When to switch insulins?

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Julie Sue & Oscar too

Julie Sue & Oscar too

Member Since 2022
This cat just keeps bouncing everytime he gets around 100. I know they say they'll quit bouncing eventually but when is enough, enough? I'm considering switching from prozinc to lantus. Feeling defeated.

@FrostD bounced again last night.
 
We say give it 3 months of methodical dose adjustments. That said, when people want to switch to a depot insulin I certainly won't stand it the way lol If you want to switch, I'd suggest finishing the vial you're on, then switch. There's obviously a lead time to get the new prescription, get the new insulin, syringes, etc. It does take time for Lantus to work as well, so know that it won't be an immediate solution.
 
FrostD said:
We say give it 3 months of methodical dose adjustments. That said, when people want to switch to a depot insulin I certainly won't stand it the way lol If you want to switch, I'd suggest finishing the vial you're on, then switch. There's obviously a lead time to get the new prescription, get the new insulin, syringes, etc. It does take time for Lantus to work as well, so know that it won't be an immediate solution.
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You think the depot insulins work better?
Do you think it's possible Oscar will settle down on prozinc if I'm persistent?
I don't know what to do.
 
Truthfully, no I don't think he'll settle down, at least not within the typical 3 month span. But my crystal ball only works so well.

I much prefer the depot insulins. They work very well in nearly all cats, and those that don't do as well usually have an underlying condition anyway
 
FrostD said:
Truthfully, no I don't think he'll settle down, at least not within the typical 3 month span. But my crystal ball only works so well.

I much prefer the depot insulins. They work very well in nearly all cats, and those that don't do as well usually have an underlying condition anyway
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Someone is sending me a cheap vial of prozinc.. so I'm gonna use that and see where we're at in a couple months. I do feel like he's doing better than previously and he will likely bounce no matter what insulin I use. I'm worried a switch will be like starting over.
I'm not sure how long we've been methodically adjusting his dose at this point.. months? It's only been a week or so on 2 units that I see some progress being made but it still doesn't feel great to me.
 
A switch won’t be like starting over. Depot insulin will take 5-7 days for the depot to build so perhaps a very short few days of being a little higher but some cats react better to the switch immediately.
 
tiffmaxee said:
A switch won’t be like starting over. Depot insulin will take 5-7 days for the depot to build so perhaps a very short few days of being a little higher but some cats react better to the switch immediately.
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Ok. That doesn't sound terrible.
I'll talk to my vet about it. Thanks
 
I suppose I disagree that it works immediately, but I think difference is in the definition. Many cats still continue to bounce for awhile, but because it's more gentle it's not as harsh or a vicious cycle. So it allows them time to slowly settle down and get into better numbers. So you should see progress sooner, but true regulation will probably take a little while. ECID, don't know til you try!
 
Hi Julie Sue if and when you might switch to Lantus let us know Lantus is very expensive in the US but there are lantus generics that work just as well and much cheaper.We all buy 5 pens that will last for almost a year .
We just insert the syringes into the gray rubber that's on the pen and draw out the insulin because if you use the pens you can only adjust by whole doses
Just wanted to give you a little information :cat:
 
FrostD said:
I suppose I disagree that it works immediately, but I think difference is in the definition. Many cats still continue to bounce for awhile, but because it's more gentle it's not as harsh or a vicious cycle. So it allows them time to slowly settle down and get into better numbers. So you should see progress sooner, but true regulation will probably take a little while. ECID, don't know til you try!
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I said many and not all. Earlier I posted that the first week might be high.
 
@FrostD
Just wanted to ask you a question. Oscar should be coming down off this bounce.. looks more gentle this time. Unfortunately I'm working all week and won't be able to get midcycles. Do the numbers I have look alright for the moment? I will catch more midcycles this weekend.. but I remember you saying if he's up above 340 at preshot, the data is fairly insignificant.
At least his preshot #s look somewhat consistent. I hope he will settle on this dose at some point.
How do you think it's going? Ty
 
Linking to the thread you're referencing- https://www.felinediabetes.com/FDMB/threads/amps-458-are-we-bouncing.265552/#post-2975624

To clarify - that was a piece of advice specific to that cycle and whether or not you needed to stay around to test. The trend that day indicated he was going to be high and flat, so no need for extra tests.

Looking at his spreadsheet you can see he can and does drop from the pinks (or reds) into blues/yellows, so it is still good to test if you're around.

This next part is up to you given schedule and goals - I think he could use an increase. I don't think he's seeing nadirs below 170, but with the nighttime gaps I can't say that with total certainty. Remember, we want nadir in the 90-150 range, ideally 90-120.

His spreadsheet looks pretty typical for a cat in his situation (i.e. methodical dosing for about 2 months now). I am hoping in the next few increases hell start to come down a little more overall, or spend more time in lower numbers (so less pink/red, more yellow/blue).

There's not much else you can do at this point except stick to the dosing!
 
FrostD said:
Linking to the thread you're referencing- https://www.felinediabetes.com/FDMB/threads/amps-458-are-we-bouncing.265552/#post-2975624

To clarify - that was a piece of advice specific to that cycle and whether or not you needed to stay around to test. The trend that day indicated he was going to be high and flat, so no need for extra tests.

Looking at his spreadsheet you can see he can and does drop from the pinks (or reds) into blues/yellows, so it is still good to test if you're around.

This next part is up to you given schedule and goals - I think he could use an increase. I don't think he's seeing nadirs below 170, but with the nighttime gaps I can't say that with total certainty. Remember, we want nadir in the 90-150 range, ideally 90-120.

His spreadsheet looks pretty typical for a cat in his situation (i.e. methodical dosing for about 2 months now). I am hoping in the next few increases hell start to come down a little more overall, or spend more time in lower numbers (so less pink/red, more yellow/blue).

There's not much else you can do at this point except stick to the dosing!
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That's helpful, thank you!
Considering he's doing a lot of bouncing, when do you think an increase would be helpful. My vet wants to see if he settles into a comfortable pattern on 2 units... Which I think he's starting to with the pre-shots being closer together and seeing movement during those cycles.
 
I would do it sooner rather than later. He is still over renal threshold nearly all of the time, so that is wearing on his kidneys. And glucose toxicity will continue to build up the longer he sits on a dose with too high of a nadir.

I certainly understand trying to keep your vet happy, just know you probably won't get the result youre looking for (and be sure to stay on top.of ketone testing).

Truthfully I don't see a lot of progress or movement when I look at his spreadsheet. Those preshots are all within meter variance, his midcycle numbers are still pretty similar, you're just testing more. This isn't meant to be disheartening, it's very normal.

I dug for some spreadsheets to show you what I mean, but truthfully (1) a lot of the cats currently on ProZinc forum are new and trying to get in the groove, (2) almost all the others with spreadsheets like Oscar's switched over to Lantus, and (3) the others are complicated cases that make it a little harder to explain.

George is probably the best example I can give you. Go to 4/9/2021. You can see he didn't have much progress for awhile, then finally after about 2 months and around 3.25U he hit what we call a breakthrough dose. That's where all of a sudden numbers start to come down and stay down. Now, not every cat does it that nicely - but it's what we always hope for.
 
FrostD said:
I would do it sooner rather than later. He is still over renal threshold nearly all of the time, so that is wearing on his kidneys. And glucose toxicity will continue to build up the longer he sits on a dose with too high of a nadir.

I certainly understand trying to keep your vet happy, just know you probably won't get the result youre looking for (and be sure to stay on top.of ketone testing).

Truthfully I don't see a lot of progress or movement when I look at his spreadsheet. Those preshots are all within meter variance, his midcycle numbers are still pretty similar, you're just testing more. This isn't meant to be disheartening, it's very normal.

I dug for some spreadsheets to show you what I mean, but truthfully (1) a lot of the cats currently on ProZinc forum are new and trying to get in the groove, (2) almost all the others with spreadsheets like Oscar's switched over to Lantus, and (3) the others are complicated cases that make it a little harder to explain.

George is probably the best example I can give you. Go to 4/9/2021. You can see he didn't have much progress for awhile, then finally after about 2 months and around 3.25U he hit what we call a breakthrough dose. That's where all of a sudden numbers start to come down and stay down. Now, not every cat does it that nicely - but it's what we always hope for.
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I feel like George figured that out kinda quickly!
Alright. Here's my plan. I'm going to get some tests to fill in the gaps the rest of this week. This weekend I will likely increase the dose. Next week I should be able to check in on him mid day.
If I can't manage to get his numbers down with the new prozinc vial I'll be getting next week.. I will ask my vet to switch to lantus.
Does this sound like a reasonable plan?
 
The 230 you got later in the cycle yesterday tells me he was blue a few hours before that. So, bouncing from blue like always, silly cat!

I don't see his cycles evening out much, no. But I do see his numbers getting a little better over time. Another thing to consider is that when switching to Lantus, the Lantus starting dose is often the same as the current ProZinc dose +/- 0.25U. So while you wait for Lantus, you can still be fine tuning the ProZinc dose to give him a better start on the Lantus. Again, targeting nadir in the 90-120 range.
 
FrostD said:
The 230 you got later in the cycle yesterday tells me he was blue a few hours before that. So, bouncing from blue like always, silly cat!

I don't see his cycles evening out much, no. But I do see his numbers getting a little better over time. Another thing to consider is that when switching to Lantus, the Lantus starting dose is often the same as the current ProZinc dose +/- 0.25U. So while you wait for Lantus, you can still be fine tuning the ProZinc dose to give him a better start on the Lantus. Again, targeting nadir in the 90-120 range.
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If it were your cat, would you make the switch right away? I'm going back and forth about it but maybe I should just switch him to lantus now.
 
@FrostD I feel like I should switch him now as it looks like I will have to eventually anyway. I'm hoping to get the glargine yfgn deal from Costco if I can get a script from my vet today.
What dose should I start at with the u/100 syringes? What is the sizing on those syringes so I know what to ask for?
Anything else I need to know as I make this change?
Thanks again!
 
If it were me I would use up the vial. I would use that time to get the script, find the best deals for the insulin and the syringes. The pens are usually cheaper per unit, and preferred here since you can typically use them up til the last drop (instead of the vial, which usually ends up losing efficacy long before you can use it all up).

You'll want 0.3cc U100 syringes with half unit markings. They make both shorter and longer needles, so that part is preference. A few of the major brands are BD, CarePet, UltiCare, SureComfort, and Advocate. Feel free to drop a link to what you're looking at and we can double check them for you. At the moment I'm not sure where best price is because it's always changing - ADW, Countryside Pet Supply, Amazon are a few of them. I would assume places like Chewy, Petco, etc also carry them.

When you're ready to switch, the day before you plan to start I would post over on the Lantus forum asking for starting dose advice.

Edit: I can absolutely help with Lantus if/when needed, there's just a team over there that's been doing it much longer than I have and have seen a lot more switches
 
FrostD said:
If it were me I would use up the vial. I would use that time to get the script, find the best deals for the insulin and the syringes. The pens are usually cheaper per unit, and preferred here since you can typically use them up til the last drop (instead of the vial, which usually ends up losing efficacy long before you can use it all up).

You'll want 0.3cc U100 syringes with half unit markings. They make both shorter and longer needles, so that part is preference. A few of the major brands are BD, CarePet, UltiCare, SureComfort, and Advocate. Feel free to drop a link to what you're looking at and we can double check them for you. At the moment I'm not sure where best price is because it's always changing - ADW, Countryside Pet Supply, Amazon are a few of them. I would assume places like Chewy, Petco, etc also carry them.

When you're ready to switch, the day before you plan to start I would post over on the Lantus forum asking for starting dose advice.
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We've been on this vial of prozinc for about 2 months so it's time. Rather than start a new vial I'm gonna make the switch.
Costco has glargine yfgn for $85 for 5 pens.. so I will try to pick that up after work today if my vet is able to write a script. I will post on the lantus forum for dosing advice.
 
@FrostD got the ok from the vet and free glargine from a local nonprofit. Getting varying advice about where to start on dosage, but I agree with my vet that 1.5 might be a wise choice.

He had a wild drop today. 450 this morning to 190 when I got home. I expected him to be high on that bounce still.
What do you make of that?
 
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