Started Prozinc August 1 after 6 years with Lantus

D

DianefromDallaa

Member
Bella is a 17 yr old, diabetic with CKD, Dental disease, Pancreatitis and now a potential heart issue (echo scheduled on 9/2). For the past 18-24 months, it has been impossible to regulate her on Lantus. No matter what we did, she would drop fast from the 500s into the 100's and back up again all within 5 or so hours. I worked with FDSG to introduce using Novilin R and even with that, we could not regulate her. Her dental disease may have played a part. Additionally, she was diagnosed with pancreatitis in March - but we thought it had passed because she was eating well and not vomiting (without meds).
But on 8/16, things took a turn. Bella was very ill and not eating. I took her to ER where she was put on fluids, pain meds and she started to eat. Great! After 24 hours she came home.. But on 8/19 she took a bad turn. This time, her ketones were at 4. She never had ketones before so this was a shock. She went back to the hospital for 2 days. There there did an ultrasound and luckily this was all pancreatitis according to the report. There was some fluid noted around the pancreas due to the inflammation.

In the last 12 hours of hospitalization, they were unable to handle her and her glucose was over 700 and not coming down. Luckily she was still eating. They told me to come and get her and be prepared to EU if I couldn't get her glucose controlled.

The first 24 hours home were awful. Her ketones jumped to 6.5! But by some miracle I got those down and am starting to see some normal glucose patterns!!! My vet and I closely monitor her through a Freestyle libre. It is not accurate but provides good directional data.
Initially, Bella would only last 6 hours under 400 (500+ according to a handheld). My vet would direct me to use Novilin R when she was very high at the end of a cycle to attempt to keep her numbers from skyrocketing. This has worked! I was using R almost 2x/day - but haven't had to use any in 3 days! I am not only seeing very high numbers for approximately 4 hours each day (beginning/end of each cycle.

ISSUS - I continue to see sharp drops and increases - 250 to 300 point swings at the beginning/end of a cycle that happen over a 2 hour period. Is this normal? How can I "flatten" her curve more? If I increase the dose, she crashes - and the swing from high to low is just greater. I would love to get to a point where she is in the 150-250 range for 6 hours. Is that possible?

NEW ISSUE - just a few weeks ago, we noticed Bella was having some issues so I started monitoring her blood pressure. It was HIGH (over 200). Her heart rate was consistantly in the 170-185 range. She was on 62.5 mg of amlodipine. 1x/day.
When she came home from the second ER visit, her heart rate is always above 200 and we are having a tougher time getting her BP under 150. I spoke with my vet who initially thought it was the stress of the hospital visit - but it didn't come down. I persisted and showed a chart with all the measures from the BP machine. Finally a few days ago, we did bloodwork and an xray. She was slightly anemic (perhaps due to all the ER fluids). We did a small dose of Aranesp (we did this in early July when we saw her HCT drop slightly). At first I thought that could explain the higher heart rate. Additionally, she had been put on a higher dose of bupernex during the ER visit - so although unlikely the culprit it was possible. But the xray showed an enlarged heart as compared to an xray taken in early June. I am gutted. We have not had any signs - no murmur no coughing, nothing. Bu Bella does get 125-150 ml of fluids daily for her CKD. This has never caused an issue. In the ER she was put on a maintenance does of IV fluids (I think the rate was "16"). {Perhaps that was just too much. I don't know what to make of this but I am so upset and stressed thinking the ER visit caused a heart issue. It's been 8 days since I noticed the increase - and I don't see any change. It coincides with the higher BP too.

What is causing what? Is the anemia causing the enlarged heart which in turn is causing the BP and heart rate to go up? Does she suddenly have cardiomyopathy which is causing all of this? Now that we are seeing diabetes improvements, it's like getting kicked in the gut.

We have an ultrasound scheduled on Tuesday. I was hoping to get it done by a cardiologist but we are using a traveling ultrasound person who my vet knows (he's a retired IM with TONS of experience.)

Any ideas or thoughts on all of this?

Here is Bella's meds, etc

Prozinc - 1.25 units 2x/day (currently no Novilin R - but the dose was .25-.5units as needed)
Bupernex .2ml 3x/day
Zofran - 1/2 pill 3x/day
Amlodipine - 62.5 mg now 2x/day
(I stopped cerenia and Elura as both seemed to make her sicker and she's not needed them)
Normisol fluids - now 75ML/day

I stopped Porous One and Catney One when the pancreatitis popped up on the 15th because I was trying to ensure she would eat. The IM said her 4.6-5.2bloodwork value suggested it may be too early for a phos binder.
 
Hey @DianefromDallaa. Happy to see posted. Since you're new, it may get more eyes if you post in the Health Forum which has a lot more activity so your post should get more comments. You can just copy/paste what you've said here.

Also, the spreadsheet link you have in your signature here belongs to another group, the FDSG. You do have a spreadsheet that is the correct one for this board, but neither of them have had any testing data since June 1. People here will need to see updated numbers before they'll be able to give you much in the way of advice. Here's the link to the correct spreadsheet for this board. Bella's Spreadsheet (003) as of 072325.xlsx

I'm not familiar enough with Prozinc (especially with the occasional use of R) so I can't really help but I did want you to know that you had posted (since you said you couldn't find your post on the board in the Feline Diabetes group)
 
Hi there. You are dealing with so much with your baby. My heart goes out to you. I can't help with dosing because there's no current spreadsheet data (last I can see if several months ago.) Can you add more current BG tests.
 
DianefromDallaa said:
SSUS - I continue to see sharp drops and increases - 250 to 300 point swings at the beginning/end of a cycle that happen over a 2 hour period. Is this normal? How can I "flatten" her curve more? If I increase the dose, she crashes - and the swing from high to low is just greater. I would love to get to a point where she is in the 150-250 range for 6 hours. Is that possible?
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DianefromDallaa said:
Bu Bella does get 125-150 ml of fluids daily for her CKD.
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What is she eating (low carb wet food?) Still eating the Fancy Feast? Is she getting snacks of wet food at +2, +4, etc. feeding her food at regular intervals during the early portion of the cycle before her nadir (if you don't know when that is now, just stopping food somewhere around +6)? This is important to help prevent steep drops in BG and the bouncing that can occur due to those steep drops. When exactly and how much is she eating (not in exact amount like grams or ounces... but how many teaspoons or tablespoons -- if you know how many ounces that's okay, too.)

How much does she weigh? If her heart is compromised, that may be too much fluid for her and can cause pleural effusion. I've had it happen in my own cats when they had undiagnosed heart disease. You will know more after the ultrasound on Tuesday. In the meantime, monitor her breathing rate by counting her breaths per minute. When she is sleeping (not purring) count each rise and fall of her chest as one breath. Count for 15 seconds and multiply by four. You really don't want those BPM over 30 maximum.

So she is anemic, I am not surprised with everything she has going on. Anemia is common in CKD kitties. It is also not uncommon in older cats and cats with chronic disease/conditions.

There's so much here that you have going on and I have only touched on a few things. I am going to request that this thread be moved over to the Feline Health Forum. I would like to see what's been going on with her numbers since you started the ProZinc.

@Sienne and Gabby (GA) are you around? Can you move this thread over to Health?
 
Suzanne & Darcy said:
What is she eating (low carb wet food?) Still eating the Fancy Feast? Is she getting snacks of wet food at +2, +4, etc. feeding her food at regular intervals during the early portion of the cycle before her nadir (if you don't know when that is now, just stopping food somewhere around +6)? This is important to help prevent steep drops in BG and the bouncing that can occur due to those steep drops. When exactly and how much is she eating (not in exact amount like grams or ounces... but how many teaspoons or tablespoons -- if you know how many ounces that's okay, too.)

How much does she weigh? If her heart is compromised, that may be too much fluid for her and can cause pleural effusion. I've had it happen in my own cats when they had undiagnosed heart disease. You will know more after the ultrasound on Tuesday. In the meantime, monitor her breathing rate by counting her breaths per minute. When she is sleeping (not purring) count each rise and fall of her chest as one breath. Count for 15 seconds and multiply by four. You really don't want those BPM over 30 maximum.

So she is anemic, I am not surprised with everything she has going on. Anemia is common in CKD kitties. It is also not uncommon in older cats and cats with chronic disease/conditions.

There's so much here that you have going on and I have only touched on a few things. I am going to request that this thread be moved over to the Feline Health Forum. I would like to see what's been going on with her numbers since you started the ProZinc.

@Sienne and Gabby (GA) are you around? Can you move this thread over to Health?
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I’m going to try and figure out how to post a spreadsheet. Some use Dropbox, some use google spreadsheets and there’s another few alternatives. My head spins.

I realized after I did the spreadsheets thst I don’t have good AM/PM shot data. I would rely on the Libre which was always showing high numbers and was ALWAYS less than the handheld. ALWAYS.

You asked about food and glad you did. I used to free feed because she grazed. For years it was fine. She started losing muscle and weight so I would entice her throughout the day with fresh Fancy feast pate. She had been on kidney food for years and I was told by someone to get her off because she was in stage 2. When I took her off kidney food. She flourished and gained 2 pounds at the time she was about 7 1/2 pounds and so she went up to 9 1/2 which was wonderful, but then I ran into all these issues with diabetes and her glucose and she is settled around 8 lbs. 4 oz. she now only eats fancy feast pate which is not the best but at least she’s eating. She’s maintained her weight when she was in ICU last week. They told me to only feed her four times a day that just doesn’t seem right to me, especially in the middle of the night when she eats most of her food. So I’ve been trying to feed her at +4 and +8, but I think your suggestion of +2 and +4 is right on point. It will slow her drop, but how do I slow the rise?

As for her heart, this came out of left field. She’s never had open mouth breathing and her resting breath. Per minute have always been the same although they are not 30 and run more like 36. Her blood pressure has been high even though she’s on amlodipine . We just increased her dose to 1.25 mg twice a day when your cats were diagnosed with plueral effusion what happened? i’m really scared that something is going on with her heart because her heart rate was in the 170s and 180s before her ICU visit and in the 200s when she came home to me that feels like fluid overload affected her heart, but my vet felt it wouldn’t at the rate they were doing IV.

I’ve cut back on fluids at home to 75 or 100 ML a day. She stage 4 CKD so we need to do fluids. It’s interesting because lately I’ve noticed she doesn’t need as many fluids and isn’t drinking as much because I seem to have found the sweet spot for her diabetes. We’re getting better at that each day. It’s gonna be really hard to tell when you look at the spreadsheet. I know this group doesn’t like to use the libre data but that’s actually better to look at. I’ll try to get that updated and I’ll try to include all of her labs

But please tell me what happened when your cats had the plural effusion.
 
Chris & China (GA) said:
Hey @DianefromDallaa. Happy to see posted. Since you're new, it may get more eyes if you post in the Health Forum which has a lot more activity so your post should get more comments. You can just copy/paste what you've said here.

Also, the spreadsheet link you have in your signature here belongs to another group, the FDSG. You do have a spreadsheet that is the correct one for this board, but neither of them have had any testing data since June 1. People here will need to see updated numbers before they'll be able to give you much in the way of advice. Here's the link to the correct spreadsheet for this board. Bella's Spreadsheet (003) as of 072325.xlsx

I'm not familiar enough with Prozinc (especially with the occasional use of R) so I can't really help but I did want you to know that you had posted (since you said you couldn't find your post on the board in the Feline Diabetes group)
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Where can I find instructions on posting spreadsheets and correcting my byline?? The amount of stuff here is soooo much.
 
Please try not to stress out too much. Don’t feel pressure about starting the spreadsheet. We can help you with that, by the way. We have lovely people here who can get your spreadsheet set up for you in a few minutes.
 
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For your signature, just click/touch on your avatar at the top of your screen and you should see Signature as an option to select and you can make changes from there.
 
The main signs of pleural effusion in my cats have been an increase in their breathing rate as well as increased respiratory effort (sides of chest moving more than normal). Then you also may see open mouth breathing, which is, of course, an emergency. This can happen in a short period of time or symptoms can gradually worsen over several days.
 
Suzanne & Darcy said:
Please try not to stress out too much. Don’t feel pressure about starting the spreadsheet. We can help you with that, by the way. We have lovely people here who can get your spreadsheet set up for you in a few minutes.
@Marje and Gracie
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I just posted what I have. I really rely on the Libre and only spot check with handheld. I know everyone is nice. I just wanted to be honest because I don't know how much logging I can do. I have a huge spreadsheet for giving Bella meds, testing blood pressure and really following up since my vet has no time (one man shop). I hope you understand.

There is a lot going on with Bella...I don't know how much more she can handle...
 
DianefromDallaa said:
I just posted what I have. I really rely on the Libre and only spot check with handheld. I know everyone is nice. I just wanted to be honest because I don't know how much logging I can do. I have a huge spreadsheet for giving Bella meds, testing blood pressure and really following up since my vet has no time (one man shop). I hope you understand.

There is a lot going on with Bella...I don't know how much more she can handle...
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We do have people who must rely primarily on the Libre for data. It’s helpful for trends. The thing that I like to see is that you can check the low numbers with a handheld meter because the Libre sensor generally gives much lower numbers (alarmingly low) when kitty is in the green (50-99) numbers.
 
Suzanne & Darcy said:
The main signs of pleural effusion in my cats have been an increase in their breathing rate as well as increased respiratory effort (sides of chest moving more than normal). Then you also may see open mouth breathing, which is, of course, an emergency. This can happen in a short period of time or symptoms can gradually worsen over several days.
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She showed signs of that last year and we've done xrays. We've done 2 ultrasounds and I need to look back to see if we looked at the heart. For the past year, I've not seen anything. In fact, I insisted on xrays in June after IVs for 2 days and they looked good. I ONLY asked for new xrays due to higher heart rate. She was just in ICU ER - I would have thought they would have seen something. We talked about doing an echo but the doctor thought it wasn't needed.
 
Suzanne & Darcy said:
We do have people who must rely primarily on the Libre for data. It’s helpful for trends. The thing that I like to see is that you can check the low numbers with a handheld meter because the Libre sensor generally gives much lower numbers (alarmingly low) when kitty is in the green (50-99) numbers.
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I always check the lows before taking action. Today we had hypo. I was surprised because the handlheld was only 20 points higher than the libre! It's usually much more than that.
 
DianefromDallaa said:
She showed signs of that last year and we've done xrays. We've done 2 ultrasounds and I need to look back to see if we looked at the heart. For the past year, I've not seen anything. In fact, I insisted on xrays in June after IVs for 2 days and they looked good. I ONLY asked for new xrays due to higher heart rate. She was just in ICU ER - I would have thought they would have seen something. We talked about doing an echo but the doctor thought it wasn't needed.
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I will say that I am very impressed by how thoughtful and vigilant you have been with her care. I can tell how much she means to you. ❤️
 
DianefromDallaa said:
They told me to only feed her four times a day that just doesn’t seem right to me, especially in the middle of the night when she eats most of her food. So I’ve been trying to feed her at +4 and +8, but I think your suggestion of +2 and +4 is right on point. It will slow her drop, but how do I slow the rise?
Click to expand...
Back to the feeding— here is the reasoning behind the feeding I recommend: ProZinc usually onsets (starts to lower BG) at about +2. So that is a good time to feed a couple of spoonsful of food, and again at +4 and possibly +6. This really helps smooth the cycle and prevent steep drops. As you start to feed like this, you can tailor the feeding schedule based on her numbers- in case it needs tweaking. As for trying to keep the BG from rising too much toward the end of the cycle — mainly try not to feed much after nadir. Some cats take time to get better duration of the insulin.
 
If you can't see a cardiologist, can you see an internal medicine vet? Neko had stage 3 CKD and I was giving fluids. Out of nowhere, she lost her appetite. She lived for food! I got into the IM vet but they also had a cardiologist on staff. She was diagnosed first with small cell lymphoma, then her heart condition the following day. She had HCM (hypertrophic cardiomyopathy) diagnosed over a year previously, but it hadn't changed much over time and she was on no medications for it, just being monitored. As the IM vet and cardio vet said "heart rules over CKD". We stopped giving fluids and treated the heart condition, she was in heart failure. She did get over that. Several months later the IM vet thought I could try a really small dose of fluids, 50 ml every other day. Neko's heart still said that was too much. I counted RR (resting respiratory rate) and anything over 26 for Neko meant a trip to the vet.

Regular ultrasounds don't generally look at the heart. You do want a heart specialist to do an echocardiogram.
 
Suzanne & Darcy said:
Back to the feeding— here is the reasoning behind the feeding I recommend: ProZinc usually onsets (starts to lower BG) at about +2. So that is a good time to feed a couple of spoonsful of food, and again at +4 and possibly +6. This really helps smooth the cycle and prevent steep drops. As you start to feed like this, you can tailor the feeding schedule based on her numbers- in case it needs tweaking. As for trying to keep the BG from rising too much toward the end of the cycle — mainly try not to feed much after nadir. Some cats take time to get better duration of the insulin.
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Such great advice. Thank you.

I did notice the +2. That’s why we use R if she’s already very high at +8 as sh has a long way to go for relief.
 
Wendy&Neko said:
If you can't see a cardiologist, can you see an internal medicine vet? Neko had stage 3 CKD and I was giving fluids. Out of nowhere, she lost her appetite. She lived for food! I got into the IM vet but they also had a cardiologist on staff. She was diagnosed first with small cell lymphoma, then her heart condition the following day. She had HCM (hypertrophic cardiomyopathy) diagnosed over a year previously, but it hadn't changed much over time and she was on no medications for it, just being monitored. As the IM vet and cardio vet said "heart rules over CKD". We stopped giving fluids and treated the heart condition, she was in heart failure. She did get over that. Several months later the IM vet thought I could try a really small dose of fluids, 50 ml every other day. Neko's heart still said that was too much. I counted RR (resting respiratory rate) and anything over 26 for Neko meant a trip to the vet.

Regular ultrasounds don't generally look at the heart. You do want a heart specialist to do an echocardiogram.
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I am so sorry. This is scary stuff. Did Nemo have a high heart rate too or just fast breathing? Heart murmur? High blood pressure?

I’m frustrated because I always asked about the heart because I’m doing a high volume of fluids daily per my vet. Now she’s suddenly saying “I’m not a heart doctor”. I had to chase her all week to call a cardiologist. In all of Dallas/Ft Worth, there are only 3! They are booked out 3 weeks. They are all off on Fridays. My vet finally got around to call…on Friday.
There is a retired IM guy who travels to do ultrasounds. He’s an old school guy but knows his stuff. He was available Tuesday. I grabbed the slot. Yes I wanted a cardiologist but this was the best we could do.
I’m frustrated that the IVU doctor didn’t see anything and in fact discouraged a look at the heart after looking Bella over. But at that time, her heart rate was still good. When she was on her last night the vet said her blood pressure was really high so they doubled the meds. First mention of any heart issue.

Bella doesn’t move around much because she’s on bupernex for pancreatitis (and dental disease). The crazy thing is we had a dental scheduled this week and I now think she would not have made it with pancreatitis brewing and possible heart issue.

Crazy.

I monitor her breathing a lot. It’s always in the 30s. Has been for 2 years.
I started monitoring blood pressure because my country vet wasn’t.
That’s when I started noticing the increase. Poor girl may have been suffering awhile.

What meds was Nemo put on and how long has it been?
 
DianefromDallaa said:
I am so sorry. This is scary stuff. Did Nemo have a high heart rate too or just fast breathing? Heart murmur? High blood pressure?

I’m frustrated because I always asked about the heart because I’m doing a high volume of fluids daily per my vet. Now she’s suddenly saying “I’m not a heart doctor”. I had to chase her all week to call a cardiologist. In all of Dallas/Ft Worth, there are only 3! They are booked out 3 weeks. They are all off on Fridays. My vet finally got around to call…on Friday.
There is a retired IM guy who travels to do ultrasounds. He’s an old school guy but knows his stuff. He was available Tuesday. I grabbed the slot. Yes I wanted a cardiologist but this was the best we could do.
I’m frustrated that the IVU doctor didn’t see anything and in fact discouraged a look at the heart after looking Bella over. But at that time, her heart rate was still good. When she was on her last night the vet said her blood pressure was really high so they doubled the meds. First mention of any heart issue.

Bella doesn’t move around much because she’s on bupernex for pancreatitis (and dental disease). The crazy thing is we had a dental scheduled this week and I now think she would not have made it with pancreatitis brewing and possible heart issue.

Crazy.

I monitor her breathing a lot. It’s always in the 30s. Has been for 2 years.
I started monitoring blood pressure because my country vet wasn’t.
That’s when I started noticing the increase. Poor girl may have been suffering awhile.

What meds was Nemo put on and how long has it been?
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Neko. Spell check kept changing it.
 
Suzanne & Darcy said:
Regarding the spreadsheet, you need to change the permissions to “anyone with link” can view spreadsheet.
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The aces said anyone with link.
Can you see if you can open this?

I may try to post the Libre graphs as thst may be easier.

Today she dropped to 70. That may not sound low but she acts hypo at 90. I think her body is so used to being high. Even the IM doctor said she may be good at just staying 250-350!

Bella's Spreadsheet (003) as of 082925.xlsx
 
Suzanne & Darcy said:
make sure all the fluid seems to be absorbed and the “fluid bump” is gone before giving additional fluids.
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Her skin is so loose and just hangs. Sometimes it’s hard to tell.

Thinking back I used to tell my vet thst Bella seemed sluggish after fluids. I’m kicking myself for not pushing harder on this.

We changed from LRS to sodium chloride and she perked up. But her electrolytes got out of whack. IM said to use Normisol. Another IM said it’s too high in alkaline. My heads spins.
I have all 3 at home.

Please forgive the spelling. I’m working on my phone.
 
I can open your spreadsheet link now, thank you.
DianefromDallaa said:
Did Neko have a high heart rate too or just fast breathing? Heart murmur? High blood pressure?
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She had bradycardia, so slow heart rate. Heart murmur is why we first started investigating her heart. But the first echo showed it was caused by just age related change to her heart, nothing to be concerned about as long as the murmur stayed at the same level and location. Her BP was fine, once we tested it that wasn't stressful. Think barking dogs banging against her kennel kind of stress.
 
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