9/8 Yahtzee AMPS 380 +5.5 329 PMPS 300 +3 214

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Deb & Yahtzee

Deb & Yahtzee

Member Since 2012
Yesterday's Condo

I keep telling Yahtzee that pink is NOT his color!!! Blue matches his eyes, and even better, green matches the beautiful wilderness in the yard that he adores through the windows all day ;-)

Admittedly, I haven't gotten a good curve in for a couple days. Vetty tried to convince me to ignore his numbers following the change in dosing (from SID to BID). OK, I understand that there's going to be some adjusting... but IGNORE... no way!! I'm way too paranoid! I'll be testing through the night as tomorrow will be day 3 (6 cycles) of 0.5 BID. Trying to keep closer tabs to see if a dose increase is necessitated. Vetty and I agree that Yahtzee is fairly sensitive to insulin, so dose increases will be in tiny amounts. I'm thinking a fat 0.5 (or 0.6) may be in order. But I want to get a full day or two of curves in before I up the dose.

Fingers and paws crossed for stability in everyone's cycles!
 
Well, a blue creeped in.

I'm trying to understand why you think Yahtzee is sensitive to insulin.
I see a +6 or +7 possibiity for nadir most of the time. ( of course that can change any time Yahtzee sees fit to do so)

But I also see some bounces.
So I'm just asking what I'm missing.
 
I guess I'm just going by our vet's comments pointing out that a 0.5 dose can send him anywhere from high 300s to double digits. Maybe that is poor terminology to use. I just meant that I was going to do increases gradually so I can closely monitor the nadir, since it's not all that regular yet. Do you think I'm being too cautious with the minor dose increases? I know the vet is extra cautious and I lean to be more aggressive in treatment.
 
I see why you are saying that now, or why the vet thought it?

Is you vet talking about remission or just regulation? We have plenty of vets here who seek only for regulation so they get nervous when
the numbers get low especially when they cause it by starting out too high in some cases. You got an early green which would have been
a dose decrease if Yahtzee had made it to 49. If Yahtzee was at the vets for those curves, then the night they got those low numbers,
they didn't check on the bg at all. Then you have that red bounce number the next am cycle.

In your case the vet started you out too high on dosage and then pulled back.

Are you doing the relaxed protocol or the Tight regulation protocol?
I'm going to get someone to look
 
Good morning, Deb!

I think it's hard to say whether Yahtzee is insulin "sensitive." The Tight Regulation Protocol that we use here is an aggressive approach to diabetes management. While aggressive in it's goal to bring numbers into normal range, it is also an approach that is safe because dose changes are made in relatively small amounts that are based on what the numbers at nadir dictate. Based on the protocol,
  • If nadirs are mostly over 300 for 6 cycles, increase the dose by 0.5u;
  • if nadirs are mostly under 300, increase by 0.25u;
  • hold the dose for 6 cycles (3 days) unless nadirs are mostly below 200, in which case, hold the dose for 5 days.
In general, then, you are increasing the dose by 0.25u increments (and decreasing by the same amount when numbers drop below 50). If you want to increase in smaller amounts, that's up to you. If you're home and able to monitor, you can always increase by 0.25u or if you're concerned that it's too large of a change, then fatten the dose. Either way, I think you should have an open mind with respect to evaluating the effectiveness of your dosing strategy. I think it's important to weigh whether the smaller increases are letting Yahtzee sit in a BG range that's above renal threshold (above the lower 200s).

The initial SID dosing, may have caused your vet to describe Yahtzee as being sensitive to insulin. However, you vet started Yahtzee at 1.5u and then increased to 2.0u rather quickly by TR standards. Most cats are started at a smaller dose (usually around 1.0u BID). The higher dose may be what caused the vet to come to the conclusion he did. (We use a formula to calculate initial Lantus dose: initial dose = 0.25 x ideal weight in kilorams.)

I'm with you -- I couldn't, in good conscience, ignore the numbers or not test. It wouldn't be safe. I wonder if the vet would think the same thing if this were his child. (I bet he wouldn't say to ignore the numbers.) To say to not be overly concerned if numbers go up for a cycle or two is a different statement -- we refer to this as "new dose wonkiness" (NDW).

I think you've been doing a reasonable amount of testing. You don't need to do a curve on a daily basis -- spot checks are just as good and sometimes even better. Right now, I think you're seeing a bounce off of that blue number on 9/7. It can take up to 72 hours for a bounce to clear.

This is a copy of the article published in a leading veterinary journal that describes the research that lead to the Tight Regulation Protocol. It may be helpful to share this with your vet.
 

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Rhiannon, our vet has mentioned the possibility of remission but I believe she is just aiming for regulation. This is where her and I differ, as I am prepared to follow the TR protocol. I discussed with her the study by Drs. Roomp and Rand and she was clearly hesitant to follow this aggressive approach. This is where the sensitive comment came in.

I have to apologize for the intermittant half-day curves in our early weeks of dx. These curves were done by the vet and I was not home testing yet to monitor the follow up bounce routines. The vet curves were done 10-14 days apart so the info is scattered. The info is minimally helpful, but I included it as an easy way to keep track rather than looking through all my vetty receipts.

When Yahtzee was started on insulin by our vet, it was 1.5 BID. The IM vet was the one who suggested increasing to 2.0 BID when he had his weekend stay at the hospital for pancreatitis. Then our regular vet decreased this a week later based on their curve. So, yes, I realize there were some quick dose changes in the beginning. I believe this had to do with different vets advising and myself not being knowledgeable enough at the time. After that, Yahtzee had curves done at the vet every 10-14 days and this is how we reduced from 1.5 BID, to 1.0 BID, to 0.5 BID, and to 0.5 SID. This is the point when I started home testing. I now realize the TR protocol suggests smaller increment reductions and that's exactly what I plan to do going forward.

The vet's "sensitive" comment came up on 9/6/12 when I was reporting Yahtzee's recent BG numbers. I think she was looking at the 8/26 PMPS of 336 going to 85 at +7. I was also discussing the study by Drs. Roomp and Rand, so maybe the sensitive comment was just to try to scare me away from an aggressive approach to treatment. Despite the vet's hesitance, Yahtzee and I would much rather follow the TR protocol.
 
I agree with you. I think your vet is being conservative. After all, if she's wrong, it's her butt in the sling.
We have a lot of vets who seem to start higher and pat you on the head and say see you in 2 weeks.
They aren't into the daily management and for some of them, it's a brave new world. She was also probably used to doggie insulin
which works a lot differently otherwise she would know that Lantus is twice a day and wouldn't have gone to SID.

So no worries on the beginning stuff, we are all on a steep learning curve and so much of this is trial and error in the beginning.
It's help you learn to adjust and change strategies. If you look around, many have had poor starting advise from their vets and
corrected course after find help here.
You might not have full vet support for the TR so be prepared for that. Many here have had that discussion with their vets.
But you have more experienced eyes here who've been doing this for years and really know the insulin and how it works.
Many vets don't have a lot of hands on experience with diabetes and certainly not with Lantus. They aren't specialized, they
are general practitioners.

And anytime you need help and aren't getting an answer, pm someone who can tell you what dose or direction to go.
I think you could see some action with your next increase. ( IMHO)
 
Often and especially with vets who are not using the TR approach coupled with caregivers who don't home test, vets are uncomfortable with seeing cats in numbers that we consider highly desirable. Vets are scared of green numbers. And, if someone isn't home testing, they should be nervous. Vets are concerned about their liabiilty and don't want to put a cat at risk for hypoglycemia. In addition, they are not entirely familiar with how this kind of Board works (and probably consider us the crazy cat ladies of the internet). Vets know that they aren't available 24/7 if a cat's numbers are running low and their reaction, if you can reach them, is to take the cat to the ER for a dextrose drip. More often than not, there is someone here 24/7 and they are experienced at managing low numbers. Our reaction is typically to tell you to take a deep breath and crack open a can of HC food, and plan on testing and feeding every 30 min. (There are times when we do tell people to get their cat to an ER.) We will also stay up with you to help manage those low numbers. As you work toward getting Yahtzee's numbers into a better range, the unspoken bonus is that you will also be educating your vet about the TR Protocol and (hopefully) your vet will encourage other caregivers of diabetic cats to use this approach as he sees how well Yahtzee responds.
 
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