? Switching from Lantus to ProZinc, need a plan

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Helena and Gandalf

Helena and Gandalf

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Hi all!
It has been a long time since I was last on FDMB, it has been a busy semester.
I am starting to get really discouraged because we haven´t been able to get Gandalfs' diabetes under control yet. It has been a whole year! Our period on vetsulin did not work at all and when he was on Lantus we never seemed to get the same values from one day to another regardless of the dose (he was at 1.5U at the end, higher than that he would go on a rollercoaster). He was rarely over 17 mmol/l but also rarely under 10 mmol/l, so basically he has spent a whole year in the yellow values... I have not been updating my spreadsheet since the summer so now it is new insulin-new spreadsheet.

I would really appreciate some help with how to tackle ProZinc, I have read the guide but I would appreciate som advice from people who have made it work. You can see in the spreadsheet how it has been going the past nine days since we started. I need help to take a step back and trust the insulin. Because when I look now at what we have done the past few days it feels like we have been rushing it and made some questionable desicions. :(

We went from 1.75 to 2U last night and he was at 9.3mmol/l this morning, we stalled and gave 1.5U because he was at 12.8 30 minutes later and my partner will be home all day and can monitor him. Should we have done it differently?
We feel that 2U was to much and will restart at 1.5U now, does that seem like a good idea or should we start over even lower?

We had planned to do a curve tomorrow (sunday) but because of the values this morning it feels like we should wait until we have been able to hold a dose for some cycles.

How long should we be holding a dose to see some effect? It said 3 cycles before making any changes in the guide but it feels like we are rushing it if we follow that.
If we hold a dose for several weeks could the values eventually be dropping or are we supposed to see some result after a few days?

You who have your cats' diabetes under control using ProZinc, what did your journey look like?

In september we did about all possible tests there is to see if diabetes is his only problem, all test were looking good so he is healthy otherwise. We try and test for ketones but it is really difficult, the few tests we have managed to do has been negative but we haven´t been able to do any since the fall.
Sorry for all the questions but I am so down and depressed because we cannot make it work. I just want to start over and forget everything from the past year. It also feels like ProZinc is his last chance to get his diabetes under control which just adds to the pressure.

Thanks, Helena and Gandalf
 
Welcome Helena and Gandalf! What a handsome boy! :) Oh, how I truly understand your frustration because one year later my kitty is still unregulated. He started on Lantus for two months, bounced like crazy, had a DKA episode and then we switched to ProZinc at the beginning of April 2016. I only began doing things the FDMB way in mid August and it's given me a clear picture of why my kitty is so tricky. I'll begin by answering your questions and then I'll share what works for me:

Helena and Gandalf said:
I need help to take a step back and trust the insulin.
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Yes, you do need to relinquish your desire for control, do your routine BG testing, log your data and learn to interpret Gandalf's reactions by studying the spreadsheet.

Helena and Gandalf said:
it feels like we have been rushing it
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As is often said here, it's a marathon and not a sprint. Some kitties take a long time to achieve any semblance of regulation, especially if their response to insulin is unpredictable. It's easy to get upset when we see other kitties go into regulation and/or remission in a short time but ECID - every cat is different.

Helena and Gandalf said:
9.3mmol/l this morning, we stalled and gave 1.5U because he was at 12.8 30 minutes later and my partner will be home all day and can monitor him. Should we have done it differently?
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As time goes on and you accumulate more data, you'll probably be able to shoot a full dose at a low-ish PS like 9.3. I'm in Canada so I use world units as well.

Helena and Gandalf said:
We had planned to do a curve tomorrow (sunday)
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If his responses are similar tomorrow to what you've been seeing, a curve is of limited value right now. Spot checks at various times in the range of +5 to +7, before bed or in the middle of the night (if you're willing to set an alarm for that occasionally) would be more useful. Once you're at a dose that looks like it might be working better, a curve can be done to give you a full day's picture.

Helena and Gandalf said:
How long should we be holding a dose to see some effect? It said 3 cycles before making any changes in the guide but it feels like we are rushing it if we follow that.
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A minimum of three cycles is best but I'll also say "It depends." There are situations where you might change it sooner or wait longer. You'll learn what these situations are after you have a lot of data and can "read" Gandalf's BG language on the SS.

Helena and Gandalf said:
If we hold a dose for several weeks could the values eventually be dropping or are we supposed to see some result after a few days?
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The values won't drop if you hold a dose that's too low for a few weeks. The other side of that is if the dose is too high and has caused BG to be high as a result of kitty's body overcompensating ("bouncing" as we call it) he can get "stuck" in high numbers. Constant exposure of his body to high BG can create "glucose toxicity" which makes him resistant to insulin. The way out of this is to slowly and carefully raise the dose until you start getting a response to the insulin as seen in lowered numbers. It's possible for the "good" dose to drop lower then.

Helena and Gandalf said:
You who have your cats' diabetes under control using ProZinc, what did your journey look like?
Click to expand...
There are several people on the ProZinc forum who have complicated kitties - me, Phoebe's dad, Hermione's mom, Chuck's mom and so on. This shows you that it's not that unusual and as one other forum person said to me quite a while ago, "It's more about the kitty and less about the insulin." That really stuck with me. Some other kitties show a good response early on - eg. Lisa's Smoky.

Helena and Gandalf said:
We try and test for ketones but it is really difficult,
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We have tips and tricks to help. I put a shallow long-handled kitchen spoon (now labelled Teasel's testing spoon!) under Teasel's backside when he's urinating. You only need to catch a little urine to test.

Helena and Gandalf said:
Sorry for all the questions but I am so down and depressed because we cannot make it work. I just want to start over and forget everything from the past year. It also feels like ProZinc is his last chance to get his diabetes under control which just adds to the pressure.
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I certainly understand why you feel this way. It's easier said than done but if you can:
  1. accept that Gandalf is a tricky kitty in his responses to insulin
  2. learn ways to adapt/tweak his dosing to get better numbers more often
  3. let go of the need to get it all working perfectly by some set date
  4. understand that you are doing everything you can to help him
you'll start feeling a lot better over time. Follow some of the other threads on this forum and you'll see how the people I've mentioned above keep going day to day, sometimes getting frustrated, but mostly being philosophical about dealing with a complicated diabetic.

Now what works for me:
  • adopting the mindset I described above
  • using U100 syringes and a conversion chart to dose ProZinc, a U40 insulin - I can explain later
  • not changing too many things at once because it sends Teasel into a tailspin
  • using very tiny dose changes
  • recognizing that he gets stuck easily in high bounce numbers and needs to be shifted out of them ASAP with a dose tweak.
ProZinc shares some attributes of Vetsulin - in and out insulin, amenable to more frequent dose changes, flexibility in dose timing - but it's slower in onset and (mostly) gentler in action. My opinion is that the Lantus depot which works well for most kitties can be a problem for kitties who are unpredictable in their responses.

I hope this helps. :)
 
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Hi Helena and Gandalf! Kris has given you plenty of info above and I don't want to repeat anything, so I will just say welcome! We're here to help and while yes, it is hard and depressing at times...it's also incredibly rewarding to love a sugar kitty. Let us know what other questions you have!
 
Thank you so much for your relpies, it helped a lot!
Sorry for not replying yesterday but he had (for him) very bad numbers yesterday during the day and I was completely devastated. Then at PMPS he was at 13.1 mmol/l and I as really pleased that he got some rest from being in high numbers. We are currently giving him 1.5U and will soon increase to 1.75 again, or use our 100U needles and increase by a bit less, to see if we can get him a bit lower. Today at PMPS he was at 16 mmol/l same as AMPS this morning. Today was the first time in days we actually thought he looked symptom free, he has been playing A LOT and did not drink much water. He can look so miserable when he is high which makes me even happier when I can actually see he is feeling better. We have noticed that he start to show symptoms around 15-16 mmol/l so we really hope we can keep him around and under that now.

I also managed to do a succesful check for ketones yesterday! YAY! It was negative, thank god... We recently changed litterbox and although the spoon had not worked for us previously, the way he pees in it now allow us easy access. :D So I will defenitely set aside a Gandalf´s testing spoon!

I don´t have any more questions right now, will defenitly be back if I do! Again thank you so much, answer to my questions and encouragement has helped so much!:bighug:
 
I looked at your spreadsheet. I agree that going up to 1.75 u is a good idea. Leave it there for 3 or 4 cycles and if he's still giving you pink and yellow raise it to 2 u. The U100 syringes with the conversion chart would be very useful.

I'm glad I was able to help with my first post. :)
 
Kris & Teasel said:
Checking in to see how you're doing. Do you have any questions?
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During the night Gandalf has not been feeling well, he has been lethargic and sleeping under the bed instead of by my feet. He did not come running when it was time for breakfast but at least he ate it all, but not with the same enthusiasm as usual. I am very worried since I am going away for the weekend and leaving him with my partner, who is perfectly capable caring for him but I would be crushed if something happened when I was gone. I am especially worried it is ketones since he has been in high numbers for so long now.

We did a curve yesterday, and it showed about the same as the spot checks have shown: he is not dropping anything mid cycle! Why??? It has rather been the opposite, the numbers are rising until mid cycle and the dropping again to be at about the same number for the next shot. Is it only because the dose is to low or is this just how he responds to Prozinc? We are a bit worried that the insulin is not active anymore, we accidentally left it out on the counter for 2 hours one day and then again for 3 hours the day after. But we found several pages saying it is fine if it is not more than 24 hours or too hot, I even think one page was the Prozinc-webpage. Could it be inactive insulin or is this just how he responds?
 
Hi Helena! Hmm he really is reacting odd. I don't think it's the insulin...that's not so long that it was out. When did you get this bottle? What days did you leave it out? If it is inactive, I wouldn't think it was from being left out because his reaction has been the same all along. You've been doing slow methodical raises, which is what we recommend...the inverted curve sometimes means the dose is too high but that seems unlikely with the low dose you started on and the methodical raises.

I'm stumped. My only thought is that he just needs the dose raised until you hit the number that causes a breakthrough. @Kris & Teasel can you take a look? Maybe you'll think of something I don't...I'll do some thinking today too. Maybe once the coffee kicks in I'll have a better idea?

On a side note, are you checking for ketones?
 
I've reviewed our posts here and, unless I missed it, you didn't say what food you give Gandalf. We strongly recommend a low carb wet food diet. Many vets sell prescription diabetic food in kibble form (always too high in carbs) or wet form (often too high in carbs). If Gandalf is getting any type of dry food or higher carb wet food that can have a major effect on his BG levels. So that's the first thing to address.

If he's eating only low carb wet food then you need to keep up your careful increases every 3 cycles. Have you tested his urine for ketones recently? That's important right now.

I'll wait to see your reply about his food.
 
Helena and Gandalf said:
During the night Gandalf has not been feeling well, he has been lethargic and sleeping under the bed instead of by my feet. He did not come running when it was time for breakfast but at least he ate it all, but not with the same enthusiasm as usual. I am very worried since I am going away for the weekend and leaving him with my partner, who is perfectly capable caring for him but I would be crushed if something happened when I was gone. I am especially worried it is ketones since he has been in high numbers for so long now.

We did a curve yesterday, and it showed about the same as the spot checks have shown: he is not dropping anything mid cycle! Why??? It has rather been the opposite, the numbers are rising until mid cycle and the dropping again to be at about the same number for the next shot. Is it only because the dose is to low or is this just how he responds to Prozinc? We are a bit worried that the insulin is not active anymore, we accidentally left it out on the counter for 2 hours one day and then again for 3 hours the day after. But we found several pages saying it is fine if it is not more than 24 hours or too hot, I even think one page was the Prozinc-webpage. Could it be inactive insulin or is this just how he responds?
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I agree that that the flat cycle may mean more insulin is needed. I would not describe it as rising in the middle. If we consider that general 20% variance, he basically stayed flat the whole cycle. If I were you, I would give the two units the 3 cycles and see what the cycles look like, catching a number around nadir whenever you can.

Kris gave you a wonderful overview and lots of great information. One observation I have is that kitties who were difficult to regulate on other insulins are difficult to regulate. I would sit back and figure you are in this dance for the long haul, looking for more regulated numbers as a goal for now. Remember he doesn't know he is diabetic; he just wants snuggles and great snacks and food. Try to find a dose that give you yellow preshots and a drop for nadir, and that seems to make him feel good. Then work on fine tuning. Don't let him sit in higher numbers for too long - I think insulin resistance is a big problem in kitties who have been on insulin(s) for a long time. They build up a tolerance that requires that careful response Kris does so well with Teasel.

My two cents...
 
Hi all!
Thanks for your replies! I am back home now and Gandalf is feeling much better again. He had diarreha all friday which explains his odd eating-behaviour. I am off to school soon so I have no time to fill in the spreadsheet but I will do that this afternoon. But basically he only licked the sauce of the wet food (low carb, the one all diabetic cats in Sweden are recommended) he was offered since he would not eat his normal raw food (which is actually listed in my description :)). We stopped giving him dry food the day of his diagnosis, he has been raw fed for little over a year now. My partner did not manage to test for ketones since Gandalf was pooping more than peeing. Eventually we will take a trip to the vet this week, but that comes down to time and money. We have no car and to not stress him too much we did start to take a cab there instead of the bus. He has had a very sensitive tummy since the summer when he took a 7 hour trainride.

We are gonna give him a worm-pill and also send a faecal sample to test for some of the less common parasites since he is an outdoor kitty. We will just keep on with the raises to see if something happens. He has the occasional low PS value but it is usually high again at the end of the cycle, without a low drop in between. I raised to 2,25 this morning and my partner is home all day to check on him. We will soldier on, as long as Gandalf is happy i am happy!

Thanks again!
 
Ahhh, you're right! The food is listed right there...I missed it. Your numbers could be due to whatever is causing the tummy upset. If he's not feeling well, that could cause higher BGs.
 
An update!
This morning he threw up at +3. Thank god my partner was home all day! He called the vet and could go straight in. Took blood test and liver, kidney and pancreas values all looked fine. BUT he had elevated white blood cell count. If the high WBC count is from his tummy problem or vice versa is hard to say. He was also slightly dehydrated. I guess there is a possibility that he has had an infection for some time that has affected his BG values and is going away, or he just caught something now. He looked really miserable when I got home but closer to dinner time he seemed a bit more alert. We decided to give him wet food as it is easier to add extra water to. He ate about 2/3 of it so he also got a little bit of his rawfood. It is a bit harder to digest than wet food so we do not want to give only that. We waited about 30 min to see that he got to keep his food, then gave him his insulin. We also got a test kit from the vet to collect poop and send for analysis to check for parasites. There has been sooo much poop-talk the last few days! :rolleyes: We also still have to check for ketones so we are keeping 4 eyes on him right now.

We will try and ride this one out and hope he will get better BG values at the other side. If not we will just keep going until we find a method that works for him.
 
Glad you were able to get him right in to the vet! One day at a time is the way to do it. Let us know how things go, especially once you get that poop sample in! :)
 
When something goes wrong, it is scary. (Wouldn't it be nice if they could talk?). But good to know there might be some contributing factors that could explain his being difficult to regulate, and that they could be fixable. Paws crossed.
 
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