I have a 14 year old cat that was diagnosed as being diabetic (again for the 4th time) on Dec 26th, 2013. The first time she was diagnosed in 2008 she was prescribed PZI and did very well and went into remission after about 6 months. The last three times she became diabetic, including this last Dec. she was prescribed lantus. She is never on much insulin and goes into remission. The issue now is that she is on just 1/2 unit per day but her blood glucose drops too low and then swings up. She needs to be on some insulin. The vet has suggested PZI.. I am confused as to the different types of PZI available now and how to purchase.
Help with PZI
- Thread starter MidnightM
- Start date
- Status
BJM
Member Since 2010
It is possible to measure 0.25 units of Lantus by eyeballing it or to measure using drops. To do drops, takes practice, so keep an old syringe, draw up 0.5 units of a colored liquid, so yo can see it, and carefully squeeze out drops one at a time. The objective is to make the drops equal in size and have the same number of drops per 0.5 units. It may help to twist the plunger rather than push it directly.
Also, getting a magnifier helps immensely with small doses. The Carson Clip and Flip clip onto existing glasses and flip up out of the way when not needed. Visor type magnifiers are on a head band. And of course there are stand and hand held magnifiers.
ProZinc is available by prescription from many vets directly or from large pet supply stores such as Fosters and Smith. It is U-40, meaning it has only 40 units per mL, which makes it easier to measure smaller doses. No depot to worry about and you can "shoot what you see" once you know how low it takes the glucose. Many of us use U-100 syringes and a conversion chart (basically, each half unit mark of a U-100 syringe = 0.2 units of a {-40 insulin)
BCP is ordered by Rx too; the vet can get a trial vial to see how that goes. It comes as U-40, U-50, or U-100. I'd suggest either U-40 or U-50 due to ease of measuring small doses.
Also, getting a magnifier helps immensely with small doses. The Carson Clip and Flip clip onto existing glasses and flip up out of the way when not needed. Visor type magnifiers are on a head band. And of course there are stand and hand held magnifiers.
ProZinc is available by prescription from many vets directly or from large pet supply stores such as Fosters and Smith. It is U-40, meaning it has only 40 units per mL, which makes it easier to measure smaller doses. No depot to worry about and you can "shoot what you see" once you know how low it takes the glucose. Many of us use U-100 syringes and a conversion chart (basically, each half unit mark of a U-100 syringe = 0.2 units of a {-40 insulin)
BCP is ordered by Rx too; the vet can get a trial vial to see how that goes. It comes as U-40, U-50, or U-100. I'd suggest either U-40 or U-50 due to ease of measuring small doses.
Deb & Wink
Member Since 2013
Would you tell us what you mean by "too low"? Under 40 mg/L? Under 50 mg/L? Something else?
What meter are you using for testing?
Answers to these questions would help us to help you better.
Would you tell us what you mean by "too low"? The first blood curve I did after 10 days on insulin, Midnight's 1st blood glucose reading was 45mg/dl. before administering insulin. I immediately fed her, checked the meter with control solution which indicted the meter was OK. I did not administer insulin. I called the Vet when they opened. They thought it was an inaccurate reading. With a new vial of test strips( other vial was used up) which I tested with a control solution, I tested 2 hours after she ate, her blood glucose was 90 mg/dl. Vet advised to administer next dose at usual time.
After consulting with the vet after she saw the blood curve, I administered 1/2 unit lantus per day repeating blood glucose curve in 7 days. This time the low point went to 88 mg/dl. I was not willing to let it go any lower, so fed midnight 1 TBs of food.
What meter are you using for testing?- Alpha trak2
After consulting with the vet after she saw the blood curve, I administered 1/2 unit lantus per day repeating blood glucose curve in 7 days. This time the low point went to 88 mg/dl. I was not willing to let it go any lower, so fed midnight 1 TBs of food.
What meter are you using for testing?- Alpha trak2
BJM
Member Since 2010
Normal non-diabetic glucose is under about 150 mg/dL on an Alphatrak.
Anything under 80 mg/dL on the AlphaTrack earns an automatic 0.25 unit reduction when giving insulin. Yes, you'll have to eyeball it as no syringes measure a U-100 insulin than finely unless in a lab. (And those have to be autoclaved).
At pre-shot, unless you have data to know it is safe, don't shoot that.
Many of us leave food out almost all the time, so that if the cat goes low and feels hungry, it can eat.
Anything under 80 mg/dL on the AlphaTrack earns an automatic 0.25 unit reduction when giving insulin. Yes, you'll have to eyeball it as no syringes measure a U-100 insulin than finely unless in a lab. (And those have to be autoclaved).
At pre-shot, unless you have data to know it is safe, don't shoot that.
Many of us leave food out almost all the time, so that if the cat goes low and feels hungry, it can eat.
Deb & Wink
Member Since 2013
Ok, thanks for those replies MidnightM.
From the readings you are getting and gave to us, I'm not sure that your cat needs any insulin at all.
As BJM indicated, those numbers are in the normal range for a cat.
What food are you feeding?
What other numbers did you get during your curve? (A curve being, testing every 2 hours, starting with a pre-shot test and continuing for 12 hours)
Was a fructosamine test done?
Have there been a lot of higher numbers, over 130 mg/d L?
What other clinical symptoms is your cat showing? (i.e. excess peeing, excess thirst, ravenous appetite, etc.)
Some thoughts.
1. There may be some changes in what food you are feeding that could make a difference.
2. Kitty may be in remission once again.
3. Kitty may be a microdose kitty.
Sorry, we are just a bit puzzled here as to why your vet is saying to switch to another insulin when it does not look to us like you kitty needs any insulin.
From the readings you are getting and gave to us, I'm not sure that your cat needs any insulin at all.
As BJM indicated, those numbers are in the normal range for a cat.
What food are you feeding?
What other numbers did you get during your curve? (A curve being, testing every 2 hours, starting with a pre-shot test and continuing for 12 hours)
Was a fructosamine test done?
Have there been a lot of higher numbers, over 130 mg/d L?
What other clinical symptoms is your cat showing? (i.e. excess peeing, excess thirst, ravenous appetite, etc.)
Some thoughts.
1. There may be some changes in what food you are feeding that could make a difference.
2. Kitty may be in remission once again.
3. Kitty may be a microdose kitty.
Sorry, we are just a bit puzzled here as to why your vet is saying to switch to another insulin when it does not look to us like you kitty needs any insulin.
What food are you feeding? We are feeding 6oz Wellness grain free Chicken formula per day 3 oz AM 3oz PM
Blood Curve: The protocol I follow is test every 2 hrs unless blood glucose is 150 mg/dl then test every hour.
Results blood glucose pre food and insulin 217mg/dl
+2hr=257mg/dl
+4hr=143
+5hr=110
+6 hr= 112
+7 hr= 88 fed 1 tbs of food
+8hr= 114
+ 9hr= 133
+10 hr= 141
+ 12 hr= 152 fed 3 oz food
I was concerned/confused about this curve so began testing again 6 hours after she was fed or 18 hours after insulin
+ 18 hours= 324
+ 20 hr = 314
+ 22 hr = 398
+ 24 hr= 396 fed 3 oz food and 1/2 unit insulin
+ 2 hr= 406
+ 4 hr= 319
+ 6 hr=263
+ 8 hr= 158. Cat was done having me poke at her ear.
Was a fructosamine test done? Yes I remember the results being 548 ( unsure of range)
Have there been alot of higher numbers over 130 mg/dl? What other clinical symptoms is your cat showing? She began peeing outside the litter box which is the first sign of return to diabetes. Did a 12 hour blood glucose curve with readings between 220 mg/dl and 345 mg/dl. Had vet do examination. There was about 2lb weight loss since went off insulin in August. Tests revealed abnormal liver enzymes. All else was normal( kidney, urine, thyroid) except frutosamine results. Recommended she go back on insulin. For elevated liver enzyemes prescribed denamarin ( 1 pill per day) and metronidazole (.65ml) two times per day with food.
Last Friday liver enzymes were redone and weight taken. Liver test came back normal and has regained some weight. My vet consulted vet internist specialist. Recommendation was to continue 1/2 unit insulin but to either leave more food out or to change to a different insulin. PZI was the recommended one.
Thank you for all your help
Blood Curve: The protocol I follow is test every 2 hrs unless blood glucose is 150 mg/dl then test every hour.
Results blood glucose pre food and insulin 217mg/dl
+2hr=257mg/dl
+4hr=143
+5hr=110
+6 hr= 112
+7 hr= 88 fed 1 tbs of food
+8hr= 114
+ 9hr= 133
+10 hr= 141
+ 12 hr= 152 fed 3 oz food
I was concerned/confused about this curve so began testing again 6 hours after she was fed or 18 hours after insulin
+ 18 hours= 324
+ 20 hr = 314
+ 22 hr = 398
+ 24 hr= 396 fed 3 oz food and 1/2 unit insulin
+ 2 hr= 406
+ 4 hr= 319
+ 6 hr=263
+ 8 hr= 158. Cat was done having me poke at her ear.
Was a fructosamine test done? Yes I remember the results being 548 ( unsure of range)
Have there been alot of higher numbers over 130 mg/dl? What other clinical symptoms is your cat showing? She began peeing outside the litter box which is the first sign of return to diabetes. Did a 12 hour blood glucose curve with readings between 220 mg/dl and 345 mg/dl. Had vet do examination. There was about 2lb weight loss since went off insulin in August. Tests revealed abnormal liver enzymes. All else was normal( kidney, urine, thyroid) except frutosamine results. Recommended she go back on insulin. For elevated liver enzyemes prescribed denamarin ( 1 pill per day) and metronidazole (.65ml) two times per day with food.
Last Friday liver enzymes were redone and weight taken. Liver test came back normal and has regained some weight. My vet consulted vet internist specialist. Recommendation was to continue 1/2 unit insulin but to either leave more food out or to change to a different insulin. PZI was the recommended one.
Thank you for all your help
BJM
Member Since 2010
That curve was pretty nice (did not get below 80 mg/dL on AlphaTrak), but after more than 1 day at the dose of Lantus, you could end up too low at 0.5 units. Really suggest you try reducing it to 0.25, or just by a drop or two). If you do try another insulin, I'd go with either ProZinc or PZI (get the U-40 concentration of PZI) and non-depot (don't build up over time).
Perhaps the following will be helpful.
Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.
[Glucose reference ranges are unsubstantiated and have been removed by Moderator]
How to use the glucose reference values chart:
When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.
Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.
Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.
Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.) Funny you should ask that.. let me find it.
Perhaps the following will be helpful.
Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.
[Glucose reference ranges are unsubstantiated and have been removed by Moderator]
* * * * * * * * * * * * * * *
How to use the glucose reference values chart:
When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.
Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.
Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.
Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.) Funny you should ask that.. let me find it.
Deb & Wink
Member Since 2013
Thanks so much for the additional information and some more background as to what is going on.
I see by your testing, that the numbers do head back up to the 200 and high 300 range if you do not give any insulin.
From the additional info you have given us, looks to me like your kitty does still need a bit of insulin. Since you are already using the Lantus, it makes sense to keep using it and simply reduce the dose from 0.5u to 0.25u. You just have to eyeball those 0.25u dose increments, since no syringes are available that will measure that small.
I would not call that 88 BG reading on the Alphatrak too low. We get concerned and more watchful if the number drops below 80 on an Alpahtrak. That 80 BG reading still gives us some wiggle room to feed a bit of a higher carb food to gently bring the numbers back up.
Switching to another insulin like PZI or Prozinc would certainly be an option if that is what you and your vet decide to do after talking. But, the Lantus is one of the good insulins for a cat, with a more gentle curve. You are getting good results with the Lantus. It may just be your kitty is trying for yet another remission and needs that reduction in dose.
I see by your testing, that the numbers do head back up to the 200 and high 300 range if you do not give any insulin.
From the additional info you have given us, looks to me like your kitty does still need a bit of insulin. Since you are already using the Lantus, it makes sense to keep using it and simply reduce the dose from 0.5u to 0.25u. You just have to eyeball those 0.25u dose increments, since no syringes are available that will measure that small.
I would not call that 88 BG reading on the Alphatrak too low. We get concerned and more watchful if the number drops below 80 on an Alpahtrak. That 80 BG reading still gives us some wiggle room to feed a bit of a higher carb food to gently bring the numbers back up.
Switching to another insulin like PZI or Prozinc would certainly be an option if that is what you and your vet decide to do after talking. But, the Lantus is one of the good insulins for a cat, with a more gentle curve. You are getting good results with the Lantus. It may just be your kitty is trying for yet another remission and needs that reduction in dose.
- Status