? Very little insulin needed now, have questions!

[FrostD]

Hmm at this point I really don't think it is safe to give a drop dose, especially since you are gone.

I'd consider Lantus/semglee, it should be gentle enough that you can continue to support her with insulin - but, and this is a big but, you'd have to follow the more aggressive dosing method called Tight Regulation (TR). You already test enough for it, but reductions on that method are taken if she goes below 68. It can be stressful for some to manage. Another option is to customize the Start Low Go Slow (SLGS) method to use a reduction point lower than 90, but not as low as 68.

A lot of people are finding generic Lantus (semglee or insulin glargine) pens fairly cheap, $40-60 per pen. You'd only need one, as well as U100 syringes. You can also check the supply closet here on the forum.

You can continue to skip insulin and just monitor, but know that over time she will probably go up...at which point you'd want to restart on a more gentle insulin like Lantus anyway.

It's really up to you. The Lantus would give you the best chance at a strong, lasting remission. It's possible it may bring her too low as well, but not as likely. Or, you can continue to monitor and worry about restarting insulin when the time comes. I'd still check ketones occasionally, just to be cautious.

 

[David - coco]

Hmm at this point I really don't think it is safe to give a drop dose, especially since you are gone.

I assume this is specific to the prozinc insulin?

I'd consider Lantus/semglee, it should be gentle enough that you can continue to support her with insulin - but, and this is a big but, you'd have to follow the more aggressive dosing method called Tight Regulation (TR). You already test enough for it, but reductions on that method are taken if she goes below 68. It can be stressful for some to manage. Another option is to customize the Start Low Go Slow (SLGS) method to use a reduction point lower than 90, but not as low as 68.

Is the only difference between TR and SLGS methods, is how aggressive you are with shooting at low numbers? And are the reduction numbers you mention above (68 and 90) for the AlphaTrak or human meters? I notice on all the stickies its always recommended to use a human meter? Or is the Alphatrak ok to still use?

A lot of people are finding generic Lantus (semglee or insulin glargine) pens fairly cheap, $40-60 per pen. You'd only need one, as well as U100 syringes. You can also check the supply closet here on the forum.

Why the pens and not a vial? For the pens, do you mean I would need to get the U100 pen needles? Or can you use regular syringes with the pen cartridges?

You can continue to skip insulin and just monitor, but know that over time she will probably go up...at which point you'd want to restart on a more gentle insulin like Lantus anyway.

It's really up to you. The Lantus would give you the best chance at a strong, lasting remission. It's possible it may bring her too low as well, but not as likely. Or, you can continue to monitor and worry about restarting insulin when the time comes. I'd still check ketones occasionally, just to be cautious.

So at this point, if she was going to go into remission, it would have already happened? The fact that her BG still been going down after eating and not super high PS, does this mean she's sort of in a weak state of remission?

Will going back onto insulin actually be helpful in the possibility of fully going into remission?

It's possible it may bring her too low as well, but not as likely

This is my main concern. I read a bit and most of the time her PS number at this point would be to low to shoot or right on the edge to skip or reduce. The fact that even a drop dose on the prozinc dropped her, the mornings would be extremely nerve racking.

What dose would I likely start her on with the Lantus? I would guess no more than 0.25u?

Is what is happening right now with her numbers and not having insulin for a week, unusual? I mean, her body is somewhat working but her numbers aren't low enough for remission but not really (or borderline) high enough for insulin.

I'm likely to wait another week and monitor. If I do start insulin again, I'll wait until the weekend when I have a couple days to monitor.

This is frustrating as we seemed to be so close. I doubt the young again dry food has anything to do with it but I plan on not giving that to her for a couple days and see what happens with the numbers. In general, she’s seems to be acting a little different (kinda sickly), just a little more sleepy and eating slightly less. Maybe coincidence but it was right around when she hurt her food on Thursday and that’s when her numbers really stalled.

Thanks for the help.

 

[FrostD]

Yes, specific to ProZinc.

Correct about the difference between methods, yes those numbers are for the AT, you can absolutely continue to use it.

Pens are smaller and it's more likely you would use it up before it goes bad. The Lantus board would have to advise on starting dose, but it's moat likely around 0.1U. At that rate you'll waste nearly the whole vial. And I'd only buy one pen because I'm hopeful she'd go into remission before that pen is used up, but as you know, we never know.

You can use the U100 syringes with a pen, I'll tag @Diane Tyler's Mom for the pic and instructions if you're interested.

Correct, you can think of it as a weak state of remission. The normal range for an AT meter is 68-150, so she's a touch over that. Most caregivers that get their cats into remission on Lantus are 68-120 on the AT, with quite a few staying in green.

Yes, if she was going into remission it would have happened by now. We do say to give the food transition two weeks so show full effects, so it's possible she may still come down, but she's plateaued.

No, it's not unusual (for ProZinc) for it to get so close and yet not safe to give insulin. It actually just happened with @SKittyMom as well. You would want to start Lantus when you have a day or two to keep an eye on things, but it does take a week for the insulin epot to fill.

 

[Diane Tyler's Mom GA]

You can use the U100 syringes with a pen, I'll tag @Diane Tyler's Mom for the pic and instructions if you're interested

As for syringes, if you have a Walmart near you, you can get U100, 3/10ml, 30 or 31 gauge insulin syringes (the 3/10ml syringes ALL have half unit marks no matter what they might tell you). They should hold a maximum of 30 units. Either one of these is fine (and can be 30 gauge or 31) They are $12.58/100. You need to go into the store, they are not sold online

Or these
https://www.adwdiabetes.com/product/1316/surecomfort-u100-syringes-half-unit-31g-3-10cc-5-16in-100ct

10% off your next order!

 

[Diane Tyler's Mom GA]

Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen!

markings

 

[David - coco]

Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen!

markings

Hmm, so it works just the same as a vial? Can still do a drop dose if needed?

 

[Diane Tyler's Mom GA]

Hmm, so it works just the same as a vial? Can still do a drop dose if needed?

Yes it does, You can still do a drop dose if needed

 

[David - coco]

Yes, specific to ProZinc.

Correct about the difference between methods, yes those numbers are for the AT, you can absolutely continue to use it.

Pens are smaller and it's more likely you would use it up before it goes bad. The Lantus board would have to advise on starting dose, but it's moat likely around 0.1U. At that rate you'll waste nearly the whole vial. And I'd only buy one pen because I'm hopeful she'd go into remission before that pen is used up, but as you know, we never know.

You can use the U100 syringes with a pen, I'll tag @Diane Tyler's Mom for the pic and instructions if you're interested.

Correct, you can think of it as a weak state of remission. The normal range for an AT meter is 68-150, so she's a touch over that. Most caregivers that get their cats into remission on Lantus are 68-120 on the AT, with quite a few staying in green.

Yes, if she was going into remission it would have happened by now. We do say to give the food transition two weeks so show full effects, so it's possible she may still come down, but she's plateaued.

No, it's not unusual (for ProZinc) for it to get so close and yet not safe to give insulin. It actually just happened with @SKittyMom as well. You would want to start Lantus when you have a day or two to keep an eye on things, but it does take a week for the insulin epot to fill.

Thanks for the reply again.

Interestingly enough, she was much lower today then the last several days. So I'll interested in seeing what happens the next few days. As I mentioned, I did stop giving her the Young Again dry food as of Sunday night. Is it really possible that was causing her BG to go up? Even though it has basically no carbs? That would be a bummer since she liked it and was interested in supplementing it with her wet food for some easy calories. I'm sort of interested in trying it again and seeing if they go up but also don't want to try lol.

I'm definitely interested in going to the Lantus if I go back to insulin, I'll probably have a chat with my vet this week about. Fortunately my vet is really cool. He basically told me he trusts me to do what ever I need to do at home, just wants to be in the loop.

My main concern with going back on insulin is of course her dropping to low, especially when I'm not home. And not knowing what her "no shoot" number is anymore. Since her BG is naturally dropping, pairing that with insulin would just dropping it a lot, wouldn't it? Not sure about starting back on insulin this weekend, not sure I could get everything in order on time, plus her numbers may be dropping again.

Would going back on insulin actually be beneficial in her going into full remission? At what point would you deem her in full remission, if she maintains the BG levels you noted above for 2 weeks straight?

I took a look at SKittyMom's spreadsheet and her numbers look better than mines, why wouldn't she try a OTJ trial at this point? Just curious, I know every cat is different but almost makes me feel like I should still be on insulin.

Again thanks for the help. Ill be curious what her numbers are tomorrow! @Suzanne & Darcy Would be interested in your take as well!

 

[FrostD]

Yes I would wait a few more days. And yes as we mentioned, sometimes for whatever reason that dry food - even low carb - tends to elevate them a little more. No idea why.

The goal of the insulin this close to remission is just to give the pancreas that extra little nudge to help it heal. So by helping it out and having it do less work, it can recuperate a bit. It's hard to get the action of ProZinc out of your kind, I know. But Lantus is typically much, much more gentle.

Seeing as she was normal range today, wait and see what happens with that YA out of the picture. Just wanted to cover the Lantus basics in case she creeps up again or you decide you may want to try it.

The criteria for an OTJ trial depends which method you follow. Assuming you're already on a drop dose, the OTJ trial begins when the next reduction is earned. For TR on an AlphaTrak, that is a drop below 68 or a week in all green for a week. With SLGS, a drop below 90 (which she's already doing without insulin) or a week in all green. So, circling back, that's why I said you'd have to do TR or potentially modify the SLGS reduction point to a lower number.

Bottom line - her numbers today don't leave a ton of room for even a drop dose on Lantus. I would wait another 5-7 days and see where she's at.

Also - need to start a new thread.