Dr. Esley's Clean protien chicken flavor, Young Again Zero Carb, and Epigen 90. All of these companies will send you a free sample if you ask for one.
     
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  10. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    There's a labs tab in the spreadsheet if you want to enter his numbers. What was the creatinine and BUN?
     
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  11. Mopem'sMom

    Mopem'sMom Member

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    JanetNJ, thanks so much!
     
  12. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    JanetNJ, yes that is my hope for today. I just got his results yesterday. I am trying, unsuccessfully, to juggle him and work. His BUN/Creatinine ratio was 18 (ref 4-33) and his creatinine was 1.6 (ref .6 - 2.4) I don't see BUN by itself. Is there a way to attach a pdf to the ss or do I have to type it all in by hand? Thx
     
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  13. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    There's probably a way to attach a pdf. I always type it in because i find it easier to compare to each other so I can see changes. OK the creatnine isn't bad. It's creeping up to where you want to be careful of the kidneys... It's the high end of normal. 1.8 is considered stage 2 kidney disease. http://felinecrf.org/how_bad_is_it.htm just add lots of water to the food and maybe consider finding a wet food that is slightly lower in phosphorous. I feed weruva foods because they are low in carb and phospherous. Do you have the phospherous level on your lab report?
     
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  14. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    No, there is no way to attach a PDF to the spreadsheet. You have to type in all the values, AND first you have to enter a reference range column for the testing lab that was used (Idexx, Antech, etc). Each lab has it's own set of reference ranges, and they do differ on some tests. Then you add another column, for the test results for the date where these tests were done.
     
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  15. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    Yeah, that makes sense for comparison. Thanks for that. I typed it in yesterday. The vet clinic never sent the pdf to my email. Phosphorus (2.4-8.2 mg/dL) 3.8
     
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  16. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    Thanks, I typed it in. There was a reference range on the template, luckily from Antech which is the lab the vet uses. I did add a ref range for one of the levels which didn't have one. Thanks for your advice
     
  17. JanetNJ

    JanetNJ Well-Known Member

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    I'm going to tag a member good at reading labs. It stands out to me that they found a little bacteria in the urine. The wbc isn't super high but maybe slightly higher then it would ideally be. Makes me wonder if he's fighting a UTI. The phospherous and kidney's are ok. I'd just add some extra water to the food. OK tagging @marj
     
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  18. Deb & Wink

    Deb & Wink Well-Known Member

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    Tagging @Marje and Gracie

    I know she is dealing with her civie, a very sick Tobey, so she may not be able to look at the labs for some time.
     
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  19. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    oh, sorry to hear that. Well maybe someone else notices something
     
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  20. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    JanetNJ and Deb&Wink- Thanks for your input. I sent an email to the vet yesterday asking about antibiotics for the possible UTI, no response yet. SMH. It's possible it's contamination, his rear legs don't support him in the box, he sits in it. I'm always cleaning him, but I don't think antibiotics would hurt right? Seems like the logical thing to prescribe just in case it is a UTI. Unless there is a reaction with antibiotics and insulin I don't know about??
     
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  21. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    None that I'm aware of.

    Are you giving methyl B12, to help with the neuropathy?
    Is his potassium level ok? That is the other condition, low potassium, I know of that can cause weak back legs.

    Did you only give 2U this morning, as your SS indicates?
     
  22. Mopem'sMom

    Mopem'sMom Member

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    Deb&Wink,
    I am not giving methyl B12- never really heard of it. I'll put it on my research list for later tonight or tomorrow- I have a full day of work today.
    His potassium on 6/11/20 labs was: Potassium (3.4-5.6 mEq/L) 4.5 so that seems ok?
    I did only give 2u of Vetsulin yesterday morning, he was 372 at the AM Pre-shot, and we will be going to 1unit of Prozinc starting tomorrow morning, so I'm sticking with 2u-2.5u so he's not in for too big of a shock when we go down to 1unit tomorrow. The 2-2.5u seem to be doing ok for him, he was 356 @+3hrs, 209 @+6 hrs, 347 @+9 hrs but he got to kibble :-( He was 466 at his 12 hour mark so he got 2.5units last night. This morning he was 372 again so he got 2u. I'm setting my clock to check on him overnight every 3 hrs but I'm not testing because I'm not coordinated enough at that time.
    I am trying to be very diligent on updating the spreadsheet. I am extremely concerned about him; my ex-husband, sister, boss, and another friend all have the link to his sheet as well, just in case. What I put on the sheet is always accurate. I try to make notes about his food intake there too.
    Thanks for being involved with Mopem- I really appreciate all of your advice! Enjoy your weekend!
     
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  23. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Look for Zobaline or Vitacost's less expensive alternative. It helps with neuropathy.
    See this thread for more info. http://www.felinediabetes.com/FDMB/threads/b-vitamins-for-neuropathy.230992/#post-2584645

    It really does not make sense to reduce the insulin dose that much, when you switch insulins. Plenty of people have switched from Vetsulin to Prozinc, and kept the same dose or only lowered the dose by 0.5U.

    Why the big drop in dose? Did the vet suggest you do that?

    Please test for ketones, since you are dropping the dose so much. Ketones form when there is not enough insulin, not enough food, infection/inflammation (think bad teeth or UTI). Ketones can lead to DKA which is a multiple day stay at the vet emergency clinic.
     
  24. Mopem'sMom

    Mopem'sMom Member

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    The vet suggested the 1 unit to start when we switched to Prozinc, as did JanetNJ above. I know you had recommended keeping the current dose if we were not in the process of switching food as well. I think because we are also switching food right now to the wet/low carb dry there is a concern that he will go too low. The comments regarding that are above.

    Also, there is a UTI which I am STILL waiting for antibiotics to be delivered (no local pharmacies had the 150mg amoxi and the vet clinic had none in stock and refused to call in to another vet clinic. I had order sent to Chewy but waiting on delivery.) I know I need a new vet.

    He was negative for ketones when the vet did the urinalysis last week. I have not gotten test strips and locking him in a room by himself to get a sample will not go well considering his personality so I have been reluctant to try. The vet pumped him full of fluids and put him in a cage with a catch tray on the bottom to get their sample.

    Today was the first day we used the Prozinc, he was 382 this morning, which is what he has been around if he doesn't get kibble. I gave him the 1unit. I'll be testing every 3 hours today just to see what his body does. I've read that it takes 6 'cycles' to see what a dose does- is that six 24 hour cycles- so 6 days?

    So I guess my question is the same as when I started the thread- is the 1unit going to be enough? When can I increase his dose if necessary? He has a lot of things going on at once and I just want to do what's best for him. The vet is gone for the weekend- which isn't a big deal she is a loser, and I do have an emergency clinic within 45 minutes of my house just in case, but I'd rather avoid that. I'm so confused and stressed for him.

    Thanks, as always for your input.
     
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  25. Deb & Wink

    Deb & Wink Well-Known Member

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    No, a cycle is 12 hours. So there are 2 cycles in each 24 hour period. A cycle is based on the fact that you need to give the insulin dose 2 times each 24 hours for feline diabetics. We don't say a day, because the dosing cycles when you increase or decrease the dose can span more than one calendar day.

    Probably not.
    Depends on which protocol you are using. With MPM, in 3-6 cycles, as long as you are around to monitor. With SLGS, 14 cycles. But that may be too long for Mopem, with the untreated infection and those high BG levels.

    The sooner you can stop all the dry food, the sooner you should see some improvement in the BG numbers overall. But that end to the dry food, which depends on a stubborn cat like Mopem, it could be weeks.

    But you don't want to keep Mopem in high BG levels because you aren't giving enough insulin. Plus holding a dose for weeks, can lead to insulin resistance, which means you need to give more insulin to combat that issue.

    Untreated UTI + not enough insulin can lead to ketone production. Try these Urine Catching Tips, or the trusty old ladle trick.


    When you say on your SS, that you are feeding Mopem the Friskies Shreds, no gravy, what do you mean?

    The Friskies Shreds are not low carb. https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
    They are all 12-14% carbs, so a good medium carb (MC) food to keep in your hypo kit.
    The Whitefish & Sardines in Sauce shreds are 18% carbs, so a good high carb (HC) food to keep in your hypo toolkit.
     
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  26. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    He eats Fancy Feast pate, but only so much. His siblings eat Friskies shreds, but some just lick the gravy off so when they walk away I take the shreds that are left, rinse them in some water and give them to him on top of his pate so he eats more wet food than dry. I gave 1.5 units tonight he was so high, almost 500, and I panicked over the number. I'm around to monitor all day and night. I'm planning on testing at 10:30pm and hopefully 1:30 am as well. I know the numbers will change once he is off dry and has AB's and the insulin dose will probably need adjusting again. I am beyond frustrated with the delay in getting food and antibiotics. I thought I could just get a dose from the vet and the right food and meds and we would be on our way to good management. I guess not. Thanks for the urine link, and for your input. Mopem and I are lucky you are here. Have a good night.
     
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  27. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Tag me to come look in the morning. I'm not up that late usually, so 10:30 pm will probably have come and gone before I see your next reply.

    I'm not sure if the Friskies Shreds would still have some gluten (and carbs) in it, even if you rinsed it off after the other cats are done eating. No way to tell, if the wheat gluten, corn starch, soy flour are only in the gravy or are in the shreds part too. My guess, would be that the shreds themselves contain some of those ingredients. I'd think the wheat gluten is what is holding the shred into shape.

    Does he like a different texture than the pate? Like a chunky style food? Fancy Feast has the roasted,flaked,chunky styles which are all around 4-6% carbs.
     
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  28. Mopem'sMom

    Mopem'sMom Member

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    Jun 12, 2020
    Morning Deb &Wink!
    I did order FF chunky and roasted, waiting on delivery. Covid19 is messing with deliveries in my area; I'm pretty rural, it's a 45 minute drive to town. The local stores don't carry a big selection of FF, mostly gravy or pate. I did get some flaked fish, but I worry about the phosphorus. Even Walmart and Price Chopper are pretty limited with their selections of pet products. I know the Friskies isn't the best, he's one of 8 so I need a budget friendly option for the rest of the herd and that was the recommended brand for the hypo kit. I just figured even if the Friskies is higher in carbs it's not as high as the kibble and he needs to eat, so better he eat some high carb wet than super high dry. Maybe that's not the right way to look at it though? They will all get the 'good' dry until such time as I can get them off of it. I ordered the Hill's M/D but plan on mixing it with Dr. Esleys'. I'm paranoid about dropping his carbs too low too fast, and he is prone to IBD so unfortunately the food is going to be a longer process than it should be. I've been picking up the kibble for a few hours at a time, that seems to be going ok. I am afraid to pick it up overnight for now- he just doesn't eat enough wet and I'm scared he'll go low the 6 or so hours I grab some sleep. I'm not sure how to tag you @Deb & Wink Not sure if I did that right, I'm sleep deprived and have a bad migraine from all of this stress. I'll update his SS in about an hour or so when I do his AMPS reading. I have to work today, but luckily have a job where I work from home (even before the lockdowns) so I can keep an eye on him. Thanks again for all of your support, and for your input. It is greatly appreciated.
     
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  29. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Mopem is bouncing from that low blue, the 110 BG from last night. It will take him time to settle back down. Usually, 3-6 cycles. I see you reduced the dose, since you got that yellow pre-shot at AMPS on 6/21/20.

    Migraines are horrible. Hope you were able to rest and recover from yours. Dark room, no noise, medication if you have it, should all help.

    What do you do for fun? What do you love to do to relax and energize yourself and feed your soul? A walk? Yoga? Reading? Horseback riding? Something else? Whatever it is, make sure to take at least a little time each day, to do those things that bring joy to your life.

    To de-stress a bit, you might try Mindfulness Breathing. Or simply concentrating on your breathing and relaxing each part of your body. It's what I do when I get stressed out, like this afternoon, when I got overwhelmed with all the things I need and want to do.

    If you find out that Mopem does like those chunky/roasted/flaked Fancy Feast flavors, Chewy.com carries a good selection. Shipping is taking longer these days, than the stated 1-3 days. More like 7-10 days from order to delivery, at least to where I live. I haven't ordered from them in about a month, so perhaps the shipping has improved.

    The Special Kitty at Walmart is an ok option, at least the pate style is <10% carbs. Not in the food chart, but I've used it myself for cats. If you can find the 22 ounce cans, it goes farther with a lot of cats. I've bought some for feeding ferals in the past.

    The Friskies brand is a good one, but only a limited number of the foods meet the recommended <= 10% carbs you are looking for to feed a diabetic cat. When I fostered and then adopted Wink, all 3 cats were getting the Friskies pate style foods. To this day, I still feed my 1 cat the low carb foods. Can't break myself of that habit, and wouldn't want to.

    Have you seen the Food Chart, by Dr. Lisa Pierson? Last updated in 2017, so newer foods released since then won't be found on there. The Meow Mix foods are on there, and some of the foods in sauce and the ones in gravy are too high in carbs. But some of the Meow Mix foods are just fine for a diabetic cat.

    You did the tag correctly. I'm not usually on the message board, until later in the evenings. Summer is here and the gardens and outdoors call to me.:joyful:
     
  30. Mopem'sMom

    Mopem'sMom Member

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    Yes, I have the food chart downloaded to my pc and look at it frequently. He does like the chunky, it arrived yesterday, so that's a good thing. I am still waiting on the Dr Elsey's to be delivered, but he's eating less dry on his own so we may be able to go a little faster on the transition. I feed my feral outside Special Kitty, my indoor guys don't like it- but they ate it before they got rescued and moved indoors so go figure.

    I have my garden as well, but right now my focus is on Mopem and work. I'll feel better when the antibiotics are here (Chewy claims today) and we get a real pattern going. Thanks for everything! Enjoy your outside summer time! Also glad the tag worked!
     
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