More deep thoughts...
The website you found, yourdiabeticcat.com (YDC) is a site that advises "Tight Regulation" for users of PZI. You may have seen in the Protocol this:
PZI insulin has a peak activity time in most cats at 6-8 hours after injection. This means that the blood glucose level in the diabetic cat will be at its lowest point 6-8 hours after the last dose of insulin. After this time, it will begin to rise again until another dose of insulin is injected. Because of this, I ask my clients to perform a blood glucose test at 6-8 hours after each dose. If the blood glucose is still above the normal range (greater than 150) then another injection of insulin is warranted. In the beginning days of tight regulation, owners typically test three to four times per day and often give insulin, in doses dictated by the blood glucose reading at each test, this often as well.
And this from the FAQ:
Q: Sometimes I can't be home to give one of my cat's shots; is it okay to give it late or early?
Although work and family schedules may make it hard some days to keep to a regular schedule for dosing your cat with insulin,
it is critical to do your very best to give doses at 6-12 hour intervals. Giving insulin at intervals less than 12 hours has a very beneficial effect on the regulation of the feline diabetic. This fact is well understood in the area of human diabetes, where patients typically test themselves every few hours and give insulin “as needed” to keep their blood glucose very level. It is keeping the blood glucose “level and low” over an extended period of time that allows the patient to feel well, and return to normal in most cases.
Dr. Hodgkins' TR protocol involves extensive BG testing and monitor for rises in BG which indicate that more insulin is needed. You can be giving your cat at least two, if not three or possible more shots per day. You have to test every 6 hours at the minimum, around the clock. Many people find our "Lantus TR Protocol" to be test-intensive. PZI TR is that and then some.
There have been at least two people who have come to FDMB who were members of YDC first. One, a guy named Wally, arrived totally overwhelmed by their protocol. According to what he told us after the first couple of days, he was banned from their forum for not following the protocol, and for seeking advice "elsewhere". You may learn a whole bunch of useful info from reading there, but I personally wouldn't recommend the site or the protocol.
Also, in Dr. Hodgkin's "welcome" message, she is talking about a version of PZI that is no longer made. It combined porcine and bovine insulin extracted from those animals' pancreases. It was discontinued a few years ago due to the non-availability of pig and cow parts. There is currently a form of PZI available, which is what I used, and it is 100% bovine insulin, compounded in a couple of labs. The one I got mine from was in Houston (VPA) but I don't know if they are still making it. There is also another lab in Texas (BCP) that makes it. You get a 'scrip from the vet, and purchase it by phone and it is air freighted to you.
What most people in this forum use is "Prozinc" which is not the same thing. It is a recombinent Human Insulin that is specially genetically altered so that it works in cats. PZI and Prozinc are the only insulins available that are specially formulated for use in cats and recognized as such by the FDA or whatever government agency is responsible for that sort of certification. Lantus and Levimir are not approved for use in cats,but can still be prescribed by vets.
Jennifer,
After reading your posts since the day you found FDMB, it seems to me that the bigger issue isn't the type of insulin, but the "protocol" for each insulin. I know you have been overwhelmed with the "you have to test a lot" advice that you have gotten from most people who have participated in your threads. You should know that people are only trying to help you keep Spot safe. And testing of the BG, besides helping you figure out the "right dose" is the best way to ensure the safety of a diabetic cat.
In order to figure out what that "right dose" is, with Lantus especially, it is really necessary to test several times a day, even if you don't plan on following a "tight regulation" protocol. First, it takes a week or so for the insulin to "fill the shed". I won't even try to explain the "shed" concept because I really don't "get it". But Lantus users do, and it's in their "sticky" threads in the forums. Once you have done that, the testing doesn't need to be so intense. It is still required that you test before every shot (no matter what kind of insulin you use), and because the dose amount with Lantus is based on the nadir number, you still have to check around nadir time, during at least one of the cyles AM or PM so that you can know the dose is working correctly, and know if it is too high or too low if it isn't "right".
Well, with PZI and Prozinc, you still have to do that. Although the "P" insulins are not dosed based specifically on the nadir reading, you still need to know what that number is. The amount of drop from shot time to nadir tells you if the dose is too high or too low. So you're still looking at three tests a day, minimum, to really do this safely.
You'll see on some people's SS that it just isn't possible for everyone to do that. So instead of 3 or more tests a day, they set aside a day per weekend, or a day they don't have to work, and do a curve, getting maybe half a dozen tests that one day. It's harder to use Lantus that way, but there are also lantus users who follow that plan, because that is all they can do.
As far as your particular vet being willing to prescribe PZI or Prozinc.....the answer is "yes, they can do it". I am not sure that they will do it. They may be partial to Lantus or Levimir. However, given that they prescribed Lantus and told you to only shoot one shot per day, that would indicate that while they might prefer Lantus, they really don't understand the way it works in cats, so I'm not sure how much faith I would put in their advice on treating diabetes, period. That puts you in a really crappy place. You might be able to get the vet to agree to an insulin change, but that still leaves you with a vet that doesn't know much about treating diabetes in cats.
And that is where a place like FDMB comes in. There's hundreds of regular posters here that are dealing with, or have dealt with managing feline diabetes. Yes, we can be overwhelming, and yes we tend to offer advice when advice isn't asked for. That's because we all want to help. We want to share what we have learned here with everybody who walks in the door. All at once, and all together. So we tend to overwhelm people but it's not on purpose. In my opinion, FDMB is the greatest resource for people trying to manage this disease in the entire world. And not only diabetes. There are people here who have had to deal with every condition found in cats. It's just a matter of finding the right person or people to help with whatever the problem is. I have yet to see any question go unanswered in the 10 months I've been around.
Looking at your spreadsheet, I won't even say "you aren't testing enough" because I know you have tested as much as you have been able to test. I will say that it probably hasn't been long enough to determine that Lantus won't work for Spot. Looking at the numbers, I would say (and I am NOT experienced with Lantus but I have read lots of lantus threads and their stickies and the TR protocol) that it is probable that Spot will need an increased dose if you aren't seeing any improvement in his numbers. They are still "high" numbers. What everyone has been pointing out is because you don't have a lot of "in the middle" data yet, you haven't determined where his "low numbers" are, or what they might be yet. And without that information, it is impossible for people who have experience with the insulin to tell you if the dose needs to be increased or decreased or kept the same. That's just "fact". You can't adjust without knowing the numbers. If you were to bring Spot to the vet and they were to run a curve, they would be testing him every two hours all day long to see what one cycle on that dose does. Then they would recommend a dose adjustment according to the numbers they saw. The problem with that is that they would be adjusting based on just one 12 hour period. You can't tell anything from one 12 hour period, except how the insulin did on that day in that environment. Gathering curve data over the course of several days gives you a more accurate picture. Look at any SS on the board. Kitties don't act the same way on the same dose for two days in a row. Every day is different. But over several days, what emerges is a pattern of how the dose does, and you can make judgements based on the patterns and know if the dose needs to be increased or decreased.
Bottom line. I don't want you to be discouraged. I don't want to feel like everybody is ganging up on you. But what you need to tell us is this:
How much
can you do? How often
can you test? How
hard is it to maintain a 12 hour shot schedule? No matter what the answers are to those questions, people can and will help you out. But give us an idea so we can work
with you to help Spot, and so you won't feel like you are damned no matter what you do. Okay?
Carl
