Guidance Requested: Remission/OTJ Protocol?

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Shannan

Shannan

Member Since 2023
Hello! I think we are on the road to remission. Albus has been doing really well (I suspect if I or my vet were more knowledgeable we could have managed this with a diet change, but not point in dwelling on things you cannot change!). Where do I find remission protocols? Albus is almost fully in the GREEN even as we have stepped him down and even skipped a dose and stayed green. Consistently BGs in the 50s & 60s, which has made me nervous about shooting at all, but so far so good. It's been 8 days since we had some low 200s and only a few in the 110-170 range.

I am went down to .25 at the PM shot yesterday. Had another .25 at the AM today and is holding steady at 62 at +3 today.

I would really appreciate and guidance or resources you can point me to as we move through this. I am thrilled but do not want to get my hopes too high or to mess this up!

Thank you in advance for your help--I think my spreadsheet is in my profile, but just in case it's not:

https://docs.google.com/spreadsheet...pqPJ2N054GiDkD3-XCEjLI1vSc/edit#gid=361360320

Shannan & Albus
 
From the FB Group Chris Ronkoski said:
There are two ways to earn reductions (with the hope being there's no place else to go except zero insulin). If they drop below 90, you reduce by .25. If you're already at .25, you reduce to 0.1 before trying an OTJ trial.

The 2nd way is to stay in normal numbers (between 50-120 with most numbers under 100 on a human meter) for 7 days. If they stay in normal numbers for a week, they earn a .25 reduction (again, unless you're already on .25 and then you'd go to 0.1).
If the cat stays in normal numbers for 7 days on 0.1, then it's time to try the OTJ trial which is 14 days without insulin and numbers staying in normal numbers

Ok--am going to try to take the patient approach and do .25 for ~7 days. and then figure out how the heck we measure .1u :) I am feeding about every 3 hours and that seems to keep things regulated as well (and fasting for 2+ hours before retesting)

Please jump in if you think I am doing something wrong!
 
Actually, since he dropped below 90 already today, he earns the reduction to .1. That’s the very 1st line in the syringe before 0. You can mark it with a sharpie and post a pic here if you’re unsure. After .1 the next reduction is 1 drop. You get that basically by pressing the plumber all the way in as much as you can, inserting the syringe into the vial and then releasing it. When you release it, it will draw 1 drop
 
Chris quoted part of the reduction criteria for someone following Tight Regulation with Lantus or Levemir, and that does not apply to Caninsulin/Vetsulin. If your kitty goes below 90, you reduce the dose. That part is consistent with SLGS. I would reduce now to 0.1 units. The drop dose is also something for Lantus/Levemir users and not part of the dosing methods for Vetsulin. After 0.1 units dose, the next reduction earned takes you down to 0.0 units. :)
 
Wendy&Neko said:
Chris quoted part of the reduction criteria for someone following Tight Regulation with Lantus or Levemir, and that does not apply to Caninsulin/Vetsulin. If your kitty goes below 90, you reduce the dose. That part is consistent with SLGS. I would reduce now to 0.1 units. The drop dose is also something for Lantus/Levemir users and not part of the dosing methods for Vetsulin. After 0.1 units dose, the next reduction earned takes you down to 0.0 units. :)
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ok, wow! thank you. once we go to 0.1 how long do we stay there before starting the OTJ trial? Just until he is below 90?
 
Ok, went to 0.1 for the AM shot and at +3 he is at 67. Do I stay with 0.1 for a few days?
 
Wendy&Neko said:
Chris quoted part of the reduction criteria for someone following Tight Regulation with Lantus or Levemir, and that does not apply to Caninsulin/Vetsulin. If your kitty goes below 90, you reduce the dose. That part is consistent with SLGS. I would reduce now to 0.1 units. The drop dose is also something for Lantus/Levemir users and not part of the dosing methods for Vetsulin. After 0.1 units dose, the next reduction earned takes you down to 0.0 units. :)
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Hi, if you have a moment. We did 0.1 AM and PM today and his numbers were great, but at +5 from the PM shot he went to 47, I fed him ( he was super hungry) but I am heading to bed… should I worry?
 
Sorry I didn't get to you earlier. Did you leave him lots of food out? If under 50, you need to feed high carb food, and keep testing to make sure he gets above 50, before calling it a night.

It's time for that 0 units dose tomorrow morning. Try testing AM and PM at your regular time for 14 days. That's what we call at OTJ (off the juice) trial. If he's still under 100 for 14 days, we call it remission.
 
Wendy&Neko said:
Sorry I didn't get to you earlier. Did you leave him lots of food out? If under 50, you need to feed high carb food, and keep testing to make sure he gets above 50, before calling it a night.

It's time for that 0 units dose tomorrow morning. Try testing AM and PM at your regular time for 14 days. That's what we call at OTJ (off the juice) trial. If he's still under 100 for 14 days, we call it remission.
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Thank you! We are starting OTJ trail today!
 
Day 4 of the trial, and looking good! :D By the way, you only need to test at what was your preshot times. As long as he's below 100 then, you don't need to test again until the next PS time.
 
Wendy&Neko said:
Day 4 of the trial, and looking good! :D By the way, you only need to test at what was your preshot times. As long as he's below 100 then, you don't need to test again until the next PS time.
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Thank you so much for that--he will be so happy to have less checks!
 
Wendy&Neko said:
Day 4 of the trial, and looking good! :D By the way, you only need to test at what was your preshot times. As long as he's below 100 then, you don't need to test again until the next PS time.
Click to expand...
QQ he is SO hungry! Our numbers are staying in the green and he's super frisky--but he wants food all the time, is that "normal"? I am giving him smaller portions more frequently so he isn't exceeding 3-4 cans of FF pate--but I think he totally would eat more if I gave it to him (#onceafatcatalwaysafatcat). Thank you!
 
Are you weighing him to see if he's gaining or losing weight, or staying steady on his current food? I wonder if super frisky means high metabolism and needs more food. He's also still getting used to these normal green numbers and knows that food will keep him safe.

Feeding several small meals per cycle might help, if you aren't doing that already.
 
Wendy&Neko said:
Are you weighing him to see if he's gaining or losing weight, or staying steady on his current food? I wonder if super frisky means high metabolism and needs more food. He's also still getting used to these normal green numbers and knows that food will keep him safe.

Feeding several small meals per cycle might help, if you aren't doing that already.
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Thank you, we weighed him on Day 1 of OTJ Trial and he was at 14lbs for the first time since diagnosed (he had been staying at around 13+, so I will weigh him in a couple days to double check! I will keep up with the smaller frequent meals and keep an eye on everything. Appreciate it!
 
@Wendy&Neko @Suzanne & Darcy If you have a moment to look at my boy's SS--we are on day 14 of OTJ Trial and he had gently nudged up--until he was at 100 at the AM check on Day 13 and then today, Day 14 he was 105 at the AM (but it was a weird looking drop) so we retested 5 minutes later and he was at 98. Yesterday, because of the initial 100, I did a midday check after a fast and he was at 86. What do you all think? Thanks for the help!
 
That later check is showing that his pancreas is working to bring down his numbers. Any chance he had a snack before PS time yesterday or this morning? How often are you feeding him now?

A little late, but here are the formal OTJ trial instructions.
If he/she is green 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 he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.
Good luck with the trial!!!
Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to changehis/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar inthem and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes(excessive drinking, eating, urinating, weight loss), testhis/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!
 
Wendy&Neko said:
That later check is showing that his pancreas is working to bring down his numbers. Any chance he had a snack before PS time yesterday or this morning? How often are you feeding him now?

A little late, but here are the formal OTJ trial instructions.
If he/she is green 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 he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.
Good luck with the trial!!!
Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to changehis/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar inthem and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes(excessive drinking, eating, urinating, weight loss), testhis/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!
Click to expand...

The AM "PS" check is usually after approx 6-8 hours without food--and there is no chance of him getting anything extra.
We have been solidly green from 12 days and then 100 on Day 13 at the AM, but it comes back into normal range after food and time. Day 14 (today was initial reading of 103, but 98 just 5 minutes later and in the 80s after food a couple hours.

Tomorrow morning would be the end of of the OTJ Trial--do I perhaps keep on testing AM/PM for a bit longer to make sure he is good?
And/Or should give him a snack with the autofeeder in the middle of the night?

Appreciate it!
 
Try giving him a little snack around +8 or +9 during the cycles. That should kick in his pancreas to produce insulin and bring the numbers down. I would continue several small meals for a while, just to make it easier on the newly healed pancreas. You can always keep testing, maybe once a day for a week to make sure he's still good.
 
Wendy&Neko said:
Try giving him a little snack around +8 or +9 during the cycles. That should kick in his pancreas to produce insulin and bring the numbers down. I would continue several small meals for a while, just to make it easier on the newly healed pancreas. You can always keep testing, maybe once a day for a week to make sure he's still good.
Click to expand...
Ok, great. Let's hope that helps to keep him below 100 tomorrow AM! Thank you!
 
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