Switching from Caninsulin to PZI, what dose to start at?

Angel started at 2U Caninsulin (vet wanted 3U, I felt like that was too high so they said 2U was okay too), and her numbers have been all over the place. Went up to 2.5, then 3, but she's just getting worse (both in symptoms and numbers). Went down a tad to 2.8 (roughly) a few days ago, numbers got a bit better.

I've been asking to switch her over to Lantus for 3+ weeks now, my vet was willing initially, but unfortunately we found out that it's illegal in my country until you've exhausted all veterinary med options. So we ordered PZI and waited. It finally arrived today, so I got a new Libre 2 put on her and picked up the PZI, ready to inject tomorrow.

But at what dosage? Vet said 3U, I'm thinking no more than 2, maybe even lower?

PS: If you check the spreadsheet, please take a look at the screenshots from the librelink I posted in remarks. In those first few days on 2U she went down really low.

This is my first post, hope I've done everything right! Please lmk if not.

 

I'm sorry that I don't even know what a dose of 2.8 would be. 2.75 maybe, but 2.8? how do you measure that? What kind of syringes are you using? U-40 syringes that are used with ProZinc (with half unit marking hopefully?)

 

Okay, so I am looking at the spreadsheet. First, you must absolutely get preshot tests done so that you know it is even save to give insulin at all (preshot high enough.) I don't see preshot tests. I'm sorry and I don't want to be obnoxious, but I want your baby to be safe.

 

Also, I tried the link and I wasn't able to look at the Libre data that you are referring to. How low did Angel go... and when? I need the data from the Libre at least to be loaded up to the spreadsheet if possible. I would go with a lower dose if you are in doubt and you can always increase from there and we will be happy to help!

 

2.8 mmol/L isn't the exact measurement, it's just what I estimate in numbers what I visually see on the syringe. I drew up slightly less than 3U (3U with daylight under the line, like I read here under fine dose), just to see if a small reduction would show better numbers (it did). I'm indeed using U-40 with half unit markings.

The preshots are in the AMPS and PMPS columns, or did I not do that right? Or did you mean that those need to be done every single time?

Are you able to see the screenshots if I post the link here directly? https://imgur.com/a/bbnzJCd It says that it may contain adult imagery and to confirm that you're over 18, I have no idea why it says that or how to remove it because they're literally just screenshots of the librelink app. I'm still trying to figure out how I can extract the data from the app, otherwise I'll have to transcribe it all and that might take a while. On april 22 she went down to 4.6 mmol/L (82.8 mg/dl) at the lowest, on the 2U caninsulin dose. I notified the vet but she didn't want me to reduce the dose unless she went down even further. On the 25th she hit 6.4 (115.2), on the 26th 5 (90). All nadirs. But a lot of the time she was still HI (27+/486+), and with some shots didn't have much of an affect at all, so the vet wanted me to keep upping.

She's had 2 shots of 1.5U prozinc so far, the latest one 2 hours ago. She didn't have a noticable nadir during the first shot, preshot was 22.4 and she mostly hovered around 22 (396) with one peak to HI after 6ish hours, but that might just be her adjusting to the new insulin and new dosage. Preshot from 2 hours ago was at 22.9.

 

Yes. A preshot fasting blood glucose measurement needs to be taken every time before insulin is given. So no food for two hours prior to the preshot test (or Libre reading.). I will reply more in a few minutes. My family is waiting to eat dinner. Luckily, all cats are fed. I will be back.

 

She's freefed, so she's never fasted.

My country is lagging behind in diabetes care standards, from what I'm beginning to understand. The standard advice here is still "here's some caninsulin, start at X dose every 2 hours, bring her back in 2 weeks so we can do a bloodtest and adjust the dose if necessary" and that's it. Remission isn't mentioned as a possibility at all. I only got the libre because a diabetic friend mentioned that they read that it can be used in cats too, and bought the freedom lite meter when the libre gave out. Even then, the vet said home measurements were totally optional, and if she's been on the same dose for a while, pretty much unnecessary. Bought some ketostix when I read about ketones, and started pushing for Lantus when I read that this is the international gold standard. Unfortunately by law we have to try prozinc first, and only if that doesn't work well enough yet we will be allowed to try Lantus.

Take your time, enjoy dinner!

 

What country do you live in? Many vets in this county tell their clients the same thing — do not test — just look at the clinical signs, etc. vets in the United States receive very minimal training in diabetes at all — let alone Feline Diabetes. I an happy that you are educating yourself on the best way to manage things and help your cat.

The reason for withholding food for two hours prior to the AMPS and PMPS (a.m. and p.m. preshot tests) is to ensure that the number is not influenced by the food they’ve been eating— meaning that, if they’ve been eating, the BG number will be higher because of the food. If you shoot insulin on a food influenced number then the food may wear off and your cat’s blood glucose may drop too low. So the AMPS and PMPS tests are to make sure that it’s safe to even give insulin (i.e. they’re not too low) and to see if it’s necessary to give a reduced dose for that cycle because the BG is too low.

 

Oh, and regarding vets who tell their clients not to monitor BG at home: Many times a cat who is hypoglycemic will not show any signs at all of having too low blood sugar— at least until they get into very dangerously low BG. So you cannot tell just by watching the cat with your eyes, you have to test.

 

Stick with the 1.5 units of ProZinc for now — for a total of 7 days (unless Angel drops below 90 and then that earns a mandatory .25 unit reduction in dose for the subsequent cycles.) Don’t increase the dose. We need to stabilize things. It looks like your kitty is bouncing for now. Keep watching for him to clear the bounce and blood sugar will go down. I understand how hard it is to wait!!

 

Have you read through this sticky note on ProZinc dosing methods? The section on Start Low Go Slow is the method you should read. There are other helpful sticky notes at the top of this forum as well. See this link:

https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

I will check back in with you tomorrow. It’s midnight here. I will be happy to answer your questions.

 

I live in The Netherlands. She always has access to food, eats small amounts frequently so it doesn't really get the chance to wear off. I currently do not have the ability to withold food for 2 hours before every shot.

I'll stick with the 1.5U prozinc! Made her spreadsheet up to date again too. I've read the link!

 

Okay. Right now it is not critical that she be fasted for two hours before the preshot test but only because her numbers are so high. When she gets down into more normal numbers it could be a problem. Let’s say she has a preshot of 100 or 150. How will you know, since that number of 100 or 150 is safe to shoot? We won’t. Because the number can’t be trusted because it is inflated by the consumption of food.

 

Now, having said all that (which is just an explanation and not a criticism) I understand that sometimes people have constraints on them that hamper things.

Do you have other cats? What is your schedule like? Work schedule? I’m asking because it can be important especially when feeding and testing are necessary. So far you are doing a great job

 

It does look like she is going to need an increase to 1.75 after we have tried this 1.5 dose. But let’s let things stabilize for her body. It’s hard to wait, I know. What proportion of wet to dry food does she eat? Would you be able to estimate? Do you know how many carbs are in her dry food — and her wet food?