? New to insulin Dosage increasing?

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buddhasmom

Member Since 2016
Started on 1 unit once daily, 2 weeks ago. BG has come down from 566 to 470. Vet wants to increase to 2 units, twice daily. I thought maybe I should increase more gradually to 1 unit, twice daily first. Vet said no & he usually starts at that dose & only did the other dose as a trial to make sure I was able to give the shots. Thoughts? He's 5.5 lbs, IBD, 1 cc? of Budesonide, pancreatic enzymes, & probiotic. He's 14 yrs old, all blood work good except the diabetes & IBD.
 
We don't ever do increases in whole units Insulin is a very powerful hormone and when we do increase it, we do it in .25U increments.

What insulin are you using? Are you home testing?

Also, the insulins that work best in cats (Lantus, Levemir and ProZinc) must be given every 12 hours, not just once a day. A cats metabolism is too fast for once/day dosing

Give us as many details as possible and I'm sure we'll be able to help you
 
Like I said, 1 unit, 1 time daily was trial to see if I could even do the shots myself as he's a difficult cat, but he's doing well & not fighting me at all. So...vet now wants to increase to 2 units, twice a day. I wanted to do it gradually, from the 1 unit, 1 time daily to 1 unit, twice daily, but he said no, just go to 2 units, twice daily. He's on ProZinc. It would be 12 hrs apart, regardless.
 
buddhasmom said:
Like I said, 1 unit, 1 time daily was trial to see if I could even do the shots myself as he's a difficult cat, but he's doing well & not fighting me at all. So...vet now wants to increase to 2 units, twice a day. I wanted to do it gradually, from the 1 unit, 1 time daily to 1 unit, twice daily, but he said no, just go to 2 units, twice daily. He's on ProZinc. It would be 12 hrs apart, regardless.
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Ultimately it's your cat and you hold the syringe. You are the one that cares most about your kitty.

I've not used Prozinc but I did treat Saoirse for a while with Caninsulin, another in-out insulin. Although theoretically all of the blood glucose lowering effect of in-out insulins should be 'finished' by the time the next insulin dose is given sometimes you can get a residual glucose lowering effect - a carryover - from the previous dose to the next. If there is carryover it can add to the effect of the next dose. With your kitty's current once-a-day dosing schedule you have no idea of whether there might be some carryover of effect from one dose to the next. Perhaps you might go back to your vet, explain that you're nervous for safety reasons about doing such a big change all in one go, and perhaps negotiate a dosing strategy where you move to twice-a-day dosing at the current dose for a short time to make sure it's safe before increasing the dose further.

Another thing: as Chris mentions above the general approach here (provided there are no unusual circumstances such as a cat being at risk of DKA) is to increase doses in small increments so as to ensure treatment is as safe as possible and also that the 'goldilocks' dose to suit the cat's current needs isn't missed as a result of ramping up the dose in steps that are too big (e.g. 1 unit at a time). I'm tagging @Sue and Oliver (GA) who knows a great deal about Prozinc to see if she can give you further suggestions about dosing and what to discuss with your vet.


Mogs
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I already said to the vet, shouldn't we just try doing 1 unit twice a day first? And he said no, I want you to go ahead & do the 2 units, twice a day.
 
buddhasmom said:
So, you'd increase to 1.5 units, twice daily?
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I think I'd try 1 unit twice a day first, and then get some tests somewhere mid-cycle on the AM cycle (like 5 to 7 hours after the shot) and then at least a "before bed" test on the PM cycle

We need to find out how low the dose is taking him and the only way to do that is to get some tests in during the cycle. We have a spreadsheet that we all use here that's really a very valuable tool, so I hope you'll use it. It will help us to help you with dosing decisions.

Here are Instructions on getting the FDMB spreadsheet. If you have any trouble, just let us know and we can help set it up for you
 
buddhasmom said:
I already said to the vet, shouldn't we just try doing 1 unit twice a day first? And he said no, I want you to go ahead & do the 2 units, twice a day.
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Been thinking about your situation. Is there another vet in your area you might consult to get a second opinion?


Mogs
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Based on google results & all of the input from you guys, I've decided to start today at 1 unit twice a day, will increase to 1.25 or 1.5 twice a day after 5 days based on BG if I can get a home test done. Then increase after 5 more days to what vet suggested, 2 units twice a day if needed. Prayers that I can do home testing w/ my difficult cat. What at home monitors do you suggest?
 
If you let us know which country you're in we can let you know the meter types that are popular with members where you are.


Mogs
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In the US, the relion Micro or Confirm are good human ones. You can also get pet one's online from a variety of places but they are more expensive.

I thought testing Fern was going to be difficult but cats do like routines. Pick a spot that will be your testing space. For Fern, it is on the couch right next to the arm so that he really can only go forward if he wants to leave and he telegraphs so I normally can stop him easily from leaving before we are ready. I then give him some love by warming his head and ear with a rice sock. We poke, get the blood and then most of the time Fern gets a treat. Sometimes he just gets love or if it's before a meal he get's the meal.
 
Then any of the walmart Relion's are good. The confirm and Micro both only need a small amount of blood strips are about $35 for 100. The Relion Prime is also OK but takes 2x the blood of the others although it's strips are cheaper $20 for 100. Make sure when you start out that you are using larger lancets than what comes with the meter. Most of us start using an alternate site lancet in the 25-28g size. After the ears "learn to bleed" we switch to a smaller size 30-32g.
 
Does anyone ever do different doses, i.e. 1 unit at night & .5 in the morning? Or is it always the same dose no matter what?
 
buddhasmom said:
Does anyone ever do different doses, i.e. 1 unit at night & .5 in the morning? Or is it always the same dose no matter what?
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There is some good information on PZI here:

http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/

"Starting Doses
The recommended starting dose for ProZinc or BCP PZI is .5 units or one unit twice daily. It is suggested that if the initial numbers are high, doses can be changed every three cycles, increasing by .5 at a time. If the initial numbers are in the 200-300 range at preshot and midcycle (nadir) numbers are not too low (not 50 and under), increases can be made .25 units at a time. During this early period, especially if wet low carb food is replacing higher carb dry, monitoring is very important. Insulin plus a diet change can result in sudden low numbers or in a gradual lowering of numbers overall, depending on the cat.

Over time, as data is collected and nadir numbers are available, doses can be adjusted more confidently.
If the cat is in the 250+ range at preshot and does not drop 50% or more for nadir, a small adjustment could be considered, if monitoring is possible.
If the cat is in the 250+ range at preshot and drops below 50% at nadir, bouncing is a possibility (bouncing occurs when the cat’s body perceives a drop that is below what has been occurring and releases extra glucose, resulting in an “artificial” rise in numbers) Bouncing most often involves a lower midcycle number than the cat has experienced previously. If bouncing is suspected, any increases in doses should be tiny and monitored carefully.
If the cat is high and flat during the entire cycle, the dose could be raised .5 units, as long as monitoring is possible.

ProZinc and PZI are unique in that they can be dosed in two ways, depending on how the car responds. Some cats seem to do best if a specific dose is held for several cycles. It seems to take that long for their numbers to really change. Some cats respond to a sliding scale, getting a different dose for different preshot numbers. Collecting data will help you see which regiment works best for your cat. If you need help with a sliding scale, ask people on the PZI forum to guide you."


If you need further help with dosing adjustments you could try posting on the PZI/Prozinc forum. There are a number of experienced members who use this type of insulin that could help with fine-tuning the dosage as needed. This is the link to that forum:

http://www.felinediabetes.com/FDMB/forums/prozinc-pzi.24/
 
Prozinc is an insulin that can be adjusted based on the preshot numbers. I give a variable dose. If it is over 400 it is 2.8 u, 350-400 2.6u; 300-350 2.5u and under 300 2u.
 
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