Frustrated, Considering TR Protocol - Questions

I am considering dosing according to Dr. H's protocol. Napoleon is on BCP PZI. He was diagnosed in December and I feel like we are getting nowhere. Here is a little history for you:

DX - 12/09 - Started compounded ProZinc 2 units SID - increased to 4 units SID after curve at vets then ended up at 6 units SID in
March. Numbers would drop fast at 6 units way to low. Decreased to 5 1/2 then 5 units SID - numbers still too low.
Started over at 1 U, then 1.5, then 2 units SID. No progress and symptoms began to come back, drinking and peeing a
lot.
Here we are at the end of April starting fresh on BCP PZI U100 - 2.5 units SID. Started at 2, but was barely dropping. I home test and wanted to know if it could possibly be beneficial to start dosing according to his numbers. I am very, very frustrated. My poor guy has little energy and a history of ketones, which scares me.

Anyone have any advice? I'm at my wit's end. Thanks :sad:

 

Hmm, a sliding scale (dosing calibrated for BG preshot ranges, ie 200-300 1U, 300-400 1.5U, etc) may not be necessary. Even with a sliding scale, you need to dose every 12 hours. SID is once a day, is that how often you are dosing?

SID is a common recommendation from vets it seems, especially if owner expresses difficulty with BID or every 12 hour dosing. It's what mine recommended on PZI Idexx (now discontinued) over 5 years ago.

Yes, we got nowhere on it and were also up to 6U. After finding FDMB, I learned the truth - SID dosing rarely works.

The general guideline then is to cut the dose in half and start giving every 12 hours. Since you are currently at a fairly low dose, beginning with 1U every 2 hours 12 hours would be great!

Hope that helps.

 

If you move up to twice-daily dosing for a while and you're still not seeing most numbers below 200, then consider using Dr. Hodgkins' protocol. But remember, her protocol starts with some completely arbitrary doses on a sliding scale that is expected to be adjusted for your particular cat.

As soon as possible, get some help from the Doctor or someone experienced on her forum, on how to adjust the scale for your own needs, based on your history.

You'll need to take more tests and probably shoot more often than even twice a day. Good luck!

 

Im sorry, yes we are now on a BID schedule. That was a typo. Thank you!

 

how long have you been hometesting? any chance you could post what numbers you have either here or in a spreadsheet that alot of us use? instructions for that are here http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=16

if not maybe type them up here like

4-26-10
AMPS 235 2U (amps is morning number before shot and then the dose)
+4 176 (number obtained 4 hours after last shot)
+7 188 (number obtained 7 hours after last shot)
PMPS 250 2U (evening number before shot and then the dose )

 

Definitely will do that, thanks! Will start tomorrow. I have been home testing since January and I am using a Freestyle Freedom Lite monitor - this registered closest to my vet's of my 3 monitors.

 

Oh, that's good.

Are you familiar with the Insulin Support Group section of the board? viewforum.php?f=5 You can post in the PZI forum and perhaps members there could help direct you in the sliding scale method.

As Steve said, it should be tailored to the individual cat and may take a fair amount of blood glucose testing to determine the scale of doses. But some people have had success with it, so it is worth trying.

I alerted PZI forum members to your thread here, so perhaps someone else will be along shortly.

Good luck!

 

Thank you Vicky!

 

Hey there. A couple of us on the PZI board went through Tight Regulation just a bit ago. It helped immensely for us as my Aria was extremely hard to regulate after going through a few months on Vetsulin BID. We switched to ProZinc in February and shortly after I went to TID (three times a day) to start tight regulation per Dr. H's protocol. We were at an 8/8/8 shooting schedule. Here's some things I found:

Good:
I was able to adjust Aria's dose after fewer hours.
I was finally able to keep her under 300
She responded to it very well and we are not at a SIGNIFICANTLY reduced dose and back on BID solidly staying under 180 (which was my goal)

Bad:
It takes a lot of dedication of time/energy
You go through a pile of test strips (find ones that are inexpensive and easily found)
You'll find your shot times still have to be adjusted

Per the TR from Dr. H. - IMHO the theory is sound, but we had to make adjustments to make it work well for us and be viable. Her sliding scale was far too high for Aria for Prozinc. ECID. Because you're shooting every 8 hours, if you slide too much all the time, you end up bouncing a lot. It worked a whole lot better for me to adjust the base dose based on several cycles. Luckily those cycles are shorter, so my kitty didn't have to stay in any high numbers for a super long time. You will go without some sleep and you will worry at times. You have to find the balance between running yourself ragged and doing the best for your kitty.

The best thing I found about shooting TID was the vast amount of information I was able to learn about how Aria's body dealt with the shots and food. I was able to tell that something was wrong with her that wasn't insulin related due to her numbers going outside what was normal for her. Having others check your spreadsheets was very, VERY helpful. Even if they didn't shoot TID, they were able to sometimes spot trends I would miss. I was also able to give my vet our ss so I didn't have to pay for a fructosamine every few weeks.

If you have any specific questions, feel free to PM me or come over to the PZI board. Michelle hangs out over there and she and I were TID'ers together.

 

Thank you for all of the information Hope! I am glad Aria responded well. The TID scheduling will get tricky for me once I start working within the next month again. I am currently laid off. I really do love my Napoleon though and I want to do anything I can to get him better.

 

Are you aware of the Board that follows Dr. Hodkin's protocol, Diabetic Cat Care? Not that I'm sending you away from the fine resources here, but some folks following that protocol have belonged to both Boards. It's worth it to at least take a look at the stickys and announcements there to understand the Dr's protocol.

 

Welcome.

"compounded ProZinc" - there is not such thing as compounded ProZinc. The real deal ProZinc is a manufactured insulin. There are some online pharmacies that advertise "compounded PZIR" I think, but that is not ProZinc.

But now you are on BCP so no use looking back. The U100 strength BCP will be a little less easy to deal with small dosing changes. Most of the kitties on PZI are on a U40 strength.

You also might want to get a profile put together and link it in your signature and probably start a spreadsheet too. Both of these will help you communicate your sitch efficiently with the folks here. Instructions can be found in the tech support forum:
viewforum.php?f=6 [in the stickies at the top]

Feel free to join us over in the PZI group too. [in your spare time ;-) ] There is lots of reading in the stickies in this health forum and also in the PZI forum.

 

Thanks for all of your help everyone. I will post Napoleon's numbers on the PZI forum and go from there

Gator, you are correct he was on a compounded PZIR that was compounded with Humilin from Wedgewood Pharmacy in NJ.

 

You are not the only person who has come through here & been on the Wedgewood PZI. Again, since it is history there is not much to look back at but you might ask in your post in PZI group about other's impressions of the Wedgewood [I might even be interested to read any replies]. I don't understand why they seem to get kitties on it - IMHO it does not have any of the advantaged of BCP or ProZinc.

I've been trying to compile instructions for BCP sourcing. Do you mind saying how much you paid for the insulin itself? And what sized bottle you got [10ml]? And what the shipping cost was? And if you were billed directly by BCP or your vet got a chance to take some profit off the top? Any details or hints you can share would help.

 

Sure thing. The BCP was $52 for 5ml. I use U100. The shipping was overnight refrigerated and was an additional $13.50. $65.50 altogether and the shelf life is 6 months. My vet called in the prescription and I was billed directly and it was shipped directly to my home. Hope this helps.

P.S. - For the first time today Napoleon is getting a decent curve. I will post the results tonight on the PZI thread. Finally!!!