Is it time to change from Lantus to Prozinc?

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DianefromDallaa

Member
Bella is almost 17. She’s CKD and been a diabetic for over 5 years.

Her glucose has been running really high on and off for 2 years. Most recently, been working with someone to get her bounces under control by doing Lantus at 10am/pm and then Novilin R at 4am/pm. Sometimes doing Novilin R also at 8am/pm.

Bella just doesn’t seem to have a long effect with Lantus. Maybe 4 hours, maybe 6. It usually takes 2 hours to see any movement.
She’s on .5u of Lantus and if I increase, she goes hypo.
She quickly responds to .25u of NovilinR.

I am trying to post my spreadsheet. You’ll see a lot of high numbers.
She recently had her first bout with pancreatitis. Awful but lasted a few days. Then today she decided to vomit.

Her PCV is dropping- did this last year and a round of Pepcid and carafate helped. we also did Aranesp when her pcv was 25% last year and people freaked out.

Here’s her full drug list

lantus- .5u twice daily
Novilin R- .15u at least twice daily
Pepcid- twice daily
Carafate- twice daily
Cerenia- once daily
Zofran- every 8 hours
Subq fluids- 100 to 125 ml DAILY (separated in 2 sittings)
Zobaline daily

Bella has dropped from 8.9 to 8 # in a month.

The high glucose numbers are starting to cause lots of face and head twitching. (I think it’s caused by high glucose)


So how do you know when you SHOULD go to a different insulin???
 
What dosing method are you following, is it SLGS as per the SS? I don't understand why you reduced the dose on the PM of March 11th. SLGS says to reduce if they go below 90, which she did not do.

As someone who has used R, I see several problems with your use of R. First of all, you do need to monitor closely, and following TR for dosing is better if you are going to use R. Since early March, the amount of testing has dropped off a lot, which is counter to what you should be doing if shooting R.

There are several principles with using R, that I'm not seeing happening here. First, you must test more when you give R. R can drop them hard and fast (which can cause a bounce or take them too low). You don't test just when you give it, but also test to see what it's doing. You need to understand the Lantus action, and also the R action so you can understand what happens when you combine them.

I think the dropping hard and fast is what is causing a lot of bouncing. She was doing that before you started using R, and R is now making it worse. You don't want her to drop more than 100 points over the duration of R or you will set off another bounce. Improper use of R can set you up for vicious drop/bounce cycles. As an alternative to R, you need to think about when you are feeding her in the first part of the cycle, and see if you can slow down her drops. This post has a lot of good information and it was about a cat that had numbers similar to Bella's: Using Food to Manipulate the Curve I also think that if you properly slowed down her drops, you might be able to do away with R. Adding R is making it worse, not better.

I see other issues with the use of R here. The timing of giving R is all out of whack. You do not want nadirs of the L (Lantus) to happen at the same time as the nadir of R, which they can do if you shoot at +4. We don't give the same dose of R all the time, but rather base it on the R preshot (not the Lantus one). Some cats need only a drop or 0.1 units of R, cats on larger doses might need even more.

Summary, Bella is not a cat for whom I'd suggest using R. I'd focus on slowing her curve with food first and stop the R. I don't know if Prozinc would help her, you'd likely have a lot of the same problems with her dropping and bouncing, but we don't know for sure. Typically people switch from Prozinc to Lantus, not the other way around. But ECID - each cat is different, it may work better for Bella. The one thing I'd caution you with, if you switch to Prozinc, do NOT use R at first, or maybe not at all. There is very little experience with people using R and Prozinc.
 
Thanks Wendy

Let me fill in some blanks….
Since late February, I have been using Freestyle Libre to help in monitoring. I am finding the Libre is 100-150 points LESS than the Pettest Advocate.
Before I do ANY dosing, I test with the handheld and then watch the trend on the Libre.

Why did we introduce R? We repeatedly found that Lantus only lasted about 4-5 hours!! No matter what I did.
Bella free feeds and gets Fancy feast pate which is low in carbs. When I tried to impact her curve with food, nothing happened.
She’s been diabetic for a LONG time. We started having weird curves the past 18 months. She frequently had UTIs (high sugar didn’t help this st all!).

You asked about the reduced Lantus- we saw a slight decline in the bounce and we’re trying to work that- but another UTI (or an unresolved one) got in the way.

So…we introduced R to try and address the HUGE gap between Lantus shots.

Changing food times doesn’t work and I only get 5ish hours from Lantus.

———what do you suggest???———

I even asked about doing 3 Lantus shots daily but was told it’s a depot insulin and that won’t work.

I’ve had her hospitalized for 3 days and they had no luck even getting her off the max numbers.

Im at a loss and she’s going downhill quickly since she’s been so high so long.
 
Are the numbers in the spreadsheet now from the Libre? If you are using the Libre instead of the Pettest, please update the signature and the meter listed on the top of the spreadsheet. I would also be handy to put a blank line on the spreadsheet between when you switched meters, so it's easy to see that change happened. Label that line "switch to Libre" or something like that.

Another approach to slowing the drop is to give her slightly higher carb foods, maybe something in the 8-9% carb range. That might slow the drop and allow you to get more insulin into her without her dropping too low. Not all cats do well with the lowest carb foods.

What is your regular feeding schedule each cycle now? Can you point to the dates when you tried impacting her curve with food?
DianefromDallaa said:
We repeatedly found that Lantus only lasted about 4-5 hours!!
Click to expand...
I see lots of examples of Lantus lasting longer than 4-5 hours, look at all those cycles when she makes it down to the blues. 2/28 it lasted the full 12 hours. 3/12 was looking like a good cycle until you "fed carbs", whatever that means. Use the Remarks section to describe what amount and % of carbs you gave. If you give too many carbs at or around nadir, you are going to shorten duration.

Bounces don't impact how we change doses in Lantus, we primarily use the nadirs to tell us what to do.
 
The spreadsheet is only Pettest because I didn’t want to mix as there was a HUGE difference.

if you look at the file, you will see a new tab with Libre.
2/28 was an anomaly because she got very sick that night.
3/12 was off because she was dropping too quickly and I was leaving the house so I fed carbs.

she had previously been on science diet that was higher in carbs but she stopped eating which is why I went to FF.

Her nadir has been very quick.
I just started R in late Feb.
Take a look at 2024 and you will see the issue.

I am open to trying things but she is very delicate right now.
I forgot to mention she’s on cyproheptadine too each day.
 
DianefromDallaa said:
2/28 was an anomaly because she got very sick that night.
3/12 was off because she was dropping too quickly and I was leaving the house so I fed carbs.
Click to expand...
This is where writing notes in the Remarks column can be very useful. A couple months from now you might forget the details too. When you say you fed carbs on 3/12 - define "carbs", how much, what % carbs.

You said that previously you had tried feeding the curve. Can you tell me when you did that so I can look at the spreadsheet for that time period? Hint, this is another reason notes in the Remarks section are handy. You could remember, and I wouldn't have to ask. I am specifically looking for when in the cycle you fed, and what carbs.

DianefromDallaa said:
I just started R in late Feb.
Click to expand...
Feb 13th according to the spreadsheet.
 
I have a ton of different logs. Not sure I can manage any more to be honest.


Maybe I don’t understand how to use food to manage the curve. I read the article and am confused. Am I supposed to feed higher carbs around shot times and lower at nadir? By doing that, how does it extend the time for Lantus??? Looks like it would flatten the curve but my issue is that it is very short acting. I’m really confused how this works.

Does prozinc have the supposed 12 hour coverage? Why do people use prozinc vs Lantus - what are the benefits.
My vet is wondering if Bella is developing a sensitivity to Lantus and not metabolizing it like she did in the past - hence the desire to switch.

I’m pulling out my hair.
 
What you want to do to manage the curve is to first figure out when the big drops are at the beginning of the curve. Then use food, start with something higher carb than her regular LC, but could still be just higher LC, say 8-9%, and feed that 1/2 hour before the big drop happens. You want to have extra carbs in her for when the big drops happen. That will slow down the drop. You may have to experiment with both timing and % carbs that you use.

Prozinc is also supposed to be 12 hours, though I think people find Lantus is better that way. But as I said above, every cat is different, it might work better for Bella. People who use Prozinc do because that's what their vet starts them on. In some countries, like the UK, laws make it easier to use Prozinc than Lantus. So lots of different reasons. If you want to try Prozinc, do so. But as I said above, do it without R. You want to learn how she's doing on Prozinc. Keep your Lantus just in case it doesn't work out.
 
So I can see how the food changes the big drops- but how does that help in extending the duration past 5-6 hours?


Tonight has been a very interesting one for Bella. She got Lantus at 1130. Based on Libre, she didn’t start to drop until 1:45 am.
she didn’t eat at all which is VERY VERY unusual. Her glucose dropped by more than 200 points and looks like it hit nadir at 5:45. Usually she would hit nadir by 3am.
Now she’s rapidly increasing. probably by 8am she will be up 300 points.

This is one of the longest durations but she hasn’t eaten at all.
 
Slowing the big drops reduces the amount of bouncing. Reducing bounces keeps the numbers lower longer. It doesn't actually impact duration. Feeding after nadir can impact duration, so if you are feeding higher carbs later on, that could be a cause of loss of duration,.

Onset is typically 2-3 hours after the shot and you saw it 2.25 hours later, so that makes sense. A nadir 4 hours after that is also typical Lantus.
 
What is your definition of "hypo"? On the 12th, she was barely into the 90's, not even low enough to earn a reduction when following SLGS.

DianefromDallaa said:
So how can I get a longer duration??
Click to expand...
What I said above, try using food to slow down her fast drops. Those fast drops are causing bouncing which means she's zooming up at the end of the cycle. It's not a duration problem, it's a bouncing problem. I'd also recommend stopping the R, it could be making the dive/bounce pattern even worse.
 
You are completely correct. However, I saw the Libre had dropped to 47-55 and I freaked.
She had dropped 200 points in an hour and I relied on Libre when I should not have.
 
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