Rocky's update 2nd July

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Marlena

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Rocky is doing well on drops of insulin.
I'm trying my best with the drops, it's only approximate but the doses are so small that he should be safe.
Today he went down ever so slowly and had a late nadir. I decided to delay his shot by an hour and play safe with a small dose because an hour before his scheduled PM dose he had nadir and was so desperate for food that I couldn't keep him longer hungry and gave in. He got a shot 2 hours after he had some food at +11 which was his nadir.
 
I think you are doing fine, i'm only wondering something... If I look at your SS, the AMPS numbers are the last few days 6.6mmol or lower (on a pet meter what means they are lower on a human meter right?) so i thought you would keep the rule if Rocky is on 6.6mmol or lower you wouldn't give a shot right?
And what I 'think' i'm seeing is the last couple off days right after AMPS you gave drops but then at +3 the numbers are higher, instead of going lower... What do you think about that? I think maybe the drops are working agains the BG dropping...
Does this make sense what i'm saying? Or not? Because 6.6 is +/- 120mg and it's even less then 120 because it's a pet meter right... So i'm thinking, is it still needed to keep up with the drops?

@Rachel @Sue and Oliver (GA) what do you think of my oppinion on this?
 
Marlena, I think you are in that crazy gray area of OTJ land. No insulin may give you numbers just a bit higher than regulation but drops of insulin give you some wonky numbers. I do think, Ruby, that sometimes giving insulin on normal numbers causes the levels to go up rather than down. Usually if that is the issue, the whole cycle will be inverse with preshots levels the lowest of the cycle. Rocky does rise a little sometimes after a shot, but not much and not consistently.

If you are using the pet meter, Marlena, are your numbers low enough to be considered OTJ?

My only contribution is to suggest - although you may already have tried this - trying for the lowest possible carbs you can and feed small frequent meals. Supposedly that helps out the pancreas. And you might try an off insulin trial again and see if he stays lower.

@Elizabeth and Bertie any ideas?
 
@Ruby&Baco , @Sue and Oliver (GA), @BJM

Dear girls!
You can't imagine how much I appreciate your opinions as I'm really struggling with making decisions! Not that you would make decisions for me but your input and our joint effort to do the right thing for Rocky is most important here.
Now, let me explain my thinking:
Ruby, you are right to point out to me that I set BG of 6.6 of top number for not shooting if below. Frankly, I forgot that (ha ha ha! terrible memory) in my quest to push Rocky a bit harder.
Another thing is the meters comparison: I have read everything I could here about differences of meters, done my own comparison od various meters, got a slap on the wrist by an important person here for trying to come to some sort of comparison figures of the pet versus human meter and basically done a lot of thinking and my conclusion is as follows:
pet meters read differently to human meters and human meter read differently against each other. In very general terms human meters read lower then AT2 but it seems meaningless. One can observe a bigger difference on high numbers but on low numbers the difference is barely noticeable, I usually had almost no difference or human meter was reading higher than AT2! So, in my situation with Rocky one can clearly observe that he is mostly staying in blue numbers, which might be slightly lower when tested on human meter but we still don't see him getting more green numbers which are more important for regulation. At this stage, and after all my reading and thinking about meters I conclude that the point about human meter potentially reading lower is not valid. This is not an advice for anybody, this is just purely my observation. I think for remission in Rocky's situation I would like his numbers to be in the range of 3.8 - 6.6 (68 - 120).
The reason I decided to try OTJ was that I saw other cat's SS (Baco was one of them) and caregivers stopped giving insulin on blue numbers (on numbers which were sometimes as high as 9 (160) and the cats were doing so well on OTJ trial that the longer they were off insulin the lower their BG was getting! I did NOT get the same result with Rocky.
When you look at his SS you will notice that he goes too high after shot and food but not always. One might think that the dose was too high and he's bouncing but the same thing happened when he was off insulin and on different doses! I remember sometime ago somebody replied in my post saying that if he goes that high a few hours after food it probably means he still needs insulin. On other occasions he goes too high on a reduced dose and goes lower on increased dose but he is inconsistent so the picture is not clear.
Yesterday he went into green numbers with nadir late in the cycle so I reduced the dose and he was too high this morning.
I have doubts about him bouncing now when he is well regulated, does anybody know about bouncing at this stage? I suppose nobody will know for sure. If he was bouncing now why did he not bounce from the hypo BG on the 20th of June?
Sue, your suggestion of feeding regime is a very good one but I think I might struggle with that.
I feed Rocky exclusively raw meat (with bones, egg shell powder, organs) diet without carbohydrate only adding a tiny bit of green beans or broccoli when his numbers are low. Usually he gets 4 equal meals in 24 hour: a meal with his shot (for distraction otherwise he wriggles) and then meal between shots at equal intervals. He has an automatic feeder and seems obsessed by it! I know that more frequent feeding would be better but it is difficult to do as it would mean I have to be at home most of the time which is not possible. The best I could possibly try is feeding every 3 hours. Using automatic feeder during the day is difficult as I don't know where Rocky is going to be (indoors or in the garden) on a particular day and I have a dog as well.
Now I have a question regarding feeding so frequently and testing his BG. At present I try to test away from food so often test 3 hours after his food and injection to see how he's responding and then 3 hours later before his meal. So how do I judge his BGs levels with frequent feeding? May I please have your opinion on this.
This is how I interpret Rocky's sugar dance but more brain power and experience of you guys could only help me with decisions making so don't worry about telling me what you think even if it is different to what I conclude.
Oh, and there is another thing with Rocky : when his BG is a bit high he would meow and pester me for food constantly so it is a sign for me that his BG is not so good as oppose to those few weeks leading to and being in OTJ trial when he was so settled and quiet! Unfortunately he can be very meowy when his BG is normal so go figure it out!
I apologise for a long post but I hope you have enough patience to read it through and let me know what you think.
Most grateful for all your help, consider myself lucky to have such wonderful people in my life.
With love to you,
Marlena:)
 
Marlena

You are certainly struggling with the OTJ approach. The only input I can offer is that normal ranges for a kitty's glucose levels, according to IDEXX, are 4-9.7 mmol/L (72-175US) using vet lab equipment. Since you use the AT2 meter your readings would be closer to the lab readings. You could check your lab reports and see what ranges they give as normal. I know you want a good solid remission and you are so so close to what you are aiming for. Sending positive energy that Rocky can have a successful OTJ real soon. :bighug: :bighug:
 
Marlena, FWIW, I'm not sure aiming for more green numbers is really necessary. Given the different normal range for the AT2 meter, you will in all likelihood see more blue than green numbers in an OTJ cat using a pet meter. Rocky seems to be within the IDEXX range most of the time. A little stress (something spooked him), excitement (he chased a squirrel through the yard while outside:woot:), or he hunted or even ate something other than his prescribed diet (a yummy caterpillar!) could potentially put his BG temporarily above the upper limit of 9.7 but he is within normal range well over 90% (probably more like 98%) of the time and I don't think reacting to one off numbers that exceed the range is necessary. I think you need to look for numbers that stay up before giving insulin.

Rocky's normal range may be within the higher normal numbers rather than the lower ones. He may also be prone to a longer food spike than some other cats (higher numbers +2 to +3 hours post meal). Every biological being is going to have their own systemic "normal" range but because none of us know what our cat's normal was prior to being diagnosed diabetic, we have no baseline with which to compare numbers when OTJ is on the horizon. I think sometimes we get so strung out by the numbers and colours on the spreadsheet that we forget that our little ones are unique individuals and are going to occasionally fall outside of the expected normal ranges.

In short, I'd be inclined to give OTJ another go., I think he's looking good!
 
The reason meters may read so differently is the FDA allowed +/- 20% variation from what a lab would get.
You can narrow in on the range by double testing, but that takes more strips and ups your cost and your time.
 
I've read your whole post Marlena ;) it was long yes but that doesn't matter, everything is clear now!

I'm with @MrWorfMen's Mom on this one to try another otj trial.
The blue numbers will pop up more than green because of the pet meter numbers. The reason why Baco was on more green numbers had to do with the human meter. Although the pet and human meters aren't that different when they both read low numbers like you said, they do are a little different (you know what I mean?)
 
I'm sorry about my last post - I don't know why it was sitting there for such a long time, maybe I forgot to send it! Silly me.
Ruby, Rocky is doing very well today, no insulin at all and feeding regime seems to suit him. It is just a pain for me and I will not be able to do all the time. For now I'm doing what I can. Rocky seems a little less chubby, maybe lost weight?
I refuse to buy the scales for him - another gadget and expense but might need to reconsider as taking him to the vet's just for weighing is too stresfull for him.
So all in all GOOD!
How about you? How's the job? Is Baco still good?
I hope all is well, wishing you all the best
Love,
Marlena
 
I refuse to buy the scales for him - another gadget and expense but might need to reconsider as taking him to the vet's just for weighing is too stresfull for him.
Well I had the same thing, I didn't want to buy it but then I don't wanted to bring Baco into the vets because of the stress so I bought one. It is expensive I know but it's really good to have one. Maybe you can find a less expensive baby scale in the future so you can put Rocky onto it?

I'm really happy you are trying the otj trial again and i'm sooooo confident that it will work for you! Keeping my fingers crossed and Baco is marking her kalender for the parrrrrty already:p she loves a party!:bighug::kiss:
 
Menace says "A Party? Did I hear someone say PARTY? I'm ready when you are Rocky!"
smiley-happy105.gif
Cheering you on!
 
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