1/1 Sebastian PMPS 277,+3-294,+4.5-240

[Caryl & Sebastian & Alex (GA)]

HNY LL,

yesterday


I hope everyone had a nice New Year's Eve. I stayed home with my 3 cats and watched TV.

Well I sure had a surprise last night. I have been shooting .25s for the last 3 days (and just an FYI, Sebastian eats VERY well). On one of those cycles I even gave him Wellness NON-grain free food in error and he came through it in the blues. I have noticed (and someone else did too-Julie I believe) that Sebastian nadirs very late. I've been shooting through it because the numbers haven't been scary low and I figured they'd rise which they have been....until last night. I checked him at +5 and he was at 42 :shock: I don't panic at this cause I had a lot lower with Alex but I don't take it lightly either. I fed him 1/2 can of chicken gravy lovers FF and tested an hour later and he was at 100. I overslept this morning but he was at 284 at +13 which I totally expected. I shot .25s to get through the bounce but....

Should I be decreasing him tonight? I know below 50, decrease. But to what? Alex was a 2.5 U tid cat so I don't have a whole lot of experience with kitties that react so well to insulin!! (Not that I'm complaining) :razz:

I'd appreciate advice...thanks

 

[Rachel & Chyna (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease?

Morning Caryl Wow, nice eye opening drop! When I went down from 0.25, it was to 0.1 (or 1 drop). I'm terrible at microdosing and there are many ways to do it and different sizes of drops...but one member said to me that she pushed the plunger in hard, then put it in the bottle of Lantus and let off the pressure so it pulled in 1 drop. Then push the plunger super hard when it's in kitty to get that drop out...that worked for me and I practiced with a syringe and water for awhile :lol: I never knew the trick of screwing the bottom of the syringe till then either, instead of just pushing the plunger to adjust the dose, I had a lot of wasted insulin I guess, haha.

I'll try find the posts on microdosing for you...I know the protocol on reducing says "Try to go from 0.25u to 0.1u before stopping insulin completely" ;-)

Happy New Year to you too :smile:

Edit: found some of the pages with pics: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139
http://www.felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease?

Morning Caryl Wow, nice eye opening drop! When I went down from 0.25, it was to 0.1 (or 1 drop). I'm terrible at microdosing and there are many ways to do it and different sizes of drops...but one member said to me that she pushed the plunger in hard, then put it in the bottle of Lantus and let off the pressure so it pulled in 1 drop. Then push the plunger super hard when it's in kitty to get that drop out...that worked for me and I practiced with a syringe and water for awhile :lol: I'll try find the posts on microdosing for you...I know the protocol on reducing says "Try to go from 0.25u to 0.1u before stopping insulin completely" ;-)

Happy New Year to you too :smile:

Edit: found some of the pages with pics: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139
http://www.felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

I just looked at Chyna's SS as I did with a few others that I knew went OTJ and when you decreased her she was already mostly green and you didn't decrease her because she went below 50. It was just time to see if she was ready to go lower, correct? Sebastian has been mostly NOT green so I'm really confused nailbite_smile

 

[Rachel & Chyna (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease?

TR protocol says decreases are also done when the kitty stays in normal numbers in that dose for 7 days, that's why I did those reducies Chyna flew down the ladder after her switch to all wet food, so some of her decreases were from that too, as I had to work and wanted to be safe. Then her dental took out those infected teeth and showed me her pancreas was working but needed a few more weeks of support

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease?

Decreases are also done when the kitty stays in normal numbers in that dose for 7 days, that's why I did those reducies Chyna flew down the ladder after her switch to all wet food, so some of her decreases were from that too, as I had to work and wanted to be safe. Then her dental took out those infected teeth and showed me her pancreas was working but needed a few more weeks of support

I noticed the same 7 day pattern on several spreadsheets. Sebastian doesn't have that so I'm uncertain. Maybe I'll just ask for eyes

 

[Rachel & Chyna (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

For sure, I'm not an expert, just reading through the protocol I'm not sure if Sebastian is considered long term or new with the OTJ thing and reductions are based on that in the protocol too...Your subject should be about reducies though, dosecrease is an increase ;-) I hope someone can come and confirm what you should do for this

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

I do trust Rachel's advice but I'm also scared that with Sebastian getting numbers in the 200's -even the low 200's-pretty often .1 may not be enough. I think I need some dosing help here. I may have started in the wrong place because I started blindly-ish. When I adopted him I thought he was OTJ but SURPRISE!!! (He hadn't been tested in quite some time and all I've seen is a ss from years ago

 

[Rachel & Chyna (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

Sorry I can't help more, I just don't know enough about reading spreadsheets, just TR protocol, and ECID :sad: . It's early yet, on a stat, there will be more people along soon Hopefully, Sebastian will be back OTJ before you know it!

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

Sorry I can't help more, I just don't know enough about reading spreadsheets, just TR protocol, and ECID :sad: . It's early yet, on a stat, there will be more people along soon Hopefully, Sebastian will be back OTJ before you know it!

you were VERY HELPFUL. Please don't apologize silly!!!! :razz:

 

[Sienne and Gabby (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

Just to make this even more complicated, Sebastian is not a newly diagnosed diabetic. With a cat that's more than a year past diagnosis, numbers need to drop below 40 to warrant a reduction if you're using the modification of the TR protocol in the sticky. OTOH, the 42 is pretty close especially since that was your first test after PMPS. Here's the quandary as I see it.

If you think Sebastian's numbers actually went lower than the 42, then you need to take a reduction to 0.1u,

If you don't think he went lower than the 42, you have 2 options.

• You can take the "skinny" off of the dose and try to measure a fat 0.1u.
• You can opt for the approach that the German forum uses and hold your current dose until Sebastian drops between 40 - 49 three times and then take a reduction.

You don't yet have a ton of data with Sebastian, especially when it comes to shooting low numbers. The next time you see a green pre-shot, I'd get a +3 test. It will give you some sense of where the cycle is heading. (You may need to play this by ear given the later onset with Lev.)

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

Just to make this even more complicated, Sebastian is not a newly diagnosed diabetic. With a cat that's more than a year past diagnosis, numbers need to drop below 40 to warrant a reduction if you're using the modification of the TR protocol in the sticky. OTOH, the 42 is pretty close especially since that was your first test after PMPS. Here's the quandary as I see it.

If you think Sebastian's numbers actually went lower than the 42, then you need to take a reduction to 0.1u,

If you don't think he went lower than the 42, you have 2 options.

• You can take the "skinny" off of the dose and try to measure a fat 0.1u.
• You can opt for the approach that the German forum uses and hold your current dose until Sebastian drops between 40 - 49 three times and then take a reduction.

You don't yet have a ton of data with Sebastian, especially when it comes to shooting low numbers. The next time you see a green pre-shot, I'd get a +3 test. It will give you some sense of where the cycle is heading. (You may need to play this by ear given the later onset with Lev.)

:YMSIGH:
I'm wondering if Stefani kept a spreadsheet on Sebastian. I have the one Venita used but there is no way that this cat needs split dosing anymore. The insulin more than lasts its 12 hours. (actually Stef split dosed also so it really wouldn't do me any good now) I guess a fat 0.1 would be exactly the same as skinny-ing down a .25s? (yes I have the pictures if only the syringes were actually that big)

I don't think it's going to take much to get him back in remission and I'm thankful that he's not going into the 3 and 400's (unjinx)...I just don't know.I really would like to avoid the bouncing and high carb food because until last night I haven't given him any (on purpose)


I really don't think he went lower than 42 because his pattern is to go lower later.

I thought the German Forum was the TR protocol? I know you read a lot. What are you comparing it to?

Thanks so much Cheryl

 

[MrZ]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

Hi Caryl,
Zeke and I are fairly new members to the FDMB family. I'm Laura and Zeke is the youngest of three kitties that my husband and I have the pleasure of "serving". You have the benefit of the most knowledgeable and caring people in the "business" available to you right here on FDMB to offer dosing advice so I therefore would not even think to provide any myself. I do however want to offer my morale support as you help Sebastian with his FD. In reading Sebastian'S profile I'm compelled to say, "Sebastian got the best Christmas gift ever - You as his mommabean (but then again, it sounds like you did too with him)!!!". Had he been adopted by someone else that didn't already have the FD experience that you have, I don't believe it would have gone well for him. You're on top of the situation and I will be checking Sebastian's condo and rooting him (and you) on to a happy, healthy life. Regards.

 

[julie & punkin (ga)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

hmm, i'm not sure either. I would vary the times you're getting tests, however, rather than always the same time slots. might give us some good info. I'd probably try to get a few more tests in as well, just to fill out the picture, especially since you're assessing the dose.

The protocol Sienne is referring to is the Tilly Protocol. Take a look at the tab with the TR Protocol and you'll see 2 different links in the text. One goes to the Rand/Roomp, which is based on the Tilly, but with slight modifications. Our own is slightly different as well. So there are actually 3 versions of a very similar protocol.

One difference is that we give weight to bounces and hold doses through them.
A second is that the Rand/Roomp and Tilly both have you feeding when faced with a low-preshot number on Lantus. (That would be different with Lev, because of the later nadir that many cats have.)
A third difference is when you take reductions.
Lastly, the R/R offers the possibility of split dosing when faced with a lot preshot. we discourage that.

They are essentially the same but the minor modifications can make a difference to some cats.

 

[Marje and Gracie]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

Lots of good info today to think about. I hope you and the boys all have a super day, Caryl.

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

Hi Caryl,
Zeke and I are fairly new members to the FDMB family. I'm Laura and Zeke is the youngest of three kitties that my husband and I have the pleasure of "serving". You have the benefit of the most knowledgeable and caring people in the "business" available to you right here on FDMB to offer dosing advice so I therefore would not even think to provide any myself. I do however want to offer my morale support as you help Sebastian with his FD. In reading Sebastian'S profile I'm compelled to say, "Sebastian got the best Christmas gift ever - You as his mommabean (but then again, it sounds like you did too with him)!!!". Had he been adopted by someone else that didn't already have the FD experience that you have, I don't believe it would have gone well for him. You're on top of the situation and I will be checking Sebastian's condo and rooting him (and you) on to a happy, healthy life. Regards.

Awww Thank you Laura , as I will check on you and Zeke!

Yes, my Alex, who I lost in June, was diabetic but some people believe that he was an undiagnosed IAA kitty. He took quite a bit of insulin daily and I could just 'feel' what he needed. Not so yet with Sebastian. His body is very sensitive to insulin and I never had the pleasure of micro dosing so while I'm far from new to this board I'm new with this cat :razz: And confused....although Sienne's advice has helped me.

You're right, Sebastian had to go to someone with FD experience ...but I thank you for the kind words just the same. He is a love bug and I'm the lucky one that somebody didn't snatch him up sooner...which I really don't understand but LUCKY ME!!!!

Thanks for stopping by...I'll do the same later or tomorrow. Right now I'm paying bills.......... UGH :roll:

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

Lots of good info today to think about. I hope you and the boys all have a super day, Caryl.

You're not kidding especially after my test just now sigh

A Happy & Healthy New Year to you and your family, Marje! Beans and Kittehs :razz:

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284 dosecrease? Eyes Please

hmm, i'm not sure either. I would vary the times you're getting tests, however, rather than always the same time slots. might give us some good info. I'd probably try to get a few more tests in as well, just to fill out the picture, especially since you're assessing the dose.

The protocol Sienne is referring to is the Tilly Protocol. Take a look at the tab with the TR Protocol and you'll see 2 different links in the text. One goes to the Rand/Roomp, which is based on the Tilly, but with slight modifications. Our own is slightly different as well. So there are actually 3 versions of a very similar protocol.

One difference is that we give weight to bounces and hold doses through them.
A second is that the Rand/Roomp and Tilly both have you feeding when faced with a low-preshot number on Lantus. (That would be different with Lev, because of the later nadir that many cats have.)
A third difference is when you take reductions.
Lastly, the R/R offers the possibility of split dosing when faced with a lot preshot. we discourage that.

They are essentially the same but the minor modifications can make a difference to some cats.

OMG Julie I am confused but thanks for all the info.

I just tested Sebastian at +5 and he dropped 200 points on .25s. I held the dose to shoot through the bounce and had made up my mind to do the Tilly but now I don't know? It seems as if Mr. Pancreas may be sending me signs.....to decrease or not to decrease, any votes?

 

[julie & punkin (ga)]

Re: 1/1 Sebastian PMPS 284,+5-85!

i want to see more mid-cycle numbers, caryl, before i risk giving you an opinion. i am not criticizing, it's just that i don't want to give you poor advice when i can't really be sure how low this is taking him. it's always safe to reduce, of course.

 

[Sienne and Gabby (GA)]

Re: 1/1 Sebastian PMPS 284,+5-85!

Thanks, Julie for letting Caryl know about the "Tilly" page. Here's the full link to the protocol used by the German board. The Roomp & Rand (U of Queensland) is the original TR Protocol. Both the German board, that Kirsten Roomp is involved with, and this board have made modifications to the original 2009 TR Protocol. What it amounts to is that you have options.

FWIW, I usually don't suggest shooting through a bounce unless a cat is in numbers that are higher than 300. This is especially the case when you don't have a ton of data. You're still getting to know how Sebastian responds. I really hope you got another test or two after the +5. I can't tell where Sebastian's nadir is falling and that was a big drop.

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284,+5-85!

i want to see more mid-cycle numbers, caryl, before i risk giving you an opinion. i am not criticizing, it's just that i don't want to give you poor advice when i can't really be sure how low this is taking him. it's always safe to reduce, of course.

Most days I try ri get a +6 during the day. My schedule allows that. Today a +5. Yesterday a +7. Seems to me that these are all pretty much mid cycle. At night it's harder cause I'm usually asleep mid-cycle. I've set the alarm a couple of times but I didn't think I needed to most nights.....

 

[julie & punkin (ga)]

Re: 1/1 Sebastian PMPS 284,+5-85,+8-134

thanks for clarifying all of that, sienne!

caryl, i'm really not criticizing. it's just that i don't know Sebastian and i hesitate to say much without more info. i don't think you need to get up during the night, though. i know i need my beauty sleep! :lol: the next time you're home during the day, could you maybe get 2 or 3 hrs in a row, or something like that. like maybe the +5 and also a +6, so we could see when the nadir is. or a +6 and a +7, something like that. i know that doesn't help you right now for what you want to shoot tonight, but i'd feel better if i could see a nadir more clearly.

you're an angel to take Sebastian in - and it sounds like he's exactly what your heart needed!

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284,+5-85,+8-134

thanks for clarifying all of that, sienne!

caryl, i'm really not criticizing. it's just that i don't know Sebastian and i hesitate to say much without more info. i don't think you need to get up during the night, though. i know i need my beauty sleep! :lol: the next time you're home during the day, could you maybe get 2 or 3 hrs in a row, or something like that. like maybe the +5 and also a +6, so we could see when the nadir is. or a +6 and a +7, something like that. i know that doesn't help you right now for what you want to shoot tonight, but i'd feel better if i could see a nadir more clearly.

you're an angel to take Sebastian in - and it sounds like he's exactly what your heart needed!

I do love him a ton as I love Jake and Dylan. I'm just confused. And now mad at myself cause the snack i gave him at +5 was not lc (it's not on any charts but similar stuff is)so the +8 reading isn't "real". So now his PMPS is going to be high again and I'm screwed :cry:

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284,+5-85!

Thanks, Julie for letting Caryl know about the "Tilly" page. Here's the full link to the protocol used by the German board. The Roomp & Rand (U of Queensland) is the original TR Protocol. Both the German board, that Kirsten Roomp is involved with, and this board have made modifications to the original 2009 TR Protocol. What it amounts to is that you have options.

FWIW, I usually don't suggest shooting through a bounce unless a cat is in numbers that are higher than 300. This is especially the case when you don't have a ton of data. You're still getting to know how Sebastian responds. I really hope you got another test or two after the +5. I can't tell where Sebastian's nadir is falling and that was a big drop.

Thanks for the links again Cheryl...
This is sooooo confusing to me as Alex was so abnormal that I didn't end up following any of this. I want to cry because I feel like I keep doing stuff wrong
The Tilly page is the one I always read. It's the one I have printed out

 

[julie & punkin (ga)]

Re: 1/1 Sebastian PMPS 284,+5-85,+8-134

don't beat yourself up Caryl!!!! it's one great big old learning thing with this FD. 2.5 years with punkin and i'm still learning.

the carbs from whatever you gave him at +8 will wear off by +12. no worries.

 

[Libby and Lucy]

Re: 1/1 Sebastian PMPS 284,+5-85,+8-134

There are some interesting comments in this condo about protocols. Rather than hijacking your condo, since those are not specific to Sebastian, I decided to start a new thread to reply to those: Tight Regulation Protocol: Myths Debunked.

With regards to Sebastian, I agree that you are doing NOTHING wrong, you're just finding yourself all the way back at the beginning of the learning curve. As someone who has now had three diabetic cats, I understand the feeling of thinking you should know what to do, but finding that the new kitty has a different playbook than the previous ones. :?

I would vary the times you're getting tests, however, rather than always the same time slots. might give us some good info. I'd probably try to get a few more tests in as well, just to fill out the picture, especially since you're assessing the dose.

Agreed.

My suggestion is always to try the LL modified protocol first, as long as you can manage the testing. Most cats will become tightly regulated quickly following the modified protocol. If yours does not, then the protocol helps you learn what you need to know about your cat's patterns so you can figure out what adjustments you need to make to get your cat where you want him/her to be. Letting the cat go under 50 three times, or shaving the dose instead of taking 0.25u reductions, are two techniques that work well for some cats. Still, I recommend the "tried and true" first.

For Sebastian, as a long-term diabetic returning from the Falls, we would have you hold the dose until he drops below 40. You don't know for sure whether he did or did not drop below 40 (if so, you didn't catch it, and you don't have the data yet to know when his nadir falls). You can either hold the dose and step up the testing to try to catch when his lower numbers are coming, or you can go more conservative and assume he did go below 40, reduce the dose, and if the reduction doesn't hold then go back up. Regarding the amount to reduce, I would follow the protocol and reduce to 0.1u since you don't yet have any data that shows this will not work. If that doesn't work, there's your data and you will know to try something different the next time.

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284,+5-85,+8-134

There are some interesting comments in this condo about protocols. Rather than hijacking your condo, since those are not specific to Sebastian, I decided to start a new thread to reply to those: Tight Regulation Protocol: Myths Debunked.

With regards to Sebastian, I agree that you are doing NOTHING wrong, you're just finding yourself all the way back at the beginning of the learning curve. As someone who has now had three diabetic cats, I understand the feeling of thinking you should know what to do, but finding that the new kitty has a different playbook than the previous ones. :?

I would vary the times you're getting tests, however, rather than always the same time slots. might give us some good info. I'd probably try to get a few more tests in as well, just to fill out the picture, especially since you're assessing the dose.

Agreed.

My suggestion is always to try the LL modified protocol first, as long as you can manage the testing. Most cats will become tightly regulated quickly following the modified protocol. If yours does not, then the protocol helps you learn what you need to know about your cat's patterns so you can figure out what adjustments you need to make to get your cat where you want him/her to be. Letting the cat go under 50 three times, or shaving the dose instead of taking 0.25u reductions, are two techniques that work well for some cats. Still, I recommend the "tried and true" first.

For Sebastian, as a long-term diabetic returning from the Falls, we would have you hold the dose until he drops below 40. You don't know for sure whether he did or did not drop below 40 (if so, you didn't catch it, and you don't have the data yet to know when his nadir falls). You can either hold the dose and step up the testing to try to catch when his lower numbers are coming, or you can go more conservative and assume he did go below 40, reduce the dose, and if the reduction doesn't hold then go back up. Regarding the amount to reduce, I would follow the protocol and reduce to 0.1u since you don't yet have any data that shows this will not work. If that doesn't work, there's your data and you will know to try something different the next time.

Thank you Libby..so much. Oddly enough it IS like relearning everything I thought I knew all over again. I can hold it I'm home to test. If I decide to go that way I'll be staying with .25s. If not 0.1 and see what happens. I'll be deciding in a few minutes nailbite_smile
Starting at .25 leaves you so little legroom....totally the opposite of what I had with Alex. Now how many days does he have to fall below 40? Is it one or 3 like Tilly? (I KNOW Tilly was a cat for Goodness Sakes the web page starts with the story of Tilly the cat ) :lol:

Sorry I forgot to post on new thread... I will with anymore protocol questions

Happy New Year Libby and to your Kitties too :razz:


THANK YOU JULIE AND CHERYL TOO FOR YOUR VERY WELL THOUGHT OUT ANSWERS. Sebastian and I appreciate it!

 

[Sienne and Gabby (GA)]

Re: 1/1 Sebastian PMPS 284,+5-85,+8-134

((Caryl))

You knew how Alex's FD worked inside and out. With Sebastian, you're essentially at the same place as you were when Alex was first diagnosed. You're going back to square one. You've done this. You just need a bit of a refresher.

I don't disagree with Libby. What I would be curious about, though, is what she would recommend if Sebastian drops below 40. At least to my eye, if his numbers stay pretty much where they are now, I don't know that reducing the dose -- which would mean the next reduction would be an OTJ trial -- would be warranted. Usually, with a cat that's back from the falls and/or a long term diabetic, we work to keep them on insulin for as long as we can to give the pancreas the support it needs. Perhaps Libby will stop back and offer her thoughts. It's tricky when a cat is on a low dose.

 

[Libby and Lucy]

Re: 1/1 Sebastian PMPS 284,+5-85,+8-134

Now how many days does he have to fall below 40? Is it one or 3 like Tilly?

Only one time below 40.

From the Tight Regulation Protocol sticky:

Please do not let yourself become complacent or blasé about drops into the 20s or 30s.

• If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.

• If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.

To answer Sienne's question, if he goes below 40 then I would recommend 0.1u. If that doesn't work, then I would cross that bridge when I come to it. :lol: I just suggest gathering as much data as you can so you can see what Sebastian is doing between the shots. so when decision times come you'll have enough information on which to base the decisions. I'm not criticizing you at all. You've only been working with him for such a short time that of course you don't have data yet. Just get it when you can. Hopefully Sebastian will be one who only needs a short stint back on insulin, or maybe he just needs some help while he is adjusting to his new home.

 

[Caryl & Sebastian & Alex (GA)]

Re: 1/1 Sebastian PMPS 284,+5-85,+8-134

((Caryl))

You knew how Alex's FD worked inside and out. With Sebastian, you're essentially at the same place as you were when Alex was first diagnosed. You're going back to square one. You've done this. You just need a bit of a refresher.

I don't disagree with Libby. What I would be curious about, though, is what she would recommend if Sebastian drops below 40. At least to my eye, if his numbers stay pretty much where they are now, I don't know that reducing the dose -- which would mean the next reduction would be an OTJ trial -- would be warranted. Usually, with a cat that's back from the falls and/or a long term diabetic, we work to keep them on insulin for as long as we can to give the pancreas the support it needs. Perhaps Libby will stop back and offer her thoughts. It's tricky when a cat is on a low dose.

I was thinking this too Cheryl....where do you go from .25s ? It IS sort of like an OTJ trial isn't it? It is tricksy business :?