? Switching from 7.2 units Prozinc to Lanuts, so many questions.

[StephG]

Hi everyone! I'm switching from prozinc (on prozinc for 6 months and 2 weeks) to lantus and I'm full of questions. I'll try to keep this from jumping around.

*What is the best way to feed? Right now Chuck gets 4.5oz food at meal time and then .8oz (the rest of the can) at +4. He also gets a spoonful of YA zero Mature at +7. He's very reactive to food. He is very bouncy! I have a feeder that I can separate his meal into smaller meals but I don't know if he'll be happy with any less than 3oz at meal time. I think he might get use to less once he realizes his snacks are coming. I also add 2 tablespoons of water to his meal and 1 tablespoon to his +4 snack. He gets PetAlive Pancreas Booster 1/2 cap each meal and Zobaline 1 pill in his PM snack.

*What dose do you think I should try starting with? Chuck is getting 7.2 units Prozinc twice a day. I think he needs an increase because his typical nadir is around 250-300+... Today he just had to show off.

*How long does a VIAL of Lantus last being stored on the counter? I ask this because my step-dad has 1/3 of a vial left (so about 300ish units) and he has been using it for about 2.5 to 3 weeks. He always uses a fresh needle so I don't think there's worry for contamination. I don't want to start him on a decreased potency dose. He does have other vials, unopened stored in the fridge. I might be able to buy a whole vial off him. (Not sure what's "legal" haha don't want to get into trouble on my first post) I have a prescription for 5 pens with 3 refills and my vet was ok with me buying from Marks in canada. I am looking to start low cost since I bought two vials of prozinc in the last month. (I thought one was damaged)

*Is the onset and nadir any similar to his current trend on Prozinc? At this point I usually can tell by +2 or +3 if he's going to have an over-active cycle or if it's going to follow his normal trend. If the dose is too big how quick can he start dropping too low? I know that really depends on the PS level but the typical onset of Lantus, if I remember right is around +2? Or that's where he should be hitting his preshot level. I've been quick to panic and over-steer with food but have been working on that when it happens.

I would like to start him tomorrow afternoon but it might have to wait until Friday afternoon. I'm pretty nervous about it but hopeful that this will get him closer to regulation at a better cost!

 

[Sharon14]

Bump!
Welcome to L&LL Steph! I think you and Chuck will like it here. You may want to add a question mark to your title to get more eyes on your questions.

 

[StephG]

Bump!
Welcome to L&LL Steph! I think you and Chuck will like it here. You may want to add a question mark to your title to get more eyes on your questions.

I'm curious to know if Colin is on any medication for Acro? I see he's down to under half of what his dose once was... or was this just from his pancreas winning the battle with the acro? I'm hoping Chuck will need less Lantus but from most of the research I've done it seems like he might need to start where he's at with prozinc.

 

[Wendy&Neko]

Hi Steph, and welcome to you and Satan - or do we call him Chuck? Let's see if I can answer some of your questions. First of all, I presume you've been reading the Sticky Notes at the top of this forum. People here follow either Tight Regulation or Start Low Go Slow as their dosing methods. You'll have to decide which one fits your particular circumstances. Since Chuck seems to be a big gulper, I'm going to be biased and recommend Tight Regulation but it's up to you. First you'd have to get rid of the dry food. Don't know if you've read Dr. Lisa's post on that. TR requires an all low carb wet or raw food diet.

What is the best way to feed?

Several small meals are fine, try to get most of the carbs down before nadir time. I LOVED my autofeeder. Also, when you are new to Lantus, try not to feed from +10 onwards, so the preshot is not carb influenced.

What dose do you think I should try starting with? Chuck is getting 7.2 units Prozinc twice a day.

Typically we switch to a similar dose, which might be 7 units if you want a little margin for error. Note that some cats have a strong reaction to a switch in insulin. So you'd want to do the switch when you can monitor closely for a couple of cycles. Has Chuck every been tested for high dose conditions? It's something we recommend for kitties over 6 units.

How long does a VIAL of Lantus last being stored on the counter?

It's listed as lasting 28 days, but we haven't had anyone test if it goes longer than that as everyone stores it in the fridge.

Is the onset and nadir any similar to his current trend on Prozinc?

Depends on Chuck. Typical onset is +2 to +3 and "typical" nadir is around +6. For comparisons sake, on Lantus, Neko was reliably nadiring from +3.5 to +13, though most often from +7 to +9. I have seen some cats nadir as early as +2.

'm curious to know if Colin is on any medication for Acro?

The only known medication for acromegaly, called pasireotide, is something like $15,000 a year. That's in Canada where it's cheaper. There are drug trials ongoing for a cheaper med, but I haven't seen results yet. The acro tumor can wax and wane, and the insulin needs go up and down with that.

 

[Sharon14]

Colin is not on any meds for acro. Not sure what happened to cause the dose decrease, probably just a blip in the tumor activity because we are on the way back up the dose scale at 10u BID and in need if another increase. One day soon I will update my SS

 

[StephG]

welcome to you and Satan - or do we call him Chuck?

His official name is Satan but some people don't like his name or are uncomfortable with it. DH calls him Chuck Norris- aka Chuck. I'm so use to it that my brain auto-responds to it. Either name works for me. Whatever you're comfortable with. I have been using Chuck for the most part on the forums.

First you'd have to get rid of the dry food.

Even the Young Again Mature Zero. Suppose to have zero to scant carbs. He only gets a spoonful or two at most to hold him over til mealtime. He is a quick climber so usually any carbs after +6 sends him soaring. He doesn't get any food for 2 hours before his preshot test.

Has Chuck every been tested for high dose conditions? It's something we recommend for kitties over 6 units.

He just saw the vet today and she didn't think the test were necessary just yet. I guess once we see how the long acting insulin works we will go from there. Hoping once he's on a longer acting he won't spike to reds or black for his PS. If he still needs higher doses of Lantus she said we could do the test.

$15,000 a year. That's in Canada where it's cheaper.

HOLY COW! So basically the dx just confirms there is a tumor and medically justifies the higher doses? Not much to do besides medical trials and that expensive medicine...

I think I'm going to try to get a new vial from my step-dad. He has plenty! Still waiting to hear from my aunt (dr) to see if she has any samples of the pens at her office. If so I'll go with that since it's less likely to go bad before it's used up.

 

[StephG]

Typically we switch to a similar dose, which might be 7 units if you want a little margin for error. Note that some cats have a strong reaction to a switch in insulin. So you'd want to do the switch when you can monitor closely for a couple of cycles.

I really hope he doesn't react strongly to the lantus. Looks like we will be trying 7 units to start.

 

[StephG]

Another question: If I get a 10ml vial that's 1000 units. On 14 units a day that will last about 2 months (around 69 days). Does the vial last that long in the fridge? It might be worth getting a whole vial from my step-dad.

 

[Wendy&Neko]

So basically the dx just confirms there is a tumor and medically justifies the higher doses?

It's also worth getting tested for IAA (insulin auto antibodies). Some cats have it in combo with acro, a fewer number have it by itself. The antibodies are supposed to be self limiting after around a year. Which can mean they need less insulin. Getting a diagnosis also can change the dosing strategies. With both IAA and acromegaly, there can be unexpected changes in amount of insulin needed. With a large depot on board, that inspires caution if the change is a decrease. But you also have to be aggressive to get ahead of resistance if increases are needed.

The other thing about confirming acromegaly or not is being aware of symptoms associated with excess growth hormone. A simple example with Neko - she had some red marks on her gum line. Regular vetty thought it was an infected tooth that probably needed to come out. I went to a dental specialist instead, who realized it was soft tissue growth on the gum that meant her canine was rubbing on the lower gum. She got a tooth shave instead of an extraction. Kitties can get soft tissue growth in the throat too. Some kitties need kitten sized intubation tubes if undergoing anesthesia - not something vetty would look for in normal run of things. Those are a couple of examples for soft tissue growth. Growth hormone can also impact organs. I strongly recommend any acro with a heart murmur have an echocardiogram. I've seen a number of crisis from kitties that have had hypertrophic cardiomyopathy. It can happen without any obvious warning signs. On a personal note, it can happen to Maine Coons too, and I had a MC civie have a massive stroke from his HCM two days before a scheduled echo. But there are medications that can help if you know about it in advance.

Does the vial last that long in the fridge?

We've had people use the same vial for 5-6 months.

 

[StephG]

Very interesting. I really started to wonder about acro since he got up to 6 then dropped down to 5 and now back up to 7. *sigh* That reminds me I forgot to ask the vet about when Chuck does a weird chicken or dove head bob movement when swallowing sometimes. Looks like maybe he will need the acro and IAA tests before getting a dental cleaning. I had a cat with CHF with a congenital defect in his top right side of his heart. There was a growth above the valve that looked like a shelf. He must have had it since birth and lived to 11-13 years old. The cardiologist at Cornell Animal Hospital were so intrigued by his condition that they took his picture and made a file for him keeping detailed notes and I got a few "free" echos and other tests. Dr. Brewer was his cardiologist and towards the end of Bubba's life he left Cornell. I was sad to see him go.

(Did I forget to mention I'm a chatty cathy?! haha sorry)

 

[Wendy&Neko]

Did I forget to mention I'm a chatty cathy?!

That's OK - I'm reading all of it.
Neko had her first dental before her IAA and IGF-1 tests. Part of my process of eliminating anything else, and before she got to 6 units. She had a benign heart murmur show up a couple of years later. It got less than benign (heart block and CHF) a couple of years after that. Course, she also has some MC heritage. Part of the reason I chose to go with a dental specialist for her subsequent dentals was because of her heart and the additional heart monitoring they did. She also had dentals for odd reasons. At one point she had a bony growth on her jawbone which was impacting her eating. I could even feel the bump under her cheek bone. Vetty thought it was osteocarcinoma - but thankfully he was wrong. Neko had a number of side effects that impacted her eating. She did a lot of grinding the last year, but after the heart block showed up, she could no longer have anesthesia. I ended up going to an internal medicine specialist at a vet specialty clinic, same place as her cardiologist. I got a few free echos too.

 

[Pumpkin's Mom]

Pumpkin will be tested for Acromegaly on Wednesday. We can't seem to get the numbers down. He is at 9u of Lantus 2x day. This morning blood sugar was 339. The vet said time to test so at least we know. The weird thing is that my sweet kitty has been so full of energy. He is jumping on the sink again and wrastling with our 4 yo kitty. He is even pushing the jingle ball around. If I didn't know, I would have no idea he was sick.

The vet sends the blood test to some university for testing. It takes a few weeks to get results. The vet doesn't want to push the dose too much more until he knows what he is up against. It makes me so sad that his life will be shortened if he has it. I'm already sad but hoping for the best.

 

[Bronx's dad (GA)]

Pumpkin will be tested for Acromegaly on Wednesday.

Make sure to get an IAA test as well. MSU does both tests.

 

[Bronx's dad (GA)]

I'm curious to know if Colin is on any medication for Acro? I see he's down to under half of what his dose once was... or was this just from his pancreas winning the battle with the acro? I'm hoping Chuck will need less Lantus but from most of the research I've done it seems like he might need to start where he's at with prozinc.

Here are some common medications for acro conditions that arise but not to treat the acro directly: https://docs.google.com/document/d/...MCYQcpHjG747KRK6c/edit#heading=h.13u2ceexi1kb

 

[Pumpkin's Mom]

What does IAA stand for? I will have that done.

Also - are there outward signs I should see? He is actually doing well, very peppy, affectionate, and happy. He even jumps on the counters again.

Thanks!

 

[StephG]

Just wanted to update on our switch to Lantus. Chuck ended up having a UTI and we are treating with baytril for 16 days (11 more days to go) then we are going to switch to Lantus. I have two pens waiting in the fridge. Still nervous as heck and will hopefully have a smooth transition.

 

[Pumpkin's Mom]

Good luck. Lantus has been our only one and Pumpkin is good with it. We just need to figure out why his numbers are so high. Have you tried Pretty Litter - it changes color if they have a UTI.

 

[Wendy&Neko]

@Pumpkin's Mom IAA = insulin auto antibodies - think of it like an allergy to the injected insulin. Some kitties have it by itself or with acromegaly, like my Neko did. Here is the information on the test you get done at Michigan State University. It's a fairly cheap add on to the acromegaly test and done at the same place.

@StephG - Sorry to hear the news about Satan's UTI. I hope he feels better soon.

 

[StephG]

Good luck. Lantus has been our only one and Pumpkin is good with it. We just need to figure out why his numbers are so high. Have you tried Pretty Litter - it changes color if they have a UTI.

I have heard of the pretty litter. He has never had a UTI in the 10 years we have had him. I took him to the vet to talk about the switch and the possible causes for the increase in insulin and she told me to test his urine at home since I had the strips to do so. I was actually very surprised that he tested positive! He had no symptoms besides I guess smaller pees. His numbers are still too high and not moving much with increased insulin. I keep thinking I need to stop being so cautious and go for it to get the numbers down but I don't want his antibiotic to kick the infection and have his numbers drop after I give him a big dose increase. His urine test tonight showed leukocytes still but more of the "small" color vs moderate. Negative ketones too! So I'm happy with that!

 

[Carol & Murphy (GA)]

Hi Steph - I remember you from the Prozinc forum and I just wanted to say "welcome" to L&L. Will follow along with fingers crossed for a great response to Lantus when you start

 

[Kris & Teasel]

I have heard of the pretty litter. He has never had a UTI in the 10 years we have had him. I took him to the vet to talk about the switch and the possible causes for the increase in insulin and she told me to test his urine at home since I had the strips to do so. I was actually very surprised that he tested positive! He had no symptoms besides I guess smaller pees. His numbers are still too high and not moving much with increased insulin. I keep thinking I need to stop being so cautious and go for it to get the numbers down but I don't want his antibiotic to kick the infection and have his numbers drop after I give him a big dose increase. His urine test tonight showed leukocytes still but more of the "small" color vs moderate. Negative ketones too! So I'm happy with that!

You've been a champ dealing with Mr. Trickiest Cat in the Universe, Steph! It's possible that the depot action of Lantus will help to curb some of his extremes and keep him lower for longer. You might not (probably) see a full 180 from tricky cat to "easy" cat but if he's like Teasel, there'll be more of the nicer colours on the SS. That's progress.

 

[Susan and Timmy]

Cheering you both on!!! Will be following the journey with you and Chuck, along with Kris and Teasel, for when I make the switch to Lantus.

 

[julie & punkin (ga)]

Even the Young Again Mature Zero. Suppose to have zero to scant carbs. He only gets a spoonful or two at most to hold him over til mealtime.

You can do the same thing with canned low carb. It's not just about the carbs, it's also about how dry it is. Diabetic cats are by definition, dehydrated. High numbers make them pee excessively - one of the ways diabetes is diagnosed is by excessive urination. High blood sugar is hard on the kidneys - we see many diabetic cats develop compromised kidneys, and giving a wet diet is one thing you can do to help kidneys. Dr. Lisa, a vet who occasionally posts on FDMB, just wrote an informational post on dry food - specifically Young Again.

In any case, one of the prerequisites for following the Tight Regulation Protocol is that the cat not be eating dry food on a regular basis, so if you can get rid of that afternoon snack of dry food, you would have the option of following Tight Reg. It's more flexible and allows you to adjust the dose more quickly than the Start Low Go Slow dosing guide.

hat reminds me I forgot to ask the vet about when Chuck does a weird chicken or dove head bob movement when swallowing sometimes.

The hormones produced by the acro tumor causes the cat to grow. In a cat that is already an adult, the first place to grow is the soft tissue - organs and other soft parts. Punkin's tongue was the size of a child's tongue and was one of the first things I noticed had grown. Many acro cats develop a rumbly breathing sound, kind of like a snore. That's from excess tissue that has grown in the airways. I'm wondering if Chuck's difficulty in swallowing might suggest that he's got some excess tissue in his mouth or throat there that is making it hard for him to swallow smoothly. You might look at his tongue and see if it's normal small-cat sized or bigger than you'd expect.

Eventually bones do grow as well, resulting in arthritis for example. When the jaw grows, the teeth spread apart and might have gaps between them.

It's good to get the test done so you know what you're dealing with.

We just need to figure out why his numbers are so high.

Most cats have their highest numbers in the morning because of Dawn Phenomenon. If you want to know how low the dose is taking Pumpkin's blood sugar, you really need to see some tests in between shots. One of the most revealing tests is the one right before bed. If I were you, I'd try to routinely get a test then, just for safety and to help you know what to do with the dose. It appears that your vet is having you increase the dose based upon the am preshot test, but with depot insulins, the lowest numbers are the most important in figuring out when to increase or decrease the dose.

Also - are there outward signs I should see?

In the earlier days, the symptoms of acro aren't visible. The changes are happening internally. If you want some help with Pumpkin's dosing, just open a thread for him and ask. People will be happy to help you get him out of what appears to be some pretty high numbers. In kitties that are constantly high - and we can see by a few more mid-cycle tests that there aren't any hidden lower numbers - we can help you fast track to get Pumpkin into more normal numbers. Just holler if you want help.

Hope some of that is helpful.

 

[StephG]

I started adding 2 tablespoons of water to each meal and 1 tablespoon plus an ice cube to each +4 snack. So in total he's getting 6 tablespoons of extra water a day because he seemed to be getting a little slower response on his scruff pull test. He still drinks from his fountain but not as much as he was before the extra water.
I'm hoping he will reach his Target weight quicker than it took him to gain the last 2 pounds (6 months). One more pound and I cut out of second snack and such with the 1 can per cycle. He reacts to any and all food with an increase of BG levels. Even plain baked chicken breast.

 

[julie & punkin (ga)]

There have been others who said plain chicken increased their cat's blood sugar - I've always wondered if there were some additives in the chicken. Unless you're buying organic it's possible it's been injected with something.

 

[StephG]

Could be... I have tried baby food with no starch added, beechnut brand, and anything over .25 oz and he usually goes up. Anything after +6 use to make him spike but lately with the YA it didn't seem to be... He'd just surf. He's so touchy with that bounce trigger and he likes to race to the blacks.
I'm hopeful the lantus will calm down his ups & downs. ProZinc hasn't really lasted long enough with him. We had a few good days but it's just getting really expensive and after 6 months it's only fair to try something that might make him better.

 

[julie & punkin (ga)]

I think you'll be really happy with the switch. Did the vet suggest that you wait for the infection to clear before you switch? I would think you could go ahead.

 

[StephG]

She didn't advise against it but thought it wouldn't hurt to stay on ProZinc until the antibiotic is finished or close to the end of it around day 10 or 12. At this point I will have to wait until Friday or Saturday before switching which would be day 9 or 10 on the antibiotic. I'll be home most of the week next week so it's a good week to switch.

 

[Tricia Cinco(GA) & Harvey]

I'll be home most of the week next week so it's a good week to switch.

Hi Steph.

You have already gotten some great advice from our most experienced high dose people. I just wanted to pop in and say that I think it's a good idea to wait until you can monitor for a couple of days to make the switch, especially with such a high dose kitty. We will all be watching for your posts as you get ready to start Chuck on Lantus and will pitch in wherever we can to help.

If you haven't already done so, I highly recommend reading the stickies at the top of the Lantus & Levemir page. Unless you are a sponge, you will probably need to read them multiple times to absorb all the great info there. To further help you, here is a post we put together for new L&L members: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

Keep asking questions - we love to show off what we know - I mean, we love to help!

 

[Kris & Teasel]

You've been given great advice here, Steph!

 

[Pumpkin's Mom]

Pumpkin's blood test was this AM. Acro and IAA. We will see in a few weeks what the test says. I am hoping for negative on both!

 

[Pumpkin's Mom]

@Pumpkin's Mom IAA = insulin auto antibodies - think of it like an allergy to the injected insulin. Some kitties have it by itself or with acromegaly, like my Neko did. Here is the information on the test you get done at Michigan State University. It's a fairly cheap add on to the acromegaly test and done at the same place.

@StephG - Sorry to hear the news about Satan's UTI. I hope he feels better soon.

@Wendy&Neko @Bronx's dad thanks so much for the information. We just got Pumpkin's test back and he has IAA but not Acromegely, so good and bad. Now I need to research IAA in cats. My vet hasn't seen itmuch but he is also researching it. I will start a thread to see if there is anyone else who's cat has just IAA. Thanks again for telling me to add that! (Pumpkin would thank you too, but he is napping in front of my keyboard.)