4/14 Charlie AMPS 182, +5 93, PMPS 142, +1 126, +2 112, +3 98

Bandit's Mom said:
It's possible that this is an end of cycle nadir and he might head up from here. No harm in holding the dose another cycle to be extra careful. You can go up tonight if he heads up.
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Thanks so much! I try to prepare as much as possible but he loves to throw a wrench into my plans! haha. I had a feeling he was about to do something funky last night when he went up at +2 and then dropped at +3.
 
The sun finally came out and Charlie is loving it!! Could be a nice day for surfing if you ask me… :cool:
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I think I'm going to hold this dose through tonight and through this upcoming bounce (if he has one) to see if he can go into the greens again. Similar to the example in comment #17 in this thread. Can I do that? @Bandit's Mom
https://www.felinediabetes.com/FDMB/threads/tight-regulation-slgs-myths-debunked.111088/
I'm still trying to decide whether I want to switch to SLGS now that his numbers are in a better range. Maybe one more tiny increase and then I'll switch? I know TR is the best option to try to get him into remission, but it's already taking a toll on me and my stress levels. I'll feel like I'm failing him if I switch, but I'm also worried my own health if I don't.

Curious what y'all's thoughts are.
 
Marielle said:
Aw, man! He's doing so darn good! Work it, little buddy! You go!



I'm curious: what about TR makes you nervy?
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How low it allows them to get in the greens and therefore how much you need to be on alert. I'm already in a constant state of anxiety when I have to shoot low/when he starts to drop from 100, and I haven't even gotten that low yet! That mental stress plus having to stop what I'm doing to test and feed every hour is starting to become incompatible with my other responsibilities. I get stressed easily and it wreaks havoc on my health.

I was reading over the SLGS guidelines and it said the goal is to keep them flat around 90. I'm comfortable with that number. And from my understanding, the no-shoot threshold for SLGS can be tweaked to fit the caregiver's comfort and lifestyle.

Something that looks like today's cycle would be ideal for me and I think good for Charlie too. Obviously, I know it's not possible to reproduce it every time, but it seems like the goal for SLGS is pretty much exactly what I saw today. Am I understanding it correctly?
 
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Marielle said:
Also, NO ONE is going to judge you for going back to SLGS. And you are NOT failing him if you decide to do so. You are doing the very best to take care of that cat, and you need to decide which dosing method is the best for the two of you.
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Thank you so much for saying that. I can be extremely hard on myself. I'll probably beat myself up about this a lot, but I'll remember that you said this and it will help in those moments
 
Charlie'sMom22 said:
I think I'm going to hold this dose through tonight and through this upcoming bounce (if he has one) to see if he can go into the greens again. Similar to the example in comment #17 in this thread. Can I do that? @Bandit's Mom
I'm still trying to decide whether I want to switch to SLGS now that his numbers are in a better range. Maybe one more tiny increase and then I'll switch? I know TR is the best option to try to get him into remission, but it's already taking a toll on me and my stress levels. I'll feel like I'm failing him if I switch, but I'm also worried my own health if I don't.

Curious what y'all's thoughts are.
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Holding the dose tonight is ok. Keep in mind that with TR, you're looking for nadirs in the 50-80 range. He's not quite in that range but looks like he's getting very close.
If you switch to SLGS, then you want nadirs in the 90-120 range.
 
Angela & Cleo said:
Holding the dose tonight is ok. Keep in mind that with TR, you're looking for nadirs in the 50-80 range. He's not quite in that range but looks like he's getting very close.
If you switch to SLGS, then you want nadirs in the 90-120 range.
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Thank you Angela!

Aside from the nadir range, the other key difference then is the shooting guidelines, right? For TR, you shoot no matter what. And for SLGS, there are some general thresholds for no-shoot or shooting a reduced dose, but those can be adjusted.
 
Charlie'sMom22 said:
For TR, you shoot no matter what
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When following TR, you can shoot any BG over 50. Also, another key difference is the minimum number of tests.
Charlie'sMom22 said:
And for SLGS, there are some general thresholds for no-shoot or shooting a reduced dose, but those can be adjusted.
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Yes, you don't shoot if under 90. You would stall without feeding test again, then if over 90, shoot. Adjusting from the guidelines technically means you would be "custom dosing".
 
Charlie'sMom22 said:
How low it allows them to get in the greens and therefore how much you need to be on alert. I'm already in a constant state of anxiety when I have to shoot low/when he starts to drop from 100, and I haven't even gotten that low yet! That mental stress plus having to stop what I'm doing to test and feed every hour is starting to become incompatible with my other responsibilities. I get stressed easily and it wreaks havoc on my health.

I was reading over the SLGS guidelines and it said the goal is to keep them flat around 90. I'm comfortable with that number. And from my understanding, the no-shoot threshold for SLGS can be tweaked to fit the caregiver's comfort and lifestyle.

Something that looks like today's cycle would be ideal for me and I think good for Charlie too. Obviously, I know it's not possible to reproduce it every time, but it seems like the goal for SLGS is pretty much exactly what I saw today. Am I understanding it correctly?
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This makes perfect sense! And understanding what you hope for the end-goal to be with him is important (keeping him flat around 90 OR remission). I would be interested in hearing what people say about cats receiving higher doses of insulin going into remission. Does this happen often? I don't recall reading on your page if Charlie has been diagnosed with IAA/Acromegaly? Or is he just requiring a higher dose of insulin. Also, talking to folks like @bluesunshine, who shoot higher doses on a regular basis and getting their input might help. I can tell you that I've gone through periods following TR of trying to get Jude regulated, and I was up all night for several nights in a row (a couple of weeks). Once I realized that I could control what was happening with him with food (by boosting his bg), I was okay. The worst part was the lack of sleep; it was difficult going through that period, but now he's regulated, and I don't think he would be had I not followed TR (and let me add that Jude went into remission last year when we were following SLGS). Some on here live with that lack of sleep almost on the day-to-day. I don't think I could do that (I actually suffered a corneal erosion when I was staying up all night for a couple of weeks with Jude because my eyes became so dry with lack of sleep). But, as I said before, whatever you decide is fine. It's just good to have all the information you need on the table, so to speak, when making decisions. Wishing you and Charlie the best of luck with your decision.
 
Marielle said:
This makes perfect sense! And understanding what you hope for the end-goal to be with him is important (keeping him flat around 90 OR remission). I would be interested in hearing what people say about cats receiving higher doses of insulin going into remission. Does this happen often? I don't recall reading on your page if Charlie has been diagnosed with IAA/Acromegaly? Or is he just requiring a higher dose of insulin. Also, talking to folks like @bluesunshine, who shoot higher doses on a regular basis and getting their input might help. I can tell you that I've gone through periods following TR of trying to get Jude regulated, and I was up all night for several nights in a row (a couple of weeks). Once I realized that I could control what was happening with him with food (by boosting his bg), I was okay. The worst part was the lack of sleep; it was difficult going through that period, but now he's regulated, and I don't think he would be had I not followed TR (and let me add that Jude went into remission last year when we were following SLGS). Some on here live with that lack of sleep almost on the day-to-day. I don't think I could do that (I actually suffered a corneal erosion when I was staying up all night for a couple of weeks with Jude because my eyes became so dry with lack of sleep). But, as I said before, whatever you decide is fine. It's just good to have all the information you need on the table, so to speak, when making decisions. Wishing you and Charlie the best of luck with your decision.
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Those are two very important points I've been thinking about as well. I suspect he may have acromegaly, but his vet is fighting me about his care and making it very difficult to get the tests done. I'm trying to figure something out there. But to your point--something I've been weighing is: if remission is rare for acro cats/cats on high doses, then is it worth putting us through all of this? All the testing and stress and me fussing over him affects his quality of life too.

The sleep deprivation is the other thing, and it's a major one. I just can't function on a lack of sleep; I've never been able to. And I'm talking like, less than 6-7 hours and I'm trashed the next day. As you said, some of the people on here live with that lack of sleep day-to-day--I don't know how they do it! I'm so sorry you had corneal erosion from the sleep deprivation. I hope it's something you were able to treat?

Thank you so much for taking the time to give me that info and brainstorm with me. And for your support. It really means a lot. I've been crying a lot the last few days trying to make this decision. I don't have anyone that I can talk to who understands aside from you guys.
 
Angela & Cleo said:
When following TR, you can shoot any BG over 50. Also, another key difference is the minimum number of tests.

Yes, you don't shoot if under 90. You would stall without feeding test again, then if over 90, shoot. Adjusting from the guidelines technically means you would be "custom dosing".
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Oh, I thought you don't shoot if it's under 150, with room for adjustment (down to 90 at the lowest) based on how much data you have, experience, your schedule, etc
 
Charlie'sMom22 said:
if remission is rare for acro cats/cats on high doses,
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What makes you say this? As a CG to a long term diabetic, I can say that quality of life is the goal with as much time as possible under renal threshold. There are a number of Acro kitties that have achieved remission. Most recently, see this https://www.felinediabetes.com/FDMB...t-of-mine-with-diabetes-please-advise.300077/ Kokkinoulis is off insulin now but still on Cabergoline.

Charlie'sMom22 said:
The sleep deprivation is the other thing, and it's a major one. I just can't function on a lack of sleep;
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Me too! Looking at your SS, I think that you could have gone to bed and stopped testing after the PM+3 last night.
Another thing that greatly helps with sleep is learning Charlie's carb sensitivity. There have been a few pm cycles where I've had migraines or had to be out all night taking care of my mother-in-law (she has Alzheimer) and AM cycles where I was out all day either working or with hubby at his cancer treatments/appointments and have over-carbed to keep Cleo was safe.

I read that your Vet is giving you a hard time getting the additional tests for IAA and ACro :mad:, and also that you were looking into maybe having the blood draw done at home by a mobile vet or vet tech. Here is a great post by one of our members that was able to directly ship the blood for testing https://www.felinediabetes.com/FDMB/threads/msu-vdl-testing-instructions-for-igf-1-and-iaa.277084/

I understand how exhausting the first couple of months getting a handle on FD can be and completely empathize :bighug::bighug:I do promise you that it does get easier.
 
Angela & Cleo said:
If you switch to SLGS, then you want nadirs in the 90-120 range.
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SLGS has you hold the dose if nadirs are in the 90-149 range.
Charlie'sMom22 said:
if remission is rare for acro cats/cats on high doses, then is it worth putting us through all of this? All the testing and stress and me fussing over him affects his quality of life too.
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First of all, Charlie is not on what I'd call a high dose. I do remember just one person who had a acrokitty that got up to 55 units and her kitty Lily went into remission, without any treatment. I remember one other who got more into Charlie sized dose and went into remission. Note, I've also seen kitties on the under 10 size dose go into remission, then have to go on insulin again but not be tested for acro/IAAuntil the second time on insulin. Diabetic remission is much more common on acrokitties that are treated. As Angela said, Kokkinoulis's mom posted today about a second diabetic kitty. Kokki's spreadsheet here if you want to take a look. He was more on a Charlie sized dose. As a matter of fact, kitties that have gone into remission after starting cabergoline tended to be more in the under 10 unit size of dose. Prompt treatment increases the odds of remission.

It they go into remission, there is a lot less testing needed. Even without remission, treatment (if acro) greatly improves quality of life. I don't regret treating Neko for a minute, even though she never went into remission. Most of her diabetic life she was on less than 3 units.

Just so you know, it is unfortunately very common for vets to be reluctant to test. Which is unfortunate, I've seen references saying unregulated cats over a certain number of months on insulin should be tested. And this 2024 web page in New Zealand that recommends all diabetic cats be tested. It's a good read to the end, including summarizing how caregivers of acrokitties felt after just giving insulin or actually treating.
 
Angela & Cleo said:
What makes you say this? As a CG to a long term diabetic, I can say that quality of life is the goal with as much time as possible under renal threshold. There are a number of Acro kitties that have achieved remission. Most recently, see this https://www.felinediabetes.com/FDMB...t-of-mine-with-diabetes-please-advise.300077/ Kokkinoulis is off insulin now but still on Cabergoline.
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I was just assuming, I guess. Incorrectly. Kokki's spreadsheet gave me some hope.

Angela & Cleo said:
Me too! Looking at your SS, I think that you could have gone to bed and stopped testing after the PM+3 last night.
Another thing that greatly helps with sleep is learning Charlie's carb sensitivity. There have been a few pm cycles where I've had migraines or had to be out all night taking care of my mother-in-law (she has Alzheimer) and AM cycles where I was out all day either working or with hubby at his cancer treatments/appointments and have over-carbed to keep Cleo was safe.
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I wish I had stopped testing after the +3 last night, because it looks like I'm going to be up all night tonight. doh! I was worried he was going to have a late nadir and drop a bunch, so I woke myself up for that +7. I need to get better about recognizing when it's safe to sleep. I worry a lot. Like you said, learning Charlie's carb sensitivity will help with that. I'm sorry to hear about your MIL and your hubby. Alzheimer's is a terrible and cruel disease, as is cancer.


Angela & Cleo said:
I read that your Vet is giving you a hard time getting the additional tests for IAA and ACro :mad:, and also that you were looking into maybe having the blood draw done at home by a mobile vet or vet tech. Here is a great post by one of our members that was able to directly ship the blood for testing https://www.felinediabetes.com/FDMB/threads/msu-vdl-testing-instructions-for-igf-1-and-iaa.277084/
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Thank you for sharing that! It's good to know that's an option. I wish the vet would just do what I'm asking her to do instead of wasting my time arguing with me about the sensor and dosing method.

Angela & Cleo said:
I understand how exhausting the first couple of months getting a handle on FD can be and completely empathize :bighug::bighug:I do promise you that it does get easier.
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Thank you :bighug::bighug:
 
Wendy&Neko said:
SLGS has you hold the dose if nadirs are in the 90-149 range.

First of all, Charlie is not on what I'd call a high dose. I do remember just one person who had a acrokitty that got up to 55 units and her kitty Lily went into remission, without any treatment. I remember one other who got more into Charlie sized dose and went into remission. Note, I've also seen kitties on the under 10 size dose go into remission, then have to go on insulin again but not be tested for acro/IAAuntil the second time on insulin. Diabetic remission is much more common on acrokitties that are treated. As Angela said, Kokkinoulis's mom posted today about a second diabetic kitty. Kokki's spreadsheet here if you want to take a look. He was more on a Charlie sized dose. As a matter of fact, kitties that have gone into remission after starting cabergoline tended to be more in the under 10 unit size of dose. Prompt treatment increases the odds of remission.

It they go into remission, there is a lot less testing needed. Even without remission, treatment (if acro) greatly improves quality of life. I don't regret treating Neko for a minute, even though she never went into remission. Most of her diabetic life she was on less than 3 units.

Just so you know, it is unfortunately very common for vets to be reluctant to test. Which is unfortunate, I've seen references saying unregulated cats over a certain number of months on insulin should be tested. And this 2024 web page in New Zealand that recommends all diabetic cats be tested. It's a good read to the end, including summarizing how caregivers of acrokitties felt after just giving insulin or actually treating.
Click to expand...

Thank you for sharing this. I'm relieved to hear it. It's also a relief to know that some kitties are okay for a bit without treatment. I've been putting a lot of pressure on myself to get this test and diagnosis right away, and it's been stressing me out with every day that goes by. Like today, I used the whole day doing chores and playing catch up that I was unable to email the vet, and have been feeling guilty about it all night.

I digress. I want to read the page you linked but my eyes and brain are shot and I still have a long night ahead of me I think. I'll certainly read it tomorrow if I don't tonight.

Edit: I know that prompt treatment is imperative, I hope it didn't sound like I'm dismissing that. I'm very tired and not articulating correctly
 
So if I’m happy with his numbers and don’t want him to go any lower generally, then I would switch to SLGS and stay at this dose unless something changes, right? Or can I continue to hold this dose on TR as long as I’m getting greens?

I’m so sorry to be so annoying about all of this, I have to make this decision tomorrow AM (I think) and I can’t think straight right now
 
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With TR, the goal is lower nadirs, ideally between 50 and 80. He's not quite there yet, and if you were to increase, I'd suggest trying a 0.25 unit increase, just to see if you can tweak his nadirs down a touch. The thing with a bit higher dose, is it might also bring down the higher numbers. I found that if Neko was nadiring in the 70's, she was generally under renal threshold, so easier on her kidneys.

If following SLGS you would hold the dose until his nadirs creep up, or he earns a reduction.

Sorry about the muscle shot. :bighug:. That can result in a bit quicker action for the one cycle. The bit of blood you saw could have just been a nicked capillary, not to worry about it.
 
Hey Jess, sorry you are struggling. I was going to link you to Wendy's advice for me on IAA/acro here but I see she stopped by :). As you can see from Bell's spreadsheet, she's had her ups and downs in dosage as well as stretches of blues/greens but also yellows/pinks. I also struggle with the sleep part of it a lot.

What I've found with Bell (but ECID) is that if the dose isn't strong enough, I can't keep her stable at all. She ends up bouncing all over the place. So for her, I like TR because I get really stressed out at the higher numbers but handle the lower ones fairly well (outside of the lack of sleep). Bell tested positive for IAA, so keep that in mind when looking at her spreadsheet. Wendy has drilled it into my head to focus on the nadirs, not the dosage needed to achieve those nadirs.

For me, once I had more data at the lower numbers it became less scary. When she was in her blue/green phase, I would look forward to shooting greens because that usually meant a nice flat cycle. But I don't mean to minimize the stress at all, I was so anxious with the lower numbers before I got that data.

You need to take care of yourself as well as Charlie, so it is important you are comfortable with whatever path you choose. You also can always switch between the two dosing methods if you change your mind, you're not locked in permanently to one or the other.

You did great today, Charlie had a wonderful cycle with a lot of good healing. Keep asking questions! (I'm not experienced enough to answer them, but keep asking them! :D)
 
Sorry about the sleep thing Jess. I remember feeling this way early in our journey too. It was consuming my whole life and I’m still dealing with fallout from it with my friends/family. So totally support you either way.

It seems like you’re so close though!! He’s giving you awesome greens and pretty traditional looking cycles. Maybe the folks here can help you be more strategic with the testing. We need a term for this lol. Like today when he was coming up at +6 I would have left him.
 
What Seth said about taking care of yourself, so true. I was known to temporarily lower Neko's dose if she was dancing towards a reduction, if I really needed the sleep. Then I'd take it back up once I caught up on sleep. Provided she didn't hold the reduction. You have to take care of you, to take care of Charlie.

Tim is also right about learning strategic testing. The other tool to have on hand is different carb% of food. Over time you'll learn his response to carbs at different times of the cycle. That and an autofeeder gave me a life.
 
Wendy&Neko said:
With TR, the goal is lower nadirs, ideally between 50 and 80. He's not quite there yet, and if you were to increase, I'd suggest trying a 0.25 unit increase, just to see if you can tweak his nadirs down a touch. The thing with a bit higher dose, is it might also bring down the higher numbers. I found that if Neko was nadiring in the 70's, she was generally under renal threshold, so easier on her kidneys.

If following SLGS you would hold the dose until his nadirs creep up, or he earns a reduction.

Sorry about the muscle shot. :bighug:. That can result in a bit quicker action for the one cycle. The bit of blood you saw could have just been a nicked capillary, not to worry about it.
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I think I will plan to increase by .25 tomorrow (if he’s not bouncing). But I may chicken out at the last minute. I’m just going to have to decide in the moment I think. He’s just doing so well on this dose and we just got the hang of it I feel…

what is the renal threshold number?
 
Renal threshold is the point at which the blood sugar is high enough that the kidneys have to do extra work and you see glucose in the urine. The actual number that happens at can vary by cat (and meter type). Roughly high blues to low/mid yellows.
 
Charlie'sMom22 said:
I was just assuming, I guess. Incorrectly. Kokki's spreadsheet gave me some hope.



I wish I had stopped testing after the +3 last night, because it looks like I'm going to be up all night tonight. doh! I was worried he was going to have a late nadir and drop a bunch, so I woke myself up for that +7. I need to get better about recognizing when it's safe to sleep. I worry a lot. Like you said, learning Charlie's carb sensitivity will help with that. I'm sorry to hear about your MIL and your hubby. Alzheimer's is a terrible and cruel disease, as is cancer.


Thank you for sharing that! It's good to know that's an option. I wish the vet would just do what I'm asking her to do instead of wasting my time arguing with me about the sensor and dosing method.

Thank you :bighug::bighug:
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Have you considered changing vets to one more willing to work with you?
 
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