Do Daa’s PZ Dosing

Goose said:
We also assume that the insulin can't be stopped Cold Turkey and has to be regulated back down and then off.
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If you are considering stopping the insulin, whether you stop it cold turkey or back the dose down slowly till he's off it, the result would be the same. Assuming the diabetes diagnosis is correct, Do Daa could develop ketones and DKA or he might simply have a very prolonged decline and eventually death.

High numbers for a prolonged period of time will cause damage but cats are remarkably resilient animals and it takes a long time for damage to occur.

There are secondary conditions which sometimes cause a cat to need more insulin than most. My girl, who is now in remission, had IAA and was at one time on 16u of insulin twice daily and she by no means holds the record for big doses. There are tests that can be done to rule out those high dose conditions but they usually aren't done until the cat gets to a dose of 5 or 6u twice daily. While most cats don't need large doses of insulin, a cat needs the amount of insulin it needs.

It's possible ProZinc isn't the right insulin for Do Daa and a switch to Lantus or Levemir might work better. It's also possible he has developed glucose toxicity and is going to need more insulin for a time to get past that and then the dose will decrease.

This is a marathon not a sprint and you are still in early days of treatment. I urge you not to give up.
 
MrWorfMen's Mom said:
If you are considering stopping the insulin, whether you stop it cold turkey or back the dose down slowly till he's off it, the result would be the same. Assuming the diabetes diagnosis is correct, Do Daa could develop ketones and DKA or he might simply have a very prolonged decline and eventually death.

High numbers for a prolonged period of time will cause damage but cats are remarkably resilient animals and it takes a long time for damage to occur.

There are secondary conditions which sometimes cause a cat to need more insulin than most. My girl, who is now in remission, had IAA and was at one time on 16u of insulin twice daily and she by no means holds the record for big doses. There are tests that can be done to rule out those high dose conditions but they usually aren't done until the cat gets to a dose of 5 or 6u twice daily. While most cats don't need large doses of insulin, a cat needs the amount of insulin it needs.

It's possible ProZinc isn't the right insulin for Do Daa and a switch to Lantus or Levemir might work better. It's also possible he has developed glucose toxicity and is going to need more insulin for a time to get past that and then the dose will decrease.

This is a marathon not a sprint and you are still in early days of treatment. I urge you not to give up.
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It sure is frustrating though and comes through in what gets typed sometimes. It just doesn't seem like the numbers are lowering with any amount of insulin. We really don't want the prolonged high numbers to damage him.
16u twice daily is amazing. Did she show any signs it physically affected her? What should I watch out for with high dosages? He does seem to be eating more wet food when he does eat, so that's better at least.

How would we determine if he has glucose toxicity? Or is there a way? What is IAA?
How do we determine if Prozinc isn't right for him? When does the time arrive to try a switch, does that take another 4 months?
 
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Believe me, I understand the frustration all too well but every cat is different and while some get regulated in short order, others take time.

My girl remained in good health other than high BGs despite the time it took me to realize there might be something else going on. And she remains healthy now.

IAA is Immune Auto Antibodies. Her immune system was stopping her from using insulin efficiently. The condition is self limiting and eventually my girl was on more normal doses of insulin and then went into remission. The large doses of insulin didn't harm her because that is what she needed to overcome the antibodies and be able to use insulin to get the energy she needed from her food.

There are other high dose conditions....Acromegaly and Cushings that can also cause kitties to need higher than normal doses of insulin. If Do Daa's dose gets high enough, then you can consider testing for those conditions.

You monitor a high dose cat just as you do any other cat. In some cases, they can be a little less predictable but with monitoring and getting to know your own cat's patterns, you can keep the cat as safe and healthy as any other diabetic cat.

Given how long Do Daa's BG has been elevated, I think it's likely you are dealing with some glucose toxicity. There is no test or way to confirm but with doses being held for extended period despite little to no movement in BG, it's seems a logical assumption.

Usually we'd suggest you try an insulin for 3 months to give it a reasonable trial before making a change but that is really an individual decision. There is no recipe for determining whether it's the right insulin or not. The right insulin is the one that works for your cat.
 
MrWorfMen's Mom said:
Believe me, I understand the frustration all too well but every cat is different and while some get regulated in short order, others take time.

My girl remained in good health other than high BGs despite the time it took me to realize there might be something else going on. And she remains healthy now.

IAA is Immune Auto Antibodies. Her immune system was stopping her from using insulin efficiently. The condition is self limiting and eventually my girl was on more normal doses of insulin and then went into remission. The large doses of insulin didn't harm her because that is what she needed to overcome the antibodies and be able to use insulin to get the energy she needed from her food.

There are other high dose conditions....Acromegaly and Cushings that can also cause kitties to need higher than normal doses of insulin. If Do Daa's dose gets high enough, then you can consider testing for those conditions.

You monitor a high dose cat just as you do any other cat. In some cases, they can be a little less predictable but with monitoring and getting to know your own cat's patterns, you can keep the cat as safe and healthy as any other diabetic cat.

Given how long Do Daa's BG has been elevated, I think it's likely you are dealing with some glucose toxicity. There is no test or way to confirm but with doses being held for extended period despite little to no movement in BG, it's seems a logical assumption.

Usually we'd suggest you try an insulin for 3 months to give it a reasonable trial before making a change but that is really an individual decision. There is no recipe for determining whether it's the right insulin or not. The right insulin is the one that works for your cat.
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SS Updated
I remember somewhere over the past 2 months in my thread or another, someone said 6 months to wait to switch. That's why I mentioned another 4 to go.
Thank you for the help.
 
Goose said:
a slightly small mass that's insulin colored at the bottom of the bottle
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This sounds odd. There should not be a mass in the insulin.

I don't think Do Daa is in crazy big dose territory yet. While most cats can be regulated with a dose between 1 and 3 units, it can take more for some cats. He is 14.5 pounds which does factor in here some. (ProZinc documentation indicates weight is a factor in dosing.). Even if he is experiencing resistance or toxicity, he could have a breakthrough at any time. After 3 days on a dose with his numbers remaining high, I would up the dose again.

6 months is supposed to be the amount of time to truly evaluate an insulin. I have read that a few places but also had a good conversation about it with an Internal Medicine Specialist. Not to say that there are not circumstances where the decision to change needs to come sooner, but as a loose 'rule', 6 months is about right. You are only 2 months in which is really still early. Some cats jump into remission with a couple of weeks, but a lot of cats don't. Like Linda said, this is definitely a marathon for most of us, not a sprint.
 
I agree with all Linda and FurBabiesMama have said. Do Daa is still on a relatively low dose. If you think 16u twice daily is high, we’ve had several cats in the forum over the years who had acro and their doses were 60u twice a day and I’ve seen it go higher. We don’t even recommend testing for high dose conditions until the dose is at 6u twice a day.

Please do not stop the insulin or back down the dose or you will be setting him further behind. Because we are raising the dose in appropriate amounts and you’ve done such a great job working with us on testing (and doing that +7 test at night is really fantastic so thank you so much), we know that he is not overdosed.

If you were to decide to switch to another insulin like Lantus or Levemir, we’d start the dose right where he is now on PZ. Because those two insulins are depot insulins, you definitely have to hold doses for specific number of cycles. I’d recommend we just keep at this for another month with PZ and see where he is and then revisit it. It was me that said we usually wait six months on an insulin but let’s just see where he is in a month.
 
Marje and Gracie said:
I agree with all Linda and FurBabiesMama have said. Do Daa is still on a relatively low dose. If you think 16u twice daily is high, we’ve had several cats in the forum over the years who had acro and their doses were 60u twice a day and I’ve seen it go higher. We don’t even recommend testing for high dose conditions until the dose is at 6u twice a day.

Please do not stop the insulin or back down the dose or you will be setting him further behind. Because we are raising the dose in appropriate amounts and you’ve done such a great job working with us on testing (and doing that +7 test at night is really fantastic so thank you so much), we know that he is not overdosed.

If you were to decide to switch to another insulin like Lantus or Levemir, we’d start the dose right where he is now on PZ. Because those two insulins are depot insulins, you definitely have to hold doses for specific number of cycles. I’d recommend we just keep at this for another month with PZ and see where he is and then revisit it. It was me that said we usually wait six months on an insulin but let’s just see where he is in a month.
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60u+ twice a day, holy smokes! :eek:

Thanks for that. I know I keep saying it but we appreciate everyone's help. Yeah, that +7 isn't enjoyable...but I'm glad the numbers help. It certainly won't be every night, but some numbers are better than no numbers.
We are roughly 65%+ through the 1st bottle of Prozinc, so we'll be staying with it and getting another bottle next month.

SS Updated.
 
Goose said:
60u+ twice a day, holy smokes! :eek:

Thanks for that. I know I keep saying it but we appreciate everyone's help. Yeah, that +7 isn't enjoyable...but I'm glad the numbers help. It certainly won't be every night, but some numbers are better than no numbers.
We are roughly 65%+ through the 1st bottle of Prozinc, so we'll be staying with it and getting another bottle next month.

SS Updated.
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Excellent! Thank you and Do Daa!
 
I’m sorry one of us didn’t catch the cycle count. Holidays :confused:

I would increase his dose to 3.5u. The plan is to increase every six cycles by 0.5u until you see yellow numbers. Then we will reassess.

Great job on grabbing those tests!
 
Marje and Gracie said:
I’m sorry one of us didn’t catch the cycle count. Holidays :confused:

I would increase his dose to 3.5u. The plan is to increase every six cycles by 0.5u until you see yellow numbers. Then we will reassess.

Great job on grabbing those tests!
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No need to be :confused: :D
I didn't/don't expect people to be online 24/7 especially through the Holidays :)
Thanks! for the update, we'll do 3.5u for 3 days first starting tomorrow am.
 
Marje and Gracie said:
Thank you! Two more cycles at 3.5u and if you don’t see any numbers below 300, please increase to 4u.
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SS Updated.

So you want 4 days and not 3? We're at the end of day 3 now with 3.5u...

What are we looking for to indicate better results? How many numbers throughout the day need to be below 300?

I've noticed within the last month that he has dead skin flakes, like dandruff, but bigger from his shoulders to the base of his tail. He has not ever had this before. Is this a bi-product of the insulin or high BG or?
 
Goose said:
SS Updated.

So you want 4 days and not 3? We're at the end of day 3 now with 3.5u...

What are we looking for to indicate better results? How many numbers throughout the day need to be below 300?

I've noticed within the last month that he has dead skin flakes, like dandruff, but bigger from his shoulders to the base of his tail. He has not ever had this before. Is this a bi-product of the insulin or high BG or?
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No, 4 units not four days. That means raising the dose in the morning to 4u. I see he had a 291 today.

We will see progress once we start seeing some numbers below 300. A singular one is not significant so we’d like to see either a few during one cycle or see at least one each cycle. Then we increase by 0.25u until we hit 5u. Once we hit 5u, if the dose gets that high, then we increase by 10%.

Yes, the dandruff is due to the higher numbers. My kitty was well regulated but her BG tended to rise in the winter and even #00-something numbers could cause her to get dandruff.
 
Marje and Gracie said:
No, 4 units not four days. That means raising the dose in the morning to 4u. I see he had a 291 today.
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I was referring to the fact that today is day 3 at 3.5u. I was asking if you wanted an additional day (4 days total) at 3.5u. (two more cycles, an additional day the way I read it). I did realize you meant 4u starting tomorrow morning for 3 days.
 
Goose said:
I was referring to the fact that today is day 3 at 3.5u. I was asking if you wanted an additional day (4 days total) at 3.5u. (two more cycles, an additional day the way I read it). I did realize you meant 4u starting tomorrow morning for 3 days.
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Sorry...I thought you misread 4u for 4 days.

With only one yellow number and a high one at that, I’d increase tomorrow to 4u for at least three days (six cycles) and then reassess. If you get a number below 200, please be sure and tag @MrWorfMen's Mom, @FurBabiesMama, and/or me.
 
Goose said:
SS Updated.
4u started today. I'll continue through Sunday. Hope to see some Yellow soon.
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No...just through Saturday night at first until we see how he’s doing. If we aren’t starting to see some movement, the dose would be raised again on Sunday. So let’s check back in on Saturday.

1st day at 4u -- Thurs
2nd day at 4u -- Fri
3rd day at 4u -- Sat.

Thank you!
 
Marje and Gracie said:
No...just through Saturday night at first until we see how he’s doing. If we aren’t starting to see some movement, the dose would be raised again on Sunday. So let’s check back in on Saturday.
1st day at 4u -- Thurs
2nd day at 4u -- Fri
3rd day at 4u -- Sat.
Thank you!
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SS Updated.
The 576 this morning I think was because he somehow got some food before amps.
 
Goose said:
SS Updated.
The 576 this morning I think was because he somehow got some food before amps.
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I’m glad we are starting to see some numbers below 300. He still has a way to go but let’s hope we see more yellow numbers tonight and in the next day.
 
I was just checking in since it’s Saturday night to let you know what to do with the dose tomorrow but the SS is not updated. Please be sure and tag me when you’ve had a chance to do it so I can help you with the dosing for tomorrow. Thank you!
 
Marje and Gracie said:
I was just checking in since it’s Saturday night to let you know what to do with the dose tomorrow but the SS is not updated. Please be sure and tag me when you’ve had a chance to do it so I can help you with the dosing for tomorrow. Thank you!
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SS Updated.
A high number in am (+7) (554) assume he had food before test. Another high number at amps (570) but he had eaten all his overnight food 3+ hours earlier.
Ketone negative.
 
Marje and Gracie said:
But these are all low carb foods or dry?
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Up until +3 pmps there is a mix of food, some FF can, some CP dry food. Overnight, there is only CP dry food (1/3rd of a cup) until it's taken up in the morning or he finishes it. None of the food has changed.
 
Goose said:
Up until +3 pmps there is a mix of food, some FF can, some CP dry food. Overnight, there is only CP dry food (1/3rd of a cup) until it's taken up in the morning or he finishes it. None of the food has changed.
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If the food hasn’t changed and he’s not eating more of it, it wouldn’t be the reason for the BG increase.

I’d increase his dose to 4.5u tomorrow.
 
Marje and Gracie said:
If the food hasn’t changed and he’s not eating more of it, it wouldn’t be the reason for the BG increase.

I’d increase his dose to 4.5u tomorrow.
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The food hasn't changed, but his appetite has increased so he is eating more wet food at one sitting. He's increased at amps/pmps to about 1/2 (sometimes more, sometimes less) of the FF can.
The dry food that is mixed in is the same minor amount. Just dry food overnight as mentioned which is mostly gone by am.

SS Updated. (+3) 298
 
Goose said:
The food hasn't changed, but his appetite has increased so he is eating more wet food at one sitting. He's increased at amps/pmps to about 1/2 of the FF can.
The dry food that is mixed in is the same minor amount. Just dry food overnight as mentioned which is mostly gone by am.
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Ok. Thank you! And please keep grabbing the tests as you have been. It’s very helpful to have those +3 and +7 tests.
 
Marje and Gracie said:
Ok. Thank you! And please keep grabbing the tests as you have been. It’s very helpful to have those +3 and +7 tests.
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So we are shooting at 4.5u in the morning for 3 days, correct?

I added to my post above. +3 and +7 will likely happen on different days.
 
Goose said:
So we are shooting at 4.5u in the morning for 3 days, correct?

I added to my post above. +3 and +7 will likely happen on different days.
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Yes but please be sure you update the SS and tag one of us if you see any numbers below 200. Thank you.
 
Sometimes when you increase the dose, there can be something we call new dose wonkiness (NDW). Hold the course and let's see what Do Das does in the next few cycles.
 
Appears you're getting a few more yellow readings which is good so I'd increase up to 5u and hold for 6 cycles (3 days) barring any low pre-shots or low mid cycle tests.
 
Thank you @MrWorfMen's Mom for checking in. I’ve been swamped with a few other things.

Goose..please don’t hesitate to PM one of us if it’s been three days and you don’t see dosing advice. All you have to do is click on our user name under kitty’s avatar to the left and then “start a conversation”. Especially around the holidays, life gets busy and three days flies by.

Numbers are definitely improving! I see progress. How is Do Daa? Coat looking any better at all yet? He’s still fairly high in BG so that might take getting him into numbers below 150 to see less dandruff.
 
Marje and Gracie said:
Thank you @MrWorfMen's Mom for checking in. I’ve been swamped with a few other things.

Goose..please don’t hesitate to PM one of us if it’s been three days and you don’t see dosing advice. All you have to do is click on our user name under kitty’s avatar to the left and then “start a conversation”. Especially around the holidays, life gets busy and three days flies by.

Numbers are definitely improving! I see progress. How is Do Daa? Coat looking any better at all yet? He’s still fairly high in BG so that might take getting him into numbers below 150 to see less dandruff.
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SS Updated.
I completely understand, everyone is busy, especially during the holidays.

DA (his shorter name) seems to be doing well. His coat is about the same, it looks fine and not ratty. He still has the dandruff up near the shoulders down the center of his back.

We just got a new bottle of Prozinc today. The old bottle has probably 4-7 days left in it.

Below 150, ha! I'd like to start seeing all numbers below 300 first! :)

Once we fine his "right dose" how long does it usually take to normalize? I know it's cat dependent, but just a guess? Would he stay at say 5U + for months or? I'm just trying to get a larger picture of this.

Thanks All!
 
Goose said:
Once we fine his "right dose" how long does it usually take to normalize? I know it's cat dependent, but just a guess? Would he stay at say 5U + for months or?
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You hit the nail on the head when you said it's cat dependent. Around here we often say every cat is different (ECID). If this is a case of glucose toxicity, you increase until you find the dose that gets Do Daa into better numbers and then the dose will likely drop again but if Do Daa happens to be a kitty who needs a little more insulin than average, then the 5u or whatever the dose is at the time, could be what he needs going forward to keep him regulated. There is no way to predict timing or dose or whether a cat will go into remission or not. We'd all love to have a crystal ball but unfortunately we don't. Some cats get regulated relatively quickly and others take a while. Best to take this one day at a time and make the goal to get his numbers down to keep him healthy and safe.
 
Goose said:
SS Updated.
I completely understand, everyone is busy, especially during the holidays.

DA (his shorter name) seems to be doing well. His coat is about the same, it looks fine and not ratty. He still has the dandruff up near the shoulders down the center of his back.

We just got a new bottle of Prozinc today. The old bottle has probably 4-7 days left in it.

Below 150, ha! I'd like to start seeing all numbers below 300 first! :)

Once we fine his "right dose" how long does it usually take to normalize? I know it's cat dependent, but just a guess? Would he stay at say 5U + for months or? I'm just trying to get a larger picture of this.

Thanks All!
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I’d also like to add that it’s not uncommon for a kitty to go up and down around a good dose. Sometimes they hit test dose, stay at it a bit, earn a dose reduction, then fizzle, and have to go back up. We just take it in stride and don’t get attached to a dose.

I’m glad he’s doing well.
 
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