ProZinc to Levemir switch - starting dose? timing of increases?

Status
Not open for further replies.
FurBabiesMama

FurBabiesMama

Member Since 2017
This is my first post in this forum. After 9 months on ProZinc, we will be switching to Levemir very soon. I plan to try the TR protocol. I have been reading up on this since I have to re-wire my brain to think in Levemir terms rather than Prozinc terms. :eek:

The vet said to start at 1u, but I am thinking that is too low. I think we need to start at at least 1.5u, but I would very much appreciate your input on this. From what I have read, the starting dose is normally .25u per kg of the cat's weight, and if the cat has been on another kind of insulin, that should be taken into consideration as well. Mia's weight is pretty consistently around 11.80lbs/5.35kg, and she has been on 2.5u of ProZinc.

I would also like feedback on whether I am understanding this part correctly. From what I have read, I believe I am to hold the starting dose 5 to 7 days UNLESS she has high flat curves, in which case I should up the dose after 2 to 3 days. If nadirs are always > 200, increase by .25u, or if they are always >300, increase by .50u.

Thank you for helping me make this switch. It is scary to go from what I know and have had decent results with to something I do not know and on which I am 'gambling' on getting even better results.
 
FurBabiesMama said:
I have to re-wire my brain to think in Levemir terms rather than Prozinc terms. :eek:
Click to expand...
:rolleyes:So true!!! Its like starting over. Dosing is now based on Mia's nadir not pre-shot numbers.

I'm glad to see you're starting with Lev....I'm a big fan and have seen a lot of kitties flatten out after switching. Starting out a 1U isn't too bad. If you're able to closely monitor when you switch then 1.5U would be ok too but you want to err on the side of caution because some kitties have a very marked response to changing insulins. Beenie did but I tested like there was no tomorrow. Its been advised that starting on Lev can be 70% of the previous insulin's dose which would be roughly 1.75U. Based on what I see on Mia's SS she does like to dip into those greens so I wouldn't start any higher than 1.5U..IMO.

L&L is very busy so that'll take some getting used to as well. Lots of very knowledgeable people that will help you on your Lev journey:bighug:

Best of luck to you both:)
 
At the risk of sounding like a nit picker I'd like to correct something I've read quite a few times in reference to ProZinc. This is for the benefit of lurkers or others who have no ProZinc experience. Teasel was on it for 9+ months so I know whereof I speak and I'm sure other PZ users would agree. You definitely factor in pre shot numbers when dosing ProZinc because kitty's safety depends on it. Also, you can't shoot a full dose on very low PSs as you can with Lantus. However, it's absolutely essential to put a lot of weight (most, in fact) on nadir numbers in assessing a dose. The first thing we'll say to a new member on the ProZinc forum is to get mid cycle data in order to evaluate a dose properly. Looking mostly at PSs will lead to bad dosing decisions for sure.

Descending from soapbox now ... ;)
 
Kris & Teasel said:
@Beenie (GA) Michelle - that wasn't aimed at you. You just reminded me of how often I'd read this piece of misinformation. :bighug:
Click to expand...
I know that its not just the pre shots or the nadirs, it the whole picture. I sometimes, just like others, can only give a "piece" of the information or a generalization. Of course mid cycle numbers are important too. @FurBabiesMama isn't new to this dance and certainly knows this so I was just welcoming her and agreeing its a different way of thinking when it comes to dosing L/L vs Prozinc.

I'm having no luck today on the board. I'll sign off and let the experts advise.
 
Hello and welcome. When you switch insulins, we take the previous dose of Prozinc into consideration. That means using pretty much the same dose if you can monitor. If you are a bit nervous, since you have seen some greens on 2.5 units of Prozinc, you could always take it down to 2.25 or 2.0. I wouldn't go any lower than that. Some cats have a strong reaction to the swtich, some don't. So we do recommend doing the switch at a time you can closerly monitor the first two cycles.

And yes - hold the starting dose at least 5 days (unless she earns a reduction). Ask and we can help you decide if she should go up sooner than that.

Couple of questions, are you still using the AT? Just wondering why you aren't using the AT spreadsheet. It's just another reminder to anyone looking at Mia's numbers to keep the meter type into consideration. Second question - how much dry food is she getting as "topper"? A requirement for TR is using 100% low carb wet or raw.
 
Beenie (GA) said:
I know that its not just the pre shots or the nadirs, it the whole picture. I sometimes, just like others, can only give a "piece" of the information or a generalization. Of course mid cycle numbers are important too. @FurBabiesMama isn't new to this dance and certainly knows this so I was just welcoming her and agreeing its a different way of thinking when it comes to dosing L/L vs Prozinc.

I'm having no luck today on the board. I'll sign off and let the experts advise.
Click to expand...
@Beenie (GA) I apologize if I made you feel bad, Michelle. Your input is always welcome on FDMB.
 
Wendy&Neko said:
Couple of questions, are you still using the AT? Just wondering why you aren't using the AT spreadsheet. It's just another reminder to anyone looking at Mia's numbers to keep the meter type into consideration.
Click to expand...
Hi. Yes, as my signature states, I am using the AT meter. The ranges/color coding on my spreadsheet are for AT. Since there was not a US/world version of the spreadsheet provided, I modified as needed to have one. I assume you are referring to it not having a line across the top that says it is calibrated for feline blood. You are the first to mention that; if you think people on this forum will be confused by it not being there, I suppose I could add it.

Wendy&Neko said:
Second question - how much dry food is she getting as "topper"? A requirement for TR is using 100% low carb wet or raw.
Click to expand...
She gets s small amount of it on her food, less than a tablespoon. When I read the TR information, it was clear that a low-carb, high-protein diet is very important, but I did not see where a 100% wet or raw diet was mandated. I am not saying it is not possible that I overlooked something, so if you can direct me to it, I will re-evaluate. I do recall it saying that wet food diets more often have a lower carb content than dry-food diets which I would agree with, but Young Again Zero Mature has only trace carbs and has never impacted her BG.
 
Thanks on showing AT on the SS. Some people here may give incorrect suggestions without that in their face.

I think the YA is really something like 5% carbs, which is still low carb. But being dry it metabolizes at a different rate. Check out the Requisites section of the TR protocol Sticky Note, I think it's the 5th point. The TR research was done with low carb wet or raw.
 
Wendy&Neko said:
I think the YA is really something like 5% carbs, which is still low carb. But being dry it metabolizes at a different rate. Check out the Requisites section of the TR protocol Sticky Note, I think it's the 5th point. The TR research was done with low carb wet or raw.
Click to expand...
Sorry, but that is not accurate. The YA has only trace carbs, <1%.

I see the bullet you are talking about in the sticky; however, I was focusing on the actual published TR protocol (which I got the link to on that sticky): Management of Diabetic Cats with Long-acting Insulin I think that since the YA has only trace carbs, and Mia only gets a small amount of it, and I know from ample data I have collected that it has no impact on her BG levels, it will not pose an issue. Even if the research/study was done with only wet, I do not see where giving her a little YA is in conflict with the intent/information regarding diet outlined in the TR info. The focus appears to be on high-protein, low-carb.
 
Wendy&Neko said:
it's that it's dry food. If she mostly eats wet, why not just feed that?
Click to expand...
I am very aware of the concerns about dry food. Again, Mia gets very little kibble. A few kibbles are sprinkled on top of her wet food. She gets more than enough moisture in her diet so I have no concerns whatsoever. Not only is her wet food 81% moisture, but I also add bone broth and water to it. So, I do not think any reasonable person could say her diet is anything resembling 'water-depleted' which is what the link you included expresses concern about. It also says, "Feeding a low carb dry food as a treat is no big deal." which is pretty much how I am using it by merely sprinkling a few kibbles on top of her otherwise very wet meal. I started doing it because Mia loves it, and as long as there is a little bit there, she will happily eat her wet food.

As I hope my responses show, I am aware of the importance of a high-protein, low-carb, high-moisture diet, and I have structured Mia's diet accordingly. I wanted to seek expertise/input here regarding a starting dose and timing/basis for initial increases. I appreciate the responses related to those items. Thanks.
 
I have to point out that I agree with Wendy. The requisites for using TR specifically state:
  • Feed a high quality low carb canned or raw food diet.
Click to expand...
I'm not sure where you found the information that feeding a low carb dry food as a treat is no big deal. I may have missed this somewhere but I've been here a long time and don't recall reading this. (Could you link where you found the information?) This may be entirely moot unless you plan on using the Tight Regulation Protocol as your dosing strategy. If you plan to use Start Low Go Slow, there isn't the same requirement regarding any form of dry food or treat.

Just to double check, do you have U100 syringes? Aside from syringes, you are absolutely correct that using a depot-type insulin takes a different mindset than using non-depot types of insulin. Just scrolling through Mia's spreadsheet (SS), one big difference between how we dose with Lev is the frequency of dose changes. We would likely encourage you to get some tests in at other than nadir since nadirs can and do change. It's also quite likely that Mia's nadir on Lev will be later than what you were seeing with Prozinc. So, getting some curves once the depot is established will be helpful to your having a handle on how her cycle is working.

 
Hello and welcome to L&L! I'm still quite a newbie and I believe that the pros have answered your questions, so just wanted to say hi and always feel free to ask questions here :D Everyone is very supportive and helpful.

Best of luck with the switch, I hope it proves to be a positive change for Mia!
 
"Feeding a low carb dry food as a treat is no big deal. What I am talking about is when people think that ANY dry food is a healthy substitute for a water-rich diet of either canned or homemade." - Dr. Lisa

• "you will need to feed the right diet: high-quality low-carb canned food or raw food exclusively" - from the requisite list on http://www.tillydiabetes.net/en_6_protocol2.htm

To clarify a bit further...
Dr. Lisa's comments and the requisites for following the TR Protocol (as described in the protocol & mentioned in the TR sticky) are regarding two different subjects. I can see how this may become overlooked when taken out of context.

That said, I think many of us have ground kibble to sprinkle on kitty's food when they're not eating well/off their food... using kibble as an enticement to eat. In my mind there's a difference between regularly feeding kibble and occasional use.

Just my thoughts...
 
Sienne and Gabby (GA) said:
I'm not sure where you found the information that feeding a low carb dry food as a treat is no big deal. I may have missed this somewhere but I've been here a long time and don't recall reading this.
Click to expand...
As I mentioned, the comment about feeding low-carb dry food as a treat came from the link Wendy put in her comment to which I was responding. Both Kris and Jill have since provided the excerpt as well.

Sienne and Gabby (GA) said:
Just to double check, do you have U100 syringes?
Click to expand...
I know Levemir requires U-100 syringes and will be using them once we start it.

Sienne and Gabby (GA) said:
Just scrolling through Mia's spreadsheet (SS), one big difference between how we dose with Lev is the frequency of dose changes. We would likely encourage you to get some tests in at other than nadir since nadirs can and do change. It's also quite likely that Mia's nadir on Lev will be later than what you were seeing with Prozinc. So, getting some curves once the depot is established will be helpful to your having a handle on how her cycle is working.
Click to expand...
I will obviously monitor more frequently when we start the new insulin. Mia has been on ProZinc 9 months, and there is no need for me to grab more than one mid-cycle test in a normal cycle - meaning nothing special about the PS results, not a recent dose change, nothing out-of-the-ordinary going on with her. Her nadir is consistent enough that it makes the most sense for that one mid-cycle test to normally be at +6.
There are not a lot of dosing changes at this point because 1) she is a bouncy cat, and frequent dose changes aggravate that; 2) we are at the dose that works for her - any higher and the danger of going into the hypo range is too great. The reason we are changing insulins is that we cannot safely go to a higher dose and this dose is not bringing the PS numbers down as desired.
 
Last edited:
Welcome to L&L land! I hope Levemir works out for Mia. I guess one of the major differences you'll find is that the "full effect" of the dose you pick won't be visible straight away. This, in my mind, means that if you're comfy monitoring closely, which you seem to be, you could pick the slightly higher of the two starting doses you might be hesitating between, knowing that if it's going to be too high you're going to see it coming in the first cycles. This is only an idea, not to push you there if you're not comfortable with the idea, but if that's what you'd be tempted to do, I could see that as a reasonable choice.

Caveat: idea possibly coloured by my morning spent reading posts on the DE forum, where they seem a little more chill about asymptomatic "low" numbers and higher insulin doses. Contents may have settled while shipping.
 
Hey and welcome from one who was on Prozinc for 6 months before switching to Lantus and oh, so glad we did. Now Lev is a bit different as the nadir is later than with Lantus. The biggest mindset for me to wrap my mind around was that the Lantus and Lev dose is based on the nadir with consideration to the pre shot unlike ProZinc which is based on the Pre shot with some consideration to the nadir. But, the thing that was so wonderful to me was that there is an actual protocol for Lev and Lantus using depot insulin unlike ProZinc with a sliding scale which I NEVER knew what to dose.

There is a lot of info here and peeps to help from all over the world and so much more available than on the ProZinc forum. Keep asking questions as that is how we all learned.
 
Jill & Alex (GA) said:
"Feeding a low carb dry food as a treat is no big deal. What I am talking about is when people think that ANY dry food is a healthy substitute for a water-rich diet of either canned or homemade." - Dr. Lisa

• "you will need to feed the right diet: high-quality low-carb canned food or raw food exclusively" - from the requisite list on http://www.tillydiabetes.net/en_6_protocol2.htm

To clarify a bit further...
Dr. Lisa's comments and the requisites for following the TR Protocol (as described in the protocol & mentioned in the TR sticky) are regarding two different subjects. I can see how this may become overlooked when taken out of context.

That said, I think many of us have ground kibble to sprinkle on kitty's food when they're not eating well/off their food... using kibble as an enticement to eat. In my mind there's a difference between regularly feeding kibble and occasional use.

Just my thoughts...
Click to expand...
I was told my remarks were confusing and was asked to clarify them so they wouldn't be misconstrued...

Dr. Lisa's quote above does not support feeding kibble when we're talking about the TR Protocol followed by many in this forum. Her quote and the TR requisites are separate and have nothing to do with each other. They're addressing different subjects. We can't pull out-of-context statements from here and there to support failing to act in accordance with requisites for what we're doing.

When I said, "In my mind, there's a difference between regularly feeding kibble and occasional use", the operative words are "regularly" and "occasional". If kibble is required at every meal... on every day... than the cat really isn't being fed a "high-quality low-carb canned food or raw food exclusively" as stipulated in the TR Protocol. KWIM?

If a cat's appetite is off due to any number of health issues, using kibble on occasion is ok in my mind because when we're talking cats... getting them to eat when they're not feeling well trumps everything. I think it's also safe to assume most of us usually back off dosing aggressively or at the very least proceed with utmost caution when kitty isn't eating normally.

Hope that clarifies what I said... sorry for causing any confusion.
 
Just to clarify, onset and nadir for Lev are usually later than what you may be used to with Prozinc. There's no way to know how different Mia's cycles will be once you switch. Many cats will have nadirs at +8 but as in most things feline, every cat is different (ECID).

I wasn't suggesting you change Mia's dose on Prozinc. I was merely observing that depending on which approach to dosing you opt to use, doses are generally changed every 3 - 7 days.
 
Status
Not open for further replies.
Back
Top