08.15.22 Chispa, 266 AMPS, 268 +4, 375 +11

Yesterday: https://felinediabetes.com/FDMB/threads/08-14-22-chispa-347-amps-332-2-333-6-467-pmps-367-2.267129/

Back in the yellow this morning! Hope everyone has a happy, healthy day.

 

What a lovely yellow PS! Have you heard back from your vet yet? Are you going to go "rogue" and bump up the dose some more?

It also took a lot for me to switch over from the advice of my vet to the advice of this board. But I feel really comfortable with the TR protocol given its peer-reviewed state, as well as the collective decades (centuries??) of experience this board represents, and I wanted to do what I ultimately thought was best for my cat, which wasn't quite what the vet was pushing (too much insulin, backing off too quickly).

 

I too at first wondered why would I listen to strangers over my vet. I soon realized people here knew what they were doing. My vet told me I managed Max better than any client and showed his spreadsheet to his veterinary students.

 

I am a general believer in the idea that it is better to ask forgiveness than permission.

I felt like my (very good) vet was not going to give me the explicit okay for a plan that their average client probably would/could not carry out without some risk to the cat. She did allow SLGS, but I soon moved us to TR unilaterally. When she saw the careful spreadsheet and saw how well things were working, she was fine with the changes I was making.

 

Thank you all for your thoughts & encouragement. I haven't heard back from the vet yet (very unusual), but your point (Catherine) about asking forgiveness rather than permission is well taken.

I had a note from moderator Wendy on yesterday's thread -- she commented that "TR would require at least 2 tests per cycle, the preshot plus one other. If you cannot get that second test per cycle, best to stick with SLGS for safety's sake. TR also requires 100% low carb wet or raw food diet." I've been transitioning Chispa to a low-carb diet but am not 100% there and don't know whether changing over completely is going to work for her or not. She also has CKD and GI issues and has done so well on the "prescription" renal diet that I am somewhat nervous about messing with success. But we know the prescription diet's carbs are much too high for a diabetic cat, so at her current mix of 1/2 Royal Canin (16% carbs) plus 1/2 Weruva (4% carbs), her diet is around 10% carbs. If I could nudge that to 1/3 - 2/3, we'd be at <7% carbs. I asked Wendy whether that would qualify as TR-appropriate but haven't heard back. I thought I might put the question out the the group later to find out what others are feeding their CKD + diabetic cats.

 

The only reasons not to drop TR are if you can’t get at least 2 tests every cycle and more as needed. Feeding a 10% carb diet would not preclude doing TR.

 

Thanks so much, Elise -- that is good to know. I work from home, so it's usually not a problem to do two tests or more per cycle. But what do folks do when they are going to be gone for most of a day, as I was on Saturday, and it's not possible to get that second test?

I was also worried about my upcoming week of travel (Aug. 24-31), but Cali S explained about lowering to a temporary "vacation dose" to keep her safe. That being the case, do I really need to get a Libre for her for that week, or can she coast safely on a lower dose?

One other question ... after re-reading the TR and SLGS sticky, I'm still not totally clear on what is the advantage of TR. Is it a faster route to regulation? Is it healthier because it aims for lower BG numbers? Does it more often result in remission?

Apologies for peppering you with questions!

 

No need to apologize. It’s confusing. Many people but an auto feeder that they set to go off at times when they won’t be home and when they need to sleep. Once you have data you know what type of food (lc, mc, hc) in the feeder.

We can help with a vacation dose. It’s too soon to decide but about 3-5 days before you go we will figure that out. Right now you could increase to 2.5 with TR. With SLGS you hold each dose for 7 days and then decide if an increase is needed. If ever under 90 you decrease. Even if the bg goes up and stays high you need to wait 7 days to increase. With TR if a reduction fails, there’s not a strict number of days to wait to take the dose up.

TR is a faster route to regulation. It helps avoid glucose toxicity which can happen when a dose is held too long. With glucose toxicity you eventually need to keep raising the dose. TR allows for a longer time in pancreas healing normal bg because they don’t earn a reduction unless the bg falls under 50 vs 90. Normal bg is 50-120 for cats not on insulin. And finally yes, more cats go into remission on TR than SLGS but we do see cats go into remission on SLGS as they still can become diet controlled by eating lc.

A Libre is not needed while you are gone but might give you peace of mind. Her current dose would be fine while away.

Keep asking questions and hear what others say. Look at other spreadsheets. Nothing has to be forever. If you want stick with SLGS until you come back from vacation and then see if you want to try TR. You can go back and forth if too much for you or if you feel progress is not being made with SLGS.

Does this help?

 

That helps TONS. I feel better already. Thank you!!

I raised the dose to 2.5, so we'll see what happens over the next few days. One thing I noticed is that she is drinking less, which I guess is good (?). She's cleaning her plate at every meal, but she's not asking for food -- unlike before, when she would jump up on my desk and MEOWWW right in my face to let me know it was time for a meal! It seems like she is more stationary lately, spending most of the day and night in one particular spot on the rug near my desk chair, whether I'm in it or not. She's also getting up on the furniture less. She hasn't been much of a jumper for a least a couple of years, but twice lately I've seen her put her front paws up on a chair and not get quite enough lift from her back legs to make a successful jump. On the other hand, she got a clean bill of health at her recent visits with the internist and the cardiologist (other than the diabetes, that is), so hopefully everything is ok.

 

Oh, and I also got the Keto-Diastix and tried them out over the weekend. There were no ketones in her urine, but the glucose was off the charts, which I guess we already knew.