I apologize this is such a short notice, but I'm hoping that I could get one or two opinions and feedback about changing Max's insulin. I have an appointment later today with the vet and want to present her some educated info. My number one goal for Max is to give him a good quality of life. Up until now, the BG numbers themselves were not my primary concern, as long as he seemed in good spirits and still got around OK. Over the last month or so, Max has been exhibiting signs of neuropathy. He has all of the classic signs with the back legs, and although he seems like he has somewhat adapted to the situation I hate seeing him not being able to walk or jump. The only way to reverse or improve his range of motion is to get his numbers down. I tried a B12 supplement with very limited success. As you can see on his spreadsheet, I have tried to drop the dosage and raise it back up slowly. He's currently at 4.5 units twice a day. From all that I have read that is an extremely high amount of insulin per day. I've also noticed that his morning numbers are on the black or red side, with the numbers going down into the greens approximately 6 hours later. By dinnertime his numbers are back up to black or red. This tells me that either A. The prozinc in't lasting long enough, B. His body is breaking it down and using it at an accelerated rate, or C. The type of insulin isn't what is needed to treat his particular problem.... that perhaps a slow-release insulin would work better than a delayed-release insulin. I personally think the best option is to try a different insulin, one that has a different release system. Reason this is kind of a last minute thing is because we are running out of his prozinc and I certainly don't want to spend another $100 for more of it if we're going to change it anyway. Any thoughts would be welcome and appreciated.
What B12 supplement did you try? Zobaline is a very popular/successful one. It has the methylcobalamin form of B12 and includes folic acid - that is the best combination for combating the neuropathy. I think it really has to be given consistently over a period of time to get results. What are the lime green 0s on your spreadsheet? Is that times you did not test or something along those lines? I would suggest taking those 0s out so the lime green won't be scattered all over which throws things off when we are trying to scan the spreadsheet for patterns. I do not understand the dosing changes I see on the spreadsheet and very often changes have been in increments of a whole unit which is a lot and can mean passing right by the correct dose. There are times when I think 'bouncing' has come into play (when a cat goes lower than they are used to, it can cause them to then go high and even to stay fairly high and flat for a few cycles after that) and time was not allowed for that to clear before changing the dose again. Sometimes doses were held a really long time then other times changes were done quickly. There are no mid-cycle tests for some of the cycles to see the impact of the insulin yet there is then a dose increase. All of this can lead to volatility which makes it very hard to decipher what is really happening and what next steps should be. My opinion is that it is normally best to give an insulin at least 6 months before deciding to change. The internal medicine specialist I used to take Mia to (until he left to do national consulting) felt it was important to allow sufficient time to evaluate the insulin before jumping ship. If you and your vet decide to stay with ProZinc for now, I think it will be important to proceed in a very systematic, gradual manner with dosing changes. You have probably already read the sticky posts on this ProZinc forum; if not, that might be helpful. Also, you can always reach out here for help with dosing change decisions. Levemir and Lantus are longer-lasting insulins and are depot insulins rather than in-and-out like ProZinc. If you are considering a change, I suggest you go to the forum for those insulins and read the sticky posts, if you haven't already. They do work better for a lot of cats, though not all. If you switch, it will be important that you decide on a dosing protocol (there is a sticky post there explaining the two options normally used) and follow it. Dosing changes are handled differently for those insulins vs ProZinc.
I agree with FurBabiesMama and just wanted to add that a lot if not most kitty's go lower at night than they do during the day. It is very important to get some data as to what is going on at night in order to figure out best dose that gets BG down without causing it to go too low. You've seen a few day cycles where BG dropped a huge amount (yesterday from 415 down to 64) on the day cycle which will set off bouncing but also makes me seriously wonder what has been happening at night since many of the night pre-shot tests have been lower than the day pre-shots. While 64 is a safe reading, you don't want Max going too much lower. If you make it a habit to check BG EVERY night before you go to bed, you'll be able to get some clues about how fast/much BG is dropping overnight. Dose changes need to be done in small increments of 0.25u and right now, I'm seriously wondering if some of those high readings aren't from too much rather than too little insulin. One tiny bit of housekeeping.....can you please add what meter you are using to your signature so it's there for quick reference? Thx.
Waiting for the Dr, sneaking this in... What B12 supplement did you try? Zobaline is a very popular/successful one. It has the methylcobalamin form of B12 and includes folic acid - that is the best combination for combating the neuropathy. I think it really has to be given consistently over a period of time to get results. I tried B12 Sublingual Liquid Drops - Methylcobalamin 3000 mcg. I got the dosage amount from a post here (I believe the poster is name is Janet?) I just ordered some Zobaline based on reviews... It's expensive but if it works it is worth it. can you please add what meter you are using to your signature so it's there for quick reference? Done The consult with the vet went well. Unlike the last couple of visits, I felt like she really considered the info I presented to her and addressed my questions patiently. She reviewed Max's medical notes and the recommendations regarding dosages. She recommended that we cut back to 2 units twice a day based on Max weight. She said my going back and starting with lower dosages was the right thing to do; however she said to keep with one dosage for a minimum of seven to 10 days. Since I did a curve day yesterday, she recommended to do the next one at the end ... She wants a true curve reading after the insulin has had time to work. She still wants readings every 6 hours during the day and once in the evening about 3 hrs after dinner. She was also interested in this site, and said she would like to check it out. At the end, she said we can switch the insulin if I wanted. But if it were her cat she would try this method first. When I mentioned the neuropathy, she said that she thinks she had heard of a medication that would help with it, that she will check it and get back with me. So... Max is back to 2 units twice a day for the next 10 days. Hopefully 2 will be the magic number.
