Questions on Prozinc

Status
Not open for further replies.
We use U40 for caninsulin and Prozinc, both U40 insulins. Needles divided in half units.
We advise against switching to U100 needles, because mistakes are easily made. Vets that forget that they gave u100 needles the last time and give U40 the next time ... owners that have trouble recalculating the units, miscommunication on the forum, etc. But I see your point.
 
Last edited:
Stupid question, probably, but OTJ .... what is it short for (I know it means remission, honeymoon, but the abbreviation ... ????)

Another, more intelligent question, is about the not shooting at levels below 200 with newbies.
You say, it is because you don't have enough tests to know what the insulin does and the reaction of that specific cat is (ECID, I know that one now). But what could happen that requires not to have shot at all? A continuing curve downward? I can't imagine. Have there been any cats for whom the decision not to shoot was the right one, when you later knew about the reaction of that cat after more tests? Why not shoot e.g. a quarter of the normal dose, when the level of a new kitty is still going down? Is that unsafe, especially considering the cat will eat at shooting time? The cat's levels will rise again, won't they?
I can understand not shooting at a level of 130 or lower at shooting time, but above that level I would be inclined to shoot a quarter of the normal dose .... or at least a bit.
 
Haha not stupid at all! It means off the juice (insulin).

Hmmm...offhand I can't give you a specific cat that it was the right decision for. I know it has been, just can't remember off the top of my head since we've had lots of cats through here! The reasoning is that if the cat is in low numbers and still dropping, adding more insulin will overlap. So the dose might cause the cat to drop to hypo levels. While the insulin is supposed to last only 12 hours sometimes it lasts longer. Sometimes the pancreas are helping out.

Over time, as we know what the cat's reaction i s, we give insulin at lower levels, though I would never give anything at 130. That's too close to normal ranges. Often, as we get more and more data, we do give a lowered dose at lower levels to be sure that we keep the cat in good ranges. But until we know for sure that your cat won't drop 200 points at a certain dose, it's just too risky. You learn how the cat reacts at specific doses and can decide what a safe dose is for a lower preshot level. Does that make sense?
 
Yes, it does. Although ...
I know there would be an overlap, but I thought to have understood that Prozinc starts to work about 3 hours after the shot. So if the drop still continues, wouldn't it have stopped by the time the new shot takes effect? Or am I wrong in thinking that Prozinc takes such a long time to start working?

We usually give one drop (of caninsulin) when at 130. But at 200, we usually would give about 0.5 unit. At 170 o.25 unit. Approximately, depending on the cat. Saying that, we would know the cat if we did that. A new cat, I don't know. I'll ask our expert on caninsulin.
 
Well, it's not really that the insulin starts working at +3...just that any food on board shouldn't be affecting the BG anymore. The insulin starts working right away I think (could be wrong). It's just that BG values are affected for 2 hours by food.

Either way, the thinking is that we want to be sure that it doesn't keep dropping. Sure, by +3 we would expect the drop to have stopped. But can we be sure? Not really. Especially as the cat tends to go towards remission, the insulin can stay on board longer. Plus, if the pancreas have started helping out, we have no way of knowing what will happen. The cat could be producing some insulin on it's own and then we add more....it's risky.

I do understand what you are saying Jennie. Our thinking is first of all ECID. For example, one cat could drop 100 points on 1 unit of insulin. Another cat could need 4 units to drop 100 points. Until you know with some certainty what effect a dose will have, it's more risky.

Say a cat is at 130 preshot. This cat has only been on insulin for a few days. The owner sees the 130 and shoots half the dose figuring that will work. But since they've never shot that dose before, we don't know what could happen. It could be enough to drop the cat 100 points, resulting in a hypo. If this cat had had half a dose before, we could at least predict how they might react.

It would be interesting to see what you would do on caninsulin.
 
I just got a reply. A new cat that has a level of 200 preshot would get a dose of 0.25 caninsulin at the max, depending what he eats.
New cats usually are still on the prescription high carb kibble, so that keeps the level from dropping further, and the 0.25 unit would help fight against the effect of the food. If the cat were on low carb, and the numbers would be falling, I think mostly one drop. No cat goes hypo on 1 drop (that's insulin up to the line of zero units on the syringe).

Another question came up. We know that with caninsulin a higher dose can take up to two weeks to show its ultimate effect. That means that the level at nadir can become lower each day during two weeks (max), using the same higher dose. So we wait at least 5 days (unless really high levels, then 3 days), looking at the pattern, before advising a new adjustment.
How is that with Prozinc?

Before I forget, thank you very much for all the help and answers. We really appreciate that.

And I think another of 'our' cats has signed up, also a Baco ... It is a very uncommon name in our country, it was really strange to get two new cats with that name within one week.
 
Generally we say 3 to 6 cycles. So anywhere from a day and a half to 3 days. However it also is an ECID thing. Some cats need longer to settle into a dose. Some cats have a sliding scale that changes depending on each preshot.

I guess I'd say 3 to 6 cycles at first. Change the dose as needed (preferably on a cycle you can monitor). As you get more data you'll get a better idea of of your cat needs more or less time on a dose...and if needed a sliding scale can be worked up.
 
Of course, going back to the question of the no shot under 200, caninsulin does not have the problem of overlap. So I can imagine being more careful if there is an overlap.
 
previoushttp://www.felinediabetes.com/FDMB/...now-available-in-the-uk-13-april-2016.156164/
We have two types of ProZinc in the UK and it looks it is the same in the rest of Europe as new ProZinc had been now licenced for use in cats.
I have posted that information in the above post but it largely went unnoticed (only Eliz acknowledged that information). So now we have two types of ProZinc:
1. human recombinant U40
2. Hypurin 100 % bovine U100.
Both widely available in Europe. Hypurin not available anywhere outside Europe.
They are rather different insulins so we always should make a distinction which one we're talking about but on this forum we mostly talk about ProZinc U40 as Hypurin is rarely used (only 3 people have experience with it).
Marlena
 
We have the first type.
In The Netherlands only Caninsulin was registered for pet use, now Prozinc (human recombitant) has been added for cats. Lantus was only prescribed if owners requested it and the vet agreed to prescribe something not registered for animal use ...
I doubt if Hypurin may be called Prozinc, because Prozinc is a product name of Boehringer something ... (forgot the name of the manufacturer). But both are probably one of the PZI-insulins (protamine zinc based).
 
Yes, Hypurin is protamine zinc (PZI) and is British made by Wockhardt so I think is available in Europe. It is a human insulin (licenced for use in humans) and long lasting like Lantus and Levemir and can be prescribed for cats if Caninsulin does not provide good results.
Hypurin is unique as it is most similar insulin to cat's own insulin - only one amino acid difference as opposed to human or pork insulins which are three amino acids away so probably more bioactive for cats.
 
You don't know how extremely squeamish vets in The Netherlands are about prescribing anything else than the registered insulins for cats (Caninsulin, Prozinc). Lantus is a real problem for most of them, let alone another one ....
It would be great however if it were available for cats .... but then, no one with any experience on it, and even the lantus prescribing vets think lantus works exactly the same as caninsulin .... They don't have a clue about the difference between insulins with peaks and with a depot.
 
Another question, I'm afraid. We have one cat, Bitsie, 4.5 lbs, who had 0.6 unit of Prozinc and went hypo on that. The owner stopped shooting prozinc after that and is regularly testing her to get a good look at how she does. She has been 1 month without insulin, and her levels vary from appr. 150 to 240. Definitely most of the time too high, but what would you do in such a case? We are afraid that doing nothing would result in a downgoing line for her health. But shooting insulin .... At het moment she is stable, and still varying around the 180 - 200, sometimes lower and sometimes higher.
 
Nederland said:
We have one cat, Bitsie, 4.5 lbs, who had 0.6 unit of Prozinc and went hypo on that. The owner stopped shooting prozinc after that and is regularly testing her to get a good look at how she does. She has been 1 month without insulin, and her levels vary from appr. 150 to 240. Definitely most of the time too high, but what would you do in such a case?
Click to expand...
Yes, you're correct - her #s are still too high overall.

We would most likely recommend that she use U100 syringes marked on the half-unit (left side of the syringe's barrel) with the conversion table - VERY important to use - so that she could start once again with the ProZinc at what is, on the U100 syringe, just a little less than what would register as 0.25U on the U40 syringe. And, of course, she would still need to monitor her cat's BG#s to make sure that kitty doesn't drop too low. I have attached the conversion table in .pdf format below.
 

Attachments

Nederland said:
You don't know how extremely squeamish vets in The Netherlands are about prescribing anything else than the registered insulins for cats (Caninsulin, Prozinc). Lantus is a real problem for most of them, let alone another one ....
It would be great however if it were available for cats .... but then, no one with any experience on it, and even the lantus prescribing vets think lantus works exactly the same as caninsulin .... They don't have a clue about the difference between insulins with peaks and with a depot.
Click to expand...
That's really difficult then.
There are studies done on these insulins and more articles appearing in veterinary journals so it is just a matter of finding literature and suggest that owners of diabetic cats take the print outs to the vets.
There are also veterinary clinics doing studies with various insulins and vets who are not up to date on FD could contact them for advice. One of these clinics is:
Diabetic Remission Clinic, Royal Veterinary College

Hatfield
Hertfordshire
AL9 7TA
United Kingdom
 
Is she on an all wet low carb diet (8-10% carbs) That might tip the scale downward. Also we think small frequent meals help the pancreas.

Robin's U100 idea lets you dose amounts down to 0.1, which can be very helpful.

We generally say a cat is in remission if they range from 40-120 off insulin for 2 weeks (measured on a human meter) Bitsie is a little high and yes, the risk is that her pancreas will not have a chance to heal and she will eventually go higher. Another idea is to give a drop of insulin. So you put water in a syringe, measuring the amount you can see most clearly - say 0.5. Let the water out by drops, counting. If you count 7 drops in your measure, then the next time draw up insulin to your level and let out the drops save one.
 
Thank you again, I have given the message to the owner. It's up to him now to decide.

Another question:
With caninsulin the insulin dose is always lowered by at least 1/3 of the original dose after a hypo, even if preshot tests show a high level (because that is usually caused by the reaction of the body on the hypo, stress hormones). We keep that low dose for about 5 days, then start upping the dose again if necessary (of course with regular testing). By that time the stress hormones are gone and the body's sensitivity for insulin has normalised.

What's to be done with Prozinc after a hypo? The dose must be lower, but how much? How long to shoot that lower dose? Are there any guidelines? The general rule of thumb in the sticky 'how to treat hypo's' is a little vague on that ....
 
I don't know that we have a definitive answer for that one. It depends on what the owner was shooting before, how low the hypo went, etc. Generally, I just check the SS, see what other doses have been doing for them, etc. Like if they were slowly increasing and went hypo on an increase, I might suggest they just drop back to the last dose or 0.25 lower than that maybe. If they were shooting 6 units and had never been home testing, had never seen how low they went, I'd probably at least suggest they halve the dose. Possibly more.

Really, we don't see a ton o f hypos here (anti jinx). Or at least...I don't. They happen sometimes, but often they are just close to hypo and steering with food works. So it's hard to tell you for sure.

Anyone else have any ideas?
 
Yes, we have. It's really good, but the costs of getting it to the Netherlands from Germany (even though we are neighbours) are very high. And my cat wouldn't eat it ... We are hoping a dutch retailer or webshop will start selling it some time soon.
 
I donated the stuff to a member that worked in Healthcare and had such working schedules that shooting insuline could not be managed every 12 hours apart, or even 10 or 11 . Her cat was mildly diabetic, and ate this food for about a year. then he passed away (I think of untreated diabetes, but well, the owner did what she could.
How do people on this forum with such job manage?
 
Which cat is well regulated on ProZinc? I would like to see the sheet of such a cat to get an impression to what we should ultimately aim at.
 
Elizabeth and Bertie said:
We see 'bouncing' a lot here, especially in newly diagnosed cats. But this is different to Somogyi (if indeed Somogyi even exists ;) ) which, as I understand it, is more to do with chronic (and dangerous) overdosing.
Click to expand...
We are trying to find the difference between Somogyi and bouncing, or to find that it's the same thing.
Somogyi is not the effect of chronic overdosing, it's the effect after a sudden drop in the level. Mostly to a dangerously low level, but that doesn't necessarily be the case. The cause is usually an overdose. The drop is fast and the rise is also fast, back to a high level after which the level stays high for a certain amount of time. The drop and rise look like a V in the curve.
Does a bounce look the same?
 
Nederland said:
Which cat is well regulated on ProZinc? I would like to see the sheet of such a cat to get an impression to what we should ultimately aim at.
Click to expand...

It might be helpful for you to look at the spreadsheets of cats in the Remission Thread (at the top of this page). Look at the last part of the thread to find the most recent cats with spreadsheets.
 
Nederland said:
[Re. Somogyi] The drop and rise look like a V in the curve.
Does a bounce look the same?
Click to expand...
A 'bounce' doesn't necessarily create a V-shaped curve. That would require that the blood glucose drops very fast and then rises very fast, and that doesn't always happen.
A cat's blood glucose can 'bounce' if it drops too low and/or too fast.
So, even if a cat's blood glucose drops quite gently, if it drops to a level that the cat's body feels uncomfortable with it can still bounce.
Also, I've seen a number of situations where the cat has seemed to have a sort of 'delayed bounce'; where the blood glucose initially rose slowly (and it looked like a bounce might not occur) but then suddenly rose high, with those high numbers sometimes persisting for some time (up to several days).

'Somogyi' is a term that is rarely used on the forum at the moment. It seems to be a somewhat controversial term (and one which has caused confusion here...).
You may be interested to see this thread:
Somogyi and bounces

And also these posts:
What is the range for hypoglycemia?
Is this a Bounce?
8/29 Charlie AMPS 371 +2 439 +4 416 +6 427 +9 418 PMPS 380

Eliz
 
Last edited:
Thank you. I will have a look into those documents.
Well, opinions can always differ on Somogyi, I know there is doubt that it exists. But we do see it with caninsulin, so we are convinced it exists. It's immediate and it takes at least 3 days for the body to recover, and we see that, too. Levels going everywhere during that time. Sometimes it takes even 5 days to recover. The required action is to lessen the dose with at least 1/3 (assuming the cat was already regulated and on the right dose (up to that unfortunate moment). When the cat is starting to show a normal response again to insulin, and the low points remain too high, the process of carefully adjusting the dose starts again.
If the cat is new, or if the cat is relatively irregular on caninsulin, we ask the owner to check pre shots all the time during those days, and base the dose on the pre shot level (an individual gliding scale), taking into account that the body is extra sensitive to insulin during that period.

Maybe Somogyi doesn't happen that often with the milder working insulins? And as in the US caninsulin is seldom used, the forum here seldom sees it?

We see bounces with lantus, but we call those reaction levels. They happen when the dose is changed to higher or lower or when the timing between the shots is changed. It can take up to three days to show. Could be the dose is changed on day 1, and the reaction is on day 3. Or the owner was late for the shot on day 1, and the reaction is on day 3. So adjusting the dose to a higher dose is never done during the first 6 shots after the change (with lantus), otherwise you would start to see reaction upon reaction. We have a completely different protocol for Lantus (TR) than for Caninsulin.
 
Hmmm, I started to write a response, but had dinner in between and now my text is gone. I suppose I waited too long.

We actually see Somogyi's effect with caninsulin. The study mentioned in the first link was on lantus cats, we never see Somogyi with lantus. We do see bounces with lantus. We respond differently in both occasions.
The bounce at lantus occurs after a change in dose, or when the timing of the shot was changed, or any change. It can take up to 3 days to show, so after such a change the dose is never increased the first 6 shots after the occurence. It's lowered when needed of course. The reaction is never long, sometimes only 1 preshot level, sometimes 2.
Somogyi's with caninsulin is immediate, a sharp V, and it takes the body to recover from the stress dump of glucose for at least 3 days (sometimes up to 5 days). In that period the levels can be irratic, and with caninsulin it means you have to take great care. When the cat was well regulated, the dose is lowered by at least 1/3 of the former dose. We ask the owners to take preshot levels and some do. Levels preshot can vary from very high to very low. If they do take preshot tests, and the levels are awkward, a gliding scale is made and temporarily the dose is based on preshot levels, but never more than 2/3 of the former dose. When the pattern becomes normal again, a new dose will have to be determined, very carefully, as always. Some cats stay irratic and the dose will remain based on preshots and we will advise them to switch to lantus.
 
I have been watching this thread for a few days now and want to say thank you for getting all this info out there! Cooter started ProZinc Thursday evening and I needed all the info here to help me along :) I do have a question though.... I know the nadir on Prozinc is usually 5-7 hours after the injection, but how often have any of you seen early nadirs? Cooter seems to be at his lowest point at 3-4 hours. I have been giving him a little LC around +4, but only because he honestly appears hungry at that point, and i dont want him losing any weight since he dropped alot the last month and a half. His low point on the vetsulin was the same timing, could it just be his metabolism acting the same on both insulins?
 
Status
Not open for further replies.
Back
Top