The vet looked at norton's spreadsheet as he had to be hospitalized for an emergency catheterization. Based on his unpredictable response to the vetsulin we discussed a possible change of insulin and her suggestion was prozinc. I would appreciate hearing from anyone with experience in this transition. Thanks Norton's Spreadsheet https://docs.google.com/spreadsheet...Erp5A3aMWPhhxfyGw9LPDbxtzOfdtKYqeRo7I/pubhtml
I dont have any experience switching insulins but I do know that Prozinc is a much better insulin than Vetsulin. Vetsulin is an intermediate lasting insulin and works okay for dogs but not so much for cats.
Thank you for your info. Certainly looks like Tootsie's experience with Prozinc has been really good.
You could drop the dose a little (half a unit?) when you switch to ProZinc. It has a similar - although gentler - action as Vetsulin. It's an in and out insulin so the dose is generally gone at the end of the cycle. Its onset is usually around +2 and the nadir in the +5 to +7 range. It lasts close to 12 hours in most cats. I suggest you read the info stickies on the ProZinc forum and post over there fore help with dosing.
Thank you. Have read the post stickies on Prozinc and found them very helpful. I will try posting on the prozinc forum.
I have spent most of the last 5 days trying to figure out what to do to help Norton. Discussed with the vet switching insulins - her thought was Prozinc as she's had some limited success with it. Since then I have been poring over Norton's ss and think that there is evidence that 3 units of Vetsulin has dropped his glucose very quickly and rather low, but also that his evening glucose levels were low to the point where I was so worried about dropping too low overnight that ended up holding his PM doses. This I know is not a good thing. On the other hand I think it looks like 2.25 units of Vetsulin were not adequate. So now my question.....rather than immediately looking to changing the type of insulin, would it make sense to give the Vetsulin a further try at 2.5 units or if necessary 2.75 units, before deciding that it is absolutely not working. I would really appreciate any feedback. Thanks
Please take a look at Norton's ss. I am totally lost as to what is happening - I'm trying to stay the course at 2 units of vetsulin but he doesn't seem to be responding to it at all yet when he was previously on 2 units he actually made it down to the green/blue. My plan was to persevere with the vetsulin for a bit longer to try and see if 2.5 or 2.75 might work before looking at switching (I really believe 3 units is too much) but after the numbers over the past few days I don't know what to do other than stay at 2 units. Is it possible he is still having some rebound from 5 days ago? Any thoughts/suggestions would be appreciated. Has your vet suggested which insulin to switch to from the Vetsulin?
Thank you for that - I'm so afraid that I might be giving him too much insulin rather than not enough. He seemed somehow better on less but generally the numbers did not reflect that. Have you discussed with your vet what insulin you might switch to? The more I read about the 3 alternatives, the more confusing I find it. My vet has really only suggested ProZinc as I think it's the only other one she's ever used. I know, in the end, the insulin to use is the one that ends up working, but.....
I agree with Janet. Try 2.5 u AM and PM for a couple of days. Bump it up to 2.75 u if you don't see decent numbers and hold that dose AM and PM for a few days, and so on. It's very common for a dose to give better numbers for a few cycles and then stop doing that. The numbers will usually be consistently better once you're at the good dose range. Don't give up - this is a marathon, not a sprint (very common saying here!).
When I try the 2.5 units should I be doing a curve on the first day? After all the tests I am still unable to see his peak or the duration. Are you able to identify any kind of a pattern?
I personally want to try ProZinc for the little bit of flexibility in dosing time. Both ProZinc and lantus are good
We are giving Norton 2.5 units of the vetsulin today and doing a full curve. If it looks reasonable we will try to stay there for while to try and maximize the vetsulin before starting over with something else. Thank you for your advice and support.
This morning first yellow AMPS in weeks. Only 3rd day on 2.5 units, felt very unsure of Norton's response at this level, stalled for 30 min, retested and it did go up to 12.1. Decided to err on the side of caution and gave him 2.0 units. Will keep a close eye on him. My question is am I being too conservative because I am so afraid of him ending up hypo?
That yellow AMPS was very nice. The only way to know if the 2.5 u was OK on a PS like this was to give it and monitor. A test at +2 is often predictive of where they're heading. If that BG is significantly lower be prepared to monitor more frequently and/or give small snacks to control the BG's descent. As you do more of these dosing "experiments" and gather data on how he responds the more history you'll have to draw upon to make future dosing decisions. It can be stressful but it's a necessary part of getting BG down into a better range. You could also have reduced by only 0.25 u.
Thank you - good advice going forward. Before Norton was diagnosed he was pretty much free feeding. When he was diagnosed I tried to feed him half of his food with his insulin but that just didn't work - he either refused or threw up. Therefore started giving him the majority (about 2/3) of his food with his insulin and then the rest about 4 hrs later. I'm not sure if this is making it harder to regulate his BG but it seems to avoid problems with getting him to eat all his food. Not sure if this is the best approach?
Most of us divide up the day's food ration into multiple meals. I feed Teasel 4 meals a day - breakfast, lunch, dinner and an evening snack.
Any idea of what is happening? Yesterday AMPS 11 gave 2 units stayed yellow most of the day till PMPS 26. Gave 2.5 units and AMPS now 26. Want to stay the course - gave 2.5 units. At these numbers how often should I be testing? I don't know if it's too much insulin or not enough or that the insulin doesn't last long enough? When he was getting 3 units AM his PMPS numbers were too low to give his next dose????
Give 2.5 night and morning for two days. If it's not enough you can raise to 2.75-3. 3 was too much a month ago but insulin needs change. Try to get a test mid cycle (5-7) and try to get a before bed test.
Will do - will do my very best not to be scared off by a lower number, rather test more and give small snacks. Thanks
Last night checked Norton's sugar at +4 and it had dropped faster than I've seen. Even after his usual snack at +4 it kept dropping so he had 2 more snacks until at +7 it was up in a comfortable blue. This morning of course it was in black. Nonetheless I was concerned enough about that drop that I reduced by .25 and will monitor. Would you see the numbers from last night as an anomaly or are they an indicator that 2.5 units is too much insulin?
Those are nice greens. However, they're a little low for Caninsulin. Because of its strong action it's better to have more of a "cushion" at nadir, especially if you had to give food to keep him there. I agree with a dose reduction to 2.25 u. Ignore the black - it's a rebound reaction (bouncing).
Thank you for the info. By process of elimination it seems like 2.0 units of the Cansulin doesn't bring him down into the blue and now we know that 2.5units takes him too low for comfort. That leaves 2.25 which I'll try to stick with for a few days - if that doesn't put him into the range I think I need to go back to the Vet and ask her about starting him on Prozinc. I'm hoping that the slower, more gentle action will work better for Norton. He and I both need to find a dose that helps him with enough consistency that we don't need to be testing multiple times through the day (or night!). His ears and my nerves are both beginning to fray Does this sound like a reasonable plan?
Norton surprised me with a green number this morning when tested at +4. Gave him his usual snack (1/3 of his food for the 12hrs)at that time and two hours later he was in the blue. We're on the 4th day of 2.25 units BID and I would like to try to hold it there but am wondering if it might be wise to give him his snack earlier so that maybe his drop won't be quite so steep? This may have been entirely a "one off" but I'm planning to check him again this evening at +4. Should I modify his snack time already this evening? Would appreciate advice. Thanks
That's up to you. Continue this dose for now to see if a new pattern is arising. Cats are notorious for throwing wrenches into the works. Steep drops can be an issue with Caninsulin.
Thank you - staying the course and decided not to change anything. Looks like that green # was one of those wrenches. He seems a bit happier, but his weight continues to drop slowly.
I understand what you are suggesting because of his weight loss. The issue is, if I increase again, I have to do more testing and that is going to be a problem. I need to try and test him only for his pre shots for the next while because he is becoming more agitated with the testing. I'd like to stay at this level for a while longer, see if his weight stabilizes (he's not severely underweight). In the long run I realize we may still have to go up but I'd like to try this a bit longer. Thank you for responding.
It's been a couple of weeks and have held Norton's insulin to 2 or 2.25 units. He's been getting some lower PS numbers and have only dropped his insulin to 2 units when he's approaching blue. For the most part this seems to be working but today he threw another wrench in dropping down into lower green numbers on the 2 units. His food is completely unchanged but we have started Tylan to help with his chronic diarrhea and that does seem to decrease the frequency. When his numbers go below about 5 he doesn't seem to feel well and I know I start to worry about hypoglycemia. Not sure now how to handle PS numbers in the blue or low yellow range? Previously he was on insulin 1.5 or 1.75 and that didn't seem to be enough. Overall, he seems better at this recent dose - less ravenous, less drinking and starting to regain a bit of weight, but the low nadir numbers worry me. Any suggestions?
If he's still on Vetsulin you could try 1.75 u for a few days to see if your lows give you a bit more breathing room.
Thank you for your response Yes, he's still on vetsulin - it seemed he was doing better at the recent dose and wanted to give that a good trial before deciding to try another insulin. I will go to 1.75 if his PS numbers are low but then I don't know - do you think it's better to move the dose up or down .25 depending on the PS number or do you think it's better to keep to the same dose even with a higher PS number?
Dose consistency is best. I always look at the lowest numbers to judge a dose. With Vetsulin, a low in the 90 to 110 range is ideal. The PSs are often higher than ideal because of the strong action of Vetsulin - ie., start high, drop low in a few hours, rebound to high again.
Norton has been increasing his peeing outside the box recently. Was able to get a specimen and the dip shows a pH of 8. Vet feels he needs to change foods to a "pH balanced food". I have no idea where to even start to find a food that is pH balanced and also low carb so appropriate for his diabetes. Any experience with finding pH levels of foods that are available at other than vet offices?
If you aren't giving Norton D Mannose, I might suggest trying it now. When George was peeing outside his box, etc. he got tested and had a UTI. After a round of antibiotics, I started giving him D Mannose. He is doing just great now peeing in all the right places, no straining, no blood in urine, Ph normal. One potential side effect of diabetic cats is UTI, the cranberry really helps to fight the bacteria and keep any UTI's at bay. Just an FYI, I started George on Vetsulin and he was quite hard to regulate...testing all the time, changing dosage, sometime trying 3 shots a day. Finally I decide to switch insulins and he is now on Lantus. His numbers are so much better now. Lantus is a longer acting insulin, quite different in how it reacts once in the body, so abit of relearning how/when to dose, but both George and I are much happier now. It does cost more, however the dosage is quite abit less and U100 syringes are cheaper, so in the long run, it is less expensive. (note, Vetsulin uses U80 syringe/ Lantus U100 syringe, hence the Vetsulin dose is roughly 2.5X more than the Lantus dose- realize ECID). I read various posts in the Lantus/Levimar forum before switching.
Thank you George & co. Am going to check out that d mannose. Thankfully the food he is on now has brought his pH back to an acceptable level but I know the risk of UTI is there with the diabetes. Over the past few weeks Norton's numbers have become more stable and it feels like we are very close to a good dose for him so for now I am going to persevere with the vetsulin but for sure will look further into the lantus if needs be. Thank you again for your help and very happy that George is doing so much better. Always encouraging to hear.
