question about shooting into bounces?
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Sue and Oliver (GA)
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I hope I did not really confuse you about mini dosing. Can you explain the spreadsheet - I'm confused. Did you shoot .4 into the 403 today and then .1 into 377 3 hours later?
We start with 12 hour dosing, figuring the lowest point is around 6 hours after the shot. You got on board early with your low numbers, which was great. Now he seems to be in average numbers, but may be bouncing all over with the dosing. If you get a preshot in the 250-300 range, I would shoot .3 or something in that range (just to see what he does with the dose) Get a number 6 hours after the shot to see how low that dose takes him. But then allow him to rise until he gets back into that preshot range again. I would give him a whole 12 hours for a few cycles to see how he does with your chosen dose. Once you have some data and see how he reacts to a given dose, you can be more creative.
It may be that you will need to mini dose. But the trick there is that you wait he is sure rising and definitely after that 6 hour nadir. Does this make sense? If not, ask questions.
We don't consider a number a bounce until it is 12 hours after the shot. And then, we suggest shooting a normal amount, not more, because it may be the bounce that inflated the number.
We start with 12 hour dosing, figuring the lowest point is around 6 hours after the shot. You got on board early with your low numbers, which was great. Now he seems to be in average numbers, but may be bouncing all over with the dosing. If you get a preshot in the 250-300 range, I would shoot .3 or something in that range (just to see what he does with the dose) Get a number 6 hours after the shot to see how low that dose takes him. But then allow him to rise until he gets back into that preshot range again. I would give him a whole 12 hours for a few cycles to see how he does with your chosen dose. Once you have some data and see how he reacts to a given dose, you can be more creative.
It may be that you will need to mini dose. But the trick there is that you wait he is sure rising and definitely after that 6 hour nadir. Does this make sense? If not, ask questions.
We don't consider a number a bounce until it is 12 hours after the shot. And then, we suggest shooting a normal amount, not more, because it may be the bounce that inflated the number.
Sue and Oliver (GA) said:
I did do that, but I may have entered the 377 at the wrong time--it was 4.5 hours later. My reasoning was that if she only dropped about 30 after 4.5 hours, she could probably use a bit more of a boost. Since the 0.4 took 4.5 hours to be as meekly effective as it was, I figured the 0.1 would take a few hours to become effective as well, so when the 0.4 was passing its nadir, the 0.1 would be starting to kick in. I won't be home until late tonight, so I also thought it'd extend the life of the initial shot a bit. Just now, at 5pm, roughly 4 hours after I gave the 0.1, she was 234, so she hasn't dropped dangerously low, and would probably be a bit higher if I hadn't given the 0.1 "boost". I was also thinking, in a natural body, it produces insulin as needed, not just one dose every 12 hours, so I thought it would be okay and so far looks like it is.
Sue and Oliver (GA)
Very Active Member
The problem with shooting more often than +6 is that it confuses things. Yes, he may go up at the beginning of the cycle, but then he might go back down. You could be shooting a number that isn't rising. Accumulating doses isn't safe. At some point he could crash. I think it would be much safer to give a little more at preshot and let him have a complete cycle so you can see his nadir and how long the insulin really lasts.
We have people who dose three times a day instead of two, but they do it after they have lots of data, and because their cats haven't responded to twice daily, and have numbers that run high. And they never dose before + 6, most often +8. Your cat doesn't have high numbers. He has decent numbers.
You certainly can dose him the way you'd like, but we like to be cautious. I have been on the site over 5 years and never seen anyone dose before +6.
Carl explains things so much better than I do. He has said he'll post on your thread when he gets home from work. Please check back for his explanation.
We have people who dose three times a day instead of two, but they do it after they have lots of data, and because their cats haven't responded to twice daily, and have numbers that run high. And they never dose before + 6, most often +8. Your cat doesn't have high numbers. He has decent numbers.
You certainly can dose him the way you'd like, but we like to be cautious. I have been on the site over 5 years and never seen anyone dose before +6.
Carl explains things so much better than I do. He has said he'll post on your thread when he gets home from work. Please check back for his explanation.
C
Carl & Polly & Bob (GA)
Guest
To answer your original question -
On dosing and timing between shots.
There is a protocol, created by Dr. Hodgekins, that is a Tight Regulation Protocol used with PZI insulin. However, PZI and Prozinc are NOT the same thing. PZI is a bovine based insulin used on cats. It has a shorter duration than Prozinc does (8-10 hours)
Prozinc is a human recombinant DNA insulin that is genetically altered so that it can be used on cats. It has a 10-14 hour duration.
Because of the longer duration, it would not be suitable to use with the Hodgekin's TR protocol for PZI.
In that TR protocol, shots can be given as often as 4 times a day, 6 hours apart. In simple terms, they draw a line in the sand on a level of BG that is high enough to shoot at. Once kitty crosses that line, they use a sliding scale and shoot. It can be 6 hours later, 7 hours, anything less than 12 hours from the last shot. It is very involved, very BG test intensive, and shoots your schedule all to hell! I've never tried it, and while there may be a couple people who are members here who have used it, they are few and far between, so getting good advice on it would be difficult at FDMB.
Due to the normal duration of Prozinc, I'd be hesitant to shoot any closer than 8 hours apart with it. And if you did, you would need a lot of historical data that proved that you were not getting more than 8 hours duration from Prozinc most of the time. Otherwise, you could run into overlap of doses complications that could be a risk. Sometimes cycles just run long, like they get a delayed start. Instead of seeing the onset of the dose at +2 or +3, sometimes you don't see it until +4 or later. If that happens, and the nadir is at +8 or +9 instead of +6, and you shoot a 2nd dose someplace in that time frame, then the doses could end up working together just like you shot the two doses at the same time. The big problem is, you never know up front if or when that will happen. If you want to dose 6 hours apart, or add tiny amounts early in the cycle, you pretty much have to be there all day or night with a BG meter in your hand. The other difficulty is catching a rising number before giving another shot. With meter variance up to 20%, you really have to be sure that the number is rising rather than staying about the same and flat.
Carl
You wouldn't skip the shot. But we say it as "don't shoot the bounce". In other words, if you suspect that the number is so high due to the fact that kitty went too low in the middle of the cycles, you don't shoot more insulin than normal at the higher number. You keep the dose the same, (or reduce it a bit if you are concerned that the same thing will happen again). In effect, you are ignoring the inflated number and NOT increasing the dose due to higher PS readings.
On dosing and timing between shots.
There is a protocol, created by Dr. Hodgekins, that is a Tight Regulation Protocol used with PZI insulin. However, PZI and Prozinc are NOT the same thing. PZI is a bovine based insulin used on cats. It has a shorter duration than Prozinc does (8-10 hours)
Prozinc is a human recombinant DNA insulin that is genetically altered so that it can be used on cats. It has a 10-14 hour duration.
Because of the longer duration, it would not be suitable to use with the Hodgekin's TR protocol for PZI.
In that TR protocol, shots can be given as often as 4 times a day, 6 hours apart. In simple terms, they draw a line in the sand on a level of BG that is high enough to shoot at. Once kitty crosses that line, they use a sliding scale and shoot. It can be 6 hours later, 7 hours, anything less than 12 hours from the last shot. It is very involved, very BG test intensive, and shoots your schedule all to hell! I've never tried it, and while there may be a couple people who are members here who have used it, they are few and far between, so getting good advice on it would be difficult at FDMB.
Due to the normal duration of Prozinc, I'd be hesitant to shoot any closer than 8 hours apart with it. And if you did, you would need a lot of historical data that proved that you were not getting more than 8 hours duration from Prozinc most of the time. Otherwise, you could run into overlap of doses complications that could be a risk. Sometimes cycles just run long, like they get a delayed start. Instead of seeing the onset of the dose at +2 or +3, sometimes you don't see it until +4 or later. If that happens, and the nadir is at +8 or +9 instead of +6, and you shoot a 2nd dose someplace in that time frame, then the doses could end up working together just like you shot the two doses at the same time. The big problem is, you never know up front if or when that will happen. If you want to dose 6 hours apart, or add tiny amounts early in the cycle, you pretty much have to be there all day or night with a BG meter in your hand. The other difficulty is catching a rising number before giving another shot. With meter variance up to 20%, you really have to be sure that the number is rising rather than staying about the same and flat.
The problem with that logic (which is correct) is that a normal pancreas will only secrete insulin "as needed". That might be really tiny micro doses that are impossible to measure in a syringe. The body won't "overdose" itself by producing insulin in specific ".whatever" doses. A healthy pancreas puts out insulin all day long only on an "as needed basis".
Carl
Thanks for all of that information. I guess I'm just frustrated that her numbers aren't coming down more. Looking at my SS, do you think she's bouncing or do I need to use more insulin? It looks like she isn't getting that low, and is ending up with high-ish numbers, while sometimes she's doing okay. I guess I"m just a bit out of ideas right now, and not happy that she's been so high.
C
Carl & Polly & Bob (GA)
Guest
It's hard to wrap my head around the spreadsheet....
Sometimes the highs look to be "bounces". It's hard to see patterns because of the shot timing. Not just the recent "less than 12 hours apart shots", but also the days where she went almost 24 hours on a dose. Those days, the dose would have probably been too high, and caused extra long cycles. And with the recent cycles, it is hard to figure out when the nadirs might be happening, or if the doses are overlapping and when.
I'm thinking if .3 works by keeping her 12 hour numbers more consistent, then you'll be able to see what type of "drop" pattern you are getting, and it'll be obvious whether or not the dose amount is right.
Carl
Sometimes the highs look to be "bounces". It's hard to see patterns because of the shot timing. Not just the recent "less than 12 hours apart shots", but also the days where she went almost 24 hours on a dose. Those days, the dose would have probably been too high, and caused extra long cycles. And with the recent cycles, it is hard to figure out when the nadirs might be happening, or if the doses are overlapping and when.
I'm thinking if .3 works by keeping her 12 hour numbers more consistent, then you'll be able to see what type of "drop" pattern you are getting, and it'll be obvious whether or not the dose amount is right.
Carl
C
Carl & Polly & Bob (GA)
Guest
That's possible, yes. The goal is to get her cycles consistent enough so that you can shoot twice a day, get her numbers lower for her PS readings, and then reduce or try shooting mini doses when her cycle runs longer than 12 hours rather than shorter cycles with pink and red numbers. This mini dosing "almost ready for off the juice" experiment requires green and blue numbers being the rule rather than the exception over a 24 hour period.
Carl
Carl
tonight's numbers are worrying me. At +5, she's still higher than her pre-shot number, and has been above 400 for several hours. I shot 0.3 in the morning, and she was still high at +10, so I then shot 0.4, and it seems like it's done absolutely nothing. I'm going away again on a business trip tomorrow morning, for 5 days this time, and have pre-filled syringes for 0.4 and 0.2, directing is above 300 to give 0.4 and if 200-300 give 0.2, but I'm concerned that she won't go below 300 the whole week.
Pumbaa
Very Active Member
Sue and Oliver (GA) said:
I learn something new every day here. I've had a lot of questions on what was considered a bounce, and what I thought was a bounce was not considered one by others.
Thank you, Sue...I am going to go back and review Pumbaa's SS and see if this now makes more sense!
Suze
Sue and Oliver (GA)
Very Active Member
I think you are probably dealing with rebound with the frequent dosing. It will be hard to get back to regular numbers before you leave. I'd suggest a tiny dose and have your sitter dose every 12 hours. Just the data they collect may get you back on track.
Prefilling syringes isn't recommended. Can you leave a sample syringe with colored water in it that they can use as a guide?
Suze, my idea is that you need to look at the entire cycle to see what the preshots and nadir was before you consider a bounce (and then, we are making an assumption). Within the cycle, numbers are lowering and raising again based on the dose. They might be a bounce based on a previous cycle but not the current one. (I think I made that more confusing, not less)
Prefilling syringes isn't recommended. Can you leave a sample syringe with colored water in it that they can use as a guide?
Suze, my idea is that you need to look at the entire cycle to see what the preshots and nadir was before you consider a bounce (and then, we are making an assumption). Within the cycle, numbers are lowering and raising again based on the dose. They might be a bounce based on a previous cycle but not the current one. (I think I made that more confusing, not less)
Sue and Oliver (GA)
Very Active Member
I could be wrong about the prefilled syringes. Thought we didn't recommend it.
It is difficult to figure out her pattern because she isn't getting full 12 hour cycles. If she gets a dose, a nadir at +6 and then a preshot number at +12 for a couple cycles, it will be much easier to see whether she is getting too little insulin. With the frequent shots before nadir, her body is reacting to the new dose of insulin before it is done with the previous dose. The insulin can accumulate and give you all kinds of strange numbers. It isn't meant to work that way. It is the only insulin that you can dose 3 times a day but not less than 8 hours between doses. And only after you have lots of data showing you how she reacts to the insulin in normal cycle. You just can't assume because you get a number during the cycle that is higher than your number a few hours before, that the insulin is finished.
It is difficult to figure out her pattern because she isn't getting full 12 hour cycles. If she gets a dose, a nadir at +6 and then a preshot number at +12 for a couple cycles, it will be much easier to see whether she is getting too little insulin. With the frequent shots before nadir, her body is reacting to the new dose of insulin before it is done with the previous dose. The insulin can accumulate and give you all kinds of strange numbers. It isn't meant to work that way. It is the only insulin that you can dose 3 times a day but not less than 8 hours between doses. And only after you have lots of data showing you how she reacts to the insulin in normal cycle. You just can't assume because you get a number during the cycle that is higher than your number a few hours before, that the insulin is finished.
Sue and Oliver (GA)
Very Active Member
Re the prefilled syringes. I have asked a couple people. Apparently there was a thread when I was gone for a month that dealt with it. Some people have done it and it was fine. We used to tell people not to do it. They do not suggest it as an option for Lantus or Levemir. So I guess the jury is still out on the subject?
C
Carl & Polly & Bob (GA)
Guest
I agree about the jury...I will research this tonite
carl
carl
C
Carl & Polly & Bob (GA)
Guest
I looked up "prefilling syringes" and "prefilled syringes"...
It's a no-no with Lantus and not recommended for Lev, but some Lev users have done so. Apparently it was okay to do with Humulin. And I only found a couple references to PZI or Prozinc.
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=53970&p=583453&hilit=prefilled+syringes#p583453
http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=13082&p=131369&hilit=prefilled+syringes#p131369
My vet told me it was okay, but didn't say how long it would be good for (I used PZI), but I never did it. She did say to store them needle end up if I did it.
Carl
It's a no-no with Lantus and not recommended for Lev, but some Lev users have done so. Apparently it was okay to do with Humulin. And I only found a couple references to PZI or Prozinc.
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=53970&p=583453&hilit=prefilled+syringes#p583453
http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=13082&p=131369&hilit=prefilled+syringes#p131369
My vet told me it was okay, but didn't say how long it would be good for (I used PZI), but I never did it. She did say to store them needle end up if I did it.
Carl
Okay, I am using ProZinc, so hopefully it's okay for 5 days. I was storing them needleside down, however, so I've just texted my roommate to ask her to turn them upside down, so she'll do that when she gets home (before the petsitter comes to give the shot). My needles don't have 1/2 unit markings on them, and I just don't quite trust other people to get the 0.2 unit right, which is a prime driver of why I pre-filled them.
As of last night, Snowflake was at 300 at +11, so she probably got 0.4 right around +12.5. My roommate left before the petsitter tested in the morning, but when she gets home, she'll text me the AMPS number and what was given. At least I'm in the country this trip, so I can just call the petsitter if I need to address anything. I've left the instructions of 200 and below, no shot, 200-300 0.2 and 300+ 0.4.
As of last night, Snowflake was at 300 at +11, so she probably got 0.4 right around +12.5. My roommate left before the petsitter tested in the morning, but when she gets home, she'll text me the AMPS number and what was given. At least I'm in the country this trip, so I can just call the petsitter if I need to address anything. I've left the instructions of 200 and below, no shot, 200-300 0.2 and 300+ 0.4.
C
Carl & Polly & Bob (GA)
Guest
Sounds like you've got it under control! Now I'll be looking forward to some daily numbers. After this trip, you're grounded!
Carl
Carl
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