03/13 Rosa OTJ Trial Day 2 AMBG 115 PMPS 129 +2 53 +2.5 87 +3 80 +4.5 83 +5.5 80 +7 90 +8 102

Status
Not open for further replies.
I'm really not liking the numbers she got while I was out at work - I'm not sure she's going to make it this time around. I'll see where she is at her usual evening pre-shot time, but I'm not all that hopeful of her making the full trial just yet.
 
Hi April,

just wondering if you know how many drops were in your 0.1u? It can really vary depending upon the syringe. If she keeps trending up I would consider restarting the insulin. Usually when a cat starts an OTJ trial the spreadsheet is pretty much all green, maybe with a low blue (under 120) thrown in once in a while. I hope she's going to turn this around and drop back into green numbers and stay there, but i just wanted to mention it to you to be watching for in case she doesn't. Good luck!

Here's the info from the Tight Reg Protocol sticky about remission:

  • Since 2006 we've encouraged those practicing Tight Regulation to attempt reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission.
Remission:
  • From Tilly's Diabetes Homepage:
    Phase 5: Remission

    "14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible. Test the cat's BGs once per month.

    Approximately 25% cats that achieved remission using this protocol relapsed and required insulin again (frequent causes are hyperthyroidism or bouts of pancreatitis). Therefore, it is important to keep your diabetes kit up-to-date. Then you can react immediately by giving insulin and home testing. Importantly, the sooner you react to a relapse (i.e. preventing hyperglycemia and initiating other necessary veterinary treatment), the more likely a second remission will become.

    The longer a cat has had diabetes, the less likely it will go into remission. Many long-term diabetics get stuck in Phase 3 or 4. Yet there is a benefit of using this method for such a cat as well: keeping the cat's BG levels as normal as possible is much healthier for it long term. Insulin requirements will often decrease to very low levels too."
 
Thanks for the info Julie - I have seen it before, but it really helps to have just the relevant part posted right here on the thread. Especially at the end of a very long week - my eyes are tired already so looking through the whole protocol to find it again probably wouldn't have happened until tomorrow morning :oops: It seemed to be 2 very small drops to 0.1u. Though trying to cut that in half would be difficult - I wasn't able to be all that consistent with getting 2 drops every time so sometimes it seemed more like one bigger drop. That's me not being quite good enough at managing to push the syringe exactly the same amount every time. If she's not looking better in an hour, I'm putting her back on the 0.1u at her usual PM shot time though - I don't want her getting much higher than she is now. I was just talking about it with Michael when I got home from work as it's him who's in for most of the daytime testing, but he agreed that he'd rather test her for longer than let her go much higher at this point.

If we weren't still testing fairly frequently, we'd probably not even have noticed - her AMBG this morning was fine for a first thing in the morning reading. And if she'd got a decent PMBG we might not have realized she didn't have great control during the day if we'd dropped to just testing twice a day immediately. We just weren't comfortable taking out all the tests except 2 a day to begin with - and if that means we find out early that she isn't quite ready yet, that can only be better for her.

If I have to restart the insulin tonight, I'm thinking of giving her 0.1 as an initial dose to get control back quickly but then maybe trying to cut that in half as she did seem to be getting some inverse curves on the 0.1 which was why when she did so well the first couple of cycles without I thought it was worth letting her try. I'll have the weekend to figure out consistent dosing of 0.05 at least which should help.
 
manxcat419 said:
If I have to restart the insulin tonight, I'm thinking of giving her 0.1 as an initial dose to get control back quickly but then maybe trying to cut that in half as she did seem to be getting some inverse curves on the 0.1 which was why when she did so well the first couple of cycles without I thought it was worth letting her try. I'll have the weekend to figure out consistent dosing of 0.05 at least which should help.
Click to expand...
Inverse curves can also be the sign of too little insulin, so they aren't a great indicator on what to do. If you do restart insulin, good luck finding a consistent dose. Those tiny doses are the hardest.
 
It doesn't look like too much insulin to me - but she does have some odd looking curves and I can see what you mean. Rather than being inverted, it looks to me like her nadir has moved - so her highest tests are in the midcycle and her nadirs are closer to preshot.

Taking her off of insulin for a couple of days, though, is going to be good for answering if she was getting too much insulin. Sometimes you just have to try things out to see.
 
Good luck with whatever you decide to do. If you do have to restart the insulin please don't think of it as a backwards step. The advice I was given is that you need to chase the green numbers and if that means a little more support with insulin then that is the way to go.
 
I put her back on 0.1u. I don't want her trending any higher so I'd rather put her back on now and get control back. She'll have other chances if and when she's ready. I'm starting her back at 0.1 - I'll see where she goes with that over the next few cycles and take it from there.

It kind of feels like a slight backwards step (probably because I've had a tiring week - it would have been nice to have something go right without any fuss) but it's obviously what she needs for now so let's get the control back for her and see where she takes us next. :) And at least she didn't finish up over 220 so there shouldn't be any long term damage done :)

And, yes, I do think it was the only real way to find out whether she was ready or not - I'm just glad she didn't get too out of control before we noticed and put her back on a small dose.
 
I'm glad you restarted insulin. It actually looked like Rosa's numbers may have been trending up when you stopped shooting. I tend to like to see a kitty on insulin as long as possible so you can support her pancreas while it's healing.
 
I really don't know - she'd thrown me such confusing numbers over the few days before I had to skip the shot. I might never really know what was going on there - when I charted her numbers, it looked like inverse curves but there's always going to be an element of guesswork involved in interpreting anything like that as to whether it's an inverse curve, a late nadir or an overall upwards trend. I'm glad I let her try - and even more glad we were testing more than twice a day so I spotted the problem early. I might not have worried about a 129 after this morning's 115 if we hadn't got some tests in between.
 
oh boy. You might want to keep her over 50 so you can continue giving her insulin for a little bit.

Can you measure a dose that's less than what you gave tonight?
 
I'm trying but she really doesn't want to stay up. And she's in a hideous mood - she's been getting like this recently whenever she gets close to or under 50 :( I'm not sure about accurately measuring a smaller dose - I'm going to try, but it's almost impossible. Even the 0.1 often feels like I'm giving her nothing.

I'm just really finding this difficult at the moment for the first time in weeks - I don't feel like I can get anything right for her right now :(
 
Thank you. I just feel like I'm damned if I do and damned if I don't with this tiny dose at the moment. Of course now I'm questioning whether I should have given her another couple of cycles without insulin before I called it a failed trial too - I thought I was doing the right thing giving her the dose tonight! I'm checking every half hour or close to it at the moment - I know from experience if I don't she'll crash at around +4 or +4.5. Well, she might anyway, but at least if I'm on top of the testing I'll know about it as soon as it happens.
 
Looks like it's going to be another very late night. I can't leave her until she gets close to or over 100 - she's nowhere near holding the 80s on her own. And of course now she's not hungry anymore either.
 
I found the beginning of the diagnosis and this bit of journey the most stressful.

I would get the lowest dose possible by getting down to 1 big drop, I would push this drop so it beaded at the end of the syringe then draw half of it back up the syringe and tap what was left exposed off . So I was left with a very small drop in the syringe. Hopefully that makes sense.
 
It does make sense, thank you. I'll try that tomorrow - I think the 0.1 does seem to be just a little too much, but nothing wasn't quite enough. I still think she's on her way to a full trial, she's just not quite ready yet, but it's close! :)
 
Status
Not open for further replies.
Back
Top