Not regulating well on

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Trish and Blizzard

Member Since 2011
We've been treating Blizzard with ProZinc for the last 1.5 years. He does not do well on it. We've ranged from 2.5 to 4.0 units and his levels continue to be to high. We just did another curve and his levels never got below 300, after starting the day at 513. 4.0 units was given this morning.

He used to be on Vetsulin and did well on that until the last year before they pulled it from the market. Our Vet says ProZinc is the best option for him but it's not working well.

We've tried both regulated feeding and free feeding and both have the same results -- levels all across the board.

He now has neuropathy again and he's walking on his his hocks. He doesn't feel well. Lethargic and unhappy.

We aren't new to this site. Blizzard has been treated for diabetes with insulin since 2005.

His vet says that ProZinc is the best for him and just keeps increasing his dose. We don't really want to go above 4 units per day.

Any advice would be GREATLY appreciated!

Thanks from Trish and Blizzard
 
What food is he eating, Trish? Do you have a curve for us to look at? It's really helpful to see the midcycle numbers with the preshot numbers..

If ProZinc isn't working, you certainly should be able to change. Do you think you need to try another vet? If you give us your city and state, maybe we have a member nearby.
 
Hi Sue, Blizzard is on Purina DM dry and wet. He's always done well on this food and he likes it. We've also given him specific Fancy Feasts on occassion.

Here's his 12 hour numbers for today (curve):

Time Level Insulin
7:15 513 4.0 units
9:15 400
11:15 401
1:15 312
3:15 350
5:15 351
7:15 443 4.0 units

I live in a northern suburb of Minneapolis/St. Paul Minnesota. At this point, I would gladly take him to a vet that specializes in cat diabetes. Not that my vet isn't good but Blizzard had not done well for the past 1.5 years and I'm out of options at this point on how to help him. He's 13.5 years old and was well regulated (and happy) before the change to ProZinc
 
If he were mine, I would dump the dry and see if the numbers change. Some cats react to just a little dry with higher numbers. It isn't the highest dry (13%) but higher than the 6-8 % most people feed. If he will eat the wet, I'd just feed that for awhile.

We do have some members in Minneapolis. If you do a search (on the top of the page) for Minneapolis, you should be able to find a couple and send them a pm.
 
Prozinc isn't a bad insulin, but if it's not working I would try a different insulin. Lantus (glargine) and Levemir (detemir) both have a longer duration of action than prozinc, which is what helps you get better control on lowering BG.

I would print this article out to bring to your vet: , as well as the AAHA diabetes guidelines: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf, and this article comparing the insulins: (Caninsulin is the same as Vetsulin). If your vet refuses to write you a prescription for Lantus or Levemir after reading this information, I would switch vets and find one who will. Some vets insist on not writing prescriptions for the other insulins because you purchase them at a human pharmacy instead of through their office; while that may be good for their pocketbooks, it may not be the best thing for your cat.

I agree about ditching the dry food--it's still too high in carbs for a diabetic cat, and even lower carb dry foods can keep BG high. It contains corn and soy--two problem ingredients that can raise BG by quite a bit. Many diabetic cats are very carb-sensitive, especially to dry foods. Bandit can't even have a handful of grain free EVO dry food (at 8% carbs) or his numbers will shoot up by 100-200 points. But he can eat canned Merrick's Grammy's Pot Pie at 8% carbs with no effect on his BG whatsover. Purina DM canned is fine to feed a diabetic at 3% carbs, but it's pretty much the same thing as the Fancy Feast pates so you're really just paying for the prescription label. Here's a link to the diabetic safe fancy feast flavors: http://www.felinediabetes.com/glutenfree.htm. Check out the ingredients of the DM and compare them to the ingredients for Fancy Feast.
 

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Trish and Blizzard said:
Hi Sue, Blizzard is on Purina DM dry and wet. He's always done well on this food and he likes it. We've also given him specific Fancy Feasts on occassion.

Here's his 12 hour numbers for today (curve):

Time Level Insulin
7:15 513 4.0 units
9:15 400
11:15 401
1:15 312
3:15 350
5:15 351
7:15 443 4.0 units

I live in a northern suburb of Minneapolis/St. Paul Minnesota. At this point, I would gladly take him to a vet that specializes in cat diabetes. Not that my vet isn't good but Blizzard had not done well for the past 1.5 years and I'm out of options at this point on how to help him. He's 13.5 years old and was well regulated (and happy) before the change to ProZinc
Click to expand...

Hi Trish,
I am currently visiting another board member in the Minneapolis area, and she has very good vet support for her cats.
ProZinc maybe be an OK insulin for some cats, but Lantus and Lev are longer lasting, so I would definitely switch as you are not having much luck on your current insulin.

For food, any dry food is bad for a diabetic, but I think you should consider lowering your dose before you remove all the dry food because you may likely need much less insulin once you switch to low carb wet food and eliminate all of the dry food and treats.
Be sure that you are able to test BG a fair amount when you make the food change because his numbers and dose will come down.
 
Thanks Julia and Gayle for the thoughtful advice. I have an appointment on Wednesday with Blizzard's vet to discuss all. I have read many of your articles so far. I do think he may have had some of the Song... affect because sometimes he gets totally panicked for food even though his levels aren't showing an overly low number.

I want to try him on a different Insulin. He has never done well on this insulin. I also ordered the Xobaline from Life Links (Methyl B-12).

Blizzard will be difficult, if not impossible to get off of dry food. He basically doesn't like wet food very much. He'll only eat small bits of it, no matter which low carb one I give him. We've been through this before. Then I get worried that he will crash and we go back to the dry DM again. All of my other cats prefer wet food but not Blizz. Of course, Blizz would rather sleep on a cement floor than a soft cat bed so he's just a different kind of guy. I can try the wet again though. In that case, do you think free feeding the wet would help? Maybe if he gets hungry enough or feels his levels lowering than he will eat it.

Another question for you, when I switch insulins, should I start with a smaller dose and work up? I've read different opinions out here on increasing insulin and I'm not sure which approach to take. Some say to only increase by .05 units every week. It could take a long time to get enough insulin into his system by that approach.

Thanks so much cat_pet_icon
 
Have you seen this page? http://catinfo.org/#Transitioning_Dry_Food_Addicts_to_Canned_Food_. Sometimes it can take some time and effort to get dry addicts to eat canned food, but most will eat it eventually once you find the magic thing that makes it appetizing to them.

If you're removing the dry food, you're likely to see a drop in BG so I would start with a lower dose. Most cats on a canned only diet do not need much more than 1u of insulin. Bandit is a 13 lb cat, and he never needed more than 1.25u the entire time he was on insulin, and usually he needed far less than that. You do not want to move up the dose too quickly, because then you can get into a chronic overdose situation. Too much insulin can keep BG just as high as too little insulin.

Increasing by .5u weekly is the Start Low, Go Slow approach, which is generally used with Prozinc (although some Lantus users do use that protocol). The more popular dosing protocol for Lantus and Levemir is Tight Regulation, in which you increase the dose every 3-7 days by .25u-.5u, depending on your cat's daily mid-cycle numbers. This approach to dosing has high remission rates in cats (84% in newly diagnosed, 64% overall).
My friend's cat had worked up to 5u of Humulin N over 4 months, and when we switched him to Lantus we started him out on 1u. He had uncontrolled diabetes for much longer than Bandit, and severe diabetic neuropathy, so his maximum dose was 2.25u, which is close to the average maximum dose for Lantus. He's in week two of his remission trial now. :smile:
 
Trish and Blizzard said:
Blizzard will be difficult, if not impossible to get off of dry food. He basically doesn't like wet food very much. He'll only eat small bits of it, no matter which low carb one I give him. We've been through this before. Then I get worried that he will crash and we go back to the dry DM again. All of my other cats prefer wet food but not Blizz. Of course, Blizz would rather sleep on a cement floor than a soft cat bed so he's just a different kind of guy. I can try the wet again though. In that case, do you think free feeding the wet would help? Maybe if he gets hungry enough or feels his levels lowering than he will eat it.
Click to expand...

Sometimes cats are die-hard dry fanatics and it takes a while to transition over. It might be a process that takes weeks or a month rather than days. There is a link in the post above that is a good reference site for transitioning.

Another question for you, when I switch insulins, should I start with a smaller dose and work up? I've read different opinions out here on increasing insulin and I'm not sure which approach to take. Some say to only increase by .05 units every week. It could take a long time to get enough insulin into his system by that approach.

Thanks so much cat_pet_icon
Click to expand...

Are the numbers from you home testing or was that a vet office curve? I wasn't sure on that point. When you switch insulins you do need to start at a lower dose. But unless Blizzard is off dry completely I would NOT drop it to .5u and start up from there. I would start out 1/2 the dose, no lower because he is still on dry. I went from PZI to Lev and Sneakers threw ketones the first week or so until I raised her dose. The reason being is her body was used to the 3.5u of PZI BID and dropping it to .5u would have been like no insulin at all. Speaking of ketones...

Have you been testing for ketones? While the dry food is most likely the culprit of the high BG's giving dramatically less insulin is basically like shouting "COME HERE KETONES! I WANT TO SPEND MORE MONEY!!!" Anything over 350 needs to be testing daily and 400+ should be tested day and night if you can catch them at it. DKA is not a cheap thing to treat- our latest DCIN cat with DKA was almost $5000. The best way to test is ketosticks you can get at any pharmacy in the diabetic supply isle- around here they are 50/$7. I would rather pay $7/month insurance rather than $5000 because I didn't know.

Good luck on changing- if you have a choice, levemir seems to be more gentle than lantus- humans say large units of lantus stings so probably the same with cats. And go for the pens rather than the vials, larger up front costs but they last longer and if they are contaminated you toss less.
 
One note on ketones: they are not just at high BG levels, they can occur at much lower BG as some cats just seem more prone to ketones.
The recipe for ketones is usually not enough food + not enough insulin + possible infection/sick cat.

When doing food transitioning, you want to make sure your cat is eating. Catinfo.org has some good food suggestions.
When switching insulins, you want to keep a close eye on the BG because dose suggestions for switching usually err on the side of caution. The suggestion of 1/2 the Prozinc dose is a good idea if going to Lantus, just like the switch dose from Lantus to Levemir is usually 70%, but if you did choose to switch to Levemir (my preference), the 1/2 Prozinc dose should still be OK.
 
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