Prozinc is not having a big effect on symptoms at 1.88 units – is this normal?

[Astra&Purrfect]

Hello to everyone on the forum!

My pure tabby Purrfect (2 years seven months old) was diagnosed with diabetes in October. I’d be most grateful if people on the forum who have experience with Prozinc could help me know whether it’s normal for Prozinc only to have a small effect as yet. I know you like to have a few details, so here are some (hope it’s not too long – I’ll try to itemise!):

SYMPTOMS
His main symptoms consist of excessive thirst right throughout the day (250 to 350 ml water per day before starting treatment) and urination. Sometimes his coat looks a little dull. He is usually of a very laid-back temperament. But since the diabetes, I feel he starts to be slightly irritable too easily.

TESTS/LEVELS
Our vet tested him: 3.7 g/l fasting blood glucose.
Further various tests revealed negative for pancreatitis, positive for diabetes. FIV positive but immune function is currently normal.
He has normal kidney and liver function. Fructosamine 597 umol/l.

DIET
The vet prescribed Royal Canin lower carbo cat biscuits (!). I should say at this juncture that she’s used to the rather stingy attitude of French cat owners who often only give their cats dry food, no wet at all! But needless to say, we have eliminated all kibble from his diet. We only give Purrfect wet food, no supermarket stuff with added sugar, just Animonda Carny, Smilla, Catessy, some raw meat, and some delactosed cat milk.

FEEDING TIMES
The vet says that he should really be fed only twice a day at the time of his injections and she’s a bit iffy about his having a meal in the middle of the day at all. But honestly, he’s so hungry that there’s no way he could go 12 hours without a meal. 6 hours is virtually impossible. He often begs for food in between times and I give him a teaspoon or two of meat. So he gets fed 4 times per 24h and, yes, I get up at 5 in the morning to give him a small meal! He's still hungry - am I being too strict?

OUR VET
She’s a very friendly, nice person who always takes the time to explain everything. We’ve been going to her for around 5 years. She is also qualified in herbal therapy (phytotherapy) and osteopathy for animals which is very rare. This is excellent as she doesn’t always go for the heavy-handed, chemical and pharmaceutical approach, opting first for gentler, natural, well-proven remedies, often free of side effects, resistance and tolerance syndrome.

TREATMENT
The vet recommended natural therapy of brewer’s yeast and chromium, olive leaf extract and juniper berry to see if insulin could be avoided.
After 3-4 weeks, his fasting BG was still at 400mg/dl so she recommended a new insulin specially for cats called Prozinc at 1 unit twice a day. (She only has had experience with owners using Caninsulin.)

2 weeks later, we did a 1st glucose curve at home. He still started at:
406mg/dl pre-shot, pre-meal.
+2hours 415mg/dl
+4hours 346mg/dl
+6 hours before small meal 348mg/dl
+8 hours 435mg/dl
+10 hours 340mg/dl
+12 hours, before meal and injection 438mg/dl

The vet recommended a 30% increase up to 1.3 units twice a day. 2 weeks later:
401mg/dl pre-shot, pre-meal
+2 hours 410mg/dl + small meal because he hadn’t eaten much
+4 hours 383mg/dl
+6 hours 341mg/dl

At that point, we didn’t go any further with tests because the levels were so similar to before. The vet recommended an increase of .58 unit up to 1.88 units twice a day.

CHANGES
So, Purrfect's been on Prozinc for 5 weeks. He has been on that dose of 1.88 units for 1 week now. We can see that he’s still drinking a lot (250 to 290 ml) but not in the afternoon/evening, just for two hours around his injection times, particularly the morning. 80% of the water he consumes is in the two hours after his morning injection. He still would like to be fed more too.

Is it normal for Prozinc to have so little effect at 1.88 units 2/day?

Thank you so much in advance for your kindness in reading this and for your help and advice for Purrfect!

Astra and Purrfect.

 

[Kris & Teasel]

Hi Astra,
Thank you for the well laid out and very clear information! It was a pleasure to read.

Sometimes his coat looks a little dull. He is usually of a very laid-back temperament. But since the diabetes, I feel he starts to be slightly irritable too easily.

These and other symptoms are common in a diabetic cat. Some insulins agree with a particular kitty better than others but you're too early in Purrfect's ProZinc treatment to know yet if this is an issue. Unregulated diabetes is more likely the issue.

We only give Purrfect wet food, no supermarket stuff with added sugar, just Animonda Carny, Smilla, Catessy, some raw meat, and some delactosed cat milk.

Congratulations for adopting a wet food only diet. I'm not familiar with any of these foods because I live in Canada. Have you researched their "as fed" carb content? As for feeding frequency, I received that same advice from my vet - feed twice a day at injection time. My cats were accustomed to three meals a day so I told her I preferred to stick to that routine. My diabetic now gets 4 meals a day: a larger AM and PM meal with shots, a small mid day meal and a smaller bed time snack. Many people on here feed multiple times a day. If your kitty has lost weight you can feed more as well because they can't get enough glucose into their cells when they have unregulated (even if treated) diabetes.

she recommended a new insulin specially for cats called Prozinc at 1 unit twice a day.

This is the recommended starting dose of ProZinc. So many vets start at far too high a dose. It's quite possible that your current dose of insulin is too low. I'd like to know how you measured out 1.3 u and 1.88 u of insulin. Are you using U100 syringes for the U40 ProZinc?

Dosing insulin can be tricky for many reasons, not least is that too low a dose and too high a dose can both result in high BG numbers. Too high a dose can cause a counterregulatory response involving the liver that results in glycogen being converted to glucose and being dumped into the bloodstream. This response can be triggered if: 1. the BG drops too low; 2. if it drops to a lower level than the "customary" high values; 3. if it drops at a rapid rate, even if the start and end points are still high. A dose that's too high can set up a vicious cycle of what we call "bouncing" on FDMB - BG drops and the kitty's physiology overcompensates sending BG to high levels.

We normally recommend smaller dose increases on the order of 0.25 u at a time. Increases any larger than that could cause you to leap right past what might be the best dose at that point in time. Note that I said at that point in time because the good dose is very often a moving target.

You haven't mentioned whether you test Purrfect's BG at home. That, to us, is the essential tool in managing FD. We recommend testing AM and PM before feeding (no food for at least 2 hours before so the BG number is not food influenced) and at least one other time near the middle of the 12 hour interval between doses. Testing before injecting tells you whether a planned dose is too high for the current BG level and testing near mid cycle tells you how low the dose is taking the BG. Glucose curves are of limited usefulness because they only give you detailed information for the day on which the curve is being done and are based on the assumption that the BG profile is constant day to day. If the curve happens to be done on a day when BG has bounced into high numbers because of lows the previous cycle or day, you can be deceived into thinking that the dose is too high when, in fact, a reduction is needed.

Here are my suggestions:

1. Buy a blood glucose meter and learn to test blood glucose at home. It's easier to do than you think and we can help.
2. Set up a spreadsheet like the one we use here to log BG data. This is viewable by all members and is the way we can help you best to assess a dose or figure out a problem with dosing.
3. Adopt a regular BG testing schedule with Purrfect that he associates with lots of extra attention, petting, scratches, freeze dried meat treats, etc. It seems more time consuming than it is and you'll become very efficient.

My cat was diagnosed almost a year ago and I spent 7 months doing what you did: give a dose for a week, do a BG curve, confer with vet, change dose, repeat, repeat, repeat .... My vet is great and was right about many things - feeding low carb wet food, learning to test BG at home, etc. However, I was not instructed to test before dosing or test to see how low a dose took my cat. I held ineffective doses too long and it resulted in him becoming "stuck" in high numbers. One day I decided to check his BG before his morning shot and found it to be very, very low. I checked several more times that day and the next and was astounded to see the low numbers. I would not likely have caught them had I waited for a BG curve day because he might have bounced up to high levels by then. My cat is extremely "bouncy" and reactive so don't be disheartened if you look at his spreadsheet. Many kitties are easier to dose than mine. Even with that in the mix, he's doing much better since I've adopted "the FDMB way".

A curve is a snapshot in time. A daily testing routine is a movie.

I hope this helps!

 

[Astra&Purrfect]

Thank you so much, Kris, for taking the time to read my post and compose your detailed explanatory reply. Here are some replies to your questions and comments.

RE SYMPTOMS

Yes, I think too that a slight irritability issue (and unwillingness to sleep in bed as he used to) is to do with his diabetes and not the ProZinc.

RE WET FOODS

The wet foods I mentioned are made in Germany. I don’t know their carb content unfortunately but it’s something I could look into.

RE FEEDING TIMES

Purrfect has had difficulty in adjusting to being fed at regular, limited times. I must admit, we’re rather ill-disciplined when it comes to feeding our cats! Purrfect, along with our other cats, was used to being fed whenever he wanted, with quantities of wet food, nuts (kibble) and huge bowls of his favourite fresh full-fat milk, in addition to scraps of fresh meat at mealtime! Yes, three meals a day is a minimum and he has to have a small meal in the early morning too or he’d be so hungry, the poor thing.

MORNING LEVELS AND DRINKING

The tricky question I’d like to resolve is that if his levels are high in the morning and then I give him his main meal with the injection, the ProZinc won’t be active for around 2-3 hours. That means that in the meantime, his BG must be soaring which accounts for his huge drinking spree. I don’t know what to do about that. Do you have a workaround for that issue with Teasel, Kris?

Today was really terrible with his drinking 360 ml of water! Some of this was in the early morning and then mostly in the two hours following his injection. Then he went 7 hours without drinking! And just a little in the evening. The only change was he missed his second meds of chromium and olive yesterday (so cross with myself for forgetting) and I’d put shredded green beans (without the beans inside) into his food to add fibre and maybe slow glucose absorption. Otherwise, I don’t know what could be going on.

RE DOSING

Regarding how I measure the doses of 1.3 u and 1.88 u… well, that’s a good question! The vet wanted us to have U40 syringes but in the U20 version which shows half units. The ProZinc supplier promised these to her but she’s followed up many times and they still haven’t supplied them. In the meantime, we’re using U40 syringes. We’ve just got a better one with a flat plunger which also doesn’t waste copious quantities of insulin in the top part of the syringe. But as you can imagine, measuring accurately on a small syringe is a fine art and we do the best we can.

I do hope we haven’t jumped ahead too fast with the .58 increase. It’s all so worrying. The vet recommended a slow start because of his FIV positivity and the fact he’d just had a tummy infection. 2 weeks later, with a small increase of 1.3 u, it didn’t seem to make any difference from 1 u. I’ll tentatively say that because he always drinks a lot in the morning (sometimes more, sometimes less, but too much) he must be over the renal threshold. Therefore, hopefully, he’s not had an effect such as the one you mention where morning numbers are low and then there’s a rebound, bouncy effect.

RE METERS

The blood glucose meter does sound like something we’ll have to budget for, finances permitting. We’ve just purchased some more insulin which over here usually costs 75 Euros (but with a slight discount from the vet), more syringes and his continuing natural meds. I would prefer to go for the pet-specific type, such as the Alpha Track2.

The vet hasn’t said we should get a meter but recommends home testing and lends us her Wellion Gluco Calea meter for doing curves.

EAR PRICKING WHEN TESTING

There’re things which really disturb me about pricking the ear! Each time I prick Purrfect in the ear, he’s really brave but he mews pitifully which really is heart-wrenching for me. I just can’t imagine doing this torturous thing every day, although in theory testing sounds like a very good idea.

First of all, I’ll specify that we do use a hot water bottle to warm the ear and put Vaseline on afterwards in the hope the hole will reopen when we wipe it off (which it never does!) I have to reopen the hole with the needle.

The vet said that she strongly recommends pricking the inside rather than the outside, 1. because it heals far better; 2. there’s more blood available; and 3. if we prick the edge of the ear and bungle it, it will scar the ear.

She gave us a sharp syringe needle as a lancet and showed us how to do it, demonstrating it on Purrfect. When we did the first curve, that’s what we did. The next time, we tried with the lancet pen 25 gauge provided with the meter. We thought it’d be easy and were relieved at the thought of using it but it was not good! We tried three times including on deepest setting but it just couldn’t get enough blood out and hurt him. So, we had to prick him each time with the needle again. Over a week later, his ear still has not completely healed and has a slight centimetre and a half bruise from that blasted lancet pen.

Thank you again for your interest and kind advice, Kris, and best regards to Teasel.

Astra and Purrfect.

 

[Kris & Teasel]

That means that in the meantime, his BG must be soaring which accounts for his huge drinking spree. I don’t know what to do about that. Do you have a workaround for that issue with Teasel, Kris?

The polydipsia as they call it improves over time as BG becomes better regulated. It's early days for Purrfect. Teasel is not really regulated but overall his BG is better controlled and I rarely see him at his water bowl. I do add extra warm water to all his meals because hydration is important for diabetics, especially those like mine who have had a bout of diabetic ketoacidosis.

and I’d put shredded green beans (without the beans inside) into his food to add fibre and maybe slow glucose absorption.

I know that some people use extra fibre to help diminish glucose absorption from food. In the past prescription diets for diabetic cats were high in fibre for this reason. Now the thinking is that a low carb, high protein canned food is best. That's why I asked if you know the carb content of Purrfect's food. High carb food can have a significant effect on the kitty's BG numbers.

RE DOSING

Regarding how I measure the doses of 1.3 u and 1.88 u… well, that’s a good question! The vet wanted us to have U40 syringes but in the U20 version which shows half units.

I'm not sure that I understand what you mean by a U20 syringe. ProZinc is a U40 insulin which means its concentration is 40 units of insulin per mL. U40 syringes are constructed such that the first whole unit mark on the barrel corresponds to 1 unit of insulin. The most useful version of a U40 syringe is one that also has half unit marks on the barrel. I apologize if I'm telling you what you already know but I'm going somewhere with this.

Measuring a dose of 1.3 u:

• If the U40 syringe has only whole unit marks you'd be drawing the insulin up to about 1/3 of the way past the 1 unit mark, toward the 2 unit mark. You'd be eyeballing this level.
• If the U40 syringe has half unit marks you'd be drawing up insulin past the 1 unit mark almost to the half unit mark but not touching it. There'd be a tiny bit of space between the insulin level and the half unit mark. Again, eyeballing.

Measuring a dose of 1.88 u:

• With only whole unit marks, you'd be eyeballing very close to but not touching the 2 u mark.
• With half unit marks, you'd be looking past the 1.5 u mark and eyeballing very close to the 2 u mark.
• With either type of syringe it's impossible to eyeball to a level of precision that allows a dose to be recorded as 1.88 u.

The reason I'm dwelling on how you're measuring these doses is that it's very important to be sure what you're giving with a powerful hormone like insulin. Accidental misreading of syringe markings can lead to misdosing. Again, I apologize if I'm misunderstanding what you're doing.

he must be over the renal threshold.

Kitties will be over the renal threshold if they're unregulated. The renal threshold is a range (roughly low 200s for BG) and some think it varies a little cat to cat.

I would prefer to go for the pet-specific type, such as the Alpha Track2.

The AlphTrak is excellent but the test strips are extremely expensive here in Canada and the US. Many people use human meters for that reason. European members of FDMB might have suggestions for you.

The vet said that she strongly recommends pricking the inside rather than the outside, 1. because it heals far better; 2. there’s more blood available; and 3. if we prick the edge of the ear and bungle it, it will scar the ear.

This is a skill that you'll develop faster than you think. There are many resources here to help you learn how to do this quickly and efficiently with minimum (or no) fuss and bother to kitty. I disagree with your vet that you're at risk of damaging Purrfect's ears. I do, however, understand feeling badly if kitty reacts to the prick. Again, with practice you'll become very skilled and most of the time Purrfect will be barely aware that it's happening.

Hope this extra info helps. I'm quite interested to read more about how you measure your doses.

 

[Sue and Oliver (GA)]

Kris has given you some great info/ideas. If you are in Europe, is the ProZinc in a concentration different than U40 as it is in the states? @Ruby&Baco is in the Netherlands and used ProZinc. Maybe she can help with food and the concentration/dosing.

We put together two documents that might give you some additional info - a Beginner's Guide to ProZinc and a Protocol. They are both in my signature in blue.

Welcome to the site! Continue to ask questions and we will try to help.

 

[Pati]

Astra, I felt leary of testing Morris when we adopted him. But he now just gets on the stool I sit on in the kitchen when he hears me opening the cabinet and heating the pill bottle in the microwave. It does get easy very quickly. He actually wants to be tested so he can have another treat.

 

[Astra&Purrfect]

Hello, Kris and Teasel, Sue and Oliver and Pati. Thanks for your replies.

Kris, that's a great tip about adding warm water to the food! I decided to try it out on Purff. I didn't know whether he'd go for it but to my delight he did! I smashed and mixed the Carny into a similar amount of warm water and it ended up looking more like a broth! Purffect lapped it up gladly. This is, as you say, a good way of hydrating the cat, without his having to consume cold water out of his bowl.

I found a calorie and carbo calculator here although the carbo calculation leaves somewhat to be desired. At 107 calories per 100g, Carny turns out to be 20 calories more than Catessy.

Thank you for your advice on dosing in the syringes. I said 1.88 unit as that is the calculator-derived dose from multiplying 0.4 u by his weight of 4.7 kilos. It is of course impossible to attain that sort of accuracy, although I realise it is very important to get the dose exactly right. I spend a lot of time drawing it to a particular level and then pulling/pushing it back in a bright light.

Sorry if what I said was confusing about the syringes. We're using U-40 syringes with no half markings which is not ideal. The vet refers to another sort of syringe for use with U-40 insulin which she calls "U-20" which is indeed confusing! To the best of my belief, it's a syringe of 0.5 ml with 20 units and half markings shown, unlike the U-40 with 1 ml and 40 units marked out. The dosing is currently carried out trying to be as consistent as poss (as you point out).

I will indeed look for and consult the advice given here about making the ear pricking process more bearable.

Sue and Oliver. Thanks for your two docs. I read those a few weeks ago when I first signed up but I think I'll take another look to ingrain the info.

Pati, I'll have to stock up on my cereal and sugar-free treats then! I do always give a treat after testing.

Merci infiniment and bonne soirée, as they say over here!
Astra and Purrfect.

 

[Sue and Oliver (GA)]

Lots of members here use U100 needles with 1/2 unit markings to give ProZinc. It makes giving small increments much easier. BUT you must use a conversion chart because you are using a U40 insulin with U100 needles. It is here:

http://www.felinediabetes.com/insulin-conversions.htm

 

[Astra&Purrfect]

Thanks for that conversion chart, Sue.
I forgot to ask in my last post how do I add photos if I wanted to? A window comes up asking for a URL and I put the link to a photo on Flickr but the photo doesn't show on the thread. There are a number of links provided by Flickr and nomally the BBS type works on forums but doesn't here. Do you have any tips? Thanks!

 

[Sue and Oliver (GA)]

I had to have someone help me with my aviator. See if the info on this thread helps.

http://www.felinediabetes.com/FDMB/...tos-change-user-name-where-are-drafts.112203/

 

[Critter Mom]

A curve is a snapshot in time. A daily testing routine is a movie.

I like this!


Mogs
.

 

[Ruby&Baco]

Hi and welcome!

I can help you if you want with food? I see you are in France right? Do you have a website called zooplus? I think you can order from there when you're in France. There are really great options for low carb food on there like Cosma nature and Cosma original and Cosma Thai.
Also Felix is a great option, but needs to be added with something else as it is not complete food. So you can add Cosma to it's diet.

It would be great if you set up a spreadsheet so you can monitor all the numbers in it and try to find patterns. We can help you with that if you would like that?

 

[Ruby&Baco]

I don't get what you are giving for dose? 1,88? I've never seen a dose like that? Normally it would be 1 or 1,25 1,50 etc. Can you explain a little bit more?

 

[Ruby&Baco]

We only give Purrfect wet food, no supermarket stuff with added sugar, just Animonda Carny, Smilla, Catessy, some raw meat, and some delactosed cat milk.

Animonda Carny is ok, it has 2%-8,5% carbs in it.
Smilla is also ok. It is lower than 8% carbs
Catessy not ok! It has more then 10% carbs in it, some even are 20% or up! So that one is not recommended!
Raw meat: which brand are you giving? Or are you making it yourself?

 

[JanetNJ]

Thank you so much, Kris, for taking the time to read my post and compose your detailed explanatory reply. Here are some replies to your questions and comments.

RE SYMPTOMS

Yes, I think too that a slight irritability issue (and unwillingness to sleep in bed as he used to) is to do with his diabetes and not the ProZinc.

RE WET FOODS

The wet foods I mentioned are made in Germany. I don’t know their carb content unfortunately but it’s something I could look into.

RE FEEDING TIMES

Purrfect has had difficulty in adjusting to being fed at regular, limited times. I must admit, we’re rather ill-disciplined when it comes to feeding our cats! Purrfect, along with our other cats, was used to being fed whenever he wanted, with quantities of wet food, nuts (kibble) and huge bowls of his favourite fresh full-fat milk, in addition to scraps of fresh meat at mealtime! Yes, three meals a day is a minimum and he has to have a small meal in the early morning too or he’d be so hungry, the poor thing.

MORNING LEVELS AND DRINKING

The tricky question I’d like to resolve is that if his levels are high in the morning and then I give him his main meal with the injection, the ProZinc won’t be active for around 2-3 hours. That means that in the meantime, his BG must be soaring which accounts for his huge drinking spree. I don’t know what to do about that. Do you have a workaround for that issue with Teasel, Kris?

Today was really terrible with his drinking 360 ml of water! Some of this was in the early morning and then mostly in the two hours following his injection. Then he went 7 hours without drinking! And just a little in the evening. The only change was he missed his second meds of chromium and olive yesterday (so cross with myself for forgetting) and I’d put shredded green beans (without the beans inside) into his food to add fibre and maybe slow glucose absorption. Otherwise, I don’t know what could be going on.

RE DOSING

Regarding how I measure the doses of 1.3 u and 1.88 u… well, that’s a good question! The vet wanted us to have U40 syringes but in the U20 version which shows half units. The ProZinc supplier promised these to her but she’s followed up many times and they still haven’t supplied them. In the meantime, we’re using U40 syringes. We’ve just got a better one with a flat plunger which also doesn’t waste copious quantities of insulin in the top part of the syringe. But as you can imagine, measuring accurately on a small syringe is a fine art and we do the best we can.

I do hope we haven’t jumped ahead too fast with the .58 increase. It’s all so worrying. The vet recommended a slow start because of his FIV positivity and the fact he’d just had a tummy infection. 2 weeks later, with a small increase of 1.3 u, it didn’t seem to make any difference from 1 u. I’ll tentatively say that because he always drinks a lot in the morning (sometimes more, sometimes less, but too much) he must be over the renal threshold. Therefore, hopefully, he’s not had an effect such as the one you mention where morning numbers are low and then there’s a rebound, bouncy effect.

RE METERS

The blood glucose meter does sound like something we’ll have to budget for, finances permitting. We’ve just purchased some more insulin which over here usually costs 75 Euros (but with a slight discount from the vet), more syringes and his continuing natural meds. I would prefer to go for the pet-specific type, such as the Alpha Track2.

The vet hasn’t said we should get a meter but recommends home testing and lends us her Wellion Gluco Calea meter for doing curves.

EAR PRICKING WHEN TESTING

There’re things which really disturb me about pricking the ear! Each time I prick Purrfect in the ear, he’s really brave but he mews pitifully which really is heart-wrenching for me. I just can’t imagine doing this torturous thing every day, although in theory testing sounds like a very good idea.

First of all, I’ll specify that we do use a hot water bottle to warm the ear and put Vaseline on afterwards in the hope the hole will reopen when we wipe it off (which it never does!) I have to reopen the hole with the needle.

The vet said that she strongly recommends pricking the inside rather than the outside, 1. because it heals far better; 2. there’s more blood available; and 3. if we prick the edge of the ear and bungle it, it will scar the ear.

She gave us a sharp syringe needle as a lancet and showed us how to do it, demonstrating it on Purrfect. When we did the first curve, that’s what we did. The next time, we tried with the lancet pen 25 gauge provided with the meter. We thought it’d be easy and were relieved at the thought of using it but it was not good! We tried three times including on deepest setting but it just couldn’t get enough blood out and hurt him. So, we had to prick him each time with the needle again. Over a week later, his ear still has not completely healed and has a slight centimetre and a half bruise from that blasted lancet pen.

Thank you again for your interest and kind advice, Kris, and best regards to Teasel.

Astra and Purrfect.

Shane to weigh in on the testing thing. When my cat was not in remission I would test her ears 5-8 times a day. No damage to the outer edge of the ear and she barely felt it. There are very few nerve endings on the outer ear as opposed to the middle. You want to aim for the sweet spot.

 

[Kris & Teasel]

I don't get what you are giving for dose? 1,88? I've never seen a dose like that? Normally it would be 1 or 1,25 1,50 etc. Can you explain a little bit more?

Hi Ruby,
Nice to see you here. I'm glad you're able to give some European food options. Like you, I'm confused about the dose info even after Purrfect's owner explained.

 

[Ruby&Baco]

@Kris & Teasel hopefully she drops by soon to give us some more info

 

[Astra&Purrfect]

Hello, Ruby and Baco, Kris and Teasel, JanetNJ, Critter Mom and Sue and Oliver. I just popped by and saw there had been more replies – thanks!

Firstly, thanks for the tips, Sue. I hadn’t thought of uploading photos as attachments.

Dank u wel for the welcome, Ruby and Baco, and for your advice about Zooplus. Yes, indeed, this is exactly the place I order Purrfect’s food from! I haven’t yet tried Cosma. Felix is a nice food we give our other cats but it has added sugar so I have been avoiding it for Purrfect (although he does try and steal open tins of it and lick them!) I’ve just bought some Macs which Purrfect really likes. It is slightly more expensive, more soft and moist than Carny but not that different.

Yes, the cheap Catessy chunks in gelly have sugar in them, and the chunks in sauce are even worse with cereals and sugar. I don’t buy these because I imagine they would be very high in carbo. There’s only one type I do buy on their range which is twice as expensive called Catessy Fine Pâté Tray “grain-free and with no added sugar.”
Any pure meat we give is stuff we buy in the supermarket for my Dad (I’m vegetarian).

Regarding the dose: Prozinc recommend starting at between 0.2 and 0.4 units per kilo of body weight. The vet said start at 1u and then 2 weeks later she recommended an increase up to 1.3u.

2 weeks after that, she calculated a larger dose by multiplying 0.4u by his weight of 4.7 kilos = 1.88 units exactly. This would be rounded down to 1.8 or up to 1.9u. I hope that’s clear and I haven’t perplexed everyone by mentioning the exact figure of 1.88u?!

From your spreadsheet, Ruby, it looks like you’ve managed to get Baco into remission – fantastic! Well done!

TESTING TODAY!​

Now, today, we have the glucose meter from the vet for the first time since the increase to 1.9u. His first pre-shot reading this morning is a bit worrying at 449mg/dl which is the highest I’ve seen it (usually it’s at around 400). His 2nd reading today 2 hours later is lower at 419 which breaks the pattern – normally his 2nd reading of the day is slightly higher than the first! At 1 in the morning, he stole a small bowl of semi-skimmed milk and a tiny ball of cheese from another of our cats. Could this have caused the spike?

Thanks, Janet, for your tips about the ear pricking. I’m afraid I’d already pricked his ear for today’s testing rather towards the middle of the inside. I now see from what you said that the middle can be more painful? Oh, dear.

Thanks, everyone. I must look into how to do a spreadsheet to put the results up for everyone to see.

 

[Kris & Teasel]

Thank you for explaining the dosing. If you get a spreadsheet set up and enter all the data you've accumulated so far we can help you decipher what's going on. This is the SS we use:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
There are techie people here who can help you if needed. @Marje and Gracie

 

[Astra&Purrfect]

Hello, Kris. Thanks for the link. I've just set up two spreadsheets, one for the end of 2016 and one for 2017. Hope I've done it all correctly! There is a link to Purrfect's 2016 spreadsheet at the top of the 2017 SS. There aren't a huge amont of test results because, as explained previously, today is only the 3rd testing day we've done since starting the insulin. I've added remarks too. I will update the results for today as they "come in..."

 

[Kris & Teasel]

Hello, Kris. Thanks for the link. I've just set up two spreadsheets, one for the end of 2016 and one for 2017. Hope I've done it all correctly! There is a link to Purrfect's 2016 spreadsheet at the top of the 2017 SS. There aren't a huge amont of test results because, as explained previously, today is only the 3rd testing day we've done since starting the insulin. I've added remarks too. I will update the results for today as they "come in..."

That's great Astra! As you accumulate more data we'll get a clearer picture of what's going on.

 

[Astra&Purrfect]

Oh, dear, everyone - I'm now really having difficulty with the ear pricking thing especially for the last +8 test a couple of hours ago. I caused him so much pain he wanted to run away. The first 3 or 4 were ok, reopening the old prick and sealing it with vaseline. I can now see a red bruise gradually forming in the middle of the inside of the ear when I look through his ear with a torch (flashlight). I'm using a 23 gauge syringe needle. I'm so wary of trying to prick him on the edge of the ear - I'm afraid I might hit his vein.
What should I do now for the rest of the tests today?

 

[Sue and Oliver (GA)]

Can you use the other ear? If he is bleeding well, maybe use a smaller lancet. We usually suggest 25-27 gauge lancets; 23 may be too thick.

You can hold the ear for a few seconds after the poke to minimize bruising. Also put on some Neosporin with pain relief.

 

[Astra&Purrfect]

Hello, Sue - thanks for your reply. Do you think I should try the edge of the right ear (so far today, I've pricked the middle of the inside of his left ear as recommended by the vet). So afraid of making a boo boo!

 

[Astra&Purrfect]

Hello, everyone! I've just done the +10 test and uploaded the result to the spreadsheet - I pricked the inside of his right ear 3/4 of the way up.

I have two questions following the testing of today:
1. What do people think of his figures. 323mg/dl seems to be the lowest he goes down from AM pre-shot level of 449. This is at his present dose of 1.9u.
2. It's funny that when he's drops into the 300s but still well above the renal threshold, he doesn't seem to want to drink - it's only when he's in the 400s and after his post-shot meals that he wants to drink a lot - why is that?

 

[Rachel]

I think pricking up near the edge of the ear is actually less painful. When I tried the middle of the ear (my vet had showed me that too) I noticed Gypsy seemed to hurt. But near the edge, she didn't seem to hurt much. Was mostly just annoyed. If you use a flashlight to look at his ears, you can see where the vein is and try to hit above that so you don't get the actual vein, but still get blood.

He does seem to surf along at higher numbers...how long have you been at this dose?

I think that the drinking is a sign of higher numbers...since the pinks are lower for him, he probably feels better when in them.

 

[Kris & Teasel]

Hello, everyone! I've just done the +10 test and uploaded the result to the spreadsheet - I pricked the inside of his right ear 3/4 of the way up.

I have two questions following the testing of today:
1. What do people think of his figures. 323mg/dl seems to be the lowest he goes down from AM pre-shot level of 449. This is at his present dose of 1.9u.
2. It's funny that when he's drops into the 300s but still well above the renal threshold, he doesn't seem to want to drink - it's only when he's in the 400s and after his post-shot meals that he wants to drink a lot - why is that?

This dose looks like it's a little low. However, you're just beginning to gather data so I'd keep it for maybe 2 more cycles. You can reduce the testing to AM/PM before shot and maybe 1 or 2 in the +5 to +8 range.

I prick the outside edge of the ear and occasionally hit the little vein. Aside from more blood it doesn't appear to bother Teasel. I always put hold the pricked area firmly between thumb and forefinger afterward to stop bleeding and prevent bruising.

 

[Astra&Purrfect]

Hello, Rachel and Kris. Thank you very much for your replies.

Rachel, thanks for your advice about the ear pricking. It's really something I must get the hang of and everyone seems to do the pricking on the outer edge. As for the dose, It was increased from 1.3u to 1.9 on the 30th of December, so a little over two weeks. Yes, I think the pinks are better for him when the Prozinc is having a slight effect. Gosh, I would like to see some "sunny yellows" soon!

Kris, Thanks for the tips about the ear. I must press it afterwards so it doesn't get bruised. I think I'm going to have to switch over to pricking the outer edge - it just goes somewhat against the grain to do something the vet didn't recommend.
Yes, I suppose 1.9u isn't enough for Purrfect. He's been on that dose for just over two weeks. I wonder whether a small increase of 0.3u might be in order? How long afterwards should one leave it for it to have a full effect - the vet so far as said leave it two weeks.

Thanks again for your help!

 

[Kris & Teasel]

Hello, Rachel and Kris. Thank you very much for your replies.

Rachel, thanks for your advice about the ear pricking. It's really something I must get the hang of and everyone seems to do the pricking on the outer edge. As for the dose, It was increased from 1.3u to 1.9 on the 30th of December, so a little over two weeks. Yes, I think the pinks are better for him when the Prozinc is having a slight effect. Gosh, I would like to see some "sunny yellows" soon!

Kris, Thanks for the tips about the ear. I must press it afterwards so it doesn't get bruised. I think I'm going to have to switch over to pricking the outer edge - it just goes somewhat against the grain to do something the vet didn't recommend.
Yes, I suppose 1.9u isn't enough for Purrfect. He's been on that dose for just over two weeks. I wonder whether a small increase of 0.3u might be in order? How long afterwards should one leave it for it to have a full effect - the vet so far as said leave it two weeks.

Thanks again for your help!

If you're using U40 syringes without half unit marks, you could try giving a full 2 units next. Don't worry about the dose calculation per kg. Cats vary widely in their insulin requirements - eg. a small kitty might need a larger dose to achieve good numbers whereas a large kitty might achieve it with a small dose. The dose per kg calculation is only good for a ball park initial calculation of dose. It's through tracking BG values day to day at various doses that you learn what your kitty needs. There's no one size fits all. The acronym we use here a lot is ECID - "every cat is different".

If your U40 syringes have half unit marks, we recommend increasing by no more than 0.25 u at a time. You'd have to eyeball this between a whole and a half unit mark on the syringe barrel. Your next dose series might look like: 2.00 u, 2.25 u, 2.50 u, 2.75 u, etc.

We generally advise people to hold a dose at least 3 cycles (a cycle is one 12 hour interval between doses). The dose's effect should be evident by then. If it looks good then the dose can be continued. If it needs tweaking it's best not to wait too long. Some kitties can get "stuck" in high numbers if they're left too long at an ineffective dose. Two weeks is far too long if a dose isn't working.

If you haven't done so already I encourage you to read the "how to" info stickies at the top of the ProZinc forum to get more details on dosing.

 

[Astra&Purrfect]

[Thought I posted this reply yesterday - came back and saw I hadn't! If I could put a scratch-head smiley I would!]
Hey, thanks for your post and advice, Kris. I have indeed read the stickies.
We're using standard U40 with no half markings. We're now at 2u, as also recommended by the vet, especially when we told her we had our first sunny yellow 265mg/dl at nadir yesterday! So, she said be careful and go gently. I wonder whether he's 'bouncing' up from the lows because his starting levels are slightly higher than before.
Have a great evening.
Astra and Purrfect.

 

[Kris & Teasel]

[Thought I posted this reply yesterday - came back and saw I hadn't! If I could put a scratch-head smiley I would!]
Hey, thanks for your post and advice, Kris. I have indeed read the stickies.
We're using standard U40 with no half markings. We're now at 2u, as also recommended by the vet, especially when we told her we had our first sunny yellow 265mg/dl at nadir yesterday! So, she said be careful and go gently. I wonder whether he's 'bouncing' up from the lows because his starting levels are slightly higher than before.
Have a great evening.
Astra and Purrfect.

I like that yellow! Yes, there might be some bouncing going on. It's a good idea to do a test just before you go to bed to see where the PM dose might be taking him. Many cats run lower at night and that can lead to bounce next AM.

 

[Astra&Purrfect]

Hello, Kris! Yes, we must do that when I haven't given him food for a few hours. I did give him food only 2 to 2 and a half hours before his PM shot tonight - a bit off his schedule really.
I do get up in the middle of the night at around 4-5 o'clock to give him food so hope that would preclude any low lows.
A & P.

 

[Astra&Purrfect]

Hi, everybody! Just done three tests today and updated the SS. It looks like we're managing to get him down by around 100mg/dl on average - not really enough. Probably that 2u dose is too low. Will consult with vet on Monday.

 

[Rachel]

I agree...looks like it might be time to bump it up. Let us know what the vet says. I think, if he was mine, I'd bump up to 2.25 on a cycle I could monitor.

 

[Kris & Teasel]

I agree...looks like it might be time to bump it up. Let us know what the vet says. I think, if he was mine, I'd bump up to 2.25 on a cycle I could monitor.

I agree with Rachel.