ProZinc doesn't seem to help with BG

CheshireKitten

CheshireKitten

Member
Hey all,

I'm new and posted in the Welcome! section. Our cat was diagnosed with diabetes 4 weeks ago. He's on 2.5u of ProZinc and has gained weight and appears much less lethargic than before. However, he still has a large appetite. He his BG was 391 at the vets office and a fructosamine result around 590 also seemed to support diabetes.

We're growing concerned as his BG doesn't seem to be adjusting with ProZinc. He had a CBC to rule out kidney problems and thyroid conditions. He's also had a urinalyses and urine culture test done to rule out for DKA. He does have dental issues and we have an appointment setup with a vet this coming Monday. We're also set to see a medicine doctor in Nov.

I guess my question is, do some cats just not respond to ProZinc? I have no idea what the alternative would be. I heard Lantus/Glargine is good but I wanted to see if anyone had any opinions or suggestions?

Here are the numbers I've tracked using the ReliOn Premier:
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Additionally, we've adjusted his diet. He's down to 7 oz (2 cans) of Fancy Feast Classic Pate, 1 oz of dry Tiki cat food (when we're not home) and about 1 oz of raw freeze-dried food.
 
Hi there and welcome! Your kitty is responding to the ProZinc. Look at that 96 on his spreadsheet! Our problem here in interpreting what’s going on with him is that the BG tests are kind of random - here and there. It’s very important to get a BG test prior to every shot - to make sure it’s even safe to give the insulin at that time. If we don’t know where he started from then we don’t know know what’s going on. It’s important to know what his preshot numbers are, then to get a test in about +2/+3 so we can see when the ProZinc onsets (starts to kick in) and then we need to try to pinpoint when Mister usually has nadir (lowest point in the cycle.). Doses are based on the nadir so that we make sure a dose isn’t dropping him too low — and also we take into consideration the preshot number, especially with ProZinc. There are some high numbers on his spreadsheet, yes, but we can’t tell from the limited data if at least some of those are due to bouncing. Bounces are high BG that occurs as a result of a cat’s blood glucose dropping too quickly or dropping lower than the cat’s body is accustomed (which can even be relatively high numbers if the cat has been used to very high BG.). With your schedule, would you be able to get some more mid-cycle testing done so we can see a bigger picture of what he’s doing during the day? Also, please test his BG prior to both the a.m. and p.m. shots.
 
Suzanne & Darcy said:
Hi there and welcome! Your kitty is responding to the ProZinc. Look at that 96 on his spreadsheet! Our problem here in interpreting what’s going on with him is that the BG tests are kind of random - here and there. It’s very important to get a BG test prior to every shot - to make sure it’s even safe to give the insulin at that time. If we don’t know where he started from then we don’t know know what’s going on. It’s important to know what his preshot numbers are, then to get a test in about +2/+3 so we can see when the ProZinc onsets (starts to kick in) and then we need to try to pinpoint when Mister usually has nadir (lowest point in the cycle.). Doses are based on the nadir so that we make sure a dose isn’t dropping him too low — and also we take into consideration the preshot number, especially with ProZinc. There are some high numbers on his spreadsheet, yes, but we can’t tell from the limited data if at least some of those are due to bouncing. Bounces are high BG that occurs as a result of a cat’s blood glucose dropping too quickly or dropping lower than the cat’s body is accustomed (which can even be relatively high numbers if the cat has been used to very high BG.). With your schedule, would you be able to get some more mid-cycle testing done so we can see a bigger picture of what he’s doing during the day? Also, please test his BG prior to both the a.m. and p.m. shots.
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Hello! I'll respond on here since my other post also contains other convos welcoming me and getting to know other members. I had to go in to the office today so it's a long 12 hour day and I crashed by the time I got home. I did make sure to start to get in to the rhythm of testing AMPS and PMPS which were 496 and 391 respectively. I intend to test more often but blood glucose during the pre-shot testing were definitely high. He's at 2.5u at the moment and I know he's responding to something as he's gained weight but his BG is still not under control.

Anyway, aside from Saturday I am working from home for the remainder of the week so I want to try to test AMPS, PMPS and try 2 tests between each shot. I'm hoping the info can be helpful in understanding what's going on.
 
Good morning! Well, actually it’s morning for me - 6 a.m., but what time zone are you in? I’m on Eastern time.

This is great about you being home for a few days. Can you please try to get a +3 and a +6 today? We may get an idea of his nadir. Of course, if he is bouncing from any numbers that he’s not used to, he may be high. I hope we can catch him when he’s not in a bounce. If we can find out how low this dose is taking him over the course of a few days, we can make dose adjustments.
 
Be sure to give him a treat along with each BG test. What are you using? Freeze dried treats? I was just looking at your signature to remember what you are feeding. So of you withhold dry food today since you will be at home, that will be good. Can you give him a small snack (1-2 tsp.) of wet food at +2? Giving small snacks during the early portion of the cycle (before nadir) is really beneficial in stabilizing blood sugar and preventing steep drops. Steep drops set the cat up for a bounce. I know you are thinking that he’s high now anyway, but it’s a good idea to get him onto a feeding schedule like this. At first when there’s not much data, I usually recommend feeding these small low carb snacks at +2 and +4. Later, the timing of snacks can be tweaked based on how your cat’s cycles tend to go.
 
I know that you are concerned about phosphorus levels in Fancy Feast. I feed my cats Weruva BFF PLAY flavors which are low carb and also quite low in phosphorus. This will be less worrisome on his kidneys. I feed the flavors called: Chicken Duck and Turkey Take a Chance, Chicken and Lamb Laugh Out Loud, Chicken and Turkey Topsy Turvey and sometimes Chicken Checkmate.

I will send you a list I have that has low carb food that are also at acceptably low phosphorus levels for a cat with kidney disease.
 
Did you get any good recommendations for automatic feeders yet - for dispensing snacks while you are away from home? When you are working 12 hour days, this will be extremely important. Will Avery still be able to get his shots 12 hours apart on those days?
 
Just checking in to see if you have gotten any BG readings yet. I don't see anything on his spreadsheet, but then again I don't know your shot time or your time zone. Just thinking about you all.
 
Suzanne & Darcy said:
Just checking in to see if you have gotten any BG readings yet. I don't see anything on his spreadsheet, but then again I don't know your shot time or your time zone. Just thinking about you all.
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Hi Suzanne! Thank you for checking in, the fact that you even thought of us really shows how helpful and compassionate this community is. I very much appreciate it. I just updated the spreadsheet but unfortunately didn't test after the PMPS. Based on this morning's numbers I really wished I would have awoken to do so.

To answer your initial question, the 12 hour Thursday is door to door and I typically get home with around 30 min to spare. Thus far, my schedule 100% enables me to administer the shots without delay or much variance. Now, for the record, we administer the shot at 9AM and 9PM and have no missed a dose. My girlfriend and I both live on the east coast so EST. It's currently 11:20AM as I am typing.

Unfortunately his AMPS read as "HI" on the ReliOn meter, which appears when the numbers are 600+. Very scary. I administered his regular dose, provided treats as you suggested and re-tested. At 2+ his BG read at 501. Now, he is ravenous at the moment and seems like he wants nothing but food. We have Vital Essential Raw Freeze Dried Turkey Entree which I rehydrate a bit with water. Additionally, his lower lip appears inflamed so I'm really beginning to think that whatever is going on orally is severely impacting his BG. Our previous vet was completely useless and we do have an upcoming vet appointment for Monday so I really hope they can work on his gums/teeth.
 
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Okay. Very good. Try to get a test or two in tonight. I’m also really concerned about those high readings. I’m also worried about you getting a Lo and then a 511. Maybe there was a bad test strip? It happens occasionally. If nadirs continue to be so high, I will recommend an increase. A lot of cats will be ravenous in those high numbers.
 
That really is worrisome about the lower lip swelling. That could be tooth related or could also be Eosinophilic Granuloma Complex (rodent ulcer). I can’t see it so I cannot tell. It is likely, though, that if dental disease has been previously identified that it is simply related to that. I know you cannot wait for Monday’s visit to discuss the dental.
 
Suzanne & Darcy said:
Okay. Very good. Try to get a test or two in tonight. I’m also really concerned about those high readings. I’m also worried about you getting a Lo and then a 511. Maybe there was a bad test strip? It happens occasionally. If nadirs continue to be so high, I will recommend an increase. A lot of cats will be ravenous in those high numbers.
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I believe it was due to a vad strip. We retested and it was 511 and he was not exhibiting any behaviorals signs of hypoglycemia. His numbers were extremely high today, I'm thinking of bumping the shot to a 3.0 in the morning after the AMPS (if it's in the 500's again). Lowest point today was like 447 at +3. Monday cannot come soon enough...
 
I hope all goes well tomorrow. I see you had a yellow preshot tonight. Did you shoot 3 units? Try to get a +2 and +3 test tonight if you possibly can.
 
Suzanne & Darcy said:
I hope all goes well tomorrow. I see you had a yellow preshot tonight. Did you shoot 3 units? Try to get a +2 and +3 test tonight if you possibly can.
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Thank you. I will update if we get significant news. Yes, I have upped to 3u the past 48 hours or so. I decided to scale back down to 2.5 units tonight but I'm worried that I'm seesawing too quickly. It's so difficult to know how much of a variance this lip infection is playing so I'm carefully monitoring to see if 3u is too much. I was very surprised with his yellow PMPS as this is the first time this has occurred considering his AMPS have been "HI", or 600+ for two mornings. 3u seems to yield good results but again, I'm worried how much of a variance the infection plays so I'm basing 2.5u-3u on his PS.
 
Suzanne & Darcy said:
I hope all goes well tomorrow. I see you had a yellow preshot tonight. Did you shoot 3 units? Try to get a +2 and +3 test tonight if you possibly can.
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Tested him at +3 and idk how to feel. We got his first blue at 138 which is great but now I'm a little concerned for him going hypo. We have a kit ready but might be asleep. On the other hand, something is finally going right but it's hard to tell if the ProZinc is working, or if it's because the infection went down this morning. Can't accurately gauge until I get some more AMPS/PMPS results. I'm going to re-read the ProZinc guide on here but just in case you're up, is it alright to seesaw doses depending on their pre-shot values?
 
I guess you didn’t get any more tests after the 138? Or maybe you just haven’t put them in the spreadsheet? Since it was so early in the cycle and a few more hours until nadir, I would first have given a low carb wet food snack of a couple teaspoons and then I would have set an alarm to wake me up and test at +5 to see if I needed to give more LC snacks or intervene with more carbs. If you see a high preshot this morning, don’t be dismayed, it will just be a result of him being in numbers that are lower than he’s used to - his body’s response to that. It was good that you shot the reduced insulin last night because we don’t have data to see what he does when starting with a yellow preshot. The ProZinc is definitely working to lower his blood sugar. I hope you will find out about his lip or dental infection today?
 
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UPDATE: Visited the new vet today and she seemed much, MUCH more knowledgeable about diabetes. She gave an antibiotic shot due to the lip infection and instructed us to continue to wipe his lip with a solution she also provided. I added that to the notes section. We got a second blue today at 199 at +6 starting from a 504 AMPS. I think 2.5 is safe but 3.0 seems to also work on occasion. I may have to base the dose on the pre-shot data.
 
CheshireKitten said:
UPDATE: Visited the new vet today and she seemed much, MUCH more knowledgeable about diabetes. She gave an antibiotic shot due to the lip infection and instructed us to continue to wipe his lip with a solution she also provided. I added that to the notes section. We got a second blue today at 199 at +6 starting from a 504 AMPS. I think 2.5 is safe but 3.0 seems to also work on occasion. I may have to base the dose on the pre-shot data.
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What exactly did the vet think was the diagnosis of the lip infection? And she looked carefully inside his mouth for bad teeth?

I see you had a blue today, but just barely out of yellow at 199. If he is in the black, I would definitely shoot 3 units if you can monitor the cycle. Then hopefully we will see lower blues at nadir or even a high green. Hopefully, his preshot numbers will start to come down. It’s early days yet.

I hope he will continue to feel better.
 
Suzanne & Darcy said:
What exactly did the vet think was the diagnosis of the lip infection? And she looked carefully inside his mouth for bad teeth?

I see you had a blue today, but just barely out of yellow at 199. If he is in the black, I would definitely shoot 3 units if you can monitor the cycle. Then hopefully we will see lower blues at nadir or even a high green. Hopefully, his preshot numbers will start to come down. It’s early days yet.

I hope he will continue to feel better.
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No diagnosis on the infection. What's going on is that around his gum and lip got so swollen that his upper left canine is puncturing through the swelling. This seems to be leaving the wound open and unable to heal. Root cause of the infection is unknown but she wants to reduce the swelling before considering extractions. She was more concerned with seeing his diabetes better controlled and wants to test him herself 6+ next week. Additionally, she recommended switching to Lantus but didn't object to ProZinc if it appears to be working. Lastly, Avery does have some tartar and signs of gingivitis but we're still in the pre-dental evaluation. From what I recall, she doesn't think a whole mouth extraction is necessary but some extractions may be necessary.

His PMPS was 518 tonight so I am holding him at 3u as the 2.5u doesn't seem consistent enough. I will retest around +4 tonight. Additionally, I saw another one of your comments and trying to make sure he eats most of his food until +6, and then only raw freeze dried treats if he seems really hungry. He still gets 1 oz of kibble but I spoke with a local pet store and they are willing to help me purchase Weruva 5.5 oz cans closer to wholesale price so I can switch off the Fancy Feast Pate (due to the high phosphorous) and ultimately 100% wet.

I have his diet as follows:
09AM - 2 oz wet + insulin
12PM - 2 oz wet
03PM - .5 oz kibble
[This is the +6 mark, leaving 6 hours with no food unless warranted]
09PM - 2 oz wet + insulin
12AM - 2 oz wet
04AM - .5 oz kibble
[+7 mark, leaving 5 hours with no food unless warranted]

What do you think?
 
CheshireKitten said:
No diagnosis on the infection. What's going on is that around his gum and lip got so swollen that his upper left canine is puncturing through the swelling. This seems to be leaving the wound open and unable to heal. Root cause of the infection is unknown but she wants to reduce the swelling before considering extractions. She was more concerned with seeing his diabetes better controlled and wants to test him herself 6+ next week. Additionally, she recommended switching to Lantus but didn't object to ProZinc if it appears to be working. Lastly, Avery does have some tartar and signs of gingivitis but we're still in the pre-dental evaluation. From what I recall, she doesn't think a whole mouth extraction is necessary but some extractions may be necessary.

His PMPS was 518 tonight so I am holding him at 3u as the 2.5u doesn't seem consistent enough. I will retest around +4 tonight. Additionally, I saw another one of your comments and trying to make sure he eats most of his food until +6, and then only raw freeze dried treats if he seems really hungry. He still gets 1 oz of kibble but I spoke with a local pet store and they are willing to help me purchase Weruva 5.5 oz cans closer to wholesale price so I can switch off the Fancy Feast Pate (due to the high phosphorous) and ultimately 100% wet.

I have his diet as follows:
09AM - 2 oz wet + insulin
12PM - 2 oz wet
03PM - .5 oz kibble
[This is the +6 mark, leaving 6 hours with no food unless warranted]
09PM - 2 oz wet + insulin
12AM - 2 oz wet
04AM - .5 oz kibble
[+7 mark, leaving 5 hours with no food unless warranted]

What do you think?
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It's a pretty good schedule. It will be better when there's no more kibble involved as it won't shorten the duration of the insulin like the kibble will (with the high carbs working against the insulin) but it's a great starting point.

Lantus is a great insulin too. We can help you make the switch if/when you do.
 
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