Prozinc just prescribed but questionable numbers

Vinnie Van Gogh's Mom

Vinnie Van Gogh's Mom

Member Since 2021
Hi! Vinnie's vet prescribed 1u bid of prozinc and I just received my shipment. I was planning to start tomorrow but am questioning the dosage and whether or not insulin is even warranted right now. The vet did a glucose curve in office on Thursday and Vinnie's numbers were all over the place from 187 to 587. The vet based the insulin protocol on these numbers. HOWEVER, Vinnie was very stressed at the vet and even refused to eat all day because of stress so I question whether these numbers were stress induced. I am in the midst of doing my own glucose curve at home today and his high so far is only 266. I started at 9am after withholding food for 2 hours. He was 206. Since then I have tested every two hours and he has been free-feeding fancy feast classic pates. 11am was 230, 1pm was 266, 3pm was 264. I will continue testing for the rest of the day and post the #s in my spreadsheet. It seems fairly clear that the curve done at the vet's office was not the norm. Based on these numbers, do you feel I should still start with the insulin? If so, would I do 1u 2x/day or less? Or should I hold off and speak with the vet on Monday?

Background: Vinnie was diagnosed on 2/19 (possibly steroid-induced as he had been receiving monthly depo shots for asthma) and his vet prescribed glipizide. We got in numerous arguments over this as I was concerned about his liver and pancreas and really had not read anything good about glipizide. But I agreed to do it short-term on days when his glucose was high. It still did not sit well with me so I eventually decided to go to a different vet. The current vet had me take him off glipizide completely for a week before doing the curve.

Side note: I had a cat 20 years ago who died of hypoglycemia (the vet at the time had me modify his diet without providing any education on the potential for hypoglycemia or having me retest or home test, then he went on vacation. A whole devastating story that still haunts me). I am making sure this time around that I do everything in my power to prevent that from happening again. I am baffled that both of the vets I have been to have told me that frequent home testing is unnecessary. The current vet at least said that it would be a good idea for me to do a curve at home 2 weeks after being on insulin, but then told me that daily testing and doing my own glucose curve prior to him being on insulin were a waste of time and completely unnecessary. This vet is supposed to have a holistic approach. I just do not understand! If anyone has a really good vet in the Las Vegas area, I would love the recommendation.
 
Forgot to mention that Vinnie's last steroid shot was Feb 11. I hear it can take anywhere from 1-6 months for the steroids to completely leave the system and if the diabetes was brought on by the steroids, his numbers could drop as the steroids wear off.

Also just did another BG: 5pm@246
 
Thank you so much for your advice Deb. I do think I would be more comfortable giving him a super low dose as you suggested. I have been scouring all the stickies on the forum including the prozinc dosing protocols and am learning so much! Very grateful for this board.
 
The two last BGs are 7pm@218 and 10pm@198

So I still haven't started the insulin, but if I had, I would either skip the dose or stall at 198, correct?

I can't seem to find what a normal non-diabetic cat's "curve" would be like but I did read that it's normal for it to get into the 200s after eating. Do his numbers seem to be bordering on normal?

Since he is right around 200 when fasting for 2 hours and in the mid 200s when eating, I'm wondering if I should even be starting him on insulin at all right now. If I do, I will definitely take Deb's advice and start with a tiny 0.25. But I'm wondering if it's possible the steroids are on their way out and if I should wait...
 
I agree that he needs insulin but that 1 unit may be too much. His numbers in the 200's aren't super high, but on a human meter normal is 50-120, so it is elevated. You want to try to get him down into normal as much as possible.
 
Thank you Janet! Okay, so based on Deb's comment and your comment, I am feeling good about starting with 0.25u. I am going to gather supplies for the hypo kit today, then start tomorrow.

My next question is how closely will I need to monitor him when starting out. We live in a divided household* and Vinnie spends 12 hours a day with us, sleeping in his own room at night. How many hours after his injection is it safe to leave him alone in his room?


*[Background on the divided household: Vinnie was a street feral who we brought in and tamed. Initially, he tested negative for FIV and we tried to introduce him to our 2 existing cats individually (the girls). He viciously attacked each of them. Since then, he has had two positive ELISA tests and a negative PCR test. Since we are unsure of his FIV status and the two girls are FIV negative, we have resigned ourselves to keeping the cats separate. Vinnie has his own room where he spends 12 hours of the day (mostly at night while we sleep) and he has free reign of the house for 12 hours. The girls have our bedroom where they spend 12 hours of the day, getting free reign for 12 hours.]
 
Also, from the guidelines in the Prozinc SLGS method, if I HAD planned to start the insulin today, I wouldn't have shot this morning since his BG was only 178, correct? Or would I start anyway if I'm starting with the super low 0.25u dose?
 
loalar said:
Also, from the guidelines in the Prozinc SLGS method, if I HAD planned to start the insulin today, I wouldn't have shot this morning since his BG was only 178, correct? Or would I start anyway if I'm starting with the super low 0.25u dose?
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You would have stalled, without food, to see if the number is rising. Even if the BG was rising, you probably would have wanted to skip the shot if it wasn't close to or over 200. "Better too high for a cycle, than too low for one."

I think that Vinny will need some insulin, but may not need it for long as the steroids wear off more.

loalar said:
My next question is how closely will I need to monitor him when starting out. We live in a divided household* and Vinnie spends 12 hours a day with us, sleeping in his own room at night. How many hours after his injection is it safe to leave him alone in his room?
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That is very difficult to say, as to how often to monitor. It never hurts to get a +2 test, to see what direction the BG is headed. Then you make decisions after that on when to monitor and maybe feed him a bit of food to keep the BG levels up.

BUT, since you have very little test data, and Vinny has not had insulin before, you would need to (want to) monitor him closely for the first few days when you do start the insulin.

p.s. The Prozinc forum isn't always busy. If you need immediate help, then post over in the Feline Health (Welcome & Main) forum.
 
Thank you so much for your input Deb! I am trying to make sense of everything and nervous about starting so I really appreciate the clarifications and advice. And if I have anything urgent in the future, I will post in the other forum.

One more quick question - would it be a bad idea to do just the morning shot for a few days to gather data on how he is responding? I have a feeling that the answer is yes it is a bad idea, but just curious if that is an option. I won't need the answer until tomorrow evening so if no one is on this forum before then, I will ask on the main forum.
 
He was 222 this morning so I did his first insulin dose of 0.25u! Way easier than I thought it would be (he was very focused on his food bowl!) I am frustrated with my vet though. Even after giving her all the numbers including last night's 132, as well as the SLGS Prozinc info from the forum, she said that I needed to start with 1u twice a day, keep karo on hand in case he's wobbly and test his numbers after 14 days. I am hunting for another vet again...
 
Most vets don't have the same level of experience that we do with diabetic cats. On the other hand, most of us don't have the depth and breadth of experience that vets do with some many different animals and their care, illnesses, diseases. Vets also can't devote as much time to each client as we can here to each member. We are an entire community, not simply one vet.

We don't usually recommend that people only give insulin once a day. That is because the insulin does not last 24 hours in a cat. 12 hours is standard for how long a dose lasts.

You can always tell your vet that you want to keep your cat safe, and will be monitoring the BG levels more so he does not have a symptomatic hypo. Tell the vet you don't think that checking only every 14 days is sufficient. Will she pay for an emergency 24 hour vet if your cat drops too low? Probably not.

This thread has hypo symptoms to watch for, and includes a LOT more signs than being "wobbly". Don't let the dramatic title scare you. Concentrate instead on what it says.
Sticky How to treat HYPOS - THEY CAN KILL! Print this Out!!

It's a good document to print out and read thoroughly, over and over. I posted a copy on my fridge.

The insulin shot while Vinnie has his head in the food bowl is a method many people use.

Even that 0.25U dose brought Vinnie down to the nice blue BG levels! Yeah!

Another good document is the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats.

If your vet was familiar with this document, they probably would not have prescribed glipizide in the first place, which has a very low success rate in cats, and is not recommended. Here is a quote on glipizide from that document. "The TaskForce only recommends glipizide for use in cats with owners who refuse insulin therapy, and only with concurrent dietary therapy."
 
Thank you Deb! I am so grateful for you and for this site. I had a cat die from hypoglycemia 20 years ago (wish I had this community then!) and have told my vet that on numerous occasions, telling her that I am terrified of it happening again and that I want to monitor him closely. She continues to tell me it is unnecessary so I am on the hunt for another vet. This is actually the second one and claims to have a more holistic approach. The first was the one who put him on glipizide despite my protestations that it doesn't always work and can cause liver and pancreas damage.

I have the HYPOS sheet printed out and in my hypo kit (all the things on the sticky about the hypo kit).

And yes, I am happy with today's levels and with the decision to start with the 0.25u dose unless/until I have enough data to change it.

Thank you again for all your help!
 
As it turns out, his PMPS was 150. Based on the SLGS guidelines, it says:
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
Since it is exactly 150, I'm opting for the "don't give insulin". Also, I'm not sure what a token dose of 0.25u would even be and it's 10pm so I wouldn't be able to keep an eye on him afterwards if I test again in a couple of hours. I hope this is what I should do!
 
If you can get Vinnie's BG numbers to stay in the blues at nadir, more specifically the low blues, that helps to give his pancreas a rest and time to heal.

It would be even better to get his numbers down into the green BG numbers, the higher greens or tree green BG levels. But you are not ready for that yet. You need to gather more data on how Vinnie responds to the insulin, and when his nadir is. The nadir does not stay the same every cycle, and can fluctuate. Many cats nadir around +5 to +7, so tests around that time will be helpful.

Strongly recommend you get a +2 every evening, even if Vinnie''s BG numbers at pre-shot are not high enough for you to feel comfortable giving him insulin for that cycle. That +2 will let you know how his BG levels are trending without a shot. It's a good idea to get that +2 every cycle, insulin or not, AM or PM cycle. If you are up later than that, what we call a "before bed" test is good too.

loalar said:
I'm not planning on changing anything for a while, just curious as to what lies ahead...
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I would not suggest that you change the dose right now either. After all, Vinnie only started insulin a couple of days ago, and you have already had to skip shots because his pre-shot tests are too low for comfort. This is only day 2 of this journey. Give it time please.
 
Deb & Wink said:
I would not suggest that you change the dose right now either. After all, Vinnie only started insulin a couple of days ago, and you have already had to skip shots because his pre-shot tests are too low for comfort. This is only day 2 of this journey. Give it time please.
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No, I'm definitely not changing anything until I have a lot more data. I was just curious as to what the ultimate goal is.

And thank you for the +2 BG reading recommendation. I will start doing that.
 
I did the +2 last night after skipping the dose and it went from 144 to 158 but he did eat a lot between tests.

This morning, it was 147 so I skipped the dose again based on the "below 150, don't give insulin" guideline (he hasn't had insulin since yesterday morning). Retested +2 and it was even lower - 111!

Is this a sign that he's heading towards remission? Or is it too early and I'm doing the wishful thinking thing?
 
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His numbers are continuing to stay under the 150 threshold at insulin time (this morning was 118) so I am continuing to not shoot. He shot up to 167 for the +2, but he ate a ton of food (5 ounces about 30-60 minutes before the BG test). Is that a normal movement for after eating?
 
loalar said:
His numbers are continuing to stay under the 150 threshold at insulin time (this morning was 118) so I am continuing to not shoot. He shot up to 167 for the +2, but he ate a ton of food (5 ounces about 30-60 minutes before the BG test). Is that a normal movement for after eating?
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Yes, that sounds like a normal food bump.

Since you are not giving Vinnie any insulin, a test at +3 to +4 would be better, to gauge if his own body is making insulin and bringing those BG numbers back down < 100 mg/dL.
 
So his numbers were a bit higher this morning - I initially got a 186, then waited 30 minutes without feeding and it was 177 so I skipped the shot. I'm not sure how to indicate the stall on the spreadsheet? Also, he's now gone 3 days without insulin and I do see that people with more data and experience will shoot above 90. Since I really have no data on the insulin effect, having only given him two actual doses, I just want to confirm that I should stick with the starting recommendations (my understanding is I don't shoot below 200; stall if between 150 and 200 then shoot if it rises above 200).

I also tried some Purina DM yesterday mixed with his FF classic pates. Is it possible that the Purina DM is contributing to the higher numbers this morning?
 
JanetNJ said:
I think i'd do .25 if over 175. slightly under if it's like 150-175 If it's on the lower side close to 150 make sure you are available to test. I'd liek to see the naidar under 100
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Thank you! Right now, his normal dose is .25 Just to confirm, you would stick with that dose if it's over 175? Or should I do a little less than that?
 
loalar said:
Thank you! Right now, his normal dose is .25 Just to confirm, you would stick with that dose if it's over 175? Or should I do a little less than that?
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I like that dose if it's over 175. I would like to see the numbers come down mid day just a little more. Trying to push it to 80-110 during it's peek, ya know? so do just slightly less than that if it's under 175.
 
The Fancy Feast (FF) pates (aka "classic") are in the 2-3% carb range. The Purina DM is about the same in carbs, around 6%, as the Fancy Feast flaked/roasted/chunky flavors. The Purina DM Savory Selects in Sauce is around 10% per Dr. Lisa Pierson's food chart.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Some cats are more carb sensitive than others. So it's possible the DM increased the BG numbers. But I suspect it is because his body is not producing enough insulin on it's own, and he needs a bit of insulin from his shot.

There is a lower dose you can try. That is 0.1U or barely above the 0 (zero) line on the syringe.
 
Now I'm very confused. He went 3 days without insulin and with a high of 186. This morning he was 187, so I gave him a skinny 0.25u and his +2 went way up to 234. Is this normal?
 
loalar said:
Now I'm very confused. He went 3 days without insulin and with a high of 186. This morning he was 187, so I gave him a skinny 0.25u and his +2 went way up to 234. Is this normal?
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At just a +2 it’s probably still food influenced. Really there is not Much difference between a 187 and 234. The insulin probably just hasn’t kicked in yet.
 
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The only "bad" question is the one you don't ask. So ask away please.

Onset, or when the insulin starts to work can vary between +2 and +3 for most cats. ECID Every Cat is Different.

No harm in trying the lower amount of insulin. Why do some cats go up after the insulin? We don't really know, but it happens sometimes.
 
Thank you! For the cats who go up after insulin, does it come back down and stabilize? I know this is only one day of it happening so I don't have enough data yet to know if that's what's happening with Vinnie, but are there cats out there who always go up after insulin?

I'm not quite sure what to do now... Deb, you suggested lowering the dose (I did 0.15 today so getting any lower might be tricky) and JanetNJ suggested giving a full 0.25 for anything over 175 which would be increasing it. If he's in the 175-200 range tonight, will the 0.25 be risky in terms of hypoglycemia? He sleeps in a separate room (to keep him from attacking the other two cats) so I won't be able to keep an eye on him throughout the night.

If he is still over 200 tonight, any other thoughts?
 
Well as it turns out I didn't have to worry about what to do as he went back down for his PMPS - 113. Since every cat is different, is it possible that it takes more than +5 for the insulin to start working with him? Today was bizarre...
 
loalar said:
Thank you! For the cats who go up after insulin, does it come back down and stabilize? I know this is only one day of it happening so I don't have enough data yet to know if that's what's happening with Vinnie, but are there cats out there who always go up after insulin?

I'm not quite sure what to do now... Deb, you suggested lowering the dose (I did 0.15 today so getting any lower might be tricky) and JanetNJ suggested giving a full 0.25 for anything over 175 which would be increasing it. If he's in the 175-200 range tonight, will the 0.25 be risky in terms of hypoglycemia? He sleeps in a separate room (to keep him from attacking the other two cats) so I won't be able to keep an eye on him throughout the night.

If he is still over 200 tonight, any other thoughts?
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It’s all just taking our best guess. Do whatever your gut tells you.
 
loalar said:
Well as it turns out I didn't have to worry about what to do as he went back down for his PMPS - 113. Since every cat is different, is it possible that it takes more than +5 for the insulin to start working with him? Today was bizarre...
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Nice. When you get a low shot like that it’s fine to skip. Another option is to wait an hour without feeding and see if the number is on the rise. You’re doing a great job.
 
He was at 179 this morning so I opted to do a skinny .25 again (but it is a teensy bit more than yesterday so maybe around .20?. His +2 was 150 and +4 was 118 (I'm testing every couple of hours to see if I can figure out the nadir). He is seeming a bit sedate today though - he's usually more interactive and playful but today he seems to be isolating so I was concerned but his numbers seem okay.
 
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He was 125 for his PMPS so no shot; this morning he was 152, so I stalled and after 20 minutes he was 136 so no shot. Is it good or bad that he has "been on insulin" for over a week and has only actually gotten 4 doses? I think I'm comfortable shooting above 175 (and possibly a bit below that too), but should I start shooting even lower to get him on more of a schedule and try to get him into the greens? Maybe give him a lower dose, like 0.1 if he's between 130 and 150, a skinny 0.25 if he's between 150 and 175 and a regular 0.25 if he's over 175? Or would shooting anything between 130 and 150 be risky? Terrified of hypo as I lost a cat to it 20 years ago so if it's safer to just keep doing what I'm doing, I'm okay with that. Just want to make sure that it's not bad for him to get shots so infrequently.
 
If you decide to shoot lower, you need to test more and gather lots of data on what Vinnie does on a particular dose.

If you have your hypo toolkit all stocked and ready to go, you should be able to bring Vinnie's BG numbers back up with MC (medium carb) or HC (high carb) food.

Vinnie's higher BG numbers do indicate he needs a little bit of outside help with some insulin. His body isn't producing enough insulin on it's own.

It's a tough call on the dosing. Whatever you decide to do, frequent and close monitoring will be needed with Vinnie.
 
So I think I'm going to work my way down if need be and continue holding out hope for remission. Unless anyone thinks it's a bad idea, I will do a regular .25u if over 190, a skinny .25 (.20 ish) if between 175 and 190, and ~.10 if between 165 and 175. If I am able to shoot on the low ends of each of those for a few cycles and he handles them well, I'll lower the cut off by 10 points (so .25u if over 180, ~.20 if 165-180, and ~.10 between 155 and 165). And repeat until I find a place where he can nadir in the greens. It may take a while since his PS numbers are mostly under 150, but if there's no harm in skipping so many doses, doing a variable dose and keeping him in the blues, I will take my time to find the sweet spot dose-wise.
 
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