Newbie worried about Insulin Change!

Hello! I am new here and looking for some good advice! My cat Garth has been diabetic for 8 years now. He was on PZI to start with (from Lilly), it was discontiued, and he has been on Vestulin for several years now and doing great! Now I have to switch him to BCP PZI Bovine and I am extremely stressed out about it! He has done great for the past several years, on 6 units twice a day. My vet tells me to start him on 1 unit twice a day and see how he responds. I just feel like that isnt enough due to the fact he is on 12 and worry he is going to crash! I only check his urine, as he is so well controlled by his diet and insulin routine. He is happy and healthy now, (besides being overweight) and I am soo scraed to switch him!! And whats the best way to do it???? any help, please, I would be so greatful!! Oh, and he is 12 years old also and the love of my life!

 

Hope came to me on PZI IDEXX and Mishka started out on Humuling U. Hope is now in remission after 4 1/2 yrs. of being diabetic and it may be connected to her Restrictive Cardiomyopathy. It will be 8 years in Sept. for Hope. Mishka I had to switch when they discontinued the Humulins so I put her on the IDEXX also. Now that has been discontinued and when I run out of her supply I will be switching her to BCP PZI. I originally used Lily's PZI on my Patches(GA) and like you, I switched to the Humulins. Vetsulin was on a recall list recently also. I would not hesitate to switch Garth to BCP PZI. Others may suggest a newer insulin called Levemir but I am going to BCP because I am use to the PZI insulin. There is also a new one out called ProZinc, supposedly another PZI.

What food are you feeding Garth because that is a whopping dose of insulin? I agree with your vet about starting over at 1 unit b.i.d. and go from there BUT I would strongly suggest you learn how to hometest. Actually, I am amazed that Garth hasn't crashed at some point with that dose so I wonder if you are feeding him dry food only. Please read some of the recent posts on Health about hypos prevented because of hometesting. It also is probably the major factor in helping to control/regulate the diabetes. If you are feeding dry, consider switching to canned food only. DO NOT continue that size dose if you make a switch in food because then you are asking for trouble. Dry is high carb which raises the numbers up.

Please learn to hometest and do not be afraid to go to BCP PZI. Many on this board over the years have used BCP and continue to use it. I have no hopes of Mishka going into remission after all these years but I am comfortable in knowing I can still use a PZI.

Others with chime in with their opinions also and we can help you with the hometesting. I have never given a shot to one of my diabetics without testing first.

 

Thanks so much for answering!! Well, as far as testing go...we test on urine strips. If his glucose is 1/2 percent or less, we are good to go according to our vet. He has never crashed, felt bad, acted out of the ordinary...sometimes he will drink more water than usual, and he loves to eat, but in 8 years he has been diabetic, we have never had any major issues. The only time we had a problem was when he was first diagnosed and almost lost his vision. He was on insulin for about a year, and we fed him dry food (purina DM) and he always tested high for his glucose. So we then kept him only on the canned DM and he did great...0 glucose so we decided to stop the dry food. Here is the strange thing...and I know this sounds crazy....but when he is ON his insulin, there is 0 glucose in his urine. So I know when there is 0 glucose spilling- I was under the impression that I should back down on the insulin. SO we would back down, and then it would show as 1-2% again...so we would go back up and then there was 0! I feel like there is 0 glucose in his urine because of the insulin...i know, its nonsense. There was a point for about 18 months where he did not need it at all ! Completely stopped. Now he is on Fancy Feast-the flavors from Binkys List...with others as well. He also gets dry food for a snack. We havent stuck 100% by the list because he has been so controlled. Like I said, he has never crashed, been lethargic, anything really out of the ordinary! Hes been so easy and healthy sometimes I forget he has diabetes! I feel like now I need to home test with this new insulin because I just dont know what to expect, and Im scared to do it! I did order a monitor, so thats the first step! confused_cat

 

Getting a 0% on a urine test will not tell you how low Garth might be. I think Garth has a guardian angel watching over him. Here is the link that will take you to all the hometesting info and videos and pics to help you get started. Really, it is a piece of cake to do and it does not hurt the cat. Biggest problem is convincing owners of that and once they get over their fear of doing it and just do it, it will become second nature to do it. Vinnie right now is in remission but he was started on Lantus before I adopted him. Like you, I am scared of having to shoot him if he eventually does need insulin again because I have never used Lantus. I know the Humulins, Lily's old PZI, IDEXX and that is it, so Mishka will go to BCP. If you go to the Insulin Group forums, there is one there for ProZinc and you could read up on that. If Hope ever needs insulin again, I will also put her on the BCP.

viewtopic.php?f=14&t=287 Now is the time to learn before having to switch insulins and glad to know Garth is on mainly canned foods. Welcome to you and Garth cat_pet_icon

 

This is really great info Hope..thanks so much! I will be doing much reading this weekend, and ordered a test kit. My friend is a vet tech, and she has offered to come over and teach me how. It is true that Garth has had an angel watching over him because this Diabetes thing has been a piece of cake for us...there are days I dont even think about it!! Maybe its a wake up call for me to pay more attention. Im teary eyed just thinking about things not going well! I only have a few more doses of Vestulin left and then we are on to the PZI. I am trying not to worry, and reading all of this regarding curves and testing and levels is making me anxious...especially since things have been smooth sailing so far!
BTW I want to post a picture of Garth, am still trying to figure that out Thanks for the warm welcome

 

Two things.......I agree with your vet about starting over at 1 unit b.i.d. in the begining and make sure your vet tech friend knows to test the edge of the ear. There have been those times with vet techs that either do a leg draw or stick the middle of the ear. Edge only and Walmart's Reli-On meter is cheap as are the test strips. There are so many meters but I stick with my One Touch Ultra and I get test strips from Hocks.com. For inexpensive the Reli-On is a good one. One can go back and forth with the "size" of the blood drop needed. Heck, you need to see the drop and with all the meters I've tested the OTU doesn't need anymore than the others. I remember having to roll that drop of blood onto a test strip because when I started years ago the test strips for meters did not sip the blood. Don't forget when buying a meter to buy extra test strips and lancets to stick with. I use the BD UltraFine lancets. Easy to us for free hand or in a lancing device.

If you have any questions, just ask away. Someone is always on somewhere in the world.

Forgot......when buying test strips, etc. pick up some Ketostix (tests urine for ketones) or KetoDiastix (test urine for glucose and ketones)

 

I will definitely pick up the ketone sticks. I have to do the testing at home...there is NO WAY I could take Garth into the Vet to test his curves. He has way too much anxiety and I dont want to put him through that stress. Is there a place I can find to show me what levels to look for when I start? I have no idea what range the number should be in, as well as what to do if he has positive ketones. I feel overwhelmed right now, and will need to do lots of research. I want to make sure I know im doing as my vestulin is almost out! :YMSIGH:

 

I used BCP PZI for years on three of my FDs. It's not a bad insulin, and the customer service was great.

Like Hope said, learning to hometest is the most important thing you can do. I'd suggest that once you start hometesting, post your numbers on the Board and we can explain them to you, pretty soon you'll be an expert

 

http://binkyspage.tripod.com/faq.html Alot of answers can be found on this site. Also, before you run out of the Vetsulin how about learning how to hometest so you have a good handle on it before switching? With always getting 0% glucose in the urine it tells us that Garth is mainly under the renal threshold which, depending on vet, may be 250 or 230, etc. bg. Problem is we don't know just how far under the threshold he may be. For all we know he is a well controlled diabetic. Hometesting will give you the answer. It is also great if the cat vomits, acts funny, etc. We can immediately test and see what the bg is and either panic or relax nailbite_smile

 

Switching insulins can be a nervewracking time but knowing how to hometest is the best thing you can learn to do to calm those fears. Go out asap and get your meter/strips and view the videos on the Health Links section. I'd start testing right now while you are still on Vetsulin to give you a baseline/comparison point. We used BCPs PZI for many years.

 

Your vet should be able to get you a free 5ml vial of BCP. Also, Vetsulin is a U-40 insulin and I forgot to ask if you are using the U-40 syringes or the conversion chart and U-100 syringes. PZI IDEXX only comes in U-40 so I will switch Mishka to BCP's U-40 when the time comes. I am used to dosing with a U-40 insulin but BCP does come in a U-40, U-50 and U-100.

 

http://www.felinediabetes.com/insulin-conversions.htm A lot of info also on the FDMB home page http://www.felinediabetes.com/

Lots of reading to do :roll: but help is always available.

 

So I have switched to the BCP PZI and so far so good. I am waiting on my glucose monitor to arrive so I can try doing this home testing thing! I a nervous about it, but I know that it needs to be done. I only had about 6 units dosages of vestulin left, and have a busy work week ahead, so I went ahead and started the new Insulin fri night. I wanted to start while I was around this weekend to see how hes doing. I am going to try and put him in his litter box to pee for me so I can at least get that reading. He has been acting the same as he normally does...hes not feeling lethargic, eating or drinking less, or anything out of the ordinary. He seems to be the same happy garth as always. Once I get the glucose meter, I will get up the nerves to get the home testing on its way. Will I need to do this everyday...at the same time??

 

So did you do directly over to 6u 2x /day of the BCP PZI ?

What is your dose on the new insulin.

 

I've only been testing for a week now and although I don't have one hundred percent success yet it's getting easier every day. Rufus still tries to deny me access to The Ear (his left ear doesn't offer up much blood), so I'm looking at trying to see if he'll give me a paw to test... not likely.

Every cat is a different case, so I wouldn't go getting upset if you find your boy is slow to take to it (or if you are, for that matter!) I'm learning that it takes lots of Kitty Massages (shoulder rubs work the best for a tense Rufus) and a good dose of chicken on hand, too.

Also, one thing I found immensely helpful was testing the lancets on myself to prove that it wasn't going to hurt him. He only seems to mind being 'detained'... and being denied nernies (family dialect, literal translation; "TREATS!!") for a moment. Hang in there, I'm already seeing how important it is to his treatment. It's totally worth it.

As for frequency, there are definitely people better equipped to tell you about that, but so far I'm trying for three tests regularly - more if/when symptoms show up. And the first curve will be scheduled for when I finally develop my Mad Blood Drawing Skillz... um... yeah, you can see my age! :lol:

 

Please, please tell me you didn't start at 6 units????? Why are you waiting for a meter? Walmart's Reli-On is a good and cheap meter. Now I'm nervous with you. Please write back and give us the starting dose.

 

Wait a minute... was it said that 6u is being used or that only 6u was left in the vial? confused_cat

 

We're not sure. His old dose was 6u bid. (Read first post at the top of this thread).

There were 6 DOSES of Vetsulin left.

That's what we're trying to find out.

Vet suggested starting over at 1u bid...but we're not sure he did that.

 

Sorry about the confusion. I tried to scan, but I kind of have vision problems after my medicine kicks in! Thanks for the correction. /wastepost

 

He was on six units bid on his vestulin. He is only on ONE unit BID with the PZI. I had about six units left on the Vestulin, but didnt want to start in the beginning of the work week while I wasnt at home to see what he was doing, so I started this weekend with one unit. I thought about going to get a meter anyway...mine should be here soon. I also have a friend that is a vet tech that works for my vet that said she will come over and show me how to do it! Im still nervous but I know its for his own good!

 

O thank God........1 unit.........I love it......don't forget to test urine for ketones. Always a good idea when switching insulins. That is 1 unit U-40, correct? You are using the U-40 syringe or did you order the BCP in a U-100?

 

Hope, sorry to scare you!! Thanks for the concern I am using the U 40 Syringes, same I used with the Vestulin. So yes, 1 unit the the U 40. Can you remind me what checking for Ketones is for again??

 

http://www.felinediabetes.com/ketones.htm Make sure the vet tech tests only the edge of Garth's ear. A lot of us were already testing and convincing vets of the benefits long before the vet community got on board. There have been some that think you still need to get blood from a vein in the leg, some that think you stick the middle of the ear.........IMHO FDMB was lightyears ahead of vets when it came to diet and hometesting. Always test before feeding and shooting.........always. I will feel so much better when you start getting some bg numbers so we know if he needs more, just a tad increase......whatever.
Remember too that you do not increase on just a pre-shot test........do a curve on a weekend..........Pre shot test (ps) then test at 2 hr intervals so it would look like amps (a.m.) +2 +4 +6 +8 +10 and then pmps(p.m. preshot). If and when you do an increase, you do not jump from 1 unit to 2 units. There will be help here once you get some numbers. Wish I drank.......I'd go sling one down after waiting to hear what you started Garth on :lol:

 

So after two hours of testing this am we still have no reading :sad: Garth did great, he didnt bite or try and run and hide. He did hiss, but thats ok! It took several pricks from his ear and we could not get enough blood for the meter. We then tried using a insulin syringe, and the one time we got enough, there was an error reading on the meter! SO FRUSTRATING!! Then we couldnt get anymore We did the warm compress, used a flashlight, the whole nine yards. He was such a good boy, I was really proud of him. We then tried scruffing him to get some from his vein, and he wasnt having any part of that. So , my friend is going to come back Sunday with the special meter they use at the Vets and try again. (she says its requires less blood then the one I have) Even if we got the reading today, it may not have been accurate since he was stressed out. After about 15 sticks, and me in tears, we finally decided enough was enough. I was really hoping for a reading today, but it just didnt happen. He is acting like the same happy kitty-not lethargic, no dilated pupils, nothing out of the ordinary, so I so feel good about that. He has been drinking more I notice. I brought home some ketone sticks from work to check him the next time he urinates. His last urine reading was at 1.5-2 %-higher then it was when he was on the Vestulin. Today I gave him two units of the PZI. My inlaws are in town this weekend, but I may try to get a reading myself if I think I can. I feel good though that he is acting normally

 

I'm sorry if I'm adding to confusion, but is the PZI BCP u-40 concentration or u-100, they produce both.

 

It is the U 40-what is the difference?

 

You need blood so no need to try another meter.....you just need a drop that you can see. Run a thin coating of vaseline on the edge of the ear before sticking. That will bead the blood drop instead of spreading out till you get the hang of it. Also after a stick, if the blood doesn't bead, try milking towards the blood drop with your fingers. A slight push with the thumbs, let up, and push again towards the blood. Always praise Garth after each test.....praise and kisses are very important. Also, before you test try sitting down with Garth and gently massaged the edge of his ear. That stimulates the blood and also warms the ear. I though you were not going to increase the dose based on urine reading and then only 1/2 unit at a time??????

 

Check this link in the faqs, it explains. I copied and pasted just the first two paragraphs.

http://www.felinediabetes.com/pzi.htm#_What_do_the

What do the strength numbers (U40, U100) mean?

The vials of what we call insulin actually contain a minute amount of crystalline insulin, which is suspended in a fluid (called diluent) that is mostly water. Pure, crystalline insulin is measured by weight, in international units (iU).

When combined with the other ingredients, insulin strength is expressed as U100, U50, and U40, meaning that there are 100, 50 or 40 international units of insulin per milliliter (ml) of diluent (the fluid). A ml of U40 contains 40iU of crystalline insulin, and therefore a 10ml vial will contain 400iU. The same vial of U100 strength, contains 1000iU of insulin, or 2.5 times as much. Think of U100 as being more concentrated than U40.

 

thanks for the info tuckers mom! That makes more sense. I had gone up to 1.5 dose yesterday. I did a urine test today and it turned dark right away...speaking with my Vets office they said it was ok to do 2 units. I just dont think hes getting enough by his urine reading. I wasnt quick enough to also get the ketones. Will have to try the blood test again. Thanks for the info on the vaseline, I will have to try that also. He was so good and got lots of love and kisses and treats!

 

If you use a ladle, you can catch urine (liquid gold is what I call it :razz: ) and pour it into a plastic disposable cup. That way you have urine to test and retest. If you buy Keto-Distix for testing urine, then you just have to get it urine on one test strip. It tests both glucose and ketones. I bought a great plastic ladle at the food store and catch urine whenever I see Mishka going. If you move dose up too fast without giving a few days to settle into, you may go pass the dose he needs. Vetsulin was a porcine insulin and BCP is bovine. I will eventually be switching from IDEXX PZI to BCP PZI. I do not plan on the dose being the same.......Mishka may need more, may need less. You are starting Garth on a totally new insulin......respect what that effect might have on bg numbers, practice more on the hometesting. Do a few spot checks for practice. Once the insulin is in, you cannot pull it back out. Garth may very well need even more than what you are giving but get the numbers.

 

Ok so I finally was able to get a number on Garth today...my friend bought over the meter they use at the clinic and it required much less blood. His # was 412. So, he said to increase to 4 units...last night and this am he was given three as I tested his urine and it turned dark brown right away! He is acting the same as always, maybe a little more agitated, drinking more, but overall the same big happy boy. Not lethargic at all! I am going to take him into the vet on friday to do another reading. I had a feeling he probably needed a bump up!

 

The problem with bumping up on the 412 is it's only one number. Could your kitty have been really low when the shot was given and this number represents rebound? Could your kitty have been even higher and this number shows the dose needed to be increased?

Without testing at preshots and getting some spot checks there isn't enough information where I would feel comfortable changing my own cat's dose.

The glucometers at the pharmacy are great. If you're looking for one that sips quickly and takes a small amount of blood, the Accu Check aviva is great. Another that takes a small amount of blood but sips a little slower and is very cost effective is the Walmart brand relion meters.

 

Thanks for the response! The reason that we bumped up is not only because of the number, but because the past two times I checked his urine it turned dark immediately. When he was on Vestulin, he was on 6 units BID. This is why I think that he is not getting enough? Maybe I should do 3.5 first? I just want to get this under control Glad he is acting ok though, I feel like thats a good sign.

 

all the urine strips do is tell you that he was high above renal threshold at some point. It doesn't tell you if he went too low at all, and where he goes inbetween shots.

Honestly, hometesting is the only way to get a really good handle on this....data data data!

Jen

 

Like Jen said, get the data. From that point you will know if your cat is a high dose kitty or not. It will also bring peace of mind, knowing exactly how your cat is feeling at any given moment just by doing the quick test is empowering.

If Tucker seems off to me I can simply check his BGs. If they are high, I know he may be going through one of his pancreatitis flares. But if they are low, I know he may be feeling a hypo coming on and can give him food to bring him up.

 

This is frustrating to me because garthy has been diabetic for 8 years, and has never been sick, had a hypo event, lethargic, or anything! You would never know he was diabetic. Sometimes he may drink more one day than another, but I realize thats what diabetic kitties do! He only goes to the vet twice a year for blood work and dentals. He his on benazapril for his kidneys. This new insulin is making things so difficult and stressful. Does weight matter on how much insulin he needs? He is a big boy, close to 18 pounds...maybe closer to 19...

 

He may well have been fine, or less than, because kitties often hide the fact that they aren't well until it is advanced.

Weight has nothing to do with dose, to answer your question...

I know this must be frustrating, but you lucked out in the past...now you need to put a bit more time in but it will be worth it!

 

It is frustrating. Tucker's been FD for five years and two of my current FDs are diet controlled.

Just recently I posted that Tucker experienced his first ever hypo numbers in July. He got down into the low 30s. The strange part is he has a tumor and takes Pred so his numbers should be higher on pred, not lower. I can't give him more than 1U of Lev, when he gets a less than 1.5, more than 1U he goes too low again.

It makes no sense sometimes and that's why we often call this a sugar dance.

You need to also consider the fact that you are changing insulin. Tucker was on PZI, it's similar, sort of to Vetsulin. When we switched to Levemir which is like Lantus everything changed. Both my cats at the time reacted very differently to the lev than the PZI. They both loved the lev and were much more pleasant, but the dosing was really hard for me to wrap my head around. I was used to dosing them based on preshots, now I had to unlearn PZI and learn how Lev and my cats would be.

I'm comfortable now and love the Lev, but the change was not easy for me. I believe you're switching to PZI, is that correct? I like the PZI but like any insulin change, it's going to be different at first, but you'll find the right dose and you'll find it much much faster by hometesting.

 

Just wanted to add that if you are still giving dry food as a snack it can raise bg levels by a lot! Even a very small amount will raise the bg levels for most of our diabetic cats here. Try cooked chicken breasts instead. I always have some of this on hand for Tigger's 'treats'.

 

Forget the past years on Vetsulin. You are starting over on a new insulin....bite the bullet, buy a meter and please start hometesting. You are basing the previous years on what is happening now. It is a whole new ball game any time you switch insulins.