Thoughts on customized dosing

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moof86

moof86

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Hi there, so just finished a curve on Morky (though I imagine I'll keep testing through this evening) and while he seems to have a fairly gentle curve on Canninsulin, I'm struggling to get ps numbers to be lower. This moring was an odd exception, as they were lower than what is typical.

So I'm considering moving the doses to relfect the numbers, rather then a one size fits all sort of dose for him. I've just given him 3units this evening due to the high numbers pmps and will be able to monitor him throughout the night, hypo supplies at the ready.

My thoughts are more or less as follows:

22.2 (399.6) or higher: 3 units
16.7-22.1 (300.6-397.8): 2 units
11.2--16.6 (201.6-298.8): 1 unit

anything lower, don't shoot. These won't be necessarily hard and fast, but more of a guideline, taking into account ketone results and generally how he seems to be feeling.

Is this completely mad? Or have people had success in doing this? So far the only thing that has actually been done is this evening 3 unit dose.

Any thoughts or experiences would be much appreciated!
 
It's called a sliding scale and has been used very successfully for some kitties. That was how I regulated Harley for a long time using Prozinc.

While Prozinc is a little longer lasting than Caninsulin you can use the same guidelines. If you go to the PZI ISG and look under the stickies there is a thread called "Newbies and Oldies please read", there is a section for sliding scale in there that might help get you started.

While a sliding scale is usually formulated for each spicific cat regarding dose, the principles still apply.

In PZI ISG Barbara & Thumper just started using a sliding scale and so far is doing great, check out her ss if you like.
 
(Edit I posted this before reading previous post that explains a sliding scale)

I am an absolute novice so could very well be mis interpretating what I read.

But the only dosing to scale I have ran across is the Tight Regulation Protocol by Dr. Hodgkins on diabetic cat care site. You have to join there as you do here.

There instead of starting a dose based on cats weight (using lantus) they seem to dose based on the BG number and adjust accordinly down the line.

http://www.diabeticcatcare.com/COK/Insu ... s%2011.htm

This explains alot more of the program.

http://www.diabeticcatcare.com/forum/vi ... p?f=3&t=17


From what I gather you dose to scale for several shots and if that hasn't gotten the cat numbers you want then you increase dosages and basically rework your scale of dosages. But i can't find on that site how you increase the dosages or rework the scale. I am presuming it is like how the German group or Rand increases (slowly) but I am not sure. (EDIT I did find the info on how to increase dose)

Dosing to scale has one appealing element to me and that is, I presume, it has down in black and white whether to shoot low numbers or not and exactly how much to give. Whereas Rand's TIght Regulation says there are several options to handle low #s but being consistent with dose is ultimately the best option.

I think Dr Hodgkin and Rand Protocol have much in common but I am not exactly sure what the differences are. They are both TIght Regulation that require home testing but not sure where they deviate. I read about Rand study and also her work before I even found any forums.

But to dose to 'scale' is only mentioned by Hodgkin as far as I know. It may work out to close the same amount of insulin between the two systems but I am only guessing about that.

However, someone here with alot more experience can help you with more accurate information and analysis .

I have wondered about scaling dosages myself.
 
Hi Rob. Many thanks for the info! It's always nice to hear you've not completely gone off the deep end and that this has been sucessful for some. Looks like I've got some reading to do!

Cheers!
 
I think your curve yesterday looks very nice - except for the high preshots. But, as you know, that is one of the problems with Canninsulin. When it wears off, it is gone. It will be interesting to see what your numbers are today. If wonky, you might want to try increasing by .5, not one full unit.

The issue is that increasing the numbers doesn't usually make the insulin last longer, unless it gives you a scary curve like you got with 4 units when it was a long surf but you couldn't shoot on time and that messed you up.. The only way to modify the curve that way is to shoot three times a day, which is scary for a newbie and very hard on a caregiver. We have some people doing it in PZI - you might look at their spreadsheets. PZI is a little like canninsulin in that there is no shed so you don't have to worry about overlap. It often lasts through a normal curve for cats with decent preshot numbers. Sometimes it doesn't last as long in a few cats and they benefit from the TID. (Bookworm and kse are doing TID.)

You might put in your signature that you are in Europe and have few options for insulin. That will help people who would like you to switch to see that it is not an option at this point.
 
Hi Sue! Shooting 3 times a day was the other thought that I had, to try and counteract when the caninsulin runs out. Bless him I think he wants to regulate but just don't have the hold time with the insulin. But like yourself, I was overall pretty happy with the curve, it's just those pesky ps numbers! I'll read more into the tid, but would be tricky to arrange the schedule!

Just double checked the food list as well and that hills md wet version weighs in at 14 percent carbs, so that's probably not helped! Count on hills to disappoint! I'll switch over tomorrow to something less carbby, which might help (and partially explain why I didn't see a significant drop in numbers when I removed the dry food.

We are getting there slowly but surely! And I'll get that on my signature. Imho he does ok on the canninsulin, so hoping I can make it work. My insulin is also paid for by the cats protection as part of the terms of the adoption (yay!) And don't want to increase their outgoings any more than necessary.

Thanks again for lookin out for us Sue, you're a star, love it when I see something back from yourself!
 
Dr. Hodgkin's TR with pzi sliding scale is explained here:

http://www.diabeticcatcare.com/protocol.htm

It (the scale) was developed specifically for use with PZI, and there is a warning on the page stating it shouldn't be used with any other type of insulin.
I would imagine othertypes can use a scale, maybe it is the specific numbers that makes it "pzi" only"?
Bob was on a sliding scale for just about the whole time he was on pzi. It worked great for him, but ECID.
Carl
 
To repeat something Sue and Oliver eludes to so that inexperienced users notice - the type of insulin you are on matters. This shouldn't be tried with longer lasting insulins with a shed like Lantus and Lev. The longer lasting insulins are adjusted based on nadir numbers, not preshot numbers and consistancy in dosing is usually very important.
 
I agree with Melanie and Sue, and that's what I tried to say by stating that the page I linked to specifies it is for "PZI" and not other insulins.

Also, not sure exactly when that was written. At that time, not too much in the way of remission rate study relating to lantus was "out there", because if you look at the section 2 called "Proper Insulin", it states that PZI is the best possible choice, not much is known about lantus, and PZI is far superior, blah, blah, blah, and that lantus is "unpredictable.....regulation and remission more difficult to achieve...."
That runs counter to the "norm" here, so I'm guessing it predates recent lantus studies.

Anyway, yes, it would seem that using a sliding scale with a "shed" insulin like the L's would be difficult and fairly impossible to manage.

The document also recommends TID or QID shots based on the test at each shot, shooting everything over 150 (nothing below that) with a max dose of 2.0 (BG up to 410), but no suggestions if kitty is above 410. Test every six to eight hours, and shoot as needed, skipping only when the BG is under 150. The reasoning seems to be, heavy on the shoot for a few days or weeks, and eventually you'll get low pre-shots and be able to skip doses.

Actually, I'd be scared to try that TR Protocol, but it did make for interesting reading, and it does push home testing, low - carb wet food, but it also makes the claim that you really don't need to worry about hypos, which is alarming to me.

Carl
 
Robin,
Wouldn't you think that if your insulin was caninsulin, you might be able to attempt the Hodgkins sort of scale?

Carl
 
carlinsc said:
Robin,
Wouldn't you think that if your insulin was caninsulin, you might be able to attempt the Hodgkins sort of scale?

Carl
Click to expand...

No. Caninsulin in Europe was Vetsulin here. It is shorter lasting than PZI so the scale doesn't fit. I think Caninsulin is a good fit for sliding scale but I also believe that every sliding scale needs to be tailored to each individual cat and their current dose when they get regulated.

I don't believe that one size fits all when it comes down to dosing sliding scale, ECID.
 
Oh, maybe I wasn't clear..... this sort of scale (as opposed to the rand protocol).

I realize every scale needs to be tailored to the cat. Bob's was certainly different than this one. I've read the descriptions for PZI compared to caninsulin. c- has a steeper and quicker drop, less duration. But it's a "once it's gone, it's gone, insulin, so you could use a sliding scale for it. Just have to come up with a time/dose scale that fits the cat.

Going back to the original question on top of this thread, I'd say "yes", it could be done. Just don't know about the ranges and numbers. Adjusting from 1 to 3 units based on BG seems sort of over the top. And probably needs smaller/more ranges of BG numbers with smaller adjustments.
carl
 
Hello Morky's mum,

I used Dr. Hodgkins' Tight Regulation (TR) with Insuvet PZI and was able to get Major off insulin (OTJ) after 16 days. He was on Insuvet Lente for a month with no improvement (BG's were in the high 20's mmol/dL). Like Carl said, PZI and Canisulin have shorter durations, and once 'it's gone from the system', it's gone. Threfore, you can use the sliding scale (dose based on pre-shot numbers) when the BG's are rising (this could be at +7, +8, +9......) AND pre-shot BG is above (150 mg/dL or 8.3 mmold/dL) according to Dr. H's TR protocol.

It does mean that you may need to do more testing but at the same time it also gives you some flexibility. When doing it properly, you can keep Morky's BG pretty flat throughout MOST part of the day. I have never used Canisulin but Insuvet Lente is quite similar to Canisulin - short onset and short duration. It just didn't work well for my boy.

Insuvet PZI, unfortunately, is discontinued in the UK but you can get its replacement Hypurin Protaimain Zin insulin easily from any UK vet.

I have been following your and Morky's posts. Your little guy and your opening of your heart and home to a diabetic kitty touched many hearts here at FDMB. I really hope you would give Hypurin a try whether or not you are considering customised dosing (sliding scale).

I know I suggested Lantus or Levemir to you before but this was before I found out about Hypurin being available at the vet clinics in the UK just a few days ago. I know many UK vets are reluctant to try Lantus and Levemir because they are human insulin and becasue they are not aware of Rand's protocol. Do you think you may try your vet and see if you can get hold of Hypurin Protaimain Zin. There are so many PZI users at FDMB, you and Morky can get lots of help and dosing advice from many experienced PZI users here.
 
carlinsc said:
I agree with Melanie and Sue, and that's what I tried to say by stating that the page I linked to specifies it is for "PZI" and not other insulins.

The document also recommends TID or QID shots based on the test at each shot, shooting everything over 150 (nothing below that) with a max dose of 2.0 (BG up to 410), but no suggestions if kitty is above 410. Test every six to eight hours, and shoot as needed, skipping only when the BG is under 150. The reasoning seems to be, heavy on the shoot for a few days or weeks, and eventually you'll get low pre-shots and be able to skip doses.
Click to expand...

When kitty's bg is above 410, you still follow exactly the same protocol, method wise. Each kitty following Dr. H's TR protocol has his or her personalised sliding scale. You also may need to modify the scale from time to time. Initially, I did have to do TID or even QID on PZI because Major was so unregulated (we wasted one month on Lente) but he improved very quickly on PZI. We ended up doing SID after 10 days or so on PZI then one shot of PZI would go for two days then three days....then on day 16th his pancreas just work up all of the sudden. He stayed in remission for over three years till 6 months ago when he was attacked and injured by one of my rescued cats. I am using Levemir now becasue we can't get PZI here in Saudi Arabia.


carlinsc said:
Actually, I'd be scared to try that TR Protocol, but it did make for interesting reading, and it does push home testing, low - carb wet food, but it also makes the claim that you really don't need to worry about hypos, which is alarming to me.
Click to expand...

I hear you. I was scared AND skeptical when I first started the TR protocol but it worked. Major responded quickly and very well to PZI and the TR protocol. I gave Dr. Hodgkin's TR a try because it seems to have good remission rate for newly dx kitty, and I was changing Major's insuline from Lente to PZI (Major was doing poorly on Lente with BG's running in the high 20s mg/dL / 400-500 mmol/dL most of the day), and he often had keytone in his urine. The result was better than I could have imagined. Having said that, each cat is different. Many cats go OTJ without following Dr. H's TR protocol as we have seen here at FDMB.
 
SO, if the alternative dosing seems too scary (and I think it would for me particularly because you have no Canninsulin support system here to advise), can you get the other insulin? What is the "rule" about how long he has to fail on Canninuslin before the vet will consider something else? (Sounds like a cat monopoly to me.... :evil: ) You can tell the vet you have him in okay numbers during the cycle but the preshot numbers are too high because the insulin is not lasting long enough. See if he has any suggestions, and if he doesn't, he should support a change?

The only other option I see is to increase by .5 but I would only do that when you are going to be around to watch those mid cycle numbers.
 
Sue and Oliver (GA) said:
What is the "rule" about how long he has to fail on Canninuslin before the vet will consider something else? (Sounds like a cat monopoly to me.... :evil: )
Click to expand...

To convince my fomer UK vet to change Major's insulin from Insuvet Lente to Insuvet PZI was a mission impossible even after I showed him Major's spreadsheet with BG's running in high 20's mmol/dL / 400-500mg/dL. He told me that he would change to Canisulin but not Insuvet PZI because he's never used it before nor was he interested in reading the materials on PZI which I had prepared for him. I ended up changing to a different vet (thanks to one of the FDMB members) in order to get PZI.

That experience has taught me that there are other vets who are better and more open minded out there, and I don't have to be held hostaged by the vet whom I had worked with for the past 7 years. My Major probably wouldn't have been here is I had stayed with my old vet and continued with Lente.
 
But remember, she's tied to the organization she adopted Mr. Morky from - changing vets isn't really an option as they pay for his insulin.

What about shooting TID? If DCIN hadn't stepped in and purchased Lantus for KT at the cost of Humulin N, we'd still be using that. I was about to start exploring shooting 3 times a day in smaller doses to help get him off the roller coaster. Cannsulin works like Humulin in that it has single action, no what to me acts like 'timed release' anything like Lantus. I was also looking at the sliding scales back then.

Hugs,
 
Thank you everyone for chiming in, I'm certainly glad to get a discussion going and I've been given lots of things to think over and research. KSA, I will mention that other insulin to my vet during our next appointment and see what get's fed back to me. I've been pretty happy with this vet so far, as she's been supportive of my home testing and she's known Morky for a couple years now (CP vet). I've been able to get a good day of ps out of him today, I'm hoping the change in food will help us get that little bit further down.

Got lots to take in and go away to read, but I suppose most importantly, he's happy, walking on his paws, and going through slightly less litter (dumping every other day as opposed to daily :) ) Everything else I can work on.

Thanks again everyone for their support and information, I am beyond overwhelmed and humbled that so many take time out of their days for me and my kitty!
 
moof86 said:
.......
Thanks again everyone for their support and information, I am beyond overwhelmed and humbled that so many take time out of their days for me and my kitty!
Click to expand...

He's part MY kitty too....I'm just loaning you my part. :-D

Hugs
 
Squeaky and KT said:
He's part MY kitty too....I'm just loaning you my part. :-D

Hugs
Click to expand...

Who wouldn't want a piece of an Irish kitty cat? :lol: And as they say, it takes a village!
 
And you are absolutely right. We get hung up on the numbers and forget that what is important is how the kitty is feeling. If he is playing, peeing, purring and seems happy, that is the important part!
 
Gotta tell myself that every day! Lol, numbers are only part of the equation. His condition now in comparison to two weeks ago, totally different cat!
 
moof86 said:
Squeaky and KT said:
He's part MY kitty too....I'm just loaning you my part. :-D

Hugs
Click to expand...

Who wouldn't want a piece of an Irish kitty cat? :lol: And as they say, it takes a village!
Click to expand...

Well said! I am married to an Irish - Irish men and cats certainly know how to charm the ladies!

It's like a village here. We shed tears and get worried when a kitty is not well, we cheer and jump up and down (ok, maybe just me) when a kitty is getting better, we lend a hand when someone needs help.........

Strangers I met at FDMB have become my friends. I received a free testing kit from a FDMB member the first week I joined FDMB. My best and most trusted cat sitter was a FDMB member herself (nursed Major through sickness when I had to be away for a few days). The vet who put Major on PZI was recommended by another FDMB member. Looking back at Major's diabetic journey, I could never have done this alone without the help and support of FDMB. So yes, it is a village here, and my Major is also part of so many kind people at FDMB. Thank you.
 
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