New ProZinc User

Blackie, who is a 10 yo female domestic shorthair, was diagnosed in March with diabetes. We first put her on Glipizide, and that started making her vomit after a few weeks, then we put her on Vetsulin. Found out that was being recalled (according to the vet, the company wasn't making it anymore), and now she's on ProZinc, and has been since May 15 of this year. Vet recommended we put her on the Hill's Prescription W/D dry, and she was on that for some time. She's been through 2 curves at the vet's, and both times, they've increased her dosage. In fact, each time we go there, they have increased her dosage. The last time we were there (June 19th), she was at 8 units BID The time before that was 2 weeks prior to the 19th, and she was at 6 units BID. The vet wanted to jump her dosage 2 units in 1 day! On the 19th, I wanted to switch her to a commercial brand wet food (Fancy Feast Classic), but the vet wanted her on the Hill's Prescripion W/D wet. The vet was all for putting her on wet food only (providing we did that we can leave the dosage at 8 units BID), though, but not onboard with the FF... Yet. I said, "Ok, we'll try this for a week, then we'll try the FF diet, and we'll stay at the 8 units BID." Blackie was fine the rest of Saturday, all day Sunday and then all day Monday. Monday, June 21st, a friend came over and offered to show me how to hometest and brought over a spare meter, etc. Monday, Blackie was fine. Tuesday, she was fine in the a.m., and after 8 units and food, but that afternoon, she hypo-ed. She went down to 21. I panicked, called my friend, and through her, I was able to save my Blackie. That night, I dropped her insulin right to 1, and switched her food to the Fancy Feast Classic wet. The next morning, I called the vet, and told her what had happened. She asked me what the symptoms were, at which point I told her that Blackie was staggering (which was the most noticable symptom that I could see). I gave her the #'s, and told her what I was doing. I asked her what we should do next? There was about a 10 second pause on the phone, and she told me to keep doing what I'm doing, and to bring or fax in the #'s. I'll do that this weekend as it'll give the vet more information as to what's going on with Blackie. I'll ask the lady at the front desk to copy the pages as I need my log book.

I hope to not get another hypo episode like that again. Anyway, and with my friend's help, we're GRADUALLY increasing her insulin levels, not jumping. Had it not been for the spare monitor, I wouldn't have known what to do.

Does anyone else have success with using the ProZinc insulin? I'll be starting her on 1.2 units this evening. I use a I-100 insulin syringe now, and I know that the 1.2 for U-40 is 3.00 for a U-100, as per the conversion chart.

Also, can I prefill syringes with the ProZinc? It was suggested that I could, but I'm reluctant to do so as I'm used to gently mixing it.

How many times should it be gently rolled side to side or top to bottom (hoping that makes sense).

 

Angela....Puttz has been on ProZinc (switched from Vetsulin) for about 6 months now...He is doing great on it! It took about 6 weeks for his body to acclimate to it and adjust, but overall it is a very gentle insulin. I do alot of research and reading on this board and have come to my own conclusions about a.) rolling insulin ( do it gently, no shaking, roll about 6 times back and forth, b.) I never pre-fill syringes, have not heard anyone suggest that it is really a good idea. We are strictly Fancy Feast canned (Gourmet, mostly), no gluten and no greens, and definitley no dry for Sugar Babies...Good luck, there is alot of help on this board, so please ask others and make your own decisions for your SugarKitty.

 

Blackie was put on the ProZinc on May 12th. It's been over 45 days now. I know that this insulin takes time, but I'm wondering if ECID and she's taking longer to adjust to it...?

 

It's about 45 days once you get rid of the dry food, get on the low carb, start home testing, tracking your results and taking the reigns on the dosing from your vet etc. Your SS has about one week of tracking so I'll leave you with this: diabetes is a marathon not a sprint. :smile: Hang in there.

I used ProZinc successfully and was ultimately very happy with it. I switched from PZI Vet. Things could have been quicker for us had I tested more in the beginning - but es la vida. Conversely, you are doing an excellent job with the testing. So, if you are lucky and with the fact that your kitty has already has the "introduction" to ProZinc things might progress faster [hopefully].

 

Thanks, Gator. Considering that she's been diagnosed in March, was on Glipizide for about 2-3 weeks, put on Vetsulin for a short period of time, and then switched to ProZinc, yes, I should have more patience with it. Especially since she was knocked right down to 1 unit BID on June 22nd.

Isn't ProZinc a slow acting insulin?

I hope that things will progress with her. I'll give her 3 BG tests a day for now, unless I see something that'll concern me.

I'm still very new at this, and will be asking a lot of questions as I go along. I'm very reluctant to be changing her doses without the knowledge of others who have been in my shoes. Even when I become more comfortable with this treatment, I know I'll be asking more questions.

 

ProZinc is more like a medium acting insulin. Not as slow as Lantus and Levimir and not as fast has Humulin.

 

Ok. It still has a 12 hour duration...?

 

I stick by what Joanna wrote in the Sticky at the top of this forum here:
viewtopic.php?p=123637#p123637

"Duration, the time until the insulin loses most of its effectiveness and BG values start to rise again, is often between 8 and 10 hours after injection. Read more about Duration on the Pet Diabetes Wiki."

So the duration is until it begins to poop out. Then their BGs will start to rise.

 

I just posted another # on her SS. So far, so good. Thank you for the post. I'll check it out.

 

Yea, the sticky is "mandatory" reading ;-) . So make sure to read that and the links and info in the first post in the Stickey etc. All that info really is valuable in the use of PZI.

 

Hey lady! I was checking your SS and you're doing well. Unless you have a ketone prone kitty, hold the dose at least 2 or 3 cycles (shots) before upping and do it slowly. I know you don't like the reds, but the slow raises in dosage will cause you SO much less trouble over the long haul and most of us have found that a .2 difference is huge for Prozinc. I can't even imagine Blackie on 8 units when 1 is bringing her into the 150's. Remember that her body has dealt with a lot over the past month so the slow method really is the best for him.

The basic rule of thumb is that if you're reducing the dose, do it immediately. If you're raising the dose, do it gradually. You're ketones are negative, which would be the only reason to raise rapidly.

On food - Ari got soft stools on the Friskies, but Classic Chicken Fancy Feast works ok, so check out the food list and find a few different ones and see which her stomach handles. We also mix Wellness with the FF, so you can always mix together some LC wet foods.

You're doing great! Keep it up. She'll be feeling better soon.

Edited because Thursdays must be "Hope Can't Spell" day

 

Wow Hope that is really awesomely succinct advice. I read that and was like ohmygod_smile . That should be documented.

 

Not to quibble with Gator, but our vet told us that Prozinc's duration is 10-14 hours. If your dose is too low, the duration will be on the low end, if your dose is high, it can be longer than 14 hours, at least in my experience. The nadir is usually between 5-8 hours, but we've seen nadirs at 9 hours or later. I consider Prozinc to be a long acting insulin, and I know my vet considers it to be long acting.

ETA: Pet peeve of mine.....sorry, but PZI and Prozinc are not the same thing. There are differences. ;-)

 

Just to throw my 2 cents. Usually the rise back up begins at around +10 but doesn't usually hit a shootable point until +12 which I believe is what Gator is saying. The insulin holds the #'s down, but around +10 is when is starts to wear off. Also, the onset is usually at about +2 so there is some overlap which is where the vet is getting the 14.

Gator - bet I about blew your mind with my non-rambling Glad to see you around. Still smile when I see H's pic next to your name.

ETA - about the onset and overlap. Overlap is a good thing, as long as there's not too much of it.

 

Ok, Gator, I just re-read your post about the 45 days thing, and since Blackie's only been on the low carb, mod protein diet since June 22nd, the 45 days begins from then on, correct? That means, we're still in the trial period...?

Just making sure that I'm getting things correct here, is all.

 

From what I can tell you have only just a week or so of tracking your BG results - that would be the thing I would look to as your "start" point. There is nothing magic about 45 days - BUT it just so happens that, from what I can tell, there have been quite a few who have posted right around 45 days on ProZinc who, for whatever reason [psychosomatic or not], tend to note some sort of improvement/leveling out etc. There is also a study done on the switch from PZI Vet to ProZinc that seems to indicate improvements in about that time frame [though I'm guessing their dosing protocols differ then the typical dosing protocols used for PZI here on this board]. You can read it here:
http://www.vetlearn.com/Media/Publicati ... 2_24_0.pdf

Anyway, I know you are needing results by time X to prove the point with the DH ;-) but just stay lose here and roll with the flow for about a month. Locking your DH in a closet until then is also an option. ;-)

Laurie, I would figure most vets consider it a "long" acting insulin. This is perhaps because that is what the literature used to say or perhaps still says about PZI. But if you look at it relatively to all the insulins being used for kitties currently it is more like the "medium" acting insulin. There is also all this jargon associated with "lente" and "ultra-lente" etc. that I do not feel comfortable enough in the details of to bore you with. But you can read about it in the petdiabates wiki or just google searching too. As to what you vet said about "duration" all I can say to that is ECID but 10-14 was not my experience [but then again I was not testing H a whole lot either where I oculd say anything definitive]. Eventually, I was able to start doing variable dosing with him and it worked so there was less motivation to test the heck out of him. Also you should have your vet read the study from above. Supposedly during the studies the curves were a "mirror image" of the old PZI Vet curves. And there is the study that is available on the ProZinc.us website that I'm pretty sure was used for FDA approval which is another good read. I still need to follow up to see if I can get the data from the FDA, but that is another Topic which I'm not keen to work on currently.

 

This thread has jogged a couple questions about ProZinc that have been in the back of my mind after reading posts here for a while, so it seems like a good time to try to understand better. Do NOT want to stir up big debate here, just trying to clarify things I don't understand. I'll admit I haven't had the patience (or maybe brain-power ;-) ) to really read the ProZinc articles and am hoping y'all can give me the synopsis w/o my having to read it. :lol:

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1) Is ProZinc a PZI? My understanding is that there is a family of insulins called PZI, of which PZI Vet is one, BCP PZI is one, ProZinc is one, Wedgewood PZI also, and there may be others. I've noticed a number of different people distinguish between ProZinc & PZI and this has always confused me. I'm not sure if people mean to distinguish btwn PZI Vet and ProZInc (assuming that when someone mentions PZI what they really mean is PZI Vet?), or if people are saying that ProZinc isn't actually considered a PZI, it's something different?

It's extra confusing b/c I know there is at least one insulin out there (forget what it is though) that calls itself a PZI (it's one of the compounded ones), but actually has another insulin mixed in with it, so isn't truly a 100% PZI insulin.

Since ProZinc is billed as the PZI Vet replacement, I've taken that to mean it's a PZI as well, but I think it's human recombinant rather than porcine or bovine. Am I confused, is it truly not a PZI insulin? Or if it is, maybe we should start using PZIV or something for PZI Vet, so it's clear when someone means PZI in general, vs. the PZI Vet version of it...?

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2) Does the 45-days thing have more to it (from the manufacturer's perspective, leaving out people's experiences with it for the moment) than the fact that the study that was done was a 45 day study, and some variability was found during those 45 days, and cats tended to be more improved on ProZinc by the end of the 45 days than at the beginning? For a while I thought it must be something in the package insert that it is variable for the first 45 days and doesn't really "settle" fully til then, but then when I realized the study was for 45 days, I started to wonder if maybe that is something that has been extrapolated from the study rather than something the manufacturers have stated as a true insulin property? As I understand it, all insulins have some variability and some settling in, so I've been wondering how much it's just that, i.e. same as any insulin, vs. something really specific to ProZinc that it has some delayed adjustment period or something.

I suppose wonkiness in general can't be quantified, but it would be really nice if for newbies we could say "here's what to expect" in some kind of specific way. It seems like sometimes now people just get nervous that the first 45 days are a mystery ride, and then their cat will magically do better after that, which I haven't seen as the case so far (with the caveat that I haven't studied the #s closely with that in mind).

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As far as the sticky, it is meant to be one that universally covers all the insulins used in this forum (to the extent that there is knowledge/interest in any of them). If there are things that I should update to account for ProZinc's characteristics, anyone please PM me, or start a "Suggested sticky revisions" thread or something so we can spiff it up! For those who might be new and don't realize this, we only got the sticky going a few months ago, as more of a starting point that anything else. We hope it helps people - if not, let's revise it so it does!!!!!!

 

The ProZinc, from what I understand, is a human recombinant insulin. Not sure what that means, though.

 

Talk about hijacking a Topic - lol. You know I'm always game for that!

AFAIK, ProZinc IS "PZI." It is a human recombinant insulin with a PZI "base" - just like BCP is bovine insulin with a PZI "base" and is also called "PZI" and the old PZI Vet was porcine and bovine insulin with a PZI "base." Now if Larry were here he would probably take exception to me using the term "base," but you can look up PZI in the petdiabetes wiki and get the exact terminology that I'm probably twisting around and I'm too tired right now to do the research.

No, it IS a PZI insulin.

I don't think 45 days is recommended or mentioned by BIV [the mfr.]. Beyond that I would first read the Field Study and Efficacy Study on the ProZinc website:
http://prozinc.us/document_handler.ashx?document_id=13
Just by glancing at Table 1 and Figure 1 & 2 you can get the flavor. The change in the nadir is what I was initially concerned about. When I switched I had wonky numbers [including nadirs at times other than +7 which was at the start which was H's old usual nadir. I started reading and found the Study. I stuck with it and at about 45-60 days things got back to predictable. For those with tons of time on their hands, going back and reading my first couple posts about my switch might illuminate where I was coming from. But this is delving into people's experience.

Yes, I did extrapolate from the study [not the worthless insert]. I am guilty. I am also guilty of telling Terri and Putz and I think one other at the time to hang in there for 45 days. One thing led to another and it turned out that people's experience was that at about 45 days some people started noticing "improvement." If you remember at the start introduction of ProZinc [and even before that] there was all the crazy hand wringing about it. People getting really worried about the switch and so on and in my opinion getting needlessly worked up about it because in the vacuum of info some mis-info was getting spread [to further certain other insulins]. IMHO there needed to be some reassurance about it and I think there still does need to be reassurance about it. Even just from a sanity point for the newbie bean.

45 days was never meant to be a hard rule. But I think beans should give ANY insulin 45 [and probably 60] days! But after that and things are still not improving, things should absolutely be re-evaluated. If they already haven't, guidance on technique and other potential problems should be sought and addressed if needed. I'd be curious to know what Sarah and Ele would not as their breakthrough point with Lantus??

Yes, my last statement is to this point. I do not think ProZinc has any more delayed settling in period than any other insulin - but my expertise with other insulins is pretty limited.

Yes AFAIK all insulin DO have a settling-in period. Or at least I know that NOW after having taking the switch from PZI Vet to ProZinc for granted. And there are generally other factors than just the kitties little body getting used to the insulin at hand too at work during the "settling-in" "45 days" period: food changes, building technique, learning about trending, learning about dosing "protocols," learning that vets do not know everything, et al. But I think the specific 45 day thing is in part to encourage newbies to be patient, part because the study, part because of people's experience and part because newbies need to be encouraged to be patient during a very stressful period. The newbie bean should be focusing on the tasks at hand: technique, knowledge-base and gaining experience during that time, not stressing over the fact that they did not see improvement today. IMHO, that stress is counterproductive.

I suggest all newbies ABSOLUTELY read the ENTIRE ProZinc.us website that we have already linked to. This especially includes the Field Study and Efficacy Study which give a little bit of a clue - and is where I got my clue from. Most newbies don't do the reading. :YMSIGH: No, it is not a magic ride and it's 45 days of blood, sweat and tears ;-) . But at the end of 45-60 days one should be in a better place to ask if it is the right insulin or is working properly [not sure I'm saying this right].

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I think it's fine and you did a great job. Others may have more input though.

I'm hungry and a bit worn out from fixing a chainsaw today :-x [stupid blasted chainsaw!!]. I could probably do a better more informative job with this. Maybe I'll come back to it later.

 

PZI stands for Protamine Zinc Insulin - so technically ProZinc is also a PZI insulin. From how the terminology is used here - PZI denotes a bovine based insulin and ProZinc denotes a human based insulin. Protamine Zinc is the chemical the insulin is mixed with to make it a slow release insulin.

From the main page info on PZI: http://www.felinediabetes.com/pzi.htm

 

Thanks Kelly. Looking back at what I just wrote, Larry would take issue with me saying "PZI" base, as it is more a PZ [Protamine Zinc] base not a PZI [Protamine Zinc Insulin] base. I think I got jumped for being "misleading" for that at least once.

 

well my insulin is pzi vet idexx... are we all on the same insulin here or what? i mean basically the same? i know they don't make mine anymore but i was comfortable with it years ago and we went otj in under 30 days then so i'm with it now. i only have enough for probably the rest of this year. gator's gonna slap me but if we're still going i may, say may, try levemir or lantus. man, i'll need a part time job to afford all the strips you go thru on that stuff.

brased for the slap gator :mrgreen:

 

Lori,
lol, ya know I'm at that point where I first read you were braised for the slap... I guess that is a totally different thing completely. If cost is the problem I hear BCP can be gotten maybe less expensively than the L's and you would probably have little to no transition problems... Just a thought. Have you read the Sticky lately? ;-) I can attest that the SoCal lifestyle is NOT so friendly to the on-the-dot 12/12. LOL here in Indy the streets roll up at 9p [or earlier] and there ain't nothing worth keeping you occupied to have to miss a shot by a couple hours [or more]. And it's so darn humid, all I want to do is crawl for the A/C. Though that darned chainsaw could have probably gotten me to miss a shot by at least an hour. ;-)

 

no cost is not the problem for sticking with another type of pzi, it's actually more expensive to use lantus and the testing involved is hideous, not to mention the EXACT timing.
the decision would be based on no making very much if any progress here....we are ok, but we've been ok since the beginning. maybe it's asking to much but i'd like to see tom actually get better.
remember our dance gator, 200 every morning 100 every night (or in that range) just one green amps or pmps and i'd have hope.

 

Lori,
Yea, I totally agree. If there is any chance Tomtom could improve and you can take it then go for it. You'll either like it better or not [hopefully better]. Worst case, you can always go back to PZI. The insulin switch thing is a bit of a frustrator [especially when you are a bit head strong like me]. I just became so used to playing fast and lose with PZI Vet [and ultimately ProZinc] and it was always so forgiving of H's limitations and mine [and H's time was limited]. Anyway, as you know, supposedly Levimir is more flexible than Lantus so if that is something you appreciate then...

 

yes gator, i would not be looking forward to that strict schedule. anyway i won't be considering it till january or so. he's really doing well otherwise. frisky and happy amd a total lover boy.
did you hear that the tux cat who was attacking him was trapped, brought to a shelter, vetted and adopted :mrgreen:
i NEVER really wanted to kill him, i really kind of liked him, but i hated him beating up my rough tough tom cat.
wow, talk about hijacking a thread!!! ohmygod_smile

 

Yes, I heard. I was just outside with the most amazing barn cat/"feral" we have here in Indy - "Tuffy." He lived on his own [no food or support out in the barn for 3-4 years before becoming lame and yelling for medical attention at the back door. He must have been someone's kitty at one time. We had him "vetted" and have sort of adopted him. Wish we could have him "vetted" again. He is causing stress for H's half brother who is getting idiopathic cystitis. They are in a male-off contest despite both being neutered now. Tuffy is such an amazing cat - like a dog almost - and smart, smart, smart. Follows us everywhere outside, loves being rubbed on, doesn't bite. I think he will even sit and I might just be dreaming but I think he will also lay down!!! Crazy. But I need to find a cat door that will read RFID chips - was about to post in health about it. The damn coons [raccoons not the Maine Coons] keep getting into his outdoor acceptable "office" - the workshop. I've live trapped 2 coons in the last 4 nights. Ughh! Yep, farm livin' is quite the change. How's that for hijackin'?

Anyone want an awesome cat [that has to be outdoors at least part of the time]? He needs a real home so bad. :YMSIGH:

 

Ooooh, I guess I did do a major hijack though I was so excited about my PZI questions that I didn't even notice! ohmygod_smile So sorry Angela!!!! Though I see that I can spread the guilt around now to a couple others as well. ;-)

Thanks Gator & Kelly, that is all super-helpful and answers my questions, even if some bits went whoooooooosh, right over my head. But that's ok, I really should do my reading and learn a little more. In part I'm hoping my Idexx vial lasts a long time, so I don't have to read that whole ProZ article... it's daunting!!! :lol:

Lori, I wonder too sometimes about trying Lev when the vial does run out. Although I LOVE PZI, since Bix rides low these days, I've idly wondered if something that lets me safely shoot at lower PSs might not be more OTJ-friendly for him. But my vial is pretty new :mrgreen: so I expect to be PZI-ing it for at least another year. One thing I think that might make a switch easier for either Tom or Bix is that their #s are pretty good in general, so maybe not much would be needed in the way of raising the dose, or waiting while there is extended shed filling time. Well, it's just idle speculation for the moment.

Gator, Tuffy sounds AWESOME! :mrgreen: & LOVE the name... too fitting!!!!

 

Joanna,
Moms named him. He is BUILT! He trots like a bull dog. Sooooo cute. His smoker-voice moews would melt anyone's heart.

If YOU give up the PZI Ghost Joanna, yea... not sure if I'll have kind words for that ;-)

 

lol, I forgot to brace myself for the slap! :mrgreen:

 

[quote="Anyone want an awesome cat [that has to be outdoors at least part of the time]? He needs a real home so bad. :YMSIGH:[/quote]

Can't. I have 9 total, and one of them lives outdoors permanently. She was adopted from across the street last summer. Thankfully, she doesn't stray, and is fixed, vetted, and is a very good girl. She was chased off by their cats, and after countless times of putting her back over there, she kept coming back. We finally asked the neighbor if we could adopt her, and they accepted as they knew we'd take care of her. She sometimes bites, seldom hisses, but I think it's because she didn't get much socializing when she was across the street. Otherwise, she's a good girl.

 

gator tuffy sounds like tomtom, he trots like a dog, he is BUILT! my tomtom is all shoulder and muscle with shorter legs, and he does have a smokers meow. and tom is smarter than me.
btw, what the heck you doing in ind. did you move?

 

tom's attitude when strays (boy's) come by is "go ahead...make my day" LOL
that's why it hurt so much to see tux whip his ass. and tux was just over a kitten. i guess tom is getting old :sad:

 

:YMHUG: Lori. Unfortunately, so is our oldest male, Scooter. He just turned 12 this past April. He still acts like a "kitten", though. LOL When he feels like it.

 

tom is 13 and i can see subtle signs of him slowing down. occasionally he does the crazy chasing invisable mice thingy.
you were'nt here when a stray started coming around and i made the mistake of feeding him, an unneutered 1 year old (i'm guessing) and tomtom up until then has NEVER lost a fight but this went on for weeks that this cat came to the house and ripped tom to shreds...blood and everything. i was in rambo mode and wanted to kill the cat myself!

prior to that tom's reputation was 'the girls all loved him and the boys all feared him'
i don't think he's ever recovered is pride. :sad:

 

Lori, please give tom a pet and a kitten *HUGS* from me.

Scooter, unfortunately, likes to try and "play" with the females, but the females don't like it. Bubba, his nephew, is also the same way, and so is Groucho, who is one of the 4 kittens. The females don't like being messed with, and Lord have mercy if they try and play with Blackie (aka Lil Mama). LOL Diabetes or not.. She'll tear a strip into them.

 

Lori,
I'm in Indy visiting family. I kind of got trapped here - did not intend to spend so much time here. But it's been goo and I've been able to fix all sorts of things around here for moms. I did finally fix the chainsaw yesterday! So now I can officially leave lol. Next stop Maryland. Now with no cat and no GF I can kind of set my own schedule - so I'm just kind of drifting...it's nice.