? New member just switched to Prozinc from Humulin N

Cross posting my introduction here for more traffic:

We are Kathy and Tom and Cooper, a 14 year old orange and white big guy who was found with frostbite living under a dumpster in NJ when he was 3 years old. He is a scaredy cat but loves affection from those he trusts. He runs before every test/stick, but lets us do what has to be done after he is caught. While it would be wonderful to get Cooper "off the juice," our goal is simply to resolve his symptoms and keep him stable.

Diagnosed 12/13/16 with symptoms of weigh loss (>2 lbs), ravenous eating and drinking and high glucose value on a pre-dental blood screen. Vet put him on Humulin N, 2 units twice a day, and said, "home testing not necessary." Dosage increased to 3 units twice a day after 3 weeks, based on a high vet curve. After 2 more wks. with no improvement in symptoms and much research we went back to the vet and strongly requested a change to Prozinc. Vet set starting dose of Prozinc at 3U two times a day, which was started on 2/15/17. We had already started home testing on our own and are using human Contour Next EZ meter.

Current dose: Prozinc, 2.4 U-40 units twice a day (7 am, 7 pm)

(Cooper earned a dose reduction a few days ago, based on the Protocol, from 3.0 to 2.5 U-40 units. However, we set the new dose at 2.4 because we are now using U-100 syringes to make measuring easier, and the closest marker is 6 U-100 units, which corresponds to 2.4 U-40 units.)

Current weight: 15 lbs

Diet: FF (low carb) 1/2 can and ProPlan Focus Urinary (low carb) 1/2 can each AM and PM, plus a treat of poached chicken breast or Young Again Zero after BG and shots. Any additional food is noted on SS. We let Cooper (and his brother, Riley) graze, and pull all food two hours before shot time.

We are retired, stressed, and trying very hard to do the right thing by a cat we love dearly. We have the great fortune to have a daughter who has been through this experience with FDMB and her "bouncing" boy, Leo, @@Lisa & Leo on the Lantus ISG. She has helped us do EVERYTHING so far and is sitting here guiding me as I write this. She knows Lantus, but is learning Prozinc along with us. Unfortunately, she lives 3,000 miles away. She will be leaving in three days and will be available for calls, but not always, and has advised us that you folks can provide the wealth of information we need.

We have some questions for Prozinc users:

1. Please look at Cooper's SS and let us know if we are following the protocol correctly.
2. We had to skip two shots and sometimes it looks like he is bouncing. Do you think Cooper was started on too high a dose of Prozinc, which may explain this?
3. Do you have any other comments, suggestions, etc., that might help us get up to speed?
4. Can we expect dosing will stabilize at a certain level, or will we be changing doses "forever?"

We are very grateful that FDMB is available and that we can come to you for help and advice. Thank you.

 

I can't access the spreadsheet. I'm not techie enough to address what you should check though ...

 

With ProZinc there are general guidelines but no specific protocol as per the L insulins. It's very much an ECID ("every cat is different") approach to dosing. These are the general recommendations:

• start at a low dose of 1 u twice a day
• increase in fractions of 0.25 u (or similar if using U100 syringes to dose)
• hold a dose at least 3 cycles before increasing
• set up a consistent testing routine of: 1. AM/PM before feeding and injecting (no food at least 2 hours before these tests) to see if a dose is too high; 2. at least one other test somewhere mid-cycle or before bed to see how low the dose is taking BG.
• dose scheduling can vary from 12/12 by up to one hour with no ill effect
• feed only low carb canned food or very low carb dry like YA.

I'll check your SS when I can access it. You can generally identify bouncing as follows:

• BG numbers stay high on a dose that gave a good drop only a few cycles earlier
• BG is good at nadir but rises to an overly high AM/PM preshot value.

Some kitties will start doing well on a particular dose and that will continue over time with little or no change. However, it's very common for the "good dose" to be a moving target hence the need for a consistent BG testing routine.

It's safe to say that treating feline diabetes is NOT a "set and forget" process.

 

Thanks, Kris! I'm sure she's just got to set the permissions right. I'll work with her in an hour or so when she returns to get the access set properly.

 

Thank you for letting me know. I think it is fixed now. Let me know if you can see it. Kathy

 

Yes, I can see it now. I see why you lowered the dose from 3 u after those low greens. The U100 syringes give you a lot of dose options between 2 u and 3 u. Cooper might turn out to be a kitty that responds to tiny dose changes. Early days though.

The 2.4 u gave you a nice nadir last night but I see you had to stall this AM because of a low PS. The pink mid day today is a bounce from those blues. Let's see what the PMPS is. If you keep getting a too low to shoot without stalling PS you might have to lower the dose a bit. The goal is two shootable pre shot numbers. More data will tell the tale.

Congrats on already having a good testing routine in place.

 

Hi there! Yep, looking at your SS, I think it's likely you were started on too high of a dose. It seems to be lasting quite awhile some cycles and also causing those low numbers you got. As Kris said, the goal is 2 shootable preshots, so you might end up needing to lower the dose again.

Let' see...for other suggestions, have you read our Beginner's Guide? It's specific to Prozinc. And you mentioned our protocol, which is the other reading we advise for new folks.

Dosing could stabilize over time. It's hard to tell. Really, since Prozinc is dosed based on preshot and nadir, the dose can change. Some cats have a sliding scale...that's something that we come up with over time if needed. Prozinc is an in and out insulin, unlike Lantus, which means we can change the dose each cycle if needed. However, we usually start with just upping the dose gradually and methodically if needed...for now, since your dose probably needs to go down sone, I wouldn't worry about it.

What other questions can we answer for you?

 

PMPS = 267. We are shooting a falling number so we will check at around +4 and maybe he will earn a reduction tonight. But, we shot the full 2.4 units. Thanks!

 

Rachel, thank you for your advice. We are studying the protocols. Hopefully, they will soon make complete sense. Until then, we are so grateful for everyone's help.

 

It takes several read throughs usually...and sometimes it even takes reading them and then taking a break and coming back and trying again! Let us know what questions you have on the protocols and we'll be happy to clarify.

 

My Goof was diagnosed (BG of 652) just over 2 years ago, he's still doing well. I don't like to give dosing advice, but, this is what worked for us:

Beginning dose was 1 unit every 12 hours. Vet said it would take about 3 days for his body to "learn to work" with that dose. For us, the dosing would only change after 3 full cycles, (72 hours). I should say here, UNLESS the BG was too low.

He's recently gone as high as 5u, but currently 4u, the vet suspects Acromegaly, but the test is expensive and a yes or no wouldn't change anything at this point, so we'd rather spend the money on his insulin.

He gets only canned food, Friskies, Anything under 10 carbs, but mostly 7-8 carbs.

He went into remission after about 6-7 months, and strayed there for about 6 months until a bad tooth and a UTI brought him out. We were never blessed enough to achieve it again.

Wishing you good luck with your boy!

 

@K T and Cooper and I have another question about the protocol and our shooting dilemma this morning. We've found a couple different stickies describing it.

AMPS 188

Two questions:

1) One sticky says, "Every dose held for at least 3 cycles, unless BG goes too low, then reduce dose" but it doesn't say how big the reduction should be. Should a reduction be 0.25U or 0.5U?

2) We now suspect his starting dose was too high, and perhaps he should have another reduction to stop the bouncing. We see this note, and think this might apply to our current situation.

If one preshot is above 200 and shootable, and one preshot is too low to shoot, it probably means the dose is a little too high and lasting more than the usual 12 hours. Try reducing by at least .25 to see if you get two shootable preshot numbers (ideal) rather than one that is too high and one that is too low to shoot (not ideal)​

We are wondering if he should just take a 0.25U reduction now rather than making him earn one by going below 50.

Thanks!

 

The recommended reduction is 0.25 u. If using a U100 syringe to dose, that could be 0.2 read directly or 0.3 eyeballed;

I would try a reduction now. The guidelines for ProZinc are very general so there's no actual concept of "earning a reduction" as there is with the Lantus protocol. You look at the SS and make a decision that is specific to your cat at that point in time. This individual approach to dosing takes a bit of getting accustomed and it can feel as though you're flailing around with nothing to guide you. Your SS data is the guide and questions can also be posted here. Many people say that one reason they like the L insulins is that there are "rules" for dosing. Not so with ProZinc - just those general guidelines and a well developed feel for your kitty's responses.

 

Thanks, Kris.

+0.5 192

We did a reduction from 2.4u to 2.0u. If we had confidence that he was at the right starting dose, we would have only reduced 0.25u, but we'd like to get him to 2 shootable numbers more quickly in case we are still at too-high a dose. I also let them shoot technically before 200 because his past behavior shows he'll be heading up shortly and his ears are a little sore. We'll get a +4 anyway.

Thank you for the explanation on the differences in protocol. Yes, TR was very rigid and required a lot of late-night dredges through the green lagoon. I didn't sleep much for a while! I am glad there is more flexibility with Prozinc so mom and dad can pull back on the dose more easily if they are not comfortable shooting. I am only out here for a couple more days, so we are doing a lot of crash-course learning while I am here!

 

Yes, after making the switch from ProZinc to Lantus I'm learning that there are long periods when close monitoring is needed and things happen slowly for the most part. I'm officially doing TR but Teasel is so tricky that I'll have to bend the rules a bit as I go along in what I call my own version of TR - "Teasel Regulation".

 

I am smiling at your response. I have the protocols printed and sitting here. And I can so relate to the "coming back and trying again." Thanks, Rachel.

 

Whew! Those greens were a bit close for comfort! It'll be interesting to see what the PMPS is. It's possible that 2 u is too much.

 

Phew! Yeah, it's definitely looking like still too much insulin. It's hard to know how much to go down...but you're handling it well!

 

@K T and Cooper tested PMPS 190. Since he's come up quite a bit since the 74 at +7.5, we are going to go ahead and shoot the 2u. Since the greens were expected and the result of recovering from that bounce, we'll see what tonight holds. I hate to advise them to give Cooper another reduction so quickly when these greens were kind of expected. Maybe that's the Lantus-brain in me, but I hated when Leo would earn a second reduction a day later from the bounce off the first reduction!

But, we do agree that it is very possible he is still at too-high a dose, and will look for the evidence to change the dose.

Thanks!

 

ProZinc requires that you respond to the immediate numbers and not what happened a few days back or what might happen a few days ahead because there's no depot in action. There's really no such thing as a "failed reduction" because this insulin is very much "in the moment". If a nadir is too low, a slight dose reduction is in order. If there's a pattern of one PS being too low, a dose reduction is in order. It's even possible to do sliding scale dosing once you have enough data on your SS. It's extremely flexible in many ways and because it's an in-and-out insulin, every day is a new day.

 

@Kris & Teasel - thanks for the explanation. I know they are concerned about the possibility of having to choose a different dose every cycle. Hopefully he'll settle into some more normal cycles soon. Sometimes "extremely flexible" is more challenging!

On a different note, if they have more questions or an emergency, should they post in the Main forum or in Prozinc? I see people posting in both, and not sure where to advise them to post going forward.

 

In an urgent situation, post in the Main Health forum.

BTW - they won't necessarily have to choose a different dose every cycle. It depends on the predictability of the kitty and the BG situation. I'm sorry if I created that impression. Yes, there's a lot more flexibility with ProZinc and the dosing decisions require a fair bit of judgment on the part of the human but we all learned how to do it and there's always help available. The ProZinc group is small but there are owners of very tricky kitties on it who have become dosing maestros.

One benefit for your parents, I think, is that it's easier to avoid getting caught in a long monitoring situation because the ProZinc dose is gone after 12 hours. You can make a different dosing decision the next cycle.

 

"Long monitoring situation" ... do you mean the situation of having to surf a cycle because of lower values like yesterday afternoon?

AMPS 390 - Cooper is enjoying a nice bounce this morning from those greens yesterday! Based on your advice so far, we will hope for a nice shootable number tonight, and if his PMPS is lower we'll consider a lower dose. Thanks!

 

Re "long monitoring situation" - I was thinking more about the Lantus type where you've been brave and shot a low PS and you have to monitor several hours to make sure that kitty will surf and not fall. The ideal BG curve for a ProZinc cycle is a "smile" shape where (theoretically) the time spent at/near nadir values is limited. Lantus, with its ability to produce a very flat curve, can create situations were you're in nail-biting numbers longer.

It's very early days in your parents' experience with ProZinc. I think they'll come to appreciate its flexibility. If my kitty was more predictable and less bouncy I would have stuck with it.

 

Ahh, gotcha. Agreed. I shot a lot of BGs in the 60's and 70's, knowing I wasn't going anywhere soon. Sooooo glad that is over!

I hope so. We had a long conversation today where we went over the entire spreadsheet playing Monday Morning Quarterback on what we SHOULD have done, knowing what we know now about dropping the dose for just one cycle to get shootable numbers. We see how not doing that created several 24-hour cycles rather than 12 hour "smilie" faces. We understand that after the first few days, he started liking this insulin and needed a lower dose. I think we see where it will settle things out more easily, and give them more confidence that they can still shoot a number but not be forced to shoot a particular dose. Thank you for your help and explanations!