When her staff calls me tomorrow to talk about the emails I wrote over the weekend, I will try to tell them nicely that I would like to keep following the TR protocol (yes, I sent them some Romp and Rand articles, the link to the dosing page etc,
I hope they will take a look at them).
As time goes by, I think you'll be glad you did.
I have the impression that this vet does not aim for any remission, but rather to regulate cats around 200s. Which is probably why she does not feel the need for caregivers to monitor at home.
I'm not surprised. Actually, running cats in the 200s as the goal is more common than not. The reason is many people, for one reason or another, cannot or simply do not have the time to do better for their diabetic cats. There's no judgement from me.
I've often thought back to the years when I was a single mom with 3 kids of my own, temporarily raising 2 of my sister's kids, with 3 dogs and 2 cats, working a full-time job, AND getting my Master's degree all at the same time. There's simply no way I could have spent the time I did on Alex back then. Running Alex in the 200s and hoping for the best would have been all I could manage. It happens.
Some just aren't interested in putting the extra effort into their pets. Some can't for legitimate reasons. No judgement. Again, to each his own. Deciding where
you fit in all this is a personal decision for you to make. It may be that running Macka in the 200s is right for you. I don't know. It's not for me to say.
I've been waiting for the dose breakthrough! Macka is a funny guy, he'll throw a nice curve, then bounce forever, then stay high and flat and then needs more insulin. I don't understand the mechanism behind his body always needing more insulin.
What you're seeing is pretty normal. You've been treating Macka for months and have yet to come close to an optimal dose. Simply put, he needs more insulin before you'll ever see any break through. He's just not there yet, but he will be. The TR Protocol will get you there if you stick with it.
My biggest fear is missing a hypo episode. Plus, I don't have enough experience to anticipate accordingly. He makes such dives that I fear he would hypo from a 500 in 2 hours, but maybe it's just my anxiety talking and that is improbable.
When Macka throws you a lower preshot number or the +2 is the same or lower than the preshot number, hop on the forum for help. Someone will keep you company as well as offer guidance. You don't have to go through it alone.
It's certainly possible you're worrying unnecessarily. Someone will say so if you ask. They might even go as far as tell you to go to bed and get some sleep. Believe them. There will be plenty of times when you'll have to stay up to steer the curve and/or intervene with high carb food to keep him from dropping too low.
I strongly recommend studying this document:
Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers.
If you don't have a timed feeder for Macka, get one. Knowing that he has food available if he drops a little lower should ease your mind.
When numbers are very low, how long does it take to go from very low to a seizure? How much room do we have to react? I'm going to have to work again very soon and leave him home alone, it terrorizes me.
I won't lie. Kitties can go from low to seizure in the blink of an eye.
HOWEVER, since we're testing we can intervene
before that happens. I've been here over 13 years and I've yet to see a kitty go into seizures whose caregiver is testing and following the TR Protocol... and it's an aggressive dosing method!
I also encourage you to become very familiar with this document:
Don't Panic! or How to Handle Low Numbers. Learn it like the back of your hand.
I have hopes that Levemir might give flatter values and play less with my heart and sanity because more predictable. You switched to Levemir after Lantus, would you say that it is the case?
Levemir does offer flatter cycles for some kitties, not all. The only way to know for sure is to try it. However, Levemir is not a miracle answer. The average caregiver will pay their dues with Levemir, just as they did with Lantus. In other words, one still has to put the time in to learn kitty's response to the combination of food and insulin after switching to Levemir. Lev cycles won't flatten out until you get close to an optimal dose, just as with Lantus.
As for my own experience switching from Lantus to Levemir... it doesn't apply to your circumstances. Alex had been in remission for almost 3 years when a simple case of gingivitis put her back on the juice. I tried Levemir simply for the experience. Although, I do prefer Levemir and wish more cats were started on it when they get diabetes. The overall remission rate is only 3% less than Lantus... negligible at best.
Another question: bouncing cats, are they more protected from a hypo because of their panicky liver that will always intervene before anything bad happens?
No, I can't say that. However, many years ago we had a cat here that had undergone a very severe vet-induced hypo. Kitty miraculously survived, but rarely, if ever bounced again after that. Because that natural protection was damaged or perhaps gone, we didn't encourage the caregivers to allow kitty to drop into low numbers. It wasn't worth taking any chances. It's one of the reasons I sometimes get irritated when I hear caregivers whine about bounces. Thank g_d your cat bounces! It's exactly as it should be. If kitty didn't bounce, I'd be terribly worried. I only wish some weren't so darn good at it!
Interestingly, his PMPS was way lower the usual aka 308 (new thread for that). Let's see how he behaves tonight and tomorrow morning.
I'm guessing he'll bounce from yesterdays drop into yellow, but let's see how it goes. Kitties just love to make liars out of humans when they attempt to predict the future!
(I am still far from being at peace with the FD journey. I feel like I'm falling deeper into a state of depression and people around me worry. I cry a lot, I have anxiety attacks, and now my immune system is weakening=big mess. I need to find balance and peace, and I just don't know how. The more I increase, the more I will panic about the outcome. Sleeping well would help I suppose, but it's a thing of the past. This forum, and the beautiful people on it, of course offer a valuable support, and I am so glad it exists. Maybe once I see Macka happier and healthier that will put things in perspective?)
One thing dealing with feline diabetes has taught me is looking for and finding a reason for everything that happens is an exercise in futility. When I began to go with the flow instead of questioning everything (for which I would never find answers) is when I was able to stop banging my head against the wall and dry my tears. I was able to relax and begin treating the illness as "just something my cat had" instead of feline diabetes becoming the sole focus in my life. Sure I worked things around Alex and I did miss some social events, but they were choices.
A word of advice... sleep whenever you get the chance. I needed sleep... to the point that there were times when I felt like I hit a brick wall and couldn't function. I didn't do it often and obviously not when worried about ketones, but there were times when I actually skipped a shot
for no other reason than I needed the sleep. Hell didn't freeze over and Alex was no worse for wear. We all survived.
Again, thank you for your help, so much. And thank you all for your lovely support and friendship.
You're welcome.
While I'm thinking of it...
A word of caution/warning: I would wait to switch to Levemir until Macka's infection is gone and he has healed. The reason being when one switches from Lantus to Levemir the dose is usually reduced to 70% of the last Lantus dose. We don't want to reduce the insulin dose when infection is present for fear of ketones developing.
He's all swollen, shaved on the face and down. It makes me really sad.
