Newbie here...Is Clarence OTJ...or not?

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krazyfourkats

Member Since 2014
A big warm hello to all of the very caring people on this board. The passion and care that just oozes in the posts that I have read so far is so heart warming. If one is to think of a bright side to your loved feline being diagnosed with diabetes, it would be that it brings out the caring nature in many of us humans.

This is my first post here and I have so much to say and so little time to write and edit this so please forgive me if i go all over the place. I am also writing this on my smartphone, so please forgive typos etc.

My name is Ty, and my sweet little buddy Clarence (pic will come) started drinking a lot of water. When we brought him into the vet on dec 28, he was diagnosed with bg of 26.+ (aprox 470) . Other than that, his vital signs were all good. So he was sent home with purina dm wet and dry and an appointment on dec 30th with the "diabetic vet". So later that night on dec 28 he was fed some wet dm and seemed to like it, but by Sunday he wasn't eating or drinking a thing, which was very odd to us because Clarence could normally we can count on him to have a healthy appetite. So Monday morning we see the vet and she brings him in early because she is worried. After some tests, he now has some ketones in his urine. He is force fed and given sub q fluids, 2 units of lantus and sent home with us. We are told to dose him at 2 units in morning and 2 units at night. He starts to improve and two days later goes for a follow up and has no ketones but some bilirubin in urine. His bg is 29 (522) this time.

After the above visit, he starts to improve and we give a curve (sat jan 4): (all numbers aprox)

9am PMPS 20mmol/l (360)
Given fancy feast (cant remember amount)
1pm 17mmol/l (306)
5pm 15mmol/l (270)
9pm 10mmol/l (18)
Given more fancy feast of unknown amount

After first curve, the vet wanted us to change to 2 units in morning and 1 unit at night because his 12 hour curve did not show a nadir and she didn't want to overdose. This curve was extremely stressful for both him and us, so we put off doing another curve until sat jan 19th. Before I give you the numbers we got on that curve, I have to say that his clinical signs were PERFERCT (or should i say purrrrfect? :)). I knew he was in good shape now but didn't know where his numbers would be. So the second curve look like this:

Saturday Jan 19
9am PMPS 2.9 (52)
fed 1/2 can fancy feast shot held off
1pm 3.5 (63)
fed 1/2 can fancy feast shot held off
5pm 3.5 (63)
fed 1/2 can fancy feast shot held off
9pm 4.3 (77)
fed 1/2 can fancy feast shot held off

Sunday jan 20
9am 4.2mmol/l (77)
fed 1/2 can ff and shot held off
9pm 4.8mmol/l (86)
fed 1/2 can of ff and shot held off

Monday Jan 21
feeding prior to bg test was at 8pm (1/2 can ff)
11pm 4.2(77)

Wednesday Jan 22
Last feeding was at 9pm Tues jan 21 (1/2 can ff)
5am 5.1mmol/l

he has not received a dose of insulin since Friday january 18th at 9pm (100+ hours)

My million dollar question is:

Although his BG is in normal range(without insulin), it does seem to be inching up over the past 100+ hours since his last dose of lantus, should I be weening him off insulin with 1/2 shot twice daily for another week or so? Or does everyone think it would be ok to monitor his bg and only dose IF his BG goes out of normal range?

And my half million dollar question is:

It seems as tho most people here use human meters and I have read that generally to get an estimated equivalent reading that you would get from an alphatrak you would add 1.6 mmol/l (30mg.dl), so are most of the people posting their numbers converting to the alphtrak number or are most people using what they are getting straight from their human meters? My readings posted were direct from the meter, and not adjusted.

I really hope that my poor writing didn't confuse people too much.

many thanks and kind regards to all

Ty
 
Congrats on some lovely numbers! Generally we consider a cat in remission if their numbers range from 40-120 without insulin for 14 days. (people using human meters post their numbers directly from the meter. AlphaTrak users are encouraged to put their meter in their signature so we can be sure we are considering their numbers in that light when they post)

You can sometimes help with the process by feeding small, frequent meals to support the pancreas.
 
Thanks so much for your response.

To make sure i understand...

So am I to acheive a 40-120 on my human meter for 14 days? In other words would remission be declared on an alpha trak with numbers ranging from 70-150 for 14 days?

As for dosing......

He went from 3 units a day to nothing......is the general wisdom that even tho his numbers are in the normal range, should he have been weened off with 1/2 unit bid or sid before withdrawal? Or should i only start dosing if he goes out of normal range?

Many thanks and kind regards,
Ty and Clarence
 
I don't use Lantus so hopefully someone else can add to this..

Yes, your ranges are correct.

Yes, it would be unusual for a cat to go from 3 units to nothing. It might happen if he had been eating dry high carb food and went to wet low carb food during the same time. Did that happen?

You are sure your meter is correct?
 
Hi Ty and sugardude Clarence! Welcome to the message board.

We normally taper off the insulin, from 1U to 0.75U to 0.5U to 0.25U to 0.1U but sometimes, cats have a mind of their own and don't want to "follow the program". My Wink stepped to a different drummer and after a switch to a low carb food, he quickly went off the Lantus and stayed off.

Looks to me like it's possible Clarence may be trying to do the same thing.

Your numbers are too low to give any insulin, with the amount of data you have shared with us. I think the wait and see approach is a better idea at this point.

We have some OTJ (off-the-juice, insulin being the juice) trial instructions that you could follow. Let me go dig those up and I'll be right back with them.
 
Found the OTJ trial instructions by doing a search. I've added the ranges for the Alphatrak here. The colors refer to our color coded spreadsheet, so they won't have any meaning to you.

The instructions are as follows:

•Test at your normal AMPS(morning pre-shot test) and PMPS(evening pre-shot test) times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas).

•If your cat is green (< 130 on Alphatrak) at your normal test times, no need to test further until the next "PS" time, just feed small meals and go about your day. If your cat is blue(130-219 on Alphatrak ) , feed a small meal and test again after about 3 hours. If this number is lower 3-4 hours after a meal, then the pancreas is working!

•After 2 weeks, if everything is looking good, we have a party!

Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens, we just give him the support our kitty needs. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.

Good luck and let us know if you have questions.

During his first OTJ trial, my kitty Wink got another UTI, so I flunked him during his first OTJ (off-the juice) trial and put him back on a tiny 0.1U dose for a bit. He successfully passed his second OTJ trial and has been off the juice,insulin being the juice, for 10 months now.
 
Clarence went from 3 units to nothing sort of by accident. Since we didnt do a curve or bg reading for 2 weeks i assume that some of that time he was being slightly overdosed for a week. But i am still concerned as to if i am better off giving him 1/2 unit bid or sid for another week even tho his numbers are within normal range.

As for the meter, i do beleive it is correct. I compared it side by side to my vets meter a few weeks ago when he was diagnosed.

Many thanks and kind regards,

Ty and Clarence
 
But i am still concerned as to if i am better off giving him 1/2 unit bid or sid for another week even tho his numbers are within normal range.

I think that right now, with the numbers you are getting, that even 0.5U would be too much for Clarence.

If the numbers creep up even more, than it would be time to restart the Lantus. You're not there yet. If most of the numbers you are getting are over 150 on the Alphatrak, then it may be time to consider some insulin. The dose would need to be determined at that point. It may only be a tiny amount, like 0.1U or 0.25U.

ETA: Since Clarence has had ketones before, be sure to test at home daily for ketones, using the urine dip sticks you can find at any pharmacy. Anything more than a trace is cause for concern.
 
So, looks like you got a test last night about 3.5 hours after he was last fed. The good news is, you got a nice low number several hours after feeding, so that tells us the pancreas is kicking in and producing some insulin on it's own. Way to go Clarence!!!!! :cool:

What was Clarence's BG reading at your 8 PM? I'd just like to know so we have a baseline number to compare that +3.5 number of 67 to. Helps us to put the 67 reading in context.

Keep testing at what would have been your normal shot times, about 12 hours apart and keep track of those numbers for the next 2 weeks. By following the OTJ trial instructions I gave you earlier, you'll get a good idea if Clarence is ready to be off the juice and can be diet controlled.

We'll keep our fingers and 3 sets of paws crossed here for you and Clarence and hope for a successful OTJ trial.

If the numbers do start to creep up again, then we reevaluate. "Steady as she goes" and looks to me like no insulin for now.

Hope you are still testing for ketones. Cats that have had them before can be prone to get them again. It's another safety measure and great way to monitor.
 
@deb thanks for all of your time that you are donating to Clarence and me.

I do not have an 8pm number. Through the week I am only able to get one reading a day, i will take two readings on the weekend tho. I was thinking of taking a reading 1/2 hour after an evening feeding and then take another 3 or 4 hours after. Do you think that is good?

As for ketone testing....i have not done so yet, but will try to do this. Actually, i was wondering if anyone knows where to get those test strips the vets use with all kinds of info.....sugar, ketones,blood,bilirubin etc etc?
 
It would be better if you take a reading before you feed, and then another one 3-4 hours later.

That will give us a non-food influenced starting number, and then enough elapsed time 3-4 hours later to see any action from the pancreas. If you took the first number 30 minutes after food, that number could have 30-80 points just from that food. It takes food about 20-30 minutes to see any effects from the food. Better to get the test before feeding.

There are 2 types of urine test strips available over the counter. One tests for ketones only, less expensive. The other tests for ketones and glucose in the urine and cost a bit more.

I have no idea of the multiple test strips you are looking for would be available except at a vet.
 
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