Tight regulation questions

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Barbara and Goodie

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I remember there use to be a TR forum but I think the subforums are gone now, right? If I am posting in the wrong forum just direct me to the right place.

Goodie was on insulin for a few months and then OTJ for 2 yrs until this spring. After her Fructosamine last week the Vet reccomended to go OTJ again. We have been off insulin for 9 days.
My issue is that her new low (without insulin) is ranging from 120-130 and that is higher than it was before when she went OTJ (her lows at that time range 90-100). I would like her to get to the old low from before, would you let her be and see where we go from here on her own or try TR?
BTW the last amount I was shooting was between .25-.50 unit. And I use OTU glucometer. We also have an alphatrak and those number are usually about 20 points higher...
For those out there that practice TR was is the lowest BG you shoot at and how much???

thanks for your advice
 
I'd be tempted to try a very small amount of insulin. Ideally lows would be I think 60-85.

I've never shot below 120 any of the lantus cats I've worked with. When I petsat Venita's cat Ennis who is on levimir he can be shot at 100, but you really need to know the cat's reaction to insulin to do that.

Only after I've had lots of experience with a cat do I feel comfortable shooting at 120-130.

It seems like just a little nudge might get things back where they need to be.
 
THe fact is, everyone has a different comfort level in such situations. I don't have my old logs around but I think we stopped insulin around 150 and the numbers gradually went lower on their own, but we weren't in quite the same situation (being OTJ and then back on). That said, the fructosamine test really doesn't tell you whether your cat is ready to go back off of insulin again, only stopping insulin and seeing what happens will tell you that. If that pancreas needs a little more help, then many seem to find 120 still an acceptable number to microdose at if you are using lantus (and testing frequently, etc).

Jen
 
From the protocol

Phase 4: Reducing the dose

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, attempt to reduce the dose. Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. If the cat drops below 40 mg/dl once, reduce the dose immediately! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further.

If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose. Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet. Try to go from 0.25 IU to a drop before stopping the insulin completely. Reducing the dose too quickly generally does not work: most cats do not go into remission with fast reductions.
Phase 5: Remission

14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible. Test the cat's BGs once per month.
Click to expand...

The best way to get to remission is by making small reductions and continuing to give insulin as long as you can. That means you give insulin until either '1 on the lowest possible dose you can measure (usually 0.1U=a drop)the cats BG drops to low (<50 ish) or the cat stays consistantly under 100 mg/dl for a week and you are unable to reduce the further because a smaller dose cannot be measured (? I guess that would be a half drop :lol: ) when you have reached that stage then continue to measure BG daily (AM and PM) for 2 weeks if the numbers stay below 100 you are OTJ. If you happen to get an occasional higher number then feed the cat as usual and retest a few hours later. Often the presence of food will stimulate the cat's pancreas to release insulin which should lower the overall BG back into a normal range. An increased BG in a non-diabetic or a diabetic in remission can be caused by "hunger hyperglycemia". The BG drops lower due to lack of intake (calories) and this tells the body it's hungry, when food isn't availble the liver will release it's stored glucose to provide energy in the intrem temporarily raising the BG (the pancreas may not respond to this release of stored glucose right away) once food is consumed the released insulin quickly gathers up the glucose and transports it to be used for energy or stored away in the liver for future needs.
 
Welcome back, Barbara! I'm sorry you have to be back, but let's see if we can help.

Do you or your vet have any theories about why Goodie needed insulin again? You've checked her urine and bloodwork? How are her teeth? Appetite ok, and are things normal in the litter box?

Have you tried spacing out her meals differently? Multiple small meals can be easier on the pancreas than larger meals.

And yes, shooting small amounts of insulin can probably help bring those numbers down a bit. We can help you learn to do that safely in the Lantus forum.
 
Oh, yeh, what Libby said is a good point. I found for getting and keeping cats off insulin, a key was smaller meals. As the pancreas was struggling to take its job back, it still couldn't handle a full workload. Smaller meals spaced throughout the day helped keep the pancreas awake.

I knew this was working when I'd test, get a 120 or so, and give a small meal (1/2 can ff or 1/4 regular sized can), then test in 2 hours and get a lower number (60s-80s).

good luck!
 
thank you for your opinions.

Goodie actually eats the small meals during the day, she free feeds. It was a bit challenging when administring insulin but she has a sort of predictable schedule for eating so I managed. I agree that the smaller meals had actually help her pancreas. I noticed it helps.
I will wait until the following weekend that I can be home for testing to try to shoot a .10u and see what happens. She is currently off insulin but only coming down to 120. Hopefully that .10 can do the trick to bring her down a bit.

I will let you know. thanks!
 
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