6/26 Oscar - thinking its time to switch

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Kelly & Oscar

Kelly & Oscar

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Well, we upped his dose to 2u today and we'll hold it there for a few days. We took the advice of our IM 'specialist' and have been holding the doses for more than a week before we change in hopes that the number trends would change. Unfortunately, they have not. I have emailed her our numbers and I am waiting on her to call (will probably be sometime on Monday or Tuesday this coming week). I really think this might be it for us, it may be time to switch to Lantus. We've been on ProZinc since the beginning of March (4 months) and have had nothing but wanky numbers. Sometimes we get a small curve, sometimes it is flat, sometimes it is inverse, and then it bottoms out on us randomly with no warning. I need to prepare myself for the 'I want to switch insulins and here's why' convo with this woman.

Do you guys agree that we should try Lantus? Should we change something and give ProZinc longer? I have a source on 3 pens of Lantus in Nashville, TN to pick up next time the DH is down there for national guard drill, and can call around to see if any of the pharmacies around town will sell a single pen. Yoda has a lantus donation, but I really don't want to use what has been given to him (I want it to travel with him when he gets his furrrever home).
 
You know that I think ProZinc is a really good insulin, Kelly. But I also know that it isn't going to work for every cat. When I look at Oscar's SS, it seems to me that he is super sensitive to drops in BG, every time he starts to get into good #s, he zooms back up. Then he seems to stay pretty flat until the next time he drops into the blues...then back up into 300s again. It may be that since he had the hypo #s, he is just resistant to PZ. I would say that you have given it a more than fair trial, and Oscar is getting nowhere. How long should you tread water? Four months is plenty of time, IMO.

I think Lantus may be just the ticket for him, since it appears to be more gentle and has a flatter curve. I don't think you have any reason to stay with ProZinc, it just isn't working for him. I wouldn't hesitate to switch at this point.

Hey...but don't be a stranger! Come and visit us, we can use your insight! :mrgreen:
 
At the risk of being labeled a "Lantus proselytizer", ( ;-) , Gator), I will say that if you feel it's time to switch, then you should do it. I flirted around with the idea of switching for quite awhile but ultimately Buzz went OTJ before I could do so. When, 3 weeks later, she needed insulin again, I made the switch because a) I had a coupon for 5 free SoloStar pens, and b) they were discontinuing Idexx PZI. So the decision was a little easier for me, although I still second-guessed myself into the ground.

I have been happy with Lantus. I thought it might help flatten out Buzz's wild swings, and to some extent, it has. She is just a cat who is always going to bounce no matter what, so there's only so much that any insulin can do to fix that. I think what it boils down to is whether or not YOU are ready for a switch. If you're just frustrated with Oscar's #s all the time, and you find yourself thinking each time he has a bad cycle, "Man, I should switch to Lantus", then I think it's time. If you don't feel ready to make the change, then hold off.

I believe Ele was thinking about it for awhile before she made the switch, so you might get her input and see what she thinks. Blackie has had some marvelous numbers on Lantus, esp. compared with his numbers right before the switch.

Making the determination that PZI is no longer the insulin for you guys doesn't mean making the determination that it's a bad insulin, and that's where I feel like people get caught up in the insulin debates on this board. ECID, so why would anyone judge anyone else for switching? Perhaps because I'm weird, I liken it to the "breastmilk vs. formula" wars. Let's all just support each other, no matter what insulin choices we make on behalf of our kitties.

If you need specific info about Lantus, I encourage you to post in LL saying that you are thinking about making the switch, or just read the stickies. It is a completely different insulin from PZI and it will take some time to adjust to how it works. Arm yourself with information and facts, and when you talk to your vet, print out the Tilly Protocol and Queensland studies to let her read if she's interested.
Here is the link to that sticky: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581
And here is the link to Tilly protocol: http://www.tillydiabetes.net/en_6_protocol2.htm
 
The tough thing about switching is the slow starting over, especially since he gets ketones doesn't he? The ramp up for a non acrocat on lantus and lev are painfully slow, and precisely spelled out. Spend some time on the stickies, and be ready for bad numbers for awhile. I will not be able to help at all because acrocats follow different "rules", (and I have pushed those, with hand holding from experienced acromoms)

It has a storage "shed" which some of each dose goes to "filling". This means that you hold the same dose for quite a while, and gradually the numbers on a given dose start getting better and better. I sometimes wonder if this isn't the case with prozinc, ( all 3 are human recombinant insulin molecules I believe, I just can't explain the exact biological mechanism of the "shed". It has something to do with another molecule that binds it until it is needed. This gives the lower preshots as the shed kicks in as the recent dose fades. Sorry thats the best I understand it.

If you are switching you might consider levemir. Supposedly it is gentler with long slow nadir action. It is newer and less known to vets, and as I recall your vet is not exactly adventurous. It took me awhile to get my vet to research it, and she finally said a consultant on VIN named Alice Wolf, whom she respects, has acknowledged it in some way, so she agreed.

I love Prozinc and it has a lot of good qualities, but maybe its time to start researching ... just don't expect an instant solution.
 
Nancy makes a good point about the settling-in time. Buzz took a LONG time (about 3-4 weeks) to see any good numbers after her first cycle on Lantus, and I mean she had BAD numbers. Pinks and reds, with an occasional yellow throw in for good measure. I was so frustrated and worried. It was tough. But I don't think Blackie took that long, although I can't remember. Again, ECID and it could be that Oscar will settle in quickly. But you have to be prepared for the scenario in which he's wildly unregulated for a few weeks, just so you know what you're getting into.
 
Thanks for all the info guys. With each bad cycle I feel like I am beating my head against a wall and I do keep wondering about switching. I am considering Lantus instead of Levemir since I have someone that their kitty has passed and they are holding 3 pens for me until the DH can go down to TN to get them. Money, unfortunately, is still an issue for us and we just bought a new vial of prozinc 2 months ago.

I have poured over the stickies in LL many times because I was anticipating needing to switch for a while - and plus we just switched our foster kitty over a couple of days ago due to a donation.

The thing about Oscar's numbers is that they are exactly the same right now as they were before he was on insulin - which really makes no sense to me. I am prepared for unregulated numbers - because that is what we are still dealing with on most days. Hopefully I'll get that call on Monday or Tuesday.
 
Is there any chance your meter could be any part of the problem with erratic numbers that don't make sense? Before you switch insulin, could you try a different meter for a week?
 
I think you've certainly given PZI a fair trial, and his #s are all over the place in terms of any kind of consistent response (to my tired eyes at least ;-) ) so I would certainly be tempted to switch in your shoes too. I don't have any great ideas for using PZI better, though his response is at times really good and I think you could still make a go of it with PZI if you wanted to. Some cats to me clearly don't get enough duration, or get wild swings on PZI, and then it makes a lot of sense to switch. I'm not sure either of those are the case with Oscar - he doesn't generally get super-high #s, so that sets him up in a sense to do well, but then the variable response makes it really hard for me at least to make any sense of what dose to use.

My hesitation with L & L though is that you might not get any better response. In the absense of a clear "PZI is not the right insulin for this cat" I'm thinking you may still get the same kind of variability and wonky #s on another insulin. But hey, maybe you'll get a better response, and what's the harm in trying? (Although agreed, if ketones are a concern you have to be careful about how you make the switch, hopefully peeps on the L boards would be able to coach you through how to transition a ketone-prone kitty. I think you can take a short-track approach in some cases that either moves up the doses faster or starts at a higher dose, but I don't know the details - I'm thinking Ele may have done that? Not 100% sure...)

I got really good feedback on Bix by posting on the Lev board when I was thinking of switching, and thankfully a couple former PZI users were able to pinpoint what I was doing wrong and tell me how to use PZI better to make it work, and once I followed their advice Bix started doing a lot better. So I'd say it's worth some "send out feelers" posts on the other boards to get some opinions, especially since both boards do have a number of former PZI-ers there. They might be able to say they've seen these patterns before & cats like this tend to do better on one of the Ls, or maybe the reverse, that here's what you need to do PZI-wise to make it work better.

Whatever you choose, you have our support!!! If you do switch though, I hope you'll keep visiting here... we need all the PZI-ers we can get, former & current, to help with support & advice!!!! :-D
 
Nancy and Cody said:
Is there any chance your meter could be any part of the problem with erratic numbers that don't make sense? Before you switch insulin, could you try a different meter for a week?
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We use the relion confirm - are you talking about purchasing another one of the same kind or a completely different brand?
 
Kelly,

As a PZI interloper ;-) and a former Lantus user, I come here with a different perspective.

I know and understand lantus much better than prozinc. I'm learning about it because of my houseguest. I haven't looked at your SS, so I'll just share my observations.

Prozinc (at least in Blue) has a very steep drop early on. He can drop 100-200 points in 3 hours. And while he does taper off, by +5, he then bounces back up for PS time. I don't like this and for this reason, I would like to see Blue on one of the L's.

The L's don't have as steep a drop and have flatter curves, I also think it lasts the full 12 hours and I don't see that happening with prozinc.

If you can get free lantus, go for it. What the people in Lantus Forum have found is that for some reason Levimer seems to work better for higher dose cats than Lantus. There is also a proven protocol with the L's and there isn't one with prozinc, as it's too new.

Prozinc has some good qualities - especially if one cannot be on an exact 12/12 schedule and if one can't test as often as needed.

Do read the stickies on Lantus, understand the differences and nuances, also read the condos and look at others spreadsheets, so you can see how it does work.
 
When I look at Oscar's chart, it looks to me that the dose he liked best was back in April, between 2 and 3 units. Were you using U100 syringes back then? It looks like the dose bounced around a bit, and maybe you missed the perfect amount.

Even with those few low bg readings, he never seems to rebound or zoom like crazy. That's a nice sort of sugar cat to have!

I would wager that you will get to his right dose soon with the slow and steady increase you are doing. You are so patient!

But you have another cat, on a different insulin and have a supply of Lantus waiting for you. What great choices you have. Being frugal myself, I would use up all the Prozinc and then evaluate. Or at least keep at the .2u dose increase for a few more increments. It really looks to me like you were close in April and reduced too much/too soon.

I can see how it could be confusing to have two cats using two different insulins and for sanity would want to use just one. I don't think you can go wrong either way.
 
Sarah,
No you are certainty not one of the "proselytizers." ;-) But I sincerely hope you and perhaps others understand that my def of the proselytizers are the ones who know nothing of the cat [or bean] and immediately say "L&L are the bestest ever!!!" [especially when it happens to the newbies in Health]. We have a bean here who is ASKING about Lantus and who has actually tried PZI for a while. And you know, I have actually encouraged other PZI users that were not getting great result to look into other [L&L insulins] - just protecting my record here ;-) .

Anyway, Kelly,
When I actually got back to SoCal I had it in my mind to ship you my 1/2 bottle leftover PZ. But I'm not sure when that is going to happen - maybe a few weeks??? Also, I'm all for looking into other insulins if you are not getting results. I have not looked at Sarah's and Ele's SS in quite a while but their numbers were a bit all over the place the last time I looked [months ago now probably]. So if they are getting better numbers now that's awesome [about time Buzz and Blackie got a break]. Other things to could account for Blackie's improvement - Blackie has a few things going on and Blackie had done well on PZI before too. So maybe's Blackie's other issues have improved which helps the numbers improve too. As for Blue, those steep drops tend to go away once the cat is dialed in which just takes time. How much time did Balckie take to start seeing improvements with Lantus? And I'm saying all of this without even looking at any SS tonight [been at the puters too long already tonight].

Anyway, I would not hesitate to look into and perhaps switch to other insuilns. If there was a choice in the matter then Levimir would be what I would focus on. But as I've said before, just a change in scenery can help sometimes. In the end the only thing that matters [no matter the reason - insulin related or not] is the improvement for the Kitty. Even if it is for psychosomatic reasons it does not matter if the kitty does "better."
 
Hillary & Maui said:
Kelly,

As a PZI interloper ;-) and a former Lantus user, I come here with a different perspective.
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Different perspectives are good! More information is better, at least I consider it to be when making a decision. :smile:

Hillary & Maui said:
Prozinc (at least in Blue) has a very steep drop early on. He can drop 100-200 points in 3 hours. And while he does taper off, by +5, he then bounces back up for PS time. I don't like this and for this reason, I would like to see Blue on one of the L's.
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Just to play devil's advocate here, and with the disclaimer/realization that ECID and Buzz could well be one of a kind and not fit to use as an example of the Ls, let me say this: Buzz can, and does on a regular basis, drop 100-200 points by +3. She also frequently (90% of the time, maybe?) is back up in yellows for PS time. I tend to feel that Buzz is a freak in this regard and not representative of what Lantus does in general. However, it has been extremely frustrating for me to come into Lantus expecting gentler drops and flatter curves and to not see that happening (in general).

That being said, I am still happy with Lantus and am not considering switching. I just wanted to offer a different perspective as well, at least on this particular issue. :smile:
 
Gator & H (GA) said:
Sarah,
No you are certainty not one of the "proselytizers." ;-) But I sincerely hope you and perhaps others understand that my def of the proselytizers are the ones who know nothing of the cat [or bean] and immediately say "L&L are the bestest ever!!!" [especially when it happens to the newbies in Health]. We have a bean here who is ASKING about Lantus and who has actually tried PZI for a while. And you know, I have actually encouraged other PZI users that were not getting great result to look into other [L&L insulins] - just protecting my record here ;-) .
Click to expand...

I truly do understand the circumstances under which you use the term "proselytizer', and I agree with you. We've discussed this before, so I won't hijack this thread further other than to say that I was mostly just trying to give you a hard time. ;-) And for your record's sake, I have indeed heard you suggest to others that a switch is something to consider. :lol:

Gator & H said:
Anyway, Kelly,
I have not looked at Sarah's and Ele's SS in quite a while but their numbers were a bit all over the place the last time I looked [months ago now probably]. So if they are getting better numbers now that's awesome [about time Buzz and Blackie got a break].
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I addressed this in my post above to Hillary.

Gator & H said:
Anyway, I would not hesitate to look into and perhaps switch to other insuilns. If there was a choice in the matter then Levimir would be what I would focus on. But as I've said before, just a change in scenery can help sometimes. In the end the only thing that matters [no matter the reason - insulin related or not] is the improvement for the Kitty. Even if it is for psychosomatic reasons it does not matter if the kitty does "better."
Click to expand...

Kelly, you might PM Terri and see what she has to say about Lantus vs. Levemir. Off the top of my head, the only other person I can think of who uses Lev is Pat+Raja+Shadow (although I know there are many more). I believe she might have had some talking to do to convince her vet about Lev, and I know she would be happy to talk to you about its virtues or why she chose that over Lantus.
 
Hi Kelly,

I was studying an acromom's Lantus ss and thought you might find it interesting. http://spreadsheets.google.com/pub?key= ... utput=html. It is kind of erratic and has both low and high numbers, and she has struggled to find a good dose.

Cody's lev ss is pretty steady and predictable but not perfect either. The lev onset is later than prozinc at about +3+4, and until the shed is filled for him, it is not lasting past about +1 of the following cycle. Therefore our +2/+3 numbers can be pretty high before the next dose kicks in.

Remember as you look at these, acromoms aren't trying to achieve numbers under 100, and have no goal of going OTJ. I just thought they were interesting examples of 2 cats on the L's
 
OK, Ya know I was going over my earlier post and I'd like to clarify a couple things. When I said that Buzz and Blackie had been all over the place in the beginning with their switch I meant to emphasize that even with highly experience diabetic cat care givers, the switch could take a while to even out if they ever do [do not expect magic bullets]. Which kind of goes to my other point I raised about patience. 4 months with ProZinc is plenty patience though.

From what I hear [and as you are probably aware], Lantus is the least flexible time wise so figure that into your decision.

It looks like you guys have tried just about everything - even TID. Though I'm not sure you really had enough time with TID to get the results that some others here have been able to exploit so incredibly. For me, I don't think I could handle the TID schedule and this is why I'm not a fan of it personally. I'm pretty sure I would go insane and that would not be a benefit to Kitty. If it were me I'd probably try another insulin before TID but that is just me [and perhaps the hypothetical owner being selfish - I don't know].

Looks like you were doing a little "scale" type dosing then on 05/09/10 you were ramping back up from some low numbers and then maybe the "specialist" got involved in dosing? Then it went to TID and then back to consistent dosing. It looks about 10 days were given for each method after the low numbers perhaps.

So you like me as it seems believe in the shotgun approach. The shotgun approach is what I would reflexively drop back to too. I bet if I were in your shoes part of my "cat shot" I would use would be an insulin switch too. The L's are much more "protocol" oriented and that may pay off and give you the comfort you need to stick with one approach. And from what I gather from Ele's posts the protocols are nice in that they do not require as much of one's "mind space" which is a very precious thing. In your shoes dealing with multiple diabetic cats...wow - you are a very special person. :smile:

Did I clarify or muddy the waters? ;-)
 
Thank you Justin :mrgreen: that actually did clarify things for me!

ETA: explanation for our short stint on TID - we stopped TID when we traveled to the DH's parent's house for memorial day weekend and Oscar started giving us good numbers there so I kept with the BID thinking things might turn around. Plus we were constantly battling inverse curves with TID, and you already mentioned the schedule :-D
 
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