Switching from vetsulin to prozinc dosage

Our Mainecoon, Kandi, is now diabetic. Our vet is using fructosamine as the indicator for dosage. His current number is 454. We are giving 8 units vetsulin and now changing to prozinc. Our vet wants to stay with 8 units twice daily. Is that wise? We do no home testing but do know he had a 188 glucose 3 hours after his vetsulin. We do feed him throughout the day and will be starting Hills md food. We we were using fancy feast pate and calculating values but his weight increased to 22.6 pounds. He has lost .3 pounds since we went to purina ur and decreased amounts.

Sorry for the back story but the main question is it okay to stay with 8 units of prozinc since we know he was 188 three hours in to his vetsulin or should we start lower?

He may cushing's but we quit treating it.

 

Typically, you would need to post in Intro to the Forum and then in Main Health.

We can’t give dosing advice without a spreadsheet. Using fructosamine to determine dose is dangerous especially with a harsh insulin like Vetsulin. Even knowing one number is not considered enough to give solid dosing advice.

As an example, if you had been doing a lot of hometesting and over many cycles, only saw one blue number, 8u “might” be ok. However, it’s possible she’s been getting a lot lower and would need less insulin.

My suggestion is that you start hometesting before you switch her, do a spreadsheet, and post in the main health forum daily for advice. With about 6-8 cycles (3-4 days) of data where you have the preshot every cycle and 1-2 other tests during the cycle, we can offer much more help.

I’m going to move this thread to the Main Health forum for more eyes since this forum here is for current PZ users.

I hope you’ll be back with questions. If you hit “reply” to this message, I’ll get an alert that you have additional questions.

Thank you and we’d certainly like to help. We have a lot of experience here (with Cushing’s cats as well).

 

Thank you

 

You’re welcome.

 

When was he diagnosed, how long has he been on 8u, and how were the increases done (e.g. Raised by 1u increments every week).

 

He was diagnosed in Mar, 2019. He started on 2 units. He got chemistry panels with >400 glucose. We increased to 4 units. We continued this moving to fructosamine tests. We increased 2 units at a time for the most part. His insulin resistance seems pretty strong. We just received blood and urine results. The blood glucose was 175 but he had 3+ urine glucose. This tells me he is constantly running high. If I am wrong, please correct.

His kidney numbers are normal. He has been on 8 units about 2 weeks. We were on 7 units before that. He was on his dose for a while before we increased (2,4,6,7,8). Each dose was much longer than one week, some for months.

This is the whole reason of trying a new insulin and Hill's md food. Using frisky pate didn't work on him. Hopefully, this will. He is fed independent of the others.

I understand home testing but we have 12 cats and that is the straw on the camel's back for my wife.

 

We raise doses by 0.25u at a time unless numbers are consistently over 300 for six cycles and then we raise by 0.5u or if the cat’s dose gets to 5u bid. Then we raise by about 10% of the current dose. So while the 2u “might” have been an appropriate starting dose for his size, raising by 2u each time was aggressive without knowing if that’s what he needed.

There is always a delay in the amount of glucose in urine from the blood glucose. Cats have variation for when they will spill glucose into the urine which we call “renal threshold”. Generally, most sources will say the renal threshold is at a BG of 250 on lab equipment. Several of us have monitored that and found that renal threshold might be as low as 150 on human glucometers. i know that’s kind of comparing apples to oranges but from all the comparisons I’ve seen between human and pet meters, 150 on a human meter would not be 250 or higher on lab equipment.

What that means is that Kandi could be doing what we call “bouncing” meaning his numbers go lower, his liver reacts by dumping hormones into his system which bring the BG up; he spills glucose into his urine. He drops again. This is a common phenomenon in cats and is normal. However, it’s critical to find out how low the dose is going that causes bouncing. Sometimes it’s really low (as in dangerously low) and other times it’s just lower than what the cat is normally used to (e.g. if his liver is “used to” 400s, lower could be low 200s or high 100s). Keep in mind that you cannot determine how low a BG is going by watching a cat. There were occasions when I tested my kitty and she was at 25 on a human meter and had absolutely no symptoms of hypoglycemia. That means just because you haven’t seen any symptoms doesn’t mean that he hasn’t been low.

In addiiton, on this board, if we have a cat whose insulin has slowly and consistently been raised, once they get to 6u bid, we suggest strongly to the caregiver that they have them tested for high dose conditions like acromegaly and IAA. One of our members, another moderator, is the best versed I have come across in 9.5 years on high dose conditions. Has your vet even suggested testing for high dose conditions?

I understand your wife doesn’t want to hometest, but without that, we are not able to help you and I hate to say that but we won’t sacrifice your cat’s safety. We are not veterinarians and while we are very, very good (better than the majority of vets) at helping members get their cats well-regulated and many into remission, none of us can give you any kind of dosing advice without hometests. We can teach you to hometest; again, before I made any changes in insulin, I would get the spreadsheet up and running, get a human meter, corresponding strips, lancets, and start home testing. Once you have a little data on Vetsulin, then you’ll have a better idea what dose to use for PZ.

One other thing: we don’t suggest feeding Prescription foods and especially Prescription diabetes foods. I don’t know what you mean by “frisky pate” didn’t work for him. Dr. Lisa Pierson is a feline veterinary nutritionist who works with us on this site from time to time; she has developed food charts. She shows the Friskys pates as being what we would consider to be low carb and the Hills md as 13% calories from carbs which is a medium carb food. I will say that some cats do better with a food ranging in 6-10% calories from carbs. But I don’t know what didn’t work for Kandi with the Friskys pates. Can you be more specific?

 

Thank you for the information. We will manage him the best we can.

 

We are more than happy to help you and I’m certain we can figure out what is best for him regarding insulin and dosage. We just have to ask that you hometest. I hope we will see you again.

 

Hi again to you and Kandi,
I've just read through this thread and I am concerned at the way the insulin was increased. Increasing by 2 units at a time is,in my opinion, very risky. And Vetsulin is such a fast acting insulin.
When a cat drops very fast, or very low, or lower than what he is used to...they will bounce, which I see Marje has described to you above. If you are only getting fructosamine tests and urine glucose tests done, you will have no way of knowing how low or how high the blood glucose is going.

I know you said your wife couldn't manage home testing.....honestly we all felt like that in the beginning.....I felt like running away....but it really isn't hard to do and Kandi won't hate you ...In fact he will love you more!
I think testing will take a lot of the stress you are feeling out of the whole situation......it will give you the answers you are looking for, and you will know exactly what is happening and there will be no guesswork.

When I joined here, I was at my wits end....my vet didn't know what else to do and I certainly didn't.
I got amazing help and I was so relieved that there was a way through it....
There are some very experienced people here who will be able to help you.

I do hope you will continue to post.

 

I have to agree with what Marje posted. You are using an insulin that quite often drops numbers rapidly which can lead to low numbers and bouncing. Without knowing how your cat is responding to insulin, I likewise would not be comfortable offering guidance regarding dose. Home testing is the best way to keep Kandi safe and is recommended by many veterinary organizations (e.g., American Animal Hospital Assn).

 

Hi, Donouti!

I switched my cat from Vetsulin to ProZinc, it really is a much better (and safer) insulin for cats. Typically when switching from Vetsulin to ProZinc you would hold the dose amount, that said...8 units is an insane amount of insulin. Some cats need that much, but 99% of the time that's only for cats with additional problems such as acromegaly. Most people that come to the forum newly diagnosed are already on too high a dose thanks to our veterinarians so this is nothing new.

The people here hesitate to give direct dosing advice when we don't have our "lab results" so to speak - if we do not have the results from daily blood glucose testing then we really can't tell you whether 8 units is too much or not. It probably is. But to be absolutely sure (because Kandi's life could be in jeopardy) we ask for hometesting results. I waited two months before I got the nerve to home test, and by that point she was "constantly running high" much like Kandi is now. This is due to too much insulin, not too little. But we won't know for sure unless you/r wife are willing to take that step so we can help you and Kandi.

Think of it like standing in the dark asking us where the step is. You have a flashlight in your hand, but if you don't turn it on we can't help you. We wouldn't want to stay "step there" if we can't see the step itself!

We really hope you'll consider starting to hometest, it will definitely make Kandi feel better being monitored.

 

Hi there. My kitty started out on Caninsulin, which is the same as Vetsulin, but rebranded in the US. I think you will be much happier (and so will your cat) with the switch in insulin. I would be conservative in dosing, as we don’t know how Kandi is really doing on 8 units of Vetsulin. Some cats need that much, my girl did got to 5 units of Caninsulin but ultimately needed 8.75 units of Lantus. She had two endocrine conditions, acromegaly and insulin auto antibodies. But I got to 8.75 slowly and safely, knowing how low she was going on each previous dose. With treats after each home test, kitty soon comes running when you get out the test kit.