Guidelines for using PZI (split from other thread)

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Terri and Lucy

Terri and Lucy

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I emailed Dr Rand and asked her opinion on using Tilly with PZI. She asked me to clarify what I meant and I wrote:
selecting an appropriate starting dose and monitoring frequently. Then determining, based on the test results whether the starting dose is too high or needs to be increased. If it should be increased, raise in 1/4 to 1/2 unit increments every 3-5 days until achieving a range of 50-200 mg/dl or tighter
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Her response was: "This is most similar to what we recommend." Then she referred me to this document on her website:
http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf

What would you all think about using this as the basic PZI getting started document? I don't agree with the first step (she would have started Lucy on 6 units!), but other than that, I think it might help while a newbie gets her/his feet on the ground with testing etc.
 
Re: Am I just being too sensitive...

Terri-

With the caveat that I am not much of a dosing person and really only feel confident in it knowing how MY cat is going to react, I don't see why that couldn't work for PZI. Like you said, the first step is perhaps too much, although with Lantus they do say that you should dose based on IDEAL body weight, not actual, so would that change things as far as lowering the dose? Would that be too complicated for someone to work out? I guess it would depend on the person.

Anyway, it seems to me like something that could be tried without too much risk, assuming that the starting dose is correct. It's obviously worked for L/L. Again, I am not nearly as experienced with insulin and dosing as many, many people on here, so my thoughts could be way off base. ;)
 
Re: Am I just being too sensitive...

although with Lantus they do say that you should dose based on IDEAL body weight, not actual, so would that change things as far as lowering the dose? Would that be too complicated for someone to work out? I guess it would depend on the person.
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Howdy, I don't belong to this forum, so to speak but I just wanted to give a little note on this.

Lantus is not based strictly on weight, sseveral factors should be taken into consideration (dosing strictly on wieght is a basis for vets to use since they often don't have much additional information when presented with a newly diagnosed cat). Other factors include, food, overall BG trends, and if the cat has been (or is) on another type of insulin.

If the owner is attempting a diet change before beginning insulin and the cat has mid-range BG (200-300) a lower dose should be used. Also a lower starting dose is recommended if the cat can't be monitored closely the first few days of therapy.

If the cat is on another type of insulin (Caninsulin, PZI,N) then the last dose on that insulin should be considered. Although Lantus is longer acting it is also somewhat less potent. If a cat of 6kg was on PZI at a dose of 1U BID (the starting dose on Lantus by IDEAL weight would be ,25Ux6kg=1,5U BID) however we would typically use the 1U starting dose as long as the cat did not have insanely high BG or positive Ketones and assuming it is already on a low carb diet.

I think some of this is outlined in Tilly.
 
Re: Am I just being too sensitive...

Monique & Spooky said:
Howdy, I don't belong to this forum, so to speak but I just wanted to give a little note on this.

Lantus is not based strictly on weight, sseveral factors should be taken into consideration (dosing strictly on wieght is a basis for vets to use since they often don't have much additional information when presented with a newly diagnosed cat). Other factors include, food, overall BG trends, and if the cat has been (or is) on another type of insulin.

If the owner is attempting a diet change before beginning insulin and the cat has mid-range BG (200-300) a lower dose should be used. Also a lower starting dose is recommended if the cat can't be monitored closely the first few days of therapy.

If the cat is on another type of insulin (Caninsulin, PZI,N) then the last dose on that insulin should be considered. Although Lantus is longer acting it is also somewhat less potent. If a cat of 6kg was on PZI at a dose of 1U BID (the starting dose on Lantus by IDEAL weight would be ,25Ux6kg=1,5U BID) however we would typically use the 1U starting dose as long as the cat did not have insanely high BG or positive Ketones and assuming it is already on a low carb diet.

I think some of this is outlined in Tilly.
Click to expand...

Thanks for the info, Monique! :) Sorry that I misspoke about Lantus.
 
Re: Am I just being too sensitive...

No problem, you didn't mis anything! Just that the dosing strictly on weight alone is for newly diagnosed cats, that are not already on insulin and there is not much other information to go by. It's not a order it's just a guideline when you don't have a clue where to begin.

The problem is most vets don't get it right, they often use the cats actual weight instead of ideal (Fatty Katty come in weighing 9kg, has an Ideal weight of 6Kg and vet decides since the BG *under stress in the practice* was over 450 he is going to start with

9Kg x ,5U= 4,5U (Tilly specifies starting doses of .25U per Kg of Ideal weight, unless that has Ketones or high BG then INCREASES should be by .5U) vets get that wrong and use the increase in the starting dose. ohmygod_smile

Maybe they get the IDEAL weight correct (or it's just luck that Normo Kitty is not overweight) :-D but they forget to use Kg and calculated in pounds

13,2 Lbs. (6Kg) x ,25U= 3,3U ( which they round up to 3,5U) :?

But generally since most average cats are about ideal at 4-6Kg it works out well to use an average starting dose of 1U, it's conservative. typically it will need to be increased in small amounts, waiting several days before making changes until the so-called breakthru dose then it's all good after that :mrgreen:
 
Re: Am I just being too sensitive...

I've received a request to split out the conversation into a new thread, starting from Terri's suggestion of using this protocol.

The referenced protocol doesn't look that different from SLGS, except that the recommended movement on the dose is faster (but keep in mind, SLGS started with a recommendation that the dose be evaluated every 7 days). Edit: I take that back; she says every two weeks.

It actually looks a little dangerous for NPH and Caninsulin/Vetsulin, but suitable for PZI, except for the starting dose. I'm reminded of the Caninsulin protocol which advises dosing based on weight, but then caps the value at 2 units total, meaning that in practice small cats start on 1 unit and large cats on 2 units.

I'm wondering if the protocol was developed under the assumption that cats are eating a high-carb diet; if so, it would make sense to reduce the 1 unit increments to half unit increments.

Note this statement:

Lente insulin is only recommended as a first choice of insulin in countries where an insulin registered for veterinary use is required to be used initially, and PZI is not registered for veterinary use. If remission has not occurred in 6-8 weeks after initiation of lente therapy, the insulin should be changed to glargine or detemir. Remission rates decrease with time after diagnosis, so early control of blood glucose concentrations is imperative for maximizing the probability of remission. NPH insulin is only recommended when no other long-acting insulin is available.
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That's pretty much what I'm trying to say, too.

-- Janet
 
Correction

Terri and Lucy said:
Her response was: "This is most similar to what we recommend." Then she referred me to this document on her website:
http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf
Click to expand...


Dr Rand and I have exchanged several more emails and apparently, I reported the wrong link above. She believes that PZI should be dosed according to the Lantus/Lev guidelines on her website:
http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

I also spent some time reading the TT thread on the experiment Chris and I proposed using Tilly with PZI. Interestingly, most of the objections didn't really relate to Tilly. For example, several people were horrified at the idea of shooting PZI on a dose as low as some Lantus/Lev users do. However, I don't find anything in Tilly that says you have to shoot low. Instead I found options for what to do when presented with a low preshot (same as Dr. Rand's guidelines).

As someone who loves words, I also think there is a huge misunderstanding of the term "protocol." A protocol is a set of rules that have been extensively tested and verified. While most protocols have exceptions, the emphasis is on rules. By that definition, Tilly is not a protocol, nor is what Dr Rand presents, nor is SLGS. They are all guidelines with lots of latitude for individuals to make adjustments for unique circumstances.

Does anyone object to linking Dr Rand's table as a sticky?
 
Re: Am I just being too sensitive...

Thank you Terri for the UQ links. They are referenced in the stickies over on one of the L forums and I have seen them before, but had always been puzzled that I couldn't find a PZI specific one (and I've plowed through the UQ website and still couldn't find one). Nice to have that question answered.

[ETA: I'm happy to switch to saying "Guidelines" instead of "Protocol", if I remember! I have paid 0 attention (as you've probably noticed ;-) ) to whether or not I use the terms correctly. "Guidelines" sounds so vague and wishy-washy that I just haven't used it much, but I will try to switch to that.]

[ETA #2: I would love to see that link (link4.pdf I think - I think that's the one Terri is suggesting be stickied?) in our PZI sticky, with a note about the BG at next insulin PS (she has notes as to what to do at 50 - 100 I think) and that we do that part a bit differently in PZI. And of course if there are other things that should be noted for safety etc. (I'm not sure we approach dose reduction the same way?) - that one just jumped out at me as possible crisis-inducing for newbies if they just read it and followed indiscriminately.]
 
I definitely like the L&L one better. It seems pretty approximate but sensible - maybe even good in it's approximate-ness. The PS number of 100 and what to do about it might be a little low for PZI for the beginner?

Should any accompanying info about rebound and how to test for it be included or offered? Maybe also guidance for finding the "nadir" and verifying it has not moved and verifying it has not moved and....?

Terri, thank you, thank you, thank you for your work on this and jumping on this fire.
 
Gator & H said:
I definitely like the L&L one better. It seems pretty approximate but sensible - maybe even good in it's approximate-ness. The PS number of 100 and what to do about it might be a little low for PZI for the beginner?

Should any accompanying info about rebound and how to test for it be included or offered? Maybe also guidance for finding the "nadir" and verifying it has not moved and verifying it has not moved and....?
Click to expand...

My hope was that we could start with Dr Rand's and then create/find supporting documentation of the kind you are referring to. Take a look at what Vicky put together for Levemir and see if something like she did would complement this table. I just don't want to get into creating something that is going to be argued over ad nausem, like the original TR FAQ that Steve wrote. So if we using already existing documents, we save ourselves work and arguments while still helping newbies.
 
I agree about the arguing ad nauseum, and for that reason in part, dropped my pursuit a while back of a PZI sticky or pushing for usage guidelines (though I do put in a plug for it every chance I get ;-) ). So glad this is all back on the table, especially if we start getting PZIR newbies.

I'm curious why Dr. Rand doesn't have a PZI-specific chart similar to the others. Subtext = I wonder if they have the info but never bothered to type it up, and if I dream hard enough would they write up a modified chart that is geared to PZI? Since they are recommending it as choice #2, it seems logical they would have guidelines already under their belt, but perhaps didn't bother to write it up with PZI Vet going away?
 
Is this a typo or do I not get it? I thought peak was the same as nadir.
If nadir blood glucose concentration < 200mg/dL but peak is >
200mg/dL (11 mmol/L)
Increase every 5-7 days by 0.25-0.5 IU depending on
if cat on low or high dose of insulin
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Other than not understanding that, I think these guidelines are very helpful. I think this is what advice givers (is that the right term?) have been making these same suggestions, because that's basically what I think all of us do. Is it already one of the PZI Links?

Thank you Terri for bringing all of this back. I think we will see more people/kitties in this forum that could benefit from the information.
 
Does seem confusing......

That quote is from the Rand papers, on the German Katzen-Forum it's stated differently

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.
Click to expand...

Here only the Nadir is important for making changes.

I think in the Rand documents it should read :

If nadir blood glucose concentration < 200mg/dL but peak blood glucose concerntration is >
200mg/dL (11 mmol/L)
Increase every 5-7 days by 0.25-0.5 IU depending on
if cat on low or high dose of insulin


Further down under Reducing the dose it does state "peak blood glucose concentration >200.

That would be my interpertation.
 
Monique, I'm curious does the German forum have guidelines that are specific for PZI? And if so, are they something we might want to link to? (or a translated version)
 
Hi Joanna, I don't belive so, first of all it is a forum almost exclusive for Lantus and Levemir (basal insulins) almost everyone has used Caninsulin (because typically that's what the vets must Rx, it is the only insulin approved for vetinary use) human insulins may be Rx'd as "off-label" when Caninsulin is not effective, which is almost always the case. When new members show up on Caninsulin we help them to get quickly switched to Lantus or Levemir. PZI is not available in Germany (or most of the EU) I think 2006 was the last time it was available, a few cats in the forum had back then used it, it was an alternative to Caninsulin, but never very popular and most people could not comprehend the TR protocol. Historically Caninsulin has been the first choice for cats as no ther insulin is approved for animal use, while in the US Protamine Zink insulins were being tried Europe was already Rx'ing the new rDNA basal insulins to humans in record numbers. The topic of attempting to use the PZI-TR protocol with Lantus has been debated, overwehlmingly is the recommendation that this should not be attempted. There have been a few PZI users however in the pre-Lantus times when Caninsulin (Lente) was not effective there was Ultralente (Ultratard, Novo Nordisk) which is no longer available and falls into the same catagorie as PZI (long duration insulin).
 
Monique & Spooky said:
The topic of attempting to use the PZI-TR protocol with Lantus has been debated, overwehlmingly is the recommendation that this should not be attempted.
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What is the PZI-TR protocol?
 
I was reffering to the YDC (Hodgkins?) protocol. It is mentioned on the German forum and the link to YDC.

Remissionen treten bei diesen Insulinen öfter als bei mittellangwirkenden Insulinen auf, aber die Remissions-Rate ist oft davon abhängig was für ein Einstellungs-Protokoll benutzt wird z.B. gibt es für PZI ein besonders schwieriges/aufwendiges Einstellungs-Protokoll das in Amerika populär ist namens "Tight Regulation", wo die Remissions-Raten sehr hoch seien sollen. Hier wird PZI ganz anders eingesetzt als es normalerweise der Fall ist.
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Remission occurs more often with these longer duration insulins (PZI, Ultralente) than with shorter duration insulins (Lente) but the remission rates are dependent on the regulation protocol used. For example for PZI there is a extremely difficult and labor intensive protocoll that's popular in the USA known as "Tight Regulation" in which the reported remission rate is very high. In this case PZI is used far differently as is typically the case.

In another thread a Lantus user discussed if it were possable to use such an approach with Lantus. Apperently the PZI-TR forum is no longer overseen by Dr. Hodgkins (due to disagreements) the new PZI forum is http://www.diabeticcatcare.com/ I just copied this link from the thread in the German forum and I have not looked at the website. This is the only PZI protocol that I am aware of. In other cases I think PZI is used simularly to the Lente insulins doses are given every 12 hours and based upon measuring curves with respect to Preshot and nadir. The goal being to have the nadir around 80 mg/dl and keeping the BG as much time as possible under the kidney limit (<250). With Lente insulin the nadir should not go below 100 mg/dl and by limiting food intake during times that the insulin is wearing off attempting to stay as many hours as possible under 300.
 
Thanks for the info Monique. I've tried the YDC thing myself (with some modifications), and while there are aspects of it I like, I doubt I would try it again for a variety of reasons (including convenience & cost of test strips, as well as dosing questions, etc.). I agree there would be no need to even consider something like that with Lantus, especially when you already have guidelines like Tilly that appear to work well!
 
Monique & Spooky said:
I was reffering to the YDC (Hodgkins?) protocol. It is mentioned on the German forum and the link to YDC.
Click to expand...

Dr Hodgkins never put together a protocol. She made suggestions for an initial sliding scale and provided some theories that most had trouble swallowing. Very few could implement her suggestions, especially customizing their sliding scale, without a lot of hand holding. However, there were numerous cats going into remission from YDC. Dr H's same basic practice is in effect on the new forum you referenced.

Also, you should know that many of us who posted on the TR forum here (and have the bruises to prove it) viewed TR as a goal rather than a protocol. If the bean was up to collecting a lot of data, analyzing it microscopically, they could successfully achieve the goal. Lynette and Meow Meow and Dale Ann were two of the most successful. Each had multiple fosters that went into remission and then into loving homes. Others of us were able to achieve the goal, but never with as much consistency and Lynette and Dale Ann.
 
Re: Correction

Terri and Lucy said:
Terri and Lucy said:
Her response was: "This is most similar to what we recommend." Then she referred me to this document on her website:
http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf
Click to expand...

Dr Rand and I have exchanged several more emails and apparently, I reported the wrong link above. She believes that PZI should be dosed according to the Lantus/Lev guidelines on her website:
http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

I also spent some time reading the TT thread on the experiment Chris and I proposed using Tilly with PZI. Interestingly, most of the objections didn't really relate to Tilly. For example, several people were horrified at the idea of shooting PZI on a dose as low as some Lantus/Lev users do. However, I don't find anything in Tilly that says you have to shoot low. Instead I found options for what to do when presented with a low preshot (same as Dr. Rand's guidelines).

I looked for this discussion and couldn't find it....?

As someone who loves words, I also think there is a huge misunderstanding of the term "protocol." A protocol is a set of rules that have been extensively tested and verified. While most protocols have exceptions, the emphasis is on rules. By that definition, Tilly is not a protocol, nor is what Dr Rand presents, nor is SLGS. They are all guidelines with lots of latitude for individuals to make adjustments for unique circumstances.

Does anyone object to linking Dr Rand's table as a sticky?
Click to expand...

Okay, as I am trying to follow this discussion...does that mean basically going back to a SLGS type of dosing schedule? As a former supporter on the TR forum of using a sliding scale and shooting more often than BID (as needed), I just wonder if by posting just one set of guidelines that people would not be aware that there is a more aggressive way to dose PZI if they were willing and eager and able to go that route. But maybe no one here wants to go in that direction anymore. I do know it is listed in Rebecca's sticky so maybe that is all that is needed.

Terri and Lucy said:
Monique & Spooky said:
I was reffering to the YDC (Hodgkins?) protocol. It is mentioned on the German forum and the link to YDC.
Click to expand...

Dr Hodgkins never put together a protocol.

However she always referred to it as a "protocol".

She made suggestions for an initial sliding scale and provided some theories that most had trouble swallowing. Very few could implement her suggestions, especially customizing their sliding scale, without a lot of hand holding. However, there were numerous cats going into remission from YDC. Dr H's same basic practice is in effect on the new forum you referenced.

You know I always thought the idea behind her protocol was to have less hand holding. People were given the basic sliding scale to start with and helped with adjusting it in the beginning, but were soon able to be on their own if they so chose. To me, anyway, it was easier than learning Levemir and following Tilly's guidelines, but that is just me. Of course, I had already been using PZI for quite a while before Dr. H came along so maybe that helped.

Also, you should know that many of us who posted on the TR forum here (and have the bruises to prove it) viewed TR as a goal rather than a protocol. If the bean was up to collecting a lot of data, analyzing it microscopically, they could successfully achieve the goal. Lynette and Meow Meow and Dale Ann were two of the most successful. Each had multiple fosters that went into remission and then into loving homes. Others of us were able to achieve the goal, but never with as much consistency and Lynette and Dale Ann.
Click to expand...

You are right in that for a lot of people who posted on FDMB's TR forum they had a certain goal and that was to just try and keep their cat in non-diabetic numbers for as much of the time as possible. There were lots of high dose cats in the forum and lots of cats that had been diabetic for sometime and that was all they could hope for from the protocol.

BTW interestingly and as a side note, it looks like on the new YDC forum that their basic sliding scale has been modified down quite a bit from the old forum:

New forum
"Please note the BSS (Basic Sliding Scale) provided with Dr. Hodgkin’s TR Protocol is for PZI BOVINE BASED INSULIN ONLY. DO NOT USE THE BSS SHOWN BELOW WITH ANY OTHER INSULIN. Insulin specific instructions are posted on the Talking TR Forum as well as detailed instructions on how to start your cat on TR.

Blood Glucose mg/dl Units of Insulin to Inject
151-170 .25
171-185 .5
186-200 .75
201-220 1.0
221-250 1.25
251-290 1.5
291-350 1.75
351-410 2.0

Scale that is still on the 'old form':

When starting TR, use the following scale to START your dosing. Once you have a few tests done and can evaluate your cat's response, you can adjust upward or downward accordingly. Be sure you have reviewed these doses carefully based on your cats diet and insulin requirements. The following chart is designed specifically for PZI Bovine insulin for Felines.
Blood Glucose (US)----- Europe ------------ Units of Insulin to Give
--mg/dl ---------------- mmol/L

151-170 ----------------- 8.3-9.4 ------------------.5
171-185 ----------------- 9.5-10.2 ----------------- 1
186-200 ---------------- 10.3-11.1 ---------------- 1.5
201-220 ---------------- 11.2-12.2 ---------------- 2
221-250 ---------------- 12.3-13.8 ---------------- 2.5
251-290 ---------------- 13.9-16.1 ---------------- 3
291-350 ---------------- 16.2-19.4 ---------------- 3.5
351-410 ---------------- 19.5-22.7 ---------------- 4
411-450 ---------------- 22.8-25.0 ---------------- 4.5
451-500 ---------------- 25.1-27.8 ---------------- 5

I know that people often thought of the above scale as too aggressive so it is interesting to see that it has now been scaled back quite a bit.

Terri and Lucy said:
Gator & H said:
I definitely like the L&L one better. It seems pretty approximate but sensible - maybe even good in it's approximate-ness. The PS number of 100 and what to do about it might be a little low for PZI for the beginner?

Should any accompanying info about rebound and how to test for it be included or offered? Maybe also guidance for finding the "nadir" and verifying it has not moved and verifying it has not moved and....?
Click to expand...

My hope was that we could start with Dr Rand's and then create/find supporting documentation of the kind you are referring to. Take a look at what Vicky put together for Levemir and see if something like she did would complement this table. I just don't want to get into creating something that is going to be argued over ad nausem, like the original TR FAQ that Steve wrote. So if we using already existing documents, we save ourselves work and arguments while still helping newbies.
Click to expand...

Terri, I understand this is all a work in progress and I am not trying to muddy up the waters at all (even though it may sound that way)! I have debated over this quite a bit since you first posted this thread and wasn't sure if I should interfere or even have a right to since I don't post here much and since you are really just trying to get something off the ground, admirably so. :)

So I guess I just wanted to give my two cents (FWIW) and probably could have done it in a lot less space!
 
Re: Correction

pamela and tigger said:
Terri, I understand this is all a work in progress and I am not trying to muddy up the waters at all (even though it may sound that way)! I have debated over this quite a bit since you first posted this thread and wasn't sure if I should interfere or even have a right to since I don't post here much and since you are really just trying to get something off the ground, admirably so. :)

So I guess I just wanted to give my two cents (FWIW) and probably could have done it in a lot less space!
Click to expand...

Thanks for the feedback Pamela. I'll try and remember to come back and read the message through when I haven't had 2 glasses of champagne (my last night for alcohol for 2 more weeks). drinking09

The one point I want to make now is that posting Dr Rand's protocol is just a way to help newbies get started. Of course I think they should move to a TR type approach after the first week or two. But it's really hard to help that happen when they post on Health. If PZI can't get more active support, Health is where they have to be and having something is better than nothing. I really hate to see people being told they need to switch insulins when they've just got started and laid out the cash for PZI (or any other insulin for that matter).
 
Re: Correction

pamela and tigger said:
Okay, as I am trying to follow this discussion...does that mean basically going back to a SLGS type of dosing schedule? As a former supporter on the TR forum of using a sliding scale and shooting more often than BID (as needed), I just wonder if by posting just one set of guidelines that people would not be aware that there is a more aggressive way to dose PZI if they were willing and eager and able to go that route.
Click to expand...

I think our PZI sticky currently has a link to SLGS, and also a link to Supplemental Techniques, which I think references some of the other kinds of things we sometimes to with PZI. I'm not sure if that fits the bill or is specific enough to PZI to help newbies all that much... I know I found that doc helpful as a newbie, just to see what the options are.

I am SO happy to see that the new YDC site has reduced the sliding scale doses. I've seen newbies start out here on BID, go read YDC, and then come back and shoot doses that are already data-proven to be too high for their cat, from not yet understanding how to use the data to make dosing decisions. Thankfully I haven't seen results any worse than a sleepless night dealing with low #s, but it is enough that I shudder whenever someone posts the old sliding scale to a newbie and doesn't clearly explain to them how to evaluate the doses.

Anyhow, thanks for this ongoing discussion everyone, it's nice to know that conversation is going on as to how best to help the newbies.
 
Blood Glucose mg/dl Units of Insulin to Inject
151-170 .25
171-185 .5
186-200 .75
201-220 1.0
221-250 1.25
251-290 1.5
291-350 1.75
351-410 2.0

This is very cool. I like it much better than the old one.

-- Janet
 
Okay, as I am trying to follow this discussion...does that mean basically going back to a SLGS type of dosing schedule? As a former supporter on the TR forum of using a sliding scale and shooting more often than BID (as needed), I just wonder if by posting just one set of guidelines that people would not be aware that there is a more aggressive way to dose PZI if they were willing and eager and able to go that route. But maybe no one here wants to go in that direction anymore. I do know it is listed in Rebecca's sticky so maybe that is all that is needed.
Click to expand...

For several years now, I've advocated starting with SLGS for a week or two in order to get some reliable data to work with, and to give the bean time to change diet and get comfortable with testing. I do think newbies need time to grab hold of the basic treatment options so that they can make decisions about what they are willing/able to do for themselves. For example, I would hope that we could provide them with enough of an understanding of rebound (all the various approaches/debates) so that they could make an informed decision whether they wanted to scale back the dose or bump it up--not because of WHO is advocating a certain approach but because of what the syringe-holder thinks is best.

But once there is data, based on my readings, I think we should advocate progressively more aggressive treatment in order to give the cat the best chance for remission. I used to call this a start low, go fast approach until I learned that Steve had already coined that term with the emphasis on incorporating booster shots. The "go fast" techniques I prefer to advocate (given there are no ketones or other critical medical conditions) are instituting a basic sliding scale; shooting TID when possible and/or adjusting shooting times to achieve overlap.

So would the PZI regulars feel comfortable posting a starting schedule with the caveat that it applies for the first 2 weeks of being on PZI?
 
Terri and Lucy said:
For example, I would hope that we could provide them with enough of an understanding of rebound (all the various approaches/debates) so that they could make an informed decision whether they wanted to scale back the dose or bump it up--not because of WHO is advocating a certain approach but because of what the syringe-holder thinks is best.
Click to expand...
Amen.

Terri and Lucy said:
The "go fast" techniques I prefer to advocate (given there are no ketones or other critical medical conditions) are instituting a basic sliding scale; shooting TID when possible and/or adjusting shooting times to achieve overlap.
Click to expand...
Mmm boy with the little I've seen [not with H] I'm not that big on TID. I know it has it's place but that's an argument for later.

Terri and Lucy said:
So would the PZI regulars feel comfortable posting a starting schedule with the caveat that it applies for the first 2 weeks of being on PZI?
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Absolutely. With maybe a bullet point checklist of things to accomplish during that time?
  • Diet - get on wet ONLY diet with less than 10% carbs by %Kcal
  • Syringes - order in or purchase U-100's [maybe]
  • Learn about curves and testing for nadir & rebound
  • Other???
 
Gator & H said:
Mmm boy with the little I've seen [not with H] I'm not that big on TID. I know it has it's place but that's an argument for later.
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Maybe we could discuss it instead of argue? :)

a bullet point checklist of things to accomplish: (during the first 2-3 weeks)
  • Diet - get on wet ONLY diet with less than 10% carbs by %Kcal
  • Syringes - order in or purchase U-100's [maybe]
  • Learn about curves and testing for nadir & rebound
  • Other???
Click to expand...

My brain is kind of fuzzy this morning so I'm not going to try and simplify these into bullet points, but here's the other issues I think should be included in the list:

--Onset and duration with nadir and rebound.
--One thing I've always advocated for is using the timing of food as part of the treatment strategy along with the insulin.
--Separating out diabetes from any other medical problems. For instance, lots of cats have UTIs and/or dental infections when they come here and newbies need to understand the relationship of the infection and antibiotics on insulin dose.
--Back when PZI had a "party-type" roster, we also advocated stocking Bailey's or wine and chocolate for the bean.
 
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