Need eyes please and advise

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postiecat

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Well I thought I was doing really well with Cheynne until I went to the vet today (my reg vet on vacation) saw a different one in same clinic. She said his numbers are too low and she worries he will go into hypoglycemic. She said not to give him any insulin if bg is below 175 and to try and keep him at 150-250. After I left I wondered maybe if she thought I was testing with an animal meter. But I don't know, obviously I will talk to MY vet when she gets back.

But I was wondering what you guys thought? Isn't the whole process trying to get numbers low to go into remission?

Thanks for looking :)

Martine
 
We tend to be conservative with new diabetics, until we have data to suggest how they might react to a given dose of insulin. So we say not to shoot under 200 unless you have data so the number your vet gave you is certainly in line. Many people do shoot lower than 150-170, but only after they have the data that tells them it is safe to do so.

I would think your vet's numbers are more conservative than we would use. for the entire cycle. They are under the renal threshold so they are safe numbers, but higher than we might aim for.

We consider a cat regulated when they are in the mid 200s at preshot and in the 100s or under at nadir, but not as low as 40 (which would require intervention - probably first higher carb food) We consider a cat in remission if they range between 40 and 120, off insulin, with the majority of the time in double digits. If they stay in these ranges for 2 weeks off insulin, we say they are in remission.

You hold the needle :mrgreen: You decide what to shoot. And it does need to be an amount that you are comfortable with, based on your cat and whether you will be able to monitor the cycle. As you have probably seen, there are 2 approaches here - start low and go slow and tight regulation. They do have different guidelines in terms of how to dose.
 
Hello. I'm trying to find an article for you that talks about vets being conservative with numbers and why.
Vets are often happy with getting a diabetic cat to regulation.
They aren't trying for remission.
He doesn't like the lower numbers because you are closer to those possible hypo numbers.
Each cat is different so you don't know what that number is.

You want to be conservative while you are still getting your technique down and learning your cat's patterns.
So until you have a baseline and a few curves on your cats bg's, you want to stay with the go low and slow approach
as Sue was mentioning.

You need all this information and to be able to monitor frequently with bg tests if you want to progress to the
Tight Regulation (TR) protocol.
You can refer to my spreadsheet to see the TR in action as an example.
I am shooting lower numbers and soon to be earning a dose reduction according to the rules for Lantus in the TR
protocol.
There are "stickies" at the top of the lantus forum that tell everything.

I don't know if you are on Lantus. If not, there are similar guidelines in the insulin specific forum for the other
insulins.
 
From looking at your spreadsheet, I believe your cat is headed toward remission, especially if you are using Lantus insulin. The idea at this point is to support the pancreas with small amounts of insulin. That can be on an every 12 hour schedule, but may need to become "as needed."

How that works is that you set a rising BG level at which you give say .25U. For some cats that level needs to be as low as 150. Insulin amounts are very small, .25U or less. The idea is to keep their blood glucose below 150 all the time.

By not giving insulin unless his BG is 175 or better may not help the pancreas enough. Keeping him at 150 to 250 is defeating the purpose of supporting the pancreas. Does the vet not understand that cats can go in to remission from diabetes? They need to remain on a low carb diet the rest of their lives, but Lantus is an excellent insulin for helping make remission happen.

You are on the right path and lowering the doses like you have done are excellent. You may need to give even less than .25U. Here is a link to show you how to measure that with 3/10cc, half-unit marked syringes: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

Hope this helps. You are indeed doing very well for Cheyenne!
 
Hi Martine,
Just thought I'd follow up with you. I was just looking at your spreadsheet.

Is there a way that you could get something like a +2, +4 +6 +8 +10 one day and then on another day , get
+3, +5 , +7, +9 .

You've only got the +6 in the midcycles and that might be your peak and it might not.

I know my cat was peaking at +4 for a while and I think she's changing on me this week.

It's possible you are getting some lower numbers and you don't know it.
 
Trying to keep Cheynne at 150-250 will ensure that she does not achieve remission and at the upper range is above the renal threshold and will cause organ damage. If you are using Lantus skipping shots will drain her shed and impede her progress. I agree with Vicky that Cheynne seems to want to go into remission, she is looking great :mrgreen:

I can see from the curve you did on 07/18 that nadir was at about +6 but on 07/27 it seems to have come a bit later, not all kitties are 'regular'. It would help to paint the picture if you got some evening tests too (even if it's just one before bed) as the night cycle can be different from the day cycle and can go lower. Now that she is spending so much time in green I would be testing more regularly to make sure she doesn't go hypo. I don't think it will be for much longer.

If you do test below 50 you will want to intervene, please see the stickies at the top of the Lantus TR forum about shooting and handling low numbers (applies for any insulin). If you are using Lantus or Levemir you may like to start posting in that forum (you don't have to be following the protocl) to help you through what appears to be the final run to remission, maybe even before your reg vet gets back :mrgreen:
 
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