Newbie to ProZinc

JanetNJ

JanetNJ

Member Since 2016
Hi! I'm going to be switching from vetsulin to ProZinc probably tomorrow (supposed to get delivered today).

What do you guys think I should start with? I have two more weeks home before I start work again in September. So I can monitor most days until then.
 
Yay! Welcome to ProZincLand :cat: Personally, I would want to err on the side of caution and start with a lower dose since you have no idea how she will react to ProZinc. You can always up the dose every couple of days as needed. I might go with 2u, but hopefully, others will chime in. Maybe there is someone who has actually made the same switch.

I hope it works out well for you and C.C.
 
I'd suggest a little reduction of maybe half a unit to 1 unit for the first couple of cycles in case CC has an initial stronger reaction to a new insulin. I suspect you'll want to increase by the end of the weekend though. Two weeks should give you plenty of time to gather ProZinc data so you can return to work without stressing too much.

If you were new to FD management and unfamiliar with in and out insulins I might suggest more caution but I think you can handle CC's responses. :)
 
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It looks like CC was showing some ketones the other day? I'm quite concerned about your recent numbers. Has she been to the vet recently and had blood work done? Had her teeth cleaned? Checked for pancreatitis or other sneaky underlying health issues that could be causing this? It doesn't look like just advancing diabetes to me. Given that in the past week she's gone from 3u to 5u (with good reason and understanding the flexibility of vetsulin), it's hard to know what's best for the starting dose. Can you share a little more about what's going on with her since I haven't been following your posts outside of Prozinc?
 
Djamila said:
It looks like CC was showing some ketones the other day? I'm quite concerned about your recent numbers. Has she been to the vet recently and had blood work done? Had her teeth cleaned? Checked for pancreatitis or other sneaky underlying health issues that could be causing this? It doesn't look like just advancing diabetes to me. Given that in the past week she's gone from 3u to 5u (with good reason and understanding the flexibility of vetsulin), it's hard to know what's best for the starting dose. Can you share a little more about what's going on with her since I haven't been following your posts outside of Prozinc?
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She had a dental last month. Had blood work (everything was fine except glucose) and had 3 extractions. The dose was lowered by my vet to 3 because she thought maybe the dose was too high. It wasn't but that was the only way I could get her to conceed to an insulin change. So I played by her rules for two weeks doing 3-4 units and in that time she got nowhere so she finally agreed on Tues to let me switch. The ketones were very low a few days ago and I got no ketones yesterday.
 
Your signature mentions arthritis. How do you think she's doing with the adaquen? From your notes it looks like she's still having a fair amount of pain. Is the Gaba being given to help with her pain level?

Has she had trace ketones before? or is that new?
 
Djamila said:
Your signature mentions arthritis. How do you think she's doing with the adaquen? From your notes it looks like she's still having a fair amount of pain. Is the Gaba being given to help with her pain level?

Has she had trace ketones before? or is that new?
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The Gabapentin we only started less than two weeks ago, and yes it's helping. The adequan helps as well...with it she can get in her cat tree. Her arthritis is advanced so we have been giving the adequan about once a week. (Anywhere it's light blue in the comments of the spreadsheet). No doubt the arthritis adds to her numbers.
 
Djamila said:
Your signature mentions arthritis. How do you think she's doing with the adaquen? From your notes it looks like she's still having a fair amount of pain. Is the Gaba being given to help with her pain level?

Has she had trace ketones before? or is that new?
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The ketones were new. Never had even a trace before. That seems to have resolved itself but I'll check every few days for a while to make sure.
 
It makes me wonder if the inflammation is playing a bigger factor these days. Considering the ketones, I would be as aggressive as you safely can be during the transition. I like Kris' suggestion of a half unit reduction for the transition, but you'll need to monitor fairly closely, especially as you get to the third or fourth cycle when Prozinc starts to really kick in. My hunch is that your numbers are high enough it won't be a problem, but you just never know, especially as you get longer duration with Prozinc. I'm glad the ketones disappeared, but the fact that they appeared at all right now has me concerned. I know you'll keep a close eye on her. I might even check daily until you start to see better BG numbers.You've been around here long enough to know how quickly they can progress.
 
Djamila said:
It makes me wonder if the inflammation is playing a bigger factor these days. Considering the ketones, I would be as aggressive as you safely can be during the transition. I like Kris' suggestion of a half unit reduction for the transition, but you'll need to monitor fairly closely, especially as you get to the third or fourth cycle when Prozinc starts to really kick in. My hunch is that your numbers are high enough it won't be a problem, but you just never know, especially as you get longer duration with Prozinc. I'm glad the ketones disappeared, but the fact that they appeared at all right now has me concerned. I know you'll keep a close eye on her. I might even check daily until you start to see better BG numbers.You've been around here long enough to know how quickly they can progress.
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So you think start at 4.5? I can definitely monitor closely for the next two weeks. After that I can get preshots and a +4 or 5 at night.... And extra tests on the weekend.
 
Djamila said:
, but you'll need to monitor fairly closely, especially as you get to the third or fourth cycle when Prozinc starts to really kick in. .
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Could you explain the bolded part? Does that mean when it kicks in upon first starting PZ? Or is it true for dose changes as well? I’m curious for what it may indicate about how long to hold a dose before going up/down. :bookworm:
 
Jenna Josie said:
Could you explain the bolded part? Does that mean when it kicks in upon first starting PZ? Or is it true for dose changes as well? I’m curious for what it may indicate about how long to hold a dose before going up/down. :bookworm:
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So this gets complicated. I'll see if I can explain it without writing a novel.

When you first start prozinc, it can take about a week, sometimes longer, for the body to adjust to using injected insulin (as opposed to naturally produced insulin). So when someone is starting, they are generally advised to sit tight for a little bit.

When a cat is getting to an appropriate dose of insulin, the insulin will overlap from cycle to cycle. You'll often read around here that prozinc is an in-and-out insulin. That's flat out not true. At least not in the way that vetsulin is. Prozinc is only in-and-out when the dose is too low. In those cases the insulin is used up before the next cycle. When the dose is appropriate, it should last long enough to push the PS numbers down on the next cycle. So if you look at my spreadsheet, you'll see lots of pre-shot numbers in the low to mid-100's. If I skipped a cycle, Sam's numbers would climb into the higher yellows or pinks, but not right away. He'd probably last a cycle or two just climbing slowly. That's because prozinc has a lot of carryover - similar to Lantus, but not quite that long-lasting. Sometime around here you'll see people lower the dose because they are frustrated or because their vet tells them to. Then they'll have a couple of good cycles and think they did the right thing. But sure enough, around cycle 4+, those good numbers start to disappear and the BG is climbing again.

Okay, I'm getting off topic a bit. Back to your question. So once a kitty is established on an insulin, dose changes can happen more quickly (3-6 cycles) because they are fully loaded with the carry-over. If you read in the Lantus/Levemir forums, they call it the depot. Prozinc doesn't really last long enough to call it that, but if you look at the research, Lantus lasts about 18 hours, and Prozinc can last about 14 hours (once the dose is right), so they aren't all that different if they are being done right.

We often miss that impact on Prozinc because prozinc has the unfortunate side effect of letting kitties dive a bit. So it can be difficult to really get to the right dose. It works great for some cats, and not at all for others.

So at initial use, dose changes should be done slowly (after about a week). Then they can be done quite quickly (3-6 cycles), and then when the cycles are looking really good and you're fine tuning, it can depend on the cat whether you need to slow down and give a dose longer between changes, or if you can change fairly quickly, but in super tiny amounts. Every cat is different at that point.

I hope I didn't just make all of that even more confusing. Let me know if that just raised even more questions.

As for CC, there is a bit of a conundrum because CC will be new to Prozinc, but has shown ketones in the past week. So we really can't let her tarry in these high numbers. Janet will need to be a bit more aggressive, and just use her skills at steering to get CC moving quickly. Otherwise, those ketones may reappear at more serious levels. So I agree with Kris about moving after 4 cycles even though with anyone else, we would most likely tell them to wait longer. Also, Janet and CC are both great at managing the testing already, and Janet will be home consistently right now, so if CC starts to react she will be able to catch it and stay on top of it.
 
Djamila said:
So this gets complicated. I'll see if I can explain it without writing a novel.

When you first start prozinc, it can take about a week, sometimes longer, for the body to adjust to using injected insulin (as opposed to naturally produced insulin). So when someone is starting, they are generally advised to sit tight for a little bit.

When a cat is getting to an appropriate dose of insulin, the insulin will overlap from cycle to cycle. You'll often read around here that prozinc is an in-and-out insulin. That's flat out not true. At least not in the way that vetsulin is. Prozinc is only in-and-out when the dose is too low. In those cases the insulin is used up before the next cycle. When the dose is appropriate, it should last long enough to push the PS numbers down on the next cycle. So if you look at my spreadsheet, you'll see lots of pre-shot numbers in the low to mid-100's. If I skipped a cycle, Sam's numbers would climb into the higher yellows or pinks, but not right away. He'd probably last a cycle or two just climbing slowly. That's because prozinc has a lot of carryover - similar to Lantus, but not quite that long-lasting. Sometime around here you'll see people lower the dose because they are frustrated or because their vet tells them to. Then they'll have a couple of good cycles and think they did the right thing. But sure enough, around cycle 4+, those good numbers start to disappear and the BG is climbing again.

Okay, I'm getting off topic a bit. Back to your question. So once a kitty is established on an insulin, dose changes can happen more quickly (3-6 cycles) because they are fully loaded with the carry-over. If you read in the Lantus/Levemir forums, they call it the depot. Prozinc doesn't really last long enough to call it that, but if you look at the research, Lantus lasts about 18 hours, and Prozinc can last about 14 hours (once the dose is right), so they aren't all that different if they are being done right.

We often miss that impact on Prozinc because prozinc has the unfortunate side effect of letting kitties dive a bit. So it can be difficult to really get to the right dose. It works great for some cats, and not at all for others.

So at initial use, dose changes should be done slowly (after about a week). Then they can be done quite quickly (3-6 cycles), and then when the cycles are looking really good and you're fine tuning, it can depend on the cat whether you need to slow down and give a dose longer between changes, or if you can change fairly quickly, but in super tiny amounts. Every cat is different at that point.

I hope I didn't just make all of that even more confusing. Let me know if that just raised even more questions.

As for CC, there is a bit of a conundrum because CC will be new to Prozinc, but has shown ketones in the past week. So we really can't let her tarry in these high numbers. Janet will need to be a bit more aggressive, and just use her skills at steering to get CC moving quickly. Otherwise, those ketones may reappear at more serious levels. So I agree with Kris about moving after 4 cycles even though with anyone else, we would most likely tell them to wait longer. Also, Janet and CC are both great at managing the testing already, and Janet will be home consistently right now, so if CC starts to react she will be able to catch it and stay on top of it.
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That was a really helpful expanation, ty. I need to print this out. :)
 
Did you decide if you're starting tonight or waiting for morning? You test far enough into the PM cycle, that I think you could go either way. I wouldn't expect any fireworks tonight, but if they are going to happen you should be able to tell by +4 and then either load up the carbs or set an alarm.
 
Djamila said:
Did you decide if you're starting tonight or waiting for morning? You test far enough into the PM cycle, that I think you could go either way. I wouldn't expect any fireworks tonight, but if they are going to happen you should be able to tell by +4 and then either load up the carbs or set an alarm.
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I'm waiting until tomorrow.
 
I'm glad you'll be joining us, Janet! Everyone has already chimed in, so I'll just say I hope that Prozinc works out well for CC!
 
FurBabiesMama said:
Well, my 2u recommendation looks stupid now next to the two 4.5u recommendations. :oops:

I hope the 4.5 works out for you.
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No really I appreciate your opinion. 2 is what my vet wanted me to do. It's normally not a bad suggestion but given how high cc had been I know that will no doubt be too little. Poor thing had been eating and drinking non stop today. I was thinking 4 myself. But I'm ok trying 4.5.
 
FurBabiesMama said:
Well, my 2u recommendation looks stupid now next to the two 4.5u recommendations. :oops:

I hope the 4.5 works out for you.
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Not stupid at all, Mia's Mom! We were basing it all on Janet being an experienced FD caregiver and CC's show of ketones recently. With no experience in the CG we'd have been much more cautious. :bighug:
 
Djamila said:
So this gets complicated. I'll see if I can explain it without writing a novel.

When you first start prozinc, it can take about a week, sometimes longer, for the body to adjust to using injected insulin (as opposed to naturally produced insulin). So when someone is starting, they are generally advised to sit tight for a little bit.

When a cat is getting to an appropriate dose of insulin, the insulin will overlap from cycle to cycle. You'll often read around here that prozinc is an in-and-out insulin. That's flat out not true. At least not in the way that vetsulin is. Prozinc is only in-and-out when the dose is too low. In those cases the insulin is used up before the next cycle. When the dose is appropriate, it should last long enough to push the PS numbers down on the next cycle. So if you look at my spreadsheet, you'll see lots of pre-shot numbers in the low to mid-100's. If I skipped a cycle, Sam's numbers would climb into the higher yellows or pinks, but not right away. He'd probably last a cycle or two just climbing slowly. That's because prozinc has a lot of carryover - similar to Lantus, but not quite that long-lasting. Sometime around here you'll see people lower the dose because they are frustrated or because their vet tells them to. Then they'll have a couple of good cycles and think they did the right thing. But sure enough, around cycle 4+, those good numbers start to disappear and the BG is climbing again.

Okay, I'm getting off topic a bit. Back to your question. So once a kitty is established on an insulin, dose changes can happen more quickly (3-6 cycles) because they are fully loaded with the carry-over. If you read in the Lantus/Levemir forums, they call it the depot. Prozinc doesn't really last long enough to call it that, but if you look at the research, Lantus lasts about 18 hours, and Prozinc can last about 14 hours (once the dose is right), so they aren't all that different if they are being done right.

We often miss that impact on Prozinc because prozinc has the unfortunate side effect of letting kitties dive a bit. So it can be difficult to really get to the right dose. It works great for some cats, and not at all for others.

So at initial use, dose changes should be done slowly (after about a week). Then they can be done quite quickly (3-6 cycles), and then when the cycles are looking really good and you're fine tuning, it can depend on the cat whether you need to slow down and give a dose longer between changes, or if you can change fairly quickly, but in super tiny amounts. Every cat is different at that point.

I hope I didn't just make all of that even more confusing. Let me know if that just raised even more questions.

As for CC, there is a bit of a conundrum because CC will be new to Prozinc, but has shown ketones in the past week. So we really can't let her tarry in these high numbers. Janet will need to be a bit more aggressive, and just use her skills at steering to get CC moving quickly. Otherwise, those ketones may reappear at more serious levels. So I agree with Kris about moving after 4 cycles even though with anyone else, we would most likely tell them to wait longer. Also, Janet and CC are both great at managing the testing already, and Janet will be home consistently right now, so if CC starts to react she will be able to catch it and stay on top of it.
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Great explanation, Djamila!
 
I agree with everyone else @FurBabiesMama, not stupid at all! In general the recommendation for experienced caregivers is to move insulins at close to the same dose. This is tricky with CC because Vetsulin is dosed on a sliding scale, so it's hard to know what exactly her dose is since it changes. And only time will tell. We could be way off by recommending the 4.5u. There's really no way to know until they try it. And as Kris said, we would be recommending greater caution if it was someone newer or with less data, or if those numbers weren't so dang high right now.
 
Djamila said:
So once a kitty is established on an insulin, dose changes can happen more quickly (3-6 cycles) because they are fully loaded with the carry-over. If you read in the Lantus/Levemir forums, they call it the depot. Prozinc doesn't really last long enough to call it that, but if you look at the research, Lantus lasts about 18 hours, and Prozinc can last about 14 hours (once the dose is right), so they aren't all that different if they are being done right.

We often miss that impact on Prozinc because prozinc has the unfortunate side effect of letting kitties dive a bit. So it can be difficult to really get to the right dose. It works great for some cats, and not at all for others.
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I was totally with you right until this bolded part! :) Do you mean “dive” (low numbers) at nadir? I.e., a less shallow curve?
 
I believe that is what Djamila meant. Lantus and Levemir generally provide a cat a flatter curve. Of course, ECID, so that isn't necessarily true for all cats. But generally, cats on the L insulins can shoot at lower numbers because they are not nearly as likely to go as low (I believe...I don't know as much about L as Djamila and Kris). But Prozinc usually causes more of a bell curve...higher at both ends of the cycle and lower in the middle.
 
So life is compromise. This morning when I told her my plans my partner was VERY reluctant to start the ProZinc at 4.5 when the vet wanted us to start at 2-3. I get that. We talked and settled at 4. A number I think it's too little and she thinks is too much. Lol. But I think it's an ok starting place.
 
Update. I gave her a hug and noticed her breath smelled sweet. Got it the ketone meter and it's reading 1.3. My understanding is that under 2.4 is still considered trace amounts.... Not a panic number but definitely higher than before and concerning. I already put water in her food but added some more. She ate a can of fancy feast and a 3oz can of water with it. She's purring and acting totally normal. I'll test her in 4 hours and see what happens. Now I regret not doing 4.5, but let's see what happens. Glad I bought extra test strips for the ketone meter. Also glad to have an er vet a half mile down the road in case thing go south quickly.
 
Oh Janet, I'm so sorry to hear about the ketones, but know you'll stay on top of it. The good news is that she's still eating.

And yes to compromise. You both need to be okay with what you're doing, especially when you're in the experiment phase.

Please keep us posted today. You know we worry over all of the kitties on here, and especially when those nasty ketones are involved.
 
JanetNJ said:
Update. I gave her a hug and noticed her breath smelled sweet. Got it the ketone meter and it's reading 1.3. My understanding is that under 2.4 is still considered trace amounts.... Not a panic number but definitely higher than before and concerning. I already put water in her food but added some more. She ate a can of fancy feast and a 3oz can of water with it. She's purring and acting totally normal. I'll test her in 4 hours and see what happens. Now I regret not doing 4.5, but let's see what happens. Glad I bought extra test strips for the ketone meter. Also glad to have an er vet a half mile down the road in case thing go south quickly.
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Yes, under 2.4 is trace. Good idea to check again today. If she's eating well and acting normal those are good signs but watch her carefully. If she starts to show more lethargy (as in limp dishrag kitty) or loses her appetite take her to the clinic ASAP. I'm not saying this to alarm you - just going by my own painful experiences.

I'm glad you didn't lower the dose to 2-3 u. If she tolerates this 4 u through the day, I'd boost her to 4.25 u tonight and 4.5 u tomorrow AM. The goal is to get her to the effective dose range quickly with ketones in the picture. The most likely cause for them to be showing is being under dosed for many days - not criticizing, just acknowledging that you were following your vet's recommendations.

We're here to support you!
 
I got an email alert with your question about dosing, but for some reason it isn't showing up on here....? Anyway, I would go with 4.25 or 4.5. If you increase any more than that you could just set her off bouncing.
 
JanetNJ said:
Keep 4.5 tomorrow morning or increase? Still had ketones at 1.0 on the blood meter just now. Eating and drinking fine.

@Djamila @Kris & Teasel @Rachel
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I'd go up to 5 u tomorow AM. That's not too large an increase at the magnitude of dose you're giving, especially with ketones in the picture. So far, her clinical signs seem OK but continue the ketone tests for now. You were at 5 u and higher of Vetsulin when you saw blues and greens. It'll likely be that way with ProZinc too. Do you have any sense that she's feeling any different on ProZinc?
 
I agree. You've been on 4.5 for 3 cycles, and with Prozinc we often say you can increase at 3 cycles if the kitty is high and with the ketones hanging out...you want to increase. Since you're home and already an experienced caregiver, if CC suddenly started going low, that's something you could handle. :)
 
Kris & Teasel said:
I'd go up to 5 u tomorow AM. That's not too large an increase at the magnitude of dose you're giving, especially with ketones in the picture. So far, her clinical signs seem OK but continue the ketone tests for now. You were at 5 u and higher of Vetsulin when you saw blues and greens. It'll likely be that way with ProZinc too. Do you have any sense that she's feeling any different on ProZinc?
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Hard to say. She seems about the same id say. It's been hot and humid the last two days so all the cats are kind of just laying around. It just started raining so I hope it breaks the humidity. She doesn't flinch with the ProZinc at all which she would sometimes with vetsulin, so I am assuming it doesn't sting or feel uncomfortable.
 
Rachel said:
I agree. You've been on 4.5 for 3 cycles, and with Prozinc we often say you can increase at 3 cycles if the kitty is high and with the ketones hanging out...you want to increase. Since you're home and already an experienced caregiver, if CC suddenly started going low, that's something you could handle. :)
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I would be extremely surprised if she went low on 5. Let's see what happens.
 
I'd suggest 5.5 u tonight. She might have some insulin resistance built up from being high aside from pain or other issues that have ramped up her BG. You want to bust through that while you're at home to monitor.
 
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Kris & Teasel said:
I'd suggest 5.5 u tonight. She might have some insulin resistance built up from being high aside from pain or other issues that have ramped up her BG. You want to bust through that while you're at home to monitor.
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Ugh this is so frustrating. Ok. Will do.
 
I think the dates might be off on your spreadsheet. It looks like you have August 18th twice. How does CC seem to be feeling? Is she still doing okay with the new insulin? Nice to see another yellow appear. Hopefully blues won't be far behind.
 
Djamila said:
I think the dates might be off on your spreadsheet. It looks like you have August 18th twice. How does CC seem to be feeling? Is she still doing okay with the new insulin? Nice to see another yellow appear. Hopefully blues won't be far behind.
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I just can't believe she's not in better numbers by now. I had high hopes that changing insulins would help. This sucks so bad. :(
 
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