What are ProZinc dosing recommendations for an acro cat?

Discussion in 'Acromegaly / IAA / Cushings Cats' started by varlene, May 10, 2021.

  1. varlene

    varlene Member

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    Apr 23, 2021
    Those from main/welcome forum suggested I post here. Smoky's IGF-1 is 234. He is currently on ProZinc (since June 2018), and because I just bought a new vial I won't be switching to recommended Levemir right now. Are there basic guidelines for ProZinc users? I see that I shouldn't wait too long, but I don't know what that means. What constitutes a cycle, a dosage or two doses for the day? As you will see in Smoky's spreadsheet, I just upped his dose by .25 today, now at 8.75 units, but don't know if that was enough or even warranted. Also interested in cabergoline, if my vet will prescribe it.
     
  2. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Cycles are 12 hours long. You have an a.m. cycle and a p.m. cycle. Yes, a dose increase is definitely warranted at those high numbers. I just counted on your spreadsheet and you had Smoky at 8.5 units for 28 cycles with very little improvement in glucose numbers. Under either protocol (SLGS or TR) you have held the dose for too long. Holding a dose that is too low -- for too long is not good for a lot of reasons. You don't want your kitty to get too comfortable in the high numbers, which Smoky would be by now.

    Have you read through the information about the Start Low Go Slow and Tight Regulation protocols? With the amount of testing that you are doing (good job, by the way) Smoky would be a good candidate for Tight Regulation (TR), which would allow you to increase at a faster pace and hopefully get to a better dose and get Smoky's numbers down more quickly into a healthier range.
     
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  3. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I used to use ProZinc, as well. This was before I knew that my cat had Acromegaly. I kept trying different insulins (been through all of them) because I thought maybe it was the insulin. It was the Acromegaly, which I only found out about this year. My kitty was on VERY high doses of insulin. We started Cabergoline and after about 6 weeks, his insulin requirements dropped dramatically. He got as many as 41 units twice a day and is now down to about 3 units twice a day.
     
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  4. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    tagging @JanetNJ who managed her acro cat on Prozinc.
     
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  5. JanetNJ

    JanetNJ Well-Known Member

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    Hi! Try the 8.75 a few days but don't hold it too long. If you don't see any movement id go to 9 on Wed or Thurs
     
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  6. varlene

    varlene Member

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    Thank you, Janet. Will do.
     
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  7. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Smoky is a gorgeous grey baby!!
     
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  8. varlene

    varlene Member

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    Thanks, Suzanne. Smoky was a cutie that just showed up one day. We used that picture trying to adopt him out because he didn't get along with our other cats but then we ended up paying to officially adopt him ourselves when he was returned to Florida Humane because he didn't get along with a cat. He's always been a bit different but very sweet. He loves bedtime when he gets to sleep with us. Your Mr. Darcy is very handsome, but his readings on your spreadsheet would scare me to death. I am just hoping I can get Smoky's pre-shot numbers to ≤300 with a nadir in the normal range. I can't imagine going up to 41 units. Yikes. Cabergoline seems to have been the answer for Mr. Darcy. Any problem having your vet prescribe it? How much do you give?
     
  9. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I give Darcy .4 mL of Cabergoline. The strength is 200 mcg/mL, so that means he gets 80 micrograms in his dose. Note that I had been giving him Cabergoline daily, but recently he went into renal failure (hopefully an acute kidney injury that will be reversible) so I have reduced his dose to every other day. I'm just trying to give him a break for the time being until I am sure he will stabilize.

    At first, my vet seemed disinclined to prescribe it based upon another vet's advice, but I provided her with some information (from Wendy and the Board) and she readily allowed me to try it. Several FDMB kitties are taking Cabergoline now and are doing very well on it.
     
  10. varlene

    varlene Member

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    Thank you for your reply. Good to know that cabergoline is out there if Smoky needs it. I hope Darcy gets better soon!!!!
     
  11. varlene

    varlene Member

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    Hi, all and especially @JanetNJ. Smoky is at 11 units ProZinc and due to go up tomorrow. I am thinking I should try 12 instead of 11.5 but I am too new at this to do without advice and support, especially since Smoky seems to be out of sorts, not happy, not eating, and BG curves don't seem to be getting better. Thank you.
     
  12. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Janet may not be on, she is recovering from a surgery. I think you'd be fine going up to 12 units. For Lantus and Levemir, we increase by a full unit over 10 units dose, especially if not seeing anything under 100.

    I'm worried about the not eating. Maybe time to take him to the vet. Any chance he's constipated?
     
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  13. varlene

    varlene Member

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    Thanks @Wendy&Neko. Sorry to hear about Janet. I hope that her surgery was a success and that she will have an easy and speedy recovery. Thank you for your concern. At 2 hours before the PM shot, Smoky started eating again and did not vomit, so all's well for now thankfully. I scooped up poop earlier from the litter box that he only uses, so that's good too. I will try 12 units tomorrow and hope for the best. Many thanks.
     
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  14. JanetNJ

    JanetNJ Well-Known Member

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    Hi I'm doing good after surgery. :). Taking it slow and easy. I liked those blues last week. Wish they would have stuck around. I think skipping to 12 is a good idea. Crossing fingers for you. My cat had to hit 13 before going down.
     
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  15. varlene

    varlene Member

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    @JanetNJ So glad to hear you are doing okay and taking it easy. Hope you will continue to improve with each passing day. I liked those blues too!!
     
  16. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I'm rooting for Smoky! I hope the 12 units does the job. My kitty had to go very high in dose but he's a case! I hope that your Smoky won't need much more insulin to start responding.
     
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  17. varlene

    varlene Member

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    Thank you, @Suzanne & Darcy. I too am hoping we are getting close.
     
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  18. JanetNJ

    JanetNJ Well-Known Member

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    Just have to keep reminding yourself that he needs what he needs
     
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  19. varlene

    varlene Member

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    Seems like moment of truth and need help. Today first time all yellow & blue. PMPS at 154. He's looking at his food but not eating. I'm due to shoot 16 units now. Yes or No? @JanetNJ @Suzanne & Darcy @Wendy&Neko
    UPDATE: After 1/2 hour, BG was 208 and he's eaten a bit, so I shot 16 units and will test through the night.
     
    Last edited: Jun 9, 2021 at 8:44 PM
    Reason for edit: Updated
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  20. JanetNJ

    JanetNJ Well-Known Member

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    Sorry I missed this post. You did exactly what I would have suggested. I hope this means you will now start setting progress.
     
  21. varlene

    varlene Member

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    Thanks @JanetNJ. This morning's PS was 159, then after 1/2h delay 181 so gave 16 units and will monitor. Nadir that I caught was 94 at +10.5h after PM shot, but I might have slept through a lower one.

    Looks like the next TR step is "when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing" but since I am an hour behind schedule, if all goes well today, I'm thinking I could give a tad less tonight (15.5 or 15.75) and then back on 16 units in the morning, or I could just be brave, keep it 16 units and hope the hour earlier won't mess things up.

    Probably too early to ask about reducing, but TR rules state that you don't reduce until nadirs fall under 40 mg/dL, but since normal looks to be 64-170 mg/dL, I am reluctant go below 50-60 without intervention especially since some meters might be off, however, I don't want to ruin the process. I guess time will tell but wanted to get this question in writing just in case it happens sooner than expected and nobody is around to hold my hand.

    Thanks for your help. Hope you are doing well.

    Arlene V
     
  22. JanetNJ

    JanetNJ Well-Known Member

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    that model of 40 is with a HUMAN meter.... don't go below 68.... you are using an alphatrack. I like your numbers so unless you are really nervous i'd stay at 16. if the preshot is low and you wanna go down to 15.75 that's probably ok.... but 94 is where you wanna be! I would keep at 16 and give it a test before bed, or maybe set an alarm and check once at night.
     
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  23. varlene

    varlene Member

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    @JanetNJ: Thanks for getting back to me. I agree that 16 units is working well today. I might have been too optimistic thinking I could shoot an hour earlier tonight to get back to 9a/9p as I will be lucky if I can give Smoky his shot at +12h (10p) without a delay. But if all goes well tonight without a delay, I can try getting back to 9a/9p in smaller increments over the next few days.
    Someone worked on my "Arlene's Version of SS", and I am very grateful because the X axis spaces the hours evenly, which I didn't know how to do on my own. If it was you, please let me know how you accomplished it. I'd like to do the same going forward. Unfortunately, the curve didn't automatically update when I added the most recent BG so I could use some guidance. Latest was 176 at +6h. :)
     
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  24. varlene

    varlene Member

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    @JanetNJ: I see that I needed to reformat my date/time column to get the fixed time intervals on the X-axis. Thanks ever so much!!
     
    Last edited: Jun 10, 2021 at 11:45 PM
  25. varlene

    varlene Member

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    @JanetNJ: After two wonderful days and nights, todays BG's are in the high 300s and I am thinking I need to up to 17 tomorrow, maybe even if it goes lower tonight. Weird that his BGs go lower overnight than during the day. I swear he was looking for his PM shot two hours before it was due. : (
     
  26. JanetNJ

    JanetNJ Well-Known Member

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    Mine often had different night and day numbers. It might be because he eats less at night, or is more relaxed at night, or moves more. Who know.

    The suddenly higher number could also be just a bit of a bounce from going lower than usual. Hard to say. Maybe do 16.5? See what happens? Totally up to you. You are great about testing so it's your call.
     
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  27. varlene

    varlene Member

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    Thanks, I will give 16.5 and will see what happens.
     
  28. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Just wanted to make a small clarification. We don't have a Tight Regulation dosing method for Prozinc here. This document describes what we do have:
    PROZINC DOSING METHODS The two methods are SLGS and the Modified Prozinc method.

    Tight Regulation was developed and tested with depot insulins, Lantus and Levemir.

    Nice spot of green today. :)
     
  29. varlene

    varlene Member

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    Hi, @Wendy&Neko, @JanetNJ -- Had to give glucose overnight and looks like I will be testing hourly today and likely likely giving more. Needless to say, reverting to 16 units was not enough of a reduction this morning. So for the PM shot, I am tempted to reduce a full unit to 15 but would appreciate input if it is not too much trouble. Many thanks.
     
  30. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I'm not experienced in Prozinc, but I think a full unit reduction might be a good idea for now. With Lantus we change doses by full units over 10 units total dose, unless just trying to tweak a dose that's almost a good one.
     
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  31. JanetNJ

    JanetNJ Well-Known Member

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    Hooray!!! You finally found your breakthrough dose! Did you have to steer a lot today? It would be ok to reduce to 15. If he runs a little high you could go back up to 15.5.
     
  32. varlene

    varlene Member

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  33. varlene

    varlene Member

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    Hi, @JanetNJ Thank you. Your reply made me smile for the first time today. I have been rubbing glucose on Smoky's gums or giving him a bit of honey sugar water via syringe with each hourly test because he is not eating. If that is what you mean by steering, then yes I am. Just now at +8h = 109 and he started to eat a bit so will hold off giving sugar and see how he does, continuing to test each hour until hopefully good PMPS value so I can try 15u.
     
  34. JanetNJ

    JanetNJ Well-Known Member

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    Oh yeah then definitly lower to 15!!! This is very exciting!!! Nerve wracking for you... But exciting.
     
  35. JanetNJ

    JanetNJ Well-Known Member

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    Look in my spreadsheet for 2019.... In July I had her breakthrough and you can see the numbers really fluctuated.
     

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