Tilly on Hypurin Bovine PZI Nov 2011

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Raggie Doll

Raggie Doll

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hello!
Tilly has just been switched to PZI 3 days ago and already i have seen an improvement compared to caninsulin, especially with her hunger and she has gained in one week 220 grams so very happy.
 
Hi! (will you give us your name? Would be nice to have a name to insert here :-D )

I just replied over on your Health thread. PZI is a small and friendly group. There tend to be more people on in the early am and late pm than in the middle of the day. So if you ever need immediate help and no one is here, post on Health. You will get more dosing advice here than on Health as everyone here uses or used PZI or ProZinc. It is a good idea to read the sticky: http://felinediabetes.com/FDMB/viewforum.php?f=24 It is a huge document so take time absorbing it.

What dose did she start on? Is it BCP PZI or ProZinc?

I also nagged you about your spreadsheet on Health. Ask if you need help. Carl and I both help newbies set up their spreadsheets and we would be glad to help you.
 
:lol: thank you Sue and Oliver, i'm Tasha
She is on PZI Bovine the vet (not my fav person) strted her on one unit but i used the scale so to give you an idea until i get it on the spreadsheet

29/11/11

07.00.....+11......5.4/97.2......fed 1/2 a can will edit to give grams in 5 mins
08.35.....+12......10.6/190.8...0.75u
11.30.....+3.......16.8/302.4...
13.30.....+5.......14.0/252.0

Im attempting the spreadsheet but it doesn't want to load at the moment
 
may be a stupid question but what does the PS stand for in AMPS/PMPS obviously am and pm is the morning and evening
 
Great job on the spreadsheet - looks good! Interesting numbers - a lower amps than the nadir. When did you start on PZI - just this am or earlier?

Tell us about feeding - what and when in relation to the insulin. How much Humulin was he on and at what dose?
 
I started on the PZI 3 days ago but only started the TR today and i did some readings but not every two hours the other days.
When she was on caninsulin it was 2 units twice a day but her Bg readings were terrible mostly up at 468 to over 500 so this has been better already.

Feeding is still a little erratic as she is unary a lot i make sure i give her food just before insulin but she has hat food 3 ties already today about 195g of Purina md can
 
Going back and including any PZI numbers you have would really help us see the whole picture. I know, a pain. But if you could clean off today's numbers and start with the first day you have PZI numbers and then end up with today.

My concern is your low amps number this morning. If he was below 200 at preshot, did he go real low last night? It could mean a dose reduce is in order. Also if he went low last night, today's numbers could be wonky because he is bouncing from a low number.

The more data we have, the more we can help.
 
That doesn't matter. Whatever numbers you have will help us see a pattern of reactions to a dose.

Most people give amps, pmps and nadir (for PZI usually around 6 hours after the shot). Then maybe once a week (or if something wonky is going on) they get a curve every 2 hours.
 
ok Sue is it I'm not sure lol I've added to it with what i had but it was a bit erratic for the first 2 days especially as i only started TR today
 
All of that is good info.

So far it looks pretty good. You started on one unit and then you got low preshot numbers so you went down to .75. Good move. I liked your dosing better before today. Today the curve is rather flat maybe because he is bouncing from low numbers overnight. It will be interesting to see what your 2 units will do at pmps. That might be a pretty agressive dose -see if you can get a nadir number. (We usually say not to shoot into a bounce - not sure yet if that was caused your blue amps but it may have been.)

Generally we like to see a newbie stick with the same dose for several cycles to let the cat settle in - unless you get a number too low to shoot. After a couple cycles at the same dose, you have some data and some idea about what he might do with a higher or lower dose. We are not big TR fans (if you mean tight regulation with a sliding scale for every preshot.) We do have some kitties on sliding scale, but they were made especially for them based on their history, and they usually vary by less than .5 difference in dose. Where did you find the TR scale?

The other piece of information for new diabetics is not to shoot under 200, but to wait 20 minutes without feeding and test again. You want to make sure the kitty is rising, not going down with numbers. After 20 minutes, if they are over 200, we suggest giving a reduced dose.

You have gotten the big stuff done - food, testing and a good insulin. Now you just need to refine the dose.

This all sounds overwhelming. (Will it help to know we ALL felt overwhelmed at first?) But if you post before you dose, we can give you suggestions. And in a couple weeks, you will be deciding for yourself. It just a little time and a little history.
 
Sliding scale from diabeticcatcare.com i felt the higher dose would be better though as she is rising but maybe your right a single dose to see how she reacts but she does have a tendency to get very high numbers rather than low numbers.
 
The protocol here is based on the idea that Every Cat is Different (ECID) and they react differently to food, to insulin, to changes in dose. A scale that is the same for every number for every cat can create problems. The scale also doesn't take into account how the insulin worked - how low or flat they were during the cycle - it is based solely on the preshot number. What happened during the cycle needs to be part of the equation.

Check out Cello's spreadsheet: She started with the YDC scale. Once she went to a consistent dose, she got much better results. https://docs.google.com/spreadsheet/ccc ... zSnc#gid=0
 
Hi!,
When I read earlier that you had just started TR today, wasn't sure what you meant exactly, but now I understand.
We have seen the DCC scale before, which I believe is like the original Hodgkins scale from YDC, but "toned" down with regard to dose?
I used PZI for about 10 weeks on Bob. During that time, he was "shot to scale" for part of the 10 weeks. It was a much simpler scale, but it was based just on preshot numbers and didn't consider "nadir" into the equation. Bob is not on insulin any more (knock on wood), and I didn't really become familiar with the standard PZI/Prozinc protocol used on FDMB until he was off of insulin.
From what I have seen in the past 6 months, the FDMB protocol works well. It is based upon a "start low, go slow" approach where the normal starting dose is 1u BID. Tests are taken before every shot, and usually at mid-cycle times as well. Most importantly, around the +6 point, or "nadir". The "low point" of the day in terms of BG levels. The combination of the PS reading and the nadir reading determine dose. Seeing what 1u will do to a given pre-shot, sticking with that dose for several days, collecting data, and then looking at the spreadsheet to find "patterns". At a point where some improvement and/or consistency is observed, then dosing changes are recommended based on the data and the group consensus (peer review).

That's what we normally do. Of course, and decision is always "yours" in the end. All we can do is look, analyze, and advise when asked.

The difficulty with a scale, whether YDC, DCC, or one developed by one of us, is that it needs to be tailored to a specific cat. More than any other thing I have learned here is that Every Cat Is Different. Every daily routine for every cat is different. Every meal schedule, "bean" schedule, every "other" thing that might be going on inside kitty besides "just diabetes". . . it's all different. Sort of makes it impossible to use "pre-packaged" treatment routines. A scale like you are using CAN work for Tilly. It just needs to be modified to fit her specifically.
And the only way to do that, really, is to collect data while keeping as many of the dozens of variables "constant" for some period of time.

That's why we recommend sticking with one dose, keeping it the same AM and PM, and testing at shot time and "in the middle", so that it can be observed that Tilly responds to a "given", whether that is insulin, food, schedule, other meds, whatever. Once you have collected enough data, then you could adjust dose according to that data.

Starting out with a scale will most likely prove frustrating to you because you may be reacting to a "bounce" like today for instance, that is just a "normal" response by her body reacting to what her BG level was during her cycle. Her BG drops "too low", and her body reacts by dumping glucose from the liver into her bloodstream to "save her" from going too low. "Shoot the bounce" as we refer to it, and you can set off a chain reaction where the numbers go low, she pushes them up herself with her liver panic, you shoot more to get it down, and the cycle keeps repeating. Meanwhile, she swings from high to low to high all day, and feels like she's "bi-polar".

Looking at Tilly's SS, it looks to me like the past two mornings the PS was low because the dose she got the night before may have been too much, and she had longer duration as well. Yesterday it caused her numbers to "bounce" and she was higher all day than she started at in the morning. Today, same deal, except she did go from high to low to high again from +2 to PMPS. The scale said to shoot 2u on a PMPS of 370, which you did. That may cause her to go low overnight, maybe not "too low", but no way of knowing that. But the "low" doesn't need to be a "hypo" low in order to cause a "bounce". It just needs to be low enough to set off liver panic and the dumping of glucose by the liver to cause another "bounce".

At this point, what you probably should do is get some more tests in to see how she is doing in 2, 4 or 6 hours (which I know is not fun since it's night time now for you). It will be interesting to see what the 2.0 units does, but it will possibly make her bounce and show you a higher number in the AM.

That's my take, anyway!
Carl
 
Thank you Carl, i wil definitely take a look at how it is done here. I have only done the sale today the last few days was a solid 1 unit dose. But like i said i will read the information to see how you guys go with a solid dose. I don't have the readings at the moment but i have stayed up before to do a 24 hr curve and throughout the night she went higher not sure if she just has a different reaction to most.
 
Yeah for you and Tilly! What a lovely number! Do you have any numbers from earlier today or tonight (not sure what time it is in the UK) I am wondering how low she went. Where does the 109 go on your spreadsheet - pmps?

Will you let her go a whole cycle or consider shooting once she is over 200? You can give a reduced dose once she sure rises and goes above 200 but it messes up a 12/12 schedule. Would that work with your life?
 
well she went +14 before having insulin i checked her again and she had risen to 304.2 bit hard to put on the SS as she went past +11 hours so i gave her one unit
 
Okay - normal that the insulin wore off and she jumped up. You will want to wait the whole 12 hours before shooting again.

And see if you can get some mid cycle numbers. The low preshot number is a sign your dose was too high. Ideally, you want two numbers 12 hours apart you can shoot. When you get a low preshot like that, lower the dose even if it shoots up. One unit could be a little high today so hope you can get a nadir number?

Or she could have a flat, high day today if she went low last cycle. She could be bouncing. Either way, stick with a nice low dose.
 
First some homework: viewtopic.php?f=24&t=32799 There is way too much in this document so pick and choose but it is a great primer on how PZI works.

The trouble with reacting to each preshot with a different dose is that you are only considering where she is that moment, not how the previous amount you shot worked for her. When you got the 109, it suggests the previous dose was too high. You want a nice smile looking cycle, moving from a higher number slowly down to a lower number and then slowly moving back up again. She went low, then higher then lower. Might be good for you to record in the remarks if food played into that at all. If she ate between 8 and 11, it may be that the food was bringing her down which means her pancreas is helping out. (Good news!) It also means she can bounce from the low numbers and be in artifically high numbers - which is probably what is happening now. Her liver is reacting to the low glucose numbers by releasing glucose and bringing her numbers up. If you shoot a higher dose into the bounce, you can just be continuing the cycle. Does that make any sense?

Her ss is really interesting. So glad you are collecting the data. It helps us see what is going on.

I know this seems complicated, especially so soon as you start the insulin. The bad news is that you have to learn fast. The good news is that she is reacting very well to the insulin. We just want to figure the best way for the insulin to work for her and to support that.
 
Hi Tasha,
Looks like you are having an interesting day with Tilly. Trying to make sense of her last 12 hours or so, and the way the numbers went up then down then up again....

Can you tell us what Tilly has eaten and when she ate, since that 196 you got at +6? Not even sure what time of day that was, or what time it is there now. I think you're about 5 or 6 hours ahead of us on the East Coast, so I guess that would be last night or overnight that you got that +6 test?

Also, does Tilly have long hair? Where do you shoot the insulin? In the scruff or somewhere else? Any chance that all of the insulin didn't go "in" at her last shot?
Just asking because of the way her numbers have gone up since then. Sometimes when we see that, it raises the possibility that you had what we call a "fur shot", where some, or all, of the insulin misses the target because kitty moves or something right when you push the plunger, and the fur catches most of it.

If that ever happens, you can't "fix" it, because you don't know if any of it went in. You can't "try again", you just have to wait it out till the next scheduled shot. But, it helps explain weird numbers sometimes.

Carl
 
And Tasha, start a new thread each day with the date. That way your thread doesn't get too low and we don't get tangled up in the days and numbers. :mrgreen:
 
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