Hmmmmphff!

Discussion in 'Prozinc / PZI' started by Lisa and little, May 4, 2019.

  1. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    So I moved her up to 2.5 this am as she has been pretty flat it seems no matter what the dose. I am just perplexed BC if you look at SS - March 11 and the week or so after she tanked on lower doses. How can it be that now she is basically unresponsive no matter what the dose? I know. Time to consider Lantus but damn I just don’t think I’m ready to give up. Do you suggest I keep doing what I’m doing and moving her up as needed or throw in the towel and switch? That will require a vet visit, much research by me ( I really don’t understand how to work with it no matter what I read) and a possible nervous breakdown. Really frustrated. All that said.... clinically she is great
     
  2. Peacock

    Peacock Member

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    Mar 4, 2019
    How much have you experimented with her food? Peacock's numbers seem to fluctuate depending on her diet, maybe even more than from her insulin dose. When we switched to Tiki for a few days, her BG shot way up, then it dropped once I switched back to FF and DM.
     
  3. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    She’s been on TIKI pretty much the whole time since diagnosis. I thought since it’s zero carbs... it would be the best for BG. Am I missing something? I do mix in FF fish 1oz per feeding for calorie count and was going to switch that to a liver and chicken mix to see what happens. Could that little bit of fish be that inflammatory?
     
  4. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I suppose it could be, but that seems unlikely. My hunch is that she's just got a touch of insulin resistance. I'm not science-y enough to explain why it happens, but the treatment is that you essentially just keep raising the dose until you bust through the resistance. Sam ended up at 4u last time it happened here. Then once he busted through he dropped down to 2u in the course of about two weeks. (end of 2018, beginning of 2019 on his SS if you want to see what that journey looked like).

    So if that is our working theory for now, I would suggest doing the increases every four cycles at the most. Three cycles works if you can stand the uncertainty during the PM cycles - most folks prefer to raise in the morning which is why I suggest four cycles.

    The other possibility is some sort of health issue, but you'll often see less consistency in numbers and much higher spikes than I'm seeing on your spreadsheet right now which is what's making me think insulin resistance instead.
     
  5. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    Her response cycle seems to be 5 cycles. I’ve been going 6 to do the morning raise. Gonna continue for now I guess. But I’m sad and frustrated. Was hopeful we were getting somewhere when she had that response in mid March :oops:
     
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  6. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Jul 6, 2017
    Well, she is clearly staying too high. So, while you are on this insulin, I would start holding doses no more than three days (6 cycles) before doing an increase, and keep going up until you are seeing better numbers. How she responded to doses in the past really doesn't matter now. Insulin needs change; she needs what she needs.

    You have given ProZinc over 7 months, so it may not be a bad idea to seriously consider trying another insulin. If you run into the scenario where you get her into good numbers consistently at mid-cycle, but she continues to go high for much of the day (around pre-shots) and/or when the dose gets high enough to start setting good numbers, you start having occasions of drops that are too low - in other words, you are stuck where if you don't increase, you don't see good enough numbers, but if you do increase, you have too much risk of going too low - an insulin change may really help. I gave ProZinc 9 months before deciding to switch to Levemir. That has proven to be a wonderful decision, my only regret is that I did not make it a little sooner.
     
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  7. Peacock

    Peacock Member

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    Mar 4, 2019
    I would try a few days on one of the FF pates, or some other low rather than no carb foods, but prob something other than fish if it the full meal.
     
  8. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    Thank you to all for responding. Anyone else have food recommendation changes? Anyone think adding a few carbs could actually help? @FurBabiesMama i am terrified to switch. I don’t really know why but I don’t truly understand how they work differently and how I’d need to adjust dosing. What made you try Levemir over Lantus or Novolin? I’m reading a lot and dang all of those expensive and how do you get them since they don’t seem to be available on typical pet sites? All I see as another option on those sites is Vetsulin which seems to be the same as PZI if I am interpreting correctly?
     
  9. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Jul 6, 2017
    Detemir (Levemir) and glargine (Lantus or Basaglar) are very long-lasting insulins. Those are the ones you would want to consider. You would not want to consider Vetsulin or Novolin since those are not even as long-lasting as ProZinc. After doing my research, I just liked the Levemir option best. Here is an old thread you may want to read through where Lantus vs Levemir was discussed: http://www.felinediabetes.com/FDMB/threads/why-is-lantus-so-much-more-popular-than-levemir.195958/

    They are human insulins, so you can get them from human pharmacies. In the US, you have to get a prescription from your vet. You can get either in a five-pack of pens. I LOVE the pens. They are like mini vials. Once you start using a vial of insulin, the time is ticking on it. After a few months, it is no longer effective. So, I was always ending up throwing away insulin when I used vials. Since each pen holds less insulin, I am able to actually use up all of the insulin without ever throwing any out. As long as a pen is unopened, it is good until the expiration on the box which is usually a couple of years out. I got my Levemir from Costco. It was pretty expensive, but since I get to use every bit of the insulin in every pen with no waste, in the long run, it is not really that bad. A lot of people here get their insulin from Marks Marine in Canada (I think they may sell Lantus but not Levemir) because it is much cheaper, but I have not done that.

    We all know 'every cat is different', so you cannot really know how your cat will react to an insulin until you try it. I can only share with you my experience. With Levemir, the curves are much flatter. Mia was up and down so much more on ProZinc, but now, she stays nice and steady within a great range. I love no longer having the stress of deciding what to do if a pre-shot test is on the lower end. I can give her shot pretty much regardless of what her pre-shot test is and feel comfortable that she is not going to go too low. This is because the onset is later than with ProZinc and the drops are not as 'harsh'.

    I was concerned in the beginning because I had focused so much on learning ProZinc and felt like I was 'starting over' by having to learn something new, but really, it did not take long to get used to the differences, and for me, they were all good differences (like what I mentioned in the last paragraph). As far as how they work, you have probably read this: http://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/ I think of it like this... With an 'in-and-out' insulin like ProZinc, a shot mostly wears off by the next shot time (there is actually some overlap, but for the most part, it wears off which is why the pre-shot numbers can get pretty high even when the mid-cycle numbers have been good). With a 'depot' insulin like Levemir, it 'builds up' and is slowly released. As you consistently give shots, it's like you are keeping that reserve stocked so it can continue to release and be effective.
     
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  10. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    Thank you for all of that information. I guess what scares me is the depot or the reserve. If you get a lower pre shot how would you determine the dose since you don’t know exactly how much might be built up? From what you are saying you can pretty much dose the same even on lower PS numbers? Also wondering about “insulin resistance” as mentioned in above posts. If she does have that a bit and comes out of it, should I be prepared for a steep drop?
     
  11. FurBabiesMama

    FurBabiesMama Well-Known Member

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    Jul 6, 2017
    There are two dosing methods that most people use, so you could choose one and follow it: http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

    Doses are not really adjusted based on pre-shot tests results. Really only if you were to get some super crazy low pre-shot result (which has ever happened for me) would you have to drop/skip a dose. I started out using the tight regulation protocol as a guideline, but for a long time now, Mia has just been really steady at a really low dose, so there is not really much dose changing. I have done a couple of no shot tests, but after three days, the numbers crept up a little higher than what I was comfortable with, so I resumed insulin. I keep hoping that eventually she might actually be able to hold her own without any insulin, but for now, she seems to need just a little help.

    If you have questions about the other insulins, you could always post on that board. (There is a LOT of traffic there, so it can be a bit overwhelming, but there are definitely people with a lot of experience who can give you their input.)
     
  12. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    I really Appreciate that help. I’ve read that before and have also read that Lantus and Levemir are once a day insulins. Is this protocol still 2x daily at 12 hr intervals? Also the initial dose should be .25 per KG of ideal weight. Pretty sure 11 lbs is a good weight for Little so would I do .25 of actual weight in this case? Meaning1.25 U? Don’t think she really needs to lose weight...
     
  13. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    They are once/day in humans. Cats use it faster so they need it every 12 hours. FurBabiesMama has given you some great information. And it really helps that you'll know someone over there now who can keep an eye on your threads because things do move fast there and it can be easy to get lost -- but you also get responses quicker because there are so many more people on that board. It is soooo much easier to do dosing on the L's. Not all the drama and wondering that you get on Prozinc. Sam did not like either of those insulins, so we ended up back here, but if it had been up to me, I would have preferred to keep him on Levemir as I really like the long flat cycles.

    The initial dose is usually something close to your current dose. The folks over there can take a look at your spreadsheet and coach you on that though. They are very good at what they do over there. If you decide to switch, you'll be in good hands. :bighug:
     
  14. Lisa and little

    Lisa and little Well-Known Member

    Joined:
    Sep 24, 2018
    Thank you all for the info and answers. Going to give this a bit longer and see where it goes. Due to order a vial in the next few weeks so I guess I’ll determine then. You guys always make me feel better. Thanks for the support today cause I am in cry mode.
     
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  15. Yong & Maury GA

    Yong & Maury GA Well-Known Member

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    Jan 11, 2017
    You've gotten some great info here but I just wanted to comment on making changes. Only change one thing a time so you don't go crazy trying to figure out what helped/hurt ;). Are there any other health factors that might be effecting her?(Behaviour, potty habits, teeth looking ok?) Any food allergies?

    Also, I gave Maury almost 7 months on Prozinc before switching to Lantus. I ordered his from Canada through Marks Marine Pharmacy. The switched worked very well for him and the L&L members were very helpful because I was scared to try the depot insulin as well :bighug:. Towards the end I found myself still giving a shot on green PS numbers :p.

    Lastly, are you going to increase to 2.6 in another day?

    You're doing a great job with Little so don't get discouraged :bighug::bighug::bighug:
     
  16. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    Thank you @Yong was thinking of switching the food tonight but I have to do it slowly adding it gradually to what I’ve been feeding so she doesn’t get sick I’d imagine. Would you recommend changing the protein source from chicken to perhaps turkey? My other kitty is on FF chunky turkey which comes in at 7% carbs and 43 fat. Too many carbs? My other Choice was going to be FF liver and chicken. Only 4 carbs and 51 fat. Not sure what to do as I want to keep calories the same but her current diet is 0 carb 23 fat. She also only gets fed 2x daily as she will just keep eating if wet food left out. Should I maybe put out a bit of Dr elseys that I use for treats as a graze instead of switching food all together? If I start changing food should I increase the dose as well or see how she does with food change and 2.5 for a few cycles. Thank you so much for checking in. I have been having panic attacks the last 2 nights worrying what to do for her. There do not seem to be any other issues. Although her breath is yucky her teeth look fine. Again thank you so much
     
  17. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    Took away the fish and replaced with liver and chicken FF. + 4 is 124. Attribute this to food change or cycle 6 finally kicked in? Usually takes Little 5 cycles for a dose to kick in perhaps this is just coincidence? Was set to go up to 2.6 in am now not sure what to do. Anticipating AM bounce at Amps ...
     
  18. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    It's hard to know for sure. It seems so unlikely that such a little bit of fish would cause this, but some cats really don't do well on certain foods. It could be that fish made her feel a bit sick or something and that caused her BG to be higher. It's possible that she just needed that dose to kick in too...I think I'd try to not give fish for a few more days and see if that trend of lower numbers continues or not. That will help you to determine if she really is just not handling fish well or if that was just a coincidence.
     
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  19. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    Yes. Thank you Rachel. Fish is “oFISHally” gone. AMPS IS 285 so shot 2.5 and praying for a similar cycle since PS numbers are the same :joyful:
     
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  20. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    That was a really lovely cycle last night! Although not so lovely for your sleep! Here, you might need this today: :coffee::coffee::coffee:
     
  21. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    :smuggrin::joyful::D
     
  22. Yong & Maury GA

    Yong & Maury GA Well-Known Member

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    Jan 11, 2017
    For Maury 7% carbs did not impact him. I had to take out my food schedule from my signature because it was too long :smuggrin:. I kept him on <8% carbs on our first sugar dance. I feed Young Again Zero (YAZ) carb dry food but can't free feed it as I'm sure he'd eat the entire bag quickly lol. So, two feedings a day was not enough for him (and he had lost a lot of weight at initial diagnosis so I had to put some weight back on him). He gets half a can of wet food with 1/3 capsule of Pancreas Booster mixed in and a flat tsp of YAZ for his +9 snack in his timed feeder. On work days, I will leave a foodsickle (frozen cat food with water in a cube mold: 1/6 can of 5.5oz Friskies) that thaws in about 2-3 hours depending on the house temperature. I only give him a "fishy" flavour once every five - seven days. Boys are more prone to UTI's and fish doesn't help that. The downside to FF pate's, or classics, are the phosphorous levels. So if Little has any sort of kidney issue, I'd be weary of that. Hope this was helpful :).

    Lovely cycle last night through this morning's AMPS! :D (antijinx)
     
  23. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    Thank you. I have the food chart. So I’m choosing between 4 carb or 7 carb if I switch her all together from the 0 Tiki cat as well. If I use the 4 carb it would completely change the protein source from chicken to turkey. Any thoughts on that?? What ever I do I will do all this slowly so as not to upset her tummy. What is the guideline for Phosphorous? I will check those numbers as well. @Yong seems like you’ve had some success with using some dry food. That is the only way I can feed more than 2x although I chose dr elseys and not YAZ as some said it caused digestive issues. Also worried about weight gain as the FFs are higher fat as well. If I feed the same calories she may gain. All so overwhelming again. But I am determined! Any advice on the phosphorus levels appreciated as well as advice on not making her a heifer with this switch. Thank you my gurus !
     
  24. Yong & Maury GA

    Yong & Maury GA Well-Known Member

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    Jan 11, 2017
    Only thought is that chicken and turkey are still both in the poultry group so if you wanted to change protein, switch to like beef, rabbit, or lamb. Duck may even work but it's not a common flavor to find. Rabbit can be difficult too. Yes, I've had success with some dry food and I think it saves me from being eaten by Maury at night :p. I had to switch him super slow cos he has a slightly sensitive tummy and YAZ is a much richer food. Talk about some stinky poo's though for the first week! I had to go outside after one or two :woot:. How much does she weigh again? :bookworm: I usually put 350 for max phosphorous in the food chart filter.
     
  25. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    She’s a steady 11 lbs fir the last few months. Only reason for the switch would be lower carb as the turkey is 4% and the chicken liver is 7%
     
  26. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I found for Sam that over 5% did raise his BG. ECID and all. My guys looooove rabbit, but it's so dang expensive. I wish I had never introduced it because of course it's their favorite :rolleyes:. And I agree that the switch between chicken and turkey shouldn't be a big deal as long as Little likes them both.
     
  27. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Have you tried freezing some canned food and leaving that out? They can't eat it until it thaws which slows them down and spreads the snack out a little bit. Might be worth a shot so you can avoid the kibble.
     

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