how much insulin?

Hello everyone Spicey's #s
I think I should give 1 unit pzi?

1-12-10
Pmps 521 - 1 unit pzi vet 9pm
+ 4 - 317

1-13-10
Amps 298- 1 unit pzi vet 8 am
+10 - 198
Pmps 229 - .5 unit pzi vet 8:30 pm
+2 - 399
+4 342

1-14-10
Amps 486 -

 

Hi David,

can't help with PZI, but if you start a thread in the PZI forum, you'll get the PZI users looking at ur numbers and be able to offer feedback.

have u started a spreadsheet yet? Tech forum can help you with that.

Good luck to u!

 

Spicey is beautiful!!!

I hesitate to give you any dosing advice as it's been a long time since I used PZI. It would be helpful for others who do use PZI currently if you could get some mid/later cycle numbers than +4 from him, such as 5 to 7 hours after his shot today. This would determine how well the insulin is working by showing how low the dose makes his blood glucose fall. Does it fall further after 4 hours or what does it do? He may still be more sensitive to the insulin because of the hypo so this information is important.

You're doing a great job!

 

Good morning David....


Just a quick note to begin... whether in the Health forum or, particularly, in the PZI forum... it's good to make your subject unique. So you might want to change your subject line in the first message (using edit) to: Jan 14 - Spicey AMPS - 486 - How much insulin? That way people know you want info on today's reading.

Great that you posted your log here for us. It does look as if the .5 didn't have the lasting effect that the 1 unit did. So what this pattern means is that 1 unit did a lot (though some of that could be sensitivity after the hypo) but .5 didn't do as much as we'd like. What one wants to do is find a dose that they can maintain... For example... giving 1 unit at yesterday's PMPS may have taken Spicey too low... so you cut the dose to be safe - a good idea when you are not around or up to test. That dose didn't take the BG as low or have as much of a lasting effect. You could stick with it and see what it does for another cycle... you really need to check for ketones today either way... Or, you could give a dose of .75 - between the .5 and the 1 unit. 1 unit is likely safe and will bring her down... but like I said, you want to find a dose that you can keep steady. Keeping in mind that you may have been able to give 1 unit last night without her going too low but you can only shoot those lower numbers after you are data ready and know how well and when the insulin works. You need more numbers to do that safely.

Ideally, a dose like .75 would bring her closer to the 200 mark at her next preshot but not low enough that you have to change the dose. I can imagine that the dose of .75 would bring her below 300 for the nadir and she'd be just above that at next shot... Then you give the same amount again and it has a nice lasting effect as it slowly drops the BG. This way you get the BG down gradually while building your database and pattern of test numbers so you know how well and when she's acting on the insulin.

There is really no wrong answer between .5, .75 and 1 unit. There is a risk of ketones if you stick with .5 and there is a risk of a bit of a rollercoaster ride if you do another 1 unit.

Personally... the ketones are a worse risk considering the higher dose you've had her on for so long... So, again, don't mean to nag, but let's check that urine today, ok?

I'm leaving this open to the thoughts of others but wanted you to have a bit of the background on how to look at the numbers and what we want to happen and what we see happen on certain doses with certain numbers. All cats are different and you, and we, have to learn what happens specifically for Spicey.

If she were my cat and I had to make this decision on my own, I would give as close to the .75u as I could. Or just under the 1 unit (skinny 1). I think the 1 unit will put you in the same position as last night in having to the lower the dose... and the .5 makes me a bit nervous of the ketones. And we saw that the .5 unit didn't take her very low last night... or have a lasting effect like the 1 unit... which brought her down and kept her down. So you know that when the PZI wears off, it wears off. Meaning with last nights 229, you may have been ok with a skinny 1 unit... but we just didn't know... and after the hypo, you need to be safe (and sleep soundly).

Does this make sense to you?

But let's see what the rest of the gang thinks.

 

Vic's reply makes alot of sense to me. I do not currently use PZI, but dealt elaborately with it, and evaluated its effect on many cats, when Maxwell (GA) and I were in the PZI support group.

The one thing I would add to Vic's comments is that a PZI dose takes a bit to "settle." Also, there is not a "shed" effect the way there is with Levemir or Lantus, but PZI does develop an overlap, so that you get to the point where you are giving the current shot before the previous shot has completely worn off.

My observations about PZI--at least what I learned when Max was on it--are in his Wiki case study.

 

With PZI from what I have been told and have observed with my own cat, it takes 2-4 cycles (sometimes more, ECID (every cat is different)) (cycle = 1 shot to the next 1) to see what the overlap will do. If it's possible to get a +6 or so today that would be great, but totally understandable if you can't (some people (NOT ME!) do have lives, LOL!).

If you can, post any spot tests you get today, and your PMPS before shooting - hopefully someone will be around (if you can post what time & timezone you expect to post, that will help us know when to be on the lookout) to give advice.

I agree with others that 0.75 might be warranted, and then hold that for a couple days before going back to 1u if needed, but I'd like to see any data from today's shot before putting in my 2c for sure, it's just guessing/projecting for now. And would be good as others have said to get a ketone check in, to be sure that's not a developing problem. While getting regulated, it's nice to test once a day if you can, to be on the safe side. Some cats are more cooperative than others with being visited while in the box.

Personally I wouldn't worry about holding 0.5 for several cycles if the results aren't better through this cycle - the 3-4 cycles guideline is when raising the dose (if you are looking for more overlap that is, rather than trying to reduce overlap). If you lower the dose, several cycles will work in the other direction - loss of overlap - so (with some exceptions), I would expect that if this cycle isn't great, it will only get worse on 0.5u.

Just for reference, with our daily posts in PZI Land, we usually use the subject line format:

Date catname - any comments

So for example: 1/10 Bix - need advice!