Remission!

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drjsiems

drjsiems

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Jake is in the beginning of remission! His last insulin was two nights ago and his insulin needs were only about one half of the time (SID rather than BID) during the two or three weeks before that. How often should I test him during these first two weeks and how often should I test him after that? He was regulated, after a nine-month struggle to do so, only for about three weeks before the remission process started if that makes a difference. I have been unable to find any literature on the topic!

Thanks,
Judy & Jake
 
Hi, Judy & Jake!

We just got done with our trial, and we were advised to test at the usual testing times -- just called it "AMBG" and "PMBG" for AM & PM blood glucose, instead of AMPS (no pre-shot!). If the number is fine, go about your business until the next one. If the number is higher than you would like. feed, and then test again in about 3-4 hours, to see whether the kitty is producing some insulin to bring the number down. And if you REALLY don't like the number, POST it, but don't give a shot until others have had a chance to chime in.

I'm curious about your shot schedule, since it's always encouraged here to shoot Lantus BID. For example, our last doses before our trial were .25 units BID, then .1.

Good luck!
 
We generally suggest that you continue to test at the same BID times that you would ordinarily shoot. You are looking to keep numbers below 120. If you get a higher number, feed as you would ordinarily and re-test in 3 or 4 hours and see if the numbers are going down. You may want to feed frequent, small meals so you do not overwhelm a newly healed pancreas.

These are the instructions we suggest to those who post here:
• Test at your normal AMPS and PMPS times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas).
• If he is green (i.e., below 100) at your normal test times, no need to test further until the next "PS" (pre-shot) time, just feed small meals and go about your day. If he is blue (100 - 200 BG range), feed a small meal and test again after about 3 hours. If his number is lower 3-4 hours after a meal, then his pancreas is working!
 
Aha! I knew about the two-week thing, but did not know it was called a trial. The past several mornings, Jake has been well below 100, but this morning he was 138. So I fed him a small meal and will test him again in about 3 hours. It is good to know that when he is below 100 in the morning, I don't have to test again until night time. Another thing that I did not know until recently - that remission or non-diabetic cats' BG actually goes down after eating! I am so used to the other way around! After the two-week trial and assuming Jake is officially OTJ, how often do people check/test their remission kitties?

Thanks,
Judy & Jake
 
I don't believe there is a rule for how often to test once a cat is OTJ. Some people will get a daily test. Others may test daily for a month and then taper back.
 
Hi Judy! I had to taper myself off of testing :lol: Now I average about once a week. Good luck to you and Jake! You have been through alot with him. Congrats on your milestone :YMHUG:
 
Thanks, Paige. You have been so helpful during this whole thing. Since Jake's BG was "blue" this morning at 138, I fed him and just tested him again (at 3 hours later), and it is 130 so that is good - his pancreas must be doing its thing! Regarding the testing advice, I know what you mean about tapering YOURSELF. I am probably testing too much right now, but I am trainable :-)! Knowing myself, I will probably test three times a day during trial, and twice a day for a while after that before I will be able to force myself to do it only once a week - if all goes well of course! I do have another question though. If blood sugar goes down after eating in a remission or non-diabetic kitty, how do we treat hypoglycemia in such a cat? We typically feed to get the blood sugar to go up - wouldn't want it go down more!

Judy & Jake
 
I wanted to clarify what I had said the other day. I am sure that non diabetic cats still do get food spikes just as humans do right after eating. But a healthy pancreas is able to bring the glucose levels back into normals range. And I am not sure that the spike would very much to begin with. But to answer your last question---we don't have to worry about a cat going hypo when we are not giving any insulin!! :mrgreen: I've seen some kitties on their trials throw a BG in the 40's and it is nothing to worry about. You are not giving any extra exogenous insulin to worry about sending the ktty into hypoglycemia. YAY
 
Yes, Jake has been in the 40s and 50s in the morning without any insulin the night before. I haven't worried about it because of just what you said - no insulin was given. My concern is like what happened last week. Jake was going along just fine with remission numbers and that he had a 195 one night after which I gave him 1/2U. The next morning he was 42. This is an instance where I should feed him for BG to rise? It did not occur to me until I ready Kathy and Kitty's post this morning that there was a dose lower than 1/2U and that maybe at the 195 I should have given 1/4U. That's what I should do if he gets one of these numbers, e.g. 195 etc. during his two-week trial? I guess I thought that 1/2U was weird enough, but apparently not so!

Judy & Jake
 
Oh yes al of us here work on decreasing the dose to almos a drop or two before we go for the trial. You are right, 0.5 might have been too much. Kitty and a lot of others were at 0.1 units prior to going on their trials. And Lantus is recommended twice a day. It sounds as though the 0.5 is too much. Next time you can try 0.25 and see how that works. If he still drops below 50 I would try 0.1 (that's about 2 drops.
 
Paige said:
Oh yes al of us here work on decreasing the dose to almos a drop or two before we go for the trial. You are right, 0.5 might have been too much. Kitty and a lot of others were at 0.1 units prior to going on their trials. And Lantus is recommended twice a day. It sounds as though the 0.5 is too much. Next time you can try 0.25 and see how that works. If he still drops below 50 I would try 0.1 (that's about 2 drops.
Click to expand...

Actually, I disagree with Paige. First, with the 195, I would have suggested you feed and see if the number came down on its own. You don't want to fixate on one number in isolation. If you need to resume insulin, I would suggest you start at 0.1u and then increase from there if necessary. Take a look at Spot/Deb's condo for an example. Spot had a brief remission, went back on a drop or so of insulin, and is now having a second trial (although we're not calling it that!).

drjseims said:
Since Jake's BG was "blue" this morning at 138, I fed him and just tested him again (at 3 hours later), and it is 130 so that is good - his pancreas must be doing its thing!
Click to expand...
A 138 and a 130 are pretty much the same number. These numbers are within the error variance for your meter. Sorry - but Jake's numbers really didn't change. You might want to test at +4 and see if the numbers have come down to 120 or lower.

If you were getting numbers in the 190s, I would want to see your spreadsheet (SS) to get a better sense of whether this OTJ trial is premature. As Paige noted, we generally decrease the amount of insulin to micro-doses in order to provide as much support for the pancreas as possible. If you stopped dosing at 0.5u, it's possible that Jake's pancreas could benefit from insulin for a bit longer. Without a SS to look at, it's hard to know how you were dosing.
 
I am a little confused that Lantus should be administered BID. Even in the remission process? The above BG of 195 (Thursday night) was a SID only because the BG of 50 before it (Thursday morning) was too low to shoot as well as the subsequent BG of 42 (Friday morning) was too low to shoot. Could you please clarify this?

Thanks,
Judy
 
Okay, I just did a post 5 hours food test, you suggested 4, but I couldn't get it done by then. Jake's BG was 89 so I guess we know that the pancreas is truly doing what is is supposed to. That 195 he had last week was his last insulin so far (PAWS CROSSED) with little insulin the days before that.

Regarding that 195 that you said that where I should have been maybe feeding Jake at the point and testing him 3 or 4 hours later, it was late at night so I did not go that route. But the insulin I did give him should have been 1/4u not 1/2u.

Thanks Paige and Sienne - this is so very exciting especially considering how sick Jake was with DKA just 2-1/2 months ago!
And the fact that my now former vet wanted to put Jake to sleep rather than make a referral for the DKA.

Judy & Jake
 
Judy:

With the BG in the 190s, you were attempting to use Lantus as a bolus insulin (i.e., a one shot deal to lower a high number). Lantus is a long acting insulin and doesn't work like Humulin R which is a bolus/very short acting insulin. That's why I indicated that I would not have encouraged giving a shot. Like I suggested, look at Deb's Spot's SS. Numbers started trending up. It was only after there was a clear trend that she started Spot back on a tiny bit of insulin.

Also, if a cat is in remission, you shouldn't be giving insulin. Remission means no insulin and the diabetes is strictly diet controlled.

I don't mean to be confusing you. It's very hard to know how you've been dosing or how you are approaching what we call an OTJ trial without a SS or any history. I don't have a context for the 195 test result. I hope this explanation is clearer. If not, let me know.

I just saw your post. That's great to see that the numbers came down. Jake's pancreas is working!!!

Please let us know if we can help in any way.
 
Hi, didn't mean to dump out of the conversation like that. Tennessee has just had major flooding -- 12 inches in 2 days! -- so I've been a little distracted.

But of course, now that I'm late, everyone has answered the key questions.

Judy, you can look at our spreadsheet to see how we did it. We went from .5 for a week -- seven days of normal numbers earned a decrease to .25, then down to .1 -- all twice daily. So as Sienne says, rather than give one shot, we tapered off by giving two shots of increasingly lower doses.

As for how many times to test... Kitty went "OTJ" officially on Friday. I haven't tested yet, but I'll bet I'm gonna tomorrow! :mrgreen:
 
Hi Kathy,

Thanks for your response. I have been a watching the news and all about the flooding. Hope you and yours are safe and dry.

I had no idea how LL handled a cat going into remission - i.e. twice daily shot at low and lower doses. My new vet had told me to not give shots under BG 175 so that is how I ended up with so many days of just one shot until a couple of weeks ago when that became the norm up until the lone injection when I got the isolated 195 BG last Thursday. And I see where giving that shot was not necessarily the right thing to do. Anyway, Jake has not had any insulin since then so now he has had three full days of no insulin - I just tested him, and it was 124. I believe we are well into our "trial" and pray that it is truly remission. Like anything else, it is a day at a time though. I just hope I can get to the point of not holding my breath when I do a test!

Now that i am finding my way around this Board a little bit better, I shall keep you posted.

Judy & Jake
 
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