Samson does not seem to be responding to PZI

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Hi SamsonsMom! I'm sorry I am not around nearly as much as I was before since I started working. I very much agree with what Djamila and Kris said though. Especially those before bed tests. :)

Was there any chance he got into contraband or she gave a higher carb food by accident? I just recently did that myself :oops::facepalm:.
 
Bumping because there is some new info on the spreadsheet - Samson has dropped back into his normal ranges, so wondering if it was a fluke of if he was bouncing and his dose needs to be reduced? Thanks!
 
SamsonsMom said:
Hi all, my cat has been on PZI for nearly two months now but his BG numbers are not looking very good. I started him at 1 unit, increased to 1.5, and finally this past week increased to 2 but he still rarely drops into yellow numbers. In his appearance and behavior, he seems somewhat better: his oily, dandruffy fur is back to normal, and some hair loss that occurred on his hind legs (which is what led me to bring him to the vet and get the diabetes diagnosis in the first place) is growing back in, and he seems more playful and active than he had been pre-insulin. Still, I don't understand why his BG hasn't dropped more. He eats pure protein (either raw meat or limited-ingredient wet cat food, duck flavor) so it's not his diet. Can someone talk a look at his chart and help?? Thanks :D
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I am having the same problem with my cat except she is in 7.5 units of PZI. Now I am reading about "bouncing". Her numbers hover in the high 300s and higher. Don't know what I am doing wrong.
 
Ambermom said:
I am having the same problem with my cat except she is in 7.5 units of PZI. Now I am reading about "bouncing". Her numbers hover in the high 300s and higher. Don't know what I am doing wrong.
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If you can give us a little info we can start offering some advice:
  1. When was your kitty diagnosed?
  2. Do you test her blood glucose regularly at home?
  3. What food do you give her?
  4. How quickly was her insulin dose raised and by how much at a time?
  5. Does she have any other health issues currently?
Please start your own thread here on this forum so more people will see it. Right now it'll get lost in this thread someone else started. :)
 
H
Kris & Teasel said:
If you can give us a little info we can start offering some advice:
  1. When was your kitty diagnosed?
  2. Do you test her blood glucose regularly at home?
  3. What food do you give her?
  4. How quickly was her insulin dose raised and by how much at a time?
  5. Does she have any other health issues currently?
Please start your own thread here on this forum so more people will see it. Right now it'll get lost in this thread someone else started. :)
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Hi-
Amber was diagnosed with diabetes 4 mos. ago and two days later went into heart failure where she was diagnosed with HCM.
She started in 3.5 units of prozinc, but slowly kept increasing the dose which is now up to 7 units with the numbers not going below 300 at the peak. Her normal range is in the 350-395. I test her at home twice a day. She is still losing weight. 13.5lbs down from 17.5lbs.
She is also on 1.25 vetmedin, 12.5 furosemide and 5 mg benazepril.
She is on fancy feast classic wet food and some pro plan wet food.
 
Ambermom said:
H

Hi-
Amber was diagnosed with diabetes 4 mos. ago and two days later went into heart failure where she was diagnosed with HCM.
She started in 3.5 units of prozinc, but slowly kept increasing the dose which is now up to 7 units with the numbers not going below 300 at the peak. Her normal range is in the 350-395. I test her at home twice a day. She is still losing weight. 13.5lbs down from 17.5lbs.
She is also on 1.25 vetmedin, 12.5 furosemide and 5 mg benazepril.
She is on fancy feast classic wet food and some pro plan wet food.
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That's a very high starting dose. The usual is 1 unit twice a day. Cats with other health issues, including HCM, can be more difficult to regulate. It's possible she's a high dose kitty but it's also quite possible that she's been getting to much insulin all along. The only way to know is to do more testing near the middle of the cycle to see how low she goes. When do her twice a day tests happen relative to insulin dosing time?
 
Kris & Teasel said:
That's a very high starting dose. The usual is 1 unit twice a day. Cats with other health issues, including HCM, can be more difficult to regulate. It's possible she's a high dose kitty but it's also quite possible that she's been getting to much insulin all along. The only way to know is to do more testing near the middle of the cycle to see how low she goes. When do her twice a day tests happen relative to insulin dosing time?
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I did a curve on Saturday and her lowest number was 275 at 3:15pm.
I test at 7:30am and pm. Her am level is close to 370-395 and pm is 350/360, but she eats all the time, she is starving and drinking water all the time. She had bloodwork and kidney functions were still very good.
How do I know if I am giving her too much insulin especially since she is still losing weight?
 
Ambermom said:
I did a curve on Saturday and her lowest number was 275 at 3:15pm.
I test at 7:30am and pm. Her am level is close to 370-395 and pm is 350/360, but she eats all the time, she is starving and drinking water all the time. She had bloodwork and kidney functions were still very good.
How do I know if I am giving her too much insulin especially since she is still losing weight?
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The key to assessing a dose is to get BG data from the middle part of a cycle. Here's the testing routine we recommend:

Here's how to approach finding the good dose range:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
If you're testing with food recently on board, the BG will be inflated. If you're not testing in the expected low BG time period you don't know if she's dropping too low or not. BG responses can vary day to day or cycle to cycle (day versus night) so she isn't necessarily dropping to the 200s every cycle. She might be going lower but you have no way to know. Her clinical signs suggest that her BG needs better control. We ask people to track their data over time in this spreadsheet because it's viewable by all members and its the first thing we look at before offering advice.

I suggest you start your own new thread on this forum. You're still lost in Samson's Mom's thread. Then go to the top of the ProZinc forum's thread list and look for the yellow info sticky explaining how best to use ProZinc (PZI). How to decide on a dose and assess it is explained in detail there. The spreadsheet we use here is vital if you want the best feedback from us. We look at the trends to see what a dose is doing. It's very easy to use and there are people here who will set it up for you if needed. :)
 
SamsonsMom said:
Bumping because there is some new info on the spreadsheet - Samson has dropped back into his normal ranges, so wondering if it was a fluke of if he was bouncing and his dose needs to be reduced? Thanks!
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Hmmm...it's really hard to say. That 77 isn't really that low. She could try dropping the dose to 1.5 on Wednesday when she can test. Then if the numbers are higher and flatter through the cycle, go back up to 1.75. It's such a guess at this point, but I'm inclined towards thinking those higher numbers were maybe a fluke - like maybe he was just feeling a little under the weather for a few days or something. But if he is dropping during non-test times, lowering the dose a little could possibly help out. If you decide to have her lower a little, don't leave him down there for long if his nadir stays higher than green.
 
Just saw your response @Djamila - thank you!
After these posts Samson went back into his normal ranges - which, to be fair, are just OK, in the 300s AM/PM and 200s at nadir. Today, though, he was back in the red at AMPS. Is it just par for the course for there to be spikes from time to time or does this indicate a larger problem with his insulin regimen? Thanks! @Kris & Teasel @Yong

ETA: Djamila and Kris, I see you ultimately switched your cats from ProZinc to another insulin - why? I am wondering if I should switch Samson to a different insulin when I'm home for a couple of weeks in January.
 
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SamsonsMom said:
Just saw your response @Djamila - thank you!
After these posts Samson went back into his normal ranges - which, to be fair, are just OK, in the 300s AM/PM and 200s at nadir. Today, though, he was back in the red at AMPS. Is it just par for the course for there to be spikes from time to time or does this indicate a larger problem with his insulin regimen? Thanks! @Kris & Teasel @Yong
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A bouncy cat will spike into red (or black! :eek:) occasionally. Focus more on the nadir values when assessing a dose. You could try 2 u soon to see what happens - the 77 was a few days ago.
 
Kris & Teasel said:
A bouncy cat will spike into red (or black! :eek:) occasionally. Focus more on the nadir values when assessing a dose. You could try 2 u soon to see what happens - the 77 was a few days ago.
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Thanks! Why 2u? I thought we were assessing whether he should be DROPPED in his dose...
 
SamsonsMom said:
Thanks! Why 2u? I thought we were assessing whether he should be DROPPED in his dose...
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I was just scanning down the mid cycle numbers since he's been getting a 1.75 u dose and the dark green numbers are in the minority. You could certainly leave him at 1.75 u for now.
 
Not sure why a drop in dose in on the table at this point in time. Is the thinking that a slightly reduced dose might reduce the gap between PSs and nadir values?
 
When I posted a couple of weeks ago about his really high numbers, members suggested that he might be "bouncing" due to a too-high dose. So I thought that was what we were assessing? Also @Kris & Teasel can you remark on why you switched your cat's insulin and if you're happy with the switch? Strongly considering putting Sam on Lantus.
 
SamsonsMom said:
When I posted a couple of weeks ago about his really high numbers, members suggested that he might be "bouncing" due to a too-high dose. So I thought that was what we were assessing? Also @Kris & Teasel can you remark on why you switched your cat's insulin and if you're happy with the switch? Strongly considering putting Sam on Lantus.
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Your kitty's SS on ProZinc has some similarities to Teasel's when he was on ProZinc - consistently high PSs even if the nadir values were in better territory. In Teasel's case, I viewed it as a dramatic rebound at the end of each cycle. Sometimes he'd stay high and flat for quite a few cycles in a row and that's a bounce effect as well.

I switched Teasel to Lantus in February of this year and persisted with it until this past September. I also switched to a pet meter and that had an effect on the colour distribution on my SS. The Lantus allowed him to go lower without bouncing as high but he did bounce. He would also drop too low and then I had to test/steer with food/retest etc. He was lethargic a fair bit on Lantus and I could tell he didn't feel well even though his numbers were improved. I decided to try him on Levemir to see if he'd flatten out more because many kitties respond that way - very long duration, long stretches of flat numbers, etc. Teasel doesn't act that way at all on Lev. In fact it acts much more like an in and out insulin. It's what I wished ProZinc had done for him. He still bounces but they don't last long and he feels much better on Lev.
 
Kris & Teasel said:
Your kitty's SS on ProZinc has some similarities to Teasel's when he was on ProZinc - consistently high PSs even if the nadir values were in better territory. In Teasel's case, I viewed it as a dramatic rebound at the end of each cycle. Sometimes he'd stay high and flat for quite a few cycles in a row and that's a bounce effect as well.

I switched Teasel to Lantus in February of this year and persisted with it until this past September. I also switched to a pet meter and that had an effect on the colour distribution on my SS. The Lantus allowed him to go lower without bouncing as high but he did bounce. He would also drop too low and then I had to test/steer with food/retest etc. He was lethargic a fair bit on Lantus and I could tell he didn't feel well even though his numbers were improved. I decided to try him on Levemir to see if he'd flatten out more because many kitties respond that way - very long duration, long stretches of flat numbers, etc. Teasel doesn't act that way at all on Lev. In fact it acts much more like an in and out insulin. It's what I wished ProZinc had done for him. He still bounces but they don't last long and he feels much better on Lev.
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Thank you for that explanation! do you think I should switch Samson to Levemir and if so do you have any pointers on doing that?
 
SamsonsMom said:
Thank you for that explanation! do you think I should switch Samson to Levemir and if so do you have any pointers on doing that?
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Samson might do very well on Lantus - many kitties do. There are also more Lantus users than Lev users. You might consider Lantus first. It's very expensive in the US so many people order it from Marks Marine Pharmacy in Canada (based in Vancouver).

You could post on the Lantus forum asking for advice. There are a lot of very experienced people there (huge forum).
 
Thanks @Kris & Teasel ! I did post on that forum. My main questions are these:

I'd like to order the box of 5 pens from that Canadian pharmacy but it takes a long time to ship from Canada - is it not necc. to refrigerate Lantus? do you guys use syringes to draw from the pens and if so can you explain that process? any links to where to buy the U100 syringes? THANK YOU! Also, should I get .3 cc syringes or .5cc? Is 30 gauge OK?
 
SamsonsMom said:
Thanks @Kris & Teasel ! I did post on that forum. My main questions are these:

I'd like to order the box of 5 pens from that Canadian pharmacy but it takes a long time to ship from Canada - is it not necc. to refrigerate Lantus? do you guys use syringes to draw from the pens and if so can you explain that process? any links to where to buy the U100 syringes? THANK YOU! Also, should I get .3 cc syringes or .5cc? Is 30 gauge OK?
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Yes, Lantus should be shipped in a way that keeps the pens cool. In the winter freezing is a danger too. Marks Marine Pharmacy can probably give you more info on that if you call or email them.

Yes, you draw the insulin from the pen cartridge as you would from a vial. When you open up the pen, the rubber end of the cartridge should be exposed. You put the syringe into it as you would into a vial but you don't inject any air into the cartridge first.

A lot of US folks order from www.awdiabetes.com. I'm in Canada and buy syringes from my vet. You want U100 syringes that have half unit marks and are 0.3 mL (cc) capacity. I have 29 gauge syringes but many people like 30-31 gauge. My needles are 1/2" but many prefer 1/4".
 
Hi there! We were considering a possible decrease, but the data you have never caught another low, so at this point I agree with Kris that 2u might be a better way to go. Please have your caregiver increase the dose on a cycle when she can monitor with an extra test or two, or at least keep an eye on him.

When will you be back in the states and with Sam again? Many folks have been happy with the switch to Lantus or Levemir (we've tried both too), but I wonder about trying to switch insulin if you aren't here? It's often recommended to increase monitoring during a switch which might be difficult right now?
 
Good luck with Lantus! Maury is doing much better on it than Prozinc. He was a slightly bouncy boy and look where we are now :cool::D (antijinx). We had a visit to old bouncy territory but that was my fault for being a scardy cat and skipping a dose :facepalm:. I ordered from Marks Marine Pharmacy and I think I got the insulin in less than a week.
Here are the syringes I use for Maury, I used them with Prozinc towards the end with the conversion chart and to help me get used to U-100s. With Lantus there's no conversion though:
https://www.adwdiabetes.com/product/1289/monoject-ultra-comfort-u100-syringes-29g-3-10cc-1-2in-100ct

I draw the insulin from the pens, like mini vials. Here's the video:
 
Thank you @Yong this is invaluable information! Question: once starting to use a pen do you leave it at room temperature, or take it in and out of the fridge? I've read that the former is better.
 
Unfortunately, I made the agonizing decision to put Amber down. Initial Autopsy revealed she had Acromegaly. Now I know that when a cat doesn’t respond to insulin, Acro should be the first thing to look for, but I didn’t know.
Just as an FYI, she never had much pep when she was young, couldn’t play for long periods of time like a normal cat. Became overweight and had an elongated soft palate. These were all signs of potential acromegaly.
She could have been diagnosed much sooner, but who knew??? Hope my experience can help another mom out there whose cat is still treatable.
 
Ambermom said:
Unfortunately, I made the agonizing decision to put Amber down. Initial Autopsy revealed she had Acromegaly. Now I know that when a cat doesn’t respond to insulin, Acro should be the first thing to look for, but I didn’t know.
Just as an FYI, she never had much pep when she was young, couldn’t play for long periods of time like a normal cat. Became overweight and had an elongated soft palate. These were all signs of potential acromegaly.
She could have been diagnosed much sooner, but who knew??? Hope my experience can help another mom out there whose cat is still treatable.
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I'm so sorry you had to make this painful decision. :bighug::rb_icon:cat_wings>o
 
I’m so sorry to hear that it was Ambers time! I know what a difficult decision it is. Fly free sweet Amber! Land softly. :bighug:
 
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