? Yay! Magic's Switching to ProZinc (from Vetsulin). What am I in for?

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Denver & Magic (GA)

Denver & Magic (GA)

Member Since 2021
After the chaos this weekend and Magic's crash, I had a 'come to Jesus' meeting this morning with my vet. At that point he relented and is ordering Magic some from their supplier. It should be here either tomorrow afternoon or Wednesday.

I rarely get confrontational, but after the weekend and literally only about three hours sleep since Thursday I am done being nice or polite with anyone.

Now.... What am I in for?

My general understanding from what i've read here and elsewhere is that ProZinc is basically a kinder, gentler version of Vetsulin with a longer duration and more gradual release system. Is this correct?

Magic is now on 4u/2x Vetsulin. I lowered the dose after the crash. When he transitions to ProZinc, what would be a reasonable starting point? I don't want him back into the 600+'s again. (I get the impression my vet doesn't have as much first-hand knowledge about this particular insulin). I intend to do what he says - within reason. But I also just want to make sure he doesn't prescribe something that's going to crash him again right out of the gate. (Trust but verify).

Are there any issues unique to ProZinc that I should be on the watch for?

They are also going to order me some U40 syringes with half-unit markings. Doing the 4.5u interim dose of Vetsulin I tried was a pain in the @#$ without that half-unit mark. (I'll be the first to admit that even with my bifocals I'm blind as a bat).

Any guidance or information would be most appreciated. I usually don't challenge my healthcare providers this directly so I know if this doesn't work or things go south they're going to be done with me.
 
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Congrats on being an advocate for your kitty! As you learned this weekend, at the end of the day YOU are the one managing and dealing with your cat’s diabetes 24/7, not your vet, so sometimes you have to put some pressure on them when you think something is not working. Hopefully Prozinc will work better for Magic.

You are correct - Prozinc is similar to Vetsulin in that it’s an in-and-out insulin, and tends to be gentler and longer lasting. With Prozinc, onset tends to be around +2-3 and nadir around +4-7, but of course this will vary depending on your specific cat. For most cats it will last around 10-12 hours. Definitely check out the stickies in the Prozinc forum if you have not already :cat:

I will tag @JanetNJ for you to see what she thinks about the starting dose
 
Congrats on convincing your vet to switch to Prozinc!

Have you visited our Prozinc Forum? There is a wealth of information on Prozinc in the "stickies" at the top of the Forum. For e.g.:
NEW TO THE GROUP: THE PROZINC BASICS. PLEASE START HERE.

You can buy u-40 insulin syringes online from ADW Diabetes:
https://www.adwdiabetes.com/search.aspx?keywords=u40 insulin syringes


Linking your previous threads:
https://www.felinediabetes.com/FDMB/threads/magic-hypo-61-10-30a.252151/
https://www.felinediabetes.com/FDMB/threads/magic-bg-137-pmps-vetsulin-help-needed.252069/
 
Bandit's Mom said:
Congrats on convincing your vet to switch to Prozinc!
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I didn't 'exactly' convince him to switch - I told him he was switching.

I'm going to try and go through that forum section when I go to lunch. I started looking there last night but my brain is about 80% mush right now since I've been up for so long.
 
Bandit's Mom said:
OK. I'm not sure about u-40 syringes, but I've bought u-100 syringes on ADW without one. They require an Rx to ship to NY, NJ, NH, ME, CT and IL.
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It's my understanding from all that I can find that in Indiana all insulin and syringes require an Rx, except for I think one of the ancient human insulins. I'm going to stop in and ask a buddy of mine who's a pharmacist at Walmart if he's in when I go to lunch. Since they even restrict Claritin D here I'd be really surprised. But I'll definitely check... That's where I get Magic's testing supplies from anyway.
 
Denver said:
It's my understanding from all that I can find that in Indiana all insulin and syringes require an Rx, except for I think one of the ancient human insulins. I'm going to stop in and ask a buddy of mine who's a pharmacist at Walmart if he's in when I go to lunch. Since they even restrict Claritin D here I'd be really surprised. But I'll definitely check... That's where I get Magic's testing supplies from anyway.
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You can also write to adwdiabetes and check if they will ship you the syringes. When I wrote them, they responded saying those were the states for which they needed a doctor's authorization.
 
I got my u40 syringes with 1/2 unit markings on them from this website. It doesn't say it anywhere in the description so I was pleasantly surprised when they arrived that way. They're smaller too. 31g 5/16" which Mocha barely even knows he's getting a shot.

https://shoppettest.com/advocate-pettest-u-40-insulin-syringes-31g-3cc-5-16-100-box/

I'm not sure about Indiana law when it comes to purchasing syringes. I'm fairly sure you don't need one. I think it was similar to Ohio when I worked there. You just had to sign a log book. At any rate if you go to purchase them online it will let you know whether or not you need a prescription. They can't legally send them to a state that requires it.
 
Denver said:
Any thoughts on where his starting dosage should be? For those that have transitioned how did that process exactly work?
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Generally you start where you left off, so 4 u.

They are both in and out insulins so you can start at the next shot time.
 
Next question... Currently he gets his full meals at 6am/6pm. They told me he needs to eat each of them in a single sitting over about 90 minutes and then no food until the next feeding. Does that process still hold true for ProZinc? Magic has adapted to this schedule pretty much without issue. However, since ProZinc has a longer duration will this run me into trouble?

I apologize in advance if any of my questions sound stupid. I'm just trying to make sure I don't end up screwing something up on my end that will negatively impact Magic.
 
No need to apologize! No questions are stupid. We were all new once and have asked pretty much the same questions you are asking :-)

I don't think the two meals a day concept holds with Prozinc. A couple of "snacks" every 2 or 3 hours in the first half of the cycle would help. I will let @JanetNJ confirm that since I am not very familar with Prozinc.
 
Denver said:
Next question... Currently he gets his full meals at 6am/6pm. They told me he needs to eat each of them in a single sitting over about 90 minutes and then no food until the next feeding. Does that process still hold true for ProZinc? Magic has adapted to this schedule pretty much without issue. However, since ProZinc has a longer duration will this run me into trouble?

I apologize in advance if any of my questions sound stupid. I'm just trying to make sure I don't end up screwing something up on my end that will negatively impact Magic.
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It's not as important with ProZinc to have a lot of food on board at shot time. All my cats, including my diabetic when she was with us, are grazers. I used to feed in the morning... By lunch is give a little more fresh food (there is always some breakfast left). Then another meal at dinner and a little more before bed. Just no food at least 2 hours prior to the preshot test. Your questions definitly aren't stupid.
 
Next time your cat goes low, just go with some medium carb food. No need for syrup unless she's under 60 or showing symptoms... And just a little on the gums is all you need to boost it until the food kicks in (unless it's scary low). The Chunky chicken is low carb. I'd stuggest you pick up a few cans of gravy lovers or cheddar delights. They are higher carb and usually enough to steer those numbers up. You don't want to over compansate when the number is just a little low and send those numbers skyrocketing, you just want to steer up into the 70's-80's. :) being her first lower numbers though I get why you got nervous for sure.


You are doing a great job and it's clear how much you care for her. She's a very lucky kitty.
 
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Denver said:
Next question... Currently he gets his full meals at 6am/6pm. They told me he needs to eat each of them in a single sitting over about 90 minutes and then no food until the next feeding. Does that process still hold true for ProZinc? Magic has adapted to this schedule pretty much without issue. However, since ProZinc has a longer duration will this run me into trouble?

I apologize in advance if any of my questions sound stupid. I'm just trying to make sure I don't end up screwing something up on my end that will negatively impact Magic.
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There are no stupid questions here at all.

Starting at 4u is safe but I would not be surprised at all if you will need to increase to 4.5u. The reason is because I don’t think the low BGs you saw on 8/29 are indicative that that dose is too much for Magic. Why?
  • Magic was clearing a bounce from the fast drop and the 90s on 8/27.
  • Bounce clearing cycles such as the 8/29 a.m. cycle are always going to be really active.
  • Vetsulin can cause bounce clearing cycles to be even more active and if the curve is not fed from the onset, you will see the exact kind of cycle you saw.
  • Magic’s BG was not that low; 61 on an AT is not considered to be a “HYPO” BG. I read that he was under the bed when he normally is not but that was most likely because it doesn’t feel good for a BG to drop that fast even if the drop is from 600 to 400 in a such a short time span. While we would always reduce the dose for a BG below 90 for a cat on Vetsulin, it doesn’t mean that reduction will always hold given the fast drop.
  • It appears he had no food in between his PS meal and his onset. This often happens with cats regardless of insulin. For example, with cats on Lantus, we suggest feeding several minimeals because it helps to slow the drop and avoid this bounce/dive thing he has going on.
Having said all that, it’s just a synopsis of why you most likely saw that kind of a cycle. Let’s hope 4u will work perfectly for him.

I’d also suggest, if you haven’t, that you start reading all the stickys on the PZ forum. I believe they will help you immensely as they discuss feeding strategies, etc.

Good luck with PZ!
 
Marje and Gracie said:
Magic’s BG was not that low; 61 on an AT is not considered to be a “HYPO” BG. I read that he was under the bed when he normally is not but that was most likely because it doesn’t feel good for a BG to drop that fast even if the drop is from 600 to 400 in a such a short time span.
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I'm confused. The "sticky" on the Vetsulin page recommends no less than 68 on the AlphaTrak (which is what they are using).

"Q: What is ‘too low’?
As a general rule, to prevent symptomatic hypoglycemia we want to keep a diabetic cat’s BG levels above 50 mg/dL (2.8 mmol/L) on a human glucose meter. If you are using a pet meter it would be wise to keep the BG a bit higher. On an AlphaTrak2 meter, for example, you are advised to keep your cat’s BG above 68 mg/dL (3.8 mmol/L).

If you see these numbers you are advised to take action to ensure that your cat’s BG doesn’t drop any lower. If the cat’s BG drops lower, there is a real risk you cat will become hypoglycemic. (A very small minority of cats may actually show symptoms of hypo at these numbers or even slightly higher.)

Remember too that with Caninsulin (Vetsulin), it is usually best that newcomers aim for a nadir no lower than 90 mg/dL (5 mmol/L) at the peak action of the cycle as measured on a human meter (see ‘Blood Glucose Reference Information’ above.)"


I've been using both the numbers and clinical signs to make decisions about Mocha if he drops below 68 on the Alphatrak. He's never acted any different during those times. But it sounds like Magic was not being himself during that day of being at 61.

So should we just go by numbers or clinical signs or both? And what number should we begin to get worried at (on an Alphatrak)?
 
Mocha's_mom said:
I'm confused. The "sticky" on the Vetsulin page recommends no less than 68 on the AlphaTrak (which is what they are using).

"Q: What is ‘too low’?
As a general rule, to prevent symptomatic hypoglycemia we want to keep a diabetic cat’s BG levels above 50 mg/dL (2.8 mmol/L) on a human glucose meter. If you are using a pet meter it would be wise to keep the BG a bit higher. On an AlphaTrak2 meter, for example, you are advised to keep your cat’s BG above 68 mg/dL (3.8 mmol/L).

If you see these numbers you are advised to take action to ensure that your cat’s BG doesn’t drop any lower. If the cat’s BG drops lower, there is a real risk you cat will become hypoglycemic. (A very small minority of cats may actually show symptoms of hypo at these numbers or even slightly higher.)

Remember too that with Caninsulin (Vetsulin), it is usually best that newcomers aim for a nadir no lower than 90 mg/dL (5 mmol/L) at the peak action of the cycle as measured on a human meter (see ‘Blood Glucose Reference Information’ above.)"


I've been using both the numbers and clinical signs to make decisions about Mocha if he drops below 68 on the Alphatrak. He's never acted any different during those times. But it sounds like Magic was not being himself during that day of being at 61.

So should we just go by numbers or clinical signs or both? And what number should we begin to get worried at (on an Alphatrak)?
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I see the take action number on a pet meter is also 68.
I did a search and everyone says its it's 68
@Mocha's_mom

I'll tag @Marje and Gracie to be sure
 
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Marje and Gracie said:
Magic’s BG was not that low; 61 on an AT is not considered to be a “HYPO” BG. I read that he was under the bed when he normally is not but that was most likely because it doesn’t feel good for a BG to drop that fast even if the drop is from 600 to 400 in a such a short time span. While we would always reduce the dose for a BG below 90 for a cat on Vetsulin, it doesn’t mean that reduction will always hold given the fast drop.
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Hi Marje me a @Mocha's_mom are confused , always thought the take action number on a pet meter was 68
@Marje and Gracie
Thanks Marje
 
Mocha's_mom said:
I'm confused. The "sticky" on the Vetsulin page recommends no less than 68 on the AlphaTrak (which is what they are using).

"Q: What is ‘too low’?
As a general rule, to prevent symptomatic hypoglycemia we want to keep a diabetic cat’s BG levels above 50 mg/dL (2.8 mmol/L) on a human glucose meter. If you are using a pet meter it would be wise to keep the BG a bit higher. On an AlphaTrak2 meter, for example, you are advised to keep your cat’s BG above 68 mg/dL (3.8 mmol/L).

If you see these numbers you are advised to take action to ensure that your cat’s BG doesn’t drop any lower. If the cat’s BG drops lower, there is a real risk you cat will become hypoglycemic. (A very small minority of cats may actually show symptoms of hypo at these numbers or even slightly higher.)

Remember too that with Caninsulin (Vetsulin), it is usually best that newcomers aim for a nadir no lower than 90 mg/dL (5 mmol/L) at the peak action of the cycle as measured on a human meter (see ‘Blood Glucose Reference Information’ above.)"


I've been using both the numbers and clinical signs to make decisions about Mocha if he drops below 68 on the Alphatrak. He's never acted any different during those times. But it sounds like Magic was not being himself during that day of being at 61.

So should we just go by numbers or clinical signs or both? And what number should we begin to get worried at (on an Alphatrak)?
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Thank you. I’ve read that sticky many times and reviewed the draft before it was posted.

Denver said:
Add me to the confused list too...
The handout the vets office gave me and the card in the AlphaTrak box also cite 68 as the danger number for emergency action.
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Please reread my post. I didn’t say 68 was not a take action number. Here is what I said:
61 on an AT is not considered to be a “HYPO” BG
Click to expand...

That was in reference to Denver’s comment on the SS in capital letters “HYPO”. Every cat is different (ECID) but it would unusual to see a cat having a symptomatic episode of hypoglycemia at 61 on an AT. This is consistent with the sticky which states (bold is mine)
(A very small minority of cats may actually show symptoms of hypo at these numbers or even slightly higher.)
Click to expand...

Does that mean the CG should not be on top of it and feed some higher carb food and even syrup depending on where the BG is in the cycle and how fast it’s dropping? No, it doesn’t and I didn’t say anything to the contrary. I was merely saying that Magic hiding under the bed was very unlikely a symptom of hypoglycemia. Again, ECID, but most cats whose numbers are dropping and reach lower BGs will be ravenous and want to eat.

We do not want cats surfing along in the 40s on a human meter. That starts to lose the margin of error for safety. Same thing with a cat below 68 on an AT, which is not a “danger number” in and of itself, but I would not want a cat to be surfing in any range below 68 on an AT because, likewise, you start to lose the margin of error for what is safe. That’s why we use 50 on a human meter and 68 on an AT. Those BGs are safe and still have a margin below them where the cat is still safe but it shouldn’t be “toyed” with and the BG should be brought up immediately to prevent it from falling any lower.

You will also learn that where a lower number occurs in a cycle is important. If my kitty is at 61 on an AT by +3, I’m definitely pulling out the big guns. If kitty is a tightly regulated cat on Lantus and is at 61 on an AT at +10, a little low carb food should do the trick to bring the BG up above 68.

And, of course, it makes sense to use what the meter says and give credence to clinical signs. But no one should rely solely on clinical signs. My Gracie could easily be in the 30s on a human meter and show no clinical signs. Of course, a BG like that prompted a ml of syrup immediately with a retest in 15 minutes.

I hope that helps :)
 
Marje and Gracie said:
Thank you. I’ve read that sticky many times and reviewed the draft before it was posted.



Please reread my post. I didn’t say 68 was not a take action number. Here is what I said:


That was in reference to Denver’s comment on the SS in capital letters “HYPO”. Every cat is different (ECID) but it would unusual to see a cat having a symptomatic episode of hypoglycemia at 61 on an AT. This is consistent with the sticky which states (bold is mine)


Does that mean the CG should not be on top of it and feed some higher carb food and even syrup depending on where the BG is in the cycle and how fast it’s dropping? No, it doesn’t and I didn’t say anything to the contrary. I was merely saying that Magic hiding under the bed was very unlikely a symptom of hypoglycemia. Again, ECID, but most cats whose numbers are dropping and reach lower BGs will be ravenous and want to eat.

We do not want cats surfing along in the 40s on a human meter. That starts to lose the margin of error for safety. Same thing with a cat below 68 on an AT, which is not a “danger number” in and of itself, but I would not want a cat to be surfing in any range below 68 on an AT because, likewise, you start to lose the margin of error for what is safe. That’s why we use 50 on a human meter and 68 on an AT. Those BGs are safe and still have a margin below them where the cat is still safe but it shouldn’t be “toyed” with and the BG should be brought up immediately to prevent it from falling any lower.

You will also learn that where a lower number occurs in a cycle is important. If my kitty is at 61 on an AT by +3, I’m definitely pulling out the big guns. If kitty is a tightly regulated cat on Lantus and is at 61 on an AT at +10, a little low carb food should do the trick to bring the BG up above 68.

And, of course, it makes sense to use what the meter says and give credence to clinical signs. But no one should rely solely on clinical signs. My Gracie could easily be in the 30s on a human meter and show no clinical signs. Of course, a BG like that prompted a ml of syrup immediately with a retest in 15 minutes.

Does that address your questions? :)
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Thanks for explaining that Marje, totally understand it now :cat:
 
Hey @Denver congrats on the switch!!
My buddy Nico was kinda in the same boat... Quite a few crashes on Vetsulin with one really bad one to boot, and I more or less told the vet we were switching lol. Oh, to be pet parents...

Just sharing my experience, it did take Nico some time for his body to adjust to the new insulin. (But also, I found out he had an underlying urinary infection that was impacting things too!) After the UTI cleared it was like magic. His numbers were more even and predictable, it was lovely! I really wish the best for you and Magic.:bighug:
 
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