Made the change to Prozinc, need advice

Hi All,

We recently switched Nana to Prozinc from Vetsulin. She was responding well to Vetsulin for about a month, but then the same dose did not work anymore. Also, it was wearing off to fast.

I have no clue what could have changed. When we 1st started dosing her, 2 separate Vets told me to inject just once a day. I found a new Vet who said we should be dosing twice a day.

The new Vet prescribed Prozinc, but her numbers are not dropping like they used. Can someone help me with dosing? I think she needs at at least 3 units.

Her sheet is up to date.

Thanks!

 

Hi. It is usually best to hold a dose for at least three cycles, and with some cats, longer is better. So, my recommendation for you at this point would be to hold the 2.5 for a few cycles to give her a chance to adjust so you can see the true impact of that dose. Then, do an increase if it still appears to be needed. Really, she has not yet had a chance to be on any dose consistently with the first vets having you give her only one dose a day, then you going to twice a day dosing but different amounts at AM and PM most of the time. Even since starting ProZinc, it looks like no dose has been held for as long as three cycles, and the second day, there was a different dose given for AM and PM. Consistency in dosing can really have an impact, so again, I would recommend staying with 2.5 (AM and PM) for a few cycles. Then, when you increase, I would hold each dose at least three cycles before increasing further... the exception being if she starts going too low and you need to reduce for safety. It looks like you are doing a great job of testing, so you will have a lot of good data to help you make dosing decisions going forward. I hope ProZinc works out for her!

 

I'm only a few months into the Prozinc journey, and there are a lot of other people who are a lot smarter about this stuff than I am, but here is my 2 cents...

It looks like the higher numbers started when you started dosing twice a day. I think the big jump in dose when you starting giving her 2 shots per day instead of 1 is maybe too much for her, and you ended up flying right by the perfect dose. What you may be seeing is bouncing caused by her going too low/lower than she's used to at nadir and her body compensating by dumping glucose to bring her back up. If I were you I would dial it back to 1u twice a day and see how that works out, then after 3-4 cycles, if an increase is needed, increase in increments of 0.25u every 3-4 cycles. Hope this helps!

 

Thanks for the reply! So is a cycle every 12 hours?

Also, if you factor the error in the meter (+/- 20%), it seems like after the dose, her reading is a straight line. I tried changing injection sites to see if that made a difference.

If she is bouncing, wouldn't see I low reading then a climb up? I mean, she hasn't dropped down into the 100's since 4/16. The Vet tested her urine on Monday and everything was negative (except glucose).

It's very frustrating considering she was at 250 before insulin therapy. Now she's hovering at 400.

 

Yes, a cycle is 12 hours. I don't know the science behind why too much insulin can sometimes look like too little, but I had this experience with Spot a few months ago. His numbers were getting higher and more out of whack, and the vet wanted me to keep increasing. She thought I was nuts to reduce his dose by half when from her perspective it looked like he needed more, but it ended up working. The clue for me was when I accidentally did a fur shot and his numbers went down instead of up. I think from a safety perspective, assuming ketones are not an issue, you're better off experimenting with too low of a dose than too high, and work your way slowly to the right dose.

 

I agree with @FurBabiesMama that you need to give her time to settle on a consistent dose with no changes AM or PM for a few more days. Try 2.5 u AM and PM for the next two days at least.

 

I wanted to mention that always getting a pre-shot test is important, not only to make sure it is safe to give the dose (once the pre-shot numbers start being much lower which can happen unexpectedly) but also so that you can actually see the impact of the dose. If you get a mid-cycle test but you do not know what the starting level was prior to the shot, you really do not know how much of a drop that shot caused.

 

I have to admit I'm torn. I agree with holding a dose for a couple of days now to give Nana a chance to adjust and settle in, but @SpotsMom makes a good point that the daily dose was essentially doubled moving to two doses/day, and that too much insulin can stick them high and flat.

I think time and testing are the only way to unravel this. If it's too much insulin, every once in awhile, a low number will sneak in and give a hint. Nana hasn't been on Prozinc long enough to see that yet (if it's the case), but it will be something to watch for.

And don't go to 3u yet! She may end up there eventually (or not), but it will be important to do it wisely after a bit more time and data have been collected.

And yes, do make sure you get those PS tests in before the injection so you can see the PS-to-nadir change. It's an important part of analyzing a dose.

 

How is Nana doing?

 

So I decided to dose her 1.25 U for a few days just to make sure I was not giving her to much insulin. Well, that didn't work. So today I increased it to 1.75 U. Let's see how that works for a few cycles. If that doesn't work I will keep increasing by .5 U.

I think she will end up being at 3.5 to 4 units. But time will tell.

As you all know, this is one heck of a journey. I really thought once her BG was 285 (switched to low card food) without insulin that she would be able to go into remission. Now I am struggling to get her into the 100's in order to give her a body a chance to heel itself.

Thank you all for the great advise. Please do let me know if you think I am on the right track.

 

She definitely was doing better at the start with all those pretty blues, so I can understand your disappointment. Sorry the dose reduction didn't work out

I think 1.75u today was probably ok, but from here on out, it may be better to increase in increments of not more than 0.25u every 3-4 cycles. In my experience slower is better because once you get close to the right dose, too much of a jump can cause big time bouncing. Now, seeing her numbers at the lower dose, I agree that you'll probably end up higher than 2.5u but you'll want to get there slowly....

 

So at +4 there is no change at 1.75 U. I think it's pretty clear she had better numbers at 2.5 U. I am going back to that I think. I don't want to keep having her at over 300 all day.

 

Also, based all I read about bouncing and looking at her data, I don't think she ever bounced. I don't see a fast drop and high rise. Her number's are just a straight line around 330-390. That's probably just the variance in the meter. The only real drop under 300 was at 2.5 U.

 

Yes, her numbers tell you that she needs a higher dose. You did the experiment for your own peace of mind and it gave you info for the future. That's how this dance is done. Try 4 cycles at 2.5 u and increase to 2.75 u if you don't see a lot more yellow and some blue.

 

I was just giving you advice based on what I would do.. but then, I have a very bouncy kitty who tends to not take to dose changes without a lot of drama. I agree with you that these numbers don't indicate a bounce, but as you get closer to the "right" dose it may become a concern.. or maybe not. Just something to consider. You're doing a great job monitoring her, so I'm sure she'll get there no matter what you decide. I hope you find her right dose soon and can get her in good numbers

 

You're absolutely right about bouncy kitties and their reactions to dose changes. I have to go so very slowly and in tiny steps with my rubber kitty.

 

I really appreciate the advise. I am glad I tested her at the lower dose, if I didn't, it would always be on the back of mind (what if..). So I will proceed with 2.5 U for a few cycles then increase as needed.

Thanks all for the help!!!