? Is Rom on the way to regulation?

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Sue484

Sue484

Member Since 2015
Romulus is on Caninsulin and I use an Alphatrak meter. I have read through the sticky which is for human numbers, so I'm not completely sure if Rom is on the road to regulation or not. Sometimes he bounces to pinks, which is outside your guidelines, but i wondered if that counts or not. Any thoughts/advice/
 
Hi Sue, that certainly looks like an improving picture. :)
Have you seen the following info on 'Regulation' from the FAQ's?

(Note: The numbers below come from data using human glucose meters.)

6. REGULATION

Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":
  • Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
  • Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
  • Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
  • Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
  • Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
  • Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]
There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated.
http://www.felinediabetes.com/fdmb-faq.htm#regulation
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Hi Sue,

As you know the only reference number that FDMB has supportive evidence for when using Alphatrak meters is the 3.8/68 nominal hypo threshold reference point.

Not long after I joined FDMB I found using the human meter colour-coding far too confusing when trying to determine how well Saoirse was progressing and how safe she was so I use the following reference values with my Alphatrak to monitor Saoirse:

Normal BG Reference Range: 3.9 - 8.3mmol/L (provided by my vet - from Merck Veterinary Manual IIRC)

Hypo range alert - 4.4mmol/L (from a slightly older TR dosing protocol publication by Roomp/Rand)

Point where I intervene with carbs/give a dose reduction when treating with Lantus: 3.9mmol/L.

I personally would be loath to continue treating any cat of mine with Caninsulin if it were to start having nadirs less than 5.0 mmol/L / 90mg/dL unless a realistic dose reduction were feasible. Indeed, if the cat's preshots were less than 11.1/200 and it was on a microdose I would be looking to withhold Caninsulin altogether and seeking to switch to a gentler, longer-acting insulin (which would have been my preference in the first instance, I hasten to add). In closing, it is worth noting that Saoirse's BG was at 4.3 mmol/L when she had a symptomatic hypo on Caninsulin - technically well above the 3.8/68 reference point for which FDMB has an evidence base.

NB: All reference numbers above are ALPHATRAK values.


IMPORTANT NOTE:

For anyone reading this thread, please note that this approach is purely based on my personal experience of treating Saoirse with Caninsulin and the comfort zone I defined based on that experience. There is there is no formal scientific basis whatsoever for my Caninsulin treatment choices; I have based them on Saoirse's empirical data and consequently have made dosing decisions based on my view of what would keep her (or any diabetic cat I might have) as safe as possible on that particular insulin. FWIW, the only time Saoirse has had a symptomatic hypo was in the early days on Caninsulin when I didn't have the confidence to follow Dr Lisa Pierson's advice about reducing insulin dose when transitioning from high to low carb food when my vet told me to hold the dose regardless. (Incidentally that was the very last time I put someone else's dosing opinions/instructions above my own sense of what should be safe - and my own sense is based on research and Saoirse's data.)


Mogs
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PS:

Now that Romulus seems to be getting better mid-cycle numbers I'd suggest doing the following on a day when you can monitor him very closely try doing BG checks at +1, 2 and 3 to see whether he might be going even lower early in the cycle.


Mogs
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I had never seen that article before, so judging by that, Rom is regulated!! Also, Frankie is one of the rare ones, who are uncontrolled but have no symptoms apart from neuropathy. I will try and get the +1, 2 and 3 over this long weekend. I don't think he goes low then though, he seems to go lower in the second part of the morning cycle.
 
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