The Switch to Prozinc

Timmy is 11 years old and was dx in December 2016. We have been on the main board posting and getting help, thank you, @Kris & Teasel. He has been on Vetsulin at varying doses throughout that time. The extreme rising and dropping leaves him feeling really rough. He is very bouncy, which just makes matters worse trying to get his numbers lower. There have been a few times during our journey so far where he acts like his old self, before FD, but these are few and far between. Of course I want remission, but more so right now, I want him to start feeling better and acting more like Timmy more often. So fingers crossed...Prozinc here we come!!!!

I am going to start the Prozinc in the morning at 1 unit.

 

Welcome, Susan! This is a nice friendly group that you've joined with some experienced advisors to help you and Timmy.

 

Hi Susan, and welcome! Fingers crossed that Timmy will find the ride a little smoother over here in prozinc-land!

 

Hi Susan! Welcome to our little group! We're glad to have you and glad to answer any questions you may have!

 

He'll be fine with 1 u. You've lowered the dose to give a good margin of safety. After 3 cycles at 1 u you can go to 1.25 u, numbers permitting.

 

Thank you for the welcome. I just gave him his last dose of Vetsulin, so we are ready to begin in the morning. I'll admit I do feel uneasy not having the data to rely on with dosing, but baby steps getting that built back up with the Prozinc.

 

You have us, Susan!

 

Okay. Thank you. I was wondering about the 1 u not being enough, but slow is the way to go.

 

Thank goodness!!!! I would be so lost otherwise.

 

Yep, 1 unit is what I would give too! You'll get the data, and until then (and after then too!), you have the support of this group!

 

Good job starting on 1.0U! We're here to support you and Timmy Hope Prozinc helps Timmy start feeling better!

 

First day on Prozinc 1 unit. I'm freaking out a bit about his numbers today. His amps was 384 and he has steadily gone up every 2 hours. Now at +6 he is 504. His dose was not a fur shot, I'm sure of it. Is this normal?

 

Could just be due to the significant dose reduction and/or a new insulin. Two more 1 u doses and then increase. You could even increase next dose but it might be good to have this baseline data.

 

Ick. I'm so sorry you're getting those numbers! It just indicates that one unit is too low, which I think makes sense considering the previous dose on vetsulin. That being said, you're starting in the right place....you just don't want to hang out at that dose for very long. It's a process to get ramped up to an effective dose without missing something good along the way.

 

I agree with Kris that you can probably going fairly quickly through some of these low doses, but I would say to keep one unit tonight just so you have an AM and a PM cycle at the same dose. It will help to see if Timmy reacts differently during the different cycles. But I think you could up it in the morning.

 

Okay. Thank you. I am worried about ketones now. I'm going to stalk him to get a urine check today. I sure do hate these high numbers. My knee jerk reaction is to increase the dose tonight, but I don't know this insulin and how Timmy is going to react, so I will give the 1 unit again tonight and see how he does. He is hiding in my closet right now, which makes me feel horrible, but it is a process. Going back to the ketones for a second, I don't have any first hand knowledge, but keeping in mind ECID, could he develop them just from being high for this short time?

 

If he's eating well, is well hydrated and has no infection or inflammation going on he should be OK. Ketone testing is still a good idea.

 

He shouldn't develop ketones just from being high for a short time. He could, but it is usually the trifecta: not enough insulin, not eating, and an infection. Just test for ketones but don't worry about them too much.

 

Susan, I just saw the note on your spreadsheet, and I think you made the right decision. His numbers were really high today.

Prozinc does better on consistent dosing -- it's flexible, but not as flexible as vetsulin -- but if it was my kitty, I wouldn't want to see those mid-cycle numbers for too long either. You have a strong history of monitoring, so I would even say to go ahead and move to 1.5 tomorrow, but then really really hold that dose for a few cycles before the next move. If you keep going with that rate of change (every cycle) it will make Timmy start bouncing around and that doesn't feel any better than a few high cycles. So if you decide to go with 1.5 in the morning, please hold that for a few cycles after that to give his body time to adjust.

My limited understanding of vetsulin is that the response to the insulin is direct: what you dose in a cycle, responds in that cycle. With Prozinc we find that it can take a few cycles to really see how the cat will respond - sometimes it will seem like no response for the first few cycles, and then it starts to work. Other times there will be a response in the first cycle after a change, then a few flat cycles, and then some consistent drops for the nadir. That's why we recommend holding for 3-6 cycles because depending on the cat, it can take that long to really see whether a cycle is working or not.

Does that make sense at all? I'm not sure I explained that in any way that will make sense....

 

Yes, it does make sense. You explained it well. In all honesty I was actually thinking of 1.5 units for his a.m. dose depending on his numbers, but I wouldn't increase that much, that fast, without posting. I need to get those numbers down a bit so I can see what he is going to do at a dose and get a good feel for how the Prozinc works with him. I was a bit discouraged tonight with his numbers today and your response came at the perfect time. Thank you so much.

 

Since he's in somewhat higher numbers, you can increase every 3 cycles, rather than every 6 also. We usually hold 6 cycles, but when you have higher numbers we say you can go up a little faster to try to get them down.

 

Hi Susan! Assuming Timmy's numbers today are typical, are you thinking to go to 1.75u tonight? Will you be able to monitor?

 

I like the 1.75 u dose for tonight too.

 

I have been getting good data over the past two days. It may sound stupid, but I have been graphing it out to see the "gentle smile" curve, and I have seen it, just not in the lower numbers. His numbers increase and decrease so much gentler, I am so pleased. I will increase to 1.75, but I would like to do that with his a.m. dose. It will give me 4 cycles at 1.5 units so I will have that data and it wont be increasing the dose at night. If you think it would be better for Timmy for me to just increase it tonight, I will do that. Thank you so very much for the guidance.

 

I'm a fan of increasing in the AM too, Susan. That'll be fine. I think making a graph is a great idea!

 

Me too! I think the increase during the day is a great plan!

 

I think increasing in the morning is totally fine! And I love that you've graphed some of his cycles....I've done that a few times too! It's somehow comforting to see them visually like that!

 

Oh! I hadn't looked at your spreadsheet yet! Look at those yellows!!!!!! Hooray!

 

I know! I was so happy to see those yellows!!! It lets me know we're on the right track. We just need to keep this up and slowly get into some blues. I took a look at Sam's spreadsheet and it is beautiful with those blues and greens. Hopefully Timmy will get there too, but for now I am thrilled with with his yellows today.

 

You may already know this from your time on vetsulin, but tonight's high flat cycle is totally normal. That often happens after a kitty hits a new low number. Try not to let it discourage you from the great cycle this morning!

 

Timmy didn't have many flat cycles on Vetsulin, his numbers looked more like a heartbeat monitor, so these flat numbers are new to me. His numbers are kind of flat today as well and it doesn't look like we will hit yellows today. Does that mean we are still not at a high enough dose, or do we need to hold the dose while his body adjusts?

 

It means both of those things: hold the dose for three cycles to give him time to adjust, and also you are still at too low of a dose. Based on his vetsulin numbers, I think you still have a few increases to go before you start to get really good cycles. But if you just jump up to the high doses, he'll bounce around for a good while and that's hard on their little bodies. That's one of the reasons why we do the slow rise in doses, even though we know it's too low at this point - it's just gentler on them. You might get some better action tonight, or it might take a few more cycles. Depending on the cat, it's usually 3-6 cycles to see what the dose will really do. However, since the numbers are still as high as they are, three cycles is enough before you do the next increase. As you see lower nadir numbers, you'll need to slow that down a bit. So right now we just look at each increase, and then decide when to move on. So sort of a day by day decision.

So right now, I would say keep the 1.75 tonight and tomorrow morning, and then move to 2.0 tomorrow evening. However, if you prefer to do the increases during AM cycles, that's fine too. Just plan to increase for the Monday AM cycle instead.

And as always, if he starts dropping more than 50% from PS to nadir, then hold off on the increase and keep the dose a few extra cycles.

 

I see progress . I like Djamila's suggestion to hold this for 2-3 more cycles. Hopefully, Timmy will show you what the dose is doing before going to 2.0U but I think moving to 2.0U after 2-3 cycles will be OK too

 

Okay. That makes sense. I will keep gathering info at this dose and see about increasing with the Monday AM dose. Thank you.

 

Thanks for taking a look. I appreciate it.

 

The Monday AM increase is a good plan. You'll get there.

 

Slow and steady. I am getting used to the Prozinc. I still expect those huge drops that I had with the Vetsulin. His am and pm numbers are closer together, which is also surprising me. Over the last two days, even though he is at higher numbers, he is hanging out with the family more. Not a bad start if I do say so myself.

 

*paws crossed for a yellow today*

 

I'm so excited for you and Timmie. Keep up the good work Susan it's so great to see he's getting into some yellow numbers. He will be surfing in those blue waters before you know it.

 

Well now! Isn't that a nice little curve!

Brace yourself though -- that's the lowest he's been on prozinc, so you can pretty much bet on a bounce for the PMPS, or if not a bounce number, then at least a flat cycle tonight. It's so great to see that lovely drop for nadir today though!

 

!!!

 

Very nice curve! At least someone had good luck today . I'm going to counter Djamila's prediction . I don't see a reason for him to bounce for PMPS; he didn't drop more than 50% of AMPS. He got close, so we shall see

 

I feel this. My cat also had huge and sudden drops on Caninsulin/Vetsulin. She'd often drop more than 100 points lower within the span of an hour or two, only to shoot back up at +5, often just as dramatically. I'm still getting over some very real anxiety about lower than usual pre-shots because of this, though ProZinc is so different. Her cylces have been higher/flatter lately too. I am really grateful for these forums because after coming from Caninsulin, I don't think I'd know what to do with these numbers!

Just wanted to say you're definitely not alone in that experience. You got some good results though! Hope it keeps up for you and Timmy.

 

Notice I hedged and said bounce or high flat cycle.

And Susan, I saw your note on the spreadsheet, I think it's fine if you want to hold this dose a bit longer and give him some time to settle out at this dose.

 

We had a good run of numbers today. You were right in calling that bounce, but I was so hoping he wouldn't. Hopefully it won't last too long. So I will go ahead and hold the 1.75 units for another two cycles just so I can get a feel of how the numbers are going to go.

 

Nah, 401 is in line with your regular numbers, so not particularly bouncy. We'll have to wait until +4 to see if he's flat tonight, but you have a little drop already, so I might be wrong about both predictions. Sometimes it's so so good to be wrong!

 

Crossing the paws for a yellow worked, and as a bonus we got some blues! You can only use your power for good.

 

Thank you, Lisa.

 

I'm so glad you got Timmy on to ProZinc and came here! Don't worry - you'll figure it out!

 

Go Timmy! You had two really nice cycles yesterday!

 

I am too. It is a new learning curve, but best decision I've made.

 

I thought he was on a roll, but numbers today are ick. Tomorrow is a new day.

 

I'm just wondering if the increase to 2 units this morning was too fast, I am second guessing myself with the increase, I was going to hold the 1.75 units for another day or so. Do you think that is what is causing these icky pink numbers today?

 

Thank you for your encouragement. Those severe increases and decreases were hard on my nerves too. I'm glad you made the move as well. Now I just have to figure out, with help, what dose will bring Timmy down to better numbers.

 

Hmmm...could be a tiny bounce. Those are actually about the same as your normal preshots, but he did go low yesterday....and the high, flat cycle after is classic. If it is a bounce, though, I think it's just a very small one. Let's wait and see what he does tomorrow (I know, wait and see is never what you want to hear!).

 

Thank you for helping me understand what is happening. I will say that the flat cycles are interesting, I keep thinking something is wrong with my meter or test strip.

 

I agree with Rachel. Maury has been doing this for his day cycles.

 

Looks like we have multiple cats here coordinating their bounces... maybe they'll bounce themselves off that trampoline?!

Hopefully Timmy will come back down soon. At least there was an improvement in his PM +2 over his AM +2 (yikes!).

 

Timmy is lower than expected this morning at 286. I have stalled 30 minutes and he is now at 299. I am not sure how to dose him. When he was 325 a few days ago at 1.75 units he went into blue. I will stall for another 20 minutes.

 

After stalling for an hour he is at 306. @Kris & Teasel Should I stick with 2 units?

 

If you're home I'd give 2 u, Susan. The blues you had were high blues. If you'd seen green it might be a different story. What do you think? So nice to see a yellow PS!

ETA: Make sure you edit your SS to show the PS you shot at.

 

I'm not Kris, but I think you can stay at 2u safely. Your blues were still on the higher side.

 

Oops! There's Kris! Sorry for the double post!

 

Susan and I are acquainted from past discussions of Timmy's progress when he was on Vetsulin.

 

I always feel bad when I cross-post, but it is nice when the two posts say the same thing!

 

Thank you both. I couldn't tell who was on the board this morning. I will give the 2 units.

 

I panicked a bit this morning with the yellow preshot numbers. I stalled twice and he came up in slow motion. I was tempted to go to 1.75, but I didn't want to mess his progress up. He is a talker and he was quite unhappy with having to wait for his breakfast. I look at the other spreadsheets and it is so common to shoot at yellow and blue preshot numbers. That is such a foreign concept to me and I need to start training my brain for this.

 

You'll get there, Susan. Those of us using Lantus learn to shoot on green numbers! Hair-raising the first few times ...

 

The more you do it, the easier it becomes! Just remember that those blues and greens are where the healing can happen, so the more time he can spend there, the better.

 

Yikes! I panicked at a high yellow. The thought of shooting a blue makes me hyperventilate. Shooting a green... just stop.

 

He hasn't spent a lot of time at all at the healing blues or greens. Just by taking away the extreme increases and decreases have made him stop hiding, he is actually out with the family now, all the time. I can't wait to see how he will be as he gets lower and lower. Thank you for your guidance. I just appreciate it so much.

 

Timmy has been very busy with his numbers today. He dropped lower faster than I had anticipated at +3. I had to nudge up his numbers a bit with some LC food...twice. I'm not sure if I needed to do that with this insulin, but I didn't want it to get out of hand. I'm not sure if the dose needs changing.

So far though, Timmy has had 5 hours, albeit stressful for me, in those blue and green healing numbers we talked about this morning. That's so wonderful!

 

Wow! Go Timmy!!! I'm so sorry it was stressful, but that was a beautiful cycle!

Do you normally only feed him twice/day? Or does he usually get snacks?

 

He gets wet food with his am and pm shots and I leave YA Mature Zero out for him to graze on whenever. I pick up all food 2 hours before each shot time. He was grazing on the YA at +3, which I stopped him so I could steer him with the wet food instead.

Do you think I needed to steer him with the food? The way he was dropping, I was afraid not to steer him. I just don't have enough data to know what he will do right now. Also do you think the dose is okay for tonight?

 

Oh, so many thoughts about all of this! I'll try to keep from rambling too long...

You hit the nail on the head: there really isn't enough data to know yet if you needed to steer today or not. Also not enough to recommend a reduction (in my mind anyway).

It does look like his nadir is most likely closer to +4/5 than it is to +6/7, so he likely would have been fine on his own. Also, it sounds like he was self-steering, which Sam does too. It's so nice when our kitties help take care of themselves!

I think I would be inclined to hold the dose tonight. You're a pro at monitoring, and you know what to do if he does hit 50, so he'll be safe no matter what. Most likely, he'll stay a little higher tonight since this was a new low number for him. Since you usually monitor until +4 or later, you'll definitely know by then if he's going to need a boost or not.

One thing to remember is that 50 is the "take action" number, it's not the "your cat is in danger" number. So he still had some room to go before he was in any danger.

The benefit of you steering a bit was that when the drop is much over 50%, it is more likely to cause a bounce, so keeping him from dropping too much farther may ease the ups and downs for him a bit which I would imagine just feels better to the kitty. It doesn't look like he's all that prone to bouncing anyway, but it's nice to help them out when we can.

Okay, so that's my opinion, but if you would feel more comfortable with a lower dose for tonight, that's okay too. I wouldn't go too much lower though - maybe a skinny 2u or a fat 1.75u. His cycle today is really what you're aiming for, but I do understand if that's just too stressful for an evening cycle. Sleep is important, and keeping your sanity through all of this is important too!

 

What a lovely cycle you had today!

 

Agreed! Lovely numbers today.

 

I need to test in 15 minutes. If he is yellow, how do I dose him? This morning I stalled an hour because he was 286 and I wanted to get him into pinks. This is uncharted territory for me.

 

Lol....do you want my opinon? I'd say he's high enough at 241 to shoot the full 2u. Please know that I tend toward more aggressive dosing advice, and also believe in holding the dose unless you the cat forces you to reduce (i.e. goes too close to 50). Exceptions being someone who is new to it, doesn't have much data, isn't confident about being able to handle it, etc. You, however, are plenty competent to handle whatever happens, so that's why I think you can shoot the 2u. Please please please know that it doesn't hurt my feelings if you just say, "Nope. Not tonight. Don't want that kind of stress this evening."

 

That's a tough one, Susan. Your stalled preshot number was basically the same as your original PS this morning. I know you steered with food, and as Djamila says, there's no way to know for sure if it was needed.

If he was mine and at the same kind of number, and I knew I could get some tests to see how fast he was dropping, I'd be inclined to stay the course with 2 units. It got you into some good numbers, and you know how to steer him if it's needed. If that makes you uncomfortable, you could go a little lower, though. Remember, in the end, you hold the syringe!

Now that I've jabbered on about that for a minute trying to make up my mind, you're probably already testing. Let us know what you get!

 

EDIT: I just read that back and it sounds a little too aggressive even to me. There are other reasons to reduce such as long cycles, cycles you can't monitor, just getting that sense that it's too much, etc. And I'm not trying to suggest we shoot until we get hypos -- just that sometimes we reduce when we really don't need to. Rachel did a much better job of explaining this than I did tonight! I apologize if my post sounded a little over the top!

 

Saw you got a 379 preshot! Could be a bit of a bounce...don't be discouraged by it. I think 2 u was fine for that. Can you get a before bed test to just kind of see where things are going?

 

No worries. I just appreciate the info. I'm not used to shooting the lower numbers, so bear with me. It looks like I'm going to have to get used to shooting them sooner than I thought too.

 

I still get nervous shooting as low as I have to right now! It's much easier to tell someone else it's the right decision, than it is to actually do it myself!

 

I was hoping it would be a bit lower, but he had a good run today. I'm uneasy about yellow preshots, that sounds dumb when the spreadsheets here are yellows, blues, and greens. If he is at yellows at preshot, will it mess him up if I lower his dose. He did well today and I need to be careful I don't derail his numbers. For example, if he is at 260 at shot time, until I gather enough data, I would be inclined to dose 1.5 units to see what he does. Am I far off base with this? I now know from today that 2 units, when he is low 300s at shot time, is fine and gets him a great cycle. I feel like I am in the dark until I get more info from the different doses.

I will definitely get a few tests in before bed to see where he is headed.

 

That makes sense. I can see what needs to happen, but then Timmy looks up at me and starts "talking" and I chicken out. I want him to keep feeling better so I need to work on getting nerves of steel. Easier said than done for sure.

 

I've spent a lot of time studying spreadsheets on here, and I would say that most of the time when someone lowers the dose because of a lower-than-normal pre-shot, the cycle ends up going upside down (the numbers get higher as the cycle goes on, instead of lower). Meaning that they could have stuck with the dose and been just fine. Now if the pre-shot is a LOT lower than normal, then you may need to decrease to be safe, but if it's over 250 (this number changes, I'm basing the 250 on your "usual" numbers right now in Timmy's journey) I would give the whole 2 units as long as you're around to keep an eye on him. If it's under 250, I might consider a slight decrease to maybe 1.75u, but I don't think I'd go any lower than that if he's over 200. And really I think it would be better to stall without feeding and let him rise to a number you're comfortable with. With the numbers you're seeing right now, stalling will most likely work and allow you to give a regular dose.

Prozinc really does best when it's consistent. It's sort of halfway between Lantus and Vetsulin - it's more flexible than Lantus, but not as flexible as Vetsulin. There are a few cats who really need a sliding scale, but the majority of cats seem to do best when the dose is as consistent as possible. When it gets adjusted, it can take several cycles to get back to normal, and during those cycles dosing can get pretty confusing. So again, when you have to adjust for safety, of course do it, but if you can keep it steady it seems to work best for most cats.

And as always, you hold the syringe, so make whatever decision you are comfortable with. There is only so much we can know through the internet, and sometimes your mama-sense will tell you things that we can't know. It never hurts anyone's feelings if you do something different. We are all here to support each other, and totally understand when you need to go with your gut on something!

 

Djamila said it very well, so I'll just add one more thing: sometimes if you hit a yellow, you could just stall for 15ish minutes and retest to see if he's rising...it is probably safe to shoot at yellows, but it might make YOU feel better just to see that the number is still going up, not down.

Also, as Djmila said, Timmy is your cat and you have to be comfortable. If you just have a gut feeling that you need to go lower or you aren't going to be around to monitor, it's okay to reduce slightly!

Also, no one here thinks you're silly for feeling nervous about those yellows...it's not really about what OTHER people have gotten, it's about what is normal for YOU and for Timmy. Timmy doesn't usually hit those lower numbers, so they are more nerve wracking for you. You'll grow to be more comfortable!

 

Beautiful cycle today, Timmy! Ready everyone else's (gr? ) comments and think holding the 2.0U for PS numbers >250 sounds good with slight reductions for 200 - 250 like Djamila said . As you see more yellow PS numbers you will get more comfortable with them. I usually only stall with blue PS numbers now and just look at my data for yellows.

 

He had another day with healing numbers. Preshot is 268. I am going to take the advice and stall for 20 minutes to see if he comes up, just for my sanity...So after a 25 minute stall he is now at 280. I'm going to go ahead and give him 2 units. Geesh! Why at the PMPS!?

 

Good call. Yes, it's nerve wracking at first but you need data for these situations, Susan, and this is the only way to get it. He's had a great start on ProZinc!

 

Look at these gorgeous cycles! Timmy's doing great! And you are too!

 

Thank you. It is very nerve wracking indeed, but I know this step is very necessary to get the data. I keep reminding myself that this isn't Vetsulin and he will be fine and I know how to steer. I am really amazed at how he is responding to Prozinc though, which is another reason I have to learn to shoot the lower numbers. I don't want to stall his progress, plus he is starting to feel a bit better and he isn't going off by himself or hiding, which he was doing quite a bit. We are nine days in and it is definitely a great start!

 

Thank you so much for this info. It helps a lot.

 

I took your advice tonight and stalled for a bit and it did make me more comfortable when his numbers went up just a little.

 

Thank you for your encouragement. I really appreciate it. As I get more data at the lower PS numbers I know this will get easier. The next step is not to stall on a yellow...baby steps though. I took a look at your spreadsheet and Maury is definitely keeping you on your toes with that PS number tonight.

 

I'm glad the stall helped! Sometimes, just seeing that the numbers really are going up helps since you know they would keep going up if you waited. That will help you learn to be comfortable shooting at those yellows with no stalling. I'm glad Timmy seems to be feeling better! That's another thing to remember...they are more than just a number and this is obviously helping him.

 

Timmy had a good day with his numbers. He didn't stay in the greens as long today though and his +7 was a higher blue. Last night was uneventful as far as dosing that yellow and it left me with more confidence. I was all set to dose on a yellow again and his PMPS is 474. I gave the 2 units, hopefully he doesn't stay up in the high numbers for long.

 

Could be a little bounce or wonky strip. Considering he hasn't bounced from the high 80's before, I might have re-tested .

Timmy, time to work on your PM cycles