Jen&Eddie
Member Since 2013
Good morning!
By way of (not-so) short introduction, Eddie and I have been here at FDMB for about three months, and have been posting to the PZI board pretty regularly during that time period. I feel sort of traitorous asking about a different insulin. :lol: Eddie was diagnosed in mid-December and we were prescribed ProZinc. Long story short, we've been fairly successful with ProZinc thus far, and had been "earning" reductions rather quickly until about three weeks ago. We went out of town over the weekend, leaving Eddie in the hands of a lovely young vet tech, but we lost a fair amount of ground in that short period of time. Since then, we've gone back up in dose fairly close to a full unit across our sliding scale to try to get back into good cycles. Last night, finally, we seemed to get a better cycle again.
After lots and lots of reading and studying, knowing the successes of the TR protocol, I've been thinking about a switch to Lantus for quite a while, but our recent set back has me thinking about it even more. Losing ground is really disappointing.
Here's what we're doing right now:
We are shooting a sliding scale that was originally developed for Eddie with Carl's awesome assistance. That scale started to get Eddie great cycles. Eddie started having long duration, meaning that he was too low (for ProZinc) to shoot on a 12/12 schedule, so we stalled to shoot and ended up skipping shots fairly regularly. We have experimented with shooting for overlap on the ProZinc with varying degrees of success. Sometimes it works perfectly and we get the right amount of overlap, and sometimes we don't catch it quick enough to stop a huge rise at the end of the cycle. A few times, shooting pre-shots below 200 resulted in crashing. A few weeks ago, we started dipping below 50, and started earning reductions rather quickly. I caught a 30 when I came home from work for lunch one day. nailbite_smile We were down to a scale ranging between 1.4u and 1.8u depending on Eddie's pre-shot numbers. Since coming back from being out of town for a weekend, we worked our way back up to our original scale which ranges between 2.0 and 2.8. We gave up on trying to control the duration of his shot, and shoot (after 8 hours) whenever his numbers warrant. Sometimes that's at 9 hours post-shot, and sometimes it's at 15 hours post-shot.
Here's what we don't like about ProZinc and how it works with Eddie:
It can be harsh. We can get huge drops at times. It's tough to predictably shoot any overlap because the ProZinc can drop him too fast if he's sitting in numbers below 200. Duration is all over the place. Eddie has short cycles lasting 8 hours (or less sometimes), and sometimes he is still too low to shoot after 15 hours. We had an 18 hour long cycle one time. Nadir is all over the place. I can't predict with any degree of reliability when Eddie's nadir is going to be, even after three months, and lots of data/testing. Sometimes it's at +5, and sometimes it's at +10. There are times when I cannot actually tell at AMPS/PMPS whether he's rising or falling compared to his numbers throughout the previous cycle. No protocol. Obviously ProZinc has a general protocol, but that doesn't really work for Eddie. We pretty much wing it most of the time.
Things we like about ProZinc and how it works with Eddie:
Flexibility. We can change the dose as needed, and we can shoot pretty much anytime his numbers warrant. We don't have to wait till +12 to shoot again if Eddie's rising fast at the end of a cycle. I do own a pair of patience pants graciously provided at the start of our journey, but they're balled up in the back of my closet right now. :smile: The ability to adjust dose fairly rapidly works with my lack of patience. Sliding scale. There's a lot of tweaking involved in a sliding scale. We can shoot higher to pull him down off high pre-shots when needed. And of course we love our fellow PZI people (Sue, Deb, BJM, etc.).
Things we like about the idea of switching to Lantus:
A protocol! Obviously no protocol works perfectly for all cats, but having guidelines that say "if this...do this" would be nice. Lantus seems generally less harsh. Generally longer duration than ProZinc. Shoot low to stay low. Being able to safely do this with Lantus has huge appeal for me...using the depot to keep numbers in healthy ranges without huge swings on either end - I know that you can in theory do this with ProZinc as well, but we haven't had a great deal of luck doing that thus far. Obviously the remission rate also has huge appeal.
Things we have questions/concerns about Lantus - TR:
My primary concern with switching is monitoring during the day. I work full time 8-4:30. I am able to come home for about a half hour at lunch time almost every day. In a crisis, DH would probably be able to stop in as well. That said, if Eddie were to be dramatic and go too low during the day, I can get away with calling in or taking a long lunch once in a while, but I cannot do that often. I can usually only get in a test around lunchtime, or if DH gets home a little early, another test in the latter part of the cycle. Nighttime is another story. I'm a night owl, and right now with what we're doing, I'm frequently up at all hours anyway, so that's not a problem. I know Lantus does better at keeping low numbers low than it does pulling down high numbers. ProZinc is probably more effective at that. It's normal for Eddie to be in the 300's at pre-shot (although this varies wildly). Will Lantus have enough oomph to pull him down from those numbers? Finally, since we have had some success on ProZinc, and have been at it doing pretty tight regulation (as tight as we can get it), is it a mistake to pull the plug now and switch, assuming it will take Eddie some time to get into the swing of things with Lantus?
Our vet and our regular vet tech are awesome. They're willing to help us do whatever we want. If we want a script for Lantus, all we have to do is ask, and they'll write it. They prescribe ProZinc to all their diabetics. Our tech was aware of one of their patients who went into remission on ProZinc, went out of remission, and started Lantus, then switched back to ProZinc and went back into remission. Other than that, our tech was not aware of any of their other patients on Lantus. After giving them the info on what we've been doing with ProZinc, they have started to hand out the FDMB ProZinc protocol as developed here, and they also prescribe u100's and a conversion chart for use with ProZinc. How cool is that!?
Thank you for reading my novel and adding input. While I'd feel stupid throwing away a just-opened vial of ProZinc, if it's the right time to switch Eddie to Lantus now, so be it.
By way of (not-so) short introduction, Eddie and I have been here at FDMB for about three months, and have been posting to the PZI board pretty regularly during that time period. I feel sort of traitorous asking about a different insulin. :lol: Eddie was diagnosed in mid-December and we were prescribed ProZinc. Long story short, we've been fairly successful with ProZinc thus far, and had been "earning" reductions rather quickly until about three weeks ago. We went out of town over the weekend, leaving Eddie in the hands of a lovely young vet tech, but we lost a fair amount of ground in that short period of time. Since then, we've gone back up in dose fairly close to a full unit across our sliding scale to try to get back into good cycles. Last night, finally, we seemed to get a better cycle again.
After lots and lots of reading and studying, knowing the successes of the TR protocol, I've been thinking about a switch to Lantus for quite a while, but our recent set back has me thinking about it even more. Losing ground is really disappointing.
Here's what we're doing right now:
We are shooting a sliding scale that was originally developed for Eddie with Carl's awesome assistance. That scale started to get Eddie great cycles. Eddie started having long duration, meaning that he was too low (for ProZinc) to shoot on a 12/12 schedule, so we stalled to shoot and ended up skipping shots fairly regularly. We have experimented with shooting for overlap on the ProZinc with varying degrees of success. Sometimes it works perfectly and we get the right amount of overlap, and sometimes we don't catch it quick enough to stop a huge rise at the end of the cycle. A few times, shooting pre-shots below 200 resulted in crashing. A few weeks ago, we started dipping below 50, and started earning reductions rather quickly. I caught a 30 when I came home from work for lunch one day. nailbite_smile We were down to a scale ranging between 1.4u and 1.8u depending on Eddie's pre-shot numbers. Since coming back from being out of town for a weekend, we worked our way back up to our original scale which ranges between 2.0 and 2.8. We gave up on trying to control the duration of his shot, and shoot (after 8 hours) whenever his numbers warrant. Sometimes that's at 9 hours post-shot, and sometimes it's at 15 hours post-shot.
Here's what we don't like about ProZinc and how it works with Eddie:
It can be harsh. We can get huge drops at times. It's tough to predictably shoot any overlap because the ProZinc can drop him too fast if he's sitting in numbers below 200. Duration is all over the place. Eddie has short cycles lasting 8 hours (or less sometimes), and sometimes he is still too low to shoot after 15 hours. We had an 18 hour long cycle one time. Nadir is all over the place. I can't predict with any degree of reliability when Eddie's nadir is going to be, even after three months, and lots of data/testing. Sometimes it's at +5, and sometimes it's at +10. There are times when I cannot actually tell at AMPS/PMPS whether he's rising or falling compared to his numbers throughout the previous cycle. No protocol. Obviously ProZinc has a general protocol, but that doesn't really work for Eddie. We pretty much wing it most of the time.
Things we like about ProZinc and how it works with Eddie:
Flexibility. We can change the dose as needed, and we can shoot pretty much anytime his numbers warrant. We don't have to wait till +12 to shoot again if Eddie's rising fast at the end of a cycle. I do own a pair of patience pants graciously provided at the start of our journey, but they're balled up in the back of my closet right now. :smile: The ability to adjust dose fairly rapidly works with my lack of patience. Sliding scale. There's a lot of tweaking involved in a sliding scale. We can shoot higher to pull him down off high pre-shots when needed. And of course we love our fellow PZI people (Sue, Deb, BJM, etc.).
Things we like about the idea of switching to Lantus:
A protocol! Obviously no protocol works perfectly for all cats, but having guidelines that say "if this...do this" would be nice. Lantus seems generally less harsh. Generally longer duration than ProZinc. Shoot low to stay low. Being able to safely do this with Lantus has huge appeal for me...using the depot to keep numbers in healthy ranges without huge swings on either end - I know that you can in theory do this with ProZinc as well, but we haven't had a great deal of luck doing that thus far. Obviously the remission rate also has huge appeal.
Things we have questions/concerns about Lantus - TR:
My primary concern with switching is monitoring during the day. I work full time 8-4:30. I am able to come home for about a half hour at lunch time almost every day. In a crisis, DH would probably be able to stop in as well. That said, if Eddie were to be dramatic and go too low during the day, I can get away with calling in or taking a long lunch once in a while, but I cannot do that often. I can usually only get in a test around lunchtime, or if DH gets home a little early, another test in the latter part of the cycle. Nighttime is another story. I'm a night owl, and right now with what we're doing, I'm frequently up at all hours anyway, so that's not a problem. I know Lantus does better at keeping low numbers low than it does pulling down high numbers. ProZinc is probably more effective at that. It's normal for Eddie to be in the 300's at pre-shot (although this varies wildly). Will Lantus have enough oomph to pull him down from those numbers? Finally, since we have had some success on ProZinc, and have been at it doing pretty tight regulation (as tight as we can get it), is it a mistake to pull the plug now and switch, assuming it will take Eddie some time to get into the swing of things with Lantus?
Our vet and our regular vet tech are awesome. They're willing to help us do whatever we want. If we want a script for Lantus, all we have to do is ask, and they'll write it. They prescribe ProZinc to all their diabetics. Our tech was aware of one of their patients who went into remission on ProZinc, went out of remission, and started Lantus, then switched back to ProZinc and went back into remission. Other than that, our tech was not aware of any of their other patients on Lantus. After giving them the info on what we've been doing with ProZinc, they have started to hand out the FDMB ProZinc protocol as developed here, and they also prescribe u100's and a conversion chart for use with ProZinc. How cool is that!?
Thank you for reading my novel and adding input. While I'd feel stupid throwing away a just-opened vial of ProZinc, if it's the right time to switch Eddie to Lantus now, so be it.
We had been shooting around 6/6, which gave us about a 2 hour window between shot time and the time I had to be out the door for work. We just moved back our shot time to 5/5 (as much as Eddie's cycles will cooperate), so that would give us an opportunity to get some of those early tests. It is nice that you can get an idea about what might happen during a cycle if there's a drop by +2. It's sort of the same with ProZinc - at least with Eddie. Currently, I know it's going to be a big drop and an exciting cycle if Eddie's going down by +2.
