Attempting TR using PZI.... anyone else? First week numbers

Have compounded BCP PZI, seems to be responding fairly well according to the scale. I am using a scale from yourdiabeticcat.com. The insulin is lasting a long time it seems (I think) which is good and bad (hard to be home for doses on an ~14 hr. schedule)

BG Units
8.3-9.4.....0.5
9.5-10.2.....1
10.3-11.1.....1.5
11.2-12.2.....2
12.3-13.8.....2.5
13.9-16.1.....3
16.2-19.4.....3.5
19.5-22.7.....4
22.8-25.......4.5
25.1-27.......5


October 23 2011 (started at night because it was first dose and wanted to make sure he didn't have a reaction and I knew I'd be home the whole time)

TIME..........BG.....insulin
11:30 pm......17(306)......3U

woke up every 2 hours just to check how to was feeling, seemed unaffected and just annoyed that I kept waking him up.

October 24

7:30 am +8....2.7(48.6).....0
4:00 pm +17...21.4(385)....4U
10:00 pm +6...4.6(82.8).....0
12:00 am +8...3.8(68.4).....0

October 25

7:30 am +15....19.2(345)...3.5U
7:30 pm +12....7.8(140)....0
9:30 pm +14....12.2(219)...2U

October 26
7:00 am +9.5....4.4(79)...0

It seems like after dose his BG is staying pretty good (or a bit low, but no symptoms) up to 12 hours (8-10 nadir?) and then going up between 12-14 hours. Unfortunately I work long hours during the day so the 14 hour thing is a bit of a pain to time, but I'm doing my best, today I'm going to go home at lunch (around hour 15).

How does it look so far? I think the scale is working pretty well for him and hopefully I'm doing this right.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Any chance you could put this in a spreadsheet?

 

Re: Attempting TR using PZI.... anyone else? First week numb

I admit I do not know a whole lot about sliding scales, but your kitty seems to be really bouncing from highs to lows.

We had another person using the YDC protocol with the old scale. Here is Cindy and Mousie's reply to them:

"from another of your posts it appears you are trying to follow Dr. Hodgkins old tight regulation protocol? not sure if you are aware that the starting scale for a pzi type insulin has been revised to:
BG

US(mg/dl) Dose

151-170 0.25u
171-185 0.50u
186-200 0.75u
201-220 1.00u
221-250 1.25u
251-290 1.50u
291-350 1.75u
351-410 2.00u
411-450 2.25u
451-500 2.50u

as a former user of the original tight regulation protocol designed by Dr. Hodgkins, i can tell you that the huge doses the old scale had in it often caused my cat to do just what yours is doing, bounce all over the universe. honestly i don't know what to tell you because we ultimately found that smaller consistent doses is what worked for my cat. just know that if you are going to try her protocol, you have to do it 100%, not 80%, not 90%, but 100%. shooting all the time puts the cat in more jeopardy so you have to get in tune with your cat's actions & behaviors as if they were your own and test test test, to keep them safe"

I think if you are going to try a sliding scale, it is best to do what that is especially made for your cat and uses their personalized data.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Deja vu all over again...

If you are going to try TR, please do as sue suggests and adjust the scale downward?
The old scale is too high. I realize that the Hodgkins protocol does not feel you have to worry about hypos, but I think you might want to consider it a possibility.
Have a hypo kit ready just in case?
A you a member of YDC?
Carl

 

Re: Attempting TR using PZI.... anyone else? First week numb

Hi and welcome to our group to you and Cello.

Yikes that scale looks scary to me. Cindy's revised scale seems more reasonable.

Every cat is different! We do use sliding scales here too but each scale is tailor made to each cat and their reaction to the insulin after starting on "Start low go slow" and there is enough data gathered to put a scale together for that cat.

We would be happy to do a custom scale for you too once we can see how he processes the insulin doses by starting at a dose and staying with it for several days.

Can you set up a spreadsheet? Sue is our resident expert at them so she could help you do that.

Please keep posting any questions you have. This sugar dance can be overwhelming at first as we all know so sit back and start reading the stickies for tips on everything you need to know about feline diabetes.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Thanks guys! The revised scale is for ProZinc, he is on PZI, the original kind the scale was made for.

I did a curve on him at 1U to see what would happen but it didn't do much. I honestly thought that his numbers were pretty good except for that one that went down to 2.7....... But I am new at this. Is between 4-8 not the normal range for cats? He is getting into the normal range on the doses in the scale (except the first day), but I could decrease and see what happens. I have stuff ready for hypo, but honestly even at 2.7 (and when I had him on Caninsulin it was terrible, went down to 2.1) he has had no symptoms, totally 100% himself. In anycase here are the two curves I did

Caninsulin vs. PZI

As you can see the PZI didn't do much at 1U, the caninsulin was just awful........

7:30am......21.2 (378)......1 U Caninsulin
9:30am......11.8 (212)...... +2
11:30am......2.1 (37.8)..... +4
1:30 pm...... 16.4 (295)..... +6
4:00 pm...... 18.2 (327)...... +8.5



7:30am......22.1 .....1 U BCP PZI
9:30am......17.6...... +2
11:30am......14.1 ..... +4
1:30 pm...... 13.4 ..... +6
4:00 pm...... 17.8 ...... +8.5
7:00pm.......17.5........+12

So the 1U didn't even really get him close to normal range at all, while using the scale he has been in normal range after 4+ hours - 12+ hours everytime I've tested (gone lo a few times though....)

But like i said i'm new and learning!!!!

I'm willing to try lower doses for sure........ I just thought that he was actually doing pretty well since he was staying low for 12 hours post shot........ We literally just started insulin on Sunday so hopefully it will stop shooting up?

EDIT: Also happy to set up a spreadsheet (I have one but pretty different from the ones you guys use)........ is there somewhere to get the template?

 

Re: Attempting TR using PZI.... anyone else? First week numb

How long was he on one unit? We usually suggest that you do the regular BID for at least a couple weeks, holding a dose for 3 cycles or so before increasing by .25 units. Once you have data to show you how he is reacting to the insulin and where a particular dose took him on a particular number, you can consider a sliding scale based on his reactions to the insulin.

The problem with sliding scale at YDC is that every cat is different, and it assumes giving a given dose at a given number will produce a given response. I don't think it matters whether you are using ProZinc or BCP, the first scale seems drastic to us and suggests doses that we would consider too high. My concern with his recent numbers is that he is bouncing from low numbers to high numbers - not only is that hard on his system, it feels lousy. We are worrying too that he could be close to a hypo on one of those cycles when he goes low. While some cats do well with a scale (done especially for them, not a generic one) some cats like consistency. I am not sure if we know what kind of kitty he is yet

It would be so helpful if you would set up a spreadsheet. Sometimes Goggle is not playing nicely with FDMB so it can be tricky. If you would like, I would be glad to help you set one up. Send me a pm.

 

Re: Attempting TR using PZI.... anyone else? First week numb

What Sue said.

I was going to say pretty much the same thing, except I can't help you with the spreadsheet. :?

 

Re: Attempting TR using PZI.... anyone else? First week numb

Ok so I think I will down the scale for now by at least 0.5 U, especially at the higher numbers, although he has never been higher than 23 (~400) since I switched his diet to all wet high protein low carb (was at 28/504) prior to that.

My MAIN question is this - do we want to get them in the normal range for as long as possible, or is regulating them at a lower BG (but not necessarily as low as 8) sufficient.

The reason I immediately went to TR was because it seems like the quickest way to get a lot of cats into remission (I realize every cat is different and this whole diabetes this is one big science experiment and that not all cats go into remission) but the reason I am willing to be so aggressive is because there is a good chance I am going to be relocating from Canada to the UK in a few months......... I want to bring Cello with me but this requires quarantine and I can imagine having him on insulin in quarantine.

I've done TONS of reading and it seems TR has the highest success of getting cats into remission in that time scale (if I didn't have that I would just be low dosing/testing etc.)

I don't want to try to many things too quickly and not give anything a chance to work. So i'll keep testing everytime I can (I work a lot, but am willing to get up during the night etc.) and I'm going to stick with a lower dosing of TR for now, I'll keep posting the numbers and hopefully we can figure out if it's working, if he becomes more stable and if he needs different dosing. If he keeps flying all over the place then I will reconsider.

For the record: I do have someone stop by and check on him at ~nadir time (when he could be low) the days i'm working during that time, and so far they say he is doing great. There have been 0 changes in his behaviour throughout this whole ordeal except the increased drinking/urination.

Does that sound OK?

EDIT: I should mention THANK YOU THANK YOU THANK YOU to everyone responding. I'm staying positive and willing to work hard but this is a bit crazy on the emotions.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Actually I think the overall scale is too high in dosage. For example, your scale has 1.5 units at 10.5 (190) The revised scale has .75 units at that same level. (hope my math is right) Quite a difference. I think that same difference is in both low numbers and high. Our general rule for beginning diabetics is not even to shoot at 200, but to wait 20 minutes without feeding and retest to see if it is rising and above 200. We tell newbies that until they have some data to be sure it is safe to shoot at 200 and at what dose.

I see why you are in a hurry and do sympathize. But seldom is this is fast process for kitties. It will take a while for his body to get used to BCP - it is not just a continuation of insulin because it and Canninsulin are so different in the way they work. It is hard to see how it is working when he is bouncing around so much.

A regulated cat on insulin usually runs around 200 at preshot and 100 or lower at nadir (but not into the 40s) A cat in remission off insulin can run from 40 - 120 with the majority of the time in double digits. You would like him in the 200s (and below) the majority of the time so his pancreas has the best chance to heal. Here's some info on it: http://petdiabetes.wikia.com/wiki/Renal_threshold I think his bouncing back and forth between highs and lows can be taxing his pancreas and make it harder to heal.

 

Re: Attempting TR using PZI.... anyone else? First week numb

I understand your urgency now, but remember to breath. You are here now and we can all put our heads together and do our best to help you.

Can you give us some background info. How old is he, other health problems, was or is he getting steroids, etc.

Can you work with Sue on getting that spreadsheet up and running, it will be really helpful for many of us here especially if you need emergency responses. Not saying that you will. I for one can't see the patterns unless they are in a spreadsheet, sorry.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Will try to get spreadsheet updated and up tonight.

Further information:

13 y/o Male (neutered) Siamese cat.

Normal Weight (Currently ~15 lbs, but he is a large cat)

No other health problems

Never been on any drugs for anything.

Currently eating a mix of fancy feast and DM. Previously was on Max cat wet and chicken soup dry.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Also as for that other scale, just wondering where it's coming from.

Is ProZinc the exact same insulin (no differences at all) as BCP PZI?

 

Re: Attempting TR using PZI.... anyone else? First week numb

My understanding is that it came from YDC, revised from the one that used the larger doses. But not sure. I quoted Cindy and Mousie. They are low time members who used YDC first before joining FDMB. I don't know a whole lot about YDC, except that the vet who started the website is no longer associated with it and that their protocol is very strict. FDMB is into that Every cat is different thing and one size doesn't fit all.

The original insulin was PZI - a bovine based insulin- and it is no longer available. ProZinc is the replacement: http://petdiabetes.wikia.com/wiki/PZI BCP is a compounded bovine insulin that some people think is closer to the original PZI formula: http://petdiabetes.wikia.com/wiki/BCP_PZI The chief complaint with it is that since it is compounded, it may not always act exactly the same, vial to vial. We have kitties here on both types of insulin and to be truthful, every cat is different. We have cats doing great on ProZinc, cats doing great on BCP and cats struggling with both.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Ok that makes sense. Joined ydr but the posts take up to 24 hours to get posted and no high traffic. I will try the more conservative scale for now as suggested and post the numbers and questions as I go!

 

Re: Attempting TR using PZI.... anyone else? First week numb

the scale i posted comes from diabeticcatcare.com, the new hodgkin's based site.

the protocol has basically stayed the same, but with a bit widening of thought given the changes in available insulins

a few years ago, about the same time dr. H retired from practice and sold her clinic (yes, i was a client of hers and still go to the same clinic) ydc had a big blowup, the admin of the forum going a bit nuts, and dr. h pulling away from it. longtime members there branched off and started diabeticcatcare.com and had Dr. H's blessing if i remember correctly.

the posts there at the ydc forum take so long because if it's not the admin's way, it doesn't get posted. or if it gets by him and he finds it, he deletes it. it's his way or the highway there anymore, thus the big reason for the split in the board.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Yes, the admin. has blocked my post when I originally got the new compounded PZI and wanted to do a curve using just 1U, said that it was a waste of time.

I will join the new site.

Thanks.

I will also try the more conservative scale.

With the old scale his numbers were dipping really low, and then kinda staying low too long (12+ hours... impossible to regulate around a schedule) so he keeps shooting up to super high numbers before I can catch it and dose it again. Hopefully on the more conservative scale he won't go so low and it will be more reasonable to dose (8-12 hours would be great)

Unfortunately I don't have great vet support. It was really hard to get her to get me the PZI, even after I showed the caninsulin curve and she doesn't endorse home testing and "poking him all the time". Thinks I should just be giving 1U twice a day and not testing

 

Re: Attempting TR using PZI.... anyone else? First week numb

Attached my current spreadsheet. SOrry the numbers are the way they are done in Canada, I don't have time to convert them right now and the spreadsheet is a bit different then the one you guys use because I didn't know how to adapt it for TR.

 

Re: Attempting TR using PZI.... anyone else? First week numb

If I am reading it right, what I see is that you shoot quite a bit of insulin into a high number and then get too low of a number and have to skip the next shot. Then, his levels shoot way back up because he has gone 24 hours without insulin. The most effective way is to find a dose that you can give twice a day, keeping him in good numbers.

Would you consider starting back at 1 unit twice daily to see how he does? Try that for 3 cycles (getting nadirs) and if he is consistently too high, increase to 1.25 units.

IMHO, you jumped the gun going immediately to TR. Once you get some data, we can develop a sliding scale just for him - if a consistent dosing plan doesn't work.

I know you feel a hurry to get this done before you move. But it just isn't that kind of a process. You have to give his body some time to adjust.

Ps. If you want to try the spreadsheet that converts for you, let me know.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Just to let you know...
My Bob was on bcp pzi too. I used a sliding scale, but only shot BID. He was on insulin for about 10 weeks, and went OTJ.
It CAN happen quickly without TR.
ECID, but wanted to let you know that.
Carl

 

Re: Attempting TR using PZI.... anyone else? First week numb

Sue - You are bang on with reading his chart. thanks........ I think you're right. It's overwhelming and I probably jumped the gun. I think I will give steady doses twice daily for the next few days, I can't always test at Nadir because I'm not always home but will do my best, and of course always test before I shoot.

He was at 22.8 today and I only gave him 2U so I'll see how he does at +6 and +8 and post results here.

Carl - Thanks I appreciate it......

 

Re: Attempting TR using PZI.... anyone else? First week numb

Lots of members work all day and can't get daytime nadirs. Don't know if this is feasible, but sometimes they set the alarm and get a +6 at night.

 

Re: Attempting TR using PZI.... anyone else? First week numb

OK. made him a link in my signature with numbers, hopefully easier to read~!
If someone can let me know if it works that would be great!
L

 

Re: Attempting TR using PZI.... anyone else? First week numb

It looks great. It will be so much easier for us to see the US numbers.

Big drop from 410 to 184. But better nadir than the low double digits. I hope you get a shootable number at amps.

 

Re: Attempting TR using PZI.... anyone else? First week numb

It works great.

What I see is that the only day that looks like a normal curve is on 10/23 when you shot 1 unit, you started at 398 for AMPS, had a nice dip and ended with a PMPS of 306 which is lower than you started, which is perfect and what you are going for.

Honestly, I think I would try that again.

 

Re: Attempting TR using PZI.... anyone else? First week numb

thanks, I'm confident by the amps it will be shootable based on his previous numbers (shot was at 4pm) Thanks sue (and everyone) for your help.

The one really encouraging thing, although I know cats are incredibly stoic, through his high numbers while waiting to get insulin and through all these crazy bg ups and downs during my learning curve, he has had no symptoms, he has been 100% himself, playing, eating, cuddling, purring, no changes at all except the excessive urination, which has REALLY decreased since I started PZI just a few days ago. So hopefully I haven't set him back to far with my over-zealousness.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Our cats are very resilient and forgiving while we climb the learning curve. We owe it to them to keep climbing and believe me we have all been in your shoes right now.

Breeeathe.

 

Re: Attempting TR using PZI.... anyone else? First week numb

So just to clarify, TR refers to trying to have them stay as long as possible in non-diabetic numbers. So, you can get there any number of ways. Dr. H's/YDC's approach is using a sliding scale and as-needed shooting to accomplish that, but that isn't the only way. I tried that approach along the way, and found that the scale was off for my cat - the doses as the low end were much too low, and the doses at the high end were much too high (original YDC scale). Ultimately what worked for Bix was 12/12 shooting of a steady dose. He may not be typical, a lot of cats on PZI seem to need shots more often than every 12 hours, but it turned out he didn't. So for at least a stretch of time, he was tightly regulated on BID shots, with a semi-sliding scale where I would adjust the dose by maybe 0.1 or 0.2 to keep his PSs between 150 and 180. Just wanted to mention that so people are aware that YDC's scale isn't the only way to approach TR.

Most of the time here we recommend people start out with BID shooting of a steady dose, and then see how that goes - if your cat turns out to need insulin more often then 12 hours, then you can switch to TID or to as-needed shooting, and if your cat turns out to need a sliding scale, you can evolve that as you go, creating a scale that really works for your cat based on the data you are gathering.

All of that said, I am a huge fan of as-needed shooting - basically giving them more insulin after they have nadired and risen back up to 150. From my experience with Bix, and watching others who have tried versions of that, it's a lot of trial & error - gathering data and analyzing it and adjusting with each shot, and you can get really good results. A lot of it is really what you want to try - BID, TID, as-needed, whatever works for your goals, schedule, etc.

The key to all of it I think is to approach it as safely as you can - testing a lot, being sure to shoot on rising #s. To develop a solid sliding scale, you have to give a shot, and then get a nadir reading. (So you have to have a pretty good idea when they nadir, which is easier said than done with a lot of cats.) If the nadir is too low you adjust the scale down, if the nadir is too high you adjust up (taking into account that any one cycle is not necessarily representative - some cats are more consistent than others).

As for the adjusted YDC scale, my understanding is that it was adjusted downwards for PZI Vet. It may be listed now as being for ProZinc, but that I would guess is b/c PZI Vet is no longer available. My understanding is that they had uh-hum *problems* with the scale being too high back on PZI Vet. In my experience (PZI Vet), 4u is possibly an appropriate dose for a cat on dry food, but for LC canned it is often WAY too high, even with 12/12 shots, let alone with early shots and overlap. I think the YDC concept is great, but some of the implementation I think is potentially dangerous.

You can also extrapolate I think from the potentially hypo number that you got on 1u of Caninsulin that you want a dose more or less in that range (i.e. I might guess PZI in the 1.5 range would give you some results, since 1u didn't - I would be super hesitant to get up in the 3 or 4u range, without plenty of data showing that is needed).

There is always a balancing act - I think sometimes here we underdose and go too slowly, while YDC (at least the old board) had a reputation for overdosing. So it's a matter of finding the right middle ground where you are getting green nadirs, but not putting your cat overly at risk of hypo.

 

Re: Attempting TR using PZI.... anyone else? First week numb

wow. so glad I came here. I only gave him 2U last night at 4pm - bg at 410 (1/2 of the original TR recommended dose, and the recommended dose from the new scale) and he dropped down to 79 at +8 and this morning at +14.5 (6:30am) he is still only at 97. I have to go to work and can't get home until 5pm so I know he'll probably shoot back up.

I guess I should wait until 6-7 pm (want to have him on a 12 hour 6-7 am/6-7pm schedule for insulin) and just give 1U to see how he reacts to that?

 

Re: Attempting TR using PZI.... anyone else? First week numb

So glad you are testing and caught this! Yes, he will probably be very high tonight, having gone without insulin for a cycle. Wish we could try that one unit on a normal number. Come on for advice when you get a number tonight.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Hopefully that will happen tonight..... (he will be at "normal" for him and I'll dose 1U)

Is it not good that he stayed low (or close to normal) for so long?

 

Re: Attempting TR using PZI.... anyone else? First week numb

Yes ,the lower numbers are good. Now to combine them with a shootable preshot. I am just glad you are testing and have been on top of things.

 

Re: Attempting TR using PZI.... anyone else? First week numb

It's great the long ride (hopefully) in green numbers. The risks are if he was at 79 at +8 you don't know how low he was at nadir time (typically earlier than +8 but not always). If he is acting fine I wouldn't worry about it, but still, for safety it's sort of an unknown. And then another factor is just the drama of a drop down from a red # to a green # in a few hours. Might be fine, but in some cats it can trigger rebound, and/or I have heard big drops can make them feel kind of woozy. Again if he is acting fine I wouldn't stress over it, just mentioning it for general tips. So it's not necessarily too high a dose, but it might be. And then of course like Sue said that if you can't shoot at the next +12, then he goes for an extended time with no insulin, so that's not ideal.

Still at 97 at the end of the cycle can be a great sign though - you don't really know for sure if it's that the dose was too high and that's why he was still low then, or if his pancreas is sputtering (hopefully! ... anti-jinx :shock: ).

If it were me and I would be home to get a curve I might try 1.5 on a higher PS rather than dropping all the way to 1u, but I think 1u is ok to try. If he doesn't get much dip though, I'd probably go to 1.5 after that. Since you have already been at higher doses I don't see it necessarily as a need to do a do-over starting at 1u, you are almost more at a fine-tuning stage since you are seeing clear U-curves and good nadirs. Yippee!

 

Re: Attempting TR using PZI.... anyone else? First week numb

After the drop the other day after 2.25U and going over 24 hours with no insulin he shot back up to his highest number ever (he hadn't eaten though.... I then got him to eat a bunch by warming his food)

SO at 7pm he was 478, I gave him 1U, at +6 he was only down to 246 and by +12 back up to 394. I gave him another 1U this morning at 7AM and unfortunately won't be home to test at ~nadir.

I think I will try to see how he is at PMPS and do 1U 1 more time when I can test Nadir tonight around 1am. If he still doesn't go low and shoots back up to the 350-450 by Saturday morning, would it be worth trying 1.5U?

All info. is int he spreadsheet for easy reading

I should mention that Saturday I will be home and able to curve, atleast at the 5-9 hour window, so might be worth it to try 1.5U Saturday morning IF he is back up to normal numbers by then?

 

Re: Attempting TR using PZI.... anyone else? First week numb

It sometimes takes a couple of days to recover from a bounce. And, when trying a new dose, you should stay at that dose for at least 3 days. I'd stick with 1 u at least through the weekend. Try a curve and Sunday after he's had time to settle and see where he is before you increase.

(Of course, someone else may have different advice--I'm still new at this myself, with the incredible bouncing kitty.)

 

Re: Attempting TR using PZI.... anyone else? First week numb

I think your plan sounds good. It gives him enough time to adjust back after the bounces and you will have given one unit a chance. The mid cycle numbers this weekend should really help us seeing how the insulin is working.

Are you sure testing for ketones regularly? If not, do. Any time you are trying to establish a dose, you want to be sure no ketones are present.

Lisa, normally I would agree with your more conservative approach, but she is wanting to be a little more aggressive as she has to leave the country soon. As she is monitoring closely, I think trying the higher dose when she is around to test this weekend is reasonable.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Thanks sue and lisa

I will give the 1U a chance for this morning and tonight, and if he is lower than 350 tomorrow AM I'll stick with it, if not I'll go up to 1.5 and curve at ~nadir time.

He has only been tested for ketones at the vets and not by me yet. Both times at the vets was -ve.

 

Re: Attempting TR using PZI.... anyone else? First week numb

You really need to test for them daily while you are working to get a good dose. ketones It is fairly easy (we have ways if Cello doesn't like an audience in the litter box) and inexpensive. High ketones can cause DKA which can be a very serious condition.

 

Re: Attempting TR using PZI.... anyone else? First week numb

I"ve read a bit about it. You get the strips at the pharmacy?

Luckily cello is a bit of an exhibitionist and doesn't mind an audience

I bought him a litter robot when he got diabetes because he was peeing so much and he pees right by the door so it would be really easy to test if I'm correct in that you just need to get a bit of fresh urine on the strip?

 

Re: Attempting TR using PZI.... anyone else? First week numb

The ketone strips are over the counter, usually in the pharmacy section.

And yes, all you need is some fresh pee - one option is a long handled serving spoon to slide under and collect a specimen while he is urinating. We've got more ideas if that doesn't work out.

 

Re: Attempting TR using PZI.... anyone else? First week numb

Those are actually pretty good results - you got essentially a 50% drop, and then the next +12 is almost 100 points lower lower than the PS. That's the direction you want to go in - if 1u is enough the PSs should keep dropping down like that, if not, it may level out more, or creep back higher. Sounds like you have a good plan, hope you see some nice results soon!

 

Re: Attempting TR using PZI.... anyone else? First week numb

AMPS 394, +12 at PMPS still down at 270. Gave 1U. Not able to test at nadir. Will at 1am. If he doesn't go up to 350 in the am should I stick to 1U?? I think so!

edit: Was only at 318 so I'm going to stick with 1U for the next day and see if he keeps improving. Hasn't gone up to his normal resting range of 20-24, or 350-450 on the 1U since I've always been able to dose. If he keeps improving (and hopefully I'll catch Nadir today) then I'll keep with 1 for awhile!

 

Re: Attempting TR using PZI.... anyone else? First week numb

282 at nadir today, will do 1U overnight and might try 1.5U tomorrow with a curve depending on what he is at in the morning? thoughts.......

 

Re: Attempting TR using PZI.... anyone else? First week numb

Pmps was nice. Strange nadir today. Wonder if he will go down lower before pmps? See what other numbers you get before you decide on a dose. You could always go with 1.25 instead of 1.5.......

 

Re: Attempting TR using PZI.... anyone else? First week numb

was that 282 at +8, or at +6? SS shows it at +8, which would be past nadir time...
I think you need to try to stick with the 1u for the weekend. It's only been 4 cycles so far, and not long enough for a pattern to emerge.
When (if) you do increase, I'd advise a .25u step, not a .5u. He got a nice drop on 1u a couple of nights ago, and last night's number weren't bad either. Let's see where he's at by +12?
Carl

 

Re: Attempting TR using PZI.... anyone else? First week numb

it was +8 so it might have been a bit past, he seems to peak around +6-+8. I will post his number at +12, shoot 1U and try to get his +6 number tonight?

 

Re: Attempting TR using PZI.... anyone else? First week numb

That sounds like a good plan!

 

Re: Attempting TR using PZI.... anyone else? First week numb

Hope someone reads this!!!

It's +11.5 now and he has dropped to 214!

He was at 282 at +8 and I don't know if I should dose him at +12!!!

 

Re: Attempting TR using PZI.... anyone else? First week numb

NEVER shoot a falling number. Make sure he's rising before you shoot.

 

Re: Attempting TR using PZI.... anyone else? First week numb

hmmm checked an hour later and higher. Maybe it was wrong or something??? or it's going up..... I gave him the 1U cause I'm really trying to keep this scxheudle. I'll check at +6 again.

Geeez this is crazy hard.....

 

Re: Attempting TR using PZI.... anyone else? First week numb

Don't feed, and test again to make sure you have a rising number.

You will want to shoot a reduced dose once his bg is going back up.

 

Re: Attempting TR using PZI.... anyone else? First week numb

I gave the 1U (didn't see the part about the reduced dose).... He had eaten a lot between the tests, so maybe that accounts for the change.... In anycase I'll check again at +6 and again preshot this time before he eats.....

 

Re: Attempting TR using PZI.... anyone else? First week numb

Sounds good.

 

Re: Attempting TR using PZI.... anyone else? First week numb

he did really well overnight, and during the day it was looking good, but he was back in the +350 range tonight at pmps. Overall a good weekend I think...... maybe someone with more experience can look at his chart and see if sticking to 1U is good. He was dipping down into the green/blues last night so I don't know about upping it.... just dissapointed with the 376 tonight.

It seems like overnight he does better than during the day if you look at his chart.

So I'm thinking maybe 1U at PM and 1.25-1.5U AM?

 

Re: Attempting TR using PZI.... anyone else? First week numb

I think it is looking pretty good. Those low numbers last night could have been the 1 unit on a lowering number. (He could have still been going down at +12 instead of up.) I would get some more numbers before you increase - still hard to find a pattern in his numbers.

 

Re: Attempting TR using PZI.... anyone else? First week numb

ok sounds good. I'll stick to the 1U for now. His symptoms (excessive drinking/peeing) are def. way more under control so I'm happy and I *think* the numbers are pretty good all around

 

Re: Attempting TR using PZI.... anyone else? First week numb

missed testing last night in the middle of the night needed a good night sleep, exhausted from being up everynight testing and then early in the morning to shoot. Back in the +350 range this morning, have gotten pretty high PS numbers the past two cycles. Not sure why

 

Re: Attempting TR using PZI.... anyone else? First week numb

Hard to be sure. It could overall high or he could be dipping low at night and bouncing. Try to get a mid cycle number at night (I know - it's hard!)

 

Re: Attempting TR using PZI.... anyone else? First week numb

ahhh he is all over the place. I feel like I'm doing something wrong?! I will def. be checking is +6 tonight....

 

Re: Attempting TR using PZI.... anyone else? First week numb

Actually I like today. Started a little high but is down around 200 for a preshot. Yes, a mid cycle number would be great.

 

Re: Attempting TR using PZI.... anyone else? First week numb

pretty good 24 hours, higher again this amps. It is seeming to be a bit of a trend......

Just wondering IF it could have to do with eating schedule?

Right now he gets fed at 7am, 5pm and 10pm. I have the 5 compartment automatic feeders so I could split the night meal into two, HOWEVER he generally doesn't finish quite everything so there is always "grazing" food around, even overnight so I can't be 100% sure meal time has anything to do with the pattern I'm seeing.

He is most active during mid afternoon- early evening (the time I"m most often home...pattern stays the same when I'm home on the weekend) so maybe this has something to do with it???

 

Re: Attempting TR using PZI.... anyone else? First week numb

Yesterday it certainly could have been shooting right around 200 which gave you a very healthy nadir. Could be the food. Could be a bounce. Does he graze during the day also?

If it continues to be a pattern, we could look at moving the am shot earlier. But the numbers aren't bad!

 

Re: Attempting TR using PZI.... anyone else? First week numb

He gets fed at 7am, but never finishes it all. If I'm not going to be home at 5 I set the automatic feeder, if I am going to be home at 5 I just feed him. Usually there is still a tiny bit of breakfast left over at the 5pm feed which means he is grazing a bit during the day! Same with overnight (10pm feed, often a little bit left in the morning).

I am giving him 6-6.6 oz FancyFeast/DM mixed together per day, but I would say he eats about 5-6oz a day total. There is always more available to him though, he just isn't eating it all.

 

Re: Attempting TR using PZI.... anyone else? First week numb

So not much we can change with the food. We will just work with the numbers.

Can you start a new thread? Yours is getting long and it may be that people not doing TR aren't looking at it. Most people post daily with the subject line their amps and any questions they have.

 

Re: Attempting TR using PZI.... anyone else? First week numb

I followed Dr. Hodgkins' TR a few years ago using PZI, and my cat went into remission after 16 days. I saw your early post that you posted in YDC (not a lot of traffic there). You are already getting a lot of good advice here so I don't know if you are still interested in this but Dr. Hodgkin and several of the old timers from YDC have set up a new forum - Diabetic Cat Care.

I had to revised the original sliding scale - increase the dose for low BG numbers and REDUCE the dose considerably for high BG numbers.