What are ProZinc dosing recommendations for an acro cat?

varlene

varlene

Member
Those from main/welcome forum suggested I post here. Smoky's IGF-1 is 234. He is currently on ProZinc (since June 2018), and because I just bought a new vial I won't be switching to recommended Levemir right now. Are there basic guidelines for ProZinc users? I see that I shouldn't wait too long, but I don't know what that means. What constitutes a cycle, a dosage or two doses for the day? As you will see in Smoky's spreadsheet, I just upped his dose by .25 today, now at 8.75 units, but don't know if that was enough or even warranted. Also interested in cabergoline, if my vet will prescribe it.
 
Cycles are 12 hours long. You have an a.m. cycle and a p.m. cycle. Yes, a dose increase is definitely warranted at those high numbers. I just counted on your spreadsheet and you had Smoky at 8.5 units for 28 cycles with very little improvement in glucose numbers. Under either protocol (SLGS or TR) you have held the dose for too long. Holding a dose that is too low -- for too long is not good for a lot of reasons. You don't want your kitty to get too comfortable in the high numbers, which Smoky would be by now.

Have you read through the information about the Start Low Go Slow and Tight Regulation protocols? With the amount of testing that you are doing (good job, by the way) Smoky would be a good candidate for Tight Regulation (TR), which would allow you to increase at a faster pace and hopefully get to a better dose and get Smoky's numbers down more quickly into a healthier range.
 
I used to use ProZinc, as well. This was before I knew that my cat had Acromegaly. I kept trying different insulins (been through all of them) because I thought maybe it was the insulin. It was the Acromegaly, which I only found out about this year. My kitty was on VERY high doses of insulin. We started Cabergoline and after about 6 weeks, his insulin requirements dropped dramatically. He got as many as 41 units twice a day and is now down to about 3 units twice a day.
 
Suzanne & Darcy said:
Smoky is a gorgeous grey baby!!
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Thanks, Suzanne. Smoky was a cutie that just showed up one day. We used that picture trying to adopt him out because he didn't get along with our other cats but then we ended up paying to officially adopt him ourselves when he was returned to Florida Humane because he didn't get along with a cat. He's always been a bit different but very sweet. He loves bedtime when he gets to sleep with us. Your Mr. Darcy is very handsome, but his readings on your spreadsheet would scare me to death. I am just hoping I can get Smoky's pre-shot numbers to ≤300 with a nadir in the normal range. I can't imagine going up to 41 units. Yikes. Cabergoline seems to have been the answer for Mr. Darcy. Any problem having your vet prescribe it? How much do you give?
 
I give Darcy .4 mL of Cabergoline. The strength is 200 mcg/mL, so that means he gets 80 micrograms in his dose. Note that I had been giving him Cabergoline daily, but recently he went into renal failure (hopefully an acute kidney injury that will be reversible) so I have reduced his dose to every other day. I'm just trying to give him a break for the time being until I am sure he will stabilize.

At first, my vet seemed disinclined to prescribe it based upon another vet's advice, but I provided her with some information (from Wendy and the Board) and she readily allowed me to try it. Several FDMB kitties are taking Cabergoline now and are doing very well on it.
 
Suzanne & Darcy said:
I give Darcy .4 mL of Cabergoline. The strength is 200 mcg/mL, so that means he gets 80 micrograms in his dose. Note that I had been giving him Cabergoline daily, but recently he went into renal failure (hopefully an acute kidney injury that will be reversible) so I have reduced his dose to every other day. I'm just trying to give him a break for the time being until I am sure he will stabilize.

At first, my vet seemed disinclined to prescribe it based upon another vet's advice, but I provided her with some information (from Wendy and the Board) and she readily allowed me to try it. Several FDMB kitties are taking Cabergoline now and are doing very well on it.
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Thank you for your reply. Good to know that cabergoline is out there if Smoky needs it. I hope Darcy gets better soon!!!!
 
Hi, all and especially @JanetNJ. Smoky is at 11 units ProZinc and due to go up tomorrow. I am thinking I should try 12 instead of 11.5 but I am too new at this to do without advice and support, especially since Smoky seems to be out of sorts, not happy, not eating, and BG curves don't seem to be getting better. Thank you.
 
Janet may not be on, she is recovering from a surgery. I think you'd be fine going up to 12 units. For Lantus and Levemir, we increase by a full unit over 10 units dose, especially if not seeing anything under 100.

I'm worried about the not eating. Maybe time to take him to the vet. Any chance he's constipated?
 
Thanks @Wendy&Neko. Sorry to hear about Janet. I hope that her surgery was a success and that she will have an easy and speedy recovery. Thank you for your concern. At 2 hours before the PM shot, Smoky started eating again and did not vomit, so all's well for now thankfully. I scooped up poop earlier from the litter box that he only uses, so that's good too. I will try 12 units tomorrow and hope for the best. Many thanks.
 
varlene said:
Thanks @Wendy&Neko. Sorry to hear about Janet. I hope that her surgery was a success and that she will have an easy and speedy recovery. Thank you for your concern. At 2 hours before the PM shot, Smoky started eating again and did not vomit, so all's well for now thankfully. I scooped up poop earlier from the litter box that he only uses, so that's good too. I will try 12 units tomorrow and hope for the best. Many thanks.
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Hi I'm doing good after surgery. :). Taking it slow and easy. I liked those blues last week. Wish they would have stuck around. I think skipping to 12 is a good idea. Crossing fingers for you. My cat had to hit 13 before going down.
 
JanetNJ said:
Hi I'm doing good after surgery. :). Taking it slow and easy. I liked those blues last week. Wish they would have stuck around. I think skipping to 12 is a good idea. Crossing fingers for you. My cat had to hit 13 before going down.
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@JanetNJ So glad to hear you are doing okay and taking it easy. Hope you will continue to improve with each passing day. I liked those blues too!!
 
I'm rooting for Smoky! I hope the 12 units does the job. My kitty had to go very high in dose but he's a case! I hope that your Smoky won't need much more insulin to start responding.
 
varlene said:
Seems like moment of truth and need help. Today first time all yellow & blue. PMPS at 154. He's looking at his food but not eating. I'm due to shoot 16 units now. Yes or No? @JanetNJ @Suzanne & Darcy @Wendy&Neko
UPDATE: After 1/2 hour, BG was 208 and he's eaten a bit, so I shot 16 units and will test through the night.
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Sorry I missed this post. You did exactly what I would have suggested. I hope this means you will now start setting progress.
 
Thanks @JanetNJ. This morning's PS was 159, then after 1/2h delay 181 so gave 16 units and will monitor. Nadir that I caught was 94 at +10.5h after PM shot, but I might have slept through a lower one.

Looks like the next TR step is "when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing" but since I am an hour behind schedule, if all goes well today, I'm thinking I could give a tad less tonight (15.5 or 15.75) and then back on 16 units in the morning, or I could just be brave, keep it 16 units and hope the hour earlier won't mess things up.

Probably too early to ask about reducing, but TR rules state that you don't reduce until nadirs fall under 40 mg/dL, but since normal looks to be 64-170 mg/dL, I am reluctant go below 50-60 without intervention especially since some meters might be off, however, I don't want to ruin the process. I guess time will tell but wanted to get this question in writing just in case it happens sooner than expected and nobody is around to hold my hand.

Thanks for your help. Hope you are doing well.

Arlene V
 
varlene said:
Thanks @JanetNJ. This morning's PS was 159, then after 1/2h delay 181 so gave 16 units and will monitor. Nadir that I caught was 94 at +10.5h after PM shot, but I might have slept through a lower one.

Looks like the next TR step is "when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing" but since I am an hour behind schedule, if all goes well today, I'm thinking I could give a tad less tonight (15.5 or 15.75) and then back on 16 units in the morning, or I could just be brave, keep it 16 units and hope the hour earlier won't mess things up.

Probably too early to ask about reducing, but TR rules state that you don't reduce until nadirs fall under 40 mg/dL, but since normal looks to be 64-170 mg/dL, I am reluctant go below 50-60 without intervention especially since some meters might be off, however, I don't want to ruin the process. I guess time will tell but wanted to get this question in writing just in case it happens sooner than expected and nobody is around to hold my hand.

Thanks for your help. Hope you are doing well.

Arlene V
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that model of 40 is with a HUMAN meter.... don't go below 68.... you are using an alphatrack. I like your numbers so unless you are really nervous i'd stay at 16. if the preshot is low and you wanna go down to 15.75 that's probably ok.... but 94 is where you wanna be! I would keep at 16 and give it a test before bed, or maybe set an alarm and check once at night.
 
JanetNJ said:
that model of 40 is with a HUMAN meter.... don't go below 68.... you are using an alphatrack. I like your numbers so unless you are really nervous i'd stay at 16. if the preshot is low and you wanna go down to 15.75 that's probably ok.... but 94 is where you wanna be! I would keep at 16 and give it a test before bed, or maybe set an alarm and check once at night.
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@JanetNJ: Thanks for getting back to me. I agree that 16 units is working well today. I might have been too optimistic thinking I could shoot an hour earlier tonight to get back to 9a/9p as I will be lucky if I can give Smoky his shot at +12h (10p) without a delay. But if all goes well tonight without a delay, I can try getting back to 9a/9p in smaller increments over the next few days.
Someone worked on my "Arlene's Version of SS", and I am very grateful because the X axis spaces the hours evenly, which I didn't know how to do on my own. If it was you, please let me know how you accomplished it. I'd like to do the same going forward. Unfortunately, the curve didn't automatically update when I added the most recent BG so I could use some guidance. Latest was 176 at +6h. :)
 
@JanetNJ: I see that I needed to reformat my date/time column to get the fixed time intervals on the X-axis. Thanks ever so much!!
 
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JanetNJ said:
that model of 40 is with a HUMAN meter.... don't go below 68.... you are using an alphatrack. I like your numbers so unless you are really nervous i'd stay at 16. if the preshot is low and you wanna go down to 15.75 that's probably ok.... but 94 is where you wanna be! I would keep at 16 and give it a test before bed, or maybe set an alarm and check once at night.
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@JanetNJ: After two wonderful days and nights, todays BG's are in the high 300s and I am thinking I need to up to 17 tomorrow, maybe even if it goes lower tonight. Weird that his BGs go lower overnight than during the day. I swear he was looking for his PM shot two hours before it was due. : (
 
varlene said:
@JanetNJ: After two wonderful days and nights, todays BG's are in the high 300s and I am thinking I need to up to 17 tomorrow, maybe even if it goes lower tonight. Weird that his BGs go lower overnight than during the day. I swear he was looking for his PM shot two hours before it was due. : (
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Mine often had different night and day numbers. It might be because he eats less at night, or is more relaxed at night, or moves more. Who know.

The suddenly higher number could also be just a bit of a bounce from going lower than usual. Hard to say. Maybe do 16.5? See what happens? Totally up to you. You are great about testing so it's your call.
 
JanetNJ said:
Mine often had different night and day numbers. It might be because he eats less at night, or is more relaxed at night, or moves more. Who know.

The suddenly higher number could also be just a bit of a bounce from going lower than usual. Hard to say. Maybe do 16.5? See what happens? Totally up to you. You are great about testing so it's your call.
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Thanks, I will give 16.5 and will see what happens.
 
Just wanted to make a small clarification. We don't have a Tight Regulation dosing method for Prozinc here. This document describes what we do have:
PROZINC DOSING METHODS The two methods are SLGS and the Modified Prozinc method.

Tight Regulation was developed and tested with depot insulins, Lantus and Levemir.

Nice spot of green today. :)
 
Wendy&Neko said:
Just wanted to make a small clarification. We don't have a Tight Regulation dosing method for Prozinc here. This document describes what we do have:
PROZINC DOSING METHODS The two methods are SLGS and the Modified Prozinc method.

Tight Regulation was developed and tested with depot insulins, Lantus and Levemir.

Nice spot of green today. :)
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Hi, @Wendy&Neko, @JanetNJ -- Had to give glucose overnight and looks like I will be testing hourly today and likely likely giving more. Needless to say, reverting to 16 units was not enough of a reduction this morning. So for the PM shot, I am tempted to reduce a full unit to 15 but would appreciate input if it is not too much trouble. Many thanks.
 
I'm not experienced in Prozinc, but I think a full unit reduction might be a good idea for now. With Lantus we change doses by full units over 10 units total dose, unless just trying to tweak a dose that's almost a good one.
 
Hooray!!! You finally found your breakthrough dose! Did you have to steer a lot today? It would be ok to reduce to 15. If he runs a little high you could go back up to 15.5.
 
Hi, @JanetNJ Thank you. Your reply made me smile for the first time today. I have been rubbing glucose on Smoky's gums or giving him a bit of honey sugar water via syringe with each hourly test because he is not eating. If that is what you mean by steering, then yes I am. Just now at +8h = 109 and he started to eat a bit so will hold off giving sugar and see how he does, continuing to test each hour until hopefully good PMPS value so I can try 15u.
 
varlene said:
Hi, @JanetNJ Thank you. Your reply made me smile for the first time today. I have been rubbing glucose on Smoky's gums or giving him a bit of honey sugar water via syringe with each hourly test because he is not eating. If that is what you mean by steering, then yes I am. Just now at +8h = 109 and he started to eat a bit so will hold off giving sugar and see how he does, continuing to test each hour until hopefully good PMPS value so I can try 15u.
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Oh yeah then definitly lower to 15!!! This is very exciting!!! Nerve wracking for you... But exciting.
 
Look in my spreadsheet for 2019.... In July I had her breakthrough and you can see the numbers really fluctuated.
 
JanetNJ said:
Look in my spreadsheet for 2019.... In July I had her breakthrough and you can see the numbers really fluctuated.
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I am going to up to 15.5 tonight, since his nadir in high 100s, I think it will be okay. I looked at your spreadsheets and it seems you dosed day by day depending on circumstances, which I like. After Smoky's AM shot at 15u, after reviewing his numbers, it seemed I probably should have given him 15.5, and wondered if okay to just give him an additional 0.5u as it was just about an hour later. However, because I was going out for several hours, I didn't do it, but wonder if it would be acceptable thing to do if it comes up again. Gotta run; now time from his PM shot. And yes, it was/is definitely nerve-wracking!!!!
 
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@JanetNJ -- Smoky had a banner day. Thankfully a slow day working from home so was able to test him hourly. Tried to move his 10p shot time earlier but couldn't due to a sudden drop at 9:30p from 209 to 144; but at ~10p was 206 so shot 15.5u since his nadirs were green and 15u didn't work well the last time. Fingers crossed he will do okay overnight while I sleep. Thank you for your continued guidance and encouragement.
 
varlene said:
@JanetNJ -- Smoky had a banner day. Thankfully a slow day working from home so was able to test him hourly. Tried to move his 10p shot time earlier but couldn't due to a sudden drop at 9:30p from 209 to 144; but at ~10p was 206 so shot 15.5u since his nadirs were green and 15u didn't work well the last time. Fingers crossed he will do okay overnight while I sleep. Thank you for your continued guidance and encouragement.
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Wow look at those blues and greens!!!! Hold this dose a while (unless he goes too low of course.). If the numbers go up it could be from these lovely greens and blues that he's not totally used to yet.
 
@JanetNJ: Thank you for your advice. I have been feeling like a failure seeing the pinks today instead of the seemingly perfect blue & green day yesterday and doubting I was doing the right thing. I will hold tonight per your advice and will hold tomorrow too unless BG goes too low. Thank you. Thank you. At +8.5h, I finally see a yellow, so that is some progress.
 
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varlene said:
@JanetNJ: Thank you for your advice. I have been feeling like a failure seeing the pinks today instead of the seemingly perfect blue & green day yesterday and doubting I was doing the right thing. I will hold tonight per your advice and will hold tomorrow too unless BG goes too low. Thank you. Thank you. At +8.5h, I finally see a yellow, so that is some progress.
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You are facing a different set of obstacles. Her high numbers are not your failures.... They are just her little body out of wack. Look at the bigger picture. Uptrend your spreadsheet and look at the overall colors you are seeing in June verses what you had in May!!! Squint at it! Look at all those healing blues!!! You are leading her to this through your love and dedication. You are amazing and your cat is so lucky to have you.

Two weeks ago your average morning preshot was 379.6. The last 7 days it was 257. Amazing.


All we can do is take our best guess. How is she behaving? Does she seem to feel ok? Whenever you can get her to play, exercise helps the numbers too.
 
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Oh! I see she even went a little low! I'm glad you didn't increase! Ok so that means she earned a reduction. I would go down to 15.25. But again don't be surprised if you see some high numbers in the next cycle from a bounce. Good job testing that you caught that.
 
JanetNJ said:
You are facing a different set of obstacles. Her high numbers are not your failures.... They are just her little body out of wack. Look at the bigger picture. Uptrend your spreadsheet and look at the overall colors you are seeing in June verses what you had in May!!! Squint at it! Look at all those healing blues!!! You are leading her to this through your love and dedication. You are amazing and your cat is so lucky to have you.

Two weeks ago your average morning preshot was 379.6. The last 7 days it was 257. Amazing.

All we can do is take our best guess. How is she behaving? Does she seem to feel ok? Whenever you can get her to play, exercise helps the numbers too.
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You are right, of course. Reds & Blacks are now ancient history. : ) Smoky has been in pretty good spirits, even sitting quietly when the female cats Leah & Amanda ("the girls") come into the bedroom which was his territory behind a closed door for most of his life. He such a good little guy. Whenever I call, "Hey, Smoky, time for your test" he comes out from wherever he's been resting and sits at the test spot next to his food dish. I couldn't ask for a sweeter or more obedient cat.
 
JanetNJ said:
Oh! I see she even went a little low! I'm glad you didn't increase! Ok so that means she earned a reduction. I would go down to 15.25. But again don't be surprised if you see some high numbers in the next cycle from a bounce. Good job testing that you caught that.
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I don't know what woke me up but when I saw that Smoky wasn't in his usual spot on the bed I sought him out. Once his numbers were back up, I entered his BGs into the SS with the hope you would see them first thing this morning, which you did, and provided guidance. : ) Thank you!!!
 
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varlene said:
I don't know what woke me up but when I saw that Smoky wasn't in his usual spot on the bed I sought him out. Once his numbers were back up, I entered his BGs into the SS with the hope you would see them first thing this morning, which you did, and provided guidance. : ) Thank you!!!
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Oooh Liking those numbers so far today! Going into the blues without taking a nosedive. hahahaha
 
@JanetNJ The nosedive came. I had to head out today but had a feeling that Smoky was trending down, so came home and found him at 77 but didn't give glucose until I saw 48 with the next test. The GBs within one hour ran the gamut from 48 to 101, so I picked the lowest color for the spreadsheet. I am thinking this means another reduction with the PM shot. From 15.25 to 15?
 
varlene said:
@JanetNJ The nosedive came. I had to head out today but had a feeling that Smoky was trending down, so came home and found him at 77 but didn't give glucose until I saw 48 with the next test. The GBs within one hour ran the gamut from 48 to 101, so I picked the lowest color for the spreadsheet. I am thinking this means another reduction with the PM shot. From 15.25 to 15?
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Yes time to lower again! Very exciting!!
 
His numbers are not staying up and he's turning up his nose at food. At +8h I gave him commercial glucose (SOS) instead of syringes of sugar water, hoping it will work better or maybe his AM insulin dose will finally peter out.
 
varlene said:
His numbers are not staying up and he's turning up his nose at food. At +8h I gave him commercial glucose (SOS) instead of syringes of sugar water, hoping it will work better or maybe his AM insulin dose will finally peter out.
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Maybe lower to 14.75
 
JanetNJ said:
Maybe lower to 14.75
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Sounds good IF (big IF) his PMPS comes up. It was 78 at 10.5h and that is with getting glucose all afternoon. At +11.2h he is at 101 but had just 0.5h before. Today he has been skittish, hating doing testing, and running away from Leah who is taunting him and from me. : (
 
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varlene said:
Sounds good IF (big IF) his PMPS comes up. It was 78 at 10.5h and that is with getting glucose all afternoon. Going to do the +11h test now. Today he has been skittish, hating doing testing, and running away from Leah who is taunting him and from me. : (
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If he's low stall without feeding for up to an hour. If it's still low you may want to give just a small token dose.., like 4 units...
Then at the next normal preshot would you feel more comfortable doing 14.5?
 
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