Laurie and Mr Tinkles said:
When you adjust dose, do not increase by more than 0.25u at a time, and let the dose settle for 5 days before you evaluate the need for another adjustment unless you see a low nadir (<50) or unshootable ps#s. Start low, go slow...even more so with PZ, you want to make small, infrequent dose adjustments.
Just wanted to chime in to say that there are times when you want to be more aggressive with it, for instance if you have ketones present, or high #s that just aren't budging. Although I haven't used ProZinc specifically, my understanding (and what I've observed here) is that it works very similarly to the other PZIs.
My view on PZI in general is to move in either 0.25 or 0.5 increments depending on the #s you are seeing, your cat's response, etc. Similarly on the # of days to settle, I've seen opinions in the past of 2-3 days, 3-5 days, 1 week, and variations in-between. I think there is a fair amount of ECID in terms of your cats needs. If your cat is not super-sick you can go slower, but there are other times when you need to be more aggressive with it.
The main point of SLGS (start low go slow) IMO is to avoid 1) accidental hypos when overlap kicks in, and 2) rebound. Both of those I think can be managed even when using a more aggressive dosing strategy. For instance if you look at people shooting as-needed and going for TR, that is a radically different strategy that SLGS, and certainly it works very well for some cats. I don't know if it's been proven yet with ProZinc, I think some around here have done that but I forget exactly.
I think Laurie's advice is excellent advice for many cats
, just wanted to mention that there are some situations where other approaches are needed, and also other approaches that are possible that may also produce good results. It may turn out that ProZ is less flexible than other PZIs (I hope not!!!), but one of the virtues of PZI has been that you can vary things quite a bit and still get good results.
Peggy your schedule makes my head swim! :lol: I can't get my mind around it enough to offer any useful suggestions, but it should be manageable, as Laurie said you will probably have to do some experimenting & data collecting to see what works best. The earlier you shoot the more overlap you will get with the prior shot, so you generally want to reduce the dose a little bit on an early shot, and increase a bit on a late shot (often a +11 won't show much difference from a +12, but something like a +9 can give you a dramatically better response than the same amount of insulin on a +12). With PZI you always want to shoot on a rising BG, so though many of us skip a rising # test if shooting at +12, if you shoot at something like +9 you would want to get two tests maybe 15 minutes or so apart to be sure he is past nadir and his BG is headed back up.
If you don't see much better #s in a day or so, I would consider going ahead and starting on 1u BID (or 0.5 if you are more comfortable with that). When I switched Bix's food his #s came down really fast, but he was already on insulin so that helped. Often when they are in higher #s they need some help to come down from there. Hopefully though you will see better #s soon!!!!
