Leo out of remission, question on starting dose.

Sonia & Leo

Sonia & Leo

Member Since 2018
Hey FDMB beans, Looks like Leo’s fallen out of remission and we’re back for another go at this. We spot tested him this past Sunday night and his BG’s were 185. I tested again mid-day Monday and it was 238.

We have an appointment at the vet this morning for a check up and blood panel to see if there’s something going on that might have caused his relapse.

He was diagnosed with CKD back in October but has yet to show any symptoms. Assuming nothing else is going on other than the CKD, he’ll be back on Lantus and we’ll follow the TR Protocol. My question is what dosage? I’ve read through all the stickies and the TR info that says to start at .25 u per kilo of ideal body weight. Is this correct? I just want to make sure so that I don’t start at too high a dose.

Thank you,
 
Sorry to hear Leo is back on Insulin. If he does have CKD let me know. Ravan has it & I've been giving him Calcitriol & Renadyl. The sooner you start the better.
Probably a good idea to tag someone that can give you dosing advice. Wendy,Marje or maybe Bobby
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Hi Sonia, I'm sorry Leo is back and hope that he will return to the Falls quickly. Never having had a cat who went OTJ, I'm not sure about starting dose when coming out of remission. But to be safe, perhaps start with his last dose before his OTJ trial (0.10 U). If it isn't producing results, then you can go up to 0.25 U.

Welcome back, Leo! You can go OTJ twice, you know! :cat:
 
JoyBee&Ravan said:
Sorry to hear Leo is back on Insulin. If he does have CKD let me know. Ravan has it & I've been giving him Calcitriol & Renadyl. The sooner you start the better.
Probably a good idea to tag someone that can give you dosing advice. Wendy,Marje or maybe Bobby
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I will definitely check out the Calcitrol and Renadyl, thanks for that!
 
Ella & Rusty & Stu(GA) said:
Hi Sonia, I'm sorry Leo is back and hope that he will return to the Falls quickly. Never having had a cat who went OTJ, I'm not sure about starting dose when coming out of remission. But to be safe, perhaps start with his last dose before his OTJ trial (0.10 U). If it isn't producing results, then you can go up to 0.25 U.

Welcome back, Leo! You can go OTJ twice, you know! :cat:
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Thanks Ella, good idea. I was concerned because starting at .25 of his weight would have meant around 2u and it just seemed like a lot at this point. Better to start with a bit and go up from there.
 
The vet did a body and teeth check and complete geriatric panel including fructosamine and we should get the results back tomorrow. She suggested waiting for the results before starting back on insulin just in case there was something else up with him causing the BG numbers to rise. Thanks again!
 
The vet called me with Leo’s results and other than his kidneys values being slightly higher than last October, there’s nothing wrong with him. All blood work is good, as are his teeth.

The fructosomine test is within normal range but that’s just an average over two weeks. The vet suggested I test over a couple of days and call her with the numbers before starting insulin but I don’t feel comfortable with that, I’m starting tonight as his numbers seem to be getting progressively higher.


Sunday evening: 185

Monday mid-day: 238

Tuesday mid morning: 281

Wednesday morning: 378


He weighs 18 lbs so starting as a new diabetic according to the TR would be 2U.

I'm thinking of starting on the conservative side with a dose of .25.

What is normally recommended for a cat coming out of remission? Your thoughts on this would be greatly appreciated. Thank you.

@Wendy&Neko @Marje and Gracie @Bobbie And Bubba
 
Sorry to hear Leo will be going back on the juice.

Alex went back on the juice twice, the first time in 2009 after being OTJ for almost 3 years. I started with a low dose of 0.5u despite the dose calculating out to a little more than 1.3u when beginning TR. Sometimes a cat will respond to the lower dose, but more often than not the dose will end up climbing higher than the highest dose kitty was on the first time around. Starting low just seemed like a good place to start "just in case".

As you can see from her 2009 spreadsheet, I quickly became aware of the fact that the dose was set too low to start. Therefore, I increased from 0.5u to 1u bid after only four cycles.

"IF" you're able to monitor carefully, I encourage you to be as aggressive as safety allows. It's *usually* a lot harder to get a kitty OTJ the second time around. Alex saw green after only 8 days and was in double digits overall within two weeks. I firmly believe a needed dental combined with aggressive dosing and then gradually weaning her off insulin brought her back into remission within eight weeks.

Don't let all the BG testing on Alex's 2009 ss scare you. I only tested her so often because I was trying to illustrate "shooting low to stay low" and the positive effects of dosing aggressively when safely possible.

Basically, this isn't your first rodeo. My best advice to a caregiver who is restarting insulin is to be as aggressive as you can while keeping kitty safe.

C'mon, Leo! You can do this.

Good luck! :)
 
So sorry Leo wants to rent space here again. I am glad Jill poppped in. I didn’t receive the tag, just happened to be reading this post.
 
Hey there, sorry I am just seeing this now and sorry about Leo wanting more juice.....been there done that 4 times...
I agree with Jill, if the lower starting dose isn't cutting it and you can monitor, raise it and be as aggressive as you can be while being safe.
 
Jill & Alex (GA) said:
Sorry to hear Leo will be going back on the juice.

Alex went back on the juice twice, the first time in 2009 after being OTJ for almost 3 years. I started with a low dose of 0.5u despite the dose calculating out to a little more than 1.3u when beginning TR. Sometimes a cat will respond to the lower dose, but more often than not the dose will end up climbing higher than the highest dose kitty was on the first time around. Starting low just seemed like a good place to start "just in case".

As you can see from her 2009 spreadsheet, I quickly became aware of the fact that the dose was set too low to start. Therefore, I increased from 0.5u to 1u bid after only four cycles.

"IF" you're able to monitor carefully, I encourage you to be as aggressive as safety allows. It's *usually* a lot harder to get a kitty OTJ the second time around. Alex saw green after only 8 days and was in double digits overall within two weeks. I firmly believe a needed dental combined with aggressive dosing and then gradually weaning her off insulin brought her back into remission within eight weeks.

Don't let all the BG testing on Alex's 2009 ss scare you. I only tested her so often because I was trying to illustrate "shooting low to stay low" and the positive effects of dosing aggressively when safely possible.

Basically, this isn't your first rodeo. My best advice to a caregiver who is restarting insulin is to be as aggressive as you can while keeping kitty safe.

C'mon, Leo! You can do this.

Good luck! :)
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Jill, thank you so much for jumping in and for your words of wisdom. I really appreciate it.

I totally understood where you were coming from and a big part of me was tempted to start at 2U but my DH and I talked about it and decided to compromise at 1U. Mostly because if something went really wrong during a hypo, there’s no 24 hour emergency vet available in the area where we live now. This is something I’m going to start looking into. It feels scary not having that service here like we did back in Burlington.

I took some time to look at Alex’s SS’s. OMG! You sure had your hands full for so long. Saying you’re an amazing kitty mom doesn’t even come close!!! :bighug::bighug::bighug:
 
Wendy&Neko said:
So sorry Leo wants to rent space here again. I am glad Jill poppped in. I didn’t receive the tag, just happened to be reading this post.
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No worries Wendy. Thank you for keeping an eye out. Intellectually, I knew this could happen but you always hope that it doesn’t. Anyway, I’m really thankful that we got that 6 months OTJ, it certainly made our move and settling in easier and we actually got to go on vacation! Also, hopefully we caught it in time and will avoid neuropathy, that was horrible.
:bighug::bighug::bighug:
 
Bobbie And Bubba said:
Hey there, sorry I am just seeing this now and sorry about Leo wanting more juice.....been there done that 4 times...
I agree with Jill, if the lower starting dose isn't cutting it and you can monitor, raise it and be as aggressive as you can be while being safe.
Click to expand...

Thanks for that Bobbie, we started at 1U last night and we’re going to move forward and see what happens. I guess the trick is to count your lucky stars when your kitty goes OTJ but always remember you’re not necessarily out of the woods forever. :bighug::bighug::bighug:
 
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