Changing Insulin

[ChristineS]

When Wyatt was Dx on 01/21 he was prescribed 2units of Vetsulin every 12 hours. After reading about it, I want to transition him to Lantus or Prozinc. He sees his vet for a follow up tomorrow, and a fructosamine test. He, as well as his fur-sibs, have all been transitioned away from dry food! Some days I notice improvement, and other days, I don't. I know it's a journey, and we are just getting started! Also plan on home testing starting this weekend when it won't be rushed or stressful with work schedules, etc. Any thoughts or suggestions??? TIA!

 

[FrostD]

So I'll say this - we had good luck with Vetsulin for awhile. I know the general consensus is it's not great for cats, but worked for us (and my vet has seen it work in many cats). It might be worth giving it a try for a little while, especially if you already have the insulin and syringes. I will say there are fewer users with Vetsulin experience than the other insulins, and this forum specifically can be slow to get replies.

The most important thing you can do is the home testing - will save you from having to pay for fructosamine tests and glucose curves at the vet, and make sure it's safe to give Wyatt each dose. This post has a lot of helpful information and videos. If you don't already have them, you'll want to purchase some lancets. A lot of us just use the cheap 26 or 28 gauge ReliOn ones from WalMart, and find it easier to "free-hand" it instead of using a lancing device. Make sure the ear is warm and you're aiming for the "sweet spot", both explained in the link above.

Have you purchased a meter yet? If so, great! Be sure to put it in your spreadsheet. If not, a lot of us use human meters (instead of pet meters) due to lower cost. You'll end up going through a LOT of strips over time. The ReliOn Prime and Freestyle Lite are pretty popular, but you'll want a meter that (1) requires a small sample size (0.3-0.5uL) and (2) that you can easily get strips for in your area.

One of the main health concerns with diabetic cats on insulin is hypoglycemia (too low blood sugar), please have a read through this when you get a chance.

I see you already set up spreadsheet and signature, great first step! When you get a chance, there's a bit more info we like to see in the signature.

Back to your question - when considering ProZinc vs Lantus, here are some of the major differences:
- PZI is a U40 insulin still, so you wouldn't have to go buy more/different syringes if you already have a stockpile. Lantus is U100, therefore different syringes.
- PZI is lower cost per vial. A lot of users in the US and CAN buy insulin from Mark's Marine Pharmacy in Canada as they tend to have the best price.
- Lantus has a higher remission rate for newly diagnosed cats


Since you mentioned work schedules, some other things to know:
- PZI has more leeway in dose schedule, you can shoot +/- 1 hr from the scheduled time (for example, AM shot at 7am. The PM shot can be as early as 6p or as late as 8p). Lantus is +/- 15 minutes.
-PZI you feed, wait 20-30 mins, then give the dose. With Lantus, you don't have to wait to give the dose.

As an FYI the information above is condensed from the stickies in the PZI and Lantus Insulin Support groups. They contain a LOT of information that can be overwhelming for people who are new to this, but if you're feeling adventurous that's where to find all the info you ever wanted

 

[FrostD]

Also, after your vet visit tomorrow...I would not recommend any changes to dosage until you get a few days worth of home testing (at least the AM/PM preshots, some in the +2 to +6 range also very helpful). I'd also recommend and at-home curve as soon as you can.

More than likely your vet will recommend a dose change after getting results, unless the vet suggests a reduction, I'd very strongly caution against changing dose until you have more data. Blind dose changes by the vet messed us up a lot early on before I found this forum. And if the vet does suggest a reduction, you'll want to do it slowly over a few days and be testing for ketones.

 

[Shelley & Jess]

PZI you feed, wait 20-30 mins, then give the dose. With Lantus, you don't have to wait to give the dose.

Test/Feed/Shoot Prozinc too, no waiting between feeding and shooting required either.

Vetsulin/Caninsulin or NPH (humulin/novolin) are in-and-out insulins too but you need to wait between feeding and the insulin shot with these insulins because they onset faster than Prozinc.

 

[ChristineS]

Also, after your vet visit tomorrow...I would not recommend any changes to dosage until you get a few days worth of home testing (at least the AM/PM preshots, some in the +2 to +6 range also very helpful). I'd also recommend and at-home curve as soon as you can.

More than likely your vet will recommend a dose change after getting results, unless the vet suggests a reduction, I'd very strongly caution against changing dose until you have more data. Blind dose changes by the vet messed us up a lot early on before I found this forum. And if the vet does suggest a reduction, you'll want to do it slowly over a few days and be testing for ketones.

My husband took Wyatt to the vet. We are waiting for numbers to come back. But they won't change his insulin. I will give it a few months and if we cannot get him stable I will insist on a change or get a new vet! Also, they said we needed to get a AT pet meter, did not like our Relion well too bad! Said numbers weren't same lol well no kidding! Also told my husband that we do not need to test daily, only when he is looking off or not acting himself, but they did suggest doing a curve at home in a few weeks to see where he's at.

 

[ChristineS]

My husband took Wyatt to the vet. We are waiting for numbers to come back. But they won't change his insulin. I will give it a few months and if we cannot get him stable I will insist on a change or get a new vet! Also, they said we needed to get a AT pet meter, did not like our Relion well too bad! Said numbers weren't same lol well no kidding! Also told my husband that we do not need to test daily, only when he is looking off or not acting himself, but they did suggest doing a curve at home in a few weeks to see where he's at.

The vet upped his dose to 3 units every 12 hours............this scares me!

 

[FrostD]

My husband took Wyatt to the vet. We are waiting for numbers to come back. But they won't change his insulin. I will give it a few months and if we cannot get him stable I will insist on a change or get a new vet! Also, they said we needed to get a AT pet meter, did not like our Relion well too bad! Said numbers weren't same lol well no kidding! Also told my husband that we do not need to test daily, only when he is looking off or not acting himself, but they did suggest doing a curve at home in a few weeks to see where he's at.

Yeesh. I'd start looking for a new vet, sounds eerily like my first one (and every other bad vet on this forum!).

The ReliOn will do just fine for you, and you won't go broke just buying strips! Human meters tend to read lower, but the benefit is most of the guidelines on this forum were made with human meters in mind. And more importantly, we are looking for trends, not necessarily hard numbers.

When you get a chance, be sure to fill out the top two rows on the spreadsheet. You can leave the Dosing Method blank or put "N/A".

Be sure to come back and update once you get the blood work back, along with any recommendations/comments from the vet. There's a LABS tab in the spreadsheet you can use.

Additionally, be sure to update us once you start testing! Ideally we'd like a few days' worth of data and a curve before thinking about changing the dose.

 

[FrostD]

The vet upped his dose to 3 units every 12 hours............this scares me!

I would strongly caution against that without any testing. The worst that will happen by keeping your current dose is his BG will remain high, which is safer than raising the dose and him potentially dropping into a hypo.

Is there any chance you can attempt preshot testing today or tomorrow?

 

[ChristineS]

Yeesh. I'd start looking for a new vet, sounds eerily like my first one (and every other bad vet on this forum!).

The ReliOn will do just fine for you, and you won't go broke just buying strips! Human meters tend to read lower, but the benefit is most of the guidelines on this forum were made with human meters in mind. And more importantly, we are looking for trends, not necessarily hard numbers.

When you get a chance, be sure to fill out the top two rows on the spreadsheet. You can leave the Dosing Method blank or put "N/A".

Be sure to come back and update once you get the blood work back, along with any recommendations/comments from the vet. There's a LABS tab in the spreadsheet you can use.

Additionally, be sure to update us once you start testing! Ideally we'd like a few days' worth of data and a curve before thinking about changing the dose.

I need to look at the SS and get familiar with it, and then of course, start filling it in!

 

[ChristineS]

I would strongly caution against that without any testing. The worst that will happen by keeping your current dose is his BG will remain high, which is safer than raising the dose and him potentially dropping into a hypo.

Is there any chance you can attempt preshot testing today or tomorrow?

That was what I thought about upping the dose, I do not know if they gave my husband the numbers or not. They just said his fructosomine was on the high end so mabye that's why they upped it? I wish I had been able to go to the vet myself but unfortunately I could not. They scheduled him a return visit in 3 months.

Yes I am going to try to test tonight!

 

[FrostD]

That was what I thought about upping the dose, I do not know if they gave my husband the numbers or not. They just said his fructosomine was on the high end so mabye that's why they upped it? I wish I had been able to go to the vet myself but unfortunately I could not. They scheduled him a return visit in 3 months.

Yes I am going to try to test tonight!

Yes, they probably upped it based on whatever the results were.

Good luck! Don't let it stress either of you out too much, it takes practice to get the hang of it. We went through a lot of ear pokes early on. Just remember to look at the post I linked a few replies ago with the tips and videos and stuff.

 

[ChristineS]

Yes, they probably upped it based on whatever the results were.

Good luck! Don't let it stress either of you out too much, it takes practice to get the hang of it. We went through a lot of ear pokes early on. Just remember to look at the post I linked a few replies ago with the tips and videos and stuff.

Thank you Melissa & Mr. Kitty!

 

[Critter Mom]

Hi Christine,

And if the vet does suggest a reduction, you'll want to do it slowly over a few days and be testing for ketones.

Melissa has given you some great advice above but I have a different view on this particular point. If at any time a dose reduction is indicated, it needs to be taken immediately otherwise there is a risk of overdosing the cat. (If home testing subsequently shows that the reduction didn't hold the dose can always be increased again based on the cat's data.)

I agree that it is a wise safety precaution to test for ketones when it's not known what range a cat is running in and when an insulin dose is reduced (or skipped), doubly so if if your cat has any history of testing positive for ketones or episodes of diabetic ketoacidosis. The problem with the fructosamine test is that it only gives an average of what the cat's BG has been doing over the past 1-3 weeks. It doesn't give any information on how low a dose might be taking the cat in any particular cycle.

The vet upped his dose to 3 units every 12 hours............this scares me!

That's a big increase in dose. Did your vet base the dose increase solely on the fructosamine result or did they also run a curve? If they ran a curve, did they give you the readings? (Note: Vet curves may be stress-influenced but some data is better than none.) If you did get the readings since your earlier post and also the fructosamine result it would be great if you could post them here as it will help members replying to your posts to help you better.

As Melissa says above, if you could get a few days' worth of test data it would give you a better basis for assessing dose. The FDMB Vetsulin guidelines recommend dose increases of 0.25-0.50IU, depending on the range in which a kitty is running. Larger upward adjustments increase the risk of skipping over a good dose and also the risk of the cat going too low.

If I understand correctly Wyatt's not due back to the vets for a review of his diabetes for 3 months. If so, you've got time to do gradual adjustments to his dose based on readings you take each day. You can post for any help you need. It may be that he will need a 3.0IU BID dose but getting there in small increments is likely to be safer (with the caveat that ketones need to be monitored as a safety precaution).


Mogs
.

 

[FrostD]

Hi Christine,


Melissa has given you some great advice above but I have a different view on this particular point. If at any time a dose reduction is indicated, it needs to be taken immediately otherwise there is a risk of overdosing the cat. (If home testing subsequently shows that the reduction didn't hold the dose can always be increased again based on the cat's data.)
.

This is a great point, and I should have been more clear. The reductions should be done in 0.25U increments. By "slowly" I meant if the vet all of a sudden says drop him by a full 1U, I wouldn't just immediately drop him all that way at the next dose. So I would reduce by 0.25U the first day, and as long as home testing is showing nadirs above 90, hold that dose for a few days.

To Mogs' point, any time you get a reading less than 90, that's an immediate 0.25U reduction.

But as always, the home testing is key!

 

[Critter Mom]

Hi Melissa,

This is a great point, and I should have been more clear. The reductions should be done in 0.25U increments. By "slowly" I meant if the vet all of a sudden says drop him by a full 1U, I wouldn't just immediately drop him all that way at the next dose. So I would reduce by 0.25U the first day, and as long as home testing is showing nadirs above 90, hold that dose for a few days.

By way of general info, there may be exceptions to that general method. From the FDMB Vetsulin guide:

The general guidelines for making dose changes are:

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
• HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.

[Emphasis mine]

One scenario where larger and/or faster dose reductions may be needed is where a cat has been transitioned to a low carb food and tips into remission as a consequence and races down the dosing scale. Here's a recent example:

The above cat needed to have its dose reduced from 2.0IU Vetsulin down to zero in the space of 6 cycles.

Another example of a time when larger and faster reductions may be needed is when a newly-arrived cat is being severely overdosed (happens).



Mogs
.

 

[FrostD]

Hi Melissa,


By way of general info, there may be exceptions to that general method. From the FDMB Vetsulin guide:

The general guidelines for making dose changes are:

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
• HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.

[Emphasis mine]

One scenario where larger and/or faster dose reductions may be needed is where a cat has been transitioned to a low carb food and tips into remission as a consequence and races down the dosing scale. Here's a recent example:


View attachment 59681


The above cat needed to have its dose reduced from 2.0IU Vetsulin down to zero in the space of 6 cycles.

Another example of a time when larger and faster reductions may be needed is when a newly-arrived cat is being severely overdosed (happens).



Mogs
.

Another good point, I didn't want to drop too much information at once. Similar happened to Mr Kitty when I transitioned to low carb, he dropped like a rock and I had to drop dose almost as fast as the one you showed. If only those blues and greens stuck around...

 

[Critter Mom]

I didn't want to drop too much information at once.

Safety info's always droppable.

Similar happened to Mr Kitty when I transitioned to low carb, he dropped like a rock and I had to drop dose almost as fast as the one you showed.

Ditto for Saoirse. Not helped by her going off food altogether after a spot-on treatment.

If only those blues and greens stuck around...

Please God, they'll be back again soon. (((Mr. Kitty)))


Mogs
.

 

[ChristineS]

Hi Christine,


Melissa has given you some great advice above but I have a different view on this particular point. If at any time a dose reduction is indicated, it needs to be taken immediately otherwise there is a risk of overdosing the cat. (If home testing subsequently shows that the reduction didn't hold the dose can always be increased again based on the cat's data.)

I agree that it is a wise safety precaution to test for ketones when it's not known what range a cat is running in and when an insulin dose is reduced (or skipped), doubly so if if your cat has any history of testing positive for ketones or episodes of diabetic ketoacidosis. The problem with the fructosamine test is that it only gives an average of what the cat's BG has been doing over the past 1-3 weeks. It doesn't give any information on how low a dose might be taking the cat in any particular cycle.


That's a big increase in dose. Did your vet base the dose increase solely on the fructosamine result or did they also run a curve? If they ran a curve, did they give you the readings? (Note: Vet curves may be stress-influenced but some data is better than none.) If you did get the readings since your earlier post and also the fructosamine result it would be great if you could post them here as it will help members replying to your posts to help you better.

As Melissa says above, if you could get a few days' worth of test data it would give you a better basis for assessing dose. The FDMB Vetsulin guidelines recommend dose increases of 0.25-0.50IU, depending on the range in which a kitty is running. Larger upward adjustments increase the risk of skipping over a good dose and also the risk of the cat going too low.

If I understand correctly Wyatt's not due back to the vets for a review of his diabetes for 3 months. If so, you've got time to do gradual adjustments to his dose based on readings you take each day. You can post for any help you need. It may be that he will need a 3.0IU BID dose but getting there in small increments is likely to be safer (with the caveat that ketones need to be monitored as a safety precaution).


Mogs
.

Yes they based the increase in dose soley on the fructosamine test. The number was 445.

I did not adjust his dose! Held at 2U every 12 hours.

We started testing last night and I have updated my SS!
I wanted to gather some data, and do a curve next weekend before increasing him based solely on the fructosamine test at the vet. Thoughts?

 

[Critter Mom]

Hi Christine,

Great job getting your first tests in. Well done!

I wanted to gather some data, and do a curve next weekend before increasing him based solely on the fructosamine test at the vet. Thoughts?

I like this plan!

Kitty permitting, the following tests are recommended:

1. AMPS and PMPS every day (to make sure it's safe to give insulin - stall without feeding and post for help if PS <200 - test again 20-30 minutes later to see whether BG has come up high enough, and hopefully someone will have replied by then - see the FDMB Vetsulin guide for further info on this). No food 2 hours before each PS test (unless an emergency is in progress and food is being used to keep BG up).

2. At least 1 test between shot times each day - ideally one round likely nadir time in the AM cycle and a before-bed test every evening to gauge safety.

* Tests around +2: may help catch fast/steep drops and may provide an early warning of the need for additional tests/food intervention in the current cycle (in case BG might go too low).

* Tests between +3 and +6: Best time to try to catch nadir BG until you learn more about Wyatt's particular style of response to his insulin.

* Tests later than +6: typically throw light on dose duration but may also catch later nadirs.

The daily tests are really important for safety, and also for getting a better picture of how Wyatt's responding. Curves are definitely helpful but there's always the risk that one might run a curve on a day when a cat is bouncing, in which case the curve data in isolation might make it look like the dose is too low. Having both formal curve and day-to-day nadir checks provides a much fuller picture of how safe and effective a given dose is, and the combination provides a much better basis for dose adjustment decisions.

Be sure to give a shout for any help you need, Christine. If the Vetsulin board is quiet and you don't get a timely reply, remember you can always post on Feline Health for assistance (more footfall).


Mogs
.

 

[ChristineS]

Hi Christine,

Great job getting your first tests in. Well done!


I like this plan!

Kitty permitting, the following tests are recommended:

1. AMPS and PMPS every day (to make sure it's safe to give insulin - stall without feeding and post for help if PS <200 - test again 20-30 minutes later to see whether BG has come up high enough, and hopefully someone will have replied by then - see the FDMB Vetsulin guide for further info on this). No food 2 hours before each PS test (unless an emergency is in progress and food is being used to keep BG up).

2. At least 1 test between shot times each day - ideally one round likely nadir time in the AM cycle and a before-bed test every evening to gauge

* Tests around +2: may help catch fast/steep drops and may provide an early warning of the need for additional tests in the current cycle (in case BG might go too low).

* Tests between +3 and +6: Best time to try to catch nadir BG until you learn more about Wyatt's particular style of response to his insulin.

* Tests later than +6: typically throw light on dose duration but may also catch later nadirs.

The daily tests are really important for safety, and also for getting a better picture of how Wyatt's responding. Curves are definitely helpful but there's always the risk that one might run a curve on a day when a cat is bouncing, in which case the curve data in isolation might make it look like the dose is too low. Having both formal curve and day-to-day nadir checks provides a much fuller picture of how safe and effective a given dose is, and the combination provides a much better basis for dose adjustment decisions.

Be sure to give a shout for any help you need, Christine. If the Vetsulin board is quiet and you don't get a timely reply, remember you can always post on Feline Health for assistance (more footfall).


Mogs
.

Thank you for all of the detailed feedback. I did the testing this time! Not too bad, lucky Wyatt is a good boy. It was at +6.5 but I'm not sure how to note that in his SS. He was at 244.

 

[Critter Mom]

Hi Christine,

Glad to hear Wyatt is being so co-operative. You're doing great!

It was at +6.5 but I'm not sure how to note that in his SS.

From the How to Use the Spreadsheet sticky post:

Additional testing might also occur during the cycle and should be recorded as shown below:



In the example above, the first test of 103 was taken at +2 followed by another test (57) at +2.5. Two tests were taken from +3 to +4 and are recorded in the +3 column. Two tests were taken from +4 to +5 and are recorded in the +4 column; two tests were taken from +5 to +6 and recorded in the +5 column. The last test was taken at +6 and recorded in that column.

It will be necessary to manually color in the cells when recording more than just a whole number in the cell. To do this:

• record the data in the correct cell (e.g. 185 @ +3.25)
• select the color from the ranges at the top of the SS which coincides for the test (e.g. 185 would be blue)
• in the SS toolbar at the top, click on the icon which looks like a pitcher which should also show the text “fill color” when you move the arrow over it
• next, in the SS toolbar at the top, click on the underscored A to the left of the pitcher; this should show the text “text color” when you move the arrow over it.

For your test, you'd record "244 @ 6.5" in the '+6' cell and then manually colour it yellow.


Mogs
.

 

[ChristineS]

Hi Christine,

Glad to hear Wyatt is being so co-operative. You're doing great!


From the How to Use the Spreadsheet sticky post:

Additional testing might also occur during the cycle and should be recorded as shown below:



In the example above, the first test of 103 was taken at +2 followed by another test (57) at +2.5. Two tests were taken from +3 to +4 and are recorded in the +3 column. Two tests were taken from +4 to +5 and are recorded in the +4 column; two tests were taken from +5 to +6 and recorded in the +5 column. The last test was taken at +6 and recorded in that column.

It will be necessary to manually color in the cells when recording more than just a whole number in the cell. To do this:

• record the data in the correct cell (e.g. 185 @ +3.25)
• select the color from the ranges at the top of the SS which coincides for the test (e.g. 185 would be blue)
• in the SS toolbar at the top, click on the icon which looks like a pitcher which should also show the text “fill color” when you move the arrow over it
• next, in the SS toolbar at the top, click on the underscored A to the left of the pitcher; this should show the text “text color” when you move the arrow over it.

For your test, you'd record "244 @ 6.5" in the '+6' cell and then manually colour it yellow.


Mogs
.

Thank you again, Mogs! I think I am getting the hang of this! I test all by myself this morning. I have a question..........what is a "good" range for cats to kind of reside in........or is that different for each cat, also depending on time of day, etc.

 

[FrostD]

Thank you again, Mogs! I think I am getting the hang of this! I test all by myself this morning. I have a question..........what is a "good" range for cats to kind of reside in........or is that different for each cat, also depending on time of day, etc.

We aim for regulation first, here's a link that defines that. Beyond regulation is remission, also defined in that link. Not all cats can achieve remission, but chances are better the more quickly you can get regulated.

I am not sure if the tight regulation mentioned can always be achieved on Vetsulin, or even ProZinc. That's more with the depot insulins, since they generally produce flatter curves than the in-and-out insulins. I'm sure Mogs is about to hit us with a bunch of info!

The other thing to keep in mind is the renal threshold...for most cats it's somewhere between 200-280. This is the point beyond which glucose "spills over" into the kidneys and urine and can cause kidney issues over time.

I know for us, as soon as Mr Kitty goes above 250-ish, the polyuria and polydipsia start and the litter is basically glue. He also often goes outside the litter box.

 

[ChristineS]

We aim for regulation first, here's a link that defines that. Beyond regulation is remission, also defined in that link. Not all cats can achieve remission, but chances are better the more quickly you can get regulated.

I am not sure if the tight regulation mentioned can always be achieved on Vetsulin, or even ProZinc. That's more with the depot insulins, since they generally produce flatter curves than the in-and-out insulins. I'm sure Mogs is about to hit us with a bunch of info!

The other thing to keep in mind is the renal threshold...for most cats it's somewhere between 200-280. This is the point beyond which glucose "spills over" into the kidneys and urine and can cause kidney issues over time.

I know for us, as soon as Mr Kitty goes above 250-ish, the polyuria and polydipsia start and the litter is basically glue. He also often goes outside the litter box.

Melissa - I was looking at Mr. Kitty's SS and now that I am tracking I understand what I am looking at! I see he was on Vetsulin then ProZinc and now on Lantus. Are you liking the Lantus? I'm hoping to get my vet to switch Wyatt to Prozinc or Lantus.

 

[FrostD]

Melissa - I was looking at Mr. Kitty's SS and now that I am tracking I understand what I am looking at! I see he was on Vetsulin then ProZinc and now on Lantus. Are you liking the Lantus? I'm hoping to get my vet to switch Wyatt to Prozinc or Lantus.

Correct - it was a little chaotic. We did well on Vetsulin (better than most cats), then who knows what happened. We thought the vial went bad in the fridge because we were having trouble with the fridge. Decided to switch to ProZinc because it's a little more gentle, but still affordable. He just felt like crap on it, but lots of cats do well on it. Soooo decided to hop back to Vetsulin, didn't get results.

In retrospect, I think he developed glucose toxicity by then. And perhaps if i had run the Vetsulin dose up some more, we would have broken through it. But who knows!

As for Lantus...no opinion yet. I think I'm still fighting glucose toxicity, so I just have to keep on with the dose increases until we break through it. I like the flexibility of the dosing methods, and I think the flatter curves you get are much better for the body. But tight regulation (trying to keep BGs consistently in the greens) is a LOT of work once you get to that point.

One other thing to know - Lantus and Levemir aren't as good at "grabbing" high BGs and bringing them down. Their "strong suit" is keeping low BGs low. So it takes a bit of time to see results of Bags are pretty high to begin with.

 

[Critter Mom]

I'm sure Mogs is about to hit us with a bunch of info!

I'm good like that!

I am not sure if the tight regulation mentioned can always be achieved on Vetsulin, or even ProZinc. That's more with the depot insulins,

Correct. The Tight Regulation protocol is exclusively for use with Lantus/Basaglar and Levemir. Those insulins are typically gentler acting and longer lasting, and - with adequate testing - it's possible to safely drop the no-shoot limit lower than one could with Vetsulin, the latter being notorious for producing steep drops from preshot to nadir.

The dosing method advocated by FDMB for the latter is in the FDMB Vetsulin guide. The objective here is to keep the cat with nadirs no lower than 90mg/dL | 5mmol/L (human meter), hopefully with maximum BG staying under the renal threshold the majority of the time - though that can be tricky because the fast, steep drops produced by Vetsulin can make cycles quite 'bouncy' for many cats.

There are two dosing methods for Prozinc: Start Low, Go Slow for Prozinc, and the Modified Prozinc Method (MPM) developed by FDMB members with extensive experience in the use of that insulin. My understanding is that MPM is a protocol designed to help caregivers keep their Prozinc kitty more tightly regulated (but I don't know just how tight that regulation might be, nor how it might compare with the level of regulation possible with the depot insulins).

Prozinc dosing methods


Mogs
.

 

[Critter Mom]

I test all by myself this morning.

Way !!


Mogs
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[Critter Mom]

Hi Melissa,

the polyuria and polydipsia start and the litter is basically glue.

I don't know whether there's an equivalent product in the States but OKOPlus Cat's Best (*granules*, not pellets) is a really good litter. It's made from wood fibre and it clumps really well without turning into cement, so it makes it much easier to remove soiled litter - even for jumbo pees! Superb odour control too. It made life so much better for Saoirse and for me when I discovered it, and I can't recommend it highly enough.

I know there's a corn-based product over there called World's Best and it seems to work along similar principles but I haven't a clue whether or not it's any good (obvs). Maybe US members might be able to tell you whether it's a good product if you were to ask for some testimonials?


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[Critter Mom]

@FrostD -

Further info re cat litter:

Cat's Best Cat Litter


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[FrostD]

@FrostD -

Further info re cat litter:

Cat's Best Cat Litter


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Thank you!!

Husband is on litter duty until the baby gets here, maybe I'll let him suffer a little longer

 

[Critter Mom]

maybe I'll let him suffer a little longer

Don't be such a blue meanie! Poor hubbykins.

I didn't know you were expecting, Melissa. When are you due?


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[FrostD]

Don't be such a blue meanie! Poor hubbykins.

I didn't know you were expecting, Melissa. When are you due?


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I do all the research and poking and prodding, litter is the least he can do! Lol

3 weeks I'll have 2 under 18 months and 2 geriatric animals...it's going to be fun!

 

[Critter Mom]

I'll have 2 under 18 months and 2 geriatric animals...it's going to be fun!

Melissa, you're a sucker for punishment.

You won't see the three weeks going.


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