Switching from vetsulin to prozinc: Part 5

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OK so Smoky was 168 for PMPS and I'm guessing I need to give him a lower dose tonight. I think 1.5U will be too much for that BG. Any ideas for me for tonight?
He was 176 this past Thursday in pm and I gave 1.25 and Friday morning his BG was 206.
 
Lisa and Smoky said:
OK so Smoky was 168 for PMPS and I'm guessing I need to give him a lower dose tonight. I think 1.5U will be too much for that BG. Any ideas for me for tonight?
He was 176 this past Thursday in pm and I gave 1.25 and Friday morning his BG was 206.
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You gave him 1.5 u on 01/02 when his PMPS was 167 and the AMPS next morning was 247. You had a string of blues on 01/02. The greens today weren't hypo but they were lower than usual so he might be a bit more insulin sensitive. Why not try 1.4 u now that you can measure that out on a U100 syringe?
 
I gave him the 1.2 units of prozinc. It's tricky converting dose to u100 syringe. I take the printout of conversion chart in kitchen with me so I have it right there to measure insulin. I already mentioned that I keep the two kinds of syringes in different rooms to avoid a potentially deadly mix up. I just gave him some cerenia as well and then will be giving the denamarin before bed for his liver issues.
 
Lisa and Smoky said:
I gave him the 1.2 units of prozinc. It's tricky converting dose to u100 syringe. I take the printout of conversion chart in kitchen with me so I have it right there to measure insulin. I already mentioned that I keep the two kinds of syringes in different rooms to avoid a potentially deadly mix up. I just gave him some cerenia as well and then will be giving the denamarin before bed for his liver issues.
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It'll feel clumsy for a while but you'll eventually start memorizing what the dose is measured with a U100 syringe. However, I'm very cautious and always double/triple check the chart and the insulin level in the syringe even though I've been using these for a very long time.
 
I still have two boxes of u40 syringes with half unit markings and a half box of u40 syringes with whole unit on them. I have one box of the u100 syringes with half markings. I keep the u40 ones if I need a dose in whole or half unit doses. The u100 ones for when I need to fine tune his doses.
 
Lisa and Smoky said:
I still have two boxes of u40 syringes with half unit markings and a half box of u40 syringes with whole unit on them. I have one box of the u100 syringes with half markings. I keep the u40 ones if I need a dose in whole or half unit doses. The u100 ones for when I need to fine tune his doses.
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That works. I bought some U40s when Teasel first went on ProZinc but I've only used a few of them. I went to the U100s shortly after the insulin changeover.
 
Smoky was 198 for AMPS so think I will give him 1.5U and do a mid day test later and see how he is doing. His BG was 193 last Monday in the am and gave him same dose so he shld do well.
 
Kris & Teasel said:
Teasel was diagnosed at the end of January 2016 and was on Lantus for the first 2 months. It didn't go well. He had HUGE bounces (360 to 54 in a few hours then back up to near 400) then got stuck in high numbers and wouldn't budge. The vet wanted to take him off insulin for 48 hours and then restart him but after 24 hours without he went into DKA. He spent 3 days in the clinic's ICU but made it through this very $$$$ episode. He was changed to ProZinc after that. Of course I wasn't doing the FDMB thing then so I have no idea if I could've made the Lantus work. I did leave me reluctant to go the Lantus route again. My gut tells me he'd be a bouncer on Lantus and dosing in tiny fractions is a lot harder with it being a U100 insulin. Still leaving the Lantus idea on my back burner.

I've been giving Teasel ProZinc since the beginning of April last year but only came here to FDMB in mid-August. He still bounces, is still unregulated, but has better numbers over all. I have a MUCH better understanding of what's going on with him. He might never be properly regulated - he's that kind of cat. Remission isn't even on my radar. My goal is to keep doing what I'm doing to get his numbers into yellows, blues and maybe good greens as much as possible. I certainly haven't given up on him, I'm just being realistic. I find it much easier to go forward calmly day by day in this sugar dance if I don't set high expectations.
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Wow Kris, you and Teasel have been thru a lot in the last year.:bighug: I kind of feel like a knucklehead griping about Smoky now. :oops:
I am guessing you switched vets since it sounds like that one caused your boy to have a DKA episode.:mad: I can tell you are a wonderful mommy to your fur baby.:p
 
Lisa and Smoky said:
Wow Kris, you and Teasel have been thru a lot in the last year.:bighug: I kind of feel like a knucklehead griping about Smoky now. :oops:
I am guessing you switched vets since it sounds like that one caused your boy to have a DKA episode.:mad: I can tell you are a wonderful mommy to your fur baby.:p
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Yeah, we've been through the wringer! Actually, I still have the same vet because the DKA episode surprised the heck out of her. She was stunned that it set in so soon after stopping insulin. She was treating Teasel the way she's dealt with other FD cats on Lantus but Teasel is ... different. She's a very good vet and is more than willing to work collaboratively with me. She's seen my SS and knows what I do. She trusts my judgment and listens to ideas I have and doesn't require me to set up an appointment to get a new vial of ProZinc, etc. - none of those very uncomfortable situations that you and others have had to face. The DKA episode was just a very unfortunate piece of bad luck.
 
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I'm so glad you have a good vet that is willing to work with you. I think it's probably rare to find one who listens to your ideas and as you said trusts your judgement. I just assumed she was like the vets I've had to deal with lately.:oops:
I'm surprised the vet I have now will let me go and pick up a new vial of prozinc without having to make an appointment first. I think maybe she figured out that I can monitor him myself at home for the most part. I just ask for her professional opinion on how to treat Smoky. I tell her I only want what is best for him and really value her ideas and expertise.:D
 
I think the 1.5 unit dose might be too much for Smoky right now. He dropped down to 90 again at +6 hours, was 198 for AMPS today. I'm not sure if that is too much of a drop or not. I have to go back to work tomorrow so depending on his BG tonight and Tues morning may need to lower dose.
 
Lisa and Smoky said:
I think the 1.5 unit dose might be too much for Smoky right now. He dropped down to 90 again at +6 hours, was 198 for AMPS today. I'm not sure if that is too much of a drop or not. I have to go back to work tomorrow so depending on his BG tonight and Tues morning may need to lower dose.
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That drop isn't bad when you're at home to monitor. You'll probably feel better at work tomorrow if you lower his dose. You have more options with the U100s - 1.4 u or 1.2 u.
 
How would you measure out odd numbers? 1.25; 1.3; 1.75 units for example. Smoky ate two 3 oz cans of FF for breakfast, 1/2 can late morning, and 1/2 can for lunch. I think his appetite is picking up a little bit.
 
Lisa and Smoky said:
How would you measure out odd numbers? 1.25; 1.3; 1.75 units for example. Smoky ate two 3 oz cans of FF for breakfast, 1/2 can late morning, and 1/2 can for lunch. I think his appetite is picking up a little bit.
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For odd numbers, I eyeball between the half unit marks on the U100s. The marks are closer together than on the U40s but it's do-able. If I want an even smaller fraction, eg. 1.25 u, I'd nudge the end of the plunger just up to but beyond the 1.2 u line. It would just barely be touching the far side (ie., toward 1.4 u) of the 1.2 u mark. You could also dose 1.25 u with a U40 syringe.

I'm glad Smoky's more interested in food. :)
 
Someone should invent a syringe with quarter markings on it.:joyful: that would be so awesome. I've been thinking about what could be causing him not to gain weight. I am trying to give him some new low carb higher calorie food to try but he can be quite a snob at times.;)
 
Smoky was 170 for PMPS, thinking about giving a 1.2 or 1.4 unit dose. He dropped down to 90 from 198 by +6 which I don't think is too much is it? I set his no shot number for under 140. His pm shot is due in about 30 minutes from now, any ideas?
Guess I will play it safe and give him 1.2 units again for tonight.
 
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Lisa and Smoky said:
Someone should invent a syringe with quarter markings on it.:joyful: that would be so awesome. I've been thinking about what could be causing him not to gain weight. I am trying to give him some new low carb higher calorie food to try but he can be quite a snob at times.;)
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Nice PMPS!
 
Smoky was 182 for tonight, was the 1.5U too much? I noticed his PMPS is a little higher today than Monday night. I think he will be OK with 1.4U dose? I'll play it safe and give him 1.25 units tonight.
 
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Lisa and Smoky said:
Smoky was 182 for tonight, was the 1.5U too much? I noticed his PMPS is a little higher today than Monday night. I think he will be OK with 1.4U dose? I'll play it safe and give him 1.25 units tonight.
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Hi Lisa,

Just seeing this now - I was out at a meeting. He'll be fine with 1.25 u. You're really getting the hang of this sliding scale dosing and Smoky handles it well. :)
 
I don't think the 1.25U was a high enough dose last night. Either that or he dropped low and bounced. amps was 297, almost out of the yellows. I plan on giving him 1.5U this morning. Too much or too little?
 
Smoky was 232 for AMPS. Is it just me or does it seem his insulin is losing its effectiveness? He has been using the same vial for 8 weeks today. I'm not even sure what dose to give him tonight? The 1.5 or 1.75 units.

I just ended up giving him the 1.5 units, he doesn't seem to want to get his shots over the last week. Most of the time he doesn't even notice when he gets them.
He seems to be feeling bad again, maybe time to give him bupe once more.
 
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Lisa and Smoky said:
Smoky was 232 for AMPS. Is it just me or does it seem his insulin is losing its effectiveness? He has been using the same vial for 8 weeks today. I'm not even sure what dose to give him tonight? The 1.5 or 1.75 units.

I just ended up giving him the 1.5 units, he doesn't seem to want to get his shots over the last week. Most of the time he doesn't even notice when he gets them.
He seems to be feeling bad again, maybe time to give him bupe once more.
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The 1.5 u should be fine. I don't think your BGs are getting high enough to question the potency of your ProZinc. The yellows recently could be mild bouncing after the greens of 2 days ago.

Re shots: do you always inject in the same area? Maybe he's a bit tender? It might be related to him not feeling well too. You could try giving bupe.
 
I inject in several different areas and never in the same spot twice.
I think I will give him some bupe tomorrow in case he is having a flare up from the pancreatitis.
 
Smoky was 187 for AMPS, I don't think the 1.5 dose wld be too much for him. I have to work today so it's hard to monitor him. I can run home for lunch on occasion but it's our busy time of the year. Maybe 1.4 units might be better?
 
Lisa and Smoky said:
Smoky was 187 for AMPS, I don't think the 1.5 dose wld be too much for him. I have to work today so it's hard to monitor him. I can run home for lunch on occasion but it's our busy time of the year. Maybe 1.4 units might be better?
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You have the option of doing 1.4 u so go for it. You'll feel less anxious at work. :)
 
Lisa and Smoky said:
I gave him the 1.4 units for am. His appetite is still not what it was
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He might need some doses of those meds for a bit.

Edit: Some people here with sensitive/chronic issues kitties use antinausea/appetite/pain meds fairly regularly to keep kitty feeling better.
 
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Hi Lisa - Murphy also has triaditis He was on Prozinc for 10 months before I switched to Levemir and he's still not regulated. I would say that besides insulin, the most important drug for Murphy is cerenia. He gets 4 mg daily for 5 days, then skip a day, then restart. This drug has made a world of difference for him in his vomiting and pancreatitis episodes. He also gets compounded urosodial daily - I have it made into a liquid, and give him 1 ml after his pm meal, and he doesn't mind it - supposed to help with liver and bile duct issues. He is also on denamarin but I have to confess, I don't give it to him much. I definitely would never give to him on an empty stomach, which is what the package directions say. Every time I do, he vomits it up in ~10-15 minutes. If I do give to him, I make sure he has a tiny bit of food with it - that definitely helps. But my best piece of advice - at the very first sign that Murphy isn't eating at either pmps or amps, I immediately give him 1 mg of ondansteron and 1 mg of cyproheptadine for appetite stimulation. I would never give him the cypro without the ondansteron
 
Carol & Murphy said:
Hi Lisa - Murphy also has triaditis He was on Prozinc for 10 months before I switched to Levemir and he's still not regulated. I would say that besides insulin, the most important drug for Murphy is cerenia. He gets 4 mg daily for 5 days, then skip a day, then restart. This drug has made a world of difference for him in his vomiting and pancreatitis episodes. He also gets compounded urosodial daily - I have it made into a liquid, and give him 1 ml after his pm meal, and he doesn't mind it - supposed to help with liver and bile duct issues. He is also on denamarin but I have to confess, I don't give it to him much. I definitely would never give to him on an empty stomach, which is what the package directions say. Every time I do, he vomits it up in ~10-15 minutes. If I do give to him, I make sure he has a tiny bit of food with it - that definitely helps. But my best piece of advice - at the very first sign that Murphy isn't eating at either pmps or amps, I immediately give him 1 mg of ondansteron and 1 mg of cyproheptadine for appetite stimulation. I would never give him the cypro without the ondansteron
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Thanks for this, Carol. I know you have a wealth of info on managing a kitty with complex health issues. I wasn't able to advise Lisa but remembered that you and others use these meds most of the time to forestall problems.
 
Carol & Murphy said:
Hi Lisa - Murphy also has triaditis He was on Prozinc for 10 months before I switched to Levemir and he's still not regulated. I would say that besides insulin, the most important drug for Murphy is cerenia. He gets 4 mg daily for 5 days, then skip a day, then restart. This drug has made a world of difference for him in his vomiting and pancreatitis episodes. He also gets compounded urosodial daily - I have it made into a liquid, and give him 1 ml after his pm meal, and he doesn't mind it - supposed to help with liver and bile duct issues. He is also on denamarin but I have to confess, I don't give it to him much. I definitely would never give to him on an empty stomach, which is what the package directions say. Every time I do, he vomits it up in ~10-15 minutes. If I do give to him, I make sure he has a tiny bit of food with it - that definitely helps. But my best piece of advice - at the very first sign that Murphy isn't eating at either pmps or amps, I immediately give him 1 mg of ondansteron and 1 mg of cyproheptadine for appetite stimulation. I would never give him the cypro without the ondansteron
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Thanks Carol, I don't have the ondansteron or urosodial but will ask my vet about it.
 
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Lisa and Smoky said:
I don't have the ondansteron but will ask my vet about it.
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It's imperative to treat nausea. It's a human drug that was developed for people on chemotherapy. It acts differently from cerenia, which is basically an anti vomiting drug. So Murphy gets basically daily cerenia, and when he seems nauseated he gets ondansteron and when he is not eating, he gets ondansteron and cyproheptadine
 
Smoky has the cypro for appetite stimulant, cerenia although not sure why vet gave me that, he rarely has nausea.
Bupe for pain, given orally as needed. Metoclopramide for gut issues I think. Denamarin for liver health. I have to call vet about ondansteron and urosodial for him.
 
You should ask the vet about daily dosing of cerenia - it is antivomiting and anti-inflammatory as well, so can prevent pancreatitis as I understand it - it's really standard therapy
 
I can ask her about that as well. She told me to give 1/4 tab of cerenia every 3 days. He only has enough to last him for 16 doses.
He usually eats a lot of food so this is new having his appetite off. Plus my vet will only give me pre-filled syringes of bupe to give to smoky for pain. She only gave me 10 of them and I used three so far. The dose she gave me doesn't seem to have much of an effect. I am concerned that he is having so much trouble putting weight back on even when he was eating 4 to 5 cans of FF per day.
 
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Smoky PMPS was almost the same as in am, morning was 187 and night was 182.
Isn't that a good thing to happen? Also, wld it be too much to give the 1.5 units again tonight?
 
Lisa and Smoky said:
Smoky PMPS was almost the same as in am, morning was 187 and night was 182.
Isn't that a good thing to happen? Also, wld it be too much to give the 1.5 units again tonight?
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That's a great thing to happen- and they're blues! The 1.5 u was good this AM so should be good tonight.
 
This morning's 247 might be a very slight bounce if he went lower overnight. I'd try 1.5 u again because you're at work today.
 
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