New in this group, advice on keeping the dose

Daphne and Aida

Daphne and Aida

Active Member
Hi!
Aida is a sweet 16yo girl who has been recently diagnosed with DM.
She also potentially has Cushings, but only an ultrasound was positive about this diagnosis. The serum cortisol test came back inconclusive, and she just gets 1U prozinc twice daily with correct numbers.

I recently did a second curve and asked the vet if I should increase to 1.25U, as she had suggested.
Still haven't heard back from her.
Her BG is constantly changing - albeit nothing alarming. I don't know if it's normal that one day she's at 161 AMPS and another 116. It might be my tendency to 100% precision, I keep reminding myself that organisms aren't math formulas o_O

So my first question is: should I keep her at 1U, increase to 1.25, or redo a curve?

The second question is regarding a future move to a very hot country. The total travel time from the hotel to the final destination will be of 14 hours, with no possibility in-between to store the prozinc in a fridge. Although, maybe I could ask the crew members of the airplane if they could put it in their fridge.
Any ideas on how to best store it? I've tried some insulin pouches from Amazon that keep the temperature at 14°C for 2 hours and then fail to do anything.
How probable will it be that the insulin will be spoiled? I'm arriving on a Sunday, so no possibility of heading to a vet to ask for a prescription.

Many many thanks!
 
Hello and welcome to the ProZinc forum! Please do not increase her dose. Look at the nadirs you are already seeing on this dose. You are seeing green nadirs and I even see a 50 on your spreadsheet recently. We want to base the dose on nadirs in order to keep Aida safe. From the data you have recently gathered, my opinion is that an increase to 1.25 would push her into lime green territory and risk a possible hypo. In fact, if you were following the Start Slow Go Slow protocol, you would have reduced her dose by .25 units. I am not recommending that. If Aida were my cat, I would follow the Modified ProZinc method (MPM) and reduce the dose if there’s a drop below 50. I am very impressed by how you have gotten yourself up to speed so quickly since her diagnosis. One thing I would watch for is her night time BG. Many cats tend to drop lower at night; don’t see many tests during her evening cycles. It would be good if you could get a “before bed test” at around +2 (not sure what your schedule is though) or if you could periodically set an alarm to test her at a few points during the night cycle. Does she have some food available at night or a timed feeder to dispense snacks?

The duration you are getting on most days that I see recently is phenomenal. You are right — there are way too many factors at play to expect a cat’s preshot blood glucose to be the same each time.
When will you be moving? Can you simply put the insulin in an insulated container with ice packs? It is true that we would not want the insulin to get hot, but if it reaches normal room temperature for a while it should still be okay. We have had many people who forgot to put their ProZinc back in the refrigerator overnight and left it on their kitchen counter at room temperature— the ProZinc was fine and they were able to keep using it.
 
You know, the more I look at her spreadsheet and go a bit further back beyond your most recent tests, I see that several times she dropped into the 40s and she should have had a reduction but she did not. Even though you got a mostly green day on July 9 (and I am not seeing many tests since then,) if Aida were my cat, I would reduce her dose to .75 and hold if for seven days (unless she drops below 50) and I would try to catch her nadirs on .75 units. She looks to me like a cat who has a good chance at remission, but that warrants close monitoring. Some of those cats can earn reductions rather quickly once they have made up their minds ;) I also have the concern about her p.m. cycles.
 
Many thanks Suzanne!
Actually she was for quite a while on .75, her nadirs were between 56 and 82, and the vet said we should try with 1U, and then maybe further increase it. The day I did the curve on the .75 dose was kind of weird, all in the blue whereas before it was rather green.

She's due for a dental in 2 weeks, and the vet told me to keep her on a steady dose before it so that they can have better control of her BG during anesthesia. So I think it might be better to keep it 1U for now and try again with .75 after it's done.

I'm lucky that Aida is so easygoing! She stands still, actually she usually lays down when I bring the device. I use a word to let her know that I'm going to test her and she relaxes and purrs. (The "word" is pika pika, haha!!, I use words like that for them, like "let's eat" is hama hama and "let's cuddle" fushy fushy, yes I'm 3yo!)
It's thanks to her that I was able to learn how to get blood from her ear.
And about the protocols, I think I haven't understood them. I did read them many times but obviously didn't get them...

Night-time checks - yes… I've been super lazy with that… She does get food during the night: they've conditioned me to wake up at 3:30 to give them some. I should then test her. I'll do it. No more lazy.

About prozinc and heat - I had wrongly understood that it has to be strictly kept between 5 and 8°C, that makes a lot more sense! In my head I was "how on earth are people managing in warm countries otherwise, do they have carry-on mini-fridges or something else", well that makes sense! Of course, I'll put it in an ice patch and wrap it in newspapers, but that can only hold for about 6 hours.
 
Just to be sure, the MPM protocol is that I stick to a specific dose (let's say 1U for now) but if I see a 50 at her nadir, I give her .75 on her next shot. And then I keep checking at nadir, if it's ok I keep it 1U. Right?
 
Daphne and Aida said:
Just to be sure, the MPM protocol is that I stick to a specific dose (let's say 1U for now) but if I see a 50 at her nadir, I give her .75 on her next shot. And then I keep checking at nadir, if it's ok I keep it 1U. Right?
Click to expand...
About the dose during a dental, some cats do drop lower in BG under anesthesia. The concern for diabetic cats is that vets tell you to withhold food and water from midnight prior to morning anesthesia. So if you give insulin with no food the BG is bound to go lower. Some vets tell you to skip the shot and some say give a half dose.
Here’s a link to one of our sticky notes that may help you. Scroll down to the bottom portion after the links about dentals — to the chart.
https://felinediabetes.com/FDMB/threads/info-on-dental-procedures-including-pictures.144338/
 
Daphne and Aida said:
Just to be sure, the MPM protocol is that I stick to a specific dose (let's say 1U for now) but if I see a 50 at her nadir, I give her .75 on her next shot. And then I keep checking at nadir, if it's ok I keep it 1U. Right?
Click to expand...
With MPM, if the cat drops below 50 (to 49) then you reduce the dose. 50 is okay but we don’t want them going below it.
 
Daphne and Aida said:
Actually she was for quite a while on .75, her nadirs were between 56 and 82, and the vet said we should try with 1U, and then maybe further increase it.
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I don’t understand this at all. Nadirs between 56 and 82 are ideal. It would mean that you do not change a thing about the dose. Normal BG numbers for a cat are between approximately 50 and 110/120. Increasing the dose at all in a cat with nadirs between 56 and 82 is playing with fire and risking a hypoglycemic event. It may not happen right away, depending on the cat, but it only has to happen one time. It’s odd because we normally see vets who want to keep cats in the 200s or maybe the higher blues.
 
Super thank you so much!
Actually, for the dental, they told me to feed her at 6 am, test her before bringing her in (at 8 am), and if low feed again, hold the insulin and they'll monitor the BG during anesthesia. They're ok with it going high during it rather than low. They'll obviously also monitor for regurgitation and aspirate.

About her nadirs and the dose increase from .75 to 1U, I think it's because we compared our devices and found a 30 points difference between her Alphatrak and mine. So, when mine reads 50, it actually is 80, and when it's 80, it's actually 110. I think that's the reason that, to her, it was a tiny bit high and she though it best to try to bring her lower.

Many many thanks for taking the time!! I really appreciate!
 
There is no direct comparison between the Alpha Trak and a human meter. The AT tends to read a little higher. The “take action” number on an Alpha Trak meter is 68. If a cat drops below 68 on an Alpha Trak then it’s time to first give some higher carb food and then retest in 20-30 minutes. On a human meter you do that with a drop below 50. So bottom line: under 68 on the AT is hypo territory and under 50 on a human meter is hypo territory.
That is definitive. But there isn’t necessarily a linear relationship between the two types of meters’ numbers.

It sounds like the dental is under control. Very good. Just watch that, in many cats, particularly if there’s a lot of inflammation in the mouth/gums or if there’s a “bad tooth” then BG numbers can come down quite a bit after the dental procedure has been completed— I mean not necessarily the first day after, but subsequent to that.
 
We just compared one reading (mine was 79, hers 105 if I remember correctly) from which we deduced that ALL readings must be linear like that. Of course, nothing guarantees that, it would be too easy!
But since we're mainly concerned with the low readings, you're right, it must be sufficient to know about the 50 as a min.

Many thanks for the warning, I'll make sure to monitor the after-dental period! It's true that many values do change after a dental, Feloro typically has higher creatinine levels, and it drops after, for example. I think that they'll remove at least 2 teeth, she won't have many left after that… I learned too late about the importance of dental health for cats, unfortunately, and it was too late to get them used to brushing...Aida had already suffered a lot in her mouth and she won't let me do anything there, not even have a look. And of course, Feloro copies his mom, even though he never had such big dental issues!
 
Hello. Just checking in. How are you and Aida doing? Did she have her dental procedure yet? She’s doing great in her numbers. Those are all taken with your One Touch meter, right? You could have reduced her dose to .75 units on July 17 when you caught that 48, although her numbers have been excellent and steady since then. If she were my cat, I would keep her where she is and just monitor her carefully. Remember that cats’ BG tends to drop lower at night.
 
That's so kind of you! Thanks!
She had her rabies shot (mandatory vaccine before crossing borders), and she fell quite sick, she was off for a couple of days! It's the first time that she's had such a reaction, and it made me realize that she's a senior…

Anyway, the vet felt that it would be better to wait at least 3 weeks after the shot before doing the dental, so she's due to get it on August 12.
Incidentally, when she was so sick from the vaccine, her numbers were quite high! It had been weeks since I hadn't seen yellow. It's so interesting how so many different parameters impact blood glucose levels, I would have never thought!
She's steadily coming down to the numbers she had before, so yes, reducing to .75 is in my mind.
 
A lot of cats do have a negative reaction to vaccines - especially if having more than one vaccine at a time and especially with the adjuvanted vaccines. I am not surprised her numbers were high since it’s an inflammatory response. I am glad she’s back to normal now.
 
Suzanne thank you so much for your dedication!

Yes, I did ask to get the Purevax, but the vet said that it also has adjuvants (I don't know if that's true…) and that to her, it's more important to check the previous vaccine types and follow a certain protocol. So she did get two vaccines with adjuvants. The vet believes it's the rabies vaccine that can make cats feel sick.

She's having lower and lower numbers, tonight her PMPS was 94, so I gave her 0.75 U and I'll be checking her for hypo. Her nadirs haven't been under 50 (except for the day when Feloro went for his dental, I couldn't make him fast and give her food, he would have gotten crazy… So, I fed her in the evening, and then in the morning, with no midnight nor 3 am snack. She was hypo at +2 AMPS)

According to her vet, we could try 0.7U in a couple of weeks. But seeing these numbers, maybe now is the time to see how she stabilizes with a lower dose.
 
Yes…I know… I wonder, maybe she’s not well informed?
I do live in a small city, after all, and the fact that there is one cat-friendly clinic is in itself incredible! But it doesn’t guarantee that the vets are up to date…
 
I’m surprised that your vet would say that the PUREVAX vaccines are adjuvanted when they are not. I have seen quite a few cats on this Board who have had a bad reaction to rabies shots and elevated BG for a few days. Personally, I no longer give annual vaccines to my cats because I do not believe in over-vaccinating my cats since the immunity lasts a very long time. Occasionally, I have been forced to give a rabies vaccine, like when I had to take one cat to University of Georgia for treatment— as they will not see a cat without a current rabies vaccination.

Anyway, enough about that, she’s getting magnificent numbers on this 1 unit dose. I would let her earn the reduction to make the best progress and let her spend as much time as possible in the “healing greens.” Of course, as I say that, I don’t know what happened last night because your numbers aren’t in the spreadsheet yet. I hope all went well. You do such a great job of monitoring her that I feel confident she can stay at this dose until she earns a reduction. Paws crossed for a reduction!
 
And sorry for the cross posting. I started writing that at 6 a.m. and didn’t get to finish it, and I just now finished it up as you posted your message.
 
Aren’t you going to be moving soon? I hope your cats will not have to be quarantined. Will you be able to find good vet care in your new home?
 
Yes, end of August, and no, there is no quarantine within Europe - but the rabies vaccine is mandatory. I'm avoiding vaccinations too just like you, they've already had so many shots in their lives that it's impossible they wouldn't have any immunity!
I've already spotted 3 cat-friendly clinics as well as 2 referral clinics with different specializations. I'm moving to a capital city, and that will be a big difference in the level of care! (or, at least, I want to think so!)

Ok so, about her numbers, I don't know if you noticed that she was under 100 yesterday at PMPS, so I gave her 0.75. And this morning she was at 143, I fed them, and at AMPS, she was at 120! I was wow! is she starting to regulate her BG by herself? So I also gave her 0.75. Her nadir was earlier (at +3 instead of the usual +4). And now, she's at 115 again.

What do you think, should I switch back to 1U, or go on giving her 0.75 for a week to see how she goes?
The vet felt that it would be better to keep her at 1U for 2 more weeks before lowering. Maybe for the healing greens as you said?
 
Ok, I switched back to 1.00 as her PMPS was 147.
However, two hours before, it had reached 162. She then ate. And it didn't further rise! I'm super surprised by that!
There must be something that I haven't understood…
 
I was just checking in on y’all and was looking at Aida’s spreadsheet. She earned a reduction down to .75 units when she went into the 40s (lime green) on August 1. There was also another missed reduction down to .75 units a few days prior to August first’s lime green. This reduction would not be for just the next cycle after that, but for the next 7 days (unless another reduction is earned.). You can always go back up if necessary, but you need to keep her safe. She seems to be diving into lime green quite early in the cycle which tells me that she’s either not getting a snack at +2 or she’s not getting enough carbs at +2.

She is doing really well on a small dose of insulin, but has earned reductions. That is actually a very good thing!
 
Suzanne thank you so much!!!

It's been quite stressful lately, yes, I've been testing her just to make sure that…
and then with the 40 on August 1st, I had already given her a snack and she showed this number so I gave her high-carb kibble, and then she was in the yellow… it feels like a defeat when she reaches yellow, it's silly, I know, but I can't help feeling it like a defeat!

She's consistently having her nadir at +2 +3, when I have to work, I can rush back home at +4 usually, I've been trying to come in earlier, or to go later to work… Phew!
At +2 I'm usually at work…Soon I won't have that problem anymore though!

So 0.75 it is from this evening!

Thank you so much for checking on us!!

Just adding that yesterday, she was at 153, then she ate and she was at 152, and pre-shot her BG had further decreased to 146!
 
Daphne and Aida said:
she was at 153, then she ate and she was at 152, and pre-shot her BG had further decreased to 146!
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I see that. She is getting some good stable numbers with pretty decent duration despite nadiring so early. Maybe when you are home at +2 you can experiment with carbs in a snack and see if we can push her nadir out a little later. Keep up the great work!
 
Whenever I give her kibbles as a snack, she ends up with super high numbers in the afternoon… I kind of keep the kibble for emergency hypoG, part because she absolutely LOVES THEM and also because of its impact on her BG.
Also Feloro loves kibble but he has to avoid it, with his CKD…
 
Ok I totally missed the shot, I'm 99% sure it was a fur shot… I retested 1 hour later to be sure sure and gave her 0.5U to be triple sure.
 
Daphne and Aida said:
Ok I totally missed the shot, I'm 99% sure it was a fur shot… I retested 1 hour later to be sure sure and gave her 0.5U to be triple sure.
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Oh no. The rule is that if you think you’ve given a fur shot that you do not shoot more insulin. The reason is to keep your cat safe. You cannot always tell how much insulin has gotten into your cat, so it’s best not to potentially add more insulin. Everybody has a furshot once in a while and we just roll with it and get back on track.
 
Coming Monday…
Maybe a bit too early for the curve…

Today she was constantly begging for food, she remained in the green despite the extra snacks, with no particular change to food/environment or something else, really weird!
Still trying to find a logical correlation between BG levels and XYZ!
 
Suzanne, I hope you're online, I don't know if I should give a reduced dose tonight to Aida…
She had her dental today, everything went nicely, 3 extractions, and she's still off from the anesthesia (I think that anesthesia makes her sense the world in a distorted or amplified manner, from her reactions to daily sounds and sometimes to nothing at all).
She's eaten a bit since I brought her back, drinks at the fountain, and sleeps.
Her BG is currently 76.
I'm working tomorrow, so I'll be able to check her BG only at AMPS and +3 or +4, and again at +11.
Since you told me that after dental cleaning, the BG tends to go down, maybe I should entirely skip the dose? What do you think?
Many many thanks!!
 
I would have just gone ahead and skipped the shot, which I think you did. With everything going on and the fact that we don’t have spreadsheet data to support shooting the whole dose I think it was a good idea to skip. How is she now?
 
I did that, skipped the dose, so for a whole 24h period she got no insuline at all… I was dreading her BG numbers, but they didn't even reach 200, at least at the few tests I was able to do!
Yesterday morning it was even a bit, low, so, because I wasn't going to be present at +2 for her snack I gave her 0.5U.
Going to fill her spreadsheet now.

She's doing super fine!
I think that robenacoxib is her beloved NSAID, she purrs and purrs and purrs and has those super cute saucer eyes!
She had 3 extractions, the vet was very very pleased with everything, she said how easy it went with the extractions - which makes me think that it wasn't like that with Feloro, therefore they maybe were forced to leave some bad teeth in… She's back to her ravenous appetite, all good!
 
I’m so happy that she’s doing well. I hope the Onsior won’t be for more than 3 days!

She is having a lovely cycle today!
 
Onsior was for 2 to 3 days, she seemed fine today so I didn't give her the last pill.
This morning she was in the yellow, I don't like yellow, so I gave her 1U, and controlled her nadir - it didn't go very low. Evening she was 119 so I went back to 0.75U. I guess now, with the move, she's going to get very unstable and I'll have to monitor her very closely right?
Thanks Suzanne!
 
Well that could happen- getting unstable - in either direction. If you get to a point where you can not test her then just keep her running a little higher until you get settled in your new place. You keep such a good watch on her that I am not worried.
 
Thanks!

So, thinking of starting a new thread regarding a potential switch that I'll have to do at some point in Greece.
My understanding is that they don't work with prozinc there, one member here told me so, and I also emailed a couple of clinics in Athens. I could find lantus and caninsulin. Lantus would be the best choice to switch her to, right?

My question is: is it very difficult to make the switch? Will it take weeks on end, or will it be a matter of some days?

The reason I'm asking is that I could purchase an extra vial, as my vet here suggested. But the one I'm using is still more than half full, and a new vial costs 90€.

New thread, in the main forum, right?
 
Well as long as you’re still using ProZinc you can keep posting here. It’s not that bad switching to Lantus and when you get ready to do it you will start with a similar dose to what she’s already taking with ProZinc. You may want to use up your existing vial first. We might recommend only a very slight reduction in dose at first. It will take about a week maybe for the depo to fill for that initial dose — to see the full effect. You will have to get used to shooting low numbers…. But all things in good time. When you get ready to make the switch, I would post over on the Lantus forum because you aren’t really a newbie — you will be new to Lantus, of course, but not new to having a cat with diabetes that you are managing — you know about testing and giving shots and what to feed Aida and when to feed her snacks, etc. so you should be fine over on the Lantus forum when the time comes.
 
Hello!
Quick update:
The most difficult is behind us, we’re at the hotel in Paris waiting for my friend to come, leaving for Athens tomorrow.
We’re super tired, all three of us, Aida, Feloro and myself.
Aida is keeping good, I was super scared yesterday and gave her high carbs kibble before we took the landlord came, her AMPS was lower than usual so I gave her 0.5U instead of the 0.75U. Her BG shot up naturally, once we arrived at the hotel I was able to check it, no idea if it was even higher before, but again her PMPS was lower than usual so I gave her again 0.5U. I wonder if it’s an effect of the gabapentin.
Tomorrow we’ll have to be at the airport for the cats’ check in at the latest at 1:25pm, so we’ll leave the hotel around 11:00 am -> I’ll check her BG earlier, give her the gaba and also some kibble just to be sure. How does that plan sound?
 
Daphne and Aida said:
Hello!
Quick update:
The most difficult is behind us, we’re at the hotel in Paris waiting for my friend to come, leaving for Athens tomorrow.
We’re super tired, all three of us, Aida, Feloro and myself.
Aida is keeping good, I was super scared yesterday and gave her high carbs kibble before we took the landlord came, her AMPS was lower than usual so I gave her 0.5U instead of the 0.75U. Her BG shot up naturally, once we arrived at the hotel I was able to check it, no idea if it was even higher before, but again her PMPS was lower than usual so I gave her again 0.5U. I wonder if it’s an effect of the gabapentin.
Tomorrow we’ll have to be at the airport for the cats’ check in at the latest at 1:25pm, so we’ll leave the hotel around 11:00 am -> I’ll check her BG earlier, give her the gaba and also some kibble just to be sure. How does that plan sound?
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That’s a good plan — do not hesitate to keep her in higher BG (lower dose) for the journey when you cannot check her. I wish you all a safe journey. This must be so stressful for the cats (and you as a result.) It’s a shame you may have to change insulin because she is getting excellent BG control right now even with a low dose of ProZinc. Take care and update when you can.
 
Update:
We’re here! What a long trip, my poor cats…
Aida is panting from the heat, there’s no AC just a ventilator, I’m wetting her coat and she just lies on the floor… Feloro is also just lying, however he’s not panting despite having a thicker coat.

During the trip Aida had some sort of a crisis, nothing alarming, she just needed to get out of the carrier. I brought her to the bathroom, the staff was super nice and gave me some water so I was able to syringe-give her some, she waU-100ndered in the tiny bathroom and then she was much better.

Before leaving the hotel, I gave both some kibble, and then before boarding the plane I gave Aida some more. Upon arrival, her BG wasn’t very high (165) which makes me think that gaba really lowers her bg. Or that her reaction to stress isn’t typical with bg spikes.

Whatever it is, and because I don’t know what the impact of the heat will be on her system, I opted to discontinue gaba - the vet had recommended to go on with 50mg for a couple of days for both Aida and Feloro until they’re settled. They’re acclimated now to one room, their safe-space, I’ve allowed them to explore just a bit more - kitchen and bathroom. And they’re both lying on the floor sleeping.
Her AMPS was a bit lower than usual, so again I gave 0.5U instead of the usual 0.75.

Whenever we came across a handicap bathroom we brought them both in and let them roam free. I took the occasion each time to syringe-feed them water, 10ml each time, to ensure a baseline hydration. Super worried for Feloro’s kidneys… When we arrived, I first installed the litter box and their fountain, they both drank and peed, and then ate, but much less than usual. They’ve been eating much much less than usual. Must be the heat.

I’ve been looking for 0.3ml U-40 syringes in pharmacies, no luck so far. I’m going to look online now. Still have half a vial of prozinc, so even a U-100 0.3ml syringe would work with the conversion table.

That’s it for now!
 
I’m glad to know you made it there safely. I just checked the weather for Athens and it’s hot! It’s about the same as it is here right now in Georgia (summer.) It said there would be a high of 93 degrees Fahrenheit (whatever that is in celsius) and that is the same high temperature we are expecting here today (although the mornings have been cool, which is really nice.) Nevertheless, I cannot imagine being here without air conditioning. I am currently sitting inside where it is 75 degrees. Fans will only get you so far. I imagine that is why the cats are eating less. Hopefully they will not lose weight. Hopefully they will adjust quickly — you would think so since their body temperatures are higher than ours?? I have heard people talk about some kind of cooling pad they’ve bought for their cats, but I don’t know what it is exactly. Also, they do sell raised beds that have air flow underneath them. Cats will find their own preferred spots though (especially if we spend money on something we think they will like!)

You definitely could use the conversion chart and go with U-100 syringes. They allow for finer dosing changes as well.
 
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