OTJ testing times?

Discussion in 'Honeymooners / OTJ' started by SullivansDad, Feb 14, 2020.

  1. SullivansDad

    SullivansDad Member

    Joined:
    Jan 17, 2020
    Hello,

    We are following a protocol prescribed by our vet (rather than any of the great, particular FDMB ones), but I do have a question about future testing suggestions.

    At the end of this month, we will be doing a post one-week insulin-free blood glucose curve where we will be testing AMBG, +3, +6, +9, and +12/PMBG. Assuming that goes well, one month later we will be doing a similar curve and likely getting a fructosamine.

    If those all go well (*fingers crossed*), does anyone have any recommendations regarding testing for on-going monitoring? Our vet has suggested that if all goes well for the above mentioned tests, we just do a curve once every 6 months unless clinical signs start to re-emerge, in which case we would want to curve ASAP. I would rather play it safe and do SOME testing every month or two even if signs do not appear to re-emerge. In that case, is a full curve necessary? Or would something like AMBG, +6, and PMBG suffice?
     
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  2. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Future planning huh?

    So at the end of the month, you and your vet think you will be able to take Sullivan off insulin? That would be fantastic!

    Lowest BG reading that your vet is aiming for is what? Normal non-diabetic feline BG levels, <80 or only under renal threshold <180-250? Renal threshold is when the glucose spills over into the urine as it's filtered out by the kidneys.

    Any home testing between the curve at the end of this month and the next planned curve one month after that? Target numbers for the curve? Or is curve testing only being done at the vet office? If you are only testing every 3 hours, the curve needs to be done for an 18 hour period. AMBG +3 +6 +9 PMBG +3 +6. Or every 2 hours for 12 hour period

    OTJ trial instructions we use do not include a curve, but you are certainly welcome to do that extra testing. I thought Sullivan was hard to home test. Still?

    Don't even have an idea what insulin your cat is on or what dose you are giving. Hang on, found some history. No insulin right now, none since 1/26/20. But you started on Vetsulin (dog insulin) and then switched to Lantus.

    Generic OTJ instructions we use here: You are not posting daily, so forget about doing any of these OTJ instructions that you find too burdensome or time consuming. Really, there is no need. You post because you need or want to. We'd love to cheer you and Sullivan on in this journey though.

    Here are the instructions for an OTJ trial: If on Lantus or Levimir, depot has to drain first before trial starts, about 3 days or 6 cycles. No depot with in and out type insulins (NPH, Vetsulin/Caninsulin, Prozinc).

    If you are posting in the Lantus/Levimir forum, please start a new thread each day which says ‘[Cat name] OTJ trial Day 1 BG xx’ (where xx is the BG reading for that cycle PM), then day2,3 etc. If you are posting in the Main Forum, we don’t require you or need you to do that separate post for each day. In fact, if you have never posted before over in the Lantus/Levimir forum or use a different insulin, you are fine staying in the Feline Health (Welcome & Main Forum). We’ll cheer you on!

    1. Test at your normal AMPS and PMPS times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas). The morning test is now called the AMBG. The evening test is now called the PMBG.

    2. If your cat is green (0-99 mg/dL human meter, 0-130 mg/dL pet meter, 0-5.5 mmol/L) 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 the numbers are blue or higher (100-199 human meter, 130-230 pet meter, 5.5-11 mmol/L), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

    3. After 2 weeks, if everything is looking good, we have a party! And boy, do we party hearty.[​IMG]
    Sometimes, the trial doesn't work the first time and we have to give a little more support by starting the cat with a tiny dose of insulin again. I had to do that with Wink. We simply start the cat back on a tiny dose of insulin to support the pancreas with healing for a bit longer. Our goal is a strong remission and it's better to be safe now then sorry later that you rushed it. With just a little more time we will probably get that strong remission we are looking for.

    Generic Tips to stay OTJ

    1. Never feed dry - not even treats. (freeze dried is ok, Dr. Elsey's chicken flavor is ok.) If you change wet food types, be 100% sure the new food is also low carb and same low carb % as your current food. Some cats are very carb sensitive and an increase from 3-6% to 8-10% can spike the BG’s. Don’t feed if you aren’t sure!
    2. Weigh every 2 weeks to 1 month to watch for weight changes. Too much of a weight gain can cause loss of remission. Too much of a weight loss alerts you to other issues, such as hyperthyroidism.
    3. Measure blood once a week, indefinitely if possible. You want to catch a relapse quickly. Some people only do checks every 2 weeks to a month. BG checks can sometimes alert you to other issues.
    4. No steroids or oral meds with sugar - remind your vet whenever giving you any medication. Always double check. (Steroids may be needed for other medical issues. But remind your vet your cat is a diabetic, diet controlled.)
    5. Monitor food intake, peeing and drinking. If increasing, a sign of losing remission. Or another medical condition like Hyper-T or kidney disease.
    6. Regular vet checks for infection such as dental , ear or UTI. And get them treated quickly!
    7.Continue to ketone test even if your cat is OTJ. Ketones can develop if the cat’s pancreas is not producing enough insulin, or burning off too much fat if your cat is not eating properly and other reasons.

    If your cat does fall out of remission you need to be more aggressive and resolve issues/ back on insulin as soon as possible as the window for a second remission is tight if any. Pancreatitis, hyperthyroid, dental issues are the most common reasons cats fall out of remission.


    "Once a diabetic, always a diabetic."


    If I remember correctly, Sullivan is still eating the Hill's M/d dry food, so some of this does not apply to your situation. (He hates canned food, wants his crunchies, he's a grazer, doesn't gobble his food at one sitting, good table manners, always uses his napkin.:confused:) Member of DFAA (Dry Food Addicts Anonymous).;)

    Taking the dose from 1 to 0.75 to 0.5 to 0.25 to 0.1 usually give the pancreas more time to heal and gives a stronger remission. No idea if you are doing that either.

    Keeping all paws crossed for Sullivan and success. Hey, there are more ways to treat feline diabetes than we use here. Plenty of other ways. I always think maintaining the good relationship with your vet is important. Some people choose not to do that or outright lie to their vets, and that can lead to "complications" shall we say.

    Good luck to you and Sullivan both!!! (And I hope that Sullivan and you never have to come back to this message board because what you did/ are doing/ will do was/is/will be a success and Sullivan never needs to be on insulin again.)

    p.s. I'm a member of another diabetic cat group and they are not as "rabid" about no dry food and against the foods only available through your vet (sold by vets only) as this group is. Nor do they restrict the diet to <10% carbs. What works for one cat and owner may not work for every cat or owner. ECID Every Cat is Different, Every Caregiver is Different. ESID Every Situation is Different.
     
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  3. SullivansDad

    SullivansDad Member

    Joined:
    Jan 17, 2020
    Our vet generally likes the number to stay below 150 (on AT), but he has implied that he wants our guy to stay a little lower than that because of his dry food diet and how that could potentially pull his numbers higher more quickly than if he would eat LC wet food. Our vet does NOT prefer the dry food diet and refuses to sell the stuff himself, but he's a realist and knows that sometimes you gotta go what you gotta do, especially with a cat that's had DKA before and goes on hunger strikes when wet food is the only option given to him.

    That's what I was asking about: what testing should we do. :) While he's OTJ, we won't be testing every day, but we were thinking of testing AM, +6, and PM one day per week to make sure we catch it early if his numbers start to creep up at all.

    Thank you! This is EXACTLY what I was asking for information on. :)

    Thank you for this advice as well! Our vet wanted us to do 0.5 units 2x a day for 30 days and then stop the insulin. Our BG numbers started gradually creeping down (sorry, no public SS) even on that low of a dose though, so after 3 weeks we dropped to 0.25 for a week and are doing 0.1 this week. He hasn't been any higher than 115 on the AlphaTrak in weeks though, so we are planning on dropping from 0.1 units to OTJ after this week and not doing 1 drop.
     
  4. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    That sounds fantastic Sullivan's Dad! No higher than 115 on an Alphatrak pet meter is perfect. I think you and Sullivan are almost there, OTJ coming up.

    Glad to hear that Sullivan is doing well. OTJ is a fantastic goal, reaching for that brass ring on the merry-go-round. But even if you never get there, you know you have done so much to get Sullivan feeling better. That's what is most important. That his signs and symptoms are improving and he's back to his old self. Playing, preening, purring, pooping normal, peeing normal amounts, good appetite. That is what you are looking for.

    No public SS, I don't care. As long as you are working closely with your vet, and keeping an eye on the BG readings, that is what is important.

    There is more than one way to treat diabetes. The methods we use here are only one of those ways.

    I belong to a French language facebook group for diabetic cats, and there is the original German Katzen feline diabetes group where the TR (Tight Regulation) protocol originated many years ago. According to people there, the TR protocol we use here is watered down, not very aggressive, especially if a cat is in high numbers. They don't hold the dose for more than 24-48 hours, unlike the 3-6 cycles used here.

    Yes, dry food addicts can be really hard core. I tell people my diabetic cat Wink was a founding member of DFAA (Dry Food Addicts Anonymous). If it hadn't been for the Transitioning Dry Food Addicts document from Dr. Lisa Pierson, https://catinfo.org/docs/TipsForTransitioning1-14-11.pdf, I don't think I would have ever gotten Wink off the dry food.

    I'm not kidding when I say I used EVERY trick in that document to get him to accept wet food as "edible."

    Dry food diet, or as the French call dry food, croquettes can work.

    Reality meets stubborn cat with the food. Stubborn old curmudgeonly cat set in his ways. Been there. It's really hard. My vet and I even resorted to an appetite stimulant because Wink was really sick with yet another bout of diarrhea and upset GI tract. He needed to eat though.

    Can you say smorgasbord? Wink would have 3 flavors in front of him, most meals. Finally found he loved the Fancy Feast Turkey & Giblets Feast. Then, I was afraid he would decide he hated that flavor and wouldn't eat it. So gradually mixed smaller amounts of other foods in with that flavor. Kept crumbling Halo-liv-a-little chicken treats on top of his food to get him to eat a bite or two. Rinse and repeat. Took lots of patience and outstubborning a very stubborn cat.

    Keep us posted. We love to celebrate when a cat goes OTJ. I do kind of hokey picture links for each day. If you are not interested, I won't bother. Gives people hope. Hope that their cat can get better and not need insulin anymore.

    If you want to share how you and your vet treated Sullivan during his feline diabetes journey, the main forum Feline Health (Welcome & Main), would be a great place to do that. Another perspective on managing feline diabetes shall we say. Could be enlightening and informative for some folks.

    Take care.
     
  5. SullivansDad

    SullivansDad Member

    Joined:
    Jan 17, 2020
    Sullivan update: we recently tested him again one month after his one-week OTJ testing (so: 38 days after his last dose of 0.1 units of Lantus). His AMBG was 89, +5 was 97, and +10/PMBG was 87, all on an Alphatrak2 meter. Thank you to everyone here for your help and support along the way, keep up the great work, and stay healthy!!!
     
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  6. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Good news.

    Keep it down low Sullivan!
     
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