Sticky BEGINNER’S GUIDE TO PROZINC/ PZI INSULIN FOR DIABETIC CATS

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  1. Robin&BB

    Robin&BB Well-Known Member

    Joined:
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    BEGINNER’S GUIDE TO PROZINC/ PZI INSULIN
    FOR DIABETIC CATS

    It really did "take a village" to create this Guide.
    Many thanks to this great team of co-writers/editors:
    AbyResq, Bobbie And Bubba, Carol & Murphy, Elizabeth and Bertie, Jeff J,
    MrWorfMen’sMom, Rachel, Robin&BB, Ruby & Baco, Sharon14, Sue and Oliver and Tuxedo Mom.


    FEELING OVERWHELMED? BEWILDERED? WE’RE HERE TO HELP!

    We’re all in this together: You came here because you love your cat; we love our cats, too. Our common bond in this forum is diabetic cats who are getting Prozinc or PZI insulin. Welcome!

    It can be challenging to treat diabetes in a cat, so whether you’re giving that first shot, or figuring out which food is best, we’re right here with you. This guide was developed to help you get started. You are also welcome to open a new thread/ topic on the forum. Chances are you’ll get some answers within a few hours.

    Everyone here was once a “newbie” at treating a beloved kitty’s diabetes. So whether you’re feeling shocked, sad or even scared since your own cat’s diagnosis, we understand because we’ve all been there. Right now it may seem like Feline Diabetes (FD) is an awfully steep learning curve to master - and that’s why we’ve developed this guide to ProZinc/PZI: To equip you with the basics to help you safely treat your cat’s diabetes. Yes, there’s a learning curve involved, and treatment is more of a marathon than a sprint. It requires what we call "The 3 C’s":
    • Commitment: To learning how to more effectively treat feline diabetes and keep your kitty safe while on insulin. (You’ll likely end up better educated about FD than some veterinarians are!)

    • Consistency: By diligently applying the time-tested treatment and monitoring practices explained here, you’ll be on your way to getting your cat’s blood glucose better regulated and restoring your favorite, lovable fur-ball to good health!

    • Communication: Through your active involvement on this forum - posting your questions about dosing, your concerns, even how you’re feeling, and by consulting with the broadly experienced members here - you can more easily navigate any bumps in the road. (P.S. There are no “stupid” questions, either!)
    There are 3 basics to feline diabetes treatment:

    1. A mild long lasting insulin. (You already have that one covered with ProZinc!)

    2. Wet low carb food. (Details follow.)

    3. Home testing. (“Must-know” details below.)

    Your confidence in your ability to manage your kitty’s diabetes will grow in time - thanks to a great little group of ProZinc/PZI people who are here to provide you the same kind of daily guidance, encouragement and moral support that we’ve all found here after getting a diagnosis of FD from the vet.

    So onward, gentle reader! And welcome to the “club” that none of us wanted to join - but once you have been with us for a while, you’ll be so glad you did!

    HOW PROZINC/ PZI INSULINS WORK

    All insulins are prescribed to supplement an insulin deficiency in a diabetic cat. There are several types of insulin that work differently. Prozinc is a cat-specific insulin that many people have used with great success.
    • Prozinc is an “in and out” insulin. This means that the insulin does not build up in the system and stay there. “Onset” is when the insulin starts working, usually between 2 to 3 hours after the shot is given (depending on your cat’s own unique metabolism). ProZinc generally lasts 12 hours (“duration”) resulting in a “curve” of BG numbers, downward around mid-cycle, then back upward toward the end of each 12-hour cycle. For this reason, it’s dosed twice a day.
    • Prozinc does provide a cat with an excellent chance of getting well-regulated and going into remission. We’ve had many different cats go into remission using this insulin.
    • Prozinc dosing can change more often than other insulins, since it is ‘in and out’. But generally - especially at the start of treatment - it’s advisable to stick with a dose for at least 3 cycles; changes can be made after that, as needed.
    • We recommend starting low: 1 unit is a good starting dose for most cats. Then insulin changes can be made by .25 or .5 units.
    NOTE: We use the terms ProZinc and PZI interchangeably. They act much the same. Adapted from the FDMB article on ProZinc/PZI:

    PZI (Protamine Zinc Insulin) is a type of insulin combined with zinc and protamine (a protein extracted from salmon) to slow the release of the insulin into bodily tissue. ProZinc®is the first and only FDA-approved insulin for cats made from recombinant DNA (DNA molecules created from the DNA of two unrelated organisms) that is identical to human insulin. ProZinc insulin is sold only by vets. If you chose to use ProZinc, it may only be available in U-40 strength (as opposed to the more common U-100 strength) and will require special U-40 syringes or use of a conversion chart if you use U-100 syringes. The ingredients in ProZinc ® (protamine zinc insulin) are classified as long-acting with duration of effect for 10-14 hours.

    Some veterinary pharmacies make a compounded form of PZI, usually from 100% bovine insulin. It is available online with a vet prescription. It can usually be compounded in both U40 and U100 strengths.

    Europe & UK: ProZinc (the same ProZinc that's used in the U.S.) should be widely available now. There is also another PZI insulin manufactured in the UK called Hypurin bovine PZI (U100 strength). It has a very long duration. You may find it harder to get your vet to prescribe Hypurin PZI. When posting for advice, Europeans will need to make clear whether they are using Prozinc or Hypurin PZI.


    A note on U-40 syringes: If you are using U-40 Prozinc, you must be sure you are using the correct U-40 syringes. In the United States, these syringes usually have a RED cap, but the cap color may vary, depending on the manufacturer or where you live in the world. U-40 syringes are also available that show half-unit markings, making dosing easier as you are fine-tuning the dose.

    A note on using U-100 syringes with the Conversion Chart: Many people find that using U-100 syringes with half-unit markings makes it easier to fine-tune a dose, in 0.2 unit increments. (You MUST use the Conversion Chart; the link appears both above and below.) In the United States, the U-100 syringes (designed for use with the more concentrated U-100 insulins) usually have ORANGE caps - but again, the cap color may vary with the manufacturer or where you live in the world.

    PLEASE make sure you are using the correct syringes for dosing ProZinc: Either the U-40 or the U-100 (again, the conversion chart is required when dosing ProZinc with U-100s.)

    Recommended reading: Prozinc website


    HOME MONITORING

    Consistent blood glucose (BG) testing can save your cat’s life.
    • In-home testing saves you the unnecessary expense of vet clinic BG curves and/or fructosamine tests. You can even do your own BG curves at home, record your results in our handy spreadsheet (SS) and share that with your vet. See below for SS info. (Your vet will probably be duly impressed, even though it means less money in the vet’s pocket and more in your own!)
    • Your cat will likely be calmer when you test at home, which often means a far more accurate BG test result. “Stress hyperglycemia” during a visit to the vet can actually cause your cat’s BG to rise by 100 mg/dL {6 mmol/L} or more than it would normally read when your cat is relaxed in his own home. Yet another reason to test at home before shooting that first dose of insulin!
    • Does testing sound scary? RELAX! Your cat’s outer ears have very few nerve endings, so for kitty, it’s more like a mosquito bite when poked with a lancet (unlike the sharp pain you’d feel if you pricked your fingertip.)
    • Here’s a great how-to link; written instructions, photos and video: Hometesting links
    How often should you test blood glucose?
    • A daytime cycle pre-shot test (AMPS) and a nighttime cycle pre-shot test (PMPS). For your cat’s safety, always test before you shoot insulin, no matter how small the dose may be.
    • Tests (as your schedule permits) to determine your cat’s nadir, which is the expected mid-cycle low BG level that occurs usually 4 to 7 hours after insulin is administered. Some cats nadir earlier, some nadir later. ECID - Every cat is different.
    • Some additional mid-cycle tests are always useful, especially when there has been a change in dose or food. Every few weeks, a curve (tests every 2-3 hours) is very useful.
    • If you work during the week, a weekend is a good time to get additional BG testing in during the daytime and nighttime cycles. (Yes, this means setting alarms to get up overnight, but you’ll see a payoff by helping to get your kitty regulated.)
    When in doubt, ask the Forum or your vet for advice BEFORE dosing your cat.
    • The proper sequence for dosing insulin is: Test/Feed/Shoot. In the beginning, if your cat’s BG is not up to at least 200 mg/dL {11 mmol/L}, if your schedule allows, you can stall (without feeding) for 20+minutes, then retest the BG. You are looking for a number that is rising, not falling and up to 200 mg/dL {11 mmol/L}. If you stall once, but can’t do another round of stalling and your cat hasn’t reached a BG of 200 mg/dL {11 mmol/L}, you’ll need to skip the dose and wait until the next cycle. NOTE: Because pet-specific meters (such as the AlphaTrak2) often read higher than human meters, you may want to adjust the NO-SHOOT number to 225 mg/dL {12.5 mmol/L} or even 250 mg/dL {14 mmol/L} This gives you an added margin of safety when using an AlphaTrak2 or other pet-specific meter.
    • IMPORTANT NOTE: Do not feed your cat within the two-hour window right before the scheduled dose time; doing this can raise your cat’s blood significantly, giving you a higher BG number based on food. This could result in your giving insulin when you should not, or giving more insulin than you should.
    • FDMB has general BG references for use with human meters: A cat is considered regulated if BG is in the mid-200s mg/dL {mid-11s mmol/L} for pre-shot and in low 100s mg/dL {low 5.6s mmol/L} or double digits (U.S. mg/dL) for nadir. (BUT not below 50 mg/dL {2.8 mmol/L} which is approaching hypoglycemia range, which is too-low blood glucose - we commonly call this “hypo.”) If you are using an Alpha Trak2 (pet meter) your hypo range starts at 69 mg/dL {3.8 mmol/L} and below. Again: You may want to consider raising your No-Shoot number to as much as 250 mg/dL {14 mmol/L} in the beginning of this sugar dance when using a pet-specific meter. That’s your and your vet’s decision.
    • If you need help with a hypo, post right away on the PZI forum and on the Health forum with the title: 911 HYPO - Need Help ASAP to get the maximum guidance to help you steer your cat back to safer levels. If hypo symptoms are severe (seizure/loss of consciousness, etc.) go to the nearest ER vet clinic immediately.
    Essential Hypo Reading: Hypo toolkit link and HOW TO TREAT A HYPO
    • Hot Tip: Print BOTH of the above documents out; the first is a great shopping list - and we strongly suggest you post “How To Treat A Hypo” in a prominent place (like your refrigerator door).
    Ask for help on the forum before giving a shot if you are unsure, as you can never “un-shoot” a dose. When asking for dosing or hypo advice, make sure you indicate:
    • which type of meter you are using;
    • if your cat is on any other drugs and/or has health problems;
    • if already dosed, amount of that dose, time of day given and your Time Zone (such as Eastern, Pacific, etc.);
    • how much time has elapsed since you did the last BG test and your last shot;
    • when your cat last ate, type of food and how much.
    Never give an additional amount of insulin during the same 12 hour cycle, even if you think you missed and gave a fur shot. Better to be too high for a day than too low for a minute. Safety first!

    Here is a guide to dosing ProZinc/PZI: PROZINC PROTOCOL

    Please read through the Protocol and keep it handy.


    BLOOD GLUCOSE (BG) METERS: HUMAN OR PET-CALIBRATED? YOU CHOOSE
    • Blood glucose meters test the amount of glucose in the cat’s blood.
    • Human BG meters are the type most commonly used by FDMB members; they’ve been used successfully for many years to monitor cats’ blood glucose. Inexpensive human meters and test strips are widely available at pharmacies (Walmart, Walgreens, etc.) as well as online (Amazon, Ebay). Some additional info: ReliOn Meter
    • The pet-calibrated AlphaTrak2 (AT2) is widely considered by vets to be the “gold standard” for testing blood glucose for cats because the results are closer to that of veterinary lab equipment. An AT2 meter must be purchased either from a vet clinic or online. Most vets don’t carry the test strips. They are much more expensive than human meter strips. Some additional info: Alpha Trak2
    • In the UK, many people use the Accu-Chek Aviva. It’s widely available and only requires a small blood sample.
    LOW-CARB DIET IS BEST, BUT PROCEED SLOWLY
    IF KITTY’S ALREADY ON INSULIN

    A low-carb, high-protein diet is a key component to feline diabetes treatment. Not only is a higher carb diet likely to result in higher levels, it is also contrary to a cat's metabolism. Veterinarian Dr. Lisa Pierson explains it all here: catinfo

    Dr. Lisa also has an excellent food chart: Food Chart Public

    We suggest that foods have 8 -10% calories from carbs or below. If your cat is already on insulin, be sure you are confident about home testing your cat’s BG before you switch to low-carb food. The switch can result in a BG drop of more than 100 mg/dL {6 mmol/L} or even lower, so BG monitoring is essential! Also, make the switch slowly to avoid stomach upsets. These pages have useful threads for low-carb treats and transitioning from dry to wet food:
    These links may be helpful for UK/European users:
    • UK foods

    • A recommendation from the Netherlands is to feed Felix (As Good As It Gets) in conjunction with Cosma Nature, a supplementary food.

    • Porta 21 Feline Finest Sensible and Thrive ‘Premium Plus’ Chicken may currently be the lowest carb dry foods available in Europe (for dry food addicts only).
    If you ever are in doubt about a possible food and its low-carb values, please ask on the forum.


    GOOGLE SPREADSHEET: TRACKING KITTY’S PROGRESS

    It is important to track your kitty’s progress over time. FDMB has a process for this, using a Google spreadsheet (SS). Other FDMB users can provide you better help if you keep your cat’s spreadsheet up to date. Once you type in the numbers, the SS will automatically update.

    Make sure when setting up your spreadsheet that you choose the correct type: We have one sheet for human meters and another for AlphaTrak2 pet meters.

    If you are not from the United States: Make sure you choose the World version so that your numbers will automatically convert to what most members are used to seeing.
    • How to create the spreadsheet: SPREADSHEET If you have difficulty creating your spreadsheet, ask for help.
    • Post the spreadsheet in your FMDB signature. Once you create the spreadsheet, put it in your FDMB signature block. See the link above, which includes easy instructions on how to update your signature block.
    • How to interpret the spreadsheet: “AMPS” is the AM Pre-Shot test (always test before shooting to make sure your cat’s BG is high enough to give insulin). The “U” column is for "Units" (how much insulin you gave). The +1, +2, +3, etc. headings are for how many hours since shooting … so +2 is 2 hours after the shot, +9 is 9 hours after, etc. Since we have members all around the world, saying "he was at 148 at 8pm" doesn't tell us anything; we need to know how long since kitty’s last shot. At the end of a 12-hour cycle, it's PMPS time (PM Pre-Shot) and the whole thing starts over! Here is some additional info on interpreting the spreadsheet: understanding the spreadsheet.
    HANDLING PROBLEMS
    • To get urgent help from this forum, do this:
    Tag your thread with the 911 icon then post in ProZinc Forum AND in the FDMB’s Main Health Forum. ProZinc is a small group and not as active as the Health forum, especially at night. Also, you can "tag" people that you see are online to get more eyes on your thread ASAP. (To do this, use each member's screen name preceded by an "@" symbol, like this: @Sue and Oliver (GA). )​

    If you need dosing advice, tag your thread this way: Dosing Advice ASAP. Remember, if no one responds right away, stalling without feeding is the best thing to do. In the event that no one comes to your aid after a reasonable amount of time and your schedule will be too far off-kilter the next day if you were to stall, it's best to just skip the shot when in doubt if the pre-shot BG is too low. Make this your mantra: "Better to be too high for a day than to be too low for a moment." If your emergency is a hypo event, please title it as such.

    Sometimes there are circumstances, such as the presence of ketones, an unusually low pre-shot number, a caregiver leaving the cat with a sitter, relatively high and flat curves, loss of appetite, infection, a change in schedule or ability to monitor, etc. which may call for adjustments to these guidelines. Please ask for guidance if any of these or other circumstances present themselves or are of concern.
    • Multi-cat households/ Kitty “Contraband” Foods:
    It might be helpful to get all cats in your household on diabetic-friendly food if at all possible, and on the same feeding schedule. We realize that some cats have other health issues that would not allow that to happen, for instance cats with kidney issues. But if all possible, get all dry food out of your house to make it easy on your life and not have your “sugar cat” get into “contraband” food. (It only takes a few pieces of dry food to cause a big rise in BG's!)

    Until your diabetic kitty’s BG is well-regulated, your cat will likely behave like he or she is starving, but that’s just the diabetes “talking.” Dealing with a newly diagnosed cat is a bit like child-proofing your home: Contraband food opportunities for your kitty can include your dog’s or other cat’s food dishes, dishes left unrinsed in the sink, the kitchen trash can - or even a single potato chip accidentally dropped by the sofa while watching a favorite TV show! So be aware: Even a small amount of contraband food that your diabetic cat gets into can spike BG numbers. Sit family members down and explain that you’re treating a serious disease and need everyone’s cooperation to help in restoring your kitty’s health.​
    • Juggling work and having a Feline Diabetic:
    It is a challenge, but doable with some careful planning and having your shot schedule reflect when you know you can be home. Some people will wake up a bit earlier so that they have time to get at least a +1 test before they walk out the door. Also, it's a good idea to have someone else trained to test and shoot insulin in the event you are not able to be home on time. Sometimes this is another family member or it can be a pet sitter who is trained to help you.​
    • Feeding Schedules:
    There is no "right" or "wrong" approach to feeding; rather it's a personal choice. Some people like to feed twice daily, with the shots. Others like to give several small meals during the day (and perhaps the night).

    We would recommend that you base your feeding schedule on your own particular situation (whether you're able to be around to monitor BG or not, etc.) and your own cat's response to the insulin. It is very helpful if you can determine when your cat's nadir (lowest blood glucose) occurs during a 12-hour cycle. If you work outside the home during the week, this might best be discovered over a weekend when you can be around to do a bit of a curve (feeding at pre-shot time, dosing the insulin, then testing every 2 hours until you see where in the cycle your cat's nadir happens while on insulin). Taking the extra time, early in treatment, to find out when your kitty's nadir occurs can help you determine when to have extra food available for those times when you're not around, so that your kitty stays safe if the blood glucose were to drop lower than is safe range.

    When you can’t be at home to monitor BG levels, making food available in the event that the blood glucose drops low adds a measure of safety, as most cats will search out food during those times. There are several timed feeders on the market that make doing this easy: One that allows 5 different feeding slots is the PetSafe 5; there are other models that have fewer food compartments. (Amazon has a selection of timed feeders to consider). Some of the models have a depression under the food tray that will allow for a freeze pack to ensure that food does not spoil. Another idea is to freeze your cat’s serving sizes in ice trays, then pop them out into the feeder in the time-slots you select. By the time the safe opens, the food is thawed!​



    SHOPPING LIST
    Here is a shopping list for home-testing:
    • A blood glucose meter. You may have left your vet’s office when your cat was diagnosed with an AlphaTrak2 (pet-specific) meter already in hand (or have been advised by your vet to get one) as it’s widely considered the “gold standard” for home-testing among veterinarians. However, most FDMB members do use human glucose meters because the test strips cost so much less. Human meters have been used by our members for many years with good results. So whether you use a pet-specific meter or a human meter is your personal choice: Either type will work effectively. The most important point: that you DO home-test your cat’s blood glucose before shooting a dose of insulin!

      Any human meter that “sips” up the blood droplet and takes a tiny sample (0.3uL) is fine. Lots of FDMB members like either the ReliOn Confirm or the ReliOn Micro from Walmart. Both meters are inexpensive and the test strips are among the cheapest around. Some human meters are free in drugstores when purchased in a kit along with the test strips, as the strips themselves are the ongoing expense. You can, however, find strips on ebay at less than half the price you’d pay in stores.

      Regardless of which meter you choose, try it out on yourself or someone else before you try it on your cat. You want to be familiar with exactly how it works before you poke your kitty.
    • Blood glucose strips: PLAN AHEAD! Stock up so that you don’t run out of test strips when it really counts (like pre-shot test time or in the event of a hypo). While you can usually dash off to a 24-hour WalMart for ReliOn brand strips, you may not be so lucky finding some other name brand strips in stock. Special note to AlphaTrak2 (AT2) users: These test strips are generally available via online vendors only; most vet clinics do not sell AT2 strips, nor do human drugstores or WalMart stock these - so is especially important that you plan ahead when using this meter!
    • Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 26-28 gauge lancet is good. Any brand will work as long as the lancets will fit in your meter brand’s device.
      (Some of us don’t even bother with the lancing device, preferring to do the ear-poke “freehand” - do it whichever way works best for you!) Hot tip: Lancets come in boxes of 100, and you’ll usually go through them even faster than you do the BG test strips, so is a good idea to stock up with at least 2 boxes on hand for each vial of 50 test strips. (Don’t reuse the same lancet for more than one poke, either.)
    • Ketone strips (Ketostix). Just like human diabetics use. You will sometimes need to test urine if the numbers are high. If you’re unable to test your kitty’s urine for ketones, there is a meter available, called Precision Xtra: It can test blood for both blood glucose and ketones, but the ketone test strips must be purchased separately and are very expensive compared to this meter’s BG test strips.
    • Rice sack. Make this out of a lightweight sock filled with raw rice or oatmeal, and then knotted. You heat this in the microwave until very warm, but not hot. Then heat the ears before poking. You can also use a prescription bottle filled with very warm water; it provides a good surface to poke against.
    • Flashlight: So you can look at the ears and find the little capillaries that come off the vein running around the edges of the ear. You want to poke a capillary.
    • Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.
    • Reading glasses: Even if you don’t really need them to read, these handy magnifiers can be a big help - both in detecting the blood droplet when it forms after an ear-poke, and when you’re loading the syringe for a shot!
    • And some low-carb treats to give your kitty, successful test or not: Low carb treats
    FDMB’S FELINE DIABETES ACRONYMS

    There are plenty of acronyms in use at FDMB, so is a good idea to familiarize yourself with all of them! More acronyms are located here: FDMB acronyms

    Document created Sept. 2016
     
    Last edited: Sep 15, 2016
    Reason for edit: Prooreading ...
  2. Robin&BB

    Robin&BB Well-Known Member

    Joined:
    Sep 28, 2013
    bump (Thanks again, Jill & Marje!)
     
  3. Robin&BB

    Robin&BB Well-Known Member

    Joined:
    Sep 28, 2013
  4. Robin&BB

    Robin&BB Well-Known Member

    Joined:
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