Cleo on Prozinc???

Cleocatra

Cleocatra

Member
Another online FD person on FaceBook Feline Acro page (Gayle) has stated to me that Prozinc is not a typical insulin given to acros. I did some research on it and a medical study showed Prozinc lasts about 9 hrs while Glargine lasts ~11+ and Levemir lasts ~13 hrs. I pointed this out to my vet a few weeks ago and she was not aware that was the case between these 3 insulins. Cleo is now up to 9U bid and she's been maxing in 400's and nadiring down in 300's. Previously she was still up in 500's and even hit 600 a week ago.
I'm not seeing any adverse reactions to the Pz, but she still has the wobbly back legs.
 
I know I have, but I'm pretty sure others here have mentioned to you as well that Levemir is a much more common insulin for high dose cats. Yet again, your vet is showing her lack of experience with acromegalic cats. My vet didn't have experience either, but was willing to learn and let me do the dosing, with help here and using a published dosing protocol. People here have way more experience than most vets when it comes to treating acromegaly.

You will continue to see wobbly legs as long as her numbers are so high.
 
We might be trending downward now that we're up to 10U (just shot 10U tonight after 5 days @ 9U). Doing the work-from-home thing now allows me to monitor better so we'll see how it goes and then I'll report back to my vet. My vet's assistant said she's been reading up on the links & refs I've been sending her lately. I hope she's up to the challenge!
 
Cleocatra said:
I hope she's up to the challenge!
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Well, maybe you will have better luck with the vet world that others have. In my experience, it's the CG that has something at stake. At the end of the day, the vet and vet assistants go home to their life - but we are living this 24-7. Not much different than in the human medical world. It's the patient that has the most vested interest and it's up to the CG in most of the cases to advocate for their cat.
 
My cat is acro on ProZinc. I like ProZinc for the flexibility in dosing time. ProZinc gives me much better time than 9 hours. 9 hours is what I used to get on vetsulin. On ProZinc she gets 11-14 hours.

At her most she was getting about 12.5 units. I have 13 a couple times. Currently we are on 8-8.5. They need what they need.
 
Cleocatra said:
Another online FD person on FaceBook Feline Acro page (Gayle) has stated to me that Prozinc is not a typical insulin given to acros. I did some research on it and a medical study showed Prozinc lasts about 9 hrs while Glargine lasts ~11+ and Levemir lasts ~13 hrs. I pointed this out to my vet a few weeks ago and she was not aware that was the case between these 3 insulins. Cleo is now up to 9U bid and she's been maxing in 400's and nadiring down in 300's. Previously she was still up in 500's and even hit 600 a week ago.
I'm not seeing any adverse reactions to the Pz, but she still has the wobbly back legs.
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Are you giving b12 methylcobalamin supplements for the neuropathy?
 
Cleocatra said:
yes for the past 2 months. it's not getting better, but not getting worse. Just need to get the dam blood glucose down.
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I think you are waiting too long before raising the dose. she's getting stuck in glucose toxicity. I'd raise it with the next dose. I know those double digit doses are scary. I cried when I hit 10. My cat's breakthrough dose that finally brought her down was 13. But you can't hold too long. I also see you went all the way down to 2 units when you switched insulins. I probably wouldn't have gone lower then 8. It just made her stuck in high numbers longer. You will find the breakthrough dose... just keep at it.
 
JanetNJ said:
I think you are waiting too long before raising the dose. she's getting stuck in glucose toxicity. I'd raise it with the next dose. I know those double digit doses are scary. I cried when I hit 10. My cat's breakthrough dose that finally brought her down was 13. But you can't hold too long. I also see you went all the way down to 2 units when you switched insulins. I probably wouldn't have gone lower then 8. It just made her stuck in high numbers longer. You will find the breakthrough dose... just keep at it.
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that's kind of what I was thinking- at 10u, what is 1 more unit every 3-5 days gonna do? My vet initially wanted 7 days before raising, I asked for 5 and she said yes. Today is time to add another unit up to 11u. I think the risk here is that vets don't want to bypass the correct dose because when giving too much insulin, the cat goes into the somagyi effect where it releases more glucose in response to too much insulin, but you don't know it because you didn't let the system settle into the dose. Did I say that correctly??
 
Cleocatra said:
that's kind of what I was thinking- at 10u, what is 1 more unit every 3-5 days gonna do? My vet initially wanted 7 days before raising, I asked for 5 and she said yes. Today is time to add another unit up to 11u. I think the risk here is that vets don't want to bypass the correct dose because when giving too much insulin, the cat goes into the somagyi effect where it releases more glucose in response to too much insulin, but you don't know it because you didn't let the system settle into the dose. Did I say that correctly??
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I REALLY don't think you are seeing any bounce effects here. If you are worried about bypassing the correct dose you could also raise a half unit every three or four cycles instead of whole units every 5 days.
 
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My cat was acro, but he was on levemir. He got up to 19u BID before I saw consistent blues and greens. After a month or so at that dose he came all the way down to 8u where he stayed until he passed from heart problems. Not sure with prozinc, but I would see movement with just slight dose increases, but the dose would go stale quickly, so I raised every 3 days or so. I’ll see if my tag works for @Olive & Paula
 
I also agree your holding the dose to long. Its been over 4 yrs since I used Prozinc so I don't remember much about it. But correct me if I'm wrong. Prozinc is NOT a depot insulin so there is no settling into a dose.

As far as the neuropathy, it will get better once the glucoses start staying down. It's good the zobaline may help keep it from getting worse, but getting glucoses down will be the most effective. You can give 2 zobaline a day if needed.

My vet leaves the insulin dosage up to me. We discuss it at visits, she pretty much agrees with what I've done, though sometimes she tells me I'm holding dose to long.
 
Olive & Paula said:
I also agree your holding the dose to long. Its been over 4 yrs since I used Prozinc so I don't remember much about it. But correct me if I'm wrong. Prozinc is NOT a depot insulin so there is no settling into a dose.

As far as the neuropathy, it will get better once the glucoses start staying down. It's good the zobaline may help keep it from getting worse, but getting glucoses down will be the most effective. You can give 2 zobaline a day if needed.

My vet leaves the insulin dosage up to me. We discuss it at visits, she pretty much agrees with what I've done, though sometimes she tells me I'm holding dose to long.
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correct, it's not a deposit insulin. :) Thanks for weighing in. :D
 
Cleocatra said:
I think the risk here is that vets don't want to bypass the correct dose because when giving too much insulin, the cat goes into the somagyi effect where it releases more glucose in response to too much insulin, but you don't know it because you didn't let the system settle into the dose. Did I say that correctly??
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No, symogyi is something completely different. If you tested a bit more, you'd have a better idea if she's going low and then bouncing. And you could increase more quickly because you know it is safe to do so. The danger lies in not knowing how low the dose is taking the cat. If you are missing lows, it's not safe to increase. In general with insulin resistance, you don't want to hold the dose too long. I coined the phrase "the dose doing stale". It means the dose could look good initially, but not last and you have to keep increasing. You are also fighting glucose toxicity. Plus the tumour can pulse up and down changing the dose you need.

Don't get attached to the size of a dose. An acromegaly cat needs what they need. Even up the 30 units is not uncommon, and we've seen the odd one needing more than double that.
 
Wendy&Neko said:
No, symogyi is something completely different. If you tested a bit more, you'd have a better idea if she's going low and then bouncing. And you could increase more quickly because you know it is safe to do so. The danger lies in not knowing how low the dose is taking the cat. If you are missing lows, it's not safe to increase. In general with insulin resistance, you don't want to hold the dose too long. I coined the phrase "the dose doing stale". It means the dose could look good initially, but not last and you have to keep increasing. You are also fighting glucose toxicity. Plus the tumour can pulse up and down changing the dose you need.

Don't get attached to the size of a dose. An acromegaly cat needs what they need. Even up the 30 units is not uncommon, and we've seen the odd one needing more than double that.
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Omg I'm experiencing rapid dose change right now. Last night I lowered CC'S dose and still wound up with a scary hypo. Maybe that bump removed off CC'S leg a few days who was really effecting her. They need what they need.
 
JanetNJ said:
Omg I'm experiencing rapid dose change right now. Last night I lowered CC'S dose and still wound up with a scary hypo. Maybe that bump removed off CC'S leg a few days who was really effecting her. They need what they need.
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wow CC's #'s are all over the place. she sure goes low after being so hi. Cleo has never gone that low. Her nadir is ~100+/-. Sometimes she's level all day. Now that we're back up to hi dose, maybe I can keep her out of the 500's and get the nadir down to ~200 consistently.
 
Cleocatra said:
Cleo has never gone that low.
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Cleocatra said:
Sometimes she's level all day.
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Sorry if this comes across too straightforward but... She has never gone that low that you are aware of. You don't know if she's level all day - you aren't testing enough to be able to say that.

Unless you are testing and not recording your test scores on the SS, there are few tests numbers to really know what little Cleo is doing.


Cleocatra said:
Her nadir is ~100+/-
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I don't see any tests of ~100 on your SS.
 
Judy and Freckles said:
Sorry if this comes across too straightforward but... She has never gone that low that you are aware of. You don't know if she's level all day - you aren't testing enough to be able to say that.

Unless you are testing and not recording your test scores on the SS, there are few tests numbers to really know what little Cleo is doing.



I don't see any tests of ~100 on your SS.
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I meant deltas (drops) of ~100. Mis-spoke.
 
Cleocatra said:
wow CC's #'s are all over the place. she sure goes low after being so hi. Cleo has never gone that low. Her nadir is ~100+/-. Sometimes she's level all day. Now that we're back up to hi dose, maybe I can keep her out of the 500's and get the nadir down to ~200 consistently.
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She is bouncy, and it's not always predictable how much hormones the pituitary is going to be pushing out. She had a surgery on sat. morning, and I think that's effecting her numbers as well. So yeah, she had a scary hypo last night, and now is bouncing high today. It will come back down in a day or two. I miss that first year when she was soooo predictable. She was even in remission for a year until this terrible tumor.
 
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now that we're up over 10u, I will test more often. Hopefully I'll get an AMPS w/o getting bit. Already today at +6 she's at 331, lowest test mid-cycle test so far. You'll see on the SS that I've only got 3 yellows in the past 3 months (might be more because I wasn't testing every day) but she's shown a history of being in the reds or higher at mid-cycle. I'm starting to get some purples and that is a good trend. Hopefully the hi doses are doing the trick. That's my story and I'm stickin' to it.
 
Cleocatra said:
Hopefully I'll get an AMPS w/o getting bit.
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Have you tried testing her while she's eating. That's what I do with Freckles. Freckles doesn't even acknowledge anything is happening because she is focused on the food. I crumble a freeze dried chicken treat in her bowl and that gives me enough time to poke, and scoop up the blood droplet on my fingernail then use the testing strip to test that blood droplet. You can also use the edge of a credit card to scoop up the blood droplet.

I see she had a "scarf n' barf" at lunch time. If possible, try feeding Cleo very small meals (Freckles gets about 1 tsp every 2 hours up until +8) often, so she doesn't gobble too much too fast.
 
Judy and Freckles said:
Have you tried testing her while she's eating. That's what I do with Freckles. Freckles doesn't even acknowledge anything is happening because she is focused on the food. I crumble a freeze dried chicken treat in her bowl and that gives me enough time to poke, and scoop up the blood droplet on my fingernail then use the testing strip to test that blood droplet. You can also use the edge of a credit card to scoop up the blood droplet.

I see she had a "scarf n' barf" at lunch time. If possible, try feeding Cleo very small meals (Freckles gets about 1 tsp every 2 hours up until +8) often, so she doesn't gobble too much too fast.
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Thanks, Judy! Yes that's exactly what happened today! Just tested 2 hrs ago 313! So far we have 10 days w/ some consistently lower #'s- 400 or below. This cat's lucky I'm working from home now so I can test her and clean up her messes. She also knows how to tirelessly beg for food.
 
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