Looking for some help with Charlie

Hi everyone. My 10 year old kitty Charlie is diabetic. I think I have all his info in my profile, but I'll recap it here to make it easier. He weighs about 14#. he was up to 20# a couple years ago, but lost weight on a strict diet since he was pretty overweight. So he is at his ideal weight now. He had lost 2 or 3# before his fd dx, but has gained it back since being on prozinc. He has a stage 1 heart murmur. He has been increasing his dose of insulin steadily, and is up to 4.8u bid now. These issues led Nancy and Cody to mention a while back that he may be acro. We've only seen one blue on our ss so far. He also bounces for a couple days after the tiniest dose increase. Unfortunately testing for acro or insulin resistance is not an option right now. So I'm just looking for a bit of advice on how to proceed from here. I appreciate any input you'd be willing to offer.

 

Hi Claudia,

I don't want to help with any dosing because I've never used prozinc. However, I did want to welcome you and let you know that I'm happy to answer any questions that I can.

I'm sure some of the more current people will stop by some time today.

Heather

 

Hi again Claudia,
I'm gonna ask Nancy what she thinks, and I think many will defer to her due to her background with Prozinc, but I think it looks like you could use a bump to 5 and that future increases should be in the .25u-.5u range to help him catch up to his needs.

In reviewing your ss, it would appear that he does what is common with many resistant cats, which is the tricky sudden break in the numbers followed by a wall of red. This is confusing and frustrating, and makes people reticent to increase. The red is not bouncing, it's the resistance fighting back. Once you break the resistance and get to a good "maintenance" dose, all that will stop. I hate to say this but it's likely you will have to power through a few of these before you reach that dose. While that's depressing to think about, just know there IS a good breakthrough dose, and he WILL be regulated at some point.

This is what I was describing in my original post to Dragonn.. you have to work hard to get ahead of it, sometimes raising in increments and time frames that others will balk at. The difference between how we would advise if Charlie were a diagnosed acro or not is night and day. Here we will give you ideas to work with, but without that diagnosis we'll still be conservative to keep you both safe. You may still see more aggressive advice than you've tried before, and you will always hear that you are the one holding the syringe. It's all up to you.

In regard to the much relied upon sliding scale for PZI users, I am not sure if anyone has tried it with Prozinc, which is another thing to ask Nancy. She is having some local issues at the moment, but I am sure she will pop in as soon as she can.

Hope this helps to explain some things, and maybe ease your mind somewhat.

 

I'm no dosing expert so please don't take any of this as 'gospel' - but it sure looks that your insulin isn't having much of an effect so far. I wonder if you might want to think about a change of insulin? PZI is no longer a good choice and I understand that ProZinc is a longer acting version?

Also, YMMV but I'm not quite totally convinced either, that the bouncing that you refer to (when you increase dose) is really real? - I can say that we've seen some not dissimilar random fluctuations in Sooty's BGs over many weeks, that you possibly could interpret as a bounce if you wanted to, but which just as easily might be due to something else - what food he'd eaten that day, or some other unknown factors (or variations in meter readings, even). And it turned out in our case, that he really wasn't responding to insulin at all, basically!

I know this is probably a no brainer, but: As you are using U40 insulin, are you also using U40 syringes? I only ask because if you were using U100 syringes, then you'd need to multiply the dose measured on the syringe by 2.5, to give the right amount of U40 units. e.g. to inject 2 units of U40 insulin, in a U100 syringe, you'd have to draw to the 5.0 unit mark on the U100 syringe.. (so if that were the case, then you could be giving less units of insulin than you think you are, which could explain why it's not having much effect)??

Also, your profile doesn't really say but have you been able to rule out all other possible medical conditons (other than FD) that can also cause elevated BG levels? If not, then this would be advisable to do (with your vet) if you possibly can...

Anyhow I'd keep on asking Qs in the Health forum and the ProZinc forum, as you really need to rule out all other possibilities before you consider Acromegaly as a possibility, especially if (for whatever reason) you are not able to get the IGF-1 and IAA blood tests done. Some regular (no-Acro) FD cats do just need higher doses, than others...

HTH, and please, DO - keep on asking!!
Perry

 

Hi Claudia,
You've already heard from me, so there's not much more I can add.

I would suggest that you test as much as you can so that you can pinpoint Charlie's nadir - you want to see how he is reacting to this insulin. I have one with a usual nadir and another with a late nadir. Knowing Charlie's low point will help you with dosing.

I also don't know a thing about the insulin type you are using, so I can't say a word in that area. Nancy would be the best to advise you and Carolyn's advice sounds great. I have to say to err on the side of caution is the safe way to go. When in doubt, there is no harm to wait and ask others. Small tiny increases are safer until you know more.

Keep in mind that each decrease will be like ripples so you may well see what many call NDW - new dose wonkiness. Think of adding water to a container, there are ripples in the start but shortly the water surface flattens out.
I don't know how long a dose is to be held with this insulin, so I can't comment on how long you need to hold a dose before increasing the dose.

As I said before, not much will really change once you have had Charlie tested because you will still give him the amount of insulin he needs, regardless of the amount.

Take a look at some of our spreadsheets to see how we had higher numbers with setbacks, but eventually we all reached good doses and numbers leveled off.

Be sure to ask all questions you have. Someone will answer you or let you know who can.

 

OT:
Perry's mama... I see you've just switched to lev from lantus... I think you're gonna love the difference

 

Perry and sooty- Charlie is on the new prozinc, not pzi. We use u100 syringes with a conversion chart. He had a full blood panel (whatever that means) and the only thing that was abnormal was his blood sugar. I've been advised by a pz-er to get a copy of those results which I'll do this week.

I know Nancy is very knowledgeable with pz and high-doses, but I also know that she has a lot on her plate already which leaves her little extra time to help another kitty. I love her input when she's able to give it, but I don't want to demand too much of her time.

Thanks for the suggestions so far. I'm going to have to read it all a couple tines so it all sinks in. In the meantime, I will likely increase to 5u bid tomorrow unless his amps is better.

Edited to correct the type of syringes we use.my brain and fingers weren't on the same page!

 

Hi All,
Claudia has been posting for awhile in PZI and she has gradually moved up the dose scale.
along the way she has gone back and done a rebound check.
and she has tried a new vial
and she tests mid cycle regularly.

Charlie fits a lot of the common acro characteristics:
he snores, he has a big demanding appetite (must be fed on time and eats ~14oz/day), difficult regulation, heart murmur, large cat 14 lbs currently, but was much larger, male, normal pzi onset and duration with flattish nadir regardless of dose

-dental done in Feb, no other medical conditions which could explain difficult regulation

Claudia uses u100 syringes with the conversion chart (b/c Prozinc is u40) She was guided to this because in normal FD many cats respond to microdoses. Charlie hasn't.

As for Prozinc in an acro I can only tell you my experience and ECID
Prozinc is 1 yr old and I can not compare it to other PZI because I didn't really use others. I was unsuccessful in bringing Cody into any blue numbers until I reached about 14u then switched insulin. It turns out his current lev dose is 15-16u, so maybe if I had continued and gotten to 16u it may have worked. I don't know. I increased in .5u most of the time, although one time my vet had me jump from 7-9u. I tried holding it anywhere from 2 cycles to 2 weeks; shooting 3x/day, and nothing really improved his numbers until I got close to his dose. For us Prozinc onset was +2, nadir moved constantly btw +4 thru +8, and duration was +10.

Dosing is based on a combo of nadir and PS, with 200 being a typical no shot/delay shot number. Timing is flexible because duration is pretty reliable (So long as he's rising and its after +8)

In our experience- The trouble with Prozinc in a high dose cat:
1.PRICE- the 10ml vial price is similar to Lev, but the lev vial last 2.5x longer (1000u vs 400u per vial). At 14u I was buying a new vial every 2 weeks. Now its 5 weeks. I figured about $1400/year difference assuming the vial price of $90 for both. (now buying for $85 from Costco, )
At 5u BID (10u/day) prozinc will last her 40 days, and lev would last only until it dies.... how long is that? I've read 45days---so even though part of the vial is wasted, it is about a break even point. beyond 5u BID lev becomes increasingly more economical.
a 10u BID cat would use a whole vial in 50 days

and everywhere I've checked cartridges are much more expensive per unit...so ????)

2. Many/most high dose moms use Humulin R from time to time to bring a bad days numbers back in check. With Prozinc, I was never really sure when the nadir would hit because it moved so much between +4 to +8, also the onset is fast in prozinc, so it was not easy to know how to use R. In lev, I know my onset is around +4, so if I have a sky high PS, I can safely use R in addition to the lev

Back to Charlie
I would like to see her continue small increases because we do not know Charlie is acro- I think she is planning on trying 5u tomorrow. after 4 days on that she may try .4u increases.

 

Wonderful write-up and information Nancy. Thank you and I'm sure glad you're helping.

 

Wow! Thank you Nancy! It helps a lot to see it all written out like that. I may print that out for reference.

 

Marvelous stuff from Nancy et al and I can see ther's more to your situation than I had read... that's great. Yes we just switched to Lev and we're doing great on it, so far it really is clearly much kinder to shoot than Lantus - so if you ARE thinking of changing from Prozinc, then that would be my suggestion (good though Lantus undoubtedly is).
Have a great Caturday you guys!

 

Thank you!

Wanted to add my 2 cents about Levemir stability...

I have used Levemir for about a year now, and we have been able to use a 3ml cartridge to the last drop --- and that is typically 3 to 4 months each. Stored in the fridge and gently handled.

 

Phoebe,
Thanks for posting that! Thats great info- 3-4 months REALLY ? thats awesome! That was one concern that Claudia had because Prozinc is very durable.

I have used my vials to the end, but at our doses that only means 4-5 weeks, so I really didn't know.
Anybody else? I'm wondering if the vials would be different from the carts for any reason. :?:

 

I agree, great info Nancy!
I had a question about normal increase/decrease amounts for this insulin - are the normal changes done by .2 increments? And is there a length of time / number of cycles before one would know if a dose is good or not?

Thanks so much for the writeup; I know it will be helpful to many.