PZI/PROZINC PROTOCOL There is no formal published protocol for ProZinc/PZI. These guidelines have been developed based on years of collected data on hundreds of diabetic cats treated with ProZinc/PZI. The doses are determined by looking at the history of the kitty - his/her doses and how he/she responded, including pre-shot numbers and mid-cycle (nadir) numbers. Data collection (testing) is vital to this process, as is recording on the forum spreadsheet. Instructions for Spreadsheet. Spreadsheet data is essential for receiving accurate guidance from members of FDMB. It is also a wonderful tool for sharing information with your vet and forum members, and for you to see your cat’s progress. Please be aware: There are no "dose advisers" on the FDMB. The FDMB is an open board subject to peer review where laypersons with varied amounts of knowledge and experience are free to share their own thoughts and opinions through explanation and by making suggestions. We are not veterinarians. It is not our intention to take the place of your veterinarian. Please discuss dosing, methods, medications, and care for your cat with your veterinarian. STARTING DOSES The recommended starting dose for ProZinc/PZI is .5 units or one unit twice daily, every 12 hours. We follow the Start Low, Go Slow model, increasing doses slowly, if needed, based on home testing results. CHANGING THE DOSE Changing the dose will depend on both the pre shot levels and the nadir (lowest point of the cycle, usually 5-7 hours after the shot.) During this initial period, especially if wet low carb food is replacing higher carb dry, monitoring is very important. Insulin plus a diet change can result in sudden low numbers, or in a gradual lowering of numbers overall, depending on the cat. When adjusting the dose, it is wise to check with your vet and with forum members for guidance. In general, the following guidelines can be used. Be cognizant of the over riding principle for ProZinc/PZI : Every Cat is Different (ECID) If the cat is in the 250+ range at pre shot and does not drop 50% or more for nadir, a small adjustment could be considered, if monitoring is possible. A small adjustment is likely to be 0.25 units per shot. If the cat is in the 250+ range(or higher) at pre shot and drops below 50% at nadir, bouncing is a possibility. Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, releases glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". (Adapted from the Lantus sticky by Jill) If bouncing is suspected, any increases in dose should be tiny and monitored carefully. If the cat is high and flat during the entire cycle, the dose could be raised by 0.5 units, as long as monitoring if possible. Doses are best held at least 3 cycles, unless the nadir is too low. In that case, it should be adjusted down. NOTE: A cycle is 12 hours. So, when we say 3 cycles, we mean (3) 12 hour cycles. Sometimes there are circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines. Please ask for guidance if any of these or other circumstances present themselves or are of concern." If you encounter numbers under 50 on a human meter or under 69 on a pet meter, post on the PZI forum and Health to get advice. Start your thread with a 911 icon and a title like: HYPO NUMBERS HELP SYRINGES If you are using U40 syringes and find yourself trying to eyeball doses under 0.5, you may want to consider using U100 needles and the conversion chart Conversion chart for U40/U100 syringes. This will allow you to make smaller adjustments and give mini doses. KETONE TESTING It is important to test for ketones regularly, at least once weekly, even if the cat is eating well and has no infections present. Test daily if the cat is recovering from DKA and/or if any infection is present, the cat is not eating well and/or is in higher ranges. Ketone strips are available in drug stores; they are the same strips human diabetics use. You want to try to stick the strip into the cat’s urine stream or collect a sample with a ladle. If this seems impossible, ask for alternative methods on the forum. These are "general" guidelines which have worked for many cats. However, "Every Cat Is Different". Learn how YOUR cat responds to the combination of food and insulin. Please be aware: There are no "dose advisers" on the FDMB. The FDMB is an open board subject to peer review where laypersons with varied amounts of knowledge and experience are free to share their own thoughts and opinions through explanation and by making suggestions. We are not veterinarians. It is not our intention to take the place of your veterinarian. Please discuss dosing, methods, medications and care for your cat with your veterinarian. This is intended as a quick guide for using ProZinc/PZI. For more detailed information, please read the sticky, Beginner’s Guide for ProZinc/PZI Users For Diabetic Cats. Beginner's Guide As always, it takes teamwork and some wonderful members helped rework/update this sticky. Thanks to Robin&BB, Rachel, Carol and Murphy and Bobbi and Bubba for their help.