5/30 AMBG 84 +5 69 +8 85 PMPS: 79!

Miimi and Velvet Mirth

Miimi and Velvet Mirth

Member Since 2019
Looks like another no shot today. with no greenies in her system and no dry food at all and only LC food, we will monitor and see how she does.. Question: can she go in low numbers even if no insulin is injected? We were wondering...
 
Miimi and Velvet Mirth said:
Looks like another no shot today. with no greenies in her system and no dry food at all and only LC food, we will monitor and see how she does.. Question: can she go in low numbers even if no insulin is injected? We were wondering...
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With no shot yesterday and very low dose the day before, I would think the insulin “depot” or storage of insulin in cats body, will be depleted pretty quickly, so any chance of too low numbers should not be a concern at this point. Still good to keep an eye on her. Paws crossed the good numbers hold:cat:
 
here is yesterday's post http://www.felinediabetes.com/FDMB/threads/amps-76-pmps-167-3-160.215033/#post-2382145

Looking good this morning :D! Maybe you don't need that human meter after all :rolleyes:. I forgot to mention yesterday, with a no shot, can you update your title to "AMBG" so it is clear that you didn't shoot? Having had a NS yesterday morning and only 0.1u last night, I suspect at this point, any dropping she may do will be as a result of her pancreas producing the required insulin, without exogenous insulin/help. Some people here have tested their non-diabietic cats and had numbers in the 30s-40s (human meter), so continue with the LC meals. She may bump up as the LC carbs are digested, but it would be expected that as the carbs go in, the pancreas will regulate how much insulin to produce to handle what the body needs.
 
Bellasmom said:
No insulin
No hypo
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In Mimi's case yes it is highly unlikely that she will have an issue as she wouldn't really have a depot in play, because she has given 0.1u the day before yesterday if I recall correctly (I can't see the SS), skipped yesterday am, and only gave 0.1u last night. But I have seen this in a few condos where there is a misconception that when a shot is skipped the cat cannot hypo. That isn't necessarily true. Depending on the depot, the insulin can continue to drop numbers quite low even with skipped shots. Just wanted to clarify this, as there may be people who read condos like this and don't post, and I wouldn't want them to think it is absolultey not possible to hypo if no insulin is given. Even with no insulin, depending on the depot that might affect that cycle, it is important to continue to monitor.
 
Christie & Maverick said:
In Mimi's case yes it is highly unlikely that she will have an issue as she wouldn't really have a depot in play, because she has given 0.1u the day before yesterday if I recall correctly (I can't see the SS), skipped yesterday am, and only gave 0.1u last night. But I have seen this in a few condos where there is a misconception that when a shot is skipped the cat cannot hypo. That isn't necessarily true. Depending on the depot, the insulin can continue to drop numbers quite low even with skipped shots. Just wanted to clarify this, as there may be people who read condos like this and don't post, and I wouldn't want them to think it is absolultey not possible to hypo if no insulin is given. Even with no insulin, depending on the depot that might affect that cycle, it is important to continue to monitor.
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Thanks for clarifying that for both of us:bighug:
 
I really think this is moreso her own body doing the work, not any depot effect. It isn't the 0.25u any longer and by doing a few drop doses in between 0.1u here and there, you would have disturbed whatever depot would have been built of the 0.1u. This is a really good sign I think. **anti-jinx** :)
 
Today's cycle was really good! Did Mimi get a snack at +8? Sometimes when cats are getting close to not needing any insulin, feeding at +9 can encourage the pancreas, and if the preshot is lower, that's a great sign. So you can try that next time if you didn't feed.

I'm trying to make suggestions based on what I have seen here on the forum, but my Mav has never gone OTJ or close to it. Yesterday I think I mentioned a few thoughts I had. I really want this to work well for you and Mimi, and she doesn't seem to really be following the playbook, but not all kitties get to OTJ following the rules! I'm going to tag a few people who I believe have experience with remission, or can offer some guidance. And maybe in the meantime, if you can change your thread title to a question with maybe to something like "ready for OTJ trial?"

@Sienne and Gabby (GA) @Marje and Gracie @Bobbie And Bubba
@Jill & Alex (GA)
 
OTJ means "off the juice" -- that your cat is in remission.

Looking at Mimi's SS, I don't think she's ready to be in remission. A cat that is ready to stop insulin's spreadsheet has far more consistent green and low blue numbers. What I would suggest is to stick with the 0.1u dose but feed a higher carb food. I'm assuming the Fancy Feast you're giving Mimi is around 5% carb. See if you can track down some foods that are 7 - 8% or thereabout to prop up here numbers and prevent her from getting a dose reduction.

I'm concerned that if you stop insulin altogether, her numbers will end up back higher ranges.
 
Miimi and Velvet Mirth said:
I have done as suggested, but what is OTJ and how does it work? :)
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It stands for Off The Juice, juice being insulin :). In yesterday's post, I mentioned what is usually done to start an off the juice (OTJ) trial.

Christie & Maverick said:
Today will be interesting, and I'll be curious to see her PMPS. You have a bit of a dilemma, because you are using an AT2 meter. Normally it would be suggested (as copied from the information page): OTJ TRIALS: Prior to starting an OTJ trial, one wants to see kitty mostly in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range.

Remission is achieved when kitty can go 14 days without insulin while maintaining normal blood glucose values under 100 overall. Most will stay in the 50 - 80mg/dL range. Although, some will occasionally experience BG numbers up to 120 mg/dL.

The issue is that these ranges are with a human meter. There is no way to correlate between the two, but having some experience using both meters, I have a sense that even the blue numbers you saw last night (PMPS 128 & =3 116) would have been green on a human meter.

You have a bit of a special case I think, in that now that you have controlled those crazy bounces, she is actually looking really good. But my only question is has she spent enough time in green to give her a really successful remission. It would be nice to try a drop dose for a while just to give her pancreas a bit more support. So to me, you have a couple of things you might consider: since you have stopped dry altogether you can try TR, and you test enough, that would allow you to take reductions at a lower point (68 on AT2). That said, what do you think about getting a human meter, so that you can really see how she is fitting in with the suggested ranges as noted above? That way, you would take a reduction under 50, and shoot anything above 50.

Again, with SLGS you don't shoot under 90, but if she is above 90, you can give a drop dose.

Hopefully others will offer their thoughts as well.
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Sienne and Gabby (GA) said:
OTJ means "off the juice" -- that your cat is in remission.

Looking at Mimi's SS, I don't think she's ready to be in remission. A cat that is ready to stop insulin's spreadsheet has far more consistent green and low blue numbers. What I would suggest is to stick with the 0.1u dose but feed a higher carb food. I'm assuming the Fancy Feast you're giving Mimi is around 5% carb. See if you can track down some foods that are 7 - 8% or thereabout to prop up here numbers and prevent her from getting a dose reduction.

I'm concerned that if you stop insulin altogether, her numbers will end up back higher ranges.
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Hi Sienne thanks for answering the tag :), Mimi's owners have done a higher LC combo (mix between the FF classic pates which are 2-3% with FF grilled, to get to around 8% which has helped control the terrible bouncing. She is using a pet meter, and Mimi is a bit challenging to test, which complicates things a bit.

So ideally, she should try to have another week in greens on drop dose do you think?
 
Sienne and Gabby (GA) said:
@Christie & Maverick -- I just don't think the numbers are consistent enough for a trial. But, that's my 2 cents. Let's see if some of the others have to say.
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I do agree with you, I hope I didn't sound contrary, I was just adding some details on what has happened over the last week or so. I think for them as well now that dry food is out of the mix, and they test enough, TR would allow for the lower no shot number. Thanks again Sienne.
 
Thank you both! Her PMPS is at 79 and she did have a snack at +9, so I think we won't even do the whisper dose? Right now she just doesn't want to eat (she never does when she should...)
 
Sienne and Gabby (GA) said:
@Christie & Maverick -- I just don't think the numbers are consistent enough for a trial. But, that's my 2 cents. Let's see if some of the others have to say.
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I agree.
Christie & Maverick said:
I do agree with you, I hope I didn't sound contrary, I was just adding some details on what has happened over the last week or so. I think for them as well now that dry food is out of the mix, and they test enough, TR would allow for the lower no shot number. Thanks again Sienne.
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SLGS is purposely vague about going OTJ. The purpose was to enlist aid from experienced members... drawing upon their experience to help determine if kitty was ready to start an OTJ trial. In Mimi's case, I would hope to see BG numbers roughly in the 68 - 100 mg/dL range (AT meter) overall prior to starting an OTJ trial.

If you'll notice the SLGS method, as written, is filled with words such as generally, usually, however, and so on. The reason for the wording is to tailor withholding insulin and starting an OTJ trial to the caregiver as well as the cat.

For example:

"We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat."

In other words, you may find that gradually lowering these thresholds may work well for your cat when you're attempting to go OTJ. Not doing so will often require tiny doses of insulin as needed for awhile. This will end up going in one of two directions and there's no way to predict what will happen with an individual cat. Either kitty will drop into numbers of a healthy cat OR BG numbers will gradually rise to the point that it becomes necessary to restart insulin. The latter is most common. ETA: The problem with having to restart insulin is that in a whole lot of cases it's almost like starting over... more time and expense for the caregiver.

I've seen the most success when members following SLGS end up lowering their no shoot number as well as lowering the point where they take reductions in an effort to start kitty with a strong remission.


FYI: Earlier in the thread there was talk of tiny doses and the depot. FWIW, Alex's depot appeared to last for up to 5 cycles even on a dose as tiny as 0.1 unit.


Just my 2 cents...
 
Thanks very much @Jill & Alex (GA) I think this additional detail will help Mimi's owners a great deal. Mimi seemed to be doing things very differently, and because of that I was erring on the side of caution with my suggestions.
 
I had to step away to take care of Mav, but there is a lot of good feedback, and I'll try and help summarize. The concensus is that Mimi is not quite ready to stop insulin, as she hasn't really spent enough time under 100. If you stop insulin now, the concern would be that she may end up at some point soon having higher BG which would mean needing to restart insulin, and that will be like starting over again for you.

It is recommended to continue to dose 0.1u, with feeding the higher LC combination like you were doing previously. In parallel, you can think about adjusting (lowering) your no shoot and reduction numbers.

Remember I mentioned with SLGS we don't recommend shooting under 90, and take reductions also at that number? Well, it really is just a guideline and there is flexibility in that when you get more familiar with how Mimi responds to insulin, and carbs, that 90 number can be lowered. You have a good amount of information now, which will enable you to customize your no shoot and reduction number, if you are comfortable doing so. See Jill's post above. I can't tell you what those numbers should be, you have to figure out what you feel you are able to do, but if the goal is a strong remission for Mimi, you want to be able to keep her under 100 for as long as possible. You can also gradually lower as you feel more comfortable, the numbers aren't set in stone. As an example, maybe tomorrow you have an 85 for a preshot and you've decided your no shoot number is 80. Instead of skipping again, you would shoot. The tricky part is she really had a great day, so I'm sure it's hard to imagine why you would need to give her any insulin. From what the more experienced members have seen by looking at Mimi's numbers overall, (not just today's) is that she'll still need insulin for a while longer.

I know there is a lot of info today, and I'm a bit tired, but I hope this helps.
 
@Christie & Maverick gave a great summary!

It may help to look over TR to give you a feel for some of your concerns. I used TR with Gabby. I was able to shoot any number that was above 50. Please keep in mind, though, that I had a lot of data! What I often suggest to people is to think about your lower pre-shot numbers that you were comfortable shooting. How much would you be comfortable lowering that number so you are mentally prepared to shoot lower? Usually, shooting lower doesn't mean that numbers will plummet -- they can drop, but shooting a lower number may allow for a flat cycle. The flatter the cycle, the more Mimi will get used to spending time in lower ranges and, hopefully, the less bouncing.
 
Hey there! My 2 cents worth would be to start using TR guidelines now for Mimi since she is off the dry food and you test enough. As others mentioned start lowering your no shoot number. You will see how Lantus keeps low numbers flat. And keeping in mind that you are using a AT 2 meter. So you would not shoot anything under 68.
 
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