? Signs of Remission?

Hello!
Thanks to this forum and website resources, I've been able to get Chewy down from 6 units of insulin a day to 0-2 a day. I'm thrilled he's more stable and acting more like himself (i.e. Eating plastic and chewing on boxes and talking more), but wondering if his numbers mean I should take him off insulin. He did go a few days without when he was in the mid 100s but has been holding around 200+/- with his current dose.

I know remission means going 4 weeks without a shot, but what are signs I can stop insulin altogether? Should I stop now and see if he ever gets above 300 and resume dosing if he does? I know I need to get more mid-cycle readings but he's not as patient with ear sticks if I do too many in a day.

https://docs.google.com/spreadsheets/d/1ZiTB5roQrBHCvRWS_yGMidaJ-JRi963jP4yRKJJaMAY

Any advice appreciated! Thanks in advance!

 

Hi. It is actually considered remission if they go 14 days without insulin while remaining in normal numbers.

Personally, I would not stop insulin if my cat was still getting in the 200s. I would probably be consistently giving a small dose, maybe .50, rather than skipping doses, then I would adjust the dose down to .25 if needed based on results. The pre-shot values have all been pretty close to 200, so a small consistent dose might get him down into nice dark green numbers during the cycles and maybe even start to bring some of the pre-shots down a little more until you reach a point that it is clear that you should stop insulin completely for a true 'OTJ' trial. But, you really have no mid-cycle data. So, you do not know what impact the insulin doses you have given have had. It is extremely helpful to have that kind of data.. it allows you to have a better feel for how low of a pre-shot number you should still give a shot on, as well as how you should be adjusting dosing. Is there any way that you can start to get at least some mid-cycle tests? Maybe just one test somewhere between +5 and + 8 each cycle that you are home?

Those are my thoughts. I will be interested to see the others thoughts on this.

 

Ah, I read elsewhere that it was 4 weeks without a shot is considered remission. Surprisingly I was unable to find much on signs of remission, but plenty on diabetic care. Is the dark green range the sweet spot? It's a small range, so I've always been worried about pushing him too low. Is blue not as desirable?

I can certainly make more of an effort on weekends to get mid-cycle data. What does "OTJ trial mean?"

 

Sorry, 'OTJ' means 'off the juice' meaning off insulin.

The dark green and blue are both good. My personal goal for Mia is to see her stay between 66 and 199 all the time... we are not there yet. (I said 66 rather than 68 because 65 is the number in the meter/strip documentation as being the beginning of the hypo range. I use an AlphaTrak like you.)

You can look at the spreadsheets of some cats that are in remission. There is actually a forum for Honeymooners / OTJ. From the ones I have looked at, they usually have a lot of dark greens and some blues. Some cats tend to run a little higher than others while in remission. You do not really see yellows though except maybe in some special case where there is an unusual food spike or some stress or pain that caused it.

I have not had the pleasure of having a cat in remission.. YET.. keeping hope alive! Maybe some who have will comment here or you could post remission questions in the OTJ forum or even the main forum.

 

I wouldn't want to go off insulin in the 200s either. I'd say you want to get them into consistently lower numbers...normal numbers for a cat are 68-150 on an AT I believe. Check out the remission thread at the top of this forum too...lots of good SS to review on there. We'd be happy to help you figure out good dosing and how to get your cat (hopefully) into remission if you'd like? If you set up a spreadsheet like ours, it will help a lot.

 

I have seen a few different ranges of what is supposed to be 'normal' glucose levels for a cat. I think it varies a little bit due to varying professional opinions but also because different cats can have slightly different 'normals'. Another factor is that the measurement devices are not perfect, so you cannot get too hung up on EXACT numbers but have to realize there is going to be a little 'gray area' at the bottom/top of the ranges.

The documentation that comes with the AT meter says 65 and below is low/hypo and 250 and above is high/hyper, so the target range is going to be somewhere within that. The normal range on IDEXX lab test results is 72 to 175. Rachel mentioned 68 to 150. Now, maybe, you see why I said my personal goal for Mia is to see her stay between 66 and 199 all the time. I made that range up based on everything I have read and what I have seen so far with her during her treatment.