PZI doses

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Ben&Squirrel

Ben&Squirrel

Member Since 2022
Has anyone here had their cat on one dose of PZI (the U.S. version) per day at 4 or 5 units or more?

Also, can anyone recommend a San Antonio TX vet? By this I mean one who specializes in feline diabetes.

Thank you.
 
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Previous post
https://felinediabetes.com/FDMB/threads/catherine-benny-and-squirrel.260910/#post-2928320

I'm going to tag the members that replied to yesterday's post about 4 units is too high of a starting dose, is that why you are asking?
How many units did you give this morning, it's not filled out on your spreadsheet
Like others have said you need to be testing much more and if you start giving the insulin twice a day it's just as important to test during the night cycle
@Bron and Sheba (GA)

@FrostD

@Sienne and Gabby (GA)

Just a reminder Benny is still getting 4 units once a day
 
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I'm still a bit confused at times, sorry for reposting.

My concern is that my vet wants him to go up to 5 units only once a day and it's not what I have been hearing here. I'd like to know if anyone else has done this with PZI.

Will test more.

Edited to add that I have cross-posted this to the PZI thread and am not having success in deleting. Apologies for duplication!
 
Ben&Squirrel said:
I'm still a bit confused at times, sorry for reposting.

My concern is that my vet wants him to go up to 5 units only once a day and it's not what I have been hearing here. I'd like to know if anyone else has done this with PZI.

Will test more.
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I don't think so at all, like a member said yesterday I don't think your vet knows much about diabetes.

It's ok that you reposted
Honestly I would listen to the members here, if it wasn't for them Tyler wouldn't be in remission today.
Some members have been here for 25 years or more and in my opinion they know more than most vets do
Having Ben in those high numbers is not good

Have you picked up any ketostix to test for urinary ketones
t's a precaution when a cat is sitting in high numbers given that ketones can be dangerous. You dip the strip in your cat's urine and compare the result to the color guide on the container a few seconds later.
 
I did get some ketostix, which I think you recommended--thank you. It is making me crazy that his numbers are not really going down. Then again I realize I'm going to have to be patient and keep on trying.

I really value what you all have to say. I think I mentioned this before somewhere, but I had a diabetic cat, Rocket, about 20 years ago and got amazing advice here. He went into remission and lived another ten-plus years.

My concern is coming up because I have read a couple of journal articles about PZI (I have access through work) and they actually recommend starting in the amount he was started, then going up from there. The calculation of amount of insulin by body weight is within the prescription my vet is making, but might be a little high. I would like to know how far others who have specifically used PZI have gone.

Unless I find another local vet who actually does know more about feline diabetes, I'm going to have to deal with this one and would like to have the data to show him whether others get that high.
 
Ben&Squirrel said:
I did get some ketostix, which I think you recommended--thank you. It is making me crazy that his numbers are not really going down. Then again I realize I'm going to have to be patient and keep on trying.

I really value what you all have to say. I think I mentioned this before somewhere, but I had a diabetic cat, Rocket, about 20 years ago and got amazing advice here. He went into remission and lived another ten-plus years.

My concern is coming up because I have read a couple of journal articles about PZI (I have access through work) and they actually recommend starting in the amount he was started, then going up from there. The calculation of amount of insulin by body weight is within the prescription my vet is making, but might be a little high. I would like to know how far others who have specifically used PZI have gone.

Unless I find another local vet who actually does know more about feline diabetes, I'm going to have to deal with this one and would like to have the data to show him whether others get that high.
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Tagging
@FrostD

@Bron and Sheba (GA)

@Sienne and Gabby (GA)

Ladies please read #2 also
 
So advice from the other day still stands.

Here is the ProZinc insert that comes with every vial. You can see the starting dose is 0.1-0.3IU/lb of body weight, and it specified every 12 hours. So minimum you're looking at about 1.5U (which I mentioned yesterday), up to 4.35U twice a day. That is a massive and dangerous amount of insulin to start a cat on (read the field study in the insert as well about the hyperglycemia).

In my experience here, most cats on a low carb diet are well controlled anywhere from 0.1U (yes you're reading that correctly) up to around 3U. It does take a little time for them to get used to the insulin, so you have to be patient and methodical. It is very rare for a cat to truly need more than that - my cat is one, and that is because he has two underlying conditions that cause insulin resistance.

You really need some tests in the +3 to +5 window. The trouble here is going to be that even if he isn't going low right after you give the once a day shot, he comes back up so high because it's only once a day. So just because 4U once a day may not bring him too low, I can pretty much guarantee you 4U twice a day would...and would likely kill him or at the very least end up with an ER visit. I'm not trying to be dramatic or scare you, I just really want you to understand the gravity of this and how dangerous your vets recommendations are.

So:
Step 1: move to twice a day dosing, start on a day you can monitor and have hypo kit. Again, I recommend 1-1.5U twice a day. Give him about a week, maybe a little more to settle into that
Step 2: move him to a low carb diet. But again, wait for our advice before you do that, and it will be a slow transition done over the course of a week or two.

There really is no reason your vet needs to knows the ins and outs of what you're doing, though I understand it can be uncomfortable going against advice...or eventually having to have the discussion of why you're doing what you're doing. The literature (and we) are very clear that it needs to be twice a day, and what the guidelines on dose are. As are the benefits of a low carb diet.

Hold on and I will get you several spreadsheet links
 
I don't have a ProZinc insert, Melissa. The vet just gave me a vial.

I know you are right about the twice-daily shots; even the ProZinc website says it. I'm going to call another local vet who might be a good second opinion. I'm attached to this vet because I said goodbye to three of my beloved elderly cats in his office last year, so it's hard, but this is not working.

In the meantime, I'll test more in the +3 and +5 window. And just give 2 units in the morning, or go with the 4 or 5 they are prescribing?
 
Panzer (started at 6U but after a dental went down to 3U, and had continually come down since to current dose around 0.5U)

Gizmo (topped out at 1.5U, currently in remission)

Spike (recently diagnosed, went hypo at dose is 3U, currently trying to get regulated and floats between 0.75-1.5U)

Cleo (recently diagnosed, had near hypo at 2U, currently trying to regulate, dose around 1.25U)

Penny (go to 2021 tab, started 2U and had a near hypo, ProZinc ended up not being a great insulin for her so ultimately switched

Ace (go to 2021 world tab - vet started at 3.5-4U, you can see all the lime greens - we don't like limes - and she quickly had to back down to 1.5-2U range...ended up switching to Lantus because ProZinc didn't work well for him, switched and doing much better)

Wolvi (2021 tab - highest he went was around 3.6U but you can see he fluctuated in dose a lot - ProZinc just didn't work well for him so switched and doing much better)

Pebbles (recently diagnosed, still trying to regulate, but you can see 1U is getting fairly good numbers)
 
Ben&Squirrel said:
I don't have a ProZinc insert, Melissa. The vet just gave me a vial.

I know you are right about the twice-daily shots; even the ProZinc website says it. I'm going to call another local vet who might be a good second opinion. I'm attached to this vet because I said goodbye to three of my beloved elderly cats in his office last year, so it's hard, but this is not working.

In the meantime, I'll test more in the +3 and +5 window. And just give 2 units in the morning, or go with the 4 or 5 they are prescribing?
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Did you notice I linked the insert for you? Just click on the blue text.

I would give 1 or 1.5U each shot - so if you choose 1.5U, you would give 1.5U in the AM, and then another 1.5U in the PM 12 hrs after the morning shot. For now you will only want to shoot if above 300, if you get anything below that stall without feeding and ask for advice please (you may notice the dosing guidelines say 200, but that is when we know a dose is relatively good, right now I'm being cautious).
 
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Hi Melissa, I did notice the link, I was more saying that my vet did not give me a bottle or a insert, just a little vial. Is that bad?

Thank you for the specifics on a good plan. If I get anything below 300 I'll ask for advice before I feed.

The specifics on your cats' history with PZI really help.
 
Ben&Squirrel said:
Hi Melissa, I did notice the link, I was more saying that my vet did not give me a bottle or a insert, just a little vial. Is that bad?

Thank you for the specifics on a good plan. If I get anything below 300 I'll ask for advice before I feed.

The specifics on your cats' history with PZI really help.
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Was the vial already punctured do you know? It is a bit odd...the ProZinc vial comes in a little box, usually with the pet's name and prescription/dose on a sticker. And then in the box is the paper insert.
 
"Was the vial already punctured do you know? It is a bit odd...the ProZinc vial comes in a little box, usually with the pet's name and prescription/dose on a sticker. And then in the box is the paper insert."

It was punctured because they used it to give him his first dose in the office, so they could show me how to do it. The prescription is on a label on the bottle. No box or insert. I wonder if they just gave me a little insulin in a bottle because they were not sure whether they wanted me to keep using it long term.
 
Ben&Squirrel said:
"Was the vial already punctured do you know? It is a bit odd...the ProZinc vial comes in a little box, usually with the pet's name and prescription/dose on a sticker. And then in the box is the paper insert."

It was punctured because they used it to give him his first dose in the office, so they could show me how to do it. The prescription is on a label on the bottle. No box or insert. I wonder if they just gave me a little insulin in a bottle because they were not sure whether they wanted me to keep using it long term.
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Hmm. I'm mostly wondering if it had been open for awhile and used before they gave it to you, like they used it around the office, when boarding pets, etc. They're only good for so long after being opened. Is there an expiration date somewhere on the vial?

New vials are about 4/5 full, did it look roughly like that when you got it?
 
Ben&Squirrel said:
On the presciption bottle the vial is in, it says "Protamine Zinc" but on the prescription label around the vial it says "BCP PZI BOV".
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That is NOT ProZinc. It is bovine-based insulin compounded by BCP pharmacy. ProZinc is also a protamine-zinc insulin but it is compounded with human recombinant DNA human insulin (recombinant DNA origin).
The BCP PZI is a good insulin and it is thought that since bovine insulin is closer to a cat's insulin than human insulin. Before human analogue insulin like Levemir and glargine were available BCP PZI was a op chose as was PZI Vet which was a mixture of porcine and bovine insulin with protamine zinc. PZIVet was same formulation as one insulin that was used for humans before recombinant DNA human insulin was available. Last I check BCP PZI was less expensive than ProZinc on per unit basis.
 
"That is NOT ProZinc."

I was told that it was. I was also told that it was porcine; it sounds like that is not the case. Not sure whether to think this is a significant difference to the cat or not. It sounds like one appropriate choice for use, anyway?
 
Ben&Squirrel said:
was told that it was. I was also told that it was porcine; it sounds like that is not the case. Not sure whether to think this is a significant difference to the cat or not. It sounds like one appropriate choice for use, anyway?
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Yes, BCP PZI is a good and appropriate insulin. I acts like ProZinc.
 
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