1/26 Taz, AMPS-185, +6-204 (dropped to 200 five minutes later)

SaraMV

SaraMV

Member Since 2022
Taz went to the vet for a check up yesterday and the vet declared his pancreatitis healed. I'm still iffy because he seems like he has days where he's still laying gingerly or is more grouchy. But for the most part, his eating is back to normal and activity level is good.

The vet said that I can stop poking him so much now. Lol. He really liked Taz's numbers and said that we're going to hold steady at 1 unit right now. He wants me to do spot tests through out the week and said that they don't need to be done four our five times daily anymore, unless we observe that he's acting off. I do feel more comfortable with doing preshot readings though and will continue doing those. He said that for a diabetic cat, he's happy with numbers between 100-300 and Taz is staying mostly in the 100s right now.
 
Sorry but I disagree with your vet 200%. To have his pancreas healed he needs to be in normal numbers under 120 which he is not. He has improved enough that if you don’t test he could have a symptomatic hypo. Please continue to get at least an amps and pmps every day and a curve every 7 days to see how low he is getting on 1.0. Vets keep cats in that range but if that’s where he stays he will never achieve remission and eventually need more insulin.
 
Glad to har that Taz has recovered from his pancreatitis episode and is back to eating normally!

Most vets prefer to keep cats in the 150-300 range since they do not expect (nor advocate) home testing. Hypoglycemia is dangerous while hyperglycemia is not. That having been said, a cat's normal numbers is 50-100 mg/dl on a human meter and 68-120 mg/dl on a pet meter. A cat's pancreas also have the ability to heal and for a cat to go into remission.

Cats who are newly diagnosed stand a good chance to go into remission with some aggressive treatment. You have that advantage and also that of Taz having flattened out - many cats take a few months to stop bouncing. If he were my cat, I would try for remission.
 
I am so happy with the news of him doing so much better! His numbers ate finally doing much better as well!

I also agree with Elise @tiffmaxee and Bhooma @Bandit's Mom . I do not understand the logic of vets and wanting them to ride so much higher. The higher end that a vet is comfortable with is still above renal threshold which means his kidneys will work even harder and could cause more issues later. It is so scary and in the very beginning I was terrified of any number below 200. Now I'm stressed when he is in the 100s. (ETA...I am stressed when LM isnt below 100) Quality of life is so much better at these mostly under 100s <3

Now having said that we all have to play the game or do the dance with our vets as yes we need them for scripts and checkups. Its not that they arent good or dont care. They just havent been trained properly in diabetic issues.

In the end you need to do what you feel is right for Taz. Just know you have tons and tons of support here if you want to be aggressive and push for remission or at the very least tightly regulated so you arent living at the vets office and can have a life of your own. :bighug::bighug::bighug: hugs and love to you I know this is a lot!
 
I have learned from my experience with about a dozen different vets who have seen Ruby, all with varying degrees of academic and peer accolades--some generalist primary vets at our local clinics, some board certified Internal Medicine specialists, one double board certified Internist and Oncologist--none of them would ever advise you to do what the FDMB suggests. This is not because what we do is wrong, dangerous, or unscientific. Both TR and SLGS require more than weekly spot checks, not because we want to torture our cats or ourselves but because we have seen on more than one occasion caregivers adjusting insulin doses without testing, or the cat recovers from what might have been causing high numbers and needing a trip to the ER. You can keep your cat in the range suggested by the vet, but as Rainbow says, Taz will feel better if you can get him into lower numbers.
 
So with his numbers, you guys would suggest increasing his insulin? The vet told me that when diabetic cats start to go/stay below 100, that's when they start to see emergency visits and that's why he likes them to stay above 100. Ideally, remission is the goal. Realistically, diving his numbers lower scars me because im not always home or awake to catch if something were to happen. :( Its all so confusing because there's no guarantee that dropping his numbers low will give him remission. But it does raise the chance of him dying if I'm not home and he goes hypo.
 
Taz is doing well, his numbers are pretty good for a newly diagnosed cat. Pushing for remission is not for the faint of heart. It requires constant monitoring and feeding. I will say that I have not had much of a life since Ruby became diabetic and I really miss it. I was really hoping to get Ruby into remission and we came really close but it wasn't in the stars for us because of her small cell lymphoma.

It's a matter of what you can do. Some cats go into remission quickly. Others can take years, but they get there. I don't have any sense of what your schedule is like and when you are out of the house. People with full time jobs sometimes will only test for shots, but remission isn't going to be possible for them because they have to be so cautious about overdosing. You have to be realistic with yourself about what is possible within your means. You can't be afraid of hypos and want remission, because they have to stay in the 50-80 range on a human meter in order to get there.
 
SaraMV said:
So with his numbers, you guys would suggest increasing his insulin? The vet told me that when diabetic cats start to go/stay below 100, that's when they start to see emergency visits and that's why he likes them to stay above 100. Ideally, remission is the goal. Realistically, diving his numbers lower scars me because im not always home or awake to catch if something were to happen. :( Its all so confusing because there's no guarantee that dropping his numbers low will give him remission. But it does raise the chance of him dying if I'm not home and he goes hypo.
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I totally understand that fear! Honestly at some point or another everyone on this board has had all the same fears as you are having now! I would agree with your vet that I'm sure he sees more emergency visits when a cat goes below 100. But in fairness what he isnt telling you is that those visits are caused by the caregiver being instructed not to test daily.

If you look at our ss you will see that LM has more consistently over last couple weeks been below 100. He is not in any sort of danger. We have not needed an er vet visit. He has never shown signs of a hypo event. He plays more runs around now where he wasnt doing that just a month ago. To see him get the zoomies like he used too is quite a beautiful sight to see!

You are correct being more aggressive is not a guarantee he will see remission. He will however feel better and definitely be better off in long run.

Last night I finally decided I felt safe enough to actually have dinner with friends. Now I did give higher carbs at his meal and left some slightly higher carbs out for while we were gone. I so understand the fear of being gone. The best thing about this board is that someone is here at anytime day or night to answer questions. You will never give a shot at a number that you are uncomfortable with. And as you get more comfortable someone is always there to talk you through it and be with you till you feel safe.

As far as having to be gone for work I get this. Many many others on this board work full time and still follow TR and their babies are safe.

I hope this helps you you are not alone sweetie not ever here. There is always someone looking out for you. Watching your spreadsheet helping you <3

:bighug::bighug::bighug:
 
Whether to increase depends upon whether you want to follow SLGS or TR. If you choose to try TR and see if Taz will go into remission soon, I would increase to 1.25 if you can test like you have been. If you are content with the nice blue nadirs hold the dose. Taz is responding so well that I personally think it’s worth trying TR. I understand the fear and we will support you if you choose SLGS. Whichever er way you go you can change back at any time.
Take a look at other spreadsheets. George comes to mind. He’s mostly under 120 and when they go out of town they just lower the dose and return to TR when they get back.
 
Katherine&Ruby said:
Taz is doing well, his numbers are pretty good for a newly diagnosed cat. Pushing for remission is not for the faint of heart. It requires constant monitoring and feeding. I will say that I have not had much of a life since Ruby became diabetic and I really miss it. I was really hoping to get Ruby into remission and we came really close but it wasn't in the stars for us because of her small cell lymphoma.

It's a matter of what you can do. Some cats go into remission quickly. Others can take years, but they get there. I don't have any sense of what your schedule is like and when you are out of the house. People with full time jobs sometimes will only test for shots, but remission isn't going to be possible for them because they have to be so cautious about overdosing. You have to be realistic with yourself about what is possible within your means. You can't be afraid of hypos and want remission, because they have to stay in the 50-80 range on a human meter in order to get there.
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My Binx had small cell lymphoma. My heart goes out to you. What is the range if they're on an alpha track meter?
 
We want to see all greens for at least 7 days to get to remission. When a cat gets into low 100s on a consistent basis, we tell caregivers to switch to a human meter to monitor because those numbers tend to be lower than an AT, and we can judge better if they would be able to go on an OTJ trial (aka a week off the juice).
 
Katherine&Ruby said:
We want to see all greens for at least 7 days to get to remission. When a cat gets into low 100s on a consistent basis, we tell caregivers to switch to a human meter to monitor because those numbers tend to be lower than an AT, and we can judge better if they would be able to go on an OTJ trial (aka a week off the juice).
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I'm pretty sure that Taz needs dental work badly and I'm sure that's contributing to his laziness. The vet wants to wait a month, to do more bloodwork because Taz just had bloodwork done 20 days ago. I don't know why he wants to wait though, except to maybe make sure the pancreatitis is healed? At the next appointment, Taz will get pre-anesthesia bloodwork done and then we'll schedule his dental. I hate waiting when I know he's hurting. :(
 
SaraMV said:
I'm pretty sure that Taz needs dental work badly and I'm sure that's contributing to his laziness. The vet wants to wait a month, to do more bloodwork because Taz just had bloodwork done 20 days ago. I don't know why he wants to wait though, except to maybe make sure the pancreatitis is healed? At the next appointment, Taz will get pre-anesthesia bloodwork done and then we'll schedule his dental. I hate waiting when I know he's hurting. :(
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Pain can make bg higher too. So it's possible when the dental is done his numbers improve even more. I know it's so hard when we are doing all we can and it never seems enough.
 
Katherine&Ruby said:
All the more reason to test at least 4 times a day to catch any dropping numbers.
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I agree. I feel better knowing where he is. At least when I can. I don't know if I'll test in the middle of the night most nights anymore. By the time I sit with him enough to warm his ears, I'm wide awake and have a hard time going back to sleep. It's brutal when you have to be up early.

Glucose is so weird with how it fluctuates from minute to minute. I took Taz's +6 and it was 204. It was my last strip from that bottle and I had to change the code on the meter for the new bottle, so I took another reading to see if the new code would give the same results. In less than 5 minutes, he went from 204 to 200.
 
SaraMV said:
In less than 5 minutes, he went from 204 to 200.
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There is a thing called meter variance. Readings can vary from test strip to test strip, even a minute later, by about 20%. Do not take any stock in a 4 point drop. If you test at +2 and get 350, and then at +3 and get 32, it's likely a bad strip, but if it's basically the same number, you can be sure that he's holding steady. Remember, we're not focusing on static numbers but trends. Insulin is a hormone, it works in waves of action. In unregulated cats the swings between highs and lows can be extreme. Be glad Taz is leveling out. :)
 
I don’t know why he wants to wait and run the blood again. You can tell about pancreatitis by how he’s acting or a SpecfPL test. A whole panel would not be necessary. The dental could definitely help him go into remission.

To be clear Taz needs to earn reductions to .75, then to .25, then 0.1 and possibly a drop dose before seeing if he’s ready for an otj trial. It depends on whether you follow SLGS or TR as to how the reductions are earned.
Under 68 or a week in normal numbers earns a reduction with TR using an AT or under 90 with SLGS. Alternatively a week in normal numbers earns a reduction with TR without needing to go under 68.
 
The others have given you good advice about dosing, testing, and methods. Your vet stated they see ER trips under 100 - that is people who are not regularly testing, or testing at all. Insulin needs change, pancreas starts to heal, depot does different things - so yes, I'm sure they end up with hypos.

Somebody stated hyperglycemia isn't dangerous, so just a tweak to that statement- it's not as immediately dangerous as a hypo, but does have long term consequences (aside from the cat feeling like crap). Renal threshold is somewhere between 200-300 for most cats. Above that, glucose spills into urine. That wears on kidneys, puts them at increased risks of UTI, as well as ketones. Additionally, neuropathy can be an issue as well.

My cat is in remission, take a look at July 13th (start of OTJ trial) and his numbers since. Never above 100 except the one time he was very ill. I rarely see anything above 85.

Disclaimer: Since he is an acro cat that had started medication, we did not follow the proper tapering Elise mentioned, special circumstances. You would need to reduce the way she stated (I believe she missed 0.5U on that list though) @tiffmaxee
 
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