? Trying to get regulated...sick kitty...please help! :) (Thank you!)

[KenP]

So grateful I found this forum. We are using Vetsulin, which I'm understanding now is not necessarily the best insulin for cats. I'm trying to decide between PZI/Prozinc and Lantus/glargine...but Jeez, why so much more expensive that Vetsulin!!!?? I also believe we've been dosing her too high and just learned about Somogyi effect causing hyperglycemia. Her BG is 600-700+ when we measure 2x per day for over a week. We give 6.5u Vetsulin around 10am with first meal and again same dose in the evening around 5-7pm with 2nd meal. We started w/1U 2x/day w/o testing BG (no meter yet) but after reading about tight regulation, started increasing the dose to match the BG using our new AT2 meter. But now I feel we've created Somogyi and hyperglycemia. She definitely has neuropathy, weak back legs, and drinking too much, not eating enough...but this has been the case since before we started insulin. I'm currently using Solid Gold Indigo Moon dry food and add water to make gravy. It has 42% protein and 20% fat...carbs not listed. Only added carbs are potato and peas. No grains. I've looked at a lot of "wet" canned foods and find many are the same ingredients as dry food, even with grain, but just have huge water contents...70-80 %. Protein is 10% highest. If I'm going to go wet, I want a healthy food with no crap that is affordable. She's been on dry all her life. Please help w/suggestions! As far as insulin, please recommend. As far as dosing, say I start her on 1u 2x/day with PZI or Lantus, how long do I leave that dose where it is with BG unregulated (say over 150) until I start increasing the dose? Do I go up by 1/2 u or 1 u 1x or 2x/day? How long do I stay at that dose before going up again? Please post guidelines for that process. Thanks SO much for your help...I don't want to kill my kitty!!!

 

[Chris & China (GA)]

Copied from your other comment in other thread...thank you for starting a new one for yourself! We do save the 911 prefix for times when there's a real medical emergency (Like a cat in hypoglycemic numbers) so you might want to change your prefix to just the ? to indicate you have questions in your post.

It's better if you start your own new thread so we can keep track of you and your "extra sweet" kitty

Most of us using Lantus are buying it from Canada. Here's all the information on where we're all buying it from

It's 1/3rd the cost it is here in the US!

You can learn a lot about Lantus by reading the Stickies at the top of the Lantus forum. Dose adjustments are made in .25 unit increments, so if you go to Lantus, you'll need to make sure you also get U100 syringes with half unit markings.

The protein levels in dry food isn't measured the same as with wet food and what's most important in our sugarcats is low carb and lots of water! The kidneys are one of the weak points in our diabetics, and keeping lots of water in the diet helps keep those kidneys healthier! Not only is dry too high in carbs, it's dehydrating. It pulls water out of the body.

You can learn a lot about feeding your cat at Dr. Lisa's website....the worst wet food is better than the most expensive dry!! Most of us feed plain old Friskies pates, Fancy Feast Classics or 9-Lives pates, but there are lots of other choices out there. On that same website is a food chart of a lot of foods and the nutrient breakdown in Protein/Fat/Carbs

There's SO much information to share with you, but you're in the right place!! Please keep asking questions!!

It's kind of a dead time around here right now, but hopefully you'll hear from others as the day goes on.

 

[Critter Mom]

Hi, Ken. Welcome to you and Ginger.

I'm currently using Solid Gold Indigo Moon dry food and add water to make gravy. It has 42% protein and 20% fat...carbs not listed. Only added carbs are potato and peas. No grains. I've looked at a lot of "wet" canned foods and find many are the same ingredients as dry food, even with grain, but just have huge water contents...70-80 %. Protein is 10% highest. If I'm going to go wet, I want a healthy food with no crap that is affordable. She's been on dry all her life. Please help w/suggestions!

Glad to see you're home testing. You need to monitor BG very, very closely when you start the food transition from dry to wet: BG levels can come down significantly within hours of the start of the changeover so you are likely to need to make dose reductions as the transition progresses (even from cycle to cycle).

I'm trying to decide between PZI/Prozinc and Lantus/glargine...but Jeez, why so much more expensive that Vetsulin!!!??

I'm assuming you're in the US. A lot of members here now purchase their Lantus from Marks Marine Pharmacy in Canada at a much, much better price. See the following link:

http://www.felinediabetes.com/FDMB/...canadian-pharmacies.49608/page-2#post-1344374

We give 6.5u Vetsulin around 10am with first meal and again same dose in the evening around 5-7pm with 2nd meal.

[Emphasis mine]

STOP DOSING LIKE THIS IMMEDIATELY! (I cannot stress this strongly enough.)

You need to give the insulin doses 12 hours apart. The schedule you're using means that you're giving the evening 6.5 units of Vetsulin while the other dose is still in Ginger's system - AT PEAK PERIOD OF ACTION.

(Sorry for 'shouting' but the schedule you're using is putting your cat at serious risk of hypo.)

I'm tagging @Sue and Oliver (GA) to ask her to have a look at this thread for you, Ken, and to ask her if she can help you with sorting out Ginger's dosing better. (I only tend to comment on dosing when I see situations where a cat may be potentially at risk from getting too much insulin.)


Mogs
.

 

[Tuxedo Mom]

As already mentioned your schedule for shooting is not optimal. Although in many kitties Vetsulin does not last the full 12 hours, with the schedule you are doing you are shooting too close together for the morning and evening shot ( about 7-9 hours) and then having too long a time period between the evening and morning shot (about 13-15 hours). Vetsulin is a faster acting, harsher insulin and you should be testing before each shot and then again at +2 or +3 hours after the shot. This is usually when you will see the effects of the insulin really starting. If the glucose drops steeply then it is possible that your kitty's numbers will "bounce" up much higher. Trying to get as much data as possible will show how the Vetsulin is working and how low it is actually taking your kitty.

Vetsulin may not be the most ideal insulin for many kitties, but some members have had good results when using the proper dosage and monitoring carefully. If you do change Lantus and Levemir are good long lasting insulins. Again though many people have also had good results with PZI/Prozinc. As Critter Mom mentioned in her post above this Lantus can be purchased from Mark Marine Pharmacy in Canada at much cheaper prices than are paid in the US>

The Solid Gold Indigo Moon dry food that you are feeding is a higher carb food. Potatoes and peas are still higher carb ingredients even though they are not a grain. It is the amount of carbs in a food that are important not the form they are in. Wet foods such as Friskies or Fancy Feast pates are all under 10% carb which is more suitable for a diabetic kitty. HOWEVER while you are shooting such a high dose of Vetsulin you should not try to convert your kitty to an all wet food diet until you have more data. Some kitties have dropped many 100s of points simply by removing dry food from the diet. There have been some that have been able to go into remission simply with changing from dry to a low carb wet and a small amount of insulin for a time period.

As well you should set up a spreadsheet to chart your numbers and set up a consistent testing regime. The spreadsheet makes it much easier for both you and others offering advice to get a good picture of how the insulin is working. Here is a link to setting up a spreadsheet:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

If you have any problems with it there are some "spreadsheets gurus" that can certainly help you if needed.

Critter Mom has tagged Sue who is experienced with Vetsulin, to offer some advice on the dosing. She will be around and comment as soon as she is up and about and on the site.

 

[Larry and Kitties]

You need to make your your spreadsheet public so other can view it. I get the following whne I click n the your Ss link
You need permission

Want in? Ask the owner for access, or switch to an account with permission. Learn more

You are signed in as (my email address)@gmail.com.

Request accessSwitch accounts

 

[Olive & Paula]

Here's the link from your other post. There are responses here.

http://www.felinediabetes.com/FDMB/threads/911-trying-to-get-regulated-in-nc-help.156621/

 

[KenP]

Thank you all for your suggestions and support! I stayed up most of last night doing more research. Here is where I'm at right now:
1. I've decided to change vets to a feline specialist in my area endorsed by the AAFP; both she and her clinic have high ratings.
2. I'm going to request that we go off of Vetsulin and go onto either PZI or Lantus. I have found another post where I can get PZI/bovine from a compounding pharmacy in the US for $44 for 10ml/40u, and that bovine is better used by gets than porcine (Vetsulin) or even Lantus which is human recombinant (so are some forms of PZI). Bovine is only 1 amino acid away from feline; porcine is 3 and human is 4. I'll also listen to the vet's input.
3. We will continue to monitor her BG 2x/day during feeding, and I will try for a 3rd reading midway between meals when BG should be lowest.
4. We will change insulin dosing to every 12 hours!
5. I have reduced insulin to 1u per dose to account for possible Somogyi "bounce" effect for at least 3 days, depending on the vet's input as well.
6. I will plan to raise insulin by 1/2u per dose per day for 3-day stints until we find a level that controls the BG, then keep it there and hopefully step down once she begins to recover her own insulin production and reduces her insulin resistance.
7. I will change to a different food. I will definitely opt for less than 20% carbs and will discuss going less than 10% with the vet. I am considering both wet/canned food and soft/pouch type food. I personally think/feel that wet food is nasty and don't know if I can take it or if she can transition to it after 13 years of dry food. Whatever food we go to, it will be MUCH lower in carbs and likely not hard/dry. I will say that with the current food, I've been reducing the amount and adding significant amounts of water to soften it and make it easier for her to absorb the nutrition, though I realize it's still relatively high in carbs.
8. I am aware of the risks of hypoglycemia and will monitor for that.

I also would like input on "tight regulation," meaning in my understanding, adjusting each insulin dose to the measured BG level. I've found a chart by a Dr. Elizabeth Hodgkins that increases insulin by 0.5u steps depending on the BG; that's where I got the 4+u idea. I feel like the strategy I suggested above has the advantage of being more protective against hypo-g and finding the lowest effective insulin dose. She feels this shouldn't be an issue w/wet food and measuring BG 3-4x/day and will control the BG faster. What do you all think?

 

[Julia & Bandit (GA)]

2. I'm going to request that we go off of Vetsulin and go onto either PZI or Lantus. I have found another post where I can get PZI/bovine from a compounding pharmacy in the US for $44 for 10ml/40u, and that bovine is better used by gets than porcine (Vetsulin) or even Lantus which is human recombinant (so are some forms of PZI). Bovine is only 1 amino acid away from feline; porcine is 3 and human is 4. I'll also listen to the vet's input.

Actually, the insulins that have the highest remission rates in cats are Lantus and Levemir (I've attached an article below for you to print and bring to your vet). The most successful insulins with cats are those that have the longest duration of action, and the source (bovine vs. porcine vs. human) does not really matter at all. Lantus and Levemir have the highest duration of action in cats, followed by the human recombinant Prozinc, and the bovine PZI has the lowest duration of action of the 4 recommended for cats. Vetsulin and Novolin are not recommended insulins for cats.

There were some theories a few years ago that the Bovine was better because it was closer to the cat's DNA. There have been no studies that support this theory, but multiple studies that show that duration of action is linked to better success with treatment.

Lantus is pricy in the US, but not so much if you order from Canada. A 5 pack of pens is $170 after shipping, but that insulin will last you a year or more, so it actually works out to being around $15 a month, less than most insulins! It's really easy to order--all you need is a script from your vet.

 

[Olive & Paula]

Ss is working. Keep in mind any wet food with gravy, sauce, shredded with be high carbs.

Sounds like you have a plan. Monitor closely if you are changing foods it can cause a significant drop in BS readings.

 

[KenP]

Thanks, Julia, for your point of view and the info. I do think that the "which is better" insulin is a bit of a controversy. I have read research on Lantus and do believe it's excellent. Many experienced vets used it, while many also prefer PZI. Both are considered long-acting, rather than Vetsulin, which is fast/intermediate. I agree that Vetsulin does not appear to be effective in cats and often causes hyperglycemia in the fasting state. I'm still learning, and cost is a factor. We'll see what my new vet says today.

 

[KenP]

I am changing the food but also dropping the insulin to base, so hopefully we'll be ok...wish me luck!

 

[KenP]

Ss is working. Keep in mind any wet food with gravy, sauce, shredded with be high carbs.

Sounds like you have a plan. Monitor closely if you are changing foods it can cause a significant drop in BS readings.

Thanks, WW!!

 

[Julia & Bandit (GA)]

Thanks, Julia, for your point of view and the info. I do think that the "which is better" insulin is a bit of a controversy. I have read research on Lantus and do believe it's excellent. Many experienced vets used it, while many also prefer PZI. Both are considered long-acting, rather than Vetsulin, which is fast/intermediate. I agree that Vetsulin does not appear to be effective in cats and often causes hyperglycemia in the fasting state. I'm still learning, and cost is a factor. We'll see what my new vet says today. Would you mind checking my spreadsheet link to see if it's working now?

The effectiveness of Lantus and Levemir is not controversial, it's been proven in several studies. In the article I linked, note where it states "Overall, glycemic control using glargine/detemir is superior to PZI because of the long duration of action these insulin analogues, which reduces periods of hyperglycemia." The duration of action with Lantus and Levemir is 12 hours in most cats, while Prozinc/PZI can vary in cats from 8-12 hours. Because of this, Lantus and Levemir have a 80+% remission rate in cats started within 6 months of diagnosis, and while no comparable studies have been done with Prozinc, the remission rates are estimated at 40-60%. This is because while most cats get a full 12 hours of control from Lantus or Levemir, only some cats get a full 12 hours of control from Prozinc.

Prozinc isn't a bad insulin by any means, and if you want to use it, that's fine! But I just wanted to make you aware that some of your information about the insulins, how they work, and what makes them effective might not be correct. You can also always switch if you're not getting good control with the Prozinc. Just keep in mind that there is a window of remission (<6 months), so you won't want to stay with the Prozinc for too long if it's not working well (I would give it 8 weeks, tops, and switch if you're not getting good control with that). Good luck!

 

[KenP]

From Lisa/Witn (moved from Intro area): Good morning and welcome to FDMB.

I agree that your current dose is probably too high. Most cats do not respond well to Vetsulin. PZI, Prozinc, Lantus and Levemir are longer acting insulins. If your vet prescribes BCP PZI, you vet can order the first vial from BCP for free. At the bottom of this page on their site, there is a link for the form that needs to be completed by your vet. http://www.bcpvetpharm.com/products_bovine.htm

If you use either Lantus or Levemir, get the prescription for the pens instead of a vial. The pens are more economical since you should be able to use almost every drop. With the vial, the insulin starts to become ineffective long before you can use all of it. So you end up throwing a lot of money away. Depending on your dose, one package of pens could last 8 months or more. You will use the pen the same way as a vial by using a syringe to withdraw the insulin. If needed, you should be able to buy one pen at a time from your pharmacy, or I believe that you can order it from a Canadian pharmacy to help save some money.

Starting over at 1 unit is the best way to determine your optimal dose. We recommend that you wait a week before increasing it if needed. Only increase by 1/2 unit and wait another week before determining if it needs to be increased again. Using this method you help you find the dose that works best for your cat.

If you are changing food, do not remove the dry until you lower the dose. You do not want to risky hypoglycemia.

 

[KenP]

From MrWorfMen's Mom: Hi Ken. Welcome to FDMB. You've already received some great info from Lisa. I see you have already set up a spreadsheet for Ginger however I cannot view it. Your share settings need to be changed so that anyone with the link can view the document. Good job setting that up as it will help the folks here help you get Ginger on the road to better health.

You have a lot of questions and this is the welcome forum. I would suggest you re-post your questions over on the Health forum HERE to get more opinions/suggestions as that board gets far more traffic from folks with experience with all the different types of insulin.

Rest assured, you have come the right place and help is at hand. I'll be watching for you over on Health.

 

[KenP]

From Woodsywife: Hi Ken. The food is a tough one. Nature Variety wet is a decent food. It on the dry side so adding water helps. Ziwipeak is a good one though must be ordered. I just found some ProPlan True Nature the carb calculator says is fine for diabetes but waiting to hear from Purina for the as Fed values.

Most people here use Fancy Feast classic/pate. It's important Ginger eats so finding a low carb she will accept should be goal. Being on dry food there are 2 that come to mind that is lower carb Young Again which is only ordered from manufacturers, they will send free sample. And EVO cat/kitten.

Also I personally stay away from food that has carrageenans in it. It is a known intestinal irritant and carcinogenic.

The insulin your are thinking are all good ones. It's a matter of finding the one that works for Ginger. Lantus can be ordered from marks marine pharmacy in Canada. It is so much less expensive than in the States. Script is needed and can take 7-10 days to get it. Order the pens, don't need pen needles we use insulin needles and draw it like the vials. The pens last longer than vials if stored properly. Vials can break if you drop or bang them.

Feel free to ask any question.

 

[KenP]

The effectiveness of Lantus and Levemire is not controversial, it's been proven in several studies. In the article I linked, note where it states "Overall, glycemic control using glargine/detemir is superior to PZI because of the long duration of action these insulin analogues, which reduces periods of hyperglycemia." The duration of action with Lantus and Levemir is 12 hours in most cats, while Prozinc/PZI can vary in cats from 8-12 hours. Because of this, Lantus and Levemir have a 80+% remission rate in cats started within 6 months of diagnosis, and while no comparable studies have been done with Prozinc, the remission rates are estimated at 40-60%. This is because while most cats get a full 12 hours of control from Lantus or Levemir, only some cats get a full 12 hours of control from Prozinc.

Prozinc isn't a bad insulin by any means, and if you want to use it, that's fine! But I just wanted to make you aware that some of your information about the insulins, how they work, and what makes them effective might not be correct. You can also always switch if you're not getting good control with the Prozinc. Just keep in mind that there is a window of remission (<6 months), so you won't want to stay with the Prozinc for too long if it's not working well (I would give it 8 weeks, tops, and switch if you're not getting good control with that). Good luck!

Thanks, Julia! I'll discuss w/my vet today. I do feel like research is controlled by those who are trying to sell their product over others', but I have found the research you are talking about and won't take it lightly...especially about the window.

 

[KenP]

Best food suggestions, considering quality of the food (no GMOs, chemicals), price, low carbs, and best transition from high-carb dry? What about a "moist" variety, which isn't canned/wet but isn't dry either? Recommendations?

Friskies? Fancy Feast? Evo? Epigen 90? Nature's Variety?

Canned/wet vs pouch/moist? (I would prefer the latter, if possible)

Thoughts? http://www.waggers.com/waggers-tendermoist-cat-food-usa

 

[Julia & Bandit (GA)]

Thanks, Julia! I'll discuss w/my vet today. I do feel like research is controlled by those who are trying to sell their product over others', but I have found the research you are talking about and won't take it lightly...especially about the window.

The research done on Lantus and Levemir in cats was conducted by Jacquie Rand, a reknowned expert in feline diabetes, and in no way was sponsored by the companies that make the insulin. In real life, I'm a librarian, so I pay very close attention to the source of information, as we all should! I've attached the more detailed Lantus study, if you're concerned about the research behind the first article I linked.

There's quite a few canned premium foods out there that would fit your needs, and not break the bank. Wellness, EVO, Instinct, and Weruva are some that come to mind immediately. Here's a link to the cat food nutrition charts, that gives the protein, fat, and carb breakdowns for many commercial foods. Just pick one you're comfortable with that is less than 10% carbs (but preferably less than 8%). http://catinfo.org/docs/FoodChartPublic9-22-12.pdf

 

[Julia & Bandit (GA)]

Best food suggestions, considering quality of the food (no GMOs, chemicals), price, low carbs, and best transition from high-carb dry? What about a "moist" variety, which isn't canned/wet but isn't dry either? Recommendations?

Friskies? Fancy Feast? Evo? Epigen 90? Nature's Harvest?

Thoughts? http://www.waggers.com/waggers-tendermoist-cat-food-usa

Oops, I must have seen an earlier version of your post when I wrote my response! Friskie's, Fancy Feast, and EVO canned are all great for diabetics in terms of carb counts. If you're concerned about the ingredients, Friskies does contain some rice (which is why most flavors are 8-11% carbs). Both Friskies and Fancy Feast contain byproducts. I don't think Epigen makes canned food, and I've not heard of Nature's Harvest.

The Waggers appears to be only 30% moisture, so I would not recommend that food.

 

[KenP]

The research done on Lantus and Levemir in cats was conducted by Jacquie Rand, a reknowned expert in feline diabetes, and in no way was sponsored by the companies that make the insulin. In real life, I'm a librarian, so I pay very close attention to the source of information, as we all should! I've attached the more detailed Lantus study, if you're concerned about the research behind the first article I linked.

There's quite a few canned premium foods out there that would fit your needs, and not break the bank. Wellness, EVO, Instinct, and Weruva are some that come to mind immediately. Here's a link to the cat food nutrition charts, that gives the protein, fat, and carb breakdowns for many commercial foods. Just pick one you're comfortable with that is less than 10% carbs (but preferably less than 8%). http://catinfo.org/docs/FoodChartPublic9-22-12.pdf

Thanks for the food chart, Julia! So many options under 10g carbs...great! Would be super-awesome if it had prices as well. Does it contain soft/pouch foods or only canned?

 

[KenP]

Thanks for the food chart, Julia! So many options under 10g carbs...great! Would be super-awesome if it had prices as well. Does it contain soft/pouch foods or only canned?

I meant Nature's Variety!

 

[Julia & Bandit (GA)]

Also, here's some great tips for transitioning! http://catinfo.org/docs/TipsForTransitioning1-14-11.pdf

 

[KenP]

I realize I couldn't persuade you, Julia, but here's some interesting info on the PZI: http://www.bcpvetpharm.com/products_bovine.htm This one even states that bovine PZI can ultimately go to 1x/day with many cats.

And here: http://yourdiabeticcat.com/protocol.html, under "Proper Insulin". This is one of the most successful and experienced cat vets putting cats into remission.

Again, not saying Lantus is better or worse. Just that there are more options available that are good, too.

Would also like to hear your and other's opinions of Dr. Hodgin's recommended TR protocol at that same link. Thanks!

 

[Julia & Bandit (GA)]

I meant Nature's Variety!

Ok! All of Nature's Variety's Instinct canned line (both the regular and limited ingredient) are low carb and good for diabetic cats.

I'm not sure if there's pouched foods on there--most pouch food tends to be high in carbs (there's usually a starch thickener in them), so that's probably why they aren't there. I do think there's some, though...Wellness and Weruva both have pouch food on there, but I don't think any are low carb.

 

[KenP]

I believe I have heard that there are dry foods that are low-carb or no-carb, no-starch. Can you comment on these and recommend any? Also, I've read that dry food might have bacteria/mold (I'm sure it's also in wet), so neither should be left out for more than 30 minutes or so. Comment?

 

[Julia & Bandit (GA)]

I realize I couldn't persuade you, Julia, but here's some interesting info on the PZI: http://www.bcpvetpharm.com/products_bovine.htm This one even states that bovine PZI can ultimately go to 1x/day with many cats.

And here: http://yourdiabeticcat.com/protocol.html, under "Proper Insulin". This is one of the most successful and experienced cat vets putting cats into remission.

Again, not saying Lantus is better or worse. Just that there are more options available that are good, too.

Would also like to hear your and other's opinions of Dr. Hodgin's recommended TR protocol at that same link. Thanks!

The information in your first link is actually all from the drug company that makes PZI (this would be a good place to think about who is putting the information out there, and why!). Nothing that they're saying there is supported by recent studies. And no, cats on bovine PZI do need insulin injected 2x a day, that claim is not correct!

The information from Dr. Hodgkins and the yourdiabeticcat site is a bit outdated. She put that site together prior to 2009, when the Roomp/Rand study was released. Since then, I believe both she and her successor have actually changed their opinions and do now recommend Lantus. If you do decide to go with PZI, I would start with the protocol outlined in our PZI Forum, and not that one, unless you truly have the time to dedicate to testing as frequently as needed to use Dr. Hodgkins. And I would not use that protocol except with the bovine PZI--the human recombinant Prozinc has a longer duration of action, so that protocol isn't going to work the same way. But, I'm not a Prozinc/PZI user so that's just my opinion, and hopefully someone who is more experienced with them can comment!

Bandit sees an internal medicine specialist at Cornell, and their recommended treatment for diabetic cats is Lantus or Levemir to start, a low carb canned diet (no dry), and dose adjustments based off of minimum of 3 daily hime tests. If the owners won't comply with doing 3 daily tests, they adjust their dosing recommendations based on what is safe to do with the tests the owners are willing to do. They don't prescribe Prozinc except in rare cases when the cat doesn't do well on the other two, and they don't prescribe the bovine PZI at all because of the shorter duration of action than the Prozinc. I know that they do consult with other veterinarians, so if you're not confident in your vet's knowledge of Feline Diabetes, you could ask them to consult if it helps change their point of view? I don't believe they charge to consult with other vets.

 

[Julia & Bandit (GA)]

I believe I have heard that there are dry foods that are low-carb or no-carb, no-starch. Can you comment on these and recommend any? Also, I've read that dry food might have bacteria/mold (I'm sure it's also in wet), so neither should be left out for more than 30 minutes or so. Comment?

There are a couple low carb dry foods, but unless your cat refuses to eat all canned food, I wouldn't recommend these. Even the lower carb dry foods can present problems with regulation in some cats because they are not low glycemic (all dry must have a starch to bind the food together). Bandit is one of these--he can eat canned foods at 8-9% carbs with no problem, but if you give him a handful of dry at 8% carbs, his blood glucose will shoot up 100 points or more.

Also, the larger problem with dry food is that it is moisture depleted. Cats evolved in the desert, and they do not have thirst mechanisms like dogs or people do--they must get their moisture in their food. Studies have shown that cats never are able to make up for the loss of moisture in dry food at the water dish. A dry diet causes all sorts of health issues from chronic dehydration, mainly urinary tract blockages (which is incredibly painful for the cat and very expensive to treat) and contributes to chronic kidney disease, the largest killer of older cats. Diabetic cats especially need the benefits of a moisture rich diet, because uncontrolled diabetes is hard on their kidneys.

However, if your cat absolutely refuses all canned food, it's better to feed the dry than starve your cat! But keep working at the transition, and don't give up. Some cats are stubborn and harder to come around than others, but nearly all will transition eventually. If the convenience factor is the larger issue, freezing canned food portions and using auto feeders can make feeding canned just as convenient as the dry food!

 

[KenP]

Julia...just reviewed Bandit's chart...good working controlling his BG!! I do see that just before the regression this year, he received steroids...are you aware of the research around steroid-induced diabetes?

 

[Julia & Bandit (GA)]

Yes. Bandit has a condition called immune-mediated myelofibrosis. It means that his immune system attacks his own red blood cells, causing severe anemia. Last March, he nearly died from this condition and concurrent pancreatitis, and if I wasn't fortunate enough to live in the same city as Cornell, he probably would not have made it. Long term treatment for his immune condition is steroids and immunosuppressants. We knew that the steroids would make him need insulin again, but the larger health issue was his myelofibrosis.

We were able to gradually wean him off the steroids, and because we had good control over his BG he went right back into remission when we stopped them. We were not able to successfully wean him off the immunosuppressants, so he'll probably need to be on those the rest of his life, unfortunately. Luckily, those do not affect his BG.

 

[Julia & Bandit (GA)]

Oh, and I forgot to answer your earlier question about how long you can leave food out! I don't know about dry because I haven't fed it regularly to any of my cats in about 8 years, but I can commment on the canned. At room temperature, you can leave canned food out for up to 6 hours (you'll just want to add a little water in it to keep it from drying out). Frozen food can be left out for up to 12 hours (but I typically do 6), and if you're using the auto-feeders with icepacks, that frozen food is good up to 18 hours.

 

[KenP]

So, I went to the new vet today. $74 later, I'm holding an Rx for Prozinc in my hands. They wanted to sell me theirs at $140 for 10ml. I knew I could find it cheaper online, so I asked for the Rx. She did not agree to let me purchase the compound pharmacy PZI, which I could have gotten for $44, b/c she said it was "less reliable" and "possibly less effective" than the Prozinc brand, which was "made by a corporation rather than a pharmacy." She did not have Lantus on hand and didn't know much about it, rather stating she heard it was better with dogs but wasn't sure about cats. She didn't know anything about remission rates for different kinds of insulin. She tried to push the Hills brand dry food on me, but when I saw it only had 6% less protein than the food I was already giving her, it had 14 grams of carbs, plus it had pork as well as several versions of GMO corn, I balked. I'm going to follow the suggestions on this forum about the food. In the end, I'm going to have to spend almost $100 more for the PZI I didn't really want. She even told me that originally, insulin for pets came for humans, then "improved" by sourcing animals. When I pointed out that Prozinc was sourced from humans, while the PZI bovine I wanted was not, she went back to the reliability argument. She also seemed fine w/Vetsulin for cats and didn't seem to be impressed w/research showing its massive ineffectiveness. I really, really could have used that $74 for other purposes. Why in God's name do we need prescriptions from vets to buy our insulin? It's all about corporate profit and control. I thought the staff were nice but just not well-enough informed for me.

 

[Olive & Paula]

Well at least you got something other than Vetsulin. When I got Smokey (from another state) he was on prozinc which was over $200 a vial. Since I was to have him temporarily I had to stay with it. I never knew I could get it from any pharmacy. When Smokey officially became mine I couldn't afford that every month. My vet won't prescribe it for his patients because of cost. So Vetsulin it was for us. Tried it for many months but wasn't working and dose kept go up, vet said couldn't go any higher. Didn't know about this site then. When I found it, I gave the insulin options to my vet. I too was for PZI, but he said Lantus was better. So here we are today. I had to show him how to use the pens.

 

[scoobydoox]

So, I went to the new vet today. $74 later, I'm holding an Rx for Prozinc in my hands. They wanted to sell me theirs at $140 for 10ml. I knew I could find it cheaper online, so I asked for the Rx. She did not agree to let me purchase the compound pharmacy PZI, which I could have gotten for $44, b/c she said it was "less reliable" and "possibly less effective" than the Prozinc brand, which was "made by a corporation rather than a pharmacy." She did not have Lantus on hand and didn't know much about it, rather stating she heard it was better with dogs but wasn't sure about cats. She didn't know anything about remission rates for different kinds of insulin. She tried to push the Hills brand dry food on me, but when I saw it only had 6% less protein than the food I was already giving her, it had 14 grams of carbs, plus it had pork as well as several versions of GMO corn, I balked. I'm going to follow the suggestions on this forum about the food. In the end, I'm going to have to spend almost $100 more for the PZI I didn't really want. She even told me that originally, insulin for pets came for humans, then "improved" by sourcing animals. When I pointed out that Prozinc was sourced from humans, while the PZI bovine I wanted was not, she went back to the reliability argument. She also seemed fine w/Vetsulin for cats and didn't seem to be impressed w/research showing its massive ineffectiveness. I really, really could have used that $74 for other purposes. Why in God's name do we need prescriptions from vets to buy our insulin? It's all about corporate profit and control. I thought the staff were nice but just not well-enough informed for me.

My suggestion is to start looking for another vet willing to work wit you and write the prescription for lantus pens. it is by far the most cost effective way to do treatment. That current vet also sounds like she will probably start trying to dose by whatever high numbers she sees. a lot of us all have the same nightmare with our vets right now. They push expensive food, tell you vetinsulin is fine etc. In the end they are there to make money.

 

[MrWorfMen's Mom]

I've read that dry food might have bacteria/mold (I'm sure it's also in wet), so neither should be left out for more than 30 minutes or so.

Hi Ken, As the proud parent of one of those "rare" cats that refuses to be transitioned to canned food, I used to leave dry food out for an entire day without any problem and still do if I am going to be gone for an extended period of time. I think any concerns of mold are either due to improper storage of the food or adding water to it to increase the moisture. Adding water creates an environment that encourages mold to grow so if you were adding water then yes, you'd have to limit how long you left it sitting out and refresh it several times daily.

My cat is "rare" in other ways too (IAA positive) so I researched the various insulins. It's my understanding that the BCP PZI runs the risk of inconsistent potency/contamination because it is compounded by a pharmacy rather than manufactured which may be what your vet was commenting on. There is also Hypurine PZI available from the UK which is manufactured and is reported to last/work a little differently than the other PZI insulins but procuring it in the US may be more hassle than it's worth. We have a couple of members using it here but at least one is from the UK. Not sure where the other member resides.

 

[KenP]

Would still love to hear anyone's feedback about Dr. Hodgkin's tight regulation protocol here: http://yourdiabeticcat.com/protocol.html. She claims to be one of the most successful and experienced cat vets putting cats into remission. In other words, I have discovered two different methods for regulating BG. Hers measures the BG at insulin dosing and gives a sliding scale amount based on the BG. The other starts with a standard 1u 2x/day and then waits several days or a week, testing BG and only going up if the 1u isn't working, in order to conservatively find the minimum dose that works. Going up is usually by no more than 0.5u or 1u per day for several days or another week (my vet says 1-2 weeks). The more conservative method is more standard with vets to protect from hypoglycemia. But Dr. Hodgkins says that her method is better and more successful at creating remission. Her scale goes up to 4u at a time, depending on BG. I would like to hear pro's and con's for these two methods and what has worked for people here.

FYI, I went ahead and got the new technology Wagger's TenderMoist. I'm going to give it a try. It's 3x more moisture than dry food, protein at 40%, carbs at 7.5%, and no grains or starch added. It also has probiotics. I'll post how it goes. My Ginger had a bery, bery bad toofy report today, so I hope this is a good transition off of the dry for now. If it doesn't work, I'll go wet. If it does, then I'm pioneering a new cat food technology that works. If anyone's interested, I'll post links.

I'll also be checking tomorrow to see if CostCo still carries Prozinc and makes it available to non-members and will post my report. I've also found it at Allivet and ValleyVet for around $120ish including cold shipping. Hoping CostCo has it cheaper. My vet wanted $140 plus tax.

 

[Elizabeth and Bertie]

A quick note on Prozinc and remission...
The Royal Veterinary College (London) did extensive trials on several insulins including Lantus and Prozinc, and, some way into the trial, were having greater success (in terms of remission) with Prozinc than with Lantus. (I don't know what the 'final score' was, ha-ha!) ...That is good news for Prozinc. But I do wonder whether the Lantus was used in ways that might be considered on FDMB to be 'optimal'. I think a variety of 'protocols' were tried...some using variable dosing, which many folks here find doesn't use Lantus to it's best advantage...
.

 

[Elizabeth and Bertie]

Would still love to hear anyone's feedback about Dr. Hodgkin's tight regulation protocol here: http://yourdiabeticcat.com/protocol.html. She claims to be one of the most successful and experienced cat vets putting cats into remission. In other words, I have discovered two different methods for regulating BG. Hers measures the BG at insulin dosing and gives a sliding scale amount based on the BG. The other starts with a standard 1u 2x/day and then waits several days or a week, testing BG and only going up if the 1u isn't working, in order to conservatively find the minimum dose that works. Going up is usually by no more than 0.5u or 1u per day for several days or another week (my vet says 1-2 weeks). The more conservative method is more standard with vets to protect from hypoglycemia. But Dr. Hodgkins says that her method is better and more successful at creating remission. Her scale goes up to 4u at a time, depending on BG. I would like to hear pro's and con's for these two methods and what has worked for people here.

Hi Ken, @KenP

I think I'm one of the few people currently on this forum who has used Dr Hodgkins' protocol. (Years ago there were more people here using that protocol, but they've long gone. Presumably some left when their kitties passed away. But some of those relocated to one or other of the Dr Hodgkins' forums.)
I think I'm also one of the few people who uses 'sliding scale' dosing (according to preshot and expected nadir); and possibly one of the few who doesn't just shoot 12 hourly. (Bertie has an on/off pancreas that means we have a somewhat variable shooting schedule...)

Brief history...
My cat started out on 3 units BID Caninsulin. His numbers were pretty horrible (high).
It was suggested on FDMB that his dose may be too high, so I cut back to one unit BID, and worked up from there. His numbers were still pretty horrible (high).
I persuaded the vet to switch him to a veterinary PZI insulin around that time (with longer duration than Caninsulin). His numbers were still mostly pretty horrible (high), but were interspersed with sudden drops for no apparent reason.
It was then suggested to me (by an advocate of Dr H) that Bertie would do better on Dr H's dosing protocol. So I switched to Dr H's sliding scale, TID. And then he had a hypo....
The Dr H people at that time told me that Bertie "couldn't have had a hypo because of his low carb wet diet", and that I must be mistaken....
I then felt completely adrift regarding all protocols and just started 'paddling my own canoe'....

There seems to be plenty of evidence showing that cats stand a better chance of remission if their blood glucose can be kept in normal or near-normal blood glucose levels for as much of the time as possible (though even brief spells in these numbers can encourage the body to heal). This is the aim of Tight Regulation protocols.

Dr Hodgkins developed her own TR protocol using (originally) PZI, and a sliding scale based on the cat's preshot numbers. And there are certainly cats out there who have gone into remission using this protocol, there's no doubt about that.
There are problems with the protocol though (IMHO).... The main one is the 'belief' that a cat on a low carb wet diet can't suffer from hypo. It simply isn't true. It would great if it was true. Our lives would be much easier, and less stressful!

On the positive side, I've found the principle of sliding scale dosage to be a very useful one. Sliding scale dosage does work well for some cats, and with some insulins. But my experience is that the scale needs to be worked out according to the individual cat's own response to insulin (and not by using a 'one size fits all' dosing scale)...

Eliz

 

[KenP]

SOURCING FOR PROZINC: Just called Costco near me in Greensboro, NC. They do have Prozinc 40u/10ml vials in stock at $129.95 for non-members, $123.95 for members, no tax for Rx in NC. Not a great price but at least a local source. Walmart can get it by Monday for $1 cheaper. // UPDATE: No one else even carries it locally...except for vets for a much higher price ($140). ValleyVet.com is the cheapest I've found on the Net...$116 cold shipped. Allivet.com is similar base price but charges $9.50 more for the cold shipping. Finally did buy from ValleyVet online.

 

[KenP]

Hi Ken, @KenP

I think I'm one of the few people currently on this forum who has used Dr Hodgkins' protocol. (Years ago there were more people here using that protocol, but they've long gone. Presumably some left when their kitties passed away. But some of those relocated to one or other of the Dr Hodgkins' forums.)
I think I'm also one of the few people who uses 'sliding scale' dosing (according to preshot and expected nadir); and possibly one of the few who doesn't just shoot 12 hourly. (Bertie has an on/off pancreas that means we have a somewhat variable shooting schedule...)

Brief history...
My cat started out on 3 units BID Caninsulin. His numbers were pretty horrible (high).
It was suggested on FDMB that his dose may be too high, so I cut back to one unit BID, and worked up from there. His numbers were still pretty horrible (high).
I persuaded the vet to switch him to a veterinary PZI insulin around that time (with longer duration than Caninsulin). His numbers were still mostly pretty horrible (high), but were interspersed with sudden drops for no apparent reason.
It was then suggested to me (by an advocate of Dr H) that Bertie would do better on Dr H's dosing protocol. So I switched to Dr H's sliding scale, TID. And then he had a hypo....
The Dr H people at that time told me that Bertie "couldn't have had a hypo because of his low carb wet diet", and that I must be mistaken....
I then felt completely adrift regarding all protocols and just started 'paddling my own canoe'....

There seems to be plenty of evidence showing that cats stand a better chance of remission if their blood glucose can be kept in normal or near-normal blood glucose levels for as much of the time as possible (though even brief spells in these numbers can encourage the body to heal). This is the aim of Tight Regulation protocols.

Dr Hodgkins developed her own TR protocol using (originally) PZI, and a sliding scale based on the cat's preshot numbers. And there are certainly cats out there who have gone into remission using this protocol, there's no doubt about that.
There are problems with the protocol though (IMHO).... The main one is the 'belief' that a cat on a low carb wet diet can't suffer from hypo. It simply isn't true. It would great if it was true. Our lives would be much easier, and less stressful!

On the positive side, I've found the principle of sliding scale dosage to be a very useful one. Sliding scale dosage does work well for some cats, and with some insulins. But my experience is that the scale needs to be worked out according to the individual cat's own response to insulin (and not by using a 'one size fits all' dosing scale)...

Eliz

Thanks, Eliz...awesome and helpful information!!

 

[Sue484]

A quick note on Prozinc and remission...
The Royal Veterinary College (London) did extensive trials on several insulins including Lantus and Prozinc, and, some way into the trial, were having greater success (in terms of remission) with Prozinc than with Lantus. (I don't know what the 'final score' was, ha-ha!) ...That is good news for Prozinc. But I do wonder whether the Lantus was used in ways that might be considered on FDMB to be 'optimal'. I think a variety of 'protocols' were tried...some using variable dosing, which many folks here find doesn't use Lantus to it's best advantage...
.

I was prescribed Lantus for Frankie at the RVC and they do not seem to know how to dose it. They told me anything over 11 to give the prescribed dose, between 8 and 11 halve the dose and nothing under 8. They also put me on Hills prescription food and a strict twice a day feeding schedule. Maybe that is why Lantus was not doing so well in the trials? I then found this site and ignored everything the RVC told me.

 

[KenP]

SOS...trying to buy 40u 3/10cc 29G 1/2" needle insulin syringes on the internet...can't find them anywhere...does anyone have a source? My nurse wife says 1/2cc is too big, and that's what everyone has. Thanks! // UPDATE: Did finally order from ADW...see post below.

 

[scoobydoox]

SOS...trying to buy 40u 3/10cc 29G 1/2" needle insulin syringes on the internet...can't find them anywhere...does anyone have a source? My nurse wife says 1/2cc is too big, and that's what everyone has. Thanks!

http://www.adwdiabetes.com/catalog/pet-needles-syringes_112.htm
most local pharmacys sell them as well. only a handful of states need a prescription to buy them.

 

[Sue484]

A quick note on Prozinc and remission...
The Royal Veterinary College (London) did extensive trials on several insulins including Lantus and Prozinc, and, some way into the trial, were having greater success (in terms of remission) with Prozinc than with Lantus. (I don't know what the 'final score' was, ha-ha!) ...That is good news for Prozinc. But I do wonder whether the Lantus was used in ways that might be considered on FDMB to be 'optimal'. I think a variety of 'protocols' were tried...some using variable dosing, which many folks here find doesn't use Lantus to it's best advantage...
.

I was prescribed Lantus from the RVC, but I don't think they know how to dose properly. I was told, above 11 give full dose, between 8 and 11 half the dose and nothing under 8. I was also put on Hill prescription dry food and a strict twice a day feeding schedule. The doses were also increased by whole units. Maybe that is why Lantus didn't fare so well.

 

[KenP]

http://www.adwdiabetes.com/catalog/pet-needles-syringes_112.htm
most local pharmacys sell them as well. only a handful of states need a prescription to buy them.

Thanks for the link. I had already found ADW on the Net and was considering ordering from them, which I finally did. They are 1 of the few sources (besides vets) who carry the 3/10cc (.3) 40u syringes. And their prices are great, too. No one had them locally...I called over a dozen pharmacies. The 1/2cc is a more popular size, but not great for small doses, as the markings are closer together. The syringes I ordered actually have 1/2u markings, and they are lubricated...$15 shipped for 100 count.

http://www.adwdiabetes.com/catalog/productinfo.aspx?id=16363

 

[Critter Mom]

I think a variety of 'protocols' were tried...some using variable dosing,

I remember seeing a kitty here that was on the Lantus sliding scale trial. IIRC the kitty's response wasn't anything like as good as we would have expected it to be had the caregiver been able to follow TR - or even SLGS. (I remember being quite miffed about that at the time. I recognise that research has its place but it's tough seeing a cat that's not doing as well because the trial rules are getting in the way of the cat receiving potentially far superior treatment - especially when the post-Dx remission clock is ticking.)


Mogs
.

 

[Elizabeth and Bertie]

I remember seeing a kitty here that was on the Lantus sliding scale trial.

I wonder if that was the same cat that I saw... It was sliding scale with Lantus, and the cat was deliberately being taken into very low numbers to see if that would trigger remission.... The numbers kept dropping really low and then bouncing sky high. I had to watch 'through my fingers' from behind the sofa..... ...I know it was done in the interests of research but.... I really struggled with that...
.

 

[scoobydoox]

Thanks for the link. I had already found ADW on the Net and was considering ordering from them, which I finally did. They are 1 of the few sources (besides vets) who carry the 3/10cc (.3) 40u syringes. And their prices are great, too. No one had them locally...I called over a dozen pharmacies. The 1/2cc is a more popular size, but not great for small doses, as the markings are closer together. The syringes I ordered actually have 1/2u markings, and they are lubricated...$15 shipped for 100 count.

http://www.adwdiabetes.com/catalog/productinfo.aspx?id=16363

This is what I got from walmart pharmacy which has both markings

 

[Critter Mom]

I was prescribed Lantus from the RVC, but I don't think they know how to dose properly.

If my experience is anything to go by, I suspect Langford may have a similar issue.


Mogs
.

 

[Critter Mom]

I wonder if that was the same cat that I saw... It was sliding scale with Lantus, and the cat was deliberately being taken into very low numbers to see if that would trigger remission.... The numbers kept dropping really low and then bouncing sky high. I had to watch 'through my fingers' from behind the sofa..... ...I know it was done in the interests of research but.... I really struggled with that... .

With the PTSD my powers of recall are pale shadows of their prodigious forbears but the thing nagging at the back of my mind about the kitty I saw was that it wasn't getting enough Lantus because the no-shoot level was set too high. (I could not testify in court to the veracity of the above; you could well have the right of it, Eliz. I do definitely remember it wasn't pretty.)


Mogs
.