Too late to ever get Chloe OTJ?

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Chloe'sMom (GA)

Chloe'sMom (GA)

Member Since 2015
Hello all -

I'm a 2.5 month veteran here, but found this forum thanks to my Chloe's DKA: http://www.felinediabetes.com/FDMB/...ng-out-cat-has-dka.137846/page-2#post-1422775. Later, once she was clear of the DKA (even though two vets - including the ICU vet at the ER told us to put her down) - I updated her status here: http://www.felinediabetes.com/FDMB/threads/update-on-chloe.139393/#post-1438437) While I wasn't thankful for her DKA, I'm eternally grateful for the result which in large part was finding this forum! So, I'm late to the scene on protocols outside of whatever our vet was telling us, and ever ever thinking past her first 6 months she was DX that she could be "free" from this disease. Our vet told us when she was dx that usually cats once regulated can "cure themselves" after about 6 months. Unfortunately, after 6 months, we had increased her insulin dose twice. He had determined that unfortunately, Chloe wasn't going to be one of those 80% that would "cure themselves". Granted, I was only using urine strips and every time I called in for an update. It wasn't until before she went DKA that I even Googled on my own, how to test a BG in a cat and purchased a glucometer. It wasn't his advice, but it seemed to make sense to me that checking the actual blood would be more precise! lol Now checking her BG is part of our daily routine! Chloe has been a diabetic for about 1.75 years.

That is a little mini history on her - very brief, but enough to bring me to my question - while I'm reading about the two protocols here: Tight Regulation and Start Low Go Slow, I'm wondering if it is possible or realistic for me to believe that she can be "cured"? I know that the % of success in the Tight Regulation for those that are past 6 months from dx is 35% or less, but I unless I missed it, I didn't see any prognosis for the other protocol? Has any one had success with getting their kitties OTJ after being diagnosed for a while?

As I mentioned above, it's fortunate and unfortunate that I found this wonderful resource, but I don't want to set myself up with unrealistic expectations either. I will say that post-DKA, for whatever reason she's down from 3u twice daily to anywhere from .5-1u 2x/day. That's the other part - she's a bit of a roller coaster these days! I'm going to try to run a tight curve tomorrow and really get an idea of what her body is doing, but in the meantime, I thought I'd post this out there to see what others though in RE to the question above! I guess for me, it's about being realistic, and I've been telling hubby that I believe we can get her OTJ, but lately, I'm really doubting this!

Thanks for taking the time to read and chime in.

Chloe'sMom
 
Once a cat is diabetic, they're always diabetic, but they can go into remission. This is also known as being "food controlled". Your vet is dead wrong that it is now impossible for Chloe to go into remission. Sandy's Black Kitty went into remission after five years. I don't know what the odds are that Chloe will go OTJ, but I do know that it's not impossible.
 
Max was pretty much unregulated for the first 6 months. Got better regulation after that, and now is at over a year and we just took him off insulin. I don't think that 6 month mark is a hard and fast limit at all. We lost hope after 6 month and accepted insulin forever a part of our lives, and lo and behold!

Glad to see Chloe is well!
 
Thanks @Marycatmom. I just heard about her cat, and that gives me hope! Yes, I feel that my first vet may have missed the boat a little by not suggesting that I get a glucometer and really test her, etc. Though, my new vet (we recently relocated a few months ago) says that often times, they try to make it as easy on the owners as possible, since many either get really nervous with having an animal that has needs or that owners don't want to deal with it and therefore euthanize the animal. I see their perspective too - they want to instill ease and promise that the animal will get better, but I think there are plenty of us here that can vouch for the fact that we are willing and able to do all we can for our sugar kitties! I tell my new vet all of the time about this forum! The old vet didn't think it was impossible that she would after her 6mos on the insulin, but he said it was very highly unlikely. I'm still hoping for the best and willing to do what I can to make it happen!

Now just trying to decide between Tight Regulation or Start Low Go Slow!
 
Hi @Meya14! Good to hear from you - thank you again for your help during Chloe's DKA. Wow - what a fast and hard learning experience that was! You and so many here were so helpful, so thank you!!!!

Ok, good to know, thanks for the info. I'm hoping to get her off altogether. I have a few trips coming up in Sept/Oct that will require my being gone and both hubby and I being gone (which means boarding for her....boo) and possible unrest/upsets in her protocol. I'm hoping I can get her OTJ or close to it by at least the big trip in late October which will have me gone for 2+ weeks. We'll see! I'm still doing a lot of reading to see how other kitties did. How long did Max take to get OTJ once on protocol?
 
Chloe's BG is all over the place because her dosing is all over the place. Lantus likes consistency and regular dosing (time and size) and the dosing is based on the nadirs with very little attention paid to preshots. Hang around and we'll get you sorted :) To start off with I would say the 1 unit dose is too high since it's causing you to skip. I would drop back to .75 if you can do the testing required for TR - you don't have to test as often as many of us but you need at least your preshots (to make sure it's safe to shoot) and one additional test each cycle (for dosing info). Then you'd want to hold that dose for a minimum of 6 cycles unless kitty goes too low. If you're going SLGS I think I would drop to .5 units to make sure she's safe.

There's no stats on remission rates for SLGS because as far as I am aware there haven't been any studies done. We do ocasionally see a kitty go OTJ using that method but usually that would be very early on in the dance.

I wouldn't give up hope of remission at this point but mostly I would be focussed on getting and keeping her numbers in a good range (which is a prerequisite for going OTJ anyway).

ETA - what are you feeding? For TR you need to be feeding low carb wet food
 
We found this board at around 6 months after diagnosis, and had a dental done, and had finally hit a dose of insulin that did something for him. He had severe DKA too when diagnosed - almost died. We started following the protocol and his dose was slowly reduced until about last week when we came off the insulin. Having a protocol gives you a system that helps to keep the blood sugars very even and stable, which make remission more likely. The TR protocol is the one studied in cats that had a good remission success rate. He's now a little over a year total since diagnosis.
 
There's no way for anyone to know if a particular cat can heal and become diet-controlled or not.

What we can do is help you with dosing to improve Chloe's blood sugar control. Here are a couple of observations from her spreadsheet:

Lantus dosing is based upon how low the dose takes the cat. That's a change in mindset for most people - you don't increase the dose because you have a higher preshot number. So you wouldn't give more for a yellow preshot and less for a blue preshot.

Lantus is a depot insulin - which is a really important concept to grasp. When you inject it, some is used right away and some forms a precipitate in the body and then slow-releases. Think of it like a timed medicine. Every dose has a depot that corresponds in size - so a 2.0u dose has a larger depot than a 0.5u dose. When a dose is reduced, like from 1.0u to 0.75u, the 1.0u's depot will continue giving out at the rate it was giving before the dose increase - in other words, a larger dose can continue to help control blood sugar for as many as 3 days after you've decreased the dose. There's a great explanation of how Lantus works here - look at the link that says "Lantus vs Levemir, what's the difference" for the best explanation.

Also, one great characteristic of Lantus and Lev is that they hold blood sugar flat better than they bring it down. What that means in real life is that shooting the full dose into normal numbers will often just cause a cat to "surf" along and the "curve" will become a line instead of a curve. We call that "shooting low" and an experienced person will shoot most everything over 50 as long as their cat is eating normally and they can monitor afterwards. Take a look at Mikey's thread today - the subject line - and you can see that she shot low and Mikey's basically stayed flat ever since.

You can't do this and leave the first few times, however. You have to monitor.

There are a couple of posts that explain this further.

Shooting Low
Shooting a Dropping Number (look for post #6)

And on the yellow sticky called "Shooting and Handling Low Numbers" there is a section on "becoming data ready" - you're on the right track with all of this - you just need a few tweaks and you may be able to get her spreadsheet to go all green. That's the range that her pancreas can heal in, if it's at all possible.

And to encourage you, right now Chi Chi is on day 13 of her OTJ trial and Michael is on day 11. They've both been diabetic for more than a year.

Welcome to Lantus/Lev Land. I think you'll like it here. :D

edited to add - you test more than enough to follow the Tight Regulation Protocol. It provides the ability to adjust your dose every few days and I think with your goals, that's what I'd suggest. The SLGS requires holding doses for 1 week each before adjusting.
 
Hi again @Vyktors Mum ! Thanks for hanging in there with me a couple of nights during her DKA! I really appreciated you hanging in there with me when @manxcat419 so graciously stayed with me into the wee morning hours! I'll never forget that from you both. :bighug::bighug::bighug::bighug:

Yes, you're right - I AM all over the place. I get so stinking nervous with her BG going high, and I'm so afraid for her going back into DKA that I panic and up her dose. Guilty as charged! :banghead::banghead: So, yes, please sort me out - I need it. :D

Ok, thanks for the info. I'm not sure which protocol to go with, but so far that is 2 votes for Tight Reg. I think I'll revisit that one again. I work from home a lot, so I can do the testing usually, but sometimes schedules don't always allow. I'm determined, so if I have to schedule around kitty, so be it! :rolleyes:

And cycles are 12-hour periods? I'm trying to keep all of my info straight. ;)

She gets the Friskies Salmon Dinner Pate - it's 6-7% carbs depending on what sites you visit. :)

Thank you again ma'am! Good to hear from you again! :)

Chloe'sMom
 
My China's been doing the sugardance for over 2 years....and I still HOPE for OTJ!!

In the meantime though, I just keep her as tightly regulated as possible so she's as healthy as she can be
 
A cycle is the time between one shot and the next - so usually 12 hours.

The Tight Reg Protocol is the only dosing protocol for using with Lantus that has been published in a professional veterinary journal. SLGS was developed here before the Tight Reg was published. It's great for people who can't test much, or whose cat is still eating dry food. If Chloe is eating all canned low carb and you can test at least 4 times a day, Tight Reg would likely be a good fit for you.
 
Food is good for TR, schedule is good for TR (a timed feeder could be very handy for when your schedule doesn't permit you to be there - some people freeze food for 'slow release' instead) - go for it!

And yes a lantus cycle is 12 hours.
 
julie & punkin (ga) said:
A cycle is the time between one shot and the next - so usually 12 hours.

The Tight Reg Protocol is the only dosing protocol for using with Lantus that has been published in a professional veterinary journal. SLGS was developed here before the Tight Reg was published. It's great for people who can't test much, or whose cat is still eating dry food. If Chloe is eating all canned low carb and you can test at least 4 times a day, Tight Reg would likely be a good fit for you.
Click to expand...


Perfect! Thank you @julie & punkin (ga) for this info and your detailed response above. I agree, I do think I have the gist, but definitely have a few holes to cover. ;) I had wondered that if my dosing was causing her to go all over the place. Now I know! I was panicking... truly, I had no idea what DKA was until May of this year - holy moly - never want that again. :nailbiting::nailbiting:

Ok, so I'll look that info over that you suggested and I think it is a definite GO for the Tight Regulation! Thank you!

And @Chris & China, we'll do this!! :cool:
 
Hi Chloe's Mom (BTW, may we know your name?).

Just wanted to let you know that OTJ is possible at any point in this sugar dance. Recently we had a kitty that had been on insulin for 5 years go OTJ! So do not despair that you missed the boat. There are boats leaving every week! ;)

Technically, TRP means following the rules strictly and testing and shooting on schedule, but there are many here that follow TRP a little more loosely and still have regulated kitties. Nothing is carved in stone and it's very important to remember that ECID (Every Cat is Different). Just do the best you can, and I'll bet Chloe will be fine. Welcome back!
 
Anything is possible...my Trixie went into remission after being on insulin for 3 years. It's not common, but it can happen.

But one step at a time...the main thing to focus on is getting her well-regulated...even if she never goes into remission, with regulation she can still live a long, healthy life even if she's always on insulin. To get started, you'll need a dose that you are comfortable with shooting every 12 hours, and over time you will get more comfortable with shooting lower numbers. I see you've started with .75U...a good starting point. Let's see what Chloe does with it!

You've gotten some great info to start, and it awesome that you found us and are moving to TR to help get Chloe's BGs under control! Welcome aboard - and keep asking as many questions as you need!
 
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