Newbie Finally Onboard - starting Prozinc - freaking out

Status
Not open for further replies.
Tigger's Friend

Tigger's Friend

Member Since 2013
Hi All,

First I want to say I'm in the middle on menopause & trying to manage Tigger has hit me extra hard emotionally. We have an epileptic cat & a hyperthyroid cat & several other feral rescues, but I'm really spinning around Tigger.

I've read & read online & talked with 2 vet - the first put Tigger on glipizide, & he's actually doing well on it for the last 2 weeks (glucose 197 - 320)

The second uses prozinc - not bcp pzi. She doesn't use Lantus, & feels after discussing with the other vets in their group that Boehringer Ingelheim Prozinc is the best place to start.

I realize all cats are different, & the only way to know is to try, but I am exceedingly fearful - which is very unlike me! I also realize I need to try & see how he does & we can always switch to a different insulin if Prozinc isn't a good match.

I just want so badly for Tigger to go into remission and to have time to care for the rest of the 'tribe' - plus my husband is getting older & had dreams of travelling - I don't want to let him down, either.

Tigger doesn't have pancreatitis, his CBC is good, his weight is good. He does have glucose in his urine, which is slightly dilute (I add water to his NV)

Sorry for the spinning - Would love to hear some feedback so I can come down off the ceiling
 
Suzanne,

Breathe in deep breath, hold, breathe out, breathe in, hold, breathe out. Repeat as needed.

Then, go stick your head in the freezer to cool off :cool: from one of those hot flashes that instantly raises your body temperature about 20 degrees. Or at least that's what it feels like to me. ohmygod_smile

PZI is a good insulin. A bit easier to manage in some peoples minds. It is what we call an 'in and out' insulin. Inject, does it's thing, all used up, all in a 10-12 hour cycle. No overlap to worry about like those long lasting insulins Lantus and Levimir. More flexible dosing schedule and making changes as to when you can shoot. You want 10 hours between shots.

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

Have your hypo toolkit standing by just in case and print a copy of these instructions. http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887
 
I'm starting prozinc today, mostly because my vet uses it & not Lantus. She considered Lantus for me, but decided on the Prozinc because of the greater latitude around scheduling, since my schedule varies.
Click to expand...
Saw this in someone else's post. Sounds like your vet was listening to you and went with an insulin that will work better with your work schedule. It's so nice to see that in a vet.
 
Whew! Thanks Wendy - yes, its all tears & fears, with my poor husband doing his best to keep me grounded. Freezer helps! :lol:

I don't have a does yet - she will let me know this afternoon. His weight is 14.5 -

Is there a standard start does for weight?

I'll definitely do the spreadsheet - I tried a few days ago but couldn't pull it up.

My new vet considered Lantus, but with 7 other tame feral rescue special needs cats (we live on a rural property in an area where no one knows how to spay & neuter :evil: ), working, a husband, & daughter's family moving home for 6 months in just a few weeks, she re-affirmed the Prozinc they know & use will give me the greatest latitude with my schedule. The 15-30 minute Lantu leeway would be difficult for me. I also need a good 9 hour downtime at night :oops:

I see you said 10 hours is the best window with Prozinc. Because we have ferals & coyotes, my standard feeding schedule is 7:30 AM & 5:30 PM, but it does vary with my work schedule.
Typically could I give an injection at those times if Tigger eats? Or is it best to let him eat a small amount at 5:30 Pm as customary & then feed a larger meal at 7:30 PM before injecting?

Also my vet says (with testing) if Tigger eats a small amt, give 1/2 dose. Fine. If Tigger doesn't eat, give 1/2 dose - FDMB says not to dose if the cat doesn't eat, so there's a discretion. This vet says all cats are different, & the important thing is how the cat's behaving. Some cats can tolerate lower lows & higher highs, and a cat can be at 400 for 1-2 days, & be ok if acting normal. What do you think about the 1/2 dose if Tigger doesn't eat a meal?


Again, Thanks so much for all you've done - I don't know that I could've done this without this Board - its taken me over 2 weeks to get here, too long, but we've got the diet down, and it's time to take the plunge!
 
Yes, ProZinc is a good insulin and can prove to be flexible if you need it to be. It is a 12/12 schedule insulin and we encourage you to have regular shot times within that window. We do say that you can shoot earlier (like the +10) in a pinch if absolutely necessary, but it is not routine and not encouraged. It can throw the next shot often and sometimes the kitty throws a curve and drops down between 10-12. If you do dose early, you need to have the data to be sure the numbers are rising and over 200 and it should be a sometimes thing - not a routine thing. So plan to set your shot times 12 hours apart. The routine is to test first, then feed and shoot. A lot of us shoot while they are busy eating.

We suggest starting at .5 or one unit, regardless of weight. One, we want to see how the insulin works before adding more. So we start low and go slow. Begin with the low dose, get preshot and midcycle numbers and if the numbers are high after 3 cycles, increase by .25.

There is a forum where everyone has experience with prozinc. If you post there daily with your data, you can get support and guidance.

http://felinediabetes.com/FDMB/viewforum.php?f=24

It is a much smaller group than Health and busiest on weekends and in the am and pm. In an emergency, always post on Health.
 
You're right, Deb - this great vet spent at least 45 minutes with us each visit - & only charged $48 PER VISIT.

I am very lucky - and will be happy to recommend this vet to anyone in the Central Coast area!

Am checking around the local big-box pharmacies to see if its available & at what cost - will let the Board know if I get any good prices
 
Thanks, Sue

I think I'll try 8 AM & 8 PM - that way Tigger can still get a bite to eat with the rest of the tribe at 5:30 PM or so, & I can make him last for the 7:30AM feeding. I intend to try as close to 12 hrs as possible, I understand the reasoning & will do my best.

I just introduced myself in the PZI group. Glad to find a fellowship.

I'm confused about one part of dosing in the readings. If pre-meal testing shows 200 or lower, do you withold insulin & ski[ that dose entirely or wait a few hours & try again? If so, then would you dose that the new 12 hour interval or go back to the original?
 
If you get a number 200 or below for preshot, wait 20 minutes without feeding and retest. (Food causes the number to rise and you want a number not influenced by the food.) If the number is rising and over 200, depending on how much he climbed, you can shoot the normal amount or a little less. It depends on whether he jumped up right after the +12 number (with some cats, after 12 hours, the insulin is gone and they start to climb) or whether he is over 200 but just a little (in which case you'd probably reduce the dose you gave for the previous shot by a little bit.)

I know it all seems completely overwhelming at this point, but once you get started and collect some numbers, you'll be able to see some patterns and trends and they will help you figure out what to give on a given number. Meanwhile, we (the folks in the PZI forum) can help.
 
Pre-shot tests, the tests taken before you give the insulin are best if done without food for 2 hours before. There will be one test in the morning, AMPS and one test in the evening, PMPS.

When you are first starting out we set a shoot/no shoot threshold number of 200. As you gain more experience and tests to know how your cat does, then the threshold can be changed.


There are 3 options if the BG reading is under your threshold. Skip, stall, or reduce the dose.

Here is an example of stalling. So lets say this is your morning test the AMPS.
Number is 185.
That is below your threshold of 200 so do not shoot any insulin.
Do not give any food either.
Post on the board for advice.
While waiting for advice, Retest in 20-30 minutes to see if the number is rising.
Say the AMPS +.5 = 202.
Ok, that is a rising number, above 200 and I would feel safe for you to shoot.

On the other hand if the AMPS +0.5 is now 170, that is a falling number. Repeat the no shot/ no food and retest in another 20-30 minutes. Apply the rising /falling number logic and where your shoot/no shoot threshold is to determine if you can safely give the shot.

You will, depending on your commitments for the day, reach a decision point where either the number is now high enough to shoot or still too low and you need to skip the shot.

A reduced dose can be given when you know how your cat will react. This requires some test data. Eventually, you may use this reduced option, but you are not 'data ready' to do that yet.

If you do end up shooting after a 'stall', your new test, feed, shoot time with PZI an Prozinc must be at least 10 hours later from when you gave the last shot.

It is always better to skip the shot if you are unsure what to do. "Better too high for a day, than too low for a minute." Low numbers can kill quickly, high numbers do damage over time.
 
You said you were having problems pulling up the spreadsheet. I believe Sue and Oliver could help you set that up. Why don't you PM her.
 
Hi and welcome to FDMB.

We understand how overwhelmed you feel. However, I can tell you that caring for a diabetic cat while caring for other pets with medical issues can be done. I know because I have been there myself. At one time I was caring for two diabetic cats, one of them had CRF and the other had cancer. In addition I also had a dog with seizures. I just takes developing a routine that works best for you.

First, breathe... You have already received some good advice. Prozinc is a good insulin. We can help you to develop your routine for caring for your cat while dealing with everything else.

Here are my recommendations:

1) Learn to hometest. It is not difficult and once you learn how, it will only add less than 5 minutes to your daily routine. The reason this is important is that you will learn how much insulin your cat needs to manage his diabetes. This will also take a lot of stress off of you since you will be in control. Even if your are not successful on your first few tests, keep trying. Most important, give your cat a low carb treat after every test, even if you are not successful. That way your cat learns to associate testing with treats. It will make it easier for you and eventually your cat may remind you to test just to get his treat. :lol: Reward yourself with a treat too.

2) For your insulin we recommend starting low & slow. This means starting at 1/2 to 1 unit twice a day and over a period of weeks increasing it if needed to find your optimal dose. You need to give at least one week between dosing changes to give your cat's body time to adjust to it. Only then, with hometesting, will you know if the dose is working. Most cats on this board only need between 1/2 to 2 units twice a day. If you increase it too much you could miss your optimal dose which in turn could cause higher BG readings. Also, if your dose is too high, you also risk hypoglycemia. If you are not sure if you should change your dose, share your readings with us and we can help you to determine if you need to.

3) Find a routine that works best for you. You do want to do these steps in this order though: test, feed then shoot. Usually you can give insulin within a few minutes after feeding. You just want to make sure your cat does eat and does not decide to get sick afterwards. I would usually test my cats, then prepare their food. By the time I had finished making my meal, they would have eaten and I would give them their insulin and other meds.

4) Come here often. Read the posts, ask questions and share your difficulties and successes. You will not find a greater group of people then the members of this list. We understand what you are going through and are here to help you.
 
Hi Suzanne, I'm glad that you are getting settled w/ a good insulin for Tigger. What clinic/vet did you finally choose? If you need anything give me a call. Ann
 
Thanks to all for the excellent detailed instructions and guidance - I'm reading & re-reading & its very helpful - just wish it would stay in my head!

We've had another delay - the vet would only give me a written prescription, to either mail or take to a local pharmacy. Our Costco can order Prozinc for about $115, and it takes 3-4 business days to arrive (FYI for anyone near a Costco). That was Monday, so hopefully Friday I'll have it.

I'm still waiting for Tigger's dosage. I'll post it when I get it, & see what everyone thinks.

If I want to try tight regulation, I should only attempt that AFTER Tigger's regulated on the twice a day regimen, correct?

Ann, I called your vet's office & really liked them. Picked up a new patient packet, too. Sounds like they may be more supportive of home testing, but otherwise, very similar. Tigger's had so many vet visits lately, I'm going to hold off taking him there until things have settled a little more.

Again, thanks all for the support - I'm doing much better - probably in part because I haven't started yet!
 
I have a Prozinc Dose for Tigger! Would like Feedback!

My vet just called & here's how she would like to dose - I think it all sounds very positive, in line with START LOW, GO SLOW, but I'd like to get any feedback & suggestions

For Tigger's weight (14.5 pounds), she said by the book Tigger should have 3.5 units 2x day. She feels that's too high & wants to start with 1 unit 2x day.

I test before he eats. If he is below 150, or if he doesn't eat, or only eats a small amount, I only give 1/2 dose (1/2 unit)

Also, I am to test every 2-3 hours throughout the day. If, at any point Tigger's glucose drops below 150, I am to give 1/2 dose (1/2 unit) at Tigger's next dosing time.

She said later it's ok if his glucose goes below 150, but for the first few days at least, she wants to do as much as we can to keep Tigger from having a hypo, & wants to make sure he's not getting too much insulin.

I told her my goal was remission, and she said she is not expecting that. Then I spoke with her a little about tight regulation, which she's unfamiliar with. I explained potentially dosing 4 times a day based on testing & observation, with the goal of keeping the glucose in a normal range, allowing the pancreas to heal, & hopefully achieving remission. She said if I was willing to do all the testing & extra work, she had no problem with that. She also said if more people did that, & kept the glucose in a normal range, she could understand why there would be more remissions. She's going to read up on it a little more.

She also said its ok if his glucose goes above 300, even for a few days, it won't kill him, but she wants to know. She's really concerned about hypo.

I gave Tigger some petromalt (per the vet) for a persistent cough we're hoping is a hairball, & his glucose shot up to 350 on the glipizide, & his earlier fructosamine was 390, so its a distinct possibility he'll go high. Hopefully he'll stay below 400 - I'll really freak on that.

I'm figuring out the spreadsheet now & hope to have it up this evening so you can all see Tigger's numbers while on the Glipizide. It does seem to be helping him, at least for now.

Thanks for any input!
 
Hey Suzanne,

To answer your first post, tight regulation is for lantus and levemir, not I believe prozinc. But prozinc does have opportunity for remission and I hope more experienced prozinc users will chip in with their thoughts,.

My thoughts..

The dose your vet suggested to start of 1unit twice a dat is very sensible. Many vets start cats too high and they have a hypo. Best to start low and work up to the ideal dose..

I wouldn't shoot at all if he is below 200 at least until you have data to show how he will behave. The first few times you see that please come and post here.

I like the idea of frequent testing and would suggest you also get a test before bed.

I love the fact she is doing research. We can send papers on it if you think she would read them.

She is right about being high., better to be too high for a day than too low for a moment.

You could try Vaseline instead for the hairball.

Looking forward to seeing that spreadsheet.. It will help us and you a lot, plus you can share with your vet!

Wendy
 
Hi Wendy,

So if I start on Prozinc, does this mean Tigger has a worse chance for remission without the TR from Lantus? He's about 7 weeks past his first (& only) steroid shot that we believe caused the diabetes. I know the earlier I can get him regulated the better.

I think that terminology Prozinc & PZI are the same (but not the same as BCP PZI)

Thanks for clarifying!
 
Tigger's SS is finally UP!

This is Tigger's Glipizide Spreadsheet. His dose times were all over the map due to some vet visits without meds, so its been difficult getting it back to schedule.

Thanks all for your help!
 
Wendy, I am wondering where you got the tight regulation info. I am not aware of any regiment that suggest dosing 4 times a day. That sounds like a dangerous plan. ProZinc, Lantus and Levemir last more than 6 hours - 6 hours is around the lowest point, but that doesn't mean the insulin is out of the body so adding more insulin could prove deadly.

The TR plan for Lantus/Levemir involves additional testing and shooting at lower numbers, as you have more data. While ProZinc has no TR plan, the more testing you do, the more data you have and the more aggressive you can be with dosing, within limits. All three insulins have gotten kitties into remission, but there is no guarantee. Our first best hope is regulation, which all cats should eventually be able to acheive.

I like your vet's beginning dose. The malt in the hairball meds definitely can raise bg levels. We suggest new diabetics not dose under 200 until they have tested enough to know how their cat might react. Our suggestion is, when you get a preshot under 200, wait 20 minutes without feeding (food raises bg levels) and retest. If well over 200, give the usual dose. If just over 200, a small reduction.

Someone wise once said that this sugar dance is a marathon, not a sprint. You have to give the insulin and food time to help his body heal.
 
Hi Wendy & tiggy, Sue & Oliver,

I got the information about TR & PZI from Dr. Elizabeth Hodgkin's Diabetescatcare.com webpage, under protocol. Perhaps I'm misinterpreting her remarks.

The whole link is here: http://diabeticcatcare.com/protocol

Specifically she states:
The method of managing the feline diabetic that I use has been called “Tight Regulation.” This name describes the fact that this protocol uses proper diet and the correct insulin to bring the cat’s blood glucose levels into a tight range around normal for healthy cats. In so doing, it can cause permanent remissions in even chronically ill cats. One of the unique features of this method is the practice of hometesting. I recommend that all owners of diabetic cats purchase a glucometer ... Once you are hometesting, you have all the information you need, ...PZI insulin has a peak activity time in most cats at 6-8 hours after injection. This means that the blood glucose level in the diabetic cat will be at its lowest point 6-8 hours after the last dose of insulin. After this time, it will begin to rise again until another dose of insulin is injected. Because of this, I ask my clients to perform a blood glucose test at 6-8 hours after each dose. If the blood glucose is still above the normal range (greater than 150) then another injection of insulin is warranted. In the beginning days of tight regulation, owners typically test three to four times per day and often give insulin, in doses dictated by the blood glucose reading at each test, this often as well.
Click to expand...

Earlier in this protocol she discusses Bovine PZI as the best PZI. It may be that the Bovine PZI can be used with TR while the ProZinc (Human recombinant) can not? Am I misinterpreting something here?

Also, on the Diabetic Cat Care Home Page http://diabeticcatcare.com/ it states:

How TR works to quickly improve your diabetic cat's health.
How to practice TR with PZI, Lantus, Caninsulin and other insulin types.
Click to expand...

Again, maybe I'm confusing Bovine PZI with ProZinc (human recombinant)?

I'd like some clarification - I don't want to be putting out misinformation on the Board! If you think I should post this in the Prozinc Board as well, I can do that, too.

You all are amazing!
 
We do not agree with the protocol on that site. We are big on starting low and going slow and keeping the cat safe. If you want to practice that theory (which was advocated for PZI, not ProZinc - not sure about BCP PZI) you will have to get guidance from that site. People coming here from that site who decide to start over with our protocol usually have a cat that is bouncing from high numbers to low numbers and start over here with a low dose, testing and increasing slowly and carefully.

It is not a protocol I would recommend because it seems unsafe to me, but he is your cat and you decide. I would suggest that you join that site and read through the threads and see how cats are responding and what kind of support is offered.

We sometimes do have people, who have a lot of data and can monitor carefully, consider dosing 3 times daily at +8 but only after they understand how their cat responds to the insulin, if the number is rising and high after +8 consistently and if they can monitor carefully. It is called TID dosing (3 times daily) and we suggest it only with the above conditions and if you can get guidance from experienced members. We would never suggest it for a new diabetic.
 
Who is "We" in your first line? While you can make statement based on your own experience it is very hard to say that every member of the board agrees with something.
Sue and Oliver (GA) said:
We do not agree with the protocol on that site. We are big on starting low and going slow and keeping the cat safe. If you want to practice that theory (which was advocated for PZI, not ProZinc - not sure about BCP PZI) you will have to get guidance from that site. People coming here from that site who decide to start over with our protocol usually have a cat that is bouncing from high numbers to low numbers and start over here with a low dose, testing and increasing slowly and carefully.

It is not a protocol I would recommend because it seems unsafe to me, but he is your cat and you decide. I would suggest that you join that site and read through the threads and see how cats are responding and what kind of support is offered.

We sometimes do have people, who have a lot of data and can monitor carefully, consider dosing 3 times daily at +8 but only after they understand how their cat responds to the insulin, if the number is rising and high after +8 consistently and if they can monitor carefully. It is called TID dosing (3 times daily) and we suggest it only with the above conditions and if you can get guidance from experienced members. We would never suggest it for a new diabetic.
Click to expand...
 
I am speaking for the people who use or have used ProZinc or PZI and who post and help people on the PZI forum. There is no one who has or is posting on the forum who advocates that protocol. I have not seen you helping or posting on that forum in the seven years I have been posting here.

Why, are you advocating it?
 
Sue,

I'm very clear I want to START LOW, GO SLOW - THAT IS MY UTMOST PRIORITY & THE FIRST THING I'M CERTAIN ABOUT! I'd rather have Tigger be happy & well-regulated the rest of his life than dead from a hypo or trying too hard to force him into remission.

I like the FDMB site very much. (I actually am trying to be a subscribing member but Paypal won't take my money :o - I have a question into the Tech Board on that issue) I understand what you're saying & want to continue with this site. Googling feline diabetes, there's so much information that pulls up, it's hard to know what's what & who's who, but I'll be more careful. I haven't spent much time on the other site, only to read about insulins & protocol last night when I was googling prozinc insulin.

Your clarification helps - the other site has a different approach not supported here - so I'll stick to reading information from the FDMB & asking questions. I know your information & guidance has led me in the right direction & I appreciate so much your constant support & review of my doses & spreadsheet, etc.

Thanks for the clarification that Prozinc is not PZI - that's been particularly confusing for me. Even my prescription calls it BI Prozinc PZI.

Sorry again for the confusion :oops:, Suzanne
 
No problem, Suzanne. There is a lot of information out there. Yes, the people on the Prozinc forum advocate a start low, go slow approach. We'd be glad to help you. Once you have your spreadsheet set up, you can start posting on the forum and get dosing advice daily, if you want it.
 
This is not the PZI forum. Have you polled everyone who uses PZI and who is a member of this forum?
I am not advocating that protocol I am just trying to point out that you have to be careful upon which you base your recommendations.
Sue and Oliver (GA) said:
I am speaking for the people who use or have used ProZinc or PZI and who post and help people on the PZI forum. There is no one who has or is posting on the forum who advocates that protocol. I have not seen you helping or posting on that forum in the seven years I have been posting here.

Why, are you advocating it?
Click to expand...
 
& Yes, Sue, I will post my test numbers in the PZI forum once I get my ProZinc, the feedback is invaluable.

Am checking now with my vet to see if I can start ProZinc (after I receive it) as soon as the 12 hour glipizide dose is up, or if I have to go through any extended 'detox' period. I don't want to overlap doses between the glipizide & Prozinc.
 
There is a TR for PZI/Prozinc, the Hodgkin's protocol as you stated. I'm not aware of anyone "here" that has followed it, although some may have. I've only been around for two years.

The reason it specifies "bovine pzi" is because it (the protocol) was created before Prozinc was invented. It used to be bovine/porcine based insulin. It was discontinued (I think in 2009?) but there is a compounded insulin that is bovine based made in several places. "BCP PZI" is the most common one, and the "BCP" part of it is just the name of the pharmacy that manufactures it, BCP Veterinary Pharmacies , in Houston TX.

People on other forums do follow that protocol using Prozinc, but I believe they use a modified scale to base the doses on, one which calls for lower doses than the original Hodgkin's protocol specified.
 
For Tigger's weight (14.5 pounds), she said by the book Tigger should have 3.5 units 2x day. She feels that's too high & wants to start with 1 unit 2x day.
Click to expand...

I agree with the one unit starting dose. But I'm not sure which "book" she is going by. The AAHA guidelines for starting dose read ".25u per kg of lean body weight" . Even assuming 14.5 lbs is "ideal" for Tigger, that would only equate to 1.5u rounded down. 3.5u sounds crazy-high to me. Glad she suggested the 1u dose!
 
Hi Bob & Carl,

Thanks for the info & clarification. There is so much to learn here!

Congratulations on the OTJ after only 10 weeks! Was that prozinc/pzi or Bcp/bovine/pzi?
 
Bob was on the compounded form of PZI. His was "VPA PZI" as I bought it from Vet Pharmacies of America inTexas. It was bovine-based.

His treatment, done for the most part before I became active here, was sort of a hybrid method. He only got two shots a day, but his doses were adjusted (first by my vet, then just by me) based on the preshot test numbers. He started off at 1u twice a day, went as high as 4u, and then gradually his dose was reduced as he got better until eventually he no longer needed insulin. Next month will be two years since his last shot :smile:
 
That's wonderful! I keep reading good things about VPA / BCP PZI - my vet says if the Prozinc doesn't work she'd consider it, but for several reasons its not her first choice. I know liability is a big issue these days & that may be part of it.
 
Status
Not open for further replies.
Back
Top