ProZinc gone bad?

Hi everyone,

I'm new to all this, so I don't know if my ProZinc isn't working well, or if my kitty isn't getting enough of it, or what, but it seems to me that something's not quite right with his blood glucose levels (link to spreadsheet in signature). There's basically no change over the past month -- if anything, the numbers are getting worse (tonight was the highest reading yet).

At the beginning of all this, I -- very stupidly -- left the insulin out on the counter overnight. I checked with my vet, and they called the company, who said ProZinc is ok unrefrigerated for 24 hours. I'm worried, though, that they're wrong -- that the insulin has gone bad, and isn't doing what it's supposed to do.

Because Splunk's sugar levels were only slightly high at the beginning of all this, we started cautiously with 0.5 units. Today we moved up to 1.0 units, and I thought I might see more of a change in his numbers.

Any thoughts greatly appreciated!

 

Your kitty is still on a very low dose, so I wouldn't worry too much about the prozinc going bad just yet. It's possible that it's gone bad, but many of us have left it out overnight (or all day) and it's been fine.

 

The cycle on prozinc looks something like a smile....like this:



So when you are testing at the beginning and end of the cycle, you miss all the low numbers in the middle, and it looks like the insulin isn't working. That's why those mid-cycle tests are so important. You don't need to get all of them, just one or two here and there, and as days go by, you can get a pretty good picture of what's happening.

That being said, you do have some mid-cycle numbers, and based on those, I think your kitty would benefit from starting to increase the dose. It looks like you gave 1.0 unit this morning, but then 0.5u this evening. Is there a reason for that change?

 

The ProZinc is probably OK. My guess is you haven't reached an effective dose yet. Did your vet prescribe 0.5 u as a starting dose? Has it been assessed? You're home testing (excellent!) so doing a full curve on a day off is a good place to start to determine whether the dose should be increased.

 

Oh really? Ok, thanks. That's great news. 1.0 is low? Ugh... I was so worried about increasing his dose. I can't stand the thought of him becoming hypoglycemic!

 

Oh, do we all understand that! Fear of hypos is part of what drives us to test our kitties! Well, that and fear of them staying too high and getting ketones!

How is testing going? Is Splunk (great name, by the way!) doing okay with it? Are you doing okay with it?

 

Oh, this is so helpful, THANK YOU. I gave him 1.0u this evening -- just got used to writing 0.5. Thanks for pointing it out -- I've fixed it now.

I thought I was probably missing the lower numbers in the middle of the day, but I was expecting the numbers at the 12-hour mark to start getting lower -- that's the point, right? Shouldn't they be, ideally, around 10?

I guess I'll let him go for about a week on 1.0 units q12 hours, to stabilize at that dose, and then do a curve to see what's happening during the day.

 

You guys are the best... thank you for understanding! And Splunky says he's happy you like his name.
He's ok with the testing... doesn't love it, but is tolerating it. He's quite bothered by the insulin needle, though. Poor guy.

 

It is the hope that the pre-shot numbers get lower over time. But it sometimes takes a lot of time, especially when you have other health issues going on at the same time. Is his tooth infection cleared up now?

As far as dose changes, we recommend increasing by 0.25u at a time, holding that dose for six cycles (3 days), and then increasing again (if numbers indicate it's needed). So I would suggest that you go ahead and hold at 1u for a couple more days, try to get a few mid-cycle tests in (are you able during the day, or do you work?), and then we can see what to do next.

 

Most of us have our spreadsheets linked. You might take a look at a few different people here in prozinc-land and start to get an idea of doses and numbers. Every cat is different, so one cat will have a pre-shot of 250 and need 1.5u, another cat will have the same pre-shot and need 3.6 units. As you look around at the spreadsheets, you'll start to get an idea of how much variation there is in all of this, but don't let that stress you -- it will quickly start to make sense.

 

Yup, the vet prescribed 0.5u as a starting dose. His sugar was only about 12-16 when we started, so we were both worried about starting too strong. I appreciate her caution.
I'm in touch with my poor vet almost daily via email, so she's aware of what his sugar levels look like. She suggested increasing the dose to 1.0, so that's what I did today. Maybe I'm just too impatient... I was hoping he'd be in remission by now. Sigh. Paws crossed it makes a difference.

 

Oops. I'm so sorry! I just put that in american numbers. Ignore the pre-shots I said...just the idea that it all varies.

 

This is so helpful -- thank you so much. I will hold at 1.0 and see what the next few days bring. I can test mid-cycle -- I'll start that tonight.
Yes, his tooth infection has been cleared up for a few weeks, and bloodwork from about eight days ago is completely normal. He has a heart murmur, but echocardiogram shows no real HCM. So he's pretty healthy except for this darn diabetes thing.

 

I will definitely look at the ProZinc spreadsheets... thanks so much. And no worries about using mg/dl -- I'm becoming fluent in "American."

 

Your vet being cautious is a good thing - so many start kitties off at crazy high doses. Increasing to 1 unit might shift the numbers. I suggest you read the ProZinc dosing method in the yellow info sticky at the top of the thread list on this forum. It'll give you a good understanding of how to best use this insulin.

 

We all know the feeling of wishing for remission! Just remind yourself that this is a marathon, not a sprint. He didn't become diabetic in one day, so it will take longer than that to get him in remission too...but it can happen! And you're doing what you need to help it happen.

 

Yeah, my vet is pretty awesome. She's a feline specialist, so I think that helps. Thanks for the heads-up about the dosing info... I'm actually reading it right now. I'm completely overwhelmed by all the information here! I just want to get everything right for my little buddy.

 

Thank you! I'm so happy to have found all of you!

 

Nadir (lowest number in cycle) for Prozinc is usually between +5 and +7, so like Djamila's chart showed:
Usual Example; AMPS 19.2
+2 / +3 Slightly lower number and insulin starts entering
+5 / +6 / +7 Nadir (for pink AMPS, ideally getting higher blue like 9.6 or higher)
+8 / +9 / +10 Closer to +2 / +3 and insulin starts exiting
PMPS 19.2 (or close)

I'm sure the graph was more pleasant to understand . Looks like Splunky had a little bounce for tonights PMPS.
Credit to Kris & Teasel:
Here's how bouncing works:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
7. Many vets have little/no understanding of the bouncing phenomenon.

I am wondering if the next dose should have been 0.75U but we will see how the 1.0U does

 

Most cats start at 1 unit. I would have recommended you increase a while ago. Don't be surprised in a few days when we are advising you to up it again. You are no where near hypo. But we don't want her staying in these high numbers either.


Are you using a human or pet meter? Can you add that info into your signature please? I ask because normal on a pet meter is 68-150. Anything below 68 is considered the time to treat for hypo. On a human meter it's 50-120.

Let's see what happens over the next 3 days with the 1 unit and reevaluate the dose to see if it's good or needs to go to 1.5.

 

Try to catch some +5-7 numbers when you can, and do a curve (test every 2 hours for 12 hours) this weekend if you're home

 

I would not recommend increasing by .5units. Generally with prozinc we recommend increases of .25u at a time. The larger increases are indicated when the cat is stuck in higher numbers, but based on the mid-cycles that you have (4/13, 4/15, and last night), it looks like Splunk is responding to the insulin and getting some movement on a very small dose already. You may well need to get to 1.5, but I would recommend spending a few cycles at 1.25 on your way up in order to give Splunk time to adjust and hopefully avoid bouncing.

Your spreadsheet has a note that says "shaky" from last night. Is Splunk okay?

 

Thanks Janet. I did numbers at +2, +4, and +6 last night (on the SS) and this morning he was at 16.9 (304), which is more what I'm used to.
I'm using the AlphaTrak2 (it's already in my signature, but maybe buried a bit too much in all the other information there).
Thanks again for all your help!

 

Hi Djamila,

Aw, thanks so much for worrying about my monkey! Yeah, he's ok. The shakiness is possibly the start of neuropathy, but it's kind of an unusual presentation, and the vet and I are a little confused about what it could be, so now I just make a note of it when I feel it's particularly bad. His back legs started trembling in February, when all this started, and now sometimes it seems like all his legs are a bit shaky sometimes. His mobility isn't affected, and I honestly doubt that anyone who didn't know him would notice it. It comes and goes, and doesn't seem to have any correlation with his sugar levels. Splunk has been symptomatically atypical since the start of this, so it's been difficult figuring things out.

Thanks so much for your comments on increasing his insulin dose. I really appreciate you guys taking the time to think about this. I'm much more comfortable increasing in smaller increments, so we'll see what 1.0 does for him, and then if I have to go up from there, I'll probably jump by 0.25. The only thing is that my syringes (U-40, 12 units) aren't subdivided beyond the unit level, so eyeballing 0.25 will be a bit of a challenge. I wonder if I can get some that are marked in smaller measurements.

Splunker says thanks, and he hopes you're having a great day!

 

Many of us use u-100 syringes, and have a conversion chart http://www.felinediabetes.com/insulin-conversions.htm
It's a little tricky at first, but once you play around with it for a minute, it makes it easier to make very fine adjustments in dose.

Here are some links to options that work, though I don't know about shipping to Canada:
https://www.adwdiabetes.com/product/2552/monoject-ultra-comfort-insulin-syringes
https://www.adwdiabetes.com/product/16367/carepoint-vet-u-100-pet-syringe-31g-half-unit
https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes

You can also just eyeball the .25u on your current syringes. I only recently switched to the u100s, so spent a lot of time eyeballing small changes! You can just play around with water a bit until you feel confident about where the plunger should be for a 1.25u shot.

That's interesting about the shaking legs. I liked what you said about "anyone who didn't know him wouldn't notice it". We do get to know our kitties so so well when we're worried about them! Hopefully as Splunker's numbers start to come down, it will get less and less.

 

That's so helpful -- thanks. I'll think about switching syringes, but it's good to know that "eyeballing it" is an acceptable method.

Yes, we do get to know our kitties so well. I'm so happy for all the well-cared for kitties on this site. I've always been very obsessive about checking my guys over to make sure they're ok, but now I'm completely paranoid about Splunk, and watch him like a hawk. Thankfully, he's very social and tolerates this well. My kitty with IBD is very private, so it's much more of a struggle to check in with him.

I was looking at Sam's spreadsheet, and it's so helpful. I notice you have a petsitter sometimes... has that worked out ok for you? I've struggled with the idea of getting a petsitter, and will probably have to eventually, but I definitely worry about it.

 

As long as you eyeball with consistency . I still use U-40 syringes but found some with half unit markings. Makes it easier to do those x.25 and x.75 doses
https://www.adwdiabetes.com/product/16363/carepoint-vet-u-40-syringe-29g-half-unit

 

Jennifer is in Ottawa, Canada, where I am and I'm not sure what the taxes and import duty would be when ordering from adwdiabetes would be. Must be on their site though.

 

Oh I forgot
Found this site for Canada: http://www.elimedical.com/shop/index.php?cPath=319_37
They advertised having u-40 syringes with half marks but the descriptions don't specify which one that is so you may need to call to verify

 

This brand is what I buy from my vet. I have no problem with the syringes.

 

I will definitely check! Thanks, everyone!

 

Awesome! Thank you!

 

Oh yes I see it! I just missed it the first time.

 

So today is day two on 1.0u. His morning pre-shot was 16.9 (304) and now he's at 8.6 (155). This is the lowest number yet. I guess the insulin is working. Slightly worried it will continue to drop, so I'll keep testing over the next few hours.

 

The nadir is usually between +5 and +7. That's a nice blue and you have a lot of room to drop before hitting the warning number of 68 on the AT meter. As you slowly build your data base you'll be able to make better predictions about his response to a dose and better dosing decisions. That's why we keep emphasizing the importance of testing at home and keeping the SS.

 

Woohoo! That's a 50% drop which is really good. I'm all for getting another test, but I don't think you need to be worried. He's still in safe numbers.

 

Very nice blue . Might be good to grab another test around +6 since we are not sure when he hits nadir yet

 

Great!

 

Thanks, everyone. Splunk feels like he has his own cheering squad here. I really appreciate your time and expertise... it helps so much not to do this in isolation.

He's 8.7 (157) now, at +7, so I guess we're good. Hooray! I might check again in another 2-3 hours, just to see what's going on. It will be interesting to see what level he's at when it comes time for his next shot.

I still don't have a clear idea of the number at which I should hold off on (or decrease the dose of) his insulin. I mean, if he were still at 8.7, for example (I know this is unlikely), at the time of his next shot, I wouldn't want to give him a full dose... or maybe any dose at all.

 

We generally recommend no shot if he's under 11 (200) at the beginning. Once you have a lot of data that can be adjusted downward carefully.

 

Maury had a 157 (8.7) today too

 

That's a great +7! I'd stick with what Kris said for now...no shot under 11. As you acquire data (and I can already tell you're becoming one of us in the wanting more data!) you can lower your no shoot number as many here have done.

 

Thanks so much, everyone -- this is a huge help. I had a heck of a time getting the "no insulin when his blood sugar is X" number from my vet, so this is really great. I can fine-tune it later, but for now it's good to have a hard bottom limit. Early on, his BGL hit 10 one evening, and I didn't give the insulin, but she said I should have. (Granted, it was only 0.5u at the time.)

Gave him his shot late this evening, because I had an emergency with another kitty, and his sugar was 20.7... better than last night. I'll set my alarm to wake up and check it in a few hours.

 

Hope the other kitty is okay!

 

Also hope other kitty is okay. Are you talking about the 9.9 on 5 April? If so, then go ahead and change the 0.5U to a NS since you skipped . Don't feel bad about skipping, new members are usually told to skip if they are under 11.2 (200 in US) until more data is collected

 

Ha, yes, that's the one I was talking about. Thanks for spotting my data entry error -- sharp eye!

The other kitty (Banjo) is ok, and he says thanks to you both for asking about him. He's 14 too, and has quite a terrible ventricular arrhythmia with moderate HCM. The arrhythmia semi-controlled, but every now and again we run into problems. He's fine now -- thanks!