Need advice--almost at OTJ trial?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Sugarkitty15, Aug 5, 2020.

  1. Sugarkitty15

    Sugarkitty15 Member

    Joined:
    Apr 14, 2020
    Hi all!

    I need some advice. Squeaks appears to be so close to being ready for an OTJ trial, but I'm not sure how to navigate the in between period. His BG's were in the "green" for about 3 days, then yesterday they jumped up to blues. However, when I tested his BG this AM, it was 72. It appears he's not quite yet ready to start the trial itself because of those couple of "blue" BG's. My question is, since our no shoot number is 100, until I have a full week of "greens", would I just not shoot if BG is below 100 and shoot if above 100? Then, after we get a week of "greens", try the OTJ again? Thanks in advance for your help!
     
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  2. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    I dont know but this post will bump your thread to the top :p
     
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  3. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Hmmm, maybe it just means having to keep him on the drop dose for a little longer? Sometimes cats need an extended time with just a tiny bit of support for their pancreas. The reward is that in the end, hopefully you get a stronger remission!
     
  4. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Oh, and I'm sure you've heard this a million times, but Squeaks is absolutely adorable!!!! I just love the profile pic!
     
  5. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    AGREE!:bighug:
     
  6. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Isn't he just! My immediate reaction to his profile pic was, "Awww! Looka dat f-aaaaaaa-ce!" :cat:


    Mogs
    .
     
  7. Sugarkitty15

    Sugarkitty15 Member

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    Apr 14, 2020
    I'm hoping so, that would be wonderful!!
     
  8. Sugarkitty15

    Sugarkitty15 Member

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    Apr 14, 2020
    And thank you!! He's cute and spoiled and he knows it!! :cat:
     
  9. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    @Deb & Wink a little insight maybe if you have time? :cat: Betsy and I were looking at a post you gave about the OTJ trial that said the cat would need all greens for a week before trying a trial.
     
  10. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    He is a cutie for sure
     
  11. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Squeaks tried an OTJ trial at my recommendation back in the middle of July. Betsy scrubbed the trial after 3 days, since Squeaks was trending higher.

    Not really seeing Squeaks drop into the greens at mid-cycle, as we should be seeing at the +3 to +4 tests.
    When doing an OTJ trial, remember that those +3 to +4 tests are important if the pre-shots are blue, because if they are lower, in the greens, that tells us the pancreas is working properly and making enough insulin on it's own.

    Since we aren't seeing those lower +3/+4 BG tests, it looks like the pancreas is not doing it's full job.
    So you could try to do the 1 drop dose, when the pre-shots are in the blues. It's a bit unconventional, but sometimes you never know what will work for a particular cat. ECID Every Cat is Different. Every Cycle is Different. Every Caregiver is Different.

    There is a member from Italy (@Oliver the Roman ), that is giving the insulin sporadically, when his cat is a bit high. You might want to take a look at Oliver's SS.
    Oliver's Spreadsheet
    But keep in mind, that Oliver is using Caninsulin, not Prozinc.
     
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  12. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    So can a kitty try an OTJ trial if they're still getting blue pre-shots, as long as they're getting green midcycles? The other message we found from you (I pasted it in Betsy's ISG board) indicated that a blue pre-shot means no OTJ trial yet. I'm here to learn too! :bookworm:
     
  13. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    It's SUPPOSED to be all greens for a week. But that is with lantus. Those standards are much more difficult to achieve with the in-and-out insulins like Prozinc in my limited experience.

    For one, Betsy would need to drop her shoot/no shoot number <100. Maybe to 90 or so. That can get tricky if the person is not around to monitor the cycles.

    So where are there are some real "sticklers" to the rules for an OTJ trial, holding hard and fast to the requirements for a full week of greens before an OTJ trial, I'm not one of them. I see each cat as an individual and give some leeway in my recommendations.

    If the blue pre-shots are hovering around 100-110-120, then yes, I think an OTJ trial is possible. If the blue pre-shots are > 130-140, then no, the cat is not ready for an OTJ trial, even if the mid-cycle nadirs are down in the greens.

    Remember, this is my personal opinion. Plus, I'm taking a real hard look at the SS before I make my recommendations. A real hard look.
     
  14. Sugarkitty15

    Sugarkitty15 Member

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    Apr 14, 2020
    I am home to monitor, so I feel comfortable moving that no shoot number to 90. I can follow a bit of sporadic guidelines if that’s what he needs! :) (I’ll definitely check out Oliver’s spreadsheet) I’ll incorporate these changes and hopefully we’ll be able to get that pancreas working again! Thanks everyone for your insight.
     
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  15. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi all,

    Not sure whether this might help anyone, but I thought I'd share a little potentially relevant info about Saoirse's treatment.

    Saoirse was started out by the diagnosing vet on the "doggy protocol": Hill's w/d Dry and Caninsulin. (Note: In the UK at that time Caninsulin was only licensed insulin for cats and legally vets had to prescribe that first. Only when it could be demonstrated that a cat was not well-regulated on Caninsulin could other insulins be considered.) Saoirse got up to a dose of 3IU BID and was still poorly regulated because of poor duration of the insulin and the insane amount of carbs in the prescribed food.

    Switched to a different vet who supported home testing, low carb wet diet, etc. (Had been a sugar cat poppa for over 10 years himself, and it showed!)

    With the diet change Saoirse's insulin needs plummeted (w/d Dry is basically kitty cornflakes) but she still needed a little insulin. It became impossible to give small enough doses of Caninsulin (not safe due to size of drops it typically produces).

    Here's Saoirse's 2014 Spreadsheet. (Alphatrak 2 meter, custom colour coding - see top of table for key to BG ranges, but the two darker shades of green are roughly the equivalent of blues <150 and greens in the FDMB standard spreadsheet.)

    If you look at Saoirse's numbers for July/August, you can see that I had to stop insulin treatment with Caninsulin for dosing safety reasons (I would not be happy with a cat on Caninsulin on any dose likely to produce a nadir below 100mg/dL on Alphatrak). Our vet was willing to prescribe Lantus but wanted to see how Saoirse would do on her own first because he thought she was in remission. Saoirse's numbers were initially OK but a few days without the insulin support and her numbers started heading north again. (Note: the removal of insulin support also triggered a pancreatitis flare-up, and I've seen similar happen with a few other cats here [ETA - very shortly after they went OTJ].)

    With the switch to Lantus Saoirse did much better. I was able to give insulin for longer because Lantus typically does not produce precipitous drops in BG levels so it is possible to administer at lower PS levels without taking the cat too low at nadir. The small dose of Lantus enabled Saoirse's insulin treatment to continue safely for a longer period, allowing time for the pancreas to rest and heal further. Her first Lantus OTJ trial didn't quite take, but because of Lantus' 'gentler' action profile I was able to continue with microdoses safely for a while longer. Her second OTJ trial was successful.

    Maybe for kitties on Caninsulin, Prozinc, etc., who are almost in remission but just can't quite get there due to dosing safety constraints, it might be worth considering switching to Lantus* to provide them with that little bit of extra support to get them those last few steps along the path to the Falls.


    Mogs


    * (Don't know enough about Levemir to suggest it here but it might be another contender.)
    .
     
    Last edited: Aug 6, 2020
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  16. Critter Mom

    Critter Mom Well-Known Member

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  17. Sugarkitty15

    Sugarkitty15 Member

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    Apr 14, 2020
    Thanks @Critter Mom! I appreciate your insight from your experience with Saoirse! That helps!
     
  18. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    To add to what Mogs said, I was chatting with one of the staff from DCIN who's had several foster diabetics. She said at least two of her cats who she suspected were nearly remission were having a hard time on Lantus - lots of ups and downs - and after switching to Vetsulin she was able to get them into remission. And she told one of her friends about it who was struggling with their cat, so they went from Lantus to Vetsulin and also made it into remission. The depot could have been clashing with the kitty's sporadic pancreas activity so the in-and-out insulin helped them to be able to skip when needed. I thought that was a super interesting method.
     
  19. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Classic case of ECID there, and good to learn about.

    It can get tricky when a cat is close to remission and has a 'sputtery' pancreas.

    Actually you've reminded me that I did something not unlike that myself. I know that the orthodox position here is to give Lantus twice a day but I've never been a strict adherent to 'pure' FDMB TR. I always let Saoirse - and my own health limitations - guide me. (There used to be a 'Relaxed Lantus' support group in which I participated. I still think it's a loss to the forum because it was a great place for people whose cats were on Lantus but who, for various reasons, were unable to follow stricter TR to get help and provide mutual support.) Saoirse always ran lower at night so, as Saoirse got closer to remission, I took advantage of that fact and only gave her her a single droplet of Lantus on the AM cycle but no dose at night. Not de rigeur, but then cats don't read manuals. It worked. :)

    You've also reminded me of a cat that was on the board at the time I first joined FDMB. Angel was a participant in the RVC Prozinc trials. He responded really well to the Prozinc and eventually got to mostly low blues (FDMB colour coding) and some dips into safe greens. They stopped his insulin at that stage and within about a week or so he just floated down into full remission.


    Mogs
    .
     
  20. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    I've seen this suggested before. One of the issues, is to get that lantus prescription and then to only purchase a small amount of lantus, the insulin pen or mini-vial, to get that cat over the "hump" and into remission.
     
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  21. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    @Deb & Wink - Mmm. The Rx is the trickiest part. Thankfully by that time I had (and still have) a really caring vet who is really good in his approach to feline diabetics. He had a diabetic cat himself, and I think that really made a huge difference. Saoirse was the first kitty in his care to be on TR. He reviewed the TR protocol in the 'Managing Diabetic Cats...' to start with, and because he was able to review Saoirse's progress easily from her spreadsheet he was happy that I could keep her safe and let me get on with making her dose adjustments myself, knowing that I'd be straight back to him with any issues. I'm so grateful for him, and I can't tell you how much it meant to me that he placed his trust in me to properly care for my beloved girl. A really successful partnership.


    Mogs
    .
     
  22. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    We do have a supply closet forum. Perhaps someone has a pen there for this member.

    Another possibility is to ask diabetic friends and coworkers if they use lantus and see if they have a pen that is nearly empty and would be willing to pass it along to a cat owner in need.
     
  23. Sugarkitty15

    Sugarkitty15 Member

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    Apr 14, 2020
    Thanks for the info! I'll really think about possibly switching insulin to get Squeaks over the hump. Little apprehensive since I've only known/used Prozinc but if that's what he needs!!
     
  24. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Yes look in the Supply Closet :cat:
     

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