6/8 Baco AMPS 113, NS - PMPS 85, NS - questions from Dutch forum

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Bobbie And Bubba said:
Hope it will be the kind of affair that a Pirate can attend. ;)
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If you are referring to the fact if/or Bubba can join the party, OFCOURSE with his little eye pad!:cool:
But I don’t think Baco will wear anything that looks like Johnny Depp (pirates of the Caribbean) I really don’t know what she should wear, because she IS a little diva:woot:, but she’s not a girly girl…
So if you have any suggestions, please let me know!:p
 
Maybe she can wear a little piggy costume, because let’s face it, she IS a little piggy (still, but not in the near future) :rolleyes:
 
images


This would be a cute piggy costume :woot:
 
awwww no, she wouldn't like it, when she was a little kitty she had to wear a collar (just like Minnie and Sam) but she couldn’t adjust to it. She would lay down and wouldn’t move or stand up until I got it of her neck. So I think she wouldn’t like it! Well my BF once, when we were cleaning my house and looking threw a bunch of old boxes found a old baby vest that belonged to me when I was a baby… So he put it on Minnie, see the picture! Hahahahaha he reaaaaaaaaaaallllllllllllllyyyyyyyyyyyyyyy didn’t like it, you can see it in his eyes, put it fit him soooooo nice!.:p
 
Yeah, well Minnie has to wear it at Baco's OTJ party if he wants to join it. Otherwise he will be excluded from the party! :rolleyes: hihihihi
 
YIPPEE-YI-O-KI-YAY!!!!!! Ride 'em, Baco!!!!!!:D Way to GET DOWN, sweet little piggy!:p
P.S. I cannot stop laughing at all the images that are being posted on this thread - hilarious!:joyful: (Geez, Minnie could be Bat's TWIN - that's exactly how she'd look/react if I tried putting a piece of clothing on her!:rolleyes: And I'd also need a blood transfusion ...:eek:)
 
Hahahahahahahaha! I will try on some other things this week, maybe she isn't a fan of a costume ;)
 
Well i've got some questions, coming from the Dutch Forum.

We’ve had a ‘mild discussion’:p about Prozinc not being the same as Lantus and Caninsulin.
They are not agreeing with that. They think Lantus/Caninsulin works the same as Prozinc.
Here are the conversations, this was about a cat that is been off Prozinc but is giving numbers up to 140, and the Lantus and Caninsulin advisors are telling this owner to shoot, but this cat has been off insulin for a couple of months now, by just 1 shot of Prozinc (went into hypo and never needed insulin anymore) (ps 140 has been the max for this kitty and is normally around 60 – 100)

"140 = 7.8 That would both for Caninsulin as Lantus be high enough to give 1 or 2 drops.”

So I told the advisor this:
7,8mmol or well 140 is too low to shoot according to the Americans (on Prozinc). 150 is the limit for them (8,3mmol)
I would not shoot, but that's my feeling that speaks, fortunately I did not do that in any case, because as you can see, it was not necessary to Baco. I at least had saved her a hypo (what might have could happen).
Baco also has the first days show those values even though she’s not at the insulin.
My vet has indicated that the normal values for a healthy cat is max 10 mmol (180), of course, it is very high but that is the kidney limit and there is nothing to worry about.
You should do what you feel comfortable with, (givea drop or drop not), but I insist, Prozinc does not work like Lantus and Caninsulin.

Then the advisor said:
"ProZinc works according to the manufacturer's equivalent to Lantus.
I propose , therefore, to take preference to conduct the same.
Furthermore, a cat will never go hypo 1 drop of insulin . You will increase precisely to support the chance of remission by the pancreas."

So I told the advisor:
"But, this is what we’ve previously discussions, and you would ask that question to the US forum to see how people there reacted.
I do think, as you point out, we should stick to ‘a manual’, however, there isn’t one so far as nobody on this forum has experience what a drop off prozinc does with values between 6 (108) and 8 mmol (144).
So how can we just 'try'? I really think it is wise if you or as soon the other advisor comes back from vacation start this discussion with the Americans with experience of 10 years with it before it is said that a drop of prozinc ‘can be advised’
According to them it is not wise to do so, but with Lantus and Caninsulin it can but not Prozinc.
That a cat does not get a hypo by one drop, I also disagree with you on that because I saw this example, it did pass by several times on the US forum.
I definitely think you increase the risk, but if the body itself does what it does (like Baco and Bitsie) why would you still give extra insulin to the body?
In "our" case everything works, and that it may not be values that are ‘by the book’, well so what? Baco and Bitsie, should they be around 36 – 54 because according to the 'book' they should be on those kind of numbers?
I think there is nothing wrong with these values of 6 or 7 (108 – 126), this may just be because of there diets or lack of exercise to burn the food.Also, certain situations have influence on the BG."


Then after that, there came some other question:


1)Prozinc is not a depot? According to the manufacturer we will also find a subcutaneous delivery underneath the skin. So that means it IS a depot insulin.
2)Caninsulin drops even more sharply than ProZinc . And we also give a drop.
3)You can absolutely not go hypo of 1 drop of insulin . The pancreas then does it’s work too excited
And 'if' a cat get a hypo number on that one drop, that's not true hypoglycemia because the pancreas does this itself , so it is a normal value.

Can someone maybe clarify this discussion for me?
Everything I’ve learned here on the US forum is what I told them.
Like it’s an in and out insulin, and that you may not want to give a drop because of a hypo that might occur and don’t shoot below 150…
but they still want to keep the same ‘rules’ as for Prozinc and I don’t think it works like this from what I’ve learned from you guys.

@Rachel @Sue and Oliver (GA) @Robin&BB @Bobbie And Bubba

Thanks in advance.
I just want to know this because I don't want them to give bad advise to the other 4 kitties on Prozinc on the Dutch forum..
 
Ruby&Baco said:
1)Prozinc is not a depot? According to the manufacturer we will also find a subcutaneous delivery underneath the skin. So that means it IS a depot insulin.
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I am by no means an expert on Prozinc but I did recall some discussions that the Prozinc in the UK and most likely the Netherlands is slightly different than the Prozinc in the US. This is part of a discussion from another thread:

"Hi Jennie and welcome. I am assuming your ProZinc is the same version as the one in the UK. It is a little different that the ProZinc in the US. It seems to act alittle more like one of our depot insulins, as it can have a longer cycle. Our ProZinc can last anywhere from 8-12 hours, depending on the cat. I'll flag @@Elizabeth and Bertie. Her Bertie has been on the UK version and she is very experienced."

http://www.felinediabetes.com/FDMB/threads/questions-on-prozinc.156524/

Also from the European report:

"Absorption: Protamine zinc recombinant human insulin is an insulin whose absorption and onset of action is delayed by the addition of protamine and zinc leading to crystal formation. After subcutaneous injection, proteolytic tissue enzymes degrade protamine to permit the absorption of insulin. In addition, interstitial fluid will dilute and break down the formed zinc insulin hexamer complexes and result in a delayed absorption from the subcutaneous depot.Absorption: Protamine zinc recombinant human insulin is an insulin whose absorption and onset of action is delayed by the addition of protamine and zinc leading to crystal formation. After subcutaneous injection, proteolytic tissue enzymes degrade protamine to permit the absorption of insulin. In addition, interstitial fluid will dilute and break down the formed zinc insulin hexamer complexes and result in a delayed absorption from the subcutaneous depot."


http://www.ema.europa.eu/docs/en_GB...Information/veterinary/002634/WC500147211.pdf

So the statement your forum made about Prozinc being a type of depot insulin may well be valid for the European/UK Prozinc.

As far as the rest of the questions I would suggest maybe starting a new thread in the Health section to get more attention on this.
 
Thanks @Tuxedo Mom :bighug:

I know that thread, Jennie is one of the advisors (NOT one of then who asked those questions on the Dutch Forum that I just posted) She is on holiday now so she isn't been around the last 3 to 4 weeks.
She will be around again this week I think..

Hope to hear from the rest soon. Otherwise I will ask it on the health section of the forum.

Will go to sleep now so i will see your reactions tomorrow morning!
 
Hmmm...so let's see. It looks like there were several questions, and I'll try to get them all!

ProZinc and Lantus are different. The info Mary Ann gave is about BCP PZI. That's an insulin that is often used in the UK...it does work more like Lantus. However, I believe you all are using actual ProZinc, not PZI. I think Eliz specified that ProZinc had recently become available there. ProZinc does NOT have a depot. Absolutely not. Nope. So I suppose you'd want to ensure the insulin is ProZinc and not PZI, and then can assure the owner that ProZinc isn't a depot insulin. I'm confused by the subcutaneous delivery under the skin comment. That just means that the shot is given subcutaneous (under the skin). It doesn't mean there's a depot. The deposit is a build up on insulin that is released over time. But Lantus and ProZinc are both give under the skin...just ProZinc doesn't have any build up or time release.

Caninsulin does drop more sharply than ProZinc. And I would never suggest shooting Caninsulin at that number either.

Cats can absolutely have a hypo on 1 drop! If the pancreas are working and you add insulin on top of that, it can cause a bad situation. That's why we don't ever advise shooting that low. From what I understand of Lantus, they can give a drop at lower numbers because of the depot. They want it to stay full so that the insulin will continue to work. ProZinc doesn't have a depot, so skipping won't affect the cat like it would with Lantus. Does that make sense? As for the claim that it wouldn't be a "true" hypo, I promise it would be! It's not a hypo if they have NO insulin on board. But putting insulin into a cat that is producing the right amount of insulin ALREADY is super unsafe. It can drop them way too low and they can crash. Ruby, I don't want to be rude, but gosh, I hope they aren't shooting 1 drop into a cat in normal numbers and then assuming the cat will be fine! That hypo could kill.

I'm not saying we aren't conservative at times. Our motto here is "first, do no harm". I might tell you to not shoot below 200 when I'd shoot at 180. BUT...140 is too low. I would never ever advise shooting at that number and wouldn't have shot my cat at that number.

I think @Robin&BB will be able to add some good stuff to this thread since she knows Lantus much better than me and can compare the two insulins better. However, please let me know if I missed any questions or can clarify anything!
 
Rachel said:
ProZinc and Lantus are different. The info Mary Ann gave is about BCP PZI.
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If you check with @Elizabeth and Bertie she can explain the difference in Prozinc in the UK as compared to Prozinc in the US.

"'Prozinc' (as used in the US) is now available in the UK and, it seems, elsewhere in Europe! Good news, eh? This just happened last week (although it has been licensed for use in Europe for a couple of years now.)"

http://www.felinediabetes.com/FDMB/threads/questions-on-prozinc.156524/

So up until recently there has been a difference in the UK prozinc...possibly also in the Netherlands...and the US version.
 
Rachel said:
I'm not saying we aren't conservative at times. Our motto here is "first, do no harm".
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@Rachel wrote an excellent response to those questions in her post above.
Rachel said:
Cats can absolutely have a hypo on 1 drop!
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From personal experience, I can tell you that a cat can, indeed, hit hypoglycemia-zone on a single drop of insulin. My cat has done this many times - on both Lantus and ProZinc, at doses as tiny as 0.10U (a single droplet of insulin) down to 0.05U (which is about a half-droplet of insulin).

As for whether or not there can be a "true" hypo on such a tiny amount of insulin (the premise, according to the Dutch forum advisor, being that it is the pancreas itself causing that low # and not the "drop" of insulin) ... I'm sorry, but I'm compelled to say this: Hypoglycemia is ... hypoglycemia. It matters little whether you think the pancreas itself produced a little more insulin after you shot some into the cat; if the cat's numbers are already in a pretty normal range, why shoot any insulin into the cat at all, even a drop? When a cat has dropped into the 30s or 40s (mg/dL) as measured on a human glucometer after a single drop of ProZinc has been administered, you're going to tell me that my cat is not experiencing "true" hypoglycemia? And waiting for "signs" of a hypo can also be a mistake, as there are some cats who descend into hypoglycemia with NO visible symptoms (aka "signs") of hypoglycemia. This is the whole purpose of testing our cats' blood glucose: We do it to ensure our cats' safety. So, if after administering a "drop" of ProZinc to a cat, that cat drops into hypo-zone numbers as measured on the glucose meter, I'm not supposed to see that as a hypoglycemic number? That sort of reasoning is (pardon me) simply absurd!

The ProZinc that has just been approved for use in the Netherlands is the same formulation as the U.S. version of ProZinc, if I'm not mistaken (this, apparently, is why its release was newsworthy there). So to assume you can dose this ProZinc in exactly the same way you might dose Lantus (a true depot insulin) using the TR protocol for Lantus would be a serious mistake, in my opinion.

The members and advisors on the ProZinc forum here at FDMB have amassed years' worth of data on the safe dosing of ProZinc for diabetic cats - many, many spreadsheets of good, solid data. We have seen many cats go into full remission using our guidelines. If I were living in the Netherlands and dosing my cat with the ProZinc that has just recently been made available there, I would be much more inclined to pay heed to the ProZinc guidelines developed by the membership of FDMB, even if perceived by some of my associates on the Dutch forum to be "too conservative."

Safety first. Always, safety first.
 
I am not an expert in ProZinc or PZI but FWIW, I have a cat with a high dose condition known as IAA. I researched the various insulins available for cats extensively and there is much confusion between ProZinc and PZI. Both contain protamine zinc but they ARE NOT the same otherwise. The beef based PZI produced in the UK is closest to the insulin produced naturally by our felines. It is my understanding that the Uk PZI does have a "depot" or a depot like effect while ProZinc does not. The ProZinc is a human recombinant insulin. Unfortunately, this confusion seems to be wide spread even within the veterinary community. I echo Robin's comment that any assumption that a drop of ProZinc could NOT send a cat into a hypoglycemic state is simply absurd.
 
Tuxedo Mom said:
I am by no means an expert on Prozinc but I did recall some discussions that the Prozinc in the UK and most likely the Netherlands is slightly different than the Prozinc in the US. This is part of a discussion from another thread:

"Hi Jennie and welcome. I am assuming your ProZinc is the same version as the one in the UK. It is a little different that the ProZinc in the US. It seems to act alittle more like one of our depot insulins, as it can have a longer cycle. Our ProZinc can last anywhere from 8-12 hours, depending on the cat. I'll flag @@Elizabeth and Bertie. Her Bertie has been on the UK version and she is very experienced."
Click to expand...
In the UK there is quite a bit of confusion about Prozinc and PZI, because they are often referred to as the same thing, which of course, they aren't.... :rolleyes:
The PZI that has been prescribed in the UK for that past few years is Hypurin bovine PZI, an insulin with a very long duration (sometimes longer than 12 hours).
'Prozinc' is the same the world over, wherever it is prescribed, which now includes Europe. :)

Eliz
 
Thanks everyone for reacting to these questions. I've copied them to the Dutch forum to let them know what the experiences are here on the US forum. I hope they can figure it out and will rely (for now) on the US forum to help the kitties on Prozinc on the Dutch forum. If I get more questions about your answers I will post it here again.
But for now, thank you so much everyone for taking the time to explain everything so well! :kiss::bighug:
 
Please do let us know if they have more questions! Our goal here is entirely to help diabetic kitties and their people. We want to help you and them the same way we were helped when we first arrived here!
 
Thanks Rachel, I will do!:bighug:
Well I got a response from the Caninsulin advisor on everything I’ve copied from this thread (your comments)

See below.

Caninsulin Advisor:
"I am still not really coming further with this info Ruby.
There is only one ProZinc insulin , there are several PZI 's but we are not talking about that.
Regarding the drop in Lantus to maintain the deposit , in my opinion that’s not true , but that should the Lantus advisor back up , that drop is purely intended to support the pancreas and the same applies to Caninsulin .
We have never experienced here that a cat goes hypo on that one drop though.
There will always be cats that don’t need one drop of insulin, we also come across that here."


Me:
"Regarding the ProZinc and PZI story, this came up because ProZinc is often confused with PZI (this is however a depot insulin and ProZinc isn’t)
I do not understand why you do not come any further with this information? Is this even the intention then?
You and the Lantus advisor have an opinion, and advices, and these are the views from the US forum in response to your questions / comments.

Whatever is said from the US forum is only their opinion and their experiences with Lantus / Caninsulin / ProZinc.
The low numbers that are used to give a shot here are not used at the US forum. (Well with Lantus, not Caninsulin and ProZinc)
You wanted to know the views and opinions regarding your questions, and these are.
Whether you share this oppinions or not, that is obviously up to you.
You have years of experience and it’s , understandably, that it hard to be convinced by opinions of strangers.
The only thing I keep saying is, let's use the protocol from the US for ProZinc here so there are no confusions in any case about the use and the 'rules'.
In this way, Baco (almost) is OTJ, isn’t that not valuable enough?
I have followed there protocol and this has helped, at least, Baco.
The protocol of the US about ProZinc can always be changed a little when there are more kittens put on ProZinc in the Netherlands and when there is more experience in the Netherlands, but why would you now use the Lantus and Caninsulin protocol (which there is no evidence in the Netherlands that this is workable for ProZinc) for another type of insulin? And this protocol is within reach (US forum) and which helped Baco anyway?

And as for that one drop .. That is your opinion. The Americans have had this happen so it does have shown several times.
So that you haven’t experienced it on the Dutch forum yet, does not mean it does not exist I find."

I don't find this even a question anymore, I think this is just 'being stubborn' and only believing that one method for all insulins should be the way to go…
 
Late to the party, but here is my input:

With a new diabetic who is just on the cusp of needing insulin, I would not inject ProZinc below 10 mmol/L (180 mg/dL). There is a (however slight) risk of hypo. If the cat goes low, the liver should kick in and release some sugar. But if that happens, kitty will not feel very good, AND it may send their BG sky high for a day... which may lead to giving too high a dose the next day.

On the other hand, the cat is coming to no harm with blood sugar at that level. So why inject? I think it is better to look for a low carb food and feeding schedule that leads to lower numbers. The BG should come down over time as the cat loses weight and the pancreas has a chance to recover.

I was confused by these questions because in my experience Lantus and Caninsulin are very different. So how different must ProZinc be to be "different" when Lantus and Caninsulin are lumped together? :D

I have had cats on all three. In my experience:
Lantus is stronger for the first 15ish hours and then has a slow taper effect over the next few days. (Because it is a depot insulin.)
ProZinc takes an hour or so to kick in, then lasts 10-12 hours.
Caninsulin takes up to 2 hours to kick in and then only lasts 8-10 hours.

Caninsulin caused a very steep curve for my cat throughout the day (like high of 30 mmol/L, low of 10 mmol/L) whereas Lantus caused consistent readings within ~2 mmol/L (40 mg/dL) throughout the day. ProZinc seems to be in the middle in terms of gentleness and duration.

Hope this is helpful!

Lor
 
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