New to FD and PZI

[MsKarilynn]

Hi Everyone!

A few individuals at the site here have recommended I stop by and ask advice on this end of the forum.

My story in a nutshell: I have a 12 y/o cat named Brody who was diagnosed around 2 and a half weeks ago. (Wed. March 31st) Noticed he was urinating, well, everywhere. Eating a lot more, drinking a lot more, losing weight, etc. Seemed like typical signs of diabetes. Took him to the vet, blood panel was done and urine test, sure enough, BG was 485 and he was diagnosed officially. My vet clinic isn't necessarily the greatest, but they gave me a decent amount of information and taught me how to shoot his insulin. He was on 1 unit twice daily of ProZinc for a week, went in for a follow up and his BG was higher than the week before. I was told to shoot 2 units twice daily. I did this for 3 days. During these 3 days I learned how to home test (I have been using his paw) and am getting decent at it. Last Sunday I randomly tested him 7 hours after shooting and his BG was at 41. He didn't seem to be acting hypo, was eating, running around, etc. From what I was told, this was his nadir and it was too low. I have been giving him 1 and a half units (without my vets permission, but I feel kind of own my own here) I am honestly afraid to be giving him 2 after his 41. I didn't test again right after, I should have, I know, as this could have been a bogus number. I always test before shooting, but I am starting to figure out the nature of this insulin is that he goes lower and lower until he hits his nadir 7-8 hours in and starts to climb again, so every single time I test before shooting, he is high again, usually anywhere from 400-500.

Here is the complicated part... I work Monday-Friday and am gone from home between 2 pm and 11:30 pm. I work second-shift and I commute a half hour, so coming home mid shift isn't an option. I am also single and live alone, so there is no one else here to test him. I am hoping someone can tell me that this is okay, because if I have no job, I have no way to take care of this cat and that's just not an option. He's my baby. I have been shooting his insulin at 12 am and 12 pm, works best with my schedule. Today I tested him around 5 pm and 7 pm. He was at 202 the first time and 208 the second. So, no where near that scary 41. I am doing a curve with him tomorrow. A girl from the site here is actually coming over and helping me out with creating a chart. I've noticed, though, when looking at charts, that people test up to 5-6 times a day, every single day. This isn't possible for me. I can test him before I shoot and all day on the weekends and that's it.

I guess I have a few questions about ProZinc. My first question being, how long does it usually take to regulate a cat using this insulin? I read someone say it takes 45 days for the insulin to start being effective? Is this true? I haven't seen any improvement. His behavior has changed quite a bit from changing his diet to low carb wet food. His coat looks better, he has gained 2 pounds, he's running around here again. He still does urinate outside of the litterbox. The other night I watched him go in my closet and then an hour later he went on the mat in front of the litterbox. I am being very patient with him and just cleaning up after him. It's just his numbers that aren't budging. How does this work? If 2 units was too much, how was he still around 450 when testing him every 12 and 12? I realize this is a somewhat slow releasing insulin? I am just wondering if it just takes time to get him down? Going into this I knew absolutely nothing about diabetes, so please forgive me for being somewhat clueless on the topic. I am honestly trying my best here.

I appreciate everyone on the site and all the advice I have been given! Tomorrow I will post his numbers from his curve.

Thanks everyone!

 

[Nancy and Cody]

Welcome! You made it!
Were looking forward to that spreadsheet in order to help you. If you don't get it up soon, you can still post info like this, (xxx = the glucose reading you get, PS = preshot) so we can start trying to help you figure it out.
PS= xxx
+2+ xxx
+6.5=xxx
+9= xxx
ps= xxx
You can edit your post when you have new data to add.

Many folks here work, so you aren't alone. You just need to test when you can. You are gone most of one cycle, but you can grab some readings during the cycle you are home, even if you have to set an alarm once in awhile. You can do full curves on weekends.

You can learn a lot by reading the various health links on the site so you get up to speed on diabetes and his care. Check this out : viewforum.php?f=14
If he's gaining weight that means the insulin is most likely starting to work.

Others will be along soon. This weekend try to get readings every 2 hours if you can during one full 12 hour cycle

Have you tried Petzyme or any number of other "enzyme/friendly bacteria" products to neutralize the pee?

 

[Terry and Puttz]

Hi and Welcome! It sounds like you are doing great, actually, just need some fine-tuning with advice from the great people here! I have been using ProZinc, switch from Vetsulin, it has been 10 weeks now and it took us a good 6 weeks to stabilize our numbers (see spreadsheet (SS)...When I did the curve, I noticed that ProZinc was a much slower-acting, gentler insulin than Vetsulin, kicking in at about 2 hours with a duration of 10-12 hours...As you can see, we went from a high-dose to a much smaller dose these days as my SugarKitty is adjusting himself, doing great...Please be patient and ask all the questions you have...This site has been a life-saver for my little guy! Keep us posted.

 

[Hope and Aria]

I'm going to answer one of the questions in your post that I don't think got answered. I put more detail below, but I wanted to make sure this info came across.

If 2 units was too much, how was he still around 450 when testing him every 12 and 12

You can be having rebound or liver activity when he goes too low. If you check out Aria's TID spreadsheet (in my signature) and look for line 43 and 44, you'll see she was in the HIGH there (over 550) after the vet's gave her too much insulin. Her body reacted and those high numbers will hold and sometimes give you wonky numbers for a cycle or two. Aria was at an every 8 hour shot schedule at the time as she wouldn't regulate, but the principal is the same. The liver acts as a protective organ when the blood sugar goes too low and dumps glucose into the system if it can.

I have to 2nd Terry's post. Usually we don't see much response in the first 2 hours and then it starts to work well. We've also experienced a major decrease in the amt of insulin needed after the settling in period. That could just be Aria, but it was significant.

Also, at least for us, very small dosage changes made huge differences. For example, 1 unit was still way too much, but .8 is perfect. ProZinc seems much more potent and how they expect you to tune in on small dose changes with U40 syringes is beyond me. Before I started fine tuning, the vet had me go from 1 unit to 2 where 2 was WAY too much and sent her into hypo numbers. I also have a cat who does not show any signs of hypo even in the 30's, so it's possible that your low number wasn't bogus. Some cats don't show scary hypo signs when they hit low. Here's the link to the U40 to U100 syringe conversion --> http://www.felinediabetes.com/insulin-conversions.htm. If you can get some U100 syringes, you can fine tune your dose a whole lot better.

Also, since you changed his diet, you should expect to see a decrease in the dosage that he will need. You may see some inappropriate peeing for a bit. As his numbers start to stabilize, that should decrease. My girl pees on things when her BG's are too low, too high or highly fluctuating. We deal with a lot of pee here. But once she stabilizes, usually it goes away. I sometimes have to quarantine some of her go to points to retrain her to remember that the kitty box is where to go, but usually she catches on pretty well

Looks like if you shot 12am/12pm that it would fit into your work schedule just fine. You should be able to grab a +1 number right before you leave which can be helpful. I found, with Ari at least, that if her +1 or +2 was already lowering her BG's that the overlap I was getting was showing the dose as being too high. Also, maybe once a week, you could get up midcycle to test at +5 or +6 and just see where he's at. On the weekends you can be more agressive with the testing and the data will help. For times when you can not test during the day, look for trends in your PS (preshot) numbers. If you notice they are constantly way too high, try and grab a nadir check (somewhere between +5 and +8ish) so you can confirm that you are getting a nadir. Then that's a pretty good indicator that your dose needs to increase. If your PS are always low and you're waiting to shoot, there's a good chance your dose needs to be reduced.

I can't remember who said these 2 things, or I'd give credit as it was helpful to us. If you grab a nadir and you see anything below 50, reduce the shot. If you grab a nadir (that you know should be a nadir) and it's in the mid to upper 100's AND it's lower than your PS, you probably need to increase the dose.

I hope I didn't throw too much info at you at once. Ask anything you want. The people here are great and extremely helpful. FD doesn't have to be uber expensive, and sometimes if caught at the beginning and proper diet changes are made, with a little insulin help and some good testing, you have a chance for your kitty to be a diet controlled diabetic and then just have to spot test to make sure he's hanging in there. Feel free to PM if you have a question that isn't getting answered as well.

Edited because sleepiness is no excuse for lousy grammar.

 

[Joanna & Bix (GA)]

Welcome!!! Don't be intimidated by all the testing that you see in people's spreadsheets. Some of us (guilty! ) at times overtest, and/or are home a lot with nothing better to do. :lol: Seriously though, if you can get PSs every day, and a few spot checks or partial curves on the weekends (or full curves if you are up to that, but that is certainly not something you would need to do every weekend), that is perfect.

Partial curves can be every 3 hrs instead of every 2, or what I liked to do at times was test every 2 hours for a sequence of 6 to 8 hours (like maybe PS, +2, +4, +6 in one cycle, and then next PS of course) and then that's enough for one day. (Unless your cat REALLY loves the testing! ) Then maybe PS, +6, +8, +10 the next day. Even that much isn't 100% needed, it's just to help give you a picture of what is going on until you have a better sense of things. With my cat, although I tested a lot before he was regulated, now I mostly just test PSs and a nadir every few days, since he is fairly predictable.

As someone else said PZI responds quite a bit to small changes, so you may find that 1.5 isn't enough, 2 is too much, and something like 1.8 might work perfectly. I have seen with some cats (like mine) it seems to be an all-or-nothing thing - if it isn't enough insulin you don't see much movement in the #s, then with a small increase, all of a sudden you are getting lower #s. It's just a matter of fine-tuning at that point, so although it is frustrating it is actually good news - you have a bracket of the doses and you have a pretty good idea then where to fine-tune to.

I would stick with the 1.5 for now until you can get a little more data, and if it shows a nice U-curve with the nadir too high (maybe this weekend try for a PS, +3, +7, +10 and next PS, or something like that?), then you could try 1.75 or 1.8, and then the following weekend try to get some data on how that is working if you can't get spot checks in before that.

It can be overwhelming at first, but it is great that you are already home-testing, and it will start to make more sense as you go along. Just keep asking whatever questions you have! Feel free to post an update every day - sometimes some of us do that, though we have been a little sleepy lately. It's a good way though to get daily feedback and keep people up-to-date on how things are going.

If anyone else is reading and wants to post daily updates too, please do! It has been fun in the past when there are several people doing that each day, I miss it. Bix usually doesn't have much news, so I haven't been posting much on him.

 

[MsKarilynn]

You are all amazing! Thank you so much for the information - totally helpful. I am doing his curve today and so far so good. I am doing it on my own, but it's going well!

These are my numbers thus far: (got a late start today and shot him at 1 pm)
PS at 1 pm: 361
+2: 331 (down 30!)
+4: 255
+6: 279 <-- higher, worst test of the day, went through 4 strips and about 9 pokes before I got a successful reading. UGH!!!!
+8: 456 <--- ??? what?
+10: 471

Only 2 numbers so far, but he did go down within 2 hours and he was lower PS than any other day so far. I feel like I am making progress and I can thank all of you! Brody thanks you, too.
Edit: Just did his +4 and got 255! Yay!

Thank you from both of us!

 

[Kelly & Oscar]

He's such a sweet looking boy! Looks much like my Oscar did before he lost all the weight when he got sick. Congrats on successful hometesting and keep up the good work! :RAHCAT cat_pet_icon

 

[Hope and Aria]

Kelly, I was just thinking he looks like the "before" pic of Oscar you posted.

Great job Karilynn. It gets easier and the closer you get him to regulation the easier it will get He's improving and that's fantastic!! Go Brody!!

 

[Joanna & Bix (GA)]

What an adorable pic!!!

I wouldn't worry about the +6 being higher than the +4. With meter variation, the #s are close enough that I wouldn't really call it a significant rise at +6, and he may well have nadired before that anyhow, so could have been starting to rise just a little at that point.

I will be interesting to see what the +10 and next PS are. The +8 is a little higher than ideal, but based on all the data so far I don't see anything at this dose to suggest rebound, unless the +10 & PS are wacky. If those continue higher, I would say the dose is too low (but I wouldn't go up as far as 2u, I would try something mid-way for a few days).

I guess I have a few questions about ProZinc. My first question being, how long does it usually take to regulate a cat using this insulin? I read someone say it takes 45 days for the insulin to start being effective?

It certainly works great in the 1st 45 days from what I have seen. Maybe they mean it takes that long for their system to fully adjust and reach "maximum effectiveness" or something...? I have seen the 45 days mentioned, but it clearly works right from the start!

Regulation times REALLY vary by cat. Some cats go OTC in a couple weeks, some are never fully regulated. I think it is a combo of what caused their diabetes, how long they have had it, how much is temporary cell damage vs. permanent damage, what other health problems they have, etc. More or less it appears that the quicker one can get them on LC food and the less time they have been diabetic, the better chance they have for a quick remission. Generally speaking though, with LC food and a steady approach in dosing, and no complicating factors, I would say it usually takes a few weeks. But some cats regulate in a few days, and others take months, so it's hard to really predict for sure.

Based on your #s I think you are in pretty good shape for getting things under control. Don't expect overnight results though, that'll drive you crazy! It is a process, but it is definitely one that is manageable, and hopefully pretty soon it will get easier once you have a better handle on his #s and making dosing decisions.

If you haven't already read the link in the sticky at the top of the forum about Start Low, Go Slow, that is good to read to give you an idea of the process. We don't usually recommend to follow that exactly (like I think it might say to wait a week or two between doses - with PZI, 3 - 5 days is usually sufficient), but the general principles apply. Since you already know he gets a good response to the insulin at 2u, I would make dose changes in 0.2 or 0.25u increments (it's a pain with the syringes, but worth the effort) rather than the 0.5u that is appropriate at other times.

 

[Joanna & Bix (GA)]

p.s. Just wondered if you have had a urine sample checked for him lately to be sure he doesn't have an infection? The peeing outside the box, and peeing again after just an hour made me think of it. Could just be from the diabetes, but could also be a sign of infection...?

 

[Terry and Puttz]

MsK...You mentioned that you started two weeks ago, keep us posted as I am pretty sure you will see more positive results and readings in the next two weeks...It took us the good 45 day period, and then some to get on track...We are doing great at week #10, and I have been able to reduce my 'poking' to every other day recently...(and yes, we too have been through the 4 strip/9 jabs routine!)...

 

[MsKarilynn]

Thanks everyone for the advice and comments. It's been a crazy week for me. I myself was diagnosed with pre-diabetes today. I am going to test some more numbers this weekend and see where my cat is at and I am going to figure out how I can get MYSELF healthier. Eye opening experience all around.