02/04 Nigel AMBG 87, 71 @ +10.75

So, looks like I only have two more testing strips for the Prime. For how much longer would it be wise to test Nigel twice daily and does it still need to be on the times before which I had been giving him insulin (6AM/PM)?

 

First of all........another delightful reading.

As mentioned before, I think to be on the safe side, you should track BG at least until the FL fails or the sensor runs out which I believe would now be 4 days away. For consistency sake, it would be ideal to keep testing with the Prime meter.

When kitties here appear to no longer need insulin, we continue to test for a period of 14 days after the last dose of insulin, AM/PM before declaring them officially in remission. While it appears Nigel may have been diagnosed incorrectly, if he were my guy, I'd do the usual OTJ (off the juice) testing for 2 weeks just to be absolutely sure. If testing at usual shot times is an issue, testing at some other times during the day would still be useful and advisable.

The other important thing to remember is that while Nigel might not be diabetic now, something happened to raise his BG and cause some symptoms that led the vet to reach a diagnosis of diabetes, so it's possible he's borderline (pre-diabetic). That means that he needs to be monitored going forward so that if his BG shows a pattern of elevation at any point in the future, you will catch it early. The earlier you catch and treat diabetes in felines, the greater the odds you can get them into remission. Testing once a week doesn't take but a few minutes and will give you peace of mind and enable you to get Nigel checked out and treated ASAP should his BG suddenly start going up again.

 

Thanks! Alright, that all sounds reasonable. I’ll continue the AM/PM tests for two weeks and then move to weekly tests from there.

 

Beautiful start

 

If it were me, I would continue the AM and PM test for a total of 14 days after you stopped the insulin. It's like he's on an Off the Juice Trail right now. If he makes it through the trial successfully, then afterwards you could go to weekly ( I sure couldn't do that....I had to test daily for quite some time till I felt comfortable, but that's just me and other testaholics like me)

I am including the OTJ trial instructions for you as there is good info for you to know.


Start the trial on the next green pre shot.
If he/she is green 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 he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.
Good luck with the trial!!!
Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), test his/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!
During an OTJ trial IF the AMBG or PMBG is blue (not sure there is range but hoping under 120) the next test is suggested to be +3 or +4 to see if they make it to green

 

So I came home and scanned him with the FL and his readings were quite low today. I think I didn’t feed him enough. I just fed him now and tested and he was at 71. Any reason to be concerned about his numbers dropping low earlier in the day? Still wondering about the accuracy of the FL.

 

See below.

 

Grant, Nigel is not going to go hypo at this point in time. He has been off insulin for 4 days as of tonight. Some cats will run in the 40s as their normal BG. The "Normal" range you see on that graph is for humans not felines. That graph is a picture of beautiful numbers everyone here would be delighted to have.
Now that Nigel has been off insulin for several days and the depot should be clear or darn near, we just need to make sure he keeps having such great numbers. Funny enough, it looks like the numbers for Nigel MAY be more accurate at kitty normal range than they were when Nigel was running a bit higher from what appears to have been unnecessary dosing with insulin.

 

I’m glad @Bobbie And Bubba postrd the instructions for you.

One note: once diabetic, always diabetic. He is just, hopefully, going to be a diet controlled diabetic instead of an insulin dependent one.

Good luck with the trial!

 

So how would have a reacted to the insulin if he weren’t diabetic at all? Wood he have been hypoglycemic on the first couple of doses?

 

There is every possibility that Nigel could have had some hypoglycemic symptoms in those first few days when no monitoring was being done however there is a defense system that revs into action when the body perceives BG is dropping too fast, too much or has gone too low. I don't recall if you mentioned in your first post how high Nigel's BG was at the vet visit when he was diagnosed but my theory is that some of that elevated BG at the vet was likely stress induced which would under normal circumstance have simply dissipated over the course of a few hours.

When insulin was administered and started pushing Nigel's BG down too fast or too much his defense system went into action to prevent his BG from going low enough to cause a symptomatic hypoglycemic event. We call that a bounce. The body has a store of glucose it uses during exercise, hunting, fight or flight, vet stress etc. When the body perceives a threat to the BG level, hormones are pumped out that cause that stored glucose to be released into the bloodstream and the BG will go up if the stores are adequate. The counter intuitive part of this is that too much insulin can look like too little because of those elevated numbers caused by a bounce and this often leads vets to prescribe too high a dose of insulin when basing dosing decisions on curves run in their clinics or spot checks with no data to indicate how low a dose of insulin might be driving the BG at nadir.

It looks like Nigel's defense system was in good shape and managed to keep him safe through those few days of insulin. It certainly helped that the insulin dose was not overly high to begin with. Had the full 1u of insulin been continued, it is likely Nigel would have experienced some degree of hypoglycemia eventually. When the dose was reduced, we noticed the BG start to come down. Once insulin was totally stopped, BG came back down to normal levels but it has taken several days to get there because it takes that long for a bounce to clear and because with Lantus there is a stored depot of insulin that remains active for a time after the insulin dose is reduced or insulin is totally withdrawn.