Different doses am/pm?

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Sue and Oliver (GA)

Sue and Oliver (GA)

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Wondering what the wise ones think. We seem to be seeing several kitties who, even after attempts to even out their amps/pmps numbers with food changes and time changes and tweaks in dosage, continue to be higher in the am than the pm. Not usually a pmps too low to shoot but much higher in the am. I know Lori suggested it to Patrick/Sabian and I thought it was an interesting idea and was wondering if users in the past have done it successfully.

Have people tried one amount of PZI in the am and a different amount in the pm, consistently, over several cycles? Are there reasons not to? I know we usually say consistency helps, but if that isn't working?

If anyone thinks this is a better discussion for the Think tank, let me know and I will move it immediately. I thought it was more likely to get PZI eyes here.

Newbies and guests, this is a theoretical discussion, not a suggestion for dosing.

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well, not being one of the wise ones for sure, i will say i used it as common practice. shoot the numbers was my motto. i certainly would not shoot the same dose into a 215 amps and a 390 pmps. but that's me. the variable that might change that and a person should have this data asap is the mid cycle numbers. =
for example if the 390 pmps is due to a really low +5 or +7 lets say... a 35-50 or so...i would'nt necessarily keep shooting the number. i would lower shot on both ends for a few days. however if the data suggests that the mid cycles are where you like them or within acceptable range....shoot the number. my kitty always seemed to require more insulin at night.
it's always about the data.
kwim?
 
I am def not a wise one but for me this discussion brings up questions (I always have some)...

Where does the idea for holding a dose come from? Is this ProZync specific, or does this idea come from the other insulins that were around first? I got the vibe from my old vet they were taught to hold doses (for a week or more) in vet school and that was on an older insulin, not PZI.

I saw Lori mention that some of the other insulins base doses on mid day numbers too, and with PZI are we looking for the curve to be good, do we dose on pre-shoots, or a combination thereof?

As for the food thing, I started to do a snack sized feeding around 4 am and saw better numbers initially, but then it didn’t seem to make a difference after awhile, so I stopped it since Asher isn’t that interested anyway.

Sorry if that isn’t what you were looking for in the discussion, but I was curious... :?
 
ok, forgot to add...and this is where it gets a tad, ummm, up to you. my kitty on pz woke up every morning to blacks and reds. however at night he would be a simmered down yellow or pink. my mind now tells me i could have shot a higher dose into that yellow or pink without much worry as he was so consistantly a big riser at night.

that is where my whole argument goes down the drain in a sense.

ex.

amps 500+
+3---390
+6---280
+9---320
pmps 375

given this horrible scenario that was not me, but just sayin...it might make sense to shoot the same large dose into the 375 pmps. and not lower dose. and since i never did that (unfortunatly) i'll never know if that would have resulted in a lower amps.

have i thouroughly confuzeled the issue to the max?
 
donna the difference from the L's and pz is that we place much more importance here on the island on the amps and pmps. our insulin here does not grab a number and hold it for 6 hours like the L's do. also it take L insulins about 3 hours to kick in.
which allows a person to shoot a full dose into a 94 like i did this morning on levemir that's LEVEMIR not PZ. you could not do that on pz becuase you will always get a drop, a significant drop in like 6 hours or so. with the lev...well, in 3 hours i'll be up a bit (DO NOT USE TOM AS EXAMPLE AS HE IS A FOOD DROPPER AND LOWERS HIZSELF IN THE FIRST HOUR) and then a gentle slow coast down a little and ride the same 40 or so point drop for the next 6-10 hours. yes, it is like watching paint dry if you can't get it down where you want it.
 
Donna, my first time around with PZI Terri taught me to dose according to the nadir, not the PS. We only used the PS as a safety, to be sure she was not too low. My second time around, Gator and Robin taught me to shoot according to the PS and to watch the nadir to be sure she was not going too low. Gator recommended changing the dose with every PS, looking to get about a 50 point drop from PS to the next PS (more if the numbers were high, less if the numbers were low). The only thing everyone seems to agree on is to usually start at 1U and raise slowly (usually .5 unless you are in low doses). everyone also seems to agreee that PZI is a gentle and flexible insulin, so one can safely experiment, but that newbies should not be shooting into PSs that are lower than 150 or maybe 200.

I think the bottom line is that it is trial and error and you do what works! Hard to live with when what works is often unclear or changes!
 
Sue, I think your question is a good one. Seems like we need an experiment---someone who has a cat that fits the pattern and is willing to try for a week or 2.
 
There are a couple possibilities. Sabian fits the pattern but Patrick is waiting on a dental. Sue and Samwise sometimes fit the pattern. Angela and Henry are probably the most consistent. Henry always seems to have a high amps.
 
So when would you shoot the higher dose? In AM when his numbers are high? Sometimes at PM shot time, he is barely above 200 or sometimes below.
Or would it be PM to try to lower the AM pre-shot value?
 
Let's get more input, Angela. Neither Kelly or Johnna have given us their ideas.

We have always been wondering about Henry's high amps. I have no idea where this is logical or not. And then there is the question whether you would be interested in Henry being our "control".

I am basically thinking out loud, looking for peer review.

As an aside, did you get the automatic feeder and is Henry eating during the night on a regular basis? Just wanted to remove that possible variable....
 
Yes I got the auto feeder, and he sometimes eats from it before morning sometimes only a little. He still gets his 3:00-4:00 a.m
small meal most every night too. He sleeps pretty well until 3 or 4 a.m.
 
I have seen it mentioned before but never really seen it in action. The tricky thing IMO is that generally speaking you want longer duration on the shot that is ending in a high PS, which means you should shoot a higher dose on the low PS, and a lower dose on the high PS. Somewhat counter-intuitive. And very problematic given that I wouldn't recommend in most cases to increase the dose on a lower PS. If you lower the dose on the low PS then you are contributing potentially to a higher PS in consequence. And vice versa, shooting a higher dose for the higher PS could leave you unshootable at the PS that is typically low. Hopefully that made sense. :)

One possibility might be to alter the timing. If you get a high AMPS and low PMPS, why not try shooting an hour early in the AM and head off the higher #, and then your PM shot leave at the regular time so it is like +13. I am just thinking of this right now, so off the top of my head. Slap me if it's a bad idea. :-D It might be a little tricky b/c the doses might need adjusting accordingly, but roughly I'm thinking that way you could shoot a bigger dose in the AM and hopefully it lasts to +13, and then with testing determine if you need a lower dose in the PM (and since the AM shot will be at +11 there's less of a duration issue), or if the regular dose works just fine since it's a late shot. Just musing really.

My other thought really is more testing to figure out what is going on. Maybe all night is a nice ride in blues and then a jump to reds at +11, or maybe all night long it's a red ride. Without really knowing what's happening (some may already, I don't have any spreadsheets in front of me), I think it makes it tricky to make calls on the doses.

As for the question someone asked about holding doses, first I'll mention there is a lot of controversy & disagreement = can 'o worms question. Some don't believe in holding the dose at all, vs. some like 5 days (I think those cover the extremes on the board, though some vets will want to hold longer than that). What I have seen is that in some cats PZI does have some overlap (we don't call it a shed b/c them'z fightin' words :lol: ). It's not a shed like the Ls, but it does seem in some cats that somewhere in the range of 2 or 3 shots, you can keep the PSs undercontrol and get sort-of a steady state going. Some cats don't get that ever, a few get it maybe in 4 or 5 shots. Some may take longer, though personally I have not seen that (or rather have not interpreted any #s that way).

So that's why on a dose increase in particular it's generally recommended to hold for a least a day or two just in case your cat will get a little overlap going, so you don't risk dangerous lows by accident if overlap does build up. BUT, if you are not on a dose increase path then the holding IMO is less important. Sometimes you can see the effect on a dose decrease - the first cycle will be good but then you lose some momentum on cycle 2 or 3 of that dose and have to bump back up a hair. To me, once you have gotten past the basic dose increase path, you can vary doses every shot if you want - often depends on the cat whether or not that is needed. With Bix, once regulated, if his PS creeped above 180 I would usually fatten up the dose, and if it creeped below 150 I would skinny up the dose. He was more consistent though than most cats in his PSs, and not usually wonky.

Another factor is the wonky one, and I have seen several comment on this with ProZinc (which I have not used). The idea that the cat needs to get used to the dose a little and some wonky #s at first on a dose will settle down after a few days. Personally I'm not convinced it's anything more than liver training, or wonkiness to be ignored as just wonkiness. But then I haven't used ProZinc and it's possible it's enough different from PZI Vet to have a different effect. And also I am a little more on the aggressive side than some, so I don't tend to like holding a dose for very long if you don't have compelling reasons to do so (although I am very supportive of beans holding a dose if that is what they feel is right, or if there are pragmatic factors like they can only test on the weekends or such and don't want to raise doses when not around).

Whew :-D sorry for the semi-hijack... the soapbox beckoned :lol:
 
and i would like to just pipe in and say i thing we really have over used the term liver training and rebound. well, maybe not so much here but around the board in general. would'nt it only make sense for a liver to respond the first few times it see's greens. i mean after a while we can no longer blame the liver for the rise when greens have been seen and part of a cats routine.
my 2 cents.
my other 2 cents would be...if the liver is so good at overcompensating for 'eek, a greenie' than on the days we go just a wee too low...like a +4 45, why on earth do we rush to feed that? or even a +2 40 for that matter. if the liver does what we all think the liver does than it is NOT a bounce when we get a big old pink later...it's a combo of us treating with H/C and the liver doing it's job.

sometimes in lantus i see this continuous carb control, steering numbers and if that goes on long enough are'nt we in effect telling the liver, 'hey, don't bother, i got this one' to the point of messing up the bodies normal protective function.

oooooookay. was that inappropriate to the conversation and shall i delete it before i get in trouble for it?

lori
and tomtom who is partially responsible for this piece of work
 
Oh, I like the idea of shooting the higher amps earlier and making the cycle 13 hours instead of 12, Johnna. Wonder if that would help Henry's high amps numbers and give Angela a better pmps to shoot?
 
That makes sense that the higher dose would be on the lower PMPS to offset the higher AMPS. Rather scary if your cat is barely shootable though.
I just keep hoping that some more work will come our way and Henry can have a dental soon. I really think it might make a difference.
The AMPS usually is lower somewhat the morning after he gets a 1/2 baby aspirin so I believe pain could be a factor too.
 
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