Changing from Caninsulin to Prozinc

Hi from the UK, I would really like some advice as I am totally confused about how our vet is working out the new dosage, I am really concerned that it is too high. I have read the leaflet from front to back and still don’t get it. “She would need to start on a dosage of 0.7 IU/kg so she would need 3,12IU in total each injection. The concentration of the drug is 40IU/ml so she will need 8IU twice daily“ the bit I don’t get is why this increases to 8IU? I asked the question and was advised this, “ you need to divide the amount of active principle for the concentration of the drug to have the dosage“ . It’s totally confusing me as I just don’t understand her calculations and it doesn’t mention this type of calculation on the leaflet? I would appreciate any advice xx

 

No. If using U40 syringes you would draw up the insulin a little about the 3 unit markings to get 3.1 units. The concentration what determines how much volume to dispense.
Re you home testing? What was dose of Caninsulin and what were preshots and how low did BG go between shots? Without history 3 units of ProZinc may be too much.

 

Hi Thank you for your reply, she was on 5IU of Caninsulin but have been ad used that she might be resistant as her BG’s were between 18 and 20 mmol about 20 minutes before her food and insulin shot.

 

Hi Jenny,

Glad you posted to ask about dose measurement.

Couple of questions:

1. Are those home test readings? Do you know how low the dose of Caninsulin has been taking Trixabelle?

2. What are you feeding Trixabelle?


Mogs
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Yes they are home readings due to her stress levels but all the full blood test results at vets recorded high levels too.
She is fed mostly wet food, with a very small amount of high protein biscuits twice daily , she is under 5kg so not a big cat.
The lowest BG’s have been 15mmol
Many thanks

 

I am just so worried about giving her too much, she has never stabilised on the Caninsulin (5months since diagnosis)

 

She wouldn't be the first cat to have that problem, Jenny. Some cats can do well on Caninsulin but more typically feline diabetics tend to have bucket-shaped curves and don't get adequate duration from each dose.

Do you know the values for the % of calories from carbs in the foods you're giving Tinkabelle at the moment? (If not, if you can provide the brand and variety of the foods we can check for you.)

It's great that you're home testing. If you were to set up one of our shareable spreadsheets to record Tinkabelle's dose and BG reading info then members experienced with Caninsulin and Prozinc would be able to give you regular feedback on how she's responding and hopefully help you to improve her regulation. Here's the info you need to get going:

How to create your spreadsheet

How to use your spreadsheet

If you'd like assistance with getting the spreadsheet up and running, let us know and we'll find someone to help you. There would be no need to include all of Tinkabelle's BG history, just the ones you've taken for the last fortnight should do.


Mogs
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Hi
Many thanks for your reply, I will have a look at the brands thankyou and put up a post. I will look at setting up the spreadsheet and will let you know, Tinkabelle really dislikes and gets stressed with it but we are getting there.
Thanks again

 

Hi, a Vet friend has confirmed both our calculations so I will speak to our Vet today as there is no way I am starting as high as she suggests.
Thanks again
Jenny

 

I have checked what food we are giving her, should I post it here or somewhere else?
I’m not totally sure about % carbs abs I can’t find it on the labels,New have just been trying to make sure a good amount of protein.
Many thanks
Jenny

 

Fine to post it here, Jenny. Example of info needed:

Sheba Fine Flakes in Jelly - Poultry Selection - Protein %, Fat %, Crude Fibre %, Crude Ash %, Moisture %.
Felix Pouches in Jelly - Fish Selection - Protein %, Fat %, Crude Fibre %, Crude Ash %, Moisture %.
Lily's Kitchen Suppurrs - Hunter's Chicken and Duck - Protein %, Fat %, Crude Fibre %, Crude Ash %, Moisture %.

etc., etc., etc.

We'll be able to give you a bit of a leg up with the carbs and also give you some pointers on how to use the info on the food labels.


Mogs
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Hi Jenny,
Welcome! I am so glad you posted and got some really expert advice from some very knowledgable people. I just wanted to add my boy Drevon was absolutely miserable on vetsulin (I think is same as caninsulan) I was beside myself watching him become more and more depressed. I also switched to Pro zinc and he was much happier like his regular self. My boy decided he needed a long lasting insulin so we went on to lantus and then to lev where we stayed.

So happy you are testing!
You are very intuitive to realize the dose was too much

 

Many thanks for your support and advice, I am just so worried to give the wrong amount, she is only 4.5kg so 8IU just sounded way to much.
We start it tomorrow and fingers crossed as our little Tink definitely presents as depressed and not her little mischievous self for a long time.
Thanks again
Jenny

 

Hi
This is what we are currently giving her twice daily:

Sainsbury’s complete Nutrition 7+ Senior cat food fish or meat in jelly 100g

Analytical Constituent: Kcal (/100) 86, Crude Protein 9.2%, Crude Fat 5.5%, Crude Fibre 0.5%, Crude Ash 2%, Moisture 82%, Calcium 0.3%, Omega 3 0.2%, Omega 6 1%.

Twice daily approximately 2 x 30 g
HIGH MEAT DRY - Free range chicken

ANALYTICAL CONSTITUENTS

Moisture 8%
Protein 40%
Crude Fat 21%
Crude Fibre 2.5%
Crude Ash 7.5%
Ω3 0.3%
Ω6 3%
Kcal 415 kcal/100g

I would really appreciate if this is too little or too much, we have been cutting dry food slowly as this is all she used to like eating. We give her a spoon or two of of tinned tuna in spring water sometimes as well or a little piece of cooked chicken which she likes. She is always hungry though specially last hour before her meals, currently 6am and 6 pm.

Thankyou for your help
Kind regards
Jenny

 

Caninsulin is a u40 insulin too. I'm confused, is she using u100 syringes with the u40 insulins and that's why she's doing conversions?

 

No idea and panicking a bit as due to start in tomorrow and no call back from vets. A friend of mine thinks she is as that would convert to about what she makes it, but I have asked our vet and she hasn’t answered that part so I re queried it again. She’s only 4.5 kg so x 0.7 is just over 3 units?

 

3.43% kcals from carbs.

18.75% kcals from carbs

--------------------------

Formula for calculating daily energy needs (catinfo.org):

Required calories per day = [13.6 X optimal lean body weight in pounds] + 70

If Tinkabelle is at her ideal weight:

4.5kg = c. 10lb

Approximate daily energy needs = (13.6 x 10) +70 = 206.

Actual energy needs will vary based on activity level. The easiest way to manage weight is to:

* keep a little daily food diary (how many calories fed each day (metabolisable energy (kcals) in food x weight of food eaten).

* evaluate body condition weekly.

* weigh weekly. (A reasonably-priced digital baby scale like this one is ideal for this.)

* increase daily calories if weight gain needed, reduce daily calories if overweight (latter needs to be done slowly - see this catinfo.org page for info on how to help a cat lose weight safely).

* rinse 'n' repeat.

The higher carb dry food may possibly be a factor driving the higher numbers.

VERY IMPORTANT SAFETY NOTE:

Please do not reduce the dry food portion of Tinkabelle's daily diet until you are in a position to reliably get blood tests at every preshot AND also during every cycle to make sure that you know how low BG is dropping when the insulin is working at its strongest. Reducing the carb load - especially if reducing/removing a dry high carb food from the diet - may result in overall BG levels dropping quickly and significantly, sometimes over a period of many days, and the insulin dose may need to be reduced in tandem with the reduction in carb load. I strongly recommend reading the following page with info on how to safely transition a cat receiving insulin to a low carb diet:

catinfo.org - Feline Diabetes page

Attempting a transition without close monitoring of BG and insulin requirements increases the risk of a cat's blood glucose going too low.

If you can get a spreadsheet going for Tinkabelle, members replying to your posts will be able to help you interpret her readings and support you both when you've gathered enough BG readings to better understand Tinkabelle's response to her insulin and you're ready to start the safe diet transition. If you wish, you may prefer to hold off on the diet transition until after you've switched her to Prozinc (Note: The need to gather sufficient BG data before reducing the carb load would still apply.)

Two things that might possibly be affecting Tinkabelle's mood:

* high BG numbers.

* Caninsulin - or its mode of action - might generally disagree with her system.

If the former, a switch to the different insulin may help improve regulation and that should hopefully help improve how Tinkabelle feels (physically and emotionally).

If the latter, you might notice that Tinkabelle might get depressed/lethargic while the insulin's active in her system but then seems brighter and more alert later in the cycle when the dose is wearing off, only to get depressed and lethargic again after the next dose is administered. Not every insulin agrees with every cat. In such instances, a change to a different insulin may help the cat feel a lot better. Like Shayla's beloved Drevon, Saoirse had a really hard time on Caninsulin, even when her numbers were in a fairly decent range and she was only receiving a very small dose of the stuff. When she made the switch to Lantus, she was much happier, brighter, more alert and energetic, more herself. (((Saoirse))) I also remember a case where where Lantus disagreed with a particular kitty but he absolutely thrived on Levemir. ECID!

As always, please post for help with anything you need.


Mogs
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Thankyou so much x

 

If she was doing that then she should be rounding down, not up.

@JennyB51

This is the calculation we're on about:

Based on a cat at ideal weight 4.5kg:

Prozinc starting dose (per your vet) = 0.7 IU per kg lean bodyweight = 0.7 x 4.5 = 3.15 IU Prozinc (round down to 3IU on U40 syringe).

Conversion to measure correct dose of U40 insulin using a U100 syringe = U40 insulin dose x 2.5.

3.15IU dose of U40 insulin as measured on a U100 syringe = 3.15 x 2.5 = 7.88 <<< Even if using a U100 syringe to draw up the 3.15IU dose of Prozinc, this value should be ROUNDED DOWN and the edge of the plunger set to the 7.5IU or 7.0IU mark on the U100 syringe for safety.

You've been using Caninsulin which is a U40 insulin. If you've definitely been using U40 insulin syringes to administer Caninsulin thus far and will still be using the same syringes for Prozinc then there should be NO conversion. You would just measure the straight 3.0IU on the U40 syringe.

>>> Is there any chance you could post a picture of the box for the syringes you're using please, Jenny? <<<


Mogs
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Yes can do just trying to work out how to attach? I get an error box stating I don’t have permission for this function?

 

Helpful food-related links:

UK Low Carb Commercial Cat Food List

Online Metabolisable Energy Calculator -

The calculator works out % kcals (ME %) from carbs, just plug in the as fed typical analysis values for protein, fat, fibre, ash and moisture from the cat food label - a handy thing to have bookmarked on your mobile device(s) when shopping (as is the food list).

(Note: there's no reset on the calculator so you need to manually clear the data entry fields between calculations.)

( @Elizabeth and Bertie - Eliz, I'd be grateful if you could post a couple of medium and high carb wet food recommendations for Penny to add to her hypo toolkit, please. All I ever had in Saoirse's kit was liquid glucose plus Hill's i/d pouches and Temptations treats, neither of which were ever needed to raise numbers (good complaint). )


Mogs
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I see you worked out how to get the pic uploaded. There's some sort of technical problem with the Upload a File button at the moment (webmaster is working on it).

I'm assuming you used copy/paste to upload the above pic. FYI, if you need to upload a file, go to the directory it lives in and then click and drag it into the thread reply box (may take a little while for the upload to appear).

---------------

Thanks for the pic, Jenny. Dem's definitely U40 syringes. Definitely DO NOT measure the dose as 8.0IU. (It would be 2.5 times too high.)

If you're going to give a 3.0IU dose of Prozinc, draw the dose up to the 3.0 mark on your U40 syringe.


Mogs
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Hi
Many thanks for your help and support, we will go ahead with the 3IU tomorrow, I’m still waiting for a call back but have made a decision as everyone here and my vet friend have all made same calculations. It’s just worrying bad she got it so dangerously wrong and said her senior colleague checked it too!
Thankyou for the information about the food, we will look at reducing once as you say she is settled on Prozinc.
Thanks again
Jenny

 

This is way too much math for me.

 

What more can you expect from an engineer?




Mogs
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I'm backing out of this thread.

 

Hiya
We have been giving Tinkabelle the 3IU of Prozinc since Monday, but worried as we took her BG’s a couple of times but don’t know if it’s too soon to see a change? She is still getting high numbers 19 mmol 20 minutes before her evening meal. She gets so stressed us doing it though so not thinking we are helping?
I would appreciate your thoughts?
Jenny & Tink

 

Hi Jenny,

How are you keeping? Congrats on the insulin transition.

Is there any chance you could set up a spreadsheet and enter your insulin doses (both Vetsulin and Prozinc) and BG readings for the last 2-3 weeks please, Jenny? (See post #7 above for how-to links. We can get someone to help you with set-up if you'd like.) Without spreadsheet data, members replying to your posts would have no idea of Tinkabelle's pattern of response to her insulin(s) and it makes it impossible to suggest anything about dosing. To attempt to do so in the absence of data could be very dangerous indeed - and we want to help you keep Tinkabelle safe.


Mogs
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Many thanks I will try to do over the weekend, we haven’t been doing BG’s that often as she gets very stressed and we have been unwell with Covid too, we are living in such challenging times.

Also, I have had a reply from our vets today and they are still adamant about the dosage rationale and that it should be higher. I am so confused with it all.

This is a copy of the emails I have had from them. I will try and sort out the spreadsheet as soon as I can.
Many thanks to you
Jenny

 

From your vet's email:





I'm sorry to have to say it but your vet does not appear to fully understand how to measure doses using insulin syringes.

>> Yes, the calculated dose is 3.12IU for a 4.46kg cat when deciding to use a dosing rate of 0.7IU/kg.

>> Yes, Prozinc contains 40IU of insulin per ml.

>> NO, you do not perform any further calculation when you are drawing up and administering a Prozinc dose using a U40 insulin syringe.

The graduations on a U40 syringe are calibrated so that when you draw up a dose to graduation mark 'x' the volume of fluid in the syringe will contain 'x' units of insulin, i.e. in this instance, to measure a dose of 3.0IU, you draw insulin up to the 3.0 mark on the U40 syringe. You do not need to calculate the volume of fluid. (Exactly the same holds for Caninsulin/Vetsulin.)

We know from the photo you posted earlier in this thread that you are most definitely using U40 syringes.

Here is a link to the literature on the manufacturer's website describing how Prozinc doses should be measured and administered:

Easy Does It: Your Guide to Preparing and Administering Your Cat's or Dog's Prozinc With Ease

From the above:



This is information from as reputable a source as you can get, not from some random stranger on the internet so your vet can't make any argument against it. I'd suggest emailing the link to your vet along with a photo of the box your syringes come in so that, once and for all, they know that you are completely in the right about correct dose measurement. (Feel free to send a copy of my sums from one of my earlier posts too, if you think it might help.) If you had gone ahead and measured out a dose of 8 units Prozinc on your U40 syringes you might have ended up overdosing your cat.

I'm so glad that you double-checked the measurement of Tinkabelle's Prozinc dose. Vets, like the rest of us, are fallible, but not everyone finds a place like FDMB where they can learn more about diabetes and therefore catch errors. By sharing this info sheet with your vet, you'd be giving them the opportunity to improve their understanding and indirectly you could very well be helping to protect other cats and their caregivers in the future.


Mogs
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Thankyou so so much for all your help, I am so bemused.
I think I have managed to upload a copy of the spreadsheet and hopefully o er the weekend I can start populating it.
Thank you again
Jenny

 

Hi, well finally I got the correct response and I got a confirmation of the correct dosage. No apology or admission that they had got it terribly wrong. Thank you so so very much, your support helped me so much to stand by what we knew was right. I think I need to probably look for an alternative vet practice as I have totally lost confidence in them now.

Thanks again, next the spreadsheet!
Jenny & a much happier Tinkabelle!

 

Sad to say but I'm not that surprised, given that it was a potentially life-threatening error (far too big a mistake to acknowledge). That said, it's my sincere hope that they will learn from the mistake and not repeat it with any diabetic patients they may be called on to treat in the future.

You did good, Jenny, and you kept your dear Tinkabelle safe.

(((Jenny and Tinkabelle)))




Mogs
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Hi Mogs...Once again you bring the knowledge breakdown! I hope you are doing well

 

Dearest Jayla, it is good to see you here, my friend. I'm hanging in there, and my sleeps as screwy as ever. I hold you in my heart. How are you managing?

(((Jayla)))




Mogs
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Thank you Mogs....as you know all too well nothing but time can ease this pain. My bf gave me a valentines day card from the boys today-we both cried. Dre passed on Aug 23...he was so devastated when Rico passed it was gut wrenching. Going to PM you.