Info Reminder: *earning* reductions and starting OTJ trials

Jill & Alex (GA)

Jill & Alex (GA)

Member Since 2009
There seems to be a lot of misinformation floating around lately about guidelines for *earning* reductions as well as numbers to look for prior to starting an OTJ trial.

Hope this helps put everyone back on the same page...


REDUCTIONS:

Newly diagnosed diabetics - less than one year since diagnosis
  • 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.
  • reduction *earned* after a single drop below 90 mg/dL for those following SLGS
Long term diabetics - more than one year since diagnosis
  • reduction *earned* after a single drop below 40 mg/dL for those 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.
  • reduction *earned* after a single drop below 90 mg/dL for those following SLGS.
We highly suggest taking a reduction any time any kitty drops into the 30s or below. There are very few exceptions given for caregivers following TR who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.



OTJ TRIALS:

Prior to starting an OTJ trial, one wants to see kitty mostly in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range.

Remission is achieved when kitty can go 14 days without insulin while maintaining normal blood glucose values under 100 overall. Most will stay in the 50 - 80mg/dL range. Although, some will occasionally experience BG numbers up to 120 mg/dL.
 
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Hmm...I didn't know that an long term diabetic could earn a dose reduction if they are under 100 but over I guess 40 for a week. Did I understand that correctly? I'm being super aggressive with Penny following a 10 month long bout with glucose toxicity, though.
 
Jill & Alex (GA) said:
There seems to be a lot of misinformation floating around lately about guidelines for *earning* reductions and numbers to look for prior to starting an OTJ trial.

Hope this helps to put everyone back on the same page...


REDUCTIONS:

Newly diagnosed diabetics - less than one year since diagnosis
  • 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 and stays under 100 mg/dl overall for at least one week and following TR.
  • reduction *earned* after a single drop below 90 mg/dL for those following SLGS
Long term diabetics - more than one year since diagnosis
  • reduction *earned* after a single drop below 40 mg/dL for those following TR, or
  • reduction *earned* after three drops between 40 - 50 mg/dL on three separate days for those who are following TR, or
  • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week and following TR.
  • reduction *earned* after a single drop below 90 mg/dL for those following SLGS.
We highly suggest taking a reduction any time any kitty drops into the 30s or below. There are very few exceptions given for caregivers following TR who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.



OTJ TRIALS:

Prior to starting an OTJ trial, one wants to see kitty mostly in the 50 - 80 mg/dL range, but under 100 overall... with only occasional readings in the 100 - 120 range.

Remission is achieved when kitty can go 14 days without insulin while maintaining normal blood glucose values under 100 overall. Most will stay in the 50 - 80mg/dL range. Although, some will occasionally experience BG numbers up to 120 mg/dL.
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bump
 
RobynWilson said:
Hmm...I didn't know that an long term diabetic could earn a dose reduction if they are under 100 but over I guess 40 for a week. Did I understand that correctly?
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  • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week and following TR.
In the TR protocol, the "normal range" of a healthy cat is defined as 50 - 80 mg/dL.

That said, I know many caregivers of long-term diabetics or with kitties who have fallen out of remission who maintain that normal range for longer than one week in an effort to give their cat a little more time to stabilize. It's one of those "Know Thy Cat" things...
 
This is a good thing to see all in one place. Thanks for the compact reminder. This will be one of those I screenshot and add to my desktop collection.

I do have a question, though. With Basil (OTJ Feb 2010) he was over 100 routinely (but under 120) during his OTJ trial and after his official welcome to The Falls. Since I always thought under 120 was the "normal" number, not for nadir but fr top number in a cycle, I am wondering what happened in the interim.

Thanks!
 
Lydia & Rosie AKA &Basil said:
Since I always thought under 120 was the "normal" number, I am wondering what happened in the interim.
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Hi Lydia. Not sure what the question is...
The protocol hasn't changed. Only people offering advice in the group has changed.
Perhaps there were reasons at the time? Sometimes exceptions have to be made for one reason or another.
There have been so many kitties who have come through here... before and after Basil... I don't recall the particulars.


ETA: 50 - 80 mg/dL is considered normal for a healthy cat. It's the goal for remission cats when following TR.
120 is the high end of the normal range.
 
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Hi Jill! If you remembered Basil's particulars in any way, I would come kidnap you and sell you to the CIA or something. Or maybe the circus. LOL!

My question was about the staying under 100. I thought it was about staying under 120. Or maybe the answer is it has always generally been staying under 100 preferentially, but Bsil's numbers were such that he showed the right pattern, he just went up to 110 to 120 t times. He certainly did that forever, so maybe the people who were helping me were able to see that coming from his numbers. They were very regular, and I have to say, I wouldn't mind it if Queen Bounce Rosie learned a little of that regularity!
 
The circus would be fun! :D

Lydia & Rosie AKA &Basil said:
Or maybe the answer is it has always generally been staying under 100 preferentially,
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This. :)
Lydia & Rosie AKA &Basil said:
but Bsil's numbers were such that he showed the right pattern, he just went up to 110 to 120 t times. He certainly did that forever, so maybe the people who were helping me were able to see that coming from his numbers.
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I suspect Basil was an exception based on those patterns...
 
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I've taken a reduction on a 51 and ended up having to go back up and wait for the reduction to be earned properly because the reduction was taken too soon and numbers didn't hold. I had to take Sly back up and down a few times on the lower doses to get him to settle in and show more under 100 before taking him to trial because I didn't think it was boding for a strong remission to having him in the blues so much with the blips over 120.
I've been wondering if what seems like an increase of cats returning to insulin is just because of the higher traffic (so there are more in number, but not in %) or if it might be because more are a going off too soon without having the patience to wait for "... see kitty mostly in the 50 - 80 mg/dL range, but under 100 overall... with only occasional readings in the 100 - 120 range." I know some meters read higher than others, but I think most strong remissions are still going to come with a solid pattern of under 100.
 
Melanie and Smokey said:
I've been wondering if what seems like an increase of cats returning to insulin is just because of the higher traffic (so there are more in number, but not in %) or if it might be because more are a going off too soon without having the patience to wait for "... see kitty mostly in the 50 - 80 mg/dL range, but under 100 overall... with only occasional readings in the 100 - 120 range." I know some meters read higher than others, but I think most strong remissions are still going to come with a solid pattern of under 100.
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The interesting thing is traffic has not been higher. The number of daily participants has dwindled over the last few years and yet we're seeing more and more kitties coming back from the Falls. Is it coincidence when it's clear following the suggested guidelines has become, for lack of a better word, lax?

Just my opinion: I don't think so. I see a direct relationship between kitties falling out of remission and whether they started off with a strong remission. If I were to make an educated guess based strictly on observation... I would say the turning point was when somewhere along the line the suggested guidelines were misinterpreted. You know how it is on the board. All you need is one person spreading misinformation or a wrongful interpretation and before you know it, it becomes gospel on the FDMB. Unfortunately, there's more of that kind of thing happening all the time. Well meaning and many times prolific posters (not necessarily newbies) think they know something and run with it... without a full understanding and worse... not knowing there are exceptions nor how to spot them. In no time at all the misinformation/misinterpretations are quoted by other members... and so it spreads... and within no time at all... becomes gospel.

Melanie and Smokey said:
... but I think most strong remissions are still going to come with a solid pattern of under 100.
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I agree with you 110%. It's why I felt it necessary to bring the subject up.

judytomlinson said:
Can this be a "sticky" so that we can always find it?
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No, it will not be made into a sticky, but I will place the link in the "Information and Discussion" links found at the bottom of the "New to the Group? Please read..." sticky at the top of the forum. I'll be working on that as well as a few other stickys this weekend.
 
I just reduced Doodles based on the "normal" numbers for 7 days (14 cycles). He had 2 food spikes, a 112 & a 107. He's on the 4th cycle of the reduction and I'm skeptical as it looks like we'll be going back up.
 
Jill & Alex (GA) said:
Just my opinion: I don't think so. I see a direct relationship between kitties falling out of remission and whether they started off with a strong remission.
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110% agree. I haven't been here anywhere near as long as you, Jill, but even so I've seen a number of kitties with remission and trial numbers that I wouldn't have accepted coming back in a matter of weeks or months. Or kitties taken from a higher final dose straight down to zero without going through the micro-dosing phase. I even tried it myself once for Rosa and had to go right back on the insulin with her after 2 days (I was tired, I thought I knew better, I was wrong ;) ). Of course that doesn't mean that there aren't any cats out there that can go from a higher dose to zero and hold their remission long-term, nor does it mean that a long-term remission is guaranteed for every cat that goes through micro-dosing. But I think it does increase the chances of a longer, more stable remission. And certainly for Rosa, although she wobbled around for a few weeks after her disastrous boarding experience, she was able to get her numbers back down without ever going over 145 (and the minute she went over 140, I got a very itchy trigger finger) - I think that is down to the good advice I got here to keep her on insulin as long as possible at a tiny dose before attempting a trial. I would also suggest to everyone that they try to test their meter against lab values on more than one occasion - I've found that, although Rosa seems to settle mostly in the 80-100 range, my meter also reads consistently within 5 points of lab value...and the lab range is 72-175 so she's still firmly in the lower half of that range. That does vary from one meter to another - I got very lucky (completely by chance) with my meter, but because I know where it reads I also know that seeing mostly 80s and 90s and even the odd low 100s on my meter is not cause for major concern.
 
Clarification needed: We have just started having Ivana earn a reduction by dropping between 40 and 50 three times, due to not holding her reductions well. The original post says the three drops must be on separate days, but does this actually mean separate cycles? She had her first drop in yesterday's PM cycle, then the second directly after in today's AM cycle. Surely if she drops again in today's PM cycle it will still count as the third drop even though it's the same day? Thanks!
 
Tara & Ivana said:
The original post says the three drops must be on separate days, but does this actually mean separate cycles?
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"Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose."
http://www.tillydiabetes.net/en_6_protocol2.htm

I take it as three separate days as written... mostly because the authors have been at this for 10-15 years now. They know the difference between cycles and days.

JMO.
 
Glad to revisit this again as I had forgotten that the trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range. I get some caught up on the color green :rolleyes:
 
Thanks very much. My problem is translating human meter #s to pet meter numbers. Can you tell me, in pet meter #s, what the equivalents are for 40, 80 and 100?
 
Jen , since you use a pet meter , your reduction point is under 68 on the pet meter. Take that at face value. If you switched to a human meter the reduction would be 50 in the human meter.
 
Bobbie And Bubba said:
Jen , since you use a pet meter , your reduction point is under 68 on the pet meter. Take that at face value. If you switched to a human meter the reduction would be 50 in the human meter.
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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.
 
fearlessmom said:
Thanks very much. My problem is translating human meter #s to pet meter numbers. Can you tell me, in pet meter #s, what the equivalents are for 40, 80 and 100?
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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).

fearlessmom said:
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.
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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.

 
Jill & Alex (GA) said:
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.
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Gosh, I wish someone had told me that when I first started following this MB.
I was waiting for a good time to start using the human meter I just purchased. I think now that Fearless appears to have bounced again I'll make the switch tomorrow.
 
fearlessmom said:
Gosh, I wish someone had told me that when I first started following this MB.
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I'm sorry you missed it. The info is typed in bold red towards the top of both the SLGS and the TR protocol stickys. I put it in red to help make it more noticeable. I'll have to think of a better way to make it seen.
 
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