When is it time to change insulin?

Hi. The vet is suggesting that we change the type of insulin for Mia. She has been on ProZinc since dx on 7/5. She started on 1u and was changed to 2 by the initial vet after a couple of weeks based on fructosamine results (that was before I started home testing). That was about the point I decided not to return to that vet (one reason being her recommendation against home testing). I gave 1.5 for a while then s2.0 then ended up back at 2 by the time I started with this new vet. Vet and I agreed to go to 2.5 on 8/16. That has resulted in some sharp drops (cases where nadir is well over 50% lower than PS) and 'bounces' to higher numbers. It has just not leveled into a smooth curve. So, at this point, the vet is recommending the insulin change. She says ProZinc is not lasting enough, but I do not know how you can even tell that when she is in this pattern of ups and downs. Also, if it is not lasting long enough, why are some of her nadirs late in the cycle (such as +8)? I told her I would think about it, and in the meantime, I wanted to try 2.25. She said to 'go ahead', so that is where we are right now.

How do you know when it is time for complete change in insulin? The thought of introducing something new when I am just learning this one concerns me a bit, but I do not want to waste time if a change is warranted. Anyone care to share stories of overwhelming success after changing from ProZinc to xxx?

 

Achieving regulation can take a long time. Mia is a bouncy girl so that makes it harder to judge the effect of ProZinc. I don't think it lacks duration, though. The high numbers are bounce numbers. It's worth trying 2.25 u for several days to see if she settles. It's possible that Mia would do better on Lantus which is a slower onset, gentler insulin. She might still bounce but it might be less dramatic. Food for thought.

 

I have been on 4 insulins with Dre including ProZinc..... Pro Zinc did not last long enough for Dre so we switched to lantus but he is the dive king and really increased his diving skills on lantus-we are now on lev and I think this is the best one for us. He is still bouncy but it is not as fast(gives me time to steer with food) and because he is a grazer I don't have to worry about him eating right away since lev sets in (for us) at about 3-4 hours after shot.
Vetsuin was the first one we were on and it was awful-he was terribly depressed.

 

I would try Lantus or Levemir since using them seems to result in a very flat curve. I have three cats on Levemir. I previously used Lantus but the curve on Lantus is lower with less variability. Also, for Badger who I adopted as an already diabetic cat on Lantus. I had very large swings in BG but they were erratic. I tried Levemir, N, and ProZinc with similar results. Badger also had his left ear oozing due to polyps in the ear canal. I then had the polyps removed during a dental. One removed and the ear infection resolved with various antibiotics Badger now had a flat cyreve generally under 100 with about 1/3 if the original dose on insulin. Does Mia have on health problem that could be causing the erratic (sometimes going low) BGs?

 

She had an exam with full bloodwork and urinalysis at diagnosis, 7/5, as well as a follow-up visit two weeks later, 7/19, with another urinalysis. She was also examined when I changed vets on 8/9. Nothing was found nor do I see any symptoms of anything.

 

How are Mia's teeth? Dental problems frequently cause BG regulation problems.

 

Each exam I mentioned included looking at her teeth, and there were no issues found.

 

She's only been on it less than 2 months. It takes a while. Took me about 3 months the first time to get cc regulated. Takes some even longer. I say stay with it for a while longer. When it's time to replace the vial reevaluate if you want a change.

 

2u and 2.5u did not work. So far, it is looking like the 2.25 is not going to either. So, where is there to go from here other than changing? I would be willing to give it more time, but there seems to be little wiggle room on dose, and I need to see improvement.

 

A very important thing to understand about FD is that your kitty's good insulin dose is a moving target. It's not "find the dose and that's it". It can fluctuate up and down by varying degrees over time, often for unknown reasons. That's why we test and log data. That allows you to assess the effectiveness of a dose and change it if needed. Changing to a different insulin is usually done because: 1. kitty feels unwell on an insulin; 2. there's too large a variance between PS and nadir and it doesn't improve over time; 3. sometimes, cost.

You're less than 2 months into the FD marathon and that's very early in the race. Yes, some kitties settle quickly but most don't. Some of us have been struggling to achieve regulation for a very long time. Patience in large quantities is what will keep you sane. We're always here to help.

 

Hi, I came across this post today and was curious. Why does dental problems cause BG regulation problems? Thank you!

 

I am not a expert but I do work closely with my vet. Dental issues I think on any species can have a very big impact on many parts of the body. With fd there is a immune system not working at its optimal level.
If teeth have excess bacteria or gum disease it can raise not only bg but liver and I have even seen liver values increase.
Depending on the amount of dental disease I do believe there is still a unknown element as to why it causes diabetics such trouble.
I am sure wiser people than myself can explain better. Great question !

 

Anytime they are in pain it can raise bg levels.