Switching from vetsulin to prozinc: Part 5

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Link worked fine! Glad you reduced...he definitely needed it! Those yellow preshots are nice!
 
Smoky was 193 for AMPS so am deciding between 1.5 and 1.75 units? Leaning towards the 1.5 though.
 
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I'm still reading all the stickies on there yet. The price of Lantus is the hardest part to consider. The dosing doesn't seem to be as flexible as the prozinc. Smokys BG's seem to be stabilizing again. I ordered the u100 syringes and they sent me the wrong order so I had to return it.:eek: I shld get the right ones with half markings in a few days. What size needle do you use with Teasel? The 5/16 or 1/2 inch ones?
 
I'm still reading all the stickies on there yet. The price of Lantus is the hardest part to consider. The dosing doesn't seem to be as flexible as the prozinc. Smokys BG's seem to be stabilizing again. I ordered the u100 syringes and they sent me the wrong order so I had to return it.:eek: I shld get the right ones with half markings in a few days. What size needle do you use with Teasel? The 5/16 or 1/2 inch ones?
I use 29G 1/2 inch needles on Teasel. I find these thin enough while being a bit less prone to bending and I like the slightly longer needle because it gives a little more margin depth-wise. My hands are crap so I need all the help I can get. ;)

Yes, Lantus is very expensive for you. However, many people order from Marks Marine Pharmacy here in Canada and from what I gather that's perfectly legal. You can post on L&L to ask more about that. The dose timing is definitely more restrictive with Lantus because of the depot. ProZinc is so very flexible - one of the things that I really like about it.
 
That is the same size I use for Smoky with the u40 syringes, I have two boxes of those now. I had a hard time in the US finding u100 syringes with half unit markings that are 29 G and 1/2 inch?

I spoke to pharmacist about that and it's more common to find u100 syringes that have half markings with shorter needles which I don't like. She gave me a few sites that sell them with 1/2 inch needles.

I know you use FS lite strips in your AT2 meter at times. Do you always do a comparison between those and AT2 strips when you open a new bottle? I ask this since I have a new unopened bottle of FS lite strips but only 3 or 4 AT2 test strips left. Do I need to change the code on my AT2 meter each time I open a new bottle of strips?
 
That is the same size I use for Smoky with the u40 syringes, I have two boxes of those now. I had a hard time in the US finding u100 syringes with half unit markings that are 29 G and 1/2 inch?

I spoke to pharmacist about that and it's more common to find u100 syringes that have half markings with shorter needles which I don't like. She gave me a few sites that sell them with 1/2 inch needles.

I know you use FS lite strips in your AT2 meter at times. Do you always do a comparison between those and AT2 strips when you open a new bottle? I ask this since I have a new unopened bottle of FS lite strips but only 3 or 4 AT2 test strips left. Do I need to change the code on my AT2 meter each time I open a new bottle of strips?
I buy my U100 syringes with half unit marks from my vet because it's hard to find those at a human pharmacy here and the price is the same. I pay $25 CAD per box of 100 and can buy OTC if a human pharmacy stocked them. You can probably get them cheaper where you are.

Re FS strips: I'm using them almost exclusively now because I've learned to trust their readings in my AT meter. They read very close to the AT strips. I start by testing a strip from a new vial of FSs with the AT control solution. At the beginning I always did 3 or 4 same drop comparison tests when I started a new vial. This last time I didn't, only did the control solution test. I really should have done at least a couple of same drop comparisons. However, if Teasel throws a low number I always retest with an AT strip to verify. The last time I did that recently, the FS strip in AT meter gave me a 5.6 and the AT strip a 5.4. Not the same drop but still a good comparison.

I leave my AT meter set at whatever cat code my current vial of AT strips requires. So - at this point, my supply of very $$$$ AT strips ($102 CAD for a 50 strip vial from my vet) is relegated to being used as "double checking" strips or to use if I end up in the position of tracking progress through a hypo.

My plan going forward is to keep using the FS strips routinely but always have a backup vial of AT strips fer verification purposes. I know that FS strips are still pricey for you compared to other human meter strips. Almost all test strips here are relatively expensive and we can't get Walmart ReliOn products here. The FS is a decent compromise for me.
 
The FS lite strips run about $60 for a vial of 50 in my area. I can't get AT2 test strips from my vet, have to order them online.
So you reset code on AT2 meter each time you start a new vial, is that correct?
The AT2 strips are $55 to $60 for 50 of them so about the same price. The Relion strips are $35 for 100 of them.
What brand do you use for the u100 syringes?
 
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The FS lite strips run about $60 for a vial of 50 in my area. I can't get AT2 test strips from my vet, have to order them online.
So you reset code on AT2 meter each time you start a new vial, is that correct?
The AT2 strips are $55 to $60 for 50 of them so about the same price. The Relion strips are $35 for 100 of them.
What brand do you use for the u100 syringes?
Yes, the AT meter has to be set at whatever cat code number is on the vial of AT strips. Having said that, I've had cat code 38 for several AT vials in a row. There isn't a large number of different codes. My FS strips end up costing me about $36 CAD for a vial of 50.

I've had Monoject brand syringes from my vet, Ulticare from a human pharmacy and the last several boxes from my vet are a brand called Elimedical marketed to vets for animals. They have a cat and a dog on the box.

I saw on the L&L forum that you contacted Marks Marine Pharmacy. They're based in Vancouver. Would they ship Lantus to a Canadian pharmacy across the border at a point closer to you? You mentioned maybe driving to pick them up. Shipping in the winter is a problem.
 
I would have to get a passport first to go into Canada. I would have to check on the possibility of them shipping Lantus to a closer place. I don't actually know if it is legal to drive into Canada and transport insulin in a car across the border.
Do you have to put in the code from a vial of FS lite test strips into the AT2 meter or is that just for the AT2 strips? Can I use the FS strips in that meter or do they have to be FS lite strips? I have a vial of the FS lite strips.
 
Do you have to put in the code from a vial of FS lite test strips into the AT2 meter or is that just for the AT2 strips? Can I use the FS strips in that meter or do they have to be FS lite strips? I have a vial of the FS lite strips.
No, you leave the AT meter set at the cat code from your current vial of AT strips. Ignore any code on the FS vial. When I mention FS strips, I'm referring to Freestyle Lite strips, the ones that have the butterfly on them and are identical in appearance to the AT strips. They are, in fact, identical. They're both made by Abbott/Zoetis. The difference is that the AT strips undergo special batch testing to ensure they work properly in the AT meter when it's set at the cat code on the vial.

Sounds like accessing Lantus in cold weather would be a major undertaking for you. You might consider staying with ProZinc for a bit longer although I know you're concerned about how Smoky is feeling.
 
He was doing better yesterday and today. I don't know how he would be though if he needs higher doses of prozinc. I read on another thread that cats with pancreatitis could benefit from being given enzymes. How do I tag someone on this forum? I believe it was @Critter Mom who mentioned it.
 
He was doing better yesterday and today. I don't know how he would be though if he needs higher doses of prozinc. I read on another thread that cats with pancreatitis could benefit from being given enzymes. How do I tag someone on this forum? I believe it was @Critter Mom who mentioned it.
You've just tagged Critter Mom by putting the @ symbol in front of her screen name.

I think there are many factors that play into Smoky feeling better: insulin dose, maybe ProZinc itself, more calories so he can gain some weight, more time recovering from all he's been through since diagnosis, the challenges of his other allergies, etc. He's not a simple case as I'm sure you know. I think he's still in recovery mode. His BG progress on ProZinc has been very good and it might be that his good dose will be smaller along with him becoming accustomed to lower numbers as someone else mentioned.

The best you can do right now is keep notes on his clinical signs as the PZ dose changes. Are you trying to give extra meat at his meals? More calories is one thing you can tackle right now. He's not a cat that needs any sort of restriction in amount of food at this point. How is he handling the Petsafe feeder?
 
I cooked a pork chop for him but he won't eat it mixed up in his canned food. I cut some of it up for him and he ate it that way. Smoky loves meat and would probably do well on a raw food diet. Unfortunately, that's not something I can afford to do right now. If he gets too filled up on the meat he won't eat his regular food. He doesn't like the pet feeder as the compartments are smaller than his bowl. He will eat out of it and has already learned that when he hears tray turning to come and look for food.:cat:
 
I cooked a pork chop for him but he won't eat it mixed up in his canned food. I cut some of it up for him and he ate it that way. Smoky loves meat and would probably do well on a raw food diet. Unfortunately, that's not something I can afford to do right now. If he gets too filled up on the meat he won't eat his regular food. He doesn't like the pet feeder as the compartments are smaller than his bowl. He will eat out of it and has already learned that when he hears tray turning to come and look for food.:cat:
Could you put some meat snacks in his Petsafe so you're not messing with his canned food meals?
 
Yep, I can do that. I have it set for brunch 4 hrs after his breakfast, and 4 hrs after that so he can eat lunch. I get home from work about an hour after that. I then pick up any food he still has down to have that 2 hour window open before his PMPS test.
I still have two time spots open I can set to put in his meat snacks for him.
 
Yep, I can do that. I have it set for brunch 4 hrs after his breakfast, and 4 hrs after that so he can eat lunch. I get home from work about an hour after that. I then pick up any food he still has down to have that 2 hour window open before his PMPS test.
I still have two time spots open I can set to put in his meat snacks for him.
Sounds like a plan! Many people here swear by a raw food diet but it can be expensive. I have three eating in separate rooms and different foods. Too complicated ...
 
Sounds like a plan! Many people here swear by a raw food diet but it can be expensive. I have three eating in separate rooms and different foods. Too complicated ...
I know what you mean. My roommate has two civvies, one eats his food in kitchen, the other cat eats her food in roommates bedroom, and smoky eats in my bedroom.:facepalm:
 
Actually, that's a nice drop. Is he still feeling OK today?
Smoky is looking a bit out of sorts. I think he might be a little nauseous so may give him some cerenia tonight. His appetite has dropped a lot today. He was 174 for PMPS so debating between 1 or 1.5 units to give him tonight. The other option is to skip his shot, give him the cerenia, and see how he is in the morning. I suspect he may be having a flare up from his pancreatitis.
 
Lisa, what you could do is feed Smokey his regular food but then supplement it with fresh food. Since he has allergies you might want to stick with only one "extra" species such as beef so that if he started reacting you could easily determine the culprit. You could get ground beef and freeze it into daily or two day amounts. Ground beef is easy to mix into his regular food so it is all stirred together.

Beef heart is also good in that you can cut it into the size of pieces you want and use it for treats. It isn't very expensive, probably less than buying packaged treats. Same as the ground beef, cut into pieces and freeze and thaw only a day or two at a time. My apologies if you already know this but it is important to thaw in the fridge always (not on the counter) with raw meat.

Re-reading your signature (pancreatitis), beef heart might be better than ground beef because it is lower fat. Or at least get ground beef with a lower fat content.

I assume it is the same with cats as with dogs. Generally when feeding a commercial diet formulated to AAFCO, you can get 20% of daily calories from fresh food without wrecking the ratios of the commercial food, such as calcium to phosphorus, zinc to iron, zinc to copper, etc.

I see Smokey is allergic to soy. So am I. I have a dog that is trained to check my food for soy.
Beef tends to raise his BG's somewhat.
I noticed when I stopped giving him beef or venison his BG would improve and these meats seem to aggravate his IBD.
Oddly enough, he is allergic to chicken but not turkey, duck, pork, or quail.:joyful:.
I don't get that at all.
 
Smoky is looking a bit out of sorts. I think he might be a little nauseous so may give him some cerenia tonight. His appetite has dropped a lot today. He was 174 for PMPS so debating between 1 or 1.5 units to give him tonight. The other option is to skip his shot, give him the cerenia, and see how he is in the morning. I suspect he may be having a flare up from his pancreatitis.
Maybe 1 u or 1.25 u? Maybe give him the cerenia to nip it in the bud and get him eating?
 
I think 1.25 might be better so his BG doesn't go up too much. It's odd that he was doing OK last night and today only eating half as much, 3 cans so far instead of his usual 4 to 5 cans of FF. I hate to wait him up to give him his shot soon.:eek:
 
I think 1.25 might be better so his BG doesn't go up too much. It's odd that he was doing OK last night and today only eating half as much, 3 cans so far instead of his usual 4 to 5 cans of FF. I hate to wait him up to give him his shot soon.:eek:
Are you going to try the cerenia?
 
I read on another thread that cats with pancreatitis could benefit from being given enzymes. How do I tag someone on this forum? I believe it was @Critter Mom who mentioned it.
Hi Lisa,

To the best of my knowledge pancreatic enzymes help more for exocrine pancreatic insufficiency (pancreas does not secrete enough enzymes to properly digest food). I tried them with Saoirse once but didn't notice any benefit. (Normal poops without the enzymes so not really surprising.)

According to the IDEXX guidelines liver support supplements may help with the pancreas as well, e.g. Denamarin. (Contains active ingredient from milk thistle plus SAMe; supposed to have significant strong antioxidant effect. If you and your vet agree that they might be helpful be careful of nausea with Smoky because these supplements are recommended to be given preferably on an empty stomach but any time I've given them I've always given a little food at the same time.)

IDEXX pancreatitis guidelines


Mogs
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Hi Lisa,

To the best of my knowledge pancreatic enzymes help more for exocrine pancreatic insufficiency (pancreas does not secrete enough enzymes to properly digest food). I tried them with Saoirse once but didn't notice any benefit. (Normal poops without the enzymes so not really surprising.)

According to the IDEXX guidelines liver support supplements may help with the pancreas as well, e.g. Denamarin. (Contains active ingredient from milk thistle plus SAMe; supposed to have significant strong antioxidant effect. If you and your vet agree that they might be helpful be careful of nausea with Smoky because these supplements are recommended to be given preferably on an empty stomach but any time I've given them I've always given a little food at the same time.)

IDEXX pancreatitis guidelines


Mogs
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Hi Mogs,
Smoky had taken Denamarin at one time and it made him feel better. I didn't know if it is something he can take on a regular basis though. His stools are formed but very soft. I was thinking his food is passing thru partially digested. He has very stinky poop, it's so bad we have to light candles. Any thoughts on that?
 
Hi Lisa,

Hi Mogs,
Smoky had taken Denamarin at one time and it made him feel better. I didn't know if it is something he can take on a regular basis though.
I've used a similar supplement, Hepatosyl, and our vet said it's OK to give regularly but I suggest you check first with Smoky's vets because they will have his full history and will be able to assess whether it's OK for him to take to help resolve the flare and perhaps continue on with regularly thereafter.

His stools are formed but very soft. I was thinking his food is passing thru partially digested. He has very stinky poop, it's so bad we have to light candles. Any thoughts on that?
Could possibly be due to pancreatitis. If the malodourous stools are yellow/pale/clay-like in colour and have a sort of 'fluffy'/marshmallowy texture (steatorrhea - see if the stools will float in the toilet bowl) that may be suggestive of exocrine pancreatic insufficiency which could be a temporary issue that resolves after a flare or could be chronic if it persists after a flare subsides, in which case pancreatic enzyme supplementation would be indicated.

I have recently learned that one possible cause of chronic diarrhoea (and perhaps vomiting) can be due to hyperthyroidism. (Lúnasa's just been diagnosed with this after months diagnostics and treatment for possible colitis/IBS.) I know from Saoirse that pancreatic issues may produce a knock-on effect in the function of other parts of the endocrine system. Saoirse was biochemically mildly hypothyroid for a time (ESS - euthyroid sick syndrome). Apparently an overactive thyroid can impact gut motility, speeding it up so that food doesn't stay in the gut long enough to be digested properly. Note: Lúnasa was severely polyphagic on one particular food; she was eating nearly double what she should have needed and she was pooping about 4-5 times a day (foul-smelling, paler, fattier stools). Also, she could not go any longer than about 3½-4 hours between feeds without throwing up.

It might be worth asking your vet whether it would be worth running some blood tests to check Smoky's status. I'd suggest checking liver and kidney function, Spec fPL to check status of pancreas, B12/folate (in case food malabsorption might have caused levels to fall), and perhaps a thyroid test.


Mogs
.
 
Hi Lisa,


I've used a similar supplement, Hepatosyl, and our vet said it's OK to give regularly but I suggest you check first with Smoky's vets because they will have his full history and will be able to assess whether it's OK for him to take to help resolve the flare and perhaps continue on with regularly thereafter.


Could possibly be due to pancreatitis. If the malodourous stools are yellow/pale/clay-like in colour and have a sort of 'fluffy'/marshmallowy texture (steatorrhea - see if the stools will float in the toilet bowl) that may be suggestive of exocrine pancreatic insufficiency which could be a temporary issue that resolves after a flare or could be chronic if it persists after a flare subsides, in which case pancreatic enzyme supplementation would be indicated.

I have recently learned that one possible cause of chronic diarrhoea (and perhaps vomiting) can be due to hyperthyroidism. (Lúnasa's just been diagnosed with this after months diagnostics and treatment for possible colitis/IBS.) I know from Saoirse that pancreatic issues may produce a knock-on effect in the function of other parts of the endocrine system. Saoirse was biochemically mildly hypothyroid for a time (ESS - euthyroid sick syndrome). Apparently an overactive thyroid can impact gut motility, speeding it up so that food doesn't stay in the gut long enough to be digested properly. Note: Lúnasa was severely polyphagic on one particular food; she was eating nearly double what she should have needed and she was pooping about 4-5 times a day (foul-smelling, paler, fattier stools). Also, she could not go any longer than about 3½-4 hours between feeds without throwing up.

It might be worth asking your vet whether it would be worth running some blood tests to check Smoky's status. I'd suggest checking liver and kidney function, Spec fPL to check status of pancreas, B12/folate (in case food malabsorption might have caused levels to fall), and perhaps a thyroid test.


Mogs
.
Hi Mogs,
Smoky was recently tested for those things you mentioned. His vet just approved him taking the denamarin for a second time starting tonight. She also gave me bupe for him for pain caused by flare ups from the pancreatitis.
The vet said to give it to him every 12 hours for five days. I thought it was given on an as needed basis.
 
The vet I take smoky to said to give him 1/4 tab of cerenia every three to four days. Is it normal to give it once a day?
From Teasel's pill bottle:
Cerenia Green 16 mg tablets. Give 1/2 tab once daily until eating well and no vomiting.
I don't know what the "green" means in the name. At the time Teasel wasn't vomiting, just off his food.
 
Hi Mogs,
Smoky was recently tested for those things you mentioned. His vet just approved him taking the denamarin for a second time starting tonight. She also gave me bupe for him for pain caused by flare ups from the pancreatitis.
The vet said to give it to him every 12 hours for five days. I thought it was given on an as needed basis.
From Teasel's buprenorphine prescription:
Buprenorphine 0.2 mg/mL. Give 0.3 mL once every 8 hours as needed for pain.
He had this for his bouts of cystitis.
 
Smoky PMPS: 222
Buprenorphine 0.3 mg/mL
Give 0.14 mL every 12 hours
Dose is already pre measured in syringe.
Trying to decide what dose to give, maybe 2 units? That might be too much though.
 
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Smoky PMPS: 222
Buprenorphine 0.3 mg/mL
Give 0.14 mL every 12 hours
Dose is already pre measured in syringe.
Trying to decide what director give, maybe 2 units? That might be too much though.
Looks like Smoky's bupe is more concentrated than Teasel's but the dose is about half the volume. I was given an empty dosing syringe with the correct dose level marked on it. If you have a sense that Smoky is in pain you might want to give him some bupe. It's a narcotic so it can make him a bit spacey too.

You gave 2 u on a PMPS of 222 on 01/04 and he was fine. I think you can do that and get a before bed test.
 
I can't really give him the bupe tonight if I have to give it every 12 hours. I would have to give it to him at the same time am and pm so would have to start him on it tomorrow.
 
I am a little worried about giving him bupe and then going to work all day.:nailbiting:
If you can't check him mid day then maybe it would be better to wait until tomorrow evening. Or - you could give him a dose now and then the next dose tomorrow early evening. He'd get some benefit right now and then the next dose could be the start of the every 12 hour regimen.
 
Smoky dropped down to 107 at +3 after pm shot. I hope he doesn't go down too much more. That seems a lot in 3 hours. I'm going to wait until at least tomorrow morning. I might just wait until after work tomorrow, it would be a +9 after am shot. I could keep an eye on him for the next 6 hours after that. He actually seems better today after the dose of cerenia last night.
 
Smoky dropped down to 107 at +3 after pm shot. I hope he doesn't go down too much more. That seems a lot in 3 hours. I'm going to wait until at least tomorrow morning. I might just wait until after work tomorrow, it would be a +9 after am shot. I could keep an eye on him for the next 6 hours after that. He actually seems better today after the dose of cerenia last night.
He's giving you some exciting times I see - 2 u was a bit high after all. And a no shot this AM. Good call if you can't monitor. I realize there are limitations in deciding on a dose based on the result of that same dose in the past.

In your post above, are you referring to waiting to give bupe? If he seems better just with cerenia you could wait on the bupe. You want him feeling better but the fewer meds at one time the better. Have you given him the denamarin? You've said it's a supplement so it shouldn't be an issue and your vet OK'd it.

One day at a time ... :)
 
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