Info Reminder: *earning* reductions and starting OTJ trials

Sorry I didn't make myself clear. The statement I was referring to was "we've always discouraged the use of pet-specific meters," which is why I bolded the statement. I know the protocols are written using human meter #s. But no one before you had strongly suggested I switch.
 
I'm assuming that's directed toward me, Bobbie. Yes, I get that 5o(human)=68(pet). It's the other numbers in the "Reminder: earning reductions" post that I can't follow because I don't know what they are in pet meter terms.
Yes,sorry, I forgot to tag you. I see that Jill has given you the info you need. You will save a bundle using a human meter as the AT strips are very pricey.
 
Gotcha. I misunderstood.
That's really too bad. Using the appropriate meter makes it so much easier on both caregiver and those offering advice. That said, there are many who still want to stick with using a pet-specific meter. All we can do is make suggestions, but ultimately all decisions are for the caregiver to make. I'm truly sorry if this wasn't made clear at the start.
 
Jen, when you switch to a human meter, you could do some comparison with the same droplet of blood and both meters to see the approximate differential. Approximate is the keyword because of the 20 % + / - meter variance with all meters. IMHO, the only important numbers for comparison in TR for human meter vs Pet meter is the 50/68 one for reductions and that is strictly for safety.
 
I think I'm going to try to switch cold turkey. Too many variables for me to wrap my pee brain around. When we got the meter we did a couple comparisons and got 103(pet)/80(human) and 391(pet)/305(human). BTW, when will I know if the reduction to 1U failed and I should go back to 1.25U? The difference between a bounce and a failed reduction eludes me.
 
BTW, when will I know if the reduction to 1U failed and I should go back to 1.25U
My rule of thump is, if they go steadily up after a couple of days ( 3 days) , go back up to a bit less of a dose that caused the reduction. It seems to me that when they are bouncing, the numbers wobble around higher, lower, higher again. If it is a failed reduction, the numbers seem to go steadily upward with no downward movement. A failed reduction is one of the hardest things to discern IMHO .
 
upload_2017-10-11_18-46-27.jpeg
 
No, I'm sorry. I cannot give you equivalents for 40, 80, and 100. No one can. What you can do is start making comparisons yourself using your own pet-specific & human meters on the same droplet of blood. However, even that will not necessarily be accurate after factoring in that every meter is allowed to be off by +/- 20% in the US and +/- 15% in Canada.

The protocols used on the FDMB today were written for use with human meters... which is why we we've always discouraged the use of pet-specific meters. Those using pet-specific meters are taking an unnecessary risk when using a pet-specific meter when following either of the two protocols presented in this ISG.

Because of the aggressiveness of the TR Protocol, 68 was chosen on the low end for those using a pet-specific meter strictly for safety... given how low kitties are taken before the guidelines suggest a reduction. The 18 point difference was simply created as a buffer since there's no way to determine an equivalent for 50 either. Contrary to what is usually said on the FDMB, a 50 (human meter) does not equal 68 (pet specific meter).


Less than 68 is the reduction point when using a pet-specific meter when following TR. The other reduction points... take them at face value as Bobbie said.

Make sense?


ETA: Because 40 mg/dL (human meter) is so low, if I were using a pet-specific meter and following TR, I'd probably stick with taking reductions when kitty dropped below 68, but that's just me... just my opinion. I'd rather err on the side of safety.

Thanks so much for the info in this post and the reminders about how to think about starting OTJ trials.

Just a question, though, re pet vs human meter. I do understand that the protocols here were written for use with human meters and that many people prefer human meters as the strips are cheaper. However, I'm just wondering whether you are suggesting that human meters are better than pet meters like AlphaTrak2. It's a bit scary to read "Those using pet-specific meters are taking an unecessary risk when using a pet-specific meter when following either of the two protocols presented in this ISG." :eek:

Could you clarify what the "unnecessary risk" you're referring to is so I could understand better? Is it just that people using a pet meter need to be aware that the "take action" number is 68 and not 50, as on a human meter?

Also, as I was feeling a bit queasy about all of this, I went back and re-read the Roomp & Rand 2013 Management of Diabetic cats where they discuss the difference between pet vs human meters and readings and how to calculate insulin dose at lower readings using pet meters. In that study, they do seem to give numbers for pet meters, unless I'm completely misunderstanding them: "When glucose meters calibrated for feline blood are unavailable, it is recommended that glucometers calibrated for human blood be used. The type of meter used, feline or human and whole blood or plasma, will determine the exact cut points used to adjust insulin dose. If a serum chemistry analyzer or plasma-equivalent meter calibrated for feline blood is used (eg, AlphaTRAK, Abbott Animal Health, Abbott Laboratories, Abott Park, Illinois), the measurements at the low end of the range need to be adjusted and are 30% to 40% higher than for a whole-blood meter calibrated for human blood. The doses, when using such measuring devices, should be changed as follows: the lower limit of the range should be adjusted accordingly by adding approximately 18 mg/dL (1 mmol/L) to the value listed in the protocol in Table 2. For example, a target value of more than 54 mg/dL (>3 mmol/L) becomes more than 72 mg/dL (>4 mmol/L) when using a serum chemistry analyzer or a meter calibrated for feline use. Alternatively, use the normal range for feline blood glucose concentrations as a target when using a meter calibrated for feline blood. Most of the major human brands of glucometers now report plasma-equivalent values and these are intermediate between those measured by whole-blood meters calibrated for human blood and plasmaequivalent meters calibrated for feline blood. Be aware that test strips sold by the major human companies now provide plasma-equivalent readings, even when used in older whole-blood meters, although their accuracy and precision are not as good in the whole-blood meters."

I find the summary at the end of Tables 2 and 3 easier to understand on this: Table 2: "If a serum chemistry analyzer or plasma-equivalent meter calibrated for cats is used (eg, AlphaTRAK from Abbott Animal Health), increase the target blood glucose concentration by about 1 mmol/L, 18 mg/dL, or adapt the normal range reported for cats as the target nadir glucose concentration (eg, change 3–4 to 4–5 mmol/L, change 54–72 to 72–90 mg/dL)" and after Table 3 (for intensive monitoring): "If a serum chemistry analyzer or plasma-equivalent meter calibrated for cats is used (eg, AlphaTRAK from Abbott Animal Health), increase the target blood glucose concentration by about 1 mmol/L, 18 mg/dL, or adapt the normal range reported for cats as the target nadir glucose concentration (eg, change 2.8 to 3.8 mmol/L; change 50 to 68 mg/dL)."

They also then wrote that, "In general, with the availability of accurate and precise glucometers calibrated for feline blood, their use is recommended in preference to meters calibrated for human blood because of the greater accuracy for blood glucose measurements around the normoglycemic range. Using meters calibrated for feline blood facilitates the use of target blood glucose concentrations in the normal range reported for cats and avoids some of the confusion with human meters whether they are reading whole blood or plasma"

I'm just trying to understand, so any help clarifying this would be really greatly appreciated! I've probably just misunderstood, which is highly likely. And I do understand that the advice given here and in the stickies and protocols were written by those here at FDMB who have years and years of experience with this. :-) I actually came across this 2013 Roomp and Rand and the others as I found the links to them in the TR sticky, and I was reading everything I could get my hands on when I first started to try to get my head around all of this. Not that my head is around all of this yet, by a long shot! :-)
 
I am not sure how (for long term diabetic) kitty can achieve 3 separate "Under 40" SAFELY when the bean works full time. If last night had happened during the day (while I was at work) Gizmo would have had a server hypo event.

I don't think it is realistic to tell people that the TR protocol is possible with a full time job and not endanger the kitty if you must adhere to the protocol "to the letter" I would rather have a failed reduction than to put Gizmo in danger. You can always increase the dose back up.

There are also exceptions with high dose kitties and a reduction point at 70 or 90.

While I understand the importance of the protocol I think we all have to put the safety of the kitty first. I also think it is confusing to beginners to see others not follow "to the letter" and not understand that there are exceptions. I think it is important that we explain in our condos our decisions.

JMO.
 
No no, you 've misread!

You are absolutely correct. My BIG bad. :(

Long term diabetics - more than one year since diagnosis
  • reduction *earned* after a single drop below 40 mg/dL for those following TR,
While Gizmo didn't get below 40 (46 at +2) I still took the reduction because I'z a big scaredy bean. My biggest fear is to look at the webcam and see him hypo and know I am 30 min away. :eek::nailbiting:
 
You are absolutely correct. My BIG bad. :(


While Gizmo didn't get below 40 (46 at +2) I still took the reduction because I'z a big scaredy bean. My biggest fear is to look at the webcam and see him hypo and know I am 30 min away. :eek::nailbiting:

Gosh, oh gosh! I'm curious about your use of the webcam: are you looking for the outward signs that he might be hypo? Girlie dropped down really low one day, and didn't give her usual "tell" or diving for the food bowl, which really threw me. I like the idea of using a webcam, but what do you look for?

I am also a really big scaredy bean re: being away during the day when she has tended to dive; I'm just counting the days to when I have to be back full-time every day, and it scares me absolutely whitless! I'm pushing this "still recovering from surgery and need to work from home, still" for everything it's worth right now...but at some point, the boss is going to say "come back or else!" Yikes! :nailbiting:

I'm so torn between wanting to stick with TR because she's shown such great progress so far, and fear of her fascination with the deep end of the pool... :nailbiting: I don't have to decide just yet, but it's getting close to that time...
 
curious about your use of the webcam: are you looking for the outward signs that he might be hypo?
I have it mounted above the feeder so I can make sure he eats. He will also sleep in that room too so I make sure he is moving :rolleyes:. I know, probably over the top :joyful:. The webcam can tilt and pan and has an intercom. I have been known to "yell" at him to "come eat" - which, surprisingly he usually does. Haha. More than anything it gives me great peace of mind for $60. There is an app for the phone for live view as well as a desktop program to watch from it.
 
I think I'm going to try to switch cold turkey. Too many variables for me to wrap my pee brain around. When we got the meter we did a couple comparisons and got 103(pet)/80(human) and 391(pet)/305(human). BTW, when will I know if the reduction to 1U failed and I should go back to 1.25U? The difference between a bounce and a failed reduction eludes me.
I am using the AT and i was thinking to switch to human meter to make it easier for others to advice me but when i make a few comparison sometimes the difference is more or less than 29% soecially on high numbers. Numbers above 240 on AT comes around 170 on human meter which looks good but when see 240 on AT is scary, i am afraid of high numbers more because of many problems that might come with specially renals. That is why i am afraid to switch but at some point i have to because it is what everyone is using here and has experience with.
 
I am using the AT and i was thinking to switch to human meter to make it easier for others to advice me but when i make a few comparison sometimes the difference is more or less than 29% soecially on high numbers. Numbers above 240 on AT comes around 170 on human meter which looks good but when see 240 on AT is scary, i am afraid of high numbers more because of many problems that might come with specially renals. That is why i am afraid to switch but at some point i have to because it is what everyone is using here and has experience with.

Well, I'm still using the AlphaTrak2 for now: I've got lots and lots of test strips! Girlie has spent a LOT of time in high numbers and is back there again right now, although I'm hoping that she'll come down quickly. We haven't had problems so far, and she's finally started to come good as far as better numbers lately - since we started TR. If you look at Girlie's SS, you'll see that even cats who bounce sky high can come good! Meme isn't even close to where Girlie has been in her travels since diagnosed. Meme's numbers look very good, and she's on such a low dose now! You must be very happy. :)
 
Would anyone want to take a peek at Davis' spreadsheet to see if we should do an OTJ trial? We've been dosing at .1 for a little over a month now. His numbers have stayed pretty low and steady, but I don't know if they're low enough to try going off insulin. Thank you for any feedback you may have!
 
if we should do an OTJ trial?

I think it's time to try it!!

Here are the OTJ trial instructions:

Start the trial on the next green pre shot.

If he/she is green 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 he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!

Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

After 14 days of no insulin, 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/her the support needed. 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 with the trial!!!
 
I have it mounted above the feeder so I can make sure he eats. He will also sleep in that room too so I make sure he is moving :rolleyes:. I know, probably over the top :joyful:. The webcam can tilt and pan and has an intercom. I have been known to "yell" at him to "come eat" - which, surprisingly he usually does. Haha. More than anything it gives me great peace of mind for $60. There is an app for the phone for live view as well as a desktop program to watch from it.

Love this! My husband calls me a stalker because I have a cam where my cats eat and the main walk through area. I also have a plug and play one that I will move around wherever my sugar baby is sleeping when I leave in the morning just so I can watch him and (make sure he moves!). I told my husband it would be great if we can get a cam on a drone so I can fly it around the house looking for my guys during the day. :)
 
Why IS there no difference for reductions for SLGS with long term diabetics and newly diagnosed?

I have to follow SLGS as I can't do TR yet I have to make adjustments all the time to the SLGS method as I know what works and doesn't work for Silver. After two failed reductions having followed the "reduction any time he hits 90" statement above, I will be following the TR rules when it comes to reduction. Not for increasing, for that, I will still follow SLGS. But Silver won't earn a reduction until he follows these:

  • reduction *earned* after a single drop below 50 mg/dL and following TR, or
  • reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
  • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.
 
Why IS there no difference for reductions for SLGS with long term diabetics and newly diagnosed?

The goal of TR is to push kitty's numbers down to that of a healthy cat (50 - 80mg/dL) as quickly and safely as possible. The "requisites" for following the TR Protocol are in the TR sticky.

The goal of SLGS is to regulate kitties safely without pushing their numbers down too low. The reason is generally speaking, caregivers who choose to follow SLGS can't, won't, or don't want to monitor often, feed a high-quality low-carb canned food or raw food exclusively, and/or feed small meals/free feed throughout the day... for one reason or another.

However, the guidelines in SLGS are suggestions. Oftentimes, caregivers who have accumulated enough data to learn their cat's response to insulin and food (in other words, "know thy cat") will take it upon themselves to lower their "no shoot number" as well as their "reduction earning number". At this point the caregiver is the one to make these kind of decisions as well as taking on the responsibility of keeping their cat safe... perhaps to a greater extent than usual. No one else will intentionally offer advice that could put kitty in danger.

That's "why" there is no difference made between newly diagnosed and long term diabetics when following SLGS. It's plain and simple. The necessary safeguards* to safely push kitty's numbers down below 40 or 50 are not in place with SLGS.

Make sense? :)


*safeguards: frequent monitoring, feeding frequent meals or access access to food, low carb vs feeding dry
 
After two failed reductions having followed the "reduction any time he hits 90" statement above, I will be following the TR rules when it comes to reduction. Not for increasing, for that, I will still follow SLGS. But Silver won't earn a reduction until he follows these:
  • reduction *earned* after a single drop below 50 mg/dL and following TR, or
  • reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
  • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.

Juliet, given your particular set of circumstances and for reasons of safety, I strongly suggest you reconsider.
In my opinion, what you've written above would result in taking a huge risk with Silver's life. You do not have the necessary safeguards in place to follow TR guidelines for reductions.
 
Juliet, given your particular set of circumstances and for reasons of safety, I strongly suggest you reconsider.
In my opinion, what you've written above would result in taking a huge risk with Silver's life. You do not have the necessary safeguards in place to follow TR guidelines for reductions.
But I can’t reduce when he hits 90 either. He hit 50. I reduced. I should not have. It failed and I’ve had to go back to again.
 
But I can’t reduce when he hits 90 either. He hit 50. I reduced. I should not have. It failed and I’ve had to go back to again.
Like I said in your thread earlier today:

"However, whenever one deviates from the norm (no matter which protocol, method, or customized plan one is following), they're assuming an even greater responsibility for keeping their cat safe. Greater responsibility = careful/frequent monitoring + access to a food supply so kitty can bring their blood glucose up on their own. Since we know that's not an option, you'll probably find it necessary to run him in a little higher numbers than you'd like to see (to keep him safe)."
 
Like I said in your thread earlier today:

"However, whenever one deviates from the norm (no matter which protocol, method, or customized plan one is following), they're assuming an even greater responsibility for keeping their cat safe. Greater responsibility = careful/frequent monitoring + access to a food supply so kitty can bring their blood glucose up on their own. Since we know that's not an option, you'll probably find it necessary to run him in a little higher numbers than you'd like to see (to keep him safe)."
So how do I get him down the dosing ladder?

My concern is that I am leaving him for three weeks in Sept and I either have to take him off insulin altogether in that time or give a nominal 0.25 and let my pet sitter shoot blind. I can’t afford to put him in kennels and wouldn’t trust a vet or vet tech to dose as I request let alone test. This is my only reason for trying to get him on a much lower dose. This is not a holiday or I would cancel. My parents are elderly and sick and it may be the last chance I ever see them alive. My pet sitter is 70 and could not get the hang of testing. Any advice on what to do would be welcome.

Maybe we should move the last two posts to Silver’s condo?
 
So how do I get him down the dosing ladder?
You don't. He'll bring you down the dosing scale when or if he's ready.
My concern is that I am leaving him for three weeks in Sept and I either have to take him off insulin altogether in that time or give a nominal 0.25 and let my pet sitter shoot blind. I can’t afford to put him in kennels and wouldn’t trust a vet or vet tech to dose as I request let alone test. This is my only reason for trying to get him on a much lower dose. This is not a holiday or I would cancel. My parents are elderly and sick and it may be the last chance I ever see them alive.
Juliet, I understand, but you're trying to control something you cannot possibly control. September is a long way away. He may or may not be off the juice by then. You'll have to deal with wherever he's at in September/closer to the time.
 
You don't. He'll bring you down the dosing scale when or if he's ready.

Juliet, I understand, but you're trying to control something you cannot possibly control. September is a long way away. He may or may not be off the juice by then. You'll have to deal with wherever he's at in September/closer to the time.
I hear you, but I have to make plans long before that...I can't book a flight and then find in Sept that I have no sitter, no clue what to do with him. I need to have some sort of a plan. It keeps me awake at nights with worry. Sick parents - sick cat - and me in the middle trying to be in two places. I'll ask advice again nearer the time when we know where he is at then....being patient with no plan is not a good place for me. But I appreciate your advice and I am listening to it. I won't be silly with his care.
 
I hear you, but I have to make plans long before that...I can't book a flight and then find in Sept that I have no sitter, no clue what to do with him. I need to have some sort of a plan.
All you can possibly do is come up with contingency plans. It's all any of us could do.
I don't know what else to say.

I'll have to come back to this later if necessary. We're going out to grab a bite to eat.
BBL...
 
Back
Top