Beau - 8/19 - Concerned, need advise

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alicia.1771

alicia.1771

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It has been a month since we started Beau on ProZinc. He seemed to do well in the beginning but not so much lately. His numbers were pretty good when he was on 1.25-1.5 along with decreased clinical signs (less ravenous appetite, less urination and softer coat). So we started tapering him off as he had quite a low nadir on that dose. But his numbers started to go everywhere hitting the same low #'s on different dose and different #'s on the same dose. I have tried a few cycles with 0.8, 1.0, and 1.2 but have not gotten a consistent response. On Monday the vet suggested we increase his dose to 2.0 for one week and maybe consider switching to Lantus if he is not improving.

I'm quite concerned as his PS #'s has been consistently in the 400-500+ range for the past 2 weeks with nadirs mostly in the 100's and a few 90's/200's. I will do a curve tomorrow at the 2.0 dose but would like to get some input on the following questions:

1) Having such a high PS #'s with an acceptable nadirs in the 100's, is this telling us he is getting too much or too little insulin?

2) How come he responded so well before at a lower dose and not so much now at a higher dose? I'm considering lowering his dose again for a few cycles to see if his numbers improve before deciding to switch to Lantus, is 0.5 too little to restart? Is another week of ProZinc dose trial going to affect his response to Lantus?

3) He has a few bad teeth that seems to bother him and maybe we can use another urine culture (he had PU surgery which makes him prone to UTI, but he hasn't had one in almost 8 years and culture was negative last month). Should these be done before moving forward to another dose increase or switching to Lantus? How soon do you guys have your kitty's dental done after starting insulin?

4) Has anyone here switched from ProZinc to Lantus and got their kitty regulated or into remission? I'm a bit concerned about the strict 12/12 schedule, even though I have been able to keep Beau's shots within +/-1 hr of the schedule most of the time I don't know if I will be able to do that long-term on my own.

I'm quite lost at this point and would really appreciate any comment on our current situation and recommendation for our next step. Thank you all for the support!
 
Hi Alicia,
We havent really talked but I wanted to take a look at your spreadsheet to see if I cuold see anything for you.
I am in NO way an expert and I still struggle with Shakes,
but in looking at your sheet I have to say that I think you started off too high of a dose.
and it looks like you have shot the same dose into a 300 number that you shoot into a 170 number..
I came over from Lantus and started slow with Shakes...probably too slow but I didnt want to start too high in fear of rebounding over and over.

ok here is my opinion...If I were you..I would start over at maybe .50 unit, 2 times a day
and keep him on that dose for 5 days..It seems to me that he could be all over the place because he
has been given too much insulin.
Wait to see if anyone chimes in but I would definately go lower than 1 unit.
I hope it works for you guys..
shakes was on Lantus for 2 months and we had a terrible time with it but I think its because
the vet I had been seeing told me to start at 3 units 2 times s day, and I really believe that was too much for him
to start with.
If you do go to Lantus, please start very low and go slow...
I hope this helps a little
Denise and Shakes
 
If he has bad teeth that you know are bothering him, then that *definitely* can effect things. Not only from a pain increasing numbers stand point, but also an infection will increase the numbers too. I'd get that taken care of first before switching to another insulin. A couple of things could be going on here. It looks like to matter your dose, your preshots keep increasing lately - so I am strongly wondering about an infection going on. The big drop in numbers from preshot to +2 tell me that it is probably a duration issue for you guys. You get the same 200pt drop on a 2u dose vs a 0.8u dose, so I don't think it is a case of rebound. Before you think about a TID schedule possibility, or even shooting early when you can (if work hinders TID) - ask your vet about scheduling a dental first.
 
Thank you Denise and Kelly for your input.

I will check with the vet about scheduling a dental appt and I want to try a lower dose for a while before switching insulin. I like the flexibility of ProZinc and Beau did respond well in the beginning so I want to give it a little more time before switching insulin and also until I can read up more about Lantus.

Since it takes a few cycles for the body to respond, how would I know if the lowered dose is a BAD decision since his #'s are all over the place right now?
 
Hi Alicia, I know you want specific answers, I can tell by your SS that you feel A+B=C .... but in a diabetic cats life, that isn't always so. You have only been doing this a month ..... that is not a long time for either you or Beau.

Once again the problem with Beau is his ability to go real low, so it is hard to be really aggressive in his dosing. But a couple of things do stand out now. His teeth, I would get that taken care of because that can mess with his numbers, sometimes in a big way.

The timing of his shots .... Prozinc is very forgiving as far as timing, much more than other insulin BUT his shots should be given within 15 minutes of the last 12 hr. shot to get the best numbers. If you are giving his shots at + or - an hour of the last shot 12 hrs. ago, that will mess with his #'s. Any insulin needs to be as consistent as possible, which I know is hard but all it takes is planning and by looking at your SS, you can plan!! So it is Fri. I don't want to give Payne her shot at 6AM on the week-end, so for her first shot (she is t.i.d.) I will start moving her time by 15 min. and by tomorrow morning, her first shot will be at 7AM. But it is done in 15 min. a shot.

I don't think you have given pzi a chance but it is certainly an option changing to another insulin. If it were me I would go back to 1u and hold for a few days and get the dental done. If you want more opinions on what the dental can do to BG#'s post on health, you would be amazed!

Think of Beau as a diabetic child who cannot talk .... diabetic people take BG readings frequently and adjust, adjust, adjust. What they eat, how they feel, etc. etc. all this changes how much insulin they need. We take readings, keep data and try to put it all together, plus you need to re-learn your cat as a diabetic. None of this is easy, therefore there are no easy answers ......

Take it one day at a time, you will get beyond this.

Nancy and Payne
(who is sleeping in the sun with no worries ...... :)
 
Quite a few have switched to the Ls and really liked it from what I understand. I think Lev may be more forgiving on the shot timing (?) than Lantus is, so you might want to look at it.

High PSs to low nadirs can be too much insulin triggering rebound (hence the lower dose test), or it can be not enough duration (which means you might try TID or another insulin). It is one of the common problems on PZI, and a reason many have switched insulins. We lucked out in that Bix got relatively shallow drops and long duration, but I don't think we were the norm.

What I think happens sometimes is they don't have quite enough duration to get good numbers to +12, and then with higher PSs you start seeing steep drops like you are now, and that may trigger some rebound and then it's hard to break that pattern, and it can be hard to separate out the two problems.

If you try the dose reduction test, I would not stay there long if the numbers aren't good. Rebound should wear off mostly in a couple cycles (can take up to 3 days, but usually you see improvement pretty fast), and so if a lower dose is what is needed, the numbers should improve quickly.

If you do go with a lower dose, watch out for any problem signs like lack of eating, and be sure to test daily for ketones.

It's possible too that he has a sputtering pancreas and/or some liver training issues, and that could explain some of the wackiness in a blue PS one day and a black one the next on the same dose, with nothing mid-cycle to explain the difference. I can see your frustration, it is hard to find one pattern to hang your hat on and decide what is needed.

It is good though that you are getting a fair number of good numbers, and he clearly responds to the insulin, and those are often the biggest hurdles. It may just take some experiments to tweak the dose. The drops do look too steep to me right now, but there are some other cycles with no steep drop and then still a black # by +12, so I suspect there's more than one thing causing the higher numbers. If you can stomach shooting early (lowering the dose accordingly depending on how early), that is a good way you can head off the higher numbers and avoid the steep drops.
 
Hi Alicia, and of course you too Beau,
I'm no expert either, but it seems to me that you have some "liver panic" going on with Beau. When he drops from 500 to blues, it's like his body can't deal with that "low" a number, so his liver dumps glucose into the system and pushes him right back up to 500 for his next pre-shot.
It would almost be better, if that is what is going on, that he not have that steep a drop. If he were starting at 500 and only dropped to 300 - while that might not look good on a spreadsheet, and you'd think all his numbers were too high - you'd see a softer, more gentle curve. That might convince his liver that 300 is not too low, and it wouldn't try to fight the insulin.

Perhaps what Denise suggested will work out. Drop him to .5 and keep it there for 4-5 days and see what happens. What I would hope happens in that case is that you see a smaller dip, and by the end of 4-5 days, you'd see a curve that was still not really big, but you'd get PS's in the 300 range, and a nadir in the mid-100s. When his pancreas starts healing more, it would start producing its own insulin, and at that point, you might not even have to increase doses. But even if you did, as long as you kept the increases small (like .25 more BID), the rate of increase might keep his liver from reacting.

I know this can be very frustrating. When I was in that situation, I still hadn't joined the group. I watched Bob go from 1u BID to 4u BID in a matter of weeks (following vet advice), and couldn't understand why he was still not seeming to feel better. Once I did join, and read a whole lot, I started decreasing his daily intake of insulin, and a month later, Bob went OTJ. I know it sucks to feel like you're starting over, but that might be just what Beau needs. Looking at his SS, I definitely would not increase to 2u BID right now. I think that would cause even steeper drops and dangerously low nadirs, plus if it is his liver fighting the insulin, that would probably make it even worse.

Just my thoughts,

Carl in SC
 
I absolutely agree, I would drop down to .5 units and start over. 2 units is way to much for a starting dose but sadly a very common starting dose because of vet stress.

I would give the .5u at least 3 to 5 days to let him settle into it. Get the dental and then decide about an insulin switch.

Hang in there, you are doing fine.
 
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