What Pro Zinc Dose to Try Next?

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lovey11

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Should I try 1.75 or go back down for a few days? If my cat is bouncing, he will bounce more on 1.75. If the numbers are better, then maybe it wasn't bouncing? Or is the 1.5 too much insulin so the numbers are inaccurate? 1.5 dose doesn't seem to be a good with a decent PMS or a very high PMS general. One some days with lower preshot, +6 was hardly down. 299 to 235 Then once in awhile with a very high preshot, numbers were much lower.

It looked like more consistent and lower midcycles a few weeks ago. I made a vet's appt. for today. I wondering if it will help with anything. Just give the cat a checkup or fructasomine test, show spreadsheet, weight, ask about possible flare up of pancreatititis?? My cat has been more lazy lately, laying down a little more, not walking around as much in the dawn hours. Although my cat is almost 11 years old. She was never been very active. She has a laid back personality. She does clean herself nicely. Her coat is shiny. She is going to the bathroom normally, eating normally besides vomiting from hairball yesterday. I will try to check for ketones again was negative about a week ago.

PLEASE give me your feedback? You are more knowledgeable than me and I want to have your opinions to measure against the vets.

A few members have mentioned to me that the fructasomine test won't give me too much more info. If the average blood sugar is high. Could that show that the insulin dosage is probably incorrect. I guess an average doesn't give the full picture, especially in terms of bouncing. My cat didn't bounce as much before if my current readings are bounces. Sorry for all the rambling. Not enough sleep.
 
the fructasomine test is just going to confirm what you already know...that you're dealing with diabetes. In the few instances where it might come in handy it's usually for brand new diabetics that it's possible MIGHT not really be truly diabetic and just have something else going on that has temporarily spiked the BG levels (like recent cortisone shots with no other symptoms of diabetes) All that test does is tell you what the "average" blood glucose has been over the past 2 weeks.....it's mostly a waste of money.

Also, when your cat is tested at the vet, they've had the stress of the trip over, the wait in the waiting room, being poked and prodded by people they don't know, and it stresses them out. Blood glucose reading can raise up to 200 points just due to stress so tests done at the vet aren't very accurate...and CAN lead to the vet thinking their BG readings are much higher than they really are and recommending raising the dose to an unsafe level.

As for your questions about bouncing. At this point, it's kind of hard to tell for sure since you're not getting any mid-cycle tests during the AM cycle. Pro Zinc's doses are more based on the pre-shot number than Lantus is, but the nadir is still a factor in how much to give, so it's hard to know if there is any bouncing without those mid-cycle spot checks.

What's a bounce? ....When insulin brings the blood glucose down into a lower number than the liver is "used to", it panics and releases hormones and glucogen(sugar) to "bounce" it back up to where it's more "used to" being. As you get the blood sugar under better control, the liver re-learns what "normal" is and slowly stops panicking as hard, so bounces will become less high and take less time to "clear" the body. It can take up to 72hours at first to "clear a bounce" and during those bounces, we just have to wait until we see that it's cleared before making any big decisions about increasing the dose. Again, without a little more data during your AM cycle, there's just no way to know if he's bouncing, or just needs more time on this dose, or even needs more insulin.

That being said, from what I do understand about Pro Zinc, I think you could go up to 1.75, but I suggest you don't do it until you have a cycle where you can be available to do more testing....maybe on a weekend?

Good luck to you at the vet today!
 
Thank you for all your input. It doesn't look clear cut, OK. I will try to get some more numbers for the Am midcycle. I am home today and tomorrow for the Jewish holidays. Thanks again Chris. I am at a loss. I guess at the very least they can check Lovey, weigh her. I was going to show them my spreadsheet but maybe they won't be able to help.
 
Something else you might want to discuss with your vet....and this is TOTALLY up to you! We don't know your situation, and I'm just throwing this out there. Have you considered maybe changing over to Lantus? I ask only because there are so many of us using Lantus so we have a lot more experience with dosing and advising.

It's also the only insulin that there's a definite protocol for that includes home testing, small dose changes and consistency....and has been proven to get up to 84% of newly diagnosed diabetics off the juice within the first 6 months of use.

Just something else to think about
 
Thanks Chris. Lantus sounds good especially if it increases possibility of not needing insulin. Does it require a lot of home testing? I am trying to work on playing with Lovey's ears so maybe that testing will be less stressful, but I am not there yet?
 
We like to see at least 4 tests per day

AM and PM pre-shot tests to make sure you've got a number that's safe to shoot

A mid cycle test (+5 to +8) during the AM cycle, and a "before bed" test for the PM cycle.

We like to do a curve once/week or so too...either a full curve (every 2 hours for one complete cycle) or a mini-curve (every 3 hours for a complete cycle)
 
I would go ahead and show the spreadsheet to the vet to see what they think.
I also think based on the data that an increase could be given a chance.

Please let us know what the vet thinks?
 
Thanks Larry, Bob, Chris for all your assistance and help.
My vet is on vacation. He will be back next week. This substitute vet said that 1.5 was fine based on the cat's weight gain and appetite and signs. Lovey was down 3 pounds when he was diagnosed. He has gained about 1 pound 12 ounces back.

I probably should have waited until my vet comes back. The other vets probably follow the orders or notes of the vet that sees the animal. They probably agree to not make any decisions until the client's vet comes back. My vet suggested 1.5 a few weeks ago so he was reaffirming what my vet said. I don't think he would recommend something different. He said that the low 200's were fine to stay in all day. And without a full curve, you don't know if the cat is going lower. I want a safe margin because I am gone for work but not that safe. I do have a problem that I can't do intense testing with the paw pricks. I can check some midcycles and preshots etc. I mentioned the high preshots and the fact that it goes up from 200's later in the cycle. He thought that a 100 or low 100's were too low? My regular vet wanted a least 180 as a low point so the 200's don't make sense.
I don't think the vet is thinking about hoping the cat's pancreas heal itself with low numbers.
I guess they just want to keep the cat from going to low or make it easy for the client.

He was against going to 1.75. I did mention that of course I would check the cat's response to it. He almost forbid me. my cat would crash. He said that it would hard to check response when working full time and I wouldn't see full effect of dose until several days. He said that the cat could go too low. When I was in the office, they did a BG at +3 and 20 minutes and the reading was 233. The preshot was 377 so he thought that it was a good lowering and that it would go lower.

Thanks for all your help everyone.

If I check 1.75 on a weekend, would I have to go back to 1.5 when I am at work until I have enough data to see if the 1.75 is safe.
 
We hear that exact same speech from a LOT of vets...if you read as many posts as some of us, you'd see a lot of people's vets tend to say that 180 is a great number...and 200 "isn't bad". My own vet included although my first vet was even a little worse...he said "If we can get her into the 200's (not just 200...anywhere in the 200's), it'll delay the damage to her kidneys and eyes and she won't go blind or into kidney failure as soon"

WHAT??? I didn't want to "put off" those things...I wanted to prevent them!!!...the search for a new vet was on...took vet #3 before I found one willing to actually listen and acknowledge that maybe he didn't know everything there was to know about diabetes and was willing to learn from China and I.

The renal threshold is about 240..after that, the sugar dumps into the urine and that can cause a lot of trouble with bacteria (it loves "sweet stuff" to grow in) so the vet wanting Lovey in the 200's is just bad medicine....although not done "on purpose"...it's more a lack of education. Vets just can't keep up on the latest treatments for every disease for every type of animal they see. 180-200's is still just too high for Lovey to be as healthy as she could be.

With the numbers you've been getting, I really think you're probably perfectly safe to go on up to 1.75..but I probably wouldn't try it until maybe tomorrow so you wouldn't have to worry about a possible low number and being up all night worrying..and Lovey did drop quite a bit, so it's also possible the 1.5 is starting to "kick in" a little better..let's see what the numbers show us later today. If you can get those 4 tests in per day, you're really doing great.

Of course you have to do what's most comfortable for you. If you can do more tests on the weekend and want to wait, that's fine too! A couple days at the new dose should give us enough data with the extra testing to at least advise you if it'd be safe to continue while you're at work. The other option you can look into is an automatic feeder. Then while you're at work, you can have the feeder open during the day and give Lovey some food at that mid-cycle time...just an added measure of safety while you're away at work. Lots of the people who work full time here use them
 
Chris, In general, it sounds like your first vet might have been more familiar with canine diabetes than the feline version. Particularly because he mentioned "blindness" which can happen with long-term diabetes in dogs. I can't recall reading here that anyone had that happen to a cat.

Catherine - the thing I don't necessarily buy that your substitute vet said today is that you " wouldn't see full effect of dose until several days.". I know some people feel that way, and some have seen that in their cat's numbers. But I don't. I think an adjustment to a Prozinc dose is fairly quick to show results, provided the difference in dose is big enough. When people observe a difference in numbers after an adjustment of .25u (or sometimes less than that), I feel a large part of that is guesswork, or trying to make the numbers fit into their logic. And not due to a minor tweak in dosage. My way of thinking is definitely a "minority point of view" on that, however.

As far as how long it takes for a dose adjust to show results with a non-depot insulin like Prozinc? One cycle, or two at most. If the numbers don't change much at all within two cycles, I think the cause is that it wasn't a large enough difference in dose to make a real difference. I'll qualify that by saying that the smallest adjustment I ever made to Bob's doses were .5u, until he got down to 1u doses when he was nearly off of insulin. At that point, I tried adjusting .25u at times, but he was off insulin within a few days after that.
I don't think the vet is thinking about hoping the cat's pancreas heal itself with low numbers. I guess they just want to keep the cat from going to low or make it easy for the client.
Click to expand...
That might be part of his reasoning. It might also be possible - although I would hope not - that this vet doesn't realize that cats can go into remission and become diet-controlled.
 
Cats do get cataracts from diabetes/high blood sugar but it is much much much slower than in dogs. I say it in my Mitten who was diabetic for 10+ years and I am seeing it on my patches who was likely diabetic for about the same time period.
http://www.ncbi.nlm.nih.gov/pubmed/10892302
If you feel more comfortable waiting til the weekend to raise dose to 1 3/4 I can't object.
 
Chris, In general, it sounds like your first vet might have been more familiar with canine diabetes than the feline version
Click to expand...

That's just one of the reason's he's my "former" vet!! He also insisted that I follow his directions to the letter, forced a bag of dry W/D in my hands (and of course on my bill) and when I mentioned I'd done some research on diabetes, he copped his usual attitude of "How DARE I question HIM!!"....His exact words when I brought up that I'd read that wet food was best were "You're right Christine...This is the first diabetic cat I've treated in my entire 50+ years of practice"....as he rolled his eyes and gave me a "I dare you to question me again" look.

After telling me that "insulin was a big hassle, and if we could get her numbers into the 200's on the W/D, I should be satisfied with that", I'd pretty much made my mind up that I'd have to look for another vet. My son is diabetic..My mom is pre-diabetic...and I know that "the 200's" is not in any way considered "controlled". He then told me to "bring her back in a week for more blood work". Then I was charged almost $300 for bloodwork, urine test for ketones, the dry W/D and one night's boarding.

Needless to say, we've not graced his establishment again since that day.

Vet #2 wasn't much better. Again I asked about what I should feed China and that I'd done a lot of research on the internet that had said wet food only...He replied "you shouldn't believe anything you read on the internet. If it's a "good quality" dry food like Science Diet or Royal Canin, you'll do fine". Thank you for your time doctor....on to vet #3

Finally!! A vet who was willing to consider that maybe he didn't know the latest information!! He immediately asked what insulin she was on and was shocked she wasn't on any, and agreed that she needed it and that he'd be happy to "order it". He said that noplace around carried insulin so it'd have to be ordered. When I told him that I'd read that we could use human insulin's like Lantus or Levemir he was truly interested in hearing about it. Two days later we were in his office for a thorough checkup (although he agreed he could start with the test results from vet #1 instead of insisting on running new ones) and advice to start her on 3 units once/day. When I said I wouldn't be comfortable giving her that much to start with, he was very kind in saying that I could start wherever I felt comfortable....but he thought we wouldn't get anywhere until we were on at least 3 units. I was charged $30 for an office call and left with a prescription for Lantus.

2 months later when we went in for a weight check and general follow up, he couldn't believe the numbers on her spreadsheet and that she was doing so well on as little as .5 BID and specifically told me that wherever I was getting my advice, it was better than any he could give me and I should continue to lean on those people. (of course he was talking about this wonderful message board!!)

The only thing I wish I could convince him of is to get online..he says the internet "confuses him"..but I'll keep trying!! He's worth the effort!!
 
Thanks everyone for all your input. I will try 1.75 and see what happens.

Larry, Mittens had diabetes for a long time. Was she diagnosed as a kitten. How are Patches and Mittens doing?

Chris, I bought an automatic feeder when I go to work. I set it for +4. Do you think it would be better set a little later?


I need more advice as usual. I noticed that Lovey had more trouble watching on her back legs tonight and this morning. She had diabetic neuropathy from the diabetes and different walking stance. She couldn't jump as much. However, it has been improving since she was on insulin. SHe walking and she was jumping a little better as well. Yesterday night and this morning, she looks like she is having trouble with the hind legs. Do you think the higher numbers are causing the problems or another issue? When I was trying to give the insulin shot, she was hissing at me.

Yesterday, after coming home from the vet, the loud noise of the garbage truck startled her, and she ran on her leash faster that I have seen her run in a year or two. could she have hurt herself? She disliked the paw prick this morning even more than usual. Could it hurt her?
 
I had to say goodbye to Mitten about two years ago because of congestive heart failure. I adopted her as an already being treated diabetic and she was diabetic for many years before she came into my house.
I adopted Patches in February 05 as an already being treated diabetic kitty. She is doing OK, getting old.

Yes, the higher BG numbers can makes the neuropathy worse.
 
Oh, Larry I didn't know Mittens passed away. How old is Patches? Wow, that is nice to adopt a cat with special needs. I don't think many people would adopt cats with health issues to begin with. And as always, thanks for the help.
 
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