Blue Cat 4-12-2010

[Steve and Blue]

Well it's been 17 hours since Blue has needed a dose of insulin. His last dose was a 1.2U. He's hovering in the low 100's even after eating meals - in fact it's dropped in the last few hours! I think that this is a very good sign?

When he does start to rise over 150, I'm thinking of going with the 'sliding scale' and lessen his dose instead of waiting for him to rise to where he should get a 1.2U (180-200 or so). Opinions please!

Thank you.

 

[Gator & H (GA)]

First let's change that to "if" he does go over 150. :smile: We're keeping our paws crossed for you.

Depends on what you mean by "sliding scale" but in general I am very for variable dosing strategies. In my head it is all about giving the insulin the cat needs at the time. Some cats do better with VDS than others. In my switch to ProZinc it seemed that H maybe needed a little training to get his little body to get used to a different dose every shot. You also might call what you are thinking of doing as just a simple dose reduction which might be in order too. I shoot at numbers as low as 90-100 but with much reduced doses [and experience/data to feel comfortable doing that] so...

I'm happy to hear things are improving for you guys. As I said it takes up to 2 weeks for the food change to really take effect then you may see continuing improvements beyond that. So it's good to see you are getting the rewards of your hard work [and attempted patience ;-) ].

If Blue does go into remission, please make sure to post in the recent remissions topic here:
viewtopic.php?f=24&t=5659

 

[Steve and Blue]

Hi G&H,

What I mean by 'sliding scale' is by what is outlined in the Tight Regulation protocol by Dr. Hodgkins. Basically a .5 dose on an upswing of 151-170, 1.0U dose on an upswing reading of 171-185, etc. and I would probably check his BGL at least every 6 hours to make sure he is rising before shooting. As of right now at last check he was at 80 @ +18 and is still eating well.

He's doing so well on those 1.2 doses I hate to mess with it - but want to keep him in the 'zone' at the same time so maybe it's best to shoot 'as needed' instead of waiting on the 12/12? Hopefully he can keep himself in the zone so I wouldn't have to make that choice, but I don't want to be too optimistic.

Thanks for the wishes and info - it's been invaluable! Thanks for the link too. Although I am hesitant to even think of that 'R' word at this point!

 

[Gator & H (GA)]

Keep in mind that every sliding scale should be CUSTOMIZED for the cat. I would be surprised if Dr. Hodgkins even intended what ever scale you are referencing for every cat. And I've read that the YDC site has an updated beginner scale too so you would want to make sure you have the latest if you were just going to use some blanket scale.

I think it is important to note that the VDS I use is not anything set in stone either. It changes frequently depending on what's going on with H. My, scale is more a moving average with probably the past 3 days with the most influence, then probably moving to 10 days and then with just kind of keeping things in the back of my head are all of history.

You will also want to stay flexible since Blue's situation seems to be changing at this point.

Also it appears that scale is incremented in only .5u increments and you are able to do much finer adjustments than that. Especially when you are working at lower doses you will want to make small changes [certainly in .1u increments and I even make changes in "0.05u" increments sometimes].

Your other option is to use your common sense and intuition and develop your own "scale." And this just basically means trying lower doses and seeing what they do then use that data for future dosing. If you shoot to low then the worst case is that they just zoom faster that you would have wished. The things to pay attention to are deltas [change from PS to nadir] and changes from one PS to another.

The bottom line is that I've had good success in making small but frequent changes in dose which some people might call "sliding scale." 0.5u changes are 100% not what I would call "small." But if you feel it is needed by all means do make changes - no matter their "size" - in doses that you fell are appropriate for Blue. I would hate for you to not make a dose reduction that was appropriate because Gator said, "make small dose changes." :smile:

Also keep in mind that how I do things is a little different that how many others here go about it. And the advice you have been getting from the others I completely support too.

 

[Steve and Blue]

G&H,

I mentioned the doses above for the sliding scale as just an example for what I meant. I would certainly customize dosing for Blue on what HIS numbers were telling - not just for what any prewritten scale said to dose. Though in the beginning of this 'drama' I did reference it as a general guide. Thanks for noting that and making sure I know that. ;-)

I think it is safe to say that his pancreas is functioning - to what extent I don't know. I just hope it continues, and if not I think I just want to be prepared to make any adjustments. I'm still unsure of when I would shoot him a dose - most likely if he were to hit 150 but am tempted to drop the threshold to 130 or so. Just don't want to make him drop to a low number and risk any rebound issues.

In any case I think today's numbers gives reason to remain positive about all this.

Edit: 106 @ +21

 

[Joanna & Bix (GA)]

Yippeeeeeeeeeeeeeeeeeeeee!!! Good kitty, Mr. Blue! :mrgreen:

I would stick with 150 as your cutoff, as long as he is still moving #s around like he is (i.e. bringing them down on his own). There is a theory I have been told that one reason not to shoot below that is that their pancreases need to get the picture they need to do the job - if you shoot at lower #s, their pancreases can get the message that they can be lazy and not bother. I'm not sure I subscribe to the theory, at least it hasn't seemed to be the case with Bix, but that's what I've been told - I believe it comes from Dr. H.

One thing you can try if you see a slightly higher # is to feed him a little and then test a couple hours later and see if he brings things down on his own. If yes, then you are back in #s you like, if not, you can shoot then.

From here out I think ECID really applies, and you have to do what feels right to you, with some trial and error, to keep assisting the pancreas when it needs it, without interfering too much. On the one hand it might be a delicate line to try to find, on the other hand, from what I have seen, when their pancreases have healed nicely, doesn't matter too much what you do (within limits), and they will be just fine.

Personally, I would probably be tempted to shoot either 0.8u or 1u if he crosses 150 (or possibly if he hovers in the 130+ zone for an extended time, with no sign of bringing the #s down further on his own). Some people actually raise the no-shoot at this point, to 180 or even 200. If you look around at OTJ spreadsheets, you can see that sometimes they will spike up over 180, but then still come back down and continue OTJ. Also from what several people have said, it seems like in the 1st week or 2 they can run a little higher (like low 100s), but then by the 2nd week with no shots are bringing themselves down to the 50s & 60s nicely on their own.

Remember too that if he is diet-controlled, NO higher carbs. Sometimes people feed a few bites of dry food here and there thinking 'what can it hurt, it's a tiny bit', and end up back on insulin.

 

[Steve and Blue]

Yippeeeeeeeeeeeeeeeeeeeee!!! Good kitty, Mr. Blue! :mrgreen:

Indeed!

I would stick with 150 as your cutoff, as long as he is still moving #s around like he is (i.e. bringing them down on his own). There is a theory I have been told that one reason not to shoot below that is that their pancreases need to get the picture they need to do the job - if you shoot at lower #s, their pancreases can get the message that they can be lazy and not bother. I'm not sure I subscribe to the theory, at least it hasn't seemed to be the case with Bix, but that's what I've been told - I believe it comes from Dr. H.

Interesting... only one way to find out if it applies in this case I suppose.

One thing you can try if you see a slightly higher # is to feed him a little and then test a couple hours later and see if he brings things down on his own. If yes, then you are back in #s you like, if not, you can shoot then.

Sounds like a plan.

From here out I think ECID really applies, and you have to do what feels right to you, with some trial and error, to keep assisting the pancreas when it needs it, without interfering too much. On the one hand it might be a delicate line to try to find, on the other hand, from what I have seen, when their pancreases have healed nicely, doesn't matter too much what you do (within limits), and they will be just fine.

Not familiar with that ECID acronym, but I can guess.

Personally, I would probably be tempted to shoot either 0.8u or 1u if he crosses 150 (or possibly if he hovers in the 130+ zone for an extended time, with no sign of bringing the #s down further on his own). Some people actually raise the no-shoot at this point, to 180 or even 200. If you look around at OTJ spreadsheets, you can see that sometimes they will spike up over 180, but then still come back down and continue OTJ. Also from what several people have said, it seems like in the 1st week or 2 they can run a little higher (like low 100s), but then by the 2nd week with no shots are bringing themselves down to the 50s & 60s nicely on their own.

Good info. Not sure what direction I would take yet. I'm leaning toward shooting a .5 or .8 if he hits 150 and shows signs of climbing from there. The 'not letting the pancreas get lazy' theory gives me pause, however.

Remember too that if he is diet-controlled, NO higher carbs. Sometimes people feed a few bites of dry food here and there thinking 'what can it hurt, it's a tiny bit', and end up back on insulin.

Nope, Mr. Blue will not be getting a single popcorn kernel, dry food morsel, or pizza as long as he is around. Sorry Blue. ;-) Actually, he loves his current diet.

Thanks for the insight J&B and everyone else as well! As always will take into consideration all the advice and info given and will hopefully make the right choice if and when I need to - given the options. Of course it'd be nice if Blue's pancreas just starts doing what it was born to do and leave me out of it altogether. :lol:

 

[Michelle & Prudence]

I would stick with 150 as your cutoff, as long as he is still moving #s around like he is (i.e. bringing them down on his own). There is a theory I have been told that one reason not to shoot below that is that their pancreases need to get the picture they need to do the job - if you shoot at lower #s, their pancreases can get the message that they can be lazy and not bother. I'm not sure I subscribe to the theory, at least it hasn't seemed to be the case with Bix, but that's what I've been told - I believe it comes from Dr. H.

First of all - Congrats on Blue's numbers!!! drinking24 I have not heard of this theory, but I do believe it rings true to some degree. I was shooting at a lower# and although Pru has been doing awesome... she slipped into the 300's cat(2)_steam I don't know if it's because I wasn't around the last few days. Not sure if she's eating as much? maybe she's depressed cause we we're together 24/7 but she did go over a week w/o insulin. Anyways... I had to give her a little bump of insulin, so I will see how that goes...but I am going to try the cutoff at 150 too.

 

[Steve and Blue]

I would stick with 150 as your cutoff, as long as he is still moving #s around like he is (i.e. bringing them down on his own). There is a theory I have been told that one reason not to shoot below that is that their pancreases need to get the picture they need to do the job - if you shoot at lower #s, their pancreases can get the message that they can be lazy and not bother. I'm not sure I subscribe to the theory, at least it hasn't seemed to be the case with Bix, but that's what I've been told - I believe it comes from Dr. H.

First of all - Congrats on Blue's numbers!!! drinking24 I have not heard of this theory, but I do believe it rings true to some degree. I was shooting at a lower# and although Pru has been doing awesome... she slipped into the 300's cat(2)_steam I don't know if it's because I wasn't around the last few days. Not sure if she's eating as much? maybe she's depressed cause we we're together 24/7 but she did go over a week w/o insulin. Anyways... I had to give her a little bump of insulin, so I will see how that goes...but I am going to try the cutoff at 150 too.

Thanks. Good luck to you with that and congrats on the OTJ week! A minor bump in the road I'm sure. I'll be looking for updates on Prudence and will be looking for the those green numbers once again. :smile:

 

[Steve and Blue]

Well, Blue guy is still hovering around 150 (156 at last check at +26). I'm sooo tempted to shoot him up, but I came across this from Dr. Hodgkins (which J&B also spoke of):

"The rationale for not shooting at these near-normal levels is to see if the pancreas of the
cat will handle the matter itself. You never know when the pancreas will feel "up to"
handling these small rises, and if you shoot from outside, you certainly do obscure that
observation. Additionally, if the pancreas and the liver are getting into sync with each
other at such a time, giving insulin causes the liver to do exactly as it should if a fairly big
burst of insulin shows up (our dosing, even when conservative, is always excessive
compared to the much smaller, measured and frequent doses that come from the
operating pancreas in response to the gradual rise in BG that happens in any animal. We
are, after all, a very crude substitute for the operational pancreas under the best of
circumstances). So, at some point, all of us want to find out what the cat itself can do.
We don't want to go too long before we decide that the cat needs help from outside,
that's for sure. So, the answer to your question is really a matter of whether you can
follow the rising BG (given your schedule) and wait a bit, or whether you cannot test
again in the near future and don't want to risk the BG getting too high before you can get back and test again."

So, even though Dr. H was speaking of numbers closer to 130 I believe, I can check on Blue Cat's numbers the rest of the night if I need to. He is hovering around 150 and hasn't eaten in a few hours (sleeping, he almost sleeps through his gluco tests). I think I will wait a bit after he eats and see if his system can regulate itself before he gets too high. If not, he'll likely get a small .4 to .8 dose if need be.

Edit: Still at 153 @ +28. He ate a good meal an hour ago and remains steady. I somewhat wish he would go in one direction or the other - but apparently his pancreas is programmed to stay right at the shooting threshold. confused_cat Almost shot a .4, but will wait it out a bit more...

 

[Michelle & Prudence]

Thanks. Good luck to you with that and congrats on the OTJ week! A minor bump in the road I'm sure. I'll be looking for updates on Prudence and will be looking for the those green numbers once again

Thanks Steve!

Like other ppl had mentioned... it can take a few weeks before the diet/insulin starts working properly, so try and be patient. It took me close to 8 weeks to get where I am, but I am praying that Blue will be able to go OTJ sooner :smile: I am just wonder if I got a little ahead of myself by not giving Pru a few more rounds of insulin at 0.1 units :-| You are doing awesome, just try to figure out if Blue could use a bump here and there like you had mentioned. Even if it means going to a smaller dose, but letting him ride somewhere in the greens. Looks like he's riding in the blues 100 to 150 range and that's what Pru did... I just don't want you to have to back track like I am right now, ok ;-)

Hugs to Blue!!!!

 

[Steve and Blue]

Thanks Michelle - Just saw Pru's profile for the first time - She is a cutey! I think Blue would like her. A fine stable of friends she has there as well.

It's tough to say whether a few more doses would have made a difference with Pru or not. Like others have said you have to do what feels right and make your best educated guess. In most cases when going OTJ you will have a setback or two (at least) it seems - sooner or later.

In my case tonight it's a question of giving the panc a little push, or hoping that the brain tells it to ride a bit lower on it's own. I'm a pretty decisive (and impatient) person, but I'm darn hesitant to do anything right now since Blue has been riding that 150 threshold for quite some time - food or no food. So weird it's right at that number I predesignated for action. @-) When I think I make up my mind, I read something else that makes me doubt the choice. I'm trying to be patient and it isn't easy! Maybe patient is not good in this circumstance? I don't know.

What I do realize though, is that in all of this there is no 'right' answer for everyone (ECID right?) ;-) In my quandary tonight I think that even if Blue should ride 150 for the night it will not do him any harm. Sooner or later his number will budge one way or the other.

We're both in a good place I think - not perfect - but pretty good. At least we know that our cats are capable of a perm remission. It will happen.

edit: 159 @ +29 Wrong way. He gets a bump.

Thanks. Good luck to you with that and congrats on the OTJ week! A minor bump in the road I'm sure. I'll be looking for updates on Prudence and will be looking for the those green numbers once again

Thanks Steve!

Like other ppl had mentioned... it can take a few weeks before the diet/insulin starts working properly, so try and be patient. It took me close to 8 weeks to get where I am, but I am praying that Blue will be able to go OTJ sooner :smile: I am just wonder if I got a little ahead of myself by not giving Pru a few more rounds of insulin at 0.1 units :-| You are doing awesome, just try to figure out if Blue could use a bump here and there like you had mentioned. Even if it means going to a smaller dose, but letting him ride somewhere in the greens. Looks like he's riding in the blues 100 to 150 range and that's what Pru did... I just don't want you to have to back track like I am right now, ok ;-)

Hugs to Blue!!!!

 

[Joanna & Bix (GA)]

Thanks for putting in the quote from Dr. H, that actually clears up some confusion I had about what she meant. Wish I had gone & looked for it a while back myself oh well.

I would shoot. I think it's clear from her quote that she isn't intending you leave them at 150 for a length of time, but rather you wait a bit to see if they'll bring the #s down. She doesn't define "a bit", but since she is encouraging people to test more often than BID, I would think she probably only means a few hours, to see if the #s are rising & falling, or more hovering and gradually rising.

If you have fed him and his #s are over 150 and not budging, I would go ahead and shoot something. I think any amount up to 1.2 is probably fine, dealers choice ;-) You could always experiment like you said with a much smaller dose, maybe 0.5u, and see if that gives him the nudge he needs. Bix (and I've read of some other cats like this) doesn't respond at all to the tiny doses, but some cats do and will get a nice drop off of even 0.2u. Personally I would probably shoot more and aim for the really good #s that will help promote more healing, on the theory that his panc might not quite be ready yet to go it alone, but I don't think there is a right or wrong answer really. And I agree you don't want to trigger rebound and have things get mucked up temporarily.

Sorry to hear Pru got off track a bit. I guess that is why they say you should go 2 weeks w/o insulin before holding an OTJ party. For a while Bix was going close to a week between shots, but has never lasted more than 10 days (and I think I let him go too long & now we are back to BID). Hope she is back in a good place soon!

[just saw you are already shooting... hoping for a nice green ride! (but not too low Blue!!!)]

 

[Steve and Blue]

Yeah I shot as you were posting J&B. I shot a .5U to see how he reacts to it. If I need to go higher next time I will. I figure that if I go higher he may drop too much and he has been known to rebound as you mention. He was also climbing ever so slowly so I don't think he needed much to get him down. Hopefully he will ride green soon. We will see how he does with this small a dose. I will test (well, someone will) at +5 or so.

Well it's been an interesting night. Once again, thanks for all the support everyone. I feel lucky to have found this place. Hopefully more people will learn how to properly treat their cats as I'm trying to spread the word whenever/wherever I can.

Did I mention you guys rock! \M/

'Nite to all! I-)