Thursday Day 14! Going OTJ! Testing schedule & microdosing of Lantus.

I think my cat Edwin is getting ready to go OTJ from Lantus and I have some questions about how often I should be BG testing and whether any microdosing is necessary. For more information about Edwin, his intro post is here and the thread following his progress is here.

Edwin's Lantus use has been somewhat non-standard as his BG readings were often not high enough to dose him twice a day everyday and thus build up an actual depot. Edwin started Lantus on February 1st (diagnosed about a week before that) and we quickly went from the prescribed 1 u b.i.d to 0.25 u q.d or b.i.d. depending on his BG numbers. I've been very conservative in his no shot limit keeping it at 185 and only shooting at that level if I was able to monitor him closely and test as needed. Even at 0.25 u, Edwin had a tendency to sometimes drop large amounts very quickly.

Since he didn't seem really motivated to be diabetic, I've made a number of food changes. Edwin also has stage 2 CKD. He's always been free fed dry food (slow feed bowl for binge/purge problems) and a small amount of canned food everyday. I switched him to low carb Friskies Special Diet canned with no fish. I noticed early on in BG testing that he experienced BG spikes after eating foods with fish. The big change came last week when I finally began switching him from dry Hill's k/d (44% carbs!) to Young Again Zero Carb Mature Heath. I'm so glad that Young Again came out with a food that addresses both his diabetic and CKD needs.

For the past 8 days Edwin's BG numbers have been low enough that I have not given him any Lantus. For the past 3 days the highest reading I've gotten is 104. For a number of days after beginning the dry food switch he was not eating very much (food changes cause stomach troubles and bloating), but his appetite seems to have picked up again and is almost back to normal. This may have been aided by the addition of B12 (MethylCobalamin).

If he continues on this trend of normal BG numbers, how often should I be testing his BG? Since stopping Lantus I've been typically testing twice a day, some days near his normal preshot times and some days near his previous nadir times. I assume that if he continues this way that I'll eventually test less frequently. When should that start?

Also, another member mentioned a possible need for microdosing, though 0.25 u was a pretty small dose already. Is there a BG level at which I should administer a microdose of Lantus or, since his BG numbers are now falling entirely in the normal range, should I just let him be?

 

It appears that the diet change just might be enough for Edwin. Lucky you! No dosing advice from me but I do know that usually they don't stop insulin completely unless the BG is under 120 and mostly green. It's 12:45 a.m. here but someone on the East coast will be around in a few hours to advise you. Good luck.

 

Elise is correct -- we usually encourage people to taper down the dose slowly so your kitty's pancreas has as much support as it needs for as long as possible. That said, it looks like Edwin has been doing well for the last several days. The instructions we provide are as follows:

• Test at your normal AMPS and PMPS times.
• Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas).
• If your cat’s numbers are in the green range at your normal test times, there’s no need to test further until the next "PS" time, just feed small meals and go about your day. If he is blue, feed a small meal and test again after about 3 hours. If his number is lower 3-4 hours after a meal, then his pancreas is working!
• Post every day so we can monitor your progress and see if any tweaks are needed. It is not unusual for cats to get blue numbers during their trial, especially at first. Don't panic and don't shoot unless we tell you to.
• After 2 weeks without an insulin shot, if everything is looking good, 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 he needs. Our goal is a strong remission and it's better to take our time to get that thanto rush into remission just to have it fail later on.

If you want to see photos of micro-doses, take a look at the photos at the bottom of the "New to the Group" sticky.

 

AMPS 85, PMPS 105

@tiffmaxee and @Sienne and Gabby, thanks for the advice and instructions. I had planned to taper Edwin's Lantus down, but his sudden drop into normal numbers so soon after his food change took me a bit by suprise. I expected his numbers to get better, but not that much better that quickly. A strong remission is definitely my goal.

I was hesitant about giving him any insulin as he seems to be unusually sensitive to Lantus, even 0.25 u can sometimes drop him over 100 points in just 2 hours (his nadir seems to be at about hour 5). I considered dosing a small amount for the reading of 171, on the second day of low readings, but I did not have time that particular day to monitor him very closely to make sure he was safe.

As far as feeding small meals, I've always free fed Edwin so timed feeding won't work very well for us. In addition, Young Again strongly suggests free feeding of their food. Edwin naturally tends to eat small amounts at a time, unless he plans to have a little binge and purge party. (My hint that he was diabetic should have been that he stopped throwing up, unlike normal cats who often start throwing up.) As soon as he gets back to eating normal amounts, which will be soon, I'll probably put his slow feed bowls back in place.

I've been noticing that his PM numbers for the past 5 days tend to be 104-105 at the highest, which is just barely into the blue region. Are those close enough to count as green or should I test a second time later on? The fact that he's not fed on schedule makes feeding and then testing 3 hours later difficult.

Also, right now I'm just glad that he's eating mostly normally again and I don't want to change anything to jinx it. He could stand to put on some weight. If the 104-105 PM numbers won't cut it, I could take away the bowl that still has some k/d mixed into it.

There are currently 5 bowls of food throughout the house; 2 YA only and 3 bowls mixed 2/3 YA and 1/3 kd. He's eating out of both of the YA only bowls, but only one of the YA/kd mixed bowls. I could pick up the mixed bowl he's eating out of, and the other two uneaten YA/kd mixed bowls, and it would definitely drop his numbers down by at least 5-6 points and he would totally be in the green. But again, I hesitate a bit in doing this so as not to disturb his current delicate eating balance. I'd rather that his BG stays a bit high as long as his appitite keeps improving, unless you strongly advise otherwise.

Let me know if you have any other suggestions. Thanks again for your help.

Edit: On second thought, I pulled up all the remaining kd/YA mix. Now it's Young Again only out in the bowls. If it doesn't work, I can always put the mix back out.

 

those numbers are still within the normal range and I would say close enough to green but to do the eating test with a free feeding kitty you could just time it to him, i.e. When you see him eat a decent amount test immediately after, before the foods had a chance to show up in his BG, if you get one of those that's blue test again in 3 hours. But I wouldn't be worried about it at this point if 105 is the highest you've seen.

Vyktor also free feeds but I think I continued removing food at +10 until the trial was over so he'd be nice and hungry then.

Good luck if he passes the OTJ trial you can taper off the testing to once a week. I think the instructions say that after a month you can then taper off to once a month but I continue to test Vyktor once a week as I find it easier to remember and I want to be right on top of it if it ever comes back.

 

Good suggestions for testing a free feeding kitty. I'm off to stalk my cat. (Are you eating yet? No? Okay, how about now?) Edwin usually eats after being outside for a bit, but it looks like the weather is changing so it won't be so nice out anymore. Pooh, I was getting used to sunshine and warmer temperatures. Edwin will be giving me dirty looks again because, obviously, I'm the one who makes it cold outside.

 

Ha ha ha ha Vyktor also used to blame me for the weather. If it was raining at one door that was almost acceptable but if it was also raining at the other end of the house I was in trouble! He's not so keen on outside these days and I have a covered back patio so I haven't been in trouble about the weather for a long time but it's making me laugh to remember

 

Congratulations on Edwin's remission. I agree that remission is usually more successful when the dose is reduced slowly and the cat is in the GREEN most of the time, but it really does sound like the diet change was really all Edwin needed. However, I do think you should do regular weekly testing to be able to catch any high BG that might occur. It is said that once a diabetic always a diabetic and there is always a possibility that something like an infection might upsets the apple cart and Edwin might need insulin again.

 

I think the weekly testing is definitely a good idea. If he does need insulin again I'd like to know sooner rather than later. That way he won't have to let me know something is up by repeatedly peeing on the floor. A once a week blood test is much more pleasant.

 

Here is a little more information on remission that might be helpful:

Remission:

• From Tilly's Diabetes Homepage:
  Phase 5: Remission
  
  "14 days without insulin and normal blood glucose values. Most remission cats are able to stay in the normal range all of the time (50 to 80 mg/dl), although there are a few cases of sporadic higher and lower BGs. Don't stop feeding low-carb and try to avoid cortisone if possible. Test the cat's BGs once per month.
  
  Approximately 25% cats that achieved remission using this protocol relapsed and required insulin again (frequent causes are hyperthyroidism or bouts of pancreatitis). Therefore, it is important to keep your diabetes kit up-to-date. Then you can react immediately by giving insulin and home testing. Importantly, the sooner you react to a relapse (i.e. preventing hyperglycemia and initiating other necessary veterinary treatment), the more likely a second remission will become.
  
  The longer a cat has had diabetes, the less likely it will go into remission. Many long-term diabetics get stuck in Phase 3 or 4. Yet there is a benefit of using this method for such a cat as well: keeping the cat's BG levels as normal as possible is much healthier for it long term. Insulin requirements will often decrease to very low levels too."

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AMPS 77 PMPS 88

Ooooh, both green, but there is unfortunately a drop in appitite to go along with taking out all the Hill's k/d. He's not even eating out of the all YA bowls that he was eating out of before. By hand feeding (yeah, these are treats. You'll really like them. I shouldn't be giving them to you. They're totally not just that same food that's in all your bowls. They're special.) and with some freeze dried chicken treat supplementing, I think I've gotten enough food into him for him to be okay. I even cut up some of a grilled pork chop, but so far no interest in that. Edwin never does really well with change so hopefully this is just another bump in the road and he'll get over it soon. That or I'll have to get some sliced chicken. He almost always goes for that.

@julie & punkin (ga), thanks for the additional information. Hopefully Edwin's numbers will keep looking good and his regular appitite will come back. I see that you did accupunture with Punkin. I'm looking into it as another way to help treat his arthritis. I've been asking around to find out if anyone can offer a recommendation for a good cat accupressure/accupunture reference. One that includes ear, paw, leg, and hip points. I have pressballs and accupunture needles, I use them on myself, but my skill level is still such that I only use needles in locations away from major organs.

In addition, can anyone point me to directions for long term storage of Lantus? Since Edwin wasn't on Lantus long, and only used very small doses, there is still quite a bit left. Is there some way to better seal the 10 ml bottle to help keep it good longer?

 

Once you've used the Lantus I wouldn't plan on keeping it for more than 6 months. Just put it back in the box for the next 6 months and keep your fingers crossed that you won't need it. Or donate/sell it to someone.

I'd keep it for a while at least.

Yes, we tried acupuncture. It helped at first, but after a few times of just the needles, the vet hooked them up to a slight electrical charge. That was a mistake. Punkin went crazy trying to bite the needles and pull them out. It was terrible. After that he trembled so badly when we went in for it i didn't have the heart to continue to make him. We also did cold laser therapy, which also helped. I would just say don't do it too often in the same body areas.

 

Sounds like good ideas about the Lantus. I didn't know if sealing the top with plastic, putting it in a ziplock bag, or vacuum sealing it might help. The weak point is the permeable top. Of course, even factory sealed it's still only good for so long. Too bad there's no long term storage solution so that if Edwin comes out of remission a year from now I won't have to pony up the big bucks again for a new vial.

Cats and accupunture and electricity sounds like a bad combination. I've had it done before and, while it wasn't bad or painful, it was an unusual feeling. It feels a lot like using a TENS machine (hmmm..., I do have one of those, but that would involve shaving the cat and I know he won't like that). Come to think of it, we do still have a laser therapy device (with built in accupunture point finder, does it have a cat setting?) borrowed from a PT friend. I wonder if that would help? It is a LLLT or cold laser (the head on it offers both LED and laser diodes), but I need to do more research before I'll even consider using it on my cat. Thanks for bringing that up. I hadn't even thought of that idea.

 

AMPS 102 PMPS +2 98

Still mostly hand feeding, but I'll put the food down and he'll eat it sometime later. According to the Young Again website, Edwin should only need 3.5 Tbsp of food a day. I'm pretty sure I'm getting that much into him, but he's still not eating any canned food and he could still stand to put on some weight. He doesn't seem to be losing any weight though.

Still, there's not necessarily poop in the litterbox every day even when he's been inside all day. (Though come to think of it, he sometimes skipped a day here and there even before he had any medical issues.) Last week was really nice outside. He was outside for part of those days and may have pooped out there on days that there was no poop in the litterbox.

On the other hand, his coat looks way, way better than it has in a year. He seems to be acting fine, but has been sleeping more again since it's cold and gray out again (me too).

I keep forgetting to pick up his food 2 hours before testing (somehow I never even thought about doing that when he was on insulin). However, there are currently 5 bowls of food out, 3 piles of "treats," and a plate of canned food. I'm also usually sleeping 2 hours before test time. As someone else just posted on the main forum, how much of a difference would there be in his BG numbers from not picking up zero carb food 2 hours before testing? I'm afraid I haven't been sneaky enough to catch and test him right after he eats. Note to self: must be more sneaky.

 

@Vyktors Mum made me think of a good idea on another thread. I'm going to start picking up his food at the normal PS time and testing 2 hours after that so I can get a better idea of what his BG readings really are without insulin. Does this sound sensible? If he was still on insulin, I would definitely consider investing in a timed feeder.

 

If you want to make sure his pancreas is kicking along - all indications are that it is - then what you want to do is test just before eating and then test again two or three hours later to make sure he's come back down. So what you could do in your case is remove the food and test as you've suggested by which time he'll hopefully be nice and hungry and tuck in and then remove the food again and test again in two or three hours to make sure he's come back down.

I really don't think you have anything to worry about though, every test you've got in the last 6. Days has been within the normal range.

 

I am like ninja this morning. I hear cat eating and leap from the bed. Okay, okay, pain woke me up and I more rolled out of the bed, but I did manage to test him immediately (within minutes) after he ate a good amount (BG 92). I took up all the food and will retest in 2-3 hours.

 

AMPS -1 92 (ate large amount of food, tested immediately after, and all food was taken up) AMPS +2 111 (a bit higher than I'd like, but between the two tests he slept heavily)

I'm not sure what to make of this. I'm wondering if his pancreas is still a bit sluggish or if the fact that he was sleeping heavily inbetween the two tests, and not up and about, could account for this. Any suggestions on what I can do to support his pancreas more? I'm mean other than chanting "go pancreas, go! Make that insulin."

I'll see if I can repeat this when he's more up and about.

Update: AMPS +3.5 94 (tested immediately after eating a pile of freeze dried chicken treats but no other food since AMPS -1, has been up and about, including outside for about 1 hour). Question, does YA zero carb food, which takes longer to fully digest than higher carb food, perhaps keep the BG numbers slightly higher for a longer period of time? Higher carb food spikes BG, but does its effects on BG wear off more quickly than zero carb foods?

 

To sum up today:
AMPS -1 92 (ate large amount of YA, tested immediately after, took up all food)
AMPS +2 111 (slept heavily between first test and this one)
AMPS +3.5 94 (ate pile of freeze dried chicken breast treats, tested immediately after, no other food consumed since AMPS -1, was up and about and outside for ~1 hour before test and another couple of hours after on the deck, too cold to go very far)
PMPS 108 (took up food at AMPS +10, sleeping normally for 4 hours before test)

Looks like more activity and less sleeping might be good for his numbers (probably good for me too ).

I'm still wondering if zero carb food (YA zero carb mature), which is supposed to digest more slowly, ups his BG a smaller amount, but for a longer time; as opposed to higher carb foods that spikes the BG higher, but for a shorter duration.

 

No idea about the fuds (although your theory seems to make sense) but exercise is definitely a good thing, particularly for our diabetics. Just ten minutes of play a day can make a big difference. I wouldn't be concerned about those numbers though they're all within the normal range. LOL at your ninja impersonation!

 

Edwin's still looking good - he's an entire week now all under 120. That's all normal numbers. He's on day 13 of no insulin . . . we usually have a party on day 14.

My understanding about the pancreas bringing down the BGs is that it takes more like 3-4 hrs to have that happen. It's ideal for an OTJ kitty to graze his/her food. That spreads the food out around the clock and eases things for the pancreas.

Although I'd like to see the movie of "Go Pancreas Go! starring you and Edwin!"

 

If it's 3-4 hours for the pancreas to bring down the BG numbers then Edwin is right on schedule looking at yesterday's numbers. Edwin is free fed so he already grazes small amounts throughout the day.

I'm not sure when to start counting days for Edwin being OTJ. I didn't purposely start the trial, his BG just dropped after changing food and then it was too low to dose. After the 171 on the second day I thought I would probably need to give insulin that night (we had skipped some days before because of low BG numbers and his somewhat odd sensitivity to Lantus), but then his BG numbers dropped on their own.

Is there anything I should provide for the party (like pictures or virtual punch and pie)? I'm not sure what it all involves.

 

Usually there is a countdown going on in the subject line noting each day of the OTJ 14 day trial. The women who make the OTJ videos watch for those and ask for pics. I'm not sure how to proceed - there isn't time to do one by tomorrow.

You might want to just post a new thread and add some pics of your sweet Edwin and let everyone join in and celebrate.

 

I'll just make a new thread with pics. I wasn't sure how to proceed as as usual Edwin is being a very tricky cat even in going OTJ. I did manage to find the photos and negatives from Edwin's first days (some cats are so old that they have pictures with negatives.) I'll have to pull a hard drive from an old laptop to get the pictures from the inbetween years. Who the heck's been organizing my old photos? I'm in Bogata one minute, in high school the next, in Mexico, at summer camp, and there's my grandfather in his frilly apron.

 

AMPS 104 PMPS +1 95

This upcoming day will be day 14 OTJ! And more good news, Edwin has decided to start eating out of one of his bowls in addition to all the hand fed "treats" I leave out around the house. Hopefully he'll up his food intake and, since his BG is back to normal, he'll put back on some weight.

I went through my photos, got them all together, and will post some tomorrow (well, actually later today - I'm still on a late schedule). I'm looking forward to a more normal sleep schedule. Now if I can just get my body to agree with that.

I'd like to thanks all those on this Forum who offered advice, support, and laughs for the short time I've been here. Let's hope this remission is a long one and that Edwin can be kept on track just with the dietary changes we've made.

 

Can we see grandpa in his frilly apron too

 

It could happen.

 

Edwin's OTJ Party (and my grandpa in his frilly apron) are over here: http://www.felinediabetes.com/FDMB/threads/edwins-otj-party.135202/

 

I wanted to give you the "post-OTJ-trial" directions for you to have in the weeks ahead. You'll want to hang onto them.

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!

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