otto amps 499 high for 2 months may switch to prozinc, help?

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babbie & otto

babbie & otto

Member Since 2015
After 2 1/2 months of high amps and pmps and relatively few nadirs below 300 my vet thinks we should switch to prozinc to try to get a response. We had 1 scary day of hyperosmotic response which could have killed my boy and praying for some change in the high numbers ever since to no avail.. Im on weruva (1% carb) now, lots of broth, fluids when needed and nothings happening. Otto is happy, hungry, pees a ton! but rarely grooms. I hate to switch as it looks like a nightmare but feeling I should. Thoughts.
 
Some cats need more insulin than others. Neko has two high dose conditions and needed to go up to 8.75U before she hit a reduction. You've been at this dose long enough. I would increase to 6.5U at the next cycle and keep evaluating and increasing every six cycles until you are seeing a lot more blue. With kitties that need more juice, you don't want to linger on a dose or glucose toxicity can set in, requiring even higher doses to get a breakthrough.

I think if you switched to Prozinc you would find he needs more insulin there too. I am also worried about Otto going back down in dose on a new insulin, given his other issues. An alternative that often works better for higher dose cats is Levemir. Lantus with it's acid base can sting some at higher doses. It did not for Neko but some have reported quite a change when they switch.
 
I'd try the increase too...and if he still doesn't start to respond, you might want to consider getting him tested for the high dose conditions like IAA and acromegaly....If he's a "high dose" cat, he'll be high dose at ProZinc too but you'll have to kind of start out all over again
 
I feel like if I had started higher like my vet wanted I wouldnt have put him through this high of numbers for so long and endangered his organs! I picked up the Prozinc today and told the vet I would report in the morning. uggh
 
Think of IAA as being like an allergy to the injected insulin. The antibodies bind to the injected insulin, making them unavailable to be used by the body. There is a description on one of posts on the high dose forum and also in the Where Can I Find post. Sorry, on IPad so can't link right now. Prozinc is not cat insulin and may have the same issues as Lantus. We did have a couple of IAA cats do better when they switched to Levemir. IAA does mean having to be aggressive in keeping on increasing to stay ahead of the antibodies.
 
Im so confused - my vet said prozinc is a cat insulin (there's a pic of a cat on the package). The box says "recombinant human isulin", like I know what that means!
What is the benefit of Levemir - dont know the dif between the insulins.
 
It's an insulin for cats, but it's not made from actual cat insulin. IAA react to the foreign body insulin.
 
Usually, when we see a cat needing 6u, it makes sense to rule out a high dose condition. Both the test for acromegaly (IGF-1 or insulin growth factor-1) and insulin resistance (IAA -- insulin autoantibodies) are fun by the vet lab at Michigan State University. They have very specific instructions on their website about how to send a blood sample.

Just to make a point, Prozinc is, in fact, an insulin formulated for cats. I'm thinking that Wendy meant that a cat can still develop a resistance to it if IAA is what's effecting Otto's numbers.
 
whats the benefit of Levemir over Lantus? Thanks for answering all these questions!!! 1st Im thrilled and think my vet has the answer then I look at the ss's for the Prozinc and want to vomit then talk to you guys and really feel sick - just so scared to keep him in these high numbers. Ill check out Cobb's ss.
 
Levemir has a neutral ph base. Lantus is slightly acidic. Punkin stayed on Lantus and he peaked at 15.5u per shot before being treated for acromegaly.

Levemir and Lantus are both great insulins for cats. Prozinc is good too, but it doesn't last quite as long in the body as Lantus and Levemir. Especially with high dose cats, lasting longer is a huge asset. I wouldn't go from an L insulin to ProZinc. There's nothing bad about ProZinc, but most people switch from ProZinc to an L insulin because they simply last longer in the body. We've been told that Lantus and Lev are similar in duration (how long they last) but given by the spreadsheets I've seen, I can't help but think that Levemir lasts longer. Cats do vary in how long a short lasts (its duration) before it wears off.

I would've suggested you stick with the Lantus and work on dosing more aggressively. Usually we suggest giving an insulin 6 months with good dosing before deciding it doesn't work. All of them will work but you have to get to the right dose. If you're not seeing a lot of blue, increase every 6 cycles following the guidelines below. Look at the nadirs over the past 6 cycles, decide if they are mostly over 200 or under 200, and if they are over 200 increase by 0.5u. Once you've passed about 5u we suggest moving to 0.5u increases instead. Think in terms of the % of increase. On a cat getting 1.0u, an increase of 0.25u is 25%. When you have a bigger dose, you need bigger increase increments to make a difference. Holding a dose too long is a mistake - if the dose isn't getting the cat into good numbers, that dose allows Glucose Toxicity to build up. Then you need even MORE insulin to bring them down.
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
It might be good to get him tested for acromegaly and iaa. Acromegaly is more common with the latest research indicating it affects 1 in 3-4 diabetic cats. We see a LOT of kitties whose diabetes was caused by acromegaly. We are seeing more iaa kitties too. The "look" of iaa is that initially a dose might get a cat into lower numbers, but then it's like the dose "goes stale" (Wendy's great description) and then the dose won't get them into good numbers again. I'm not really seeing that on Otto's ss, but the incremental cost of getting the iaa done in addition to the acro is only something like $15. It's well worth it to get both tests done at the same time.

edited to add: HEre's the Where Can I Find? post. There is a description of how Lantus & Lev each work in several of the stickies at the top. Try the one on the Insulin Depot.
 
The vet draws the blood and it's sent to the lab at Michigan State University lab. The links for how to do that might be in what Chris linked above. I'm on my phone at the moment but if you don't find the directions there, say so and I'll find them for you.
 
Your vet would do the blood draw, but the tests for both go to Michigan State University (MSU). Here is the test for acromegaly and IAA. Best to have the vet (or you) contact MSU to determine shipping requirements. There will be a shipping fee on top of the test fee.
 
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