How long before Prozinc kicks in? | Feline Diabetes Management Board

How long before Prozinc kicks in?

Emerie

Member
I'm getting concerned that Unc doesn't seem to be responding to the insulin. He's been slowing increased since his diagnosis and is now at 2.5 twice a day. He seems mostly OK, is grooming still and interacting with us, but his symptoms haven't changed. Still hungry and peeing huge amounts, but drinking a tad less. His numbers are consistently high, over 400 on the ear prick and Freestyle. Readings do drop a bit mid cycle but still way too high. My vet is knowledgable and I appreciate the conservative treatment but I want him to get better and this seems really drawn out. He hadn't lost anymore weight at his last visit which was good news.
 
How can I tell the difference between the Libre readings and the Alpha Trak readings? FL is for Libre and numbers that have no letters after them are Alpha Trak? I just want to be sure.
 
It can definitely take some time to get your cat regulated on insulin. Many cats have been diabetic for a long time before they are officially diagnosed as having feline diabetes. It can take time to find a dose that begins to work for them. I am sorry. I completely understand how incredibly frustrating and worrying it is. I went through that and I will never forget.

Looking at Uncle Charlie’s spreadsheet, if he were my cat, I would increase to 3 units tomorrow. His nadirs (such as they are) are so high that another half unit increase is warranted.
 
Nothing else going on with him like an infection or inflammation (bad teeth?)

He does need a cleaning. The vet says he has 'mild gingivitis'. His breath doesn't smell bad, but you can see that he has a bit of inflammation. Vet says he should have a cleaning as soon as he is regulated, and I agree. On his past appointments for yearly shots, she noted that he would need a cleaning sometime in the future, but it wasn't bad enough to rush to do it.

He has no other problems other than being FIV positive. He was diagnosed with that years ago and hasn't had any issues related to it so far.
 
It can definitely take some time to get your cat regulated on insulin. Many cats have been diabetic for a long time before they are officially diagnosed as having feline diabetes. It can take time to find a dose that begins to work for them. I am sorry. I completely understand how incredibly frustrating and worrying it is. I went through that and I will never forget.

Looking at Uncle Charlie’s spreadsheet, if he were my cat, I would increase to 3 units tomorrow. His nadirs (such as they are) are so high that another half unit increase is warranted.

I think he needs an increase, but I'm uncomfortable doing it without the vet's direction, so I emailed her. She's very good about quick responses. She increased it last time after an email.

*EDITED TO ADD: Well! I opened my email to send a message to the vet, and she had already written me to increase his insulin to 3 units starting tomorrow. She also said she loves the spreadsheet and wishes more of her patients did that. ☺️
 
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Hooray! That is awesome. I told you going to 3 units was the way to go! 😊. I remember when I saw my first yellows. This is good to start seeing a response to the ProZinc. Now, from here, we can slow down the increases a little bit and give things a chance to stabilize. In other words, since his nadirs are in the 200s we should increase in smaller increments of .25 units. This is assuming (and hoping) that he will continue to have yellow nadirs. I would hold the three unit dose for 7 days and if he is still having yellow nadirs, I would then increase to 3.25 units. Hopefully you have the U-40 syringes with the half unit markings because you will need to eyeball it between the 3 and 3.5 marks.
 
Well, the celebration was short-lived. I ear-pricked him at +6, and he had shot back up to 403. 😞 Is this the bounce I've read about?

Yes I have the syringes with the 1/2 markings.
Oh darn. I was sincerely hoping he would not be a bouncy cat. It may or may not be a bounce. If his numbers go up and stay relatively high and flat for a bit then it probably is a bounce. If he goes back down in the evening then it’s not a bounce (just lack of duration.)
 
I am just checking in on Uncle Charlie. Be sure to get some scans done today of the Libre (and tonight) so we can document how long his bounce lasts (if he is bouncing). If he comes back down in this or the next cycle we will know. Bounces can last up to six cycles (but they don’t always last that long.)
 
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I am just checking in on Uncle Charlie. Be sure to get some scans done today of the Libre (and tonight) so we can document how long his bounce lasts (if he is bouncing). If he comes back down in this or the next cycle we will know. Bounces can last up to sox cycles (but they don’t always last that long.)


Hi, thank you for checking. I have updated his chart. He just had a reading of 297. My vet recommends a bump to 3.5 units, but that was before the current reading.

Wondering if I should wait and see if his numbers continue to go down before the bump?
 
And try to gather as much data as you can even at night - with a couple of Libre scans.

I see the yellow for today and it’s just into the yellow zone. I hope he will drop a little lower before coming back up.
 
Don’t give him much to eat after about +5. We don’t know exactly where his nadir is/will be yet, but feeding after nadir can shorten the duration of his insulin and cause numbers to rise prematurely. If he needs to have the LC treats when you are doing a manual test, of course, that is fine because he should have a treat with every test.
 
Hi, thank you for checking. I have updated his chart. He just had a reading of 297. My vet recommends a bump to 3.5 units, but that was before the current reading.

Wondering if I should wait and see if his numbers continue to go down before the bump?
You will be on track for an increase on 6/25. Any Libre scans today?
 
Question: most members here that I work with who use the Libre CGMs have almost every single cell on their spreadsheets filled in because they are getting the data continuously from the sensor. On Uncle Charlie’s sheet there aren’t that many data points in the cells. Are you not getting continuous data from the Libre continuous glucose monitor?
 
You will be on track for an increase on 6/25. Any Libre scans today?

Yes, I just did one, and it was 380 at +6.

The vet wanted me to increase today, but I held off. Why do you suggest I wait until 6/25?

No, I don't (think) I get continual readings from it with this app. I got a notice yesterday to update the app, and that one indicated that it will give me continual readings, but I have to wait until they get a new sensor put on. I tried to read the sensor he has on now with the latest app, and it gave me an error.
 
The vet wanted me to increase today, but I held off. Why do you suggest I wait until 6/25?
The reason is because your spreadsheet and signature say you are following the SLGS method. Have you read the ProZinc dosing methods? If you want to follow MPM, then the protocol allows for dose increases to be made every 3 days (6 cycles) if needed.

I am attaching the sticky note with the ProZinc dosing methods. Let me know if you have any questions. Normally, we like to let SLGS be given a chance first but you really have not seen a great response to the insulin yet so that is why I had previously suggested an increase earlier than 7 days. I was fast tracking him a bit because his nadirs were all over 300. In Uncle Charlie’s case, I definitely think that, at least for now, the Modified ProZinc method is the way to go.

Sticky - ProZinc Dosing Methods
 
The reason is because your spreadsheet and signature say you are following the SLGS method. Have you read the ProZinc dosing methods? If you want to follow MPM, then the protocol allows for dose increases to be made every 3 days (6 cycles) if needed.

I am attaching the sticky note with the ProZinc dosing methods. Let me know if you have any questions. Normally, we like to let SLGS be given a chance first but you really have not seen a great response to the insulin yet so that is why I had previously suggested an increase earlier than 7 days. I was fast tracking him a bit because his nadirs were all over 300. In Uncle Charlie’s case, I definitely think that, at least for now, the Modified ProZinc method is the way to go.

Sticky - ProZinc Dosing Methods

Ah OK, thanks for the information.

I did increase him today to 3.5 (today) as recommended by his vet. His Libre sensor is done in 2 days. I was thinking of giving him a break from that and just doing ear sticks for a bit. But in your opinion, is continual monitoring better at this point?
 
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Ah OK, thanks for the information.

I did increase him today to 3.5 (today) as recommended by his vet. His Libre sensor is done in 2 days. I was thinking of giving him a break from that and just doing ear sticks for a bit. But in your opinion, is continual monitoring better at this point?
Well, it’s very important to be able to get information during the cycle. What is your schedule like for being able to scan his Libre. Are you gone from home a lot during the day? Evening? He has been so high lately that we haven’t really discussed the optimal times for scanning/testing yet. Hopefully he will get into better numbers very soon though! So, how is it going with the ear tests lately? I thought he was not making it easy on you? If you are pretty proficient at ear tests now then you could possibly skip the Libre (if he is cooperating 😊)
 
Do you have any tests/scans from today? I am just really really hoping and pulling for Uncle Charlie to see some better numbers so I am hopefully checking his spreadsheet!
 
I am mostly retired and work from home part-time, so my furry overlord can have my full attention when needed. Advice on testing cycles is welcome. What I've been doing so far is trying to test at +6 in the daytime and the same in the evening, and a last one before I go to bed, usually around midnight my time.

Both of us are getting better at the ear pricks! He recognizes the Tupperware tray I keep the tools in now. He likes the kitchen, so I sit on the floor with him, and if I do it quickly, he won't fuss. He sure enjoys that dried chicken/salmon after.

His AMPS today was 286 (ear prick)! But just now he's back up to 318. *sigh.

We have an appointment with his vet tomorrow. I am waiting for her to answer my email - we may reschedule.
 
He’s never had a yellow AMPS before! That’s good. It probably means he dropped lower than that last night and was coming back up again in the morning as the insulin was wearing off. I don’t see any evening tests on the spreadsheet for the last two nights — so it’s hard to know for sure, but it sure looks that way. If he’s true to form though, he will bounce from those yellows that he’s not used to.
 
And congratulations on your success at getting him used to the testing! Well done! The treats sure do help. 😊 I used to test and shoot Darcy on a barstool in the kitchen area. After a while he would let me do it anywhere.
 
Update after the vet:

She tested his urine (at my request) and no ketones! His weight is stable with no loss. We put on a new freestyle and are going to watch him for a few days at the current insulin dose, then adjust from there. She's going to email me on Monday to discuss. Reading just now at +7 is 275!
 
What great news that he had not ketones at the vet — and no weight loss is also good news. I see he had another yellow. It looks like he’s on track for another increase by Monday anyway (after 7 days) unless something changes. Try to vary the times that you scan or test him — one day get a +4 and a +6 and another day get earlier tests like a +2 (which will tell us if the insulin is onsetting by +2) and then a +8 (which will give us some indication of what kind of duration he’s getting.
 
Normally, those following SLGS who don’t get a lot of mid-cycle tests are asked to run a curve where they test every two hours for one cycle. For you this would be easy with the Libre. Some people pay their vets to run curves, but it’s really a waste of money when you can do it yourself at home — and you avoid potential elevated BG due to the stress of being at the vet. If you get a lot off tests at various points of the cycles, though, your spreadsheet will become filled in like a checkerboard and you may not need to do a curve at all. A curve just gives you a one day picture and it’s not particularly useful if curve day happens to be a day where the cat is bouncing.

How is he behaving? Does he seem happy?
 
Well, the Libre spontaneously went bad/offline last night, and I have no idea why. I will write to Abbot for a replacement without mentioning it's for my cat.

His PMPS last night was alarmingly high at 579 (ear stick). I gave him his dose and food and waited to see if his behavior changed or if he got sick. He didn't. He ate and was fine. I wasn't able to get another stick later in the evening; he's better about it, but last night was just too bitey, and the same problem this morning. After a few pokes, I stopped, not wanting to stress him.

He isn't drinking as much water as he was before. He is still pretty hungry, though, and still has a large volume of urine. Sigh.
 
I think he needs an increase. Have you talked to your vet? Sorry about the Libre! You’ve managed to get a few tests and that’s good. Well done! Keep trying and keep the treats coming!
 
Just a minor update on Unc; he's about the same. No overall negative symptoms either way, thankfully, despite his BG shooting up alarmingly high a couple of times. The vet is checking in this week and will probably increase his dose. I'm wondering if he should be on a different type of insulin, because how high can he go with Prozinc?
 
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