I'm ready to switch back to Prozinc, any thoughts?

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Rob & Harley (GA)

Member Since 2009
It's been almost 5 months and I'm not even close to any kind of regulation like we had with Prozinc. His bg's just seem to get worse.

If there is something I'm missing or not understanding please fill me in, otherwise I may switch back this weekend. I just hate seeing all of these high numbers, I'm afraid they will finish off his kidneys.

Thanks in advance for any input.

Robin
 
Hi Robin,

Sorry to see Harley is not getting good control now. I can only speak from my personal experience with Levemir. We only used ProZinc for a month before changing to Lev. I played around with the 1 drop dose changes for a good 4 or 5 months also. It wasn't until I started to get brave and raise the dose by .25 un at a time that we started seeing progress. When I finally reached 1.75 and held that for a few weeks, we started to see wonderful progress. I think part of my thinking (and inexperience) was that if he was on a higher dose, like over 1 unit and almost up to 2 units, I would never get him off the juice! I didn't have the whole picture that by raising the dose and allowing his pancreas to heal, eventually I might be able to lower the dose. But I did it, and looking back I could just kick myself for not making bigger increases sooner. And now, in the past 6 weeks we have dropped from 1.75 to .2 un.

Again, this is just my experience so far, but Harley's spreadsheet is about as colorful as Jack's was. I'm sure others can give some further advice to you. :-)
 
I am not clear on what insulin you are using now - this post is in the lev forum but the ss shows started lantus in June.

I have not used Prozinc, but have used lantus and lev for my two.
Shadoe did not do as well on Lantus as she does on Lev.

I can't really comment much as your dosing is not like any for those following the protocol in the Lantus forum.
Just wondering if you have seen and read all the links in the lev/lantus forums...

Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers
Lantus & Levemir: Info, Proper Handling & Storage has picture of syringe and insulin pens.
Lantus & Levemir: What’s the Difference?

Just one question:
Are you using the u100 syringes or the u40 ones?

Maybe you can post over on the Lantus forum and ask what they think.
Because Lantus is nothing like prozinc, you need to always consider the shed when using Lantus or Lev.
When you started Lantus, it's usually recommended to start at a low dose, maybe .5u with the U100 syringes, and you must HOLD that dose for 4-5 DAYS / 8-10 cycles in order for the shed to be in place.
On your ss, it looks like you kept changing the dose based on ps numbers, but Lantus is based on nadir.
It could be for these reasons that you are not getting anywhere near regulation.

If you can give it a bit more time, following the below portion from the protocol, you will probably see much better numbers and stability.


"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
 
Hmmm... well, Darlene has a point about raising until you "break through" and you may need to do that again. I see that he has a "LO" meter reading in early Sept off a dose of .4u. Did he not eat well that day? If he was eating ok, his insulin needs might have just been less (decreasing). I wonder if you had dropped him to just .3u instead of .2u he would have maintained the momentum? He probably rebounded a bit from the LO and the HC food you fed.

I also notice that his numbers are getting worse as you are raising the dose - all yellows with some blues on .25-.3u to all pinks with some reds on .5- f.5u most recently.

If it were me, I would try .25u for a good 5 days and see if there is improvement in the numbers. (be sure to test for ketones if the numbers are in the 300s as they have been for the past 10 days or so). If not I would go back to .5u and let it settle then go to .75u and see if you get better numbers - and might move to "break through" numbers again. Normally, I would suggest dose changes of .1u from such a low dose, but I think he is either in a rebound cycle and/or starting to experience insulin resistance from the higher numbers. Beau didn't go OTJ until he had a period of time in "normal" numbers all day long.

I just have to laugh about someone questioning a lantus user posting on the lev ISG when there are dozens of lev users posting on the lantus ISG all the time. People should post where they feel comfortable posting. There is experience to share and learn from in both ISGs. The insulins are very similar. The ISGs are different styles, but there are good results, excellent results, on both of them.
 
Here are links to help you understand what could be causing Harley's highs.

http://petdiabetes.wikia.com/wiki/Insulin_resistance

http://petdiabetes.wikia.com/wiki/Glucose_toxicity

http://petdiabetes.wikia.com/wiki/Glycogenolysis

It helps to understand the effects of these phenomena and the BGs which result. If you graphed Harley's numbers, the graph would probably turn out like this
TN_IMC16199_550X0Y.jpg


Those BGs are in mmol/L.

Those phenomena are why increasing the dose works. Since you always do a good job getting tests on Harley, it's worth trying .25U increases to hopefully break this cycle of highs. But if you are toward the end of your Lantus, there is no crime in going back to what worked. I understand the frustration. :YMHUG:
 
Hi Robin,
I am not sure if you know that Shakespeare was on Lantus for about 5 months before going
to PZI. As you know I am no way an expert on this, but in looking at Harley's SS, I am
going to agree with Sheila, especially if you think you are going to change back to PZI
I would lower the dose to .25 and stay there for a few days without changing the dose
and see what happens. If you want I can tell you our story some other time
Denise and Shakes
 
Sorry for the delayed response, things have been so busy lately.

Thank you all for the responses and links, interesting reading, I had read some of it before.

I tried dropping him down to .25u for a few days and his bg's went extremely high, I know, I have no patience, so I gave up and started him on the Prozinc last night and of course he went even higher and was almost 500 this morning. Ugg.

I wanted to thank everyone for your expertise, support and responses. I hope you won't mind if I pop in occasionally to say hi.

Thank you all so much,
Robin
 
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