Protocol for Going off Insulin

Discussion in 'Honeymooners / OTJ' started by Heather&Squash, Nov 12, 2018.

  1. Heather&Squash

    Heather&Squash New Member

    Joined:
    Jul 4, 2018
    Hello!

    My cat has been on 1 unit of Lantus insulin since June. Today, my vet recommended we try weaning her off as he feels she's in remission. I repeated the protocol back to him but the reasoning doesn't make sense to me....but I'm not a doctor! Haha.

    Our schedule since June has been:
    • 7:30 AM - 10 AM - Breakfast is offered and left down
    • 8ish AM - Insulin given
    • 10 AM - Pickup breakfast bowl
    • Between noon - 2 PM check glucose level (if checking that day)
    • 7:30 PM - 10 PM - Dinner is offered and left down
    • 8ish PM - Insulin given
    • 10 PM - Pickup dinner bowl

    So, my question is about when to check insulin now. My vet has told me to stop JUST the morning dose and then check her glucose between 9-11 PM. Wouldn't it make sense to check her glucose during the day (since she would have a missed insulin dose)? If I check in the evening, she will have had an insulin dose several hours prior.

    Thank you! :)
     
    Last edited: Nov 13, 2018
    Reason for edit: typo :)
  2. Noah & me (GA)

    Noah & me (GA) Well-Known Member

    Joined:
    Dec 3, 2016
    I assume you meant blood sugar, not insulin. First, congratulations on hopefully joining the OTJ club.
    There is no harm in testing between 9AM and 11PM. It's just a test. Keep an eye on her food intake and general behavior. You could go down to 1/2 units and see how that affects her levels. I've never used Lantus, that's all the advice I can give you.
     
  3. Heather&Squash

    Heather&Squash New Member

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    Jul 4, 2018
    Yes, that was an error, I went in and corrected it.

    Thank you for your advice! :)
     
  4. Idjit's mom

    Idjit's mom Well-Known Member

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    Apr 3, 2018
    Heather, I suggest you post this in the Main Health forum and also in the Lantus forum. You said "if checking that day" referring to checking the glucose level, and I don't see that you have a spreadsheet set up to record what blood glucose tests you are doing. I don't understand how the vet could think Squash is in remission without testing data. Really, check in with experienced members before just eliminating the morning dose of insulin, and review the testing/feeding/shooting protocol, as well as getting more BG tests in the cycles to see what the insulin is doing.
     
  5. Heather&Squash

    Heather&Squash New Member

    Joined:
    Jul 4, 2018
    Okay, I will try posting in the other forums you mentioned.

    I've got data going back to June that has been communicated with my vet every 2 weeks. We began with checking several times daily and slowly backed off to once a week checks once she became more stable (which is why I said "if checking that day"). I haven't used a sheet like the one in your signature. I use a spreadsheet that I have created and just write on.

    I was just trying to find out of it would make sense to check her glucose level after a long absence without insulin or shortly after the insulin dose when cutting back the morning dose.

    Thank you for your insight!
     
  6. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    What makes the vet think Squash is in remission? Was this based on a fructosamine test, one BG test at the office or readings you had taken at home?
    Usually the dose of insulin would be slowly reduced until kitty is maintaining normal glucose levels with a very minimal dose of insulin (min dose would be a max of 0.25u twice daily and we often use 0.10u here). Then you do an OTJ (off the juice) trial for 14 days which consists of checking BG twice daily and if for a period of 14 consecutive days, kitty stays in normal range BG (usually below 100) then kitty can be considered to be in remission. Then we test weekly, then monthly just to keep an eye on things and catch it quickly if kitty falls out of remission.
     
  7. Heather&Squash

    Heather&Squash New Member

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    Jul 4, 2018
    My understanding is that he suspects remission based off her glucose levels (ranging from 68-117 for the last month or so). I suspect he is testing his hypothesis by bringing her off slowly and seeing if she is officially in remission.

    All of her glucose checks have been done at home as she turns into a monster in the office. She hasn't had any labs done in the office since she was hospitalized in June when she was initially diagnosed. The vet felt like this was the best plan of action to keep her stress level to a minimum.

    She's on a fairly low dose of Lantus as it is, only 1 unit twice daily. He recommended we cut her dose in half (by removing the morning dose and just doing one in the evening). I follow back up in a week and then try to remove the evening dose at that time, if there haven't been any glucose checks over 180.
     
  8. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Do you think it might be better to reduce the dose to a half unit morning and night, instead of eliminating the 1 unit morning dose and seeing how the BG is affected? I totally understand her not liking to go to the vet and the home testing you are doing solves that problem. When Idjit was diagnosed the vet had us giving only 1 unit 1X a day, and I learned that Lantus works best in cats on a 12/12 hour dosage. We were searching for 1/2 unit syringes, and his BG, being diet affected, just came down. In a panic I stopped the insulin, but now realize I should have gradually reduced the amount of insulin and given twice a day to ensure complete healing of the pancreas and a strong remission. We were lucky and his remission has lasted 6 months, although I was incorrect about how we arrived.
     
  9. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I agree with Idjit's Mom. Lantus needs to be given twice daily and shooting once daily just doesn't work well 99.9% of the time. Dosing once a day could just set up a lot of bouncing up and down which is only going to confuse Squash's body and muddle the picture you get with any testing you do. Please consider splitting the dose between morning and night shots, testing before all shots to ensure it is safe to give insulin and if/when possible, get some mid cycle tests to see just how low the insulin is taking Squash's BG. A test before you go to bed is also a good idea because a lot of kitty's seem to go lower at night than they do in the daytime.
     
  10. Heather&Squash

    Heather&Squash New Member

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    Jul 4, 2018
    A half dose would make more sense. Maybe I will just do that instead... Out of curiosity, I checked her around 1 PM and her BG was 76 (that was with the full skipped dose this morning). I may do as you suggested and cut back to half tonight and do a half in the morning.

    So, after doing half doses in the am and pm, what would be your next step? Cutting both doses completely?
     
  11. Heather&Squash

    Heather&Squash New Member

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    Jul 4, 2018
    Yes, I will do that. Thank you. That makes a lot more sense than what was suggested to me by the vet.
     
  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Just one word of caution given that reading of 76 midway through the cycle period with no shot this morning, PLEASE DO NOT give insulin tonight without testing beforehand to be sure it is safe to do so. Are you using a pet meter or a human one? You have not been testing much and giving insulin at that low a reading could be very dangerous.
     
    Idjit's mom likes this.
  13. Heather&Squash

    Heather&Squash New Member

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    Jul 4, 2018
    Agreed! I definitely will.

    It's a pet meter - the AlphaTrak 2.
     
  14. Idjit's mom

    Idjit's mom Well-Known Member

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    Apr 3, 2018
    Heather, again I suggest that you move this discussion to the Main and/or Lantus forum. I am so glad MrWorfMen's Mom has chimed in. You need to have the experienced members advising you, and I am not one of them. You can start a new thread asking for OTJ/remission advice and include the link to this discussion for background.
     
  15. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    On the AT2 meter, that 76 is a beautifully normal BG and just 8 points above the 68 we use here as the point at which to take action to prevent a potential hypo situation. Squash is not going to go hypo since you didn't give insulin this morning. Your vet may be right so if I were you, I'd check BG again tonight and skip the shot. Then test again tomorrow morning to see if Squash is holding in normal range. If she is, then consider today as the first day of an OTJ trial. If Squash's BG goes up a lot, then post for advice in the Health Forum HERE before shooting. Fingers crossed for you and Squash.
     
  16. Heather&Squash

    Heather&Squash New Member

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    Jul 4, 2018
    Done. :)
     
  17. Heather&Squash

    Heather&Squash New Member

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    Jul 4, 2018
    Thank you, I will do just that. :)
     

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