Re: 1/2 Boo Radley PMPS 276

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Jessica & Boo Radley

Jessica & Boo Radley

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I thought I'd touch base with the PZI group before I go to pick up Boo tonight and before we begin his first dose of Prozinc!

We've been on Lantus since August of 2011 without much success. After a second DKA episode.....we figured we were long over-do to try to try something different.

I am an RN by trade, I'm used to a tight regulation protocol, am home testing, and am feeding low carb.....so have that under my belt. I'm sure the learning curve for me is going to be based on how Prozinc works and the variable dosing vs. my experience with Lantus.....

I wanted to say thanks before we even get going, because I learned in Lantus Land....how very valuable experience from others plays out in this dance.

As info, I did read the sticky's, visited the manufacturer's website, printed out U40 conversions and a few sliding scales I found, so I hopefully have a reasonable beginning ;-) I do welcome any advice that I may be missing and will post our new numbers as soon as we start tonight.

I guess the two big questions I have right now.....when you input your dose on your spreadsheet...is it the U-40 dose or the conversion. And the second one is....do I hold this first dose for 5-7 days like you do with Lantus (unless of course they drop too low), or do I start using the scale immediately? If I understand PZI...I would think it would be variable.

Thanks again!!!!
 
Re: 1/2 Boo Radley New to Prozinc (Lantus user)

Wow! You are all set to go, Jessica. Welcome to you and Boo Radley (love the name) You'll find we are a much smaller group than Lantus. More people tend to be on in the am and pm, so give us a while to reply or in an emergency, post on Health.

Post the PRoZinc number , not the conversion. We want to think in PZI terms, not have to convert in a hurry. I think the biggest difference is that ProZinc almost always just lasts 12 hours - there is no shed. That makes easier to vary doses, shoot early if needed or give a different dose am and pm. None of which we would like to see you do until you see how it is working for Boo. :mrgreen: the other difference is that we like to consider both the nadir and preshot number when considering dose.

We think, as far as holding the dose, ECID. Some seem to do okay with changing often, some don't seem to react to a new dose for that 3-5 day period., and then suddenly you see a change. You will have to see how Boo works with it.

What dose was Boo on with Lantus? What dose of PZI are you considering?


If you haven't already, check out some other people's spreadsheets. That will show you how adaptable it can be. Shakes and Denise and Rob and Harley, particularly, as they both switched from Lantus to PZI.
 
Re: 1/2 Boo Radley New to Prozinc (Lantus user)

Hi Jessica and Boo! Welcome to PZI land.

We post the U40 units when we talk about our doses, even though many of us use the U100 needles and the conversion chart to dose.

It seems some PZI kitties here do well on a sliding scale of PZI. My kitty Asher seems to like consistency in his dose and food. So we learned to hold doses (after a lot of trial and error) and that has worked best for us to get him regulated. Is seems that ECID, the mantra ;)

That said, we all seem to like PZI’s flexibility, in that if you have to move doses due to work schedules, or we have at least one kitty here, Henry (of Angela and Henry) that does not shoot on a 12/12 schedule and this has worked better for them.

I am no dosing expert, just here to cheerlead :) But there are many knowledgeable folks here that will help you out.

Welcome, and all the best to you and Boo Radley :mrgreen:
 
Re: 1/2 Boo Radley New to Prozinc (Lantus user)

Lyresa....OOOH...WE MISS YOU TOO! I could always count on KT to be as crazy as Boo!


Sue - thanks for the welcome and the tips. I don't really think I can give you a reasonable answer for what dose of Lantus we were on....I took that part of my spreadsheet down on purpose. We started at 1.0, followed the protocol up (with very flat, flat numbers) to almost 4 units and ended up with crazy wide swings (350++ pre shot, 40's and 50's pre nadir requiring carb feeding), then huge bounces. I began to think we were overdosing and seeing chronic Somogyi rebound, so I reduced to 2, then 1.5, then 1.0.....my numbers stayed eerily the same. Tried higher again...same thing. I just never saw that Lantus curve that I saw so many people achieve. He's been in the hospital for two days off of Lantus all together, on regular only. We plan on starting Prozinc tonight.

Do you have a recommendation for the starting dose? I've read 1 unit bid, I've read 0.25units/lb, I've read weight doesn't matter.....It seems that consensus is more related to what you're reading vs. a hard fast rule....I would love to hear your thoughts.

It makes sense to hold the dose for a few to see how he's is going to react. I will run some curves this week to get a handle on his reaction and adjustment so better decisions can be made.
 
Re: 1/2 Boo Radley New to Prozinc (Lantus user)

Just wanted to pop on and say hi and welcome to PZI. Still learning here so I'm joining the cheering squad.

:RAHCAT
 
Re: 1/2 Boo Radley New to Prozinc (Lantus user)

Hi and welcome Jessica and Boo Radley.

Geez don't look too hard at Harley's ss yet, I'm just now starting to get him back on track.

The one thing I wanted to touch on is the sliding scale. Which scales have you looked at? Here some do use a sliding scale, if you look at Harley's first time around on PZ a sliding scale worked really well for him. The thing I wanted to point out is that at least here in PZI the sliding scale is formulated for each individual cat according to how the PZ is working for them and what doses are working on what PS's. There is no set scale for all cats.

In the beginning we usually say to hold the dose until we start to see the patterns, then we know which way to go with dose.

Again welcome to our little group.

Robin
 
Re: 1/2 Boo Radley New to Prozinc (Lantus user)

I don't know what to say about your beginning dose. For a new diabetic, one unit would be reasonable. For a kitty who has been on 4 units and had DKA, it might be scary to start that low.

The other complication is that rebound doesn't always look the same way in each cat on PZI. Often a cat on high doses will suddenly throw that low number and we think rebound. But sometimes, it seems to take a long time before the cat throws a low number. When we see a pattern of high numbers, we are torn between thinking the dose can be too high or too low.. (Sev's spreadsheet might be interesting to look at. It seemed like too little insulin until he reduced. Now he is on .1 unit) So starting on a higher dose may not get us where we can figure out things as fast as we would like.

Long winded way to say I don't know. The thing that is nice about Lantus is there is a protocol that works for most cats. We don't have that because of the variability of PZI. What is amazingly successful for one cat may not work for another.

You could start at one unit and if you get high numbers, start increasing. (ketone tests would be vital). Or you could split the difference and give 1/2 your Lantus dose. You have a good handle on this dance. What are you thinking?
 
Re: 1/2 Boo Radley New to Prozinc (Lantus user)

He's 10.6 lbs, which would equate to 1.2 units on the 0.25units/kg calculations. Knowing that many start on 1 unit..... I'm thinking 1 unit bid is reasonable as a fair go between the two trains of thought. My plans are to keep the IV in for a few day so I can microdrip him at home to ensure he remains hydrated and flushing.

Thinking this through.....I think I'd like to hold him on this dose for at lea`st 5-7 days even if I see some higher numbers as he's historically been a "late reactor" (Lantus experience only). As such, I think it may be wise to ask for some R to cover us if necessary as we feel out the Prozinc. I get this may taint my numbers.....but I will just need to extrapolate as the week progresses. I'm off work, willing to test as often as possible, will check ketones, etc. Sound like a reasonable game plan?

Robin - I will have to find that scale again and will definitely post as information. I do get what you're saying and agree that it probably makes much more sense to fine tune to the cat vs. a one size fits all approach. Thanks for pointing out the obvious (sometimes I need that ;-) ;-) )
 
Re: 1/2 Boo Radley New to Prozinc (Lantus user)

If the scale is YDC, we have had several new diabetics come in trying it and it has been too aggressive in every case. We are big on ECID.....Robin is our resident sliding scale expert and has put together several for individual cats.

I think your reasoning on dose is good. No experience with R in conjunction with PZI. I know it works with some Lantus cats because it acts faster than the Lantus. I don't know how it would work with PZI.
 
Re: 1/2 Boo Radley New to Prozinc (Lantus user)

Hi Jessica and Boo Radley and welcome to PZI
Shakespeare was on lantus for a few months and did horribly!
he was up to 3 units and unable to walk due to neuropathy
I switched in April this year and he is now able to walk and jump again and
doing so much better on PZI
You situation sounds like ours on Lantus
My opinion would be to start on one unit and hold for a few days to see how he reacts..
Any questions or problems we are here for you both!
Good luck and please keep us posted
 
Thanks again everyone for the warm welcome and shared advice/tips/stories!

We injected our first dose tonight at 7:15pm....1 unit sub-q.

I'm going to pay close attention tonight to follow his first dose numbers! He's been dehydrated the last few days, so I'm hoping I made the right decision going sub-q vs. IM. I was apprehensive of dosing an insulin I've never worked with in the muscle. I do have R on hand if we get into trouble tonight with absorption and have a good handle on how he reacts to that. Keep your fingers crossed for us!
 
Ok, keep usposted on his progress...
Just an fyi for you...I ususally go to bed around 9pm and I am ususally the only one on
in the early am....between 5:30 and 6am....

Good luck tonight!
 
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