Re: 9/18 KT AMPS 102 +1.5-75 +2.5-62 +3s-66/67 +4.5-72
Hi Lyresa!
I just got home from work and saw your PM, and I'd be happy to weigh in. :smile:
You are right, that changing to Prozinc would give you more flexibility, both with dose and with shot timing because it isn't as rigid as an L insulin as far as a 12 hour schedule goes. You've gotten great input from Sienne, Marje and Libby already.
First let me explain my approach to Prozinc/PZI dosing. For the most part, like Marje said, people base the dose on PS numbers with the "P" insulins. I however, base my advice using both the preshot and the nadir numbers. Prozinc is much more of a "if this, then that" insulin. Once you've collected data to see what a dose does, you can to some extent get an "expected" amount of drop on a given dose. So based on history, you can give a bit more, or less, and have some control over the drop in BG. And for the most part, you don't worry much about carryover, no depot to fill or empty. It's a much more "linear" or "proportional" way of thinking. I judge a dose to be effective based on "percentage of drop" rather than looking at the raw numbers. To me, a drop of at least 50%, but not more than 75% seems to have some measure of control over the "bouncing".
What you seem to be hoping for is a "sliding" scale, so that you can worry less about steep or deep drops at nadir, where you would shoot a lower dose at PMPS than at AMPS? That is "possible". But I will tell you that sliding scales don't seem to work well with some cats. It
is the way that Bob was dosed for the 10 weeks he was on insulin. Many PZI folks have tried it, with varying degrees of success. Determining the scale is the hard part, and the only way to do it is to do it, gather data, and adjust accordingly. That can take time, and it can also mean just as much, if not more, testing that you would normally do with Lantus.
You're going to run into the same issues regarding food no matter which insulin you choose. In some ways, you have greater flexibility with Lantus and Lev. With the later onset, you don't have to insure that your cat eats before or at shot time. If KT were to be Mr. Picky-eater, he wouldn't be a rock. He'd be a boulder.
Sienne makes an excellent point here. If your normal dose of PZ on a 250 preshot is say 1.5u, and that gives you a nadir in the upper greens with normal food intake, that's a nice cycle. Remove the food, however, and that 95 nadir might give you a 40 nadir instead. The insulin is going to do what it is going to do, and it is going to do it "this cycle". You could reduce your dose, betting that he won't eat much, but then he decides to eat, and all of a sudden, that 95 nadir turns into a flat yellow cycle, That might be okay, but it isn't helping him get any better, and it isn't getting him used to low blue and green numbers. Which means he's more likely to bounce when he does see them.
There are also some characteristics of the P's that might drive you crazy. While some cats have a fairly normal regular cycle in terms of timing, other cats experience things like the timing of the nadir changing, and for no apparent reason. And I have seen where a dose that is too high can do one of two things. It can either cause a deep drop around +6, or it can cause a "long cycle" where the nadir happens later, and instead of a dose lasting 10-12 hours, you have a cycle with a non-shootable number until +15. With PZI, there is definitely a "no shoot" threshold. Like with any insulin, if a member is "new", we put the line at 200. If you are a BOS sort of girl, you might lower that number, but not until you have the data to back it up, just like the L's. I shot PZI into Bob on "normal" range BG numbers (not because I had BOS, but because I listened to my vet, whose "no shot number advice" was "
if he's under 100, call me before shooting". I wasn't an active member here for most of his time on insulin, so my advice came mainly from my vet, until I started looking around FDMB, realized I wasn't testing enough mid-cycle, and unilaterally decided to start lowering his doses. I still used a sliding scale, but it was my own scale, not the vet's.
With PZ, there isn't a "shoot low to stay low" methodology. If you shoot low, he's
going low. If you skip, he's most likely going high next preshot.
Another "con" in my opinion is that there is no protocol to follow. The TR protocol used to scare me, as people like Sienne and Marje I am sure recall ;-) . It used to be "no way would I do that!". I still wouldn't, but not because it scares me because now I at least understand it. My schedule, and my job, would make it impossible for me to follow the protocol. I could not shoot every 12 hours and I couldn't test often enough at the right times to "do right" by my cat. But at least now I grasp the concept of how Lantus works, and if I thought it offered my next sugarcat his or her best chance at remission, I'd use lantus and rely on the amazing people here to get us through it as best as I could manage.
The protocol, however, in terms of how and when to adjust the dose? To me, it is a huge "comfort". It's logical. For the most part, there's no guesswork. Sure there's wonky happening all the time. But that happens with every cat, with every insulin. There are dives and managing the curve with food, but you'd see that with PZ as well. What you wouldn't have is a logical set of guidelines to follow.
If you were using Prozinc... this morning, you would not have given insulin. You could have stalled without feeding until KT came up to your "no shoot" line, and shot a reduced dose. Or you could have skipped entirely. At PMPS, you would see most likely a high number (pink at least). You wouldn't know if that was due to the low green and a bounce, or from the reduced dose or skipping. Probably a combination of the two. With Prozinc, the advice is "don't shoot the bounce". In other words, if KT bounces, you don't up the dose because of the higher preshot number. Just stick with his normal dose...... see the problem with that? If you're using a sliding scale, how do you know what number you're shooting into? Is it bounce? Is it due to no or little insulin? You don't know, so you sort of have to wing it, erring on the side of caution. Otherwise you're up all night testing. I guess what I'm saying is that there isn't really any greater feeling of security regarding dose, or how much diving and dropping is going on, if you're using a sliding scale and you're running into the same stuff you're seeing on Lantus....low numbers at AMPS or PMPS, bouncing, etc.
I have never "watched" a kitty who switched to Prozinc from Lantus. I know that some have. Robin (Rob and Harley GA) I believe used Lantus, Lev, and Prozinc. But that was all before I joined the board. Deb (Barn Cats R Us) went from Humulin, then Lantus, to Prozinc, but did not post much, and ended up coming up with her own plan that worked to get Marilyn OTJ. I'm sure there have been others, but I am not familiar with the specifics. Yes, it's an option for you, and I would do whatever I could to help you out if you were to take that route. I'm just not sure it's an attractive option for KT, and I can't say he'd do better or that it would lessen the stresses that this dance is putting on you and your family.
I hope that helped?
Hugs,
Carl
