Challenging General on Prozinc

By way of introduction. General Sterling Price (named after John Wayne's cat in True Grit-came named) around 5yrs old is an orange tabby rescued from a friends driveway after being on the street three yrs. He weighed 16 pounds then and unfortunately and retrospectively we overfed him, mostly wet with dry and he went up to 19.5 pounds (too many greenie treats). Polydipsia and polyuria followed and was diagnosed about two years ago. Home testing started on Lantus and initially with weight loss and insulin and only wet food went into remission. Then failed and have been on the roller coaster. Found to have multiple tooth abscesses, had teeth extracted (6) and got through that ok. Continued to bounce around testing frequently. Initially went back to 15 lbs now 12.5 has lost lots of muscle mass. Never ketotic no hypo episodes. On Lantus bouncing constantly and have followed vets advice believe he has been chronically on too much insulin. Elevated lipids and liver enzymes probably mild pancreatic insufficiency giving probiotics and foods all less than 10 carbs no dry. On weekly B12 no other issues. Happy wonderful soul with a great disposition.
Decided to start on prozinc but believed bouncing and did not seem to last the 12 hours.and went back to lantus panicking . Then last week a roller coaster with very high sugars. Had terrible day yesterday wouldn't eat regular til in the night with high BG and decided to give prozinc another try. Got 1.5 lantus and added some 1.0 prozinc last at 6PM last night. +6 120, +8 136
AM pre dose 315, gave 1.2 units prozinc trying not to go fast. BG +6 235. Trying to decide PM dose. Gut is to stay with 1.2 for several doses and then curve.

 

Hi Ted! And welcome! I don't have any advice for you, but wanted to say hello.

Here is a link so you can make your signature. That's the information that shows up at the bottom of our posts and explains a little about our cat, food, insulin, dose, etc. It will save you having to repeat the same information over and over. If you run into any trouble with it, just post and someone can help you get it worked out.

http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

There is also a link on how to set up your spreadsheet to keep track of General Sterling's BG and doses, but I can't seem to find it right now. I'm sure someone will come along soon who can help with that part.

Welcome to the group!

 

Hello Ted, and welcome.

Can I just ask you to clarify the insulin situation:

Did you give your kitty lantus and Prozinc in the same insulin cycle?

Eliz

 

Yes. two hour later. BG was going up and eating some. Yes in same cycle. Lantus pools and he nadirs at about 6. Eating today. 1.2 this am.

 

Hello Ted and welcome to our little forum!

So, trying to understand, are you planning to continue giving Lantus and ProZinc in the same cycle? I really wouldn't advise that as the ONLY time more than one insulin is given is when someone uses R or N with Lantus...and then it's usually due to ketones. And even that is done only with lots of data on the cat and with lots of advice from others who have done that.

We'd be more than happy to help you with ProZinc dosing if you want to stick with that insulin for awhile.

 

Lantus and Prozinc? In the same cycle?
Ted, you better watch your kitty, this might prove dangerous, I'm worried. Have you spoken with your vet?

 

Not going to mix insulin. Last night felt if we did not bump him down he would not eat which is the pattern. Extra Lantus depots and shows up with low low sugars even after 12 hours in him.
Understand the risks. He was on 3 U bid lantus recently. But my suspicion we have been chasing our tail bouncing him by going up too quickly. When sugar is high he throws up and lays around and wants cool places. He ate about one small can yesterday am Weruva. Minimal snacking just tidbits during day yesterday. Chicken in limited amounts post PM dose. Once sugar got down in the middle of the night he ate half a can fancy feast classic low carb and a half a can equivalent of baked chicken. Unless sugar is very high he eats what we give him. Going to try the prozinc for awhile. Frankly frustrated with his weight loss and watching him wither. Ketones neg yesterday and today. Behavior and voice (squeaks when sugar high) normal today. Eating everything this PM, no vomiting and happy. On the porch watching birds. I need a nap too. Appreciate the concern.

 

Ok, you seem to be on the ball.
You know your kitty.
Good luck and have that well deserved rest.
There is lots of very knowledgeable people here to help.
Sending hugs

 

Will get with my better half and make a chart to let others see where we have been. We both have long work hours so this is challenging at best. Thanks for the concern. Plan is to slowly go up and curve when job lets us. Want to keep this cat around awhile. He is a gem and knows it and we are empty nesters. There are multiple Prozinc charts on the web makes it confusing. I think this depots less as we have often considered the two doses AM and PM lantus are combing to drive BG too low during the day and nadirs are bouncing him- leading to too rapid an increase in dose. Will work on him some more.Thanks for the hugs.

 

Gotcha. My suspicion is that you're right and you've probably been going up too quickly. Since you're wanting to give ProZinc for a bit, let me give you a quick intro to the forum. This is a small, but friendly forum. We're busiest in the morning and evening when preshots are happening. If you ever have an emergency, post both here and on Health to be sure you get eyes on it quickly.

My thought is to definitely stick with one dose for a few cycles and go from there. Are you using the u100 needles with ProZinc? I know they are for Lantus, but you can use them for ProZinc IF you use the conversion chart. I can find it for you if that's what you're doing and you don't already have it.

Generally, we say no shot under 200 at first. As you build up data, you can go to a lower preshot as needed.

Have you read our beginner's guide? It's pinned to the top of the forum. It gives a good general overview of how the insulin works.

What other questions do you have for us?

 

Have read the guide. Understand insulin. Both in the medical field. Using u-100 with conversion already. Started 1.2. Probably gonna stick with that for now, previously 1.0 too low. Then will curve in a day or so. I think the "wearing off" more likely bounce and that for some time his insulin needs not as high. Vet pushing to go up always but with teeth fixed and weight loss my gut is he has been symogiing or bouncing the whole time we have been frustrated. I think slow increase may show that to be correct. We will have a go. Thanks for your input and concern.

 

So PMPS 333 tonight went to 1.4 U ProZinc as 6+ from am dose 235. Felt needed to go up slightly tonite. Lantus from yesterday unlikely to be contributing at this point. We agreed to camp at that dose times three periods then see whether to adjust up or unlikely down.
Any alternative thoughts? On 1.0 ran flat high.

 

Hi Ted - here is the link to the spreadsheet we use since it doesn't look like that has been shared yet:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

That will really help for getting dosing advice. There are some amazing people on this forum who really know how to guide us through making good decisions for our cats. Looking forward to seeing the General's journey!

 

Just finished as much as we had on the spreadsheet. Must admit some data points missing. did not try to make a day a line til lately so the early incomplete part could be scanned by all. At first the vet would have us only curve weeks apart to check then make a recommendation for a dose for the next month. Obviously lately we have a lot more data. Would appreciate the curve gurus input. We can go back to Lantus but to me looks like more insulin is needed. Going to bed just checked him at midnight. Thanks to all. Especially whoever put spreadsheet together.

 

SS looks good! Yeah, most folks who come here don't have as much input at first. Honestly, even if people DID know they should home test, it takes a bit to get those cats used to it...so more data comes over time as we get them used to the idea of those pokes!

 

Thanks for getting up the spreadsheet. It looks to me like it would be wise to decide on a dose and hold it for a few cycles, getting pre shots and nadirs. Then, unless your numbers are too low, you can decide whether to increase and by how much. Increasing in small increments of 0.25 would likely be best

Getting advice on data collected once monthly is not a logical way to get to remission. Reacting to cycles every couple of days with dose changes as needed should get your cat into healing numbers efficiently. We can help with that on ProZinc or you could go back to Lantus with a measured approach. Your cat has decent numbers and I think fine tuning is possible with either insulin, but needs to be done in a systematic way.

 

I put his AMPS in at 264 gave 1.4 PZ but not showing up on my spreadsheet as a change. What am I doing wrong, do I have to save it someway to the sheet?
Changed it under my google log in? On my drive it looks changed.

 

I see it. I have always been confused about whether the person who has the spredsheet in their signature can see it on their post or if it is just shared with others. @Kris & Teasel can you help?

 

I can see General's SS. I can also see Teasel's non-editable SS when I click on the link in my own signature.

 

PMPS 289 Gave PZ 1.4---- at +4 264
Thats three doses at 1.4 all BG in the upper 200
Would you creep forward to 1.6 tomorrow or hang?

 

I think the increase is a good idea, as long as it is a cycle you can monitor. (A caution we use for the first cycle after an increase - just in case you'd get an unexpected response.)

 

Then will wait til PM when we can +4 and +6. Thanks to all. After looking at some of the sheets, its obvious that many of you are dealing with tougher situations. My prayers for all.

 

We do have some tricky kitties here on this forum! Hoping the increase does some good for you.

 

He was 353 on PMPS tonight-not happy with that. Continues on 1.6 PZ-concerned about bounce will test frequently tonight.
will add tonights values to this post
+3 234
+6 205

 

AMPS 343 TB my better half concerned that the PZ is not lasting long enough during the night our pre dose on this increase seems higher after several cycles. She is not sure whether we need to continue to go up. Plan to curve tonight but did not look like too much of a nadir last pm, may try 1.8 over the weekend but still concerned about the pre shot being higher. What does the expected PZ curve look like if there is such a thing. Is it normal for it to be used up in 8 hours or so?

 

SO the argument this morning is what is the real BG value. My better half prefers to write the value on the glucometer. I go with what the vet said originally which was that it read 20 high. The only thing that argues in the face of that is when he has been on the very low glucose wise he is asymptomatic and seemed ok. If it reads high he was really low. Is there a solution that we can measure which will be reflective of the real cat glucose? The instrument, is a ReliOn CONFIRM and the calibration solution says its accurate. But is there a way to know for sure where this unit is in relation to real cat glucose? Vet could test at same time but that always costs another 300 bucks and at first she said 20 high another time said low. Don't know what to believe.

 

I would do the curve before thinking about a dose increase. His numbers were better with the lower dose. This could be a couple things: a drop midcycle that is causing a bounce for the pre shot number, or reacting to a different dose with a little higher number at first before settling in. Only a full curve will help you figure that out. You have some midcycle numbers but if he dropped earlier or later, you could have missed it.

Yes, pet meters generally show higher levels. For that reason, some people here use them. The issue for others is the price initially and then the price of strips going forward. REliOn has the cheapest strips and in an emergency, when you are facing a low number and testing every 20 minutes, running out to the store for more strips can be a life saver. The pet meter strips are only available on line or from the vet.

My idea is that trying to compare or thinking of your number as lower is crazy making. Better to deal with the meter you have and work to get him in good ranges.

 

PMPS 253 PZ 1.6 units +2 259

He tends to slowly eat his supper prob why bg doesn't drop much.
will do a full curve tomorrow maybe a couple of values tonight.

 

Nice! It may be his pattern to take a few cycles to react to a dose change. His initial pre shot numbers on 1.6 were discouraging, but he has been dropping every since. His other pattern seems to be a flat cycle, not dropping much for nadir, which is not as common. It would be nice to see a lower nadir...wonder if it comes earlier or later than the 5-7 hour time frame.

 

This morning AMPS 364 Vet is coming Monday to let us calibrate and check liver enzymes. Today 3+ 284. I am still reporting 20 low as that is how I made the spreadsheet. Will adjust it if we find the ReLiON is too low. We are curving q 3 today. My guess is he will bounce over low 4 and change units a day looking at the whole sheet but I guess there really is no comparing Lantus to PZ total daily dose. We curve today. Thought he would settle down and look forward to some predictability. Will probably curve some PM today also. He really doesn't like getting stuck this much. He does get food frequently all wet and low carbs-we are trying to get some weight back on him. He is light for his frame and a good weight prob 13.5-14 lbs.

 

More data should help. Are you sure giving a treat with each poke? NEurosporin with pain relief can help too - put a tiny thin smear on after poking. Also holding the ear for a few seconds will help with bruising.

 

We use Bactroban to make it bead up. He gets food afterwards. Tried the topical lidocaine cream but did not seem to help. We do compress after getting sample. We can get it done but even with us being calm he fights a bit. Feel sorry for the little man. He puts up with a lot. Maybe eating on and off through the day is making our curves flat.

 

+6 186 so that is quite a swing down 180 in 6,

 

Not bad, around 50% which is pretty normal. Be interesting to see when he starts back up.

Low enough to bounce from, though. Don't be surprised by a higher pmps.

 

So if he bounces do we go up tonite or hold this PM? I hope we can do better than these levels long term. Next phase is what. Continue on PZ going- up more slowly or back to lantus and titrate.

 

So the plot thickens. Bought a brand new ReliON Confirm today. New one on test solution 125. Old one on same drop of test solution 118. Both within range for the calibrated control.
Went to test PMPS same drop of blood at same time (within a second). Old one (which we thought was a bit high ) read 414 (previously I would have called that 20 lower). ..... BUT new one on same drop read 319. Any thoughts. 100 units far from the same. What would you do?

 

So the plus 6 glucose is New Relion 342 Old Relion 353 actual readings. This makes no sense that one time they match and the other they are way off. Gives me no sense of security, wonder if we often read high and have dosed on variable data

Which meter is the most accurate???

 

Hard to compare two meters. I tried this in the beginning and it drove me nuts (short trip haha). The best advice I was given was pick a meter and stick with it. I did and it has worked out just fine.

 

So tonight we got fired by our vet. We took our spread sheets to try and get some advice on where to go. She said that sticking daily was ridiculous and that you can't adjust insulin frequently in cats and that cats take weeks to stabilize on a dose. She also said we should have never used a U100 scale to give PZ insulin even with a conversion and that if we were going to micro manage our cat that she would not be our vet. She said he is on way too little insulin and should be on 3 and stay there. Unfortunately on three he pukes, poops and lays around in between gulping water. Very upset and frustrated. We lost 6 pounds doing it her way.

 

Just reading through forum, wow I think that vet felt threatened. Sounds like you guys, and General, are doing way better without that vet. And saving some money. $300 to test his BG?! Crazy.

 

Wow....you're way better off without that vet! How ridiculous. I mean we have vets tell people they don't have to test all the time but to say she won't be your vet because you're taking an active approach and doing what is needed after her approach caused your cat to be sick?!?!?! That really ticks me off!!!!

There are much better vets put there. I'm sorry you had to deal with that!!

 

Sorry to hear that you had such a bad experience. It sounds like your vet has forgotten she is employed by you...Are you in a decent sized town? We have some questions to ask when you interview for an FD friendly vet.

Are you feeling confident in your care for General? You are doing the best for him. One of the sayings we have is that wouldn't give insulin to your child for a week without checking glucose levels, so why would you do that to your cat? You know how to keep him safe with testing and to increase the dose slowly and carefully.

You definitely can manage the diabetes at home. You will need a vet for vaccines and emergencies and things, and to get more insulin when you need it.

 

That was not just for glucose. Visit plus a few labs usually over 300 to be fair. Feel abandoned. Now we think we just wasted a year and a half with someone that wont't think out of the box. So on to another vet. And continue the struggle. At least his weight stabilized on our feeble attempts. We learn by doing and move onward shaking off the dust.

 

Thanks for the emotional support. She also told us glucometers don't work but she advised dose changes based on them. We will recover but interesting dynamic tonight. I wanted to react but momma said if you can't say something nice.....Blessings to all. What doesn't kill us makes us stronger

 

Wow...well as you said, on to another vet. We do have questions to ask to interview new vets, and you might also post on Health and ask for vet recommendations near you...never know there might be someone nearby.

 

https://docs.google.com/document/d/1BqrojKe9oBVAoexL59pUWidEd7viNmxSqW5l2IBTWjY/mobilebasic

 

Can't get IM appointment til Mid March. He looks worse today. Laying around +6 sugar 280 Feeling like the best control now that we are vetless was on lantus at 1.5. Tempted to go with what we know at this point. We are in Memphis. If anyone has a vet nearby give us a shout.

 

I think either insulin will be fine - go with which you are more comfortable. But I would really encourage you to follow the protocol for that insulin and test before every pre shot and get a nadir whenever possible.

 

+8 274 He looks bad today only ate limited baked chicken this AM. Stools very mushy. Recent O and P in January. Really off his feeds last 48. Probably depressed over his vet abandoning him.

 

Make sure to tell him it's not his fault!