Buddha 1/14 p.m.

I am just going nuts trying to figure out Buddha's correct dose of ProZinc. His numbers are up and down the charts and I am so frustrated. Take a look at his spreadsheet.

My instinct is telling me that he's getting too much insulin, that maybe a 1.5u shot tonight might work. But I am so tired of guessing and poking and testing and angsting.

A generic question, increasing a dose of ProZinc (or a long action insulin like PZI) does what? Increases the steepness of the curve, the depth of the curve, the duration of the curve, all or some of the above?

Assuming that Buddha's lowest bg was 136 today, and in hind sight I suspect that it wasn't, then I want to decrease his dose. But if 136 WAS his lowest bg and I want to increase the duration of the insulin, then is that what an increased dose would achieve?

I tried twice to get the pmps number, and came up with HI both times. But we struggled a bit, and I had to get the towel out.

I just don't get it.

 

It looks like you're having the same problem we've been having lately. We really need to stick to a dose for at least 3 days (6 shots) to see if you have the right dose. Of course, you should change it if they go to low, but otherwise try to stick with the same dose. If it were me, I would have shot 2 tonight and then stick to 2 units unless he goes too low. I know it's hard when he's high, but this might be why you see him jumping around so much. As an example, look at my post from yesterday: viewtopic.php?f=24&t=2450

I hope you find the right dose soon.

 

I agree with Ele, you're jumping your doses around too much. Since you shot 1.5 tonight, I'd stick with that dose for a couple of days (unless he goes too low). If the 1.5 doesn't give him a good curve, I'd raise the dose to 1.6 for a couple of days, then 1.8, etc. In other words, I'd systematically increase the dose. You might find that he needs something in between like 1.7. But without the systematic dose increases, you can't do anything except keep guessing like you're doing now. The good news is that he seems to respond well to the PZI.

 

Hi Donna, what a doll he is! Love that pic!

Potentially all of the above, in my experience. PZI (PZI Vet - I don't have ProZinc experience or knowledge) worked best for my cat when we could get a nice alignment of everything, and he would get PSs around 150 and nadirs around 80 (very approximate numbers). I found the components worked fairly well in tandem - if he dropped too much, his duration would then be too long to get in another shot at +12, and vice versa.

As Ele & Terri said, it's hard to get a good picture when the dose is changing a lot. For Bix, I was all over the map and finally took a really systematic approach (at Terri's urging) of picking the lowest dose that I felt clear-cut was not too much (in his case 1 unit, but that was him), and then holding that dose for a couple days (barring a nadir under 80 on my cat meter, which would be 50 on a human meter, or a PS below 150 - in either of those cases I would reduce the dose a bit). Then if the #s weren't good, I raised by 0.2units and held that new dose for a couple days, continuing like that until we got a breakthrough and he magically seemed to pop into a pattern of PSs around 150 and good nadirs.

I can't tell from the spreadsheet a "perfect dose". I used to think that way with Bix, and finally had to let that concept go out the window. The dose that has worked for him started at 1.8u, came down gradually to about 0.6u over a couple weeks, then I had to go back up to 1u after he had his teeth done, then after a while we reduced again. For him at least, that perfect dose has been a moving target. Reacting to changes on a shot by shot basis hasn't worked great for me (unless there are low numbers, then I reduce right away), but reacting fairly fast - 2 or 3 days at a dose and then raise it if it's not enough, worked great.

Hope that helps some! It looks like he is on all low-carb canned, except when his #s went too low and you gave him HC, is that right? (just clarifying for my own understanding!) And also, are you checking for ketones daily, and does he have any history of them? If you have any background too on how he got to the doses he's on (i.e. did your vet start him at 1u and you've increased gradually to get where you are, or did you start higher than that, etc.) - that info is always good so we have a full understanding of what is going on. (Sorry if that's all been covered elsewhere or is clear in your spreadsheet or a profile that I missed - still getting the hang of the new board and finding all the info!)

 

I'm going to be totally honest with you [and this coming from someone who used to use PZI Vet on a sliding scale]. So far I've not had the best luck with large dose changes using ProZinc. In fact right now were are changing the dose in 0.05U increments. We're currently at a 0.55U dose. And even then I'm trying to let those changes settle for a couple cycles.

I know the others here are going to be shocked I just admitted this :smile:

However, I do not have the best data yet for ProZinc so I'm being really cautious.

 

Thank you all! I'll put together a profile--is there a template you all use?

I'm new to the concept of ProZinc. We used Vetsulin for over a year, and some of the techniques and actions seem to be different. With Vetsulin we had steep curves, so when I get low numbers with ProZinc I freak. With Vetsulin I was used to giving large meals at shot time, but with ProZinc is it ok to feed on demand? Or feed on demand from +2 to +6 and then wait til the next shot?

So with a PZI type insulin, changes of .5u are considered large? And a U100 syringe would help me make more reasonable adjustments (even though ProZinc is a U40 insulin designed for cats, I mean if incredibly small adjustments made such huge differences, why don't they dose it in U100 terms?)

In real life my frustration threshhold is fairly low. And I can't keep algae out of the pool in the summer. But this is a challenge I can't mess up.

 

I put Lucy's food down and let her decide whether she wants to eat it all at one time or nibble over the course of the day. On days when she's high, she gobbles it all up. When she's under 200, she nibbles. If Buddha is naturally a gobbler, you might find it helps to put down half a meal at mealtime and the other half a couple of hours later, if you are home to do that.

Changes of .5 units are considered large when you are fluctuating back and forth between 1.5 and 2.0 trying to find a good dose. You've narrowed the range of a dose that works for Buddha, now you need to refine it with smaller adjustments. That's the way every insulin works. One of the best attributes of the PZI is that it is U-40, so you can get those smaller increments by using the U-100 syringe. With U-100 insulin, you can only eyeball doses like 1.6 or 1.9.

Yep--feline diabetes helps build patience.

 

Hi Donna! Over on the Tech forum there is a Sticky that has info on setting up profiles in Googledocs I think.

I switched from Vetsulin as well - it was really confusing for me for a while - PZI just does not have that immediacy and predictability that I got used to with Vetsulin. After a while, PZI will make more sense, it just takes some getting used to.

Bix freefeeds. Some people do a small meal at shot time, and another I think around +4 or so. I think it probably varies by cat as well as personal preference/lifestyle. Cats with steeper drops may need meals timed accordingly to balance the drop, etc. I'd start with whatever your preference is for feeding, and see how well that works for your cat on PZIR.

I wanted to be sure you are clear that with the U-100 syringes, we use those with U-40 insulin and a conversion chart so that we can measure the smaller doses. You wouldn't actually be able to do that with U-100 insulin (which some compounded PZIs are I think), it would just be unit for unit in the syringe, so you wouldn't be able to do microdoses well at all. When we measure say, 1 unit of U-40 PZI, we are measuring to the 2.5u mark on the U-100 syringe. The conversion with the addition of 1/2 unit markings makes it all possible. See the PZI Sticky up top for the conversion chart and more info.

If the stuff on the syringes doesn't make sense, just ask. What I recommend to people is to post what they think they'll be shooting in the U-100 syringe before shooting the 1st time, just to be sure. We've had a couple people who it turned out had gotten the wrong size syringe, or misunderstood something, and would have shot the wrong thing had they not checked in. Better safe than sorry, and it is pretty confusing at first.

Don't worry about feeling frustrated - we've all been there ourselves, and will try to help you figure things out.

 

I just realized the syringe link the in sticky is wrong. The description of the link is correct - just the actual link was wrong.

Here is the correct link
http://hocks.com/hocks-healthcare/hocks ... 82316.html

The link in the old one went to 1/2cc and you want the 1/3cc ones.

I'm working on getting the link fixed ASAP.

EDIT - The link in the sticky has now been fixed.