01/14 Marshmallow: AM+10 105, AM+11.5 202- Need Prozinc Dosing Advice ASAP

Hi everyone, so thankful to have found this board and so many knowledgeable people! I've read so many helpful threads in the short time that I have been here.

My cat Marshmallow was newly diagnosed on December 12. We started insulin on December 20th. My vet initially wanted her started on 2u of ProZinc but after reading all I could get my hands on I only started her off on 1u. My vet never talked with me about home testing but I equipped myself with a meter and we've been testing since day 1. We're about 3 weeks in with our numbers running in the 200's morning and night. We've been consistent with insulin times, switched to a low carb diet and test before we shoot.

I got a call today because I haven't made a follow-up appointment. I've been hesitant because I didn't start her out on the dose my vet wanted. I called her this afternoon and we have a nice talk. She is usually really great with me because Marshmallow also has asthma so we've got good communication. We both agree Marshmallow needs an increase to get those numbers lower. I was thinking like 0.25-0.5, she wants me to increase her 1 whole unit, so 2u for tonight's shot. I have to admit I'm a bit scared!

Does this sound reasonable or is this a pretty big jump? I trust my vet but I also trust input from people who live with and manage their diabetic pets everyday.

Any advice would be greatly appreciated.

Diana

 

Hi Diana,

I'm glad that you're finding lots of helpful info here, and it's great that you're monitoring Marshmallow's blood glucose (BG) levels at home. I'm going to tag some members experienced with Prozinc for you:

@JanetNJ
@Panic
@Deb & Wink

In the meantime I'd like to ask you to set up one of our shareable BG tracking spreadsheets as members replying to your threads will need to see how Marshmallow's responding to her insulin in order to give you solid suggestions on dosing. Here's the info you need to get going:

FDMB spreadsheet instructions

Understanding the spreadsheet grid

If you need assistance to get your spreadsheet up and running just give a shout and we'll find someone to help you.

In addition to the preshot readings, getting some readings between the preshot tests will give you information on how low the current dose is taking Marshmallow at nadir. The Prozinc people will be able to give you a steer on the best times to test for this.

That's really encouraging.


Mogs
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So you said the numbers are in the 200's.... Is that just at preshot times or mid cycle as well? Can you post a log or spreadsheet of numbers? We recommend that increases are made in 0.25-0.5 increments.

 

That's a big bump up in the dose, that your vet is recommending. Doubling the dose.

We need to know how low the current 1U dose is taking your cat Marshmallow, in order to know how well the current dose is working.
Most cats have their nadir (lowest BG level) somewhere in the +5 to +7 hour time frame. So some tests around that time would be really helpful.

 

I've gotten readings on her a handful of times at the +6 hour mark since we've started. I've had 140 and a 159. +8 hours 189.

I had a long conversation with my vet about increasing up 1 full unit. I think that's to much, I wanted to do 0.25 or even 0.5 but my vet says if we don't be aggressive we are going to lose our chance at getting her into remission. I'm all for attempting remission but don't want, nor can I afford, a trip to an emergency vet for a hypo incident.

I ask her if she's worried about it happening, she said no. She told me not to even get glucose reading for yesterday or today, just do the 2 units and test Friday. She says I'm getting into the game of chasing numbers. Don't get me wrong, I very much like my vet and highly value her opinion. I just feel like we might be playing with fire.

I also ask about giving Marshmallow more food in between shots, she seems ravenous. She said until we get the insulin dose down pat she'd prefer I only feed morning and evening before we shoot. I'm fine with that.

So, that brings me to the past two days since I've upped the ProZinc to 2u. I've had consistent low numbers. This AMPS 90, +2 71. That warranted a call, my vet said she's fine with it that low but advised I give her food. I thought no extra food until we got this dose down pat? I did give her half a can. Tested +4 70, +6 74. I'll test again at +8 but I don't like messing with numbers that low.

Should I be concerned? I just happen to be off work right now but it won't always be this way. Should I decrease her dose? Maybe 1.5U or leave her on for another day and see what we have tomorrow?

I will be working on getting my spreadsheet set up so you don't have to sift though my post for numbers.

Thanks for any advice you can offer.

Diana

 

Hi Diana,

Great that you managed to get those mid-cycle tests, especially after the large dose increase to 2IU Prozinc BID.

100% with you on this.

For a cat just starting out on on treatment (less than 3 months from diagnosis), the recommendation in the FDMB Prozinc Dosing Methods guide is to set 200 as a 'no shoot' threshold. For low preshot BGs, the general guideline is to stall without feeding and test again in 20-30 minutes to see whether BG is rising, during which time you can post for help.

If you hadn't fed after that +2/71 reading there's a chance that Marshmallow might have dropped too low by nadir point in the cycle. I've not used Prozinc so I can't help on the dosing side of things. Your vet might be cool with giving insulin on a 90 preshot, but this early in treatment I think that's very risky. I'd certainly want to test and feed mid-cycle to make sure my cat was safe, even if a token dose was given. (Note: Extra caution is required when considering skipping a dose if a cat is prone to generating ketones or has a history of DKA.)

The Prozinc guide Start Low, Go Slow dosing method says that the dose should be reduced by 0.25IU immediately if the BG drops below 90 (human meter), so that applies to Marshmallow. I don't know enough about Prozinc to say whether a larger reduction might be safer.

I'm going to tag some of the Prozinc people to ask them to give you more specific advice on dosing and feeding.

@Deb & Wink
@JanetNJ
@Panic

Pretty please!


Mogs
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Thanks so much for your reply. Her +8 94, +10 105. She is coming up but still low numbers. She will be due for her next dose at 7:50. Would you say reduce the dose and if so by how much?

Thanks so much!

Diana

 

Hi Diana,

I suggest grabbing a test at +11.5 and post for help then. Hopefully some of the Prozinc people will be around then to help you better at that time to give you better help, and by the time you get the PMPS test you'll get a better idea of whether Marshmallow's rising and not get behind too much with your dosing schedule (especially if you might also need to stall). I'd suggest changing the title of this thread then to:

01/14 Marshmallow: AM+10 105, AM+11.5 <add BG reading> - Need Prozinc Dosing Advice ASAP

(Click on Thread Tools above your opening post to edit the thread title.)

As I mentioned above, I've not used Prozinc, so can only point you to guidance in the Prozinc guide. In the event that you don't hear back from one of the experienced Prozinc users, here's the relevant section from the Prozinc Start Low, Go Slow method:

How to handle a lower than normal preshot number when following SLGS:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• 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
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

​

[Emphasis mine]

I wish I was able to help you more.


Mogs
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Thanks so much!

01/14 Marshmallow's AM +10 105, AM+11.5 199

Diana

 

I wouldn't recommend more than 1U for your Marshmallow right now.

She earned a dose reduction, and I think your vet raised the dose too much, too fast.

Yes, we really would like to see an SS (spreadsheet) setup. It helps to see the trend in the BG levels much better.

There is no such thing as "getting the insulin dose down pat" as your vet said. It's adjusting the dose, sometimes frequently, based on the mid-cycle nadirs.

 

Hi Diana,

For future reference, if you go back to the very first post on a thread you've created, you'll see a Thread Tools button above it (RHS of screen). If you click on that you'll see this:

Any time you need to update/change the title of a thread, click on Edit Title. Next, edit the current title to indicate the help you're looking for then save the change. That'll change the title of the thread on the Feline Health thread list and alert members to the assistance you need.


Mogs
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@Deb & Wink - Thanks, Deb.


Mogs
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