Update on Dexter | Feline Diabetes Management Board

Update on Dexter

LisDiedrich

LisDiedrich

Member
Hello!

Dexter is 5 days back on insulin and he is at 116 (on a relion strip) @ +10 & still looks like he’s heading down. Here is his libre graph. We have two hours til next shot but am I skipping under 200 or? This is on .25U PZ. Thank you!! 🙏💕
 

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Let's see where he's at at 11.5 and then again at PMPS. If he's below 150 at PMPS, stall, DON'T feed and re-test in 20-30 minutes. Use that time to post here and edit your subject line to something like "STALLING...NEED HELP!"....when you get somebody, you can go back and edit it to the usual format.
 
Chris & China (GA) said:
Let's see where he's at at 11.5 and then again at PMPS. If he's below 150 at PMPS, stall, DON'T feed and re-test in 20-30 minutes. Use that time to post here and edit your subject line to something like "STALLING...NEED HELP!"....when you get somebody, you can go back and edit it to the usual format.
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92 ten min before shot
 

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OK, you can continue stalling if you can get off schedule (and he'll let you since I'm betting he wants his dinner) or you can skip tonight but expect him to be high in the morning.

Since you don't have syringes with half unit marks yet, I'm not sure if he got more than 0.25 this morning. From the picture I saw, it looked like it could have been 0.5.
 
Chris & China (GA) said:
OK, you can continue stalling if you can get off schedule (and he'll let you since I'm betting he wants his dinner) or you can skip tonight but expect him to be high in the morning.

Since you don't have syringes with half unit marks yet, I'm not sure if he got more than 0.25 this morning. From the picture I saw, it looked like it could have been 0.5.
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Ok thank you! I am unable to get too far off schedule so going to feed & skip. But what # would I be looking for before I shot if I was able for future?
 
LisDiedrich said:
But what # would I be looking for before I shot if I was able for future?
Click to expand...

No particular number exactly but you do want to see his numbers going up without the influence of food. That's why we tell you when you stall, don't feed. We want to know which direction the BG is going....if you feed, you don't know how much of an effect that has on his BG and how much is because of the last shot wearing off.

From the Prozinc dosing methods:

How to handle a lower than normal preshot number when following SLGS:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin once you have data and understand your cat’s cycles. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.
 
Hi Lis, I noticed on your SS that your new vet took Dex off insulin. What was his/her rationale for this? I've never heard of this approach before.
 
Hello! She was not 100% convinced he had diabetes off the initial fructosamine when he was constipated & diagnosed from other vet & wanted to make sure. The first couple nights he randomly hit below 200 on his own but now has been in mid 300s. We are coming up on a week no meds now and after she looks at his #s we will go from there.
 
Hi again! Lis, I'm not an expert here, and I'm not encouraging you to go against the advice of your vet, but Dex is clearly seeing consistent numbers in the diabetic range. If he were my cat, I would be worried about him not getting insulin, especially since he's had ketones before.

I'm going to tag a couple of people who are much more experienced than me to get their feedback.

@Sienne & Gabby (GA) @Wendy&Neko
 
I really think Dex needs insulin. His numbers the past few days have been uncomfortably high. He's basically had one day where his numbers were in the blues and greens and even then, a lot of the cycle was over 120.

What concerns me is that with numbers in the 400+ range and no insulin, you are looking at risk factors that contribute to DKA. If you are going to follow your vet's advice and continue to withhold insulin, please test for ketones.
 
I'll pile onto the idea that Dex looks like he needs insulin. Unfortunately with holidays, you might not be able to talk to/see a vet except an emergency vet for a few days. Please test for ketones, for his safety.

Which Purina Pro Plan are you feeding now? Except for the DM, they are all too high in carbs to feed a diabetic cat. The DM is OK carb wise, but ingredients aren't the best.
 
He sure looks like he needs insulin. He’s way too high. Are you testing for ketones? Test strips would also show if there’s sugar in his urine. Did your vet run a fructosamine test? It would give a range of his bg over the last couple of weeks.
 
Thank you all!! Dex is back on insulin as of this morning. This last visit was to a new vet as his last one had no treatment plan for us after rx’ing bexacat after insulin and I wanted to get him checked out. His insulin was coming up on 60 days and I needed new rx for it & refuse to go back to old vet. So this new vet said she wasn’t 100% convinced he was diabetic but told us to try Purina pro plan DM (he was on fancy feast classic pate, mostly beef & chicken.) & no insulin for a week. Saturday was a week no meds and I emailed his libre charts to the vet. The office girl said there was not a vet in but would call if she heard. I did not hear from the vet until yesterday afternoon & she asked if the sensor was broken for the last few days. I said no you’re not seeing any data bc his #s are so high they are not on the chart…I expressed my concern about ketones & dka & she told me she was not concerned about his #s at all “but I could put him back on insulin”. She wrote me the new insulin rx & told me if I don’t trust her I can find another vet. We have an appt w a different vet for a follow up on Friday.

I got the syringes w 1/2 unit markings so .25 was a lot easier this morning. I have a keto mojo but I’m out of ketone strips as I went through some (getting errors practicing) but have some coming. I am beyond frustrated & am really trying to do what’s best for my cat. Appreciate you all. 💓https://felinediabetes.org/fdmb/threads/1st-post-lis-dexter-advice-please.1125/
 

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I'm going to make a very un-PC comment. Your vet needs to take a continuing education workshop on feline diabetes management (and pass the post-test). (Or the truly un-PC remark is that this vet is an idiot or was asleep when being taught about diabetes.)

Please read the sticky notes at the top of the Prozinc board. @Suzanne and Darcy do the lionshare of input regarding Prozinc.

You do not need to change Peanut's food. Purina DM is low carb but the ingredients are not wonderful. You have lots of choices regarding low carb foods. Let us know if no one has linked the food chart we use.

If the blood ketone meter is giving you a headache, can you stalk Peanut to the litter box and try using Ketostix to test urine?
 
Thank you so much. I feel like I am going crazy!! I couldn’t believe this is what I dealt with after our first vet that didn’t know anything either?? I almost had to argue with this one for the insulin rx bc her plan was to “wait and see & get more data” for another week. I’m trying to do everything right and still feel like I’m failing him.

I would like him to be on a low carb with decent ingredients but I guess I am not too familiar with the options. I had switched him to fancy feast before this after seeing it is what a lot of yall use.

I was using the blood ketone strips bc I heard they show up faster in blood first. I could try the urine sticks
 
LisDiedrich said:
Thank you so much. I feel like I am going crazy!! I couldn’t believe this is what I dealt with after our first vet that didn’t know anything either?? I almost had to argue with this one for the insulin rx bc her plan was to “wait and see & get more data” for another week. I’m trying to do everything right and still feel like I’m failing him.

I would like him to be on a low carb with decent ingredients but I guess I am not too familiar with the options. I had switched him to fancy feast before this after seeing it is what a lot of yall use.

I was using the blood ketone strips bc I heard they show up faster in blood first. I could try the urine sticks
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Hi Lis! So glad to hear Dex is getting his insulin. What a nightmare you and he have had to endure up to this point. One of the wonderful things about this board is that there are a lot of people who are knowledgeable when it comes to FD, so it's such a great resource. No one is anti-vet here, but hearing stories of vets not understanding FD treatment isn't all that uncommon. I hope that this new vet is more understanding and knowledgeable.

Many of us here do feed FF classic pates because they contain fairly low carbs, and they are affordable. One of the downsides to them is that they are high in phosphorous, which can have the potential for being rough for certain cats with kidney issues. There are a lot of other foods to choose from, though. Here is the link to the food charts: Sticky - Food Charts - USA, Canada, Mexico, etc.

I hope that Dex quickly begins to respond to the insulin!
 
That's higher than we like to see, How is Dexter's energy level and appetite today? If anything is off, a phone call to a vet may be in order. Is there any way you can entice him to drink more fluids? Even something like plain chicken stock (no onions, garlic or veggies), tuna water from unsalted plain tuna. Fluids can help flush out ketones. Make sure he gets lots to eat. A little reading for you:

Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones​

 
Hi Lis @LisDiedrich
How are things going?
Have you been able to give Dexter any extra food and fluids?
How does Dexter seem?
Is he alert or lethargic?
Have you been able to check the ketones again?
 
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Thankfully he is still alert/hungry/thirsty. I just woke up and saw the tip about extra food. I will have to grab some stock or tuna for the extra fluid but he’s been drinking from his water fountain & I mix some in w his pate.
 
Thank you all!! 😩💓💪 I wasn’t able to retest ketones before work today. I will let you know how he’s doing & retest when I get home. His auto feeder was set up for a mid day meal and I did see him eat it on the camera. I do have a vet appointment w a new vet on Friday but will take him somewhere before then if I need to.
 
Hey yall! Dex still eating/drinking/acting normal 🙏💓 His pmps was 319 on a relion strip a lil over half hour ago. His sugar a lil lower but his ketones have gone up to 2.8 😩 The tuna with no salt had veggie broth & a lot of the chicken stocks have veggies but I am looking. He still drinking water though.
 

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Make sure there are no onions or garlic in the broth. They are not good for kitties.

The ketone reading is higher than we like to see. Please keep an eye on the level and I'd get another test today. If the ketone reading gets any higher or you notice that Dex is lethargic or his behavior is off, it's a trip to the vet.

Info on ketones
 
Thank you!! Luckily I already have a vet appt at 9am tomorrow. I’ve been trying to get him checked out. Today his pmps was 352 on a relion & ketones still at 2.8 He still eating, drinking , going after the laser. 💕
 
Did you start a new bottle of Prozinc July 8th?

There's virtually no difference in his numbers now compared to the time he was off insulin recently. Looking at his response to insulin in June I would expect at least some movement in his numbers now, even a little bit, but he's been so extremely flat that I'm wondering about the efficacy of the insulin.

You could try an increase this morning, or if you're not comfortable with that, I'd definitely increase after 6 cycles if you're not seeing any movement.

NOTE: This recommendation is specific for Dexter only, based on the MPM protocol and taking in to consideration the history of ketones.
 
Hi there. Sorry I never saw any tags that I can recall — on this thread. I would encourage you to post for help on the ProZinc forum because I am a lot more likely to see it there. Or send me a direct message to let me know you would like some help and I will come and look.

But anyway, what dosing method are you using? Have you read through the different dosing method guidelines (sticky notes) on the PeoZinc forum? If you are going to follow MPM, then you still need to hold the current dose for a total of 6 cycles (3 days.). It would be premature to increase before then and not recommended. If his nadirs stay in the 300s, after 6 cycles are complete, you can increase by .5 units so your new dose would be 1 unit — and again would be held for a minimum of 6 cycles before we re-evaluate numbers to see if another increase is warranted. Reductions would be taken if his BG (on the ReliOn meter) drops below 50.
 
Hang in there! Keep up the good work with testing and please check for ketones once a day. Make sure he’s eating well and drinking (add water to his food for extra hydration) and make sure he’s not lethargic or vomiting. How is he feeling by the way? Eating well? Normal activity level?

I’m sorry I didn’t see the tags from last week. They don’t always work — and I was kind of out of pocket last week with cat issues (an understatement.)
 
Suzanne and Darcy said:
If you are going to follow MPM, then you still need to hold the current dose for a total of 6 cycles (3 days.).
Click to expand...
From the Prozinc MPM dosing method:

If nadirs are 100-200, increase the dose by 0.25 unit.
hold the new dose for 3-6 cycles unless the BG drops below 50. If the BG drops below 50, decrease the dose by 0.25u on the next cycle

If nadirs are more than 200, increase the dose by 0.5u. Dose increases should be made every 3-6 cycles and should continue to increase until nadir numbers begin to come down.

ETA: For safety, @Marje and Gracie noting what we discussed after the above was quoted:

The Prozinc MPM protocol has now been revised to hold the dose for a minimum of 4 cycles.
 
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I do not advise increasing until you have completed 6 cycles. And I already said to increase dose by .5 unit. If ketones get quite high, I might alter that suggestion — or if he’s lethargic, not eating, etc — which I have already inquired about.
 
Shelley & Jess said:
From the Prozinc MPM dosing method:

If nadirs are 100-200, increase the dose by 0.25 unit.
hold the new dose for 3-6 cycles unless the BG drops below 50. If the BG drops below 50, decrease the dose by 0.25u on the next cycle

If nadirs are more than 200, increase the dose by 0.5u. Dose increases should be made every 3-6 cycles and should continue to increase until nadir numbers begin to come down.
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MPM is an advanced method of regulation for PZ users. We recommend all PZ users, unless they are experienced with another insulin like Lantus & with the TR protocol, start with SLGS.

Having said that, for ketone or DKA prone kitties, even if following SLGS, we can recommend fast-tracking but we typically hold the dose for at least four cycles if we are increasing by 0.5u.

I agree with the advice from above by @Suzanne and Darcy. If ketones increase at all, we can fast track but not yet.

And once the ketones are normal, I would suggest using SLGS until Lis has a bit more experience with PZ.
 
Hey all! Thanks for checking! Dex is still eating & acting normal. I am still trying to flush the ketones. I did get a 1.8 ketone but today he is 2.4

If I am using slgs & has been on the increase from .25 to .50 for six cycles & his lowest nadir is 275, are yall saying to increase to 1.0?
 

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