Off the juice (for now...)

[Robin&BB]

I've suspected for a while not that Bat's 0.12U dose is not really doing anything. And then looked like I gave her a fur-shot on Tuesday night, so we're trying her OTJ --- just to see what happens. Ran a full curve yesterday.

She's been 24 hrs without insulin as of this morning, not counting the fur-shot, which (if that was a fur-shot) would make it 36 hrs & so far it appears that I may be right in thinking that micro-dose has had minimal effect.

Worst case scenario? If Bat pops out of the blue zone at any point, I put her right back on the juice! Vet's opinion was that if she needs a bump of insulin, I should resume at that same 0.12U. But that dose was where she went into the "plateau zone" and stayed there. (The sticky bit was that any time I've attempted to increase the dose slightly, she has either bounced or held onto the insulin way more than 12 hrs.) So I was thinking that if she does pop a high #, perhaps after being OTJ for more than a day or two I may be able to increase it a bit --- and perhaps that would induce a "reset" of sorts?

Any thoughts on this? (You know, like: "Robin, your head is positioned where the sun does not shine..." )

 

[Sue and Oliver (GA)]

I think this sounds very reasonable, Robin. And all you can do is try something new if the old thing isn't working. I'd set a target and if she goes above that, shoot. (Normally the target would probably be around 140/150)

 

[Robin&BB]

I think this sounds very reasonable, Robin. And all you can do is try something new if the old thing isn't working. I'd set a target and if she goes above that, shoot. (Normally the target would probably be around 140/150)

Thanks, Sue! But here's where I'm stymied, because of differing blood glucose target ranges, as follows:

Target BG Ranges as per FDMB:
Human glucometer #s [30%-40% lower than readings on Alpha Trak2] followed by (AlphaTrak #s):
Off insulin: 40-120 mg/dL (56-168 mg/dL on AlphaTrak)
On insulin: 50-130 mg/dL (70-182 mg/dL on AlphaTrak)

Also from FDMB (an excerpt from the "Glucometer Notes" pages):
50 - 130 mg/dL (2.8 - 7.2 mmol/L) {71-83 to 186-217 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

Primary goal of management from ISFM (Consensus Guidelines, March 2015, made available on FDMB):
To maintain BG between a PEAK of 180 –252 mg/dl and a NADIR of 80–144 mg/dl
(I'm assuming these are pet-specific/AlphaTrak glucometer #s they're referring to here.)

See why I'm kind of confused? If I go by the first set of guidelines, Bat should be back on the juice right now; according to the other two, she's right in the ballpark. Makes it hard to know what I'm supposed to be shooting for here.

 

[Sue and Oliver (GA)]

Thanks, Sue! But here's where I'm stymied, because of differing blood glucose target ranges, as follows:

Target BG Ranges as per FDMB:
Human glucometer #s [30%-40% lower than readings on Alpha Trak2] followed by (AlphaTrak #s):
Off insulin: 40-120 mg/dL (56-168 mg/dL on AlphaTrak)
On insulin: 50-130 mg/dL (70-182 mg/dL on AlphaTrak)

Also from FDMB (an excerpt from the "Glucometer Notes" pages):
50 - 130 mg/dL (2.8 - 7.2 mmol/L) {71-83 to 186-217 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

Primary goal of management from ISFM (Consensus Guidelines, March 2015, made available on FDMB):
To maintain BG between a PEAK of 180 –252 mg/dl and a NADIR of 80–144 mg/dl
(I'm assuming these are pet-specific/AlphaTrak glucometer #s they're referring to here.)

See why I'm kind of confused? If I go by the first set of guidelines, Bat should be back on the juice right now; according to the other two, she's right in the ballpark. Makes it hard to know what I'm supposed to be shooting for here.

. I am not sure what you are asking. The bottom guideline is a regulated range - on insulin but doing well. Not in OTJ numbers. So a cycle with a pre shot of 225 (mg/dl) and a nadir of 100 would be regulated. With a diabetic, that is the first range to shoot for. The other two ranges are tightly regulated and may be ranges for Lantus/Levemir users where the cat can go lower and , because of the normal longer flatter cycle, be in safe ranges. We don't think of ProZinc cats as that tightly regulated often because the cycle tends to be more volatile - dropping faster and not lasting as long.

If she were mine, I'd start with 150 as a shoot able pre shot (if I could sure monitor) and give her a small dose (you need to think about how much - it depends on how aggressive you are willing to be.). Try that for awhile and reevaluate. Is she in good ranges or do you need to add more? I wouldn't shoot under 120 but there are people who have and been fine. (I am using mg/dl numbers, not AlphaTrak). I'd say her last two days without insulin, she is too high for remission. Not by much, but not in that magic 40-120 with the majority of the time in double digit range. The problem with quitting too early, when the numbers are close but not quite, is that she is likely to lose that momentum you've built up.

Another possible approach is to chase the numbers. When she is over your target number and clearly rising, shoot a tiny amount. Usually you end up shooting more than 12 hours apart, and way off schedule, but your goal is to continually have her below the target.

I am still not sure I understand or have answered your question. Maybe others will chime in.

 

[Robin&BB]

. I am still not sure I understand or have answered your question. Maybe others will chime in.

Thanks for clearing up for me that the ISFM BG range guidelines are referring to management of the numbers while on insulin.

Alpha Trak numbers are stated in mg/dl in both of the FDMB references I quoted earlier. (It's my understanding that pet-calibrated glucometers read higher #s than human meters because there's about 35% more glucose in whole blood of cats vs. the whole blood of humans.) So I need to be going by AlphaTrak-specific BG ranges, as that's our meter.

My confusion about the BG #s primarily stems from the differing ranges I've seen on FDMB docs as relates only to the AlphaTrak numbers. (See Glucometer Notes doc attached in BJ's signature - that's where I saw the BG range of 71-83 to 186-217 mg/dl on an AlphaTrak, noted in that document as "On insulin - great control when following a tight regulation protocol" and "Off insulin - normal numbers." (Reflects that 30% to 40% differential from human meter readings.) But it also shows the human meter BG range as 50-130 mg/dl in that same category, rather than the top end # being 120 mg/dl. So maybe those are outdated numbers in that particular document?

Regardless, I may just have to bite the bullet (cost-wise) and put her back on Lantus again, given the problems we keep having with bouncing/too long hang-time on ProZinc whenever I've tried to increase her dose slightly in recent weeks. <sigh>

 

[BJM]

The Consensus Guidelines are not for those following the Tight Regulation Protocol.

The numbers for AlphaTrak in my Glucometer Notes are estimates using 35% (the midpoint between 30 and 40%) to adjust the AlphaTrak Numbers.

 

[Robin&BB]

The numbers for AlphaTrak in my Glucometer Notes are estimates using 35% (the midpoint between 30 and 40%) to adjust the AlphaTrak Numbers.

Thanks, BJ. That's kind of what I was thinking those #s were - adjusted BG estimates for that 30%-40% differential. I'm not really expecting Bat to truly be in remission; all I'm really doing here is trying to see how she fares without that tiny dose she's been on: Will her numbers be stable trying to control her by diet alone?

I have adjusted Bat's feeding schedule the past few days - same amount of food daily, but split into 4 "mini-meal" feedings/day. Before I started this, she was on 2 larger portions am & pm, with only a tiny snack to steer her at nadirs if needed.

So right now - without that tiny insulin bump - she's not dropping to lower mid-cycle #s; makes sense that her blood glucose is staying on a flatter level, given the change in how the food is more evenly distributed throughout the day. Her water consumption, so far, has not increased; nor have I seen any change in urine output, behaviors, etc.

That said, I'm fully prepared to resume insulin if her #s start jumping out of the blues. The main difference I've seen - overall - in comparing her 1st course of treatment (2013) with Lantus to this year's go-round with ProZinc, is that she stayed in the greens much more readily while on Lantus. (But looking back at her old records, I can see that she went deeply in the "hypo-zone" several times, too. Yikes!) So I'm still trying to decide - when I need to start injecting her again - if I change her over to Lantus or just keep trying with the ProZinc. (Is my understanding she needs at least 24 hrs. without ProZinc before starting Lantus. If I'm going to switch, I guess I'd better make up my mind pretty darned soon, huh?)

 

[BJM]

ProZinc has no depot, so it is out by the next shot. If you need to switch to Lantus, do so at the next shot. Do review the 2 protocols in the Lantus forum.

 

[Robin&BB]

ProZinc has no depot, so it is out by the next shot. If you need to switch to Lantus, do so at the next shot. Do review the 2 protocols in the Lantus forum.

Thanks - yes, I'll review those. Bat was hanging onto the ProZinc (in a manner of speaking) longer than 12 hrs a lot of the time (requiring repetitive BG cks before I could safely shoot her on some days, and throwing her dosing schedule off by as much as 2 hrs). But as ProZinc has no depot, maybe this was more of a metabolism thing in her case? Is a mystery ...

 

[BJM]

It takes Lantus 5-7 days to hit a stable level, so even if there is a small bit of dose overlap, it isn't likely to make much difference.