? Still trying to get regulated...

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KenP

KenP

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Have been on Prozinc now for 2 weeks, after transitioning from Vetsulin for 2 weeks prior to that. Results are mixed. Started w/1u and have gradually increased by 0.5u after several days. Finally got one AMPS in the normal range at 2u and several in the 300s but then lost it. Went up to 2.5u and now we're hovering in the 400s and higher again. Wondering if ever the BG gets worse when incrementally increasing the insulin...which is counter to reason...unless it's the Somogyi "bounce" effect going on. Am considering going up again to 3u after several more days if we don't see progress (i.e, getting down in the 100s) but don't want to go up too high. What is your experience about what initial insulin dose or range tends to get a handle on the BG level and starts to normalize it? My vet stated her experience was usually somewhere in the 2-4u range. One noticeable positive side effect is that at 2.5u, her appetite seems to have increased. Feel free to look at her numbers and give your 2 cents. Appreciate it! :)
 
VERY IMPORTANT NOTE: Dose adjustments should be based on the nadir, the lowest glucose post-shot. The appetite may have increased because you are giving too much insulin. Please get some tests in the +5 to +7 hour range post-shot, when the likely nadir is expected, so we can see if he is going too low.

Here are our ProZinc guidelines, just in case you've not had a chance to read them over yet.

Also, please read and print out this instructions on How to Handle A Hypo. It is better to be prepared and not need it, than to have an emergency and not know what to do or not have the tools to manage it.

What are you currently feeding and how much? Maybe add that to your signature.
 
I agree with BJ. Only having the preshot numbers give you only part of the picture. How low does the insulin take him 5-7 hours after the shot? If he drops low, then he could be bouncing back up for the preshot. (If his body perceives a level lower than expected, it releases extra glucose, causing the next numbers to be higher than "normal". ). If he doesn't drop, but is high and flat the whole cycle, then an increase is needed.

Can you get some midcycle numbers? Some people get curves (levels every 2-3 hours) on the weekend. Some set an alarm at night and get up and get a number then.
 
Thanks for that, BJM. Added food to signature (only 7.5% carbs in Waggers, no grains or starches). Not really sure what you mean by the adjustments are based on the nadir. The guidelines seem to say just to check that the nadir is not too low before considering upping the dose (either 40-50 or less than 50% of the BG at injection). Also, what does "high and flat" mean? Also, what "sliding scale" is referenced and where is it located? Also, can you say more about what is "too low to shoot?" I've heard 200 and 150 both. Some proceed w/regular insulin dose unless under 100, especially if giving food directly after. Wish that more of the terms and technical references in here were defined. Thanks, again for your help. Will try to get some nadir readings. Btw, Ginger is a she. ;)
 
BJM said:
nadir, the lowest glucose post-shot
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Too low to shoot: starting out, when you haven't a lot of mid-cycle (aka between shot) data, we suggest you not shoot below 200 mg/dL on a human meter or roughly 230 mg/dL on a pet meter, until you know how low the dose of insulin will drop the glucose. As you collect data to show it is safe (does not go below 68 mg/dL on a pet meter or 50 mg/dL on a human meter), you may gradually lower that no shot level.

A sliding scale may be developed as you identify how much a dose of insulin may drop the glucose. You then start adjusting the dose based on recent data from mid-cycle tests and the current pre-shot. It is different for each cat, so it has to be developed from your cat's own pre-shot and mid-cycle data. This is possible for non-depot insulins (so NOT for Lantus, nor Levemir).

There is a glossary (under Tech Support and FAQ).
 
KenP said:
Thanks for that, BJM. Added food to signature (only 7.5% carbs in Waggers, no grains or starches). Not really sure what you mean by the adjustments are based on the nadir. The guidelines seem to say just to check that the nadir is not too low before considering upping the dose (either 40-50 or less than 50% of the BG at injection). Also, what does "high and flat" mean? Also, what "sliding scale" is referenced and where is it located? Also, can you say more about what is "too low to shoot?" I've heard 200 and 150 both. Some proceed w/regular insulin dose unless under 100, especially if giving food directly after. Wish that more of the terms and technical references in here were defined. Thanks, again for your help. Will try to get some nadir readings. Btw, Ginger is a she. ;)
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ProZinc is unlike the depot insulins where only the nadir is considered when adjusting the dose. But we do need the nadir number to see how the dose is working. If she is dropping low midcycle and bouncing back up for the preshot, we wouldn't want to increase a dose that is causing a big drop at nadir - that would only make the nadir lower and the bounce higher.

I define high and flat as a cycle that doesn't drop much but is in the 200-300 range with little variation. Sliding scales are based on each individual's cat's numbers. After at least a few weeks, data from past cycles is considered - what percentage did she drop on this level with this amount of insulin? Is that fairly consistent? So could we suggest that a dose of X on a level in the Z range would be a reasonable dose and cause a nice drop for nadir?

200 is the standard for beginning diabetics who have little data to guide them. Once you have more data and know how she might react, that number could be lowered to the 150-180 range. Depot insulin users shoot lower preshots - they base their dose on the nadir not the preshot because their insulin tends to have longer, flatter cycles.
 
Lantus and Levemir are depot insulins. I am not a speaker for those insulins, but in very general terms, it means that the insulin has to build up a "depot" in the body before it is used efficiently in the body. If a dose is skipped for example, that can deplete the depot and levels can be wonky for a while. The cycles are longer and flatter because of the depot effect. You can look at the topics on the top of the Lantus forum and get more detailed info.

ProZinc is considered an in and out insulin. There tends to be little if any carryover from dose to dose. Doses can be switched more often with ProZinc (thus the sliding scale that can be used with ProZinc and can't be used successfully with the depot insulins). ProZinc is also more flexible so dosing can be done in different time frames than every 12 hours. All of these alternative methods are used once the cat is well established on the insulin and enough data has been collected to make some conclusions about how it might work best with that cat's body.

There are advantages and disadvantages to both types of insulin. We are big here on "the best insulin is the one that works best for your cat"
 
Thanks for that explanation. We did a nadir reading today that was in the three hundreds so I'm not sure how much bounce she is getting if any. How many days do I need to test the nadir before I decide whether to go up or down with a dose?
 
That's a big drop but still in a higher range. Wonder if she was lower earlier or later? The nadir isn't a fixed point that applies to every cat, but usually somewhere between 5-7 hours after the shot.

It would be best if you could get more data, but it is hard to argue with numbers that high. Do you have time this weekend to do a curve - getting a number every 2-3 hours all day. If so, that'd be a good time to raise the dose. That'd be good information for you to have. Maybe then up it to 3 units?
 
Take a look at my signature link Secondary Monitoring Tools for some additional assessments which may be helpful in evaluating your cat. Given the high numbers you've been seeing, testing for urine ketones and smelling his breath to observe its qualities would be good idea.
 
We're going to give 3u a try for the next few days. Her appetite has been going up quite a bit, which is good, b/c she was barely eating. She appears to be more energetic and active and gaining her weight back. That might also explain the higher BG levels.
 
So 3 units was not effective, so we went up to 3.5. After a few days, we got a normal morning reading (today), 91. I'm wondering what is the protocol when the cat finally starts to get normal readings? My wife (a nurse) wants to give her only 1u, b/c she's worried about hypo, but I don't believe that is correct. I believe that she needed the 3.5u to have a normal reading, so drastically reducing is not what she needs. She also is not showing signs of hypo but the reverse. She is more active with a more normal appetite. She's even started to make small jumps again, so the back legs are strengthening. If anything, I feel should continue the same units for a few more days or go down by 0.5u back to 3u. I also notice that when I feed her evening meal later in the evening or I give her extra food (3rd meal) later int he evening, her BG in the morning is higher. Yesterday, I fed her 2 normal meals, not late in the evening. I will continue to do that for more accurate and consistent readings. Please check her numbers and advise. Thanks for your help!! :)
 
That number is a normal number OFF INSULIN. that is not a shootable number for a cat on insulin. Usually a cat doesn't get a shot under 150/180 at the lowest and only if you will be around to monitor.

The 91 is an indication she is getting too much insulin as it is not a shootable preshot. Let me look at your ss.
 
We still don't know how low she is going midcycle. As we have said, it is quite possible that she is dropping low midcycle and bouncing back up for the next preshot. So shooting too much insulin in those bounce related preshots can be driving her further lower until today the insulin is still working at +12. I am worried how low she might have gone overnight midcycle.

I can't urge you strong enough to get some tests 5-7 hours after the shot so you can really see how the insulin is working and how low the dose is taking her. Then you can safely adjust the dose, which clearly needs to be done - downward.
 
If you look at her chart, we did do a nadir reading a few days ago, which did not go below 300.
 
That was with a lower dose and one number. She could have been lower before or after that test. Some cats nadir at +4, some at +8. It may be that 2.5 is too low and 3 is good and 3.5 is too much. Or it could be that there are some midcycle numbers in there that help us figure out this puzzle differently.

But clearly 3.5 was too high for the last cycle. I hope you will skip today unless she jumps up above 200 in the early part of the cycle. Then maybe one unit IF you can monitor. That will throw your schedule off as you would need to dose 12 hours after that shot. Tonight, if you skip, she is likely to be high as she will have been 24 hours without a shot. But I would still reduce the dose as you don't want to shoot a dose that gave you an unshootable preshot.

Ken, I am sure this is frustrating for you. But the best way to treat this disease and treat it safely is to collect data, use past levels and doses to predict future dosing. If you can't get numbers during the day, then get a before bed test, wake up once overnight and get a test, get an out the door test during the week and get a complete curve on the weekend. The good news for you is that the insulin does work - this morning proves the dose worked too well - and all you need to do is figure how best to work with it.
 
I appreciate your help, Sue. I would say perplexing would be a better term than frustrating. I just want to get it right. I don't want to stick my cat's ear 10x/day. There are competing views on how to do this. Some say (like you), 200 is the lowest shoot point. Some say 150. I have looked at many charts on here where after BG is under 150 or 100, they just go down 0.5u of insulin, say from 2u to 1.5u or 3u to 2.5u, not skip a dose or go down to 1u.

There are 2 different approaches in general that I have discovered for doing this...1 being a sliding scale and 1 being a steady and slow increase over 3-7 days per level...more like a slow wave. You seem to be advocating more of a sliding scale. I have not been using that method but the other one. I started out w/1u and slowly increased the dose to a level that brought a "normal" reading, but of course only this 1 time. We've only 1 other time had a reading under 150. Of course, I don't want to bring her to hypoglycemia, but on the other hand, if I didn't give her 3.5u for her last shot, where would she have been this morning...300? 400? 500? So, clearly she needed that much to go to "normal." That's why I don't believe that dropping to zero or 1u is right. Yes, I'm quite confused now!

This is also directly from your protocol: "Low Preshot Numbers--The general recommendation for new diabetics is not to shoot a preshot under 200, but to wait 20 minutes (without feeding as food raises blood glucose levels) and retest. If the number is rising and above 200, then a shot can be given with perhaps a little less insulin given." So, this seems to contradict the advice you just gave me not to shoot at all today??
 
"But I would still reduce the dose as you don't want to shoot a dose that gave you an unshootable preshot." I don't know if I can agree with this statement, Sue. If you continue to follow this logic, you would conceivably never get her off of insulin, b/c you would continually give too little insulin that would consistently keep her slightly hyperglycemic. There is at least another popular vet on the net who advocates bringing the cat consistently under 150, even under 100 (but above 80), to actually keep the cat in the normal range, so her body learns to do that by itself. I can't see how a cat could get to that range, 80-150, if you are consistently targeting the 150/180+ range. This vet, Dr. Elizabeth Hodgkins, does advocate a no-dose under 150, b/c she does use a sliding scale. So, in that respect, she agrees w/you. I guess it boils down to my disagreeing that 91 means that too much insulin was given. I would agree that 60 means that but not 91.
 
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This is what I wrote in the previous post:

I hope you will skip today unless she jumps up above 200 in the early part of the cycle. Then maybe one unit IF you can monitor. That will throw your schedule off as you would need to dose 12 hours after that shot. Tonight, if you skip, she is likely to be high as she will have been 24 hours without a shot. But I would still reduce the dose as you don't want to shoot a dose that gave you an unshootable preshot.

I helped write the protocol. I think my advice is pretty consistent but maybe I wasn't clear.

Yes, you can use either a sliding scale or stay with a dose over time. But, if you are staying with a dose and get a preshot under 200, you have to adjust downward. And again, 90 is normal for a cat who is not on insulin. We generally consider a cat regulated if they range from mid 200s at preshot to double digits at nadir - but not below 50 (on a human meter) or 68 on a pet meter which is approaching hypo territory.

The only time ProZinc users dose under 150-180 is when the cat is when they have lots of data, and the cat is clearly moving into remission and they are usually dosing 0.1 or 0.2 units and monitoring carefully. Depot insulin users do dose at lower preshots but as I think we have discussed before, the insulins are dosed very differently and the protocols are not interchangeable. If you are using the info on YDC, the vet is no longer associated with that site. One of the many things that I would disagree with on that protocol is that a cat never hypos if they are on low carb food. That has been proven wrong here, time after time, on this forum.

We can certainly agree to disagree and you can adopt any protocol you like. But we have cats going into remission often on this site - check the spreadsheets of the people posting here today. I am a firm believer in doing it safely.

If you had given 3.5 units this morning on a 91, it is very likely that Ginger would have dropped down to very low levels quickly. If 3.5 units on 476 dropped her 385 points, what would that same dose have done on a number like 91?
 
Okay Ken, I just read through the thread. I am with Sue, you can't shoot 3 units at a PS that is 91. You would send Ginger into a hypo event that could be very serious. She hasn't been on insulin very long and I see that you started at 6 units. Holy cow that is a lot of insulin and most cats are started off at 1 - 1/5 units twice a day. Then it looks like you lowered it to 4 units and then back up to 6.5. With out any test through the cycle to find out where her nadir is, your dosing isn't going to be effective. You could be seeing a bounce number as the pre shot number from a much lower dose through the cycle that you did not catch. When cats bounce, it can take up to 3 days to clear the bounce and if you keep adjusting up the dose, you could very well go past the right dose for her at the given time and causing her numbers to elevate at preshot and it just becomes a vicious cycle.

My suggestion would be like Sue's please get more test in so we can help you regulate your cat. This sugar dance is a marathon not a sprint and she has had diabetes for a lot longer than she has had symptoms and she isn't going to be regulated overnight.

Sue has been doing this for a very long time and she knows her Prozinc. Please let her help you.
 
KenP said:
I guess it boils down to my disagreeing that 91 means that too much insulin was given. I would agree that 60 means that but not 91.
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Ken, just wanted to chime in here to say that what Sue is telling you is correct. (And BJ, too.) Please keep in mind that you are still in the "learning curve" phase of dosing your kitty on ProZinc - and that ProZinc is NOT a depot insulin, so you really should not be shooting insulin from an AMPS/PMPS of 91. That can be safe IF you are using Lantus/Levemir (both depot insulins) AND you have lots and lots of data already to support dosing at such a low number. But - again - ProZinc is not Lantus. Please don't make the mistake of confusing yourself with protocols written for people using tight regulation with a cat on a depot insulin.

You'd said:
KenP said:
I don't want to stick my cat's ear 10x/day.
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None of us like much like the idea of testing our cats 10 times a day. But sometimes - and especially at the beginning - frequent BG checks are what it takes for you to fully understand how your kitty is processing the insulin throughout her 12-hour cycles. I realize that this is not always possible, given work schedules, etc. But is helpful to do more testing whenever possible (like on the weekends) to help you see your cat's cycle patterns; this will pay off in spades by helping guide your hand in making dosing decisions.

While some cats do well on a sliding scale while on ProZinc, when you're first starting out it's usually a good idea to hold a dose for at least 3 cycles because some cats' bodies take a while to adjust to a dose. (Obviously, you wouldn't hold a dose if you're getting one pre-shot # that's high enough to shoot and the next too low to shoot. In that case, a reduction is in order.) Having plenty of data (BG tests) accumulating in the SS is one of the best ways to determine which method of dosing works best for your cat, and you really do need to be doing some testing around the usual hours of a nadir - anywhere around +3/+4 to +5/+7.

I can sense your frustration, Ken, and we can all relate to that!;) It's only been a little more than 2 weeks since you started Ginger on ProZinc, isn't that right? Getting a cat regulated is a marathon rather than a sprint. So although it is frustrating, try to hang on to your patience here, because it does take time. We've all been where you are right now; we understand how it feels.:bighug:
 
Hi Ken (and this is the first time I've seen a fellow Waggers user)
Since your wife is a nurse, and probably has experience treating patients with diabetes, and the use of insulin - it may be a good idea to getting her more involved in Ginger's insulin dosing. Insulin is a very powerful hormone and hypoglycemia kills. Cats can be notoriously difficult to regulate if your cat is not one of the lucky ones that goes into remission with a low carb diet alone. Insulin works by bringing down the blood sugar - if you start out with a normal blood sugar, and give a whopping 3.5 units, it is very likely your cat's blood sugar would go very, very, very low with a very bad outcome. From what I have observed with my cat, and with other cats here, it can take a while for their bodies to get used to the exogenous insulin we are giving them, and their response to insulin can be erratic at first. Murphy's response to prozinc (take a look at his spreadsheet) is VERY different now than what it was when he was diagnosed 9 months ago. Especially at the beginning, you have to be careful - Murphy's nadir changes every week it seems - anywhere from +3 to +8 at times. It is very difficult to know exactly how prozinc is working by not getting more tests in during the mid cycle - is there any way to get some tests in - either during the day or at night? Without these data, it is difficult to know what your 'no shoot number' is and how she would respond to differing doses. In any case, I agree with Sue and would not shoot Prozinc with a preshot blood sugar of <200 yet - without more data - I still would not give Murphy insulin with a blood sugar less than 180 (in which case I would give a tiny tiny tiny dose like 0.5 units) I know how frustrating this is (I am still frustrated) but you have to be patient in working out his dose and his response to Prozinc.
 
Well, you all freaked me out, so we didn't dose her this morning. Her BG shot up to 545 at the supposed nadir, 6 hours after her initial test and meal. I decided to give her 2u and then test again at 12h and dose again. My wife and I converse about this entire process and she actually tests and administers the insulin. I'm the one who does the research, obtains food, equipment, supplies, and input. I also want to ask about food vs. dosing. Currently, we test, feed, and dose 1st in the late morning, then feed again in the early evening, then test and dose again in the late evening (at 12h). I'm wondering if that schedule is not ideal for dosing evenly, since she' s essentially having 2 meals between day and evening tests/doses then zero meals between evening and morning tests/doses. What are your current schedules? Would it be more optimal to test/feed/dose, wait 12 hours, then test/feed/dose again? Do any of you have luck making your cat wait 12 hours in between morning and evening feedings? My cat is chomping at the bit no later than 8 hours after 1st meal. Is it appropriate w/my current schedule to split the doses at 2/3 to 1/3 instead of 50/50? For example, instead of 3u/3u do a 4u/2u, to account for the feeding schedule? Please advise. Thanks, again for all your help. Btw, some of you are testing and documenting WAY more than I every could...!! As much as you all want data...and I understand that, this has to be manageable. I love my cat but don't have time for doctoral research dissertation!
 
We didn't want to freak you out, but the idea of giving any insulin at a normal number was very scary for us. I am also nervous about your plan tonight. ProZinc lasts at least 8 hours in most cats so dosing again in 6 hours is not wise. It would be okay to dose 8 hours apart IF you are sure the number is rising, not falling, and in a safe range. I would wait until at least +8 from this last shot, do two tests to be sure the number is going up, and then dose conservatively. You don't want to add insulin when the previous shot is not gone. Overlap can be dangerous. And unpredictable. And your present plan would mean 4 units in a 12 hour period - more than your highest dose and higher than the dose that gave you a very low preshot this morning.

People feed differently. Some cats seem to do best with the amount of food fed daily into several smaller meals. They seem to stay flatter this way; some people think this method is best for the pancreas. Others feel strongly that two meals at shot time are best with maybe a small snack at nadir. It depends on what works best for Ginger and what is most convenient for your schedule. The one caveat is to be sure she is not fed in the two hours before the test. You want a number that is "true", not influenced by food (which usually raise the glucose level) to base your dose on.

My idea would be to base a dose on the preshot number, not the food or any other variable. For me, varying the dose is dependent on the number you get before shooting.
 
If you didn't dose this AM, then the number you got at +6 was not her nadir because she didn't have any insulin on board for approximately 18 hours from the last insulin shot you gave her. So you shouldn't be dosing her on that reading.

As far as food goes, I used to feel strongly about feeding twice a day but I have changed my mind on that and I now feed Bubba two meals at AM and PM with two snacks spaced out about every 4 hours in between and he is doing better with that method. A lot of us use automatic feeders with timers to be able to give those meals and snacks when we are not home. Petsafe 5 is a popular one who can get on Amazon.

Yes, a lot of us test a lot. I for one because I have Bubba in TR and I am running him in real low numbers . My SS might not be a good one to look at as he is on Lantus. I help out here because we have been short handed with people in this forum.

Keep asking questions because that is how we all learn. I can't say this enough, Sue and BJ, Robin and Rachel all know this insulin very well and can help you if your want the help.
 
Yep, I just fed twice a day, 12 hours apart. But that's just how my schedule worked out. Some people feed differently. As Sue said, as long as you don't feed 2 hours before the test, you should be good.

So you shot at +6 today? Are you saying you are going to test again at 12 hours AFTER that...or at your normal time? I wouldn't ever suggest dosing at your normal time if you shot at +6. The insulin you gave could still be on board so you'd be giving insulin on insulin. That could cause quite a large drop tonight.

I know it was frustrating to have a low number that you couldn't shoot this morning. It feels like you're losing momentum. BUT...we have a saying here. Better too high for a day than too low for a moment. You'll get there! :)
 
Hi Ken You will get there - look, when I first started, I once shot in mid cycle until I understood how Prozinc works - basically , unless the cat is going into remission, you absolutely don't want a pre shot number that is too low to give insulin because then in a few hours they will be high and high the whole cycle. What I do then is to shoot the next shot 1 - 1.5 hours early (so about 10.5 or 11 hours after the time the 1st shot should have happened) But there is no way around getting some mid cycle numbers - +3-+5 +7 (not all three)
 
Hello community. I am checking in today after leaving my cat at the local vet for 3 days while I went out of town. I left my low carb Waggers food with the vet and instructed them to give her that food twice a day along with her insulin shots 12 hours apart. After overcharging me and not explaining to me their weekend regimen it turns out they fed her a completely different food and gave her insulin shot 8 hours apart twice a day rather than 12. When we got her back her blood sugar was over 700 and has stayed over 600 for the past few days. I called back today and complained. The vet is pushing the hills ID diet and gave her canned food all weekend. The food has wheat gluten corn starch and rice in it. I read reviews on the food and most of the owners were saying that their cats mostly liked it though some said their cats stop liking it after several days. Notwithstanding whether the food tastes good I am concerned about its nutritional content. It even has guar gum in it. Does anyone here use the Hill's diet? My research shows that the carbs are in the 15 to 20 plus range for this food. I am considering not taking her back to the vet again. What do you all think? Thanks again for your feedback.
 
KenP said:
Does anyone here use the Hill's diet? My research shows that the carbs are in the 15 to 20 plus range for this food. I am considering not taking her back to the vet again. What do you all think? Thanks again for your feedback.
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Yes, you are absolutely right about the too-high carbs in the Hill's - ALL of the Hill's prescription diets (from what I've seen) are all too high in carbs for a diabetic kitty! The only prescription food I was able to use for Bat-Bat was the Purina DM canned (original formula, not the Savory Selects), as that was just 3% carbs. But it's so ridiculously expensive! I use the Fancy Feast Classic pate turkey with giblets now; that is only 3% carbs (she's very carb-sensitive, so can't go higher than that) & she loves it - & it costs so much less, too. There are many good choices for your cat that are less than 8%-10% carbs, have attached a good food chart in pdf doc for you below.

As for the vet ... unfortunately there are quite a few veterinarians out there who don't really know very much about effectively treating feline diabetes (it's a pretty common problem:rolleyes: for those of us with diabetic cats), so here's a good list of vet interview questions for you: Vet Interview Topics
 

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Went vet shopping, checking out a highly-rated regular vet and cat specialist vet. Regular vet said most of their cats are on glargine (lantus) and was pushing the Hills diet, like the other 2 I've already been to. The cat vet said most of their cats are on Prozinc/PZI, so I may go there. We are still struggling to get regulated. One thing we are finding is that the PMPS dose seems to work better than the AMPS dose, when these are the same, to bring down the BG. We want to attempt a sliding scale, based on Dr. Hodgkins work. The only problem I see is that if she does actually need a larger dose at AMPS to account for food during the day and still keep the BG down, using a sliding scale might actually result in a larger dose at PMPS when the BG is higher and a smaller one at AMPS when it is lower...so not sure how it will work. Any help on that would be great!

I do have a few other uestions for the group:

1. Dr. Hodgkins says that even though Prozinc is advertised at 12 hours max effectiveness, it appears to begin wearing off with most cats after 8 hours, and many can't regulate w/12 hour doses. I'm assuming that's why many on here have moved to Lantus. However, she recommends trying 8 or even 6 hour dosing, and I wonder if anyone on here has ever tried that? 8 hour would work w/our schedule, and she said 8 hour is fine. I'm thinking w/all we've tried and we still can't get down below 300 almost ever, I'd like to try 8 hour dosing. Of course, we would be measuring BG each time, to make sure we don't overdose. And, we would be using a sliding scale and not dosing under 200 or 150.

2. Another question I have is about the food. I have been trying to use the Waggers TenderMoist low-carb kibble, which has 300% more moisture than regular kibble and carbs are at 7.5. Though Ginger will eat it, she will only eat it if I chop it, add water, mash it in, and then keep adding water every few hours to keep it moist. (Yes, she has me well trained). She usually takes several hours to consume a 1/4 cup...sometimes doesn't quite finish when time for her next feeding. It would be great to see her eat it more readily. So...after 12 years of dry food...I am thinking about trying canned food. Apparently, she ate it readily at the vet. I'm suspecting she may have some dental issues as well, which may keep her preferring the moist version. I have the cat food chart w/nutrition info that someone on here kindly gave me, and I know a lot of people on here are using Fancy Feast or Friskies by Purina. I'm not trying to feed my cat GMO ingredients or grains and want to keep it low-carb (and affordable!), so please share your thoughts and experiences. I'm not too enthusiastic about canned food...b/c I've just always felt it was nasty. And of course, it is not convenient to travel and leave several wet food feedings for the cat.

Thanks for your continued help!
 
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Ken- I agree that Prozinc is not lasting the 12 hours. I have Fritz on Prozinc since March 24th 2016.
Ken I did the sliding scale please look at Fritz SS.
I am considering switching to Levemir as Lantus can sting at higher doses.
I feed Fritz raw rabbit which I order from wholefoods4pets.com. I then add a supplement from Alnutrin. I do have FF LC on hand but Friz is so sensitive to carbs his #'s go up.
I have also made my own raw food from chicken thighs with bones and with out bones. Fritz loves that too but chicken is higher in fat and Fritz weighs 25lbs so rabbit is a better choice for weight loss.
Please keep us posted if you do the sliding scale.
 
Ken, I think trying canned food is a good plan. You can look around some and try different types to see what works best. The wet food is loved by my cats! I thought it was nasty too, but I quickly got used to it and realized how much better it was for them (and how much they loved it!!).

As for the claim that Prozinc wears off after 8 hours...well sometimes it does. But I've found that to be EXTREMELY rare. In most cats I've seen (and I've seen a LOT) it lasts around 12 hours. Sometimes a bit more, sometimes a bit less.

Looking at your SS, I really can't advise on dose. We really need some mid cycle numbers before I can suggest anything. We don't know if Ginger is sitting in high numbers all day, or dropping low and then bouncing back up. Anytime you can grab some mid cycles numbers would be super helpful. Even if it's a +2 or 3 before bed or before heading out in the AM. And anytime you can get a nadir, we could really use that. Without those numbers, there is just no way to know what's really going on.

I will say this. We don't really follow Dr. Hodgkins here. I'm not saying a sliding scale won't work, but we develop our own based on your cats numbers.

Would there be any way you can get some mid cycle numbers soon so we can see what's going on?
 
Since it's the weekend, could you get some midcycle numbers? Maybe 4/6/8/10? That will give you a much better picture of what is happening.

We do have people who dose every 8 hours. But first you have to know that the insulin wears off in 8 hours. With only preshot data, you don't know what is happening midcycle. We do not recommend every 6 hours as ProZinc most often is still lowering the levels by then. Dosing every 8 hours requires a lot more time and testing - you have to be sure the number every 8 hours is definitely rising, not still falling.
 
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