1st post! Lis & Dexter. Advice please!!

[LisDiedrich]

Hello! My name is Lis & my cat’s name is Dexter. We live in USA. I made a post on the fb group last night & was referred here. Apologies for the long post but I really need help/advice as I’ve been trying to listen to/trust the vet. I initially took him in for constipation last month and the vet told me he is diabetic. Diagnosed 5/6. His ketones at diagnosis were 6.5 and they did a fructosamine. No dka. She prescribed hill science w/d wet food but he wouldn’t eat it. He is now on fancy feast pate mostly beef & chicken. His constipation is gone. We initially started on 2U Prozinc 2x a day. I know now that was a high starting dose. Eventually we got down to 1/2 a unit as needed. She was having me skip the dose if he was 250 or under bc 1/2 unit was sending him low (he hit 40 on the libre while I was sleeping) from pmps 425 on 6/13. Then she told me to skip insulin for a few days to see how he did. 250 was the lowest he got last weekend with no insulin. She then suggested we test his ketones again and try bexacat. She said to be a candidate his ketones would have to be lower than 3.5 and he tested at .4 so he had his first pill on Monday night. (Comments on the fb post say he was not a candidate for bexacat bc he had insulin) It ended up doing the exact same thing a 1/2 unit did. He was at 450 (stress from vet) when I gave him the pill and i woke up & he was reading LO (in the red below 50) but acting normal. I was told the libre runs low. (I have not home tested yet to see the difference in a strip vs the libre but I just got a keto mojo). After I got him up from the red with honey & food he literally the best 18 hours he’s had surfing in target range the whole time. The vet told me to discontinue use of bexacat bc he was not supposed to drop that sharply. She told me to come in for another ketone test and we’d talk about a new plan. He tested .8 for ketones on Wednesday (6/18/25) after he was .4 on Monday (6/16/25) but she didn’t seem too concerned about that. I am waiting to hear results of a liver & kidney blood test but she had said his values were fine on initial diagnosis. The thing is she does not have a plan moving forward. She said she felt like she was getting a crash course in diabetes and even told me to post on the internet group. I am so overwhelmed. I feel like they are playing with my cats life. He is 14 and has never had any other health issues. Monday was his first pill of bexacat and the last medication he’s had because I don’t know what to do. His last dose of insulin was 6/13 evening. Chris from the fb group & here was kind enough to help me set up a spreadsheet so I will attach that. The numbers filled in are from 6/10 are current to this morning. Any advice/a plan would be appreciated. Thank you so much. This is my baby!!!Dex spreadsheet

 

[Sienne & Gabby (GA)]

Welcome to FDMB.

Dexter is a cutie!!

I'm very glad you were informed that he's not a candidate for Bexacat. Not only is it an inappropriate choice because he was started on insulin, if ketones are present, it is a flat out contraindication. You vet should do her homework. We have a post that discusses its use if you're interested.

I'm more than a little concerned that with an initial ketone reading of 6.5 that Dexter wasn't hospitalized. That is a very high level. We recommend anything over 4 is serious and warrants a vet visit. It doesn't matter if your cat isn't demonstrating symptoms. The lab values shouldn't be ignored. It's possible that it was a bad test and frankly, the vet should have run a second test if she thought the lab value was inconsistent with her physical exam. There are blood ketone meters that are available and one would think the vet would have one for use in the office.

Just out of curiosity, how did your vet diagnose Dexter's diabetes? Did she get a fructosamine level? This is a blood test that is a cousin of a hemoglobin A1c which is how diabetes is diagnosed in humans. It's a definitive test in that it gives an approximation of what blood glucose levels have been over the course of a few weeks.

Looking at Dexter's spreadsheet, he's still in diabetic numbers. The question in my mind is why. Did the vet run a full blood panel and do a urinalysis? I'd want to rule out any sort of infection or inflammation that may be causing the variability in Dexter's numbers. If your vet didn't do a full physical, Dexter needs one. I can't imagine that your primary care doctor would tell you your diabetic without getting at least a blood panel in addition to an A1c. There are any number of reasons that blood glucose can be elevated in cats or humans and for cats, one of the reasons is stress. The trip to the vet's office and being at the vet's office can easily elevate blood glucose levels.

If it were my cat, I'd want him back on insulin. I'd start at a dose of 0.25u. It's much easier on your nerves to start at a lower dose and work your way up. Hopefully, you have syringes that are marked in 0.5u increments. You'll have to eyeball a 0.25u dose. What I'm not sure about is whether you should wait to get some of the test results back.

Also, if your vet is telling you that she's getting a crash course in diabetes management by treating your cat, that's worrisome. Feline diabetes is not an uncommon condition. How do you feel about finding a new vet? Are there any cat only clinics nearby that will be more knowledgeable? The link is to a search resource for cat friendly practices.

 

[LisDiedrich]

Welcome to FDMB.

Dexter is a cutie!!

I'm very glad you were informed that he's not a candidate for Bexacat. Not only is it an inappropriate choice because he was started on insulin, if ketones are present, it is a flat out contraindication. You vet should do her homework. We have a post that discusses its use if you're interested.

I'm more than a little concerned that with an initial ketone reading of 6.5 that Dexter wasn't hospitalized. That is a very high level. We recommend anything over 4 is serious and warrants a vet visit. It doesn't matter if your cat isn't demonstrating symptoms. The lab values shouldn't be ignored. It's possible that it was a bad test and frankly, the vet should have run a second test if she thought the lab value was inconsistent with her physical exam. There are blood ketone meters that are available and one would think the vet would have one for use in the office.

Just out of curiosity, how did your vet diagnose Dexter's diabetes? Did she get a fructosamine level? This is a blood test that is a cousin of a hemoglobin A1c which is how diabetes is diagnosed in humans. It's a definitive test in that it gives an approximation of what blood glucose levels have been over the course of a few weeks.

Looking at Dexter's spreadsheet, he's still in diabetic numbers. The question in my mind is why. Did the vet run a full blood panel and do a urinalysis? I'd want to rule out any sort of infection or inflammation that may be causing the variability in Dexter's numbers. If your vet didn't do a full physical, Dexter needs one. I can't imagine that your primary care doctor would tell you your diabetic without getting at least a blood panel in addition to an A1c. There are any number of reasons that blood glucose can be elevated in cats or humans and for cats, one of the reasons is stress. The trip to the vet's office and being at the vet's office can easily elevate blood glucose levels.

If it were my cat, I'd want him back on insulin. I'd start at a dose of 0.25u. It's much easier on your nerves to start at a lower dose and work your way up. Hopefully, you have syringes that are marked in 0.5u increments. You'll have to eyeball a 0.25u dose. What I'm not sure about is whether you should wait to get some of the test results back.

Also, if your vet is telling you that she's getting a crash course in diabetes management by treating your cat, that's worrisome. Feline diabetes is not an uncommon condition. How do you feel about finding a new vet? Are there any cat only clinics nearby that will be more knowledgeable? The link is to a search resource for cat friendly practices.

Hello! Thank you!

I dropped him off initially in the morning for constipation & they ran his bloodwork so he was at the vet for over 8 hours but they gave me insulin & sent him home with me that night. She did a fructosamine & heska comp & cbc. I attached his initial vet itemized & bloodwork. He was very constipated and needed an enema but that has subsided. they told me he was diabetic according to his bloodwork on 5/6. I even last last week if there was any chance it wasn’t diabetes & she said no. Last ketone test was wed (6/18) and was .8

I had asked about a .25 dose a little while ago and she blew me off. I was told to skip dose if over 250. I called the office & his results from the liver & kidney blood test are in but she is not in the office until tomorrow. I am having them emailed to me if y’all wanna take a look. I only have 1U syringes but Chris sent me a link to some with a .5 line & I ordered some last night. I do still have PZ in the fridge that is good for another month.

I am definitely open to finding a new vet after this information. There is one on the site you recommended that is only 15 min from me.

Update: attached his bloodwork from initial visit & 5/6 and this Wednesday

 

[Sienne & Gabby (GA)]

Just so you know, there's a tab on Dex's spreadsheet where you can enter lab values. It makes it easier to compare results over time. (I generally would highlight or color results that were out of normal range.)

I didn't see the fructosamine results on what you posted. There are some inconsistencies in his labs. His ALT is elevated initially and then is normal range on the next set of labs. I can't actually tell if these are the same tests since the notation is slightly different. The other liver values seem to be fine.

Are you testing for ketones at home? You can use either urine test strips (Ketostix) that you can get at any pharmacy. The downside is that you have to stalk your cat to the litter box to get a sample. There are also blood ketone meters. The testing is the same method for glucose testing. The strips are expensive though -- about $1.00 each but you don't need to test that much unless ketones are a big concern.

The vet blowing off your asking about giving a small dose is not an uncommon response. They tend to think in 1.0u increments. We think in smaller quantities and make dose changes in 0.25u amounts. I'm glad you're getting half unit marked syringes. Just as an FYI, they are also available on Amazon and you don't need a prescription.

Here's a different scenario. When you first brought Dex in, you had all of the usual vet stress plus the constipation. The latter undoubtedly made him feel lousy. His blood glucose was elevated as a result. When he went back to the vet more recently, the blood glucose in the 200s may be been due to vet stress. However, his numbers are all over the place at home where there's unlikely to be stressed. My inclination is to get Dex back on insulin. I've asked some other experienced members to stop by in case I'm missing something.

Also if you plan on joining us here, we have a post on helping us to help you. It has instructions on setting up your signature and how to embed the link to your spreadsheet there. It also contains a great deal of useful information.

 

[LisDiedrich]

Just so you know, there's a tab on Dex's spreadsheet where you can enter lab values. It makes it easier to compare results over time. (I generally would highlight or color results that were out of normal range.)

I didn't see the fructosamine results on what you posted. There are some inconsistencies in his labs. His ALT is elevated initially and then is normal range on the next set of labs. I can't actually tell if these are the same tests since the notation is slightly different. The other liver values seem to be fine.

Are you testing for ketones at home? You can use either urine test strips (Ketostix) that you can get at any pharmacy. The downside is that you have to stalk your cat to the litter box to get a sample. There are also blood ketone meters. The testing is the same method for glucose testing. The strips are expensive though -- about $1.00 each but you don't need to test that much unless ketones are a big concern.

The vet blowing off your asking about giving a small dose is not an uncommon response. They tend to think in 1.0u increments. We think in smaller quantities and make dose changes in 0.25u amounts. I'm glad you're getting half unit marked syringes. Just as an FYI, they are also available on Amazon and you don't need a prescription.

Here's a different scenario. When you first brought Dex in, you had all of the usual vet stress plus the constipation. The latter undoubtedly made him feel lousy. His blood glucose was elevated as a result. When he went back to the vet more recently, the blood glucose in the 200s may be been due to vet stress. However, his numbers are all over the place at home where there's unlikely to be stressed. My inclination is to get Dex back on insulin. I've asked some other experienced members to stop by in case I'm missing something.

Also if you plan on joining us here, we have a post on helping us to help you. It has instructions on setting up your signature and how to embed the link to your spreadsheet there. It also contains a great deal of useful information.

Thank you so much. I will set up my signature & update the spreadsheet. I attached his initial fructosamine here though as well.

His .8 ketone test was Wednesday from the vet with a meter. I have not home tested once yet because he is wearing a libre but I just got a keto mojo and am off today and tomorrow to try to get a test in. I read ketones show up first/quicker in blood. Also I would like to see the difference in test strip v libre. I don’t have the numbing cream or the other stuff to disinfect his ear yet though.

The link Chris sent me for syringes ($16.50 for 100) is a lot less than I paid at the vet (over $50 for 100 w only 1U marking)

 

[Sienne & Gabby (GA)]

Thanks for the fructoasamine results. It's helpful. It's very likely that Dex is diabetic unless the constipation was going on for more than 3 weeks and was the culprit for raising his numbers.

 

[LisDiedrich]

Thanks for the fructoasamine results. It's helpful. It's very likely that Dex is diabetic unless the constipation was going on for more than 3 weeks and was the culprit for raising his numbers.

You’re welcome! His #s did come down after he cleared out but he was already on insulin on the first day. I just listened to the vet. And his #s are still running high on no meds the last few days

 

[Chris & China (GA)]

I don’t have the numbing cream or the other stuff to disinfect his ear yet though.

You don't need anything special. The edges of the ears have very few pain receptors but most cats just don't like having their ears fooled with. With some conditioning, and the right high-value treat, they pretty quickly learn to accept testing (and a lot of them end up actually running to their "testing spot" when they hear us getting the supplies out!)

We also don't use anything like an alcohol pad since alcohol is very drying and hard on kitty's delicate ears. A thin film of Vasoline can be helpful though because it will keep the blood from wicking into the fur and will just bead up on the Vasoline. (think oil and water).

I agree with @Sienne & Gabby (GA) on restarting the insulin too. 0.25 would be a good place to start. As long as you can test, you should give the insulin if he's over 150. If he's under 150, you can stall, DON'T feed and test again in 20-30 minutes to see which direction his blood glucose is going. If it's obviously going up without the influence of food, that's usually a good sign that it's OK to shoot, but you can always post here while you're stalling to have somebody help you make decisions. Make sure your Subject line says something like "Stalling! Need help!" to get somebody's attention. Once you have somebody, you can go back and edit the subject line again to the usual format.

As you gain more experience and get more testing data, that 150 "stall point" starts to come down. We have lots of members who will shoot anything over 50 once they have enough data, understand how their cat reacts to food and are able to test as much as may be necessary. "Know Thy Cat" is a very important part of decision making here.

 

[Mary & Jude]

Hi Lis! I just wanted to welcome you to the forum. I saw your post over on the FB page; I'm glad you decided to pop over here for guidance.

 

[SqueeM3]

Don't feel bad. I paid $54 for a box of insulin syringes at the vet I made full use of the entire box: Leroy used the syringes and the rats got the empty box to play with. I buy my insulin syringes from ADW now. I don't need a prescription to buy from there but people in certain states may be required to provide a prescription. Amazon doesn't require a prescription. I use my HSA funds to buy (Human) insulin syringes and test strips for the (Human) meter, even the (Human) insulin. Pet diabetic supplies aren't covered by HSA or FSA.

ProZinc is a U40 insulin but some people use U100 insulin syringes for fine tuning doses. Someone can point to to the dose conversion chart if you're interested in that.

 

[Bron and Sheba]

Hi Lis and Dexter and welcome to the forum. Dexter you are a very cute kitty!
I am so glad you did not continue with the bexacat. He had several contraindications to being a candidate for it.
I am also concerned about his ketones being 6.5 and he wasn’t hospitalised.
We are here to help

 

[LisDiedrich]

You don't need anything special. The edges of the ears have very few pain receptors but most cats just don't like having their ears fooled with. With some conditioning, and the right high-value treat, they pretty quickly learn to accept testing (and a lot of them end up actually running to their "testing spot" when they hear us getting the supplies out!)

We also don't use anything like an alcohol pad since alcohol is very drying and hard on kitty's delicate ears. A thin film of Vasoline can be helpful though because it will keep the blood from wicking into the fur and will just bead up on the Vasoline. (think oil and water).

I agree with @Sienne & Gabby (GA) on restarting the insulin too. 0.25 would be a good place to start. As long as you can test, you should give the insulin if he's over 150. If he's under 150, you can stall, DON'T feed and test again in 20-30 minutes to see which direction his blood glucose is going. If it's obviously going up without the influence of food, that's usually a good sign that it's OK to shoot, but you can always post here while you're stalling to have somebody help you make decisions. Make sure your Subject line says something like "Stalling! Need help!" to get somebody's attention. Once you have somebody, you can go back and edit the subject line again to the usual format.

As you gain more experience and get more testing data, that 150 "stall point" starts to come down. We have lots of members who will shoot anything over 50 once they have enough data, understand how their cat reacts to food and are able to test as much as may be necessary. "Know Thy Cat" is a very important part of decision making here.

Thank you so much. I had wanted to get him a dose in this morning but of course his libre stopped working last night. I did get a second test with a strip done. I am going to practice more for a pm shot. I was on a 6:30a/6:30p schedule as I work 11.5 hour shifts 4 days a week. My sister would usually stop by mid cycle and scan him w her phone to get a reading to check on him but she won’t be able to use a test strip.

I still only have 1U marking syringes, the others should be here soon.

Does this look like .25?

May I ask why someone would dose at say a 55 & how does it not send them hypo?

 

[LisDiedrich]

Don't feel bad. I paid $54 for a box of insulin syringes at the vet I made full use of the entire box: Leroy used the syringes and the rats got the empty box to play with. I buy my insulin syringes from ADW now. I don't need a prescription to buy from there but people in certain states may be required to provide a prescription. Amazon doesn't require a prescription. I use my HSA funds to buy (Human) insulin syringes and test strips for the (Human) meter, even the (Human) insulin. Pet diabetic supplies aren't covered by HSA or FSA.

ProZinc is a U40 insulin but some people use U100 insulin syringes for fine tuning doses. Someone can point to to the dose conversion chart if you're interested in that.

Thank you! Do they have markings smaller than .5?

 

[LisDiedrich]

Hi Lis and Dexter and welcome to the forum. Dexter you are a very cute kitty!
I am so glad you did not continue with the bexacat. He had several contraindications to being a candidate for it.
I am also concerned about his ketones being 6.5 and he wasn’t hospitalised.
We are here to help

Thank you so much!!

 

[Sienne & Gabby (GA)]

Do they have markings smaller than .5?

The smallest increment on an insulin syringe is a half unit.

This post from the Lantus board has photos of fine dosing. (I really can't get a good sense of the dose in the photo you posted.) Also, are you using U40 syringes? Typically, they have a red cap. It should say on the syringe if it's U100 or U40. Prozinc is a U40 insulin and you want U40 syringes. There's a way to convert but using the right syringe is much easier.

May I ask why someone would dose at say a 55 & how does it not send them hypo?

Your question makes perfect sense and the answer is completely counterintuitive. First, if the low number is a surprise as a pre-shot, think about the context -- it will help. By shot time, the insulin is wearing off. Yes, some cat's have a late nadir but even with that, once you're moving past nadir, numbers are rising. On top of where numbers are heading, you're feeding your cat. The food bumps numbers up.

In other situations, if your cat is seeing a good amount of blue and green numbers, there's a high likelihood that you've been reducing the dose. There also a good chance that your curve is pretty flat -- you cat is spending a lot of time in normal or close to normal numbers. Corky's spreadsheet is a good example. (I was looking for a Prozinc user.) If you shoot low, often the result is your curve stays flat. You need to keep an eye on the numbers if for no other reason than cats hate to be predictable and there's no way to know if a cat's healing pancreas will kick in and drop the numbers.

Particularly with Lantus but I suspect it's similar with Prozinc, the mantra is "Shoot low to stay low." @Suzanne and Darcy may have some additional observations.

 

[LisDiedrich]

The smallest increment on an insulin syringe is a half unit.

This post from the Lantus board has photos of fine dosing. (I really can't get a good sense of the dose in the photo you posted.) Also, are you using U40 syringes? Typically, they have a red cap. It should say on the syringe if it's U100 or U40. Prozinc is a U40 insulin and you want U40 syringes. There's a way to convert but using the right syringe is much easier.

Your question makes perfect sense and the answer is completely counterintuitive. First, if the low number is a surprise as a pre-shot, think about the context -- it will help. By shot time, the insulin is wearing off. Yes, some cat's have a late nadir but even with that, once you're moving past nadir, numbers are rising. On top of where numbers are heading, you're feeding your cat. The food bumps numbers up.

In other situations, if your cat is seeing a good amount of blue and green numbers, there's a high likelihood that you've been reducing the dose. There also a good chance that your curve is pretty flat -- you cat is spending a lot of time in normal or close to normal numbers. Corky's spreadsheet is a good example. (I was looking for a Prozinc user.) If you shoot low, often the result is your curve stays flat. You need to keep an eye on the numbers if for no other reason than cats hate to be predictable and there's no way to know if a cat's healing pancreas will kick in and drop the numbers.

Particularly with Lantus but I suspect it's similar with Prozinc, the mantra is "Shoot low to stay low." @Suzanne and Darcy may have some additional observations.

Thank you! Yes I am using U40. Left is what I have rn. Right is what I’m waiting on in the mail.

The only time I ever saw a # close to 50 was mid cycle so I couldn’t imagine shooting at 55 rn but i understand. I hope to get Dex evened out!

 

[Chris & China (GA)]

My sister would stop by mid cycle and scan him w her phone to get a reading to check on him but she won’t be able to use a test strip.

Maybe you could teach her how to test so you'd still be able to get those mid-cycle numbers. Once you're totally comfortable, you should be able to show her how easy it is! Worth a shot! (pun intended)

 

[LisDiedrich]

Maybe you could teach her how to test so you'd still be able to get those mid-cycle numbers. Once you're totally comfortable, you should be able to show her how easy it is! Worth a shot! (pun intended)

Maybe! I am not super comfortable yet but I did just get a ketone strip done. He went down to .1 from .8 four days ago and saved him a lot of stress at the vet.

 

[Chris & China (GA)]

Maybe! I am not super comfortable yet but I did just get a ketone strip done. He went down to .1 from .8 four days ago and saved him a lot of stress at the vet.

Well if you can get the ketone test done, you can get the glucose too! The ketone strips usually need more blood than the glucose strips do

 

[LisDiedrich]

Well if you can get the ketone test done, you can get the glucose too! The ketone strips usually need more blood than the glucose strips do

I had tried another glucose strip & only a small drop of blood came out but I did just get some of the 26g lancets as u suggested & am going to try again.

 

[Chris & China (GA)]

only a small drop of blood came out

People sometimes think they need more blood than they actually do. I don't know about your specific meter, but most of them take less than 0.6

 

[LisDiedrich]

People sometimes think they need more blood than they actually do. I don't know about your specific meter, but most of them take less than 0.6
View attachment 637

I was using a keto mojo & I honestly thought it looked like enough (I was happy to see any) but he started moving & I wasn’t quick enough & the reader said E10 which troubleshooting said was insufficient sample.

I did also get the relion today bc the difference in strip price.

I had gotten a freestyle libre back on him so I felt comfortable dosing him & now his libre is giving me an error after 3 hours. We at pm+1 around 360 (last libre reading). .25U after none for 8 days.

 

[Chris & China (GA)]

I was using a keto mojo & I honestly thought it looked like enough (I was happy to see any) but he started moving & I wasn’t quick enough & the reader said E10 which troubleshooting said was insufficient sample.

I did also get the relion today bc the difference in strip price.

I had gotten a freestyle libre back on him so I felt comfortable dosing him & now his libre is giving me an error after 3 hours. We at pm+1 around 360 (last libre reading). .25U after none for 8 days.

You can also scrape the blood onto a clean fingernail and test from there.

 

[Elizabeth]

I was using a keto mojo & I honestly thought it looked like enough (I was happy to see any) but he started moving & I wasn’t quick enough & the reader said E10 which troubleshooting said was insufficient sample.

I did also get the relion today bc the difference in strip price.

I had gotten a freestyle libre back on him so I felt comfortable dosing him & now his libre is giving me an error after 3 hours. We at pm+1 around 360 (last libre reading). .25U after none for 8 days.

What error are you getting on the Libre?

 

[LisDiedrich]

What error are you getting on the Libre?

It ended up being just a connection error and reconnected. It’s still going. This is his first time wearing the 3. He had been wearing the 14 day and every time that one disconnected it never came back. I am still practicing test strips so I get a little anxious with no libre on at the moment. I just set it up with the spare phone so I can see his #s while I’m at work.

 

[Elizabeth]

It ended up being just a connection error and reconnected. It’s still going. This is his first time wearing the 3. He had been wearing the 14 day and every time that one disconnected it never came back. I am still practicing test strips so I get a little anxious with no libre on at the moment. I just set it up with the spare phone so I can see his #s while I’m at work.

That does happen with the 3. It can be that the cat is too far away from the phone, or that the glucose is going up or down really fast. It takes care of itself in a few min.