82 (AT2) at +2

The only dose less than 0.1U is a drop dose. Literally, 1 drop. Takes practice to draw that up.
So practice with a used syringe and some colored water or juice.

If you don't have time to practice that 1 drop dose, skip the insulin for tonight, as long as Max is still not showing any ketones present.
 
Instructions on drop dosing. A write up I did some time ago, to help people practice that "drop dosing".

Drop Dosing

How many drops do you get from your insulin syringes if you draw the liquid up to the first line? Not the first line with a number next to it, or the shorter line that shows half unit markings. The very first line on the syringe. What we think of as the zero mark.
  • Practice, practice, practice to see how many drops you can get out of the syringe.
  • Use some sort of colored clear juice like apple juice or colored water.
  • Mark the syringe well. Painter's tape, duct tape, masking tape at the top of your “practice syringe”. So you don't forget and use that syringe to draw up insulin.
  • Draw the "test liquid" up to the first line on the syringe.
  • After you have drawn up a tiny bit of “test liquid”, point the needle up towards the ceiling and give the syringe a "finger flick. To move/push the air bubbles to the top of the syringe. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the “test liquid.”
  • Then when one small drop of “test liquid” is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
  • You are looking for consistency.
  • Try to get evenly sized drops.
  • Practice, practice, practice until you get a consistent number of drops.
Do you think you have the technique down for the drop dose?

Then let me know.


When it’s for real. You’ve practiced and are ready to give a tiny “1 drop” dose.

Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "finger flick”. To move/push the air bubbles to the top of the syringe.
  • Push out the air bubbles that have floated to the top.
  • Slowly “twist” the syringe plunger to push out all the insulin.
  • Then when one small drop is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
"Finger flick” technique - make a circle with thumb and first 2 fingers tucked into first thumb joint. Quickly “snap” those first 2 fingers against the syringe barrel held in your other hand. That will force any air bubbles up to the top of the syringe. Then you can push the air bubble out.

Syringes have a lubricant inside. Before you draw up insulin, moving the syringe plunger up and down a couple of times helps the plunger move more easily.

Give the shot. Monitor.

Later, if you need to, you could increase the number of drops.

Be aware that some syringes can vary on where the lines are on the barrel.

Bear with me, while I try to find the pictures, that show the tiny drops of insulin.
 
Deb & Wink said:
Instructions on drop dosing. A write up I did some time ago, to help people practice that "drop dosing".

Drop Dosing

How many drops do you get from your insulin syringes if you draw the liquid up to the first line? Not the first line with a number next to it, or the shorter line that shows half unit markings. The very first line on the syringe. What we think of as the zero mark.
  • Practice, practice, practice to see how many drops you can get out of the syringe.
  • Use some sort of colored clear juice like apple juice or colored water.
  • Mark the syringe well. Painter's tape, duct tape, masking tape at the top of your “practice syringe”. So you don't forget and use that syringe to draw up insulin.
  • Draw the "test liquid" up to the first line on the syringe.
  • After you have drawn up a tiny bit of “test liquid”, point the needle up towards the ceiling and give the syringe a "finger flick. To move/push the air bubbles to the top of the syringe. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the “test liquid.”
  • Then when one small drop of “test liquid” is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
  • You are looking for consistency.
  • Try to get evenly sized drops.
  • Practice, practice, practice until you get a consistent number of drops.
Do you think you have the technique down for the drop dose?

Then let me know.


When it’s for real. You’ve practiced and are ready to give a tiny “1 drop” dose.

Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "finger flick”. To move/push the air bubbles to the top of the syringe.
  • Push out the air bubbles that have floated to the top.
  • Slowly “twist” the syringe plunger to push out all the insulin.
  • Then when one small drop is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
"Finger flick” technique - make a circle with thumb and first 2 fingers tucked into first thumb joint. Quickly “snap” those first 2 fingers against the syringe barrel held in your other hand. That will force any air bubbles up to the top of the syringe. Then you can push the air bubble out.

Syringes have a lubricant inside. Before you draw up insulin, moving the syringe plunger up and down a couple of times helps the plunger move more easily.

Give the shot. Monitor.

Later, if you need to, you could increase the number of drops.

Be aware that some syringes can vary on where the lines are on the barrel.

Bear with me, while I try to find the pictures, that show the tiny drops of insulin.
Click to expand...

Will practice this! He did have a low of 84 last night. Not sure if you saw.
 
I do have Max's SS open, so yes I do see that Max had earned another dose reduction, which is why you only gave him 0.1U this morning, 7/9/20.
I'm leaning heavily towards skipping. Maybe even starting an OTJ trial.

p.s. SS says it was 82!;)
 
Deb & Wink said:
I do have Max's SS open, so yes I do see that Max had earned another dose reduction, which is why you only gave him 0.1U this morning, 7/9/20.
I'm leaning heavily towards skipping. Maybe even starting an OTJ trial.

p.s. SS says it was 82!;)
Click to expand...

Sorry yes, 82, was going off memory. So nervous about an OTJ trial, but I trust you. Shots have become such a daily norm now.
 
Deb & Wink said:
I do have Max's SS open, so yes I do see that Max had earned another dose reduction, which is why you only gave him 0.1U this morning, 7/9/20.
I'm leaning heavily towards skipping. Maybe even starting an OTJ trial.

p.s. SS says it was 82!;)
Click to expand...

Do you want me to continue +1 and +2 feeding tonight or would you rather see what his body is doing naturally?
 
Gotta Wink out of me! ;) I was teasing you, as you should know.

Yes, I can understand that you are probably nervous about an OTJ trial, but let's see what Max does for a few cycles with NO insulin.

Let's first try with the feedings as you would be able to do when you have to go back to work. If that includes a +1 or a +2, then continue those feedings.
But we have been using those additional feedings to keep Max's numbers running higher, and keep him from diving too fast.
Would you normally be able to feed Max at +5 to +5.5?

Prozinc can last a bit longer than the 12 hours in some cats, so please test tonight as you have been doing.
Don't get discouraged if Max's BG levels are higher at AMPS tomorrow 7/10/20. And possibly for the PMPS too. It may take a cycle or 2 for Max's body to accustom to no insulin.

Since you are stopping the insulin, please test for ketones at least once a day. If Max's appetite is off, or he has an infection/inflammation (think bad teeth, UTI, etc.) then test more often.
 
Deb & Wink said:
Gotta Wink out of me! ;) I was teasing you, as you should know.

Yes, I can understand that you are probably nervous about an OTJ trial, but let's see what Max does for a few cycles with NO insulin.

;)Let's first try with the feedings as you would be able to do when you have to go back to work. If that includes a +1 or a +2, then continue those feedings.
But we have been using those additional feedings to keep Max's numbers running higher, and keep him from diving too fast.
Would you normally be able to feed Max at +5 to +5.5?

Prozinc can last a bit longer than the 12 hours in some cats, so please test tonight as you have been doing.
Don't get discouraged if Max's BG levels are higher at AMPS tomorrow 7/10/20. And possibly for the PMPS too. It may take a cycle or 2 for Max's body to accustom to no insulin.

Since you are stopping the insulin, please test for ketones at least once a day. If Max's appetite is off, or he has an infection/inflammation (think bad teeth, UTI, etc.) then test more often.
Click to expand...

;)

When I go back to work I plan on either having my oldest feed them at +5.5 or get an auto feeder (frozen cube). To me, 9 hours is a long time to go without food. At Max’s last check (2 months ago) the vet said he needed a dental. I do plan on doing that, but I worried about the stress on him while going through FD. I’ve been sitting about 6 ft from the litter box For about 30 mins trying to get a sample, but I guess he knows this and isn’t going. He always goes after he eats.

Very nervous right now. My anxiety is out in full-force. Will check him at +2. Thanks again. You are so kind to dedicate your time to helping many on the board. I’m so grateful.
 
What has your anxiety high? The fact that Max isn't getting insulin means he can't have a hypo.
What else has you worried?

NoahFL said:
You are so kind to dedicate your time to helping many on the board. I’m so grateful.
Click to expand...
You're welcome.

p.s. Can't garden in the dark, so here I am, on the message board! :p
 
Deb & Wink said:
What has your anxiety high? The fact that Max isn't getting insulin means he can't have a hypo.
What else has you worried?


You're welcome.

p.s. Can't garden in the dark, so here I am, on the message board! :p
Click to expand...

Just the unknown worries me. Setbacks. This cat had my heart as a 4 month old kitten, but now he really has my heart.

PS - I share your passion for gardening. It’s my stress relief. Had a great vegetable garden this year.
 
If the reduction to 0 (zero) insulin doesn't hold, then you start Max back on insulin. No big deal. No worries.

If you like gardening, you should check out this thread in the Community & Off-Topic forum.
2020 Gardens

Share some pictures with us, over in that thread. In your copious, free time. :rolleyes: Not enough sun here where I live for much of a veggie garden. Surrounded by 80- 100 foot oak and hickory and pine trees. I do have rhubarb and some herbs.
 
NoahFL said:
Can you link me a good one? I’m not familiar with them.
Click to expand...
I use the keto MOJO meter. I like it but it's a little pricy. I got mine several years ago before it came with the fancy software. Lol it can also read glucose so it can be used as a backup bg meter. KETO-MOJO Bluetooth Ketone & Glucose Blood Testing Kit + APP, 20 Test Strips (10 Each), 1 Meter, 10 Lancets, 1 Lancing Device, Monitor Your Ketosis & Ketogenic Diet https://www.amazon.com/dp/B0789G8KTG/ref=cm_sw_r_cp_api_i_26vcFb1K01X1R

Looking on amazon the ketosense meter had good reviews and is cheaper KetoSens Blood Ketone Monitoring Starter Kit - Ideal for Keto Diet. Includes Meter, 10 Test Strips, 10 Lancets, Lancing Device & Carrying Case https://www.amazon.com/dp/B07MPCX4DZ/ref=cm_sw_r_cp_api_i_.8vcFbNGDK2FK
 
@Deb & Wink Good morning! How do you think Max is doing on his OTJ trial? He’s acting very happy and lovable. Purring a lot. Still trying to get another urine sample, but he’s not cooperating. He doesn’t seem to like an audience.
 
Max is looking pretty good for no insulin!

Remind me, and I'll post the official OTJ instructions for you in the morning, Sunday 7/12/20. Or the evening.
Brain is fried, being up this late.
 
Deb & Wink said:
Max is looking pretty good for no insulin!

Remind me, and I'll post the official OTJ instructions for you in the morning, Sunday 7/12/20. Or the evening.
Brain is fried, being up this late.
Click to expand...

Thank you. It’s been a ride today for sure. Hope you can get a restful night.
 
OTJ Trial Guidelines (These are the criteria we use when following an OTJ Trial.)

Here are the instructions for an OTJ trial: If on Lantus or Levimir, depot has to drain first before trial starts, about 3 days or 6 cycles. No depot with in and out type insulins (NPH, Vetsulin/Caninsulin, Prozinc). The trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range. Start the trial on the next green pre shot.

If you are posting in the Lantus/Levimir forum, please start a new thread each day which says ‘[Cat name] OTJ trial Day 1 BG xx’ (where xx is the BG reading for that cycle PM), then day2,3 etc. If you are posting in the Main Forum, we don’t require you or need you to do that separate post for each day. In fact, if you have never posted before over in the Lantus/Levimir forum or use a different insulin, you are fine staying in the Feline Health (Welcome & Main Forum). Or in the specific ISG (Insulin Support Group) for your insulin. We’ll cheer you on!

1. Test at your normal AMPS and PMPS times. Remember, you want a 2 hour fast before those AMPS and PMPS test times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas). The morning test is now called the AMBG. The evening test is now called the PMBG.

2. If your cat is green (0-99 mg/dL human meter, 0-130 mg/dL pet meter, 0-5.5 mmol/L) 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 the numbers are blue or higher (100-199 human meter, 130-230 petmeter, 5.5-11 mmol/L), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

3. Your cat may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

4. After 2 weeks, 14 full days, if everything is looking good, we have a party!

Sometimes, the trial doesn't work the first time and we have to give a little more support by starting the cat with a tiny dose of insulin again. I had to do that with Wink. We simply start the cat back on a tinydose of insulin to support the pancreas with healing for a bit longer. Our goal is a strong remission and it's better to be safe now then sorry later that you rushed it. With just a little more time we will probably get that strong remission we are looking for.

While Max didn't get into the normal range of a non-diabetic cat, he did keep getting those low blues and earning dose reductions during the cycles. So we are trying an OTJ trial with Max anyway.
 
So 10, 10 and a half days on the OTJ trial?



OTJ day 10 ocean theme.jpg
Cheering post for day 10.


OTJ day 11 FL.png
Cheering post for day 11! Livin' it up in the sunshine state.
 

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JanetNJ said:
The numbers since remission are amazing
Click to expand...

I’m so proud of Max. Right now we are eating 3 times a day with FF and some dried chicken. His hair isn’t filling in, but doesn’t seem to be bothering him and no breathing issues. I’m hoping after this hot allergy haven summer is over his hair will grow back. I have to admit though, I still think I stop breathing while the glucometer is preparing the reading. Trying to test once a week.
 
NoahFL said:
I’m so proud of Max. Right now we are eating 3 times a day with FF and some dried chicken. His hair isn’t filling in, but doesn’t seem to be bothering him and no breathing issues. I’m hoping after this hot allergy haven summer is over his hair will grow back. I have to admit though, I still think I stop breathing while the glucometer is preparing the reading. Trying to test once a week.
Click to expand...
Cat hair often takes a while to grow in
 
JanetNJ said:
Cat hair often takes a while to grow in
Click to expand...
Like a couple of months usually. Think of those tiny shaved bellies, when kittens have their spay/neuter surgeries. Or the leg is shaved on a cat for an IV or a patch of fur is shaved on the back of the cat, to install one of those Freestyle Libre CGM's.
 
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