Info Carryover and Overlap....things to think about

Discussion in 'Prozinc / PZI' started by Carl & Polly & Bob (GA), Feb 19, 2014.

Thread Status:
Not open for further replies.
  1. As if there aren't enough variables to think about, I've been doing some reading lately on "carryover" and "overlap", so I thought I'd share...

    We often think of Prozinc/PZI as "in and out" insulin. According to what I've read before, compounded PZI is advertised as
    - having an onset around +2
    - nadir/peak at +4 or +5
    - duration of 8-10 hours

    Prozinc, according to the manufacturer -
    - onset by +3
    - nadir/peak between +5 and +7
    - duration of 10 to 14 hours

    Before anything about carryover or overlap, first there are three other "concepts" I want to mention. These 3 things are critical to determine so that you can figure out what's going on with a cycle of insulin.
    1- Onset
    2- Nadir
    3- Duration

    You have to collect data to figure out when onset, and nadir are taking place. And you can get an idea from those as to what type of duration you're getting. A lot of times, I've read (and occasionally said) that a cycle of long duration can indicate a dose that might be "too high". I've reconsidered that. And I've also come to think that there's absolutely nothing wrong with a cycle that lasts "too long", as long as you know what to do with it when you see one. Actually, if you're getting long cycles, you can use that to your advantage, and smile when you see it happen.

    Here's something I hadn't read before, from the petdiabetes wiki: PZI is considered to be a "long lasting insulin", although I've usually seen it described as an "intermediate" duration insulin. Yes, compared to a "depot" insulin like Lantus or Levemir, it is "shorter". But according to the wiki, BCP PZI has the following properties:

    No type of insulin is absorbed 100% all at the same time. A large portion of a dose might be, but part of the dose will be absorbed more gradually. And other stuff can affect the rate of absorption. Like how hydrated the cat is for instance. I've read on the TR forum that on any given cycle, the rate of absorption can vary by up to 50%. None of this is an exact science. Every cycle is different. So some days you might see a 10 hour cycle, and some days you'll see a 14 hour cycle. I think we go with "shoot every 12 hours" because it makes sense. Twice a day, same time every day, because then you can have a real schedule with this and with the rest of your life. But a cat can't tell time, and they sure don't follow any kind of schedule. They are pretty much on a schedule of "Eat, sleep, play, sleep, eat, groom, sleep, mess with the bean's head, sleep, nap, and sleep. Lather, rinse, repeat. And their "Shuffle" button can't be disabled.

    Carryover -
    Overlap -
    If you have what seems to be a "long cycle" going on, then you're seeing duration that is longer than usual (assuming your prior data shows duration of 12 hours or less). But what's the problem with that? I don't see one. You can use that knowledge. You can see less of a rise after eating because the first shot isn't completely pooped out. You have a lower preshot, so you can reduce the dose if you want to. The dose will be working against a lower BG than "normal", and you can keep the numbers lower overall. Kitty can spend more time in good numbers, preferably below the renal threshold for as many hours per day as possible. That's got to help, right?

    This isn't something you do without careful consideration. Can you test later in the cycle? Do you know what to do with low numbers when they happen? Have you collected enough data to feel good about when onset and nadir usually take place, and do you have a good idea what sort of duration you usually get?

    When in doubt, err on the side of caution. Always. But in my opinion, if the choice comes down to "skip" or "shoot", if I were holding the needle, I'd shoot. I'd rather shoot a lower number with a lower dose than skip and pretty much count on a high preshot 12 hours later. To me, that's a missed opportunity, and a loss of momentum. Right when it looks like "progress is being made", you end up right back where you started.

    All of this is "my opinion". I'm not a vet, my cat was only on insulin for 10 weeks three years ago, and I didn't test nearly as much or as often as most of you do. What I did do was use a sliding scale for 10 weeks, shot numbers well under 200 regularly, aimed for greens, ignored bounces, and loved Bob like today was our last day together every day. And my reward was two and half years of a life with him that I wouldn't have otherwise had, and that I wouldn't trade for anything.

  2. New info thread copied from old one.
  3. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
    Thank you for this Carl--I have read it several times and glad I did and do-
    Our TP journey is going well--Drevon was 240BG this morning and when I came home from work to check him at +7 he was 158!!!! <gave 1/4 (+3 after that 135 bg) This a a huge step in the right direction I don't think he has dropped and held like this before.…..I will be setting my alarm to stay on our schedule as it seems to be helping him hold the lower numbers….fingers and paws crossed! Thank you for the helpful info on PZI-
  4. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
    Having a phone consult with Dr Ankone from California…she is one of the doctors who is experienced in Dr. Hodgkins protocol ( Dr H no longer is in practice) From the way it sounds she worked at the same clinic. It is a mainly holistic clinic which is right up my alley. (Both of my other Dr's are as well)
    I will be calling her at 12:30 Chicago time this Monday. It is a 1 hour consult and I spoke for a while to the receptionist who was awesome….I have sent her the blood work and my regular vet has also faxed info to her-I will be sending the ss as well as my personal ss with notes on his behavior and playfulness etc…closer to Monday so she has the most current data.
    I am told she is very skilled at diabetes protocols and she has great reviews (a few eh ones but ya can't please everyone)
    So far my new dosing is going good….better numbers holding longer here and there--- a few higher but I am trying to be patient….not my best virtue!
    stay tuned :))
  5. Ask her about carryover and overlap. I think their protocol tries to take advantage of both.
    Let us know how the consult goes.
    Glad things are going well for you and Drevon!
  6. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
  7. Okay, raise your hand if you haven't seen overlap and carryover.

    Put your hand down and look again.
    It has been happening to one PZI cat or more, every day, for at least the last two weeks that I've been watching.
    Cara and Wynken (GA) likes this.
  8. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
    lol..raise your paw!!
    My consult is in another hour and a half--
    I sent so much info I hope she really has time to look at it-they just called for more records which I see as a good sign!
    I have been pondering if I should do a fairly strict 6 hour rotation as he drops about 3-3.5 and starts rising about 4-4.5
    by 6 he is enough out of "normal" to cause the pancreas stress, I will be asking this as well-
    Very hopeful that this Dr will have some ways to regulate my baby boy-(and by regulate I mean revert)
  9. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
    Ok Dr Ankone-who took over Dr Hodgkins practice…. 1 hour consult….
    So I sent her all my data and she had the blood work for the past 2 years-I was not prepared for what she had to say.
    She feels Drevon would benefit from switching to lantus. He does not hold his numbers low and she has about a 85% success rate of remission (if there is not a underlying problem) in her patients (she said it is usually on a 12/12 schedule which surprised me). She has seen only cats for 15 years and she appeared to get pretty involved in her patients. She had empathy for both Dre and myself as this disease has pretty much consumed us with the testing and dosing-she suggested I stop testing so much not only for my sanity but for his ears…..I liked that she cared about his ears :)
    We briefly spoke about carry over and overlap and it was basically that the way I was dosing it was possible that it could catch up and be a "over dose" although it can work in our favor but it can be a 50/50-
    He needs to lose a few pounds and we are working on that. I did not know that PZI and Pro Zinc were different. I am using Pro zinc which is controlled but PZI is different from batch to batch which could be a problem. She cautioned me about making sure I use the U100 syringes and to start with 1 unit every 12 hours for a week and let him adjust before changing the dose-we will be working with Dr Katz on that.
    She did not think it necessary to test before dosing on the 12/12 schedule but I will be terrified to dose if I do not check-I think he can handle 2x a day-
    My BF and I talked about it and I think we are going to start lantus on Thursday as I am off work Th and Fri-
    She is not a fan of science diet nor am I so we agreed on our food choices although mine will not eat raw because I did not start them young.
    She was pretty adamant about not being so focused on the number but how he feels---I already did this but it just drilled it in a little more that he may not go into remission but he can live a great life that is well managed. I have been putting off a dental on him and I am reconsidering that but I would have to find a place I really trusted to keep him on fluids and check his Bg etc…. for right now we are taking 1 step at a time….so much to absorb and I love him so much, I would do anything for him I just wish I had a crystal ball.
  10. Merlin

    Merlin Well-Known Member

    Mar 18, 2014
    Thank you Jayla for sharing your results. It is very interesting and am glad that you have options. You are such a good momma to Drevon and he is so lucky to have you and your BF taking care of him. Hopefully, with this new direction, you will also be able to get a little more time back to yourself as that is just as important to you as it is to Drevon. I totally agree with you about pre-shot and nadir testing and would certainly continue with that. Again, thank you for sharing your journey with us.
    jayla-n-Drevon likes this.
  11. Hi Jayla, thanks for the update!

    I have to say I'm very surprised that the vet who took over Dr. H's practice is a "Lantus" advocate. But, it is supposed to offer the best chance at remission (conditional of catching the diabetes early, and following the TR protocol). It does do best on a 12/12 schedule and consistent doses, unlike the "P" protocol you've been using. So in some respects, it will make things less chaotic for you and Dre.
    I've never used Lantus but have spent lots of time watching how it is used in the L & L forum. There are some very experienced L users who post there regularly, and loads of help can be found there.

    Yes, Prozinc and PZI (compounded) are two different beasts. Compounded PZI is bovine based, while Prozinc is rDNA human insulin. But in terms of how they work, very similar. There can be variation between batches of compounded PZI, and several pharms might make it. I believe the "best source" is BCP in Texas. Bob used "VPA PZI", and batch reliability didn't matter in his case because he went OTJ before I used the entire first vial I bought. I had bought a 2nd vial just in case I needed it, but I ended up donating it unopened.

    Absolutely, you will need u100 syringes (orange cap) and get the ones with 1/2 unit marks. Lantus is a u100 insulin, and dose adjustments, when made, are in .25 or at most .5 unit increments. BG testing is still very important, especially the nadir reading. With Lantus, it's the nadir results that indicate if a dose should be increased or decreased. Preshots are still important. The same spreadsheet works, just stick a row in there that defines when you switch insulin to make it obvious.

    Glad you were able to discuss overlap and carryover with her. I think they are important to understand more so with Lantus because that is the nature of a " depot insulin". There are some great informational Stickies in the L & L forum that you should check out before switching that will give you better understanding of how the "L's" and the "P's" differ.

    Best of luck, and hope to see you posting in the L & L forum!
  12. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
    I was a bit surprised at the lantus suggestion as well--a bit shocked actually. But that being said she has a great success rate and as you probably know lantus was not around when TP was originated--or was very new (forgot what she said exactly) I am browsing the L+L forums--a whole new beast!
  13. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
    I was just looking at Chinas numbers and she is doing great!!
    Drevon is doing really good-we bumped to 1.25 Wednesday PM--been mainly in the blues-
    Started fluids 2x a day instead of 1 and it seems to have done the trick…. he does better when not flooded with 1 big dose.
    No sitting at the water bowl forever-
    thinking he is really going to get into remission!! That would be a very Merry Christmas….
    How are you?
    Cara and Wynken (GA) likes this.
  14. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
    Bob!! your back!! we missed you :(
    SO much has happened… I have Drevon on the slow protocol now as he dropped a few times and with it being Christmas week my nerves were shot and the stress was not good for Dre or me. He is on 1.25 as of Monday evening and I am craving those greens ! trying to be patient as he seems to be feeling really good and he is happy-playful. How are you? How was Christmas?
  15. Hiya, Jayla!
    First it was a week down with the flu, then a week "off the grid" on vacation in Virginia. Christmas with my daughter and son in law was fantastic!!!
    I've been watching how you and Dre are doing and he's looking great!
    jayla-n-Drevon likes this.
  16. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
    Hi Bob Welcome back :)
    We are back to tight regulation--I am ready this time!
    I ordered YA for the days he refuses all 9 plates of food on the table -:banghead::banghead::banghead:
    I know it is not great but he needs to eat even if 10-20 kernels. It will not be his main food.
    So far so good otherwise-very close to green:D
    So glad you had a great holiday:)
Thread Status:
Not open for further replies.

Share This Page