? 5/8 Tennessee, First green number EVER (79) And its time to shoot. +1 78 +2 68 +3 67 +4 75 +5 110

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Andrea&Tennessee said:
Thanks Suki, I love the "expect the unexpected" line in your signature- Tennie is going in for his Acro and IAA test next week. I am excited but a little nervous to see what the results are.
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Hi Andrea; First of all, congrats on shooting your first green! definitely scary, but kind of exhilarating too! :eek::D. Hope Tennessee continues to respond.
I see you're going for an acro/IAA test soon; I thought that's what I was doing yesterday too, but my vet was a bit balky and wants to check other things first. I'm curious as to your vets take on things. Is he/she receptive and aware about the TR protocol and this forum? I'm so tired of beating my head against the resistance of vets. I guess I should have held a line and just said, this is what I want done please. Anyway, I'll be curious to see how your results go too. My Oren is only to 6.25 now, and that dose seemed to horrify my vet. Sigh. So why not do the IAA/Acro test then?! Good luck!!
 
@Megan & Oren
Initially my vet wanted me to do an ultrasound. But somehow that fell through the cracks. So I decided to schedule the Acro and IAA tests. We will see what she says at our appointment. She had mentioned the possibility of Acro when Tennie was diagnosed, but we have never talked about him getting tested. She has never mentioned IAA, that is why I am bringing the info about both tests to our appointment.
I have spoken with her regularly about the fact that I speak with people on the forum. My vet actually said that this was one of the place online that she would prefer me to be, as it is a more reputable site.
I have never discussed the TR protocol with her. When Tennie was first diagnosed, I was reading a lot on the forum, but was not yet a member, so I cant say that I was following it. When I did ask her about her "protocol" she seemed more like a SLGS person, and she did tell me not to shoot under 200.
Each time we go in for a visit, I bring her his latest spreadsheet, and she has never had a problem with the dosage decisions that I have made. Although I do question if she may be upset that I shot a green number! The only thing that she has said to me was that his numbers looked good, but she was concerned that we have to keep going up on his dose.
I'll let everyone know the results when they are in. OR I'll be here to vent is she wont do the tests- but I'm pretty sure she will. After all its my dime.

Hopefully Oren will even out soon, and you can quit the dose increases!
 
Well done! Paws crossed for the vetty visit and tests. Whatever they show, there are folks here who can help you. That's great that your vet is deferring to your decisions. There's no way any vet could reasonably provide the kind of advice that you need with FD.
Liz
 
Hi Andrea! Congratulations on Tennie's first green numbers! Wow, reading this thread brings back a lot of emotions for me. Liz and I have only been here a short time, but going through FD is certainly a bonding experience, and I feel so much gratitude for the people here who have supported and taught me.

Anne & Zener (GA) said:
There's no way any vet could reasonably provide the kind of advice that you need with FD.
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Anne is right, and one of the vets at Liz's clinic told me that the people on this board know wayyy more than he ever will about feline diabetes! FDMB is AWESOME!

Good luck with your visit to the vet. :cat:
 
You'll want to start a new thread for today, but since this one is still going I just wanted to suggest that if/when you talk about shooting a green number with your vet, you use last night as a way to illustrate things. Lantus and Levemir both work better at holding blood sugar flat when it starts in a lower range than they do at bringing high numbers down. In fact, the cycle you had last night, starting at 91 and only moving as far as 67 is very typical. That was a spread of 24 points between the start of the cycle and the nadir. If you'd shot at 71, he still might have only gotten to 67. If a dose has been arrived at methodically per the protocol, ie, no 1.0u dose increases, increases appropriate for the nadirs, leaving an appropriate amount of time in between dose increases, then you can have some confidence that the dose is "right" and a nice flat cycle can be the result.

You can also reassure your vet that we never suggest someone shoot low and leave their cat unmonitored. After you have a few cycles that establish what your cat's response is to shooting low (ie, shooting the full dose into normal numbers) then you can spread out the testing and not test so often. Cats on their way to OTJ are often flat and might only get 1-2 tests in mid-cycle because their people have learned the cat's response and can be confident that the cat will stay flat and not move much.

In the links I gave you to read up on (today would be great to do that) there are some spreadsheets included that demonstrate exactly how this works. It's not for people who aren't willing to do the follow-up testing while they learn how it all works, but in your circumstance last night, you had strips, high carb and were willing to monitor, it was a good choice.
 
It's not just ok - it's better in many ways. For a person who wants their cat tightly controlled to protect their organs or to work their way off of insulin, shooting low is safer. It's one of those counter-intuitive things, but shooting a 400 might very well end up as a 40 at nadir and the cat might be back to 400 again at the next preshot. Sometimes it's like the cat's in freefall. Or the cat might only go to 200 at nadir. There's no predicting how low a cat will go when you shoot a high number. When you shoot a normal number, the cat is more predictable - if you've worked up to the dose as I've mentioned above. You can predict what the cycle will likely be like when you shoot a lower number.

Also, when you've had a few cycles like last night it's likely to be enough for the cat's body to re-accept normal blood sugar range as normal, and then the cat stops bouncing. Maybe the most unpredictable cycle of all is when a cat is clearing a bounce. Inexperienced people often think if they shoot a high number, then their cat's high enough that they won't go low. But you just can't make that assumption in the beginning.
 
I'm starting to understand what "shoot low to stay low" means now.
We haven't had any lows in quite a while, so this is all good.

@julie & punkin (ga) I wanted ask you if you thought it might be a good idea for us to switch to levemir? We are at 9 units BID right now. He does not seem to mind the Lantus, no sting yet (that I can see) But I see that most high dose cats seem to switch over to Levemir at some point.
We are getting to the bottom of his Lantus vial, so now might be a good time to talk to the vet about making the change.
What do you think?
 
I've seen some amazing improvements in cats that have switched to Levemir, but it depends on the cat. There are also some cats that continue with very similar cycles on it. I didn't switch punkin because of the expected later nadir - i'd gone back to work and couldn't imagine having to monitor him in the early morning hours. At that point, though, I also hadn't seen so many cats switch and do so well. Doing it over again I think I would have tried Lev.

If you're at a point that you have to buy new insulin, there's nothing to be lost by switching. You can always change back if you want. Anna/Bailey is the only one I know of that switched and then switched back, but I don't think she gave it long enough to get to a good dose. He only stayed on Lev maybe 2 weeks and she'd decreased his dose with the change and not gotten him back up to the Lantus dose yet before she changed him back. Most of the time people are happy with the switch.

Punkin didn't react to the shots either, but the Lantus people do say it's acidic and some cats do react.

The two most dramatic success stories in a high dose cat switch to Lev that I've seen, were probably Ozy (12/20/14) and Cobb, (8/7/14). Both of them ended up with nice flat cycles after they'd gotten to a good dose following the switch to Lev. Supposedly Lantus and Lev both have a duration of about 12 hours in cats, but it does seem like in many cats, the Lev lasts longer.
 
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