4/2 Elizabeth AMPS 96 no AM shot PMPS 86, +2 86

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No dosing advice but looking great. I'll be curious to see what the advisors say. I know what I would think but they don't always suggest what I would do so I'm keeping it to myself. Either way she looks great!!
 
tiffmaxee said:
I know what I would think but they don't always suggest what I would do so I'm keeping it to myself.
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Thanks, Elise....I appreciate the support! This is probably another skip this morning since I haven't yet heard from anyone. Hoping it goes well....
 
I am not familiar with the AlphaTrak meter, I know it is different than a human meter, but it looks like you skipped last night and Elizabeth is looking really good this morning. Prior to last night's skip you were down to a drop, so I think it might be a toss up. Give a drop and see what happens, or start an OTJ trial. It looks like you did a skip earlier in the week and when you went back to a drop she hit 49, so if it were me I would say skip and start the OTJ trial, but you will need to decide if that is the best option for you and Elizabeth.
 
Wondering what the thoughts are on Elizabeth getting no shot last night PM or this morning AM. I assume keep testing and see what happens? And keep my fingers crossed?
 
Hmm, well looks pretty good to me too. Can you get another test today to just check in? I'd like some other folks to weigh in too, but i'm thinking she might be ready for a trial.
 
I guess I'm a little confused and need some clarification...
You're using an AT meter and following the TR protocol, right?
  • The TR protocol would have you shooting a dose to any preshot number 68 or over (on an AT meter).
  • 68 (AT meter) would also be the reduction point when following the TR protocol.
I have to admit, I have not been following your journey.
Is there a reason you're not shooting low or maintaining the dose unless Elizabeth earns a reduction by dropping below 68 (AT)?

I must be missing something...
 
Should I do a test prior to the PMPT, or wait until then? I am about 2.75 hours away from would be her shot time. Thanks!!
 
Jill,
Yes I am using an AT meter. I suppose I am not following proper protocol. That's why I have questions. Are there cases where the numbers are good and the shot isn't needed, or should I continue to give her the one drop shot?

I am not a person that can wake up every few hours and test at night then go back to sleep. Once awake, I am up for good, and so I have just been staying up, which means exhaustion sets in. I can only stay up so many nights in a row to test. Her number was low enough last night that I wasn't comfortable since I wasn't going to stay up. I'm hoping I have answered your questions.
Thanks!

Thanks!
 
Vicki, what Jill is talking about is the same issue that we've talked about on 3/30:

julie & punkin (ga) said:
Here's the thing - we know that it helps a kitty have a stronger remission if they get insulin support as long as they need it. Elizabeth has come down the dosing scale really quickly - only 10 cycles since she was 200+ and on 0.5u. She hasn't had a lot of time in normal range for her pancreas to do a lot of healing. Although we can't see inside her and know if it's been long enough or not.

Experienced people will shoot everything over 50 (human meter)/68 (AT) and the well-regulated cat will often just stay flat for the rest of the cycle. It's impossible to know if Elizabeth will do that tonight or not.

You sound really reluctant, though. She's on the verge of a trial, but I don't know if she's had enough time in good numbers or not. It's up to you. Do you want to try skipping again tonight and seeing if she holds? Or do you want to shoot the smallest amount you can?
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julie & punkin (ga) said:
yuppers - what Chris and Ella said.

If she goes below 68 on this dose, then that's the time to start a trial. Because cats are all so different, this is a one-step-at-a-time process. You shoot a dose and reduce it when the cat goes below 68 AT. You shoot the reduced dose until the cat goes below 68 AT. Repeat until there is no smaller dose.

Some cats do bounce all the way to OTJ - it's just variable.
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Just my thoughts from a quick read through and looking at Elizabeth's spreadsheet. On Alphatrak readings, unless I'm missing something, Elizabeth has been in completely normal numbers for 7 days including when you've skipped shots. There's probably no certain way of telling whether she's ready for a trial without letting her try it. But if you're exhausted, unless something really weird shows up on her test at what would usually be her shot time, it doesn't look to me like there'd be any real harm in at least skipping one more shot and getting a really good sleep. I had to do it early on with Rosa even when I knew skipping the shot was going to push her up towards 400 - sometimes you just have to sleep so you can be ready to deal with the whole thing again the next day! By tomorrow morning after the 3rd skipped shot in a row, you might well be able to get a better idea of whether she's really ready for a trial or if her numbers are likely to start creeping back up gradually.
 
There was that 3/31 +5 test of 49. Yes, it may have been a bad reading, but previously when that happened (a low reading that might have been a bad strip), y'all treated it as a reason for a dose adjustment. (I would have taken a 3rd reading if I had known to do that) So if that BG 49 is taken into consideration for that 3/31 reading, since I am at .1, the only adjustment is no insulin.

Yes, I have suffered from exhaustion. And I don't feel comfortable testing as often as many of the people on this board test. That's just me, and I have to do what's best for my lifestyle combined what's best for Elizabeth. Every decision I make since signing on here is done with serious consideration of the advice I receive here. I have relied heavily on this board to advise me, because I think your advice is excellent. I am asking for clarification on this, and would like to know what my options are. You are all very knowledgeable, and I plan to continue taking advantage of that.

Am I to understand that your advice (Julie and Jill) is to continue with the 1 drop of insulin even though Elizabeth's BG is in the normal range? And continue with that dose until I have a reading under 68? Or until more time passes that you feel it's appropriate for an OTJ trial?

Thank you!!! Always appreciate y'all!
 
It's really up to you.

Yes, we encourage people to continue giving the last dose of insulin until the cat drops below 68AT to signal that it's done with insulin. But if you are exhausted and don't feel like you can monitor, for example, then it's probably better not to shoot her. It's a balancing act, isn't it?!

Whatever decision you make is ok.
 
That 49 reading is my other concern with giving a dose at night if you're too tired to monitor. Even if the true reading was somewhere in between the 49 and the 100 (which isn't all that unlikely if you consider that they both might have been off by 20% in different directions), it still might have been under or just about at 68. With numbers like Elizabeth's getting right now, I wouldn't be comfortable giving a shot if I was too tired to monitor.

And yes, you have to make this fit with your lifestyle as well as the protocols. A lot of us have had times where we've skipped a shot or shot a smaller dose (I know, that's not an option for Elizabeth now she's only getting a drop of insulin just as reducing the shot is no longer an option for Rosa) because there was something we needed to do - and I would include a need for sleep in that. I've had to skip a whole load of AM shots recently because Rosa can't be monitored while I'm at work and I'd rather skip than put her at any risk at all. In the end, you have to make decisions you can live with.
 
Vicki said:
Am I to understand that your advice (Julie and Jill) is to continue with the 1 drop of insulin even though Elizabeth's BG is in the normal range? And continue with that dose until I have a reading under 68? Or until more time passes that you feel it's appropriate for an OTJ trial?
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Here's what we like to follow...

Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet. Try to go from 0.25 IU to a drop before stopping the insulin completely. Reducing the dose too quickly generally does not work: most cats do not go into remission with fast reductions.
http://www.tillydiabetes.net/en_6_protocol2.htm

and why:

Short term success is great, but we're looking for long term success.
Over the years we've seen far too many kitties come back here after being OTJ for 2 - 3 months (sometimes 2 - 3 weeks) when things are rushed. While it's nice to see the caregiver again, I feel so badly when I see them back here.

julie & punkin (ga) said:
Yes, we encourage people to continue giving the last dose of insulin until the cat drops below 68AT to signal that it's done with insulin. But if you are exhausted and don't feel like you can monitor, for example, then it's probably better not to shoot her. It's a balancing act, isn't it?!

Whatever decision you make is ok.
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I agree with Julie...
 
Okay - I will do the PMPT and see what I come up with, and no doubt be back here for advice! Thank you!

Or PMPS - whatever in the heck it is!
 
She's 86 at PMPS, and I so with this number and her history the last couple days, y'all say I should give her the insulin, correct? Shot given.
 
Hang in there Vicki. Hang in there Liz!

You are both doing great. So quickly you have come to such a difficult place! The advice here is great, but bodies and brains have their limits. A cat is no good without a human who is rested enough to make decent, informed decisions.
Don't beat yourself up Vicki, and Liz.... cold you just tell us if you'll be OTJ for a while or just for a honeymoon???? c'mon Liz just let the cat out of the bag already! I, for one hope I speak for many who want: their cats to be healthy, their lives to be sane and the cat goddesses to be happy!!!
 
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