Switching from Lantus to Prozinc on 12/27/16

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Shoeskitty-GA

Shoeskitty-GA

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Since Lantus is a depot insulin, how long should my cat go without insulin prior to his first Pro Zinc shot? He is currently on one half (0.50) units Lantus. He is presently bouncing from some lows yesterday down to 57. I am thinking no more doses after today's PM dose that he just got.

Any experienced ProZinc user have any suggestions or advice on this?

Here is a link to my introduction post.
http://www.felinediabetes.com/FDMB/threads/a-few-questions-for-the-prozinc-users-please.169825/

I would really appreciate your input since Lantus is a depot insulin.

Thanks and wishing all a Merry Christmas!
 
Hello!
Well I would say 12 hours between the last Lantus shot untill the next Prozinc shot and of course carefully monitor the BG of your kitty to be sure he doesn't make strange drops.

Maybe somebody else will stop by with any advise but if I would be in your shoes I would go with 12 hours.

Merry christmas!
 
Ruby&Baco said:
Hello!
Well I would say 12 hours between the last Lantus shot untill the next Prozinc shot and of course carefully monitor the BG of your kitty to be sure he doesn't make strange drops.

Maybe somebody else will stop by with any advise but if I would be in your shoes I would go with 12 hours.

Merry christmas!
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Thanks!
 
Hmmm...tough one for me. I've never used Lantus so I don't have much info about it and how the depot works...or how that could interfere with Prozinc. I think I've seen before that the depot lasts about 12 hours, making Ruby's suggestion a good one. I'm going to take @Kris & Teasel too and Kris has used Lantus and might have some suggestions and input that I don't.

I just read through your previous thread. Are you going to have to leave him at the vet for the first few days like you thought? What does are you planning to start at? With your current Lantus being 0.5, I would say that's a good dose to start with here as well.

I can't see your SS right now...do you have it set to allow others to view?

Merry Christmas! Ask whatever questions you want...that's what we're here for!
 
Thanks Rachel. I do not have my ss set for anyone to view right now. In higher doses, I know lantus can affect 3 cycles or 36 hours. I misspoke in my first post in this thread about his current dosage. He earned a reduction yesterday to 0.30 but he is bouncing really high. I think that I can probably give him his AM shot tomorrow and not worry about the depot when we start the ProZinc Tuesday.

I won't be leaving him overnight because there is no one at the vet's office overnight but I will probably have to leave him during the day Tues. And maybe Wed for the vet to do his curve to check dose. I don't want to as I can do the curves at home since I use the AT2 but I will probably have to. And I will lower the dose if too high when he starts it. O won't be dosing agressive.
 
DHTK said:
Merry Christmas. Can I ask why u don't like lantus?
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It is not being absorbed properly by my cat causing big swings and inconsistent numbers. It doesn't work in Shoes like it does in other cats. Have tried it for 10 months. Shoes is a very very bouncy kitty and hard to regulate.
 
Gotcha! Yeah I think you should be fine giving him his AM shot tomorrow. I understand about not wanting to leave him at the vet...but if the vet requires it for liability reasons, I can understand that. I don't like it as you don't, but they do have to cover themselves. At least he'll be home at night, so I'm sure he'll be fine.

Please do let us know how it goes and when you get him back, if you want, we'd be happy to help advise on dose. We have some aggressive dosers here in the forum, but generally speaking they have a LOT of data and experience with this insulin behind them. We tend to be conservative in our advice for most people, and everyone who starts out does not dose aggressively. It's just too dangerous. So trust me, you won't be alone in that! :)
 
Rachel said:
Gotcha! Yeah I think you should be fine giving him his AM shot tomorrow. I understand about not wanting to leave him at the vet...but if the vet requires it for liability reasons, I can understand that. I don't like it as you don't, but they do have to cover themselves. At least he'll be home at night, so I'm sure he'll be fine.

Please do let us know how it goes and when you get him back, if you want, we'd be happy to help advise on dose. We have some aggressive dosers here in the forum, but generally speaking they have a LOT of data and experience with this insulin behind them. We tend to be conservative in our advice for most people, and everyone who starts out does not dose aggressively. It's just too dangerous. So trust me, you won't be alone in that! :)
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Thanks Rachel. I will definitely need dosing help! My biggest fear is hard and fast drops like when he was on Novolin.
 
I think you might need to wait longer then 12 hours when switching from Lantus to Prozinc as Lantus can last longer then 12 hours in a cat.
In humans Lantus lasts between 24 - 48 hours, in cats usually half of that so it might still be in the system for quite a while so I would wait 24 hours before starting another insulin specially that you said you had an unusual response from Lantus.
Would be interesting to see what L/L users think about that.
 
Shoeskitty said:
Thanks! I am very nervous. Can't go through another hypo.
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Aren't there some guidelines for reducing dose when you transition to a new insulin? I think I've read that some (brave) people do a 1 to 1 dose translation but I wouldn't do it myself. Maybe post another question marked thread asking about that?
 
The stickys suggest 1 unit as a starting dose. I have not idea what vet will decide but I will be asking for .50 unit to start.
 
Shoeskitty said:
The stickys suggest 1 unit as a starting dose. I have not idea what vet will decide but I will be asking for .50 unit to start.
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Because there's no depot that needs to fill with ProZinc, it's "in-and-out"-ness allows you to change dose more readily. You'll know in a few cycles what the 0.50 u is doing.
 
Kris & Teasel said:
Because there's no depot that needs to fill with ProZinc, it's "in-and-out"-ness allows you to change dose more readily. You'll know in a few cycles what the 0.50 u is doing.
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That is why I posted this question. I think his depot will be pretty well drained by tomorrow as I dropped him down to 0.3 for the PM Shot on 12/24 and he won't get a shot tonight or in the am so it should be drained. As we all know ECID and since Shoes doesn't absorb the lantus like other cats, I truly think this will be enough to completely drain him. Prayers I am right.
 
Shoeskitty said:
That is why I posted this question. I think his depot will be pretty well drained by tomorrow as I dropped him down to 0.3 for the PM Shot on 12/24 and he won't get a shot tonight or in the am so it should be drained. As we all know ECID and since Shoes doesn't absorb the lantus like other cats, I truly think this will be enough to completely drain him. Prayers I am right.
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We can only do what we think is right, Sandi. If 0.5 u is significantly lower than his Lantus dose you should be OK. I'm sure you've arranged it for a day when you can monitor. ;)
 
Well, I just heard from our vet and he spoke with an internist at Purdue University's Veterinary College and that vet told him to stick with the Lantus. Am so danged upset about this now!! I had finally gotten over most of the fears and was ready to change but vet won't agree to it now. I take Shoes in for bloodwork at 8:30 am tomorrow so will discuss further. GRRRRRR
 
Shoeskitty said:
Well, I just heard from our vet and he spoke with an internist at Purdue University's Veterinary College and that vet told him to stick with the Lantus. Am so danged upset about this now!! I had finally gotten over most of the fears and was ready to change but vet won't agree to it now. I take Shoes in for bloodwork at 8:30 am tomorrow so will discuss further. GRRRRRR
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I'm sorry this roadblock has been put in your way. I wonder if the internist had anything to offer about your kitty's absorption issues. The vet academics will of course go by the published research (Roomp and Rand) but I'm not sure why your vet is so closed to the idea. Do you really like your vet?
 
I hope to find out why tomorrow. And yes, I have had this vet for 26 years and I do like him and trust him. But am pretty frustrated and angry with him at the moment so I would change if I felt like I had to.
 
Shoeskitty said:
I hope to find out why tomorrow. And yes, I have had this vet for 26 years and I do like him and trust him. But am pretty frustrated and angry with him at the moment so I would change if I felt like I had to.
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I'm lucky in that my vet prefers a collaborative approach with her clients. She was the one who suggested ProZinc after Teasel's DKA at the end of his time on Lantus. I'm the only client using ProZinc. When I talked to her at length about my switch to the FDMB way of doing things she was very supportive.
 
Dang, I'm sorry to hear that. Lantus is a good insulin, but you've been on it for some time now...and are ready to make the switch. Has this vet at Purdue ever even seen your cat?
 
Rachel said:
Dang, I'm sorry to hear that. Lantus is a good insulin, but you've been on it for some time now...and are ready to make the switch. Has this vet at Purdue ever even seen your cat?
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No the vet at Purdue has not seen Shoes. I didn't even know our vet was going to do a phone consult. I am mad to say the least. I hope to find out why he changed his mind when I see him tomorrow.
 
Shoeskitty said:
I hope to find out why tomorrow. And yes, I have had this vet for 26 years and I do like him and trust him. But am pretty frustrated and angry with him at the moment so I would change if I felt like I had to.
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My old vets office was ours for his whole life after he was fixed at 5 months (started spraying so got fixed a month early). We switched after he was Dx with FD. I lost faith in their office all together after his usual vet looked over his records and didn't really see a problem starting on 7 units twice a day no matter how much he ate or didn't eat.
My new Vet loves the home care approach and just wants me to check in every now and then so she knows how he's doing.

Maybe YOU can get a phone consult with the vet at Purdue. See if that will convince them you know what you're talking about and have done plenty of homework on it!
 
Yeah the fact that the vet hasn't even seen Shoes and that your vet decided to do a phone consult without telling you...tells me he doesn't know how to deal with diabetes. The research you have done should be enough for him in my opinion. Let us know how it goes tomorrow.
 
Rachel said:
Yeah the fact that the vet hasn't even seen Shoes and that your vet decided to do a phone consult without telling you...tells me he doesn't know how to deal with diabetes. The research you have done should be enough for him in my opinion. Let us know how it goes tomorrow.
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I will.
 
Well, I am not as angry as I was. I would definitely prefer that my vet or my physician to consult with a specialist if he were uncertain about something. My vet did tell the internist at Purdue everything that pertained to Shoes, his hypo, absorbing issues, age, that I work, my fear of another hypo, everything and she said that we really needed to increase his insulin to 1 unit or more (we settled on 1 unit) and to stay with the Lantus because in her experience it was the best for Shoes now. She said that the drops were gentle, etc. and I can give higher carb if needed to help regulate him. Not sure if I totally understood everything that was told to me but basically, she said that the dose I was giving was really not doing much of anything to help him, that his pancreas kicked in putting out natural insulin at the times when he had his low numbers etc. She said that Shoes body would react the same on the ProZinc too if I was not giving enough insulin for his needs. My vet said I could continue with my present course and not increase up but changing would not solve the issues if I was not willing to increase as needed and overcome my fears of another hypo. So it basically made sense to me and I agreed to try it for now. We increased up from .50 to 1 unit tonight. And I am absolutely terrified! I will also be leaving more food out 24/7 so that if Shoes needs to eat due to getting low, he can have access to food if he wants it.

This specialist was also very much involved in the PZI insulin, that is no longer available from the original manufacturer. In what capacity I don't know but was evidently part of that team. So she has not problems with Pro Zinc, just thinks a higher dose of Lantus would be better for Shoes.

So that's what I found out today. If you are a person that believes in prayer, I would appreciate them as I struggle to do this. Thank you all for everything!

Sandi
 
I don't really believe in prayer but I will send tons of good and healing vines for Shoes and tons of hugs and support for you! I can't really advise at all on the Lantus but you might try their page for some help and support? Of course, you're welcome to post here too...and we'll be happy to offer encouragement! :)

Let us know how things go.
 
Shoeskitty said:
Well, I am not as angry as I was. I would definitely prefer that my vet or my physician to consult with a specialist if he were uncertain about something. My vet did tell the internist at Purdue everything that pertained to Shoes, his hypo, absorbing issues, age, that I work, my fear of another hypo, everything and she said that we really needed to increase his insulin to 1 unit or more (we settled on 1 unit) and to stay with the Lantus because in her experience it was the best for Shoes now. She said that the drops were gentle, etc. and I can give higher carb if needed to help regulate him. Not sure if I totally understood everything that was told to me but basically, she said that the dose I was giving was really not doing much of anything to help him, that his pancreas kicked in putting out natural insulin at the times when he had his low numbers etc. She said that Shoes body would react the same on the ProZinc too if I was not giving enough insulin for his needs. My vet said I could continue with my present course and not increase up but changing would not solve the issues if I was not willing to increase as needed and overcome my fears of another hypo. So it basically made sense to me and I agreed to try it for now. We increased up from .50 to 1 unit tonight. And I am absolutely terrified! I will also be leaving more food out 24/7 so that if Shoes needs to eat due to getting low, he can have access to food if he wants it.

This specialist was also very much involved in the PZI insulin, that is no longer available from the original manufacturer. In what capacity I don't know but was evidently part of that team. So she has not problems with Pro Zinc, just thinks a higher dose of Lantus would be better for Shoes.

So that's what I found out today. If you are a person that believes in prayer, I would appreciate them as I struggle to do this. Thank you all for everything!

Sandi
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Thank you for passing this on, Sandi. I found it very interesting reading. I'm intrigued about giving higher carb food if needed, I assume because it allows larger insulin doses with a lowering of hypo danger. I know that's an approach taken for DKA kitties because they need hefty doses of insulin to clear ketones. This sort of meshes with my thinking about Teasel's insulin doses. I tiptoe ever so gently around them and still have bounces galore. I often think I just need to hit him with big enough doses to get his numbers down but didn't think about using higher carb food as part of the protocol. Lots to think about ...
 
Rachel said:
I don't really believe in prayer but I will send tons of good and healing vines for Shoes and tons of hugs and support for you! I can't really advise at all on the Lantus but you might try their page for some help and support? Of course, you're welcome to post here too...and we'll be happy to offer encouragement! :)

Let us know how things go.
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Thank you Rachel, I appreciate whatever support you believe in and can send my way!
 
The good news is that you know how to deal with a hypo if needed. My concern is the rationale from the specialist. I would think we would want the pancreas to kick in and if a low dose did that, it would be a good thing, but maybe I am not understanding. Giving more insulin and planning on dealing with low numbers with food is what TR is all about, but it is tricky and a little nerve wracking, and I had thought difficult with your schedule. It is true that Lantus tends to be a gentle insulin with flatter cycles, so I hope this is what you see. Paws and fingers crossed here.

You are prepared if he drops low, so increasing the dose and watching carefully should give you information and evidence, if it proves to be needed, to try ProZinc, if you decide to try that.
 
I am still somewhat confused still. I agreed to try it and will start tomorrow morning. I don't go back to work until Jan 3 so that gives me 5 days to try it. If I am not comfortable with it, will stop it and continue as is.
 
Shoeskitty said:
I am still somewhat confused still. I agreed to try it and will start tomorrow morning. I don't go back to work until Jan 3 so that gives me 5 days to try it. If I am not comfortable with it, will stop it and continue as is.
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The only way to test out these things is to try them, Sandi. You can always go back to Lantus without worrying about a depot.
 
Sue and Oliver (GA) said:
The good news is that you know how to deal with a hypo if needed. My concern is the rationale from the specialist. I would think we would want the pancreas to kick in and if a low dose did that, it would be a good thing, but maybe I am not understanding. Giving more insulin and planning on dealing with low numbers with food is what TR is all about, but it is tricky and a little nerve wracking, and I had thought difficult with your schedule. It is true that Lantus tends to be a gentle insulin with flatter cycles, so I hope this is what you see. Paws and fingers crossed here.

You are prepared if he drops low, so increasing the dose and watching carefully should give you information and evidence, if it proves to be needed, to try ProZinc, if you decide to try that.
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More thoughts here Sue after my original reply. I was at my oncologist appointment for 6 mth. checkup and reply hurriedly. I think that the specialist meant that the small doses that he has been on was not having an effect or minimal effect because he doesn't get into the low yellows, blues or high greens frequently and when he does, that it is only because the pancreas has decided to put out it's own natural insulin, then stops putting it out. Then he bounces thanks to Mr. Liver. I thought that the Lantus was causing the drop to lower numbers so I was wrong. She said something about leaving food out 24 hrs. and getting him to self-regulate himself better. I thought that meant that this meant that he would go eat when he dropped too low (he won't do this) but I was wrong but I can't remember why. Anyway, I still have reservations about this but will try it, but maybe start with 0.75 dose instead of the 1 unit and try to get him to eat the higher carb food, etc. His appy is not always consistent so that's an issue with increased dose too. My vet is not pro meds so he won't give my cypro or another appy stimulate right now.
 
Shoeskitty said:
I think that the specialist meant that the small doses that he has been on was not having an effect or minimal effect because he doesn't get into the low yellows, blues or high greens frequently and when he does, that it is only because the pancreas has decided to put out it's own natural insulin, then stops putting it out.
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This is a very interesting statement to me. I've often wondered why Teasel will be in too high a range on a dose but then he gives me an odd low here and there on that dose. This might be (part of) what's going on.
 
I had always thought the pancreas doesn't join the party until the levels are lower. At least that's what we usually see - the levels start to drop and pretty soon you see a long cycle with a lower than expected pre shot. It looks like the insulin is lasting longer than 12 hours, but we figure the pancreas has kicked in to keep the levels lower.
 
Sue and Oliver (GA) said:
I had always thought the pancreas doesn't join the party until the levels are lower. At least that's what we usually see - the levels start to drop and pretty soon you see a long cycle with a lower than expected pre shot. It looks like the insulin is lasting longer than 12 hours, but we figure the pancreas has kicked in to keep the levels lower.
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Her comments were probably specific to Shoes and we all know ECID. But I think it is true in Shoes case. I believe that diabetes is a result from a malfunctioning pancreas so it makes sense to me. So basically Shoes needs more insulin to have lower numbers. My vet said it would be much easier to dose insulin if the pancreas was totally unable to produce any more insulin because you wouldn't see the crazy swings from really low numbers to high numbers for the most part because there would be no unexpected bursts of insulin released by the pancreas. The exogenous insulin would be the only insulin in play. This makes a lot of sense to me.
 
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