Kiki's Charlie - Experienced Eyes on spreadsheet?

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charliesmom

charliesmom

Member Since 2012
Hi old friends,

It has been a long time since I've been on here since my little Charlie girl passed away. My Otis and Ella are growing so big, and are such sweethearts who have a better chance at a healthy life and future thanks to everything I learned over the 2 years that I was on this board nearly full time. Thank you for that!

For the past 2 weeks, I've had a little bit of deja vu. I'm babysitting for my friend Kiki's Charlie (also a girl with a boy's name... also diabetic). She is a real sweetheart. Since April when Kiki's Charlie was diagnosed, I've given her all the advice I can, and she is really seeing some strong progress by diligently following the rules you guys taught me. So thank you for that! Although we had a very sad ending with my little Charlie, I am now able to personally "pay it forward" and help another person and another cat. That makes me feel good.

With that in mind, can some of you please take a look at Kiki's Charlie's SS and give some input on her numbers?

I am watching her for 2.5 more days and can test whenever you recommend. It's a little bit difficult to get the night shots since the cat is not at my house, but if really necessary, I can make it happen if you give me a slot that's critical to get.

Meanwhile, her SS is updated and I look forward to your input!

Remember that she is still using a PET meter. I gave her my human meter but she hasn't switched over. So any advice you give should be based on that reality. Thanks!

All the best, old (young!) friends.

Jill

Last Thread from Kiki
 
Hi Jill!

Here's Kiki's Charlie's spreadsheet. Hopefully i've got the right one - would you double check?

Is this an Alpha Trak still? I'm assuming it is.

My reaction is that Charlie is a cat who could be working off of insulin, and instead of doing less testing, i'd do more. The normal range on a human glucometer is about 50-120 - holding a cat in that range allows the pancreas to heal if at all possible. If her pancreas is healing, it will put out insulin itself, and the amount that was just right last week will be too much if her body is adding to it today. I would get a mid-cycle test in every cycle without fail at this point - if you miss when she needs a dose reduction she could become hypo without being cared for.

An AT equivalent of that range is about 68-165ish. The protocol says that if a cat spends 7 days completely in that range, you can try to reduce the dose and see if they will remain in normal numbers.

A second way to reduce the dose is if Charlie drops below 68 just one time - below that is listed in human glucometer readings, ie, 50 as the BG to reduce the dose.

Tight Regulation Protocol
Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

Please do not let yourself become complacent or blasé about drops into the 20s or 30s.
If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
Please ask for advice.

If anyone suggests otherwise, they are putting your cat at risk! Our kitties are not just numbers. They are living beings who trust us to look out for them. The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive.

Keeping YOUR cat safe is the #1 priority of the FDMB.
Let's keep all our kitties in the Lantus Tight Regulation ISG safe by suggesting and taking appropriate reductions.

If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.

Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose.
Since 2006 we've encouraged those practicing Tight Regulation to attempt reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission.

Remission:
From Tilly's Diabetes Homepage:
Phase 5: Remission

"14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible. Test the cat's BGs once per month.

Approximately 25% cats that achieved remission using this protocol relapsed and required insulin again (frequent causes are hyperthyroidism or bouts of pancreatitis). Therefore, it is important to keep your diabetes kit up-to-date. Then you can react immediately by giving insulin and home testing. Importantly, the sooner you react to a relapse (i.e. preventing hyperglycemia and initiating other necessary veterinary treatment), the more likely a second remission will become.

The longer a cat has had diabetes, the less likely it will go into remission. Many long-term diabetics get stuck in Phase 3 or 4. Yet there is a benefit of using this method for such a cat as well: keeping the cat's BG levels as normal as possible is much healthier for it long term. Insulin requirements will often decrease to very low levels too."
Click to expand...
 
That is the correct spreadsheet.

I am not aure what brand of meter it is. I will check tomorrow. Whatever Kiki told you previously is the same machine since her last post.

From memory, it seems to be an unbranded machine from the vet, with different plastic chips that you install depending on the animal (cat, dog, horse, etc)?

Gnite guys. 2:20am here.

Thank you so much for the reply! I will encourage kiki to test more upon her return on sunday. Meanwhile, I will test as well tomorrow, but what times are most critical?
Jill
 
i don't know - there isn't enough there to tell when Charlie's nadir is, but she appears to be running low throughout much of the cycle, so i'd probably start with a +2 or 3 and see how much lower it is than the preshot. It's hard to say. When you're trying to catch the low point of a cycle to determine if they need a dose reduction, in general, you would test until you start seeing the rise that indicates the cat is past the nadir. Punkin almost always was past his nadir by +6, unless it was a bounce-clearing cycle. But this is one of those ECID (every cat is different) things - cats can nadir anywhere from +3 to the next preshot - just depends on the cat.
 
I agree with Julie that you need to do a bit more testing at this stage. I noticed a 3.5 (63) on the spreadsheet a couple weeks ago and that is below the reduction level of 3.8 (68), but the dose was kept at .5U. It's great of you to look after your friend's cat. So nice to have someone who knows how to test while you are gone.
 
I don't know how that compares to an Alpha Trak, which is the pet glucometer most people in N. America use. On the AT, the number that is most significant is 68 - at 68 you would begin giving carbs to keep Charlie above 68 and if she goes below that point, you would reduce the dose by 0.25u.

Around here, the strips for the pet meters are very expensive, and that can often be the reason why people using pet meters aren't testing as often as those using human glucometers. If that's the reason, perhaps Kiki can switch to a human glucometer. From looking at Charlie's ss, this looks like a kitty who has a sputtering pancreas, who has the possibility of going into remission and becoming diet-controlled. She's got some great blood sugar numbers.

As I said, I don't know how your glucometer compares to the AT, but the normal non-diabetic cat range with the AT is about 68-165 or so. If Charlie's BGs can be kept in that range for 7 consecutive days at a particular dose, you could try reducing the dose and seeing if the good numbers held. I can't encourage you to push her numbers down further, though, without also saying you've got to test enough to make sure she isn't getting into danger. The risk of the TR protocol is that a cat is running just above the blood sugar range that can cause hypoglycemia. That is done to allow the pancreas to heal and switch back on. The safety mechanism that protects cats on TR is the testing. The testing is essential if you're trying for remission and following the TR protocol.

I suspect that Charlie is one of those cats that with a little intensive help, has a strong chance of going OTJ. I can't promise it, but that is a very hopeful spreadsheet.
 
I totally, totally agree with you. This cat has been amazing. She lost weight at the beginning after the switch to the right low carb, wet food (Bozita salmon and turkey in this case). She also has gotten to being only on .5 units after only 6 months. Excellent progress!

Tonight, she actually dipped under the 3.7 number that you noted. So I assume that means a dose reduction to .25 in the morning?

This dip to 3.5 came already at only +2, and since I had to go home for the evening, I decided to feed her some HC food, test again, and then leave out more food for the evening. At +3.5, she was at 4.1

Hopefully she will do fine this evening after getting the food to hold her over more.

Kiki is back tomorrow night, but I will still need to make the call for tomorrow morning.

I will emphasize to Kiki that the testing needs to continue at each cycle, and it is at this stage where it's important to act immediately when dose reductions are earned.

I believe Kiki has continued to use the pet meter because she gets the test strips from the vet a tad bit cheaper. The relion machine from walmart doesn't exist here, so her only other option is to use the Abbott human meter that I gave her previously. Thus far, she hasn't switched over to that meter. I will encourage her to consider it, but in the end, this is her cat and she will make the calls. I am just helping and advising where I can.

All: Thanks for all of your responses and input these last few days.

Jill
 
It's so good of you to take care of Charlie for her. One of the hardest things about having a diabetic cat is that you mostly can't get away.

So that's been a huge gift you've given her.
 
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