A Few Questions for The ProZinc users please.....

[Shoeskitty-GA]

Hi, I will be switching my soon to be 17 year old cat, Shoes, to ProZinc from Lantus on 12/27/16. We have been on Lantus for 10 months on the day of the switch and for him, he has not responded predictably like many on Lantus do. Some background - he was diagnosed Sept. 9, 2015 and put on Novolin N. I was not home testing at the time as I was told it was not necessary, like many others. He hypoed and actually should be dead now on Jan. 24, 2016. Was in a coma when I found him and his body temp. would not register and down to 26 on AT2 when I got him to the ER. But he survived, thankfully and I started a few home tests. We stayed on Novolin for another month until he began to hypo again the morning of 2/24/16 just before I was to leave for work. He was 33 on my AT2 so I was able to pull him back up to over 50 and off the the vet's office we went. At this point vet agreed to try Lantus so he was left at vet's for a few days in order for vet to determine the dose to start him on Lantus. He (vet) started him on 2 units which was too much. I brought him home on 2/26 and we started on 1 unit then. We joined FDMB at this point and I chose the SLGS protocol. He would have these steep drops then high bounces and has generally been doing this on varying doses but never more than 0.50 units after the 1 unit proved too high as well. I take part of the responsibility for his being higher than he should because I work full time M-F and have been afraid to dose him agressively because of his hypo's and his steep drops and all around unpredictable response to a dose, depot, etc. I am a testaholic and helicopter mom too. He has the twitches in the front feet that others on here have mentioned that their kitties had on Lantus and he goes off by himself after getting the shots so that's a strange response too. Because I work, I get up at 4:30 am every day to be sure that I have time to get a +2 and more before leaving for work at 7:15 daily. I rush home to check on him around +4 if his +2 looks like it will be an active cycle, then home again at lunch at +6.25 then not home until +11.75 or right at PS time. Enough background for now, LOL!

Questions:
1. How critical is eating a lot of food at shot time? Shoes doesn't like to eat immediately and most of the time will only eat a bite or two at shot time, coming back later to eat more. The Novolin N would drop him like a rock which I was unaware of until the hypo. Shoes is a grazer and will eat throughout the day.

2. For most of you, how long does the ProZinc last in the system? And when is the likely nadir point? I have read the stickies many times but would like to hear from users too.

3. Would love to know any bad experiences users have had with ProZinc too and any quirks you have noticed with your kitties.

Thanks, and sorry for writing a book here.

PS. Spreadsheet is not currently available for all to view for personal reasons.

 

[Kris & Teasel]

First thing, Sandi, I think you should take a look at Teasel's SS because he is an Olympic level bouncer. You can see that the ProZinc is not a magic solution for him. Other accomplished bouncers on here are Hermione (ShipsCat), Chuck (StephG) and Phoebe (EricH). Also no magic for them on ProZinc. BUT: this insulin is far more "tinkerable" than Lantus and that's what we do to keep our guys safe/in not bad numbers/hoping for better as we keep up with the FD sugar dance.

 

[Shoeskitty-GA]

Will definitely check each of these SS out. One thing that I should have included in my post is that I am not in the market for remission, just numbers that are not too low. I would be perfectly happy with the 200's the majority of the time.

 

[Kris & Teasel]

Other:

How critical is eating a lot of food at shot time?

Much less so than Novolin but I'm no expert. Teasel is a champion eater, thank heavens!

Shoes is a grazer and will eat throughout the day.

Grazing is not a problem.

how long does the ProZinc last in the system

It lasts a good 12 hours in Teasel, sometimes a bit longer as you can see by some low-ish PSs on his SS.

when is the likely nadir point

The likely nadir is around +5 to +7 for Teasel but he can drift a little later sometimes. I've never (rarely) had it early with him.

bad experiences users have had with ProZinc

Not really bad experiences: it's expensive, only comes in a 10 mL vial and gets used up faster if your doses are medium in size. Teasel hasn't had any injection site reactions, twitching, reactions to the solution itself (the sting of lantus bothered him).

 

[Kris & Teasel]

Will definitely check each of these SS out. One thing that I should have included in my post is that I am not in the market for remission, just numbers that are not too low. I would be perfectly happy with the 200's the majority of the time.

Hear! Hear! I'm with you on that.

 

[Sue and Oliver (GA)]

Questions:
1. How critical is eating a lot of food at shot time? Shoes doesn't like to eat immediately and most of the time will only eat a bite or two at shot time, coming back later to eat more. The Novolin N would drop him like a rock which I was unaware of until the hypo. Shoes is a grazer and will eat throughout the day.

2. For most of you, how long does the ProZinc last in the system? And when is the likely nadir point? I have read the stickies many times but would like to hear from users too.

HI and Welcome!
You'll find this forum small and friendly. We have fewer members than Lantus. No rules about posting. Some people post daily with their numbers. Some post when they want advice. Either is fine. If you ever have an emergency, post here and on Health so you'll get the most eyes. For dose advice/input, here is best. Check out some of the other posts and spreadsheets to see the varied ways people dose ProZinc.

I think I'd plan to test, make sure he has something in his tummy and then shoot - at least as first, until you know what his patterns are. Some cats drop a little early and are helped by a little snack around +2; some rise after the meal with the shot and are higher for a couple hours; some just gradually drop toward nadir. Nadir is often between +5-7 but that varies with each cat (and sometimes with each cycle!)

We are big on "Every cat is Different". More than with any other insulin, there are no rules. Your job is to figure out how the insulin works for him and use the many dosing options to best meet his patterns. So, at first, I would be conservative with the dose, plan to monitor and collect data. You will find the more you dose, the more you'll become confident about dosing. We're glad to help you with ideas.

Throw away the Lantus rule book. We don't shoot low to stay low - ProZinc's cycles can be too short and unpredictable to do that. Most people use 200 as a no shoot number at first. Once you have data and can predict what he might do with a dose, you can lower that number, but usually it is above 150. We like to see a "smile curve" with the pre shots in a similar range with a slow steady drop at nadir. Often that is the pattern, but some kitties just refuse to read the manual. We generally consider a cat regulated if they are in the mid 200s at preshot and double digits or low 100s at nadir, but not below 50 (human meter) or 68(pet meter). Once in a range around that, you start fine tuning the dose. Some cats do well with a constant dose for 3-5 cycles before switching (as long as they are not too low). Some cats are fine with a sliding scale - lowering the dose for s lower preshot, raising it for a higher one. Again, a few days should give you an idea about Shoe's preference.

 

[Shoeskitty-GA]

Thanks for the kind welcome! I think my biggest problem and fear is the eating before shooting. This is really going to be a serious issue because most days, he just will take a few bites. Do you think an appetite stimulant would be a good idea if I could convince vet to prescribe? I will have to leave Shoes at the vets all day for the first few days after starting Pro Zinc for him to do the curves to find the starting dose. I will bring him home at night. I am perfectly capable of doing the 2 hour curves myself but I don't think I can get the vet to change his mind on this. I can tinker with the dose myself when I get him home, I know, but my biggest fear is the eating.

 

[Sue and Oliver (GA)]

A few bites should be enough to have a little in his tummy. If he will continue to graze during the cycle, that is actually good.

I know you know that the vet won't be able to find a good starting dose. We can probably find some vet studies that show that the vast majority of cats are stressed at the vet, and since stress raises big levels, doses determined by a vet curb are often too high once the cat gets home. Could you argue that you'll carefully do the curve and then share the results? Or could you argue that he won't eat well at the vets and that could be dangerous, especially if there is no one around 24 hours? It's hard for a vet to argue with a bean who is worried about her pet's safety. And I know you know that you are the customer and he is the provider and should respect your wishes. Easier said than done, but...

If there is no way to avoid this, I would plan to give less than the curve at the vets suggests, at least in the beginning. You can always raise the dose but, of course, can't get it out of the cat if it is too much.

 

[Shoeskitty-GA]

I am planning to do my best to convince vet that I can do the curves, but I am pretty sure I won't win that argument. I think that he would not feel comfortable in prescribing the Pro Zinc without his data from the lab equipment for liability purposes. I can understand that, but don't like it. So when I get him home, I will use a lower dose at first. He's been my vet for 25 years and I do think he's a good vet. He knows how I am about my pets and that I would do pretty much anything for them and am willing to learn whatever I need to do to care for them. I know he trusts me to take care of Shoes but I think he won't bend on the initial dosing for liability purposes. Shoes doesn't normally get really stressed at the vets, but who knows? That can change with the next visit.

Shoes has been off dry food since last Sept. but would that be allowable in the event that he won't eat?

 

[Kris & Teasel]

I am planning to do my best to convince vet that I can do the curves, but I am pretty sure I won't win that argument. I think that he would not feel comfortable in prescribing the Pro Zinc without his data from the lab equipment for liability purposes. I can understand that, but don't like it. So when I get him home, I will use a lower dose at first. He's been my vet for 25 years and I do think he's a good vet. He knows how I am about my pets and that I would do pretty much anything for them and am willing to learn whatever I need to do to care for them. I know he trusts me to take care of Shoes but I think he won't bend on the initial dosing for liability purposes. Shoes doesn't normally get really stressed at the vets, but who knows? That can change with the next visit.

Shoes has been off dry food since last Sept. but would that be allowable in the event that he won't eat?

Will you be off for a few days after Shoes comes home from the insulin changeover? If so, you can experiment a bit to see how Shoes' eating habits mesh with the ProZinc. If you plan to lower the dose from what your vet recommends, you should be safer doing this. In a pinch, you could use a bit of kibble to get him started if you find he needs more food/carbs before injecting. The experiment could give you valuable data.

 

[Kris & Teasel]

As Sue said above, the approach here is very much ECID. You'll be on perhaps a bigger learning curve for dosing than with Lantus because there isn't any set in stone protocol. You'll have to learn how to read Shoes' responses and decide on a dose. It can be anxiety-causing at first because you're in charge, not a set of rules. There are general guidelines though, including "Advanced Techniques" once you're up to speed.

BTW - my guy is giving me a run for my money today. My guess is he's become less glucose toxic than he was and my doses have to come down. That's what I see today - tomorrow could be in another planetary system far, far away ...

 

[Shoeskitty-GA]

Will you be off for a few days after Shoes comes home from the insulin changeover? If so, you can experiment a bit to see how Shoes' eating habits mesh with the ProZinc. If you plan to lower the dose from what your vet recommends, you should be safer doing this. In a pinch, you could use a bit of kibble to get him started if you find he needs more food/carbs before injecting. The experiment could give you valuable data.

Yes, I will be off until Jan. 3 so that will allow me to experiment.

As Sue said above, the approach here is very much ECID. You'll be on perhaps a bigger learning curve for dosing than with Lantus because there isn't any set in stone protocol. You'll have to learn how to read Shoes' responses and decide on a dose. It can be anxiety-causing at first because you're in charge, not a set of rules. There are general guidelines though, including "Advanced Techniques" once you're up to speed.

BTW - my guy is giving me a run for my money today. My guess is he's become less glucose toxic than he was and my doses have to come down. That's what I see today - tomorrow could be in another planetary system far, far away ...

I saw this that you decided to cancel your afternoon plans as Teasel was lower than expected. I hope he has come up for you now. This sort of scares me. I am questioning my decision to change now.

Nothing is easy with FD at all!

 

[Kris & Teasel]

Yes, these lows can happen and in the interest of full disclosure, I wanted you to know. You just won't know how Shoes will react until you try. Teasel is fine now and if you look at his SS that sort of drop isn't his usual pattern. ProZinc won't stop a bouncy kitty from bouncing, nor will Lantus in many cases - as you know from direct experience. You can select doses that will make him less likely to drop too low but they might give you more pinks than you'd like. ProZinc is in and out so every day is a new beginning and you can make that work for you. Using U100 syringes for this U40 insulin allows small fraction dosing much more easily. There are advantages but as I said, it's not a magic bullet.

Feel free to keep looking at SSs, asking questions, reading our stickies, etc. Very hard decision for you and I understand that.

 

[sherrib]

I know you like your vet and trust him, but it really bothers me that you have to convince him to let you do your own curve. IMO, he should support your decision to do your own. Remember, he works for you.
I have a new vet now because The one that I have when skittles was first diagnosed does not support him testing, me doing my own curves, the feeding of low canned carb food, and me using a human meter. And 3 times if I had listen to her staff , my skittles would be dead... 3 different times within a 10-12 day time period. Thank goodness I had #1. Listen to my gut and #2. Work in the animal field and know a lot and never what they were saying was wrong
But one thing you need to know about me is yes I work in the veterinarian field ,and yes I have a alot of knowledge about animals ,but when it comes to treating skittles with his diabetes I second-guess my every move therefore I ask a LOT of questions here . I don't know why I do this, but I do and I've just learned to deal with it LOL!

Why are you not interested in getting your baby in remission? I have gotten 2 of my cats into remission ( thanks to the wonderful advice and support of this site ) Right now skittles has a tooth infection and his BG numbers have been elevated so I have had to give him insulin two times in the last week. I am praying this is just a temporary setback and once everything is corrected with his tooth that he will completely go back in to remission. Honestly I don't even know if he's considered out of remission because he has had to have insulin. If you get a chance to look at his SS you'll see that his BG levels have been pretty good.

 

[Shoeskitty-GA]

I know you like your vet and trust him, but it really bothers me that you have to convince him to let you do your own curve. IMO, he should support your decision to do your own. Remember, he works for you.
I have a new vet now because The one that I have when skittles was first diagnosed does not support him testing, me doing my own curves, the feeding of low canned carb food, and me using a human meter. And 3 times if I had listen to her staff , my skittles would be dead... 3 different times within a 10-12 day time period. Thank goodness I had #1. Listen to my gut and #2. Work in the animal field and know a lot and never what they were saying was wrong
But one thing you need to know about me is yes I work in the veterinarian field ,and yes I have a alot of knowledge about animals ,but when it comes to treating skittles with his diabetes I second-guess my every move therefore I ask a LOT of questions here . I don't know why I do this, but I do and I've just learned to deal with it LOL!

Why are you not interested in getting your baby in remission? I have gotten 2 of my cats into remission ( thanks to the wonderful advice and support of this site ) Right now skittles has a tooth infection and his BG numbers have been elevated so I have had to give him insulin two times in the last week. I am praying this is just a temporary setback and once everything is corrected with his tooth that he will completely go back in to remission. Honestly I don't even know if he's considered out of remission because he has had to have insulin. If you get a chance to look at his SS you'll see that his BG levels have been pretty good.

This is not applicable to us now as we did not make the switch.