I've been doing some thinking lately.... I wish I'd done a better job of data collection and SS stuff when Bob was on PZI. Bob (I think) was probably "overdosed" when I was giving him insulin. I shot some pretty scary high doses into some fairly low numbers, and didn't get nadir tests while doing so. So I don't know how many times Bob lived in the greens. If I knew that for sure, I'd be more willing to encourage people to do what I did probably.
Sue is right. We've looked at a couple former PZIers who went to Lev, and yes, their numbers have improved. But they've also in a couple of cases increased their doses to numbers they never even considered shooting while on PZI. I'm thinking "you can't argue with success" though. Perhaps, in general, we shoot less than we need to? I know speaking only for me, a large part of that is "Hey, I don't want to be the guy who tells you to increase and then see your cat go hypo". That's just a self-defense mechanism in me. I understand "you hold the needle" and all that... but when you get to a point where you are advising a lot of people on a lot of different things, eventually, people start to think "Hey, he's been right before....." so there's a lot of "responsibility" that goes with being a person who is tossing advice out there to people, and I take that pretty seriously. So the natural tendency is to hold back at times, and be cautious.
Anyways... a couple of things...
1 - the whole glucose toxicity thing. Kitty needs to get out of the high numbers as quickly as possible. The sooner you get the numbers down, the less damage the body is taking, and the better the chances that healing and/or remission can take place. Even with the "L"s, if you read the studies that resulted in the protocols, the best chances of remission are in the first few months of treatment. 84% is a pretty impressive number, isn't it? The fine print though is
"More recent work has also shown that already treated diabetic cats which have not gone into remission with Caninsulin/Vetsulin and a low carb diet can achieve remission upon switching to Lantus. Significantly higher remission rates are achieved in cats switched to Lantus within 6 months of diagnosis (84%), compared to those cats switched later (35%)."
Nevermind the switching thing. What I find important is the rate of remission during the first 6 months vs. later. The sooner the numbers are controlled/regulated, the better.
2 - Protocol - This is something that I think (and Sue and I have discussed recently) we really need with Prozinc. I hope "L" users don't take this the wrong way, because it isn't meant as a slight in any way, but they have it "easier" than we do with this. There is a published protocol that they can follow. Very clear cut guidelines and rules to follow for doses, and when to increase or decrease their doses. While they can have all sorts of wonky stuff going on just like we do, their protocol is sort of like an "autopilot" to some degree. IF something isn't working, then you take the next step. You increase by .25. stick with it for X days, and then reevaluate and adjust accordingly. I used to think they tested a lot more, and around the clock. But while some of them do, they aren't required to do that. A lot of us test just as often, or more often, than a lot of them do. The major difference is that they have a set of rules that tell them what to do next. We don't. We have lots of history, and lots of spreadsheets to look at, but we don't have a study that set out a clear protocol of "what to do next". You can look and google but there isn't a "Prozinc Protocol" out there for us to follow. There is a study that tested Prozinc against the PZI IDEX or whatever it was called. But that study was done simply to verify that Prozinc was a good enough alternative to the old PZI, so that Prozinc could be marketed as a suitable replacement for an insulin that was being discontinued.
So what we need is some guidelines, some proven method of using Prozinc that will help all the P kitties out there. So what do we do? Invent one? Can we somehow compile a set of "rules" or guidelines to follow? I don't know?
Anyway, didn't mean to hijack your thread, Angela. But what Sue mentioned makes sense to me. Henry is already getting pretty high doses compared to many kitties. And the numbers, at times, have been really decent. But maybe you could increase when it's possible to monitor, and see if he can be "forced" into the greens, ignore any bounces, and just see if by making him live in greens and blues more often, then maybe his overall numbers will come down? What has always confused me with Big Hen, and one of the reasons I don't "advise" much in your threads, is that I just don't understand why sometimes it looks like he does great, and then for some unknown reason, it just stops happening. I don't "get that". He's a mystery to me.
Sorry for rambling...
Carl
