? 12/1 Teddy AMPS 247 PMPS 253 “Question”

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Sher (Teddy)

Sher (Teddy)

Member Since 2021
Teddy is a 13 yo neutered male tabby who was diagnosed with DM a year ago (excess thirst/urination/appetite with weight loss) who responded well to switch from dry food to Friskies Pate LC canned food and glargine insulin, with reversal of his clinical symptoms. His vet has been very supportive of my desire to use the TR protocol. My frustration is that I feel like we are moving in circles and have not achieved remission. He has hypoglycemic nadirs out of the blue; all have been asymptomatic, even when down in the 20s. Then he rebounds to hyperglycemia in the 300s (3 times in the 400s). I follow the protocol with dose adjustments, being much more conservative and very cautious about his dosing when I am away all day at work on M, T, some W when I cannot monitor his BG midcycle. I feel he has never been regulated, although his insulin requirement is lower than it used to be. Is he one of those cats that gets stuck in Phase 3/4 or is there something I am doing wrong? Are his flats in the 200s suggestive of chronic rebound and he actually needs a lower dose? Please review his spreadsheet and let me know what I should be doing differently. I worry the possibility for remission is slipping away from us.
 
It's a little hard to tell with the lack of midcycle testing; if your schedule doesn't allow, I'd suggest following SLGS instead. Some of these nadirs make me wonder if you're missing reductions overnight or cycles you don't get a mid test on. At the very least, I would not consider increases until after 10 cycles on a dose and you can do a full curve (like on the 19th - that 54 you got tells me perhaps the increase was premature).

@tiffmaxee @Bandit's Mom @Wendy&Neko @Bron and Sheba (GA) thoughts?

What's his feeding schedule?
 
Wow, thanks so much! Yeah, I know what you mean about missing all those midcycles. Sometimes I get up in the middle of the night on work nights to get one. Teddy is open fed and has access to fresh LC canned food at all times.
 
Have you happened to notice when he eats the food? My cat also free fed, but when he was on insulin he tended to snack early on, then eat the bulk of his food a bit before nadir, then barely anything after nadir.

Just wondering if maybe he needs his meals spread out differently to help flatten his curves out a bit
 
TR requires a minimum of two tests each cycle. How long are you home after amps? Is there any way to move shot time so you can get a +2 or even a +1? Do you have an auto feeder?
 
Despite the improvement of his clinical symptoms, he still seemed to eat a lot until the last several weeks; seems he was eating all day long, occasionally scarfing and barfing. Now he is eating less, but he still visits the bowl throughout the day. No autofeeder - the days I work, his bowl gets topped off by husband; the days I don't, I can keep a closer eye on him. On work days, I leave about 1.5 hours after his insulin is given, then get home about an hour before it is due in the evening.
 
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