Questions on Prozinc

I have just introduced myself on the introduction part of the forum. My name is Jennie and I am a moderator at a forum for diabetic cats in The Netherlands. We advise on the use of caninsulin (vetsulin) and lantus. Recently, ProZinc has been introduced, and we are trying to get as much info as possible to be able to help owners.
I have some specific questions on ProZinc, and I hope someone can answer them. More questions will probably follow.

- Vets apparently have been told that shots once a day could be enough for some cats to get the diabetes under control. Do you have the experience that that may be true? Or definitely untrue? We doubt it sincerely, as the insulin does not work for 24 hours as far as we know ....
- Hypo's seem to occur frequently (according to a study, but we do not know how often the cats were tested in that study). We have a hypo guideline for caninsulin, which we will also post on our ProZinc forum. We believe it can be used in the same way. With caninsulin we consider the cat 'safe' after treating the hypo, when he measures 6.0 mmol or more on a human meter (109 mg or more). Is the same to be said for ProZinc, considering the insuline works longer?
- You speak of a cycle. Am I correct that that means 12 hours?

 

Before you will want to explain to me that I also have to take into account the timing of the hypo.... I know. I will make that question more detailed: suppose that the test (and/or the behavior) shows a hypo just around the onset of the nadir, is 109 a safe value after treating the hypo? Considering the nadir is probably more prolonged with ProZinc than with caninsulin, and a relapse may occur?

 

Hi Jennie and welcome. I am assuming your ProZinc is the same version as the one in the UK. It is a little different that the ProZinc in the US. It seems to act a little more like one of our depot insulins, as it can have a longer cycle. Our ProZinc can last anywhere from 8-12 hours, depending on the cat. I'll flag @Elizabeth and Bertie. Her Bertie has been on the UK version and she is very experienced.

In some ways, the two act the same so I can answer your general questions. In my experience, the only time ProZinc can be given successfully once daily is when the cat is going off insulin - into remission- and a small dose is lasting a longer time, most likely because the pancreas is "waking up" and helping out.

We strongly encourage people to home test, so they can get a real feel for how the insulin is working for their cat, including how long it tends to last each cycle. We like to see a test done before each shot (before eating so the food doesn't artificially raise the numbers) to be sure the number is high enough to shoot safely and that the dose planned is a good choice. Then we suggest a test 5-7 hours after the shot to see where the lowest point is in the cycle and how low it takes the cat.

We put together a protocol for ProZinc. It is in my signature in blue and may be helpful.

We see few hypos, because people test regularly and can intervene if they see a cycle going in lower ranges than expected. We suggest giving a snack of regular low carb first and retesting to see if that is enough to stop the levels falling drastically. That is often all that is needed to flatten out a cycle and keep a kitty in safer numbers.

The biggest differences I see between ProZinc and Canninsulin: it is nice to have some food on board early in the cycle with ProZinc, soon after the shot. We often say test, shot and feed. Many people shoot while the kitty is eating. With Canninsulin, it is important to have food on board before the shot as it can have a fast, harsh onset, which is not common with ProZinc. And, although we are big believers in "Every Cat is Different", Canninsulin seems to often last 8 hours, while in many cats ProZinc lasts 10-12. ProZinc usually is milder and longer lasting than Canninsulin.

With cats new to diabetes and insulin, we suggest not shooting under 200 but waiting 20 minutes, without feeding. Retest to be sure the number is rising, not falling, and 200+. After people have data, they often shoot in the 180 range and sometimes lower, but only with careful monitoring.

I hope that helps.

 

Two of our board members will have a meeting with a person from the manufacturer of Prozinc in a few weeks. I will ask them to raise the question about the types of ProZinc, because that is very interesting.

Indeed we also promote home testing, we say: meten is weten (it rhymes in Dutch and means: testing is knowing).
So test, shot and feed with prozinc. We always test, feed and shot at lantus. And we only pretest at caninsulin if the cat has had a hypo or if the values fluctuate strangely (nearing a remission most often). Of course we do a testing around 4 hours after the shot caninsulin every week at the least. But we want to be sure the food goes in and stays in. If I understand correctly, you shoot before the food goes in. I would consider that a risk....

The protocol the vets have here is: shoot a certain dose and come back next week ....

When do you consider the level low? We start treating it as a hypo at caninsulin with levels below 4.0 (72).

 

Do you use Prozinc in the US or another PZI-insulin?
Our Prozinc is produced by Boehringer-ingelheim and they mention the following composition in a document:

1 IE equals 0,0347 mg humane insulin.
produced by recombinant DNA technology
Protamine sulfaat 0,466 mg
Zinkoxide 0,088 mg
Fenol 2,5 mg
Glycerol
Dibasic natriumfosfate, heptahydrate
Hydrochloric acid (for pH-adjustment)
Natriumhydroxide (for pH-adjustment)
Water for injections

ATCvet-code: QA10AC01 Insuline (humaan).

Not that this means anything to me, I'm no pharmacologist. And maybe this question doesn't belong on this forum .... It just intrigues me that there could be different kinds of ProZinc.

 

The reason we test, feed and shoot is that we want a "true" number, not influenced by food. As I said, many people shoot as the cat is eating. If you want, you can test and feed and wait awhile (but not more than 15 minutes or so) to be sure the food is staying down, not coming up. But the stomach doesn't have to have food on board beforehand as you do with Canninsulin. ProZinc is milder and much less likely to have a harsh, fast onset.

We find it varies with the cat. We suggest staying with the original dose for several days at least so the cat's body can adjust to the insulin and usually the food (as many people come here feeding dry, high carb foods). We suggest starting with one unit twice daily to start and then adjust upward, as and if needed, based on home testing numbers. But, we also don't suggest shooting under 200, especially at first. One of the advantages of ProZinc is it can be dosed in different ways. Some cats do well with a dose held for a week; some cats do well with a sliding scale with the dose changed depending on the levels; some cats who consistently have one higher preshot and one lower one do well with 11/13 or 13/11 dosing. We are big on that ECID thing - not assuming that one method works for every cat.

With a pet meter (usually AlphaTrak in this country) we consider 78 a time to start monitoring carefully and be ready to intervene. With a human meter (which many people here use) we consider below 50 a time to monitor and be ready to intervene. 40/45 is considering low with intervention necessary and ongoing and a possible visit to the vet.

 

Hi Sue @Sue and Oliver (GA)
'Prozinc' (as used in the US) is now available in the UK and, it seems, elsewhere in Europe! Good news, eh? This just happened last week (although it has been licensed for use in Europe for a couple of years now.)
So, I expect you will soon be seeing the first Europeans on Prozinc!

This is great news for European kitties!

Eliz

 

Thank you for the information!
We always tell people to test within 10 minutes after feeding. Some cats do not allow any hankypanky on their bodies until they have had something to eat, and we have found that hunger-stress can also slightly elevate the glucoselevel. So feeding first happens every now and then, but with testing straight away after the meal.

So we have the same stuff as in the USA? Do I understand correctly?

Is there a preferred feeding schedule for Prozinc? Or is ad lib eating advised?

 

We are struggling to make sense of the working of Prozinc. Today one cat seems to have the nadir at 14 hours after the shot (she gets one shot a day since one week). And maybe it will be lower still, because at this moment it is 14 hours after .... Every cat is unique, I know. But this unique?

And we find this part of the protocol really scary: "If the initial numbers are in the 200-300 range at preshot and midcycle (nadir) numbers are not too low (not 50 and under), increases can be made .25 units at a time"
Increasing when the nadir is just above 50? We consider 50 a hypo .... Could anyone explain why to increase the dose when the nadir is that low? Is the dose not based on the nadir? Is there no risk that the nadir will even be lower on an increase of the dose?

 

Still more questions, I am afraid.
Do you have a graph of an ideal prozinc-curve or are all the cats so different that an ideal curve does not exist?
Does the type of food (dry/wet) influence the timing of the nadir (this seems to be the case with caninsulin)? We feed low carb canned, but also low carb dry food (Porta 21 feline finest sensible adult without grain has about 11% carbs in the dry matter).

 

Again, it's that ECID thing. Some cats do well with two meals a day; some do better with small frequent meals.

Perhaps we need to rewrite the increase part of the protocol. What we meant was if the cat is 200-300 at preshot and is not dropping low at nadir, then we would consider an increase of 0.25. No, if the cat has a nadir of 50, the insulin would not be increased. It would likely be decreased. We base the dose on the preshot number in connection with the nadir. It would be unlikely that the curve would start at 250 preshot and drop to 50 for nadir. More likely that a 250 preshot would have a nadir in the 100s or higher, and then, if the owner wants to try to push the cat a little lower, and has been on the insulin awhile and can monitor, they might consider a small increase like 0.25

We sometimes think a ProZinc cycle is like a smile - starting from a preshot level, dropping to a lower level 5-7 hours after the shot and then back around the am preshot level in the pm. Of course, the kitties Do not realize this is what we are looking for and often don't cooperate.

 

What does ECID mean? I am not a native speaker of English, I am afraid....

Any thoughts on the cat with a nadir at 14 hours after the shot (posting #9)? She really doesn't cooperate on a nice cycle .....

 

'ECID' is short for 'Every Cat Is Different'.
.

 

So the lowest point is 14 hours after the shot? How long before the number is back up to the preshot level? The normal reaction to a long cycle is to reduce the dose, but that is REALLY a long cycle. @Elizabeth and Bertie - any ideas? Is this common for the UK version? I know it lasts longer than our ProZinc, but this seems like a really long cycle.

 

ProZinc dosing is normally done on 2-doses-per-day schedule, the injections given 12 hours apart. Without seeing that cat's recent blood glucose numbers in a spreadsheet, is hard to know what's really happening, although my guess would be that this cat would do much better at a lower dose given 12 hrs. apart rather than a single dose every 24 hours.

 

This is a link to the sheet .... She tested every half hour .... poor kitty ...
https://docs.google.com/spreadsheet...kYg1zpGzvc0l5o9Gw8KkZpbxw/edit#gid=2112851081
The owner went to bed after the +15 test, so she doesn't know when the level is up again. The only thing we can think of is a pancreas that decided to help ...
This is the same Prozinc as in the US, as far as I know, the one from Boehringer ingelheim, only recently on the market in Europe.
I would really appreciate your thoughts on this strange curve.

The owner has problems with giving doses 12 hours apart, due to work.

 

Jennie, @Nederland
That's a possibility.
Or it might be that the cat's blood glucose was dropping out of high numbers that had been caused by a 'bounce'/rebound. (When the blood glucose drops too low for the cat's comfort the liver can release stored glucose to raise the level, and also counter-regulatory hormones, the purpose of which is to keep the blood glucose high for a time. Sometimes cats will drop out of a bounce in the next insulin cycle, but in some cats it can take up to several days....)
.

 

Sue, as of last week 'your' Prozinc is available in the UK and Europe.
(So, now we have Prozinc (as in the US) and Hypurin PZI here.)
.

 

I know about the Somogyi rebound effect. We see that happen with caninsulin and suspect it could also happen with Prozinc. But that would mean the dose is too high ....
I have to think this through .... saturday she will make another day-curve.

 

I would not expect a next preshot level of 20.4 mmol again, if it was 'coming out of the Somogyi effect' yesterday.

 

@Nederland
Aha, yes I see, Jennie.... Hmmm....

I think there are quite a number of possibilities (and it could be that there is more than one thing going on at any one time...) Here are a few that spring to mind. And it may be that none of them are right!
It may be that the pancreas was doing some work, but it got tired and ran out of steam so the number rose again (or food was given and the pancreas couldn't cope with the increased blood glucose level from that.)
It may be that the cat was dropping out of a bounce, but the numbers swung up high because the pancreas couldn't hold them down (and there was no injected insulin in the system).
It may be that this morning's 20.4 is the bounce from yesterdays 'blue' numbers. This seems less likely, because it would mean that the cat is having a very long cycle on this insulin (although I guess it's not impossible).
...Incidentally, we have seen newly diagnosed cats 'bounce' on numbers around '10', even though these are no real threat to the cat. A bounce can be triggered just because the blood glucose drops lower than the cat has become accustomed to.
We see 'bouncing' a lot here, especially in newly diagnosed cats. But this is different to Somogyi (if indeed Somogyi even exists ) which, as I understand it, is more to do with chronic (and dangerous) overdosing.
Long story short, I don't know what has caused this unusual pattern, ha-ha!

I think this is one of those situations where more blood testing data is needed in order to work out what is going on....

Sue, who replied to your posts above, is very knowledgable about Prozinc. (I've not used it. I use a different PZI (Hypurin bovine)).

Hoping the mystery can be solved...

Eliz

 

I agree that more data might help. I will say this. When she does another curve, it really isn't necessary to test every half hour. We usually do a curve by testing every 2 hours. That way, we still get the data needed without poor kitty having to get quite so many sticks!

 

But concerning the 'personal life' issues: we all have or had to deal with that. That's no different for any owner of a diabetic cat. Life has to be rescheduled.

Now another thing, could Ruby start her own topic and can your moderator move the postings #23 to #37 to that new topic for Ruby and Baco? I really would like to keep this topic for general questions on the workings of Prozinc with an example of a real cat such as Baco every now and then.

 

Please be patient with the ProZinc forum. It is quite small and some of our more experienced people who can answer your question are working right now. Also, another one is not available for a while due to a personal issue. Carl and Libby are both familiar with ProZinc so I have tagged them and hopefully they can weigh in to help you.

 

There is a time difference, I know. You sleep when we are awake. So I will wait. I'm not really in a hurry, I do not have a specific cat that needs help. But we really want to learn as much as possible of ProZinc, as we already have 4 (!) cats on our forum using this. One of them Baco, then another Baco (by coincidence), Freek, and one tiny cat of 4.5 lbs that had only one shot of 0.6 IE Prozinc and went hypo and hasn't had insulin since.... miraculously cured? Or misdiagnosed?
Anyway, I will be patient.

 

Thank you! I have my topic back and Ruby has her own.

 

You're welcome!

 

So glad we have that all straightened around, Jennie @Nederland. It was becoming a little confusing; I apologize for any part I played in helping to confuse or move the dialogue away from your main focus regarding ProZinc use overall. (I think that started with the first reference to a specific cat & posting of the link to Baco's SS - but no problem! And I see there's a separate thread for Baco now. (Thanks, Jill!)

Jennie, I would suggest that you let members of your local forum know that we're always happy to help as best we can with individual diabetic cats But that each person should start a thread specific to his/ her own diabetic cat, as "every cat is different (ECID)."

One thing more to tell your forum participants: For general health/diabetes questions - as well as emergency situations (meaning it may not even be related to a specific type of insulin, such as ProZinc) it is a good idea to also post a thread in our Main Health forum - as that will help ensure that as many "eyes" as possible (including our members in other places, (such as the U.K., Spain, Australia, etc.) will see that particular thread and respond quickly.

We're all happy you've "landed" here - so again: Welcome to FDMB!

 

It is not all that unusual for a cat to spike much, much higher blood glucose numbers in the veterinary clinic than the cat would when tested in-home by the owner, where the cat feels more comfortable and secure. Unfortunately, when vets do not take "stress hyperglycemia" into consideration when determining the starting dose for a cat, it can turn out that the dose was much too high! We have seen this happen time and time again ...

That is why, when a cat has uncomplicated diabetes (no other serious medical complications, such as ketones or CDK, pancreatitis, etc.), we'd rather see cats who are put on ProZinc started at a lower dose - because you can always increase the dose later. This, of course, requires that the cat owner is willing to monitor blood glucose regularly at home, including the all-important pre-shot test.

Ha, you might be surprised at the # of times someone who would otherwise normally be sleeping over here in the U.S., is up in the middle of the night - testing his or her cat!

 

Our forum does not differ very much from yours in that aspect. We have a 911 subforum for emergency situations, and very experienced advisors on lantus and caninsulin. They know everything there is to know on the working of those insulins and on feline diabetes, and all the problems that can come with it. But we are new on ProZinc, just as our vets (which is one reason that I have a hard time believing the statement of the vet of Baco, that she has more than one cat on a once a day dose and it is working very fine on those cats .....). There are several stories circulating on prozinc, some we know to be untrue ('it works in the same way as lantus'), some we just don't know (it works for 14 hours, 18 hours ...., many hypo's, aiming at a nadir of around 180 to stay safe ...). That's the reason I started looking for more info from experienced users.
But we will certainly tell the Prozinc-users of this forum, and to make their own topic (and not use mine .....) if they want to. We do however not want to loose those members, because how can we learn and gain experience if we don't see them anymore? And there is the time difference .... emergency situations need to be dealt with immediately, and during our waking hours there is always someone online to give first aid on our forum (usually: feed, test, feed more, test again... go to vet NOW). And the language of course.

I know I started the detour with that specific cat ... I'm to blame too. But sometimes a certain question needs an illustration to make it more clear ...

 

We know about the vets, the stress testing etc., too high doses because of that. I suppose it is the same all over the world. We see that time and time again, and urge our new members to start home testing. But the most difficult part is the job is: getting them to trust us and make them realize that the vet has insufficient knowledge of the treatment of diabetes. "the vet knows everything, I trust him, he always helped so well, he studied at uni". Vets reacting with: 'don't believe everything you read on internet', when they tell about the forum that contradicts the vet.

 

Yes, Jennie - we can all relate to that! We often tell FDMB members (because it's generally true) that vets get about only one hour's worth of training in veterinary school (here in the U.S. anyway) about diabetes in felines. I think there's much more than an hour's worth of good reading material in the FDMB's
yellow "stickies" (at the top of each forum) on the subject.

As you well know, the learning curve can be steep for newcomers. (I know it was for me, and even though I've been dealing with this for a few years now, there's always something new yet to learn.) And is sometimes hard for newcomers to accept the realization that effectively treating diabetes in a cat requires a considerable time commitment - and when a less-educated vet tells them that dosing ProZinc once a day is "just fine" - well, who wouldn't rather believe that's true? As doing otherwise can require some serious adjustments to one's way of life - at least temporarily - and in some cases (heavy &/or unusually long work schedules, etc.) it may feel virtually impossible to someone with a newly diagnosed cat.

Oh, please know that I was not in any way suggesting that your forum members "switch over" to FDMB. Rather, it's that we are simply happy to offer the hand of friendship & support - if and when needed - to all, worldwide, who are trying to learn the steps in the "sugar dance" that is what we all do when treating feline diabetes.

 

I know you advise canned or raw food only. Are there any cats on Prozinc that eat dry food on this forum, that you know? We are wondering if the type of food (dry/wet) may lead to another timing of the nadir.

For the european members we have a suggestion if your cat will not eat canned food, whatever you try. Porta21 feline finest sensible adult, without grain (green bag) has only about 11% carbs in the dry matter and it is very affordable. The carbs are too high, I know, but the best choice if the kitty won't eat canned food and if ziwipeaks is too expensive .... For sale at zooplus, the online shop.

 

We are very glad with your help. We are all in it together.
Our vets have a little more training in diabetes, appr. 8 hours in their second year. But I imagine they will have forgotten most of it after graduating 4 years later .... and then: when will they see the first cat with diabetes? And how many during their carreer? Some think a cat is a dog and test the nadir with caninsulin 6 hours after the shot ... with dangerous consequences.
And unfortunately, only some will admit they have limited knowledge and are happy there is a forum with knowledge and loads of experience.

 

There are some who have cats who refuse to eat anything but dry. But yes, you are correct that we generally advise against it and strongly encourage the owner of a diabetic cat to try everything possible to get their cat on low-carb canned, homemade wet food or raw-food rations. There is an excellent article by veterinarian Dr. Lisa Pierson on her website (catinfo.org) about the importance of getting a "dry-food addict" accustomed to eating the low-carb wet foods. I have attached it in .pdf format below.

 

The dry foods that some of our people use for that kitties that are lower carb are Young Again (only available online) and EVO. All the others are just to high in carbs but if you have a dry food addict, what are you going to do if they won't eat wet? You feed them the dry and make sure it is the lowest in carbs you can find.

About the vets and their training on FD or lack of, it's nice to know that another part of the world realizes this too. If I had listened to my vet my cat would probably be dead due to hypo events. He did not want to teach me to test...........

 

We had one vet that didn't allow the owner to shoot the insulin. She had to go to the vet twice a day (once for testing on the wrong moment, the other time for the once a day shot of caninsulin). The cat didn't response well enough, the dose was in no time up to 8 units, still no reaction (insulin resistence due to an overdose, I know, the vet didn't). Then the vet wanted to try once more: 16 units .... She found us in time, found another vet, the cat was saved and is in remission now. This was the worst case of ignorance I have witnessed on our forum.

Young again and EVO are not available in our country, I think. I will look into it.

 

Hi Again - I have a kitty with triaditis - chronic pancreatitis, IBD, and liver involvement - feeding him is a roller coaster He is on about 50% dry food and 50% wet on a good day -many other days he eats 75% dry. there are actually two other dry foods that are lower carbs and do not affect his blood sugars than are mentioned above - they are (in addition to Young Again and Evo) Epigen 90 made by a company called Wysong and a semi-moist food made by a company called waggers www.waggers.com-- of these foods, Evo probably has the worst effect on Murphy's blood sugars - I am not sure these dry foods change when the nadir happens (Murphy's nadir can be anywhere from 3-7 hours but usually about 5 hours), but it could I suppose. In any case, I don't really notice that they make a difference for Murphy. The Epigen 90 said that they are about 5% carbs (not sure that is true) and Waggers is less than 12%.

 

Thank you, Carol, for the information. I will look at Murphy's sheet later today.
And I will look into that dry food, too. Maybe some of it is available in The Netherlands.

 

Another question, I'm afraid.
What protocol for ProZinc is used by vets in the US?
Do they advise preshot home testing twice a day? Or do they tell the owners to shoot a certain amount twice a day and "come back next week so I (the vet) can test the glucose 6 hours after the shot"?

 

There isn't really a protocol that I know that vets use. I think they just kind of play it by ear. We've developed one (I'll try to find it and link it in a bit) here on the forum. My vet told me about home testing but didn't push it. That could be because I was sobbing in her office though

My vet suggested home testing before every shot with a human meter. She showed me how to get blood when I came in later. As I said, she didn't push it. But when I brought my SS in, she said I was doing exactly what she would be in testing and dosing. She basically let me do what I wanted and didn't advise unless I asked since I had it. Other vets have either not mentioned home testing or actively discouraged it. Some suggest just testing once a day. Some several times. Some recommend a pet meter, some a human meter. Some want a curve at the vet's office, some don't care. Basically...it varies.

I don't know how long ProZinc has been available here, but vets don't have much info it seems. I was super lucky in my vet choice. I didn't realize how much until I found this place!

Please do keep asking questions! I've been super busy at work, but I will certainly check in when I can. I admit, I go straight for the dosing questions when I'm here to make sure everyone is getting what they need. But I will make it a point to check your thread after that to answer any questions I can if others haven't gotten to them yet!

 

Here's our protocol! http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/

 

Thank you, Rachel. I know, dosing questions have priority and usually more urgency.

The vets in our country are basically the same, except for one thing: I have never heard of a vet that advised preshot testing before every shot (not even for lantus). Some advise hometesting after deciding on the dose after several tests in the vet's office (I know, stress levels....). But many ask the owner to come back once in three months (!) to have the glucose checked.

Apparently the manufacturer has no other (better) instructions for the vets in the US than for vets in The Netherlands. I was hopeful ... hope crushed ....

 

I'm sorry! I will say this. A lot of folks go to their vet with our protocol and the vet backs it. Some go in with just information...just share what they know and the vets back it. I think the truth is that most vets just don't know enough about FD. Since vets have to know about different diseases in different animals, it just isn't that surprising. Some vets have even come to this forum and started recommending it to their patients.

 

Our vets are not so easy to back what the forum does .... 'don't believe everything you read on the internet', and an enormous ego-problem in other cases. There are a few however who are happy with the forum, some follow 'their' cats by checking the sheet.

 

Unfortunately vets have to be knowledgable on many illnesses and for many species, from cats to snakes and beyond! The info we have gotten is that they get a short workshop on feline diabetes and a presentation on food from Purina (who has some of the worst high carb foods). Only if they delve further into the subject do they get better info. There is a US vet who feels strongly about a low carb wet diet and home testing and has been vocal. She has a website (www.catinfo.org) which is full of vital information.

Many vets send home people with food (from Purina) and insulin and needles. We think that may be because they feel if the overload people, the cat will be euthanized. Many people come here, start a spreadsheet, start testing, change the food and when they go back to the vet, the vet is amazed and supportive. (Mine was). But many are threatened by someone who has taken their cat's care in their own hands and are not supportive. As more and more vets start to understand the relationship between food and insulin, and the value of testing at home, we are seeing more vets who are FD friendly and support that protocol from day one.

 

My current vet lies in between the best and the worst. I was strongly encouraged to test before shooting from the beginning and was basically called out on not testing a couple of times during my first week. But now that I have more knowledge and am asking more complex questions from my vet I'm getting absolutely nothing. I supplied them with just a few readings a couple of weeks ago and a specific question and got no response back. On my third time trying to get an answer I called and basically asked if I should send them any continuing info. They said yes we put that in your file. Which is nice I guess, but the vet still hasn't called back to discuss my concern. I'm planning on finding a new vet shortly. Them blowing hot and cold really is getting to me.

 

My vet immediately wanted me to do home testing - not before every shot though and my vet basically thinks I test too much. I think many vets want the cats to be in the 100s- 250 blood sugar ranges (sorry I can't convert that to mmoles) Almost every vet people have posted about recommends increasing doses in 1 unit increments instead of .25 or 0.5 units

 

Divide by 18 and that is the approximate number in mmol .... (it's actually divide by 18.082....)
Around 100 is okay, but 250 ...
I think the manufacturer advises increases with 1 unit at a time (at least, for caninsulin). We also never advise that. Based on the nadir mostly 0.25, sometimes (if really high) 0.5. Caninsulin. No experience yet with Prozinc, but increases with all insulins should be done carefully and slowly. With a couple of days to see what the ultimate effect is before thinking of a higher dose (of course, lower doses are another story).
We usually do not ask the vet for advice anymore on the treatment of diabetes. Just mentioning every now and then how he is doing, the dose, the nadir level. We don't need the advice of a vet, when the forum advises with far more knowledge than a vet could ever dream of having. But for all other problems of course, we do need him/her.
We consider a vet 'good' for diabetes, if he admits that he lacks knowledge and accepts that the forum advises and not he .... A vet is excellent if he actually knows about the treatment of diabetes. Unfortunately, they are needles in a haystack ...

 

that is exactly how the Prozinc advice goes on upping the dose (increments of 0.25 or if very high 0.5 units) --and usually lowering the dose as well unless it is clear the dose is way too high I don't know if Caninulin is a U-40 or U-100 insulin Prozinc is U-40 of course, so people usually start with the U-40 syringes (with half unit markings if possible) After a while, many switch to the half unit U-100 syirnges using the conversion chart to allow for more precise dosing (my vet recommended switching to U-100 syringes)

 

We use U40 for caninsulin and Prozinc, both U40 insulins. Needles divided in half units.
We advise against switching to U100 needles, because mistakes are easily made. Vets that forget that they gave u100 needles the last time and give U40 the next time ... owners that have trouble recalculating the units, miscommunication on the forum, etc. But I see your point.

 

Stupid question, probably, but OTJ .... what is it short for (I know it means remission, honeymoon, but the abbreviation ... ????)

Another, more intelligent question, is about the not shooting at levels below 200 with newbies.
You say, it is because you don't have enough tests to know what the insulin does and the reaction of that specific cat is (ECID, I know that one now). But what could happen that requires not to have shot at all? A continuing curve downward? I can't imagine. Have there been any cats for whom the decision not to shoot was the right one, when you later knew about the reaction of that cat after more tests? Why not shoot e.g. a quarter of the normal dose, when the level of a new kitty is still going down? Is that unsafe, especially considering the cat will eat at shooting time? The cat's levels will rise again, won't they?
I can understand not shooting at a level of 130 or lower at shooting time, but above that level I would be inclined to shoot a quarter of the normal dose .... or at least a bit.

 

Haha not stupid at all! It means off the juice (insulin).

Hmmm...offhand I can't give you a specific cat that it was the right decision for. I know it has been, just can't remember off the top of my head since we've had lots of cats through here! The reasoning is that if the cat is in low numbers and still dropping, adding more insulin will overlap. So the dose might cause the cat to drop to hypo levels. While the insulin is supposed to last only 12 hours sometimes it lasts longer. Sometimes the pancreas are helping out.

Over time, as we know what the cat's reaction i s, we give insulin at lower levels, though I would never give anything at 130. That's too close to normal ranges. Often, as we get more and more data, we do give a lowered dose at lower levels to be sure that we keep the cat in good ranges. But until we know for sure that your cat won't drop 200 points at a certain dose, it's just too risky. You learn how the cat reacts at specific doses and can decide what a safe dose is for a lower preshot level. Does that make sense?

 

Yes, it does. Although ...
I know there would be an overlap, but I thought to have understood that Prozinc starts to work about 3 hours after the shot. So if the drop still continues, wouldn't it have stopped by the time the new shot takes effect? Or am I wrong in thinking that Prozinc takes such a long time to start working?

We usually give one drop (of caninsulin) when at 130. But at 200, we usually would give about 0.5 unit. At 170 o.25 unit. Approximately, depending on the cat. Saying that, we would know the cat if we did that. A new cat, I don't know. I'll ask our expert on caninsulin.

 

Well, it's not really that the insulin starts working at +3...just that any food on board shouldn't be affecting the BG anymore. The insulin starts working right away I think (could be wrong). It's just that BG values are affected for 2 hours by food.

Either way, the thinking is that we want to be sure that it doesn't keep dropping. Sure, by +3 we would expect the drop to have stopped. But can we be sure? Not really. Especially as the cat tends to go towards remission, the insulin can stay on board longer. Plus, if the pancreas have started helping out, we have no way of knowing what will happen. The cat could be producing some insulin on it's own and then we add more....it's risky.

I do understand what you are saying Jennie. Our thinking is first of all ECID. For example, one cat could drop 100 points on 1 unit of insulin. Another cat could need 4 units to drop 100 points. Until you know with some certainty what effect a dose will have, it's more risky.

Say a cat is at 130 preshot. This cat has only been on insulin for a few days. The owner sees the 130 and shoots half the dose figuring that will work. But since they've never shot that dose before, we don't know what could happen. It could be enough to drop the cat 100 points, resulting in a hypo. If this cat had had half a dose before, we could at least predict how they might react.

It would be interesting to see what you would do on caninsulin.

 

I just got a reply. A new cat that has a level of 200 preshot would get a dose of 0.25 caninsulin at the max, depending what he eats.
New cats usually are still on the prescription high carb kibble, so that keeps the level from dropping further, and the 0.25 unit would help fight against the effect of the food. If the cat were on low carb, and the numbers would be falling, I think mostly one drop. No cat goes hypo on 1 drop (that's insulin up to the line of zero units on the syringe).

Another question came up. We know that with caninsulin a higher dose can take up to two weeks to show its ultimate effect. That means that the level at nadir can become lower each day during two weeks (max), using the same higher dose. So we wait at least 5 days (unless really high levels, then 3 days), looking at the pattern, before advising a new adjustment.
How is that with Prozinc?

Before I forget, thank you very much for all the help and answers. We really appreciate that.

And I think another of 'our' cats has signed up, also a Baco ... It is a very uncommon name in our country, it was really strange to get two new cats with that name within one week.

 

The Baco's are taking over Jennie

 

Generally we say 3 to 6 cycles. So anywhere from a day and a half to 3 days. However it also is an ECID thing. Some cats need longer to settle into a dose. Some cats have a sliding scale that changes depending on each preshot.

I guess I'd say 3 to 6 cycles at first. Change the dose as needed (preferably on a cycle you can monitor). As you get more data you'll get a better idea of of your cat needs more or less time on a dose...and if needed a sliding scale can be worked up.

 

Of course, going back to the question of the no shot under 200, caninsulin does not have the problem of overlap. So I can imagine being more careful if there is an overlap.

 

previoushttp://www.felinediabetes.com/FDMB/...now-available-in-the-uk-13-april-2016.156164/
We have two types of ProZinc in the UK and it looks it is the same in the rest of Europe as new ProZinc had been now licenced for use in cats.
I have posted that information in the above post but it largely went unnoticed (only Eliz acknowledged that information). So now we have two types of ProZinc:
1. human recombinant U40
2. Hypurin 100 % bovine U100.
Both widely available in Europe. Hypurin not available anywhere outside Europe.
They are rather different insulins so we always should make a distinction which one we're talking about but on this forum we mostly talk about ProZinc U40 as Hypurin is rarely used (only 3 people have experience with it).
Marlena

 

We have the first type.
In The Netherlands only Caninsulin was registered for pet use, now Prozinc (human recombitant) has been added for cats. Lantus was only prescribed if owners requested it and the vet agreed to prescribe something not registered for animal use ...
I doubt if Hypurin may be called Prozinc, because Prozinc is a product name of Boehringer something ... (forgot the name of the manufacturer). But both are probably one of the PZI-insulins (protamine zinc based).

 

Yes, Hypurin is protamine zinc (PZI) and is British made by Wockhardt so I think is available in Europe. It is a human insulin (licenced for use in humans) and long lasting like Lantus and Levemir and can be prescribed for cats if Caninsulin does not provide good results.
Hypurin is unique as it is most similar insulin to cat's own insulin - only one amino acid difference as opposed to human or pork insulins which are three amino acids away so probably more bioactive for cats.

 

You don't know how extremely squeamish vets in The Netherlands are about prescribing anything else than the registered insulins for cats (Caninsulin, Prozinc). Lantus is a real problem for most of them, let alone another one ....
It would be great however if it were available for cats .... but then, no one with any experience on it, and even the lantus prescribing vets think lantus works exactly the same as caninsulin .... They don't have a clue about the difference between insulins with peaks and with a depot.

 

Another question, I'm afraid. We have one cat, Bitsie, 4.5 lbs, who had 0.6 unit of Prozinc and went hypo on that. The owner stopped shooting prozinc after that and is regularly testing her to get a good look at how she does. She has been 1 month without insulin, and her levels vary from appr. 150 to 240. Definitely most of the time too high, but what would you do in such a case? We are afraid that doing nothing would result in a downgoing line for her health. But shooting insulin .... At het moment she is stable, and still varying around the 180 - 200, sometimes lower and sometimes higher.

 

Yes, you're correct - her #s are still too high overall.

We would most likely recommend that she use U100 syringes marked on the half-unit (left side of the syringe's barrel) with the conversion table - VERY important to use - so that she could start once again with the ProZinc at what is, on the U100 syringe, just a little less than what would register as 0.25U on the U40 syringe. And, of course, she would still need to monitor her cat's BG#s to make sure that kitty doesn't drop too low. I have attached the conversion table in .pdf format below.

 

That's really difficult then.
There are studies done on these insulins and more articles appearing in veterinary journals so it is just a matter of finding literature and suggest that owners of diabetic cats take the print outs to the vets.
There are also veterinary clinics doing studies with various insulins and vets who are not up to date on FD could contact them for advice. One of these clinics is:
Diabetic Remission Clinic, Royal Veterinary College

Hatfield
Hertfordshire
AL9 7TA
United Kingdom

 

Is she on an all wet low carb diet (8-10% carbs) That might tip the scale downward. Also we think small frequent meals help the pancreas.

Robin's U100 idea lets you dose amounts down to 0.1, which can be very helpful.

We generally say a cat is in remission if they range from 40-120 off insulin for 2 weeks (measured on a human meter) Bitsie is a little high and yes, the risk is that her pancreas will not have a chance to heal and she will eventually go higher. Another idea is to give a drop of insulin. So you put water in a syringe, measuring the amount you can see most clearly - say 0.5. Let the water out by drops, counting. If you count 7 drops in your measure, then the next time draw up insulin to your level and let out the drops save one.

 

Thank you again, I have given the message to the owner. It's up to him now to decide.

Another question:
With caninsulin the insulin dose is always lowered by at least 1/3 of the original dose after a hypo, even if preshot tests show a high level (because that is usually caused by the reaction of the body on the hypo, stress hormones). We keep that low dose for about 5 days, then start upping the dose again if necessary (of course with regular testing). By that time the stress hormones are gone and the body's sensitivity for insulin has normalised.

What's to be done with Prozinc after a hypo? The dose must be lower, but how much? How long to shoot that lower dose? Are there any guidelines? The general rule of thumb in the sticky 'how to treat hypo's' is a little vague on that ....

 

I don't know that we have a definitive answer for that one. It depends on what the owner was shooting before, how low the hypo went, etc. Generally, I just check the SS, see what other doses have been doing for them, etc. Like if they were slowly increasing and went hypo on an increase, I might suggest they just drop back to the last dose or 0.25 lower than that maybe. If they were shooting 6 units and had never been home testing, had never seen how low they went, I'd probably at least suggest they halve the dose. Possibly more.

Really, we don't see a ton o f hypos here (anti jinx). Or at least...I don't. They happen sometimes, but often they are just close to hypo and steering with food works. So it's hard to tell you for sure.

Anyone else have any ideas?

 

Jennie, have you tried this dry food? Just wondering what your thoughts are on this one (Power Of Nature grain-free)....
http://www.cats-country.de/en/for-Cats/Cat-dry-food/Golden-Years/Natural-Cat-Fees-Favorite-2Kg

Eliz

 

Yes, we have. It's really good, but the costs of getting it to the Netherlands from Germany (even though we are neighbours) are very high. And my cat wouldn't eat it ... We are hoping a dutch retailer or webshop will start selling it some time soon.

 

Ooh, yes, just seen that it's 11 euros to post to the UK too....

Ouch!!!
.

 

I donated the stuff to a member that worked in Healthcare and had such working schedules that shooting insuline could not be managed every 12 hours apart, or even 10 or 11 . Her cat was mildly diabetic, and ate this food for about a year. then he passed away (I think of untreated diabetes, but well, the owner did what she could.
How do people on this forum with such job manage?

 

Which cat is well regulated on ProZinc? I would like to see the sheet of such a cat to get an impression to what we should ultimately aim at.

 

We are trying to find the difference between Somogyi and bouncing, or to find that it's the same thing.
Somogyi is not the effect of chronic overdosing, it's the effect after a sudden drop in the level. Mostly to a dangerously low level, but that doesn't necessarily be the case. The cause is usually an overdose. The drop is fast and the rise is also fast, back to a high level after which the level stays high for a certain amount of time. The drop and rise look like a V in the curve.
Does a bounce look the same?

 

It might be helpful for you to look at the spreadsheets of cats in the Remission Thread (at the top of this page). Look at the last part of the thread to find the most recent cats with spreadsheets.

 

Ah, yes, we ultimately aim at remission, of course. Thank you, I'll have a look.

 

A 'bounce' doesn't necessarily create a V-shaped curve. That would require that the blood glucose drops very fast and then rises very fast, and that doesn't always happen.
A cat's blood glucose can 'bounce' if it drops too low and/or too fast.
So, even if a cat's blood glucose drops quite gently, if it drops to a level that the cat's body feels uncomfortable with it can still bounce.
Also, I've seen a number of situations where the cat has seemed to have a sort of 'delayed bounce'; where the blood glucose initially rose slowly (and it looked like a bounce might not occur) but then suddenly rose high, with those high numbers sometimes persisting for some time (up to several days).

'Somogyi' is a term that is rarely used on the forum at the moment. It seems to be a somewhat controversial term (and one which has caused confusion here...).
You may be interested to see this thread:
Somogyi and bounces

And also these posts:
What is the range for hypoglycemia?
Is this a Bounce?
8/29 Charlie AMPS 371 +2 439 +4 416 +6 427 +9 418 PMPS 380

Eliz

 

Thank you. I will have a look into those documents.
Well, opinions can always differ on Somogyi, I know there is doubt that it exists. But we do see it with caninsulin, so we are convinced it exists. It's immediate and it takes at least 3 days for the body to recover, and we see that, too. Levels going everywhere during that time. Sometimes it takes even 5 days to recover. The required action is to lessen the dose with at least 1/3 (assuming the cat was already regulated and on the right dose (up to that unfortunate moment). When the cat is starting to show a normal response again to insulin, and the low points remain too high, the process of carefully adjusting the dose starts again.
If the cat is new, or if the cat is relatively irregular on caninsulin, we ask the owner to check pre shots all the time during those days, and base the dose on the pre shot level (an individual gliding scale), taking into account that the body is extra sensitive to insulin during that period.

Maybe Somogyi doesn't happen that often with the milder working insulins? And as in the US caninsulin is seldom used, the forum here seldom sees it?

We see bounces with lantus, but we call those reaction levels. They happen when the dose is changed to higher or lower or when the timing between the shots is changed. It can take up to three days to show. Could be the dose is changed on day 1, and the reaction is on day 3. Or the owner was late for the shot on day 1, and the reaction is on day 3. So adjusting the dose to a higher dose is never done during the first 6 shots after the change (with lantus), otherwise you would start to see reaction upon reaction. We have a completely different protocol for Lantus (TR) than for Caninsulin.

 

Hmmm, I started to write a response, but had dinner in between and now my text is gone. I suppose I waited too long.

We actually see Somogyi's effect with caninsulin. The study mentioned in the first link was on lantus cats, we never see Somogyi with lantus. We do see bounces with lantus. We respond differently in both occasions.
The bounce at lantus occurs after a change in dose, or when the timing of the shot was changed, or any change. It can take up to 3 days to show, so after such a change the dose is never increased the first 6 shots after the occurence. It's lowered when needed of course. The reaction is never long, sometimes only 1 preshot level, sometimes 2.
Somogyi's with caninsulin is immediate, a sharp V, and it takes the body to recover from the stress dump of glucose for at least 3 days (sometimes up to 5 days). In that period the levels can be irratic, and with caninsulin it means you have to take great care. When the cat was well regulated, the dose is lowered by at least 1/3 of the former dose. We ask the owners to take preshot levels and some do. Levels preshot can vary from very high to very low. If they do take preshot tests, and the levels are awkward, a gliding scale is made and temporarily the dose is based on preshot levels, but never more than 2/3 of the former dose. When the pattern becomes normal again, a new dose will have to be determined, very carefully, as always. Some cats stay irratic and the dose will remain based on preshots and we will advise them to switch to lantus.

 

I have been watching this thread for a few days now and want to say thank you for getting all this info out there! Cooter started ProZinc Thursday evening and I needed all the info here to help me along I do have a question though.... I know the nadir on Prozinc is usually 5-7 hours after the injection, but how often have any of you seen early nadirs? Cooter seems to be at his lowest point at 3-4 hours. I have been giving him a little LC around +4, but only because he honestly appears hungry at that point, and i dont want him losing any weight since he dropped alot the last month and a half. His low point on the vetsulin was the same timing, could it just be his metabolism acting the same on both insulins?

 

Sarah,

I am afraid you will get lost at the end of this thread. I started you a new thread called Sarah and Cooter and will comment on it. It is here:

http://www.felinediabetes.com/FDMB/threads/sarah-and-cooter.157142/