Tonka 2/24 reduction last night and still in the greens (so far)

[jmalasiuk]

Came home last night to a message from our vet (to whom I'd sent Tonka's latest numbers to see if she felt he was stable enough to go ahead with his dental or not). She wanted me to reduce his dose to 0.5 units, given how fast he's been falling in insulin requirements and knowing that I'm away for long hours during the day. I know some would say that this is too conservative, since he didn't officially "earn" a reduction (I keep intervening with food before he hits the below 50 level), but I appreciate her concern in this case, and to be honest, I was curious how he would do with that (I can always being his dose back up if he starts climbing, right?).

Anyhoo, she's never personally seen a cat climb down in dose needs that quickly before, especially after only being regulated for a short period) and is talking about trying him on no insulin if he keeps dropping into lower-than-comfortable levels after a week at this dose. In that case, I think I'd argue for going with increasingly smaller doses rather than cutting it out entirely, since I've read here that they seem to better getting taken off more gradually than going cold turkey from the 0.5 unit doses that vets typically work in. Is that the case? I don't want to ignore her advice, because she's had many diabetic cats in her care that have gone into remission, but I also want to give him his best chance and if going off gradually does increase that chance, then that's what we should do. (I expect the 0.5 unit reductions are based on the fact that it is harder to read anything less than half a unit accurately, and most people out there are not going to go to the extent of effort involved in micro-dosing accurately that people on this board do)

That said, what should I be looking for in terms of whether or not he fails this reduction? If he stays in the normal range, he's all good, but at what point do you consider him failing it if he does start to climb up?

Yesterday's PMPS = 70
+3 = 76
+4 = 88
+11 = 94 (yes, I finally got to sleep early enough that I was able to drag myself out of bed early enough to do a +11!)
Today's AMPS = 94
PMPS = 58

To be fair, he didn't eat much today and that probably helped him stay lower. He gobbled up Everything tonight, so we'll see where he is later on in the evening/tomorrow morning.

He is so much more like his old self these days: Trouble cat is back!

 

[Melanie and Smokey]

Looks like Tonka's pancreas just decided to start pulling its own weight one day.

My opinion of the microdosing is that the longer we support that newly diagnosed pancreas, the longer it gets to heal before having to pull the full load. If you look at Cecil's spreadsheet he did about the same, just went for the green and never went back. We kept him on insulin longer, so that his pancreas could take it easier and heal more so that remission had a better chance of sticking. (We don't do 0.1U like recommended on the board because my husband's eyes and fingers don't allow for accuracy at that dose and he usually did our evening shots).
Smokey was very similar, she went into remission very quickly. If we'd followed the newbie rule of not shooting under 200, we might not have given Smokey any insulin when we first showed up! But that micro-dosing let her pancreas heal and gave her a year and a half off of insulin despite having a large mass attaching it to her intestines.

Good luck! It looks like Tonka will be having a party soon

 

[jmalasiuk]

Thanks Melanie. I'm cautiously optimistic. He was having a couple crazy low readings (after eating normally) previously after a similarly small level of insulin to what he was on just over a week ago, but he just rebounded so much that I could never find/keep him at a healthy level. Now that his liver has calmed down, it might just be that he is coming back down to where he would have been otherwise (prior to the infection or whatever it was that spike him up so high for a while there - his improvement started after he was done on the antibiotics). He might just be a low dose cat. But here's hoping, in any case. Considering that I'm home so little during the summers, it would do my mind much ease if I didn't have to worry about him being on insulin and risking hypos for those times that I'm working away.

 

[Wendy&Neko]

He is so much more like his old self these days: Trouble cat is back!

Love hearing that! Tonka is looking very green lately. We've seen lots of cats that become very determined to get off insulin when they start being all green. We do like to keep them on insulin support as long as safely possible, but I think you've done the wise thing reducing him. Especially given tonight's numbers. I think he's good with the last reduction. If he goes low again, I'd go to .25 units.

How many of your vet's clients have done home testing? I was the first at Neko's vet's clinic.

 

[julie & punkin (ga)]

My understanding has always been that giving the cat's pancreas the support it needs for as long as possible, decreasing the dose as the cat's own pancreas begins to sputter back to life, is the way to ensure the best possible remission. We see a lot of cats return from remission, so anything you can do to support Tonka's pancreas as long as possible will be one way to help ensure that Tonka's not one of those kitties that goes back on insulin in a little while.

When in doubt for how to proceed, I always look directly at the guidelines on the TR Protocol page:

• Since 2006 we've encouraged those practicing Tight Regulation to attempt reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission.

Remission:

• From Tilly's Diabetes Homepage:
  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.
  
  Approximately 25% cats that achieved remission using this protocol relapsed and required insulin again (frequent causes are hyperthyroidism or bouts of pancreatitis). Therefore, it is important to keep your diabetes kit up-to-date. Then you can react immediately by giving insulin and home testing. Importantly, the sooner you react to a relapse (i.e. preventing hyperglycemia and initiating other necessary veterinary treatment), the more likely a second remission will become.
  
  The longer a cat has had diabetes, the less likely it will go into remission. Many long-term diabetics get stuck in Phase 3 or 4. Yet there is a benefit of using this method for such a cat as well: keeping the cat's BG levels as normal as possible is much healthier for it long term. Insulin requirements will often decrease to very low levels too."

Take a look at a couple of other spreadsheets of recent OTJ kitties. Davidson's spreadsheet is particularly fun - he went all green in February but he worked his way down the dosing scale 0.25u at a time, mostly by spending one week in normal numbers. It took him until April to go off of insulin, but there he is. That was time that his pancreas was healing. We hear from Shawna regularly that he's still doing well.

Dimitri's spreadsheet is another one that shows his particular way of going off of insulin. He was only off for a short time, back on, then back off insulin again.

Good luck - it does look really optimistic for Tonka. I just wouldn't want to rush things now instead of supporting Tonka for as long as he needs.

 

[jmalasiuk]

Love hearing that! Tonka is looking very green lately. We've seen lots of cats that become very determined to get off insulin when they start being all green. We do like to keep them on insulin support as long as safely possible, but I think you've done the wise thing reducing him. Especially given tonight's numbers. I think he's good with the last reduction. If he goes low again, I'd go to .25 units.

How many of your vet's clients have done home testing? I was the first at Neko's vet's clinic.

Yup, he even poked poor old Teeger out of the scratching post the other day in his determination to get up there. Good thing that Teegie is a little gentleman - he humoured Tonks and let him take it over

Thanks for the advice on the reduction. I'll see where he goes and figure it out day by day My vet suggested not injecting him at all if he has another morning that he starts out too low or doesn't feel like eating, to see how high he would climb on no insulin - I get the feeling she expects that he would not climb all that high. But I'd rather take him off a bit more gradually (as long as he's not stupidly low or not eating at all, that is).

As far as my vet goes, she's definitely one of the good ones. I don't know how many of her other clients actually do home test, but she does suggest it and provided many hand outs on feline diabetes, and secondary monitoring (in case home testing wasn't working out - the home testing was still her first suggestion, with a close eye on the other indicators), including the web address for this site.

 

[jmalasiuk]

My understanding has always been that giving the cat's pancreas the support it needs for as long as possible, decreasing the dose as the cat's own pancreas begins to sputter back to life, is the way to ensure the best possible remission.

Thanks Julie - that's the impression I was getting from what I'd been reading. Glad I interpreted correctly. And thanks for the links to the spreadsheets. It looks like they both went directly from 0.25 to 0.1. So that minimal bit of insulin as support is the key? I think I've seen a few folks recording doses of 0.2, 0.3 etc., but I can't see myself being able to get that fine with any real consistency, even if I do start using calipers. The 0.1 dose (assuming he gets to that point) will probably be variable, no matter how carefully I try to measure.

 

[julie & punkin (ga)]

You don't need to use calipers at this point. I wouldn't worry about that for a moment.

Yes, i think it makes a difference to go from 0.25u to 0.1u, measured as best as you can. There are photos of tiny doses on the New to the Group sticky. The suggestions on these guidelines have come from experience with literally thousands of cats over the years. I take them seriously. We've had hundreds of cats go off of insulin - i don't know how many, but while some go down the dosing scale quickly and some go slowly, they really aren't that different from each other.

Basically you want to take your cues from the tests. Try to get mid-cycle tests so you catch it when he goes below 50, then take the reduction. That's the safest way to go down the dosing scale.

 

[jmalasiuk]

Sounds good. His last reading was 56 at a little after +2. He hasn't been descending too rapidly the last little while, so I'm trying to give his paws a break but I should probably test him again soon.

 

[jmalasiuk]

59 at +4. Nice and flat. I'm tempted to just head to bed, but maybe will leave a bit of extra low carb food out for him, unless someone response in the next 20 minutes or so and says that it shouldn't be necessary...