1/2 Quintus: no juice today + musings on treating FD

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Stephanie & Quintus, Jan 2, 2018.

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  1. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    condo: http://www.felinediabetes.com/FDMB/...ps-173-2-83-3-53-green-day-ns-tonight.188907/

    No juice!

    Things are looking pretty good for Quintus this morning! After getting "0.1ui" yesterday morning and swimming with the sharks (but not so far out that I needed honey), he went up to 149 in the evening before feeding time (185 after having his food). Two hours later he was down to 119.

    So, I'm going to not shoot this morning either, and continue monitoring to see how he does "on his own".

    In my readings yesterday, off and on the board, I stumbled upon a bunch of stuff by Dr Hodgkins. I know her protocol isn't widely followed here and that it wasn't developed for Lantus, and that her sweeping affirmations about clinical hypo not being a possibility within the parameters of her protocol are refuted.

    Now for some reflexion

    I would like, however, to highlight a couple ideas I found worthwhile, and that echoed my "gut feeling" for what to do though they seem to go against how things are usually done in this community. I would therefore to curious to know more about the history and rationale for doing things "this way rather than that". I offer these reflexions with the caveat of my limited FD experience, and in that they are applied to what I've seen happen with Quintus, who is a recent diabetic secondary to pancreatitis ("Type 3" diabetes?).

    The first is the idea of not "feeding the curve".

    Quote (EH): "I am, as you all know, against using insulin to lower BG and then pumping a diabetic cat full of new glucose precursors (food) to get it back up; Cats roller-coaster enough without us MAKING them do so. "

    from https://www.diabeticcatcare.com/DCCCOK/PearlsGleaned.htm

    As I see things so far, a cat that gets "near hypo = lime green" numbers has more insulin in his system than needed for the sugar that is available. So there are two options to prevent that from happening: give more sugar, or give less insulin. Now, once the insulin is in the system, obviously you give me sugar. But giving more sugar (moreso for an animal that is not really designed to function with dietary sugar?) easily becomes "too much sugar" => higher numbers possible from both a bounce and exogenous glucose.

    Both TR and SLGS, by the way, indicate that when "low" (as defined in each protocol/method) are reached, it is sign that "too much" insulin is being used, inviting a dose reduction.

    For me it doesn't really make sense to be "pushing and pulling" at the same time to keep the numbers right. One gets a flatter line, but it's full of tension. A little off on one side or another and it gets skewed. In Quintus's case, he's always been a grazing free-feeder, and the idea of giving him the whole of his 12-hour ration in the space of three hours really didn't sit right with me. Of keeping to feed him honey on each cycle to prevent him from going too low, only to end up with him heading up afterwards either because he did indeed go too low for his comfort or get too much honey because I didn't want to be testing like crazy every 15 minutes. I'm aware that with experience a CG will know better how much HC to give. But still. It seems an awful lot of work to keep on giving what seems like "too high a dose of insulin" based on what the cat's physiological response is telling me.

    In addition to that, here's something I've been wondering about. Doing this puts more control in the hands of the CG. It's reassuring to be in control, as it relieves anxiety. Control-oriented action is also a way to escape from grief (don't I know it). What part does that play in the way we choose to care for our kitties? The "pushing and pulling" method seems to me to be a high-control method that requires a lot from the CG, and so far I'm not convinced it's really better for the kitty than just... inching the dose down so kitty can stay in safe numbers without intervention.

    Sharks and honey with Quintus

    After dipping my toes in there on 29th evening despite having dropped the dose from 1ui to 0.5ui (many thanks to @Stacy & Asia for holding my hand through that stressful evening!) I decided it was not the way I wanted to go, and that my aim was to keep Quintus in the best numbers possible with the least intervention possible. I'd been stressing out for days to get food in him early in the cycle (he's a nice guy, if I bring his bowl to him and stick it under his chin, he eats) and now with the appearance of lime greens I was testing like crazy and adding honey to the mix.

    The next morning (30th) he was "high enough" in the blues (and I knew there were still high doses in the depot -- that's when I started wondering about computing a rough "depot indicator", you can find that in a tab in the SS) that I shot 0.5ui again, and swam with the sharks again. I dropped the dose again to 0.25 that night, fed him early in the cycle, and don't know what happened because I didn't stay up, but he was at 70-80 the next morning (31st), down from blue two hours earlier.

    I was hesitant even to shoot, but did a small 0.25 (0.2). I still had to put food in him early in the cycle and use some honey to keep him up. His numbers were up in the evening, and I banked on the fact it was bouncy/honey numbers, and didn't shoot (also because, new year's eve). He was already coming down in the evening, and the next morning he was at 170. A bit high, sure, but lower.

    I gave him 0.1ui (best estimate) because I was there to monitor, and didn't want to risk his numbers going back up if the low numbers I'd seen recently were the higher doses still in the depot. Well, we still saw a shark or two, but I managed to stay away from the honey, and by +11 he was at 150. I decided to skip the shot that evening to see how he'd do on his own. And he seems to have done quite well, coming down to 85 this morning. So I'm still not shooting.

    Which brings me to my second reflexion topic.

    Giving insulin on low numbers

    EH again, from the same source:

    "I think giving insulin at low numbers can actually be counter productive. If you think about it, the liver, even once it is retrained and completely onboard with health and recovery of the diabetic, still has the job of keeping BG from going too low. If the cat is happily going along at 110, and it gets insulin from outside, it's no different than the cat having to run hard and long to get away from a coyote. In such a situation, the liver is supposed to get busy and get more glucose into circulation. So it does, in both situations. In other words, when we shoot at low numbers, we make the liver do something we really don't want it to do. I know this is weird, hearing me say that there are times when shooting is a bad thing (and not because of hypo, but because of the effect of doing so on the liver), but if you don't really need insulin, you want to just let the body be.

    The rationale for not shooting at these near-normal levels is to see if the pancreas of the cat will handle the matter itself. You never know when the pancreas will feel "up to" handling these small rises, and if you shoot from outside, you certainly do obscure that observation. Additionally, if the pancreas and the liver are getting into sync with each other at such a time, giving insulin causes the liver to do exactly as it should if a fairly big burst of insulin shows up (our dosing, even when conservative, is always excessive compared to the much smaller, measured and frequent doses that come from the operating pancreas in response to the gradual rise in BG that happens in any animal. We are, after all, a very crude substitute for the operational pancreas under the best of circumstances). So, at some point, all of us want to find out what the cat itself can do."

    I know the common way of doing things here is to keep on giving tiny doses of insulin before stopping, a real tapering off. And that there is this idea of a "strong remission". I'd really be interested in knowing what it's based on. (Again, my wariness of cognitive bias and taking into account human psychology in assessing how we care for our cats.)

    I've seen yesterday morning that a tiny dose had an effect on Quintus. So... I'm not saying the doses are useless. But as EH argues in the paragraphs quoted above, I think it makes sense to see what the cat is capable of doing on its own. Particularly for a cat like Quintus who is a recent pancreatitis-enabled diabetic.

    I also read this conversation that seems to go in the same direction as my intuition: http://www.felinediabetes.com/FDMB/threads/treating-hypos-with-glucose-might-be-bad.86621/

    And this article, that I've yet to read in full and assess, seems to confirm my concern for "sending kitty low" repeatedly: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568263/

    This leads me to wonder if there is not more risk in continuing to give low-dose insulin to a cat who can otherwise stay in largely healthy numbers on its own.

    Also, trying to keep things in perspective: my initial objective with Quintus was to keep him under 360 for as many hours a day as possible, then 270 (20 and 15 mmol/l respectively). So at this stage, I thought it was really interesting to see how his pancreas is behaving "off juice", particularly as I a looking for a "less interventionist" way of managing his FD.

    What now?

    It's clearly too early to cry victory. This is just one morning and one evening with no shot. I'm keeping a close eye on his BG, and who knows, might shoot tonight. We'll see.

    But boy, does it feel relaxing to not have to watch him like a hawk, worry about his numbers falling or rising too much, worry about getting food in him. I wrote a few days ago about how all-consuming treating this FD was becoming for me, that all my interactions with Quintus were becoming medical, and that I was at risk of losing not only my sanity but my relationship with my cat through all this, turning into 100% caregiver and not "human with a cat" anymore.

    Quintus might very well be one of those lucky cats (again, considering his medical history) who will go into remission pretty much whatever the CG does. I'm willing to let him hang out in slightly higher numbers than TR would aim for, at least momentarily, if it means I can get some of my life and some of my cat back.

    Also important: I really think this improvement we're seeing has to do with taking care of the underlying pancreatitis. We don't know for how long he's had pancreatitis, but his lipase numbers, though slightly elevated, were normal end June. They were through the roof end September, which led to diagnosis and all that followed.

    The two ultrasounds showed issues with his gallbladder (jelly-like). He's been on two bouts of ursochol for it, with visible improvement (on ultrasound) between the first and the second. He's been on marbocyl the second time around. He had omeprazole in October and November (for the pancreatitis "relapse"). He's been on convenia since early November (the relapse). I resumed his Onsior (anti-inflammatory, NSAID) treatment on December 18th, after we interrupted it mid-November. I am certain the Onsior and Convenia both helped (and it's quite logic when you think of what pancreatitis does). I was hesitant whether to stop the Convenia now or give him another shot, which would be due end of this week, but I'm now pretty much decided to give him this last one -- if the antibiotic coverage provided by the Convenia has played a role in dealing with his pancreatitis and help his FD become less severe, I do not want to run the risk of interrupting it prematurely.

    Off to lunch, but will keep you posted on how this day goes!
    Last edited: Mar 11, 2018
    Reason for edit: wrong link to my musings from a few days previous!
    Kris & Teasel and LuanneP like this.
  2. Alicia & Maggie (GA)

    Alicia & Maggie (GA) Well-Known Member

    Jun 17, 2017
    I hope he does well without the insulin. Good luck!
  3. Kathy and TiTi

    Kathy and TiTi Well-Known Member

    Feb 12, 2016
    I've not used honey for ages and I do shoot low, and it works out well.
    However, TiTi is a high dose kitty (possibly due to acro) , so her needs fluctuate.
    Good luck with Quintus today!
  4. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    Thanks for your messages! Today was an incredibly relaxing day. I feel like a huge weight was lifted from my shoulders.

    What about Quintus? Well, he got poked less, and has had (poor thing) to become hungry enough to seek out his food bowl. I've been watching, though. He's eaten.

    His numbers on no insulin since the 0.1 yesterday morning:

    So, rising slightly, but not high enough yet that I'm going to stop "watching to see what he does on his own". I'm curious to see if the numbers are down or up tomorrow morning. I tested +9 after doing +8 because he'd gone out (exercise) and eaten and I wanted to see if it seemed to have an immediate impact.

    Some of you might remember that I added a graphical chart to Quintus's SS. I think it sometimes makes certain things easier to see. I've added my comments to the curves of the last few days, I think it gives a good idea of how things played out:

  5. Gill & George

    Gill & George Well-Known Member

    Oct 27, 2015
    You don't keep giving the dose, if the cat hits lime green then you take a reduction. But..... because the depot of the higher dose can affect numbers in following cycles, taking back to back reductions may in some instances not be advisable, this may in some cases require you to monitor closely, when the depot is full and kitty is heading down the dosing ladder. Some cats come down faster than others and there are other factors that can influence the speed at which they come down. But neither protocol encourages you to hold on to a dose that looks like it is too much.

    From Mangos thread

    QUOTE="Stephanie & Quintus, post: 2101393, member: 21836"]I see a ton of psychological reasons for believing that going OTJ gradually is better, and so far the justification seems to stop at "we noticed that". The two together make me skeptical. So if there is more data or better arguments (or scientific reasoning on how/why) I would very much like to hear. There's a personal stake in this for me of course as I'm in the process of maybe taking Quintus OTJ fast, because it's the conclusion I've come to weighing the pros and cons for him and me, and if I'm missing a big chunk of those (pros/cons), I'm really interested in adding them to my assessment for what to do now.[/QUOTE]

    He is coming down quite quick, but also what I see when looking at the data on his ss is that the dose was taken up unconventionally too, it's entirely likely that you missed a good dose and he ended up on too much insulin which led to some of the marathon testing/feeding sessions.

    FWIW just looking at the numbers if he were my cat I would be thinking along the lines of continuing some insulin support, those yellow numbers he was getting a few days ago make me doubt he is ready, as does the 185 yesterday (even with a AT2 that's on the high side)
    It is possible to shoot what we call 'some insulin' by depressing the plunger firmly in the syringe, inserting it into the vial, releasing the plunger, it will draw a tiny amount by suction and then injecting that, I found it to be a little under a drop.

    I am not aware of any empirical data, I'll have a scout around and ask around see if anyone has.
  6. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    So, what I was thinking of here is "feeding the curve", as I understood it: putting enough food in the cat that it doesn't come down to the reduction-earning numbers. That is what doesn't make sense to me. Or maybe I misunderstood it?

    Yep, agree we went up too fast with the doses (there's a history) and he ended up on "too much". However, the marathon testing/feeding sessions were all in these last days, when he was on much more "reasonable" doses. So... not certain they are linked to having missed the good dose by starting out too high. Possible, though, but doesn't "feel" like the right explanation.

    So, I'm thinking it's 50/50 that I'll be giving him "some" insulin tomorrow, indeed. His numbers have been creeping up all day, though they are still "comfy" (if we're aiming 4-8 mmol/l).

    I personally think the yellow numbers on 31st were due to a combination of bounce and carbs from the low numbers in the morning, particularly as they came down to blue by themselves by the next AMPS, with no shot in the evening. So... something used up that glucose between PMPS and AMPS. Was there enough in the depot to be taking them down that well? Or was it his pancreas too?

    The other thing I'm thinking of right now is that it'll be a week tomorrow that he got his convenia shot, and I have been noticing that a week after the shot "something" starts wearing off. If the convenia is doing something, it's fighting an infection. Could convenia wearing off and an infection (which one? not sure) coming back make the BG go up too? If I do indeed end up giving him another convenia injection it'll be interesting to see what it does to his BG, particularly if I can have him "off insulin" at that moment. I'm definitely going to catch my vet to discuss the convenia/infection question.
  7. Wendy&Neko

    Wendy&Neko Well-Known Member

    Feb 28, 2012
    If the infection is coming back, maybe Convenia is not the right antibiotic. And yes, infections/inflammation can increase the blood sugar. But I wouldn't give an antibiotic without knowing there was an infection.

    Have you seen this post on earning reductions and starting OTJ trials. Especially post #17 by Jill. In general, kitties ready for a trial don't bounce very much at all. He could still have a bit of depot in play, even today. Have you gotten rid of the kibble yet?
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Dec 28, 2009
    [edited by moderator to remove inaccurate information]

    You are more than welcome to try to stop Quintus' insulin. To my eyes, your cat is not ready for an OTJ trial. If your cat is still bouncing, then your cat is not in normal BG numbers. If you look at Chris' China's SS, you'll see what a SS for a cat that's on trial should look like.

    As for Convenia, does Quintus have a skin infection? That's the only pharmacologic indication for the antibiotic.

    Last edited by a moderator: Mar 13, 2018
    Reason for edit: self-explanatory
  9. Gill & George

    Gill & George Well-Known Member

    Oct 27, 2015
    Am I right in thinking it was urinary tract infection?? am I remembering correctly.

    I think this may have been mentioned before, but convenia is not very effective at treating UTI's

    That's not how I viewed feeding the curve.
    When I started feeding the curve with George it actually flattened him out, and reduced his bouncing.

    He would often drop fast early on in a cycle.
    If he dropped hard at +1 I would feed, not HC generally, but MC or more often LC, that slowed the drop, and stopped him from bouncing from a fast lowish drop.
    On the ss I recorded what I fed and when. The object of feeding the curve was to flatten him out not to prevent him from earning a reduction.
  10. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    We've been assuming it had to do with the pancreatitis. You know, during the first fortnight of November, Quintus was doing so bad that we just threw everything we could at him. The vet doing the ultrasound thought he had a tumor and was on his way out. When you're in that situation you just try stuff and hope, and see if something works. Convenia is clearly doing something for him, because he has been perking up after each injection, in addition to getting generally better.

    So, is the convenia helping with the bacterial mess caused by the pancreatitis, is it a pancreatitis with local infections, or is there something else that we've missed?

    Yes, I'd seen the thread, and have now read post #17 again. So, if I understand correctly, in response to a comment regarding a higher number of "returning diabetics", Jill notes she observes a relationship between cats being hurried OTJ and relapse. I'd still, at this stage, be interested in more details of these observations.

    Another possible hypothesis regarding relapse: after going OTJ, "diabetics in remission" are monitored. If the BG goes up, we see it. Just like when you've had cancer, they screen you for a bunch of years afterwards. Would these OTJ cats having high BG again be spotted if the caregivers hadn't been monitoring? Also, we have a self-selecting group here. How often do old/older cats become diabetic, in the general population? Is the percentage of relapses higher compared to a general control group (ie, does having diabetes "previously" make you more likely to have it again, or could it statistically be an independent occurrence)?

    Why do kitties ready for a trial not bounce very much? What makes them less bouncy? Could it be because the pre-OTJ dose is so small it does not manage to send them low enough to bounce?

    I must come across as annoying with all my questions. But I like understanding things as much as possible.
  11. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    Whoops, hit post too fast. I can perfectly imagine there is still a bit of depot in play, and that the depot wearing off is why his numbers are slowly rising.

    I haven't got rid of the kibble yet, though I've tried reducing even more as the last stools were encouraging. But I'm not sure I'll ever manage to get completely rid of it -- or not without putting a lot of energy into more food experimentations, at the cost of poop in unwelcome places (including my bed).
  12. Wendy&Neko

    Wendy&Neko Well-Known Member

    Feb 28, 2012
  13. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    I sense some animosity. Real question: have no cats ever died following TR/SLGS?

    I know about the history of EH's TR, and the controversy around her instructions to not give HC to a cat when the numbers go low, and that she trusts they will eat or produce glucose to keep themselves out of it.

    But this is not what I'm talking about here. I don't believe in throwing the baby out with the bathwater. I can disagree with the idea that a cat cannot hypo, and still think there is some value in other ideas she brings. Like, for example, intervening less with insulin when values are low, or sticking less carbs in cats to be able to continue holding higher doses.

    I am very glad that this board does not banish members raising questions and that open discussion is possible here. Again, if somebody's style of management displeases me, it does not mean I will automatically put every idea they have in the rubbish bin.

    If you give 0.1u of insulin to a non-diabetic cat, what happens? How do the numbers look? Do we have that data? It would be interesting as a comparison point.

    No, Quintus does not have a skin infection. I have seen many times on this board that people are very negative about convenia here. As you certainly know, there is a cultural dimension to medicine. You'll find certain practices in certain countries and not in others. I can assure you that convenia is widely used in Switzerland, for infections from abcesses due to bites to those accompanying pancreatitis. Now, I haven't read the docs, so maybe it's off-label use? Just like Onsior, that Quintus has been taking for years, and is only "supposed" to be given for six days at a stretch.

    I would really like to be able to mention convenia here without somebody systematically jumping in to make a negative comment about it.
    Last edited by a moderator: Mar 13, 2018
    Reason for edit: self-explanatory
  14. Gill & George

    Gill & George Well-Known Member

    Oct 27, 2015
    ,What have you tried food wise with Quintus? I'm in Spain, get George's food on line, most of it comes from Germany, I use zooplus, they have swiss site, he also has early CKD so I may be able to suggest some lower P, good quality protein and LC foods, that you have not come across or be aware of.

    Do you know/suspect what it is in the food that causes the poop issues?
  15. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    No, not this cat -- confusion with another, certainly! The convenia is part of what we're doing for his pancreatis. And given I am observing that it is doing something positive, we have kept at it (the original plan was 2 months of coverage, and we're at it now, and I'm going to discuss with my vet about tacking on another 10 days).

    Right, so that approach makes sense to me. What I had to do these last days, and which seemed nonsensical to me (and what I'm maybe mistakenly calling "feeding the curve" -- my apologies if I am) is giving Quintus pretty much all his food of the cycle within the first couple of hours and propping him up with honey when he reached lime greens. And what I understood of the "better" way of doing this was to feed him enough carbs before so that I would not have to prop him up with honey because he wouldn't reach the lime greens. That's what I understand as pushing the numbers from below so that we can keep pushing from above with insulin. Make sense?
  16. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
  17. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    Unfortunately I have not managed to narrow down what it might be. So far, I've noticed that dairy does not agree with him (d'uh!), grass, NF pouches. If he has any of those, his poop takes the shape of "nicely-formed at the start, liquid with mucous and blood at the end". The poor thing ends up straining on the bathroom rug and I find drops of poo-mucous-blood on it and on the floor. I've also seen him rub his butt on the floor a few times after a strained bowel movement. He had Urinary Stress at one point, same problem. Previously he was eating k/d+Mobility, same problem. On NF kibble however, pretty poop. Caveat: we diagnosed and started treating his hyperthyroidy (and got it under control) since I tried the other foods -- but he has nibbled on grass and had trouble since then.

    When switched to DM he got nice runny poop within days. A blind cat with diarrhea means he steps in it and you get it in various places (including my face at 4am).

    The gradual transition from NF kibble to DM can has gone quite well. I sped it up by mistake at some point and ended up with diarrhea again, so I backtracked (cf. SS remarks and food transition tab).

    Two things:

    - I have heard the spiel criticising vet diets again and again (they're not that good, they're expensive, Big Pet Food, etc) and am not on board, I'm quite happy to continue using veterinary diets
    - I am however not at all closed to giving non-veterinary diets, particularly if you have concrete suggestions for things you have checked out and are available in CH (I'll certainly pore over the labels being the control freak that I am, but the idea is much less daunting than "starting from zero")

    So, yes, please, I'm very interested in food suggestions, thank you for the offer!
    Kaori &Utyun likes this.
  18. Gill & George

    Gill & George Well-Known Member

    Oct 27, 2015
    I use the following brands
    Detailed info on contents of the foods I've listed available on this link

    Granata Pet symphonie
    • No 4 Turkey and Salmon
    • No 5 Chicken
    • No 6 Chicken and veal
    • (they are all 0.9%P, and under 5% carbs they do some other flavours which may be suitable for you but I can't get them in spain, you will find the details on the link above)

    Chicken with squash and catnip (single protein source) 0.8%P 3.1% carb

    Terra Faelis
    • Chicken with squash and catnip (0.6% P 5% carb)
    • Turkey with zucchini and chamomile (0.6% P 5.1%carb)
    Thrive Complete
    • Chicken (0.95P 1.9% carb)
    • Tuna and salmon (0.82 %P Carb 2%)
    • Tuna filet (0.85% P Carb 1.9%)

    I rotate his foods (he gets longer rotations with the Terra Faelis as this is lowest in P), with no problems, he's at a good weight now, FWIW my personal experience of the Rx diets is not a good one, he was basically on a weight control diets from Royal Canin and hills since we first adopted him, 60g of kibble for the 10 years, he didn't loose significant weight :banghead::banghead::banghead:(maybe 50 -100g) he was always hungry and obsessed with food. It took a while, but once on the above foods and his BG stabilised his apetite has normalised, he still likes his nosh but he isn't always circling in the kitchen obsessing about his next snack, and I have got him down to good weight, something I was not able to achieve on the Rx diets, I'm sure the vet thought I was cheating and giving him food, but I wasn't. Just my experience.
    Stephanie & Quintus likes this.
  19. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Dec 28, 2009
    My reaction isn't animosity, it's disgust. Hodgekin's approach scares me to death.

    To the best of my knowledge, I know of only one death of a cat that was here. The cat came out of remission and the caregiver was posting on the FDMB Facebook page. She was not diligent about monitoring and was very cavalier the second time around. She shot a low number and left for the day. She came back home and found that her cat had died. She did not have a necropsy done so her cat could have died from some other cause but there were sufficient details to suggest her cat died from hypoglycemia.

    Regarding your observation in Mango's condo and request for data to support what you presume is a confirmation bias, you are more than welcome to enter the data from kitties that have gone OTJ vs those who have gone OTJ and fallen out of remission. While I like data, if you want to enter data from a SS much like Gabby's, more power to you. As much as I like data and statistics, I just don't have that kind of spare time. Frankly, we have no investment beyond a healthy cat, in suggesting a slow taper off of insulin is generally a way to insure a strong remission. It's not like any of us work for Sanofi. A number of us have been here for years. We are likely to have a perspective based on years of experience on what helps a cat achieve a strong remission. Again, what you do is your choice.
  20. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    @Gill & George thanks for the food recs, will look more closely tomorrow as eyes are closing now! I'm lucky that Quintus has always been a model eater. Likes his food but not obsessed. Weight-wise I'm also lucky too, he was a bit "comfy" when I got him but he rapidly reached his ideal weight and pretty much sticks there. He lost 3-400g with the pancreatitis but he's put most of it back on. We'll see if he keeps gaining with the food change but given his appetite has waned with his BG going down, I'm optimistic. Thanks for dropping in on my condo for the discussion!
    Gill & George likes this.
  21. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    Well, sorry for asking!

    FWIW I am not "presuming" it is a confirmation bias. I am concerned that it might be, and your response, honestly, is not doing much to reassure me on that point.

    I am in doubt. And like many people, when in doubt, I would rather not intervene than intervene. And I know that's a bias, by the way.
  22. Girlie's mom

    Girlie's mom Well-Known Member

    Jul 3, 2017
    Stephanie, I do apologise if this is too personal, but what do you do? I was wondering whether you were involved in the sciences yourself, or perhaps statistics or something like that. If that's way too personal, I do apologise!
  23. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    Not too personal, it's all over the internet for who wants to dig. I started out studying chemistry, wanted to do research. Failed after three years, then went into human sciences (anthropology, philosophy, literature, that kind of stuff). Was self-employed 10+ years in the digital field, what's become "social media", learning a dozen different jobs in the process, as one does. Aside from that I'm interested in all sorts of things and am lucky to learn fast and remember well, particularly scientific topics. So... not a professional scientist, but let's say I have a solid background!
    Girlie's mom likes this.
  24. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Dec 28, 2009
    I think a very important point has been overlooked. Dr. H's comments are based on the use of PZI insulin... not Lantus. The action of PZI and Lantus are different... very different. PZI can be dosed every 6 - 12 hours depending on the cat and circumstances... according to Dr. H. Lantus is *usually* dosed every 12 hours (with certain exceptions).

    The short of it is kitties respond differently to PZI than Lantus. In contrast to PZI, Lantus has a hard time pulling down higher numbers than PZI. I honestly can't speak to the use of the newer Prozinc insulin except to say personally, I haven't been impressed with the results we've seen on the FDMB. Outside of the FDMB, I'm hearing a lot of the same as noted at another website/messageboard (take off from Dr. H's original site): http://www.diabeticcathelp.com/COK/InsulinScales.htm [​IMG]

    When using Lantus, feeding the curve can help to get enough insulin into the cat. Getting enough insulin into the cat is effective at bringing both ends of the curve down. Feeding helps prevent kitty from bottoming out. It also helps with bouncy and/or kitties that experience huge food spikes. My Alex was one of the latter. My strategy wasn't to feed a low as much as it was to feed her normal amount of low carb food at strategic times in the cycle... times that would prevent kitty from going too low. I wanted to keep her nice and flat. However, kitties always have their own agenda. Sometimes I'd have to feed a low to prevent kitty from going lower, but pushing her too low was never part of the overall plan.:)

    Anyway, just wanted to bring attention to the fact that we're talking about two different insulins. It's kind of like comparing apples to bananas. They're both fruits, but are so different!

    Good luck!

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  25. StephG

    StephG Well-Known Member

    Sep 8, 2016
    Following this post.
  26. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Dec 31, 2009
    Hi there :cool:

    Interesting condo here today - might be a good idea to take a few items over to Think Tank... for further rumination
    We've got a pretty good track record here at the FDMB , I imagine the number of FDMB kitties to go OTJ is approaching 400, and they got there safely. I've been here since January 2008 and with the exception of the incident Sienne mentioned, am unaware of any loss of life caused by our way of doing things.

    My understanding of treating FD is that, if the hope is remission, you want to get BG into the 'healing numbers' (50-120) and try to keep BG in that range, so that healing and restoration of the pancreas function can take place. At the same time any infections/inflammation must be addressed. Its a balancing act with insulin on one side and carbohydrates on the other. In some cases it can get extremely nuanced.

    Regarding feeding the curve, since there is no way to know if and when and how much of the pancreas will come back into service, one must always be prepared for the possibility that numbers may have to be guided with food. Its an ECID thing for sure. I didn't use much HC with BK; it was a year before he enjoyed his first bites of HC.. Only once in the 21 months he was on Lantus did I give him karo and it was just a taste.

    It is a high control method and can at times be downright exhausting. Caregivers must get to 'know thy cat' which can be tricky because in the world of treating FD, constant change renders data older than about 2 weeks pretty much ancient history.
    The way I see it, the pancreas spent a mostly unknown length of time disabled. It makes sense to ease the pancreas back into the full time work of providing all your kittys insulin needs. We went that route, (they had to practically pry the syringe out of my hand) BKs remission held 6.5 years, which was the rest of his life. I think that qualifies as a "strong remission", particularly since he was the last cat anyone, myself included, thought would go OTJ :D
    For the sake of his kidneys, I recommend you test his urine to find out what his renal threshold is and aim to keep BG below that, and while you are at it please also frequently check his urine for the presence of ketones. Your experiment in withholding insulin when if fact he may still need it can make him vulnerable.

    We all came here, finding ourselves in uncharted waters. Following the TR protocol or using the SLGS guidelines helps us safely find our way.:cool:

  27. Girlie's mom

    Girlie's mom Well-Known Member

    Jul 3, 2017
    I'm really interested in this: so SS data older than about 2 weeks isn't useful, then? I thought I could look throughout and be able to see patterns and such, especially with foods used to steer at a certain dosage. But is that not the case?

    Sorry to jump in to your post, Stephanie!
  28. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
    No worries, jump ahead, I've spent enough decades online to enjoy when a conversation picks up :)

    (Will reply to other comments in a few hours.)
  29. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Dec 9, 2017
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