Info Whole lotta bumpin goin on

Discussion in 'Prozinc / PZI' started by Carl & Polly & Bob (GA), Nov 6, 2015.

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  1. Haven't posted here in forever, but I used to do so quite frequently...

    You might have noticed three "info" threads that got "bumped" today? First off, thanks to @Jill & Alex (GA) for bumping the first two, on Glucose Toxicity and Insulin Resistance. And the 3rd is about Carryover and Overlap. Three old threads with tons of good information for you to read if you have time. Sort of a "PSA" if you will.

    I think what I'm trying to do is encourage people who might not be seeing good numbers (yet), while at the same time trying to share some tidbits I learned in the past four years. One of the people who I have had the pleasure of "talking to" here on the board is Dr. Lisa. Several years back, she posted a few times (see below) in threads of "Lori and Copper" (owlgal). And those posts left a huge impression on me and others here at the time. So much knowledge and wisdom is so few words...

    Here are some links to three threads, and things I think are extremely helpful that Dr. P posted at that time:

    The first is a good thing to look at when you find yourself at a loss trying to explain what your cat's BG numbers are doing. It isn't just about the dose you are giving. You only have control of two things in this adventure.
    1 - the dose amount and timing
    2 - the food you put in the bowl.
    What happens after that is completely up to your cat. And it sometimes can't be explained by just how much insulin you shot.

    Entire thread:
    http://www.felinediabetes.com/FDMB/threads/wackiness-s-copper.61241/
    Dr. Lisa's post:
    http://www.felinediabetes.com/FDMB/threads/wackiness-s-copper.61241/#post-663242

    #2 is a long post about "rebound" which is usually called "bouncing" here. And the important distinction as to whether the rebound (the high numbers you might see at preshot) are "warrented" or if they are "unwarrented". Was a bounce caused because the cat actually went "hypo" or just because the numbers dropped lower than the cat's body has become used to after weeks or months of diabetes? It's important because if it is "warrented" than that probably means you might need to lower the dose. If "unwarrented", then you might want to think about doing "nothing" in terms of adjusting the dose. In other words, don't lower the dose just because your cat bounces.

    Entire thread:
    http://www.felinediabetes.com/FDMB/threads/new-day-after-yesterdays-hypo.58953/
    Dr. Lisa's post
    http://www.felinediabetes.com/FDMB/threads/new-day-after-yesterdays-hypo.58953/#post-642503

    And the last one has several posts by Dr. P, and you should read the entire thread. Good info regarding "repeatability", and why you shouldn't always react to things just because they happen once. Sometimes you might see a wonky number that makes no sense to you. Like a low green number that you haven't seen that just sticks out like a sore thumb in a sea of blue, yellow or pink numbers. The first thing you should do when you see something really ODD is immediately retest. Maybe it was a strip or meter error. But basically, don't ever assume that what happened yesterday will happen again today. And never assume that what happened today is going to happen tomorrow, even though you shoot the same dose all three days. Don't overreact to a "one off" reading. And don't obsess over one number on your spreadsheet.

    http://www.felinediabetes.com/FDMB/threads/very-confused-now-what-is-going-on-with-him.57769/

    Summed up nicely in one short sentence by Dr. Lisa:
    "Look for repeatability before panicking or making any important decision."

    There are a few things that I believe, based on personal experience and on reading thousands of threads in the past 4 1/2 years. You may or may not agree, and that's fine.

    1 - I think PZI is best used when dosed on a sliding scale based on prior data and your gut feeling.
    2 - I do NOT believe that PZI is an insulin that requires that a cat "settle in to a dose". It's a 12 hour insulin, it doesn't work like a "depot insulin" such as lantus or levemir. You shoot a dose, it does its thing, and you start over 12 hours later. YES, there is such a thing as carryover and overlap from one cycle to the next. But it isn't something that happens every cycle, and in some cats, it rarely or never happens. ECID is true, but honestly, most cats are pretty much the same.
    3- I don't advocate "micro - adjustments" on dose. Sorry, but I don't believe that there is a definite difference in what you might see as far as numbers go if you are tweaking the dose by .1u. Not that can be proven to be due to that small of a dose adjustment. It is far more likely that the difference in your numbers was caused by one of the many "something else" reasons detailed by Dr. Pierson on a day by day basis. If you are going to adjust the dosage, IMHO it should be by enough so that you can draw some real conclusions afterwards.

    I don't give dosing advice primarily because my advice would be seen as too aggressive. And because I addressed Bob's diabetes very aggressively (and it worked for him), I can't tell anyone that they should do it the way I did it. Because Bob was my cat, the treatment was my decision, and I sure could not live with myself if something I suggested led your cat to suffer, or worse. But I truly believe that most cats are dosed too conservatively, and that staying with insufficient doses for too long leads to insulin resistance due to glucose toxicity. I will never again treat a diabetic cat myself. I can't. But I truly wish all the best for you and your sugarbabies. I guess my parting thoughts would be "don't be afraid of insulin, don't be afraid of low numbers, trust your gut instincts and use the data you have spent so much time collecting".

    Love to all,
    Carl
     
    Last edited by a moderator: Nov 6, 2015
  2. Merlin

    Merlin Well-Known Member

    Joined:
    Mar 18, 2014
    Thank you so much Carl for this very invaluable information. I can't wait to start diving into my new homework and learning new things. Thanks again for taking the time to put all these links together and for sharing your knowledge and thoughts.
     
  3. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Yes, thank you very much. I need to sit quietly and digest all this.
     
  4. Carol & Murphy

    Carol & Murphy Well-Known Member

    Joined:
    Aug 9, 2015
    yes, all of your words are so timely and seem to address so many of my issues at the moment
     
  5. I'm very happy that some of you are finding the information potentially useful!

    Carol, once upon a time, I was in your shoes. Just about everyone has been. I know it's not easy. People come and go, but other than Sue (who used to be fondly called Saint Sue), all of the "old pzi peeps" that helped me are no longer around. I wish all of you had met them.
     
  6. Carol & Murphy

    Carol & Murphy Well-Known Member

    Joined:
    Aug 9, 2015
    Carl- I wish I had too - but am so grateful to Sue - most vexing issue for me are the bounces - you said to ignore the bounces but I am not sure how to do that - if I use a sliding scale - the bounce would definitely influence the dose, yes?
     
  7. The first thing you have to determine is if what you are seeing is actually a bounce. And if so, was it caused by a really low number? That would be a "warranted bounce".
    However, if your preshot are in the red/black range, and your nadir is like 225 or so, and you see another high preshot next time, then yeah, I ignored that. It was either because the insulin tapered off early, or just because Bob's system freaked out and saw a 225 as a " low number" when it really wasn't.
    My basic theory was to try to keep the numbers as close to the normal range of BGs for as many hours as possible per cycle. The hope was that Bob would "relearn" what normal was, and quit overreacting to a perceived low reading. I changed Bob's dose every cycle for the most part, based on how high or low he was at shot time. His doses, over the course of the time he was on insulin, ranged from 1u to 4u. Until that last couple weeks when I started shooting less than 1u, and his preshot numbers were in the "blues" or high greens.
     
  8. Carol & Murphy

    Carol & Murphy Well-Known Member

    Joined:
    Aug 9, 2015
    One quick clarifying question - I am sure Murphy has unwarranted bounces - in your example, if the preshots were reds and blacks (due more than likely from a blue or yellow earlier) would your sliding scale be geared towards the red/black bounce or would you continue with the dose that led to the blu/yellow number to begin with ?
     
  9. In general, I shot the number he showed me at preshot, unless I saw a very low number mid-cycle. So in your example, I ignored the bounce, and hoped for another blue or yellow nadir. I figured eventually he'd stop bouncing from dropping to a nadir in the 150-250 range since those numbers are actually above "normal" BG.
     
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  10. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

    Joined:
    Apr 21, 2012
    I appreciate all the bumped info!!! Thanks & I will try to read/assimilate it all!
     
  11. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Carl,
    are you writing here about American PZI or all ProZin/PZI and British Hypurin long lasting insulin?
    I am very confused about these insulins because they apparently work differently but often are group together.
    I am having some problems with my cat but I have support from wonderful members of this blog but I find it difficult to stick to advice until I've got all facts.
    Many thanks
     
  12. Marlena,
    The PZI that I used was compounded PZI, 100% bovine, that was made by Vet Pharmacy of America in Texas. Today most people seem to be using "BCP PZI" if using compounded bovine PZI, also made in Texas. I think what you would call "American PZi".

    Not the same as British hypurin, although I don't understand how it is different.

    Contrary to common belief, none of the "P" insulins should be thought of as "in and out insulin", because they are not. Some might last longer than others, but they aren't all used up at a consistent rate. On a cycle by cycle basis, the duration of the insulin can vary and any of them can still affect the BG for more than 12 hours. In many cases, the blame is put on the "insulin just doesn't last long enough", when the real problem is that the dose is too low.

    I know Elizabeth and Bertie use the British PZI, but off the top of my head, I can't think of others with lots of experience with it. From what I have read on the board though, it sounds like it could be used more effectively on a cat than any of the American P options. The more hours per day that you can have an active and effective level of insulin working, the better, IMHO.

    To answer your question about the specific words you quoted above.... Regarding bouncing, I'd say that applies to any and every insulin. If a cat bounces from going down to 150 to 200, you need to ignore the fact that they are bouncing. The "fix" is not to reduce the dose to avoid dropping to 150. If a cat can't become "used to a 150", they'll never get better because their numbers would never get into "normal range". A day of flat 200s is worse than a bounce caused by a 150.
     
  13. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Carl - rather than your having to write a long explanation, where do I need to read to change my thinking on/understanding of the 'P's'. I thought it was an 'in and out'. This is the first I've heard anyone say this.
     
  14. http://www.felinediabetes.com/FDMB/threads/carryover-and-overlap-things-to-think-about.147568/

    http://petdiabetes.wikia.com/wiki/Carryover

    Years ago, people who used PZI/Prozinc were very aware of the carryover and overlap seen with their kitties, and took advantage of them. If you go back to 2009-2010 here, like pages 80-95 on this forum, you can learn lots of great things, and see the successes they had. Back then, there was nothing people liked more than a "long cycle" and seeing a low preshot that they could use to their advantage. Somewhere along the way, that "art" has been lost unfortunately.

    The sad thing, for me, is that the history prior to 2009 is no longer available to us. When TR was the way to use PZI, and "aggressive" was the norm. We could all learn a great deal if that history was still viewable.
     
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  16. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Carl,
    thank you.
    I would like to ask you to look at my cat's spreadsheet and tell me what you think. I am not going to ask you for advice but to give an opinion if that's ok with you.
    I have a gut feeling that the dose my cat is on is too conservative and it looks like he is not getting insulin, it does not give any good nadirs and poor thing is in high numbers all the time. I am really worried although lovely girls using Hypurin keep telling me that I have to be patient. I am very grateful for their help but I really like to have a lot of information to make up my mind what to do although some might say that I haven't got any experience to be able to have an opinion. I am writing this as I had read your posts and that got me thinking.
    Would be grateful for your prompt reply.
    Many thanks
    Marlena
     
  17. Marlena
    I'd be happy to take a look this evening after work, and post in the thread you have on the Health forum
     
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  18. Marlena

    Marlena Well-Known Member

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    Nov 25, 2015
    Dear Carl,
    God bless you my darling, many thanks
    PS. The SS is incomplete as we started Hypurin on 9th Jan.
    His numbers were: +0 PSAM 16.4 (295) 0.5u given, +4 21.3 (383), +7 21.9 (384), +12 PSPM 21.3 (383), 0.75u or almost 1u given
     
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