Discussion in 'Prozinc / PZI' started by Goose, Feb 10, 2020.
Previous Do Daa's PZ Dosing Thread3
The link above goes to the previous PZ discussion.
Went back to 4.5u, seems he didn't like 4.25u right now.
That 600 last night was the high before the break. He cleared the bounce today. I’m really glad he didn’t do anything too dramatic.
Great job with the curve! Let’s hope he will flatten out a bit in high 90s.
I'm glad he didn't do anything too dramatic also. He seems to like 4.5u right now.
Looking at the SS, when do AMPS and PMPS numbers start to get better on a regular basis, or will they? He's only had a few yellows and blues at those times.
AMPS are often the last to come down so even cats about ready to go into remission might have a higher AMPS (e.g. lower blue) but we have ways to address that. However, his AMPS and PMPS are most likely higher because he’s so bouncy. So until he stops bouncing so much, you’re likely to continue to see higher preshot numbers.
Thanks for the explanation.
SS Updated. Yellows and such....
Let’s see if he clears the bounce soon.
497 point drop this morning...
583 this am, (high before break?) followed by some blues and greens. Did Not reduce to 4.25u today, he seems more stable at 4.5u? Thoughts?
Yes...definitely high before the break. Great job identifying it. But when you see that and suspect it, you might want to test a bit earlier to catch that drop.
I’d hold the dose, too. We’ve been using 70 but the lowest he got was 69 and he came right up.
SS Updated. Black amps again. We are holding the dose at 4.5u.
That drop of 497 was between amps and +5, we did test at +4 @161. (on 2/13, @86 he had 1 spoonful of FF Gravy, some food, it popped him up to 123, he fell to 69 and we gave him FF Gravy, and 15 temptations, then up to 130.)
Ketone still negative.
Great you are checking ketones. He’s just back in a dive/ bounce cycle.
3rd morning amps in a row for Blacks. In your opinion, will this dive/bounce cycle work itself out soon, or should the insulin be adjusted?
We've been checking for Ketones since a member here recommended we do in October. We've been doing so twice a week since, and luckily he's still negative.
If it were me, I’d increase the dose to 4.75u and watch the BG. Sometimes it just takes a swift kick in the pants for one cycle to get things improving.
I’m glad you took the ketone testing seriously.
Ok. We'll increase tomorrow to 4.75u amps/pmps and see what happens. We have taken the Ketone testing seriously.
4.75u doesn't seem to be helping, I think that 4.5u did a better job.
May go back to 4.5u depending on tomorrows amps numbers......
It takes up to six cycles for a bounce to clear. I would not change the dose, unless he drops below 70, until he’s completed six cycles after the blues he had.
Ok, it just seems as though no progress is being made and the numbers are remaining high.
So we should hold the course another 4 days @ 4.75u unless a drop below 70 occurs. Thanks!
I understand but you don’t want to lower the dose. He does not look overdose.
Blues today aside from amps/pmps. Managed well +4 thru +6 with food.
You might want to think about increasing the dose. His bounce cleared but only to blue.
Greens +4 thru +7.
We held the 4.75u dose even though he hit a 64. Should we reduce tomorrow even though when we reduced from 4.5u to 4.25u he seemed to be bouncy for a couple of days?
Well isn’t he the little trickster? They read their condos and when a dose increase threat is made, they drop.
On whether to reduce or not, it depends on how comfortable you are feeling with testing and controlling the lows. Often after getting experienced with both, members might decide to lower the reduction number a bit...say to 60. So, it’s up to you.
Tell me about it! The vacillation is annoying tho!
We are feeling more comfortable with controlling the lows. FF gravy in particular seems to bump him at a minimum of 30-50 points (per 3 tablespoons) and adding 10 to 15 pieces of temptations if we need a higher level of cushion, so that information helps a lot.
We only use this tool when he's at a low number say two hours before nadar when we can see that he may crash because the insulin still has 2 or 3 hours of peak effectiveness before its influence begins to subside. We will also use the above information if say, in the middle of the insulins effectiveness, he stays high and does not drop until +8 or +9 and that has been known to happen and he may be too low to shoot at +12.
About the reduction point currently being at 70. How would lowering it to 60 help? Is there some information about reduction points like this you could mention or point me to so I can read more?
There seems to be quite a bit of inconsistency in Do Daa's numbers on a semi-regular bases and whether we increase or decrease the insulin he seems to find some reason to not like it and bounce.
I know you know this but just a reminder that we want to be sure we don’t use any high carb food, gravy, or treats after +10 to bump the BG up enough to shoot. Of course, if he’s in the 30s, you gotta do what you gotta do but then you need to stall the shot without feeding more so you know you aren’t shooting a food spike.
It would allow you to hold a dose that’s working longer. For more experienced PZ users, they will often use below 50 as a reduction point and if the cat has been diabetic for over a year, they will use below 40 while perhaps “shaving the dose” a little bit if the BG drops between 40 and 50.
While I’ve been away, I’ve been working with a very experienced PZ user (who, unfortunately has not been able to post in a while due to family issues) who has worked with several other PZ users to update the PZ Dosing Methods. I’m working to get those into a consolidated document which will replace what is currently seen as the stickys and the PZ Protocol. In that regard, I’ll give you a sneak preview regarding reducing the dose:
Cats bounce until they don’t and, when they are bouncing, your focus needs to be on when they clear it because that’s when they are most likely (and almost always do) do it with alot of fast action and dropping. But, again, and I know I’m a broken record, but if the BG drops with no control, then kitty will likely continue to bounce. A fast drop always equates to a hard bounce. You can see this any time he goes back up to black.
He was high all day after a good day yesterday with a black today at +6. Not a thing in his schedule, including food, has changed one bit from yesterday. This is the frustrating part for us, we're definitely not very experienced at this.
Yes, we definitely know not to give any food of any kind after +10. His amps/pmps are 9am and 9pm and he has no food after 630am and 630-7pm, 2hrs+ away from shooting.
Right now we are reducing at 70 and at 4.75u. Most of the recent numbers indicate that 4.75u is ok (a mix of blues and greens), other times, like todays 500 at +6 would say to me a need to increase to 5u if tomorrows numbers aren't better - or hold the course and wait it through... so confusing.
So say he hits 60 at 4.75u in a couple of days only once, do you reduce it just because he hit it once or wait another day to make sure he'll hit it again at the current dose?
What if the low number, a 60, was a freak occurrence and he stays hi like he was today and he hit a 500 and we just the day before reduced his insulin because of the 60 - wouldn't that invite a bounce cycle all over again? Now we have to wait up to 6 days to start over again.
The black comes from the drop from 439 to 94 in four hours. At first, we all tend to divide the drop by hours to get the drop per hour which, in this case, is pretty fast but what more likely happens is he takes a big drop at onset. Uncontrolled drops = big bounces.
Try not to determine whether he needs a dose increase when he’s in the middle of a bounce. You are looking for the nadir between the bounces. If it’s not green, you have some room to increase as long as you test.
I would hold the dose unless he drops below 60. You can also judge by whether it’s a bounce-clearing cycle or not because they will always be a little more active as the dose clears.
Yes if he drops from 500 down to 60, it will trigger another bounce. I’m not sure what you mean by “Now we have to wait up to 6 days to start over again.”. You only have to hold a dose for six cycles after an increase, not with a decrease.
I feel I’m missing something you are trying to ask.
Goose PMd me as he wasn’t sure if I was still in town so I’m moving his questions here.
You want to try and be consistent with dosing to the extent you can. I see you dropped the dose back to 4.75u at PMPS tonight. You can see how he does tonight and where his AMPS is but I would have held the 5u dose until he dropped below 60. I’m not sure if you mean should shoot 5u at AMPS and 4.75u at PMPS but, no, I wouldn’t do that.
If he sees green but above 50, I’d hold the 5u dose. If he drops below 60 during the cycle, decide on a reduction by considering:
Is he clearing a bounce and dropping fast? If so, as long as he doesn’t go below 50, you might want to hold the dose.
Does he drop below 60 and come up pretty easily or does he hang around there for a long time with you having to feed him to keep him up? If he does the latter, you might want to reduce.
Follow your gut; you have a good feel for what works for him.
Ok, thank you.
You’re welcome. I hope that answered your questions!
I believe you did. I printed it out to look over later.
He'll be on 5u for a little while, while we see if it works for him again.
If you don’t see more green soon (next cycle or so), he will need an increase.
I’m off tomorrow. Good luck and don’t hesitate to ask for help.
Ok. We'll give a a couple more days to see what's up, then possibly bump it up.
Safe Travels and enjoy!
Reduced to 5u because of the 62 today.
Mostly Blues and Greens today managed with normal food, nothing HC or additional sugars.
Reduction Point is 60. He hit a 55 & 57 today. BG rose up slowly even with gravy/food/20 Temptations. We reduced the insulin to 4.75u, we'll see what happens.
He hit a 57 again @ +5.5. His insulin was Reduced to 4.5u. Hopefully the right call, we'll see.
Nice catch on the 57. Good luck with the reduction. FYI - dose is missing on the spreadsheet for yesterday AM.
SS Fixed, thanks!
Added more to remarks in SS about gravy and syrup during and after the 57.
He hit a 43 @ +4.5 today. Food management was not particularly available up until that test point. We Did Not Reduce. I believe it was a lack of normal food on a specific schedule that we weren't able to meet that pushed him to the 43. We are going to hold him at 4.5u through at least Sunday, (minimum of 2 points on 'the graph' to make sure that number wasn't a fluke.)
It’s nice to see he kicked the black to the curb while I was gone anti jinx. It looks like he’s bouncing right now so let’s give him total of six cycles past the blues a.m. cycle 3/14 and if you don’t see green, he might need a little extra juice.
Great job with him!!!! I hope all is well there.
Hi! , and Thanks!
He hit a row of Greens today. So we'll keep him on 4.5u for the next 3 days, thru Friday to see what's up.
Time for a new thread. Up to 50 posts with this one.
I’ll reply here but a new thread would be appreciated.
Because he’s just dipping his toes in green and then bouncing several cycles, I’d consider increasing the dose to 4.75u but be sure you don’t do it when he’s clearing a bounce.