Variable dosing on pz

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Charliemeow

Charliemeow

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Charlie's numbers have been rather stagnant this past week or so. We got a bit more movement today...so maybe he just needs a slightly higher dose. But my question is about variable dosing. In my last thread there was mention of the thought that pz is supposed to be dosed variably, based on the ps's. Is that what I should be doing? If so, how?? I don't really have any idea how to figure out the doses, or if I have enough info at this point to do it successfully. So, should I just continue with my straight dosing with increases every few days, or switch to variable? confused_cat I hope everyone had a wonderful Christmas!
 
I think one of the parts to "variable" [which is just a name I made up because a) "scale" seemed to have a bad reputation for some people around here and b) it does differ a little from scale in my brain] is finding the dose that they are "responsive" to first. And for whatever reason it seemed like you were the earlier with the 12/9 episode but now it seems that has not carried over. Whatever happened on that breakthrough is still unknown. Anyway, finding that "responsive" dose is just the same way - methodical increases. So I actually think you are doing the right thing...Except your increases have been small for the dosing range you are in. So either increase the frequency of your increases or increase the size. That would be my input. That late nadir was kind of ??. Also if you were doing a scale type dosing [including variable] you would have lost ground if you shot less on that late nadir.

One of the parts to variable in my head is that it is a moving average [maybe about 10 day] with the most recent history having the most weight. Whereas scale is a hard thing that really changes little over time unless you reset the scale. So if you look at your most recent history [and ignore your previous breakthrough] it is clear you need to keep moving up in dose. So "variable" to me is kind of a synthesis of various strategies.

So if you are lucky enough to find that dose that he is responsive to then you can make small changes in that dose to move the numbers. I've outlined in Lori's ProZinc suggestions topic [now linked in the Sticky] what I like to see as the ideal drops in PS numbers at various ranges.

A couple other parts to is that that "responsive" dose changed for me frequently - seemingly in tune with H's appetite. But even if I look at Robin's SS it seems Harley's "responsive" dose seems to change - maybe more in line with his pancreas sputtering. So again this is where the weighted moving average things comes into play. Just because last week your cat needed 1u to get traction then next they may only need .5u [your dose is admittedly much larger].

The last point I want to be very honest with you about is that I personally have not seen anyone successfully apply "variable" to higher dosing situation. This could be for several reasons unrelated to the higher dose. We just don't have that many folks in here experimenting is the primary one that comes to my mind. And hopefully as one gets it going then they can bring the numbers down slowly over time - and maybe reduce the dose a little. With higher doses too the process of regulation is much more difficult because of the [very real and worthy] chicken factor. Also here in PZI we are pretty quick to recommend other insulins to people [despite what some of the other users on this board may say ;-) ] . So we lose a lot of people that would normally be sticking it out with other insulins. I'm not saying this is a bad thing - I think that anyone having trouble should [at least be open to] throw the kitchen sink at the problem and if the kitchen sink doesn't work you can always come back to things you have tried in the past and try to refine. The kitchen sink advice is questionable too :roll: . A "good" thing that I see in your numbers is the lack of [any sort of pattern of] huge deltas. Those are the folks that I usually see that in my head duration is an issue with PZI and they either need TID or a longer lasting insulin [and I'm curious to see how Kristen's experiment goes re the large deltas]. Anyway, I would hopefully like to not revisit the insulin change thing, I'm just trying to point out some things I'm seeing and be honest with you about the limitations of my advice.

Let me know if I can clarify any of these ideas or I failed to answer any of your questions clearly enough.
 
I agree with Gator, in the higher doses consistant dosing seems to work the best. Keep increasing his dose until you start getting all yellow days with some blues. Then you can start fine tuning with variable dosing.

I also think that you can increase by bigger increases (like another .1u) but hold the dose a little longer (maybe 3 to 4 days) to see what he can do with it.

Charlie's ss looks much better than it used to.
 
More notes:

I often describe a "ceiling" dose. This is the dose at which you have shown to have response from at the max insulin need. For now this might be 6u for you. This "ceiling" evolved over time for us. So the deal is that I had that ceiling dose in mind I could blow though the increases more aggressively - a bit larger and quicker up to that ceiling. The idea is here that one did not get rebound before on any of the intermediate doses so one should not get that again up to that dose. And perhaps the cat has had the experience of those doses before and would be less likely to rebound.

So there are two concepts the current "responsive" dose and the "ceiling" dose. The responsive changes quickly the ceiling over a much longer period of time.

A current working theory for me is that beans get frustrated a lot by the fact that the insulin needs change in cats all the time. I'm probably way overgeneralizing by trying to apply it to other cats. But, this is where weighing H's food came into play: I was able to actually see something correlating to those changes in insulin needs. So I never really had the idea that his dose was ever something static - I knew and accepted [and could literally visualize though charting his weight] that I would always be playing catch up with the ever evolving picture. I think this is where other dosing strategies have difficulty - they cannot keep pace and then the bean is left frustrated and confused_cat . On the other hand variable and scale can make beans reduce the dose when the numbers go down and make them lose track/time. That's like PZI's greatest strength and weakness - the ability to adapt to changing situations quickly.
 
I don't see it as a "supposed to" but as a good and useful PZI tool - something you can use when it fits for your cat. The problem that I see is that it can slow down regulation (at least it did for me) if you get overly focused on that angle, and often can lead to underdosing IMO. When it is used successfully - identifying doses from the data that work well for that cat, or used to deal with issues like variable eating patterns in cats with health issues - then I think it is an awesome tool.

If you can achieve a nice pretty regulation with PSs that are close to the same every cycle - which works for some cats but not others - then it's a non-issue, as the PSs are pretty much the same. IMO it makes sense to go for that kind of regulation first, which means you don't have to worry about a sliding scale - you just shoot one dose BID, lowering or raising if needed based on the data, and initially lowering a bit on lower PSs for data collection. Then when you are hitting 150-ish PSs and 60-ish nadirs steadily, then you are good to go.

If that doesn't come together, or you have a cat with known issues that are factors (like vomiting/variable eating), then you start looking at other strategies, including sliding scale. Just my 2c. :) I vary Bix's doses within a narrow range, b/c I no longer tend to catch him at the perfect PS since he gets good #s well past +12 generally, so in his case I find it a useful tool.
 
p.s. Just for clarity, IMO PZI dosing should be based on the combo of PS and nadir, not on PS's alone. Not sure about basing it on nadir's alone like the L's do.
 
Wow. Thank you, gator, robin and joanna. It makes sense. For now I'll focus on increasing his dose to get him closer to regulation, then worry about variable dosing once we get there. Hopefully it'll be relatively soon. I've been a chicken with his increases lately since I dropped back from 6 u. But I'll get back on the ball. I know I have to for charlie's sake!
 
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