Alex - 8/7--we have GREEN, but at PMPS

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and just for the record, i wanted to see the chart with ginny's eye's so we could both understand what the numbers were 'speaking' as it is so hard to have that
'conversation' writing posts...i asked her to come back here with her thoughts and dose thoughts and questions. ok, no harm done i hope. :razz:
 
oh, kelly...i agree with your suggested dose. i am no longer really 'here' so i am totally not up to speed with the current methods. i remember pz was NOT working like the pzi so i'm sure methods are being tested to find a way thru....
it's interesting and i will quietly keep an eye on Alex as this has my heart now...poor boy. a DKA on those little numbers!!!! such a shame.
 
lori and tom said:
why would anyone shoot a morning 380 the same dose as the same evening pmps of 189?
this happened with alex and ginny.
can someone explain this to me?
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This is actually something we have all been musing over several times here in the past few months. What we are noticing with breakthrough numbers with kitties on prozinc (breakthrough = lower numbers out of the blue) is that it takes a similar dose to keep those numbers coming. Reducing the dose on those numbers (within reason) equates to some sort of lost momentum that results in these wild swings between high numbers after reducing the dose and low numbers after raising the dose on the high number.
 
lori and tom said:
oh, kelly...i agree with your suggested dose. i am no longer really 'here' so i am totally not up to speed with the current methods. i remember pz was NOT working like the pzi so i'm sure methods are being tested to find a way thru....
it's interesting and i will quietly keep an eye on Alex as this has my heart now...poor boy. a DKA on those little numbers!!!! such a shame.
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I hope you don't feel a need to keep quiet because of me! :-D It is always good to have another set of eyes in here. I came back over to help out because so many switch from prozinc and leave this ISG.
 
Ginny & Alex said:
and I guess I don't understand. I thought I was supposed to try to shoot the same dose of ProZinc in the AM and PM.
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Lori, if memory serves me you were the one that decided that Prozinc was exactly like the L's and was advising accordingly.
 
Kelly & Oscar said:
You do need to shoot the same dose am and pm right now. Unless the numbers make you have to change the dose. Right now until you get data, I wouldn't shoot a full dose into a number below 180.

Lori - not many are using sliding scales around here anymore. Right now with people it seems consistency of dose seems to help get more consistent numbers and really helps us see what that one dose is doing for the cat. We aren't advocating shooting a full dose into a 150..... not until *a lot* of data has been collected.

Alex is on his way up right now. I'd shoot either a 1.6 or a 1.8u dose tonight. Just make sure to do a couple of spot checks tonight. Once that high carb stuff wears off, the bounce will probably be in full swing is my guess. Of course, you hold the syringe, so if you feel more comfortable with a lower dose, that is completely fine too.
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This is why people are shooting 3 units into a 300 and have no problem shooting 3 units into a 160. Because you all have moved into L advising on Prozinc. We have had 4 hypo/near hypo events in the last month so what do you think of your advise now? What if they were at work? and couldn't test through it and intervene?

Yes you have been advocating shooting a full dose into a 150 and have been for a while now.
 
I don't think it's L advice. That was what I was told when I got here, and was advised on PZI Vet. The way PZI works as I understand it is more in percentages than in absolute numbers. So while you might reduce the dose on a lower PS to be sure you are data-ready to shoot the lower numbers, the goal is to find a steady dose that gives you PSs in the 150-180 zone and nadirs in the 50-80 zone. From what I have seen, you don't get there by lowering the dose a lot as the PS comes down.

With Bix, I only got him regulated when I held the dose. Everytime I lowered it on a 150 PS, he went high. When he finally had a breakthrough I think I lowered the dose by 0.1 on his blue PS, and that was the point when he got regulated. As his zoom settled down, I dropped the dose in 0.1 or 0.2 increments as needed over several days. But previous to that, when I lowered his dose more than that, it was always a setback.

As for sliding scales, at the risk of sounding like a broken record, I think they only work when you are getting green nadirs. If you have green nadirs on a 150 PS and find you need to raise the dose a little on a 200 PS, and a little more on a 250 PS, etc to keep the good nadir, then they make sense to me. When they are used as a way to reduce the dose on every good PS and delay regulation, then I think they make little sense, and that's why I don't usually suggest them. If someone works it out on their own and gets a scale that works, more power to them, but more often, I see cats that are consistently underdosed, as their bean lowers the dose as the PSs come down. Now I do think that's a good idea to gather data, but that is only on a limited basis, and the dose should be increased as the data shows it is warranted.

On a completely different note, I would say if a cat is in green numbers and acting hungry, you should let them eat. I do think the LO reading thankfully was a bad reading, but even before that came up in the thread, what jumped out at me is you want to let them eat on a 65 if they are acting hungry. I'd be less worried about an accurate PS number than about letting them eat - their body naturally triggers hunger if they are going low, so the simplest way to avoid any hypo risk is to let their behaviour guide you. Hypo is probably very low risk at +12, but still I would always feed on a 65 if they are acting hungry.

As for the recent potential hypos, I think we have to take into account that people shoot more aggressively if they can monitor. People tend to shoot less when going off to work, so I think it's apples & oranges to say "what if they hadn't been home". They were home, they knew the risk (hopefully), and they monitored and treated. Well, I can't say that is true for all b/c I don't recall the details. I am more concerned that we had a kitty in the ER with DKA. Well of course that sounds stupid, both hypo and DKA are scary and can be fatal, but when I look at the number of cats here who are unregulated and who have a DKA history, that scares me a lot more than green numbers that beans got when they were home & monitoring and knew what to do.

Really, it is a really tough boat to be in I think, it is extremely difficult to get a cat regulated or OTJ without taking some risk of lower numbers. For the most part, I would say almost every cat I have seen who has done well has had at least one cycle with some scarier greens. But those who shoot timidly from what I have seen have a much lower success rate of getting regulated. So I see it as calculated risk. The more someone can shoot a strong dose, knowing the risks, the better chance their cat has of doing well, but you have to be around to monitor. If you can't monitor, then you shoot less for safety and accept that you might not be able to get them regulated. That is where vets have traditionally settled for the 300-100-300 model. It is safer, but it's not going to get most cats OTJ.

So I am more aggressive than that, with a better goal IMO, but also with more risk. From there I think it is up to each bean to decide what their goals are, what risks they want to take, and what approach they want. To me, if we can't encourage people to shoot enough insulin to get their cats regulated (even with the *managed* risk of lower numbers), then what is the point of the board?
 
Well, thank you for the 'splanations.
I've been gone from this room for so long I guess.

So, the struggle goes on.
This insulin is a real nail biter is'nt it?

No looking back at the good ole pzi days....it's move forward or get in back of the line.

I had noticed a weird trend of hanging numbers...shallow curves shall we say, whenever I took a look at who evers SS I was looking at for the moment.
That is very L like.
The fact Joanna that you are mentioning shootings based on nadirs....L like.
And the idea that you want to maintain doses regardless of the ps's.....L like.

Hey...what if we just go all out L on it.
I would like to say that the late nadir today....also an L feature.

Has anyone had any double dips? L.

I'm not saying this is Levemir.
What I AM saying is it sure has a lot more in common with it than with PZI.

I will study your SS's and work with you if you want me to. I like a challenge. I like a stabile cat more...but if it takes working thru this mazze to get there I will do what I can.



All I want to say...this is NOT going on with Levemir, and I would'nt send you over to Lantus unless you are a masochist (gonna take heat for that statement) sooooo, just consider it.

Anyone who want me to 'try' to help just ask me, pm me, whatever and I will do it. And if no one wants me to help that would be perfectly understandable.

Will continue watching dear Alex...it so sucks that he got those nasty ketones on such low numbers.

Hugs,
Lori
 
I'm not sure that PZI is more L like than we think, I don't enough about the Ls to say, but I would say that there was an attempt to take the L protocols and adapt them to PZI, and that I think is where some of the advice that I got may have come from. I don't think it was misguided though, as in taking something that only applies to L and trying to make it work for PZI, I think it was a great attempt (shot down by board politics as I understand it) to take a protocol that seems to work for one insulin, and see where we can use that knowledge and adapt it for PZI and get good results. It worked for Bix.

The shallow curves and hanging numbers look to me like temporary insulin resistance or dose too low (or both) for the most part. When we see a breakthrough, we see more what you expect on PZI, with bigger drops, so that's where I think it's probably not the same as the Ls, just looks similar on the surface maybe.

Double dips I have not seen.

Late nadirs as I understand it in PZI are typically from the dose being too high, with some exceptions of a few cats who naturally nadir later, and sometimes a breakthrough will give you a late nadir when resistance is broken through, and the dose might not actually be too high.

What I am really curious to know is what people like Dr. Rand have to say (if anything) about ProZinc. I haven't taken the time to email her, but I am really curious if sooner or later some comments are published (maybe they are already, I haven't been looking, nor do I check Think Tank too often - only on the days I am feeling hardy! :lol: )

And although I will agree with what Rob hasn't said yet but I'm sure is thinking :lol: :lol: :lol: that you shouldn't come over to the PZI board and try to sell another insulin, I do agree that if any cat isn't doing great on this (or any insulin) it is a good idea to look at others. Generally I think 6 - 8 weeks is the timeframe I have read - if you don't have them regulated in that time on any insulin, you should at least consider switching insulins. I know some here are on PZI for specific reasons, like can't shoot 12/12 or have cats with health problems or eating patterns that require rapid dose changes to keep up, so for those cats I think PZI is likely the more appropriate insulin.

Lori, all that aside :-D I am really glad Tom is feeling better, yay! Pippa isn't on the mend or anything, but she is comfortable. She is the equivalent of in bed and in hospice at this point, which means it's "strawberry ice cream" time - only the good stuff - baby food, tuna juice, whatever she wants for as long as she is comfortable. We have had a nice quiet weekend (til my blood pressure went up with this thread, LOL :lol: :lol: :lol: )
 
hey joanna, what about this thread did your blood pressure a number? i thought it was a pretty non-event. was it me showing up?
and as far as selling an insulin....well let's agree, this insulin is a pain in the you know where.
you think I could be useful here...or just more trouble?
I can handle the truth....you and I both know I've had ALOT worse.
And your Pippa....bless her sweet comfort in these final days or weeks. I could'nt bear it with Tom...could hardly look at him. I was a MESS! So the powers that be made him all better for me...so I could become a human again.
 
Rob & Harley said:
Kelly & Oscar said:
You do need to shoot the same dose am and pm right now. Unless the numbers make you have to change the dose. Right now until you get data, I wouldn't shoot a full dose into a number below 180.

Lori - not many are using sliding scales around here anymore. Right now with people it seems consistency of dose seems to help get more consistent numbers and really helps us see what that one dose is doing for the cat. We aren't advocating shooting a full dose into a 150..... not until *a lot* of data has been collected.

Alex is on his way up right now. I'd shoot either a 1.6 or a 1.8u dose tonight. Just make sure to do a couple of spot checks tonight. Once that high carb stuff wears off, the bounce will probably be in full swing is my guess. Of course, you hold the syringe, so if you feel more comfortable with a lower dose, that is completely fine too.
Click to expand...

This is why people are shooting 3 units into a 300 and have no problem shooting 3 units into a 160. Because you all have moved into L advising on Prozinc. We have had 4 hypo/near hypo events in the last month so what do you think of your advise now? What if they were at work? and couldn't test through it and intervene?

Yes you have been advocating shooting a full dose into a 150 and have been for a while now.
Click to expand...

What is it about the above bolded statement that you don't understand? I try to tailor my advice per the cat that I am looking at. If I was using Prozinc right now, would you be less hostile to my same advice? Is it because I use Levemir right now that makes you cringe when I give more aggressive dosing advice? We have had a couple cats here go DKA because the dosing was too conservative. Kitty is not going to go hypo out of the blue. You don't do aggressive dosing if you aren't home to monitor. Hypos are a part of regulation. Hypos happen on every ISG here. It is a known risk we all assume when we go for regulation and eventual OTJ. It is not my fault that they happened.

The only thing that can be construed as L advice from me would be consistent dose WHEN POSSIBLE and dosing off of the nadir. Even the L's don't recommend shooting into a number below 180 until you have data to do so. There have been a handful of people here on the PZI ISG that have shot numbers around the 120 mark with micro doses because they have worked their way down to doing that safely by collecting data. The notion is not out of the question IMO and there is no way to work down to that kind of regulation unless you gradually shoot lower numbers when you are able to stay around to collect data.

In the future, if you have questions or issues with advice I give, there are better and more tactful ways of questioning said advice. We are all here to help the kitties. I have no personal vendettas here.
 
FWIW what happened on this to Alex on this thread can hardly be considered a hypo.
And it was actually unnecessary to treat this with food at all. The 'LO' on the machine was the only excitement here and it was an error.

Sooooo, what exactly constitutes a hypo?

Certainly nothing in the 50's after +6 agree?
And let us agree even a 50 in the smaller hours are not hypo's...just 'hey, feed me'
A hypo for more experienced peeps, is hitting a number under 40 is the early hours of your cycle.
And EVEN THAT is NOT a hypo once fed.
Hypo fears are highly over hyped.

A cat in health was 27 on his very first test.... hours after dose. He was ok, granted in need of some quick FOOD but yep, he got thru just fine.

Let's take a deep breath ok.

I think the worse thing that generally happens with your guys low numbers is you might bounce on up, not die...or sieze.

Breath, take a few risks, be sensible,,,,,it's not rocket science, but it IS EXPERIMENTAL I think it is safe to say when finding a suitable dose with this particular insulin.
 
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