? Pearl +39 Looking for those with remission experience..

Pearl and Emily

Pearl and Emily

Member Since 2018
Hi there.
Not looking for emergency advice but was wondering if someone could provide info based on experience regarding the remission process.

Pearl received no insulin this morning, ate a great meal at 6:30a and 6 hours later she's at 39mg/dL (alphatrak). I'm assuming this is caused by the still existent insulin depot and the 1 drop Lantus last night? Just looking for confirmation or other ideas.

Should I be concerned about the insulin depot for a few more days or do we think it's the higher Lantus dose last night that caused this hypoglycemia?

I was considering giving her a kiss of insulin once daily for a bit, but it doesn't seem she wants it.
 
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I would monitor because that 39 is too low on the AT meter.

I don't think you're ready for an OTJ trial with all the blues on the SS. What is your definition of a 'kiss' dose?
 
First, is there any way you can keep Olive out of the dog food?

I would keep your dosing consistent. Trying to shoot down a higher than desirable pre-shot number is not really the way Lantus works. It also makes it hard to evaluate how Olive is doing on a dose. It's also not atypical for the numbers around AMPS to be the last to come down. Some of those numbers, though, are still a bit higher than desirable for an OTJ trial.

You've also been doing a bit more dose adjustment than what's recommended with TR. Again, changing the dose before it's warranted makes it hard to know just how stable Olive's numbers are. I think she's close but I don't think the numbers look close enough for a trial.
 
Sienne and Gabby (GA) said:
First, is there any way you can keep Olive out of the dog food?

I would keep your dosing consistent. Trying to shoot down a higher than desirable pre-shot number is not really the way Lantus works. It also makes it hard to evaluate how Olive is doing on a dose. It's also not atypical for the numbers around AMPS to be the last to come down. Some of those numbers, though, are still a bit higher than desirable for an OTJ trial.

You've also been doing a bit more dose adjustment than what's recommended with TR. Again, changing the dose before it's warranted makes it hard to know just how stable Olive's numbers are. I think she's close but I don't think the numbers look close enough for a trial.
Click to expand...

Since *Pearl got into the dog food yesterday while my husband was home and then for 1 nibble today, we came up with a solution, so yes, to answer your derisive question, that is possible.

I feel as if when I ask questions, I spend most of my time defending myself.

I have a degree in veterinary medicine, though I have never owned, and managed a diabetic cat myself. She is not a typical DM cat as she is very young and it was brought on by chronic Prednisolone use. Those two factors make her more likely to go into remission, FYI. Switching the food recently has obviously made a huge difference. With the Alphatrak and many meters, the difference between 111, 101, and 115 could be absolutely nil, or it could actually by 10+ mg/dL. Just because 100 is still considered "blue" on the chart does not mean it is any more of a deal breaker than 99.

To address the dose adjustments:
Throughout my experience in helping clients with their diabetic patients, we would NEVER Rx a dose of 0.25u (2gtt) or .1u (1gtt) as it is SO objective. It's never going to be 100% accurate, so if one day I said I gave *Pearl 1gtt or 2gtt, it's very likely to be inaccurate by +/- 0.5gtt. So if you want to reprimand me for giving *Pearl 2gtt instead of 1gtt I get it, but it is not even something that is done regularly for the majority of the population. Pearl's attending veterinarian thinks I should just be giving 1 dose of Lantus SID, which is considered a normal and reasonable course of treatment and because she has 25 years of experience! I am doing more than that by giving her daily droplets.

*Pearl has a unique food schedule that we are also working out. It is needless to say that 1.5 hours postprandial she is going to be at her highest BG. That being said, today her postprandial number was 130mg/dL which is a totally acceptable number after a decent sized meal. She regulated herself down (with the help of what you call my shooting down of a high number dose) to 39 mg/dL after just 6 hours. Which would most likely indicate, she was capable without the Lantus to regulate into a safe zone. (I have asked others for their opinions on feeding schedules but that post was another nightmare of condescension)

I guess I will use my own judgement going forward so as to avoid the judgement on here. Thanks for your input.
 
Hey @Pearl and Emily , I’m sorry that the responses you got here upset you. I actually felt similarly when i first came on here, I am not sure why sometimes responses come off that way. Maybe people are in a rush to respond to multiple posts, and just come off very “matter of factly.” But once you stick around for a while and learn the protocols, and get to know the people here, i think you may learn a lot to help your own cat, as well as your patients as well. So, first of all, welcome to the forum :)

I’m a PA by profession also (even though obviously human medicine is different), so I understand that part of what you’re saying as well. I honestly don’t think you’re being judged, and I would love more vets to learn more about our approach here, so i really hope you stick around :) I also just love “meeting” and talking to fellow health professionals (in any capacity)

Have you had some time to review the 2 protocol this site developed for managing feline diabetes? It does talk about the recommended time to holding doses, and how to make adjustments based on nadirs, rather than pre shot numbers.

Take a look and see what you think. Some people on here use digital calipers to measure out doses less than 0.25u. I never did any of that and never gave less than 0.25. Unfortunately I lost my baby to his multiple medical issues last week :( he had Cushing’s disease and skin tears and a rare cardiomyopathy. It’s been hard. However, I want to stay here to try to help other members.

Hope to hear from ya! ❤️

Ana
 
I apologize if my post came across as judgmental. I don't know that I've spent much time in your condo and I do tend to go into teaching mode. There's no way, unless someone discloses it, to know anyone's background or experience.
 
I have experience with getting Davidson (GA) ,who sadly recently passed, into remission 4 yrs ago, and again prior to having to say goodbye to him early Sept., and he was again going into remission but things changed rapidly. I also helped Garfie achieve remission last week and have to agree with Sienna that a couple of things need to occur before the R word comes into play.

First as you’ve heard' stick to the low carb wet food only, test often and be consistent with the dosing. Yes, there’s a 10-20% + or - factor on the meter readings. And yes, when micro dosing it’s difficult to get the precision on the exact amount each time you fill the syringe. However, I know I was at least consistent with the doses and tried to pin point a place on the wall or sem area that I used to measure up the dose. I couldn’t have Ben too bad hainvg reached remission, lol.. you can use calipers if you like. I never did even though I have them here, my eyesight is still eagle sharp......others aren’t so lucky.

Nothing is EVER personal on this sight, and being dyslexic I know first hand who difficult it is to comprehend emails or what someone is trying to convey. Then add stress, anxiety, pressure and being overwhelmed to the equation and everything reads wrong. We’re all here for the same reason - solely for our kitties health, and some like myself most recently are here to help others since our beloved kitties have passes over the rainbow bridge. Sure I haven’t been here often, it’s difficult having just Davidson, but I’ve been active with members on a daily basis and contribute when I can.

We, like our cats are all different. Some understand better the others, and others need a lot more help as the try to understand the complexities of this disease. Be patient you’ll get the help you need.

Looks like the insulin is still needed, maybe not for long but there’s too many blues over 130 from what I see to start an OTJ trial.

Keep asking questions, there are no stupid ones and eventually it will all come naturally to you.
 
the best remission is a strong remission where you microdose until you are giving no shots. The best way to really do that is to use calipers to keep the dose consistent. I can put the link on here for microdosing if you are interested.
Some syringes can have their markings differ a lot even from syringe to syringe.

It sounds like there may be a condition that could need prednisolone in the future which will very likely make you lose remission status. You will want to always monitor bg so that you can stay on top of that if that is the case. Unfortunately, once a diabetic, always a diabetic. But remission sure is sweet.


I hope you will give every one another chance. No one means to sound judgemental... lately there aren't as many here to advise as there used to be. Some of us oldtimers get distracted by other life occurrences. I used to spend hours here every day and with all the newer members, I don't know histories like I used to.
 
@Pearl and Emily my first diabetic, although older than Pearl and not steroid-induced, also headed into remission quickly. FWIW, and I have the utmost respect for anyone measuring doses with calipers and taking that extra time every day, my dosing was much less scientific than that. I did dose in 0.25 unit increments, using 0.5 u marked syringes and simply getting the dose between the two markings the best I could. Once I got below 0.25 u, the only doses I did after that were 0.1 (as close as I could get to 1/2 of the 0.25) and 0.05 u (which for me was the hub of the needle). I understand the concerns over the markings on syringes maybe not being consistent, but I can honestly say I never saw enough of a variation either visually on the syringe or in the numbers I was getting to make me worry about it personally. When it came to the 0.1 u dose, I simply tried to make my doses as consistent to each other as I could - it mattered little if they matched anyone else's idea of 0.1 u (and they probably didn't since many seem to do 2 drops and 1 drop as lower doses than the 0.05, which was the smallest dose I was comfortable measuring) as long as I was dosing as close to the same amount each time as I could. I didn't ever do drop dosing because, although I tried, I wasn't able to consistently push drops of the same size out of any syringe. Ultimately, it mattered little and Rosa made remission and maintained it to the end of her life.

I do notice there are comments saying you're seeing too many blue numbers to consider remission. However, given that the spreadsheet is designed around the use of a human meter, with a normal range of 50-120 and you're using an Alphatrak with a normal range of around 68-150, this could actually be a bit of a red herring. The green numbers for a human meter run to 99, leaving only 20 points that are still in the normal range but blue. If you translate that to the Alphatrak, you're looking at being able to go to at least 120, or maybe even 130 and still call that a "green" number. With that said, there are still a few numbers in there that are over 150, although the only ones in the last week appear to be after Pearl managed to steal a bite of dog food. If you've got that problem resolved, then you have my total respect - with the best will in the world, there were days when Rosa managed to sneak a bite of dry food from one of the other cats, or even steal a potato chip or other human food item that one of the kids had dropped on the floor. Unfortunate things happen despite our best efforts.

Overall, I suspect Pearl is extremely close to remission given her numbers over the last week - the secondary way of a cat "earning" reductions is for them to see all normal numbers on their current dose for a week and, had it not been for the dog food incident, you may very well have got those over this last week. Given the drop into the 30s, albeit off the back of a skipped shot, when the protocol calls for an immediate reduction from a drop below 40, you would be justified in trying Pearl off insulin at this point. Or you can continue with an ultra-low dose until you get a drop below 50 on a day when she's had insulin. That choice has to be yours, although if you do stop the insulin you should be ready to re-start that low dose if her numbers start to increase out of the normal range for the Alphatrak.
 
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