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J-Roc

J-Roc

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I've had J-Roc on prozinc for about a month now. Was on Lantus for 2 years but - after a brief remission period - has been poorly controlled ever since. The history is here. It has been recommended that I post in the Prozinc forum instead of the main forum, as this is where all the PZI experience is to be found. Below is is latest completed curve. You can see two prior curves in the thread linked above.

J-Roc BG Curve Dec 7_2015.jpg

He's been on 2.8 units of Prozinc (U-40) since Thursday. I'm using U-100 needles so I can move up in finer increments (2.8 U-40 = 7.0 U-100). I'm thinking I should increase again.
 
Looks like its time to take the dose up.

We have some guidelines for using ProZinc and PZI here.
 
BJM said:
Looks like its time to take the dose up.

We have some guidelines for using ProZinc and PZI here.
Click to expand...
Thanks. According to the guidelines, I am good to increase after holding steady for 3 days and doing a curve. So he should be good for an incremental increase starting tomorrow morning. His vets are far more conservative about increasing the dose, but I understand why. The last thing they want is a hypo episode because they didn't urge enough caution.
 
We increase in small amounts (0.20 units if using a U-100 syringe and conversion chart, or eyeballing 0.25 units, and recommend pre-shot testing for every shot, plus getting mid-cycle tests around the probable nadir (+5 to +7 hours post-shot) whenever possible.
 
Has anyone switched from Lantus to prozinc due to poor response to the Lantus? I'm hoping the prozinc works better.
 
Hi, I can't answer your question about people switching from Lantus to ProZinc, usually it seems it is the other way around. But every cat is different and you gave Lantus a long time to work. Best of luck to you with the ProZinc!
 
I had my girl on Lantus with a poor response. I switched her to Levemir to see if that would improve her numbers and it hasn't. My girl needs some dental work done and I am hoping that will improve her numbers but my vet has already suggested that if the dental does not bring about an improvement we should try ProZinc. So my answer would be yes...sometimes folks do switch from Lantus to ProZinc. It's not the popularity of the drug that matters....it's what works for your cat!
 
Welcome! I hope we can be of some help. One thing that will help us is for you to attach your spreadsheet to your signature. That way it will come up each time you post, updated. To do so, be sure to choose "Share with anyone with the Link". And then take the URL and copy/paste it into your signature. You might also add in your signature the food he eats (sounds like after a big struggle, you got him on wet low carb) and that you are using ProZinc. (Find your signature in the upper right hand corner of this page) and choose Edit)

He has an interesting cycle, getting his lowest numbers at the very end of 12 hours. I wouldn't say that is a very common pattern with ProZinc. More often there is a smile curve with the nadir in the 5-7 hour range. And if the dose is too low, then the overall cycle tends to be higher and flatter, but usually with a nadir somewhere in the middle.

But yes, I'd increase. The good news is that he does drop and that he is not in super high numbers and hopefully increasing will bring his numbers down. I don't know about the Lantus and the high dose you ended up with - that is worrying. Lantus usually has a good success rate. As Lynn says, sometimes people switch from ProZinc to one of the depot insulins, especially if their cats have moved up to higher doses with high dose conditions. Levemir especially is supposed to sting less with higher doses, so often that is the choice.

One thing I would wonder is what happens after +12 if you don't give insulin? Does he continue to drop or does he go up? It is just such an unusual pattern that I wonder if he hangs on to it longer than the norm and what adding more at that point does....I would suggest getting some numbers at night to see what happens - maybe a before bed test and then (ugh) waking up somewhere in the middle and getting a test. I assume he either drops at night or continues flat all night. Either would be good info.

The dental could also be part of the issue. You might look for a feline only dentist and see what they might be willing to do.
 
Sue and Oliver (GA) said:
He has an interesting cycle, getting his lowest numbers at the very end of 12 hours. I wouldn't say that is a very common pattern with ProZinc. More often there is a smile curve with the nadir in the 5-7 hour range. And if the dose is too low, then the overall cycle tends to be higher and flatter, but usually with a nadir somewhere in the middle.

One thing I would wonder is what happens after +12 if you don't give insulin? Does he continue to drop or does he go up? It is just such an unusual pattern that I wonder if he hangs on to it longer than the norm and what adding more at that point does....I would suggest getting some numbers at night to see what happens - maybe a before bed test and then (ugh) waking up somewhere in the middle and getting a test. I assume he either drops at night or continues flat all night. Either would be good info.
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Hi. Thanks for the detailed reply. I'll add the spreadsheet to my signature tonight. His pre-shot reading this morning was 17.8. I upped it to 3 units (7.5 on the U-100 barrel).

I did get the "smile" pattern once or twice on his older curves. In the thread I linked to, you can see his first curve on prozinc was a more typical smile pattern, with the last reading or two being higher than the prior ones. He is always highest in the morning. That was true on Lantus as well. Weird, because he goes from 10:30 at night until 6:00 in the morning with no food, by far his longest gap. I would think his BG would drop on an empty stomach. Nothing about J-Roc is normal. Ever. I can hypothesize that he starts getting hungry at 4:00 a.m., and by the time we feed him at 6, he is really, really upset that we haven't gotten up to feed him earlier. He gets frantic close to feeding times, especially the morning one. We have always refused to accommodate him earlier as the last thing we want is for him to get used to 4:00 a.m. feedings!

It is true his numbers aren't terribly high, but also haven't really gone down much with the increase in dose thus far. His behaviour has changed with the increase in prozinc. His water consumption was extremely high when we stopped the Lantus and switched over. It's now coming down. Also, the constant hunger and food craving (crying for food non-stop, always "foraging" on the countertops and floor for scraps of food) has abated as the prozinc increases. This behaviour seems to stop with each dose increase, but returns to some degree as he adjusts to the dose. I'm hoping we can reach a point where that doesn't happen.

This foraging and insane hunger was a constant feature as long as he was on Lantus. Any reduction in this behaviour is a HUGE relief to us. He would cry for food constantly. We basically listened to him scream for food for the past 2 years. It was disappointing to take him to the vet 9 months ago and have her tell me that "Well, some cats that were free-fed in the past develop a food obsession and they just never get over not having access to food all the time." His BG levels and fructosamine tests were high at the time, but they had no suggestion other than to keep him at 8 units Lantus twice daily. In fairness, prozinc was not available in Canada during that period. Maybe they just had nothing else to offer. At least the last time I took him in, they realized that something had to be done. He had lost over a pound from his previous appointment despite no change in diet. I was also more insistent this last visit that I did not think his behaviour was normal, no matter how "food obsessed". It can't be fun for the cat to feel like he's starving all the time either.
 
Some ideas for the food:

Some people add some warm water to the pate and make a kind of gravy. Not only does that improve the texture for them, but it increases their fluid intake and makes them think they are getting more to eat.

A pet feeder could help with the overnight problem. We love our PetSafe5 (available on Amazon and I have heard PetSmart matches the price). It is completely programmable and has 5 slots, so you could spread out his food during the day and night and see if he feels like he is eating more. It would solve your early morning dilemma - just have the slots all close 2 hours before the test time.

If he is underweight, you might look for some higher calorie, but low carb foods that might fill him up. The chart is here:

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

We suggest foods under 8-10% carbs.

One other idea, as you say he is constantly hungry. Has he been tested for hyperthyroidism? It is not uncommon in diabetic cats. Here is some info:

http://www.catinfo.org/?link=felinehyperthyroidism
 
Glad you made it over here! You've gotten lots of good advice already so I'll just add that if you have any questions, let us know!
 
Sue and Oliver (GA) said:
Some ideas for the food:

Some people add some warm water to the pate and make a kind of gravy. Not only does that improve the texture for them, but it increases their fluid intake and makes them think they are getting more to eat.

A pet feeder could help with the overnight problem. We love our PetSafe5 (available on Amazon and I have heard PetSmart matches the price). It is completely programmable and has 5 slots, so you could spread out his food during the day and night and see if he feels like he is eating more. It would solve your early morning dilemma - just have the slots all close 2 hours before the test time.

If he is underweight, you might look for some higher calorie, but low carb foods that might fill him up. The chart is here:

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

We suggest foods under 8-10% carbs.

One other idea, as you say he is constantly hungry. Has he been tested for hyperthyroidism? It is not uncommon in diabetic cats. Here is some info:

http://www.catinfo.org/?link=felinehyperthyroidism
Click to expand...
Hi. I always add 2 tablespoons of water to each meal, and he gets 3 meals per day. In fact, I feed all 3 cats the exact same diet with the water added. We started doing that after Houdi, our youngest, got a life-threatening urinary tract blockage 2 years ago. It cost us a $2000 hospital stay and another $500 for urine testing after. Since Houdi refused to drink water, we started adding it to his food, and doing the same for all 3 cats. Since then, they all get 100% canned food with 2 tablepoons water added - three meals per day.

We started feeding them that way after reading the Catinfo.org site. Reading that site is what convinced me to drop the terrible "prescription diet" crap and get rid of all kibble from the house and feed only canned, low-carb, grain-free food with water added. Without that site, I'm pretty sure I would have lost both Houdi and J-Roc by now. Houdi to UTI and J-Roc to diabetes.

As for hyperthyroidism, I'm pretty sure they screened for it with the $500 plus worth of blood screenings they just did. But I will ask next time I speak with them.
 
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Looks like his numbers are coming down a little with the increase. Once you get a nadir (day or night or both) you can think about an increase after three cycles. (I'd get that nadir just to be safe. Doesn't look like he drops low in that +5-7 window, but you want to be sure before you increase.)
 
Sue and Oliver (GA) said:
Looks like his numbers are coming down a little with the increase. Once you get a nadir (day or night or both) you can think about an increase after three cycles. (I'd get that nadir just to be safe. Doesn't look like he drops low in that +5-7 window, but you want to be sure before you increase.)
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I probably won't get a nadir until Saturday, as I'm not home from work before 6 p.m. His nadir is consistently late in the day, 2-4 hours before his next shot. I'd need to test him about 4 or so. But, if his nadir is still high on Saturday, I'll move up to U-40 3.2 (a half unit up on the U-100 needle to 8 from 7.5).
 
If you happen to wake up at night, you can try to get a nadir then too. I used to set an alarm until I realized that at some point...I was definitely getting up. Ah well..it helped get nighttime tests at least!
 
Well this is weird. I did not take a reading this morning but gave him his current dose of 3 units. Tonight, I tested him pre-shot, and he was 26.7! All the progress we've made this month gone in an instant. I know for a fact I did not miss the shot this morning, and did not blow the shot either. I always check, and I can smell the insulin if it didn't go in. I tested him two hours later and he's still at 22.3, so that earlier test was not a fluke.

We know with absolute certainty that there was no food he could have gotten into while we were at work. We know better than to leave anything around - if he can get at it, he'll eat it. What's even stranger is that his evening pre-shot reading is consistently one of his lowest readings, if not the lowest, when we do a curve (see the curve above).

I'm going to call the vet tomorrow and see if he's been tested for thyroid issues. I'm pretty sure that was one of the things they screened for last month, but I want to find out for sure. He has not tested this high since he started on prozinc. It's disappointing.
 
Without the amps, it is hard to tell what happened. Maybe it was lower and then the nadir caused a bounce? Regardless, it is only one number and only one cycle. I wouldn't worry unless it becomes a pattern of higher numbers.
 
He was about 22 again this morning. I phoned the vet - his thyroid was tested just last month. It was "low normal", so he's not hyperthyroid. She told me to boost him to 4 units BID from 3. When he was there last month they told me his teeth are bad and that could be part of the problem. But they didn't want to do the dental work until we got his BG down somewhat, as they didn't want to put him under in his condition (even though he's not terribly weak or anything). I wonder if that isn't a mistake. What if the bad teeth are causing the poor diabetes control? I've heard that can happen.
 
His amps is not a huge jump from where he has been. I would be reluctant to increase by a full unit, especially when there is no midcycle data.

It varies. Sometimes a dental makes a huge difference, sometimes not so much. One of those Every Cat is Different things. You might post on Health and ask for people who have done dentals on unregulated cats. I know people have.
 
Sue and Oliver (GA) said:
His amps is not a huge jump from where he has been. I would be reluctant to increase by a full unit, especially when there is no midcycle data.

It varies. Sometimes a dental makes a huge difference, sometimes not so much. One of those Every Cat is Different things. You might post on Health and ask for people who have done dentals on unregulated cats. I know people have.
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I gave him about 3.25 this morning. His PMPS was 16.6 tonight, so much better. I'm not going to 4 units right away. I'm notching it up to 8.25 on a U-100 needle, which is about 3.3 on the U-40.
 
Well, we're up to 3.4 U-40 units now, and not much sign of improvement. He woke us up frantically crying for food at 5:30 a.m. as usual. He was 15.6 about 1.5 hours after his morning shot, and 20.8 pre-shot tonight. As for his behavior today, he didn't start begging for food again until about 4 this afternoon - shortly before his afternoon mealtime. He usually starts at noon on days when we're home and we listen to 4 hours of it. So that's an improvement I guess. Only saw him at the water dish maybe twice.
 
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Sounds like there are some clinical improvements but no number improvements. I would continue up the scale, increasing every third cycle as long as you can monitor the first time you increase.

IMHO, you could be looking at insulin resistance.

http://www.felinediabetes.com/FDMB/threads/insulin-resistance-long-really.67645/

Or the teeth. Or a high dose condition.

http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/

He has been on different insulins; he is on a low carb diet; you have increased slowly and carefully. It just seems likely that there is something else going on in addition to the usual diabetics. We don't usually think High Dose conditions until they are at +5 units, but since he was on a higher dose of Lantus, you might check out that thread and see if any of the symptoms fit..
 
Sue and Oliver (GA) said:
Sounds like there are some clinical improvements but no number improvements. I would continue up the scale, increasing every third cycle as long as you can monitor the first time you increase.

IMHO, you could be looking at insulin resistance.

http://www.felinediabetes.com/FDMB/threads/insulin-resistance-long-really.67645/

Or the teeth. Or a high dose condition.

http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/

He has been on different insulins; he is on a low carb diet; you have increased slowly and carefully. It just seems likely that there is something else going on in addition to the usual diabetics. We don't usually think High Dose conditions until they are at +5 units, but since he was on a higher dose of Lantus, you might check out that thread and see if any of the symptoms fit..
Click to expand...

Interesting that one cat mentioned in that link was on 27 units of Lantus per day, and actually ended up OJT. I wish I would ave pushed the Lantus much further before switching to prozinc (it's also much cheaper here - $67 per bottle instead of $127). However, that is not the adivce I got from the vets. They seemed reluctant to go over 8 units BID, even though his BG levels were uncontrolled and his fructosamine test came back showing prolonged poor control.
 
Well, his preshot numbers just keep getting more ridiculous as the dosage goes up. On the spreadsheet, some of his preshot cells are in the black now. I have not seen readings this high since his very first curve when he started the Lantus more than 2 years ago. I think this prozinc experiment has failed miserably. He hasn't been at 4.0 units very long yet - only a couple days. I'll be doing a curve on Monday, but if it's still ugly, I think I'm going to switch back to Lantus (I still have a fairly fresh almost full vile in the fridge), and try pushing the dose with that. If I'm going to go with super-high dosing, I feel a little safer with Lantus. Whether that's logical or not I don't know.
 
Insulin dose adjustments are based on the nadir, the lowest glucose post-shot, not the pre-shot levels.
You've been increasing without checking the nadir.

And as with Lantus, bouncing happens. When the glucose drops to an unfamiliar level (even if that is in the 200-300s), or drops quickly, or drops too low, or any combination of those factors, hormones release stored glucose to bring the level back up. This elevation may last a good 3 days, so you have to wait it out and be patient.

Here is the ProZinc guide.
 
BJM said:
Insulin dose adjustments are based on the nadir, the lowest glucose post-shot, not the pre-shot levels.
You've been increasing without checking the nadir.

And as with Lantus, bouncing happens. When the glucose drops to an unfamiliar level (even if that is in the 200-300s), or drops quickly, or drops too low, or any combination of those factors, hormones release stored glucose to bring the level back up. This elevation may last a good 3 days, so you have to wait it out and be patient.

Here is the ProZinc guide.
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Hi. Thanks for the reply. His nadir has traditionally been very late in the daytime cycle, an hour or two before preshot. Sometimes it is right at the PM preshot (see curve at top). I'll be checking the nadir in mid-to-late afternoon tomorrow, and doing a full curve on Monday and see where he is.
 
I agree some nadirs will be helpful, especially a curve since his nadir does seem to be late in the cycle. I wonder if he is dropping at all mid cycle and if the dose increases you have done are helping overall.

If he is going to be a high dose kitty - and I think the jury is still out on that - then Lantus might be a good idea. It tends to give a flatter, longer cycle. If you go back to it, then you might look at the TR protocol and dose him aggressively.
 
Sue and Oliver (GA) said:
I agree some nadirs will be helpful, especially a curve since his nadir does seem to be late in the cycle. I wonder if he is dropping at all mid cycle and if the dose increases you have done are helping overall.

If he is going to be a high dose kitty - and I think the jury is still out on that - then Lantus might be a good idea. It tends to give a flatter, longer cycle. If you go back to it, then you might look at the TR protocol and dose him aggressively.
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I've never been aggressive enough to even get to the point where TR was feasible. The vets never wanted me to go as high as I did (8 units BID Lantus). I'll be making more of the decisions myself from now on. I appreciate that the vets are concerned about hypo above all else. The last thing they want is for a cat owner to phone them in hysterics because they hypoed their cat and now he's dead after a recommended dose increase. And I'm sure they've had exactly that experience. However, I also need to keep in mind that vets are probably assuming that many cat owners just don't have the time and patience for regular, proper monitoring. They make assumptions based on some lower common denominator, and that is likely based on their experience of all cat owners. I am willing to put in the effort to monitor and do it right, so I can afford to be more aggressive than the vets would normally recommend. I don't always need to wait for their approval. My mom had a cat who became diabetic at age 11. She kept him alive until age 18, and pretty good quality of life too. This was from 1999-2006 when he finally died of digestive tract issues. She was using Humulin, and he actually went into remission for much of his final two years. She tested him religiously twice per day (I don't remember her doing curves, but maybe she did), and basically made her own decisions independent of the vet regarding food and dosage. He hypoed once, but she was able to bring him back with corn syrup.
 
Here is his latest curve, done today. Looks pretty good compared to before. But I screwed up by mis-timing his shot. Last night we got home late from having supper out and I gave him his shot at 9 pm. This morning, I took his pre-shot measurement at 7:15 and shot him right after. So I started too early, and his numbers look much better as a result. Regardless, I am still encouraged that he's able to stay below 20 for an entire 12 hour cycle if he's got enough insulin in him. This curve is ever so slightly better than the one at the top of this thread done two weeks ago.

upload_2015-12-21_21-53-35.png
 
It definitely looks better.

Still interesting that he has a late nadir. Maybe consider staying at a lower dose for pmps and upping the amps by a little?
 
Sue and Oliver (GA) said:
It definitely looks better.

Still interesting that he has a late nadir. Maybe consider staying at a lower dose for pmps and upping the amps by a little?
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Late nadir is pretty normal for him, even on Lantus. I was looking at some of his old curves today - many late nadirs.

I was considering the opposite - upping the PM shot a bit, since by morning he's usually very high. Or maybe shifting the timing a little bit, to 9 at night, and 7 in the morning, like I did last night and this morning. It actually seemed to work well for him today. Then again, he was clearly on his way back up at the 12 hour mark tonight, so he got his shot at 7:15 pm. Maybe a small "booster" shot after his late night meal is in order, provided he's not too low at that time. I did experiment earlier this week with breaking his evening dose into two, one after each of his evening and night time meals. But it seemed to make little difference and his morning PS was still high.
 
People definitely shoot 11/13 or 13/11. I haven't seen anyone try 10/14. I think it'd be a possibility if you are careful with the +10 - making sure it is a rising number. The problem with the increase for the pmps is that it is the lower number and then you could get a lower number overnight when it is harder to monitor. The booster is problematic. It's been done, but it, again, means some careful monitoring because you can be looking at two separate nadirs.

Of the three options, If he were mine, I'd consider the 10/14. And the first few cycles, be sure you can monitor.
 
I might try the 10/14 and see how it goes. It seemed to work OK for him last night and today. His numbers still aren't great, but just keeping him below 20 all day is progress.
 
UPDATE: His first vial of Prozinc is nearly empty already. I have an almost full vial of Lantus still in the fridge - maybe two months old and no doubt still good. I fail to see how purchasing another $127 vial of prozinc vs using a $67 vial of Lantus I already own is the right way to go, considering that the prozinc results were no better than what I was getting with Lantus. This isn't a decision I've taken lightly, simply because I have Lantus on hand. The fact is, the prozinc was just an experiment to see if it worked better - and really it hasn't. Not worse necessarily, but certainly not better. If anything, he's lost even more weight on this stuff.

Now, I know I've seen threads about switching from prozinc to Lantus, but cannot seem to find them at present. Does someone have a link? Not being lazy - I did several searches, but a whole mess of barely-related posts came up.
 
The best way I know to search is to go to the Lantus forum, type in Switching from ProZinc and search that forum only. Three people I know who switched are Jen&Eddie, Bobbie and Bubba and Sharon14. You might search for them specifically.
 
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