10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Advice

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Kiki's Charlie

Kiki's Charlie

Member Since 2014
My Charlie is doing extremely well right now and I think she is very close to remission, I just need advice on the last steps!
She is on a dose of 0,1 and went low today (67). This would normally mean a dose reduction! So I'm wondering if I should not give her any insulin at all tonight?
I'm also wondering if it's okay to go back and forth between nothing / 0,1 / 0,25 quickly, or do I need to hold the doses for a few days?
I'm also wondering what the protocol is for when she is insulin free!?

Advice appreciated! I feel we are so near now and want to make sure we actually get there!

PS - PLEASE NOTE I'M USING A PET METER -

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Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

Morning, Kiki and Charlie

In order to earn a dose reduction, you need to have any # below 50 for 1 time for newly diagnosed kitties, or below 40 for 3 times for long term diabetics. With each new dose, you need to make sure that you keep it at the same consistent amount for 6-10 cycles (3-5 days) to ensure that the kitty's body gets used to the the new dose. In my honest opinion, I don't feel like you're there yet. Do you know when her nadir is? That will tell you if you need to decrease or not.

In the past, someone once told me that in order to go down in #s, you need to go up in doses. Since you've switched from .10 to .25, I'd go back up to 0.25 for about 3 more days, and then go from there. You may be experiencing a bounce because of the switching back and forth from those 2 dose amounts right now. FWIW, you may need to go up again after the 3 day period. Try and get a +1 and +2 test if at all possible. Those #s will also tell you how fast or slow she's dropping.

Hope that helps. :-D
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

Hi Angela

I'm using a pet meter so my 'cut-off' number for reduction is 68, not 50! She's gone low today (67) on a dose of 0,1 so technically speaking I need to reduce, which would mean no insulin tonight... Hence my questions!
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

You're right with an alpha trak meter.

I went and cut and pasted the instructions.

Start the trial on his next green preshot.

If he 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 is blue, feed a small meal and test again after about 3 hours. If his number is lower 3-4 hours after a meal, then his pancreas is working!

Post every day so we can monitor your progress and see if any tweaks are needed. It is not unusual for cats to get lots of blue during their trial, especially at first. Don't panic and don't shoot unless we tell you to.

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 the support he needs. 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!

If he gets 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 and small meals for the rest of his life. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood sugar weekly for the next few months and then monthly forever. It's a good idea to weigh him monthly. His weight should remain stable. If he seems "off" or sick, or is showing symptoms of diabetes (excessive drinking, eating, urinating, weight loss) test his blood sugar right away. Keep the teeth clean; dental issues can bring a cat out of remission.

If you see rising blood sugar numbers, post here before you restart insulin and ask for advice on how to proceed.
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Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

I'm not sure why you went up to .25U last night, but that due to the nature of the Lantus depot, that .25U could be influencing today's numbers. Did you test again 1/2 hour after she got to 67 to make sure she's up? If she came up easily enough, one possibility is to hold the .1U for a few more cycles and wait for either another number below 68 or a week in normal numbers, which is 68 to around 160. (3.8 to 8.9).
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

Thanks Wendy! I went back up to 0.25 yesterday because her numbers were so high even at nadir. I fed her at the 67 dip today - her numbers always picks up quickly after feeding.
So if I understand you right, I should just continue and give her 0,1 tonight (even though she earned a dose reduction today)!?
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

Thanks Rhiannon! She hardly ever has green pre-shot numbers. But she does take a dip at nadir (today to 67, which is the 'cut-off' point with a PET METER for a dose reduction), so she should technically earn a reduction!??
From the varied responses I'm getting it seems like I should just keep her on 0,1 for a while, but it's not entirely clear to me when I should then reduce the dose/take her off insulin all together.
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

Angela - I've been told that she earns a dose reduction at 68 (with a PET METER)... She hit 67 today so...?
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

I don't know if anyone on here uses a pet meter or not. Most of us, myself included, use a human glucometer. To earn a dose reduction for a newly diagnosed kitty, which Charlie is, the # has to be below 50 one time. 67 isn't 50. I'm seeing the US version of Charlie's spread sheet to go by that.

Try doing a bit more testing, especially getting those +1 and +2 #s after she eats to see what she does. You can also get a +4 to a +6 or +7 to see how low she gets before rising again. Not many tests, but enough to get an idea of where roughly her nadir is. You'd be surprised what #s she'd give you.

Hope that helps! :-D
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

I'm not familiar with a pet meter. Sorry. I can't help you with that. I'm not 100% sure others on here can help you with that, either. Most, if not almost all of us, use a human glucometer. I use a Relion Prime. I'm going by what the strict protocol states, and from my own experience with dose reductions, and increases. IF there is someone on here that does use a pet meter, I hope that person can help you very soon with your question.
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

I couldn't get your ss to open so I didn't see the data when I posted.

something for you to check as you continue your tiny dose.... load up a syringe with some other fluid and see what actually comes out
at 0.1 u.
I found when I was on the tiniest dose.... that nothing was coming out at all. I thought I was giving one drop and I wasn't after all.
I had to load a little more just to get a drop out of the syringe.
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

I think Wendy is right, that low number today could be shed action from going back up to the .25u. I'd stick w/ the .1u but get lots of checks in to be safe.

Angela. pet meters usually read about 30 points higher than human meters. Sp that 67 would be a 37 on a human meter.

I can get your US tab to show but the World SS just keeps loading. It could be because you have the editable version linked in your signature. Go into your User Control Panel and edit the SS link in your signature. Change the ccc that I've highlighted in red, to pub https://docs.google.com/spreadsheet/ccc?key…………………… That will show a view only SS and take much less time for us to open and give advice. Sometimes the ccc links just hang up indefinitely. You need that link to edit your SS but we don't.
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

Thanks Ann, I checked the SS link in the control panel and it looks exactly like how you advice (see attached screengrab) so not sure why it doesn't work? I re-started my laptop too so maybe it works now...
Regarding Charlie: I'll keep her on the 0,1 dose tonight and monitor - thanks for the advice!
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

And now with the attachment... ; )
 

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Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

The depot means that what you shot in a previous cycle can often influence the next cycle. If you can monitor closely, then try ontinuing on at the .1U dose. I hope that by giving Charlie insulin for a little bit longer than you can bring down some of those higher numbers you were worried about last night. The other "trick" you might try doing if you want to lower the preshot numbers, is to give Charlie a small snack at about +9 in the cycle. If her pancreas is starting to work, that should help bring down the preshot value. This "trick" only works for kitties on small doses of insulin who are getting close to remission.

I can see your US version of the spreadsheet just fine - just load the World version and look at the US tab. But I use the World SS myself.
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

The pet meter throws people off - you're right that 68 is the equivalent of the human meter glucometer at 50. The earlier information was that there was a 30 point difference between the 2 meters, which is what Ann is referring to. The last information that came out with the updated PDF on the TR Protocol page is that the low number difference is 18 points, and the difference increases as the BGs move into higher ranges - roughly 30-40% in highest numbers.

Back to Charlie, though, I think i'd keep her on 0.1u a little longer. 67 isn't much below 68 and she's still got some higher numbers in there. You'd consider under 160 to be normal (equiva to human glucometer of 120) and roughly 130-140ish to be "green" numbers. The idea is that all of her BGs should be under 160 and almost all/all of them should be under 130-140ish before you start a trial.

The +9 snack of about 1 teaspoon of food can make a lot of difference in pulling down the preshot numbers. I'd try that for both am/pm cycles, and perhaps that will be the nudge that Charlie needs.

Good luck! She is looking great!
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

PS - It seems to me that the difference between a human meter and a pet meter points should be expressed in percentage rather than '30 points difference for high numbers and 18 points difference for low numbers'!? (Alternatively I could just change over to a human meter - I know ; )
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

I wouldn't chamge meters at this point with remission almost here. I hope the drop of insulin and snack brings a trial real soon. Congrats.
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

Thanks for your expert advice Julie! You were saying :
"Back to Charlie, though, I think i'd keep her on 0.1u a little longer. 67 isn't much below 68 and she's still got some higher numbers in there. You'd consider under 160 to be normal (equiva to human glucometer of 120) and roughly 130-140ish to be "green" numbers. The idea is that all of her BGs should be under 160 and almost all/all of them should be under 130-140ish before you start a trial."
Does all her numbers have to be within this range for a week? She just dipped below 65 at AM+3. I'm giving her some food and I'll know she'll pick up the numbers quickly, but is it okay that she dips down like this and still keep her on the same dose and not reduce, because the rest of her numbers in the cycle is slightly too high?
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

right - when you're trying to regulate a cat, the goal isn't to get her off of insulin asap, but to keep her in normal numbers (68-130ish) asap and hold the cat there for as long as possible.

my hesitation is that you're missing nadir checks on several cycles. The possibility exists that she's hitting lower numbers and the 130-150's are bounces. i think to get the answer of what to do next, you really need to try to get nadirs for several cycles in a row.

I could see 2 equal possibilities with Charlie - either she's going too low on the 0.1u and bouncing up to those slightly higher numbers, or she needs a hair more insulin to bring all of the numbers under 130ish.

The confusion about the AT and how it's numbers relate to human glucometers exists because we have conflicting information. In the earlier version of the Roomp/Rand Protocol see page 3 where it gives AT numbers. That document says to add 30points to the chart of human numbers to get AT equivalents:

It is very important to note that blood glucose concentrations measured using a whole blood glucose meter calibrated for human blood may measure 30-40% lower in the low end of the range than glucose concentrations measured using a serum chemistry analyser or a plasma-equivalent meter calibrated for feline use. Therefore, if using a meter calibrated for feline use (eg. AlphaTRAK, Abbott Laboratories, CA, USA), or a serum chemistry analyzer, add approximately 30 mg/dL (1.7 mmol/L)
to the target glucose concentrations (see Table 3B). For example, a target > 50 mg/dL (2.8 mmol/L) becomes > 80 mg/dL (4.4 mmo/L) when using a meter calibrated for feline use. Instead of aiming for 50-100mg/dL (2.8-5.6 mmol/L) , aim for 80-130 mg/dL (4.4-7.2 mmol/L [round numbers 4.5-7.0 mmol/L). Meters calibrated for feline use may read higher or lower than the actual value, in contrast to consistently lower readings for meters validated for human blood.
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In the latest document published it says to add 18 points on the human meter to get the AT equivalency. I was told earlier that the range is 30-40%, but i'm not finding where that was from at the moment.

In any case, i think i'd suggest getting consistent nadir checks for at least 6 cycles in a row so you know if she's going below 68. Personally, I wouldn't try an OTJ trial for one 65 at this point - that's probably equivalent to a 48 or so on the human glucometer. I'd want more information.
 

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Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

Without any midcycle testing on a lot of those recent cycles, you can't know if those high preshots are because of bounces off of low numbers or because Kiki is still just naturally going high and still needs insulin support because the pancreas is not healed enough. If its a continuous too low-going high, then you'd possibly look at stopping insulin to stop the bouncing. But this last step you never want to take too early or you could lose the progress you've made by making the pancreas work too hard too soon. As long as you are seeing higher numbers frequently, you want to look to see what's causing them and how to bring them down before stopping the insulin support.

What is your feeing schedule? Sometimes putting some food around the +9 spot will cause the pancreas to fire up and stop those preshot rises. Are you feeding at shot time in the AM? Maybe more food will stop that drop and allow you to flatten things out.
 
Re: 10/22 Kiki's Charlie AMPS 117 +3=67 ALMOST Remission? Ad

Julie - Thanks for the advice. My schedule will actually allow me to do nadir checks for the next days so will definitely try to do that!
Melanie - I feed her 100 gr in the morning and evening, 25 gr at lunch time and bed time = total of 250 gr. I started the +9 'snack trick' yesterday (without any noticeable result), but will keep on trying it. Maybe I'll get a better result tonight.

Thank again guys for your advice! I'm sure we WILL get there pretty soon : )
 
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