puddersmom said:
I guess I don't know what to do. Because Carl and Jennifer (his case manager) have both said looks like he will be OTJ. So I am confused. Carl has said DO NOT give him insulin below 200. Everyone else says do. Some say don't give him insulin. Some say do. I am getting really confused. And really close to just giving up. I just don't know what to do. And getting really really confused. Wish just once person would tell me what to do with him and tell me what the right thing is to do with him. I was told by some that if it stays below 150 he is OTJ. And now he isn't. My head is starting to hurt. Don't know if I can handle all of this and school and everything else that I have to do. Am I or am I not doing the right thing?
Niki and Oreo
Wow, Niki. I'm sad to read that you're feeling confused and obviously frustrated. And I realize that's in part, due to what I've said previously.
I went back and looked at the times I've posted in your threads and I think you are remembering this from one of your earlier posts on the Health forum.
When someone is new to treating feline diabetes, and just starting home testing and giving insulin, we usually recommend that they not give a shot on any number below 200. That is primarily because you haven't collected much data yet to determine how effective the insulin has been. It's a "safety" thing. But we don't say that because it's a low number. Just sort of low to give insulin on when you're just starting out. Once you have data that shows what a given dose has done, it's very common to shoot numbers like 150 or even lower. Just before Bob went "off the juice", I gave insulin on numbers under 100 on a few occasions. But they were very small doses, and I'd been doing "this" for a while. A lot depends on which type of insulin you are using too.
The first thing I need to say is that I did not use Lantus on Bob when he was on insulin. I used PZI, which is a lot different. I didn't follow a "protocol" either, whether it was Tight Regulation or "Start Low, Go Slow" which are two protocols that are followed by many people on FDMB. There wasn't really a protocol for PZI, and I more or less flew by the seat of my pants. I have often told people here that Bob went into remission
in spite of, rather than
because of what I did or didn't do right. He and I were just very blessed and fortunate.
Like I said in that Health thread, shooting under 200 at first is not advised, because people lack the data needed to do it safely. The more data you have, the better you can make decisions on dosage, or even on whether or not to give any insulin.
When I look at Pudder's spreadsheet since you stopped giving insulin is this:
I see a couple of times where you saw numbers I'd call "too high". Like the day he gradually went up from 115 in the morning to 189 in the evening. And I see your notes that show that was possible due to stress. You were away from home with him at your folks, right? And a few times he's been above 120 (top end of what is considered "normal") in the morning?
What I see that I really like is that just about every day, in the middle of the cycle, you're seeing nice numbers below 100. That tells me that his body is doing its best to function the way it's supposed to and control his BG levels.
Can you tell me this? Is he eating just two meals a day at AMPS and PMPS? Are you giving him a meal or snacks in between breakfast and supper?
The people who are suggesting that maybe Pudders isn't quite what we'd call "off the juice", well they all know a lot more about Lantus that I ever will. They've followed the Tight Regulation protocol with their cats, and they've helped and watched hundreds of cats go into remission after following that protocol. And they're right in that it's very rare for a cat to go from 1 unit doses to "zero" immediately. I've also followed along and "watched" lots of cats go off the juice on this forum. Just about all of them have gone from 1u, to .75u, to .5u, and to .25u and even smaller doses before finally going into remission. That's the way the protocol works, and although I've only been watching for less than a year here, it works incredibly well.
I think what people are trying to communicate is that you and Pudders have done a terrific job. Look at where you were on the day you first posted on FDMB, and look at where you're at today. Beautiful numbers, no insulin for two weeks. Has it been easy? No, I don't think anybody thinks that. I'm sure you don't. What everyone is concerned about is that they don't want him, or you, to see things "go bad". They don't want to see his numbers begin to get worse instead of better. Nobody wants to ever see you come back after thinking all was good and say "oh my god, Pudder's BG this morning was 300! What do I do now?"
Could Pudders use a tiny dose of insulin? Possibly. Could he stay in this range, at or just above "normal"? That's possible too. It's also possible that he may continue to improve. If you could (if you aren't already do so) space out his feedings so that he's getting less at one time, and the food is hitting his system in small amounts several times during the day or night. Maybe that could help his pancreas put out small amounts of insulin more often, and keep his numbers flat and in the 70s all day and night.
I don't know the answers for sure, Niki. Nobody does. I just don't want you to get frustrated or be confused. I want Pudders to be in remission for the rest of his life like I hope my Bob will be. And I also want you to be able to handle everything else on your plate with as little stress as possible. If I can help make any of that happen, I'd be happy to try.
Carl
