ADVICE NEEDED: ProZinc Not Lasting As Long

I've been pretty frustrated with Missy's numbers recently. I had a consultation with Dr. Pierson on 09/02/10, and she suggested lowering the ProZinc to 0.75 units twice a day. I did, and that night she dropped down to 39 within 5 hours. I was told to lower the dose to 0.5units. I misunderstood initially and gave her 0.3 units yesterday morning, so her numbers stayed in the pink all day. At +8 she was at 318, so Dr. Pierson suggested I go ahead and shoot 0.5units of insulin, stating some cats need insulin every 8 hours as opposed to every 12. At +7 following the "PM" shot, she was at 147. I check again at +8.5 and she was at 314! I gave another 0.5 unit and went to bed. Now this morning at +7 she's 322!

I guess my question is, why is the duration not as long as it was in the beginning? Nothing has changed. If you look at Missy's SS, 0.5unit used to last almost the full 12 hours, and now it's not. But 0.75 drops her too low. Do I continue to shoot every 8 hours or so, depending on her reading? At this point, do I just play around with food, adjusting carb type and feeding schedule? Food was left out all night, so I'm not sure when she last ate for this morning's reading. I'm still learning about all of this, and it seems like every time I finally have a plan of action and I have some idea of what I am doing, Missy's numbers throw a curveball. Any advice would be appreciated.

Thanks,
Krista

 

Well, I have not used the new ProZinc formula -- I used PZI from BCP for a while and liked it. It does seem a bit strange that the duration has changed -- it could be something in the insulin or it could be some factor in your kitty or the environment.

If your schedule can accommodate TID (shots every 8 hours), that is a good way to go -- I did it for ~2 months with Norton and he had the best numbers ever.

How old is your vial of ProZinc? The old PZI was good to the last drop but maybe something in the new formula is less stable.

Sorry I don't have any good answers for you

 

Thanks for your response.

The vial is brand new. I've only had it for two weeks. I work from home, so I can definitely give shots TID. Do the numbers eventually level to where she'll only need shots twice daily?

 

Possibly - with Norton, about every third day he would be too low to shoot at one shot time, so we would skip that one, so he would get 3 - 3 - 2 usually.

We only did the TID for about 2 months before we discovered that Norton had inoperable cancer and had to cross the bridge.

Also, we were using a custom sliding scale for Norton -- meaning that we would test his blood sugar at shot time and consult a chart with his scale for adjusting dose. This works great with PZI or even Humulin N, but not the longer lasting insulins like Lantus and Levemir. (because of the "shed")
I mention this because many people may read this post, and I don't want someone using Lantus or Levemir to try a sliding scale -- with those insulins, this would cause the blood sugar to bounce all over because of the shed of stored insulin.

If you're interested in developing a sliding scale for Missy, we would start by analyzing your spreadsheet. Let me know if you want to do this or not.

With PZI, you can even dose QID -- IF the blood sugar is RISING -- this means testing an hour before you want to give the shot, then testing again at shot time. If the blood sugar has increased by at least 20 points, then consult the scale for the appropriate dose and shoot.

I'll post a link to Norton's TID and sliding scale info (in our old FDMB profile), but keep in mind that Norton was a High Dose Acro-cat, so his custom dosing scale was much higher than most kitties. http://www.felinediabetes.com/phorum5/p ... hp?25,5529

 

A sliding scale would actually be amazing. That is one of my biggest concerns... that I have no clue how to adjust the dose based on her levels. I tend to do better with "If A, do B" type things.

 

Ok - let me take a look at your spreadsheet... we will be looking for how Missy "usually" reacts to a dose -- for example - 1u makes her drop 100 or ???

 

The pinks you are having now after that 39 are probably a bounce. Meaning her body recognized it went too low and is trying to protect itself by pumping more glucose into the system for a little while. Some cats clear a bounce in one day, and others take like 3 days. If it were my kitty I would recommend keeping with the 0.5u every 8 hours with close monitoring for a few days and see where she evens out to.

For some kitties, especially in the beginning, PZI/ProZinc does not last the full 12 hours in the system. For some reason, the longer they are on it, the longer the insulin tends to last for them. Who knows why.

If you scroll about half way down Oscar's spreadsheet you can see where I set it up to linearly show TID and had one line for each day. Just another option for how to log it.

 

wow - ok - we really don't have enough data yet to make a good sliding scale - I forgot how new you and Missy are to the sugar dance.

Missy is quite sensitive to the insulin, and you may want to go back to the U100 syringes so it is easier to give small doses.

Looking at your spreadsheet...

8/26 0.8u dropped Missy from 361 to 54 in 8 hours <== this is a nice time frame but 54 is a bit low for your "ideal target" (especially if shooting at +8)
9/1 1u dropped Missy from 401 to 39 in 4 hours <== too fast / too low -- this is too much insulin and caused a rebound

Both of these tell me that Missy needs less the 0.8u BID. If we do go to TID, we usually start by taking the DAILY dose (0.8 x 2) and divide by 3, or 0.5u TID

I would say the duration on 9/1 is shorter because it is too much insulin -- Missy bottomed out and her liver panicked and flooded her body with extra sugar (rebound) to protect from Hypoglycemia.

Looks like you're already starting 0.5u TID -- stick with it for a week to let Missy get used to it UNLESS her BG is below, say 150, at shot time.

Do you still have some U100 syringes around? If yes, you can easily measure 0.2, 0.4u doses.

If at shot time, blood sugar is between 150 and 180, you could give a tiny 0.2u dose.

so -- initial sliding scale might be:
BG < 150 no shot (test again in an hour and shoot if above 150)
151 < BG < 180 0.2u (.5 using U100 syringe)
181 < BG < 220 0.4u (1.0 using U100 syringe)
221 < BG < 400 0.5u
401 < BG ..... 0.8u (2.0 using U100 syringe)

Sliding scales need some fine-tuning, so try it and see if we need to make adjustments -- If you decide to use it, please add this to your spreadsheet so anyone looking will be able to see the scale (add a row at the top)

 

Thanks Kelly. It's nice to hear that others have had similar issues. I haven't noticed a lot of people dosing shots TID, so it makes me feel a little better to know we're not the only ones. Originally I thought the higher numbers were due to rebound. Then last night her numbers were very good, up until the sudden jump to 314 at +8.5. She did nibble on some food right before that, but I didn't think it would be enough to shoot her numbers up that high. That's what makes me wonder if she is really carb sensitive. I'm planning on trying to switch her to a low carb food (5% vs the 9% she's currently eating) to see if that makes a difference.

Phoebe- You are a life-saver! I feel a million times better having a set plan to follow instead of just guessing and hoping for the best. I do have U100 syringes. I just bought some more yesterday since her dose is so low. Thank you so much for your help. I greatly appreciate it.

 

You're welcome -- you'll see from Norton's data that we shot at odd times - not precisely 8-8-8 because of how DH and my work schedules overlapped. We usually shot 10-8-6, making the sliding scale particularly helpful.

TID is not very common because of people's time schedule since many work, and also Lantus and Levemir pretty much have to be 12 hours.

 

Luckily I work from home so it should be fairly easy. Again, I appreciate all the help! Fingers crossed we can finally get Missy regulated.