High dose cat getting nowhere w/ BCP PZI, any thoughts?

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ursa68

ursa68

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I started Colby on BCP PZI over a week ago, after being on Humulin N since diagnosis, and a brief try of Vetsulin. I have been slowly increasing and have been very patient... currently, up to 14 units of U40. Could someone look at Colby's SS and tell me what they think? He is a suspected acro cat, by the way, so don't freak out over the high dose!

I just feel like I am getting nowhere with the PZI. I would like to switch to Lantus or Levemir, but I will have to wait until payday to do so. He seemed to have better numbers on Vetsulin! Should I perhaps try a combo of Vetsulin and PZI until I can start him on another insulin? He has been eating very well, but has also been doing this strange meowing thing. Yesterday, about every half hour, he would get up from his bed and go get some water and then start yeowling. I don't think he's in pain when he does this.... I really can't figure out what it means. He did this a lot at the end of last year when he was having pancreatitis issues. It seemed to go away when I started supplementing him with B12. He's still getting weekly B12, so I don't know what is going on.

Also, when are the critical times for checking his BG? I should have done an hourly curve last weekend, but I was just so tired.

Any advice would be greatly appreciated!
 
You were getting lower BGs/larger drop when on 7 unit Vetsulin vice 12 and 14 units of BCP. That type of trend tends to indicates that 12/14 units is too much. This is evident since with 14 units yesterday evening BG went up.
 
Key times to check are preshots (always) and mid-cycle tests to determine how low a dose is taking Colby. I'm not familiar with Prozinc. I hope someone else can advise on good mid-cycle times for this insulin.
 
I think you may have increased too fast. We generally increase no more than .5 units at a time. You may have skipped over the ideal dose.

Nadir for PZI is usually 5-7 hours after the shot. Dosing is based on both preshots and nadirs.
 
I agree that you did increase fairly fast. A slower but measured increase might be good. I think Larry's 6 cycles is a good gauge. And then increase by .5 every time, getting a number somewhere in that +5-7 hour time frame as often as possible. If he is a high dose cat, this faster schedule is wise.

Have you figured out why he might be a higher dose cat. Do any of these symptoms sound familiar? Have you had any tests done?

http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/
 
Hi Sue, I believe him to have acromegaly. I have not had a definitive test done b/c of financial constraints, and also, b/c that diagnosis would not change the way I'm treating him. He has had some physical changes in the past few years. That, along with the high insulin needs, lead me to believe he has acro.

I backed off to 8 units last night, but am wondering if maybe I should go down even further. He was being boarded when he first started the PZI, and by the time I got him back, the vet said to try 8 units. I guess I went up so fast b/c I was so desperate to see some improvement, and b/c he was on high doses of previous insulins.
 
Unfortunately the only way to figure this out is to try and see if you get any drops. Is the period when you were at 4 and 2 units, the beginning of the PZI? If so, the numbers didn't change much. (Although sometimes it takes a few cycles). Sometimes if the dose is too high on PZI, you see an inverted cycle, with the highest number coming in the middle. Sometimes a dose that is too high means a cycle that lasts more than 12 hours, with the lower numbers at the end. I don't see either of those with him. If he were mine, I think I'd continue increasing every three cycles and see if you get any lower numbers.

I know this won't be good news to hear, but generally the high dose cats here are on Levemir. I think the theory is that it works better and stings less at high doses. You might post on the Lantus and Levemir (combined) insulin forum and specifically ask for responses from acro cats. There is also a Facebook forum for acro cats.
 
Thank you, Sue. Yes, it says 2 U and then makes a jump to 8U. He was in boarding at the vet during that time. I tried to make the PZI switch obvious on my SS by putting it in bold, but then it switched all my comments for that date to bold and I didn't like that :) I'll play around with it some more. I'm sure if people glance at it, they maybe don't realize that my SS reflects 2 different insulins and they think I'm just randomly changing doses!

I did hear from some acro cat people (or should I say, "beans"), and they did mention the fact that the Levemir doesn't sting as much. I know my vet will prescribe the Lantus, not sure about the Levemir. I plan to make the switch next month, unless I see some magic from the PZI between now and then!
 
I am the same with Ursa. I am not getting anywhere either on this stuff. I went to 3 units this morning despite what others have said because I am tired of seeing him high 300s and not going down. So 3 units this morning dropped him from 391 to 268 but now it went back up to 299. I just don't see this crap working and once again I probably bit the bullet believing what others have said and thinking just because this is a cat insulin that it would work. So far 4 days and he has not went under 240 at all.
 
rbrumbaugh82 said:
I probably bit the bullet believing what others have said and thinking just because this is a cat insulin that it would work.
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Hi,
There is a saying here that "The best insulin is the one that works best for your cat." But, unfortunately, none of us can predict in advance which insulin that will be. The only way to know is to try the insulin and see what happens.

The insulin you're using now has worked very well for some cats. If it turns out not to work for Pooper then you do have other options to try. You are fortunate living in the US as you have a number of insulin choices available to you. It's not like that everywhere. Some folks have very limited options indeed.

I know you're disappointed that Pooper's blood glucose hasn't dropped as much as you'd like. You've seen his BG drop to better numbers in the past and you want him to get back to those. That's understandable. But do also bear in mind that at least Pooper's BG levels aren't swinging all over the place (that kind of thing can make some cats feel really off).

Maybe he just needs a higher dose. That's OK. But it's not something you can rush....

Eliz
 
Yes don't get me wrong, I am fortunate that his BG is not going up and down so much. However, I'm just disappointed that he can't escape the 200s and even below 240. I hate to keep seeing the Ketone stage code due to him testing higher than 240. I upped his dosage to 3 units because I do not feel 2 units is even doing anything let alone 1 unit. Yes he is a big cat(obese) at 20 pounds but thought 2 units would do the trick. IF 2 units was enough then I think he would be testing lower than 240 if his body was waiting for a healthy insulin supposedly like this one is supposed to be.
 
My cat is having a VERY similar issue---he is staying in the 260-360 range for 2 weeks now despite an increase in PZI from 2 to 3 units. I have stopped his probiotic the last 2 days thinking that might be it.

The vet suggested a dental cleaning or perhaps this could be a sign of infection. Not sure. Going to call him now to see what he suggests. Has your vet considered that anything else might be going on with his health to cause the higher BG?
 
I haven't talked to my Vet about any of that. This stuff stresses me out the way it is. I feel like if he had an infection then would that prevent him from seeing healthy numbers? When he was on N it would drop his numbers down into the 100s for a short time.
 
Tanya&MK said:
My cat is having a VERY similar issue---he is staying in the 260-360 range for 2 weeks now despite an increase in PZI from 2 to 3 units.
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Hi Tanya,
I can't see any entries on your SS since 19th Jan. Any chance you could update the data so folks could take a look at that?
.
 
The vet told me to consider a teeth cleaning in the next few months if he doesn't respond to 3.5 units. He said that's the most common place for infection if there is one.

Yes I will update my SS this evening.
 
Check to make sure you're using the right needles! I have u40 insulin and bought new needles a month ago and their u100 so I've only been giving him half or less of his dose!! I feel like a fool but so relieved and glad it only went on a month.
 
Hi Cindy... wow, Colby has been for quite a ride. A couple of things that occur to me.

First, if Colby (or Mr. Kitty) have dental issues, that could very well be messing with his numbers and need for a higher dose. Have you had bloodwork done recently? Also, why is he on Pancreazyme? My dog was on that about 12 yrs ago... for maldigestion or malabsorption. It may be that IBD and occasional p'titus is looking like one of those, though it may not be needed. Just curious. The fluids will also help bring down the numbers a little (as you noted "pink!"), in addition to the p'titus.

Looks like you're feeding low-carb food, such that that's probably not too much of an influence on his numbers. One thing, IF he's an Acro-kitty, (and the ravenous note leads me to think that's likely), you need to feed him. At his most ravenous, Grayson was eating 12-14 3oz cans of FF. And I still caught him sneaking Kitt-N-Kaboodle and dog kibble (he knew how to open canisters!) So we say "Feed the Beast". Grayson had been 18# for his earlier years, then jumped to 22#. At FD dx, he was ~18 and looked like death. The IBD issues, on top of everything, meant that he was 12# and anorexic looking when he went for SRT. Once we beat the IBD and he started improving, he started gaining weight, ultimately reaching 25.4#.

Some of his characteristics were enlarged paws, the gap between the canine teeth, the "saddlebags" - like pregnant bellies on each side. His eyes were perpetually dilated, and appeared a little further apart than his younger pictures. And his lower jaw was much larger and protruded more than my other kitties. And he snored - the stridor was much more pronounced as time went by. Grayson also had a heart murmur - from a leaky valve; and organmegaly (increased organ size - not diseased, just large - as shown on an ultrasound). I think there are some pictures representing these things in the acro forum, though I haven't checked since they changed the software. The first sign I noticed, however, was during one of his ravenous times when he was raiding the breadbox (where kitty treats were kept). His back legs suddenly looked like those of a jack-rabbit! Does Colby have any of these issues? There are some others as well, but unfortunately, our kitties tend not to read the instruction book, and often have different characteristics. Sneakers was a petite female... she defied ALL the norms!

I've used ProZinc and Levemir/R with Grayson, and switched a foster from N to Lev. He was on 13u N... and has never been on more than 2u Lev. Another foster I had was on high doses as well, but not tested. With the diet change, she never needed insulin. My Herb was on Lev for 1 weeks - diet change worked for him as well. I agree with the statement above that "the insulin that works best for your kitty is the best choice for your kitty". More than one may be successful for him. I opted for Levemir, partly because that seems to work best for Acros. As noted above, it doesn't sting at high doses (it's pH-neutral), vs the more acidic Lantus which SOME people indicate appears to make their kitty more resistant to their shots. In 3 yrs, G never flinched - even with obscenely high doses. I would be inclined to stick with the insulin you're using for at least a month to settle in and let his body acclimate to it. At one point, I was like you... though mostly red and fewer blacks... I thought we had missed the dose, and did a "reboot". It was discouraged. I did it anyways, but had to stay on top of the ketone checks because he was so high. (Glad to see you're testing ketones). Once we had the IAA dx, (insulin resistant), I realized that the reboot wasn't necessary. I just needed to climb - and aggressively. So based on that, even without the tests, I would encourage you to continue increasing. I generally did a 20-25% increase until I started seeing mid-blues. You're nowhere near that, so I would continue increasing.

Will check back in on you. Please feel free to ask any questions you may have.

Lu-Ann
 
@Grayson & Lu Hi, Lu-Ann! Your post has been the most encouraging and helpful I've seen in a while! It seems like everyone freaks out when they see the high dose Colby is getting. Unfortunately, I wasn't testing on a regular basis or keeping a log back when he was on Humulin/Novolin, but he got up to a pretty high dose. I've only been keeping a log since he's been on Vetsulin.

Grayson & Lu said:
First, if Colby (or Mr. Kitty) have dental issues, that could very well be messing with his numbers and need for a higher dose. Have you had bloodwork done recently? Also, why is he on Pancreazyme? My dog was on that about 12 yrs ago... for maldigestion or malabsorption. It may be that IBD and occasional p'titus is looking like one of those, though it may not be needed. Just curious. The fluids will also help bring down the numbers a little (as you noted "pink!"), in addition to the p'titus.
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As for dental issues, he could stand to have a cleaning, but the vet didn't see any obvious inflammation. I've discussed it with him and he worries about putting Colby under for one at this time. And yes, we have had blood work done recently, about 3 weeks ago, right before we started the PZI. I don't have the numbers with me right now, but his BUN and creatinine which had been elevated back in Dec., were down. I'm sure that's due to the subqs he's getting. Everything else looked pretty good.

Colby was receiving Pancrezyme for suspected malabsorption or EPI. I quit giving that to him a while back b/c I was having trouble getting him to eat the food with it. He had classic, eye-watering stinky, cow-patty poops, and a ravenous appetite, along with weight loss and poor coat. He was tested and came back high (I think I posted his tests in my profile?) for all the pancreas tests...fPLI, etc. So, at one time, we were probably dealing with some sort of pancreatitis or EPI issue. His poops have become much more normal lately, so I think that may have resolved (knock wood).

Yes, he is hungry all the time! I let him eat all he wants. Unfortunately, I can't leave food out during the day and overnight for him to graze b/c I have other kitties who will pig out on the food! Once, I tried putting Colby in an extra large crate so he could have his food all to himself during the day, but it seemed to stress him out too much. He gets as much as he can eat in the mornings for a couple of hours before I leave for work, and then at night, he gets let in and out of the bathroom all night where his food is kept, until I go to bed.

Grayson & Lu said:
Some of his characteristics were enlarged paws, the gap between the canine teeth, the "saddlebags" - like pregnant bellies on each side. His eyes were perpetually dilated, and appeared a little further apart than his younger pictures. And his lower jaw was much larger and protruded more than my other kitties. And he snored - the stridor was much more pronounced as time went by. Grayson also had a heart murmur - from a leaky valve; and organmegaly (increased organ size - not diseased, just large - as shown on an ultrasound). I think there are some pictures representing these things in the acro forum, though I haven't checked since they changed the software. The first sign I noticed, however, was during one of his ravenous times when he was raiding the breadbox (where kitty treats were kept). His back legs suddenly looked like those of a jack-rabbit! Does Colby have any of these issues? There are some others as well, but unfortunately, our kitties tend not to read the instruction book, and often have different characteristics. Sneakers was a petite female... she defied ALL the norms!
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The dilated eyes! Colby has had permanently dilated eyes for years now. I didn't know that could be a symptom of acro. I took him in to the vet back when I noticed it a few years back (before the diabetes dx) and the dr. didn't have an answer. We did routine blood work and he had his blood pressure checked, but everything was fine. He has always been a large cat, but yes, I do think he has bunny rabbit paws. The paws and the slightly broadened forehead are the only physical signs I see right now. I haven't noticed his belly getting any bigger, and he really isn't gaining much. I will probably break down and have the tests run for acro and IAA at some point. I'm just tapped out financially at the moment.

As for the insulin, if you look at Colby's SS, you can see we backed off a little (cut back by almost half), or "rebooted" recently. I don't think my vet was very happy about it, and I wish I hadn't now. I've started increasing quicker, and now with your encouragement, I will definitely do so with more confidence that I'm doing the right thing! I'm going to give the PZI a little longer and see where we get, and then try Lantus or Levemir.

Thank you so much, Lu-Ann!
 
Last night I popped on to the Lantus/Lev forum and responded to some of Suki's questions about Crystal. They had actually been checking out Grayson's SS (I've got tabs for G, Spartacus & Herb in one SS - Grayson's are the tabs that have the insulin and the year, further to the right). You may want to check out that post as well, as I was talking through some of the same issues you may be dealing with. There have been people managing Acros on BCP PZI, as well as other insulins. But the high dosers generally do best on Levemir (if you're given the choice, or if you request a change). Lev is pH-neutral, thus tends not to sting at higher doses, and it tends to bring a more level curve. In the meantime, I think it's important to give an insulin 6-8 weeks to see how it's working for you before you start thinking to switch.

IF you decide to do the testing, have your vet call MSU and request the pre-paid mailer. Usually takes a week or so to get that. I printed out the test sheets, took them to my vet and asked her to do the blood draw and order the mailers. Once they were in, we drew on a Monday morning (blood is spun then frozen), FedX overnight, and we had the results on Friday afternoon. One of the tests they (at least 3 yrs ago) they ONLY ran on Wednesdays. Some people had to wait nearly 2 weeks for results, so timing and viability of the blood is important. I also offered to take the package to FedX, but my vet did that. I think she only charged me for a blood draw... others have had their vet tack on a chunk of other charges. You may want to talk to your vet before proceeding so you don't get sticker shock. I was EXTREMELY lucky, as my vet and I went through a LOT of the info I had gathered (copied/highlighted). She was very willing to do any tests I asked for, although she was more surprised with the anorexic looking boy being a giant kitty more than I was! And ultimately, as I was told by SEVERAL vets, the IGF-1 test is not a slamdunk dx. We followed up with an ultrasound which showed organmegaly, and an echo of the heart which showed a slight murmur due to a leaky valve. Acros tend to have heart issues. Still, not definitive until he had the CT and they SAW the tumor. But that wasn't done until he was at SRT... you have to have a CT to do the physics for radiation, so you don't want to pay for that twice. Also, we opted for SRT at CSU. They had done the initial research, and had done more Acros than anywhere else. There are other places doing it, but I wanted to "go to the mountain", if you will. If that becomes something you consider, please get back with me and I'll offer more thoughts - I'll spare it for now.

The Pancreazyme worked well for my dog Murphy, but I think when you've got an FD or Acro kitty, it's more likely that it's IBD. Glad to hear you've discontinued it.

As for the re-boot... when you changed from N, there was probably a sizeable drop in dose. I think Spartacus was on 11u... and Lev since last April, and never more than 2u.

Keep me tuned in to your progress. If I'm not around regularly, feel free to send a PM and tell me to pop in, as that will trigger an e-mail. Hang in there! This is more like running a marathon than a sprint.

Lu-Ann
 
Thanks, Lu-Ann! I'll check out that thread. I still intend to give the PZI a decent try. I have enough left in my vial for probably another week, and then the vet finally received the free sample from BCP that I can use too.
 
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