Murrie - Looking for Advice (TR or SLGS?)

Hi Lantus peeps! Please meet Murrie - his little bio is here.

Murrie was diagnosed in November 2017, it was a difficult road to get him regulated but I think we're at the point where I want to look into either Tight Regulation or SLGS.

If you have the time, would you mind taking a look at Murrie's numbers and perhaps give some advice? I'm not sure which method would be better suited to him. I would also very much appreciate some clarity re: BG targets; should I actually be wanting him in the dark green, or in the blue? At first diagnosis I was told anything under 108 (6 mmol) was too low, so I have been trying to keep him only in the blue.

Any thoughts / experience welcome as we are still learning to navigate this new world!

Many thanks in advance,
Amy, Andrew and Murrie <3

 

Wow. Great job taking care of him. Good instincts!

You are testing enough to use TR. If dry food is no longer in the pictiure, that would be my recommedation. Please review the sticky note and post any questions you have. Welcome Murrie and family!!

 

Isn't Murrie just the cutest little boy?!

 

Thank you Carol! Nice to e-meet you. No dry food whatsoever, have a fully stocked hypo kit ready to go. He scared me once with a 52 (2.9 mmol) and I've made sure to be prepared ever since.

 

But you should see the attitude... dude thinks he's a prince! But I mean, he's not wrong. His kingdom is just a lot smaller than he thinks ; )

 

Hello and welcome from George and me,

That pic of Murrie is so cute. I want to tickle him under his chin.

Thanks for the link to the intro, you had a scary start to FD, you've done a great job getting those tests and his numbers look good. To answer a question in the intro post with a human meter if you are following TR the idea is that you have them spend as much time in the normal range, that is 50-80 with a human meter (2.7-4.4 in your money).



TR gives you a stronger shot at remission if that is what you are hoping for (antijinx)

You are testing enough and it seems you have kicked the dryfood into touch. So as long as you are comfortable with it that would be my choice. But some might say I'm biased, George went into remission after 6 months of following TR diagnosed end oct 2015 into remission April 2016.

Are you going to be able to continue testing in a similar manner

I can only see the world numbers on the SS, is it just me or are there no US numbers?

 

I too can only see the world numbers @Gill & George and need the US to help. Welcome to the FDMB. I’m sorry your fd road started out so rocky but you will be fine from now on. If you can test as much as you have been I would give TR a try.

 

Welcome Murrie, Amy, and Andrew! Handsome boy you have there. Good job taking control of Murrie's treatment. Another vote for TR here, as long as you can test frequently. Come pursue dark greens with us.

 

Don't know if something has changed but I can see both World and US

 

Hi @Gill & George, @tiffmaxee, and @Alicia & Maggie - thanks for your responses! It's nice to meet you all. FYI I have updated Murrie's spreadsheet to show the US numbers as well. @Tracey&Jones You were on it!
Ok so at diagnosis, I was definitely instructed to keep him between 6 - 10 so I have been very wary of the dark greens. Interesting. I had even decreased his dose to keep him in the blue. I put him back up to 2 units last night to hopefully get him back in the dark greens.
I can test morning / noon / evening / night the majority of days.
And congratulations to George on his remission!! I'll give Murrie a chin tickle for you, if you give George one for me : )

 

Good luck with the dose increase. With that much testing as you do and no other barriers - I would vote for TR as well.

 

I’m confused that you raised the dose from 1.75 when you had a green nadir on the 9th. I would have held the dose a little longer.

 

If you have any other cats at home, you might want to give them a test. My non diabetic would usually test in the 50's (3.0 or 3.1). Hello and welcome from the west (wet) coast of Canada. Boreal is hard to get on this side of the country now, but looks like it's good ingredients. Good on you feeding low carb wet and home testing.

When looking at dosing, ask yourself the question "who low is this dose taking my cat?". Is there room to safely go lower. 1.75 units got Murrie down to 3.8 (68) a couple of days ago. That doesn't leave much room for an increase. We reduce on TR if they get below 50 (2.8) or below 90 (5.0) if following SLGS. I would have stayed with 1.75 units a bit longer.

By the way, the larger number of peeps on here are from the US, so we usually talk US numbers for their benefit. Especially if we want their help on dosing.

As for "ideal numbers", you'll hear different things from different people. Vets, who are used to having most clients NOT test, don't feel comfy seeing any numbers below mid blue. People heading for tight regulation with a view to remission, want as much green as possible. If your goal is under renal threshold, so good regulation but not tight, then it's mix of blue and green. But with a kitty on insulin, we try to stay away from the lime or light greens.

 

Kia Ora and welcome from me also .

There can't be too many princes.

 

@Wendy&Neko @tiffmaxee Thanks for getting back to me. No other cats at home - thanks for sharing re: your non-diabetic kitty being in the 50s. It's kind of helpful to have a bit of a benchmark. And I will try and get better with US numbers for sure! Right now I'm just trying to go one step at a time, and atm there are a lot of steps : )

So because we were originally told to stay in the blue 108 - 180 range (6 - 10), we were increasing his dosing if we saw multiple dark greens. I'm only now from FDMB learning that dark green can be good / even ideal, which is why we brought him back to 2 units last night.
It seemed at 1.75 units he was majority blue, even hitting yellow. But at 2 units he was a good mix of blue and dark green. So from your experience and in looking at his numbers, would you say he should stay at 1.75? Or at 2 units? I'm definitely going to get another nadir tonight before bed so maybe tomorrow will be a clearer picture.
And I'm not sure I understand the statement "If your goal is under renal threshold"... but Murr-baby has never been in the lime green (antijinx).

We've only just gotten him a bit more regulated / stable, which was priority. I'd like to keep him stable for a while before attempting TR, but it's definitely something I'd like to explore further. There's so much to learn. Thanks again for all of your help - from Murrie and I!

 

I'd suggest taking a look at both the Tight Regulation Protocol and Start Low Go Slow stickies. In part, this will dictate how to answer your question about Murry's numbers. For the sake of argument, I'm going to reply from the standpoint of TR.

With TR, the goal is to keep your kitty in normal numbers -- 50 to 120. You look at blood glucose (BG) numbers from the perspective of how low does a given dose take your cat. The lowest point in the cycle (the nadir) is how you decide whether a dose reduction or increase is needed. On a 1.75u dose, the lowest Rufus went was a 68. (Just as suggestion, with the 68, I would have gotten at least another test or two. You don't know if Rufus' numbers kept dropping. From all of the data you've been collecting, it looks like Rufus can nadir a bit later in the cycle.) Since you've increased the dose to 2.0u, I would hold that dose for 5 days/10 cycles. (If nadirs are generally below 200, you hold the dose for 10 cycles; above 200 you hold the dose for 6 cycles.) If the numbers fall below 50, you reduce Rufus' dose by 0.25u.

Just to belabor a point, on the spreadsheet (SS), with TR your cat may fall into the "lime green" range. For a cat that drops into low numbers, the numbers can be scary but just because a cat drops low, doesn't mean that this is experiencing symptomatic hypoglycemia. The reason you test is to make sure your cat doesn't drop too low and should numbers be in a low range, you can use food to steer your cat out of danger. That's why home testing is so important. You just don't want your cat to be in low numbers overly long.

Regarding renal threshold: Diabetes is very hard on the kidneys. If a cat doesn't go into remission, generally you want to keep the cat's numbers below the point where there is a high risk for kidney damage. The only way to determine the level where this happen is to test a cat's urine for the presence of glucose. The BG number at which the urine no longer registers any glucose is where your cat's renal threshold is. If you don't want to go to all of this trouble, renal threshold is typically around 200.

 

Hi there - thank you so much for providing such detail. We are still learning best practices "on the fly", while also still learning the day-to-day!

We will definitely follow-through 10 cycles at 2 units, and we're going to try for two 12 hour curves this weekend to really pinpoint his nadir.

Glad to know it's ok to see a lower number, so long as we monitor and give food. Based on his first very rocky days, I have been very concerned with hypo and seeing him around 50 definitely was stressful. And he just went from +2 = 128 to +3 = 72... It's the sharp drops in such a short amount of time that cause us to panic a bit.

And thank you for the clarification re: renal threshold. I can't get over how many things this disease affects, all in tandem. Very grateful to have so many helpful people here for guidance and support. Thanks again, Amy + Murrie.

 

No one will discourage your having a healthy fear of hypoglycemia! Once much of this becomes routine, if you start looking at other cat's spreadsheets, you'll see that cats can visit rather low numbers (e.g., the 20s) and be none the worse for it. We obviously reach for syrup or other high carb (HC) food and monitor very closely (See the "Shooting & Handling Low Numbers" sticky) in order to get the kitty back into safe numbers.

As for nadir, that's great that you're going to do a curve. Just use the information as a data point. Cat's nadirs can and do change. It's not a fixed point in the cycle. In general, my cat's nadir was at +3, except when it wasn't. There are some places where our kitties like consistency (e.g., shot time, meals) and some places where they refuse to be consistent if for no other reason than their being unpredictable drives us crazy and we have to always pay attention to them.

Murrie's numbers are looking good!

 

@Sienne and Gabby (GA) Thanks for your help, I still can't help but get nervous when he's below 100 but I'm sure I'll get more comfortable with it, with a bit more experience. When most folks do curves, is it at 1 or 2 hour intervals? I feel so bad for his little ears.

 

Folk either do 12 hrs at two hour intervals
Or 18 hours at 3 hour intervals.

As for his ears, are you applying gentle pressure after the poke?

I use to use a cold cotton pad and I would apply gentle pressure, counting slowly to ten, that seemed to minimize bruising and his ears looked great, even though I tested very often.

George thanks you for the tickle, and I thank you for the US numbers.

 

Neosporin with pain relief can help with ear pokes. You use a very small amount of the ointment and since it's a bit greasy, the blood will bead up. It also numbs the area just a bit. Neosporin goes by another name in Canada. @Wendy&Neko may recall what the name is.

 

Polysporin

 

Oh fantastic, I actually have Polysporin here at home too. And I would definitely appreciate some help with the blood beading, lately his blood has been matting into his fur and I am so sad to have to poke him again : ( I'll put the Polysporin on before or after poking?
Thanks, @Sienne and Gabby (GA) @Red & Rover (GA)

 

You could put a very tiny amount on before poking so the blood will bead and then the pain relief is in place.

 

I used the Polysporin Complete - Black and Yellow package. It has pain relief. Just put a very fine film on the fur before poking. Especially helpful when you have a cat with black ears!

 

I was actually thinking today, I have been lucky that Murrie's ears are a bit lighter because I'm still so inexperienced at getting a good bead. His ears have some dark brown in them and even that can be hard enough to see through! Black kitties are so stealthy, even in their BG monitoring!

 

Silver went OTJ after a month following SLGS back in 2014 and was OTJ for the next three years.

Hope Murrie is coming down for you. Oh and Silver is THE prince of all princes

 

K that is very promising news! Also based on your signature you might be able to help me with something I've been wanting to clarify for a while - I have never been able to find specifically "Fancy Feast Classics" in Canada - is that a US thing? Is it FF Pate outside of the US?

 

Oh they are called Fancy Feast pate here. Keep away from the ones in gravy or the FF sliced. Then you’ll be fine.

 

To clarify - Silver was also on dry food when first diagnosed.

 

OK thank you! When Murr was diagnosed, I went to a million different stores trying to find Classics. I assumed it was under a different name in Canada but wasn't sure what that was (The FF website also lists a "Timeless" line? Confusing.)
Fingers crossed that Silver will get back into remission for you soon (antijinx). Out of curiosity, what kind of maintenance does remission entail? For ex. how often do you test?

 

Oh I was bad and didn’t test at all. I did for the first couple months but then stopped. I was on the look out for symptoms returning tho and when I came back from vacation and he was sneezing a lot I knew to test. That’s his warning sign that something is wrong. I’d had blood tests done at the vet just a month earlier so I know I caught him as soon as he was out of remission. Vet had him on steroids which is what did it.