Advice needed on dosing (is my cat bouncing) and transitioning to Levemir from ProZinc

[CheriB]

I initially posted on the ProZinc board, but was recommended to post here as well since we will be transitioning to Levemir.

Looking for advice on whether I need to adjust Meggie’s insulin and if so, how much. General consensus from ProZinc users was that I probably need to increase her dosage of ProZinc...

Here's her information: She was diagnosed with diabetes about 6 months ago. The vet put her on ProZinc. We started out at 1U and worked our way up to 3.5U. All of this time she was under the care and monitoring of the vet and eating prescription dry food. The vet never said anything about testing at home. She would spot check her in the office and do fructosamine. She has been back and forth at the vet every 2-3 weeks...in Nov/Dec/Jan for not eating and throwing up. She usually gets subcutaneous fluids and a cerenida injection, and she feels better. The doctor felt that she could have pancreatitis (one of her labs was slightly elevated). We ended up doing an ultrasound and everything looked fine--which is good. I always felt that her BG numbers were too high (when spot checked at the vet she was in the upper 300-400 range), but the vet said it was because she was stressed when they tested her. Anyway, during all this time, she has never returned to her pre-diabetic self--still very lethargic and lays around only in a few places in the house close to her food, water and litter box. She used to go outside, hang out with my children and sleep with them at night...

Since Jan 25, I started following some message boards and joined the Feline Diabetic Support Group on Facebook and I took over and stopped listening to the vet. I purchased a glucometer (Relion Confirm micro) and have been monitoring her at home. She is currently on 4U ProZinc and 0.5U Novolin R (started this fast acting insulin Jan 30th per a recommendation, because her numbers were so high). She is strictly on wet Fancy Feast now and has been since Jan 25th. I’m feeding her 2 cans 2x a day when I give her her shot. I am in the process of getting Levemir because obviously the ProZinc isn’t lasting long enough. I think I should have a pen by sometime next week. Just to give some insight as to why I added the R...Because her AMPS and PMPSs were so high, it was recommended to try 0.25 R to knock the numbers down initially so that the ProZinc would be more effective when it kicked in. I started out with the 0.25 U, but it was kind of hard to be consistent with the U100 syringes since the dose was so low. It seemed like her numbers were such that I could increase the R to 0.50 U, so I did and I was happy to see several blue numbers. In hindsight, I think the ProZinc kicks in for her with her NADIR ~ 4-5 hrs...perhaps the R is just working a little to help get her numbers down, and as you guys are observing, she may just need to increase her ProZinc with no R.

Hopefully, I can get her off the R when she begins the Levemir. I am going back to 4.0 U ProZinc + 0.5 U of the Novolin R today. It helps me so much to get another view and advice, since I'm a newbie. I cannot thank you enough. Just want my Meggie to feel better and I don't want to mess her up in the meantime.



I still worry that her numbers are too high and after reading some recommendations regarding dosing on this website, I think that she may be bouncing--I'm not sure since I have no experience with this (I'm a bit overwhelmed). Was hoping someone could take a look at her spreadsheet and give me some input. Input from the ProZinc forum was that they didn't feel that she was bouncing, that she probably needed a higher dosage. I did 3.5U ProZinc with 0.5U Novolin R yesterday (her levels didn't drop very much through the day and she remained, but with their advice which I agree with, I increased her back to 4.0U + 0.5U Novolin R.

I know her numbers are still to high. I should be getting a Levemir Pen in the mail within the next week. Just looking for advice on if I am doing the right things and help with transitioning her over to the Levemir.

It helps me so much to get another view and advice, since I'm a newbie. I cannot thank you enough. Just want my Meggie to feel better and I don't want to mess her up in the meantime.

https://docs.google.com/spreadsheet...lv1zalGcRpwWCRC_prxlQqiUE/edit#gid=1131435116

 

[Kris & Teasel]

I'll tag a few people who have used R:
@Wendy&Neko
@Bobbie And Bubba

 

[CheriB]

Thanks!!!

 

[Wendy&Neko]

Hmm, accidentally opened Teasel's spreadsheet by mistake. @Kris & Teasel Teasel - 1.8 really?!

Hello and welcome Cheri and Maggie. First, I'm going to admit that I've never used Prozinc, so can't say much about that. I have however used R, and am really really surprised you are using it. Who suggested you try it? I do think your R dose is too high. At least with Lantus and Levemir, we don't want the R to drop the kitty more than 100 points from when you give it, or you can create a big drop that causes a bounce. 0.5 units R seems to be dropping Maggie way more than 100 points. I would go back to either zero R or at most 0.25U if you must use it until you start Levemir.

You will have to get used to 0.25 unit increments with U-100 insulin. We have some pictures of what those doses look like in the Sticky Note on Fine dosing. Some U-100 syringes are easier than others to draw those in between doses. Thinner ones are better. Magnifiers or head lamps can help. Some people use digital calipers to get those measurements.

Is there any history of ketones with Maggie? That can play into dose recommendations or be a valid reason for using R. How is her appetite? Is she maintaining her weight?

As for starting Lev, will it be a day or two when you can be home to monitor regularly? Some cats have a strong reaction to an insulin change so you may or may not have to be monitoring closely after you switch. I would also make sure you have plenty of test strips and some high carb food or karo on hand. I would put the R in the back of the fridge and leave it there for quite a while. Typically we take the existing dose into consideration, but we don't really have a good idea how 4.0 units is working for Maggie, because you are using R. Is it possible to do the next 3-4 days, without R, so we can get a better picture? Then ask for Lev dose advice again closer to the weekend.

 

[saltycat]

Hi Cheri and Meggie, fellow prozinc to levemir convert here. My cat was stuck in high numbers as well when on prozinc(I think the dose was just too low). I recall the prozinc would produce more of a valley in the numbers then Levemir does. Levemir is better at keeping the numbers flatter throughout the day.

I'm a bit surprised you are using R as well so early on. It can be potent stuff and just learning about feline diabetes can be overwhelming without adding in a 2nd type of insulin. It also helps to know how a catss normal cycles look before starting R so you know better if it is working. I see some days she had a pretty normal drop from amps to nadir on just the prozinc.

My guy was a poster-child for what Wendy said above about a strong reaction when switching. He went from pinks and reds to green the first day of levemir. Being around to test is a very good idea. It might be an uneventful day of testing, but could also be a pretty stressful day if the numbers drop more then expected. I know I was a nervous wreck that first day of seeing green and got lots of good advice from members here. Let us know when you plan to start Levemir so someone can pop in and check on Meggie's spreadsheet.

Wendy's idea of stopping the R insulin a few days before the switch sounds like a good idea assuming her point of no issues with ketones in Meggie. This will give you a few days to see her normal patterns before the switch. I fought Jack's numbers for quite some time before we got into better numbers. I was reminded a few times that this is more of a marathon then a sprint. Nice steady increases and patience go a long way in getting into better numbers!

Welcome and ask away, we all came here with limited knowledge and everyone here is more then happy to share their knowledge and experiences.

 

[Kris & Teasel]

I'm glad you're getting good advice here from people who have used R insulin.

 

[CheriB]

Hmm, accidentally opened Teasel's spreadsheet by mistake. @Kris & Teasel Teasel - 1.8 really?!

Hello and welcome Cheri and Maggie. First, I'm going to admit that I've never used Prozinc, so can't say much about that. I have however used R, and am really really surprised you are using it. Who suggested you try it? I do think your R dose is too high. At least with Lantus and Levemir, we don't want the R to drop the kitty more than 100 points from when you give it, or you can create a big drop that causes a bounce. 0.5 units R seems to be dropping Maggie way more than 100 points. I would go back to either zero R or at most 0.25U if you must use it until you start Levemir.

You will have to get used to 0.25 unit increments with U-100 insulin. We have some pictures of what those doses look like in the Sticky Note on Fine dosing. Some U-100 syringes are easier than others to draw those in between doses. Thinner ones are better. Magnifiers or head lamps can help. Some people use digital calipers to get those measurements.

Is there any history of ketones with Maggie? That can play into dose recommendations or be a valid reason for using R. How is her appetite? Is she maintaining her weight?

As for starting Lev, will it be a day or two when you can be home to monitor regularly? Some cats have a strong reaction to an insulin change so you may or may not have to be monitoring closely after you switch. I would also make sure you have plenty of test strips and some high carb food or karo on hand. I would put the R in the back of the fridge and leave it there for quite a while. Typically we take the existing dose into consideration, but we don't really have a good idea how 4.0 units is working for Maggie, because you are using R. Is it possible to do the next 3-4 days, without R, so we can get a better picture? Then ask for Lev dose advice again closer to the weekend.

Hitting all of your questions...
Who suggested you try it? Someone on the Feline Diabetic Support Facebook website recommended using the R. Meggie's BG values were really high and she thought that we needed to get them lower so that the ProZinc would be effective. It helped her numbers come down, but it may just be that I needed more ProZinc. It seems to be working in combination ok, but I think that they are overlapping. I will drop the R tonight and keep her at 4.0 U ProZinc to see how she does over the next few days (per your recommendation for getting ready to start the Levemir).

As far as measuring out 0.25 U of the R. I have the right syringes with the lower increments. I can eyeball 1/2 the 0.5U, but it's so small, I'm just not sure how consistent my eyeball is for that low of an amount. Someone recommended going to 0.5 U and dispensing the same number of droplets to remove 1/2...I thought that would probably be more consistent. If I have to go back to this, I will work on dosing. She is definitely dropping more than 100 points. I'm fine with stopping the R, so I will do that tonight.

History of ketones? I'm not sure. I don't have the lab work from the vet. I did get some test strips when I picked up my meter. I read about some ways to test. I have clumping cat litter (and 2 cats). I'm not exactly sure how to do this testing. There is no way I can catch her peeing. At this point, I have just been monitoring BG. Felt I may have to monitor this, but I haven't pursued trying to figure out how to do that yet. I have 2 cats and they share 2 litter boxes in the same room. This may be a challenge to get urine. I will be looking for advice here too.

Appetite? She was initially ravenous (Jan 25). That has decreased over time. The past few days she hasn't been eating as much--eating more initially when I give her the food, but leaving some to eat on during the day. At first, she would gobble it all up and then be waiting by the food bowl until I would give her more. I think she is still getting enough calories, but she shares food with her brother so it's hard to tell who's eating it when I'm gone. I know she bullies him and he has to let her eat first...even with 2 separate bowls.

Weight? She has been maintaining her weight. She went through a period when the vet was treating her where she would stop eating and on occasion throw up during these spells. I was taking her to the vet every 2-3 weeks for fluids and a cerenia injection. She would loose about a pound, then gain it back. Since I have changed her diet and been monitoring her BG levels, she has not had those symptoms and I believe she is maintaining her weight...I need to weigh her to confirm.

As for starting Lev...It will definitely be a day when I will monitor her. Sounds like it needs to be at least 2 days. I will definitely do that!

Possible to stop the R? YES! I would love to and I will. It makes me nervous anyway! I will stop the R for tonight and see what she looks like at only 4.0 U ProZinc over the next few days. I update her spreadsheet on my phone when I do the readings.

Before I start Levemir, I will seek out advice on the dosage level and make sure I have 2 days (minimum) to check her regularly.

 

[CheriB]

I'm glad you're getting good advice here from people who have used R insulin.

ME TOO!! I AM SUPER GRATEFUL for all of the help!!!

 

[CheriB]

Hi Cheri and Meggie, fellow prozinc to levemir convert here. My cat was stuck in high numbers as well when on prozinc(I think the dose was just too low). I recall the prozinc would produce more of a valley in the numbers then Levemir does. Levemir is better at keeping the numbers flatter throughout the day.

I'm a bit surprised you are using R as well so early on. It can be potent stuff and just learning about feline diabetes can be overwhelming without adding in a 2nd type of insulin. It also helps to know how a catss normal cycles look before starting R so you know better if it is working. I see some days she had a pretty normal drop from amps to nadir on just the prozinc.

My guy was a poster-child for what Wendy said above about a strong reaction when switching. He went from pinks and reds to green the first day of levemir. Being around to test is a very good idea. It might be an uneventful day of testing, but could also be a pretty stressful day if the numbers drop more then expected. I know I was a nervous wreck that first day of seeing green and got lots of good advice from members here. Let us know when you plan to start Levemir so someone can pop in and check on Meggie's spreadsheet.

Wendy's idea of stopping the R insulin a few days before the switch sounds like a good idea assuming her point of no issues with ketones in Meggie. This will give you a few days to see her normal patterns before the switch. I fought Jack's numbers for quite some time before we got into better numbers. I was reminded a few times that this is more of a marathon then a sprint. Nice steady increases and patience go a long way in getting into better numbers!

Welcome and ask away, we all came here with limited knowledge and everyone here is more then happy to share their knowledge and experiences.

So great to hear a success story with switching!!! I just commented on all of Wendy's questions, if you have a chance take a look at the responses. I've never seen a green, I think it would scare me but I would be BEYOND excited too!! Hopefully, my pen will be here soon. I really think changing insulin will help her so I'm excited about that prospect for sure. I just really want her to feel better. She loves my kids and only tolerates me, but through all of this she has come to like me too, I think

I am going to stop the R tonight and see how things look over the next few days, then go from there.

It means so much to have you all out there giving me advice! I'm kind of in shock and not very trusting of the vets advice since she hasn't helped me go in the right direction.

I will remember that it's a marathon and be patient! THANKS FOR THE SUPPORT!!!

 

[Bobbie And Bubba]

I can't comment too much on the R use as I had guidance every step of the way while using it. But, I can tell you that I was so glad to switch from ProZinc to Lantus as their is an actual protocol where as ProZinc I was always guessing what the dose should be. There are lots of knowledable peeps here for the R use and the Levemir which is similar to Lantus except a later nadir and not stinging if on a higher dose.

Keep asking questions as that is how we all learned. We are here to help you.