Info Reminder: *earning* reductions and starting OTJ trials

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Jill & Alex (GA), Dec 30, 2015.

  1. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    There seems to be a lot of misinformation floating around lately about guidelines for *earning* reductions as well as numbers to look for prior to starting an OTJ trial.

    Hope this helps put everyone back on the same page...


    REDUCTIONS:

    Newly diagnosed diabetics - less than one year since diagnosis

    • reduction *earned* after a single drop below 50 mg/dL and following TR, or
    • reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
    • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.
    • reduction *earned* after a single drop below 90 mg/dL for those following SLGS
    Long term diabetics - more than one year since diagnosis
    • reduction *earned* after a single drop below 40 mg/dL for those following TR, or
    • reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
    • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.
    • reduction *earned* after a single drop below 90 mg/dL for those following SLGS.
    We highly suggest taking a reduction any time any kitty drops into the 30s or below. There are very few exceptions given for caregivers following TR who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.



    OTJ TRIALS:

    Prior to starting an OTJ trial, one wants to see kitty mostly in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range.

    Remission is achieved when kitty can go 14 days without insulin while maintaining normal blood glucose values under 100 overall. Most will stay in the 50 - 80mg/dL range. Although, some will occasionally experience BG numbers up to 120 mg/dL.
     
    Last edited: Jan 15, 2016
    Reason for edit: to clarify
  2. Robyn and Penny

    Robyn and Penny Member

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    Hmm...I didn't know that an long term diabetic could earn a dose reduction if they are under 100 but over I guess 40 for a week. Did I understand that correctly? I'm being super aggressive with Penny following a 10 month long bout with glucose toxicity, though.
     
  3. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

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    bump
     
  4. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week and following TR.
    In the TR protocol, the "normal range" of a healthy cat is defined as 50 - 80 mg/dL.

    That said, I know many caregivers of long-term diabetics or with kitties who have fallen out of remission who maintain that normal range for longer than one week in an effort to give their cat a little more time to stabilize. It's one of those "Know Thy Cat" things...
     
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  5. Tara & Ivana

    Tara & Ivana Well-Known Member

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    What constitutes a kitty not holding reductions well?
     
  6. Lydia--(Rosie & Basil) GA

    Lydia--(Rosie & Basil) GA Well-Known Member

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    This is a good thing to see all in one place. Thanks for the compact reminder. This will be one of those I screenshot and add to my desktop collection.

    I do have a question, though. With Basil (OTJ Feb 2010) he was over 100 routinely (but under 120) during his OTJ trial and after his official welcome to The Falls. Since I always thought under 120 was the "normal" number, not for nadir but fr top number in a cycle, I am wondering what happened in the interim.

    Thanks!
     
  7. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Repeatedly failing dose reductions... developing a pattern of failed dose reductions.
     
  8. Tara & Ivana

    Tara & Ivana Well-Known Member

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    Hmmm, I think my Ivana might fall into this category. I will ask someone to look at her ss next time it appears she's due for a reduction. Thanks!
     
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  9. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Hi Lydia. Not sure what the question is...
    The protocol hasn't changed. Only people offering advice in the group has changed.
    Perhaps there were reasons at the time? Sometimes exceptions have to be made for one reason or another.
    There have been so many kitties who have come through here... before and after Basil... I don't recall the particulars.


    ETA: 50 - 80 mg/dL is considered normal for a healthy cat. It's the goal for remission cats when following TR.
    120 is the high end of the normal range.
     
    Last edited: Dec 30, 2015
    Reason for edit: to clarify
  10. Lydia--(Rosie & Basil) GA

    Lydia--(Rosie & Basil) GA Well-Known Member

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    Hi Jill! If you remembered Basil's particulars in any way, I would come kidnap you and sell you to the CIA or something. Or maybe the circus. LOL!

    My question was about the staying under 100. I thought it was about staying under 120. Or maybe the answer is it has always generally been staying under 100 preferentially, but Bsil's numbers were such that he showed the right pattern, he just went up to 110 to 120 t times. He certainly did that forever, so maybe the people who were helping me were able to see that coming from his numbers. They were very regular, and I have to say, I wouldn't mind it if Queen Bounce Rosie learned a little of that regularity!
     
  11. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    The circus would be fun! :D

    This. :)
    I suspect Basil was an exception based on those patterns...
     
  12. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  13. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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  14. Doodles & Karen

    Doodles & Karen Well-Known Member

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    Great reminder, thank you
     
  15. Melanie and Smokey

    Melanie and Smokey Well-Known Member

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    I've taken a reduction on a 51 and ended up having to go back up and wait for the reduction to be earned properly because the reduction was taken too soon and numbers didn't hold. I had to take Sly back up and down a few times on the lower doses to get him to settle in and show more under 100 before taking him to trial because I didn't think it was boding for a strong remission to having him in the blues so much with the blips over 120.
    I've been wondering if what seems like an increase of cats returning to insulin is just because of the higher traffic (so there are more in number, but not in %) or if it might be because more are a going off too soon without having the patience to wait for "... see kitty mostly in the 50 - 80 mg/dL range, but under 100 overall... with only occasional readings in the 100 - 120 range." I know some meters read higher than others, but I think most strong remissions are still going to come with a solid pattern of under 100.
     
  16. Judy and Boomer

    Judy and Boomer Well-Known Member

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    Can this be a "sticky" so that we can always find it?
     
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  17. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    The interesting thing is traffic has not been higher. The number of daily participants has dwindled over the last few years and yet we're seeing more and more kitties coming back from the Falls. Is it coincidence when it's clear following the suggested guidelines has become, for lack of a better word, lax?

    Just my opinion: I don't think so. I see a direct relationship between kitties falling out of remission and whether they started off with a strong remission. If I were to make an educated guess based strictly on observation... I would say the turning point was when somewhere along the line the suggested guidelines were misinterpreted. You know how it is on the board. All you need is one person spreading misinformation or a wrongful interpretation and before you know it, it becomes gospel on the FDMB. Unfortunately, there's more of that kind of thing happening all the time. Well meaning and many times prolific posters (not necessarily newbies) think they know something and run with it... without a full understanding and worse... not knowing there are exceptions nor how to spot them. In no time at all the misinformation/misinterpretations are quoted by other members... and so it spreads... and within no time at all... becomes gospel.

    I agree with you 110%. It's why I felt it necessary to bring the subject up.

    No, it will not be made into a sticky, but I will place the link in the "Information and Discussion" links found at the bottom of the "New to the Group? Please read..." sticky at the top of the forum. I'll be working on that as well as a few other stickys this weekend.
     
  18. Doodles & Karen

    Doodles & Karen Well-Known Member

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    I just reduced Doodles based on the "normal" numbers for 7 days (14 cycles). He had 2 food spikes, a 112 & a 107. He's on the 4th cycle of the reduction and I'm skeptical as it looks like we'll be going back up.
     
  19. Jen&Eddie

    Jen&Eddie Well-Known Member

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    Huh. Guess Eddie shouldn't have gone OTJ the first time, then based on this.
     
  20. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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  21. Laura and Gremlin

    Laura and Gremlin Member

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    Based on this Gremlin definitely shouldn't have gone OTJ. Though I had no choice with my vet withholding insulin. I sure hope he doesn't relapse!!
     
  22. manxcat419

    manxcat419 Well-Known Member

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    110% agree. I haven't been here anywhere near as long as you, Jill, but even so I've seen a number of kitties with remission and trial numbers that I wouldn't have accepted coming back in a matter of weeks or months. Or kitties taken from a higher final dose straight down to zero without going through the micro-dosing phase. I even tried it myself once for Rosa and had to go right back on the insulin with her after 2 days (I was tired, I thought I knew better, I was wrong ;) ). Of course that doesn't mean that there aren't any cats out there that can go from a higher dose to zero and hold their remission long-term, nor does it mean that a long-term remission is guaranteed for every cat that goes through micro-dosing. But I think it does increase the chances of a longer, more stable remission. And certainly for Rosa, although she wobbled around for a few weeks after her disastrous boarding experience, she was able to get her numbers back down without ever going over 145 (and the minute she went over 140, I got a very itchy trigger finger) - I think that is down to the good advice I got here to keep her on insulin as long as possible at a tiny dose before attempting a trial. I would also suggest to everyone that they try to test their meter against lab values on more than one occasion - I've found that, although Rosa seems to settle mostly in the 80-100 range, my meter also reads consistently within 5 points of lab value...and the lab range is 72-175 so she's still firmly in the lower half of that range. That does vary from one meter to another - I got very lucky (completely by chance) with my meter, but because I know where it reads I also know that seeing mostly 80s and 90s and even the odd low 100s on my meter is not cause for major concern.
     
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  23. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  24. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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  25. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  26. Judy and Boomer

    Judy and Boomer Well-Known Member

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  27. Vegetable (GA)

    Vegetable (GA) Member

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  28. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  29. Tara & Ivana

    Tara & Ivana Well-Known Member

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    Clarification needed: We have just started having Ivana earn a reduction by dropping between 40 and 50 three times, due to not holding her reductions well. The original post says the three drops must be on separate days, but does this actually mean separate cycles? She had her first drop in yesterday's PM cycle, then the second directly after in today's AM cycle. Surely if she drops again in today's PM cycle it will still count as the third drop even though it's the same day? Thanks!
     
  30. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    "Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose."
    http://www.tillydiabetes.net/en_6_protocol2.htm

    I take it as three separate days as written... mostly because the authors have been at this for 10-15 years now. They know the difference between cycles and days.

    JMO.
     
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  31. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    If I had to hazard a guess as to the rationale, there's potentially carry over from the current dose into the next cycle. Allowing for 24 hours may take the carryover into account by allowing the depot to drain.
     
  32. Judy and Boomer

    Judy and Boomer Well-Known Member

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  33. Judy and Boomer

    Judy and Boomer Well-Known Member

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    another bump
     
  34. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  35. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  36. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  37. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Bump for newer members! :)
     
  38. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Glad to revisit this again as I had forgotten that the trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range. I get some caught up on the color green :rolleyes:
     
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  39. Gussie's mom

    Gussie's mom Well-Known Member

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    Bumping this up as I am re reading it daily !
     
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  40. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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  41. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  42. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  43. Kathy and TiTi

    Kathy and TiTi Well-Known Member

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    worth a few more bumps!:cool:
     
  44. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Time for another bump...
     
  45. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  46. Mandy & Rex

    Mandy & Rex Well-Known Member

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    @fearlessmom, this is what you are looking for about earning reductions.
     
  47. fearlessmom

    fearlessmom Member

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    Thanks very much. My problem is translating human meter #s to pet meter numbers. Can you tell me, in pet meter #s, what the equivalents are for 40, 80 and 100?
     
  48. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jen , since you use a pet meter , your reduction point is under 68 on the pet meter. Take that at face value. If you switched to a human meter the reduction would be 50 in the human meter.
     
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  49. fearlessmom

    fearlessmom Member

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    I'm assuming that's directed toward me, Bobbie. Yes, I get that 5o(human)=68(pet). It's the other numbers in the "Reminder: earning reductions" post that I can't follow because I don't know what they are in pet meter terms.
     
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  50. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    No, I'm sorry. I cannot give you equivalents for 40, 80, and 100. No one can. What you can do is start making comparisons yourself using your own pet-specific & human meters on the same droplet of blood. However, even that will not necessarily be accurate after factoring in that every meter is allowed to be off by +/- 20% in the US and +/- 15% in Canada.

    The protocols used on the FDMB today were written for use with human meters... which is why we we've always discouraged the use of pet-specific meters. Those using pet-specific meters are taking an unnecessary risk when using a pet-specific meter when following either of the two protocols presented in this ISG.

    Because of the aggressiveness of the TR Protocol, 68 was chosen on the low end for those using a pet-specific meter strictly for safety... given how low kitties are taken before the guidelines suggest a reduction. The 18 point difference was simply created as a buffer since there's no way to determine an equivalent for 50 either. Contrary to what is usually said on the FDMB, a 50 (human meter) does not equal 68 (pet specific meter).

    Less than 68 is the reduction point when using a pet-specific meter when following TR. The other reduction points... take them at face value as Bobbie said.

    Make sense?


    ETA: Because 40 mg/dL (human meter) is so low, if I were using a pet-specific meter and following TR, I'd probably stick with taking reductions when kitty dropped below 68, but that's just me... just my opinion. I'd rather err on the side of safety.

     
  51. fearlessmom

    fearlessmom Member

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    Gosh, I wish someone had told me that when I first started following this MB.
    I was waiting for a good time to start using the human meter I just purchased. I think now that Fearless appears to have bounced again I'll make the switch tomorrow.
     
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  52. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    I'm sorry you missed it. The info is typed in bold red towards the top of both the SLGS and the TR protocol stickys. I put it in red to help make it more noticeable. I'll have to think of a better way to make it seen.
     
  53. fearlessmom

    fearlessmom Member

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    Sorry I didn't make myself clear. The statement I was referring to was "we've always discouraged the use of pet-specific meters," which is why I bolded the statement. I know the protocols are written using human meter #s. But no one before you had strongly suggested I switch.
     
  54. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Yes,sorry, I forgot to tag you. I see that Jill has given you the info you need. You will save a bundle using a human meter as the AT strips are very pricey.
     
  55. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Gotcha. I misunderstood.
    That's really too bad. Using the appropriate meter makes it so much easier on both caregiver and those offering advice. That said, there are many who still want to stick with using a pet-specific meter. All we can do is make suggestions, but ultimately all decisions are for the caregiver to make. I'm truly sorry if this wasn't made clear at the start.
     
  56. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jen, when you switch to a human meter, you could do some comparison with the same droplet of blood and both meters to see the approximate differential. Approximate is the keyword because of the 20 % + / - meter variance with all meters. IMHO, the only important numbers for comparison in TR for human meter vs Pet meter is the 50/68 one for reductions and that is strictly for safety.
     
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  57. fearlessmom

    fearlessmom Member

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    I think I'm going to try to switch cold turkey. Too many variables for me to wrap my pee brain around. When we got the meter we did a couple comparisons and got 103(pet)/80(human) and 391(pet)/305(human). BTW, when will I know if the reduction to 1U failed and I should go back to 1.25U? The difference between a bounce and a failed reduction eludes me.
     
  58. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    My rule of thump is, if they go steadily up after a couple of days ( 3 days) , go back up to a bit less of a dose that caused the reduction. It seems to me that when they are bouncing, the numbers wobble around higher, lower, higher again. If it is a failed reduction, the numbers seem to go steadily upward with no downward movement. A failed reduction is one of the hardest things to discern IMHO .
     
  59. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  60. Jan Radar

    Jan Radar Well-Known Member

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    time to bump this up
     
  61. Gill & George

    Gill & George Well-Known Member

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  62. Beth 73

    Beth 73 Well-Known Member

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    Jill, thank you so much for continuing to watch over and advise us all :bighug: Your input and wisdom is priceless :)
     
  63. Girlie's mom

    Girlie's mom Well-Known Member

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  64. Girlie's mom

    Girlie's mom Well-Known Member

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    Thanks so much for the info in this post and the reminders about how to think about starting OTJ trials.

    Just a question, though, re pet vs human meter. I do understand that the protocols here were written for use with human meters and that many people prefer human meters as the strips are cheaper. However, I'm just wondering whether you are suggesting that human meters are better than pet meters like AlphaTrak2. It's a bit scary to read "Those using pet-specific meters are taking an unecessary risk when using a pet-specific meter when following either of the two protocols presented in this ISG." :eek:

    Could you clarify what the "unnecessary risk" you're referring to is so I could understand better? Is it just that people using a pet meter need to be aware that the "take action" number is 68 and not 50, as on a human meter?

    Also, as I was feeling a bit queasy about all of this, I went back and re-read the Roomp & Rand 2013 Management of Diabetic cats where they discuss the difference between pet vs human meters and readings and how to calculate insulin dose at lower readings using pet meters. In that study, they do seem to give numbers for pet meters, unless I'm completely misunderstanding them: "When glucose meters calibrated for feline blood are unavailable, it is recommended that glucometers calibrated for human blood be used. The type of meter used, feline or human and whole blood or plasma, will determine the exact cut points used to adjust insulin dose. If a serum chemistry analyzer or plasma-equivalent meter calibrated for feline blood is used (eg, AlphaTRAK, Abbott Animal Health, Abbott Laboratories, Abott Park, Illinois), the measurements at the low end of the range need to be adjusted and are 30% to 40% higher than for a whole-blood meter calibrated for human blood. The doses, when using such measuring devices, should be changed as follows: the lower limit of the range should be adjusted accordingly by adding approximately 18 mg/dL (1 mmol/L) to the value listed in the protocol in Table 2. For example, a target value of more than 54 mg/dL (>3 mmol/L) becomes more than 72 mg/dL (>4 mmol/L) when using a serum chemistry analyzer or a meter calibrated for feline use. Alternatively, use the normal range for feline blood glucose concentrations as a target when using a meter calibrated for feline blood. Most of the major human brands of glucometers now report plasma-equivalent values and these are intermediate between those measured by whole-blood meters calibrated for human blood and plasmaequivalent meters calibrated for feline blood. Be aware that test strips sold by the major human companies now provide plasma-equivalent readings, even when used in older whole-blood meters, although their accuracy and precision are not as good in the whole-blood meters."

    I find the summary at the end of Tables 2 and 3 easier to understand on this: Table 2: "If a serum chemistry analyzer or plasma-equivalent meter calibrated for cats is used (eg, AlphaTRAK from Abbott Animal Health), increase the target blood glucose concentration by about 1 mmol/L, 18 mg/dL, or adapt the normal range reported for cats as the target nadir glucose concentration (eg, change 3–4 to 4–5 mmol/L, change 54–72 to 72–90 mg/dL)" and after Table 3 (for intensive monitoring): "If a serum chemistry analyzer or plasma-equivalent meter calibrated for cats is used (eg, AlphaTRAK from Abbott Animal Health), increase the target blood glucose concentration by about 1 mmol/L, 18 mg/dL, or adapt the normal range reported for cats as the target nadir glucose concentration (eg, change 2.8 to 3.8 mmol/L; change 50 to 68 mg/dL)."

    They also then wrote that, "In general, with the availability of accurate and precise glucometers calibrated for feline blood, their use is recommended in preference to meters calibrated for human blood because of the greater accuracy for blood glucose measurements around the normoglycemic range. Using meters calibrated for feline blood facilitates the use of target blood glucose concentrations in the normal range reported for cats and avoids some of the confusion with human meters whether they are reading whole blood or plasma"

    I'm just trying to understand, so any help clarifying this would be really greatly appreciated! I've probably just misunderstood, which is highly likely. And I do understand that the advice given here and in the stickies and protocols were written by those here at FDMB who have years and years of experience with this. :) I actually came across this 2013 Roomp and Rand and the others as I found the links to them in the TR sticky, and I was reading everything I could get my hands on when I first started to try to get my head around all of this. Not that my head is around all of this yet, by a long shot! :)
     
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  65. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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  66. LizzieInTexas

    LizzieInTexas Well-Known Member

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    I am not sure how (for long term diabetic) kitty can achieve 3 separate "Under 40" SAFELY when the bean works full time. If last night had happened during the day (while I was at work) Gizmo would have had a server hypo event.

    I don't think it is realistic to tell people that the TR protocol is possible with a full time job and not endanger the kitty if you must adhere to the protocol "to the letter" I would rather have a failed reduction than to put Gizmo in danger. You can always increase the dose back up.

    There are also exceptions with high dose kitties and a reduction point at 70 or 90.

    While I understand the importance of the protocol I think we all have to put the safety of the kitty first. I also think it is confusing to beginners to see others not follow "to the letter" and not understand that there are exceptions. I think it is important that we explain in our condos our decisions.

    JMO.
     
  67. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    No no, you 've misread! It goes : reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR

    Once only if below 40 for the long term patients.
     
  68. LizzieInTexas

    LizzieInTexas Well-Known Member

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    You are absolutely correct. My BIG bad. :(

    While Gizmo didn't get below 40 (46 at +2) I still took the reduction because I'z a big scaredy bean. My biggest fear is to look at the webcam and see him hypo and know I am 30 min away. :eek::nailbiting:
     
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  69. Girlie's mom

    Girlie's mom Well-Known Member

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    Gosh, oh gosh! I'm curious about your use of the webcam: are you looking for the outward signs that he might be hypo? Girlie dropped down really low one day, and didn't give her usual "tell" or diving for the food bowl, which really threw me. I like the idea of using a webcam, but what do you look for?

    I am also a really big scaredy bean re: being away during the day when she has tended to dive; I'm just counting the days to when I have to be back full-time every day, and it scares me absolutely whitless! I'm pushing this "still recovering from surgery and need to work from home, still" for everything it's worth right now...but at some point, the boss is going to say "come back or else!" Yikes! :nailbiting:

    I'm so torn between wanting to stick with TR because she's shown such great progress so far, and fear of her fascination with the deep end of the pool... :nailbiting: I don't have to decide just yet, but it's getting close to that time...
     
  70. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    I have it mounted above the feeder so I can make sure he eats. He will also sleep in that room too so I make sure he is moving :rolleyes:. I know, probably over the top :joyful:. The webcam can tilt and pan and has an intercom. I have been known to "yell" at him to "come eat" - which, surprisingly he usually does. Haha. More than anything it gives me great peace of mind for $60. There is an app for the phone for live view as well as a desktop program to watch from it.
     
  71. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    :bighug::bighug::bighug:
    You are doing so very well for him - I know one day the fair Karma will pay back handsomely to both of you.
     
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  72. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    :bighug::bighug: thank you. :kiss:
     
  73. rawia

    rawia Member

    Joined:
    Aug 24, 2017
    I am using the AT and i was thinking to switch to human meter to make it easier for others to advice me but when i make a few comparison sometimes the difference is more or less than 29% soecially on high numbers. Numbers above 240 on AT comes around 170 on human meter which looks good but when see 240 on AT is scary, i am afraid of high numbers more because of many problems that might come with specially renals. That is why i am afraid to switch but at some point i have to because it is what everyone is using here and has experience with.
     
  74. Girlie's mom

    Girlie's mom Well-Known Member

    Joined:
    Jul 3, 2017
    Well, I'm still using the AlphaTrak2 for now: I've got lots and lots of test strips! Girlie has spent a LOT of time in high numbers and is back there again right now, although I'm hoping that she'll come down quickly. We haven't had problems so far, and she's finally started to come good as far as better numbers lately - since we started TR. If you look at Girlie's SS, you'll see that even cats who bounce sky high can come good! Meme isn't even close to where Girlie has been in her travels since diagnosed. Meme's numbers look very good, and she's on such a low dose now! You must be very happy. :)
     
  75. HWright

    HWright Well-Known Member

    Joined:
    Jun 19, 2016
    Bump please :bighug:
     
  76. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
  77. Girlie's mom

    Girlie's mom Well-Known Member

    Joined:
    Jul 3, 2017
  78. Becky Young

    Becky Young Member

    Joined:
    May 11, 2017
    Would anyone want to take a peek at Davis' spreadsheet to see if we should do an OTJ trial? We've been dosing at .1 for a little over a month now. His numbers have stayed pretty low and steady, but I don't know if they're low enough to try going off insulin. Thank you for any feedback you may have!
     
  79. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    @Becky Young you may want to start a new post with your question in the title with a "?" to get more eyes on it. Davis is looking good but more experienced eyes should advise. :cat:
     
  80. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    I think it's time to try it!!

    Here are the OTJ trial instructions:

    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!!!
     
  81. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Bump
     

    Attached Files:

  82. Girlie's mom

    Girlie's mom Well-Known Member

    Joined:
    Jul 3, 2017
    Bump, bump, bump!!!
     
  83. HWright

    HWright Well-Known Member

    Joined:
    Jun 19, 2016
    Bump please
     
  84. Anela

    Anela Member

    Joined:
    Nov 29, 2017
    Love this! My husband calls me a stalker because I have a cam where my cats eat and the main walk through area. I also have a plug and play one that I will move around wherever my sugar baby is sleeping when I leave in the morning just so I can watch him and (make sure he moves!). I told my husband it would be great if we can get a cam on a drone so I can fly it around the house looking for my guys during the day. :)
     
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  85. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
  86. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
  87. Juliet

    Juliet Guest

    Joined:
    Sep 8, 2017
    Why IS there no difference for reductions for SLGS with long term diabetics and newly diagnosed?

    I have to follow SLGS as I can't do TR yet I have to make adjustments all the time to the SLGS method as I know what works and doesn't work for Silver. After two failed reductions having followed the "reduction any time he hits 90" statement above, I will be following the TR rules when it comes to reduction. Not for increasing, for that, I will still follow SLGS. But Silver won't earn a reduction until he follows these:

    • reduction *earned* after a single drop below 50 mg/dL and following TR, or
    • reduction *earned* after 3 drops between 40 - 50 mg/dL on three separate days for kitties who have shown they do not hold reductions well and following TR, or
    • reduction *earned* when the cat regularly has its lowest BGs in the normal range of a healthy cat (50 - 80 mg/dL) and stays under 100 mg/dl overall for at least one week and following TR.
     
  88. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    The goal of TR is to push kitty's numbers down to that of a healthy cat (50 - 80mg/dL) as quickly and safely as possible. The "requisites" for following the TR Protocol are in the TR sticky.

    The goal of SLGS is to regulate kitties safely without pushing their numbers down too low. The reason is generally speaking, caregivers who choose to follow SLGS can't, won't, or don't want to monitor often, feed a high-quality low-carb canned food or raw food exclusively, and/or feed small meals/free feed throughout the day... for one reason or another.

    However, the guidelines in SLGS are suggestions. Oftentimes, caregivers who have accumulated enough data to learn their cat's response to insulin and food (in other words, "know thy cat") will take it upon themselves to lower their "no shoot number" as well as their "reduction earning number". At this point the caregiver is the one to make these kind of decisions as well as taking on the responsibility of keeping their cat safe... perhaps to a greater extent than usual. No one else will intentionally offer advice that could put kitty in danger.

    That's "why" there is no difference made between newly diagnosed and long term diabetics when following SLGS. It's plain and simple. The necessary safeguards* to safely push kitty's numbers down below 40 or 50 are not in place with SLGS.

    Make sense? :)


    *safeguards: frequent monitoring, feeding frequent meals or access access to food, low carb vs feeding dry
     
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  89. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009

    Juliet, given your particular set of circumstances and for reasons of safety, I strongly suggest you reconsider.
    In my opinion, what you've written above would result in taking a huge risk with Silver's life. You do not have the necessary safeguards in place to follow TR guidelines for reductions.
     
  90. Juliet

    Juliet Guest

    Joined:
    Sep 8, 2017
    But I can’t reduce when he hits 90 either. He hit 50. I reduced. I should not have. It failed and I’ve had to go back to again.
     
  91. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Like I said in your thread earlier today:

    "However, whenever one deviates from the norm (no matter which protocol, method, or customized plan one is following), they're assuming an even greater responsibility for keeping their cat safe. Greater responsibility = careful/frequent monitoring + access to a food supply so kitty can bring their blood glucose up on their own. Since we know that's not an option, you'll probably find it necessary to run him in a little higher numbers than you'd like to see (to keep him safe)."
     
  92. Juliet

    Juliet Guest

    Joined:
    Sep 8, 2017
    So how do I get him down the dosing ladder?

    My concern is that I am leaving him for three weeks in Sept and I either have to take him off insulin altogether in that time or give a nominal 0.25 and let my pet sitter shoot blind. I can’t afford to put him in kennels and wouldn’t trust a vet or vet tech to dose as I request let alone test. This is my only reason for trying to get him on a much lower dose. This is not a holiday or I would cancel. My parents are elderly and sick and it may be the last chance I ever see them alive. My pet sitter is 70 and could not get the hang of testing. Any advice on what to do would be welcome.

    Maybe we should move the last two posts to Silver’s condo?
     
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  93. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    You don't. He'll bring you down the dosing scale when or if he's ready.
    Juliet, I understand, but you're trying to control something you cannot possibly control. September is a long way away. He may or may not be off the juice by then. You'll have to deal with wherever he's at in September/closer to the time.
     
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  94. Juliet

    Juliet Guest

    Joined:
    Sep 8, 2017
    I hear you, but I have to make plans long before that...I can't book a flight and then find in Sept that I have no sitter, no clue what to do with him. I need to have some sort of a plan. It keeps me awake at nights with worry. Sick parents - sick cat - and me in the middle trying to be in two places. I'll ask advice again nearer the time when we know where he is at then....being patient with no plan is not a good place for me. But I appreciate your advice and I am listening to it. I won't be silly with his care.
     
  95. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    All you can possibly do is come up with contingency plans. It's all any of us could do.
    I don't know what else to say.

    I'll have to come back to this later if necessary. We're going out to grab a bite to eat.
    BBL...
     
    Juliet likes this.
  96. HWright

    HWright Well-Known Member

    Joined:
    Jun 19, 2016
    Bump please!
     
  97. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
  98. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
  99. Beth 73

    Beth 73 Well-Known Member

    Joined:
    Aug 2, 2016
  100. Girlie's mom

    Girlie's mom Well-Known Member

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    Jul 3, 2017

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