Anybody know ProZinc's NB Mean median maximum dose?

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awkohr

Member Since 2013
I see in the University of Queenland Austalia "Dosing protocol for cats on glargine or detemir using daily home monitoring of blood glucose concentrations to adjust insulin dose" publication http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf that "NB Mean median maximum dose in cats on detemir is about 30% less than for glargine (1.7 U/cat BID; range 0.5 to 4.0 IU versus 2.5 U/cat BID; range 1.0 to 9.0 IU BID)." I was wondering does anybody know what the Mean median maximum does of ProZinc is? (if possible/you know it could you also reference the source of this figure, though I may be able to google it if I have the actual number.)

If you don't know for sure do you have a personal experience of my cat used to used to be on XU's of ProZinc but now that they where switched to using Y units of Levemir or Z units of Lantus they had the same blood sugar levels. (I know each cat is different just looking to see what the general consensus is.)

I am have been trying to convince my vet to switch from ProZinc to detemir (Levemir) or glargine (Lantus) because of the published tight regulation protocol from a reputable source that when combined with proper diet is likely to more likely to lead to remission. Though that might be a pipe dream or it might just be the tighter food regulation that helps with remission.

Also there is a thought that this might be able to save me money due to cheaper needles, less cost per unit and with the pens cartridges less units per bottle to potentially contaminate or ruin in other ways.
 
We use the pens like mini vials and use a U-100 syringe to pull out the insulin from the cartridge. The pen needles are too imprecise for feline dosing.

You might go to the ProZinc website and see what you may find.

Another potentially convincing display would be printing out some of the spreadsheets for the TR Lantus or Levemir cats vs some of the ProZinc cats. It becomes very clear that for many cats on depot insulins, the curve is much more gentle than for those on ProZinc.

And for support of Levemir vs Lantus, for the bouncy cat, see Lucian's spreadsheet in Relaxed Lantus. He's doing so much better on Levemir!
 
Imprecise is not the right term. Pens dose more accurately at low does than syringes but pen only dose in one unit increments.
http://www.ncbi.nlm.nih.gov/pubmed/20515311


BJM said:
We use the pens like mini vials and use a U-100 syringe to pull out the insulin from the cartridge. The pen needles are too imprecise for feline dosing.

You might go to the ProZinc website and see what you may find.

Another potentially convincing display would be printing out some of the spreadsheets for the TR Lantus or Levemir cats vs some of the ProZinc cats. It becomes very clear that for many cats on depot insulins, the curve is much more gentle than for those on ProZinc.

And for support of Levemir vs Lantus, for the bouncy cat, see Lucian's spreadsheet in Relaxed Lantus. He's doing so much better on Levemir!
Click to expand...
 
Thank you for your conscientious warnings about the pen's and their limitations and not being good for cats.

Seems I need to be a bit more carefully with my wording. By "cheaper needles," I was thinking needle/syringes combos and not the special needle tips for the pen's. I had read elsewhere you the pen cartridges as a bottle vial.
 
I picked up ReliOn syringes at WalMart - short needle, 3 mL, 30 gauge, U-100 syringes, with half unit markings. They seemed to work OK.

Orm you might try our shopping partner ADW for syringes. If you need a prescription in your state, it will need to be sent to them.

Some folks find bubbles in the syringe to be a problem. It can help to move the plunger in and out a few times before drawing up the insulin.

Also, check the syringe markings for consistency. Sometimes production batches are off in the markings and if you get a bad batch, you may want to return them.


(Contentious? Stating pen needles are too imprecise for cats is factual. Half unit adjusments can be too large and the pens only measure full units.)
 
BJM said:
(Contentious? Stating pen needles are too imprecise for cats is factual. Half unit adjusments can be too large and the pens only measure full units.)
Click to expand...

Ahh the wonderful world of auto correct and an initial misspelling on my part. I have changed the word to conscientious. There was nothing Contentious about it.
 
Oh good. I was rather startled at the post!

Word does autocorrect often enough that I turned it off!
 
Hi Alex,
Tell your vet that you want to switch to Levemir. That's all. You are at a high dose of the current insulin and you want to try a longer lasting insulin. Your insulin is more of a medium-long lasting, with Lantus lasting a bit longer and Levemir lasting the longest. I would say that you could prove it to your vet by doing a curve but if the numbers you are getting don't give much of an indication that you are near regulated.

I am hoping you are testing regularly and before every shot since you are at a fairly high dose of insulin. If you could put the numbers into a google spreadsheet and put the link in your signature, it would be very helpful to others who will be better able to give suggestions on where to go next.

You had mentioned that you were feeding some dry food. Dry food is going to contribute to lousy numbers that seem all over the place. She is eating wet food fine to cut out the dry food and let her eat more wet food. Be sure you are testing fairly often when you remove the dry food because if it's contributing to the high numbers, you will see a drop in numbers and you may have to drop the dose as well.

If she has an insulin resistance issue, still remove the dry food.... but you may not see much change in the numbers when you test.

Once you have tossed all the dry out the window, and your vet has you giving Levemir, ask the people who did the same switch, from Prozinc to Lev, at what conversion did they switch. It may not be 1 to 1, so if you are at 6u, they may say go with 4u Lev for the switch.

How's your cat's weight now and how was it before?
Any other health issues that she's having as well as the diabetes?

Tell your vet that the current insulin and syringes are too expensive for you and you have been told that you can get Levemir and U100 syringes that will be cheaper for you, considering your current dose.

Gayle
 
I will try your idea on the vet. Though I don't know how well it will work as I think part of the biggest part of the problem switching is that I hardly ever seem to be able to talk to the same vet as it seems to be a large practice, so I have to start over from scratch and they all have different opinions on lantus/levimer. Maybe I can try to schedule and appointment with a specific vet.
Due to the vet changing all the time, I was hoping for a peer reviewed or at least "scholarly" article that I could print it out and say listen lets switch and it should save me lots of money. However anybody saying I was at X U prozic and and I am at Z U levimer or Y U lantus would at least give me some kind of idea of wether I should be trying to fight this battle or not.

In regards to other things like Dry to wet conversion, weight, Health issues, some readings/curves ... please see "Intro/Highly Varient blood glucose readings " post. viewtopic.php?f=28&t=103722
short completely off dry food for over two months. (dry food being tossed out the door handful by handful to feral cats.)
Weight is up over 1lb.


-Alex
 
abstract: Pharmacodynamics of insulin detemir and insulin glargine assessed by an isoglycemic clamp method in healthy cats.
"RESULTS:

The only significant difference in the pharmacodynamics of insulin detemir and insulin glargine was onset of action (1.8+/-0.8 and 1.3+/-0.5 hours for insulin detemir and insulin glargine, respectively, P=.03). End of action of insulin detemir was reached at 13.5+/-3.5 hours and for insulin glargine at 11.3+/-4.5 hours (P=.18). Time-to-peak action of insulin detemir was reached at 6.9+/-3.1 hours and for insulin glargine at 5.3+/-3.8 hours (P=.7). The time-action curves of both insulin analogs varied between relatively flat curves in some cats and peaked curves in others."

- ie, on the average, Levemir started kicking in later, peaked later, and lasted longer than Lantus. a logical inference is that Levemir may be useful for cats who don't get enough duration on Lantus.
 
Yes, my experience is that less Levemir is required when compared with Lantus. I noted what when I used up Levemir left over from Tonis on Thunder (noted change in both directions) and when I switched Dante/MurrFee from Levimir to Lantus.
awkohr said:
So I guess in short I interpret the lower recommended starting dosages of Levemer/Lantus at places like http://www.diabeticcatcare.com/DCCCOK/InsulinScales.htm to mean that I will probably use less U per shot.

Here is a spreadsheet I made up including some graphs with margin of error graphs based on the assumption that my meter is within plus or minus 20 percent of what a table top reading would be. https://docs.google.com/file/d/0BwVYzIo ... sp=sharing
Click to expand...
 
I don't follow anything from DCC or DCH sites; I did not find the sites very inviting.

ProZinc is more of a medium/longlasting insulin, Lantus and Levemir are much longer lasting, with the nadir for Levemir being later than the nadir on Lantus, plus some people have needed less Levemir than Lantus.

I prefer Lev because one of my cats was jumpy, stressed, and have more extremes in her numbers on Lantus, but within a couple days of switching to Lev, she was a diff cat.... calmer, more level numbers, and all around happier and healthier. My other cat was the same on both insulins.
I did switch at a lower Lev dose than on Lantus, but they both went up to the same dose but with better results.

You don't need to get all crazy with the +/- % on anything ... I like the KISS method - keep it simple stupid. Everyone before you has done all sorts of comparisons, but it always comes down to the same things.

Stick to low carb wet food. Use Dr. Lisa Pierson's food list for food under 10% or else go raw.
Stick to one meter, just one, any one, and it doesn't have to be any expensive pet meter - Relion or Bayer or OneTouch are perfectly fine and MUCH cheaper for strips. (FreeStyle and TRUE meters are crap).
Test before EVERY shot, and dose based on nadir, not preshot numbers. (that's for Lantus and Lev, not the vet insulins).

When you next go to the vet office, tell whatever vet you get that you want to test for acromegaly and IAA.
IAA Test
IGF-1 (Acro) Test

Do regular curves.... test every 2hrs between 2 shots for a curve, every 3hrs for a mini-curve.
You can't tell a thing by testing just before shots..... what's happening in the middle? how long is the insulin lasting each cycle? when's her nadir? are her numbers flat all across the 12hrs or is there a dip, big or small somewhere in the middle.

YOU are the one who owns the cat and pays for the cat's bills and meds.
YOU can say what you want done.
Tell your vet the insulin you want is Levemir, no discussion. Also, make an appt with the vet for a blood draw to ship by FEDEX to MSU for the two tests. If you are feeding low carb wet food and need to give a dose of 6u BID and you are still getting some readings in the 200s and 300s, something's going on.

I am assuming that there are no dental problems or meds or steroids that she has that would affect her dose.

Gayle
 
Gayle.

Thanks for the test suggestions. I will tell the vet to do an Insulin Auto antibody test as I am sure that was not done. I will also confirm that the "liver" test they did included the acromegaly/Insulin Like Growth Factor-1 test.

My dosing changes are made after vet visits or phone conversations based off of curves that have been run and the theoretical nadir numbers. (there are some in their) Granted the curve may have been a few days old by the time I talked to the vet. I unfortunately don't have the ability to test at the 6 hr mark or run a curve all the time only occasionally.

I believe that 7/5/2013 is the last time I used anything that should have been over 10% carbs mark on Dr. Lisa Pierson's food list. Though with some of the 96% foods they might not be but due to the high animal content it is a safe bet bet they would be. The chart shows what they where feed including the donut she trash picked.

As for the KISS, In college I majored in physics, and have been accused on numerous occasions of over analyzing things. I don't mind spending some time validating the repeatability of other peoples hypotheses and to confirm my equipment is working as expected. I honestly feel much more comfortable with my meters numbers now that I have a bunch of side by side tests.

My vet uses Alpha Trak 2 meters and has an Alpha Track loaner program where you put down a deposit on the meter and buy the supplies so you can see if you want to do home testing. I jumped into the loaner program.

After some education I picked up a relion confirm meter as it supplies are much cheaper and did my side by side comparisons. Luckily I did as the side by sides as I had to convince the the youngest vet in the office and has only been only practicing veterinary medicine using table top and alpha trak meters that the human meters can be roughly correlated to the fancy expensive pet meters. Though I know this discussion is no where close to done with that specific vet.

For now I don't plan on switching from the relion confirm. As you can see the alpha Trak numbers pretty much disappear staring on 7-11-13. However whenever I am at the vets they will use the alpha trak meters and I will use the relion confirm on the same drop of blood so we can have a current side by side number. That way they can feel better about the reliability of the reline readings. I will continue to put them into this my chart for documentation purposes.

As for the going all crazy with the plus minus 20% numbers chalk it up to the scientist in me. I know the home testing meter readings are not accurate & I know the margin of error, therefor I am going to plot the margin of error. Especially now that I already have it set up to do the calculations and to resize the charts when I enter in the readings. I have renamed the columns as it isn't really plus or minus 20 percent from my reading.

To add to the complexity, when the vet tech set up the meter they fell victim to the extremely poor labeling on the Alpha Trak test strip container. So the Vet tech used the prominently displayed alpha trak II code. Buried in the middle of the fine print was the proper alpha trak series one code. Also nobody at the vet's labeled the meter with the special sticker that initially came with the Alpha Trak II test strips to use code 7 and not the Alpha Trak II code on the older meters. After I noticed this I called Alpha Trak support line to see if I had treat those numbers as trash. Support gave me a the formula to convert the readings to what it should have been. Hence some more added complication to the sheet due showing the actual readings in one column and what the actual reading should have been depending on weather a code 37 when code 7 was programmed into the meter at the time.

Not that you mentioned it but I weigh my cat in Kg as the electronic scale is more precise then the lb/0z setting on the scale and the sheet also auto converts to lbs, for when I am at the vet office as they use lb. From what I have read, I feel it is important to track her weight.

Thanks you so much for your tip about the test for insulin resistance. I hadn't read about that yet.
 
Alex,

BJM was doing a data collection of side by side meter testing. I'm sure she would appreciate your testing data if you are willing to share it.
 
Alex,
You should have your IGF-1 test result number within a week, so be sure that your vet does followup with MSU for the result. The IAA test at MSU is done in a week as well.

Gayle
 
Deb & Wink said:
Alex,

BJM was doing a data collection of side by side meter testing. I'm sure she would appreciate your testing data if you are willing to share it.
Click to expand...

Pounce!

I'll add it the spreadsheet I have going and can share the comparison data I have.
The AlphaTrak may read anywhere from 30-40% higher than a Relion Confirm (the lines are not parallel)
 
I only have a bout 12 side by side tests mostly in the low 200's on the re-lion scale. I will send BJM a private message though.
 
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