Options for Kitty....

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kse

kse

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Please throw this around and give me your thoughts.....

First let me explain a little......As most of you know, Kitty has been impossible to regulate or even get in decent full cycle numbers on Prozinc. Well, according to the fructosamine test results--she might not be as bad as advertised....But, Mama isn't happy!

I have got to find some way to keep her out of the Red and Black preshots. I am convinced there is some insulin resistance going on and a pattern of rebound. The delima comes in with what I should try next....for 5 months we have dosed Prozinc bid. And, there are obstacles or unknowns with every available option.

First option Prozinc tid---this probably would be a Great option---but, even at my best attempt--it will next to impossible for me to dose every 8 hours. My work schedule includes a lot of travel and Kitty has to spend time boarding at the vet (a lot in the Fall) and there is no way they could do tid. So, I don't feel it is in our best interest to commit to this--forseeing the obstacles ahead of us.

Second option Lantus-- this is a definite option--and maybe the best, but my vet couldn't be any more scared of doing this than flying solo over the Bermuda Triangle. And, if we choose this option, she wants to start at 1 unit of Lantus--and I am not comfortable with that with the ketone and DKA history. I can admit Kitty to the vet hospital and have them make the transition, but as much as my vet wants better numbers....she is so leary of this?????

Third optionn Lev---vet has never used it...don't really want to be the experiment

Forth option--- this is a little intriguing to me, so please wrap your thoughts around it. I could continue to dose Prozinc on my 12 hour schedule, but on any and all days that I am availble (which would be a lot), I would give a token dose (1-2 units) at +8 to help tide her over until the next shot. My vet has never tried this, but I can sort of buy into it. The flexibility this would allow would be greater than any Prozinc option. If I can't administer the token dose, I am no worse off than I am now---but, at least I would be keeping her on a schedule that the boarding vet could adhere to if I wasn't around. Has anyone seen this dosing strategy before? To me it is similar to tid, but would allow me to keep her on a schedule that I could commit to--and if she missed the token dose at +8--she would still be on the Prozinc bid (no worse than now). Does anyone see any risk here--I would test before shooting, but being low has never been a problem.

Ultimately, Lantus might still get the nod....But, I wish you could have seen my vet's reactions when we discussed Lantus yesterday.

Does anyone have any other intriguing Prozinc strategies that I might could consider?

I am hoping to make a decision Monday morning to which strategy we will choose.

Please give me any and all feedback------and pray that the 5 units gives remarkable results this weekend, so I can just stay where we are.

I am going to read my book again....Who Moved My Cheese!!

Thanks!
 
Humm, if your vet is that freaked out about the Lantus she will keep you freaked out about it too, trust me, my vet #2 did that to me too. It seems to me that she could at least read up on the Lantus to get to know about it. Maybe you should have her read your book Who moved my cheese. Lantus and Lev are so similar that I don't think she would feel any different about Lev.

I heard an interview of a woman who collected turtle figurines, she said the turtles remind her that she has to keep moving forward. When the turtle is protecting itself it pulls its head, legs and tail into it's shell, but if the turtle wants to go anywhere it has to stick it's neck out.

Maybe tid is your best option. You could do tid while you are home and the vet could do bid while you are away.

I'm off to the hospital but I will keep mulling it over today.

Have a great day.
 
I have no idea ..... but so like you to come up with option #673 .....

There are some people who are doing some interesting things with Levemir, which seems to be a little more forgiving than Lantus.

If I were to try and change again, I would try levemir and increase dosage at a faster pace to get back to the dose she is on now with pzi. I think that was my mistake, not getting more insulin into her faster. I would read the L group and see how it feels. They even have a couple of people using levemir t.i.d. .... and adding R in the mix.

Nancy and Payne
(who is only 16 weeks from last DKA and doesn't even want to look at a L :)
 
I like the tid option. Any chance you could try it for a while this summer to see if it helps? (Some cats do TID for a while, get settled down and are ready to go back to BID.) No guarantee Kitty would follow that scenerio....

I don't know that I have heard of anyone trying the tid option interminently. Maybe we have had someone try it on the weekends and then go back to BID during the week? Wendy is the most recent TID user. Maybe she will have some ideas.

You might start giving your vet some info on Lantus and see if he warms up to the idea. This article is full of good info with lots of links to vet studies: http://petdiabetes.wikia.com/wiki/Lantus I agree starting back at one unit is not a good idea. I would ask the people on the Lantus forum for guidance for a beginning dose if you chose that route.
 
On the Lantus/Lev question, personally I would not care a whit if my vet was scared of it. I found it too difficult to try to merge vet advice with board advice, and given that most vets don't have time for the kind of daily feedback you get here on the board, I opted to go with the board, and use my vet for emergencies and other health issues, but not diabetes management beyond a basic level. If you did try Lev, you're not really the experiment - for the vet yes, but lots have used it successfully here and you would be getting feedback from them. In fact in a lot of ways I think either of the Ls is easier to use because they have a protocol to follow. PZI has kind of a basic framework, but the Ls from what I have seen have a lot more guidelines for what to do when, and how to interpret the curve balls.

On the token dose at +8 a vehement NO NO NO! Someone will hopefully correct me if I'm wrong, but I have never heard of PZI being used that way. The problem is that when you get to your next shot time, you are at +4 in the cycle from the token dose. The rules I was always told are that you NEVER shoot PZI until you are past nadir. So while there's no issue with the +8 shot in itself, you are looking at a +4 shot that is almost certainly before nadir. So the +4 shot will be kicking in right when the +8 shot is actually nadiring, and that is dangerous. Now you are looking at a lower dose at +8 and presumably that is where you might consider that it changes the rules, but still I have been warned repeatedly in the past about doing stuff like that. If it were something like 0.2u then it's probably not a major issue, but something as high as 1u I think is a rule-breaker. You wouldn't be able to shoot a full dose at +4 IMO safely. You could have a monster drop by +2, because really at that point she would have 6u in her system. I think it will make the data a nightmare to interpret too - I see where you are going I think, that you want to shoot enough late in the cycle to hold the PS low and avoid the wide swings, I just don't think it's safe to do it that way with PZI.

If you did want to do bolus dosing (not sure I got the term right), that's where you use something like R, the reason being that it wears off FAST, so as long as you time it not to double up the nadir with PZI, you can use that either at the beginning or in the later half of the cycle to bring down the numbers at the times when PZI is not at peak. I think Nancy has used that, maybe she could help you decide if that would be a good option. Maybe that at +10 would give you a good PS for the PZI? I have never used it and don't know a lot about it, so that is just a stab in the dark.

I do know a number of people have done early shooting on the weekends, so either TID or something like +10s during any stretch where they can monitor better, and have gotten good results from it. If the issue is primarily liver training, if you can get a couple days with much of the time in greens and blues, that can go a long way towards getting past the liver training. If it's more actual rebound from steep drops, I'm not sure how useful it would be - you might get good results for a couple days and then back to bad results during the week, and it might just make everything confusing if the dose isn't quite right - sometimes if you go TID they drop into good numbers right away, but it's probably more common that it takes some time to get the dose right, so if you only have 2 days to do it, you might not get good numbers anyhow. I think it's certainly worth a try b/c if the issues are resistance or liver training, the benefit could be huge, so why not give it a shot.
 
Well, you know me... we like TID! :mrgreen: I also have a difficult schedule, but it has worked so well for her I'm going to make it work. On days where my schedule has been more variable, I've missed the occasional dose and had to do either BID or do something sort of similar to what you suggested with a tiny dose followed by a larger one later. It has worked, but of course there are risks so you have to be careful on dosing. She's never gone really low either, but she has bounced on occasion. I've also had times I've had to shoot an hour early or late, and with dose changes it was easy to get her back to where she needed to be. Last night I accidentally shot two hours early. :shock: I had planned an hour early to try to get her back on schedule, but miscalculated (very tired) and ended up giving a lower dose two hours early. The only effect this AM was that she was actually falling a little at +8 but she went back up in a half hour so we shot then and she has been normal since then. We even got a blue.

Just reading posts of various people on this board whose cats also have pancreatitis in particular, most seem to have a problem with duration regardless of the insulin used. I think this is where TID come in. I know that PZI isn't supposed to have a storage shed like the L's, but it sure seems that way sometimes the way she acts -- almost like there is a little bit of overlap. I think in her case that's a good thing and something that has helped to keep her BG from going into the stratosphere like she had been prior to this. Since switching to TID I've found I need to use less insulin than on BID, so I think there is something to this. I find it interesting that some who have switched to the L's will sometimes also have to use R or go to TID to try to get their cats regulated. Dosing frequency may be more important than we think with these cats, possibly due to insulin resistance. I'm no vet, but it seems logical to me.

If your vet is scared of the L's, and you aren't sure either, maybe giving PZI a chance on TID will work well enough you won't need to change insulins. And even if you need to travel, there are ways of making dosing and schedule changes if you are careful. I'm sure you could make it work. It is worth a try, I think.

Incidentally, when Shaikha was having that bout of crazy-high readings and my vet took her in for regulation, after he got her sorted out he actually did some as-needed dosing with PZI to tide her over to the next shot. Increments were tiny of course, and it requires a lot of careful checking, but he's done it with other cats in a effort to get them back on schedule with PZI and it has worked well. For cats that still can't get regulated, he'll go to Lantus, but has found it is harder for his clients to manage than PZI due to it being more complicated and less forgiving.

Hope this helps, but my suggestion would be to give TID a try. I cannot believe how much better Shaikha has done on it. The first few days after switching back from BID we didn't have dosing quite right, but I think we are getting there and she's adjusted pretty quickly. By Day 4 of TID she was already getting blues again. Hoping that continues!
 
Wendy--Kitty is 371 at + 8 ---I am thinking of shooting 3 units now and just starting the tid---I don't need the vet's buy in--is there any danger in starting now that you see?

I can't imagine there is.....just asking....
 
kse said:
Wendy--Kitty is 371 at + 8 ---I am thinking of shooting 3 units now and just starting the tid---I don't need the vet's buy in--is there any danger in starting now that you see?

I can't imagine there is.....just asking....
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If she's rising, you can certainly start. So you are thinking of 3 units every 8 hours then? That's probably a good cautious start given that she's been taking 10 units per day. Monitor closely to see where her nadir is. I haven't looked at her SS that recently. When is her nadir usually?
 
Given how early hers is, I really think TID is a better option. What did you decide to do? Did you give her insulin at +8? Sorry I didn't respond sooner.

For us, we just started right in on TID. I took her normal dose and split it into threes and that's what we used, though if I remember we might have gone down a little due to overlap. It worked pretty well from the start though. Shaikha usually has an early nadir, around +4 to +6 too, though sometimes she'll surprise me and still be falling at +8 so we have to delay or skip the dose. It doesn't happen often, but today it has been. So far there's only been a 1/2 hour delay in dose, though before she's rising again. I may try 0.5U next to see if that helps vs. the 0.6U she's been getting. She seems to be feeling better so that may be part of it.
 
It's debated, but I have certainly seen overlap with PZI even at BID, and I am sure there would some at TID. I don't know the distinction between a shed and overlap so I am happy saying PZI has no shed, but it may just be semantics. I briefly shot Vetsulin TID [NOT recommended, though we actually got good results], which for Bix appeared to be shorter acting than PZI. I absolutely saw overlap even though it would have seemed less likely with that than with PZI, and ultimately I stopped TID b/c the overlap appeared to be getting to be more and more and I was having trouble predicting what a dose could do.

The difference I see is that with the Ls they say that the current cycle isn't necessarily much reaction at all to the current shot, it could have a lot more to do with the previous shot or shots - so that to me is almost like delayed onset, or with the shed concept maybe there is not even a really clearcut onset point, it's more a continuum.

Vs. with PZI even when there is overlap (on BID at least, with TID it may harder to distinguish what's what), you can more or less time it out by the hour. I saw times with Bix where I shot a tiny dose following a big dose, and got undexpected good results til say +4, at which point he went into mega-zoom. So I could see where there was overlap where the 2nd shot kicked in and there was still some oomph left from the 1st shot, but then you could really see in the numbers where the old shot wore off completely and the new shot was going it alone. I don't think Lantus is so much like that, but I haven't looked into it a lot.

Anyhow.... blah blah blah :-D

Now that I think on it Wendy, I wonder if that's why she started doing well on such a lower dose on TID to the point where she seemed to get extended duration. Do you think maybe that was just really good overlap in play, like she had her own little TID-induced mini-shed on PZI? And then when you went to BID it was like cleaning house and all that got lost? I don't really know, just reading what you wrote that popped into my head.
 
Joanna & Bix (GA) said:
Now that I think on it Wendy, I wonder if that's why she started doing well on such a lower dose on TID to the point where she seemed to get extended duration. Do you think maybe that was just really good overlap in play, like she had her own little TID-induced mini-shed on PZI? And then when you went to BID it was like cleaning house and all that got lost? I don't really know, just reading what you wrote that popped into my head.
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I think you may be right about that, Joanna. Because as I've written to Kim elsewhere, sometimes what I have to do when she starts to get more duration is to actually cut back on dose so she copes with the +8 dosing better. If I skip a dose to see how long she lasts, usually the most I can get is +9 or maybe +10 before we are into zoom mode. Today she's lasting a wee bit longer than usual with a later nadir, so I've cut back a tad to try to manage that. So much of it with her though is how she feels -- if her pancreas is calm, there's no infection on board, etc. And of course, there are the steroids in play.

Interesting about your observations about Bix, because I've seen the same with Shaikha. Since the insulin is designed to last 12 hours, it makes sense that dosing more frequently would mean there is some in play in terms of overlap, even though the cat may be rising by the time you give it. It is an interesting insulin to work with. I don't know why, but the L's scare me. I think part of it is they are more complicated to use, and my life is complicated enough as it is right now! :roll:
 
The Ls seem dicier to me when you have a cat with "other factors" - like if they don't eat consistently, or get really variable numbers. i.e. Shaikha :mrgreen: With the whole shed thing, I don't know how they deal with say 2 days that are higher but then back to normal. You can't really raise on those 2 days and then crash after that, right? Or if they aren't eating normally, yikes! Can't react quickly with a lowered dose. I haven't studied the Ls a lot, but my reaction is that for straightforward cats they are probably the better choice, but for complex kitties, might not be. I don't really know though, just my uninformed 2c. :)
 
I sure am glad you missed this dance Kim! :lol:

This all just makes my head swim so I decided to quit even reading it! :smile:

I hope it goes well for Kitty...and you!
 
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