Bob - Been switched to Prozinc

[Tilou]

Hi everyone

We've just collected Bob from a two day stay at our vet's hospital, where she has had him on a drip to try and regulate his diabetes, a his BG was off the scale. In the course of this she has switched him from Lantus to Prozinc - hence my posting to this part of the forum.

I must point out, before I ramble on, that we are Scots living in France. Our vet is French and speaks hardly any English. Our French is fair to middling - until it becomes a case of discussing complicated medical issues!

I know a lot about Lantus (as DH uses it to manage his human diabetes) but am new to Prozinc. I have read the notices posted on this forum - a big thank you to everyone who pulls this information together.

The vet says Bob has a complex diabetes and she's started him off on 2ui morning and evening with instructions to feed him before giving him his shot. Here in France they are very keen on dry food diets, but Bob had always been on a mixed diet, with wet food as his main intake and dry "kibbles" as snacks and she's ok for us to continue that (thank goodness as I have just taken delivery of a couple of dozen packs of Animonda wet food!)

She's also requested that we try to limit Bob to set mealtimes - something he's never done in 13 years. Because we've had up to eight cats in the household, over the years, a running buffet has always been on offer.

Needless to say on arrival back the first thing Bob did was sit at his (empty) food station. When I didn't feed him he did something he's never done before... took out his frustration on our faux leather sofa and has left some lovely claw rips in it!

He then took himself outside to a favourite mouse hunting area of the garden - at which point I capitulated and opened a tin of Almo Nature chicken, which he ate and then went to his bed.

He is so lively now compared to prior to his hospitalisation and even though the vet said his BGs have only reduced by a margin, he's obviously feeling great.

Interestingly the vet also said there was no need for me to check his bloods several times a day now. She suggested once a week or if we suspected a hypo. She will do a control test in 10-15 days.

So I'm back to basics.... I can see this is going to be fun.

 

[Kris & Teasel]

Welcome! I'm glad you've read the ProZinc stickies. It's a good idea to print them out so you can make notes on them or flag things you have questions about.

Was it your vet's advice to switch him to ProZinc? Lantus can usually keep them flatter when dosed according to the TR or SLGS guidelines on that forum and I see on your SS that he was on it for only a little over a month. I also see some more frequent dose changes than are recommended with Lantus. That can interfere with the size of the depot and lead to erratic responses. I'm sure the L forum people said these things.

A bouncy cat like your kitty is hard to regulate on any insulin but we'll do our best to help. Here are the things you'll "hear" from us ad nauseam:

• you need a pre shot test before every dose (no food at least 2 hours beforehand)
• try hard to remove all high carb dry food from his diet - if he's carb sensitive it'll wreak havoc with his BG
• if he goes outdoors that adds another layer of complexity to his situation.

Re feeding: most of us feed several small meals of wet food a day. It keeps kitty happier and can help to stabilize BG.

 

[Djamila]

So he's been on three different insulin types since January? Have you already started the Prozinc? If not, I would suggest keeping with the Lantus and studying and following the protocols over there instead of switching him again. It can take several months on an insulin before a cat starts to be regulated. We often say that managing diabetes is a marathon, not a sprint. It takes time and careful consistency to get the best results.

It will be very important to figure out the carb contents of the food you are giving him. Anything over 10% carbs is too much. Usually you have to write to the company to get the carb % since it isn't included in the packaging of most pet foods. If it's over 10%, that is likely why your kitty is in such high numbers and bouncing around. Carbs are very hard on them since their bodies are not designed to process them. So see if you can find some contact info for the company and you can also post the ingredients on the Main forum - sometimes folks can get an idea from the ingredients if it is obviously okay or not okay.

 

[Tilou]

Thank you for the replies

Unfortunately this is yet another change of insulin. Bob was originally diagnosed by our old vet (and it was a late diagnosis!) who only uses Caninsulin and a dry food regime. Caninsulin was only lasting around six hours, so having researched alternatives I initiated a change to Lantus, which went down like the proverbial lead balloon with the vet... as did my use of wet food.

Bob then went down with a reoccurring infection that was very badly handled by our old vet and we switched to a new vet who has only recently set up in town. However, although a young lady (original vet was an older man) the new vet has been trained in the Caninsulin route that is standard here in France. She also derided the use of Lantus and to stamp her authority on the situation, while attempting to appease my DH (who as a diabetic has very strong opinions on the subject) has put Bob on Prozinc. Ironically this adds to our outgoing finances because Lantus didn't cost anything, as my DH gets it on a free prescription that's probably another reason why the vets here don't like to prescribe it.

I'm pleased to hear that the feeding of a little wet food in the period between shots is acceptable. The vet said she'd prefer if we didn't feed Bob between meals - but she doesn't have to live with him!

Bob's wet food is Animonda Integra Diabetic, plus tins of complimentary food by Almo Nature. Carb content in the former is minimal and practically zero in the latter. He does like a treat of dry kibbles, so has the diabetic specific ones although the vet gave me sample packets of Hills Metabolic, which is apparently suitable for diabetic cats, to try. Bob was being fed that while in the hospital.

Bob is an outdoor cat so if I don't feed him when he asks he'll just go out and catch something

Re blood tests, the vet told me there was no need to test so much - once a week would be sufficient. I will test more than that though!

Thanks for all the advice

 

[FurBabiesMama]

I am so tired of ignorant vets. This one point stresses me out more than any other part of managing diabetes. Over and over and over again I see stories of vets telling people the absolute wrong things, and personally, I struggle with finding a vet that does not do the same. There is just not enough time spent educating these people about feline diabetes... or, in many cases, about anything feline-related. Dr. Lisa Pierson has done extensive work in feline nutrition, and if you have not visited her site yet, I recommend it. It is catinfo.org. Simply put, a dry-food diet is never the best choice. A low-carb, high-protein wet food diet is the best. If you feel that you need to include dry food, finding one with the lowest carbs possible is important. These 'prescription' foods vets love to push on people are usually too high in carbs. I have a bag on hand that I use only when Mia's glucose level is getting too low and I need to steer it up - knowing it has that direct impact on her glucose level will prevent me from ever giving it to her as a meal. Feeding only twice a day is something else that a lot of vets tell people to do, yet in my own research, I find that, ideally, they should be fed several times per day. The AAHA guidelines that I have a link to in my signature recommend feeding four times a day. There are updated guidelines which I have not finished reading yet, but I did get far enough to see that they still recommend feeling multiple times.. rather than specifically saying four times now, I think they just say multiple which, to me, leaves it up to the owner based on their cat's needed. I think what is important is making sure your cat will eat some at shot time, that you are not over-feeding if your cat is overweight and that what is fed and when is kept as consistent as possible - consistency is good when you are trying to keep blood sugar level and smooth.

And, home testing... a person would not inject themselves with insulin without knowing their glucose level, so why do so many vets want us to do that to our cats?! If a cat is unexpectedly low, and you give insulin, that can be very dangerous. That is also something I see stories of here.. people listen to their vet and do not test, then the first time their cat has a bad, scary hypo episode, they realize the importance of home testing.

Glargine (Lantus) works well in many cats, and that is well documented, so why a vet would be so against it's use, I do not understand. It has better results and more chance of remission than Caninsulin according to any studies I have seen. ProZinc is a good insulin, too. So, if that insulin makes your vet and husband happy, I hope it works out well for Bob. You can get a lot of great advice, support and understanding here. The more you can educate yourself, the better you will be able to navigate knowing when to listen to the vet and when not to.

(Sorry if this sounds 'fussy'. I am very aggravated with vets right now.. none of the frustration in it is intended for you.)

 

[Rachel]

That's too bad that your vet is against Lantus. Prozinc is a good insulin, don't get us wrong, but getting Lantus for free would definitely be easier for you guys!

I let my cats free feed (I don't have a sugar cat anymore, but when I did, she free fed too) and just took up food 2 hours prior to insulin shots so we could get a true number. Wet food really is best, but I don't know anything about the ones you're using. The Hills dry food is most likely too high in carbs though...most of those prescription diets are.

I'm glad you're going to test more than that! We always test preshot, and get mid cycle numbers whenever possible. The more data you have, the better you can control things (I'm sure you already know this).

Please ask any questions you have. We're happy to help!

 

[Tilou]

I am so tired of ignorant vets. This one point stresses me out more than any other part of managing diabetes. Over and over and over again I see stories of vets telling people the absolute wrong things, and personally, I struggle with finding a vet that does not do the same. There is just not enough time spent educating these people about feline diabetes... or, in many cases, about anything feline-related. Dr. Lisa Pierson has done extensive work in feline nutrition, and if you have not visited her site yet, I recommend it. It is catinfo.org. Simply put, a dry-food diet is never the best choice. A low-carb, high-protein wet food diet is the best. If you feel that you need to include dry food, finding one with the lowest carbs possible is important. These 'prescription' foods vets love to push on people are usually too high in carbs. I have a bag on hand that I use only when Mia's glucose level is getting too low and I need to steer it up - knowing it has that direct impact on her glucose level will prevent me from ever giving it to her as a meal. Feeding only twice a day is something else that a lot of vets tell people to do, yet in my own research, I find that, ideally, they should be fed several times per day. The AAHA guidelines that I have a link to in my signature recommend feeding four times a day. There are updated guidelines which I have not finished reading yet, but I did get far enough to see that they still recommend feeling multiple times.. rather than specifically saying four times now, I think they just say multiple which, to me, leaves it up to the owner based on their cat's needed. I think what is important is making sure your cat will eat some at shot time, that you are not over-feeding if your cat is overweight and that what is fed and when is kept as consistent as possible - consistency is good when you are trying to keep blood sugar level and smooth.

And, home testing... a person would not inject themselves with insulin without knowing their glucose level, so why do so many vets want us to do that to our cats?! If a cat is unexpectedly low, and you give insulin, that can be very dangerous. That is also something I see stories of here.. people listen to their vet and do not test, then the first time their cat has a bad, scary hypo episode, they realize the importance of home testing.

Glargine (Lantus) works well in many cats, and that is well documented, so why a vet would be so against it's use, I do not understand. It has better results and more chance of remission than Caninsulin according to any studies I have seen. ProZinc is a good insulin, too. So, if that insulin makes your vet and husband happy, I hope it works out well for Bob. You can get a lot of great advice, support and understanding here. The more you can educate yourself, the better you will be able to navigate knowing when to listen to the vet and when not to.

(Sorry if this sounds 'fussy'. I am very aggravated with vets right now.. none of the frustration in it is intended for you.)

No worries about sounding "fussy" - I get just as frustrated with the vets, especially the ones here in France who will not be told anything. It drives me nuts!

On the food front, I had looked at the information on Dr Pierson's site. It was one of the first things I searched for when I found this forum. I've tested Bob out with several of the low carb varieties recommended (and are available here in France) and his absolute favourite is the Animonda Integra Diabetic wet food (but only the chicken and beef varieties). He wouldn't touch the GranataPet, Catz Finefood or Kattovit wet food so those tins are heading to the local animal rescue centre. He will also only eat the tins of chicken & prawn by Almo Nature or Cosma complementary food (but won't touch the Cosma sachet version!). He's been used to having some dry food and our original vet, who made the diagnosis, sold us a bag of Royal Canin diabetic biscuits, which Bob loves (sod's law!) So he gets a modicum of those as treats, because he doesn't like actual treats (except bacon rind and butter!).

I'm glad the AAHA guidelines recommend multiple feeding times. I've never restricted any of our cats to a specific timetable - because all nine of them couldn't be guaranteed to be in the house at the same time. So I shall continue with our usual routine for feeding.

As for blood testing - I'm not going to just shoot without testing. As you'll see on Bob's SS I don't get to pre-test every time as Bob still has an active feral element to him and if he doesn't want to be tested then I can't get near him. Interestingly, the vet covered her backside when telling me I didn't need to test quite so much by instructing us to make sure we feed Bob before giving his shot, ho hum

I will certainly keep up to date with news and views on here. I've found the forum invaluable in this journey and really appreciate everyone's help and advice

 

[Tilou]

Yikes! Just done a PMPS BG and Bob's at 34.8 (626). That's as high as he was when he was hospitalised. What's going on?! Given the 2ui instructed by vet and will retest in a couple of hours. I am not a happy bunny

 

[Rachel]

Its hard to say...could be a number of things causing the high BG including food, stress, or something else. Might Ned a few days to settle in to the new insulin too. I know its worrisome but give it a few cycles and let's see what happens.

Do you test for ketones?

 

[Tilou]

Its hard to say...could be a number of things causing the high BG including food, stress, or something else. Might Ned a few days to settle in to the new insulin too. I know its worrisome but give it a few cycles and let's see what happens.

Do you test for ketones?

I hope so. Don't fancy having paid the vet a fortune to have him back with the same numbers - although he is looking and acting a lot better. He was really poorly on Thursday, now he's running about all over the place.

Yes I try to check for ketones using urine strips - quite difficult as I have to stalk Bob into his hiding places outside and it can get rather tricky to collect! The vet did check also and he's been clear from my tests and hers.

Hopefully this is just a blip. Normally when he goes as high as this he becomes incontinent

 

[Tilou]

I'm guessing that we're back to stage one with Bob's diabetes. Despite his two days at the vet's hospital to (supposedly) reduce his BG, its still running in the 20s & 30s (400-600).

I've removed his biscuit treats entirely and he's only eating Animonda and fresh chicken. This morning - after eating almost an entire packet of Animonda - he vomited up most of it, along with a fur ball

So he "re-ate" another packet to replenish what he'd lost by being sick.

Unfortunately we couldn't get an AMPS BG number - he's been really wild and bitey with us since coming back from confinement in the cage at the vet - so my first opportunity to see what his BG is at was at +5 and its at 27, which is better than the 30+ numbers last night.

He's still very lively though - gave a kitten-like chase towards old Joey this morning, who was not impressed

 

[Rachel]

Ouch! Those furballs can be no fun. I've been there...cat eats breakfast and then returns it with a nice hairball! The good news is that he ate again and getting that hairball out had to make him feel better.

You might be back in those high numbers for a bit...and it could be for several reasons. Looking over your SS, I am wondering if being in those higher numbers for a bit hasn't led to some glucose toxicity (NOT as bad as it sounds...basically just means he was stuck in high numbers for awhile, so it's going to take fairly steady increases to get him back down). We've seen that a lot here...it happens. Usually when it does, fairly steady increases keep the cat in high numbers until one day you just break through and suddenly the cat starts coming back down! I'm not sure that's what's happening, but it's possible.

As for testing...do you have a good testing routine? I always took Gypsy to a special spot (towel on the floor by the fridge was ours...some use a counter or back of the couch or wherever...), warmed her ear, tested, and then immediately handed out special "testing treats". They were her favorites and she ONLY got them at test time. That way, she was willing. She even went running to that spot when it was time. She never LIKED it, but she tolerated it for the treats. Do you do something like that? I know that semi-ferals can be harder, but you can get there. It might help Bob be more willing and less bitey.

As for the running around and stuff...great! The other thing to remember while in high numbers is that Bob is more than just a number. You gotta pay attention to how he FEELS and it sounds like he feels pretty good!

 

[Tilou]

Ouch! Those furballs can be no fun. I've been there...cat eats breakfast and then returns it with a nice hairball! The good news is that he ate again and getting that hairball out had to make him feel better.

You might be back in those high numbers for a bit...and it could be for several reasons. Looking over your SS, I am wondering if being in those higher numbers for a bit hasn't led to some glucose toxicity (NOT as bad as it sounds...basically just means he was stuck in high numbers for awhile, so it's going to take fairly steady increases to get him back down). We've seen that a lot here...it happens. Usually when it does, fairly steady increases keep the cat in high numbers until one day you just break through and suddenly the cat starts coming back down! I'm not sure that's what's happening, but it's possible.

As for testing...do you have a good testing routine? I always took Gypsy to a special spot (towel on the floor by the fridge was ours...some use a counter or back of the couch or wherever...), warmed her ear, tested, and then immediately handed out special "testing treats". They were her favorites and she ONLY got them at test time. That way, she was willing. She even went running to that spot when it was time. She never LIKED it, but she tolerated it for the treats. Do you do something like that? I know that semi-ferals can be harder, but you can get there. It might help Bob be more willing and less bitey.

As for the running around and stuff...great! The other thing to remember while in high numbers is that Bob is more than just a number. You gotta pay attention to how he FEELS and it sounds like he feels pretty good!

We were happy to see the fur ball as Bob generally can't bring them up!

I'm beginning to suspect that he was suffering from glucose toxicity (or possibly early symptoms of DKA) but due to language problems with our vet she hasn't explained anything other than she was trying to get his BG down. He was on a drip for two days. From the invoice one bag contained electrolytes, not sure what the other had in it. Whatever the problem was last Wednesday, Bob is 100x better for the treatment.

As for blood tests, he is a nightmare. Hates his ears being touched and doesn't react to treats. I test on his back paw pads, so that's another reason I limit the times I do it because I don't want him to pick up any infection in his feet as he's an outdoor cat. The main signal I get in order to know he's going too high is his water consumption, because when he's in a lower range he rarely drinks.

At the moment we're just happy he's a lot more active and has got his "oommph" back!