? BG levels consistently high, looking for thoughts re changing insulin type

[Michele & Theo]

My Theo has been on Prozinc insulin since the end of January 2019. We started Prozinc at 2u 2x/day (corrected from 1.5u 2x/day) and have increased the dosage twice since then to the current dose of 3u 2x/day (changes made in discussion with VET). However none of these changes has resulted in a drop in is BG levels (see his spreadsheet). His avg BG levels (both AM and PM) are in the high teen/low 20s mmol/L. His neuropathy is getting worse, now affecting all 4 paws (now cannot jump much more than a a foot or so, if that; problems in the litter box; tires quickly). I have had preliminary discussion with my VET re changing type of insulin and am looking for advice from folks here on a possible different type of insulin which could help bring his levels closer to normal (I need to get a new bottle of insulin in the next couple of days).
Theo eats well (2+ cans/day). I treat his neuropathy with a compounded version of Zobaline (2 caplets/day that were made at a local compounding pharmacy with only the two active ingredients at the same ratio as Zobaline (methylcobalamin+ folic acid) since it is difficult to get the product to Canada.

It was suggested in another Forum response to the same question that I should ask about the Lantus or Levemir as alternatives to Prozinc for Theo's high BG levels

 

[Chris & China (GA)]

Both Lantus and Levemir are good choices, but they need to be used correctly. The way you've been using the ProZinc isn't the recommended way we do here.

We don't recommend doing dose increases in whole units....we do them in .25 unit increments. Too much insulin can look like too little.

It's also important to get tests on the PM cycle....most cats go lower at night and if your cat is doing that, he could be dropping low at night and then bouncing high during the day. Without testing, there's just no way to know.

We also don't hold a dose that's not working for the length of time you have. If it's not getting them where we want them, we increase the dose every 3-7 days.

I think you could try either Lantus or Levemir, but I'd really encourage you to post often and get advice from those members that have a lot of real life experience with treating this disease.

I don't mean to sound like you've done anything wrong or anything.....I know it's hard to trust a bunch of crazy cat ladies on the internet over your vet, but we've found that the vast majority of vets just really don't know what they're doing when it comes to treating a sugarcat.

 

[Ella & Rusty & Stu(GA)]

Hi Michelle and welcome to you and Theo,

As I understand it, Prozinc is an in-and-out insulin: the dose stops working when it is "used up" even though that may be considerably earlier than the 12 hours we expect from a dose of insulin. Both Lantus and Levemir are "depot" insulins: every time you shoot your dose, some of the insulin remains in the cat's body as a "depot". The depot gives the insulin its ability to work over a 12-hour period. Therefore it will probably benefit you to switch to either Lantus or Levemir. You can read about both in the informational posts ("Stickies") at the top of this forum.

Theo is now getting 3 Units of Prozinc, but, as @Chris & China (GA) pointed out, you have been holding his dose for a long time before raising it. And you have been raising his dose in full units. Do read the "Stickies" about how to dose Lantus and Levemir, when and by how much to raise the dose, and about the differences between the two insulins. We use two dosing methods here: Tight Regulation (TR) and Start Low Go Slow (SLGS). You will read about them in the "Stickies" and can decide which one would work best for your lifestyle and schedule. (You can switch from one to the other if need be, so it is not an irrevocable decision.)

I don't know at what dose you should start. I hope that someone else will be able to help you with starting dose. Normally we would start with a dose that is close to the present dose of Prozinc, but since you have raised Theo's dose by a full unit each time, that might not be correct in your case.

When you switch to either Lantus or Lev, it will be more economical to purchase the insulin in boxes of 5 pens or cartridges. You use these as "mini" vials, drawing the insulin with a syringe from the gasket of the pen or cartridge. Both Lantus and Lev are U100 insulins, so you must purchase U-100 syringes.

Best of luck to you and your beautiful kitty. You will find a lot of help here on the Lantus and Lev. forum.

 

[Michele & Theo]

Both Lantus and Levemir are good choices, but they need to be used correctly. The way you've been using the ProZinc isn't the recommended way we do here.

We don't recommend doing dose increases in whole units....we do them in .25 unit increments. Too much insulin can look like too little.

It's also important to get tests on the PM cycle....most cats go lower at night and if your cat is doing that, he could be dropping low at night and then bouncing high during the day. Without testing, there's just no way to know.

We also don't hold a dose that's not working for the length of time you have. If it's not getting them where we want them, we increase the dose every 3-7 days.

I think you could try either Lantus or Levemir, but I'd really encourage you to post often and get advice from those members that have a lot of real life experience with treating this disease.

I don't mean to sound like you've done anything wrong or anything.....I know it's hard to trust a bunch of crazy cat ladies on the internet over your vet, but we've found that the vast majority of vets just really don't know what they're doing when it comes to treating a sugarcat.

My mistake re dosing. We started at 2 units and increased by 0.5u twice to get to the 3u 2x/day we are currently at. I will correct my original post.