Remission questions and advice please

Discussion in 'Feline Health - (Welcome & Main Forum)' started by David - coco, Mar 18, 2023.

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  1. David - coco

    David - coco Member

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    So we've OTJ now for a 3 weeks now from the advice I was given on here. I'm just looking for advice on where she's at as of now with her numbers. We've had a few higher PS numbers that seem sort of random, like this morning at 163 and I tested again right after to make sure and was 155. I know normal range is 68-150 on the AT meter so When I get a number above 150, it freaks me out.

    I was told that after 2 weeks to just test once per week. So since I'm still testing twice per day, am I testing to much and thinking to much about the numbers I'm getting? I would like you guys to look at my spreadsheet and let me know if everything seem normal for remission.

    I've looked at several other members spreadsheets who's cats have been in remission it seems their numbers are much lower than my cats numbers so it makes me nervous.

    It seems she's riding a fine line of remission and potentially needing insulin still. But I don't think its high enough for even a drop dose at this time, at least without very close monitoring, which I cant really do in the mornings. I've wondered if a switch to a long acting insulin like Lantus, and just doing a dose in the evening would be of any benefit? I guess she's in a weak state of remission, would you say? Or is everything pretty normal?

    For what its worth, she's been a totally different cat the last month or so. She is way more energized and plays like a young cat again, even for 17. She's still a little picky with her food but we're working on that, switching to Weruva.

    I guess I'm just looking to see what you think of where she's at in this remission and what you recommend. Maybe everything is OK and I'm just worrying for nothing? I want her to have the best chance at keeping this up!
     
    Last edited: Mar 18, 2023
  2. tiffmaxee

    tiffmaxee Well-Known Member

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  3. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    To my eyes, and I hate saying this, I don't think Coco was ready for an OTJ trial. The yellow pre-shots were not where we typically like to see a cat's numbers prior to starting a trial. Food is definitely bringing Coco's numbers back down which is a good sign of a working pancreas. I do wonder if her pancreas needs a bit more support, though.
     
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  4. David - coco

    David - coco Member

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    I sort of had the same feeling but was just taking some advice from here. Obviously I’m not going to put any blame on someone here as it was ultimately my choice. Definitely the low carb food helped a lot with her numbers and they headed in the right direction but sort of stalled.

    So would you say she’s in remission, just a weak one?

    So are you suggesting I should put her back on insulin to give her a better chance at a stronger remission? My concern will be and has been, with her low pre shot numbers and since her pancreas is working, is her dropping to low. As you can see on my SS, even when she was in the 200s, a drop dose would drop her into the 80s or 90s. If I do back on insulin, I was going to consider switching to Lantus.

    I do see people who still give their cat insulin, even with low 100s PS and do fine. But I wonder if their cat’s pancreas is working as good as mine? Also, at what point would you know your ready for a otj trial?
     
  5. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    I'm linking Tessa's spreadsheet. Keep in mind, this is a Lantus user. The cats on OTJ trials are tracked more closely on the Lantus forum than elsewhere but it should still give you a good idea of what an OTJ spreadsheet looks like.

    Every insulin is different. With Lantus, there are two dosing methods. With the Tight Regulation Protocol, I would give a shot as long as Gabby's numbers were above 50. With Lantus, you ideally see a flat curve. That said, she was a cat who's numbers could easily drop early in the cycle. I also don't view numbers in the 80s or 90s as overly low. Those are solidly normal numbers.

    I tend to think a cat is ready for an OTJ trial if the vast majority of numbers are in the 50 - 120 range (on a human meter). In other words, there may be an occasional blue but the spreadsheet is largely green. You may need to adjust upward a small amount if using an AlphaTrack but not by much.

    And you are correct -- it looks to me like it's a weak remission.
     
  6. tiffmaxee

    tiffmaxee Well-Known Member

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    With lantus we don’t start an otj trial until all bg under 100 and mostly even between 50-80. I see Sienne has responded.
     
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  7. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Ther PS is not really an indicator of the pancreas working. My snuffles has acromegaly and typically hss PSs or between 100 and 120. He get between 11 and 13 units of insulin twice daily.
    You just guess and try and see what happens with BGs. Since between meals you are getting excellent BG but the before food BG are a bit high. I have had 3 cats go into remission. For two remission was a definite possibility since both were obese and went into remission when they lost almost half their body weight. For the third one I have no idea since so history came with cat when I adopted him.
     
  8. David - coco

    David - coco Member

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    So I am using the alpha trak and my understanding is for that meter, the normal range that's used is 68-150 (v.s. the 50-120)? Which she's largely been between those numbers the last 10 days or so, except a couple times.

    So ultimately, what are you guys recommending I should do from here based on her current numbers? I guess there's really only two options. 1) keep her off insulin and see if they stay consistently below 150 (per AT meter) OR 2) go back on insulin.

    I'm all for putting her back on insulin if it means she might have a better/stronger remission. Again, my only concern is her dropping to much and it becoming a difficult and stressful thing to manage. I can only monitor her in the morning for 2-3 hours before I leave for work at 8:30 and not back until 5:30-6:00pm.

    She was on prozinc and still have half a vial, although its 3 months old now. I can maybe even try it tomorrow and Monday to see what happens since I'm off? But do you think Lantus (or its generic version) would be a better option for her given everything? The prozinc seemed to hit her hard and fast the last times I was giving it to her.

    I'm going to call my vet on Monday with an update, it'll be interesting to see what he says. Fortunately my vet is really good and he's basically given me the reigns on this to do what I need to, just wants to be in the loop with things. He did say he'd prefer I use the Alpha trak pet meter so that's why I've stuck with it. Although its getting expensive with the strips lol. I really appreciate the help
     
  9. tiffmaxee

    tiffmaxee Well-Known Member

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    With an AT we are not really sure the range. TR was developed using a human meter and I quoted the range for that. Sorry about get. The low we use is definitely 68. Any chance you would consider using a human meter?
     
  10. David - coco

    David - coco Member

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    Can you clarify this part?

    Im not opposed to the human meter myself. Seems plenty on here use them and work ok, I wouldn't mind the savings on the strips either. Obviously its the concern on the variance between the human and pet peter that I'm not sure about. Like I said above, the reason I'm still using the Alpha trak is my vet wanted me to use it. I'm fortunate that my vet has basically given me the reigns on testing, curves and regulating her at home, he just wants to be updated. But he wanted me to use the pet meter. I wonder what he would say if I told him I switched. What is a quality human meter you recommend? Hopefully one that needs very little blood, similar to the alpha trak? I'd even consider getting one tonight.
     
  11. tiffmaxee

    tiffmaxee Well-Known Member

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    We use under 68 as a reduction number with the AT. It’s a guess with the high normal I think. The reason I asked if you would consider using a human meter is because our methods were formulated based upon a human meter. Sometimes when people switch the BG readings drop enough that it’s clear the cats are in remission but not always. I guess many of us feel more comfortable with human meters. Ir is not required though.
     
  12. David - coco

    David - coco Member

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    What is a quality human meter you recommend? Hopefully onethat needs very little blood, similar to the alpha trak? Do I need to do anything different to calibrate it?

    And is your suggestion to switch to a human meter and see what her readings are for a while before going back on insulin?

    I'm not really sure, I'm sort of back and forth between human and the pet meter haha. Just wish there was an expert on here for the alphatrak. It seems from my research that the human meters will read lower vs the pet meters. So I guess its possible my numbers are more in line with a human meter reading? Maybe thats why when I look at others SS I feel my numbers are higher, I dont know, my head is spinning.
     
    Last edited: Mar 18, 2023
  13. tiffmaxee

    tiffmaxee Well-Known Member

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    Unfortunately the meter I used was changed and I don’t know if its replacement uses a small enough amount of blood. Ask on main what people recommend.

    Yes, I am wondering what your readings would be on a human meter. It’s impossible to compare and know the exact comparison between human and pet meters. Many have tried including one of our moderators. The mods all used human meters.
     
  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    When Tight Regulation was developed, Dr. Rand used 68 as the dose reduction point on an AlphaTrack vs 50 on a human meter. That's the extent that the equivalency goes between a pet-specific meter and a human meter. As the numbers increase, the difference between the different species meter becomes larger. The the higher end of the 68 - 150 range is an approximation.

    Personally, I find vet's affection for the AT meter perplexing. When I first started, the numbers on an AT and a serum chemistry analyzer were compatible and a human meter was still as it is (or was). Some vets were adamant about people using an AT. I doubt the vets had any idea of the costs involved. With the recent innovation of continuous glucose monitors (e.g., the Freestyle Libre), many vets are suggesting that caregivers use these monitors since you don't have to poke your cat for a BG reading. However, these are human meters. It makes my head spin!

    You could certainly pick up a Walmart Relion meter if a Walmart is close by. You can compare the readings and see what Coco's numbers look like. FWIW, I used a Contour meter but that was quite a few years ago.
     
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  15. David - coco

    David - coco Member

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    Seems the relion is the most popular?

    I'll be interested to see what my vet says when I talk to him about her numbers. When I search for "normal glucose range" for cats, I get a few different answers like 80-120 or even 80-160. So I'm not sure what range they consider normal and whether he'll think she's in remission. Considering I'm using the pet meter, I assume (and my vet will assume I think?) that my numbers would have been close to the same that they would have gotten whatever method the vet does. I have a feeling he'll just tell me to keep doing I'm doing for a while and see what happens, which may not necessarily be wrong.

    So you already suggested that she's in weak remission and maybe shouldn't have went off insulin yet, in your opinion what do you think I should do from here? Should I get a human meter and see what those numbers end up being? Go back on insulin for a while? If so, what insulin do you recommend?
     
  16. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    In part, my experience is with using a human meter. All of our dosing methods are based on numbers from a human meter. Since there's no number-to-number way to convert from one type of meter to another, we're approximating. The Relion won't break the bank so I'd suggest using a human meter so you have a better feel for what the remission looks like.

    In the mean time, one suggestion if you're not already doing so, is to feed Coco somewhere around +8 or +9. You're already seeing how food brings her numbers down. Feeding your cat a bit later in the cycle may help to pull the pre-shot numbers into a better place. It's a technique that we often suggest as cats are getting closer to an OTJ trial since the pre-shot numbers are often the last to fall into line.
     
  17. Jacques and Pumpkin

    Jacques and Pumpkin Member

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    I've tried three different meters and I would recommend the ReLion.

    I used the TrueMetrix and found it very temperamental. It errors if you take more than like 30 seconds after inserting the strip. It's very picky about getting a sizable sample. As soon as you touch it to some blood that's it and if you didn't give it enough you have to start over with a new strip.

    The ReLion in theory uses the same size blood drop but in practice I've found it much more forgiving. It gives you quite a bit of time after inserting the strip before it turns off. If you don't have quite enough blood in there you can often get some more before the 5 second countdown ends.

    The Abbott FreeStyle is basically the same meter as the AlphaTrak, just calibrated for humans. The test strips look exactly the same (butterfly logo and everything). But, in my admittedly unscientific experience, it reads lower than the other meters. I've tested the same drop of blood with the ReLion and the FreeStyle 16 different times, and every time the FreeStyle gave a lower reading. There's a chance that it was just those particular batches of test strips, but I think it's unlikely based on some other experiments I've done. One thing to keep in mind is that all my numbers were 300+ when I did that, so it might behave differently down below 200.

    Given that you want to get into a nice strong remission, I wouldn't chance a meter that could read low. Especially since the ReLion is so much cheaper and is used by most people on the forum. My suggestion is to give the ReLion a try, and if you struggle with the large drop size, then try the FreeStyle.
     
  18. David - coco

    David - coco Member

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    I did get a relion and started using it today in conjunction with AT, so we’ll see.

    Feeding at +8 isn’t possible for me really as I work during the day. That just seems like a forced way to lower her BG, but will it actually help in the long run?
     
    Last edited: Mar 19, 2023
  19. Jacques and Pumpkin

    Jacques and Pumpkin Member

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    Give the Cat Mate C500 feeder a try. It's got ice packs in the bottom, so it can keep wet food fresh for 8 hours (just don't put it in direct sunlight).
     
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  20. David - coco

    David - coco Member

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    I’ve seen that but just not sure about it, seems the ice pack would thaw to quick but I don’t know. I was already thinking of freezing some wet food and putting that out before I leave for work and bed, just so she isn’t forced to eat so much, so quick. She’s a slower eater. Just not sure how to go about freezing the food and how well it works. Can’t really time it either for +8 or so, she’ll just eat it whenever, with my luck she’d leave it and eat it at +10 lol.
     
  21. sandysh66

    sandysh66 Member

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    I have a Catmate 500 and I leave the feeder out for about 11 hours (the last snack is around 7 hours) and the ice pack is still cold after 11 hours, no ice but cold. You can set it so it will turn to an empty slot if you don’t think she will eat it in a timely manner.
     
  22. Jacques and Pumpkin

    Jacques and Pumpkin Member

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    Just checked mine which is currently at +8.5. It’s still cold. The ice packs are thawed but everything is still cold to the touch.

    If you want to be xtra paranoid you could always freeze the food and then put it in the CatMate. I think that’s unnecessary, but then you have the best of both worlds.
     
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  23. Jacques and Pumpkin

    Jacques and Pumpkin Member

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    Just in case this wasn’t clear for someone who doesn’t use one of these, if you leave the feeder at an empty slot when you leave for work, programmed to turn to a filled spot at +8, and then to turn again to an empty slot at +9 or +10, then you can be sure she’ll only eat it between +8 and +10, giving you that two hour fast you want before the PMPS test.
     
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  24. sandysh66

    sandysh66 Member

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    The auto feeders are great! My kitty was hesitant at first but she does great now! :cat:
     
  25. sandysh66

    sandysh66 Member

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    Pumpkin is adorable! :cat:
     
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  26. David - coco

    David - coco Member

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    So last week I purchased the Relion meter and started using that in conjunction with the AT meter, I have the numbers in my spreadsheet. Curious what you think now?

    Additionally, I purchased a catmate feeder and have been trying that but out of 4 days, she only has noticed the food 1 time so that'll be a work in progress for her to get used to that. So far I've just tried it during the day since I only have one ice pack but another is on the way. The only thing with feeding her late in the cycle, isn't that just forcing her numbers to look better, but in reality they aren't? Regardless of BG #s, the feeder could be helpful as she is a slow eater and I tend to pick up her wet food with some still on the plate as I obviously don't want it left out all day/night and she sometimes tends to undereat because of it.

    @Suzanne & Darcy I know you were tagged earlier but didn't see a comment so just curious your thoughts?
    @Bron and Sheba (GA)
    @FrostD @tiffmaxee
     
    Last edited: Mar 25, 2023
  27. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    I'd suggest getting a test somewhere mid cycle to see where Coco's numbers are. While the numbers are lower, they are still largely outside of normal range at least at pre-shot times.

    I don't look at a snack later in the cycle as "forcing" the numbers. What you're doing is causing Coco's pancreas to respond to food by releasing insulin the way a non-diabetic cat's pancreas would respond. If Coco's pancreas wasn't working, giving her a snack would cause a rise in numbers. The question, at least to me, is whether her pancreas still needs a bit of support versus her flying solo without benefit of insulin.
     
  28. David - coco

    David - coco Member

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    So I got some mid cycle tests today. Although I just had a wrinkle thrown into the mix. I tested her at +9 and she was 193/143 (AT & Human meter). I retested to make sure and it was 181/131. WTH! Super random. The only thing is, I had grabbed her to test from sitting in the sunshine. She had been in the sun for quite a while, probably 2+ hours napping. First time in a while I had opened the blinds completely and she was loving it. Can the sun and heat cause BG to raise??

    Gave her a little food in her times feeder to try and get her used to it and will test again at PS time.

    Update: As an update to this, the food yesterday evening (3/26) at about +9ish definitely brought down her PMPS #s. She also got some food at about +8ish last nigh/this morning but didn't have the same effect it seemed for the AMPS (for 3/27). Gave a little food at +9 this afternoon and her pmps was good tonight.
     
    Last edited: Mar 27, 2023
  29. David - coco

    David - coco Member

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    Bueller.....
    Bummer no one has any advice. I talk with my vet tomorrow and I'll see what he says and recommends and report back I suppose. FYI, thats why, at least for the time being, am still using the AT meter, so I can report to him those numbers.
     
    Last edited: Mar 27, 2023
  30. tiffmaxee

    tiffmaxee Well-Known Member

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    I doubt being in the sun would raise the BG. I’ve never heard that. I’d keep up the +9 snacks.
     
  31. David - coco

    David - coco Member

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    Well the sun was the only variable I can think of. Today I made an effort to prevent her to stay out of the sun and her +9 was fine vs yesterday…but who knows.

    I’ll try with the snacks. She’s still getting used to the feeder. She’s mostly not even noticed this week. Im assuming this should only be a few bites of food and not a meal? I was hoping this feeder could help her to eat more since she’s a slow eater and doesn’t finish her meal usually but feeding her half a meal +9 doesn’t seem ideal but feeding her earlier may not have the same effect on BG at PS.

    Also, I know you were curious of her numbers on a human meter. I’ve been using one and the data is on my SS. What do you think?
     
    Last edited: Mar 27, 2023
  32. tiffmaxee

    tiffmaxee Well-Known Member

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    Yes, just a could teaspoons is good for a snack. Try feeding her from the feeder when you are home.
     
  33. David - coco

    David - coco Member

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    That’s what I’ve been doing this weekend, feeding her snack in the feeder to get used to it.

    Again, what do you think of her numbers with the human meter relative to remission?
     
  34. tiffmaxee

    tiffmaxee Well-Known Member

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  35. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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  36. David - coco

    David - coco Member

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    Fwiw just in case you didn’t realize, the 160 was the AT meter. She was 126 on the human meter. But I get what you say on the blues.
     
  37. tiffmaxee

    tiffmaxee Well-Known Member

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    That’s still too high on a human meter. We want to see all green in a human meter, mostly 50-80.

    I suggest you look at some of the spreadsheets of cats that have gone otj.
     
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  38. David - coco

    David - coco Member

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    I have looked at others spreadsheets and that’s what I keep seeing. I fear she’s in this “tweener” where her #s are to low for insulin but to high for remission, or at least a strong remission by the standards from this site. That’s why I’ve tried asking this but can’t really get a definitive answer on what people think I should do. I know a drop dose of prozinc was dropping her hard and fast, and that when her numbers were in the 200s. Someone had mentioned maybe trying Lantus as it may be less harsh.

    It’ll be interesting to see what the vet says tomorrow. I have a feeling he’ll deem her in remission and suggest to just let it ride with no insulin and see what happens, which may not necessarily be the wrong answer in this situation. I’m not sure what BG range the vets use as “normal”?
     
  39. tiffmaxee

    tiffmaxee Well-Known Member

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    I am nit a Prozinc user. Looking on the Prozinc forum it looks like normalized is under 120 rather than 100. See what Suzanne and other Prozinc users say.
     
  40. David - coco

    David - coco Member

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    Hopefully they will chime in. If I was to go back on insulin, based on what was recommended here, I would likely try Lantus but note sure.

    Her number was higher this morning. And of course she did not see her snack in the feeder before it closed. Not sure what to do about that. She knows there’s food in the there because she can smell it but probably doesn’t hear it or is sleeping when it’s open. I can probably open it earlier but if she eats it to early, it may not help her numbers to much at test time.
     
  41. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    With any test, there's roughly a 20% error margin. The numbers you were seeing on the second test were within the 20%. The tests on the same meter were essentially the same numbers.
     
  42. David - coco

    David - coco Member

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    Looks like I caught everyone on vacation or something, not many chiming in. Especially the prozinc people.

    I talked with my vet today and let him know what was going on and her numbers. He basically said that based on her current numbers that he would just leave her off insulin for now. Obviously that should be great news but the feeling I’m getting from the people on here is to go back on insulin but that’s only from 1 or 2 people. No prozinc people have chimed in at this point. Prozinc would really be my only option since I doubt the vet will approve a script for Lantus at this point. I think I could probably get it without a script but not sure I would want to do that without the vets approval.

    Part of me says to let her be and live her life with occasional testing. She’s been acting and feeling great it seems and is more playful than I’ve seen her in years. But another part says to try insulin again for a while but I’m just not sure how beneficial it’ll be. Plus with her pancreas working+adding insulin I worry it’s going to be a constant struggle with hypo concern, and I just don’t have that kind of time to manage her during the day. But I’m willing to give it a shot and I suppose I could try with a dose this weekend of the prozinc and see what happens? Prozinc May still be a good option? I only thought Lantus since someone mentioned it might be better but I have no idea.

    I know the old timers on here’s thoughts are to be meticulous with the numbers and I insulin for as long as possible for a strong remission but is that always necessary for success? I really don’t know what to do at this point…
     
    Last edited: Mar 29, 2023
  43. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    My question to your vet would be what does he consider normal range numbers to be? Many vets use a higher range than we do because their clients do no home test and the vets want to avoid the possibility of a cat being in hypoglycemic numbers. Obviously, we encourage home testing.
     
  44. David - coco

    David - coco Member

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    Seems a bit beside the point of my questions but he said it at first 80-120. But after the told him her numbers recently were about 140-170, he said those weren’t astronomical either. He has been on the conservative side of things since the beginning which is his way to not overwhelm the owners, fwiw.

    Since this thread is getting long and with no responses from the prozinc tagged people, I may just start a new thread…
     
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