Switch from Caninsulin to ProZinc

Discussion in 'Prozinc / PZI' started by Andra&Ozzy, Jun 5, 2016.

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  1. Andra&Ozzy

    Andra&Ozzy Member

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    Hello,

    I have posted in the main forum about Ozzy's pancreatitis treatment and wanted to ask for some specific advice/ guidance on his insulin switch. We are switching him tomorrow, from Caninsulin, which he's been on for 6 years (8 units, mostly) to ProZinc (vet has advised starting on 3 and 1/2 units,based on his very high glucose readings lately - please see S/S). It looks like the Caninsulin is no longer working, or his pancreatitis is so out of control that this is not the right insulin anymore. I know that many think ProZinc is s superior insulin anyway, but until recently Caninsulin was the only one approved for animal use in the UK. If this does not work, the plan is to use Lantus, but there are, apparently, 'cascade rules' in the UK whereby vets have to first prove that the animal insulins do not work before going to Lantus.

    I am doing the curve myself, from home, since he gets so stressed at the vet's that they cannot get accurate readings. I am, however, very nervous. Since his pancreatitis flare-up about 6 weeks ago, he has consistently run very high numbers. In the last week alone, his dose has gone up to 12 units, just to keep his glucose readings within loosely manageable levels. He was at the vet's over a weekend, two weekends ago, to reduce his numbers by having him on a drip and insulin (drip), but they did not manage to bring the numbers down within a satisfactory range. I am incredibly scared of DKA. Any advice for tomorrow and this week and the switch in general? Is anyone available tomorrow for advice on this? How does the switch work, can one put dosage up quite quickly? I ask this because even though I imagine the advice is to go up incrementally and very slowly, we need to get his BG numbers down, fast.

    **UPDATE**

    1) I have now attached Ozzy's S/S

    2) One thing worth keeping in mind is that he does still have the upper respiratory infection, aside from the pancreatitis, in case the former impacts readings/ the switch as well.



    I am tagging a few people that I have either interacted with before, or whose names people have suggested. Thank you for your help!


    @Sue and Oliver (GA) @Rachel @Robin&BB @scoobydoox @Critter Mom @Wulfwin @BJM @Woodsywife @LindyKindy @Sharon14 @tiffmaxee @Carol & Murphy @jayla-n-Drevon @suki & crystal (GA)
     
    Last edited: Jun 5, 2016
  2. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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  3. Rachel

    Rachel Well-Known Member

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    Hi Andra! Welcome to the prozinc forum. I've read through your previous thread, and I'm with Sue...could you set up a SS so we can see some numbers? 3 1/2 units is a pretty high dose, but some kitties do need higher doses. However, without knowing a bit of history, it's hard for us to tell you what a good dose would be.

    You're in the UK, correct?
     
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  4. Robin&BB

    Robin&BB Well-Known Member

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    Hi, Andra!
    I am VERY glad to hear you're home-testing blood glucose because a cat can, indeed spike incredibly high #s from stress at the vet's office. Something I'd like you to do right away is start a spreadsheet on Ozzy, and here's the link to do that:
    FDMB SPREADSHEET INSTRUCTIONS Please make sure you choose the spreadsheet template (there are 2) that is for your type of meter, as we have one for human glucometers and another for people who use the pet-calibrated AlphaTrak 2 meter.

    Which type of meter are you using? It's important we know this because human meters (which is what most people at FDMB use) run somewhat lower BG #s than the AlphaTrak meter does, which is particularly important at the low end of BG numbers.

    Getting your BG test results into the spreadsheet (SS for short) is important because - as you plug the BG#s and his dose amounts into the chart - the more data we have, the better we can see how Ozzy is processing his insulin doses throughout the cycle; this will help us to help you.

    When you say "horrendously high glucose readings lately," what ARE those numbers? Had you been testing BGs at home all along, or are you only starting to test at home now, with the ProZinc? Because if you'd been relying exclusively on #s that came from vet visits and in-clinic curves, you may find that those numbers may be markedly higher in general than what you'll get at home where Ozzy will feel much more comfortable and relaxed. (Cats can spike BG # in excess of 100+ points MORE at a vet clinic because of stress.)
    You should be checking regularly at home for ketones if this has been a problem for Ozzy in the past.

    I am going to go back now and try to find your earlier thread on the Health main forum & read through that ... In the meantime, would be great if you can get that SS up and running and also do a signature to appear at the bottom of your posts (see mine above) with Ozzy's pertinent info: Diagnosis date, insulin type, meter type, additional health problems, such as his pancreatitis, brand & formula food he eats, etc. Just go up to the blue bar at top of page and on the far right where you see your name, click and in the drop-down box you'll see "Signature," then click on that and follow the prompts to create your own signature.:)
     
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  5. Andra&Ozzy

    Andra&Ozzy Member

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    Hi Sue. Yes, he is on meds for pancreatitis, I have just filled in the details in my profile (Cerenia, Buprenorphine, Lactulose and Mirtazapine). He is also on an antibiotic (Marbocyl) since he has an upper respiratory infection that has lingered. We tried another two types of antibiotics and it did not go away. I can set up the spreadsheet, but am very confused about how. I have opened the document and it looks very intimidating (I do not have experience with Excel). His readings in the last few weeks have been starting around 25 pre-shot and going only as low as approx. 14 at his nadir.
     
  6. Andra&Ozzy

    Andra&Ozzy Member

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    Hi Rachel, thank you. yes, I am in the UK. Having a look at the S/S now.
     
  7. Robin&BB

    Robin&BB Well-Known Member

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  8. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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  9. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Let's tag @Marje and Gracie she is wonderful at setting up spreadsheets. Looks like you'll need the World version.
     
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  10. Andra&Ozzy

    Andra&Ozzy Member

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    I am going to set up the S/S now. I have downloaded the world version, since I am using the AccuCheck until the G-Pet strips arrive this week. I compared the two glucometers on a previous reading, and it did seem to be the case that the Accucheck is, on average, 2.2 points higher than the G-Pet. I have always checked his blood glucose, so the readings will be from home, not vet's. Thank you for helping us!
     
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  11. Andra&Ozzy

    Andra&Ozzy Member

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    Thank you, Sue. I'll attempt to fill it in now.
     
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  12. Andra&Ozzy

    Andra&Ozzy Member

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    May 18, 2016
    I have done the S/S for Ozzy. Hopefully, members can now see it.
     
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  13. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Hi Andra - so glad you made it over here !!
     
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  14. Andra&Ozzy

    Andra&Ozzy Member

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    Thanks, Carol!
     
  15. Sharon14

    Sharon14 Well-Known Member

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    Hi Andra, welcome to ProZinc!
     
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  16. Andra&Ozzy

    Andra&Ozzy Member

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    Thanks, Sharon!
     
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  17. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Your spreadsheet works! So did you start at 9 units or is that when you started home testing?
     
  18. Andra&Ozzy

    Andra&Ozzy Member

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    May 18, 2016
    No, I only have the information from that point on. I've always home tested. He's been on 8 units for years and stable, so I wasn't writing readings down, because they were what we were expecting. Then, when the pancreatitis hit about a month ago, his readings started going higher and higher, so I increased to 9, and then more, until yhe current 12 (on vet's advice). It seems too low to start on 3.5 of ProZinc, given how critical it is at the moment to get his BG down. What do you think?
     
  19. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    I am unsure. It is impossible to know if his numbers are so high because the Canninsulin has been wearing off at +8, and how much they are influenced by his other issues. And the blues you have gotten for some preshots are a mystery. We always try to err on the safe side. The Hills can be part of why he is high, and if you are changing over to wet low carb, we want to be careful as that can make a huge difference downward.

    When are you planning to start ProZinc? You can monitor the first cycle, right?

    @Elizabeth and Bertie - any ideas? I know you have used both insulins and also know UK foods.
     
  20. Andra&Ozzy

    Andra&Ozzy Member

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    The most recent blue, I think, was after I gave him 13 units yesterday evening. He must not have eaten much last night...

    Yes, I can monitor the first cycle tomorrow. But I am worried about the build-up of toxicity in his body. I don't like the emergency service the vets use here- it's a different company and I didn't get a good feeling from them. They are the only ones that operate after hours and weekends in my town. My normal vets open tomorrow morning.

    The food is a problem- he's on Hills dry because it's the only thing he'll eat and keep down. Have tried everything (I think) available on the UK market. My next step in terms of that is a slow transition to homecooked+EZ complete, or ordering food from the US to see if he'll eat it. He's very difficult in terms of food. I know that this isn't the right one for him... In the meantime, I have to keep him eating, though. I feel so locked from all directions with this. The only wet food he'll touch at all is just Sheba cod, and only the jelly from that. Probably worse than the Hills and no nutritional value in that jelly, I'm sure. If anyone has any suggestions about food, I'd love to hear them, though.
     
  21. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Oh Andra I so feel for you - and yes, you need to keep him eating I think just be cautious for the next few days/weeks when he begins prozinc and transitions his food
    So you are going to give Prozinc tomorrow morning - how much are you going to give him?
     
  22. Andra&Ozzy

    Andra&Ozzy Member

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    Hi Carol. Thank you...Yes, the vet said we should start with 3.5 units of ProZinc from tomorrow morning (8 am UK time). We are not transitioning his food at the same time, there is nothing I have found yet that he will eat other than the Hills dry M/D... On the Caninsulin, he has had 12 units tonight (8 pm).
     
  23. Carol & Murphy

    Carol & Murphy Well-Known Member

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    just a note - I have the same issues with Murphy and eating - I try to rotate through these dry foods (I don't know if you can get any in the UK) Epigen 90 from Wysong, Young Again Zero Carb, Evo, and Waggers. I give him roughly half dry and half wet - I also have royal Canin glycobalance, Purina D/M and Hill dry M/D. Of all of them, the M/D really raises his blood sugar, and in fact, I kept just a little bit to have on hand when he is going hypo-it raises his blood sugar that much. Murphy will always eat the M/D. I suspect your insulin requirements will go down when you can transition to something else. good luck tomorrow morning
     
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  24. Robin&BB

    Robin&BB Well-Known Member

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    Hi again, Andra - I'm curious now ... Has your vet ever tested your Ozzy for high-dose conditions, such as acromegaly or IAA? I was only wondering because you mentioned that your kitty has been on 8 units for years, and stable until recently. (But even 8 units seems to me to be quite a lot of insulin.)

    Here's a link that explains high-dose conditions. (We have an entire forum that discusses these problems, btw - might want to check that out, too.):
    Acromegaly and Other High Dose Conditions: What We Know
     
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  25. Andra&Ozzy

    Andra&Ozzy Member

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    Thank you! Most of the foods you mentioned aren't available in the UK (apart from Hills, Purina and Royal Canin). I'll look those up. It's interesting to know that M/D, particularly, raises blood sugar. Why on earth would they make s diabetic kibble that does that? :( This is driving me crazy... If only he'd eat wet... I'll keep trying, I'm researching new foods every day, buying some, throwing away lots, constantly following others' posts for food suggestions, etc. He used to eat Hilld I/D dry, that's what he was stable on for years (since 2010). With the recent pancreatitis attack he got very bad constipation and had to be manually evacuated. He had been throwing up the I/D pretty often prior to that. So I guess that's out too, now.
     
  26. Andra&Ozzy

    Andra&Ozzy Member

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    Thank you for the link, I didn't know about these. I don't know whether the vet tested for that, specifically, or it was assumed that the dry food and the IBD is causing the high numbers. Recently, because of the pancreatitis and infection, the assumption is that this is what's pushing the numbers up. Before that...vet said they'd run "all the tests". I'll ask when I talk to her this week.
     
  27. BJM

    BJM Well-Known Member

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    Switching to a low carb food could reduce the insulin dose by 1-2 units. Given what you're already dosing, have been regularly testing, and the numbers you're getting, I'd definitely consider having him checked for high dose conditions.

    Do note on the spreadsheet what insulin you're using and if you switch, when you switch.
     
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  28. Rachel

    Rachel Well-Known Member

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    I agree, I think testing for high dose conditions is the next logical step.
     
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  29. Carol & Murphy

    Carol & Murphy Well-Known Member

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  30. Andra&Ozzy

    Andra&Ozzy Member

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    There is a list somewhere - I remember someone mentioning it- of UK low carb foods. I'll go through that and order what I haven't tried. It was either here or the FB group. He isn't adverse to wet food, but very, very picky and with a sensitive stomach. Things he's liked so far that were wet foods have either given him diarrhoea or made him vomit. But I definitely want to reduce his numbers, and even though the 1-2 unit decrease wouldn't explain the need for his really high dose, I want to give him the best chance of keeping those BG numbers down.

    Before the pancreatitis, when he was on 8 units, he was going quite low in the middle (around 4 or below, with hypos, if throwing up) and starting with pre-shot numbers in the (mostly high) teens. Vet said that she'd checked for everything that could be wrong (at that point, which was in 2010) and she can't see any reason why he would still need such a high dose, other than that he's a "peculiar" case. Sometimes it's just that, I know. But now I will ask the new vet to check him for acromegaly and IAA. I'll start a thread with his readings once I switch him over to the ProZinc at 8 am.

    I must have missed the place where I was meant to input which insulin is being used on the spreadsheet. I'll have another look, thank you!
     
  31. Sarah Smith

    Sarah Smith Member

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    There isnt really a place to put what insulin on the spreadsheet Andra. you may want to just skip a line, and write on it switched to prozinc when starting tomorrow. I shaded in the old caninsulin numbers, and wrote prozinc in under the dose when Cooter first switched over because we swapped between an AM and PM cycle :)
     
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  32. Andra&Ozzy

    Andra&Ozzy Member

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    Thank you. I'll do that. I'll start another post now for advice with the switch.
     
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  33. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Hi Andra,

    The grains in the Hill's M/D, especially the corn, will raise blood glucose levels. And some cats are also intolerant to grains, which can raise blood glucose further in susceptible individuals.

    There are dry foods in the UK that are a bit lower in carbs than the Hill's dry M/D. There are also dry foods in the UK that are grain free.

    There is only one dry food (that I’ve yet found in the UK) with less than 10% calories from carbs, and that is 'Ziwi Peak' air-dried cat food. This is really dried meat, so the texture is not like that of regular kibble. It's pricey, and needs to be bought online (Amazon sell it).

    There are two other dry kibble foods that are fairly close to 10% calories from carbs. The first is 'Porta 21' Sensible 'grain free', online only from Zooplus (about 10.8% calories from carbs). The carbs in the food are from potatoes. The reviews on the Zooplus website seem really divided about this food, with some cats loving it and some cats not liking it at all...

    The second is 'Thrive Premium Plus' chicken cat food (widely available). This may be slightly higher or lower than 10% calories from carbs, but I've been unable to determine the exact carb content (because it's been difficult to get some questions answered by the manufacturer.) This food contains sweet potato and potato instead of grains.

    Do you know what type of foods Ozzy might like? What sort of texture?
    And do you know which food/s he is sensitive to?

    Do have a look at the links in my signature below.
    The first is to the UK low carb food list.
    The second is to general information about UK foods.

    And please let me know if I can help further. :bighug:

    Hugs,

    Eliz
     
  34. Andra&Ozzy

    Andra&Ozzy Member

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    Hi Eliz,

    Thank you very much for this, that list you drew up is invaluable! And so is your advice, so thank you for posting here. Foods he likes that are wet are mainly gravy. I have cycled through dozens (mainly the 'health food' versions at Pets at Home, for example, and the vet's; I have avoided Felix, Whiskas, etc.; I did see Felix on your list, but i can't figure out which one it is.). I have noticed that he won't touch wet foods that resemble real meat. He also won't touch 'human' food. So the 'healthy' ones that come out of the can or pouch and look/smell like real meat, he won't even lick at. He likes sauce. The more sauce, the better. But obviously, that's bad, right? It's mainly gravy he likes and one type of jelly. Of everything that I have tried so far, he will only lick at the jelly from Sheba cod. He ignores the meat (not that the fish is good, I know, but at once point he was eating nothing, not even the dry, and I eventually found this one). Same with the Hills pouches (of prescription diets, I have tried the M/D cans, and also the Hills I/D pouches). He won't touch the M/D can, and from the I/D pouches, he only licks the gravy. From your list, I've tried Nature's menu and Lilly's kitchen. No luck.

    I will order the dry UK foods you suggested, even if they're not ideal. I am really panicking, the situation feels like a ticking bomb with his sugar up and not coming down at all and a (too low, at the moment) dose of ProZinc. At least on Caninsulin, he was at least coming down to 14, 15, 16 lately and then climbing again. No lower than that, and on a huge dose, which is why we are switching...

    I was wondering how high in carbs Hills I/D dry is. Do you know? He was on this for years (only one he'd eat and settled on without throwing up all the time). But then, the throwing up increased, and he went off it. That was the start of the pancreatitis bout we are dealing with at the moment (diagnosed about 6-7 weeks ago), and it also constipated him so badly that he had to be manually evacuated. Recently, he reluctantly picked at I/D again, but then the vet said we should switch him to M/D, and that's where he's at... The Prozinc doesn't seem to be dropping him more than 2 points in one cycle (started yesterday, and so far the readings are consistent with that). Any idea why that might be? (this question is open to anyone who can help, of course). Does ProZinc not drop the insulin as 'low' as Caninsulin? (I remember reading that C was 'harsher', if that means dropping lower). I know that it acts faster...
     
  35. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    According to the info at Catinfo.org (a few years old now but maybe still helpful) the I/D is around 23% calories from carbs, compared to M/D at 14% calories from carbs, so quite a difference there. (But the I/D does not list wheat on the ingredients).

    Caninsulin starts working quickly and quite often drops the blood glucose fast in the first few hours. Quite a few cats will have the nadir (lowest number) at around 4 hours after the shot (or a bit later, and occasionally, a bit earlier). Prozinc tends to drop the blood glucose more gently, so the nadir will usually happen later into the cycle. It's hard to say whether Caninsulin would drop the blood glucose 'as low' as Prozinc. That may depend on the individual cat. But with Prozinc the cat should have insulin it it's system for more of the time (Caninsulin rarely lasts for 12 hours, and quite often fizzles out after 8 - 10 hours...)

    What you might see when switching from Caninsulin to Prozinc is that you'd start getting slightly lower preshot numbers. This has happened in some cats (perhaps because of Prozinc's longer duration; or because of fewer bounces caused by Caninsulin's fast drop.) But I know it's very early days for Ozzy on Prozinc...

    Keeping fingers and paws crossed that Prozinc works well for him. :bighug:

    Eliz
     
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  36. Andra&Ozzy

    Andra&Ozzy Member

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    Thank you, Eliz! And thanks, also for the clarification on I/D. That is actually a massive difference. About the wheat- not sure how to establish whether he's allergic to it. Wouldn't he have thrown up if he was? In any case, I am going through your list systematically and ordering foods. I'm REALLY hoping something or other takes..
     
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