Two steps forward, one step back

[Amy and Hershel]

It's been 10 days since Hershel's first shot and he hasn't needed insulin the past 48 hours. I've been so proud of him and amazed at his progress....and then he pees outside the litter box today for the first time since September 27. At the time of his diagnosis, he'd started peeing exclusively on a towel I'd placed on the couch for him and as soon as I switched him to LC wet food he began using the litter box again, about 50% of the time. He hasn't peed outside of the box at all since he started insulin and I really thought we were out of the woods on that front. I usually scoop the box twice a day but I hadn't cleaned it yet today and litter was running low so I'm hoping that was the reason for the "accident." I'm just confused because in the past, he was only urinating outside the box when his BG was through the roof, and his levels have been so good lately. Would someone mind taking a look at my spreadsheet and tell me if I'm doing something wrong?

 

[Chris & China (GA)]

Some cats are VERY picky about their litter, so it's very possible that's why he peed where he shouldn't. I wouldn't lose hope about his improved habits just yet.

You're not doing anything wrong, except I think you're rushing things. We never just stop insulin like you did, going from 1U to nothing so quickly

He hasn't been "earning" his reductions.

We want to see them in normal numbers for at least a week before dropping the dose down by .25....and then normal numbers for another week before reducing by another .25.....all the way down to a dose of 1 drop.

We want a strong remission, not a fast one. He may be able to go into remission this way, but it may not last very long either.

Here's some information on Earning reductions and starting OTJ trials

 

[Amy and Hershel]

Thanks @Chris & China. I feel like I'm missing something...I've read the protocols on the site numerous times and understand that reductions are earned based on nadirs but I still don't have a handle on "no shot" thresholds, and my vet really stressed the importance of withholding insulin on pre-shots below 12mmol/L to the point where I'm really apprehensive to shoot too much lower than that. I'm fine with shooting when he's a bit lower than 12 but with these recent pre-shots of less than 7 I'm just not comfortable. I guess I'm too scared to give insulin at these lower numbers since I can't always be home or awake for mid-cycle tests and am terrified of him going hypo since I haven't yet had to deal with that.

 

[Amy and Hershel]

and based on this:

• reduction *earned* after a single drop below 90 mg/dL for those following SLGS

wouldn't he have earned his reduction from 0.25u to 1 drop on October 10?

 

[Chris & China (GA)]

The morning of 10/7, he earned a reduction to .75 by dropping below 90

He should have stayed at .75 for at least 7 days of normal numbers, OR dropped below 90 again on subsequent days

If he'd dropped below 90 again, he would have earned the reduction down to .5....and then that 7 days would have started over (unless he dropped below 90 again)

Then he would have dropped down to a .25 dose for another week....then down to .1....then down to 1 drop.

We want to give the pancreas as much support as possible so it has the longest time to fully heal and hopefully get that strong remission we all hope for.

Your signature doesn't say if you're doing SLGS or TR, but since you said you're doing SLGS, I'm using the 90 ....On TR we wait for them to drop below 68 on the AlphaTrak

Does that make sense?

 

[Amy and Hershel]

Yes, that makes sense and I really appreciate you taking the time to explain this to me. But again, my discomfort is about the pre-shot numbers being lower than I'm comfortable shooting at. Is it really safe to shoot when his pre-shot is 76 and I won't be home until +8? The reduction from 1.0 to 0.5 was at the suggestion of someone else on the forum but I see now that I could or should have tried 0.75 first. I don't fully understand the difference between TR and SLGS aside from testing more frequently on TR and can't say I'm following either one. I guess I've just been trying to find a happy medium between my vet's instructions and what all of the knowledgable people here have been advising me to do.

 

[Chris & China (GA)]

Is it really safe to shoot when his pre-shot is 76 and I won't be home until +8?

Not at first, no!! That's why we are so big on getting as many tests in as possible

You learn about how YOUR cat responds to both food and insulin and the Pre-shot number slowly comes down. You don't start shooting a 76....You start by shooting a 200....then a 180....then maybe a 150.....then maybe a 120....until you're gradually shooting lower Pre-shot numbers

Even on SLGS, you want to work towards shooting anything over 90

You don't shoot a lower than usual number on days you can't test....shoot them at night or on weekends when you're home and can keep him safe.

Safety is our #1 rule around here so learning to shoot lower and lower numbers takes time and "knowing thy cat"

 

[Chris & China (GA)]

And I understand the problem with your vet

Most vets don't want their clients dropping as low as we suggest because their main focus is usually on just keeping the cat out of a hypo situation....they aren't used to clients who home test and are able to take a more "hands on" approach.

They also don't have the time to stay up to date on the latest treatments for any disease! They only have so many hours in a day and there's just no way they can stay up to date on the latest and still have time to see real patients!

But there's also very good research out there that shows that the sooner you can get your cat into "normal" numbers, the better their chances of obtaining remission. Letting them stay above 12 (216) won't do that. Most vets also don't understand that there are ways to shoot lower amounts than 1U. We've heard lots of stories where people's vets told them there was no such dose as .75 or .5, much less .25 or less!! But the people here know different!

It takes a leap of faith to listen to a bunch of crazy cat ladies on the internet over your vet. We all assume that our vets (like our doctors) are the ones with the degree's and we should be able to trust their diagnosis/treatment decisions. However, as most of us can attest, that's just not the case most of the time.

I have to get offline now....it's after 1am and I have to be out early in the morning to take my mom out to her hair appointment. Hopefully some others will drop in and help explain anything I've left out or done a bad job of explaining!!

Don't worry....none of us learned this overnight....it'll take time!!

 

[Amy and Hershel]

You've done an amazing job explaining everything. And this crazy cat lady does trust all the other crazy cat ladies and gentleman on the internet! I would be completely lost without all the wonderful support I've received here. I am not one to blindly follow a doctor's orders, I'm just terrified for my baby and am trying to sort out all the info coming my way from various sources. With Hershel's diagnosis plus a health scare with my non-diabetic cat, I've spent over $2000 on my fur family in the past few months. I know that being hyper-vigilant in these early days will save me money in the long run, but at $1.50/test strip, these BG tests are more painful for me than for Hershel. I plan on switching from DM to Friskies soon, and perhaps I can justify the cost of more frequent testing with the money I'll be saving on food. I'm also considering switching to FS test strips and/or a human meter to cut down on costs.