Insulin Prozinc Getting it Right Question for 78 year cat

Discussion in 'Prozinc / PZI' started by C&C, Mar 20, 2018.

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  1. C&C

    C&C Member

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    Mar 20, 2018
    Cat weighed 13.8 lbs Nov 2016 she was getting 7.0 units of Prozinc daily. October 2017 her weight dropped to 11.8 lbs & she was dropped to 6 units daily-her level tested was 44-test/58-lab. March 1st 2018 her weight dropped to 10.5 lbs & her level was 24--I found her breathing heavily and tongue out so I rushed her to the vet. She was hypoglycemic. They gave her dextrose which helped that situation but, now she is also on heart medication. (We do feed her right before her shots and she was on Purina DM Diet but dislikes it so Fancy Feast Turkey Giblet Classics and cooked chicken are her main meals.)

    On March 2nd her test they did said 333, 317,187. We gave her only 2 units that day per the Vet.

    On March 3rd her level was 434 before her shop they put her on 4 units per day-split 2/2. March 7th vet tech test AM level after the shot 301.

    March 16th weight 10 lbs insulin checked 1:45pm was at 74. Vet said to drop insulin to 1.5 & 1.5 T=3.0 ( was considering doing 2.0 then 1.0) Cat got diarrhea that Friday evening she did get insulin of 3.5 that day-2.0/1.5. Saturday she got insulin only of 1.5 as she wasn't feeling well but was drinking a lot of water. Sunday she ate some and got 2.5 insulin-1.5/1.0. This was the vet texting on what to do. ie lower the dose or give none if she doesn't eat.

    March 19th Monday went to Vet only given insulin of 2.0 that day due to incident over the weekend. Insulin readings were 362-before the shot of 1.0, then 278 & 140. Cat ate some food--did a 3 oz can plus a few chicken pieces this was up to 2am Tuesday morning. She ate some while at the vets and when taken home.

    March 20th did insulin of 1.0 with food brought to vet tech reading was 380. Vet tech called at 6pm and said the vet wants to increase her levels to 4.0 ie 2 units in the AM and PM. The cat did eat well today

    So thank you for reading this story as there have been several significant things going on with this cat--

    Too much insulin, weight drop, heart issues and then diarrhea and not eating.

    We are struggling with trying to understand this insulin issue as you can see the suggestions are all over the place and now after the cat has had incidents with hypo & diarrhea and has just started to eat again is it a good idea to increase this insulin to 4.0 just like that when she has been taking for the past 6 days-4.0, 3.5, 1.5, 2.5, 2.0, tonight we did 2.5 to be safe. What would you all do? How are you getting your cat regulated as we do not want to self test but, this seems like the Cat is going through a nightmare getting regulated.
     
  2. Smokey and Jessica

    Smokey and Jessica Member

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    Feb 8, 2018
    Can I just ask why you wouldn’t want to test? There is no better way than to test at home. There is NO safer way or any better chance to avoid another serious hypo than to test at home. It can be a little hard at first, but it gets easier and becomes routine.
    I didn’t give insulin long enough to be able to give dosing amount advice, but I can tell you how important it is to test at home, and I do agree your cat is going through a nightmare with all those changes. A dose should be held for several cycles to see how it’s working. All those changes over such a short time there’s just no way to know how effective any of them could’ve been. It’s recommended here to only increase .25 units at a time, and test regularly at home.
     
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  3. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Oh I'm so sorry that things are so rough right now! It sounds like your kitty started on a very high dose...I'm glad that you've come down from that! So all these tests that you've got are coming from the vet's office? I ask because the numbers can be much higher at the vet's office due to stress.

    Okay, first off, the diarrhea. I'm not sure what that's coming from...has the food been suddenly changed? Is she eating well overall?

    Second, the insulin. It's really hard to give you a good dose without home testing. I don't want to push you (because I know this is stressful enough!) but without home testing there's no way to really know what's a good dose. Home testing will allow you to keep an eye on numbers at home, which will be less stressful for her and will help you to really get her regulated. That will make both of you feel better I think. It'll also be cheaper. ;) Okay, with that said, let me ask a question about March 19. You said the insulin brought her down to 278 and 140. Do you know roughly how long after insulin that was? We dose based on both preshot number AND how far down that number brought the kitty.

    I think the reason your kitty seems to have days where she feels okay and days where she doesn't is due to the insulin amounts changing. Her BG numbers are probably bouncing all over the place, poor thing! It's tough when your vet is giving you such changing advice. I would NOT go to 4 units. I'd want to do something like 1 or 1.5 consistently for a few days (about 3 days maybe) and get tests whenever you could to see how that does, and then raise the dose as needed. But again, without home testing, it's going to be REALLY hard to get the cat regulated or keep her safe. We all home test here and have found that it's not that tough, and it gives us some great info to help get our cats into good numbers!

    I'm sorry that this response has been kind of rambly (still consuming that first cup of coffee). Let's see what the others say, too. :bighug::bighug::bighug:
     
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  4. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Jessica and Rachel have both given you good advice. Getting started on home testing can be scary at first, but it's soon as routine as brushing your teeth, and while this may be hard to believe, many cats come to be eager partners in the process - even reminding us when it's time. They seem to understand fairly quickly that what we are doing helping them feel better.

    I agree with Rachel that based on the numbers you shared, giving 4u would be dangerous. It looks like the March 19th dose had some good action and brought a safe, healthy number. However as Rachel said, numbers in a vet's office are stress inflated so at home that 2u might be too much.

    You may find this helpful: www.felinediabetes.com/FDMB/attachments/management-of-diabetic-cats-pdf.11641/

    It's the study that our protocol is based on. In the study, they used Lantus/Levemir although the approach with Prozinc is similar. There is a little more art to dosing Prozinc, but reading this will help you (and maybe your vet) understand a little more about how to safely approach this. We would be more than happy to help guide you through getting your Cat into a safer and healthier place. Vets try really hard, but because they need to know about so many different conditions in different animals, they are rarely specialized in feline diabetes. We have a ton of information here and are happy to help!
     
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  5. C&C

    C&C Member

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    Mar 20, 2018
    Well it has been over 3.5 years since she got diabetes and was relying on the prior vet....clearly the cat was getting too much and it took along period of time for this to happen and effect her heart as well. You think you are doing what is best for them since it costs a lot to go to a vet but clearly not all get it.

    So if you can explain how you do the testing in simple terms such as what time or times, how often and how you base the decisions on this so I understand.

    Also, where do you get the kit to do this testing that is reasonable in cost? I am in florida but can order online. Do you need a RX from the vet? Where do you test at ie what part of the cats body?

    Thank you...
     
  6. C&C

    C&C Member

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    Mar 20, 2018
    I replied to Jessica about the testing so if you want to share with me on how you do the testing etc ie answering my questions to her I would appreciate it.

    Yes I understand from reading that the stress can increase it up to 100 so that is a factor. She was eating so so prior to the diarrhea incident and had only been on the heart meds since March 2nd so 2 weeks. I gave her some turkey that she doesn't usually eat that day so that could have caused it or the pills....once she got past last weekend she hasn't had diarrhea yet again.

    So to put it into perspective:

    after the hypo incident the vet wanted her on 4.0. down from the 6.0 that she was on. On March 16th she was tested around 1:45pm. Her breakfast and insulin was at 10:32am so that was at the vets and her level was 74. The vet then said give her 1.5 and 1.5 of insulin --the vet first was thinking 2.0 and 1.0. The cat then got diarrhea and had received 3.5 units that day. Next day she ate enough in the morning to give her 1.5 units but vet said don't give any in the evening. Sunday she ate maybe 4 oz+ and got 2.5 units.

    This past Monday the vet tech tested her before her insulin and she was at 302. They gave her some food and gave her 1 unit of insulin. Maybe an hour later they tested her again and she was at 278. Around 4-4:30pm she got another test and was at 140. She had some food but understand that she hadn't been eating a lot all weekend and even prior to that not as much as she could eat which would be say 2.5 cans of 3 oz of fancy feast turkey classic and some chicken pieces. Also, she was drinking a lot of water over the weekend too. So the vet said that for Monday night if she doesn't eat a lot only give her 1 unit.

    Tuesday Morning March 20th around 10:07am we fed her and gave her 1.0 units. Around 11:45am the vet tech tested her and she was at 380 level. She had picked up her eating on Tuesday such that we felt she did not need a IV to help her out. From when we fed her Tuesday evening to early Weds AM she ate 2 cans of fancy feast and some chicken and a few treats so her appetite is improving. The vet tech called last night and said to increase her insulin to 4.0 back to what she was on March 15th. We only gave her 1.5 last night and also this morning which is Weds March 21st.

    History:
    Cat was diagnosed diabetic on September 11th 2014 her dose ranged from 2-4 units or 4-8 total--average 3.5.
    October 5th 2017 went to new vet did blood work wt 11.8 levels 44 and lab had 58 dropped insulin from 3.5 to 3.0 twice daily.
    Prior to Feb 1st 6 units but had incident of hypo on March 1st 2018 weight dropped --level 24 dextrose given
    March 2nd 2 units levels 333,317, 187
    March 3rd-March 15th 4 units- ((tested before shot March 3rd level 434; March 8th before shot in AM level 301))
    March 16th Diarrhea-evening 3.5 units; vet tech tested 1:45pm level 74-insulin given at 10:32am
    March 17th 1.5 units
    March 18th 2.5 units
    March 19th 2 units levels 302-before,278-after,140-afternoon
    March 20th 2.5 units level 380 after shot
    March 21st AM-1.5 units

    So this is the overall picture and like I said the vet wants us to give her 4.0 daily!
     
  7. C&C

    C&C Member

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    Mar 20, 2018
    HI I provided a lot more detail to Jessica and Rachel but still have not sure what to do now re her levels. I see these spreadsheets but have no clue what they mean level wise. I realize that all cats differ but trying to see when your cats had the numbers that my cat did what dosing you all did?
     
  8. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    It's okay to just respond to one of us when we all ask the same questions. ;)

    We recommend testing before every shot so that you know the blood glucose (BG) is high enough to safely give the shot. Then whenever you can, to get a test mid-cycle: +4 to +7 (four to seven hours after the shot is given) is the ideal range, but many of us have to go to work, so we either grab one as late at night as we can, or we shift the shot time earlier in the morning and grab a +2 or +3 test as we leave the house for work. Dosing is based mainly on the lowest BG the cat reaches during the cycle, but also taking into consideration how high the BG is right before the shot.

    So in general we say 3-4 tests per day, but some days need more than that (usually on a weekend day for those of us who are out of the house during the week).

    A healthy, non-diabetic cat will have BG in the range of 50-120 on a human meter, so we aim to get the dose that brings the cat into that range for as much of the day as possible. How much insulin that takes really depends on the cat. My cat used to only need 0.3u to get there, now he needs 2.6u or more because he's developed some other health issues. So the insulin needed varies from one cat to the next, and even from one week to the next. In time figuring out how to adjust the dose becomes easier, but it can be tricky at the beginning and we are very happy to help day to day as you learn what your cat needs.

    Here is a link to some videos of folks testing their cat, and some helpful pictures that show the best place to test:
    http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

    As for a meter and test strips, if you have a WalMart near you, many folks use one of their ReliOn meters since they are cheap and easy to access. I use this one from ADW Diabetes: https://www.adwdiabetes.com/product...lucose-test-strips-lancets-and-free-pro-meter

    The downside of the ADW one is that the lancets are way too small to be usable (it's better to get 26-28 gauge when you're first starting), and you have to order a lot to get free shipping. That's no problem for me since my cat is a long-term diabetic so I don't mind stocking up, but when you're just getting started you might find something from a local pharmacy easier to manage cost-wise.

    And here is the link to setting up the spreadsheet we use. It looks like you have enough data already that getting one started might help:

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

    I know that's a lot all at once. One step at a time, and we are always here to help as you have questions.
     
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  9. C&C

    C&C Member

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    Mar 20, 2018
    Thank you for the information. I use ADW for my insulin needles. I could not find though on their site if they just let you order more strips and lancets as seems what you are using they have just kits? Also. are the testing strips interchangeable in meters?

    We are retired so we can test in the AM and thereafter but when you say cycle if I would normally give the cat her insulin at 10am then what times typically during the day are they tested? Is it right before 10am then in what times after that? What is the peak time?

    Then when you get these numbers how are they interpreted so we know how much prozinc to give them- where is there a conversion chart on how to do this?

    Are you changing your cats units daily or doing it every so many days with changes?

    Do you have to have a prescription from a vet to buy the meters and lancets and testing strips?
     
  10. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Yes, lancets and test strips are sold separately from the kit. No, you can't use the same strips in different meters (with very few exceptions within the line carried by Walmart). You have to buy the strips that go with your meter.

    Here's the basic testing schedule we recommend and how it's used to determine dosing:
    1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
    2. test at least once near mid cycle (a cycle is the 12 hours between doses) or at bedtime daily to see how low the BG goes
    3. do extra tests on days off to fill in the response picture
    4. if indicated by consistently high BG numbers, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
    5. post here for advice whenever you're confused or unsure of what to do.
    The insulin action is at its peak around the middle of the 12 hour period between AM and PM doses. This is when the BG is expected to be lowest. That low point is called the nadir.


    There's no conversion chart. This takes some experience, knowledge of the dose range that's too high/too low and how to manipulate insulin dose to achieve and maintain a good BG range.
    Too high = 250 and above
    Too low = below 50 on a human meter
    Ideal range = 50 to 120 on a human meter
    Take action because BG is getting too low = 50 on a human meter.

    A well regulated cat with good BG control will have pre shot BG in the low to mid 200s and a nadir in the high double digits to low 100s range.

    Insulin doses should be the same AM and PM for at least a couple of days in a row. A change up or down can be made based on test data accumulated over those days. A dose is decreased at the next dose time if a very low BG reading was obtained in the 12 hours prior. If a dose seems to give BGs in a good range that dose is maintained as long as the numbers are good.

    You don't need a prescription to buy a meter, lancets or test strips. In some states a prescription is needed to buy syringes.
     
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  11. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Kris and Djamila have given you great info already (I was in a meeting all day so I couldn't reply earlier). So I'll just say, PLEASE keep asking questions. If we're ever unclear, let us know. We want to help you and the only way we can do that is to make sure you're getting the info you need from us!

    I'm so glad you're willing to home test. I think we can help you get your baby back on track and in better numbers, and make sure that she really FEELS better too.
     
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  12. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    At the top of the Prozinc forum there are some yellow "sticky" posts that give some basic background information. Here is the beginners' guide:
    http://www.felinediabetes.com/FDMB/...prozinc-pzi-insulin-for-diabetic-cats.164995/

    And here is the protocol:
    http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.165103/

    There's a little more to it than what is in there as these are intended to help people get started. Please do post and ask tons of questions as Rachel said since even after you read those documents, it can still be hard to know what to do sometimes. They are good guidelines, but every cat is unique and we can help you sort out your own cat's responses.
     
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  13. Smokey and Jessica

    Smokey and Jessica Member

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    Feb 8, 2018
    With Smokey I dove right in with testing A LOT. I’m a stay at home mom so testing every couple hours or more all day was possible for me and good thing I did because he was on too much! I immediately started testing at minimum Pre-shots around 8am/pm and mid cycles. Some days I watched more closely than others as needed.
    I’ve had really good luck with testing on the ears. Some people test paws. You can use the search option on the top to see some other threads where people have posted really good in detail descriptions and pictures.
    I started with an alphatrack from Amazon because it gives the same numbers as the vet- literally we checked together- but now I use a human meter because the alphatrack strips are so expensive. I think if Smokey comes out of remission I may go back to alphatrack but it’s not necessary at all. Human is just fine. It tells you if it’s high or low and the actual number is irrelevant.
    You really can save so much money and time and stress and actually know more and accomplish more if you take on home testing.
     
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  14. C&C

    C&C Member

    Joined:
    Mar 20, 2018
    I did review the videos on how to get it from the ears but do you do the ears inside as she has a lot of hair being a long long hair kitty. How do you hold the ear when you do it and stop the bleeding or it running down? Also, so when there is that drop of blood do you just hold the meter with the strip so that blood drop falls into the strip? Do you put anything on the ear to clean it before and afterwards? Thanks.
     
  15. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Good questions! Let me try to hit them all:
    • When poking the ear, most of us hold a cotton ball or pad on the opposite side so we have something to push against. I usually just rubbed her ear for a minute, then held it firmly with one hand with the cotton on the other side. If you poke near the vein instead of in it, it usually just lets a drop or 2 of blood out, so it doesn't run down.
    • Yes, you just put the end of the strip in the blood drop and you're good! The strip kind of "sips" up the blood. I suggest trying a test on yourself first...that's how I learned and it really helped me when I did it on her! It'll hurt you some, but it really doesn't hurt them as much, I promise!
    • I used neosporin (gel not cream) with pain relief. That not only helps it heal and hopefully numbs it a bit, it gives the blood something to bead up on, which might help a lot! I also pressed hard on the spot for a few seconds after the poke to help reduce bruising.
    What other questions do you have? Keep asking!
     
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  16. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Yes to everything Rachel said. And I usually poke on the outside of the ear where the hair is shorter, but once in awhile I'll poke the inside edge - usually just if he's had a lot of pokes for one day and I'm looking for a new spot. :cat:
     
  17. C&C

    C&C Member

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    Mar 20, 2018
    Thank you for the information on the testing...New Topic and Questions: Should I also post this somewhere else?

    Below are my questions so please share your experiences, what you have read and anything else you can think of

    1-Anyone experience Prozinc giving a cat Diarrhea?

    2- Anyone experience your cat getting Diarrhea from Fancy Feast Turkey & Giblets Classic wet food?

    3- Anyone experience your cat getting Diarrhea from taking Enalapril which is a heart medication?

    4- Anyone experience your cat getting Diarrhea from taking Furosemide-diuretic which is like a water pill?

    5- Anyone experience or have thoughts about 1-4 above cumulatively and the effect on Diarrhea?

    6- Does the level of insulin effect how much a cat pees?
    a) If the cat is on a diuretic won't they drink more water and pee more due to being on these medications?
    b) If a cat is not totally regulated diabetes wise won't they drink more water anyways?
    c) Will a cat drink more water if their insulin is too high or too low?

    Thank You.
     
  18. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    1-4: no. But my cats haven't taken either of those medicines ever.

    5. I'd need to do a bit of research on those meds (and I'll try to look that up later).

    6. Sort of. It's more how regulated a cat is that affects how much the cat pees. The level of insulin is involved in that, but it depends. Some cats are regulated on 0.5 units...some are regulated on 6 units. But no matter how much the cat is on, regulation will help determine how much they pee.
    a) I believe a diuretic would make them both drink and pee more.
    b) Yes! Most non-regulated cats drink a great deal more. Gypsy used to just lay down next to the water fountain and rest her chin on the edge....she was probably so thirsty she preferred to just hang out there. Broke my heart when I figured out why.
    c) They could, but again, it's probably attached to their regulation, rather than how much insulin they are taking.

    You might post about the specific meds you mentioned in Main Health as well..ask if anyone has experience with them.
     
  19. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    1-Anyone experience Prozinc giving a cat Diarrhea? No - although Sam gets diarrhea when his BG is too high, so I could see how someone might mistakenly connect the insulin to that.

    2- Anyone experience your cat getting Diarrhea from Fancy Feast Turkey & Giblets Classic wet food? No, although if the cat has a sensitivity to any of the ingredients, it's certainly possible

    3- Anyone experience your cat getting Diarrhea from taking Enalapril which is a heart medication? No experience with this

    4- Anyone experience your cat getting Diarrhea from taking Furosemide-diuretic which is like a water pill? No experience with this.

    5- Anyone experience or have thoughts about 1-4 above cumulatively and the effect on Diarrhea? Just curious what these meds are for? I haven't heard of a cat on a water pill before. They are always so dehydrated anyway this seems surprising to me.

    6- Does the level of insulin effect how much a cat pees? I agree with Rachel's responses on the rest of these

    a) If the cat is on a diuretic won't they drink more water and pee more due to being on these medications?
    b) If a cat is not totally regulated diabetes wise won't they drink more water anyways?
    c) Will a cat drink more water if their insulin is too high or too low?

    IBD is a common problem with our diabetic kitties. Many of us give a probiotic daily to bring the liquipoo under control. S. boulardii is recommended here and many of us have had good results with it. It takes a little while to build up and work, but it can really help. If you don't know the cause of the runs, you might give it a try and see if it helps solidfy things. :confused:o_O
     
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  20. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Not sure but I think these can be given if kitty has a heart or blood pressure issue.
     
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