? Terry from Caninsulin to Prozinc and considering Lantus, please help!

Let me introduce my friend from the Dutch forum @Fabiënne and her lovely cat Terry. Terry is almost 8 years old and weights 6.5KG (14.30LBS). Terry was diagnosed at the beginning of July and started with Caninsulin. The vet started with 3U of Caninsulin, that wasn’t enough according to the vet so a couple of days later they increased his dose to 4U, after that they went back to the vets to do a BG check and he gave an 8mmol (144mg/dl) nice right? The next day everything was going wrong, he got a hypo.. Fabiënne thought he was really lethargic and he only wanted to lie down the whole day. Fabiënne gave food but he didn’t want to have it and they drove directly to the vet. At the vets, they discovered his BG was extremely high, 29mmol (522mg/dl) He was hospitalized for a couple of days and the vet still gave Caninsulin. They discovered that Terry didn’t respond anymore to Caninsulin after making a curve a couple of times and the BG stayed around 20mmol (360dg/ml). After those couple of days he finally was given Prozinc on 7/17. He was feeling better after he was put on Prozinc. When the switch was made Fabiënne joined the Dutch forum and wanted help with dosing/food etc. to get Terry well regulated.
We are trying to help Terry get nice numbers but he’s really bouncing a lot. We’ve advised Fabiënne to switch foods a couple of times because we thought that Terry was on food that had a lot of carbs in it (first started of with prescribed food from the vet) after that started lower carb kibbles but still was too high in numbers. Now since 9/4 Terry is only eating raw food and low carb other wet food (containing +/- 6.5% carbs) I do think Terry is doing better seeing his numbers as of from 9/4 but we can’t seem to understand why he’s having low AMPS or PMPS and after a dose reduction on that pre shot number he seems to go up really high again.
For example, see 9/5 PMPS a really beautiful 7.8mmol (140.dg/ml) and we advised 1U, but he managed to have a +1 of 16.3 (293dg/ml) and a +2 of 18.3 (329dg/ml). After that night you can see at 9/6 he has a really high AMPS 21.6mmol (388dg/ml)
The same goes for 9/7, see the nice AMPS with a nice day curve, he was surfing a little bit, and his PMPS was beautiful 8.3mmol (149dg/ml) What I still don’t understand why he has low PMPS’s.. is this maybe his pancreas helping out? And then we upped the dose (because 1U wasn’t working the last time) to 1.5U and again he gave a +3 of 18.2mmol (327dg/ml)
Can someone please take a good look at what’s going on with Terry right now? It can’t be the food because he gets food that contains the least amount of carbs that is available in The Netherlands, so it can’t be food spikes. Fabiënne is getting to a point of real frustration (can’t blame her) about Terry right now. Her bottle of Prozinc will still be enough for 2 weeks but she’s considering to choose Lantus over Prozinc. This because the moderators/advisors on the Dutch forum are thinking this is a better insulin for Terry. I get that but I think that Terry is showing much better progress since he’s off almost all the carbs and is really showing some better numbers but we just want to understand them… So some extra eyes on his sheet would be really welcome. Please tag people to help look at Terry’s sheet. Oh, btw, Terry only uses MMOL instead of dg/ml so his sheet doesn’t convert but you can multiply it by 18 if you are looking at it so it multiplies to dg/ml.
Also if there are people here that have switched from Prozinc to Lantus and please tell your story as Fabiënne really wants to hear some success stories about that switch.
Thanks you in advance for helping my Dutch friend understand what’s going on with Terry’s numbers.

Here is Terry's sheet.
https://docs.google.com/spreadsheet...18ScODUj6dFaFy5Fr1IgRzCHU/edit#gid=2112851081

@Sue and Oliver (GA) @Rachel @Bobbie And Bubba @Sharon14 @Robin&BB @Kris & Teasel @TempestsMum @AbyResq @Tuxedo Mom
Please tag other people for an extra pair of eyes to look at Terry's case.

Thanks so much guys!

This is beautiful Terry!

 

Thank you Ruby!
I really hope someone can help us...

 

Hi Fabiënne.

What % of calories from carbs are in the food? If it's very, very low (e.g. less than 2%) it might be an idea to do a food trial with a food containing a slightly higher carb%. (For example, my Saoirse does better on 4.4% carbs than 1.6% carbs - I think it may be that the insulin has more to work on and that stops her liver from 'over-reacting' and releasing too much stored glucose between doses when the insulin's most active in her system.) If the slightly higher carbs make matters worse you can switch back to Terry's current food straight away.

Can't help with the Prozinc side of things (no experience with that insulin).


Mogs
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@Critter Mom The raw food doesn't contain any carbs (or really like 1 or 2% depends on the flavor) but the other low carb food does contain 6.5%. There is nothing lower in the Netherlands than that 6.5% then raw food.

 

Thanks for the additional info, Ruby. I don't know what else to suggest.


Mogs
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Still, thank you Mogs! We will await some prozinc users / experts to give there opinions about this case!

 

Hey there ~ I just took a look and I think it is too soon to think about switching again. It has only been since 7/17 since Terry was switched to ProZinc and it looks like he is hitting some greens and then bouncing. I noticed the Dutch color chart is different for instance the 8.3 is green and equates to 149.4 and that would be blue on our system. Also, wondering why the PM side of the chart only goes to +7 hours? It might be a good idea if Fabiënne could get some +5 -+7 PM test on Terry to get an idea of what is happening with the insulin at that point. It looks like his nadir is anywhere from +5 - +7.

If it were me, I would give it a few more months on ProZinc and if Terry is no where near being somewhat regulated at that time, then think of switching.

I did switch from ProZinc to Lantus after 6 months being on ProZinc and I will be happy to share that with Fabienne but for now I would keep doing what she is doing and letting bounces clear. Remember that they can take 3 days to clear. Just my opinion.

 

Well Fabiënne can't really get those test because it's in the middle of the night and we don't really test those numbers... She has 2 really young kids and a day job so she does need some sleep. Also she gives Terry insulin at 7:30PM so that makes her +5 and +6 really late for her.
But she does grabs a lot of +6 moments during the day cycle when she can.

 

Welcome Fabienne! Terry is adorable! Just waking up here, but I agree with Bobbie that it's too soon to switch. It does look like there is some bouncing going on and, as you know Ruby, that can take awhile to clear! How is Terry feeling otherwise?

 

I understand, that does make it hard. Perhaps, if she gets up in the middle of the night to go to the bathroom she could grab a test. I know working outside the home and doing this sugar dance can not be easy! My hat goes off to everyone that does it.

Let's see what the others say but, I think it's too soon . If Fabienne is really set on switching to Lantus, have her go to that Forum and read some of the stickies .

 

Fabiënne did also join us so she will write something in a couple of hours about Terry and the questions that she has.. I just started the thread for her and tagged some of you who I know can give some good advise and tips for her.

I do also think the switch is too soon, but I also get why she's being advised to switch due to the bouncing and the high and low numbers. For example his AMPS today is 27.8mmol (500dg/ml) and just now his +5 is 12.7mmol (228dg/ml) and Fabiënne just told me he's not even feeling well... But that # should make him feel well you know what I mean? I think he's not feeling well because he drops and goes up to quick in short periods of time. Also Fabiënne is thinking of the switch because maybe Lantus could get him steady / lower in # (probably) quicker (is this true) so that is also good for his organs right?
Being all the time high in # it can damage his organs... what do you think about that?
Because I do understand that it's maybe too short being on Prozinc to say that it doesn't work for him, but we also need to look at what it's doing for him... What do you think about that?

 

Lantus does have a gentler curve but, kitties can still bounce drastically on Lantus also. The extremes can make some cats feel horrible just like it does with some humans.

 

Could she sometimes get a PM+11, 1 hour before the morning dose is due, as well as the AMPS test? It could throw some small bit of additional light on what Terry's BG is up to.


Mogs
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Another thought: Lantus is dosed by the nadir with consideration to the pre shot where ProZinc is the opposite. With out any mid cycle test through the night ( which is typically kitties lowest time) it will make using Lantus difficult.

 

I think that some cats need more time to adjust to getting insulin than other cats do. Some take well to immediate dose manipulation to get the BG numbers down as quickly as possible whereas others struggle just to get used to insulin in the early days. Changing doses too much and too often might be another stressor for them. I can see how this might make them feel quite ill. We all want our kitties to be in good numbers right away but I think it takes more time for some - ECID and patience is the key.

BTW - my cat started on Lantus, had wild BG swings and then got stuck in high values from chronic rebound. It made him insulin resistant. After a very expensive DKA at the end of March 2016 I switched him to ProZinc. He still bounces a lot but I feel that I have better dosing control.

 

We'll try, Fabienne.

 

She can but Terry is a little terrorist because at that moment he is really hungry and he gets 'food stress' from it so what Fabiënne does is she gives him some raw food, then test, and then give the other low carb food...

 

Can you please explain DKA, considering that Fabiënne does not know what that means.

@Fabiënne ECID means every cat is different.

 

DKA means "diabetic ketoacidosis". Here's a link to an article from this website:
http://www.felinediabetes.com/ketones.htm

 

If she tests immediately after giving Terry a very small snack at +11 the food would not have enough time to have a big impact on the BG levels. Might be worth a try. If Fabienne does decide to try this I suggest it would be better to do it on a day when she can test in the hours after the next insulin dose because the small snack might impact the preshot test and therefore caution would be needed about the dosing decision in such a circumstance.


Mogs
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Thank you Sharon! Terry is not feeling well for months now. The most of the day he lays in a corner. Sometimes he has a good day and plays with his brother. That are mostly the days when there are no bounces.

 

The time he was hospitalized the vet warned me about DKA. I tested for ketones last week and now he’s in a room apart from the other cat with an empty cat box. I hope I can catch some urine to test again.

 

I could try that. But I already test after raw food, because Terry is always very hungry. Normally he gets raw food at 6.30/6.45 , I test at 7 then give him wet food, and give him an insulin shot at 7.30 .
Do you mean, it would be useful to test an hour before the shot? Because that’s only half an hour earlier. Normally I get up at 6/6.30 am. I could test him at 6am. Is that usefull?

 

Hi Fabiënne,

Yes, it would be useful to test at 6am. While the +11 test usually doesn't give info about how low the dose might be taking a cat in a given cycle, taking the +11 and then the preshot can give you insight into whether the BG is rising or falling at preshot and that may provide some insights to better inform dosing decisions. All data are valuable.


Mogs
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Thank you all for your comments!

At first, sorry for my English writing…. Please forgive the mistakes

Terry does not feel well at all. Sometimes he has a good day. And I believe the days that he feels better, are the days he doesn’t bounce. It doesn’t matter if his BSS is high or lower. As long as it is stable, I think he feels better. But every time his scores get better he bounces back up. There is no time for his body to recover from a bounce because the next one is immediately there. I compared a lot of Lantus-sheets to ProzinC-sheets and I must say the Lantus-Sheets are much more stabile, that’s why I consider to switch to Lantus. I just want Terry to feel better. He was feeling even better before he was diagnosed. From the time we started insulin its gone worse.
I have a few more questions…

• I understand it takes a while to adjust on ProzinC, 4-6 months… But if he will stay bouncing like this, can that damage his organs? Is there a bigger chance of DKA?
• Is there a way to get his scores down more gently, that way he would feel better because there are less highs and lows. ?

 

And I want to add to that that the bottle Prozinc will be finished in 2 weeks and that Fabienne is really considering Lantus.. So in your honest opinions, should she stick with Prozinc a bottle longer? Considering the bouncing and maybe this is not really good for his well being, or should she go for Lantus?
I would think the first because she's just been on Prozinc for less then 2 months, so it is not really showing it's power yet and she just switched a couple of days ago fully to low carb food... but then there is the way Terry is feeling,, that's also not nice for him...
There are so much pros and cons to this... Maybe a new methode for Terry's case with Prozinc can help him get steady in # ? We are also a little bit frustrated at the Dutch forum because he's bouncing really extremely. Maybe there's someone who can take a look at the dose...

 

It is really her call as to whether she switches or not. She will need to get some readings from around +4 - +7 on Terry as that is when Lantus usually nadirs and without knowing the nadir the dosing will be impossible. She is correct about Lantus is a flatter curve than ProZinc but kitties can and do still bounce on Lantus. But, maybe it could be what flattens him out some. Fabienne, go with your gut and only you know what is best for Terry.

If you do decide to switch, go to the Lantus Forum and introduce yourself and give a little history about Terry and have that forum guide you as to what dose to start at. Wishing you and Terry the best.

 

Saoirse had very wide swings when she was on Caninsulin and she hid for 9-10 hours out of every cycle. She started hiding at injection time, too. She did better first time round on Lantus; her BG was much more stable but she was close to remission and only needed a tiny dose. This time round I've had to increase her Lantus dose over the last few weeks to 2.25 IU BID and she's not doing as well on it. Her BG is in a better range but as the dose has increased her mood has become progressively more subdued. It's not straightforward to know what to do. I am thinking of asking my vet if he will be willing to prescribe Levemir for Saoirse because I've read good things about it here and I do wonder whether it might address the mood problems, but I don't know how amenable he will be to this proposition.


Mogs
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If Terry were my cat and was feeling that carp, I'd try a different insulin sooner rather than later. Quality of life is what we're aiming for, not just extension thereof. Saoirse was absolutely miserable when she was being treated with Caninsulin. If there had not been an alternative I think I might have opted to let her go rather than keep her long term on that particular insulin; in many ways that specific treatment made her feel worse than the actual disease. Thankfully she did much better with Lantus and subsequently went into remission less than three months later (see my prev post on this thread).


Mogs
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That's really true Mogs! there are so many good things to switching but also is this long enough to have tried... that is the question... I suggested to Fabienne to let her guide the last 2 weeks of her using Prozinc on the FDMB, and see if the new advise/tip and other set of eyes will get Terry more steady in numbers than he is now.. She agreed and will be here for the next 2 weeks on Prozinc, hoping that you all can help her get Terry better regulated.. If not, and she finishes the bottle she will go and try Lantus.

 

I suggest waiting to get input from other members more familiar with ProZinc; they may have a different opinion. It is better for Fabienne if she has a number of viewpoints to consider before making a decision.


Mogs
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Yes I know, we are awaiting them Hoping Sue and Rachel will stop by soon.

 

btw I just made a world spreadsheet for Terry, and it's in Fabienne's signature so it's easier for you to see what the numbers are instead of having to multiply it.

 

I can't see Terry's world spreadsheet but having looked at the original it appears Terry seems to be having the same patterns as Cappuccino is on Prozinc, I'm not sure if it is just her or that I am not yet used to Prozinc, having changed from Caninsulin. These are the differences I am seeing between the two insulins.

With Caninsulin the drop starts usually at +2 and continues to nadir mid cycle, with a rise again to the pre shot number. With Prozinc her numbers go up to start with and then drop with nadir around +8 (this is good news for me), before rising, so having discovered this I am now more comfortable giving insulin at quite low pre-shot numbers with consistency in dosing - I am not due another curve for a few days so only time will tell. Cappuccino is on low carb food and tends to get a food spike.

Once thing the specialist advised me to do was if there was a low pre shot number was to test at +1 and if the number was shootable to give the normal dose of insulin then to give it at +1 and only to skip if the +1 stayed low - this is what I did 2 days ago with a PMPS of 8.8 (the actual protocol is a bit more complicated and tailored to Cappuccino).

Terry may be feeling a bit 'off' as he is getting higher numbers in the early part of the cycle than the pre shot numbers. Prozinc seems to like consistency so I wonder if sticking to the same dose for a few days in a row would help - at the end of August a 3 unit dose was giving nice numbers. As Prozinc is in/out I find it a much better option than Lantus because I can't test with the frequency the protocol demands for Lantus.

I would suggest sticking with Prozinc for now and seeing what consistent doses do and getting a curve done in, say, a week.

 

Can't you see it via this link @Alexi ? :
https://docs.google.com/spreadsheets/d/1aqxBsReFiZbRBBodlqieMs8IvEjyJcTzMfoO8ElVrI0/edit#gid=5

 

no - still can't see it - have the permissions been set to 'anyone who has the link can view'?

 

no, sorry I think it's this one
https://docs.google.com/spreadsheets/d/1aqxBsReFiZbRBBodlqieMs8IvEjyJcTzMfoO8ElVrI0/edit?usp=sharing

 

Yes - I can see it now, thank you.

 

Winnie wasn't on Prozinc for long enough for me to have gotten a feel for it enough to advise on dosing or what could be happening with Terry's numbers, but we switched from Prozinc to Lantus and have had great success. Winnie was getting similar duration of less than 12 hours with Vetsulin and Prozinc, but Lantus has pretty consistently kept her under 300 since we made the switch. She occasionally bounces, but she has been so much happier and healthier since the switch. (Life has been chaotic, so I don't have any recent all-day curves, but her pre-shots and mid-cycles have been better than ever, and her previous lethargy and irritability are all gone.)

I'm sure the wonderful people on this forum can be a great help with these 2 weeks on Prozinc--maybe the duration is more than 12 hours but wears off after the meal?--but I just wanted to chime in with a success story from basically the same insulin path as Terry