Any help appreciated

[Lisa and Eddy]

I am new to this journey and am afraid I really messed up my cat’s dosing and I am confused on how to backtrack. Short story is we started on Lantus right away and I did not get consistent testing and after a week the vet suggested an increase from 1 to 2 units BID. The vet has been aggressive with the dose increases since then after no results and basically gave up on Lantus early in the process and had me switch to Prozinc (an insulin he prefers). Started Prozinc on 2 U BID but increased the next day to 3…a few days later we are at 4. We've been on 4 for several days now (All on spreadsheet). There has been zero progress and I feel like we overshot the proper dose a long time ago due to my lack of testing in the beginning (I am testing regularly now) and just trusting the vet because I am so desperate to get these numbers down.

If the issue is that the insulin dose Is too high, how do I slowly decrease to see if I missed the right dose? He had one low (for him, 200s) the other night and I wonder if there was a bounce. But since then I haven’t seen ANY other low numbers. I’d rather not switch back to Lantus at this point because I have the Prozinc now and don’t want to switch insulins again.

I am so lost. Any help is appreciated. I understand I shouldnt have agreed to move the dose up so quickly and now am kicking myself. Also i feel like I need a new vet but once again, hate to start over...

I got some good advice on here and was torn between following the vet's guidance and the advice here, and ended up following the vet's advice which was probably a mistake.

 

[Diane Tyler's Mom GA]

Hi first off can you add to your signature that you switched to Prozinc and the date, and highlight it on your spreadsheet and at the top of your SS where it says insulin
You can put Lantus , now Prozinc and the date
You might have not given lantus a chance and plus you were increasing by whole units and you were giving different units for AM and PM

You are right we do not increase by whole units, we adjust doses by 0.25 units
I can tag a few members for you to see if they can help you out
Her kitty was on lantus for 10 days then switched to prozinc as you will see on her previous post
@Sienne and Gabby (GA)

@Wendy&Neko

@Chris & China (GA)

@tiffmaxee

@FrostD

@JanetNJ

Thank you ladies

Lisa you might want to read the dosing method again for Prozinc since you are following SLGS
https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

When Eddy was on Lantus did you read the SLGS for lantus
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

@Lisa and Eddy

 

[Diane Tyler's Mom GA]

Previous post for continuity , her kitty was on Lantus at this time
https://felinediabetes.com/FDMB/threads/new-member-looking-for-help.256857/#post-2891216

 

[Katherine&Ruby]

Hi Lisa, I don't have any experience with Prozinc, but it looks like as of late you've been testing enough (great job!) so it's hard to believe you'd be missing any lower numbers that could indicate that you've missed the right dose. It seems that Eddy just needs more insulin. For safety's sake, though, I would not increase by whole units. My kitty was on a drop of insulin for a while when she was close to remission and it made a big difference. Hopefully some Prozinc users will stop by and give you more ways of moving forward.

You're doing a great job, so don't lose faith! Eventually you will get the hang of how to manage dosing with help from the members of this forum and you won't need so much guidance from your vet anymore. All of the vets I work with know that I manage Ruby's insulin and they handle everything else.

 

[Denver & Magic (GA)]

With numbers that high, I’m wondering if you’re dealing with glucose toxicity. I went through this with Magic until we hit a “breakthrough dose” at 5u and then we’ve been reducing. Vet said that if they’ve been high for awhile they kind of get stuck and forget how to use insulin.

For us, ProZinc did take some time for his body to figure out how to metabolize it. Initially we held doses for almost two weeks before things started happening. This may be what’s happening to you.

 

[Sienne and Gabby (GA)]

I tend to agree with your observation that your kitty may not have had an adequate trial of Lantus. However, both Lantus and Prozinc are very good insulins for the treatment of feline diabetes.

One quick question. When you switched from Lantus to Prozinc, did you also change syringes? Prozinc is a U40 insulin (vs. Lantus with is a U100 insulin) and you need U40 syringes for proper dosing of Prozinc.

With Prozinc, you have two options with regard to dosing. The two methods are similar to what you may recall from Lantus -- there's Start Low Go Slow (SLGS) and the Modified Prozinc Method. They are described in detail on the dosing methods sticky on the Prozinc forum. Looking at Eddy's numbers, I'd lean toward the MPM if for no other reason that given where Eddy's numbers are currently landing, you can increase the dose by 0.5u.

Whether the dose is too high is moot. If you start over (which I don't recommend), you will lose time especially if your cat is needing this amount of insulin. Once you hit a good dose, the numbers will drop. It's just going to take a bit more patience.

I'd like you to get some input from @FrostD and @JanetNJ as they are experienced with Prozinc.

 

[FrostD]

Hi! If the dose was too high you'd be seeing more lower numbers every so often, so I don't think that's the case.

I agree with Sienne - I would recommend following the MPM method, you already test enough for it. It will allow you increase more quickly to hopefully get to a good dose soon. You've been at 4U for 7 cycles, I would increase to 4.5U tomorrow. And I would continue to increase every 4-6 cycles (2-3 days) until you start to see some blue numbers. The reason you can do it so quickly with ProZinc is because it's an in-and-out insulin....Lantus is a depot so you can't change doses too quickly because the depot needs to stabilize. If you are going to increase this quickly, you will need a minimum of 4 tests - the two preshots, plus one other test each cycle (more than that is always helpful!)

It's possible you are dealing with glucose toxicity as someone mentioned, but if you start getting up to 6U without much improvement you'll want to consider tests for IAA and acromegaly, they are both conditions that cause insulin resistance. I would actually schedule an appointment to have those labs drawn in 3-4 weeks, I know vets here are booking out far in advance and it takes time to get the results back. Worst case his numbers and dose come down and you can cancel (assuming no cancellation fee).

 

[Lisa and Eddy]

Hi first off can you add to your signature that you switched to Prozinc and the date, and highlight it on your spreadsheet and at the top of your SS where it says insulin
You can put Lantus , now Prozinc and the date
You might have not given lantus a chance and plus you were increasing by whole units and you were giving different units for AM and PM

You are right we do not increase by whole units, we adjust doses by 0.25 units
I can tag a few members for you to see if they can help you out
Her kitty was on lantus for 10 days then switched to prozinc as you will see on her previous post
@Sienne and Gabby (GA)

@Wendy&Neko

@Chris & China (GA)

@tiffmaxee

@FrostD

@JanetNJ

Thank you ladies

Lisa you might want to read the dosing method again for Prozinc since you are following SLGS
https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

When Eddy was on Lantus did you read the SLGS for lantus
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

@Lisa and Eddy

Thank you so much! I've updated my information. I read up on the SLGS method and realize we did not follow that in the beginning and then when I talked to the vet his approach was totally different. I just went with his method being nervous and uneducated about this but in hindsight recognize that we should have followed SLGS.

 

[Lisa and Eddy]

Hi Lisa, I don't have any experience with Prozinc, but it looks like as of late you've been testing enough (great job!) so it's hard to believe you'd be missing any lower numbers that could indicate that you've missed the right dose. It seems that Eddy just needs more insulin. For safety's sake, though, I would not increase by whole units. My kitty was on a drop of insulin for a while when she was close to remission and it made a big difference. Hopefully some Prozinc users will stop by and give you more ways of moving forward.

You're doing a great job, so don't lose faith! Eventually you will get the hang of how to manage dosing with help from the members of this forum and you won't need so much guidance from your vet anymore. All of the vets I work with know that I manage Ruby's insulin and they handle everything else.

Thanks, Katherine. That is reassuring to know that at least I don't need to start over or go lower at this point. Thanks for looking over my info and for the encouragement!

 

[Lisa and Eddy]

With numbers that high, I’m wondering if you’re dealing with glucose toxicity. I went through this with Magic until we hit a “breakthrough dose” at 5u and then we’ve been reducing. Vet said that if they’ve been high for awhile they kind of get stuck and forget how to use insulin.

For us, ProZinc did take some time for his body to figure out how to metabolize it. Initially we held doses for almost two weeks before things started happening. This may be what’s happening to you.

Thank you for sharing your experience. The glucose toxicity is definitely a possibility and looking at your SS was very helpful. You had a similar pattern in the beginning that I am facing now!

 

[Lisa and Eddy]

I tend to agree with your observation that your kitty may not have had an adequate trial of Lantus. However, both Lantus and Prozinc are very good insulins for the treatment of feline diabetes.

One quick question. When you switched from Lantus to Prozinc, did you also change syringes? Prozinc is a U40 insulin (vs. Lantus with is a U100 insulin) and you need U40 syringes for proper dosing of Prozinc.

With Prozinc, you have two options with regard to dosing. The two methods are similar to what you may recall from Lantus -- there's Start Low Go Slow (SLGS) and the Modified Prozinc Method. They are described in detail on the dosing methods sticky on the Prozinc forum. Looking at Eddy's numbers, I'd lean toward the MPM if for no other reason that given where Eddy's numbers are currently landing, you can increase the dose by 0.5u.

Whether the dose is too high is moot. If you start over (which I don't recommend), you will lose time especially if your cat is needing this amount of insulin. Once you hit a good dose, the numbers will drop. It's just going to take a bit more patience.

I'd like you to get some input from @FrostD and @JanetNJ as they are experienced with Prozinc.

Thank you, Sienne. Yes, I am using the U40 syringes now with the Prozinc. I will look over the MPM and use that for guidance. Thank you for explaining this to me!

 

[Diane Tyler's Mom GA]

@Lisa and Eddy
Hi Lisa on signature for the DX date you have
Lisa and Eddy, DX: 12/8/2.
Just add the 1 after the 2
12/8/21

 

[Lisa and Eddy]

Hi! If the dose was too high you'd be seeing more lower numbers every so often, so I don't think that's the case.

I agree with Sienne - I would recommend following the MPM method, you already test enough for it. It will allow you increase more quickly to hopefully get to a good dose soon. You've been at 4U for 7 cycles, I would increase to 4.5U tomorrow. And I would continue to increase every 4-6 cycles (2-3 days) until you start to see some blue numbers. The reason you can do it so quickly with ProZinc is because it's an in-and-out insulin....Lantus is a depot so you can't change doses too quickly because the depot needs to stabilize. If you are going to increase this quickly, you will need a minimum of 4 tests - the two preshots, plus one other test each cycle (more than that is always helpful!)

It's possible you are dealing with glucose toxicity as someone mentioned, but if you start getting up to 6U without much improvement you'll want to consider tests for IAA and acromegaly, they are both conditions that cause insulin resistance. I would actually schedule an appointment to have those labs drawn in 3-4 weeks, I know vets here are booking out far in advance and it takes time to get the results back. Worst case his numbers and dose come down and you can cancel (assuming no cancellation fee).

Thank you! OK I went ahead with 4.5 U this morning and will continue to monitor. I'll also ask the vet about those tests. He mentioned testing for the pituitary tumor but wanted to try titrating the Prozinc first. If I have more dosing questions, should I post on this thread again or should I start a new thread each time I need help?

 

[FrostD]

Thank you! OK I went ahead with 4.5 U this morning and will continue to monitor. I'll also ask the vet about those tests. He mentioned testing for the pituitary tumor but wanted to try titrating the Prozinc first. If I have more dosing questions, should I post on this thread again or should I start a new thread each time I need help?

If it's just dosing questions, you can post a new thread over in the ProZinc forum and tag myself and @JanetNJ (tags are typed exactly as you see them, the @ symbol followed by username, no space between the symbol and name).

If it's questions about general health - foods, health issues, labs, etc you you can post in the Feline Health forum. Or for anything time sensitive, such as you got a low number, or a low preshot and not sure what to do, etc. More people watch the main forum vs ProZinc

 

[Lisa and Eddy]

If it's just dosing questions, you can post a new thread over in the ProZinc forum and tag myself and @JanetNJ (tags are typed exactly as you see them, the @ symbol followed by username, no space between the symbol and name).

If it's questions about general health - foods, health issues, labs, etc you you can post in the Feline Health forum. Or for anything time sensitive, such as you got a low number, or a low preshot and not sure what to do, etc. More people watch the main forum vs ProZinc

Hi! Thanks for the clarification. I will post dosage questions over on Prozinc from now on but just wanted to ask you about something continuing from the conversation above. I increased Eddy from 4 to 4.5 U as we discussed. This PM dose was his 4th shot at 4.5. His numbers are higher and flatter than ever. They just increased since dinner from 400s to 500-600s. He only had 3/4 of a 3 oz can of 0 carb Tiki cat for dinner so I don't think the spike is food related. I am so perplexed by this. I am also in a complete panic. Should I try one more full cycle of 4.5U tomorrow before increasing (for a total of 3 cycles, if i'm following MPM) or should I increase to 5U in the AM assuming he's still sky high? I was supposed to follow up with the vet this week but I'm afraid to report that there's been no improvement over the weekend because I assumed he would tell me to increase to 5. I just didn't want to be too hasty which is why I'm trying to follow the advice on here. @FrostD @JanetNJ

 

[FrostD]

You will likely have some time to go before you hit a breakthrough dose, his numbers are very high with not a lot of movement. I know it sucks to see, just have to be patient and methodical.

Yes I would increase to 5U either tomorrow or Thursday, whichever day you can keep a better eye on him.

 

[JanetNJ]

I agree that it’s probably glucose toxicity. Looks like the numbers my acro cat was getting. I’d ask soon about testing for it. At least then you know what you’re dealing with. My vet insisted it couldn’t be because it was too rare and that I must be overdosing my cat. Finally she took a seminar on it and after that agreed to test and it was positive. She didn’t question me about my dosing after that. My cat got up to 13 units before finally reaching a breakthrough dose.

 

[Lisa and Eddy]

Thanks Janet. If it is acro, would I just continue titrating up as I am now following MPM? And continue to increase by 0.5 after 2 cycles if I don’t see any yellow numbers? I will ask the vet about it but he’s out the rest of this week. I mentioned it awhile ago and he also said it was so rare. I will push for the testing at this point.

 

[Lisa and Eddy]

You will likely have some time to go before you hit a breakthrough dose, his numbers are very high with not a lot of movement. I know it sucks to see, just have to be patient and methodical.

Yes I would increase to 5U either tomorrow or Thursday, whichever day you can keep a better eye on him.

Thanks! I increased to 5 this morning. Keeping fingers crossed….

 

[JanetNJ]

Thanks Janet. If it is acro, would I just continue titrating up as I am now following MPM? And continue to increase by 0.5 after 2 cycles if I don’t see any yellow numbers? I will ask the vet about it but he’s out the rest of this week. I mentioned it awhile ago and he also said it was so rare. I will push for the testing at this point.

acro is not as rare as once thought.
There are a few options if it’s acro…. There’s a medication (cabergoline) that helps some cats. I opted to just treat with insulin. She had diabetes 5 years, with acro diagnosed the last few years. In the end though her diabetes was pretty controlled, she died of cancer in her spleen.

 

[FrostD]

Thanks Janet. If it is acro, would I just continue titrating up as I am now following MPM? And continue to increase by 0.5 after 2 cycles if I don’t see any yellow numbers? I will ask the vet about it but he’s out the rest of this week. I mentioned it awhile ago and he also said it was so rare. I will push for the testing at this point.

*2-4 days, not cycles, just to clarify. Once you start seeing yellows/blues, you will want to hold just a little longer.

My cat is also acro. Like Janet said there are a few treatment options - surgery ($$$), radiation ($$), cabergoline medication (usually fairly cheap), or treat with insulin. Pros and cons to each but I'd cross that bridge when you get there. I was fortunate that my cat responded very well to cabergoline and is now in remission