Prozinc-- is this a normal drop?

Sebastian has been on Prozinc for almost two months now. I've been extremely frustrated with it-- his numbers just aren't as low now as they used to be on Vetsulin.

We've been through several different doses, and his pre-shot numbers are always in the high 200s (they were in the high 100s on Vestsulin, and he went a few months with no insulin at all!)

Last night his pre-shot number was 298. He got his 1 unit of Prozinc, and we tested him at +4 and he was 140. Is that normal? Scary? We were not able to test him again at +6 because it would have been 1am. We won't be able to run a curve until Sunday.

He has just not been as active or playful lately like he was on the Vetsulin. I don't know if it's because it's summer now and the house is kind of hot or if his numbers are just swinging too wildly or what. Or both?

I will have more info, of course, this weekend. I don't have a spreadsheet yet. Though he gets tested before every shot and I have a record of that, my husband and I both work full time can't find the time for curves or consistent spot checks. Last night's drop was definitely bigger than we have seen before though, at +4.

 

That sounds like a fairly normal for some kitties. It all depends on how low the nadir is though. Can you get a +6 or +8 test done today though just to check?

 

Not sure if this helps? I checked Pru's SS back on 3/13, but we were TID. Anyways, she was BG 314 and at +4 152... again, not sure if this even matters due to every kitty is different, but I would think Sebastian hit his nadir around +6 or +7. I would take this as a dose decrease. or at least the decrease is coming soon. Do you have a SS?

 

Did you switch from Vetsulin b/c of the recall thingy (are people pretty much not using V any more now?)? Some cats do better on one insulin vs. another. We switched from Vetsulin, and I have been happier w/PZI, but ECID. I had a difficult adjustment time when we switched - with Vetsulin I found his drops a lot more predictable, PZI is more of a wait & hope insulin. When you can get the dose right though, it can work really well, and for Bix has given him the duration he wasn't getting on Vetsulin. My experience with PZI has been that when the dose is too low you see very little drop, but then as you get to a better dose the drop can be more dramatic (or too dramatic on a dose that is too high - with that you might see a drama drop by +1 or +2, which from what I have seen with PZI is generally a sign the dose is too high).

Bix would usually (PZI this is) get the most drop between around +2.5 to +5, then it would taper off to a nadir around +6.5. So a big drop by +4 probably wouldn't worry me too much, depending on the actual #s of course. More or less with PZI you are looking for a ballpark 60% drop from PS to nadir. So what you saw might be a little steep, or it could be perfect if he didn't drop too much more to his actual nadir.

If you have been doing this for a while and are getting consistently higher PSs but a good drop to the nadir (which is how this looks to me without having the full data picture), you might want to try shooting early for a while. Several people who are around have gotten really good results from that - shooting early for a few days or a couple weeks to try to catch their cat at a lower PS, and then be able to shoot a little less insulin to still get a good nadir but avoid the big swings. When it works well, it seems to help extend the duration on PZI, and then they have been able to return to 12/12 shooting with better results.

Just a thought.

It can be very stressful to do that and you go through a lot more test strips, but when it works, I think everyone who has done that, at least that I've seen, would probably say it's worth the trouble. I wouldn't recommend it for everyone, but if you have a consistent pattern with a big drop and high PSs (and not attributable to rebound), it can be a good strategy. Since you said this particular drop was bigger than normal I'm not sure that strategy is really what you need, but it's hard to say much without seeing more #s...

 

Thanks, everyone!

We switched from Vetsulin because of the recall (or whatever it is). Our vet wasn't supplying it anymore. The PZI has definitely been a big adjustment. I'm just so frustrated that his pre-shot numbers aren't coming down any. We wanted to try Lantus but our vet (who is not a big believer in hometesting) won't put him on it without making him stay in the hospital for TWO DAY monitoring. :roll:

We did another spot check (+4) last night. He went from a pre-shot of 268 to 140.

Tomorrow will be the first chance to really find the nadir (+6 and +8) so I will start putting together a spreadsheet with more data! We might try the shooting early idea if no change comes soon.

 

268 isn't terrible for a PS though - you may find that a dose just a hair higher (waiting to see the curve before really recommending that, just mentioning it for now) makes all the difference. My experience with PZI has been that even a dose change of 0.2u can make a huge difference, and if you can get nadirs in non-diabetic #s, you may find the duration improves as well. No specific advice for now - I'd keep doing what you are doing til you get the planned tests in and then reevaluate - just wanted to give you a little encouragement that there is hope.

PZI is nice b/c it is so flexible that if one approach isn't working you can try another, and if you have the time & patience & a boatload of test strips :lol: you can often get results by taking advantage of that. If you do want to go with Lantus, you might be able to get recommendations for another vet in your area - worth switching IMO if that's what you need to do in the end. But I'm a PZI cheerleader, so ... stick around!!! :mrgreen:

 

We did a +6 check yesterday. At 190, down from 300. We (I think stupidly) increased his dose to 1.1, and now his pre-shots have been over 300 both last night and today.

I'm thinking rebound. Dropping him back down to .8, maybe even lower depending on what we're seeing.

He never did need much Vestulin so maybe we've been giving him too much PZI all along. :-|

 

Sometimes those higher PSs are just liver-training - their liver throwing rebound #s even though there is no actual need for it, #s aren't too low, they just aren't used to them. If that's the case, then you just tolerate the higher #s (i.e. raise the dose if needed to shoot through them) to get to the good ones, and once they spend some extended time in really good #s their livers will settle down and the higher #s will go away. It's hard to say for sure though without seeing the data, but wanted to mention that. My cat had to go up to 1.8u to get action, then within a few days he was back down to 1u. But before going up to 1.8 he was just stuck up in higher #s, had a case of wonky liver or something I guess, and I had to go up through the dose increments to get anywhere. Since a 190 isn't all that low, and a drop from 300 to 190 doesn't seem that steep to me, unless all that happened in 1 hour or something, I'm thinking it might be liver-training rebound rather than Somogyi rebound. Just guessing though. Hope things improve on the new dose in any case, then you won't need to think about all that.

 

Thanks for the advice!

His pre-shot was down below 300 for the first time in days this morning (263), so I think maybe shooting .8 is helping.

Still, though, I'd like to see him even lower, back to his old Vetsulin numbers. I just don't know whether to go lower or higher with his dose-- all the variables are so confusing. :? It seems like when we raise the dose, his pre-shot numbers go higher. But no matter what, his +4 and +6 numbers don't seem to ever be that low.

He was on such a small amount of Vetsulin that it's hard for me to understand how he'd need over 1 unit of Prozinc. But we'll just keep trying to figure it out!