Hi, my name is Chuck! I'm transferring from Lantus Land...

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Chuck and Susan

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Chuck is an 18 year old previously diet controlled diabetic. He was first diagnosed in March, 2008, and, using Lantus, I was able to go OTJ about 2 months later. He remained diet controlled until February of this year.

Since February, his BG's have fluctuated wildly almost daily. He's been on a constant "roller coaster", except for one week when we withheld insulin to clear the depot and start fresh. During that week, he stayed in the mid 300-s consistently. Going back on insulin, he would be "HI" on the meter, then 6-10 hours later, he'd be below 50, all on the same unit of insulin (or half unit, or quarter unit -- it didn't make any difference).

Prior to switching insulins, the vet consulted with Texas A&M vets, and they suggested a TLI test as well as "routine" bloodwork to rule out any possible physical cause for the fluctuations. Heard back from the vet today regarding these tests. His white count is normal, his red count is normal, his hemoglobin is on the low end of normal, so the vet is thinking possibly mild anemia.

His BUN is a little high, but his creatinine is normal, so no kidney failure at this time. His BG at the draw was 431, not surprising with vet stress and the way he's been roller-coastering for the last 3 months.

His liver enzymes are normal; his T4 is low but normal, no ketones. No sign of infection or bacteria -- he had a UTI in December that took about 4 antibiotics to clear up, so they wanted to be sure he was still clear. His TLI came back at 77.5, which is in the normal range (12-82).

No pancreatitis (chronic or acute) or pancreas issues, no liver issues, no kidney issues -- it must be the insulin. He recommended either ProZinc or Vetsulin -- I'm leaning towards ProZinc. He doesn't think we need to clear out the Lantus depot, but doesn't want me to start him on the PZ and then go to work -- I should be around to monitor the first couple of days. So, we're going camping this weekend, and my plans were to sew a bunch of projects. Chuck has to go along anyway; I'll start him on the PZ Sunday morning. I have to work Saturday until 5, then we're headed to the campground; I don't want to feed him, give him a new insulin, and then put him in the truck for a 45 minute drive. My plan is to get to the camper, feed and give one last dose of Lantus Saturday night and start the PZ Sunday morning, depending on BG.

I've attached his Lantus spreadsheet. Please let me know if you do things differently in PZ-land.

Thanks for letting us "move in" for a while!
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

Welcome Chuck and Susan!

Differences. ProZinc doses are based on preshots and nadirs both. We do not shoot low to stay low. ProZinc is a 12 hour insulin. After 12 hours, it is usually gone. There is no shed or carryover. Here's a document with lots of links and info:

http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799

It may be helpful (tho ECID) to look at some other people's ss and see how ProZinc is working for them and how they dose. There is no protocol.

The other difference is the forum.. This one is very small and not very busy except at night and in the am. Be sure to post on Health if you have an emergency.

I hope Chuck gives you flatter cycles on PZI! I like your plan for starting.
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

Hi and welcome Chuck and Susan,

I would definitely pick Prozinc over Vetsulin. The dosing protocols are very different between Lantus and PZ and you should wipe your mind clear and start with a clean slate.

I love that Chuck goes camping with you.

I like your plan but am a little nailbite_smile about not depleting the Lantus shed first, especially if he drops to 50 on a very small dose of Lantus, and then you shoot PZ with the shed still in place. Did your Vet say why he didn't think you needed to do that? What dose is your vet starting with? I would keep it really really low for the first week until the Lantus is out of his system. Be sure to take a hypo kit with you.

I'm glad that Chuck checked out so healthy at the Vet. It's so reassuring to know they have a clean bill of health, especially at 18 years old.
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

We're going to start on .5U PZ and go up from there if needed. I asked about taking him off insulin for a while, but the vet didn't think it was necessary. I may just skip his Saturday shots entirely (depending on BG) -- that way I don't have to take 2 insulins and two different syringes and try to be sure I'm getting the right one in the early morning hours.
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

Skipping the Saturday shots will help.

When I switched Harley from Lantus to PZ the vet took him off insulin for 3 full days, yes he ran higher but she didn't want any overlap and I agreed.

I think the .5u is a good starting point.

I wouldn't want to take two of everything along either.
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

Well, I can skip tonight's shot, and Friday's shots, along with Saturday's. His Lantus depot should be pretty much depleted by then, do you think?

I've been "dose hopping" with the Lantus, but trying to get some regulation going rather than the "HI" on the meter follow by a 78 10-12 hours later. So, yesterday he got nothing in the morning (106 at shot time and 166 2 hours later). He was 505 at PM shot time, so got a full unit. 2 hours later, 527; 3 hours later 425, 4 hours later 455 and I gave 1/2 unit. 6 hours after that 1/2 unit, he was at 340, so I gave another 1/2 unit. This morning, he was 266 at +3, no shot. And now at +9 from the last 1/2 unit, he's at 255. I haven't gotten his spreadsheet updated for today yet...

Because he can drop like a rock (or shoot to the moon!), I generally don't give insulin if he's below 250-275. A lot depends on how he's acting -- he's doing pretty good at letting me know when he's going low or high. Low --- he wants constant attention. High -- he hangs out in the closet. Otherwise, he hangs on my computer desk, looking out the window.
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

Based on what you shot yesterday I would definitely stop giving him insulin tonight and start with the PZ on Sunday, the Lantus shed should be mostly depleted by then. Do you have internet access while camping?

With PZ you want to stick as close as you can to a 12/12 schedule, shooting every 12 hours. If you do a fur shot (happens to all of us) you have to wait until the next 12 hour PS to shoot again. You don't know how much insulin actually went in so if you gave another shot you could be almost doubling the dose and you can't take it back out once you shoot it in.

I still like the .5u PZ starting dose. Once we see how he responds to the new insulin we can go from there. A PZ curve should look like a gentle smile, about a 50 to 60 % drop at nadir and back up.

Isn't it amazing how intuned we get to them and their behavior.
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

The internet access is sometimes a little shaky at this particular campground. I have a hypo kit that I carry with me when we travel, as I never know what Chuck is going to do -- sometimes, traveling is very stressful, other times it isn't.

And, since he's been on Lantus (this time) for 3 months, I'm comfortable with testing frequently (even if he isn't!) and shooting on schedule. I was doing a 12/12 schedule on the Lantus, but it didn't seem to be holding sometimes, hence the dose-hopping and smaller doses more frequently.

I'd LOVE to see a little "smile" on his curve, instead of the steep hills and valleys I've been seeing...
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

Good to hear. I didn't intend to make it sound like you were a new member, just trying to cover all bases.

I'd like to see a gentle smile on his curve one day soon too. :-D
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

Preshot test was 325, higher than I'd like to see, but I won't give him a shot. He was 255 at +9, the 325 is +14. I'm getting ready to take the travel trailer to the lake for the weekend, just setting it up tonight, so still won't have his spreadsheet updated for a while. I can give the following numbers:

5/22/2013 192 7:30 PM +3 hours
5/22/2013 51 1:30 AM +9 hours
5/22/2013 106 5:30 AM +13 hours
5/22/2013 166 7:30 AM +15 hours
5/22/2013 505 5:30 PM 1U injection
5/22/2013 527 7:30 PM +2 hours
5/22/2013 425 8:30 PM +3 hours
5/22/2013 455 9:30 PM 0.50 injection
5/23/2013 340 3:30 AM 0.50 injection
5/23/2013 266 6:30 AM +3 hours
5/23/2013 255 12:30 PM +9 hours
5/23/2013 325 5:30 PM +14 hours
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

He will probably run high for a few days but better that then overlapping insulins and him going too low while you are at the lake.
 
Re: Hi, my name is Chuck! I'm transferring from Lantus Land

Welcome Chuck and Susan! My kitty, Simba, is 18 as well! Let's hear it for the seniors! I use ProZinc too, and this is also our second dance with diabetes. It sounds like Chuck is pretty healthy. ProZinc should give you both a break from all those booster shots. LantusLand is like the NASCAR of feline diabetes, and we are the elevator music. :mrgreen:
 
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