ProZinc stopped working

Marlene G

Marlene G

Member
Hello. My kitty Ananda was diagnosed with diabetes at the end of August -- she is on steroids for IBD, which caused it. My vet put her on Vetsulin and it was working but big spikes in her numbers so I switched to ProZinc first week of October. She was doing well on ProZinc for a few weeks but since late October has mostly had no relief from high BG, mostly in the upper 300s. She was on 2 units but when it stopped helping I tried a 1u reset. Then I bumped her up to 1.5 for a week but not working. Now I'm trying 1.75, but the numbers won't budge. Tried a new bottle just in case, but same result. Had blood work done end of October and fructosamine level was good, though I suspect worse now. Slightly high white blood cells, but UTI test negative. Not sure what to do. Bump her to 2 units? Higher? Do I need to change insulin if ProZinc doesn't start working soon? Tonight it's not budging from Hi on her Libre and she is not feeling well. Thanks.
 
Hi Marlene. I’m sorry for the delay in replying. I have been out of town. Do you have a spreadsheet where we can see what’s going on with your sweet baby? I would love try to help.
 
Also, Vetsulin is no longer recommended for use in diabetic cats. So I am glad you have switched to ProZinc.

It would be very good if you could share the latest bloodwork. What does slightly high white count mean (number and reference interval) mean? Please be careful. If she’s really not eating or not feeling well and/or vomiting and seems unwell, please take her for emergency care if necessary. This can be a DKA. This happened with my cat. He had an infection of unknown origin and a very high temperature and high blood glucose and it turned into a dangerous DKA and a week of emergency hospitalization.
 
Hi. Thanks for checking in. Ananda is feeling much better today. Eating and playing with toys, so I didn't bring her in. I have a link to her spreadsheet here.

https://docs.google.com/spreadsheet...YYophZ0kI6Kg9qzRbAt0Yr_yfk/edit#gid=884718537

Also attached her bloodwork from last month. Fructosamine was at 341 a month ago. Any dosing advice appreciated! She is still taking her Budesinode for IBD, which I'm sure is not helping with her blood glucose.

Thank you!
 

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Do you regularly test her urine or blood for ketones?

Her labs don’t look bad at all, except the fructosamine is too high. It makes sense since, from her spreadsheet, she spends way too much time in the pinks. The pinks are well over the kidney threshold and those numbers are very hard on her kidneys. The dose is being jockeyed around too much as well.
 
Are you testing with the Libre? Do you have a hand held human meter as a backup in case you get a wacky Libre reading (or if the Libre conks out on you.).
 
What is her diet? Is she on an all low carb wet food diet? What is her feeding schedule like? Does she eat a morning meal and then get a few low carb mimi meals (teaspoon or two) during the early portion of the cycle (before nadir?)
 
I just use the Libre2 and occasionally test for ketones in the urine. Negative a few days ago. Her diet is all low carb wet food -- Orijen cans, Tiki After Dark, snacks are Nulo chicken in chicken broth and beef and sardines (no other ingredients). Freeze dried chicken treats. I feed twice a day but do leave some food out since I'm often out for most of the day and my other cat is a grazer. Usually leave out a Nulo beef and sardine or one of the Nulo chicken pouches.

My main issue aside from not knowing how to dose her is the shot times. I have some weeks where I can do close to 7am/7pm and other weeks where I need to be teaching 6am so have to do super early shot times. I know it's not ideal. I also travel a lot for work, so have cat sitters that come to do her insulin. I chose ProZinc over Lantus since I was told I have a bit more leeway with shot times. Not sure what direction I should be going with her doses. There were a lot of yellows and blues early on with ProZinc, but now just the pinks. Thanks.
 
What did you dose today? The spreadsheet is not up to date. I’m sorry for so many questions. I’m really trying to get the big picture. I’m sure we can work this out to help Ananda?
 
Just updated it. I did 2u this morning 7am. About to do her evening shot. The daily graph on the Libre2 shows she went down to about 270 before I got home and checked. Not sure how accurate that is, but didn't stay under 300 for very long.
 
I see the PMPS was 400. I hope you shot 2 units. Let’s gather data for a few more cycles and see where to go from here.
 
Her levels are at 400 or higher on Libre2 and not budging tonight. Is there a chance 2 units is too much but looking like too little? Hopefully she isn't resistant to the insulin -- seemed to be working a month ago.
 
Hi. I was advised to up Ananda's dose to 2.5u and then after just over a week to 2.75u. Nothing seems to get her regulated and so far 2.75 seems worse, though I know it's still early on trying that dose. Any suggestions? I'm getting worried I won't be able to get her regulated. Thanks.
 
Her spreadsheet is perplexing— how can there be so many 400s on there? Like literally 400 and not 395, 402, whatever? What kind of meter are you using?
 
And just let me say that I do understand how frustrating it is when there seems to be little to no response to the insulin. I’ve been there.

You have been at this a while. If you would like to stick around the FDMB and switch to the Modified ProZinc method, we can change her doses more frequently- when the numbers warrant it (as they do now.) her nadirs are over 200 almost all of the time and so, if you wish to do MPM (which you would add to your signature) the next increase would be after holding this dose for 6 cycles (assuming she stays high like this) and it would be an increase of .5 units (to a new dose of 3.25 units.)
 
@Marlene G
We need you to set up your signature it's information we need to know about Ananda
This will be helpful
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly.
You can take a look at mine
 
Hi. I fixed my signature. I am using the Freestyle Libre2 which only goes up to 400, so that is the reason I don't have more precise numbers higher than 400. I have also put my spreadsheet up on a Facebook forum so they suggested some of the dosing. I haven't gotten much advice from my vet on dosing. I have an appointment with him this Thursday. I know he wants me to try a Convenia shot to rule out an infection, but I don't want to do that. She doesn't seem like she has an infection anywhere. Any thoughts if I should have her checked for IAA or anything else?

Do you think there is a chance I've gone too high with the dosing and missed an ideal dose, or is it pretty clear she needs a higher dose? She was doing well on the ProZinc when I first started, but not sure if she developed some kind of resistance that has caused her BG to not come down. She has been on Budesinode for IBD since end of September (previously on prednisolone which is what caused the diabetes). She also gets a monthly Solensia shot. Thanks.
 
Marlene G said:
Hi. I fixed my signature. I am using the Freestyle Libre2 which only goes up to 400, so that is the reason I don't have more precise numbers higher than 400. I have also put my spreadsheet up on a Facebook forum so they suggested some of the dosing. I haven't gotten much advice from my vet on dosing. I have an appointment with him this Thursday. I know he wants me to try a Convenia shot to rule out an infection, but I don't want to do that. She doesn't seem like she has an infection anywhere. Any thoughts if I should have her checked for IAA or anything else?

Do you think there is a chance I've gone too high with the dosing and missed an ideal dose, or is it pretty clear she needs a higher dose? She was doing well on the ProZinc when I first started, but not sure if she developed some kind of resistance that has caused her BG to not come down. She has been on Budesinode for IBD since end of September (previously on prednisolone which is what caused the diabetes). She also gets a monthly Solensia shot. Thanks.
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Tagging Suzanne for you
Suzanne her SS looks like it's from the Facebook group, doesn't look like ours do you think Bhooma should fix it ?
@Suzanne & Darcy

@Marlene G
Hi have you read the 2 dosing methods to chose from, they will let you know when an increase or decrease is needed . I see Suzanne explained it to you in her post #20

When you decide you can add that to your signature
By the did you get the spreadsheet from the Facebook group?
I also noticed on your spreadsheet you have
DKA / ketones: Yes Keytones at the top of your SS highlighted in aqua , Did Amanda ever have DKA and Ketones?
 
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Diane Tyler's Mom said:
Tagging Suzanne for you
Suzanne her SS looks like it's from the Facebook group, doesn't look like ours do you think Bhooma should fix it ?
@Suzanne & Darcy

@Marlene G
Hi have you read the 2 dosing methods to chose from, they will let you know when an increase or decrease is needed . I see Suzanne explained it to you in her post #20

When you decide you can add that to your signature
By the did you get the spreadsheet from the Facebook group?
I also noticed on your spreadsheet you have
DKA / ketones: Yes Keytones at the top of your SS highlighted in aqua , Did Amanda ever have DKA and Ketones?
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Never DKA. When first diagnosed late August/early September she had trace keytones, but hasn't had keytones since.

Yes, spreadsheet is from the FB group. Do I need to make a new one? Her shot times aren't always exact. Usually closer to 6:30am or 7am except on days I need to teach super early. Evenings are as close to the morning shot time as I can get, so pretty close to every 12 hours. My work schedule is not always ideal.
 
I am glad you do not want to do the Convenia shot. If his white count is elevate or there are signs of infection, then you can consider oral antibiotics. Have you read about the potential dangers of Convenia? I don't want to bother linking stuff if you already are aware.
 
Marlene G said:
Do you think there is a chance I've gone too high with the dosing and missed an ideal dose,
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I do not think you have missed her ideal dose. If she were being overdosed, it would be apparent. In general, you've held the doses long enough that she would have dropped too low if she were being overdosed. And you've done a few resets (which are not really a good idea unless you've been skipping doses in whole units or even more -- as some vets will advise.) I would not recommend testing for IAA or Acromegaly yet, but if she gets into a higher dose (closes to 6 units) then I would recommend it. Right now, she needs an increase. I recommend an increase of .5 units (as I mentioned in an earlier post above.) I think you should read the Modified ProZinc Method (I think Diane linked it above in a post) and you should just adjust her doses every 6 cycles (if needed.) She's been in high numbers too long and you may just be dealing with some glucose toxicity, which really just means that she could have become comfortable in these high numbers -- the way to try to break through that, if that's what is going on, is to keep increasing, as needed -- and to not hold the doses for such a long time. I really think you need to follow MPM. We can help you with that here. Don't stress too much right now over shooting exactly 12 hours apart -- yes, that is ideal, but it sound like you are trying really hard to make it not too much beyond 30 minutes off schedule? Usually, people indicate on their SS when they shoot early/late, because sometimes that is important. So what do you think about increasing her dose by .5 units tonight? Or tomorrow morning if that's better for you?
 
Suzanne & Darcy said:
I do not think you have missed her ideal dose. If she were being overdosed, it would be apparent. In general, you've held the doses long enough that she would have dropped too low if she were being overdosed. And you've done a few resets (which are not really a good idea unless you've been skipping doses in whole units or even more -- as some vets will advise.) I would not recommend testing for IAA or Acromegaly yet, but if she gets into a higher dose (closes to 6 units) then I would recommend it. Right now, she needs an increase. I recommend an increase of .5 units (as I mentioned in an earlier post above.) I think you should read the Modified ProZinc Method (I think Diane linked it above in a post) and you should just adjust her doses every 6 cycles (if needed.) She's been in high numbers too long and you may just be dealing with some glucose toxicity, which really just means that she could have become comfortable in these high numbers -- the way to try to break through that, if that's what is going on, is to keep increasing, as needed -- and to not hold the doses for such a long time. I really think you need to follow MPM. We can help you with that here. Don't stress too much right now over shooting exactly 12 hours apart -- yes, that is ideal, but it sound like you are trying really hard to make it not too much beyond 30 minutes off schedule? Usually, people indicate on their SS when they shoot early/late, because sometimes that is important. So what do you think about increasing her dose by .5 units tonight? Or tomorrow morning if that's better for you?
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I will start tomorrow morning with the higher dose. I have had a harder time with the injection lately. She was super easy for a while and now starts moving away pretty fast as I'm doing it. I don't feel wet fur but I'm worried I won't be able to do this on my own at some point. She is a handful, which is the reason I haven't done the Relion. I can't even warm her ears without her having a hissy fit. She's gotten used to the Libre thankfully. I have some days I teach 6am so have to shoot at about 5:30am/5:30 or 6pm and some days I have to leave my place at 3pm and teach until 8pm. Mostly I do 7:30am and around 8pm, but one or two days a week I have to do it earlier. For my other job I travel a lot, but fortunately have a couple of neighbors who have been able to help. I was worried I wasn't holding doses long enough since a couple of people mentioned that, so will move to the MPM strategy. I probably would have chosen Lantus if not for my crazy schedule since I heard that is more strict with timing. Do some kitties do better on that if ProZinc doesn't start helping? I don't want her to suffer because of my schedule. Thanks for all the help.
 
@Marlene G
Just a reminder if you are going to follow MPM method please add it to your signature since you said in your post #29
I was worried I wasn't holding doses long enough since a couple of people mentioned that, so will move to the MPM strategy :cat:
 
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Marlene G said:
I will start tomorrow morning with the higher dose. I have had a harder time with the injection lately. She was super easy for a while and now starts moving away pretty fast as I'm doing it. I don't feel wet fur but I'm worried I won't be able to do this on my own at some point. She is a handful, which is the reason I haven't done the Relion. I can't even warm her ears without her having a hissy fit. She's gotten used to the Libre thankfully. I have some days I teach 6am so have to shoot at about 5:30am/5:30 or 6pm and some days I have to leave my place at 3pm and teach until 8pm. Mostly I do 7:30am and around 8pm, but one or two days a week I have to do it earlier. For my other job I travel a lot, but fortunately have a couple of neighbors who have been able to help. I was worried I wasn't holding doses long enough since a couple of people mentioned that, so will move to the MPM strategy. I probably would have chosen Lantus if not for my crazy schedule since I heard that is more strict with timing. Do some kitties do better on that if ProZinc doesn't start helping? I don't want her to suffer because of my schedule. Thanks for all the help.
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Well, when a cat is newly diagnosed it’s a good idea to hold doses for 7 days and then make any necessary adjustments. There’s no reason to hold doses longer than that if the numbers warrant an increase. But with a cat like Ananda, we need to be a little more proactive and make adjustments more quickly. You have the Libre sensor as well, which means we can find out what he nadirs are and will know if a dose is working better. When I was starting out, I got a lot of what I later realized was not good advice from a Facebook group. They meant well and were kind people, but they didn’t know how to handle my cat. I tried holding doses, resetting back down to very low doses, etc. I lost a lot of valuable time like that. Anyway, let’s try to see if we can get a breakthrough. Don’t worry about your spreadsheet just yet. I’ve been focusing on trying to help with the dose. We do have people who can help with spreadsheets though. I will be checking in to see how she’s doing.
 
Sorry, more questions. Is she on a daily dose of Budesonide or is it every other day? I’m sure that is also raising her BG. It looks like numbers got worse when you restarted the Budesonide. So if she needs it, she needs it — we just have to compensate with insulin. Have you ever tried Visbiome? It’s a very well-researched probiotic. I have a cat with IBD who was never able to go to every other day dosing of his Prednisolone (he always got diarrhea when I tried) but after starting the Visbiome Vet probiotic, he has been able to get onto a dose of pred every other day instead of daily. I order it directly from Visbiome Vet and, in fact, have now put it on automatic shipments.
 
You say she goes back to the vet this Thursday? I would recommend a CBC and chemistry panel and a urinalysis— if you can do this. Also, get the vet to check her teeth. So the Convenia recommendation is die to the fact that you can not get her to take oral antibiotics?

I love that photo of her. She’s beautiful!
 
Ananda is on daily Budesinode. A quarter pill. She has had IBD since she was a year old and I was able to get her off steroids for a couple of years, but she had to go back on last year. When she tested positive for diabetes my vet took her off the prednisolone and she was good for a few weeks. Her blood sugar went back to normal after a few weeks of Vetsulin too, but then the vomiting and bloody diarrhea came back and none of my tricks would work --Cerenia, probiotics (been using Healthy Gut from Adored Beast), s Boulardii, etc. My vet was hopeful Budesinode wouldn't be as harsh but her BG went up right away. I think I tried Visbiome Vet years ago, but can try again. I tried a couple of times to go to every other day Budesinode but in a few days she has always started vomiting her meals and then the stinky poop.

I did the 3.25 this morning -- she moved at the end but think it mostly went in. I do try when she is eating but she steps away and sits down for the shot like she has done, but it must be more painful now. She also figured out my shooting while giving treats too. LOL. I do mix up the locations a bit. There isn't much scruff under all the fluff. And she wasn't happy when I tried her side belly. She got down to about 270 for a very short time today, but then went right back up. Not sure why the numbers seem to bounce right back up when they start going down.

Oral antibiotics are no problem. I think he wanted to do the shot with a general antibiotic. I will request blood work and urinalysis. He has tried to do a full dental check but she isn't very cooperative. He does check her teeth as much as possible and he thinks they are ok. Will ask again Thursday.

Thanks for liking her photo. She's beautiful but a bit of a monster. She has quite the reputation at a few vet offices around town. :cat:
 
Also, one question. I will give her second dose about 7:45pm tonight, which matches this morning, but have to do it way early tomorrow at about 5:15am. Is that ok since the ProZinc doesn't seem to last a full 12 hours with her? She usually runs high at night, too. Thanks.
 
3.25 doesn't seem to be doing much yet. Her night numbers never even come down past the Hi on the Libre2. Not sure how high they are actually going. She is acting normal except for the excess peeing and drinking.
 
Marlene G said:
Also, one question. I will give her second dose about 7:45pm tonight, which matches this morning, but have to do it way early tomorrow at about 5:15am. Is that ok since the ProZinc doesn't seem to last a full 12 hours with her? She usually runs high at night, too. Thanks.
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Sorry I didn’t see this. I do think at this point she is running so high that the early shot won’t matter. Good luck at the vet today.
 
OK. Got just below 300 this morning but went right back up, which always seems to happen. Went up to Hi when we went to the vet of course. Her monthly Solensia shot is like magic. Currently running around and playing like when she was younger. Lost a few ounces in the past few weeks. Trying to get her down 2 or 3 more pounds. Still just says Hi on the Libre. Nothing seems to help at night at all. Will up the dose. Trying to go to every other day with the steroid. Skipped last night and gave it tonight. Hopefully that will work this time.
 
Good luck with the new 3.75 unit dose. I’m really hoping for better numbers soon. I really understand how the high numbers make you feel!
 
Here is her latest blood work. Vet didn't say anything was alarming but a few items look high-- Reticulocytes and ALP especially. I went ahead and did 3.75u this morning and results seem even worse. Just keeps saying Hi on the meter. She is acting normal still though. Anything I should follow up on for this blood work? He said we could do a week of Clavamox if BG still doesn't come down. He doesn't think she has acromegaly though didn't test specifically.
 

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