9/22 Wiley AMPS 87, PMPS 78 - starting OTJ trial?

Yesterday

Good morning. Wiley had blood panel and fructosamine yesterday. Hoping for test results today!

Preshots still hanging around in the green. Can't test today so thinking of giving microdose only.

 

Based on Wiley's numbers I probably wouldn't have shot anything if you couldn't monitor. Frankly it looks like he might be ready for an OTJ trial.

 

Did you leave plenty of food out? Too late now, of course, but I would have left some MC, just in case...

Surf safely, please, Wiley.

 

I'm starting OTJ trial tonight since his PMBG was 78, although I won't be able to do a lot of tests until Saturday. I'll try and get the AM, PM and at least a couple more tomorrow.

Yes! I left out some LC frozen wet, and also some Wellness Core dry. He tends to go on a hunger strike against wet food quite often, so I'm still giving very small amounts of Wellness and YA kibble when warranted.

 

On an OTJ trial, you only need to test AM and PM (at what would be shot time), unless you get a blue number, in which case you want to test 2-3 hours later, to make sure he came down.

 

Thought you'd like to have the "official" OTJ trial instructions:

Start the trial on the next green pre shot.

If he 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 is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his 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 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 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 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 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 monthly. Weight should remain stable. If he seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), test his 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!

 

Good luck with starting the OTJ trial.

I just saw your other post on Feline Health Regarding the BW and CKD.
http://www.felinediabetes.com/FDMB/...eed-to-treat-ckd-instead.165426/#post-1784937

It does seem as though the the kidney values are a bit worse, that may well be why you have noted that he is using the litter box a lot and still drinking.
Yay on the fructosamine and glucose though (not a bad number with vetty stress).


Looking at the phosphorus, though that seems better and falls in the lab range, the way I understand it from what I have read on Tanyas site is that it's probably a bit high for a healthy cat of 14 years
table from tanyas site, provided by the University of Texas Health Science Centre
Age Phosphorus Range in mg/dl (US) Phosphorus Range in mmol/L (International)
10 days - 2 years
4.5 - 6.7 mg/dl / 1.45 - 2.16 mmol/L

2 years - 12 years
4.5 - 5.5 mg/dl / 1.45 - 1.80 mmol/L

Over 12 years
2.7 - 4.5 mg/dl / 0.90 - 1.45 mmol/L

The above are ranges for a healthy cat, but from the info provided on the site I believe that the range for a CKD cat of 14 years should be lower.
I've provided the link below to the section of the site where all this is discussed.
http://www.felinecrf.org/phosphorus.htm#ranges

If it were me I would discuss this issue further with your vet.
I'm not sure that it makes sense to go to a Kidney diet that is high in carbs, as that will almost certainly cause problems with his BG, and having high unregulated diabetes is very hard on the kidneys.

I really hope that Wiley will be successful with his OTJ trial, I would offer a suggestion since you are likely to find yourself experimenting with food because of his CKD, and that is to monitor him on a regular basis, especially if you are switching foods, I'm a bit of a Helicopter, so I still test George on a daily basis, with being in CKD stage 2 also, I want to be sure to catch anything the minute it happens.

On the other thread someone mentioned giving fluids at home, I would also suggest that you speak to your vet regarding that as it can be a problem for kitties with heart issues. I supplement Georges water intake by adding water to all his meals and snacks, I also have a water fountain, which stimulates his thirst drive somewhat.

FWIW
I am getting Georges BW done every six months at the moment, to closely monitor his kidneys, and see how is values trend.

 

Thanks for clarifying. I will look into a phos binder. Do most people use aluminum hydroxide?

I want to start sub-q fluids in about 2 weeks. I unfortunately need to wait because I am going to be out of town for 6 days starting next Thursday and I don't want to cancel it. I haven't had a vacation in nearly 2 years. Wiley's timing is impeccable! However, you mention it can be bad if he has heart problems. I need to research that more, as I'm not sure what kind of heart problems should be considered. Wiley does have a slight heart murmur.

Thanks for your input!!

 

George has a small heart murmur too. I've never given subQ best speak to your vet to see if it's a contraindication.

I don't know, did you discuss the possibility of phosphate binders with your vet?

 

I will definitely talk to him. He did mention the subq, but not the binder. I'll discuss the heart murmur with him and get his opinion, even though he doesn't seem to be that informed or detailed in his diagnoses and treatment plans. He seemed slightly intimidated by my knowledge of diabetes and was surprised I was home testing.

 

I'll see if some more experienced members can give you some pointers of what to discuss with your vet, the CKD is a relatively new diagnosis for us, and as yet all we've been doing is keeping P down, extra water with his meals and snacks, and regular snacks (3 hourly intervals) (since kitties with ckd can be prone to acid tummy and the resulting nausea)
So far George has been asymptomatic, he is due a BW in the next couple of weeks.