Veterinarian Tools

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Stay Informed With a Variety of Professional Resources

Whether you need guidelines on diabetes care, quick and straightforward answers to safety questions or an extensive dictionary of diabetes terms, we’re here to help.

Browse the information below today.

American Animal Hospital Association (AHAA) Guidelines

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Safety Information

Browse a variety of information for veterinarians and pet owners.

  • Before starting your cat on PROZINC, be sure to talk to your veterinarian about:
    • The signs of diabetes you have observed (for example, increased thirst and urination).
    • The importance of proper insulin storage and administration techniques.
    • The importance of maintaining the cat under the same conditions for diet, exercise, environment, etc.
    • The importance of follow-up visits for testing to determine if dose adjustments of PROZINC insulin are necessary.

    Also, be sure to tell your veterinarian:

    • Any side effects your cat has had when receiving insulin or any diabetes product.
    • Any medical problems or allergies that your cat has now or has had in the past.
    • All medications that you are giving your cat or plan to give your cat, including those you can get without a prescription.
    • If your cat is pregnant or nursing.
    • If you plan to breed your cat.
  • Possible side effects of PROZINC

    PROZINC insulin, like other drugs, may cause some side effects. Serious side effects can occur with or without warning. Please contact your veterinarian immediately if you think your cat has a medical problem or side effect from PROZINC therapy. Possible side effects include low blood glucose (hypoglycemia), insulin antagonism/resistance, rapid insulin metabolism, insulin-induced hyperglycemia (Somogyi effect) and local or systemic reactions.

    The most common insulin-related side effect is hypoglycemia. Hypoglycemia can be fatal without prompt treatment. 

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  • Hypoglycemia (low blood glucose)

    In cats, low blood glucose, also called hypoglycemia, is defined by the U.S. Food and Drug Administration as a blood glucose concentration less than 50 mg/dL. Your veterinarian may begin to have safety concerns when your cat’s blood glucose level drops to 80 mg/dL. Hypoglycemia is a dangerous and potentially life-threatening condition that can occur if your cat has too much insulin, too little food or much more exercise than usual.

    The use of PROZINC even at established doses has been associated with hypoglycemia.

    How to avoid hypoglycemia

    Here are the best ways to help your cat avoid hypoglycemia:

    • Make sure to give your cat the correct dose of PROZINC on a consistent schedule. It may be helpful to have one person in the household responsible for giving the injections.
    • If you are not sure the dose was completely delivered, it is important to not give another dose. It is better to err on the side of underdosing your cat with insulin, not overdosing. As always, talk with your veterinarian if you have any concerns or questions.
    • Maintain a regular schedule for feedings and provide the amount of food recommended by your veterinarian.
    • Do not give your cat any prescription or over-the-counter medications, including vitamins or supplements, without your veterinarian’s supervision.
    • Even after your cat is stabilized, regular visits to your veterinarian are important to monitor disease progress and to make dosing adjustments as necessary.

    How to identify hypoglycemia

    Hypoglycemia requires your immediate attention, so it’s important to recognize the signs, including:

    • Weakness
    • Depression
    • Staggering or walking strangely
    • Unusual behavior
    • Muscle twitching
    • Seizure
    • Coma

    What to do about hypoglycemia

    If you suspect your cat has hypoglycemia, don’t panic. You can help your cat by following these steps:

    1. If your cat isn’t conscious, rub a tablespoon of corn syrup or honey on your cat’s gums and contact your veterinarian immediately.
    2. If your cat remains unconscious or is having a seizure, veterinary care is required. Take your cat to the veterinarian immediately.
    3. If your cat is conscious, or when your cat regains consciousness and is able to swallow, hand-feed corn syrup or honey until your cat is alert enough to eat normal food.
    4. As soon as your cat is alert enough to eat, feed the next scheduled meal instead of waiting for mealtime, and call your veterinarian for advice.

    Remember that hypoglycemia is a dangerous condition that can’t wait. It is a medical emergency that requires immediate action.

  • Hyperglycemia (high blood glucose)

    In cats, high blood glucose, also called hyperglycemia, is defined as a blood glucose concentration higher than 200-300 mg/dL. Even after your cat’s blood glucose has been stabilized with treatment, it may become elevated again from time to time. This can happen due to stress, illness or injury, or it may be caused by a departure from your normal routine — for example, if your cat eats something unusual or if you miss a PROZINC injection.

    How to avoid hyperglycemia

    The best way to help your cat avoid hyperglycemia is by sticking to your routine. It’s especially important to give PROZINC injections on time and to ensure your cat’s diet remains consistent from day to day. Anything you can do to keep your cat out of stressful situations will also help because diabetic cats’ glucose levels can spike during stress.

    How to identify hyperglycemia

    Signs of hyperglycemia were probably present when your cat was diagnosed with diabetes, so you may recognize the same signs if your cat’s blood glucose becomes elevated again. These include:

    • Increased thirst demonstrated by drinking more water than usual.
    • Urinating more than usual. If you use clumping litter, you may notice more clumps or larger clumps than you normally see in the litter box.
    • Increased appetite demonstrated by eating more food than usual.
    • Weight loss, even with increased food intake.
    • Weakness in the back legs. You may notice your cat’s stance is different.
    • Lethargic or sluggish behavior.
  • When not to give your cat PROZINC

    Do not administer the prescribed dose of PROZINC insulin if your cat:

    • Is experiencing an episode of low blood glucose (hypoglycemia). Common causes for hypoglycemia include excessive doses of insulin, failure to eat, strenuous exercise, changes in the body’s need for insulin, diabetes-inducing disease or drug effects.
    • Is not eating or is vomiting.
    • Is sensitive to protamine zinc recombinant human insulin or any other ingredients in PROZINC product.
  • PROZINC with other medications

    PROZINC insulin can be given with other medications, but the dose may need to be adjusted if the medication results in either increased or decreased insulin requirements. Tell your veterinarian about all medications you have given your cat in the past and any medications that you plan to give with PROZINC insulin. This should include medications that you can get without a prescription. Your veterinarian may want to ensure that all of your cat’s medications can be given together safely.

  • Accidental overdose

    If you inject more than the prescribed amount of PROZINC insulin, contact your veterinarian immediately. If your veterinarian is not available, seek other veterinary advice at once.

  • Missed doses

    If your cat received less than the prescribed dose or you miss an injection, contact your veterinarian as soon as possible for advice on your cat’s next dose. If you cannot reach your veterinarian and your cat is eating and acting normally, give the usual dose at the next regularly scheduled injection time.

  • Sharing PROZINC

    As with all prescribed medications, PROZINC insulin should only be given to the cat for which it is prescribed and for the condition for which it is prescribed.

  • Monitoring cats on PROZINC

    It is important to periodically discuss your cat’s response to PROZINC insulin at regular checkups that may include blood glucose monitoring. Your veterinarian can best determine if your cat is responding as expected and should continue receiving PROZINC insulin.

  • User safety warning

    For use in cats only. Keep out of the reach of children. Avoid contact with eyes. In case of contact, immediately flush eyes with running water for at least 15 minutes. Accidental injection may cause hypoglycemia. In case of accidental injection, seek medical attention immediately. Exposure to the product may induce a local or systemic allergic reaction in sensitized individuals.

  • Animal safety

    Observe for signs of hypoglycemia. Use of PROZINC insulin, even at established doses, has been associated with hypoglycemia. A cat with signs of hypoglycemia should be treated immediately. (Please see above hypoglycemia section for instructions.) Insulin should be temporarily withheld and, if indicated, the dosage adjusted.

    Any change in insulin should be made cautiously and only under a veterinarian’s supervision. Changes in insulin strength, manufacturer, type, species (human, animal) or method of manufacture (rDNA versus animal-source insulin) may result in the need for a change in dosage.

    If your cat is difficult to regulate, appropriate diagnostic tests should be performed to rule out other health conditions.

  • Kittens and pregnant or nursing cats

    The safety and effectiveness of PROZINC insulin in kittens and in breeding, pregnant and lactating cats has not been evaluated.

Diabetes Dictionary

Learn the definitions to a variety of terms related to diabetes.

  • A-F

    Blood glucose — the glucose, or sugar, circulating in the bloodstream. Blood glucose comes from carbohydrate foods and the body’s own metabolic processes.

    Blood glucose curve — a series of blood glucose measurements taken approximately every two hours for eight to 10 hours that help the veterinarian determine how well a cat’s glucose levels are being regulated while on insulin therapy. The blood glucose values are plotted, and the length of time for the glucose level in the curve to reach its lowest point is found. The lowest glucose level in the curve is called the nadir. The veterinarian can also see when the level of blood glucose starts to rise. By looking at the levels of blood glucose sequentially, the veterinarian can determine the dose of insulin and the frequency of dosing that are needed in a particular cat. Typically, clinical symptoms or signs of diabetes will dissipate if glucose levels can be kept between 100 and 300 mg/dL.1 There is currently much controversy on the reliability of blood glucose curves generated in a veterinary hospital. Cats are susceptible to a condition called stress hyperglycemia. This is a physiological response that develops as a result of an increase in the secretion of certain hormones in frightened or struggling cats. This can elevate the blood glucose levels in spite of insulin therapy and may result in the inappropriate increase of an insulin dose. Once stress hyperglycemia develops, it is usually a perpetual problem, and blood glucose measurements can no longer be considered accurate.2 To counter this, some veterinarians advocate having a willing and trained cat owner perform the blood glucose curves at home because the stress of a hospital visit is eliminated.

    Blood glucose level — the measured quantity of glucose in the bloodstream at a given time expressed in mg/dL.

    Blood glucose monitoring — the process of periodically measuring a patient’s blood glucose level by a single method or combination of methods to determine the effects of a particular insulin. The most commonly used methods are a spot blood glucose determination, blood glucose curves and blood fructosamine levels.

    Blood sugar — see blood glucose.

    Blood sugar level — see blood glucose level.

    Carbohydrate — a source of energy for the body found in most foods (for example, sugars and starches). If eaten in excess, carbohydrates are stored in the body as fat.

    CC — literally, a cubic centimeter. It is a unit of volume measurement. One CC is equivalent to 1 milliliter (1 mL).

    Coma — a state of unconsciousness from which the patient cannot be aroused. This state can occur in cats that have prolonged periods of untreated hypoglycemia (low blood glucose).

    Curve — see blood glucose curve.

    Diabetes — a general term referring to a variety of disorders characterized by polyuria (increased frequency of urination) and polydipsia (increased thirst).

    Diabetes mellitus — a condition in which the body either cannot produce insulin or cannot effectively use the insulin it produces and thus cannot regulate glucose in the body.

    Diabetic ketoacidosis (DKA) — a condition of relative or absolute insulin deficiency. In a diabetic state, the body’s glucose goes largely unused because most of the cells are unable to internalize glucose without the presence of insulin; this condition makes the body use stored fat as an alternative source of energy, a process that produces acidic ketones. Over time these ketones build up in the bloodstream because they require insulin to be metabolized. The presence of excess ketones in the bloodstream causes the blood to become more acidic than the body tissues, which creates a toxic condition. If the diagnosis and treatment of diabetes mellitus is delayed long enough, ultimately DKA may develop. This is usually accompanied by abnormally high ketones in the blood, abnormally high blood glucose, nitrogen-containing compounds in the blood due to dehydration, and metabolic acidosis. The severe metabolic consequences of DKA eventually become life threatening.2

    Diabetic neuropathy — the most common complication of chronic diabetes mellitus (DM) in cats, with prevalence occurring in about 10% of cats. Clinical symptoms or signs include hind limb weakness, impaired ability to jump, a plantigrade posture (hocks touching the ground when the cat walks), muscle atrophy, and irritability on manipulation of the hind limbs and feet. There is no specific therapy for diabetic neuropathy. Regulation of the diabetic state with insulin injections may improve nerve conduction and reverse the weakness in the hind limbs and plantigrade stance in some cats. Response to therapy is variable, and risks of a hypoglycemic event are increased with too aggressive insulin therapy.2

    Diagnosis — the determination of the nature of a disease or medical condition.

    Endocrinologist — a specialist skilled in the diagnosis and treatment of disorders of internally secreting glands (endocrine glands).

    Fructosamine level — concentration of fructosamine, formed in the serum after an irreversible binding between serum glucose and serum proteins. The fructosamine level helps your veterinarian understand your cat’s average blood glucose level for the preceding two to three weeks. Results of your cat’s fructosamine test may suggest a change in insulin dosage is needed, but dose changes are not typically made based on the fructosamine level alone. Although a serum fructosamine level provides very useful information to your veterinarian regarding glycemic control, it has limitations. It can show that the mean blood glucose levels have been high or low over the past several weeks, but it cannot show why. It also can’t reveal trends, episodes of hypoglycemia or specific instances of hyperglycemia.

  • G-L

    Glucometer — a handheld machine designed to test blood glucose levels. A drop of blood from the ear of a cat is placed on a small strip of material inserted into the meter for analysis. The meter calculates and displays the blood glucose level.

    Glucose — sugar.

    Glucosuria — the presence of glucose (sugar) in the urine.

    Glycosuria — the presence of abnormally high amounts of glucose in the urine.

    Hyperglycemia — an excess of glucose in the blood. Accompanying clinical symptoms or signs can include excessive drinking and urination and increased appetite.

    Hypoglycemia — an abnormally low level of glucose in the blood. Accompanying clinical symptoms or signs can include muscle weakness, lethargy, recumbency, seizures and coma.

    Injection — the introduction of a medicinal or nutrient substance into the body via syringe — in the case of insulins, by a subcutaneous (beneath the skin) route. Commonly called a shot.

    Insulin — a hormone produced by the beta cells of the pancreas. It helps to regulate the amount of glucose (sugar) in the blood.

    Insulin adjustment — a change in the amount of insulin to be administered after determining if blood glucose levels are too high or low.

    Ketoacidosis — see diabetic ketoacidosis.

    Lancet — a small, pointed, very sharp double-edged instrument used for making punctures.

  • M-R

    Metabolism — the process in which absorbed nutrients are broken down for energy.

    Nadir — the lowest glucose level on a blood glucose curve.

    Needle gauge — the diameter of a needle. The higher the gauge number, the smaller the diameter of the needle (needle appears thinner). The gauge for insulin needles ranges from 29 to 31.

    Obesity — excessive accumulation of fat in the body.

    Pancreas — an internal endocrine organ that secretes insulin, digestive enzymes and other hormones.

    Peak — the highest blood glucose level on a blood glucose curve.

    Polydipsia — frequent drinking because of increased thirst.

    Polyphagia — increased appetite; excessive eating.

    Polyuria — excessive voiding of urine.

    PROZINC — the first FDA-approved protamine zinc insulin for cats, made with recombinant human insulin.

  • S-Z

    Sharps container — a container specifically designed to house and dispose of used insulin syringes/needles.

    Shot — see injection.

    Somogyi effect (phenomenon, rebound, overswing) — the result of a normal physiologic response to hypoglycemia (low blood glucose) typically caused by too much injected insulin. When the blood glucose level falls below 65 mg/dL, the body releases hormones that raise the blood glucose level to prevent hypoglycemia. When these hormones raise the blood glucose level too much, it causes hyperglycemia (high blood glucose). If your cat experiences the Somogyi effect, you may be more likely to notice symptoms or signs of hyperglycemia rather than hypoglycemia. To diagnose the Somogyi effect, your veterinarian may either admit your cat to the hospital to perform blood glucose curves, or decrease the insulin dose for a few days and ask you to observe your cat for changes in clinical symptoms or signs.2

    Stress hyperglycemia — a condition where a cat’s blood glucose elevates above normal levels due to stress or nervousness.

    Sugar — a simple form of carbohydrate that provides calories and raises blood glucose levels. It provides energy to every cell in the body.

    Syringe — an instrument for introducing medicinal substances or nutrients into the body.

    Type 2 diabetes — a human classification of diabetes characterized by insulin resistance. The type of diabetes most cats have is similar to this classification.

    Unit of insulin — a measurement of insulin. Insulin is measured in international units (IU) as opposed to milligrams (mg) like many other drugs. It is the amount of insulin in a specified amount of carrier. For example, PROZINC is a 40-unit insulin, which means it has 40 units (IU) of insulin per milliliter (mL).

References
1Nelson RW, Henley K, Cole C, et al. Field safety and efficacy of protamine zinc recombinant human insulin for treatment of diabetes mellitus in cats. J Vet Intern Med. 2009; 23:787-793.

2Ettinger SJ, Feldman EC. Textbook of Veterinary Internal Medicine. 6th ed. Vol 2. Philadelphia, PA: WB Saunders; 2004:1576-1577.