? how to tackle remission.

[Cindy & Ivan]

So I'm wondering how to tackle remission in your cat.
Ivan got diagnosed in the first week of February. At what number bg do you stop giving insulin? How fast or slow do you reduce insulin and then pause?

Anyone who has reached remission in their cat can you please post your spreadsheet.

Thank you,
I'm hopping Ivan is headed for remission.

Ivans Spreed sheet:

 

[Kobe (Dean and Lesley) MO]

your previous post
@tiffmaxee, @Diane Tyler's Mom GA, @Bron and Sheba (GA)

Kobe is in his second week of his OTJ Trial. You are welcome to look at his sheet.

 

[Cindy & Ivan]

your previous post
@tiffmaxee, @Diane Tyler's Mom GA, @Bron and Sheba (GA)

Kobe is in his second week of his OTJ Trial. You are welcome to look at his sheet.

Wow that is an amazing spreadsheet. It look like his numbers were all over the place and then it settled into what looks like the start of remission. I am so
happy for you and Kobe.

I have a couple of questions. Did you change his food to low carb wet food and when did you do it?
When it says drop, what does that exactly mean?

We are giving Ivan .25 (as best as we can) right now. It is so hard to measure such a tiny amount.

 

[Kobe (Dean and Lesley) MO]

Thank you! The members on this forum suggested to me that I get some midcycle data to see how low the doses were taking Kobe's BG. Having that information gave us a better idea of what was going on. The numbers were pretty chaotic, that's for sure. It's not what I expected at all. I thought that, if it was going to happen, it would happen more gradually.

The tiny amounts are challenging to measure, for sure. It's a little easier with the U-100 3/10 cc syringes with the half unit marks. Have you gotten your hands on some of those? It makes a big difference!

The transition to wet food is ongoing. I wish I could say that he was on wet food only, but I can’t. He's not super food motivated. And if he doesn't eat enough, he is prone to ketones. So he will eat wet food, but not enough yet to meet his caloric needs. He wouldn't eat any at first, so we have made some progress.

Let me find a good description of the drop dose for you.

 

[Kobe (Dean and Lesley) MO]

So you're supposed to push the plunger down all the way, insert syringe into insulin, and draw up a tiny drop. You'll want to practice. I did it once, and then never got it to work again. But that's what it is.

It sounds like you are thinking about the next steps for getting Ivan off of Insulin. I highly recommend posting on the Lantus Forum and asking for some guidance for dosing. They helped me A LOT. I have only done this with my one cat. The Lantus crew has helped LOTS of cats.

 

[Cindy & Ivan]

So you're supposed to push the plunger down all the way, insert syringe into insulin, and draw up a tiny drop. You'll want to practice. I did it once, and then never got it to work again. But that's what it is.

It sounds like you are thinking about the next steps for getting Ivan off of Insulin. I highly recommend posting on the Lantus Forum and asking for some guidance for dosing. They helped me A LOT. I have only done this with my one cat. The Lantus crew has helped LOTS of cats.

This is Ivan’s spreadsheet.
He is really stable in his numbers. https://docs.google.com/spreadsheets/d/1HZa777FP-w04_jM6258aR-c39Wmm2PLQVElJZm3hNVc/edit?gid=0#gid=0

 

[Cindy & Ivan]

Thank you! The members on this forum suggested to me that I get some midcycle data to see how low the doses were taking Kobe's BG. Having that information gave us a better idea of what was going on. The numbers were pretty chaotic, that's for sure. It's not what I expected at all. I thought that, if it was going to happen, it would happen more gradually.

The tiny amounts are challenging to measure, for sure. It's a little easier with the U-100 3/10 cc syringes with the half unit marks. Have you gotten your hands on some of those? It makes a big difference!

The transition to wet food is ongoing. I wish I could say that he was on wet food only, but I can’t. He's not super food motivated. And if he doesn't eat enough, he is prone to ketones. So he will eat wet food, but not enough yet to meet his caloric needs. He wouldn't eat any at first, so we have made some progress.

Let me find a good description of the drop dose for you.

Ok. Literally a drop of insulin. I have small insulin syringes.
Ivan is on Fancy Feast pate food only. No kibble at all.

I keep hoping Ivan will go into remission.

 

[Kobe (Dean and Lesley) MO]

I hope he will too!

 

[Tim & Pookey]

Would you be able to get some more mid-cycle tests?

It’s important to see how low this dose is taking him. Especially since you’re shooting 80s on an Alphatrak (AT reads higher than human meters used here) to keep him safe.

Have you looked at the dosing methods?

 

[Kobe (Dean and Lesley) MO]

Would you be able to get some more mid-cycle tests?

It’s important to see how low this dose is taking him. Especially since you’re shooting 80s on an Alphatrak (AT reads higher than human meters used here) to keep him safe.

Have you looked at the dosing methods?

Pookey finished his OTJ Trial about a week ago. You should look at Pookey's sheet too. (I see that beautiful 78 from Wednesday evening, Tim. How about that! Amazing. ) Tim and Pookey did Tight Regulation dosing, and Kobe is on the Start Low Go Slow dosing method because he still eats some kibbles.

 

[Cindy & Ivan]

Pookey finished his OTJ Trial about a week ago. You should look at Pookey's sheet too. (I see that beautiful 78 from Wednesday evening, Tim. How about that! Amazing. ) Tim and Pookey did Tight Regulation dosing, and Kobe is on the Start Low Go Slow dosing method because he still eats some kibbles.

No I am not following any dosing methods. where would I find them?

 

[Ailish’s Brother]

No I am not following any dosing methods. where would I find them?

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Here the link: If you’re still early in this journey, SLGS (Start Low, Go Slow), the second one listed, is a good place to start!

You can always switch to the more intensive Tr (Tight Regulation) if your little buddy ends up needing it!

 

[Cindy & Ivan]

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Here the link: If you’re still early in this journey, SLGS (Start Low, Go Slow), the second one listed, is a good place to start!

You can always switch to the more intensive Tr (Tight Regulation) if your little buddy ends up needing it!

Thank you for the link. I guess I did read them when I started and used a bit of both methods.
Ivan was changed over to low carb Fancy Feast Pate within a few days of diagnosis. We took his BG every 12 hours, treated and fed.
We tried to use the Libre cgm but Ivan removed it with in hours or sooner. Ivan is a big boy and it takes 2 of us to get GB tested
so he is tested only a few times a day. Ivan was diagnosed 2 months ago and after the first 2 weeks we have been able to keep him
in the blue and green numbers, between 85 to 150 BG.

Ivan has also been on famotidine injections and cerenia pills for helping with his pancreatitis and digestion.

Tim & Pookey's chart is amazing and gives me lots of insight to the Remission process.

 

[Cindy & Ivan]

Would you be able to get some more mid-cycle tests?

It’s important to see how low this dose is taking him. Especially since you’re shooting 80s on an Alphatrak (AT reads higher than human meters used here) to keep him safe.

Have you looked at the dosing methods?

Hi Tim,

I guess I did read about the methods when I started and used a bit of both methods.
Ivan was changed over to low carb Fancy Feast Pate within a few days of diagnosis. We took his BG every 12 hours, treated and fed.
We tried to use the Libre cgm but Ivan removed it with in hours or sooner. Ivan is a big boy and it takes 2 of us to get GB tested
so he is tested only a few times a day. Ivan was diagnosed 2 months ago and after the first 2 weeks we have been able to keep him
in the blue and green numbers, between 85 to 150 BG.

Ivan has also been on famotidine injections and cerenia pills for helping with his pancreatitis and digestion.

Tim, Pookey's chart is amazing and gives me lots of insight to the Remission process.

 

[Tim & Pookey]

Hi Tim,

I guess I did read about the methods when I started and used a bit of both methods.
Ivan was changed over to low carb Fancy Feast Pate within a few days of diagnosis. We took his BG every 12 hours, treated and fed.
We tried to use the Libre cgm but Ivan removed it with in hours or sooner. Ivan is a big boy and it takes 2 of us to get GB tested
so he is tested only a few times a day. Ivan was diagnosed 2 months ago and after the first 2 weeks we have been able to keep him
in the blue and green numbers, between 85 to 150 BG.

Ivan has also been on famotidine injections and cerenia pills for helping with his pancreatitis and digestion.

Tim, Pookey's chart is amazing and gives me lots of insight to the Remission process.

You and Ivan are doing great. I’m just concerned about giving insulin without knowing how low he’s going during the cycles. It’s putting him at risk, but he also could still need a little juice, we just don’t know right now.

 

[Tim & Pookey]

If you haven’t seen this, this is what a “typical” Lantus cycle could look like and why I’m saying those tests are valuable.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir/Biosimilars: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

 

[Ailish’s Brother]

Thank you for the link. I guess I did read them when I started and used a bit of both methods.
Ivan was changed over to low carb Fancy Feast Pate within a few days of diagnosis. We took his BG every 12 hours, treated and fed.
We tried to use the Libre cgm but Ivan removed it with in hours or sooner. Ivan is a big boy and it takes 2 of us to get GB tested
so he is tested only a few times a day. Ivan was diagnosed 2 months ago and after the first 2 weeks we have been able to keep him
in the blue and green numbers, between 85 to 150 BG.

Ivan has also been on famotidine injections and cerenia pills for helping with his pancreatitis and digestion.

Tim & Pookey's chart is amazing and gives me lots of insight to the Remission process.

The libre works great for some cats but it gave me problems too. I know the testing can be hard, but I agree with Tim that it’s a good idea to get a few mid cycle tests to see how low the dose is taking him, specially since he’s getting such low PS’s on such a low dose. Even one more halfway between the PS could tell you a lot, and help folks here feel more comfortable advising you!

Also, how’s your relationship with your vet? Having one you trust can make such a difference. I changed vets to a guy who specializes in cats and it made such a difference in my sanity when I was at the stage you’re at now.

hang in there your guys got this!

 

[Cindy & Ivan]

The libre works great for some cats but it gave me problems too. I know the testing can be hard, but I agree with Tim that it’s a good idea to get a few mid cycle tests to see how low the dose is taking him, specially since he’s getting such low PS’s on such a low dose. Even one more halfway between the PS could tell you a lot, and help folks here feel more comfortable advising you!

Also, how’s your relationship with your vet? Having one you trust can make such a difference. I changed vets to a guy who specializes in cats and it made such a difference in my sanity when I was at the stage you’re at now.

hang in there your guys got this!

Thank you for your reply. I have done a few mid day test to check and they have been very close to the 2 times we test and I enter numbers.

I have a great Vet. She only does cats. Her and her vet techs are great. We developed a game plan when we first started and Ivan stays there in boarding when we leave on vacation.

 

[Cindy & Ivan]

If you haven’t seen this, this is what a “typical” Lantus cycle could look like and why I’m saying those tests are valuable.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir/Biosimilars: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

Thank you for this. It's very interesting. I looked at Pookey's spreadsheet and I can really understand what you are talking about. Ivan has been very stable,
like Pokey is. I think adding a mid day test for safety might be a good idea. Thank you.