What are your thoughts on the dosage advice in this website?

[Elinor & Sibon]

http://www.thecatclinic.com.au/medical-and-health-info/using-glargine-in-diabetic-cats

I'm familiar with the SLGS and TR protocols, this is why what's written there doesn't make sense to me. The dosage should remain the same if the cat's pre-insulin BG is 15-20mmol/L and/or if the nadir is 7-9mmol/L?
The cat is in remission if pre-insulin BG is 10mmol/L?

I'm asking this because Sibon's numbers started to massively drop in the past week. My vet is expecting a curve this Saturday and I want to be well prepared for when we discuss how to continue dosing.

 

[Mandy & Rex (GA)]

I couldn't finish reading that article. There are so many errors.

This really stood out to me: slightly overdose with insulin for the first 4-6 weeks ... WHY? Why would you want to overdose and cause hypoglycemia? I don't understand that at all.

Let's see what the pros have to say on this.

 

[Girlie's mom]

Wow - I wouldn't follow the advice in your link. I'm doing TR and started out doing SLGS. Read this article by Roomp and Rand (Queensland studies) that are referenced in the TR protocols in the stickies; that will help you make a more informed decision.

When I first started, I was torn between what my vet was telling me (which didn't logically make much sense to me, to be honest) and the protocols here. My vet agreed that TR was good to try and was familiar with it, but she didn't know about bouncing, what caused bouncing, how to wait out a bounce cycle, how to read a cycle properly, etc. She focused on AMPS and PMPS readings as a way to decide whether a dose was okay (which is not how you judge a dose with Lantus - you base it on the nadirs, not the pre-shot numbers). She didn't think it was possible to do 0.25 doses (and it is). She didn't think such small changes in dose would make a noticeable difference (they make a HUGE difference). She thought that I shouldn't worry at all if Girlie dropped down below 68 or even into the 50s or 40s (under 3.8) because "her body will probably kick in and she'll probably be okay); she didn't think that steering with food to help stall huge drops and avoid the bounces that followed made any sense.

I read a lot here and observed and realised that I was seeing real progress here with the cats and that the advice made sense. So I now follow TR and I have learned an incredible amount about how to help Girlie on this diabetic journey and keep her safe. And I have seen HUGE progress since I started following TR and gradually learned how to read and understand Girlie's numbers and all of the factors that go into play with her as an individual. As far as my vet is concerned, Girlie is still on 1 Unit (our last consult), but as you can see, she's now on 0.25. Still my vet is just thrilled at Girlie's progress, so I'm just going to keep doing what I'm doing.

I'd ditch that article. I wouldn't risk Girlie's safety on their advice.

 

[Girlie's mom]

Re: testing: It doesn't stress the cat out; Girlie sleeps through most of her tests, and as you can see, I test a lot. Her ears are fine and there's no bruising because I take care of them properly after doing a test. And I am armed with data to make an informed decision rather than shooting and guessing in the dark.

As you can see, I feel pretty strongly about this. I hope I haven't been too harsh, but my guiding principle is keep her safe.

Also, I wouldn't trust the BG readings done at the vets; the ones at home are more accurate as the cat isn't stressed out. And every cat is different and not all cats even out onto Lantus into the "ideal" flat line. Most of the cats SS that I've looked at don't do that at all.

 

[Gussie's mom (GA)]

I’m no pro by any means but Gussie did go OTJ as you can see in his spreadsheet from 2016.
You can also see I tested A LOT. I followed the TR protocol and yes, worked full time. I worked the protocol with the guidance of some really knowledgeable folks here and though at times I was unsure and felt totally confused, I trusted that the folks here would guide me and knew that above all else their goal was to keep him safe, and to teach me how to do that too. I also had vets question what I was doing, if they were totally unreceptive I listened, said ok, ( nobody was forcing me to agree with them but I did respectfully listen to what they had to say)..and then went home, logged in and got back to work with the protocol.
Each cat is different, ECID, as we say here..so Gussies path is not every cat’s path..they all bring their own unique rhythms to this dance...but I know in my heart he would not have gone OTJ without this protocol and without the advice and support of the folks here....
Just my two cents!

 

[Tricia Cinco(GA) & Harvey]

I didn't read the article, but from the other comments I can guess it would just aggravate me.

Testing only stresses the cat out if the bean is stressed - your emotions transmit themselves to the cat. At first it can be a little iffy, especially if you have a nervous cat, but most cats get used to it pretty quickly. I NEVER had a problem testing Cinco, who was the epitome of a mellow cat. Harvey was the opposite, but even he became accustomed to it after a few weeks. If you look at either of their spreadsheets, you will see that I was one of the charter members of Testaholics Anonymous.

. The dosage should remain the same if the cat's pre-insulin BG is 15-20mmol/L and/or if the nadir is 7-9mmol/L?
The cat is in remission if pre-insulin BG is 10mmol/L?

Can't really comment on this, as we use the US measurements here, and I do not know how to translate them. With Lantus you determine the dosage based on the nadir, with consideration given to the preshot number (ie, is it safe to shoot?). It's not either/or. A cat is in remission if it has normal BG readings for 14 consecutive days with no insulin. Normal is defined in the TR sticky as 50-80 on a human meter.

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.

I totally get why you are doing research outside this site, and I would never discourage it, but always consider the source. Dealing with FD is confusing enough without having alternative ideas thrown at you, in my opinion.

Regarding Sibon, his numbers are looking really good. Unlike with humans, a cat's pancreas can actually heal and with time and the proper support, remission can be achieved. It's often hard to say why a cat suddenly starts needing less insulin - if there is a specific reason, or if the pancreas is just starting to sputter back to life. I would say it's because you are doing all the right things to help Sibon get better! You have a ways to go before we'd say he's in remission, but it certainly is possible he's headed that way. Some vets want insulin discontinued as soon as numbers start to hit the double digits, but around here we continue to reduced the dose as each reduction is earned, until giving literally one drop, because the longer you support the pancreas, the better your chance is for a strong, lasting remission.

Don't know if that helped or not...? Hope your vet is as impressed with Sibon's progress as I am!

 

[Girlie's mom]

I just looked at your SS as well, and Sibon's numbers are starting to look really nice. I'll be curious to see how they go over the next few cycles. You must be pleased!