Nico perhaps change? | Feline Diabetes Message Board - FDMB

Nico perhaps change?

Tyleete

Tyleete

Member since 2025
Not sure if this belongs here, and the gal who was helping me in the PZ board is having an emergency of her own.
How long till we give up on an insulin type? My boy is always either in the red or black! He started treatment on the 1st of October, and has been on 2.5u for 5 cycles as of this morning.:(
I'm just so worried about him. And sick of sticking his ear when I know before shots it's going to be HI. Feeling so disheartened. Any thoughts are most welcome.😔
 
I think the real problem here is that your vet said not to increase the insulin, but he needs an increase. It could be that we haven’t reached a breakthrough dose yet. It could be that we need to break through his resistance due to glucose toxicity (where his body is so accustomed to being in the high numbers that you have to keep increasing for a while to shift things) or it could end up being that he has a high dose condition like insulin auto antibodies or acromegaly (but it’s way too soon and his dose is still too low to think of that.)
 
And no, his numbers haven’t improved that much yet. Red is red and he’s still only seeing red nadirs.

I am really sorry that he hasn’t improved yet. Don’t give up hope! I know how hard this has been on you.
 
So where do I go from here then? Do we keep pushing him up? And what's the cap or unsafe amount? Is it giving up on the 2.5 too soon? She wants me to bring him in for either a curve at the clinic, or at least a test and compare meters. I told her I don't have the $ for a curve, but can bring him in for the test. He's going to freak out. Hates the carrier and car ride. I've even stopped pricking his ear as much, cause I know right now before his shots, the meter won't even read, it's so high.
Speaking of meters, I was able to get enough blood for both the other day, and the Relion was nearly 100 points different. But when I checked my other girl, it was only off by about 20. What gives? :/
And thanks
 
Tyleete said:
So where do I go from here then? Do we keep pushing him up? And what's the cap or unsafe amount?
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Yes. A cat needs however much insulin they need. There’s no “cap” on dosage — some cats just need more than others. As long as you’re hometesting, collecting BG data, and increasing insulin dose in a slow, methodical manner, I wouldn’t worry too much. Again, a cat needs however much insulin they need. Repeat that to yourself as needed to calm your nerves — I know I had to remind myself at times.

Tyleete said:
Speaking of meters, I was able to get enough blood for both the other day, and the Relion was nearly 100 points different. But when I checked my other girl, it was only off by about 20. What gives? :/
And thanks
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Human meters tend to run lower than pet meters, so you will typically see higher numbers on the pet meter. At higher BG values, the difference can seem quite significant, but at lower BG numbers, the difference is usually much smaller. If you consider the difference a percentage, then that makes sense.

Your diabetic cat probably had a high(ish) BG, so a bigger difference between the pet and human meter isn’t surprising. Your non-diabetic was running normal, lowish numbers, so I would expect the two meters to read much closer.
 
So since my vet doesn't want to raise his insulin. When do I?
How long do we give him on all increased dosage before trying again? The literature is very confusing. Go slow, don't go slow. Wait this many days, wait less. :/ I'm definitely at a loss.
 
Tyleete said:
The literature is very confusing. Go slow, don't go slow. Wait this many days, wait less. :/
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Have you read the page on the Prozinc dosing methods recommended by this forum? PROZINC DOSING METHODS. It may seem confusing or contradictory, but really they're just two options for two different sets of needs. Typically we see members (for both Prozinc and Lantus) start with the "Start Low, Go Slow" method and then consulting with one of the dosing experts here if they want to move to the more advanced method. The more advanced methods move more quickly, but have other requirements that SLGS doesn't have (such as more tests per day).

Has your vet given a reason for not wanting to raise his dose? I would try to dig into that with them, then send them the resources from this page and explain that you'd like to use your home testing data to follow one of those methods. If they don't already have the link to your spreadsheet, that can be helpful to "show your work" so-to-speak on how dedicated you are to finding the right dose safely. I think many vets are reluctant to hand over the reins to pet parents because it would be dangerous to do so without having test data, and vets also often discourage home testing.

My personal experience -- one of the vets from my practice recommended felinediabetes.com to me in the first place, which was how I found the forum. When our kitty was officially diagnosed and put on insulin, our primary vet was very happy to hear we'd be home testing and essentially told us we could do it on our own as long as she was able to see what we're doing in our spreadsheet.
 
Lauren & Esse said:
Have you read the page on the Prozinc dosing methods recommended by this forum? PROZINC DOSING METHODS. It may seem confusing or contradictory, but really they're just two options for two different sets of needs. Typically we see members (for both Prozinc and Lantus) start with the "Start Low, Go Slow" method and then consulting with one of the dosing experts here if they want to move to the more advanced method. The more advanced methods move more quickly, but have other requirements that SLGS doesn't have (such as more tests per day).

Has your vet given a reason for not wanting to raise his dose? I would try to dig into that with them, then send them the resources from this page and explain that you'd like to use your home testing data to follow one of those methods. If they don't already have the link to your spreadsheet, that can be helpful to "show your work" so-to-speak on how dedicated you are to finding the right dose safely. I think many vets are reluctant to hand over the reins to pet parents because it would be dangerous to do so without having test data, and vets also often discourage home testing.

My personal experience -- one of the vets from my practice recommended felinediabetes.com to me in the first place, which was how I found the forum. When our kitty was officially diagnosed and put on insulin, our primary vet was very happy to hear we'd be home testing and essentially told us we could do it on our own as long as she was able to see what we're doing in our spreadsheet.
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I'm going back in today and going to try and dig in as you say. She thinks his numbers are improving, but I see only red & black. I have read the dosing page and it was back and forth to me. Unfortunately the gal that was helping me with the dosing is having her own kitty problems, so I wrote this as kind of up in the air and not sure what to do. Moving faster is definitely not something I can just wing on my own.😅
From what I've read, Lantus seems a much better insulin. With no crazy ups & downs. If that's so, I'm wondering why my cat was ever put on PZ to begin with. :/
 
Lantus is a great choice, and you can join the Lantus/Levemir/Biosimilars forum, where you post a daily "condo" which is a thread for the day. It's a very active board and you'll get a lot of eyes on Nico's SS.

I haven't used PZ, only Lantus, but I understand it works well for some cats as well. IMHO, though, Lantus is a wonderful choice.
 
Tyleete said:
She thinks his numbers are improving, but I see only red & black.
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Something else I have noticed--mostly on other boards that don't have the same standards for regulation/remission that we do--is that vets will tell people cats are in "good numbers" at a much higher level than we would. I have a theory that this also stems back to trying to keep cats out of range of hypos while simultaneously discouraging home testing. Combined with potentially just not being as well educated on feline diabetes... Vets have to know SO MUCH about so many things that ultimately they often can't devote the time/effort to learn the 'latest and greatest' on FD.

Tyleete said:
From what I've read, Lantus seems a much better insulin. With no crazy ups & downs. If that's so, I'm wondering why my cat was ever put on PZ to begin with. :/
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Many cats on here do see success on Prozinc though! The main insulin we try to avoid is Vetsulin, since it was formulated for dogs. I just think you might not be at the right dose yet. Many cats (on both Prozinc and Lantus) often see a 'breakthrough dose' effect, where they go up and up and up and then once they hit the right dose, bam, they start climbing right back down the dosing ladder. You can look at my spreadsheet (one example but probably not the best example) and see that it took us about four months to hit that point. Insulin dose is like pants size, it doesn't matter what the number is as long as it fits.

Obviously of course you can check with your vet on switching to Lantus, and we'd be supportive of that here too. You will need different syringes (u100 w/ half-unit markings) vs. Prozinc though--just as FYI.
 
Would your vet be willing to consult with an internal medicine vet or a vet who specializes in diabetes? All vets have the ability to consult with each other. Your vet can reach out a veterinary school, another vet hospital, through vet-only forums, or just by reaching out to their veterinary networks.
 
I agree with what several members who have posted have noted. There can be a dramatic shift in numbers when you hit a "breakthrough" dose. If you've been on Prozinc for a month, it may not be enough time to evaluate whether to switch insulins. Also, not increasing the dose is not a great recommendation. Could you include Nico's date of diagnosis in your signature? It's not there or on your spreadsheet.

I'd sneakily ask your vet about glucose toxicity. It's a terrible name so don't overreact. Basically, glucose toxicity involves your cat's system treating the high numbers as his "new normal." Given that we rarely know when a cat has become diabetic, Nico may have been in those high ranges for some time. Keeping your cat on a dose that isn't allowing the numbers to come down into a better range allows the cat's system to acclimate to the high numbers. In fact, when this happens in humans, they will complain that being in lower numbers (not scary low) than what they are used to makes them feel lousy until they get used to being in better numbers.

You may also want to look at the American Animal Hospital Assn's guidelines for treating diabetes. They don't discuss when to switch insulin but it will give you a feel for how treatment should be conceptualized.

Also, doing a curve at the vet's office is generally an issue for cats. They are prone to stress hyperglycemia. In other words, the stress of being in a carrier, going on a car ride, and being at the vet's office wil noise and the smell of other animals stresses them out. Stress causes blood glucose to rise in most cats. The readings at the vet's office are likely to be artificially elevated.
 
squeem3 said:
Would your vet be willing to consult with an internal medicine vet or a vet who specializes in diabetes? All vets have the ability to consult with each other. Your vet can reach out a veterinary school, another vet hospital, through vet-only forums, or just by reaching out to their veterinary networks.
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I really highly doubt it. That's why I was so relying on the combined knowledge of a specialty forum.
I agree 100% and say the same thing about vets. There's just no way they can keep up to date on every issue on 1-2 species. Like my vet, she takes her work home with her. I can text or call her 24/7 and she's the most compassionate vet I've ever come across. But, she also doesn't like it when questioned too much in what she feels is an expansive knowledge base.😬
And! Lantus it is!
She said we're going to switch.
Only weird part is, they use the Alpha Track3 and his blood test showed 490 on it. While my PetTest Advocate meter was 565. That shocked me. So I took the syringe with his blood she left, and put it on the Relion I brought as well I recently got. It showed 554.
I told her and she told me... We calibrate ours all the time, I would trust ours first. :/
Told you, she doesn't like being questioned much when she feels she's in the right. Still love her!
Mid-500's are bad for this time of day with him, but it might be due to the stress.
 
Sienne and Gabby (GA) said:
I agree with what several members who have posted have noted. There can be a dramatic shift in numbers when you hit a "breakthrough" dose. If you've been on Prozinc for a month, it may not be enough time to evaluate whether to switch insulins. Also, not increasing the dose is not a great recommendation. Could you include Nico's date of diagnosis in your signature? It's not there or on your spreadsheet.

I'd sneakily ask your vet about glucose toxicity. It's a terrible name so don't overreact. Basically, glucose toxicity involves your cat's system treating the high numbers as his "new normal." Given that we rarely know when a cat has become diabetic, Nico may have been in those high ranges for some time. Keeping your cat on a dose that isn't allowing the numbers to come down into a better range allows the cat's system to acclimate to the high numbers. In fact, when this happens in humans, they will complain that being in lower numbers (not scary low) than what they are used to makes them feel lousy until they get used to being in better numbers.

You may also want to look at the American Animal Hospital Assn's guidelines for treating diabetes. They don't discuss when to switch insulin but it will give you a feel for how treatment should be conceptualized.

Also, doing a curve at the vet's office is generally an issue for cats. They are prone to stress hyperglycemia. In other words, the stress of being in a carrier, going on a car ride, and being at the vet's office wil noise and the smell of other animals stresses them out. Stress causes blood glucose to rise in most cats. The readings at the vet's office are likely to be artificially elevated.
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How do you combat glucose toxicity? He was diagnosed the 1st of oct
 
Nope! Make that positive on the cancer. I'm trying real hard not to start full or bawling on the vet offices. This will have made my 3rd with this condition and another passed last year from bone marrow cancer. Sorry. She just told me and I'm just getting feeling a bit overwhelmed at the moment.
She's still to come back and talk Lantus with me. Are there any suggestions?
 
I would ask the vet about why the decrease in dose from the Prozinc. If it were my cat, the lowest I'd start at would be 2.0u. You can do a unit to unit switch. Dropping the dose slightly takes into account those cats who occasionally have a marked response to a new insulin. Also, do some reading. The sticky notes at the top of the Lantus board will help you understand the differences between Lantus and Prozinc. Lantus is a depot-type of insulin. It will take 5 - 7 days for the depot to build up and stabilize.
 
No one bothered to tell me NOT to shake the donated bottle of insulin at the vets. And no insert since it was a donated from a deceased kitty. We thought maybe the bottle lost its efficiency with me doing that, so I ordered a new one. She said to start back at 2, but I was advised to go back to lower number, in case my bottle had become bad and didn't want to worry about hypo. That's why the decrease and then back up.
Since then, I've read lantus/Glargine is so much better, as it doesn't send your cat through these crazy ups and downs. So I was very happy when she said she'd like to switch.
 
@Tyleete I know you’ve got a lot going on right now and your brain is probably swimming.

One very, very important thing to remember if/when you switch to Lantus — you must get different insulin syringes. Do NOT use the Prozinc syringes with Lantus.

The two insulins are different “strengths” so using your current syringes will cause an overdose. You will need u-100 syringes for Lantus. (The “U” number, as in U-40 vs U-100, represents the strength/concentration of the insulin).

Post the info from your new syringes before you shoot the first dose of Lantus and we’ll make sure you have the right thing.

.,
 
I did know that from the reading I've done so far, but Thank you for the heads up. I did order 2 boxes of syringes before the doc said that was ordered too? So I'll be stocked a little while.
 
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