Getting wide swings - switch to Prozinc?

[Shirley and Ragnar]

Ragnar has been getting wide swings in his numbers on Lantus this time around. On 3/4u, his preshot gradually rises to 400 or so, then drops into the 100s. The doctors say his pancreas is making some of his own insulin, but exhausts itself, then rests and kicks in. We tried 1u but he wasn't high enough to shoot again after 18 hours (otherwise he might have gotten 1u every 18 hours - he did have a nice, flat curve with many hours in the 100s, just didn't come up soon enough). I am trying a skinny 1u now, but have trouble getting it "skinny" without going down to his inadequate 3/4u. Dr. Jen has talked about switching him to Prozinc.

I don't know much about Prozinc - is it the same as PZI? Otherwise there doesn't seem to be a support forum here for it.

Reading about Levemir, it looks as if that might work for Ragnar; I will ask Dr. Jen about it. This seems to give a flat curve and doesn't require such high numbers in order to shoot.

I'm not sure Dr. Jen and I were taking into account the overlap effect, however. She considered it too low to shoot 1u when he was 244 at +18 (because the previous shot - his first whole unit - had dropped him by 200 points at +6), but by the time the new shot was working, the previous shot might be gone.

I am sorry the spreadsheet still isn't up to date. I should probably send my friend some of the latest numbers and skip those in between. Otherwise we will never get caught up - there is just too much data to enter!

Blessings,

Shirley and Mr. Beautiful

 

[Blue]

It is hard to say much without some current numbers and looking at the numbers from most recent, it looks like alot of dose hopping, and Lantus works when consistent.
If you want something for a more even curve, I think you would be good with Lev.

If you can update the ss, people will be able to let you know what it looks like is happening.

 

[Sienne and Gabby (GA)]

Lantus and Levemir work essentially the same way. The only difference is that in some cats, the nadir with Lev is later. It is the same protocol. You need the same consistency of dose and dosing is based on the nadir.

 

[Blue]

I found that Shadoe was much calmer on Lev than on Lantus, but Oliver was pretty much the same on both.

Lantus & Levemir: What’s the Difference?

 

[Marje and Gracie]

I believe, if you chose to switch to Prozinc, that the PZI forum is for all those folks. I'm not sure if they actually make PZI now...I think it is just Prozinc. Just throwing out a thought...we've seen folks switching from Prozinc to Lantus or Levemir and getting much better results. Prozinc is a short acting insulin and doses are varied and given based on PSs instead of nadirs. IMHO, I'd try to find consistency in dosing and schedule with lantus/levemir.

 

[julie & punkin (ga)]

shirley, i can't answer your question, but wonder what you mean by this:

Reading about Levemir, it looks as if that might work for Ragnar; I will ask Dr. Jen about it. This seems to give a flat curve and doesn't require such high numbers in order to shoot.

do you need someone to help explain how to put numbers into the spread sheet? it's not hard at all, especially since it's already set up. then you wouldn't have to coordinate with anyone else. i enter the numbers one at a time as soon as i've got them.

really, you just click on the box you want, which makes the box outline in blue, then type your number. you can use tabs or your arrow keys to move in between boxes (which are technically called "cells.") if you can make a post here, you could add your numbers to Ragnar's (who is beautiful, by the way) spreadsheet.

we used prozinc for a month before switching to Lantus. I can't say how punkin did on prozinc, really, because we only tested once a week at the vet's. i do know the vet said that Lantus offered the best chance at his pancreas healing and him getting off of insulin entirely.

 

[bev5477]

LOL!!! I read your title too fast and thought it said "Switch to Prozac". Also not a bad idea

 

[Jill & Alex (GA)]

shirley, it's hard to tell what's going on without your spreadsheet being up-to-date, but if your current dosing method is the same as what we can see... wild swings are to be expected... when using lantus OR levemir.

"She considered it too low to shoot 1u when he was 244 at +18 (because the previous shot - his first whole unit - had dropped him by 200 points at +6), but by the time the new shot was working, the previous shot might be gone."

this isn't the way lantus or levemir work. please read through the protocol, the stickies, and study spreadsheets of those who are following the tight regulation protocol. if you'd like help please update your spreadsheet and post often. there are many here to help and support you every step of the way.

having said that, if your vet sticks with the mindset of allowing preshot numbers to determine dose, a switch to prozinc may be better suited to this method. i'm sure those in the pzi support group will be happy to lend you a hand.

 

[Shirley and Ragnar]

shirley, i can't answer your question, but wonder what you mean by this:

Reading about Levemir, it looks as if that might work for Ragnar; I will ask Dr. Jen about it. This seems to give a flat curve and doesn't require such high numbers in order to shoot.

do you need someone to help explain how to put numbers into the spread sheet? it's not hard at all, especially since it's already set up. then you wouldn't have to coordinate with anyone else. i enter the numbers one at a time as soon as i've got them.

really, you just click on the box you want, which makes the box outline in blue, then type your number. you can use tabs or your arrow keys to move in between boxes (which are technically called "cells.") if you can make a post here, you could add your numbers to Ragnar's (who is beautiful, by the way) spreadsheet.

we used prozinc for a month before switching to Lantus. I can't say how punkin did on prozinc, really, because we only tested once a week at the vet's. i do know the vet said that Lantus offered the best chance at his pancreas healing and him getting off of insulin entirely.

I'd have no trouble entering the numbers - I'm proficient in Excel, Access, all that. The problem is that I can't edit the Google spreadsheets in my browser, and a friend on the Message Board volunteered to do it for me. She was busy for a while, and now we have a lot of back info piled up.

I will probably send her only the most recent ones. We've been keeping him on a steady dose since around March 1 - 3/4u until last week, then 1u to the bottom of the line, now 1u to the top of the line. The skipping around was actually his doctor's idea! - but was based on the good results he had on tiny droplets last summer, but that was when he was already going OTJ.

Yes, he is beautiful, isn't he? :smile:

Blessings!

 

[Shirley and Ragnar]

shirley, i can't answer your question, but wonder what you mean by this:

Reading about Levemir, it looks as if that might work for Ragnar; I will ask Dr. Jen about it. This seems to give a flat curve and doesn't require such high numbers in order to shoot.

I read the Forum stickies about Levemir, and the preshot numbers were much lower than those Ragnar's doctor wants me to shoot. I've been taking the vet's advice here - she may not be extremely familiar with Lantus. But we did get him OTJ on Lantus last summer, and he stayed off for over 6 months.

Our vets may be more afraid of hypo then they need to be - and I've been working with them. I have read all the info about Lantus, but it's a little scary to give a dose at 244 which dropped his level by 200 points the night before and possibly lower between checks. Scary for the vet, and scary for me!

I don't want to put him on a less reliable insulin than he is taking now, though. I will have to talk more with his doctors about it. (There are two now, both giving very much the same advice.)

Blessings!

 

[Shirley and Ragnar]

Keeping doses steady since around 3/1 - still wide swings

The numbers aren't up to date, so of course you can't see this. But we've been keeping his doses steady since around March 1 - the wide swings were on a steady dose of 3/4u, as I said in my original post.

Maybe the insulin is at fault, though I bought it from a local pharmacy and even replaced a half-full pen to be sure it was fresh. The pharmacy sells single pens from a box they keep under the counter, not in a refrigrator, and the last pen I bought was the last in the box.

This is one reason I wanted to order "fresh" Lantus from Canada - but cancelled the order when I found out it would come by slow mail from Turkey!

If we do get a low preshot, where the usual shot drops him by more than his total preshot number, what IS the best way to proceed? I see a lot of criticism and "you don't know" here (or in this case perhaps "your vets don't know," since I've been taking their advice), but no one seems to have actually answered that question. What do you do when your preshot number is this low? (I've recently been waiting for a more shootable number, then giving the same steady dose.)

 

[Ella & Rusty & Stu(GA)]

Hi Shirley,
If you're having problems editing your Google spreadsheet in your browser, why don't you try opening it in a different browser? Firefox, Safari, and Opera all do well with the Google spreadsheets.

I don't know what to say about the advice you are getting from your vets, but I do know that Lantus and Levemir both need consistency of dosing and that it is important to follow the protocol. The dose is based on the nadir, not the preshot, and I see in looking at your spreadsheet that you don't have any recent numbers for the mid cycle, which is typically the nadir (even if Ragnar has an early nadir or a late nadir, your dosing should be based on the lowest number of the cycle, not the highest). You need more data for the knowledgeable people here to be able to help you. So if you have a record of the missing bg numbers and the only problem is getting them onto your spreadsheet, try another browser.

I hope you can get everything straightened out. Best of luck. I don't know much about Prozinc except that it has little in common with the older PZI insulins. It is a synthetic insulin (as are Lantus and Levemir).

Ella & Rusty

 

[Jill & Alex (GA)]

Re: Keeping doses steady since around 3/1 - still wide swing

If we do get a low preshot, where the usual shot drops him by more than his total preshot number, what IS the best way to proceed? I see a lot of criticism and "you don't know" here (or in this case perhaps "your vets don't know," since I've been taking their advice), but no one seems to have actually answered that question. What do you do when your preshot number is this low? (I've recently been waiting for a more shootable number, then giving the same steady dose.)

hi shirley. you may have missed my suggestion to read the stickies, the "informational" posts (marked with a star), and the spreadsheets of others. you can also scan down the list and learn from and study the threads where others are shooting on low preshot numbers.

specific threads which are included in those mentioned above:

STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL
STICKY: LANTUS & LEVEMIR - DATA READY TO SHOOT LOW NUMBERS? - this sticky is all about preparing yourself (with data) to shoot on low preshot numbers. pay special attention to the section under "WHAT IF YOU ARE NOT A NEWBIE?"
Dealing with Low Preshots
Don't Panic! or How to Handle Low Numbers

hope this helps...

 

[julie & punkin (ga)]

shirley, when you change the time of the shot, that's like changing the dose. So if you're waiting for a lower number and then shooting, it's like a dose change. from your february SS, it looks like the time changed almost daily. that makes it a dose change daily, even if you inject the same amount. that's why Ella is saying you need to be consistent - both about the time you shoot and the amount.

you can have a large number drop with a dose or a small number drop with the same dose, or even an increase in his BG numbers with the very same dose. In fact, that happens regularly until the kitty gets his blood sugar closer to normal ranges. Basically the process is to keep repeating the dose every 12 hours over & over again, treating the low numbers when you get them in order to stabilize the kitty's blood sugar. That's why you want to have some mid-cycle numbers.

For example, look at punkin's spread sheet on April 17th.

his amps was 260, +3 was 210, +6 was 178. That's a drop of 50 in the first 3 hours and 82 in the first 6 hours post shot.

in the evening, same day, same dose, 12 hours later, his pmps was 178, +3 was 179, +5 was 164. That's an increase of 1 in the first 3 hours (essentially the same) and a drop of 14 over 5 hours.

in the morning the dose dropped his BG by 82 in 6 hours, in the evening same dose dropped it by 14 in 5 hours.

So you can see that the dose isn't the only factor that determines the numbers. What would help you know better how Ragnar is doing is to shoot exactly the same dose repeatedly, 12 hours apart, and get lots of mid-cycle numbers so you know what Ragnar does when the Lantus is at its most potent, somewhere mid-cycle. Doing that repeatedly is going to tell you what you need to know. But you also must be prepared to treat hypoglycemia if it occurs.

Does any of that make sense? The "official" explanations for all of this are in the stickys that Jill is referring you to, but at least this gives you an example of a specific application on one cat.

I use Google Chrome and it works great.