ProZinc not working; desperate for other options

I am new to this forum, but have always found the Feline Diabetes website very helpful.

My cat Dosie is 15 years old and has been diabetic for 6 to 7 years now. She has been very well regulated on PZI (compounded blend) and more recently PZI (Idexx). Her vet switched her recently to ProZinc when PZI Idexx was no longer available. She was at 6 units (her same dosage as Idexx) and has not responded at this level. She has been at the vet for five days now (was dehydrated, high sugar, etc.) while he tries to find the right dosage for her. She is not responding even at 10 units. The vet says he has one more option: a compounded blend (Vetsulin?) but if this does not work, it may be time to put her down. I know she has had a long full life, but I am frustrated because she is otherwise healthy, good heart, kidneys, no arthritis, etc. (other than diabetes, of course) and I hate to see her go simply because they no longer manufacture her medicine.

Any ideas of other insulin brands out there that my vet may not be aware of--or do I just have to realize we have had a" good run" for 16 years and accept what happens.

Thanks for any feedback/information. Best wishes to all of you and your precious cats!

 

In general, when you change insulin, you should NOT start at the previous dose.

You should 'start over'.....1-2 units 2x/day. And work toward the correct dose from there.

It could be that the ProZinc is actually MORE effective and your cat is in rebound.

You could have already passed the ideal (lower) dose, and you actually need to
reduce the dose.

 

You might want to read about rebound: http://petdiabetes.wikia.com/wiki/Somogyi_rebound This could be an issue. 6 units is a lot of insulin.

Are you feeding wet, lo carb? Dry food can really elevate bg levels.

Many people here use Lantus/Levemir. To learn more about them, go to the Insulin Support Group forums. There are stickies at the top of the Lantus/Levemir page that will give you a lot of info.

 

do you hometest at all?

 

[Thank you both for your comments. I will check on the rebound theory. She has been on 6 units for many years. She was even at 8 a while back. She eats Purina DM and has wet food in conjunction with her insulin shots. That seems to have worked for so long with the PZI, so not sure what has changed, other than using Prozinc. She was on Humulin and Lantus early in her diagnosis, but those never worked for her.]


You might want to read about rebound: http://petdiabetes.wikia.com/wiki/Somogyi_rebound This could be an issue. 6 units is a lot of insulin.

Are you feeding wet, lo carb? Dry food can really elevate bg levels.

Many people here use Lantus/Levemir. To learn more about them, go to the Insulin Support Group forums. There are stickies at the top of the Lantus/Levemir page that will give you a lot of info.[/quote]

 

No. I have never home-tested. She has always been fairly well regulated. We have a few high sugar episodes where she needed to have curves done, but the vet always adjusted her dosage a few units as a result, and that seemed to work.

 

Hmmmm....

BG testing at the vet is notoriously affected by 'vet stress'.

Kitty's BG will be artificially high, because of vet stress. Thus vet prescribes too much insulin.

Also, dose raises should be 1unit at a time...not 'several units.'

You can learn to home-test, save a lot of money, save stress on your kitty,
and have better regulation.

Diabetes is a home-managed disease.

 

Has your kitty ever been tested for insulin resistance?

Acromegaly == IGF-1 test (if you're in the US - costs about $100)

IAA Insulin auto-antibodies (if you get the acromegaly test, it cost about $12 more --- test is done at the same lab)


My kitty Norton had Acromegaly, and that caused him to need a high dose of insulin. At one point, he was getting 13 units BID to bring his blood sugar down.

Some acromegaly cats need a lot more than Norton did (he passed away in 2008 from cancer).

 

I'm probably overlooking the obvious here, but:

If your cat was well regulated on compounded PZI, is there some reason you can't just switch back to the compounded version? I know that the Idexx-PZI isn't being made anymore, but almost any compounding pharmacy can make a PZI insulin -- why can't you go back to the pharmacy that used to make your compounded insulin and ask them to make some more?

 

You've received alot of great comments. Have you ever tried BCP PZI? It is a compounded PZI from BCP Veterinary Pharmacy in Houston.

You vet can get a free sample of BCP's U100 formulation. Here's the form for the vet.

Best of luck.

Venita

 

We switched to PZI Idexx because the compounding pharmacy told the vet they they could no longer prepare it. I think my vet said they could no longer get one of the ingredients (pork?). I am not sure of the details, but whatever the reason, that is why we switched to Idexx. That would be great if a pharmacy could still prepare it.

 

Thanks so much, Venita. I will explore this option with my vet!

 

Please please please learn how to hometest! Those are high doses and you need to protect your cat by testing prior to each shot and you need to figure out what dose your cat really needs.

 

> We switched to PZI Idexx because the compounding pharmacy told the vet they
> they could no longer prepare it. I think my vet said they could no longer get one
> of the ingredients (pork?).

Maybe cow pancreases; that's why Idexx had to stop making theirs, anyway.


> That would be great if a pharmacy could still prepare it.

BCP still makes it, and Venita's given you the link there for their free trial offer. I also know that Professional Arts Pharmacy (Baltimore) and Stokes Pharmacy (NJ) were still making it last spring/summer; and I *think* Diamondback Drugs (AZ) still makes it as well.

You might try calling local compounding pharmacies in your area and see if they can make it for you; if it's a local place, you can pick it up yourself and save money in the long-term. BCP's trial offer is also good, but if it works well for you, then you're likely to keep buying from BCP and will spend more in the long-run on shipping costs.

Regardless of which one you try, PZI is still available as a compounded insulin. Since both compounded PZI and Idexx-PZI have worked well for you in the past, I'd suggest giving another compounded PZI a try before switching out to a different insulin altogether.


As you're probably aware from your first round on compounded insulins: compounded insulins are made specifically for the animal intended, and there may be strength variations between batches. If you home-test blood sugar levels, you can adjust insulin as needed. Also, compounded insulins also have a more limited shelf life than manufactured insulins. (Like I said, you probably know this stuff from earlier, just reiterating.)

 

As you can see, there are several options... including trying an altogether different insulin like Lantus is you must... I don't think there is any reason to say good-bye yet... Really. And if you can learn to hometest and you start over at 1 unit and go up from there... you might find that your kitty is healthier than ever. Yes, kitty could need a high dose, but it's really hard to say whether a cat was well-regulated or not if you were not hometesting. I understand that she may not have been sick... but she could likely be even better regulated and safer, if you home test regularly. Would you be willing to try to learn that?

Also, you can get away with a lower dose if you feed a good quality low carbohydrate wet diet.


I understand that you have to get the insulin situation sorted... but I fear your vet is out of his league if he's suggesting that it's time when it's only an insulin change issue and he's not suggested a few other insulin and that he didn't start over at 1 unit when switching insulins.

 

another point. i switched from PZI Vet to Lantus, which, like prozinc, is a human analog insulin rather than derived from a cow or pig's insulin. we reduced our dose slightly, and it took between 7 and 10 days to see how the new insulin would work.
cleo's onset, nadir, and duration were quite different on lantus.
you're probably seeing that with your cat, and depending on blood sugar level, it takes a while for the new insulin to build up in the system to work on the numbers.

because your dose is so high (others can be much higher, but 6 is high for a regular diabetic) and your cat hasn't tested positive for acromegaly or insulin antibodies, it would probably be a good idea to reduce the dose and start working up again. i found lantus to need that slow build up in the beginning and i'll bet prozinc does too.

if you really liked your cat's numbers on PZI Vet, tho, i echo the others in saying why not try BCP's version. it is cheaper than PZI Vet and BCP has been making it for a while. if you're looking to change insulins to lantus or levemir, you and your vet can get some valuable guidance from our Lantus/Levemir Forum, with all the people there who have direct experience managing their cats' diabetes. Many of us there follow a protocol called Tilly, which is described in the stickies at the top of the lantus forum page, or you can follow the link on my signature to the tilly page and read all about it yourselves.

if you drop the dose (which is what i'd do), be sure to test for ketones. you can pick up ketone diagnostic strips at most pharmacies. some people stick them in their cat's urine stream while he/she is peeing; others dip them into the litter right after the cat has used it and before it has soaked into the litter. ketones can be a dangerous side effect of insufficient insulin, which is why it's important to test for them when you drop your dose. but plenty of diabetes practitioners bring a dose back down to 1 or 2 units twice a day and then slowly increase the dose over time if they're past 5 units and still having trouble managing the blood glucose level (may have missed the cat's optimum dose). you just have to do it safely by ketone testing and reducing in steps rather than all at once.

 

The manufacturers of PZIR recommend that if your cat was on PZI Idexx and you switch to PZIR that it is safe to start at the same dose. However, they did find that PZIR is more potent for some cats.
http://www.vetlearn.com/ME2/Audiences/d ... DF82758ACA

 

If a dose is reached without hometesting, there is absolutely no way to know whether or not it was the RIGHT dose. Basing it on appearances alone is potentially hazardous. To know for sure, hometesting is a must and will save you a lot of grief and stress.

 

I would like to thank everyone on here for their feedback regarding my cat, Dosie. I am happy to report that after five days at the vet, she is coming home tonight! My vet indicated that she was resistant to the ProZinc, and her body was not even accepting any of it, hence her high sugar levels. (Apparently most cats make the switch fine, but there are a few who are resistant.) After many rounds of curves, etc. she is doing wonderfully on 2 units, 2x a day of Vetsulin. My vet is aware of the FDA alert regarding this insulin, and we are using a compounded formula from a local pet pharmacy. I will be checking for signs of high blood sugar and he wants to see her again in a few weeks to make sure she is on track. If there are problems my vet is open to trying the all beef BCP PZI many of you recommended. Dosie always was resistant to "human-use" insulin, i.e., Lantus, Humulin, so hopefully the Vetsulin will do the trick--and if that is discontinued or supplies run out from my compounder, then the BCP will be an option. Beyond those solutions, not sure what else would be out there for my special cat!

I am now definitely considering home testing, and appreciate all of the information regarding that. My vet said that would be a good idea if I can get her cooperation. She is a fiesty cat (takes 3 vet techs to draw her blood!), so I am hoping I will be successful with that endeavor. We did well for almost 6 years just with the diet and (now discontinued) PZi, and never had any problems, except an occasional dosage change. But having had this problem with the switch to ProZinc, I now see the advantage of home testing to find problems immediately.

Again, I cannot thank you all enough for your advice! Warmest regards, Carol from Cincinnati, owner of 16-year-old cat Dosie, diabetic for 6 years

 

I am very glad that your cat is responding better and feeling better, but please note that it may be that your cat wasn't insulin resistant at all, and was simply stressed! your current dose may not be at all valid IF vet stress artificially elevated blood glucose levels. This is why testing at home is so absolutely crucial!

 

I recommend that you include rewarding her with low carb treats every time you test her, even if you are not successful. Soon she will associate getting tested with getting treats and it will make it easier for you. She may even start bugging you to get tested just to get the treats. :lol:

 

Thank you for your kind words and concern. I understand the stress component to testing, but her levels were way high when I brought her in ( levels over 500 and very dehydrated and sick, that is why I brought her in) and apparently had been for some time. My vet factored in stress in his testing, and he does believe it was the switch in insulin, which makes sense to me given her trouble with insulins other than PZF compound/Idexx in the past. He has been successfully helping me manage my cat treatment for 6 years and I do trust his care of Dosie.

I agree home testing will help in the future. Thanks again for you concern!

 

Great idea! I do that with her shots now and she does comes running!

 

> My cat Dosie is 15 years old
[...]
> very dehydrated

Have you had her kidney levels checked recently? While dehydration can be caused by many things, especially in older cats (and people!), it can also be caused by lowered kidney function. So if Dosie does have kidney problems, it might be beneficial to switch to a more kidney-friendly diet, increase water consumption, or possibly add potassium or start fluids.