Vet switched from Lantus to Prozinc

Discussion in 'Prozinc / PZI' started by Nancy S, Oct 12, 2021.

  1. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
    Hi! I am new to Prozinc (began 1U 10/11) with my KittyLou. She is having very high BG levels lately and quickly progressing neuropathy.
    She was doing well until she had radioactive iodine therapy and her T4 went from 8.8 to 2.1 which slowed her metabolism.
    My question is, how should I proceed with her insulin dosing. I don’t think my vet knows how to do this and he told me today that this was a difficult case.
    I’m watching my girl go downhill with depression and neuropathy. The vet thinks that she might have acromegaly or cancer or something.
    He ran a lot of bloodwork yesterday and it was all OK except for glucose of 400 and slightly high BUN.
    I don’t have confidence in the vet, or in my own skills.
    Please see my SS for all the results and help me proceed. Thank you!
    I was in the Lantus group but they suggested I come here.
    https://felinediabetes.com/FDMB/posts/2864585/
     
  2. Denver

    Denver Member

    Joined:
    Aug 6, 2021
    I transitioned from Vetsulin to ProZinc and there is an adaption period. What did your vet recommend? Why did you start completely over at 1u?
    In looking at Kitty Lou's numbers you definitely need to increase the dose.

    FYI - You should ALWAYS do a preshot BG test and try and get a couple in during the cycle. The more testing you do the easier it is to figure out where you need to go.

    Here is the dosing process for ProZinc:
    https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/
     
    Nancy S likes this.
  3. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
    KittyLou had hyperthyroid and had it treated with I-131. During the month of September, her metabolism drastically slowed due to this treatment. Her T4 went from 8.8 to 2.1. Her BG numbers, around mid September started going up so the vet increased the dose of Basaglar from 2.5 to 4.5 over a two week span. Her BG numbers have never been higher and she’s gotten some bad neuropathy and is depressed. The vet decided it could be the insulin and switched to Prozinc. Her numbers yesterday were a sustained high. The vet told me to take a break from testing because it is really stressing me out because these high doses are NOT making things better. He told me yesterday that she is a “difficult case” and “complicated”. He told me we should consider hidden cancers, or acromegaly. He said he has never treated acromegaly before. I think he wants me to find another vet. Today is day 3 of the “reset”. I’m supposed to hold this dose for a week, correct?
    All the stuff I read states that when you normalize the thyroid, it’s supposed to cause a need for LESS insulin.
    There are people in these groups who tell me I need more insulin than the 4.5u she was on, and there are people who tell me that she has been given too much insulin. The vet doesn’t know what to do either.
    If you look at her spreadsheet for July 17 to 25 (all the black numbers). That’s when I tried to switch her to Dr Elseys Chicken and she started doing swings. She was also taking Methimazole to lower her t-4 during that time.
    On 8/10, I quit the Methimazole in preparation for her I-131. Her T4 climbed from around 5 to 8.8 by the end of August. We had her on 2 units of Basaglar and held it because she was feeling excellent even with the high thyroid levels, and we were not sure what the plummeting thyroid levels, after treatment, would do to the BG.
    So the month of September is when her metabolism greatly slowed, and her BG went in the black. The vet kept increasing the dose and the neuropathy got progressively worse. It’s been about a week since it’s been very bad and she feels like crap, sleeps all day, and avoids me. It breaks my heart because I AM DOING THIS TO HER!
    Surprisingly, though, the comprehensive bloodwork he did on 10/11 is relatively normal with a glucose of 431 and a slightly high BUN.(all other values were normal except those 2).
    So here we are. Where do I go from here? I ordered Zobaline for the neuropathy. I need to find a new vet. I might be killing my cat with this dose reset. I need to figure out a dose. I need to familiar myself with Prozinc. One thing I know is that my cat bounces. I love this cat. I can’t believe this is happening and I am at a loss at what to do.
     
    Last edited: Oct 13, 2021
    Reason for edit: Typos
  4. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Take a deep breath! Since you already started at 1U, and you have the Lantus Depot still possibly play, hold 1U for now.

    I cannot stress this enough, because it seems like you are ignoring/looking past the advice given in prior posts - you NEED to get her switched to low carb canned or raw food.

    With the HC dry in the picture, you can only increase once per week following forum recommendations. That will take you 2+ months before you get back to where you were on Lantus, still in poor numbers. That neuropathy isn't going to get any better if numbers don't come down.

    If you can get her switched over, (1) her numbers should come down significantly overall, and (2) you can increase as fast as every 1.5 to 3 days, depending on her numbers. So 2+ weeks.

    Really the best thing you can do for her right now is change her diet, check for ketones daily, and stay on top of dose increases when needed.
     
    Nancy S and Sue and Luci like this.
  5. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    I've found your thread and have to agree with Melissa - please change your cat's diet - nothing that anyone else says is going to matter if your cat is eating high carb food. Her health isn't going to improve on any front as long as there are high carbs going into her system when/if she eats.

    Try to increase the dose as often as you can to get those numbers down.
     
    Nancy S likes this.
  6. Pookie

    Pookie Member

    Joined:
    Oct 10, 2020
    Shelley & Jess and Nancy S like this.
  7. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I would NOT reset back to 1 esp with neuropathy starting now. I'm not sure why you want to lower, but if you really want to lower I wouldn't go lower than 3. Personally id keep it at 4.5 a few more days and then consider 5. The only way to resolve the neuropathy is to get her in better numbers. The zobaline should help as well. Acro of course is a possibility and something we usually recommend they get tested for when they reach about 6 units. My cat was acro and at one point up to 12.5-13 units twice a day.

    I agree with the others about the food change. The high carb food is doing him no favors.
     
    Sue and Luci and Nancy S like this.
  8. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    The vet wanted a reset, and it sounds like possibly some other FD groups.

    She's already been at this dose for 3 days, would you still jump up and increase like that? I'm not entirely sure I agree. I think the initial switch should have been to 3.5U-ish, yes, but unfortunately it wasn't.
     
  9. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
     
  10. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
    Nothing I would love more than to switch her to wet food. I have been trying. I have been successful in doing that with every other cat I’ve had in my 67 years. KittyLou will starve before she eats it. She has been eating but it’s not a “given”. She never had the increased appetite that so many diabetics have. I’m going to try to at least find lower carb dry foods. But is she doomed if she won’t switch to wet? At this point, I’m not looking for remission. I’d love to see numbers in the 200 and 300 and NOT 600+ point swings in one day like she was having a couple days ago when the meter read HI. She is MISERABLE with those swings.
    If I see any numbers in the 100’s or 200’s or 300’s, I know a huge bounce is around the corner. WHY???? should I find a vet that will tube feed her? Should I syringe feed her? She is not well right now. The Radioactive iodine changed her metabolism..
    I’m on Day three of Prozinc 1U twice daily. How long do I hold the dose? And what should I increase it to ? 1.5? Is that too much?
     
  11. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    There are lower carb dry foods, including air dried/freeze dried raw. Dr Elsey's and Young Again come to mind, Ziwipeak makes the air dried.

    Keep in mind 200-300 is still mostly above renal threshold, so that would be putting extra strain on her kidneys over time. 90-120 is what most people aim for when trying to regulate, but it does somewhat depend on how well the cat "cooperates".

    It does take time for the bouncing to calm down and pancreas get used to lower numbers; that said and I think was said before, the high carb food only exacerbates it.
     
    Nancy S likes this.
  12. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
     
  13. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
    I tried Kitty Lou on Dr.Elseys chicken (dry) back in July. It was my first experience with “bouncing”. Having never gone through that before, I didn’t realize the bounce would level out. Last week was the second time she did bouncing. I think that low was 141 and the high was 750+. What causes those??????
     
  14. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Yes, bouncing usually clears after a few cycles. What happens is when the BG drops faster or lower than the cat is used to (and that varies widely from cat to cat...for example Mr Kitty almost never bounced, but other cats bounce 2x a week for awhile until they get better regulated). Their liver "panics" and dumps sugar into the bloodstream.

    Some vets or even other FD groups may mention Somogyi effect - this is not the same as bouncing, and has never been proven to happen in cats. It was based on a single study done in humans a long time ago.

    George is a cat that comes to mind as a bit bouncy, though not the worst I've seen. You can see his post for today here. If you look at his spreadsheet, you'll see he would hit lower numbers then skyrocket back up. Over time you see more and more greens and blues, and far less yellow and black.
     
    JanetNJ likes this.
  15. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Bounces happen because your cats body isn't used to being in those lower numbers and thinks she's going to hypo so releases extra glucose. She just had to get used to being in those lower numbers.

    Dr elseys clean protien, young again zero carb, and epigen 90 are lower carb dry foods. All three will send you a free sample of the food if you ask
     
  16. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Hi Nancy - I just want to make one point of clarification - if you end up feeding the low carb dry foods mentioned above and in prior threads, you would have to stick with SLGS. Only low carb canned or raw will work with the modified method.

    @Marje and Gracie - are the air dried and freeze dried foods (such as Ziwipeak) are ok for modified?
     
  17. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
     
  18. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
    The vet wants to test her for Acro next week (he plans to send off bloodwork to Michigan. Is there anything else you would test for?
    Do you think KittyLou has something else going on? Or is it just my ineptness at doing this?
    I did 3 years of nursing school but ended up a high school math teacher. I didnt have the temperament for nursing. (As you can see).
     
    JanetNJ likes this.
  19. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    I don't think the acro test is worth it right now. I'll just reiterate that I really do think you need a new vet, yours seems to be in/misinformed on quite a few things.

    You have dry food in the picture, an insulin change, and a dose reset. We usually recommend testing for IAA and acro once they hit 6U on a low carb diet.

    I'll tag @Wendy&Neko for her thoughts as well
     
  20. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
     
  21. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
    So what should I have done. On the 4.5 U of Basaglar last weekend, KittyLou had a 600+ point swing. Her BG was 120 during a time so tested at night and 48 hours later it was Hi on the AlphaTrak2. What were those swings about?
    She had one in July like that when I switched to to Dr Elseys Chicken. They were little bags and Amazon and Chewy RAN OUT of them for weeks. I switched her back to Purina DM. On the Dr Elseys she went in the blue but had swings which made her feel like a zombie. I panicked.
    It’s not like I could call someone or get a hold of someone experienced from this group. I’m old. I live alone with my Down Syndrome son. I love this cat and want the best for her. She is the best cat I ever had. I still have hope that this can be improved.
    if KittyLou were YOUR cat. What would you do?
    The vet I have is supposed to be the “cat specialist”. He admits that he does not have experience with complicated cases and hers was complicated due to the hyperthyroid and the rodent ulcer (which seems much improved). After the I 131, her liver function went totally back to normal, as did her high eosinophil count go to normal (rodent ulcer = eosinophilic Granuloma Complex). I was told that the I 131 would be favorable towards the diabetes but it has been the opposite. In the other cases I have come across on these message boards, in cats with hyperthyroid and diabetes, one case is just like mine—dry food, high numbers and sudden worsening neuropathy. The other case, that cat had diabetes and neuropathy but recovered.
    I’ve had 3 hyperthyroid cats, all manifested symptoms differently. This is my first diabetic cat, and it’s not going too well.
    I can’t make her eat the wet food. ALL my other cats ate wet and dry food. All of them. I got Kittylou when she was two, 10 years ago. She had a buffet of food to choose from, but she always chose the dry. Maybe she’ll come around. When my other cats got hyperthyroid, they never touched dry food again. They voluntarily switched to all wet. Not the Lou! Now my cat reminds me of my infirm 91 year old mother. (Who lives across the street from me).
    Thanks for your help. All advice is appreciated.
     
  22. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Those swings were about the dose finally taking KittyLou down to blood sugar numbers closer to normal, but which she wasn't used to. And the result was some giant bounces. Same thing happened to my girl when the insulin dose finally got high enough to take her down into low blues. Being flat but flat and high is not better.

    Nothing wrong with getting the test done for acromegaly. I'd also add on the IAA or insulin auto antibodies. It's a little earlier than we suggest, but I've also seen people suggest doing it if kitty isn't regulated in 3-4 months on insulin. And if it does come back positive, it'll give you confidence that those higher doses were the right way to go. If negative, then you that's one less thing to deal with.
     
    Nancy S and JanetNJ like this.
  23. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I'd rather him swing down and back up than stay in high numbers. Eventually the swinging will ease as his body gets used to being in a more normal range. I am not convinced your cat is acro. It's possible, but I think it's more likely combo of the higher carb food, not enough insulin, and some insulin resistance. It's fine to do the tests though just to see.


    You said when there is a buffet of d food to choose from he always chooses the dry, but what if dry is not an option? What if you don't make it available? Will he not eat all day?

    If it were my cat is raise that dose back up to 4.5, hold it several days, and if I didn't see numbers under 120, raise to 4.75.
     
    Last edited: Oct 15, 2021
  24. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    If she were my cat, I'd:
    1. Do everything possible to get to to low carb wet food. If she absolutely won't do it, then the lowest carb dry I can find/afford. The higher carb in itself will likely cause her to need more insulin.
    2. Stay on top of dose increases. Follow the dosing stickies here - if giving dry, have to follow SLGS. As soon as she qualifies for an increase, do it.
    3. As Wendy and Janet mentioned you can do the acro and IAA test, I said not worth it right now because of everything else in the picture it may be money you don't need to spend just yet. I personally would spend the next few weeks and months trying to get her to low carb and better numbers, and if you hit 6U then do the tests (or whenever you have another appointment or for lab work, they can draw at same time).
    I will say @JanetNJ 's suggestion of going straight back to 4.5U makes me a little uncomfortable. I'd prefer to fast track increases while watching her closely vs do a big jump.
     
    Nancy S and Sue and Luci like this.
  25. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    Suggestion: Try sprinkling the dry food - grind or crush it up - over the wet food - it might encourage her to eat a few bites of wet - especially if she's hungry enough - she'll eat the dry off the wet, but there might be a little bit of the wet stuck and will introduce her to the flavors/texture of the wet food...keep trying to encourage her to eat the wet - maybe offer a little taste of it before offering dry...she'll figure it out soon enough - eat wet or have an empty tummy...
     
  26. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021

    is there anyway you could look at my KittyLous spread sheet and help me figure out where to go from here? I have been studying people's spreadsheets but wondering how they are jumping all over the place with dosages. Being that we switched insulins, I was wondering if I could do the MPM method, because its going to take too long if I do the SLGS method. Im just looking for some indication of what ballpark would be a good dosage to build on.
     
  27. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    What is the 'MPM' method?

    As long as your cat is eating dry food (which is what it says in your signature), the numbers are going to be high and you'll need to increase slowly until you start to see better numbers.

    An indication of what ballpark dosage to work on will be the dosage that results in lower numbers.

    Yes, SLGS is a slower method, but with dry food obscuring the picture of the numbers with all those carbs it's very difficult to tell how he's doing vs how the food is influencing him to do (as far as the numbers go).
     
  28. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    MPM is Modified ProZinc Method, very similar to TR with Lantus and Levemir

    @Nancy S you can only do MPM if dry food is completely out of the picture, not even low carb dry food. Must be wet canned food or raw.

    Normally per the dosing guidelines you'd hold this dose, but it's clearly not enough. Since this is a special circumstance of a reset, I'd increase to 3U tomorrow unless you see 200s or less.
     
    Nancy S and Shelley & Jess like this.
  29. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    It's actually unusual for someone to switch from Lantus to ProZinc..it's usually the other way around or you go from Lantus to Levemir but anyway, here we are.

    Going all the way down to 1U was a mistake (as was your vet going from 2.5 to 4.5 of Basaglar in 2 weeks)

    When switching from one type of insulin to another type, we always take into consideration the dose you were already on, which was 4.5U of Basaglar.

    I would have suggested starting ProZinc at 4U.
    I would also like to start seeing more PM tests. Of course always the PMPS, but at least 1-2 other tests to help see what's going on overnight with her.

    Get her off the Glycobalance completely. Keep trying to get her to eat low carb canned but even the D/M kibble is a little lower in carbs than the Glycobalance. As for the Dr. Elsey's, yes, it's supposed to be low carb but we've seen cats where it spiked their BG just like any other kibble but if the only problem you had with her on the Dr. Elsey's was bouncing, that's a normal, but frustrating part of the sugardance. I'd try continuing to work on the canned and using the Dr. Elsey's as little as possible and try noting in your "remarks" what food she eats.

    Have you ever tried FortiFlora? It's a powder they spray on kibble to make it taste so good to cats. It comes in packets and you could see if sprinkling a little on the canned food helps her like it better.

    Anyway, that's my 2 cents for what it's worth.
     
    Sue and Luci and Nancy S like this.
  30. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
     
  31. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
    I have a box of Fortiflora! I bought it for my other cat (who passed away 2 weeks ago). I though Fortiflora was for digestive issues. My KittyLou has a lot of issues, but digestion is not one of them. I took the canned food list to Pet Supplies and picked out an assortment of cans from the list (0 - 3 carbs). I’ll do the Fortiflora with it!
    I’m surprised, but she had no problem giving up the Glycobalance. I did put her back on DM. Are you sure they didn’t reformulate it? When I calculated carbs recently(from the info on the bags), dr Elseys chicken was 7% , DM was 11-13% and Glycobalance was 31-34%, Hills M/d was 22-24%. . Quite a range. I noticed with DM, in the past, she has never had the huge swings that she had with Dr Elseys and. Glycobalance.
    Her biggest problem (other than high blood sugars) is neuropathy. We started Zobaline today.
    one day at a time….thank you for you help!
     
    Sue and Luci likes this.
  32. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Sounds like a plan!

    A lot of people here use a sprinkling of FortiFlora because the cats like it...I could be mistaken but it may be the same stuff they out in dry food that makes cats find it so irresistible?

    Even the dry DM will help. Can you please note any food changes and medications in the Remarks column please?

    When did you start the DM? Her numbers are high, but that may have an effect on just how high they are...just want to keep an eye on her.
     
    Nancy S likes this.
  33. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Wonder where you might have heard that? Maybe comment #29?.....LOL

    Are we sharing the same brain tonight?....LOL

     
    Nancy S likes this.
  34. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    It's advertised as a probiotic, but it's not a very good one. There are much better ones on the shelves at your local WalMart....but it's main use here is as a "taste enhancer".

    I swear I think my China would have eaten a bowl of sawdust if I sprinkled FortiFlora on it. Most cats love it but there are always exceptions! Hopefully Kitty Lou will be one that thinks it's great!
     
    Nancy S likes this.
  35. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    Oh now that's funny :p I think I remembered Elise saying that somewhere and it popped into my head, clearly didn't read your post fully!
     
  36. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
     
  37. Nancy S

    Nancy S Member

    Joined:
    Jul 22, 2021
    Can some you who are helping KittyLou and I please look at today's spreadsheet and comment. I know the consensus is that Prozinc is not as good as Basaglar, but I notice that on Prozinc, KittyLou does not have the 400 and 500 point swings that she did on Basaglar. I have held the 3 unit dose for 3 days, should I go to 3.5? The vet did a "reset" about 11 days ago and started over at 1 U. Im trying to get her in the "ballpark", but don't want to overshoot. How slow or fast should I go with the dose increases? Based on her numbers, how long should I hold these doses?
    I should be getting the results of the acro test any day.
    She has fairly bad neuropathy these days. I started her on Zobaline 4 days ago. Since then she has had good and bad days. Today she basically slept all day. Yesterday she was agitated all day. We had storms with thunder, lightening and high winds and when that happens, she growls and hides and gets worked up.
    She is eating well, and has no other issues but the neuropathy, and the sleepiness. Any and all advice is appreciated.
     
  38. FrostD

    FrostD Well-Known Member

    Joined:
    May 27, 2020
    If she were my cat I would increase to 3.5U the next cycle you're available to monitor (i.e. home all day); it's not what the dosing guidelines suggest, but given you're coming up from a reset Id prefer to get her out of these numbers a little faster as I worry about side effects from the reset. The dosing guidelines in this case would require you to hold this dose for 7 days and only then increase by 0.25U.

    Once you hit your prior dose before the reset or start to see yellow nadirs (whichever happens first) then you should follow the SLGS guidelines as-written.

    Please do try to get at least a before bed test each night.

    Have you been testing for ketones?

    Can you please change the heading in your spreadsheet to say ProZinc rather than Basaglar? And on the days you changed insulin can you insert and highlight a row mentioning the change? See my spreadsheet for January 21-22 of this year for an example of what I mean.
     
    Nancy S and Sue and Luci like this.
  39. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I didn’t think the dose should have been lowered at all. I would have stuck with 4.5, and possibly increased to 4.75-5.
     
    Sue and Luci likes this.

Share This Page