@MrWorfMen's Mom @Kris & Teasel @Djamila @Rachel I'll try not to write you guys a short novel but there is some catch up required. After talking with Linda and getting her perspective plus knowledge of why quite a few Vets have limited knowledge on Feline Diabetes I decided to have a straight forward conversation/consult with Bear's Vet on December 6th. It actually went well and I came away with a better understanding of the massive amount of knowledge/curriculum that a Vet has to cover. I never took into account that Vets have to cover a lot of the different specialty fields like Dental, Orthopedic, Reproductive, Endocrinology, Oncology, Urology, to name just a few, plus Pediatric through Geriatric. She/the Vet has a lot of interest and concern for Bear and I believe it will be mutually beneficial for Bear and I to have a Vet who is open, plus willing to work with us. I do realize that the Vet is limited in her experience with diabetes comparatively to this forum. After studying Bear's SS the Vet's major concern were his swings into red and black as his dosage was increased and some of the data showed he was reaching red by his +8 which would put Bear into high numbers for quite a while during his cycles. Because Bear has previously had DKA this is worrisome. Options discussed: #1 Switch to Lantus for possible smaller swings and longer duration. #2 Try secondary insulin (Novolin R) in conjunction with Prozinc to lessen Bear's end of cycle swings and possibly get his body use to lower BG numbers for less overswings (Panicky Liver) #3 Reduce his prozinc dose to 2 Units and see if that stabilizes his BG swings and up his dose as needed. She noticed Bear was doing much better at the lower dose of 2 with no reds or blacks. So I started with the Novolin R option first because I could easily procure some and I was hesitant to make a dramatic change. I followed the advise on a thread labeled Humilin R vs Novolin R in which Jill and Alex plus Chris and China advised on the use of Novolin R to a fellow Prozinc user member. My conclusion after using Novolin R was, yes it did help but Bear's reaction to dosage was not reliable because using it only with a perceived bounce was guess work. How much glucose was his liver going to release to how much Novolin R will it take to adequately reduce his BG to say a pink level. Also it was time and labor intensive with hourly testing and monitoring. Sleep deprivation is no ones friend. So as to the other options, I think reducing his prozinc to 2 Units has a larger risk of failure. Lantus is the next option I want to try. I got a Lantus pen today that was my diabetic Grandmother's. I need dosing advise. I know most would post in the Lantus Forum but being an initial skeptic I have built trust in your advise over the last three months and want to hear what you guys think. To use current slang you're my peeps. Lol. I am not against other's advise or to later post in the Lantus Forum, I just like my comfort zones. So what do you guys think???
Good morning, Lora! Bear has been awfully bouncy (sometimes that just happens with cats) and Lantus could definitely help smooth out those bounces. It tends to help cats have flatter curves which can be good for those bouncy kitties. I think it's a better plan than continuing with R. While R can help, we generally don't recommend it unless as a last resort since, as you say...it requires a LOT of testing. It's a lot like when people dose Prozinc TID (3x a day). We've had that work well for people, but it's more of a last resort due to so much testing being required. Lantus should help smooth things out and hopefully control some of the bouncing, though it might take a bit. I don't have experience with Lantus, but we've had plenty of members go over and get great results, so I think it will be good for you too! Kris is one, and I know she posts over there on occasion too. I think they usually start at the same dose you're at (or slightly lower) on Prozinc, but I'm not sure about that. One thing I would do beforehand is make sure that all your R usage is documented on your SS. I see where you put it in the notes, but I can't be sure if you used it in the last week or two. That's info that will definitely help. I'd also spend time reading through their stickies to see what info you can find out! I'm excited and hope this works out well for you and Bear!
Hi Lora! I'm just seeing this now - busy time of year. Yes, Bear is very bouncy and in order to get him to spend some time in better numbers mid cycle you end up with sky high PSs. His responses day to day are also variable - goes with the bounciness and reactivity to insulin. Teasel is like that. Teasel was more volatile on ProZinc than he is now on Lantus but the journey is 3 years in the making and he went from Lantus to ProZinc (pre FDMB) to Levemir and back to Lantus. He spent a minimum of 8 months on each so I have a pretty good feel for which is best for him. He's still bouncy and erratic but less so and I've learned more about finessing his dose (not always successful!). I encourage you to try Lantus with Bear. It might help smooth things out but it won't necessarily turn him into a cat who produces flat curves and has no drama. As for starting dose, the usual approach is to give something in the ball park of whatever the current insulin dose is. I suggest you post on that forum for help. Include the blue question mark icon from the menu at the left end of the thread title bar. The L forum is huge, busy and overwhelming at first. There are very experienced members there to advise and they have two clearly laid out dosing methods to try. Many people like that list of "rules" especially when they're new to Lantus.
My first thought after studying your spreadsheet is that you might have better luck with Levemir than with Lantus. Bear needs an even higher dose than he's getting, and Lantus tends to do better with cats in lower dose ranges, while Levemir is more often recommended in higher dose ranges since it doesn't sting, while Lantus does. As far as the R, it doesn't look like you used it very many cycles. I can tell you that Sam has historically been a pretty steady cat as far as his responses to insulin, but despite his consistency, it took me a number of cycles to even start to figure out how to use R with Prozinc for him. And for what it's worth, I did not test every hour. I know that's recommended, but Sam doesn't tolerate testing well, so I typically just tested him once or twice during the R cycle (which seemed to last about five hours with Sam - differs by cat). So all that to say that you could continue to work with the R and give it time to figure out what Bear needs there. It can be complicated and posting to ask for a second set of eyes can be helpful instead of doing it on your own. Sometimes someone looking in can see things that are hard to see for ourselves. I also found with Sam that sometimes using R in one cycle would impact his numbers in the next cycle - so keeping a broader view of the data instead of just looking at one cycle or one test result at a time. Anyway....enough rambling -- I do think one of the L insulins could be better for Bear, but if you want to stick with Prozinc, I think some dose increases and some work with R could still be done.
They might be a bit vocal during the shot, pull away, run away , become "shot shy", etc. Some cats are OK with larger Lantus doses. Many people do make the switch to Levemir if kitty seems to need a larger dose.
