? 3.23 Rufus AM(PS?) 104, +9 90, +11.5 85, +14 145 (AT2) NO JUICE!

Discussion in 'Lantus / Levemir / Biosimilars' started by Sean & Rufus, Mar 23, 2018.

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  1. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Rufus's last dose was yesterday am. Vet IM wants to see what he does off the juice. I was curious to see what happens too. I will continue to monitor and collect data to make he's not going to high. Btw, at which number is too high? If he gets to 200 ish and then drops down again I assume thats "normal".

    yesterday
     
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  2. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    Just my 2 cents...I with yellows and even a pink in the recent past, I don't think Rufus is quite ready to go OTJ...he could be close, but I'd hate to see him lose the momentum, and sometimes trying OTJ too early backfires bigtime. As I mentioned in last night's condo, you will need to be extra vigilant about food - dry and HC treats could very easily cause BG issues. When a kitty goes OTJ, they are still diabetic (once a diabetic, always a diabetic), but their BGs are controlled by proper diet. Any straying from a strict LC diet could, and most likely will, cause them to fall out of remission.

    I think more than anything you will need to track trends, rather than focusing on a specific number. IMO, 200ish is way too high in general, though.
     
  3. Sean & Rufus

    Sean & Rufus Well-Known Member

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    @Amy&TrixieCat "Why did she say you should stop insulin? I’d be iffy on doing that just yet, but you never know. In general we do like to taper insulin down rather than abruptly stopping...that way you can catch it quickly if he’s not ready to go OTJ. If you do stop, I would still continue with regular testing for awhile so you can spot trends. And you know that Rufus is carb-sensitive so things like treats and dry could easily skyrocket his BGs. You will need to be extra vigilant with his food if you try going OTJ."

    So I don't want to create a short story here, but it was a weird visit once again. The tech was talking with me and collecting data, and then would leave a couple times to go relay info to the IM vet. Very strange. Come to find out IM was very busy with other patients. The tech and I had good talks about what was going on with Rufus as far as him acting better, but his eating somedays isn't "great" and still needs pepcid and onda, but I'm not even sure if they are actually needed or not because I just give them to him to avoid issues. I can't get him to eat novel because he either gets nauseause from it or just is picky. I'm not sure if the food allergies have turned into IBD or if he had IBD and turned in lympohoma or is his GI just inflammed from food allergies, even though this has been going on for YEARS and never was inappentant before. Tech said it was up to me on how to proceed as far as scope. I said ok, but I need a "push" in a direction. The IM 1st said nothing abnormal, then the 2nd set of eyes said concerning for IBD, lympohoma, again IM sadi everything was ok. Then she said well, I thought he's be eating better after the denatl and once BG was in check. He is eating better, but we still have times (not often) that he won't eat or will eat very little. But he still takes those other meds. I just don't know what to do. I don't want to pay $2000 when I think it is IBD or beggining stages, but what if is cancer and we're not treating it. This is all back and forth with tech. Tech doesn't wan to push me in any direction. Finally 1.5 hours into appointment, the IM comes in. She said well, things aren't "normal" with him. But if we get him on the right food he'll probably get better. She again doesn't think we are there yet as far as needing a scope. SO, we are going to try Atopica and see if that will calm down allergies (and hopefully GI inflammation) and give it a month or 2 and then go from there. So now I need to feed only novel. This Atopica from the vet is almost $7 a day! UGH!

    So thanks for reading so far...as far as off the juice. I had been questioning it for a while what would happen off of it. I know he goes high on carbs. I/ told her that was a concern. When I get a job, he will be eating dry food (I assume) for lunch while I am away. She said keep on testing like you are, if he gets in the 200s and drops back to "normal" again, that's ok. I said I want to keep him below renal threshold. But she wants to see what he'll do off the juice, and I am curious too. He'll go straight back on if his numbers get wonky. I want him otj, but like I said before whatever is going on with tummy and his eating and allergies are more important, so if he needs to get back on the juice and maybe even needs more juice, that will just have to be part of the plan.
     
  4. Sean & Rufus

    Sean & Rufus Well-Known Member

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    I am concerned also. I don't want to screw anything up. That pink I think was a either a bad strip, or just really high from the vet visit. He did have about 20 treats on 3.20 and only got up to 160. That's a good sign. Treats are were gone for a while, then came back, but will going away again. I just don't know what to do. There are no clear answers with any of this. And I will be switching foods, so hopefully the carbs will be ok, and I'm sure they will be under 10%, but it will not be fancy feast anymore. But like she said .25 units for a 22 pound cat is nothing.

    I really hope it doesn't screw things up.
     
  5. Sean & Rufus

    Sean & Rufus Well-Known Member

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    @Amy&TrixieCat currently I feed him breakfast, lunch, and dinner wet. I've been thinking about not making him lunch and making/letting him him dry for a couple reasons. One to see how his teeth are and to see if he will. Two because once I do get a job, I wont be here to make lunch and he will not eat eat wet food left out. He would either eat it with his breakfast but more then likely wont touch it. So question is should I start that now? No more lunch and then see what he does as far as eating on his own AND to see what happens with his numbers?
     
  6. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    I have no doubt that dry food will be your enemy if you really want to try going OTJ. And, I would not change too many things at once - not shooting; new diet; new feeding schedule. You won't be able to tell what is causing what.

    FWIW, we have had a number of cats here who did and do need tiny doses of insulin. Rusty is one of them, if you want to check out a SS like that. It seems crazy to most vets, but we've seen it. Without that teeny bit of insulin, their BGs go too high.

    Like I said, I would keep an eye on trends. I wouldn't want to see him hitting 200. I honestly can't remember what is considered the normal range for an AT for sure, but I believe 150 is the top. Hopefully someone will come along and confirm or correct that.
     
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  7. Sean & Rufus

    Sean & Rufus Well-Known Member

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    So you recommend keeping him on the .25 until things "get figured out" I take it? I do need to change diets and would like to stop feeding lunch to see what he does. Those are more important to me and him.
     
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  8. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    That would be my 2 cents, especially with the necessary diet change. But see if others chime in, too.
     
  9. tiffmaxee

    tiffmaxee Well-Known Member

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    FWIW I agree with Amy.
     
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  10. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Here are my 2 cents, as well.

    When a cat is OTJ, the cat is still diabetic. The cat is a diet controlled diabetic. Feed anything that is high in carbs, and your cat's pancreas will not be able to compensate and your cat will be back on insulin. There are alternatives, like a timed feeder, although you indicated that Rufus would not cooperate. You could consider spreading out his "breakfast" -- I fed Gabby at pre-shot, +1 and +2. I actually feed my civvie the same way. Dry food is not the answer.

    In looking over Rufus' spreadsheet, I agree with Amy, I don't think Rufus is ready for an OTJ trial. We look to see a majority of test values in the greens with only a smattering fo blues and the blues should be below 120. Rufus' spreadsheet is heavy on blues. You still have room to reduce the dose -- but I don't think a dose reduction is warranted, either. There should not be a rush to get a kitty off of insulin. You want to provide as much support for a healing pancreas as you can. Most vets don't think you can measure micro-doses.

    As far as IBD vs lymphoma, I just went through this diagnostic procedure with my civvie, Gizmo. Has Rufus had an ultrasound? This will give you a clue as to whether either of these are possibilities -- there would be intestinal wall thickening and possibly enlarged lymph nodes. If those are the results of the ultrasound, you would need a biopsy to make a definitive diagnosis. If you do not want to go that route, at the minimum, look at adding probiotics to Rufus' diet on a daily basis. The website, Raw Feeding for IBD Cats, has an excellent section on supplements and probiotics.
     
  11. Shawna & Davidson (GA)

    Shawna & Davidson (GA) Well-Known Member

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    Another suggestion for the lunch option is to freeze some food, then before you leave put it out. It takes a while to thaw out and he'll just lick it when he's hungry. I split the can in half and freeze the halves in baggies, I make lots for when I know I'm not home or will be away all day. My Guys are on FF only, and although I can be gone all day (before Davidson went back on insulin) I still know they like a snack here and there. It gives them the option of having to work for the food, and I've seen them walk away (cameras) only to come back a couple hours later to snack once it's thawed. This way it gives food when you're not there.
     
  12. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Rufus did have an ultrasound. He had mild thickening, lymph nodes were normal. IM thought that the nauesa and inappetance was a combination of teeth, being unregulated and foold allerigies. Now that teeth are fixed and he's regulated he's eating better but still not eating like he used to. I'm 99% sure his food allergies turned into IBD "light". I just don't want it to progress into full on IBD or lymophoma. Problem is he will not eat novel proteins. I have him eating fish now, even thoug 'm not happy with that, he's really never had it before.

    And I know the dry food is not recommended, but it is mixed 50/50 between Young Again Zero LID & Instinct Rabbit. It's about 16% carbs.

    I was ready to. Vet wants me to start the Atopica and doesn't want me to introduce anything else right yet.

    I guess it comes down to do I need to do an endoscope, are we there yet? I need him to eat a novel diet to see if things improve, but can't get him to. Somedays can't get him to eat real well even with fancy feast. I'm willing to spend the money for a biopsy, just don't want to spend the $2000 if we aren't there yet. He doesn't have classic signs of IBD or lymphoma either.
     
  13. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Sound like a good idea! Problem is he won't eat food that has been sitting out. I can give this a try though!
     
  14. Sean & Rufus

    Sean & Rufus Well-Known Member

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    He probably is not ready for the OTJ trial. However, His numbers in the am are close to green, especially with using a pet meter.

    Instructions for starting the OTJ trial

    Start the trial on the next green pre shot.
    If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
    Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
    After 14 days of no insulin, we have a party!!
    Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.
    Good luck with the trial!!!
    Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), test his/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!
     
  15. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Hi Sean, I think 16% carbs is too high especially with no insulin; it is too high with insulin. We like to see the food to be under 10%

    I agree with the others than he isn't ready for OTJ. Usually we take them to 0.1 unit then to a drop of insulin.
     
  16. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Yeah, I'm doubting it now too. I could possibly get the dry lower in carbs, but they will not eat the YA on its own.
     
  17. Sean & Rufus

    Sean & Rufus Well-Known Member

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    I know every cat can have different symptoms, but what were Gizmo's? What were the results? I don't want Rufus back on steroids, but if they would help reduce inflammation long enough to keep GI ok to get Rufus eating better I would strongly consider it. IM vet doesn't want to go down that road. We are trying the Atopica and I did read that it can be good for IBD. It is super expensive and has some not very desirable side effects, but at least it wont raise BG.
     
  18. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    He does seem very close, just not quite there yet. That's why I'd hate to see you give it a go just yet...it could undo all the good work you've done to get here.

    I also did what Sienne suggested with meals - I split up Trix's breakfast into a few servings so she got to eat a few times before I left for work. It can be a good compromise for a kitty who won't eat food that's been left out.

    I'm sure she'll be back later to give you the details on Gizmo, but I know he had nausea and inappetance, and his U/S pointed to either IBD or lymphoma. She did a surgical biopsy to get a definitive diagnosis. An endoscopic biopsy is not always defninitive.
     
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  19. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Gizmo is a very food motivated cat. I knew something was "off" when he wasn't eating no matter what I did. He was losing weight. He also started having bouts of diarrhea. The ultrasound showed intestinal thickening along with a cluster of enlarged lymph nodes. After considerable reading and discussion with my vet (who I really like and trust), she was encouraging me to have a surgical biopsy. Her concern was that if we did an endoscopic biopsy, if the result came back with a diagnosis of IBD, there was a reasonable chance of it being a misdiagnosis since a great deal depended on whether she was able to get an adequate sample. Surgical biopsy is a full thickness biopsy and tends to be more accurate than an endoscopic biopsy. Treating for IBD if the "real" diagnosis is lymphoma is problematic.

    Keep in mind that the treatment for IBD is steroids (prednisolone) until the inflammation is under control. I've also largely switched Giz to a raw diet (alternating pork and lamb) with some ZiwiPeak rabbit and lamb or venison, although the canned food is a small amount in comparison to the raw. He also gets probiotics added to his food. He had his biopsy on 2/5 and he's been doing great. His appetite is back, he's gained weight, no problems with diarrhea, and providing he doesn't have any side effects from the prednisolone, all seems good. He'll have a repeat ultrasound in early May.

    I am very curious regarding the use of Atopica as a solo agent. From what I've read, it is typically used in combination with a steroid in refractory cases of IBD. It's not a first line treatment.
     
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  20. Sean & Rufus

    Sean & Rufus Well-Known Member

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    That's not what I wanted to hear. I asked the tech if there would for sure be an answer, and she said yes. So a surgical biopsy would be going in through the belly? We never even discussed that. I don't know if I could do that.
     
  21. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    Sienne explained it in her post...
     
  22. Sean & Rufus

    Sean & Rufus Well-Known Member

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    So it came back as IBD I take it? It seems to me my IM vet is more concerned with getting Rufus in remission over anything, which I undersatnd would be a nice goal, but if he needs steroids I wouldn't mind having to bump up his dosage. Rufus had many things going on at once when this all started. First wouldn't eat a new protein when introduced, switched back proteins and then ate less and less dry. Then started to eat less and less of wet. Never lost weight. I suspected teeth. Wat told MANY times it wasn't his teeth. Well it was his teeth. He did lose 3 pounds from Nov to Jan when unregulated. His symptoms are nausea and constipation. He used to be all over me for any type of food, no matter what I was making. Not really anymore. He'll sometimes look at what I'm eating but then walk away. He used to vomit 4 or 5 times a week. That was 6 or 7 years ago. He stopped doing that about 2 years ago. But then about 5 years ago he began the gnawing and itching constantly. He was on a novel diet last summer, except I was stupid and fed him deli turkey as a treat. He then developed a severe ear infection. That is why we all think it's food allergies that manifested into food intolerance/IBD?

    Rufus is taking a digestive aid enzyme supplement. Like I said, Dr doens't want me to add a probiotic though I'd like to. He still is taking pepcid and ondansetron, but I don't even know of they are helping or hurting or even needed.

    Atopica has a high instance of vomiting as a side effect. If he starts doing that, he'll be off right away. I really don't know what to do or where to go from here. I was reluctant to do the ultrasound, because I told her I had a feeling it would come back as IBD and that we wouldn't know if it was that or lymphoma. She told me she's preety good at distinguishing between the 2 and could tell from markings. Now we're here and she doesn't know if IBD or lymophom, or simply inflammation from an allergy. I don't want to spend $2000 for an inaccurate test now.
     
  23. Sean & Rufus

    Sean & Rufus Well-Known Member

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    The IM said there are other lines we could try before steroids. Steroids would be a last option. I just don't want the possible IBD to turn into lympohoma. I just can not get him to eat novel!
     
  24. Sean & Rufus

    Sean & Rufus Well-Known Member

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    I think our plan is to keep him on this for a month or 2, and in the meantime switch him to novel. Then remove the Atopica and see if he still has inappetance and nausea. If he does, then we go for endoscopy.
     
  25. Sean & Rufus

    Sean & Rufus Well-Known Member

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    This is from IBDkitties.net:

    Atopica (Cyclosporine)
    Cyclosporine is an immunosuppressant that works by blocking white blood cells from organizing and responding to infection or invasion. Atopica is an oral form of cyclosporine that has been modified for better absorption in the intestinal tract. It is typically used to control feline allergic dermatitis and other immune-system based skin conditions in cats. However, it has also been used successfully in the management of Feline IBD. And like budesonide, it is less likely to cause systemic side effects. The usual dosage of Atopica for cats varies from 2.27 to 5.45 mg. per pound per day. The medication is typically given once per day for 4-6 weeks and then may be tapered to every other day or twice weekly as needed to maintain the therapeutic effect. Atopica is best given on an empty stomach (either one hour before or two hours after a meal) to help facilitate absorption. Generic cyclosporine should be avoided, as its bioavailability has not been tested in dogs or cats.

    While Atopica can be effective in treating Feline IBD, there are several cautions for pet owners to be aware of. This medication may increase the risk of infections, including toxoplasmosis, so it is recommended that cats on this drug be kept indoors and not be fed a raw diet. Atopica should not be used in cats with liver disease, as it is removed from the body by the liver and places additional stress on that organ. It is also best avoided in cats with a history of cancer. As stated in the product insert from the manufacturer, prolonged use of Atopica may increase susceptibility to the development of tumors, including lymphoma, due to the suppression of the immune system.

    This part scares me now. If is is SCL this med will make it worse?!?
     
  26. Sean & Rufus

    Sean & Rufus Well-Known Member

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  27. Mandy & Rex (GA)

    Mandy & Rex (GA) Well-Known Member

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    I saw you saying the cats won't eat YA by itself. Have you tried Wysong Epigen 90 or Dr. Elseys Clean Protein? I noticed one civvie didn't want to eat YA. I switched to Dr. Elseys and he's happy. But I give it only in my absences as my DH isn't willing to do what I do with the wet food.
     
  28. Sean & Rufus

    Sean & Rufus Well-Known Member

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    I did try the Dr Elseys, but they wouldn't eat that either! :rolleyes: The Wysong won't work for us now, we have to be on a novel protein diet now to. Ugh! Thanks though :)
     
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  29. Sean & Rufus

    Sean & Rufus Well-Known Member

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    +11.5 is 85. I want to keep on insulin if I need to, but look at his numbers today without. What should i do??
     
  30. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    No arguing he is looking good today. You hold the syringe....I would do whatever you are comfortable with. If you skip (I'm assuming you did), I would continue to gather data, and just keep in mind what everyone has mentioned about food and diet-controlled FD kitties.

    Since you're read up more on Atopica, can you call the IM vetty to discuss your concerns? I have no experience with it, so I can't offer any insight, but I'd be concerned, too.
     
  31. Sean & Rufus

    Sean & Rufus Well-Known Member

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    No shot tonight. Do you think that if/when he starts eating dry food that the insulin needs would be greater then if I were to keep giving him insulin now? Does that make sense the way I worded it? Is he he going to need more insulin to get him in good numbers, then if I hadn't stopped?
     
  32. Sean & Rufus

    Sean & Rufus Well-Known Member

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    So I guess the question is, if he is off insulin now, but needs to go back on it will be harder to regulate and may need more then he would have if he would have stayed on insulin the entire time.
     
  33. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    No way of knowing in advance. I've seen it go both ways...
     
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  34. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Do you think he should be on a token amount? He had a 90 & an 85 so he technically earned another reduction from the .25. Just not sure where to go from here.
     
  35. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    He can't "earn" a reduction if he's not on insulin. :)

    Here's the deal...
    We've found the best way to start an OTJ trial is to gradually wean kitty off insulin. That means taking them down to 0.1u or less prior to withholding insulin. It seems to offer kitty the best chance for a strong remission.

    However, I'm not going to lie. We've also seen caregivers withhold insulin before reaching that tiny dose and it's worked out just fine for kitty. These cases are in the minority rather than the majority, but they occasionally happen.

    Basically, it's up to you. Take a chance on what you're doing now (it could work out just fine) or go with a tried and true method. Your decision.
     
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  36. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Understandable. I know you already know this, but even .25 is hard to measure in a syringe. How in the heck would I get .2 or .1? Would the next step be giving .2, and then .1 and then be starting the trial?
     
  37. Sean & Rufus

    Sean & Rufus Well-Known Member

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    PMPS +2, 145 :( . So 145 2 hours after meal. Don't think it's a horrible number, but this was after a low low carb meal. Can only imagine what it would be after a higher carb meal.
     
  38. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Practice. All you need to be concerned about is giving less insulin than you were before and then trying to reproduce that amount at each shot time. That's all I ever did and Alex was the queen of 0.1u dose adjustments... I eyeballed it, remembered the amount, and never used calipers. Would my measurements have held up with calipers... probably not. Giving less insulin and being consistent about it was the important part. That's all one has to do!
    The next step is to drop to 0.1u bid. As far as dropping the dose from there... let the numbers be your guide. If Rufus is still throwing some higher numbers, but has earned a reduction you could try giving him "some" insulin: push the plunger in tight, inset into vial/pen and then release the plunger. The syringe will "suck up" some insulin.

    Looking at his numbers... I don't think you'll have to worry about this much longer. Just my opinion.

    The 0.25u depot is emptying. See how things go. You can always restart insulin in the morning.

    ETA: That's 145 @ +38. :)
     
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  39. Sean & Rufus

    Sean & Rufus Well-Known Member

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    He did have a couple treats today too, so that could be why his numbers are a little higher tonight. Hopefully when/if he starts eating dry it wont throw it off too much.
     
  40. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Oh boy! I was never willing to sacrifice all the blood, sweat, and tears involved to even chance re-introducing dry food back into Alex's life when she was OTJ.

    I won't repeat what others have already said. All I'll say is "good luck with that."
     
  41. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Oh I know. If I could get him to eat a novel wet/canned diet this wouldn't be a discussion. But he has underlying issues beyond diabetes that I beleive brought us here. He'll eat dry novel proteins. Other option might be steroids to calm tummy, but then again he might need even more insulin then. We're are just going in circles and at this point the question is would I rather have Rufus go back on insulin and eat dry food, or would I rather have him have IBD/lymphoma and be in remission.
     
  42. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    All you can do is do what you gotta do...
     
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  43. Sean & Rufus

    Sean & Rufus Well-Known Member

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    I wish there was an easy answer with any of this...2 steps forward, 1 step back.
     
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  44. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Well, maybe this Atopica will work wonders and he'll eat wet novel! :bighug:
     
  45. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    I walked away from the 'puter, but had to come back...

    When you see a higher number like that 145, if he'll eat... feed him a small meal and then test him 3 - 4 hours later to see if he was able to bring his numbers down on his own. When a cat gets down to tiny doses sometimes food will be enough to stimulate the pancreas into producing it's own insulin. This suggestion isn't meant to be a substitute for insulin, but it might help things along.

    If this method has already been mentioned... great! If not, it may be worth trying.

    Now I have to get back to packing! :D
     
    Sean & Rufus likes this.
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