Grover's very curvy curve

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crazycatlady18

crazycatlady18

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We've now had 3 nadir numbers in the green, wahoo! But, his numbers are all over the place! He is always really high at night, and though better in the morning, he is still too high. I don't understand how he can be 77 before lunch yesterday, and 6.5 hours later be at 549. I'm so confused. I printed his spreadsheet and sent it over to his doc last week and she thought he was doing best at 4 units so she wants me to keep him there and then do another curve at home on Saturday. I get so happy when we have a low number, then every night I'm like what the heck!
 
It looks like you are having a duration problem where the ProZinc is wearing off around +10.
Schedule permitting, dosing every 8 hours may manage that.

Alternatively, using a depot insulin (Levemir or Lantus) might work better. Your local Target may be willing to sell 1 pen at a time, or you could look into getting it from Canada. Given the dose you are currently using, I would suggest trying Levemir, as Lantus has an acidic pH and may sting.
 
Thanks, BJ! I did a search on Levemir and it looks like it might come in bottles as well as the pen. Does that sound right? Is there a reason to get it from Canada?

I also found this cost info on Endocrine Vet's blog, basically saying that the Levemir, though more expensive up front, actually ends up being cheaper than ProZinc.

I'm thinking that a switch might be what he needs. I'm very close to the end of his current bottle of ProZinc and also on my last pack of the U40 syringes, so it would be great to make the switch before I spend more money on the same stuff that isn't working. I'm doing a curve on him tomorrow.

Cost comparison
Levemir (detemir): As far as cost, the retail price of Levemir will be about the same or even more than glargine (~$200 per vial), so that's not a good option for this owner.

ProZinc (PZI): A 10-mL vial of ProZinc insulin will be a bit cheaper than either a 10-mL vial of glargine or detemir. Most veterinarians will charge ~$125 - $150 for a vial of ProZinc, whereas both glargine and detemir will be ~$200 or more. That said, ProZinc is certainly not an inexpensive insulin preparation, especially when one considers that ProZinc is a U-40 insulin and each vial contains only 400 units of insulin. Since both glargine and detemir are U-100 insulins, a vial of these insulin preparations will contain 1,000 units of insulin. Therefore, the cost of ProZinc, at least per unit of insulin, turns out to be even more than the human insulin analogs.
 
The cost for Levemir from Canada will be significantly less per pen or vial than in the US. There are a couple of pharmacies there that folks have used successfully - Mark's Marine and 77 Canada.
You may use all of a vial (1,000 units) before it wimps out. If you wind up using 9 units per day; it'll last about 100 days.
 
Ok great, thanks for the info! :) Well I did Grover's curve on Saturday and tried to get some extra checks yesterday, too. I'm not really sure what to make of the info? I'm sending it over to our vet to review tomorrow. Do you think his dose is too high? I wanted to check him several times during +5 to +7 but ended up only getting +6. I'm kicking myself for that because I might have missed his lowest number.
 
I went through the same thing with Bailey when we first started Prozinc (and still do have weird curves sometimes). It looks like Grover might be bouncing, which is caused by too high a dose as I understand it. Getting those blue and green numbers is good, but his body doesn't realize that yet so it's overcompensating for that drop in sugar. I got Bailey mostly out of it by keeping him at a steady medium dose (for us, at least at the end of last year, the magic number was 1.75 units and that's what I've been trying to get back to after some ups and downs the past couple of months), but he's an onery brat so he still throws me for a loop occasionally ;-) Lisa with her bouncy Ben would also be a good one on this board to talk with about her experience.

And like BJM said, it could be that an 8 hour dosing schedule would work better but I totally understand not being able to do that (I'm in the same boat with you there). But test as much as you can and gather lots of data and that will help you figure out how much to give depending on what Grover's preshot reading is. Also, the Prozinc protocol link in Sue's profile is super helpful. Might be some useful stuff for you to consider in there too.
 
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