vet interchanging Humulin NPH and ProZinc--OK?

[beepsandclicks]

Hi Everyone.
I'm brand new to the forum. My 9 year old cat TJ was just diagnosed Saturday and today he had his glucose curve test.
My regular vet is on vacation for 2 weeks, so I had to find another clinic to do this. I really am not sure how much I trust this guy, but I was hoping to just TJ stabilized and go back to my great vet when he returns.
Anyway, today this vet told me he was going to put TJ on ProZinc. When I picked up TJ I noticed he had included U100 needles, which I knew were wrong for ProZinc. Then I saw that he has Humulin NPH in my bag, which alarmed me, because even being a newbie at this, I've read nothing good about starting cats on this type of insulin. I asked him about this and he protested a bit but then agreed to switch it out for ProZinc. He said he was out of ProZinc and wants me to come to the clinic tomorrow once their med delivery arrives to pick up a vial. Meanwhile, he provided me with one dose of Humulin in a syringe for this evening's injection.

I guess I have a couple questions/concerns. First, I'm worried the ProZinc won't be in until the afternoon and I don't want to be late with TJ's injection, especially since he is just now starting to look better. Was I being overly concerned about the Humulin? He insisted he had a few feline clients on the brand and they were doing fine. I believe it is much less expensive, no? (I noticed, however, that he was trying to charge me $90 for the bottle of Humulin, the same price as the ProZinc!) Also, will everything be okay if I switch from Humulin to ProZinc...will the dosage be the same? I know Humulin is U100, while ProZinc is U40. I'm asking here because, quite honestly, I trust you guys but I don't trust this vet.

His initial glucose reading was 600 today and they did not get him under 320 all day. I believe they gave him on 2 units of Humulin but raised him to 3. That sounds high to me as a starting dose, but perhaps since his glucose levels were so high he might just need more to stabilize?

Last question. Is there another type of insulin I could substitute for ProZinc? I was thinking of just going to the pharmacy and picking up a vial tonight or tomorrow morning and just not bothering with this vet tomorrow. I notice the pharmacies do not carry ProZinc. How convenient. :-|

Just nervous here. My father was diabetic, and before he passed away, I just remember all sorts of trouble with mis-dosing, etc. I have not yet had time to process and get comfortable with all this.

Thanks all. Glad to have this resource.

Debra
Houston

 

[squeem3]

Hi Everyone.
I'm brand new to the forum. My 9 year old cat TJ was just diagnosed Saturday and today he had his glucose curve test.
My regular vet is on vacation for 2 weeks, so I had to find another clinic to do this. I really am not sure how much I trust this guy, but I was hoping to just TJ stabilized and go back to my great vet when he returns.

Welcome :smile:

A diabetic cat can't be stabalized/regulated at the vet's office. It can only be done at home with daily blood glucose monitoring and the right diet and insulin treatment. So there's no point in spending money at the vet to do inaccurate curves. Inaccurate because most cats get so stressed out that their blood glucose levels skyrocket.

Blood glucose testing can be done at home with a Human blood glucose meter, the same ones a Human diabetic uses. There are pet meters but they are too expensive and you can't buy the supplies at any store.

Anyway, today this vet told me he was going to put TJ on ProZinc. When I picked up TJ I noticed he had included U100 needles, which I knew were wrong for ProZinc.

Well, you *can* use U100 insulin syringes with a U40 insulin such as ProZinc but only with this conversion chart: http://felinediabetes.com/insulin-conversions.htm You must use the chart to ensure that your cat is getting the right dose of insulin. U100 and U40 are two different insulin strenghts. People use U100 insulin syringes with U40 insulin so that they can measure small doses.

Newbies should stick with U40 insulin syringes until they are more comfortable with dosing and using insulin syringes and understand how the conversion chart works.

I guess I have a couple questions/concerns. First, I'm worried the ProZinc won't be in until the afternoon and I don't want to be late with TJ's injection, especially since he is just now starting to look better. Was I being overly concerned about the Humulin? He insisted he had a few feline clients on the brand and they were doing fine. I believe it is much less expensive, no? (I noticed, however, that he was trying to charge me $90 for the bottle of Humulin, the same price as the ProZinc!)

Humulin N tends to be too short acting for most diabetic cats. It is fairy inexpensive to buy at the Human pharmacy.

Do the other clients test their cat's blood glucose levels at home? Without daily testing, it's impossible to know exactly how the insulin is working for the cat. The cat may seem "fine" but the blood glucose levels may be all over the place which is not good.

Also, will everything be okay if I switch from Humulin to ProZinc...will the dosage be the same? I know Humulin is U100, while ProZinc is U40.

I think the dosage should be the same. In general, don't start insulin at more than 1 unit twice a day. Insulin dose is not based on weight.

His initial glucose reading was 600 today and they did not get him under 320 all day. I believe they gave him on 2 units of Humulin but raised him to 3. That sounds high to me as a starting dose, but perhaps since his glucose levels were so high he might just need more to stabilize?

It takes a day or two for the body to respond to the insulin. Raising the dose too fast can cause your cat to become hypoglycemic and makes it harder to regulate.

3 units of any insulin is too much for most newly diagnosed diabetic cats.

Last question. Is there another type of insulin I could substitute for ProZinc? I was thinking of just going to the pharmacy and picking up a vial tonight or tomorrow morning and just not bothering with this vet tomorrow. I notice the pharmacies do not carry ProZinc. How convenient. :-|

U40 insulins such as ProZinc are pet insulins and are not sold in any Human pharmcy.

Lantus, Levemir, and Humulin N can be bought at the Human pharmacy with a prescription.

Lantus and Levemir are two very good insulins that you can ask your vet about. Many diabetic cats respond well to these insulins.

 

[Phoebe_TiggyGA_NortonGA]

Cats are usually pretty stressed out at the vets' office - which causes blood sugar readings to be extra high.

In the comfort and security of your home, it is quite likely that the 3 unit dose would be too much.

It is best to start at a low dose.

Prozinc is a good insulin for cats -- GOOD JOB for paying close attention and catching the switch.

You're right - humulin N only costs about $40 or so, and it is NOT very good for cats.

 

[Anonymous]

i think you can buy pro zinc pzi at 1-800-pet-meds (a betty white organization) but you do need a prescription. the reason i'm not certain is i bought my pzi there but have never tried to buy the pro zinc...makes sense they would carry it.

 

[Laurie and Mr Tinkles]

If the vet is only charging $90 for ProZinc, I would buy it there...that is a very good price for ProZinc! You won't do better online.

 

[Jen & Squeak]

I don't understand this vet's behaviour; switching back and forth between insulins AND not telling you? Seems VERY unprofessional to me and I'd not go back to him after you get the prozinc. Start testing at home, give a dose of 1-2 units twice a day, test for ketones, and hopefully go from there...at least, that is my nonprofessional judgement!.

 

[Sue and Oliver (GA)]

Agree with everyone it would be best to get the ProZinc, start at one unit twice a day.

The other two elements here are diet and hometesting. And no one else seems to have nagged you much about those, so it must be my turn. Check out this website written by a vet who explains why wet lo carb food is best for any cat, but especially diabetics: http://www.catinfo.org

And we hometest so we know if it is safe to give insulin and how much it is safe to give. Here is a good beginning site: http://www.sugarcats.net/sites/harry/bgtest.htm and a video: http://www.youtube.com/watch?v=_zE12-4fVn

You have certainly had a difficult introduction to this sugar dance. It seems that you won't have to do much research to know more than your vet! Luckily, this is a disease which is managed at home, and everyone here will be happy to help.

 

[beepsandclicks]

Thanks for the info!

Yes, this vet (thank goodness he's only temporary) has left a lot to be desired. He told me I should euthanize TJ when I first brought him in, saying his age (only 9!) and his heart condition (hypertrophic cardiomyopathy) made him a poor candidate for recovery. *sigh* I didn't turn and walk out only because TJ needed IV fluids badly and I had read all sorts of good reviews about the clinic. I figured I could get what we needed and get out and check back in with my "good" vet in 2 weeks. Turns out, this diabetes management thing is waaaaay more complicated than I anticipated, and this vet could have done some real damage to TJ, had I followed his advice and not stumbled upon this forum to learn about proper starting doses. Lesson learned. But I will go back to buy the ProZinc, because I do see that his price on that is very good.

Diet. I switched him to a raw diet a couple of months ago, but recently have slipped a bit and added some canned food into his diet, because my other cat does not share TJ's love of raw meat. The list of OK canned food is invaluable to me, as I was probably feeding some pretty high carb canned food. Looking forward to making these easy improvements and glad to see it can make such a profound difference in the outcome.

I have a lot of reading to do about home testing. I admit this makes me nervous. Do you do this before every injection? And if the levels are good, do you just not give the injection or just give less? So I reckon doses could be different each time? And if one tests before each dose, is there a need for the occasional (monthly?) glucose curve? Guess I better start reading before I ask too many questions...

Head spinning in Houston,
Debra

P.S. Sue--Colorado Springs? We just moved back to Houston a couple of years ago from Manitou Springs. I can't believe we left that wonderful little town. Maybe we'll make it back there sometime...

 

[kate and lucky]

Hi,

You look like your already on the ball and well oon your way with advice.

You need to hometest before each shot and get soome spot checks in, specifically +1 or2, +4 and +6.The first 2 will give you an idea how fast the insulin starts working on TJ's bg's, the third what sort of curve your getting ad that he isn't dropping too fast. The +6 is usually nadir-the lowest number in the cycle and the main number you base your dosing decisions on.
I haven't used Prozinc so can't give any specific advice on it's use, but there are now quite a number on this board that are using it and wll be able to offer guidance.

In the early days there may be numbers that he throws and your not sure whether you should inject-post and people will help you with this.Usually you either delay the shot till the number has risen or give a reduced shot. Things like your life and job have an impact on such a decision :mrgreen:

Hope your regular vet is way more on the ball!Good luck

 

[Laurie and Mr Tinkles]

I know the home testing may seem a little scary, but you can do it, and we will help you learn! It really is a very important part of getting and keeping TJ regulated. Once you get the hang of it, it will become part of the routine, and it will take less than a minute to do. Yes, you will need to test before every shot, and get spot checks in between to see how the insulin is working. Don't worry about adjusting dose based on the tests yet, just learn how to home test first. One step at a time. :smile:

If you are home testing, the glucose curves at the vet are unneccessary, and a waste of time and money! You can (and should) do your own curves at home, with much more accurate results. Cats are usually stressed when they are at the vet, so the BG readings are elevated and therefore inaccurate, leading to insulin doses that are too high. This is why we recommend starting at 1 unit of insulin twice a day, often the vet will want to start on higher doses because of elevated numbers they see in the office.

Please keep posting any questions you have as they come up, and we will help you.

 

[squeem3]

Diet. I switched him to a raw diet a couple of months ago, but recently have slipped a bit and added some canned food into his diet, because my other cat does not share TJ's love of raw meat. The list of OK canned food is invaluable to me, as I was probably feeding some pretty high carb canned food. Looking forward to making these easy improvements and glad to see it can make such a profound difference in the outcome.

Great that you are feeding a good diet :thumbup Some people here feed both RAW and canned.

Are you feeding commerical RAW or homemade? If commercial, make sure that the food doesn't contain any grains.

I have a lot of reading to do about home testing. I admit this makes me nervous.

Hometesting does seem scary but it's not :smile: It's just a quick prick of the ear pr paw pad with a thin lancet to get a drop of blood. Most cat's don't even feel it. It takes some time to get the hang of testing so don't get frustrated if you can't get it right after what seems like a million pokes :smile:

Do you do this before every injection?

Yes. At the very minimum you must test before giving each insulin shot.

And if the levels are good, do you just not give the injection or just give less?

If you test and the reading is over 200 mg/dl (11 mmol if you are outside the US). then you can safely give the insulin shot.

If it's close to 200 mg/dl, like at 180, you can retest in half an hour and give the insulin only if the reading is over 200. You can feed your cat half the meal and the rest after the second testing.

If the reading is well under 200 mg/dl, like at 100, skip the insulin.

If unsure, either ask here on this board or just skip the shot :smile:

So I reckon doses could be different each time?

No, you do not change the insulin dose based on the twice a day readings. Doing so just "confuses" the body and makes it harder for the insulin to work.

You hold a dose for at least week and then do a curve. Based on the curve, you adjust the insulin dose. The board can help you interpret a curve and suggest how much to change the dose.

And if one tests before each dose, is there a need for the occasional (monthly?) glucose curve?

Yes, a monthly curve is ideal to see how well your cat is responding to the insulin and the dose.

What you can also do in addition to the twice a day testing and the once a month curve is to get random "spot checks". This is testing 2 or 3 times a day whenever you have the time. This gives you a general idea of how your cat is responding.

Keep a log of your cat's blood glucose numbers. It will help you understand how your cat is responding to the insulin. Many people here use a nifty Google spreadsheet template. Instructions are found over on the Tech board.