? 08/20 Kitty PMPS 87 OTJ Trial?

[Corey & Kitty]

Last thread (08/13): https://felinediabetes.com/FDMB/threads/08-13-kitty-pmps-92.267093/

Okay, so Kitty is on her 7th day at the 0.1 unit dose. Should I begin an OTJ trial tomorrow?

Her feeding schedule is as follows, per cycle:

• Preshot meal
• +1.5 meal
• +8 snack

So her +1.5 meal she doesn't always eat right away, sometimes she goes for it between +2/+3. She doesn't always finish it right away either, sometimes she saves a bit to finish later. I'm wondering if this schedule should be adjusted at all for an OTJ trial or should I just keep everything the same?

She seems to have had more blues for her AM preshot readings at this dose. I've noticed this past week she has been less interested in her +8 snack, often it goes to waste because she hasn't wanted it, and the preshot is more likely to be blue if she hasn't had the previous +8 snack. When she eats the +8 snack then the preshot is green.

 

[tiffmaxee]

She can eat again whenever she wants. . Trying to get her to eat at +1.5 was to prevent big drops . For the trial which will start if green tomorrow morning feed at amps and if green feed normally. If blue wait 3 hours and test again to see if the pancreas does it’s job. I’ll give you directions when I get to my computer.

 

[Corey & Kitty]

So the thing with Kitty is that her baseline seems to be around 100. What I mean by that is that when she doesn't eat the +8 snack, by the time +12 (preshot) rolls around, she may have been fasting for 8 - 10 hours at that point. My point is that usually she gets a green preshot when she's had the +8 snack, but I have no way to make sure she eats that snack, sometimes she just doesn't want it.

 

[Corey & Kitty]

What I'm saying is that if she doesn't eat the +8 snack, chances are she will have a blue preshot.

I wonder if feeding the +1.5 meal later in the day would make a difference.

 

[tiffmaxee]

I understand. That’s still okay. I think some cats just run a little higher than others and some run lower. It’s still within normal bg range for a cat no longer on insulin.

 

[Corey & Kitty]

For the trial which will start if green tomorrow morning

Okay so I have questions. I was confused by your wording in this post. It sounds like you're saying if she is not green tomorrow morning then there is no trial. But she gets blues in the morning quite often. So I need to know, if she gets one of her typical blues in the morning that is around 100-106, I'm still going ahead with the trial and not giving any insulin, correct? What number would be high enough to call it off?

Also, am I concerned at all about ketones when she's not getting insulin injections? I haven't checked for ketones in 2 months, last time I checked she was getting 1 unit of insulin. She always used to fall in the 0.2 - 0.4 range for ketones. I decided to check her tonight and she was at 0.7, I checked again just to be sure and I got 0.5 the second time. I remember a while ago @FrostD telling me that 0.0 to 0.6 is probably a safe range but also that her cat has been as high as 1.2 and been fine. So is 0.5/0.7 on the ketone meter anything to worry about?

She can eat again whenever she wants.

Regarding letting her eat whenever she wants. I'm not home all the time to just let her eat when she wants, which is why I was wondering if I should adjust the auto feeder times at all or just keep things the way they are because she seems content with the food schedule as is.

Sorry about the long post, I'm just getting myself worked up/nervous about not giving her insulin.

 

[Wendy&Neko]

If not green tomorrow AM, the start of the trial is delayed until a green preshot.

Your reaction to a trial/no insulin is very typical.

 

[Corey & Kitty]

If not green tomorrow AM, the start of the trial is delayed until a green preshot.

A little confused by this. It would be nice to have some consistency between replies. I explained above that Kitty often gets a blue preshot when she doesn't eat her +8 snack. Elise replied with the following stating that its okay:

I understand. That’s still okay. I think some cats just run a little higher than others and some run lower. It’s still within normal bg range for a cat no longer on insulin.

So why does a blue preshot delay the trial if its on the first day, but I've seen other members get blue preshots in the middle of a trial and yet not call off the trial. What is the difference?

 

[tiffmaxee]

Instructions for starting the OTJ trial
Start the trial on the next green pre shot.
If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.
Good luck with the trial!!!
Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), test his/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!

I see Wendy has answered you. Good luck with the trial.

@Wendy&Neko Can you please answer the ketones question? Thanks.

It is fine to adjust the feeding times but if she is fine keep it as is. I thought you wanted to adjust the times because she wasn't eating at +1.5 but explained she didn't need to eat then.

 

[tiffmaxee]

It is just the first day of the trial that you need to start with a green preshot. If blue you test in 3-4 hours to see if the pancreas brings down the bg after eating.

 

[tiffmaxee]

I stand by what I said about an occasional blue being fine and still being able to reduce. I have to say I find you confrontational and will let Wendy answer from now on.

 

[Wendy&Neko]

As Elise said, at worst you'd delay the start of the trial by 12 hours. Lots of cats show the occasional low blue preshot during the trial, but go down to green after a meal 3 hours later. It's perfectly normal. We even had one cat hit red after a "dreaded car ride", and brought it down to green on his own the next day. Things happen during a trial, but as long as it's a short high numbers blip and comes down, that's OK.

As for ketones, I'd just keep an eye on them and not wait 2 months in between tests for a while. If you read the following post, there are other reasons ketones/DKA can develop:
Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

 

[Corey & Kitty]

I stand by what I said about an occasional blue being fine and still being able to reduce. I have to say I find you confrontational and will let Wendy answer from now on.

Not confrontational, my apologies for coming off that way. I just get confused and nervous/anxious and like to be 100% sure about what I am doing.

I really do appreciate all the help.

 

[FrostD]

I'll admit I was a more lax ketone tester, mostly because he never really threw any. Once a week, every other week while he was regulated. I haven't bothered to check them now that he's in remission, except for when he's been ill.