Possible remission

So my Princess has been on Caninsulin for 3 months. She's been getting some blue readings PM 4 nights in a row. Then a low blue AM reading followed by a green PM 97. No insulin. I measured again 3 hours after and 158. Figured it would be higher in the am. But no.. Am PS of 83..
She has slowly been exhibiting all her usual behaviours, last one back this morning. Snaking her way under the blankets. She's basically back to her old self.
I'll continue monitoring.. But remission doesn't seem that far off..

 

Keep up the great work, Princess!

 

Good to see you...and Princess Kraken is going very well.
You need to make sure it is a strong remission so I think you may need to continue insulin at a smaller dose. I am not familiar with caninsulin so I am tagging @Kris & Teasel for suggestions.

 

Oh I will. We've discussed drops dosage here at home.
But with a first reading a skip dose.. And the second even lower.. I'll be catching a plus 4 and plus 8 at least today .. See what she's doing. But she does look close.

 

I don't have any experience easing a kitty into remission so I'm not sure I can help much. What I know from reading here is that it's best to continue micro doses (0.10 u or less - a drop) until kitty can stay in normal range without insulin. That requires monitoring and probably some experiments along the way - ie., skipping insulin to see what happens.

 

Yeah, her last dose was 0.1 us. Before that several 0.2 units Her last night reading was low enough to earn a no shot. Then lower this am. I fully expect a few drops and even 0.1s in her future. But this is a promising start. I'd say barring any incidences she is likely headed there.. Hopefully.. Would be typical to get a 16 tonight.

 

5.6 (101) PMPS, 3rd skipped dose. Then 6.6(119) PM +1, an hour after eating.... This cat is weird. She is super chill, slept through the plus 1 reading. Ate all her food. With 1/4 cup, plus a few tbsps added water... (renal issues)
Went to box, groomed, took a nap. Could the added water in her diet be helping.. About 300 ml a day.. 500 ml the first couple of days.
She has more renal labs in end May, let's hope she at least stays low and her kidneys get a chance to work through some of that Creatine and rest up..

 

I'm gonna be cheering for you guys. So exciting to have the gradual decrease in dose and start needing skips.

 

What a great feeling. Good luck on a strong and happy remission!

 

And then 4.5 (81) AMPS.. It's like she just went... Nah.. Can't be bothered with this anymore, not enough fun.

 

And a 99 past night. When I saw a 173 at +3 I was just yeah.. To good to be true. Then this morning... 63
6th cycle no insulin.. And her numbers are dropping. I think I'm officially calling it an OTJ trial.
We will see how the next 22 cycles treat her.

 

What type of meter are you using.? Those blue numbers the last three pm cycles are of concern if you are going to try an OTJ trial. You want to make sure it is a strong remission. I am going to tag @Marje and Gracie to ask her opinion

 

I´m using a Foracare diamond mini, The blue numbers are fed number, I was thinking that last night that they were too high but then a 3.5 this morning.. That's lower than almost any reading since this started.

 

I’m sure she is almost there but I’d like to see what Marje thinks. I want you to have a strong remission not one that only lasts a few months. One way to tell if the pancreas is kicking in is to feed and then test a couple of hours later. If the BSL is lower than the before food BSL then the pancreas is starting to work. If you could mark in the SS when you feed, that would be interesting to see.

 

I agree with Bron. She isn’t ready yet. She’s had numbers that are too high the last few nights.

Because you aren’t shooting Lantus or Levemir, you can give her a drop at night and see how she does. If you get a green PS, skip the dose. You can also feed her at +9 on the a.m. cycle and see if her pancreas can bring her down so you get a green PMPS. If it doesn’t, you know she’s not ready.

Bottom line is we want to see almost all greens before starting a trial. If we don’t go into remission strong, she will be back.

Paws crossed!

 

We have been talking this back and forth here. We are hesitant to shoot anything under 105 (DH says 120). I was 100% expecting a AMPS of 110+, after the high +3 last night to the extent that I had pulled the insulin out for a drop dose and was pulling out a syringe when DH read the reading.. 63.. Like what is that even cat.. I´m doing a curve tomorrow. I had meetings all day, dropping by for late lunch. +8 she was 88 and PMPS 86

She´s on Kidney meds every 12 hours, can´t eat for min 45 minutes after, we are hesitant to alter her schedule in any way because if this turns into a failed trial which I´m saying odds are 50/50 or worse, then we need her on that specific schedule of kidney meds, blood test, if needed insulin. It´s the only schedule that works for my DH when I´m away. Its also synced with how long she needs to mostly fast for a while before them.
So her schedule is
AMPS: Main meal =76 grams of food.
+3 : Snack = 22 grams food.
+4-5: Mini Snack = 8 grams food (Is stirred with water to make a watery soup to up her water intake, all food has added water, kidneys. )

So from +1-3 or 4 is her main food digest with a little addition at +3, and a tiny drop usually +5, sometimes +4 if its early bed.

Then she doesn't eat for 7 hours before kidney meds. Its a complicated timing that means an hour with her am and pm and those are the only slots we can fit that in with absolute certainty DH is home for those two slots and check at least where the evening Nadir is going. It would be much easier if I were always at home. My cousin will likely be moving in with us in fall when she starts the arts university for music so if she's going back on insulin the schedule could probably be adjusted slightly.

 

Thanks for letting us know.

My suggestion then, is to decide what her “no shot” number is (120 is a little high but I understand where your DH is coming from) to keep her safe because your insulin can drop her like a rock. Shoot whatever BG you get above that with an appropriate dose. You should have a scale that sets the parameters for what dose you give based on her BG and keeping her safe. Until you are consistently seeing greens, I wouldn’t completely remove the insulin.

How does that sound?

 

Yes, this is where the discussion here is. After much back and forth between me and DH. Until we have more info on how she reacts to drops her shoot a drop schedule is as follows.
99 or below no shot
If we are home, anything 100 and above gets a drop.
If we are not home then nothing over 120 to 125 if no previous data acquired. When we get data we reevaluate how she reacts. I have a sneaking feeling a no shot will happen up to 130 when I've left and noone is home on weekdays to check weekday Nadir. Some lunch times our son can drop by and do a visual check but that's really it. He faints at the sight of blood poor thing. But he is 17 and can do a very basic check on how alert she is, is she purring and behaving like herself, like climb up on his shoulders And throw down food for her.

I leave may 1st until May 28th at which point DH is kind of solo although we are in constant contact about her. (This trip is going to be killer, only a cabin bag for 28 days, some of my transits are so tight there's bo way i can check luggage and complicated multiple airlines.)

We also tried to spread out the food more today within those tight confines. So she got 50 grams at AMPS, 40 at +3 and another 10 at +6. That's about as far as I can stretch the food out portion wise. I feel like the food bump wasn't as drastic as 22.04 when it was 74, vs a more moderate 40 today. I still would have liked to see lower numbers.

If she switches kidney meds we can Probably time her feedings more. She's never home alone for more than 8.5 hours, a few times a year maybe 9 to 10. We have a timed feeder so we could easily do AMPS, +3, +6, +9 and same for PMPS, but she won't switch to the optimal other kidney meds while on insulin.. This cat throws so many Catch 22s. 8 small feedings a day wouldn't be an issue. Vs 92% of her food now in 4 feedings in 3 hours.

Even before she was sick, when we went on a 3 week trip, we had people come 3 times a day, morning, midday and evening. Never more than 12 hours home alone was always the rule for her... After that she gets to mischievous ...

But yeah.. We will see where she goes.. The impatient and slightly controlling part of me just wants to finish off any drops experiments before I leave when I'm here AM cycle to monitor so we know what they do... But of course if she needs them that probably won't show until the day I leave!

 

And 101 and drop! Whew. At least we will see what drops do to her before I leave.

 

With a 6 point drop in BG with a drop I have DH sort of agreeing a drop would possibly be safe at 110 with Noone home for Nadir except maybe a visual check. Although we would like a few more drop tests to be sure.
Tonight's test has me thinking that even 95 could be OK for her. Although without data I am wary. We will see how she is in the morning. I taught DH how to drop dose on day 2, but he wants to practice again before I go.

My only worry also is that our meter was 2 points higher than the vets blood glucose test in mg/dl. We tested right after the blood was drawn, only one. It was in low numbers ours was higher. From what I've read then alphtraks run truer to vets bloods.. So if mine is running quite true to vets should I maybe be using 68 as the transition to light green.

This is like the most intricate puzzle... This cats health.

 

Are you using an alphatrak meter? Could you put what type of meter into the signature please?
If you are using an alphatrak meter then YES 68 is the transition to light green.
You are doing a great job getting data which is so important.
I’m just going to ask @Marje and Gracie if the ‘no shot’ number should be changed with you using alphatrak

 

It's a ForaCare Diamond mini dm30.
I'll update my signature to clarify that this is the meter, it just states its name. Its a Swiss meter. I don't think its widely available outside Swiss, Norway, Iceland, a few other countries.

So no on AlphaTrak, but it did read true to the vets blood draw reading. The vet pulled the needle out, I pricked her ear, got blood, gave treats. From what I've read is the AlphaTrak does read true to vets and most human meters run slightly different. So yeah.. After that I've been pondering if this means I should treat it like its reading like an alfa trak... Or if one test isn't enough to establish due to variance..

 

Just a quick question before I respond to the rest....is it a meter calibrated for human or pet blood? The SS would lead me to believe it’s for human blood.

It doesn’t matter how close the readings are to your vet’s. What matters is whether it’s a human meter or a pet meter. My first meter was a One Touch mini human meter. It read extremely close to my vet’s AT but it was a human meter and that’s the way I approached the TR protocol, as should you if your meter is a human and not pet meter.

 

It's a human meter. Just read close.

So a 167 AMPS and a 0.1 dose. DH is now fully convinced that drop doses are the way to go. But with the time difference in the next month then the mornings are completely him usually on weekdays. I might be able to sneak a text message but most days my meetings start 09. When I don´t start until after 10 then I can get a dose discussion phone call in. When the time difference was only an hour I could almost always get a AMPS call in. So we spent last night going over her numbers and coming up with a sliding scale dosing system that we feel ok with at the moment and the data we have. We will fine tune it as data comes in. When to cut to drops dose, at what numbers to shoot what dose. It is actually two scales. Which numbers we are comfortable shooting with someone home to monitor and ever so slightly higher numbers for when Noone is home from 08 to 16 on weekdays.

I put them in the SS at the bottom of the ss after the dates I'll be away. The numbers in the middle, above is home shot and below is away shots.
It does come a bit weird on US sheet although I did colour her no shot number red, so red no insulin. Value error after that is drop, 2 is 0.1 unit, 4 is 0.2 unit insulin and 5 is 0.3 unit insulin. It makes more sense on the world chart.

I made the dosing chart in the SS so it can be fine tuned as more data comes in. I'm also trying to convince DH that caliper dosing is possible.. He's not positive towards that idea.. Yet..