Panter's high BG

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Panters-mom

Panters-mom

Member Since 2020
Hi! Testing and testing BG - and it looks kind of the same - all the way up between 21-26 at +12 and between 14-17 at +5... If I understood right - it will take some time to adjust the BG - but I was wondering - how long are we talking about? He started at 2+3u Dec. 3. He went to 3+3u January 3. (except for 1 week in the middle of January with 4+3u) he has been on 3+3u till now. Should we start to expect some change or is it too early? Up in 21-26 at +12 after 3 months - that's pretty high or? (started at 29.5) Thanks for any thoughts. Best regards, Goeril and Panter.
 
Goeril --

The insulin you're using, Insulatard, is not used in the US. In fact, there's no research anywhere I could find regarding the efficacy of its use in cats. It is similar to Novolin N in that both are isophane insulin. Is there a particular reason your vet suggested this insulin for Panter?

We could be of much greater help if you were using a type of insulin that's more commonly prescribed for cats. Lantus and Prozinc (I'm not sure if the latter is available in Norway) are the two types of insulin that are recommended for cats in the US.

What I strongly suspect is that you have been holding your current dose for too long. With most of the dosing methods we use here, you evaluate the dose after a week. If the nadir (lowest point in the cycle) is not in the range you want, you increase the dose by 0.25u. We do not raise doses by 1.0u as it's too easy to miss what may otherwise be an effective dose.
 
Hi Goeril!

Thank you for starting a new thread. Here is the old one, so other people can see some of the history for Panter.
New members - G and Panter - diagnosed last month
Goeril and Panter are from Norway. She writes and understands written English fairly well. Panter is an indoor/outdoor cat and catches mice outside and eats them sometimes. He patrols the rural property for his owners and has 2 other cat roommates.

I think Panter needs a dose increase. I think you would be ok to raise the dose to 3.25U in the AM and 3.25U in the PM. I would talk to your vet very soon about getting a different insulin for Panter.

Did you finally stop feeding Panter the dry food?

Insulatard seems to be closer to Caninsulin or Prozinc in the way it works. @Ann & Scatcats is familiar with it.

Now, I thought I remember you had said you would be away again for work sometime in March. Is that happening soon?

p.s. My apologies for not giving you directions on how to start a new thread. Sorry, I should have given you a good explanation of how to start a new thread. Glad you figured out how to do that.
I was in a hurry, as I had to take care of someone else's cat and I was late leaving home to do that.
 
Levemir by Novo Nordisk is another good option for insulin with cats. The very first user of Levemir in cats started with Insulatard and switched to Levemir in 2004, with major improvements. Since then we have seen many cats do well on it.
 
Hi everyone! Thanks for the replies. Yes my former and first tread started to become more the length of a book...sorry..:-)
Will try to get hold of our vet today. Just sent her the last BG numbers. Asked about lantus or levemir. The thing with the insulatard is that it comes in pens with only 1u adjustments... I guess I could get around this somehow with using another syringe to pull it out... I'll see if we change the insulin first.
No dry food at all for a long time. But spring is here and quit a few mice are going down these days... so these is a bit hard to calculate into the feeding program. Otherwise he eats about the same everyday to about the same times. He is very hungry and eats a lot - about 500-600g a day. Stays at the same weight - 4.9kg. (still a bit skinny, but okay). My next journey will be in the beginning of April. He will be taken care of with insulin shots but not much BG tests.
 
Panters-mom said:
No dry food at all for a long time. But spring is here and quit a few mice are going down these days... so these is a bit hard to calculate into the feeding program.
Click to expand...
No Panter, keep eating those mice. They are the perfect nutrition for a cat.

You can get insulin syringes to withdraw from your Insulatard Pen. Once you start to to that, you can no longer use the dial-a-dose feature to get the insulin out. There is a rubber stopper at the end of the pen, and using a syringe to withdraw the insulin can sometimes prevent the stopper from moving and pushing the insulin out the next time.

Let's see what your vet says. We hope they are ok with prescribing Lantus or Levimir. Both good insulins for cats.

Mice (and chipmunks and squirrels) are not cute when they get inside your home and chew on the electrical wiring causing thousands of dollars in damage. Or when squirrels come down the chimney for your furnace and block the flue and carbon monoxide builds up in your home and sickens and maybe kills you. Or when they build a nest in your attic space to raise their young ones and the urine drips down into your ceiling drywall where it crumbles and you have to hire someone to come and replace that patch of ceiling, skim coat the plaster in that special pattern, and then prime and paint the entire ceiling so it matches.
 
...she also said a normal dose could be up to 0,7 (does this mean 7ie?) - and that we would increase little by little. Prozinc suppose to last more than 9 hours in cats - in dogs upto 24 hours she said. It was a new insulin at least here in Norway if I understood right. If this doesn't work she would like to check for acromegaly (tumour).
 
Greit dere fik et nyt insulin!

Panter's new treatment regimen: Prozinc 2 Units in the morning, 2 Units in the evening.
And no more cute mice and bird.


When you start the new insulin do a bg curve
Amps
+2
+4
+6
+8
+10
Pmps
 
Yes Goeril, we have experience with Prozinc here.
It's a good insulin for cats.
Many cats can get 10 to 12 hours of duration from Prozinc.
Some cats can even get up to 14 hours of duration from Prozinc.

We have 2 dosing protocols we use here for Prozinc.
Would you like the link to these documents?
The documents were recently rewritten, in February 2020.
That was to clarify what was said and to add a a second more intensive management option.
I linked the Prozinc protocol document for you below.

Sticky PROZINC DOSING METHODS

We even have a separate Insulin Support Group (ISG) for Prozinc users. Link is below.
Prozinc / PZI

 
Thanks for the links! PZI sounds promising. Would you suggest to go for the SLGS or modified method? And does 2+2u sound okay? Yes, Ann, I've tried to talk him in to go vegan but he refuses...:))
 
Panters-mom said:
Would you suggest to go for the SLGS or modified method?
Click to expand...
For starting out on a different insulin, it's best to try the SLGS Start Low Go Slow method.
In my personal opinion.
Then, when you have gathered some test data over a few weeks to a month, you can change the dosing method you are using.

You are not "locked" or "restricted" to using only one of the dosing methods with an insulin.
What you do NOT want to do, is mix or use the recommendations from BOTH dosing methods at the same time.
Mixing the recommendations can be difficult to follow and determine what is going on with your cat.
Difficult for you to follow, as well as difficult for those here trying to assist you to follow.

The protocols were written to first of all keep your cat safe.
If you ignore some of those recommendations in the protocols, than the blood glucose levels could drop too low and the cat is in more danger of hypoglycemia.

A little caution at the beginning never hurts.

p.s. I have printed out the new Prozinc protocols and have extensive hand written notes on my copies. To simplify and clarify what I have learned over the years. Notes that have nuances that are not explained well in the protocols. Or things I have learned from other forums.
 
Got you! I'm also wondering how to be able - if needed - to take DKA test on a cat that doesn't use a litterbox...? Any suggestions?
 
Panters-mom said:
And does 2+2u sound okay?
Click to expand...
When switching from one insulin to another, the dose of the prior insulin is taken into consideration.
A lower dose of 2U AM and 2U PM sounds like a good starting point to me.
Panter may need dose increases, and fairly rapidly if the 2U dose each 12 hours is not enough for him.
A dose rarely stays stable for long and will need regular adjustments.

It's going to take some extra home testing to find how the Prozinc affects Panter.
You will need to test to find out when the insulin onsets, or begins to work and starts to drop his blood glucose levels.
You will need to test to find out the nadir, or lowest point in the 12 hour cycle this particular dose takes Panter. that is usually somewhere in the +4 to +7 hour time frame after the insulin is given.
You will need to test to find out the duration of this insulin for Panter. So testing sometimes at +10 or +11 can be helpful. Not every single day. Not every single 12 hour period. But some times.

Most importantly of all, you will need to test at every pre-shot, both AM and PM. You want to make sure that Panter's BG (blood glucose) levels are high enough to give him the insulin shot.

All dosing adjustments are made based on those nadirs or low points in the cycle. Basing insulin dose adjustments on the pre-shot tests does not work.

With insulatard, you were testing first, then feeding, then waiting for the food to be digested for 30 minutes or more, then giving Panter the shot of insulin. No more waiting between food and shot. That process can all be done in a short period of time, a shortened time frame.

One big difference between the Insulatard and the Prozinc is the sequence of the steps, the routine. By that, I mean you can test, feed, shoot all in a short period of time, 10 -15 minutes or less if you can manage that.
 
Thanks Deb! I'm excited. (well, that probably tells more about me and my 'exciting' life or what....:-)) Anyway I've ordered it and will pick it up on Thursday together with BD micro syringe 0,3ml, 8mm - right?
 
Panters-mom said:
Got you! I'm also wondering how to be able - if needed - to take DKA test on a cat that doesn't use a litterbox...? Any suggestions?
Click to expand...
Yes. There are meters available that test for both blood and ketones. Dual ketone and glucose meters.
The ketone test strips are sold and used separately. The meters are expensive and the ketone test strips are expensive also.

Some blood ketone meters that are available and used in the US are the
Precision Xtra, Freestyle Optium Neo, Nova Max Plus

I'm not sure what is available in Nordic countries or Europe.
I found the On-call GK Dual in the United Kingdom.
Abbott makes the Freestyle Optium and Freestyle Optium Neo ketone & glucose meters.
Menarini makes the Glucomen LX Plus.
I have no idea if any of these meters are better than another one or if they are available in Norway.

Be careful in your search for a blood ketone meter, that you don't accidentally find and order a meter meant to test the breath instead. I don't think Panter would let you do that!
 
Panters-mom said:
Thanks Deb! I'm excited. (well, that probably tells more about me and my 'exciting' life or what....:)) Anyway I've ordered it and will pick it up on Thursday together with BD micro syringe 0,3ml, 8mm - right?
Click to expand...
U40 syringes or U100 syringes?

Prozinc is a U40 strength insulin, U40 is the concentration of the insulin. 40 units in each ml. (40 U/ml)

But it is possible to use a U40 insulin with a U100 syringe by using a conversion chart.
http://www.felinediabetes.com/insulin-conversions.htm

Basically, you multiple the U40 dose of insulin by 2.5 to arrive at the amount to measure with the U100 syringe.
 
Panters-mom said:
Oh... I ordered u100 syringes....sh... I'm a bit confused now... so this 2+2u - will change then...?
Click to expand...
Please double check with your vet, but I do not think Prozinc comes in U100 strength.
Panters-mom said:
So if I use this 100u syringe - it should be 5+5u - right?
Click to expand...
Yes.

But you need to note on your spreadsheet, up at the top, that you are using U100 syringes to measure the dose.

BUT make a note on how you are recording the U40 dose on the SS (by what you measure in the U100 syringe, or what the dose would have been if measured in a U40 syringe) Your choice. We simply have to know which way you are recording the dose on the SS (spreadsheet).

You can still use the 2 +2U dose your vet recommended as the starting dose for the Prozinc.

But since you ordered the U100 syringes, the measurement will be more in that U100 syringe.
2U in a U40 syringe is 2.5 times 2 = 5U in the U100 syringe.
2.5U in a U40 syringe is 2.5 times 2.5 = 6.25U in the U100 syringe.
3U in a U40 syringe is 2.5 times 3 = 7.5U in the U100 syringe.
3.5U in a U40 syringe is 2.5 times 3.5 = 8.75U in the U100 syringe.
4U in a U40 syringe is 2.5 times 4 = 10U in the U100 syringe.
4.5 in a U40 syringe is 2.5 times = 11.25U in the U100 syringe.
 
Alright - the insulin and syringes are in house. So does this look right - I draw up to 5u right?
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Thanks for the pictures Goeril. That helps to see the dose very well.
Yes, that looks correct. 2 Units of U40 Prozinc insulin drawn up in a U100 syringe equals 5U in the U100 syringe.
2 times 2.5 = 5U

Would you please insert a row on your spreadsheet, between the Wednesday 11.3.2020 and Thursday 12.3.2020 rows?
In this new row, please put in large letters, spreading across the group of cells for the AMPS side of the spreadsheet, in the cells where the blood glucose test data usually goes, the cells for +1 to +11, some information.
We want to make it very clear this is when you started the Prozinc.

So saying something like Prozinc or Change to Prozinc would be good to see.
If you know how to combine cells together that would be good.
If you can highlight those words in a different color, that would be good to see also.

It's going to take some time for Panter's body to become adjusted to this new insulin. So don't be surprised if the blood glucose (BG) numbers are a bit higher for now. Also, this dose of the Prozinc insulin is lower than the dose of Insulatard you were giving your boy cat Panter before.

Your vet had you start this insulin at a bit lower dose than the previous insulin. That dose of Prozinc may have to be increased. One way to find out well the insulin is working for Panter, is to keep testing. After one week, you will probably want to do a curve, testing every 2 hours, from one pre-shot test to the next pre-shot test.

Did your vet mention anything about doing something like that?
 
Thanks Deb! I tried - but only managed half - couldn't combine those cells - but I think it comes out pretty clear... Okay. I will do some testing the coming days. Our vet basically just said to do some testing.
 
Thanks, Goeril. That is very clear on the spreadsheet as to when you switched to Prozinc. Thank you.

When you switch to a different insulin, you test to find when the onset occurs. Usually +2 with Prozinc, but every cat is different.

Then you want to do some testing in the middle of the cycle, somewhere between the +4 to +7 time frame to determine how low this dose takes your cat. Vary those test times each day, to fill in the spreadsheet, like you would with the pieces of a puzzle.

Then you test towards the end of the 12 hour cycle, around +10 or +11 to see when the duration of the insulin ends.

You don't have to test all those times every day, but instead do some random testing at different times when you are home from work.
 
Looks interesting already... but have to admit - those new needles - too tick and too short...but I guess I'll get use to them. Right now it feels like I need to use 'force' to get them through the skin...and the short length with all this fur...hmm... Anyway...he obviously has got his dose of insulin so thats good.
 
Time to increase the dose? Or is too early? It's now higher than with insulatard so I believe we have some steps to go... should I increase with 0.25 or 0.5u? - the nadir is above 300...
 
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Yes, it's time to increase. No, I don't think it's too early to increase the dose. I think an increase of 0.5U at least is warranted.

I feel that starting at the lower 2U dose, when Panter was on a 3U dose of insulatard insulin was too conservative.

I think you will need to be aggressive in the dose increases, and increase the dose every 6 cycles (3 days) until you see some lower BG (blood glucose) levels. Until you see some of those blues and green colored ranges on the spreadsheet, <11 mmol/L but > 2.7 mmol/L.

p.s. You might want to start posting over in the Prozinc ISG (Insulin Support Group). It's where other people using Prozinc are posting and we can keep a close eye on you and Panter. Here is the link to that group here on the message board. Prozinc / PZI
 
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