Discussion in 'Prozinc / PZI' started by srk4cats, Jan 18, 2018.
Another DKA. Hugs and prayers appreciated.
Sending best wishes and positive energy, Roberta.
Sending purrs and prayers from me and my crew
Sending heaps of healing vines your way! I'm so so sorry to hear that's what it is. Please keep us updated and know that we are all pulling for her. And of course hugs for you and chin scratches for Cheddar and Chico and Fuzma
Hugs and prayers
Oh no, I'm so sorry to read this. I hope she pulls through.
I wonder if this might be a good time to think about switching to Lantus or levemir?
They're pretty strict about tests and protocol but start low go slow is a little more forgiving.
Praying for Chloe and hugs to you and Chloe.
I visited her a couple hours ago and she's doing much better. The doctor said I should never change her dose without consulting my vet, even if it's only .25. I am also thinking of switching insulins. I sent Chloe's SS to my vet. Turns out that when I visited her in November, she had mentioned that but I had just bought a new vial of Prozinc. Now the vial is almost empty, so it would be a perfect time to switch.
I'm so sorry. I hope she pulls through this quickly. Do look over the Lantus and Lev stickies and maybe post in their forum for some advice? That might help you make the decision.
Vets say a lot of stuff that just strokes their ego.
You have history of their dose being far too much (30 BG reading a while back).
I hate when vets say that kind of stuff.
I don't know, Steph. It's been a year and I haven't gotten Chloe regulated. I finally found a vet I can trust and I probably should have checked in with her sooner. Hopefully, I'll hear from her today. Extra vet visits wouldn't cost nearly as much as DKA's which are about $3,000.
Might be worth investing in a blood beta ketone meter too as they may give an earlier warning of ketone build-up.
Sending lots of healing vibes and prayers for Chloe to be feeling much better very soon. If she's having difficulty eating it's very wise to ask the vet for a supply of anti-nausea and appetite stimulant meds to take home with you when Chloe is discharged.
Maybe the vet can run regular curves like she needs and find the ideal dose for her. It still comes down to you finding a plan for her home care that works and keeps her safe. Mid cycle and spot tests will tell you if the dose is too much or too little. One curve a month at the vet can't replace those tests.
If they tell you to shoot blind, please don't listen to that nonsense. You saw the importance of preshot testing yourself.
I do think she will do better on lantus or levemir but if you can find the time, read the yellow stickies.
Hope she's feeling better today.
Changing the dose without consulting the vet cannot cause DKA. You test at home where Chloe is less stressed which allows you to make on the spot dosing decisions. Did the vet explain how changing the dose with the proper tests at home that keep Chloe safe caused this? Because I think that’s bull...and any vet worth their salt should see that you doing the same tests they would do is the right option.
Sending positive thoughts to Miss Chloe and to you. I know how stressful this journey can be.
I also want to add--that one of my vets in the office I go to started my cat at a higher dose than the normal. @Djamila is the one who suggested not to do that and keep her at at the 1u. I didn't listen. Long story short she was right. I can promise you these wonderful crazy cat ladies would never steer you in the wrong direction.
@Djamila @Rachel @Critter Mom @Kris & Teasel and @Chris & China know their stuff, as many others.
In the end you do what you feel is best for you and Chloe.
Chloe is doing so well that she might be able to come home tomorrow! My vet is also saying to switch to Lantus, so I guess I'd better order some. They said to get the vial. So I may be saying goodbye to all of you and switch to the Lantus board. Thank you so much for all your prayers and hugs.
They told me she started eating last night and is doing so well that she can come home tomorrow! I have to get some Lantus soon!
I'm so glad to hear she's doing well! Of course we'll miss you over here, but I think Lantus might be a better fit for Chloe. I would really recommend the pens though. Vets don't know that you can pull from the pen with a syringe and still control the dose. They think of the pens as only giving whole unit doses. It might be worth asking the folks who are currently using it, and definitely read the stickies and the research behind the protocol over there. There is a wealth of information on that board!
If you haven't, I'd go post on their board right now. Let them know you're switching (and be sure they know about the DKA) and get some advice on how to start!
With the dose Chloe is on now, I suggest the pens too. One vial is 1000 units. That would be something close to 250 days worth with 2 units twice a day. (Not saying that's going to be her dose but usually it's close to what they were on before you switch). It could go bad before then and you'd be wasting money. Chuck uses up a vial in a little over a month so a vial doesn't have time to "go bad".
A pen has 300 units so close to 75 days in each pen (at 2 units twice a day) give it take a few days to account for wasting a drop or two each dose.
So if it only lasts 60 days before it goes bad- you're only wasting 15ish units or about 7-8 days. Vs wasting 190 units in a vial or about 50 days worth of it goes bad in 60 days.
Hope that all makes sense.
Bottom line, pens are more economical and you get more by ordering 5 pens (1500 units) vs ordering a vial.
I suggest looking into Mark's for the lantus if your vet will give you a paper script.
Glad she's doing better. I hope Lantus is a better insulin for her.
The vet from the animal hospital called me again at 9 pm to update me before she finished her shift. She said they would provide me with some Lantus to start with. I had a bit of sticker shock when I saw the prices. I'll ask about it on the Lantus board. Oh yes, and she is writing a script for me.
Oh, she said everyone at the hospital fell in love with Chloe because she's such a sweetheart. That happened last time, too. For a Siamese mix, she's very laid back, even though she tries to bite me when I give her injections.
I agree with Rachel's advice to go post on the Lantus forum and inform them of the recent DKA, that it's her second hospitalization for DKA, etc. They need to know that to give the best advice. I also recommend that you read the yellow info stickies on that forum to learn more about how a depot insulin like Lantus works, the two different dosing regimens that are used and so on. It's a very different world from the ProZinc one you're used to. That forum has a load of extremely experienced folks who can zero in on what needs to be done to help Chloe. Their advice is worth its weight in gold and Chloe will definitely benefit if you follow it closely.
Just posted there. Thanks for all your help. I'm glad that you and the vets both agree on the switch.
I'm so pleased to hear that Chloe's recovering really well! (((Chloe)))
I still stick by my suggestion to ask for the anti-nausea and appetite stimulant meds. Extensive experience with nausea and appetite issues has taught me that it's far better to have a supply of meds in the house that aren't needed instead of being in a position where a kitty can't eat and not being able to respond quickly to help it - especially if the kitty is being treated with insulin (and doubly so if the kitty has a history of ketone problems).
Fingers and paws crossed that Chloe will do well on Lantus.
Be careful where you get your insulin from, I bought some on the Supply Closet. The first dose Buddy went up to over 400 and at shot time he was @149. They will not refund my money. After I received the insulin and had a problem, they started saying buyer beware, no refunds, we had no contract, if they had said that before hand I would not have bought from them. Be careful, Mark's Marine Pharmacy in Canada is a good place to buy insulin.
I hope Chloe, comes home soon and stays well from DKA. Some of us here are from the L&L forum, so you will probably still be hearing from the same Kitty Momma's.
Marks marine pharmacy is the most cost effective if you get the box of 5 pens. They will last quite some time. If you have script, call them and you might be able to email it or fax it.
I have faxed script's to Mark's Marine Pharmacy, Bud's doc said she would call them, they said that was alright. Is Chloe home yet, I bet her Momma is excited.
If you have any Diabetic friends they might be willing to sell you a vial or pen at whatever cost their insurance charges them.
Just another possibility of you find yourself in a bind and need a pen quick.
Chuck is on lantus so I'll follow along on the L&L forum and see how she makes out! Wishing the best for her!
Wow. Just called and spoke to a different doctor who said to keep Chloe on Prozinc because she didn't respond to the gargaline (Lantus). So, back to 2u of Prozinc until I take her to my regular vet next week. The urine culture hasn't come back yet, so they don't know if the DKA was caused by a bladder infection. I'll have her home in about an hour. They said she's eating and drinking and purring.
Oh no. Chuck didn't really respond to Lantus right away either. Took about 3 days to see any downward movement in his numbers.
Hopefully your other vet can help.
Keep her hydrated and keep testing for ketones at home. Happy to see she's coming home.
Oh dear. Steph is right, and I don't even know what to say about that vet. Geez! Lantus doesn't work instantly like that. It takes a few days. Hopefully your regular vet is more knowledgeable.
Lantus has to build a depot. It can take a few days. It's not like prozinc or Vetsulin at all. It's not a rapid insulin.
@Djamila Mark's Marine Pharmacy doesn't seem to dispense Prozinc. What's with that?
I don't feel comfortable switching back and forth between insulins. Doesn't that mess up her system?
ProZinc isn't a human insulin. It is specifically designed for our felines. Lantus is a human type of insulin. Very rare do "human" pharmacies carry meds specifically for felines.
Marks is for human insulin if I am not mistaken, as I looked into that option as well. It was cheaper to get through my vet, as shipping it through 1-800 pet meds requires it be kept cold--which adds on to the cost of shipping.
Djamila may have more knowledge.
Yes, what Teenuh said.
As far as switching back and forth, it's not ideal, but I really do think Lantus is worth a fair try for Chloe. Most cats do very very well on it, and the protocol is much easier to follow. Chloe's numbers are still bouncing all over with Prozinc, and she's had two DKA episodes in the past year. She needs to spend more time in healthier numbers in order to keep her out of danger, and both Lantus and Levemir are good at flattening the curves so she hopefully won't bounce as much.
Of course it's up to you and your vet, but I would strongly recommend giving it a try for a few months and see if it helps her.
On Lantus, the starting dose needs to be held for at least 6 cycles before you can assess its efficacy (depot has to be established). See Table 3 in the attached PDF for Roomp-Rand TR dose adjustment protocol.
Too late. I already ordered the Prozinc. My vet even called me when she got the prescription request from the pharmacy. She thought I would be getting Lantus, too. I'm a bit worried about Chloe's high numbers since she came home from th hospital. Maybe the Prozinc I have has lost its effectiveness. It's way past the expiration date.
That could be why her numbers have been out of control. Can you pick up the insulin today and start it tonight?
I would get a +2 or +3 before bed to make sure the new bottle isn't so much stronger than your old stuff that it drops her too fast or too low.
I always monitored closer after starting a new vial.
Some vets will give you a half a vial or a months worth at a time. That way you're not ending up with expired and weaker insulin at the end of a vial.
PLEASE push the fluids with her. With those numbers she could easily end up with DKA again. Keep testing for Ketones. At least once a day until she's out of the woods.
@Critter Mom I think I have found your second calling. FDE. Feline Diabetic Expert.
How long were you using past the expiration date?
I frequently give insulin injections at work. I remember in my medication training they indicated that if the bottle was expired then the proteins would be broken down thus not be effective.
Cat insulin may be different, but I doubt much different, as there are still proteins in it.
Don't know. The label and date is worn off.New vial should be arrizing soon.
Might be a good idea to write the date you start the new bottle and its expiry date in permanent marker on the bottle.
And also put it in the notes on your spreadsheet, or on my spreadsheet on 1/13 PM cycle you can see how I noted the new vial. That way if I want to go back and check how long I've been using it, it's easy to find.
I was about to suggest what Djamila said.
April 8,2017. I did mark it, but way on the right side. That's why I don't use that area anymore for notes. I merge some cells and write notes between the AMPS and PMPS now.
I agree, does she keep office hours.
I must say all of these ladies know a lot.
I am convinced that after about 6-7 months past the expiration date, the prozinc loses its power. I don't usually pay attention to expiration dates for foods and my medications, but I think I'll be more careful with the Prozinc.
I'd be weary about using any Rx past it's expiration date on anything for our felines, or pets in general. "We" humans can tell if something isn't right in our body, or if a medication is making us feel a certain kind of way. Our pets can't tell us.
I've used a doxy antibiotic past its expiration date. Do I think it harmed me? No, but I will never know if the active ingredients were still active.
Glad you switched to a new bottle.
I need her to migrate to the US and hold those office hours at school. I'll stop by between lab and lecture.
@Djamila @Kris & Teasel @Rachel @Chris & China are all super knowledgeable too.
There IS much more support here. Besides a therapist costs me a copay and my vet charges me an office visit. This is free.
Separate names with a comma.