2/18/13 Update on Bear

[BettyL]

Hi everyone- Gave Bear her first AM shot after PS =190. Locked her up in the bathroom with some frozen wet food ice cubes. First time I gave her a shot in the morning and left for work. Bear has been getting more and more stressed with the testing. It seems to be getting harder rather than easier. We have been having trouble getting blood even with warming up the ear. When we do get blood she jerks her head and it seems to cut her and bleed a lot. This moring Bear had some diahrea. Wondering if it is her nerves. When I tested her tonight her number was the highest ever at home-318.

Today I faxed to my vet Bear's numbers over the past week. I explained to her why I did not give the 1 unit she recommended and why I had been giving her .25u only at night. I told her that I just did not feel comfortable giving Bear a shot when I did not really know if she would be OK while I was at work all day. I also told her I did not use her meter to do my curve. I told her that I didn't think Bear was doing too bad on the small dose I was giving her. I ended my fax with the statement that hopefully we could discuss all this and come up with a common ground that we could both feel comfortable with. I was nervous all day.

My vet called me tonight and we had a very amicable discussion. She had an interesting suggestion. She said reviewed Bear's numbers and agreed 1 unit was not indicated. She said Bear's numbers were good and thought she was was trying to cure herself. She suggested to hold off on giving her any more insulin for a while and see if she could be regulated with the change to the low carb diet. I am suppose to keep a close eye on her: appetite, drinking habits, weight, coat, brightness in eyes, ect... Then she would like to see her in 2 weeks.

I think I am going to give it a try. What do you think? She said we could always go back to the insulin later if necessary. Bear has been extremely stressed, so I am wondering if a couple of stress free weeks on the low carb food might do the trick. As I said in my first paragraph, she is not a happy kitty. Since Bear's numbers are pretty good maybe she could be controlled by diet. Her PS was 318 tonight which I think was so high due to stress. I'd appreciate some feed back.

Another quick thought is that my work schedule makes it so hard to test when I should and there will be some nights I am going to be late and not give shots 12 hours apart. So maybe this is worth a try.

Thanks,
Betty

 

[Libby and Lucy]

we do see cats go into remission here all the time. Hundreds of them, including my Lucy. Bear could be heading that direction, and in fact some newly diagnosed cats will go into remission very quickly after a diet change.

That said, Bear's numbers don't look quite ready to withhold insulin yet. Bear might be able to pull her numbers down from 318, but to bring the numbers down that far without insulin is a lot to ask of a pancreas that is (hopefully) just starting to work again. Often when people stop giving insulin too soon, even if the cat is able to get the numbers down, we'll see that they can't maintain the good numbers for very long. Sometimes it does work, but not reliably. Very often those cats end up needing insulin again after being "off the juice" for a short time.

We have found the best long-term success to come from following the Tight Regulation protocol. The protocol essentially works to get the cat into numbers where the beta cells of the pancreas can heal (generally under 120), and keeping them in that range for a while so the beta cells have time to regenerate.

Tight Regulation Protocol: (bold/italics are mine)

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.

A few days ago some of us suggested reducing Bear's dose to 0.1u so you would be comfortable shooting twice a day. Actually the 0.25u dose looks fine, but most people find it easier to work their way into shooting lower numbers, and 0.1 units should allow you to shoot twice a day and still keep Bear in numbers high enough that you're comfortable giving insulin when you have to leave. I would rather see you try 0.1 units for a little while before removing insulin altogether, and I really hate to see you not give insulin when she is over 300.

Thoughts?

 

[Sienne and Gabby (GA)]

Betty --

I really don't want to rain on your parade. What I would suggest is that you look at some of the spreadsheets of cats who are no longer on insulin or who are starting OTJ (off the juice) trials.

• Denise's Honey
• Sarah's Jackson
• Bruce's Simon

I think you'll see a marked difference between those spreadsheets and Bear's.

I'm glad you had a good discussion with your vet. It helps when you feel like you have a partner in this process.

I suspect that your vet, like most vets, use a very different criteria than we do when it comes to when they feel a cat is in remission. Most vets look at what are "normal" numbers as much higher than what we do. In part, this protects them from having a cat experience hypoglycemia. We look for lower numbers because unlike the average caregiver that a vet works with, the people here home test. As a result, you learn how to direct the cycle using food and you can allow your cat to spend time in truly normal BG numbers. This gives your kitty's pancreas the best chance of healing.

 

[Marje and Gracie]

Betty

Glad to see you back today.

I have to agree 150% with Libby and Sienne. Great examples of kitties really ready to go OTJ. I hope you will elect to shoot insulin even if it is only .1u.

Let us know how we can help.

 

[BettyL]

2/19/13 Need a pep talk please

Deep down I know your're right. I guess I just wanted to believe what my vet told me for 3 reasons-1.)-It is hard to just go against what your vet tells you. I want and need her support-what do I do if Bear has a hypo situation? Tell my vet, oh by the way, I once again ignored everything you told me and did it my way, but do you mind treating my cat. It's a scary feeling going alone. 2.) Bear is extremely upset and I don't think it is helping her health. She had diarhea today and is growling and runs from us. I'm sorry, but I don't have one of those cats that comes running because I'm shacking the treat bag so she can get her ear poked. She associates the treats with something bad not good. 3.) I'm not a stay at home kitty mom. My husband and I are exhausted. We stay up until 1:00 am so we can get a +6 and have to be up at 5:30am.
We have an hour drive to work. We get home around 7:00, run over to the cat cottage, chase Bear down, do all our chores and get done by 8:00 if were lucky. I feel like the past 3 weeks all I've done is work and deal with diabetes. It's midnight and I'm sitting here typing this out , and believe me I'm not a very fast typist. I actually cried when I read your posts because I wanted so bad to believe what my vet said, but I know you are all right.

Do any of you have any suggestions on how I can manage the testing? Do I have to stay up until 1:00 to do a +6. Someone suggested setting an alarm, do the test, and then go back to bed. Bear lives in a separate cottage on our property so I would have to bundle up, go outside to the cottage, and then go back to bed? How often does the +6 have to be done? Am I right that just because a dose is safe today doesn't necessarily mean it is safe the next?

I locked Bear in the bathroom today with the food icecubes. Tonight her PS was 318. The highest it has ever been at home. I won't know exactly when she eats even if I get timed feeder so how do I know if food is what made her evening PS spike.

Sorry to whine-but just not sure how to manage all this. I actually felt like I had my life back after I hung up the phone with my vet. That may sound selfish but I have 12 other cats, a dog, and a 92 year old mother in a nursing home a half hour away from where I live. I used to stop by and visit her on my way home from work, but now it is the race home to test and shoot.

Does anyone have any suggestions on testing? We are getting worst at it rather than better. We heat her ear up but sometimes it just won't bleed. She jerks her head violently when we poke ,and then if we finally get blood it gushes. Her right ear seems to bleed better than her left, but it is getting scabby.

Well, better get to bed. Feeling very guilty because didn't give her a shot tonight. Thought what my vet said made sense and was thrilled to not have to torture Bear anymore.

Once again, sorry for the whining.
Betty