? Hello Pro-Zinc'rs :) Tell me about the nadir

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KJ & Alfred

KJ & Alfred

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I've chatted with some of you already in other parts of the board, but figure I'd make a post over here.

I'm trying to get a feel for ProZinc after being on Lantus when Alfred was first diagnosed three years ago. We're back doing the sugar dance after a 3 year remission and struggling, admittedly, to get our sea legs again. So, am I understanding correctly that I really need to be getting data about the nadir on ProZinc? It's a challenging time of day for me to test, but if its really important, I certainly will do my best. Is it the kind of thing that a few days of data will give information, or do I need more? I felt pretty confident about when to adjust dosage on Lantus, but ProZinc is all new to me.

I've added a new tab to the spreadsheet for this second go and appreciate any thoughts. We're only two weeks in so not a ton of data to go on quite yet. I know my vet is going to tell me this afternoon when she returns my call to go up to 2U (although maybe the 53 we just got at +6 after a 1.5U will change her mind). She just doesn't seem all that into finessing or closely managing, which is so different than my experience with Lantus here previously.

I am going to check him again in a few minutes (he is eating right now) and keep putting one foot in front of the other. I'm also ordering supplies to check for ketones.
 
Welcome back, KJ.

Glad you got the midcycle number. Wonder if it was even a little lower before or after then? We generally say 50 earns a dose reduction. I think I might give 1.5 minus a drop or two, if you can sure monitor. Those are big drops from the high 300/400 to the fifties so I would expect a bounce. He might be high again tonight, but I think I'd give a little less, as it is overnight. If you can't monitor, you might go down to 1.25 overnight. Definitely no increase!

Bouncing on PZI is the same as with Lantus. Did you get the concept of the bounce? The only difference is that PZI bounces sometimes clear faster than depot insulin ones because it is more of an in and out insulin.

He really is looking pretty good - just bouncing for preshots after nice numbers midcycle. The saying here is they bounce until they stop. Not good news, but bouncing is very common. Our record here is almost two years. Cassie bounced that long, then slowly stopped and went OTJ. But that scenario is unusual. More often it's a couple weeks before their body gets used to the lower levels and quits panicking. Meanwhile enjoy those nice numbers midcycle
 
Hi KJ
definitely not 2 units - seems like a lot of vets increase/decrease in 1 units which is usually too much
When Murphy first started insulin, his #s were all over the place - I think it really takes a while for their bodies to adjust to the exogenous hormone we are giving them. Nadir's usually occur in hour 5-7 but can be earlier or later
I assume you read the yellow sticky on the prozinc protocol?
I really liked Prozinc and hated that I had to switch to Levemir after a
almost a year on it - once you get used to it, it is very easy to adjust the dose as needed (even using a sliding scale)
really - this will come back to you!!
 
Hi KJ, glad you made it over! I switched from ProZinc to Levemir, a depot insulin like Lantus, so I know it's a completely different mindset! It looks like you're getting a great response so far to the ProZinc- Definitely would not increase to two units. One thing you might do to help fill in the blanks is try to get a few before bed tests at night. Don't know if you've already said, but do you know why Alfred came out of remission?
 
Oh, thank you all for your responses. Let's see if I can answer the questions....

I did a +4 check and he was at 174 @Sue and Oliver (GA) - did you mean he might have been a tad bit lower like around +5? He came up to 78 about 30 mins after the 53 (and some food). I think I am understanding the bounce concept. What do you mean by "in and out insulin"?

@Carol & Murphy - I definitely agree I wouldn't go to 2U, I just know the vet is going to say that. When she suggested it last Thursday evening, I questioned such a big jump and asked if going up a 1/2U would be better? She dismissed that as "too difficult to measure on that syringe". That was before someone here turned me on to the conversion chart for U100 syringes, which I will get ahold of and start using I guess. She also told me NOT to test for 3-4 days after the increase and then just to test morning pre-shot and at +6 and let her know. Well, I didn't do that and tested him after the first 2U dose and got the 43.

So, I was wrong. The vet just called and after sharing some of the numbers with her she suggested I go back and stay at 1U. She said it is clear that he is sensitive and reacting really quickly to dose changes. At his vet visit, they suspected pancreatitis and observed signs of dental disease. She suggested scheduling a dental surgery for him and also re-checking the FPL (?) test to see if the pancreatitis is under control. She said dealing with the dental disease could possibly make him easier to regulate but that a second remission is not likely. Not sure how to feel about that.

And @Sharon14 - it seems the pancreatitis (or whatever infection/inflammation may have been going on) it was kicked us back into the sugar dance.
 
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A depot insulin takes awhile to build up a depot and the insulin can carryover from one cycle to the next. So you don't change doses suddenly; you tend to stick with a dose longer to see results. The depot insulins tend to have longer flatter cycles. The depot insulins are dosed on the nadir only.

ProZinc usually lasts only 12 hours; there is no carryover from cycle to cycle. So we say the insulin goes in and is out 12 hours later. The dose is based on both preshot and nadir. Because there is no carryover, it allows more flexibility. It doesn't always have to be given every 12 hours on the dot.

Hope that makes sense.
 
Sue and Oliver (GA) said:
A depot insulin takes awhile to build up a depot and the insulin can carryover from one cycle to the next. So you don't change doses suddenly; you tend to stick with a dose longer to see results. The depot insulins tend to have longer flatter cycles. The depot insulins are dosed on the nadir only.

ProZinc usually lasts only 12 hours; there is no carryover from cycle to cycle. So we say the insulin goes in and is out 12 hours later. The dose is based on both preshot and nadir. Because there is no carryover, it allows more flexibility. It doesn't always have to be given every 12 hours on the dot.

Hope that makes sense.
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That makes perfect sense....thanks for the explanation.
 
Hi KJ! Just made it over here tonight. For the nadir, I know it's difficult to get that test. What I say is get it when you can. I generally grabbed nadir only on weekends. I also did the occasional midnight test. You can set an alarm to get it or (if you're like me) you might be up anyway! If I needed to get up at night, I'd swing downstairs and grab a test. NOT every night or even all that often. Just every now and then to see what's going on.

I also suggest grabbing other tests when you can. If you can't get a nadir during the week, maybe a before bed test? I'd do one last test at night about 3 hours after insulin...as I was heading up to bed. That data is useful since it tells us if the cycle is likely to be active...and all data is good data! If you can't get a nadir, get a test in when you can. When you can get a nadir, grab one. Over time, a pattern will probably emerge and help us make sense of that sugar dance! :)
 
Welcome @KJ & Alfred . I just replied to your thread in the main health forum. Happy to see you're getting help here. I think you'll quickly get the hang of Prozinc. I've seen people post about second remissions so don't think all hope is lost.
 
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