27/12 Checkers AMBG 70, +3 95, +5 90, +11 128, PMPS 128, +2.2 54, +3 56, +4 56

I didnt get any testing last night i'm afraid. So certainly no easy thing to say what happened. Quite a bit of the food is missing so he probably got low at some point, hopefully the FF i mixed in helped him out.

Looking for advice on what to do. Obviously hes wanting OTJ soon. Should I stick with 0.25U or what? AS always thanks for anyway who gives advice. You guys keep me and chcekers going.

 

Not many online at the moment @Dyana can help?

 

Are you able to test today and have the HC food if needed? This is a tough call....for me at least.

 

yes he will be getting tested today a good amount and his regular dose is just 0.25 now i think so a good chance it wont have all too much effect especially with the diminished depot he must be running.

Someone had mentioned for OTJ i should try to keep him on insulin as long as possible to give his pancreas time to recover. if thats the case then i guess the 0.25 would make sense. I just hate giving it to him when he seems like he wants to atleast try OTJ so much.

 

Here's your thread from yesterday http://www.felinediabetes.com/FDMB/...7-97-11-101-pmps-94-1-83.149903/#post-1567262 . How much longer can you stall before feeding?

 

I just read through your post from yesterday. I'm a slow reader lol.
When I first looked at your spreadsheet, and saw that you had skipped two doses in a row and then shot a dose that was only 1/3 of his regular dose, and he was still in good numbers, I thought you should stick with that 0.25.
After reading your condo from yesterday, I still think you should stick with the 0.25, as long as your are around to test and have all the supplies you need and post to the board with your numbers, but I have to work today, and will not be around to help you through the cycle. Let's see what his AMPS number is. Did he eat well last night?

 

ideally he would have got dosed 30 mins ago. i can go another 30 mins if needed.

 

just did another test marked on spreadsheet as amps and its lower at just 70, so not sure about dosing him now although i havent put down this mornings food yet although there is always some down but they certainly preferr it fresh

 

If he's 70, then I think I would just skip the shot this morning and see how he does.
Give him his food, and test again about 2 hours after he ate to see if his pancreas is pulling his numbers down after the food spike.
I will be at work during your PMBG, so just know that you may have to resume insulin depending upon those numbers.
Good luck today. And try to get those tests at night time too, when you're giving insulin.

 

Hey Luke, I agree on the no shot this morning. Good call @Dyana

Did you get any detective work done on the poop mystery?

 

I would have advised you to skip as well. It's true that staying on some insulin even a drop can help lead to a successful time OTJ. Every case is different Some just need off of dry food which is what appears to be the case here. All you can do is let Checkers lead the dance and see what he wants. Any litter box activity?

 

i forgot to seperate them last night but i found a well burried BM last night which made me pretty sure checkers is pooping just probably not regular. I think he would be showing major signs by now if impacted for 4 days or more and my other cat never really buries his BM's he just dusts them with litter at best so I think hes ok. he's still eating so I think he's good on that part.

I need to do another BG soon, i think it will be ok though.

the bm i found burried was right around where he pees so its possible hes been burying and then peeing on them. i havent been cracking open the litter i scoop out, it could be he's been hiding his BM's inside the pee clumps, the location of the BM i found last night was very very close to ending up inside one.

 

If that's what he's doing, Checkers has obviously read the "Cat Code of Conduct", rule #1 is to keep the bean confused at all times

 

Are you following TR or SLGS? This makes a difference especially with where you are now.

With TR, you shoot low numbers -- anything above 50. For a longer term diabetic or a cat that's fallen out of remission with TR, you hold the dose unless numbers fall belThis is different with SLGS.

You should be looking to keep your cat in normal (50 - 120) numbers for a week before reducing the dose. Unless there is a compelling reason,

 

I think I'm doing TR. My problem has been he just keeps earning reductions nonstop. When i'm already down to the lowest dose and he still wants reductions I only really have two options of either skipping the shot or ignoring earned reductions. we tried draining the depot and it hasnt reallly had any effect, tried waiting and he goes down instead of up, tried missing shots and still his BG doesn't rise. I'm open to any suggestions as I have no idea whats going on anymore. This is way outside of my comfort level and knowlege which is why i have been posting so much and requesting dosing advice. I was determined to stick to 0.75 4 days ago and that didnt work at all.

 

0.25 is not the lowest dose on TR, 0.1 is. I've stopped some of our "easier" cats on 0.25U 'cause my husband has a very hard time with 0.1U, but the 0.1U really weens them down to the end.

When you hit the 49 on the 0.75 you should have dropped to 0.5 the next dose, but I see you shot 0.75 again resulting in another low number and a skip to try to stop the low numbers. A reduction to a better dose can do that too.

A lot of times the higher doses will result in reductions in quick succession when their pancreas fires up. Once you get into the lower doses you often see the numbers flatten out and go sideways no matter if they get insulin or not. The longer you can give that little bit of support, the less work the pancreas has to do and the more effort it can put into healing. Some people chose to just stop insulin when they get the consistent good numbers, its not how TR works but some people do it because they are afraid of the drops into lower numbers.

Checkers is looking really great!

 

I certainly admit his dosing has been a mess. I tried to draw a line in the sand at 0.75U as many were saying i was jumping around too much. I wasn't actually planning to go TR i was going to do SLGS but i just ended up kind of naturally leaning towards TR because by the time i found the site the vet had already raised him fast, i kept trying to lower his dose enough to where i could start the SLGS comfortably but everytime i tried i ended up with low numbers and basically being in TR territory. I'm at the point where i don't really know if i'm doing either method anymore. it seems like checkers wants to do his own thing. I don't mind switching to 0.1, do you know of any good guides to how to measure that dose? A few people have mentioned ways but i havent looked into it much yet.

The main problem is everytime i try to plan the future it goes to hell. everytime i decide i will stick with something checkers does something to counter it. I think i need to increase the carbs in his food abit and that may help out alot. I tried it last night but i didn't manage to get any readings as i was so tired from the holidays i guess so i slept way too long. i do tend to sleep alot so it makes it hard to do nighttime monitoring which was another reason i wanted to go with the SLGS method.

if you think its a good idea i don't mind putting him on 0.1U, i don't see any downsides to it really. thanks for the advice.

 

Haha, you are dealing with a cat. The nice thing about TR is you don't need to plan. You hold the dose for a week, then drop. If you see a number below 50, you drop early otherwise you don't.

I've never used calipers or anything myself, I just eyeball. 0.25 to me is putting the plunger between the 0.0 and the 0.5. A 0.1 is to draw up to around 0.5 then move the plunger back to just touching the 0.0. There will be insulin in the barrel. You can use a old syringe and water to test these types of draws.

 

I think Melanie mis-spoke...on SLGS you hold the dose for a week unless they drop below 90....On TR you only have to hold the dose for 3 days (unless they drop below 50)

I would have skipped this morning too but looks like tonight you may be shooting something! If you want to try .25 again, you can....as Sienne said, on TR we do shoot anything over 50 and don't decrease again until they earn the reduction by dropping below 50 or by staying in normal numbers for 7 days but if you're more comfortable trying the .1 unit dose and seeing how Checkers does, you can always go up if you need to

Here's a picture of .1 ....but what's important when measuring dose isn't so much that it's exactly .1...it's that whatever YOU decide is .1 is consistent!

 

I don't mean to be a pest but would you please update the subject box as you test so we don't have to check the ss? I'm on my phone right now so it's easier. I agree with Chris.

 

checkers is acting crazy running around the house like a madman. Nice to see him with some energy, its been along time. He did it a little a few days ago but only a bit. He definitely likes being in the blues lol. +11 is 128 (blue), I think we will see what his PMPS says and choose betwen 0.1 and 0.25 then from the sounds of it. he may have burned some glucose with is craziness who knows lol.

 

It's so great when they start feeling better, isn't it? I had thought that China was just "an old cat" so didn't play anymore....once we got her diabetes under control, she went back to playing games she hadn't played in a long time!!

 

i was going to go with .25U if his bg went up and .1 if it went down so ofcourse he gives me the same exact reading lol. I'll probably go 0.25 but if anyone has any other opinions i'm open.

 

Well, the goal is to find a dose that you can shoot every 12 hours. If you shoot .25 tonight, do you think you'll be able to shoot it again in the morning? Or will you end up skipping because of it?

 

If you've got all the supplies you need, and can test as often (and as long) as necessary tonight, I'd go with the .25 since he hasn't dropped below 50 on that dose

There's no way any of us would be able to tell you what might happen tomorrow morning, so that's not a factor in the decision

 

i have absolutely no idea andy. There is also the loss of depot which is getting down to nearly nothing. I went with a 0.25 or maybe 0.2. i used a handheld microscope inthe end but the needles just are not designed to be used with that precision it seems, even the lines look a mess at magnification. I really should get some calipers i guess. i may be able to use this microscope but i tried to hit exactly 0.25 3 times before accepting i probably wouldnt get the line 100% right so i accepted the one i had which i think looked a hair under but close enough.

i'm not sure if 0.25 will be doable tomorrow, i have never tried shooting low (under 80) so i could try it or reduce to 0.1 if we end up low tonight i suppose.

 

I tend to agree. At this point, while the ultimate goal is a shootable dose every 12 hours, we have to deal with the information we have at hand now. Checkers is kind of writing his own rule book, but we also want to try and tapper down the doses per the TR protocol to give his pancreas the best chance at healing.

I know the last several days have probably been beyond exhausting @Lukewithcats , but at the rate Checkers is going, you are looking at remission, which may not have been possible if you didn't have all the exhausting experiences of that past week. Keep up the most excellent work you are doing.

 

I was trying to say "do what you're comfortable with", lol
Sorry!

 

i understand andy, i had already gave him his shot when i saw your message but you know i'll stick to what i'm comfortable with as his crazy dosages show. You certainly know me and checkers pretty well by now. I'm honestly a little hesistant about 0.1's as it's just so little i dont know how accurate i can make 0.1 shots but when i have to i'll give it a go but i think with his reduced depot 0.25 should still be a very small amount.

 

No, I was talking about the reduction phase of TR, not the increasing phase:

Reducing the dose:
The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus & Levemir ISG safe by suggesting and taking appropriate reductions.

• If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

 

Another vote from me for .25 as long as you can stay up with him if necessary.

 

just did his +2 and it was just 54 but i don't think he had ate in atleast a few hours. I added alittle gravy on top of his regular food and sat there and he pigged out majorly. I have found i can often make him eat when i want by sitting by the bowl and making quiet slurping noises like i am also eating, it seems to make him competitive since in his dream world hes a tough guy.

Worried he's figured out low numbers mean FF gravy, I may have to start giving gravy when he has high numbers before he catches on anymore. lol

 

I would test again 30 minutes from the last test
That's a pretty big drop for +2

 

i just did another one 40 mins later and its 3.1 so hopefully means hes on his way up.

it was a pretty big dip but i don't think he ate for some reason and he seems to just naturally be hanging in the 45-80 range. For such a tiny dose it's certainly a big dip though.

 

The slight rise you see now is the food influence, the insulin is going to keep taking him down for another few hours at least. The food will wear off in less than 2 hours. I would recommend testing again in no more than 1 hr.

 

please keep your subject line updated ...especially with that big drop

Looks like +2.75 was only 56 so you need to retest in about 30 minutes...if he ate WELL at 2.75, you could probably test again at +3.5 (45 minutes)

 

just did +3 and it stayed at 56. I need to get sleep soon, i was hoping for alittle higher

 

Now come on Checkers....you can do better than that....let's come on up a bit more, OK?

Here....this is for you, Luke!

You could give him a good snack and take a nap if you will wake up to an alarm

 

just did +3.75 and he was up from 56 to 58 lol. I'm grabbing a quick nap. will keep eye on him and set alarm clock, also just gave him some gravy just to keep him goood until next test.