? New to this, this is what I've been told.

I inherited a large Tuxedo cat named Wilson from my cousin who kinda dumped him at my Uncle's. He's a BIG cat, over 23 in long without the tail and 15+in tall at the back, filling the scale at about 20lbs, with the longest legs I've ever seem on a cat.
He never answered to his name so I started calling him Bubba and he likes it, responds to it, and looks like one too.
I already had a cat Kittybutt and wasn't thinking of another, but oh well...
They are the best of friends finding each other in their later years Kittybutt is 12, Bubba is 15.
I noticed Bubba was losing weight and the Vet said Diabetes.

I was told that there are 3 types of insulin, in price and remission possibility.
Bubba is now on #2 Protamine Zinc 40 u/ml (human orig.) 5 ml bottle from RoadRunner Pharmacy at $69 delivered.
I was also told, by the Vet, that even though the bottle says "good for 28 days" in cats it is safe to use for 3 months, If it lasts...

Am I on the right path?

1 injection so far, what should I look for, good or bad?
Thank you everyone for your help...

 

Welcome! Thank you for taking Bubba in and loving him! The price on the ProZinc is REALLY good, I might have to check that out, I currently pay $90. I've used it for 3 months without any problems. BUT, you have to make sure you handle it properly to extend the life. Are you home testing? That's important. If your vet won't explain things thoroughly, ask lots of questions on this forum.

 

you have found your guardian angels here! I had my Charlie on ProZinc and I wished I'd gotten it from wherever you got yours because I paid double what you did! Make sure you get him onto a really nice low-carb diet; there are a ton of options, some spendy, some not. Check his sugar before you feed him; if it's over 200, shoot. then watch him and test every 1-2 hours to see what it does. Some animals, like mine, react violently to the first dose and he bloody well near went hypo on me. This site has some real geniuses in answering questions on when, and how much, to shoot. Make sure you hear from @BJM. I frequently suspect she's a vet and just hiding it well.

 

Nope, I'm not a vet; I'm an epidemiologist.

That isn't ProZinc, its PZI. It is a compounded insulin; these may vary a little in potency from batch to batch. Always roll before using to re-suspend the mixture. BCP PZI is another one folks here have used.

A shot should last roughly 12 hours from shot to shot. Home glucose testing will show you how it works in Bubba.
Home testing is important to keep him safe as vets make an educated guess on dose based on what information they get at the office visit and from tests. If you change the food, home testing lets you see how that affects the glucose levels so you can adjust as needed. Pick up an inexpensive glucometer such as the Target Up and Up or WalMart ReliOn Confirm or Confirm Micro (a branded version of the Arkray USA Glucocard 01 or 01 Mini), matching test strips, and lancets for alternate site testing (25-28 gauge). See my signature link Glucometer Notes for feline specific reference ranges and possible interpretation of results.

There are some other assessments to help you evaluate your cat in my signature link Secondary Monitoring Tools. Some of these are the questions your vet likely asks when you go in for regular appointments - how is the eating, drinking, etc.

As far as food goes, pop over to Cat Info and read what Dr Pierson has to say, plus download the food chart to guide your purchases. You'll want less than 10% calories from carbohydrate for routine meals, plus a few cans of high carb gravied foods in case Bubba ever runs too low.

And speaking of low - here's our guide to identifying and managing low glucose, aka hypoglycemia.

 

Oh boy, this is really starting to look like more then I'm capable of, and I'm lost.
Am I using the best choice of insulin?
Which is better this Bovine stuff or what I have?
Do both types (Bovine and Human) require the same testing?
I saw that the Bovine is one injection only...
The vet said nothing about testing. Just 2units 12 hours apart, keep some karo syrup around and that'll be $300...
I do not have a test kit and I read the "glucose reference numbers for Cats, ha read, more like looking at a foreign language, maybe I'm dumb but I comprehended very little of it.
Then the food thing, Bubba has never been a wet food eater, I have to practically follow him with the bowl to get him to finish it. I don't think I'll ever be able to get him to eat like 2 or 3 meals he's a grazer, has been for all of his 4 with me and 10 years before me. I'm starting to wonder what would be better for him, the seeming yoyo of insulin or let him go...
Oh man this aches my heart...

 

Hi!

OK, the first thing you need to do is take a deep breath...and then a couple more for good measure!

You CAN do this. We've all been where you are now - lost, confused and not sure whether anything we're doing is right. The PZI insulin you have is fine for now. If you find, further down the line, that it doesn't work for Bubba then you have the option of changing it. That's a possibility for any cat and any insulin - some cats react better to one insulin than another but what you will want to do is give the PZI a fair trial before you decide whether or not to stick with it. All the insulins we use for cats (unless your cat has a very unusual reaction to an insulin and it lasts longer in their system) are at 2 shots a day roughly 12 hours apart.

I'm sure you're looking at a lot of people's spreadsheets here (and mine's one of them too so please don't be put off by looking at it - I chose a Tight Regulation path with Rosa) and seeing loads of tests being done and wondering whether you can do that - or even if you want to do that much testing. But you don't have to test as much as some of us do. Quite a lot of us have our cats on a Tight Regulation protocol using Lantus or Levemir - because we're regulating our cats all the way down to the lower end of the "normal" zone for numbers there are times when we have to test that much. But that doesn't mean that everyone is forced down that path - you have choices about how to manage this.

We do recommend home testing to make sure that Bubba doesn't finish up having a hypo episode. However, you don't need to test all that many times in the day - before each shot and an extra test around the lowest point on each cycle are sufficient most days (or a before bed test at night if mid-cycle is too late for you). You can use one of the reasonably priced human glucometers - ReliOn (from Walmart), Bayer etc are all fine. We do have a link to a testing "how to" and tips and all of us here would be more than happy to help you get to grips with home testing. Most cats don't have a problem with it and once they learn to associate test time with a treat, a lot of cats will actively come to be tested because they know they'll get a treat afterwards.

I'll try and give you some main pointers on glucose numbers while keeping it straightforward (this whole thing is confusing and overwhelming enough as it is without adding more confusion to the mix). A cat's normal range of numbers is between around 40 and 120 on a glucose meter. When a cat is on insulin, we don't want them going as low as 40 - if a cat goes under 50 we would treat that as a potential hypo and give high carb food or a little karo or honey to boost their numbers. The reason for that is that although a cat that is not on insulin can handle the lows by itself, with a cat that has been given insulin, the insulin is fighting the cat's own safety mechanism for bringing the numbers back up...and the insulin can win that fight.

Beyond that, it depends on what your goals are for Bubba. If you're looking for remission, then you're really aiming to keep his numbers within that normal range for as much of the time as possible (normal numbers allow his pancreas to heal). However, I should point out that not all cats will reach remission no matter how tightly controlled their glucose levels are - some cats will need insulin for life. If you're looking to give him a good quality of life and aren't actively seeking him going into remission, then you can keep him under the renal threshold so his internal organs aren't being damaged, though at that level remission is unlikely (but nothing is impossible). That would mean keeping his numbers under around 220 for as much of the time as possible (the renal threshold is not, unfortunately, a fixed number - it varies from cat to cat).

The reason we like to have people home test is that we wouldn't recommend you giving insulin if Bubba's pre-shot reading is under 200. This is to avoid him being dropped too low by giving insulin when his numbers aren't high enough for his body to cope with it.

You will see that many of us have switched our cats to wet food. However, there are options. If Bubba is a confirmed dry food addict and really won't eat the wet food, you could try him with Young Again Zero Carb dry food. There is another option for dry food that is also low carb - I believe that one is Evo. That way you are taking the overload of carbs out of his diet. A lot of us prefer wet food because diabetic cats tend to be dehydrated and the wet food of course increases their fluid intake. But he has to eat something - in the end it may come down to whatever he will eat - but using one of the lower carb dry foods might make life easier for him (and for you) than having to chase him around the house with a bowl of wet food that he doesn't want to eat.

 

The reference ranges April gave you are for using a human meter to test a cat's blood.
There are several measurement options in meters:

human meters in the US (mg/dL),
pet meters in the US (AlphaTrak and iPet, mg/dL), and
human meters outside the US (mmol/L).​

Most of us use human meters because the pet meters are crazy expensive, with test strips costing $1 or more per strip in the US. Testing just 3 times a day is about $90 a month using a pet meter. Using a human meter can be 30-40 percent of that.

 

Bubba is 15 (at least) years old, I'm his second owner. He's been a fighter all his life, enlarged heart, moved around a bunch.
Is BZI (Bovine) a better choice for him, taking remission kinda off the table.
Would he then need to be tested less, if at all, making his (and my) life easier, not having to watch for a remission.
Is there a shortage of BZI? Does anyone administer it to their cat right now and what does it cost?
So you say even BZI is still two injections per day? It's quality of life for this old gentle giant of a cat.
He is now eating Purina DM Moist and Dry.
I don't even have a way to test and no walmart's near me.
Should I stop injecting him till I get a glucose reader?

 

The best insulin is the one that works in your cat....there's no one "best" insulin, just "better" ones that work better in cats. The BZI you have is one of those

We don't test to get them into remission...we test to keep them safe from going into a hypoglycemic crisis (too low) that can cause seizures, blindness, deafness, neurological issues and death. No matter what insulin you use, you'll want to learn to test. Believe it or not, it's really easy and doesn't hurt your kitty at all...and the relationship we form with our sugarcats is the most amazing thing. We can give you all kinds of tips on testing. Do you have a Target store nearby? The have a good, cheap meter called the Up & Up. Otherwise, you can get the exact same meter a lot of us use (the Relion Confirm or Micro) from ADW....it's just called something different. Arkray is the manufacturer of the Relion meters...WalMart just rebrands them. Here's the link to the Arkray Glucocard01

I don't know of a shortage, but there are limited places you can get it. It's about the same price as the other insulins that are good for cats

Yes, all the insulins are twice a day dosing, but the needles are very tiny and sharp and most cats don't even notice they're getting their shots!

There are better (and much cheaper) foods you can feed.....Here's our Full Food Chart that shows the carb percentages for most foods (you're looking for under 10% carbs) What most of us feed is plain Friskies pate's or Fancy Feast Classics, but again, if your cat absolutely won't transition to low carb canned food, the only low carb options are the Young Again Zero Carb and the Evo Kitten & Cat

It's important to lower the amount of carbs he's eating or it's like trying to put out a fire by pouring gasoline on it. Low carb foods are the key to keeping them in the best possible numbers, whether you're trying for remission or just wanting to keep him as healthy as possible for the time he has left to give you.

This is an individual decision....It can be dangerous to give a powerful hormone like insulin without testing though. High numbers take time to do their damage....Low numbers kill quickly

One more thing for you to consider on insulin...the BZI (and ProZinc) are U40 insulins, so there are 40 units per mililiter (so a 5ml bottle would have 200 units) The human insulins like Lantus and Levemir can be bought from a human pharmacy and are U100 insulins, so a 10ml vial may cost more to begin with, but it also gives you 1000 units. A lot of us are buying our Lantus from a pharmacy in Canada because it's 1/3 the price it is here in the US

 

Actually, check your vial. Compounded insulins can be made in different strengths, typically from U-40 (40 units per mL) to U-100 (100 units per mL). You need to be sure which concentration you have.

 

How long is the shelf life? that is 5x the units.
The one I purchased are U-40 (40u) and he's prescribed 2units 2x daily, heck at 1000 units that's 250 days.
I don't think that math works with a 2 maybe 3 month shelf life??

 

Shelf life, refrigerated, may be up to 6 months; home testing will show you if the effectiveness is waning.

What do you mean "that is 5x the units"?

 

The Insulin I have is not BZI it is Protamine Zinc 40 u/ml (human) 5ml bottle, I just wondered if BZI is better because it is described as a closer match to Feline Insulin then Human is. Plus I was told remission happens very little with BZI. If he is only getting 2 units 2x per day, a u100 unit bottle is 5 times the dosage and would last five times longer how can it have a shelf life (once opened) of 5 months?? That math does not seem to work...

 

a 40u/ml bottle compared to a 100u/ml bottle...

"the BZI (and ProZinc) are U40 insulins, so there are 40 units per mililiter (so a 5ml bottle would have 200 units) The human insulins like Lantus and Levemir can be bought from a human pharmacy and are U100 insulins, so a 10ml vial may cost more to begin with, but it also gives you 1000 units"
6 month shelf life?
Really when the bottle says 28 days?? again AFTER opening for the 28 days...

I am getting more and more confused...

 

I wrote PZI, which is protamine zinc insulin.
You appear to have a U-40 concentration, which is 40 units per mL. With 5 mL vial, that is a total of 200 units. At 4 units per day, that will last 50 days.
Refrigeration of the insulin can extend its life; some folks have gotten up to 6 months with Lantus, although it was only tested for up to 1 month when applying to the FDA.

 

With Lantus, there's also something called the Lantus Solostar Pen....each "pen" is like a 3ml vial (so 300 units per pen) and it comes in a box of 5 pens (that's a total of 1500 units). At a total of 4 units a day, a box of 5 pens would last you 300 days.....and the pens last until the expiration date on the box (usually 2 years)

The vials are 10ml (so 1000 units) but the problem with the vials is that a lot of times, unless your cat is on a pretty high dose, you end up throwing away some of it. Yes, it can last for up to 6 months if handled properly but most of our kitties aren't on high enough doses to use 1000 units before it does go bad, so the pens are the better choice.

If you're getting 5ml bottles of ProZinc for $69, that's .345 cents per unit
Lantus (if you buy the pens from Canada) is .0966 cents per unit (In the US, it's more like .30 cents per unit for the pens)

 

It is PZI, not Prozinc. It is compounded by the pharmacy he is using.

 

BCP, the people who compound BCP PZI (bovine) say it is good for 6 months after you get it.

 

Ok it's been an interesting first week.
What pharmacy in Canada are people using?
Remember I have NOT been using Prozinc ( I use Protamine Zinc Insulin 40 u/ml (human) 5ml bottle), but those Lantus Solostar pens sound interesting.
Does anyone out there use the pens?
Do they need to be refrigerated before or after opening?
Could the change be made to a different insulin, without any harm?
It's been 1 week on insulin and Bubba seems to tolerate it well, still early though. I'm just getting everything tuned in with food amounts and timing...

 

"BCP, the people who compound BCP PZI (bovine) say it is good for 6 months after you get it"
Yeah but I also noticed that the web page has not been updated since 2007, so hmmm

 

Just what else is written on the vial?
BCP PZI use bovine (from cattle) insulin

 

A lot of people here use Mark's Marine in Canada - their prices for Lantus seem to be the best available at the moment.
Again, a lot of people use the Lantus pens because they can often use up the whole pen before it loses effectiveness - unless a cat is high-dose, it's much less likely that you'll be able to use up a whole vial. However, you really need to use the pen as a vial and use separate syringes to draw up doses because the pen can only dose in whole units which isn't suitable for most cats all of the time.
You do need to refrigerate Lantus both before and after opening. Then pens say not to refrigerate once they're open but that's because the pen mechanism is likely not to work properly after refrigeration. Because we don't use the pen needles for cats, you get better longevity from the Lantus if you keep the opened pens refrigerated too.
You can certainly change insulins if your vet agrees to prescribe Lantus. Every cat is different and some cats have a better result from one insulin than from the others. Unfortunately there's really no way to tell without trying if Bubba would do better on Lantus than on PZI.

I'm glad to hear that Bubba seems to be tolerating his new routine and the insulin well.

 

Sorry Larry, I'm not sure what your question is, as I said above Protamine Zinc Insulin 40 u/ml (human Orig.) 5ml bottle is what I am using for the first time now.
It says on the bottle discard after 28days, but that is FDA for people, which is what the insulin is really intended for.


But because 5ml = 200 units, now that includes the serum but that IS included with your draw of insulin. So that is 50 days if it remains viable...
If my math has not failed me (and it has before) each unit will, well should, have 1 u of insulin (40 u/ml = 200 u/5ml (40 x5)) A vial with 100 u/ml would be 500 u/5ml so a 2 unit injection with 40 u would be less then 1 unit with the 100 u/ml...
Ow, my head hurts...

 

Thank You for this wonderful information...

 

Is that all the label says? Is there a manufacturer/compounder listed? It sounds like it is a compounded insulin using human R insulin. It should like it should work just like ProZinc insulin since ProZinc insulin is a U40 Protamine Zinc Insulin made using human insulin.

 

Thank you @manxcat419 ...I am still having my days of head scratching, in spite of doing this for a few weeks now and, reading your response here has also helped reaffirm things for me as well.

 

We use the Lantus SoloStar pens. We also find it very convenient to use the pen as the injector (no syringes but you have to purchase the needle tips that screw onto the top of the pen). We use the pen directly from the fridge, screw on the needle injector, dial up the units on the dial (it measures it for you and therefore, you don't get bubbles or have to worry about putting your glasses on and pulling back etc.. You just push the button on the end, count to about 5 or 6 then withdraw. ***It will only work for you if you are using whole units. If you have to go to half units or anything in between, you can use syringes in the pen like you would a vial.****

Ironically, I spoke to the pharmacist this weekend about how long to keep using an open pen (it comes with 5 pens).
He said that keeping it in the refrigerator (all vets keep their bottles in the fridge), it should technically last until the expiration date on the box BUT...you may want to change it in 3 months. As someone else has said, your cat's numbers will tell you when it's time to change or, you just might want to play it safe and change it if you feel that you're getting to the lower amounts in the pen. Of course, if it becomes cloudy or the seal leaks or anything like that...you'll want to change it anyway.
He also said that what's written in the pamphlet that comes with it (about being more painful when from the fridge etc.) is meant for HUMAN usage whereby most humans will require much higher dosages than our cats will and that *can* become painful IN A HUMAN. Our cats at 1, 2, 3 or even up to 5 units...it's not so much of an issue.
Apparently, (our vet confirmed this too) a cat's skin is different than a human's skin so, they don't have quite the same amount of sensitivity that humans do.

And, for good measure....because I'm not a full believer without knowing for sure, myself....I took one of those tiny needles (not injecting anything of course and not attaching the pen) and stuck myself 3 or 4 times with it. Even knowing that I was doing it...I felt virtually nothing! Made Hubby want to vomit though, watching me do it!

So, the choice is yours but, I would say that having done comparisons, the Lantus Pens are the best bet and...you stand a chance of remission! Any human pharmacy will carry it or...you can order it through some of the suggested online pharmacies from members in here who order from Canada (I'm in Canada so, I'm lucky that way...but, not so lucky with food choices...can't get Evo kibble or Young Again up here and my cat is a kibble addict so, working hard to get her onto canned foods still)

Hope that helps? Ask more questions. I am also still learning and every question asked gives me more knowledge too!

 

Have you tried grinding up the kibble into a crumble and mixing in with the canned?

 

Welcome @BubbaBobBob,
Yes, it's all overwhelming at first! Everyone here remembers that feeling. There is so much great information on this forum - I learned a lot just by reading other posts in the Health and Welcome forums here. It will get easier and the numbers and all the jargon will start to make sense. One thing I didn't see mentioned in this post yet is that it's best not to make drastic changes in Bubba's food until you learn to home test. That's because switching him to a lower carb diet can have a significant effect on his insulin needs. If you haven't done already, take a look at @BJM's signature links for glucometer info and secondary monitoring tools.

I also found using the spreadsheet (instructions on how to set it up are in the tech forum) very helpful in terms of learning what the numbers really mean. If you can get a spreadsheet going and add some details to your signature (like type of insulin, which glucometer you end up using, food, etc.), that will help others here to give you the best advice.

Since you already have the PZI insulin, you could give that a go first and then switch to a different type if need be. You can do this! Bubba is a lucky boy. So glad he and Kittybutt are such good friends.

best,
Joan

 

P.S. I forgot to mention also that a lot of vets tend to push prescription foods, do not tell us about hometesting and if we ask, tell us we must use a pet glucometer. As I'm sure you've seen here already, most of us don't follow any of those 'rules'. I've learned so much more about feline diabetes here than I have from my vet.

 

Yes, thank you BJM...I have tried that but, I think it's a "texture" thing with her for some reason. She has never liked anything "goopy" to "lap up". She likes that "crunch". I sometimes call her "Captain Crunch" out of desperation. Another member in here and I have tried "baking" canned food low in carbs. What a mess and she wouldn't even look at it, even sprinkled/tossed with FortiFlora (something she loves on top of what canned foods she'll eat). I think she loves the taste of the canned food more than the kibble taste especially, with FortiFlora (the dog version and very little of it) sprinkled on it/mixed in BUT...it's that "texture" thing. I've tried chunks and even slicing the pates. No go.

I HATE giving her the m/d as I don't see much good in it nor, is it that low in carbs but, I keep plodding along, waiting her out and giving her only the canned foods recommended. I got into serious trouble with her after waiting her out for 2 days. She stopped urinating and having bowel movements. I had to call the vet who told me to just give her back her kibble and try more slowly with the canned foods. I did and it took nearly a full day before she came around again. I won't be trying that ever again!

It reminds me of my daughter when I started her on "toddler foods" where there was whole and the soupy type of consistency (home made or jarred). I had to keep things separate or she'd gag and not eat. I swear Morrigan is the feline version of my daughter in every way, including the feisty natures! And, guess who named Morrigan? (Morrigan means a Celtic Warrior Goddess....named aptly, I might add).

But, you know what? I'm going to try it again. It's been a few weeks since I've done that. It's worth a try again now. Thank you for raising that possibility again!

 

If you're in the US, check out Evo Cat and Kitten dry Turkey formula and Young Again 0 Carb (5% calories from carbohydrate as we calculate it) as an easier starting compromise on the path to wet food.

 

Yes, another fellow Canadian friend on this forum and I have been trying to get the EVO and Young Again up here but, Canadian authorities aren't allowing them to come up...or...the companies don't want to fight the red tape to get it up here and get distributors to sell it. They're not even sure that they can get it across the border if we ordered it due to Canada's FDA (our version of it anyways) rules and regulations. So, we're kind of behind the 8 ball up here with that. I was even thinking on driving across the border to get a whack of it and bring it back but...not sure if Customs would allow it through without trying to hide it all. We both think that Hills, Purina and Royal Canin have some sort of pact/monopoly up here so that we're forced to buy prescription crap foods from the vets???

I still might try going across border for the day and see if I can bring some back.

 

Maybe add Canada to your signature. I'm having trouble remember who lives where!