Elmo - need to increase again. Problems? UGH..

Hi,

Elmo started on prozinc a month ago? or so.

His numbers have been all over the place and now his back legs seem a little wobbly to me. NOt bad like walking on hocks or anything but just a bit shaky on ocassion.

I know Prozinc users say 45 days to settle. Why is this??

I was going to increase him to 2.2 units twice daily but I will be going to FL on Tues for 5 days and I don't want to have to worry while I am away.

Pet sitter is great, I worked with her at the zoo and she can give him shots, etc and is staying at my house.

I know start low go slow but with his bg numbers not moving that much it's making me worried every day and I feel that the Prozinc is not working as well as it should.

He is also having a problem with his eyes, squinting, insides of eyes very red, vet does not know, giving him triple antibiotic ointment, no cortisone.

Kinda rambling here but I am trying real hard and feel I am not doing him much good.

He eats 3 times a day friskies canned and only gets freeze dried meat treats so I dont know why his numbers are not lower.

I feed at 7-8am, give insulin then feed again at 5pm and then before bed like 10pm or so. I give pm insulin 7-8 pm in bewtween the pm feedings. Maybe I should give it early at 5pm? I think that when he eats at 5pm his numbers go up then by the time he gets pm shot he is already high again. Would that help if I gave pm shot a bit early ?

Thought I had this kinda down pat but I am feeling not so great today.

He has also been losing weight, not sure if it from only having canned now instead of free feed dry like he used to or because he is not regulated or both??

No ketones in his urine so that is good and he is acting ok just seems"floppy" or kinda depressed a bit cant explain.

Thanks for listening and as always appreciate any info.

K

 

It looks to me like you got a breakthrough once on 2.5, and have seen moderate action on lower doses, so I would guess you may end up with another breakthrough once you get the dose slightly higher than it is now. Just a guess of course. My experience with PZI Vet has been that when the dose is too low the #s run higher than I would like, and then once you get to a good dose there is a sudden breakthrough to good #s. I don't know why, but Bix never seemed to get tidy improvement, he just sat in higher #s, til all of a sudden (on a dose increase) he started getting good #s. It looks to me like Elmo is for the most part getting a U-curve but the #s are still too high, which suggests to me it's time for the next small dose increase (whenever you feel it is safe to do so). Generally with PZI you can raise every 3rd day or so, so I wouldn't worry too much about trying to go too slowly (I don't think you are, but just wanted to mention that in case you are thinking you need to wait something like a week between dose increases). I'm a bit out of the loop since I haven't been on the board much lately and haven't been following everyone's history & progress, but that's how the #s look to me. Decent actually compared to a lot of cats, but probably not quite enough insulin at the moment.

Bix also gets a touch of saggy/wobbly back legs when he needs more insulin, and tends to act sort-of down/slightly lethargic when his #s are higher. The weight loss would be consistent with higher #s as well, though of course there are other possible reasons. Other than being gone for a few days, I don't think you need to be worried & stressed out about continuing to make small dose increases every few days - it looks fairly straightforward to me (NOT an expert!) that he needs more insulin. The breakthroughs can be scary when they come, but from what I have seen from cats here it as a good thing, and even #s around 50 or so seem to be just fine for most cats. I'd worry if you got something like a 30 of course, but I don't see any #s so far that look worrisome to me on the low side.

As far as your question about giving the PM shot early, I don't think it will help if that means the AM shot will be late, I think you will find it just gets more confusing, and then the AMPSs will start running high.

Really his #s aren't too horrible, so go easy on yourself! He is clearly showing a response to the insulin, and it looks like he gets pretty decent duration, which is awesome. I know it all is really stressful, but from here things look like you are on track for some better #s pretty soon.

 

We're new here to the board. I also have a cat named Elmo, a big brown mackerel tabby Maine coon mix.

Duke though is the reason we are here. Duke too is underweight. The other day I boiled up some turkey legs and have been using them for small in between meals and for treats after we stick him in the ears . He loves it, can't get enough. I read here and other places that turkey is one of the best things for them to eat. I boiled up 4 turkey legs and carved off the meat and stuck it in the fridge. I also add a little water to all of his meals to try and keep his hydration good, which has been a problem with Duke in the past.

Hope you and Elmo are having a good night together.

 

Hi Kay, You're doing great, but I wanted to mention something that kind of stood out at me on Elmo's spreadsheet. On 5/15 to 5/19 at 1.60 Units... he look to be doing fine until he got into the dry food. ohmygod_smile Part of me feels like 1.6 is where he needs to be at. I'm just afraid going up the doses will cause rebound. 5/19 numbers looked great until the dry food deal which you went to 1.80 to bring the numbers down.. when i think you could of stayed at 1.60 units. 5/24 Elmo stole hamburger so you went to 2.0 units, but I really feel this is just throwing him off all together. I'd actually back down on the dose and try to get some +3 & +6 numbers. Hang in there! Sending you guys good vibes. ;-)

 

Thanks,

I think I am going to leave him on 2 units while I am away.

I do not think he is at risk of rebound being on this dose and even though he got into the dry food and burger I do not think I threw him off .

I test as often as I am able and from all the numbers I have seen he is no where near going hypo. I can try to test more at 2-3 hours but I highly doubt that he is going from 345 lets say to low then back up ... Maybe but I don't think.

I still do not know why people say 45 days for prozinc to settle?? If I only have to wait a few cycles or days to increase dose then the 45 day thing does not make much sense then right?

Hey is it ok to give him 2 differnet doses am and pm? Since he eats more at night should I maybe give him 2 in am and 2.2 U in pm?

just a thought.

Thanks, pardon any type o's

 

I've never understood the 45-day thing myself. If you still have the package insert, maybe that says something about it? I checked their website but nothing jumped out at me. They did a study that was a 45-day study and compared results at various days along in the study, so perhaps they observed that nadirs had shifted by day 45 compared to at the start of the study, and that results were better at the end of the study than in the early parts. Which really doesn't explain it to me, since you would expect that with longer-acting insulins since there is an overlap effect, and of course during those 45 days you are adjusting the dose I presume (I didn't read the study carefully, so I'm not sure how they did the dosing), so if results WEREN'T better by day 45 it would seem like a pretty useless insulin IMHO. But perhaps there is some other 45-day thing.

I think it's clear from results we've seen here for various cats that it starts working right away, so my take is that there may be some shifting around of stuff like nadir & duration, but I would expect that would be non-dramatic, and nothing really to worry about. With most of these studies people aren't home-testing (not sure about this study though), so sometimes when they say stuff like that it is because they assume you aren't testing. My vet had me stay at each dose for 2 weeks before I was home-testing so it would settle-in in the sense of giving stable #s so she could get a good picture when I brought him in for a curve. Once I started home-testing I asked her about that settling-in stuff and she said there is no need to wait 2 weeks between dose changes if you are doing daily testing, because that gives you a more complete picture and you can see if the #s are still adjusting to the dose, or if they have stabalized out and you need to raise the dose.

Hope that helps! I had missed the comments about getting into dry food but I rechecked the ss and the dose still looks too low to me. Even on that good 1.6 cycle pre-dry food, the nadir still is pretty high. Just my 2c, and sometimes I have been wrong when M & P was right. :? But in this case since you are seeing shallow U-curves overall, I'm stickin' with what I said! (for now, lol)

p.s. Some people do what you said with a different AM & Pm dose, but I don't see anything in his #s to suggest you should go that route. If you had say consistently higher AM PSs, you might give a higher PM dose to try to get better duration leading into the morning. If you did the reverse, higher dose in the AM b/c the AMPS is higher, you can get into a see-saw pattern. I tried something like that once to try to counter some meds Bix is on, but found it really confusing. It makes it way harder to interpret the data when you are still trying to find a decent dose. With Bix, I ended up switching his meds to BID instead of the SID he was on. If I were you, I would keep the dose steady between AM/PM, and if you wanted to balance out the food, maybe leave out a morning snack for him or something (guessing you have other critters who might snap that up though!).

 

Looking at your ss and studying your feeding/ shooting schedule, and your upcoming trip gave me these thoughts:

1) I think ultimately he will need more insulin because he is not achieving any nadir in the blues on 2u, and the few times he did get blue it was from a lower preshot number.
2) I agree I would not increase it much, or at all, if you are going away. As soon as you are back, I would go up again slightly and keep watching those nadirs. I like how you test at various hours mid cycle.

3) Did I read this right?
at 7:30am you feed & shoot
at 5pm you feed
at 7:30pm you shoot
at 10:30pm you feed

so your PMPS should always be higher because of giving food during those last 2 hours when his PZIR is fading. I notice this is not the case always. Makes you wonder if his Pancreas is functioning some.

My solution to this is this: Feed him at both preshots AND (For $30 you could) get a 2 meal timed feeder and feed him at +5.5, both AM and PM cycle. This will soften the nadir and avoid any (5pm) food spike hurting the preshot numbers. As he accomodates to this you can gradually increase the dose.

New schedule-
test, feed, shoot at 7:30 AM and PM
use the timed feeder to feed at 1PM and 1AM

He eats every 6 or so hours which helps steady his glucose intake, and you work the curve to avoid the big swings which dont feel good.

4) I do vary my AM vs PM doses a bit, because I don't feed at night anymore (Cody destroyed the timed feeder :shock: ) I try hard to avoid steep curves /panicy liver, so I don't give as much insulin at night when I'm not awake to watch for a steep drop.

5) on the 45 days - I don't know the answer, but since pzir is a human recombinant insulin like lev and lantus, it makes me wonder if it also has any mild shed effect which takes a long time to fill and level out. I really don't know...

 

Thanks A LOT everyone, I am in Orlando and headed home today.

Will write more later.

Almost right with feeding

He gets shot then fed 730 am

fed 5pm

shot 730pm

and fed again 10-11pm

have 8 cats thats why I do it this way they are used to that feedingschedule and have some senior kitties that like theri food at these times lol

I am going to change feed liek suggested and see.

write more later just wanted to say thanks

K