10/03 Butters PMPS 61/+1 115/+2.5 86/+4 83/+8 92/+10 72/

Butters & Lyla

Butters & Lyla

Member Since 2020
Yesterday was day 7 / cycle 14 @1.125u. During this time, Butters got into the 50s but never signaled to me that she was looking for a reduction. She also spent some time in the 90s and low 100s.

I need some guidance, please. I'm trying to decide what to do:

1) Hold the dose: Butters is not a steroid or diet induced diabetic. I assume her pancreas is quite damaged but I will never know why. She came to me as a 4 y/o with a sad backstory and no known relatives. Maybe this is where the train stops for her and I keep her on this dose?

2) decrease (I would do a shave)? Per TR: Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
Define "regularly has its lowest BGs"? I assume this is different from nadir. But I don't understand how to interpret it. She has stayed under 100mg/dl overall for the week. But five of her cycles averaged over 80.

3) do a fat increase, to 1.25u perhaps, and see if that kickstarts her pancreas a little more. Per TR: when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
My cat's happy place is in the lower range of normal for a non-diabetic healthy cat. I believe I have some room to do a fat increase here and see if I can help Butters back on the train that @Wendy&Neko said would be hard to stop. It seems it has stalled.

If any of the dosing experts have time to look at my spreadsheet and offer some advice, I'd be so appreciative. For what its worth, I'm thinking I should give #3 a shot.

Thank you.
 
Morning Lyla! I'm sure those veterans will be on to help :bighug:

These kitties sure know how to drive us crazy o_O FWIW, I see a healing pancreas - I love scrolling up on SS's to see what life used to be like and at what dose.

Hang in there - you are doing awesome :bighug:Hope you have a wonderful Saturday!
 
Bandit's Mom said:
Hi Lyla, I'm not sure whether to hold or to reduce. Hopefully @Sue and Luci and @tiffmaxee will come along soon. But with nadirs around 50, its definitely not an increase!
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I wasn't thinking of a .25 increase or anything like that, just to be clear. :) Some cycles have a nadir around 50 for sure, but many others do not. Some have a nadir of over 80. She does better in the lower range of normal, if behaviour is a consideration. So it seems to me like she may have stalled out a bit after all the momentum in mid-September.
 
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carfurby said:
If you look at the SS from 9/26 to 10/2 the majority of her numbers are below 80. I'd try the reduction. You can always go back up if her numbers start creeping up.
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tiffmaxee said:
I would try a reduction as well. She’s been in normal bg numbers for a long time and after a week a reduction is earned. That sea of green is gorgeous. :D
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I'm slightly hesitant without her showing me that she wants the reduction by dropping below 50 at least once, but I definitely see both of your points. Perhaps I could attempt a shaved reduction, then, rather than a full .25u for Butters? She also seems to be doing well on this dose, though.

Do you think when her numbers bobble around the 80s/90s and low 100s that it could be some kind of tiny bounce? I thought maybe those higher (but still great) numbers meant her pancreatic beta cells aren't always stepping up to produce as much insulin on those days compared to other days?

I don't get the sense from the TR Protocol as written on the forum, nor from Tilly's diabetes website, that taking a reduction in this manner (after a week of regularly being in the 50-80 range) is really one that has been earned. It reads more like it can be attempted, but not required. Whereas it is very clear to me that you immediately reduce with 1 drop below 50 for new diabetics or 3 below 50 for long term diabetics or those that don't hold reductions well. The two read differently to me. Am I over-analyzing this?
 
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52 @+4.5. Fed 1.5 tsp LC. Will recheck around +5.
What is with these early nadirs on this dose?
The previous two days her nadir was @+3.5: 52 yesterday, and 50 the day before. But then her numbers go higher almost immediately and stay up.
Early nadirs on many other cycles as well.
 
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The SS looks beautiful :D:D:D Look at all those greens! Aside from the pm cycle on 9/28, you have a full week of greens :D:D:D You are doing great with a Butters! It’s nice to see her surfing without needing to prop her up with carbs on this dose.

Interested to see whether you will try a reduction or hold the dose :)
 
I'd be very curious about how she'd do at a reduced dose...in fact, I'm dying to know! Look at all that green!!!:D:D

@Chris & China (GA) - if you take a look at Butters lovely green SS, do you think Lyla should give a reduction a try...to see if she can walk her down the dosing ladder OR would you wait long to see if Butters will initiate that reduction by dropping under 50. Butters seems to be quite content on her current dose...she never waivers one way or the other by very much.

Oh, what I'd give for a SS that looked like that... I'm swooning here:joyful::joyful:
 
I saw that, too. It was a very recently diagnosed kitty quickly regulated I think. I'm curious if there is any consideration given as to the cause for dx? This is purely anecdotal and I don't know what the story is with the cat where Sienne left the comment, but the kitties I have seen go OTJ and/or get regulated very quickly and seem headed for OTJ since I have been here have been steroid-induced.
Without a known cause for the damage to Butters' pancreas that led to the FD dx, getting her OTJ will be a lot more challenging if not impossible, I would think? This leads me to think I should be more conservative when attempting reductions. Part of me really wants to try to bring her down to 1u (currently at 1.125u), just to see if she could hold it. But another part of me thinks I shouldn't reduce unless she drops below 50.

What is with the 115 @+1? Food bump maybe? LOL. Butters wants to visit the beach now! :rolleyes:
 
Sue and Luci said:
do you think Lyla should give a reduction a try.
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There are 2 ways to earn reductions...by dropping below 50 or by staying in normal numbers for 7 days

Butters has stayed in normal numbers for 7 days so has earned a reduction.

I'd go down to 1U and if she remains in normal numbers for another 7 days (or drops below 50) I'd reduce to .75
 
Butters & Lyla said:
Whereas it is very clear to me that you immediately reduce with 1 drop below 50 for new diabetics or 3 below 50 for long term diabetics or those that don't hold reductions well. The two read differently to me. Am I over-analyzing this?
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Not quite. From: Reminder: *earning* reductions and starting OTJ trials
Newly diagnosed diabetics - less than one year since diagnosis
  • reduction *earned* after a single drop below 50 mg/dL and following TR, or
  • reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
  • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.
Note that long term diabetics (which Butters is not) reduce under 40 or the week in normal or 3 between 40-50 if they don't hold reductions well.

For Butters, I would not increase. Either hold or shave the dose.
 
Wendy&Neko said:
Not quite. From: Reminder: *earning* reductions and starting OTJ trials
Newly diagnosed diabetics - less than one year since diagnosis
  • reduction *earned* after a single drop below 50 mg/dL and following TR, or
  • reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
  • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.
Note that long term diabetics (which Butters is not) reduce under 40 or the week in normal or 3 between 40-50 if they don't hold reductions well.

For Butters, I would not increase. Either hold or shave the dose.
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Yeah, I wrote too quick. The two parts I quoted came from the SLGS/TR sticky, though.
I'm curious, if Butters were your cat what would you lean toward doing? I'm leaning toward holding a few more days, but I want to make sure I'm not missing anything in the data that tells me that I could've missed her going lower. I'm not in a hurry to move her down the dosing ladder if she doesn't want to be moved.
 
Thank you all so much for your input, Elise, Sue, Carla, Chris and Wendy. I really appreciate it. :bighug:
And thanks everyone who checks in here for your messages of support and encouragement and observations! I can’t imagine having to navigate this journey without this community. :bighug:
I am thinking the +1 could be a big food bump as she had a slightly larger DINNER (not breakfast as I originally typed) Will see what happens overnight!
 
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Butters & Lyla said:
I saw that, too. It was a very recently diagnosed kitty quickly regulated I think. I'm curious if there is any consideration given as to the cause for dx? This is purely anecdotal and I don't know what the story is with the cat where Sienne left the comment, but the kitties I have seen go OTJ and/or get regulated very quickly and seem headed for OTJ since I have been here have been steroid-induced.
Without a known cause for the damage to Butters' pancreas that led to the FD dx, getting her OTJ will be a lot more challenging if not impossible, I would think? This leads me to think I should be more conservative when attempting reductions. Part of me really wants to try to bring her down to 1u (currently at 1.125u), just to see if she could hold it. But another part of me thinks I shouldn't reduce unless she drops below 50.

What is with the 115 @+1? Food bump maybe? LOL. Butters wants to visit the beach now! :rolleyes:
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My Elie was not steroid induced and went OTJ fairly quickly...there is hope and Butters is doing so well! I think we worked our way down to 0.5 (or 0.25, it’s hard to remember), and then we skipped from a low preshot and he never needed insulin again. He did have pancreatitis at his eventual diagnosis, but was probably diabetic for years without us knowing. :bighug:
 
Many steroid induced diabetics here go OTJ quickly but not all. Some not steroid induced do as well just from a diet change. I think there is a genetic component. Lots of cats in steroids never become diabetic. I had one of those.
 
I had one of those cats, too. On prednisone for practically his whole life for colitis, never became diabetic. Kidney failure got him in the end.
Maybe genetics play a role for Butters.

thebigfuzz said:
My Elie was not steroid induced and went OTJ fairly quickly...there is hope and Butters is doing so well! I think we worked our way down to 0.5 (or 0.25, it’s hard to remember), and then we skipped from a low preshot and he never needed insulin again. He did have pancreatitis at his eventual diagnosis, but was probably diabetic for years without us knowing. :bighug:
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That's amazing! The cat pancreas is miraculous.
I'm pretty sure Butters was diabetic for a while before diagnosis too but no idea how long. Her vets at time of dx told me to forget about possible remission without a steroid or diet issue as cause. I had never thought past the point of just getting her regulated.
 
I’m really sorry that your vet said that...it is just not true :bighug: I believe in possibility and have hopes for you and Butters! (I even have hope for Cosmo!)
 
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