Advice needed -Back on PZ after 6 months

Sharron

Sharron

Member Since 2023
Hi. My cat Mac has been in remission since Feb 6 2023. I was testing regularly and all was within normal range until the middle of August when his numbers started climbing up into the 16's (AccuChek Guide). I am in Canada. I took him to the Vet. No issues were found. Food has not changed and he had gained 3 lbs (he's now 22 lbs and is 11 years). He eats only FF pate and pure bites as a night snack. He eats 2.5 cans of FF and 14g of the purebites each day. Vet can not explain why he is gaining weight. He is showing no diabetic signs.
I started him on PZ again. The vet and I had a BIG difference in the BG tests so I purchased the AlphaTrak 3 meter as advised (waste of money and I'll be going back to the AccuChek shortly). It turned out the Vet Tech read the BG as 9 mmol instead of 19. Anyway I did a curve this week and I feel I need to up his dose but not sure whether to go up .25 or .50 so I'm looking for advise. Please see Mac's spreadsheet.
Thank you
 
Oh dear - something's knocked him out of remission. Was the Vet sure he doesn't need a dental or no sign/clue of an infection? Any blood work results you can share? (I'm no good with bloodwork results but @Suzanne & Darcy can help)

Please get those pre-shot tests everyday and at least one mid cycle AM & PM. You might have been okay increasing by 0.5 units but those missing couple of days of testing makes me hesitate to recommend a 0.5 unit increase.
 
Hi. The vet was quite stumped as to what could have happened as there was no life changes or diet changes. The only exception to his life was that I went away for a week prior to the numbers escalating up into the 16's. I don't have any reports from the vet. They did look in his mouth etc and did a urinalysis which showed excessive sugar but no ketones or UTI. I did a few ketone tests at home prior to visiting the vet and all were negative.
Mac is acting completely normal. I would not have known anything was wrong if I was not doing regular testing.
I had an emergency situation come up on Thursday and my husband is uncomfortable testing (i'm working on that) but he gave him his shots. As his numbers weren't moving much I was comfortable with that.
I am going to switch back to the AccuChek reader. The strip cost for the AlphaTrak 3 are over double the cost of the human strips. Is there anything I should note/or do on the spreadsheet when I switch over tomorrow?
Also how long do I hold the 1.75 dose before deciding if an adjustment is required? I will be testing more often as I've adjusted the dose.

Thanks.
 
Sharron said:
I am going to switch back to the AccuChek reader. The strip cost for the AlphaTrak 3 are over double the cost of the human strips.
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I'm in Canada too - human meter strips are stupid expensive as it is, pet meters - forget it!!

Sharron said:
Is there anything I should note/or do on the spreadsheet when I switch over tomorrow?
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You're using the human meter spreadsheet, so no format change needed. What I would do is insert/ highlight a line above and below the section of AT3 readings to bring attention to the change from human meter to pet meter to human meter and notes in the comment section would be good too.

Sharron said:
Also how long do I hold the 1.75 dose before deciding if an adjustment is required?
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You're experienced so recommend following MPM - need to be more aggressive the 2nd time around & will require that additional testing. Hold the 1.75 units for a couple of days, see how he responds and go from there.

Hopefully in the meantime @Suzanne & Darcy will pop in with some further ideas about that loss of remission. Sound good?
 
That's how I felt about the human strips....now I'm thinking they were cheap...lol

I will read up on MPM method. Thankfully Mac is very docile about blood testing. I am retired so frequent blood testing is usually not an issue.

Thanks again
 
This will be helpful
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly.
 
Sharron said:
Hi. My cat Mac has been in remission since Feb 6 2023. I was testing regularly and all was within normal range until the middle of August when his numbers started climbing up into the 16's (AccuChek Guide). I am in Canada. I took him to the Vet. No issues were found. Food has not changed and he had gained 3 lbs (he's now 22 lbs and is 11 years). He eats only FF pate and pure bites as a night snack. He eats 2.5 cans of FF and 14g of the purebites each day. Vet can not explain why he is gaining weight. He is showing no diabetic signs.
I started him on PZ again. The vet and I had a BIG difference in the BG tests so I purchased the AlphaTrak 3 meter as advised (waste of money and I'll be going back to the AccuChek shortly). It turned out the Vet Tech read the BG as 9 mmol instead of 19. Anyway I did a curve this week and I feel I need to up his dose but not sure whether to go up .25 or .50 so I'm looking for advise. Please see Mac's spreadsheet.
Thank you
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@Suzanne & Darcy
 
Suzanne & Darcy said:
So bloodwork was done, but you don’t have a copy? Would you be able to get one? Is he eating and drinking normally? Is his activity level normal? I’m glad you have been testing for ketones.
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I will contact the vet office in the morning and see if I can get copies of the Fructosamine test they did and the Urinalyisis report. I will also ask them what other tests they did.
He is and always has been a lazy cat. He has no interest in playing with toys (laser, jumping things, anything) and really never has been interested for more than a minute or two. So his activity level is as normal as it has been before diagnosis.
 
Suzanne & Darcy said:
I’m glad you did the increase to 1.75. Were his teeth checked?
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There are 2 vets in the office. I saw the newer vet on the day I took him in (August 24th). She looked in his mouth, took his temp, overall exam. Tried to get urine sample but was unable so I did that at home. She said everything looks fine and said his numbers are up a bit. This was when they thought he was 9 mmol ( I had tested him at home right before I took him in and got a 16.3 mmol). I took the urine sample back the next day and had a discussion with my normal vet who told me I need the AlphaTrak as my human meter must be having issues....wrong! I got the same higher numbers on the AlphaTrak.
Should I ask them to do a better dental exam?
 
Suzanne & Darcy said:
Please be sure to ge the preshot tests and the mid cycle tests as well, especially if you are considering following the Modified ProZinc Method. I can’t see much about what’s been happening with Mac on the 1.75 unit dose.
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I don't see any difference yet but I will maintain this dose for 6 cycles. He's acting the same and eating well.
 
Sharron said:
There are 2 vets in the office. I saw the newer vet on the day I took him in (August 24th). She looked in his mouth, took his temp, overall exam. Tried to get urine sample but was unable so I did that at home. She said everything looks fine and said his numbers are up a bit. This was when they thought he was 9 mmol ( I had tested him at home right before I took him in and got a 16.3 mmol). I took the urine sample back the next day and had a discussion with my normal vet who told me I need the AlphaTrak as my human meter must be having issues....wrong! I got the same higher numbers on the AlphaTrak.
Should I ask them to do a better dental exam?
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Well, I am not sure what you should ask them to do. I hope they did some routine bloodwork like a CBC and chemistry panel - especially the CBC would hopefully tell us whether he is showing signs of an infection. Sometimes cats can have an infection that doesn’t really show up.
 
Hi again,

Could someone please look at Mac's Spreadsheet for me. Unfortunately I had a family emergency that took me away for almost 2 weeks but I was able to slip home for a day and test him. He was doing the same as before I left so I upped his dose to 2.50 last week. His numbers seem worse to me. I'm really not sure how to proceed from here. Is this normal that at +4 he's barely dropped? I'm wondering if I should be taking him to the vet but he is acting completely normal - no excessive thirst ot hunger etc.

Thanks for any advice.
 
Hi Sharron. I did look at Mac's spreadsheet and I am not trying to be simplistic or flippant, but I would say that since you are following MPM and Mac isn't getting very good numbers, you need to increase his dose. Since his nadirs are above 200 (well above, actually) I would recommend a dose increase of .5 units to bring him up to a dose of 3 units (as long as you can continue to do your excellent job of monitoring.) Are you comfortable with trying that? You also need to make sure to reassess the dose about every 3 days/6 cycles so we can see if he needs more insulin. You will know if he needs a reduction. Cats' insulin needs do change over time and sometimes will fluctuate. Sometimes you have to go up before you go down. Holding the doses for too long can lead to glucose toxicity and you will see higher numbers and less response to insulin (they kind of get stuck in the higher numbers.) What do you think?
 
Hi,

That's what I was going to do based on the protocol but I was hesitant to do it. I'm just a bit more nervous this time around. I'll up him to 3 units tomorrow morning as I will be able to monitor him.
His highest dose last time was 2.5 twice a day so I guess that was making me second guess myself.


Thank you for your help and advice
 
Sharron said:
Hi,

That's what I was going to do based on the protocol but I was hesitant to do it. I'm just a bit more nervous this time around. I'll up him to 3 units tomorrow morning as I will be able to monitor him.
His highest dose last time was 2.5 twice a day so I guess that was making me second guess myself.


Thank you for your help and advice
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I totally understand that. There's a mental barrier where we don't want to go up beyond the cat's last highest dose. But cats' insulin needs do change over time and it looks like he may just need a little boost right now. If we can get him into better numbers, it's a lot better for his health. And it's possible that he will earn reductions in the future if we can first get him to a dose that's working to control his BG better than his current dose.
 
Thanks. I will keep on chugging along and hope to get to a dose that will work for him.

Thankfully he is excellent with getting tested (by me anyway) and getting his shots. It sure makes it less stressful.
 
Hello again,

So I upped his dose this morning to 3 units and when I tested him at +3 he was 5.5 so I gave him a half portion of fancy feast petite which he ate no problem. I just retested at +4 and he's 4.3 .
He was 18.4 at AMPS. So I'll test him again in 20 minutes and see what's going on. He seems usually to hit his nadir at +5.

Any other things I should do?

Thanks.
 
If he would eat a teaspoon snack of his regular food at +2 it might slow him down just a tiny bit and help the greens to last longer. Don’t feed a meal after +6 (well, or after nadir, which was early today) except a low carb treat of two if you are testing him, because it will shorten the duration of the insulin if you feed much. I’m probably telling you stuff that you already know, but at least others who read along and don’t post will get the benefit of it.
 
I try to make sure he has most of his food by +7 as he can be can get very ugly when he is hungry :)

I think the low number freaked me out as I haven't seen it in quite awhile.

I will give him a snack at +2 tonight. I generally test him at +3 every night before I go to bed.

Thanks again. He's heading back up now at his +7.
 
Sharron said:
I try to make sure he has most of his food by +7 as he can be can get very ugly when he is hungry :)

I think the low number freaked me out as I haven't seen it in quite awhile.

I will give him a snack at +2 tonight. I generally test him at +3 every night before I go to bed.
You do a great job! I think you should be happy though, that the new dose budged him out of those higher numbers. He needed that. We will know if he needs a .25 unit reduction, but not yet! :-)
Thanks again. He's heading back up now at his +7.
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Let's see what he does today, but it's looking like another .25 increase is needed. We don't want him getting too cozy in these numbers.
 
Hi! That's what I was thinking. He did very well first 2 days on 3u but last 2 days have been very flat.

I will up him tomorrow morning to 3.25u. We did have company up for 2 days (Thanksgiving) but they have gone now.

Thanks :)
 
Absolutely no fancy footwork today or yesterday :(
I upped his dose this am to 3.25u and his numbers went up. I am not sure what I'm doing wrong or whether there is something else at play here. He is eating and acting as normal. He's a very large (he does not lose weight at all!) cat so his activity is low but he still walks around and eats his food no problem. Should I maintain the 3.25u for the 3 days (6 cycles)?
 
Sharron said:
Absolutely no fancy footwork today or yesterday :(
I upped his dose this am to 3.25u and his numbers went up. I am not sure what I'm doing wrong or whether there is something else at play here. He is eating and acting as normal. He's a very large (he does not lose weight at all!) cat so his activity is low but he still walks around and eats his food no problem. Should I maintain the 3.25u for the 3 days (6 cycles)?
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So it sounds like he’s okay. If he had a bad tooth I would expect him to be off his food. How old is your ProZinc vial?
 
And I would hold the dose for six cycles yes. We can’t rush the process too much. But seeing nothing but pink is really weird.
 
I agree that it is weird. I bought the ProZinc bottle in January 2023 from my Vetboffice before he went into remission. It was never opened as I didn't end up needing it. I kept it in the fridge (expiry date on bottle is 01/2025). I was wondering if this is the issue but it seemed unlikely.
Should I try buying a new bottle or do you think I should switch up insulin type?
 
I do think it would be worth trying a new vial. If you want to consider a new insulin I would read up on it first to get an idea of how it works because it’s quite different. Although I am thinking that he went into remission last time on ProZinc…. I still can’t understand why he came out of remission. But yes, other insulins are good (Lantus, Levemir) as well.
 
I am going to contact my vet tomorrow and see if I can get an appointment to discuss the lack of movement with his insulin dosing. I will ask them to check his mouth again for any issues that may have been missed. Should I get them to do any sort of bloodwork which might help determine any other causes of these weird numbers?
I'm thinking there has to be something else wrong here but I don't know what. I have no problems trying a new vial of ProZinc as well.
 
Well, just general CBC and Chemistry panel would be helpful…. perhaps a urinalysis. See if they can look in his mouth. I would do bloodwork where they send it out to the lab, if possible, and make sure they check his thyroid.
 
Hi Suzanne,

I'm very perplexed about his numbers. I have an appointment with the vet on Thursday the 19th in the afternoon. That was the earliest appointment they could give me. I upped his dose to 3.25 on Tuesday but see no changes. Should I go ahead and up him to 3.50u tomorrow? I'm beginning to feel like the ProZinc is expired or he is unresponsive to it.
When he was first diagnosed in July 2022 we were blindly giving him 2.5u x2 a day for 6 weeks and switched him to a wet food only diet at the same time. In my ignorance I was not home testing and was taking him to the vet every few weeks which is how he ended up on 1.5 unitx1 per day.
I am seriously wondering if the ProZinc ever worked for him.
 
I would increase by .5 units. He is only pink almost exclusively lately. So new dose going forward would be 3.75. With MPM we generally don’t hold doses longer than six cycles unless we see nadirs in the desired range. If you wait too long to increase, then glucose toxicity can set in, which just means that he gets comfy in higher numbers and you have to use more insulin to break through that.
 
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I understand your frustration, by the way. My boy had Acromegaly and was a high dose kitty. Before I knew what was going on and what to do, it just seemed that he didn’t respond to insulin at all. Even after I knew, he got up to over 40 units.
 
Ok. I'm trying to wrap my head around everything I've learned and he's just not co operating ...lol

I'll up his dose to 3.75u tomorrow morning for the 6 cycles.
Thanks for listening and your guidance.
I don't know how you handled 40 units! I'm freaking about 3.75.
 
So for those reading along… and you probably already know this Sharron… this recommendation to increase by .5 unit is specific to Sharron and Mac. Sharron is following the Modified ProZinc Method and she does a lot of BG testing. Mac’s nadirs have been over 200. So this recommendation does not apply to any cat, but is just for Mac and Sharron.
 
Sharron said:
Ok. I'm trying to wrap my head around everything I've learned and he's just not co operating ...lol

I'll up his dose to 3.75u tomorrow morning for the 6 cycles.
Thanks for listening and your guidance.
I don't know how you handled 40 units! I'm freaking about 3.75.
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It’s possible he just needs a breakthrough and we need to move him up in dose before he will start earning reductions. Of course, it’s a good idea to get the vet to check him out as you have an appointment to do. Hopefully, he’s just being stubborn (his body that is!)

Yeah, we got all excited about that short string of greens and then he went back up high! Disappointing. Let’s see if we can do it again and hope he stays lower this time.
 
Hi, I just read through your thread. Our first diabetic boy, Brady, was on PZI (similar to Prozinc). He went in and out of remission 4 times, almost 5 when he passed (not of diabetes or diabetes complications). He came out of remission every fall -- I remember because it was right around "football season", which in the U.S. is late August through late January. He was actually first diagnosed the week before football season in 2009, which was very stressful because we had season tickets for a team a three-hour plane ride away where we flew for every game... But then he went in to remission the first time right around the end of that football season. Fortunately, our cat sitter was a vet tech who was great.

He did great that whole first summer in remission, I tested him at least 2-3 times a week, and then as August/September was coming up, his numbers started to creep up. This cycle repeated 4 times: He needed insulin in the fall/winter, and was in remission during the spring/summer. We did every test imaginable the first couple of times when he fell out of remission, urinalysis, FeLV/FIV repeat test, bloodwork, ultrasound and nothing changed. We always suspected maybe some type of environmental allergy, like a specific plant/grass pollen although his tests didn't show any kind of inflammatory response, so we couldn't tell for sure.

So I don't have any answers, but wanted to throw our experiences in. This was a long time ago and our subsequent diabetics have both used Lantus so I didn't keep Brady's spreadsheet. Brady did become diabetic the very first time after repeated steroid injections for a skin condition, but never got steroid injections again after his first diagnosis. So I don't know if the "why" of his initial diagnosis played any part of this seasonal remission cycle, but I do know that the quicker that we re-started insulin when his numbers started creeping up, the faster we got him back into remission. Each time the insulin-dependency was shorter and his highest dosage was less.

Best of luck to you, Mac is a handsome young man, and very lucky to have you :bighug:
 
Thank you for sharing your story about Brady's journey. I like hearing and reading about other sugar babies and their journeys❤️ It gives me hope that Mac can maybe achieve remission again. He is quite the character and likes to keep me on my toes.
 
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