? Beginning Prozinc - How often to alter dosage?

Eric and Simba

Eric and Simba

Member
Hey all,

Just started my man up on ProZinc. So far he's getting 2u twice daily. His numbers have so far been pretty high, and I'm fairly positive he'll need to up the dose. I would like to get his numbers down ASAP - partially because he just had a scary episode of DKA and I do not want to see it happen again. Our previous vet had us go very slow with Lantus (having us hold him at a dose for nearly a month before even taking a proper curve/adjusting) and I want to avoid this scenario with our new vet. The advice on this forum seems much more well-researched and logical than most of the vets I've worked with so far. That said, I would still like to keep our doc in the loop and proceed with their consent for all changes.

From what I've read on here, the effects of ProZinc should be noticeable after 3 full cycles/36hrs as opposed to nearly a week for Lantus. Here's a few questions:
  • Does this mean a curve of the 4th cycle should be accurate? Are there any other considerations?
  • Since he's just now switching to ProZinc, is there a longer waiting period?
  • The sticky mentions there's no official protocol for ProZinc, but are there any studies at all to reference that advocate for 3-cycle changes? Where does this number come from? Asking partly for my own peace of mind, but mainly to show to the vet in case they ask for unnecessarily slow dose changes.


Thanks!
 
Hi Eric, and welcome to you and Simba!

Great job getting some tests in at home! I'm sorry to hear that Simba has had a recent DKA! Do you have ketone test strips at home so you can keep an eye on him?

Let's start with a few business details, and then I'll get to your questions:

It looks like you somehow got hold of an old spreadsheet. Before you get too far into this, you might want to switch to this one: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

The reason is that we use 50 now as the "take action" number, but the one you have uses 40. That's a bit too low to start intervening. It doesn't look like yours is color coding quite right either. See if moving to the new one corrects that so it will make your life a little easier and it will also add in the lime green coding.

Okay, logistics aside...

It sounds like you and Simba have really been through it lately!

In general, curves aren't necessary very often. You should be testing before each shot, and then scatter tests around in the middle of the cycle - generally focusing around +4 to +7 as your schedule allows. If you're able to collect regular data, then you only need a full curve every couple of weeks or so. Take a look at some of our spreadsheets to start to get a sense of it. Everyone tests a little differently since our work or school or life schedules vary.

In the beginning it's typical to hold the initial dose for a week-ish to begin to adjust to the new insulin, and then start to make changes. Given your high numbers and recent DKA we may suggest moving a little quicker, but I'd like to see a bit more data before saying that for certain.

The 3-6 cycles for changes are based on experience here, not scientific research. Sorry 'bout that. Some cats need more time to settle into a new dose. Others adjust fairly quickly. Time and data will help you figure out what works best for Simba. You can't say that a curve on the 4th cycle is necessarily any more accurate than any other cycle. You'll soon see that data builds on itself, and you can't take one cycle in isolation as being "accurate" more than any other cycle. Some cats will have a nice insulin response, and then get stuck up in higher flat numbers for a few cycles. Other cats will push back on a dose change and stay high on the initial cycles, then suddenly dropping on a later cycle. it's going to take a little time, and we are here to help. You'll get the hang of it soon enough, but at first it can be a bit perplexing.

Lantus has very clear protocols, but Prozinc is a nice combination of art and science and gut instinct and data analysis. It's not as clear cut, but it is interesting! And don't worry -- you're not alone.

Now for a question for you: what is Simba eating? Regular food as well as treats?
 
Welcome Eric and Simba! I'm so glad your boy is home. You'll need to be extra vigilant post-DKA because they can remain a bit fragile for several weeks afterward. Ask me how I know ... :confused:

Great advice from Djamila. She's a ProZinc expert! I've used it on my complicated kitty too. Rachel will be here to help as well. :)
 
Hi Eric and Simba! Welcome to our forum!

Yes Djamila has given excellent advice as always. I completely understand wanting to keep your vet in the loop. I was very lucky in that my vet saw my SS and told me I was doing it exactly right and just as she would do. That vet had her own diabetic dog at home which reassured me a lot. There is no specific research I know of but I can tell you I’ve been on the forum since 2013 and I’ve seen so many cats get regulated and even go into remission. Please do ask all the questions you want and feel free to ask us anything your vet wants to know! We’re happy to help.
 
Djamila said:
Do you have ketone test strips at home so you can keep an eye on him?
Click to expand...
Yup, picked them up as soon as he came back from the first hospital. Been testing whenever I catch him at the box. Last night's test came up with trace levels.

Djamila said:
It looks like you somehow got hold of an old spreadsheet. Before you get too far into this, you might want to switch to this one: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Click to expand...
Thanks - link in sig has been updated.

Djamila said:
You should be testing before each shot, and then scatter tests around in the middle of the cycle - generally focusing around +4 to +7 as your schedule allows. If you're able to collect regular data, then you only need a full curve every couple of weeks or so. Take a look at some of our spreadsheets to start to get a sense of it.
Click to expand...
This makes sense. There's usually not going to be anyone around to check him between ~+2-8, though. Also, you guys do quite a bit more testing than any of the vets ever mentioned to us. I can see why it's helpful.

Djamila said:
In the beginning it's typical to hold the initial dose for a week-ish to begin to adjust to the new insulin, and then start to make changes. Given your high numbers and recent DKA we may suggest moving a little quicker, but I'd like to see a bit more data before saying that for certain.
Click to expand...
I see. Either way, I'll be doing my best to get a pretty full curve today to hopefully get a better idea of how his BG fluctuates intraday. I would be surprised if he gets as low as 350.

Djamila said:
Lantus has very clear protocols, but Prozinc is a nice combination of art and science and gut instinct and data analysis. It's not as clear cut, but it is interesting! And don't worry -- you're not alone.
Click to expand...
Sounds like we're in for a ride :cat:

Djamila said:
Now for a question for you: what is Simba eating? Regular food as well as treats?
Click to expand...
Fancy Feast Classics, 2x 3oz cans twice a day. He's a pretty big guy and definitely not overweight (tall? long?)
I picked up a bag of dehydrated fish (0g fat, 0g carbs, low sodium, low calories) today to reward him after BG tests. Gave him 2-3 flakes for his +3 today, which the packaging says is still under 1 kcal.
Aside from that, we have never given him other treats.


Thanks for the welcome, everybody. It's really a big relief to see so many people willing to help out :bighug:
 
Well, it's still high of course, but it's good to see at least a little response!

It sounds like he's on a good diabetic-friendly diet with healthy treats. I would suggest adding a couple of tablespoons of water to the food as well to help with hydration and help keep the ketones flushed out.
Given the numbers and the ketone concern and your work schedule, I would say to go ahead and do a little increase now and move up to 2.25u
 
Found a syringe yesterday that was filled but never injected. Must've missed one since he came back from the hospital. Awful timing for that to happen - going to wait another couple days to see how he goes. Took AM & PM PS levels today and they were a bit lower.
We've been adding a bit of water to his food to keep him hydrated. Don't want to add so much that he doesn't finish the food, though.
 
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