unregulated DM, switch from ProZinc to NPH?

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hardrally

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My cat was diagnosed with diabetes at the end of February his urine showed 2,000 glucose with NO ketones.
He was started on 1 unit of ProZinc twice a day & fructosamine 2 weeks later was 794 (ref range 160-450)
He was increased to 2 units twice a day, fructosamine 2 weeks later was 734
He was increased to 3 units twice a day, fructosamine 2 weeks later (last week) was 490, last night I did a random glucose for the first time & got 161.
**I know I should have been testing glucose at home, been trying but not been able to get enough blood**
His vet is hard to get on the phone so I'm still waiting to talk to him. Not to be 'cheap' but the cost of office visits, insulin, fructosamine testing, etc. is getting out of control & the vet has been kind but when I asked about switching insulin he acted like I slapped him in the face.
My questions:
Anyone else has have such a variance with these 2 tests?
Has anyone had success with Humulin or NPH for their cat? I can't afford Lantus or Glargine ongoing
Any advice is welcomed & appreciated

PS: Loki had pancreatitis last year but recovered without issue. He is eating Instinct Raw - food was the trigger for his pancreatitis so I've not changed it since his diagnosis. Directly before his insulin he gets a spoonful of canned food.
His weight is steady at 15.6 pounds (he's a "big tom" per the vet, not overweight)
I don't measure his water intake or his output but it's decreased significantly from when he was diagnosed & is in line with my other 2 cats.
 
What two tests? The vale of fructosamine test is not directly comparable with that of a meter test.
How long after the shot was the 161 obtained?
What are you feeding and when?
Lantus is really not more expensive than ProZinc.
The 10 ml vial of ProZinc only contains 400 units while a 10 ml via of Lantus cojtains 1000 units.
ost of use purchase the Lantus pens since, although more expensive than the vial per ml, yo can usually use up a 3 ml pen before the 10 vial loses effectiveness.
 
I answered your post on ProZinc here:

The fructosamine test is an average of two weeks so it is much less precise than daily blood glucose tests. For example, if a cat was bouncing from low numbers of 40 to high numbers of 500, an average of those could be fairly high. But if you get daily tests and can see exactly how the insulin is working that cycle, a low 40 and high of 500 would give you a much different conclusion. You'd know the insulin was working, a little too well, cursing the cat to drop too low and then bounce up to a high number. (Bouncing is when the body perceives a low number that feels dangerous and releases extra sugar to bring that number up - a very layman like explanation but hope it makes sense.) The fructosamine example is imprecise also but hope you can see what I mean about the difference between it and blood glucose tests.

161 is a good number. For reference we consider a cat regulated if they are in the mid to lower 200s at present and in double digits at nadir (lowest point that is usually 5-7 hours after the shot) But not below 40. And yes, curves done at the vet are often unreliable as stress raises blood glucose levels, sometimes over 100 points. If he were mine, I would get the testing down. What is the biggest problem with getting tests? Maybe we will have some ideas to help. For us, the most important thing was to have a big enough lancet (human 30-31 gauge are often too small for cats at first. 25-27 gauge may work better) and warming the ear enough. We used a rice sack and found we had to leave it on his ear for 30 seconds at least to get those capillaries fat enough for a good sample. Once you can test regularly, then we can help you figure out how the insulin is working and what you might do to improve things. NH is cheaper but doesn't work as well in most cats. Often the lowest number is 2-4 hours after the shot and the insulin stops working by 8 hours after. I would stick with the Prozinc, tell the vet you are going to test at home and share the numbers with him and save money that way. There is a protocol we put together for ProZinc in my signature in blue. Hope it will help with some basics.
 
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I suppose I am trying to compare apples to oranges w/ fructosamine & glucose testing. The vet tells me he is "severely unregulated" however his glucose shows, to me, that he is somewhat regulated. So I am just very confused.
I got 161 before his insulin (it had been 12 hours since his last dose). His food is Instinct Raw & he gets about 1 cup/day + a spoon of canned before his shots.

I'll see if I can get in touch with his vet & order the ProZinc refill ... however they told me previously that if I wasn't testing on the AlphaTrak they would not accept home numbers & they will not write me another prescription without monthly fructosamine results or glucose curves.
Fructosamine is $100/test & curves are $100+ the 12 hour hospital stay ... it's unbelievable how expensive they make it to care for a pet.
 
3 units of ProZinc with a preshot of 161 is a high dose. It may be that Loki is dropping to low on that does and then the liver dumps glycogen to prevent going too low which then skyrockets BG resulting in the high fructosamine value.
I would practice your home testings, reduce the dose to one unit and test before each shot and periodically between shots.
ProZinc is a U40 (40 units per ml).
Are you using U40 syringes? Those have a red needle cap.
Human insulins are U100 and have an orange needle cap. If you draw a U40 insulin up to the 2 1/2 unit marking in a U100 syringe that is only one unit of the U40 insulin.
 
161 is a very good number, if a little low, for 12 hours after the shot. We generally tell new diabetics not to shoot under 200 but to wait without feeding and retest - to get he number nearer 200 and to be sure the number is rising, not falling.

Do you have any options for other vets in your town? Requiring you to continue to get expensive, unnecessary tests does not sound like a very reasonable vet. You could get the script and then start looking for a new vet? Someone here might know a FD friendly vet in your community.
 
Thank you both so much for your information.
I just tried to get a glucose reading on Loki & couldn't... he is terrified everytime I come near him now! He's hiding in the basement so I'll give him time to calm down & try again. I wish I could get this down without scaring him so badly, his ears & feet are the 2 places he hates being touched so this is torture for him.

I have been using U40 syringes & I read about converting the dose & using U100 because the U40's are so expensive; I may do that with this round of insulin.

Yes, I do think it's time for a new vet. I've called 2 other vets in the area - 1 said they don't treat feline diabetes & 1 is who suggested he write a script for me for NPH (which doesn't require a prescription).
 
Are you letting him have a treat he loves as a reward? That is the secret to this thing - making it something he looks forward to. Oliver loved Bonito flakes (a low carb treatable) so he got some after each poke. At first some people give the treat while poking. Another thing you might try is a kitty burrito. We used that the first few weeks. You wrap the kitty in a towel with only his head showing, maybe between your legs while sitting or next to the couch arm, feed him a treat and calmly poke.

You might start a new thread with your city and state to see if anyone lives nearby - both for vet suggestions and help with home testing if you want it.
 
I know it make sense but Loki doesn't like treats.

So, I just got his reading (after 5 test strips & him screaming a bit) but I'm concerned that either my machine isn't functioning correctly OR that he is over treated as Larry & Kitties suggested.
I gave him 3 units at 4:30am (west coast) with 1 spoon of canned food & some of his Instinct, he has been sleeping since - no food/water
It is 11:40am & his reading is 36
I gave him a spoon of canned food & he ate it happily and is eating some of his Instinct.

After I took the reading, and before he was purring, trotting around normally - only anomaly is this VERY low reading... guess he's heading back to the vet for more testing :(
 
He is quite low. Do you have any honey? If so, I would put a tiny dab into some of his regular food and retest in 20 minutes. He needs to come up. He may, as this may be his low point, but if he is going to drop any lower, you want to stop that drop. Yes, I think it quite likely that he is getting too much insulin.

You will need to get some tests in to be sure he stays safe today. So it may be trial by fire. One thing that might help is to double poke - a quick second poke in the same spot to make the hole a tiny bit larger. The kitty burrito may help you keep him contained too
 
While you work on home testing, see my signature link Secondary Monitoring Tools.
If you decide to go vet shopping, see my signature link Vet Interview Topics.
To know more about glucometers, see my link Glucometer Notes. The human glucometer reference ranges are from the research by Dr Rand on the University of Queensland. Unless your vet is going to pay for an AlphaTrak and its test strips, and not charge you, I'd say go with the 2nd candidate and see if you can 'train' him in the new way of managing feline diabetes. Get him all the research articles we have posted here.
 
hardrally said:
Loki doesn't like treats.
Click to expand...
Is there something else that motivates him? Is he an attention-seeker - would giving him cuddles afterwards be more his thing? Or is there something else he really likes that you can give him as a treat - if he's not food oriented, then it's sometimes a case of coming up with something he really does like instead.
 
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