? acceptable remission BG numbers

I am getting different answers from both of my vets. My question is what is the highest acceptable number to get up to if in remission? If I was dfoing only AM & PMBG checks, I think he'd be fine, but he's getting up to 220 the last 2 days, and then going down again. Is that acceptable? There is a lot more going on behind this, but just checking on the for now.

 

You need to be under 100 for 2 weeks to be considered OTJ, and then stay there.....if you check Davidson’s SS from 2014 you’ll be able to see when he went slowly off the insulin by decreasing the doses, to finally off insulin during his OTJ trial,until no insulin from there on in. Looking at the SS you provided I would not consider Rufus to be in remission.

Others can comment, but that’s what I see.

 

See, that is why I am confused. If you take away today and yesterday, he was pretty much constantly in the acceptable 68-150 range of a pet meter. IM vet told me to take him off insulin, and I felt comfortable doing it because he was under the 150. Why do they need to be under 100, when a normal cat is allowed to get to 150?

 

Sean & Rufus, I'm still kinda new ,reading posts & looking at spreadsheets trying to learn as much as i can , I thought Cats should never eat kibble? I was told it can eventually cause diabetes in an older cat?

It's so confusing, a lot of contradictions.

 

Because a normal cat doesn’t have diabetes and their pancreas is working. Not sure where you got 150 from and you bet is probably not familiar with the TR many follow on here.

There will be others in here that will elaborate in a more technical way as they are VERY well versed on FD, where I’m familiar with the TR and what is required.

Put a question mark as the prefix on your thread topic line and someone will answer. Remember there are many people from different time zones on here so give it a some time.

 

68-150 is normal on a pet meter. I've asked this question numerous times and either get 150 is acceptable, or even higher is acceptable as long as it goes back into normal. A lot of times I ask and it goes unanswered. We'll see if I get more responses.

 

Here's what we're looking for when talking remission:

"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."
http://www.tillydiabetes.net/en_6_protocol2.htm

 

Cats shouldn't be eating kibble. Unfortunetly he has a lot of other issues. Food intolerance, possible IBD, severe nausea. It's very difficult to get him to eat at all. He was eating wet, but will hardly touch it anymore. His belly is always uspset, so he feels nauseous. His new medication to calm his belly, causes nausea. If he eats anything that is not a novel protein, he get nauseous. It's a big long cycle. So, just for the sake of getting him to eat I have to allow him to eat the dry or he wont eat at all. I'm going to try a app stimulant in a couple days.

 

So obviously 220 isn't good. At all. But if he stays generally under 200 is that acceptable? Also, I don't get the "normal" number of 50 to 80. Why do cats in remission need to be lower then the 68-150 on a pet meter?

 

Because most non-diabetic cats normally run in the 50 - 80 mg/dL range.
From years 5 thru almost 15, my civvies tested in the 40s. Now they run in the low 50s.

Edited to add: I'm speaking in terms of BG measurements on a meter calibrated for humans. The measurements would be slightly higher if one was using a meter calibrated for pets.

 

I did not know that normal was in the low end. I saw somewhere it was listed up to 170 on a peter meter was acceptable, and i was thinking 150 would be great.

It is interesting to note that his BG has been higher since 3.28 when he started the Atopica.

 

I don’t think you will find an exacting and precise answer to your question here, because the truth is, nobody knows, least of all vets. The data gathered here is more accurate as far as what is a “normal” bg for a cat because we home test and many have tested their civvies. When vets test cats, they are typically stressed and the numbers skew higher than they would at home. The problem is...

The vast majority of data collected here is with human meters. The TR protocol and SLGS were developed using human meters. How does that data translate to a pet meter? Other than 68 being the cutoff for AT and 50 being the cutoff for human meters, it doesn’t. It’s a fact that people can and do use pet meters here, but this is one of the areas where you are at a disadvantage using a pet meter because it is uncommon enough (mostly because it’s too expensive) that there is a minority of AT data by comparison.

Here’s a link to an unconventional OTJ cat that used an AT if you want a comparison. I can’t think of any other OTJ cats that used AT the whole time since I’ve been here, maybe others know of a few you could look at.

https://docs.google.com/spreadsheets/d/1wx58nvzn4CcTwZt6C0SJPR_K82boATBRKHU2C4Khbak

If you want my two cents, the fact that you are hesitating and questioning probably says you’re in a grey area. If it were me, I’d rather put in a bit of extra time using insulin and seeing if I could at least bring the whole range down to blue before calling it a remission. You could also call it OTJ and monitor him more closely than someone who had lower numbers going in to remission, decide what’s unacceptable now so you don’t wait it out too long before putting him back on insulin. For example, set a rule that any mid cycle number over what he had in his trial or any AMBG over X, what have you.

My reasoning suggesting the former is that it’s a lot of hard work and any extra time you give with the support of insulin could only stand to heal his beta cells further. If it’s close but a little too soon, you could tax them into exhaustion before they even have a chance. It’s a risk I wouldn’t want to take as exciting as OTJ is, it’s still very much on the table, just perhaps a tad further away.

Of course, it’s your call.

Sorry it’s been frustrating with all the other issues clouding things. I can relate to having a cat with multiple issues.

 

Most non-diaabetic kitties will run in the 50 - 80 mg/dL range measured on a human meter.

Normal BG range for non-diabetic cats is 50 - 120 mg/dL measured on a human meter.

We have no way of translating that to use of a pet-specific meter despite all the "guesses" and "my vet said" that you'll read about here and elsewhere. All protocols found here are based on readings from a BG meter calibrated for humans since 1996. That's why we strongly recommend the use of human meters when following any/all of the protocols found on the FDMB.

ETA: Looking for "precise" results doesn't matter when following methods that were created using a meter calibrated for humans.

Are you giving the Atopica with food or following a meal? I've never used it, but I have heard it can cause tummy upset. Tummy upset could cause higher BG numbers. Just thinking out loud. Like I said, I don't have any experience with it.

 

Atopica is about 2 hours after morning eating. Really have to play around with the timing of it. Some cats need it with food, others need it without food. Rufus vomited the first 3 days on it when food was given close to dosage. funny thing is is that the Atopica is supposed to calm the belly to not be nauseous, but the product itself cause nausea. The whole point of putting him on it was to calm his GI/Food intoleance/IBD enough to get him eating a novel diet. Hasn't worked yet, and in fact might be worse. He's eating dry now, but is refusing all but a few licks of the wet.

 

I use the pet meter, and I would personally be happy with sugars 70-100. Maybe because that’s the range for a human and I’m a PA, I don’t know. But we also consider anything <70 on a pet meter hypoglycemia here. So I think we can all agree that 70 is the low end of normal on a pet meter.

It seems to me that your cat is getting CLOSE to being fully off insulin, but not quite there. It looked to me like he was doing really well on the 0.25 units without any episodes of hypoglycemia. If I were you, I would continue that dose until he starts to trend lower and lower and closer to 70. Then I would stop and try coming off of it.

 

@Stacy & Asia, Quintus numbers are pretty similar to Rufus', sans the last 2 days. If I could keep in the blues at all times, without insulin, I'd be happy. I'm going to try to test Rufus tonight and see what his numbers are. It is strange that they are high only in the afternoon. I'll watch the camera too and see when and if he's eating overnight. The dry food he is eating is 28% carbs. I am trying to mix it now half with Zero Young again to see if that'll help, but he hates that stuff.

I did read that *some* people and animals can have raised BG with the Atopica, and that is the case here, although he is eating more dry it seems. Maybe take him off the Atopica for a few days and see what happens, if he still eats and see what BG does.

 

Yeah, but those .25 number are very similar to the no dose numbers too, up until the Atopica was introduced. In fact the no dose were maybe even a bit better then the .25. But I totally get what you are saying. I'm going to give him a couple days and see what happens. He has been sneezing a bit too, maybe start of a teeny cold? This Atopica invites infections I read

 

Yah, I didn't understand using Atopica from the first time you first mentioned it. I always *thought* Atopica was prescribed for itching due to dermatitis or skin lesions. Alex had seasonal allergies. Sometimes she'd get these nasty rash type breakouts on her skin. The vet wanted to give her Atopica, but I wanted to try Halo Cloud Nine Herbal Salve first. It worked so we never re-visited the subject. It's been a long time...

Dinner time! BBL...

 

I think that’s a good plan. If he continues to trend up, I would start up with 0.25 again. I know it’s frustrating... my cat was SO CLOSE to remission, and then we went away on vacation and came back, and haven’t been able to control his sugar since. It’s frustrating for sure. Their needs just go up and down sometimes. Best of luck!! Keep us posted

 

Rufus used to vomit like 3 or 4 times a week, starting maybe 6 years ago, and vet said to try a different protein. We changed and he would be a little better, but then start gain. About 4 years ago, he began to constantly lick himself and gnaw on himself. Then about 1.5 years ago the vomiting stopped. Last year he had a bad ear infection. So, we are not sure if it is a food allergy or environmental issue or both now. Even when he was vomiting he'd eat all the time. Now his GI is inflammed and not sure of food allergy tunerd into intollerance/IBD. Could be lymphoma. So IM doesn't want him back on steroids. So we are trying the Atopica for now to see if that will call everything down. I did read on IBDKitties.com that some people are using Atopica for IBD now. But I am at a loss. Even with the Atopica, and pepcid, and ondansetron, and occasional cerenia he still is nauseous. Anf there is no rhyme or reason with it from one day to the next. thing is he was eating fancy feast (which hw shouldn't be because of need to be on a novel diet), but at least he was eating it. Now won't eat more then half of it.

 

That sucks that he was so close I obviously want him in remission, but if his dietary needs need him to be on insulin so be it. Issue is that IM vet says low 200's is ok. I'm ok as long as under the renal threshold. Thing is everywhere you read is a different answer on what is an acceptable number. I guess I just don't understand why in the 100's isn't acceptable. The labs say 64-170 is acceptable. As long as no glucose in the kidneys, what the difference between a 70 and a 170?

 

Great discussion here! As a new OTJ member this was a great question Sean! I just book marked this for myself!

 

That was my thing, at what number would Rufus be "out" of remission?

 

And btw, @Nicole Z , Aurora has awesome numbers!!

 

What are those numbers on a pet meter for normal? Am presuming vets use pet meters ? Don't know tho. When I last got lab results they showed normal range of blood glucose to be 4 - 9.7 (72 to 174.6). But I'm presuming those are pet meter readings?

 

That is what I assume. The lab report denotes BG as between 64-170 for normal range. That is why this needing to be under 100 makes no sense to me (even on a human meter).

 

Lab values in general are a range and you wouldn't really want to be on the high or low end of that range, though it's considered acceptable. Ranges accommodate all the species and varying needs and life stages. I'm just making this up for the sake of example, but let's say it's known that healthy pregnant cats run BGs in the 160s, while it may be normal for them, it wouldn't be ideal for non pregnant cats, yet they all are included in the normal range and vets have a good idea of if the cat is pregnant or young and growing certain parts of the range make more sense for them.

This is not a made up example, human children have lower normal BGs than adults. Kids are in the 70s, adults in the 80s. It's all within range, but if you had a kid running in the 90s, it would be much more unusual than an adult in that range, yet all are "normal".

From a pass fail perspective, 170 may be considered normal, but I wouldn't aim for either end of the range.

 

I agree with the others that Rufus probably needs a little insulin right now. As I understand it, the cat has to stay in GREEN numbers without insulin for the 14-day trial period. Whatever the green number scale is on the Alpha Trak, that's where he needs to be. Looking at Rufus' spreadsheet, I don't think he will be able to hold a remission at this time. Perhaps begin again with insulin at 0.25Unit.

Most vets, whether they use the Alpha Trak pet meter or not, prefer that their feline patients run higher bg numbers than we suggest here. This is because vets are not used to people home testing for blood glucose, so they play it safe and suggest higher numbers to avoid having to deal with hypos. The philosophy here on the board is that the longer a cat stays in healing numbers (green), the better the pancreas will heal and the better the chance for remission.

If you decide that it is best to abort the trial and to put Rufus back on insulin, perhaps you should switch to a human meter, such as the Relion Confirm (Walmart). You will save tons of money on strips and the meter uses a very small drop of blood and is reliable.

Wishing you and Rufus the best of luck.

p.s. Stacy explains the range in the lab tests (different labs have different ranges) very well.

 

Makes sense to me. Let me ask you this. On a pet meter, what would you rather have. 140 without insulin, or 100 with insulin?

 

Another way to explain this:

Normal range for cats

• the range talked about as normal for cats is 50 - 120 mg/dL on a meter calibrated for humans
• the lab value you just quoted is 64 - 170 as the normal range for cats

Range we're looking for to foster a strong remission

• overall under 100mg/dL, mostly in the 50 - 80 range, with occasional/sporadic higher or lower BG numbers

So how does that last one equate to BG numbers on a meter calibrated for humans? No one can give you an answer. They can guess. They can give you numbers they'd "be happy with", they can repeat what their vet has told them, but when push comes to shove... there is no definitive answer.

 

Is this so that you KNOW that his pancreas is working? I don't get why it MUST be in green.

 

The ranges that Jill referenced were for non-diabetic cat, so we are not dealing with a non-diabetic kitty but a recovering sugar cat...once diabetic always diabetic, so I would like to see as close to the normal BG's as possible (with the odd one a little higher) before going on a OTJ trail. The ones closer to the higher range would make me think that the pancreas isn't quite healed yet and need more time. You have some other factors that for some reason may or may not be driving these higher numbers. Which would make me keep on insulin. Jones was declared in remission by the vet but I kept him on a token dose as I new the prednisolone would drive up his numbers eventually.

Using Juliet's reference (which is the same range roughly I see on my lab work). Off my civvies their lab work for my CKD kid goes from 3.8 (68) to 5 (90). My fat momma cat was 4.9 (88) to 6.5 (117) to 4.9 (88) - skinny to overweight to ideal. If that helps you see what a normal cats would look.


The only time I used Atopica was for my dog. It's purpose was an immunosuppressant but it wasn't about allergies. Which makes me wonder if there is a steroidal type affect even if it is not a steroid per se.

 

But that's for a reason and it is the desired range in the TR protocol.

It's an all too common occurrence to see kitties relapse when they go OTJ when spending too much time in low blues. I wish I had a nickel for every caregiver back from the Falls who said they wished they would have pushed their kitty to a lower range (more/all green range). Over the last 5 - 10 years or so... every time I see a kitty go OTJ with too much blue remaining on their ss I stop to wonder how soon we'll see them again.

 

So as someone who only has had a diabetic cat for 3 months but has gone to school and learned about insulin for humans. I would rather personally have 100 with insulin. But that’s me, and it’s just based on some gut feeling i have. Probably subconsciously based on what I would want for a human.

I agree with you that I personally feel better when my cat’s sugars are at least below the renal threshold. There IS a study, however, that shows that the TR protocol (which was published!) is associated with remission. In other words, if you keep the numbers lower with insulin, your cat will be more likely to come off and stay off insulin. I think we could probably agree that 200s isn’t remission, so I think just based on that and the fact that the numbers over all are trending up for your kitty right now, it’s likely he’s not quite there yet. That’s what I would probably pay attention to the most. It’s not necessarily the difference between 120 or 150 or 170, as it is the fact that he’s starting to go a little higher towards the renal threshold zone.

 

I agree. I can't do TR right now, at least until he starts eating all wet again and who knows when that'll be. I'm going to give it a couple days. Maybe take him off the Atopica. The dates of 3.23 to 3.27 I think were acceptable OTJ trial numbers, given it was a pet meter. Those were the dates before the Atopica. Then again, if the Atopica doens't work we would have to go to something else, which would raise numbers probably.

How do change a 12 year old cat from being a free feeder to a timed meal?

 

And I've already cancelled our part for tomorrow. Or at least put on hold for now.

 

I agree with Ana, I would rather have a lower range on insulin. Animal studies intended to help humans have shown many diabetic complications do not manifest or are largely revisible if a human diabetic is in euglycemic numbers, but they did so with animals first. There’s just no telling how high or how long it takes for complications to arise. They do, slowly. Considering all Rufus has going on, yes, I would want to take diabetes off the list, but at the same time, a strong remission because it’s one of the few things he has going on that you have some level of control over. What you for sure don’t want to do is add high BGs back to the list.

 

That just means you’ll have an extra awesome party later!

 

I know, it really stinks! We are all rooting for you and Rufus though!! Hopefully soon.

They need heart emojis on this site LOL. <3 <3 <3

 

140 without insulin any day.

 

Me too. Maybe that is not right answer, but no injecting, no needing to make sure they eat, no insulin or syringes to buy. No hypo scares. No needing to be home at specific times.

 

That's my thoughts. Others likely will disagree. So long as he's not in renal threshold then I'm ok with higher numbers. I don't want my kitty to die by my hand. Too many hypo situations on here scare me. I'm glad I'm doing SLGS.

 

If you are using AT, the normal range is 75-150 and sometimes up to 170 is ok or even little more as long as your cat can come down later, i know some cats go up to 190 and 200 sometimes and they are not diabetic. So it depends on stress and feeding style sometimes.

 

100% agree

 

There's a difference between a symptomatic hypo and a "low number"....the vast majority of what you see here are just "low numbers" that are fairly easily dealt with by feeding a little high carb food

The word "hypo" gets thrown around here too much IMHO

 

It probably is used too often, but can be scary nevertheless. Less anxiety for me might be less anxiety for him.

 

And thank you all for contributing so far. It seems this issue might be like a lot of issues in life, and there is 2 sides to it, and maybe not a definite answer.

 

I've been around here 10 years now and although there have been a couple cases of accidental overdosing, usually by someone other than the primary care giver, I can't recall anyone following TR having their cat go into a symptomatic hypo.

140 is above normal/still a diabetic and therefore still at risk of developing ketones. If he does not consume enough calories and has other systemic stress then not enough insulin completes the recipe and opens the door to ketone development and potential DKA

Why tempt fate?

 

It's a convenient way to observe how the trial is going. You can see the color. You don't have to struggle to "interpret" or justify an unwanted rising trend in numbers.

 

Even on a pet meter?? How could that be?

 

I can appreciate that, but low 100 to mid low on a pet meter would be similar to green on a human meter.

 

I thought that the spreadsheets could be cued to the Alpha Trak. Please someone correct me if I'm wrong.

 

As far as I know only light green is different between the two. Every other number is treated the same, but in reality they shouldn't be.

 

I dug up some AT OTJ SSs for you to peruse and compare. One isn't Lantus, but the insulin shouldn't matter, the OTJ numbers will be the same. I forgot about @Jess and Marky Mark or rather, I didn't realize she used AT, Mark was another AT OTJ cat since I've been here. Mark went OTJ in November and Jess is still testing occasionally and recording, so you get some decent longer term OTJ numbers to check out. A lot of people go OTJ and stop using their SSs, unfortunately for the rest of us who like to see the data.

https://docs.google.com/spreadsheet...lQa-YFzIF1qeIcpRBKwE8SehaI/edit#gid=361360320

https://docs.google.com/spreadsheets/d/1oMVd_9ohJbKWbV50Rmi635ct_252ubzzy1ERO5t72cc/pubhtml

https://docs.google.com/spreadsheets/d/1bl-WMP3h8k5uql9FIT4xgxUXSo0SO4smxP47UVadlSA/pub?output=html

 

I do know that. Not ignorant.

 

Ive seen more than that - at least four and I've only been here four years.

 

I think Rufus numbers look very comparable to Franky's, up until 2 days ago.

 

And very comparable to Maggie. When she started back on the insulin she was in constant yellow, where Rufus hits yellow and drops down. I am not saying I accept these yellow numbers but at least he's going back down.

Now I'm laying in bed, and have looked at the cam footage. He's eaten kibble at 1am, 3am, and 5am. It's 630 now. At 7 ill see if he'll eat some wet and then test him. Theoretically he should be high again/still from eating all that kibble. If not, then it could be the atopica.

 

So AMBG is 146 today. Not the best, but I'll take it as he has been eating medium carb dry kibble every 2 hours for the last 6 hours.

 

Have you tried Young Again 50/22 dry? It's not as low carb as the zero but better than regular dry. My cats clearly preferred it to the zero.

Why does your vet not want Rufus on steroids? I know the disadvantages - side effects including elevated blood sugars - but it's effective for food allergies, IBD, and lymphoma (which I'm hoping Rufus doesn't have) and it's an appetite stimulant. You of course wouldn't give it at the same time as Atopica since they're both immune suppressants. It would be bad for his diabetes but that's easier to control than his other issues IMO.

 

Atopica is the safer option vs. steroids and controls similar things. Using Atopica long term is significantly safer than steroids but like anything, not all situations are the same. I'm in a weird position with Mulan right now because she has severe allergies so she's on atopica however it's not fully controlling her itching. I also have her on weekly allergy injections. She was just diagnosed with mild to moderate asthma so we are possibly looking at MAYBE adding in a low dose of prednisolone as well - we will see. Trying a z pack type antibiotic course first to see if the asthma might be bacterial related. It's so tough. Rufus has multiple things going on as well, I really feel for you Sean - it's not easy balancing all of these symptoms!

 

Neither regular vet or IM want him on steroids. I said I would rather have Rufus on insulin and have the other issues taken care of, and they both think i'm nuts. The hardest part for me is do I go ahead and get the biopsy done? IM vet doesn't think we are there yet and should continue with Atopica, and if that doesn't work try something else. She said there are a few things to try before we talk about steroids. Rufus was on prednisone before, but it really didn't help with his appetite. That is what we originally went in for back in August. BUT in the meantime he had bad teeth, pancreatits, stomach issues, and developed diabetes so maybe that is why the pred didnt help with appetite? As far as YA 50/22, I have not tried it. I was trying to keep him on a novel diet but that isn't working either. So, I'll call them today and request a sample of that. I did mix the YA zero LID 50/50 with the other dry food he was eating and he was eating that. So that theoretically would take it down to 15% carbs.

 

Thanks Nicole. The pred when Rufus was on it actually worked very well for the itching and the gnawing. He was on a pretty low dose too. Unfortunetly the pred, pancreatits, overweight, male, older, and fixed, made him develop diabetes. I think that's the reason they dont want him back on the pred.

 

Please don't put on steroids. Seriously elevated BG. Steroids took Silver out of remission. Bad idea for diabetics.

 

I really dont want to, but if the choice is insulin or not eating/death from lymphoma I'd have to choose the steroids.

 

Yes, bad as pred is, effectively treating other serious issues trumps diabetes. The reason I mentioned going back on Pred was in case the Atopica really is causing a lot of stomach issues.

Is Rufus on an antihistamine? I've seen a lot of people swear by Cetirizine Hydrochloride (Zyrtec) for allergies in cats. I was giving it to my civvie Tiger for stomach rash/baldness and think it helped.

 

At this point, I think he has been eating more dry food because of the Atopica. He is eating less and less wet though. I'm not sure if he's eating enough calories lately. With the wet food I could tell, but not with dry. I have been giving an onda 2x daily and gave a cerenia late last night. Now this am he did eat at 1, 3 and 5 dry food, but refuses wet and wont even look at it.

Rufus took zyrtec for 3 months last year and didn't notice a change in him at all.

 

So we are at 196 now. Hasn't eaten in 5 hours, only had the Atopica. hmm.. I think tomorrow we will skip the Atopica and see what numbers do.

 

Sean, just want to thank you for asking this question which has generated so much informative discussion. I, too, wondered at what BG would a kitty be considered "out of remission".

My cat Meeja was diagnosed in Aug '17 with a BG over 600, was hospitalized for several days and started on 1U Lantus twice daily. I was following my vet's advice on dosing (quickly raised to 2U, then back to 1.5U) and was not home testing but periodically taking her to vet for tests. Big mistake on my part. About a month after diagnosis, Meeja's BG went very low (40s) and I again followed my vet's advice to stop giving insulin "cold turkey". Meeja has been OTJ for 6 months now, but according to some of the responders, she would not necessarily be considered in remission. Like Rufus, Meeja's BG has periodic spikes but seems to come back down. In hindsight, I wish I had the information & knowledge contained in the responses to your question because I would have continued Meeja on insulin and tapered off the dose, as you are doing. I've thought about re-starting her on a small dose, but that idea really drives my anxiety level through the roof at this point in time. I feel sad to think I might have jeopardized her chances for long-term remission, and as Sandy noted, increased the potential for ketones/DKA. Sometimes it's just so difficult to know what to do.

Wishing you & Rufus continued success.

 

Ok, got off the phone with Atopica. They never did testing on animals with diabetes and Atopica, however they have cases of non-diabetic cats having raised BG levels and cases of cats becoming diabetic. Also need to watch creatine levels and BUN I think he said. Half life of the product is 6 to 40 hours. So I dont have middle of the night tests, and I should get some, but I do know that he is decent in the am and then rises after I give him the Atopica and then falls back down in the pm.

So, is this product better or worse then prednisone? I don't know. I'm kind of discouraged that the IM vet didn't know that this product COULD raise BG levels. Maybe it is just that this product doesn't raise it as many animals as pred does?

 

It is very difficult to know what to do! I agree! Now that I know his BG could be elevated from this new medication, I'm not sure where to go from here.

 

Also, I think her numbers look great!! I don't think you should worry at all!

 

Not all cats on steroids develop diabetes. My overweight older fixed male civvie was on pred for a year and a half and it just raised his BG's about 20 points. And there is an alternative to pred, which is budesonide. That's what Neko was on for her lymphoma, because she could not have pred due to her heart. It did not raise her BG's, though I have seen it do so in one cat. We've had a few cats here on budesonide.

Note, it's prednisolone which is the appropriate drug for cats, not prednisone.

I too would rather deal with diabetes than inappetance/lymphoma or IBD. You can test and dose appropriately with diabetes. The rest you have no visibility into and it's a guessing game what will work.

 

When I got the "pred" form 2 different vets, both labels indicated "Prednisone". When I asked the 2nd vet about switching to "PRednilsone" instead, she said "Oh, he is on Prednilsone, they just interchange the names sometimes". Ummmmmm OK? So, I'm not sure what he was on.

The IM vet doesn't think it's lymphoma and thinks the inflammation will go away once we get the offending food out of the pic. I guess I should just get a biopsy.

Vet put that on bottom of list too, as far as I know.

 

Yikes!! My vet/vet tech was very careful about getting the right drug and labelling it properly. The lymphoma list I'm on, we've seen people get prescribed prednisone instead, so not an uncommon imistake by vets.

My vet didn't think Neko had high dose conditions, but she had two. We found out by testing. We couldn't test her for lymphoma vs. IBD, because she couldn't take the anesthesia for the biopsy or endoscopy. Sometimes you gotta go with the information you have but I'd rather have known for sure. The two conditions are treated differently. I hope you can get the allergies under control so you can know for sure.

 

Remission numbers, one data point: Quintus is between 6-8mmol/l on an animal meter (you can check his SS. I think what is important is stability. If I take his BG before food, after food, hours after food... it stays on that zone.

150 (animal meter) might come from that being a value at which a cat would be considered pre-diabetic. It’s still a “normal” reading, though it’s not ideal. The risk/benefit analysis of giving insulin vs not is different with a cat hanging out in the 150s or in the 300s.

 

It is my biggest concern. I told her that if it comes back as IBD that it could be lymophoma. She has assured me multiple times that shes confident that its not cancer. She said she can tell by markings. Now, I could do endoscopy for $2000, but who know if that will tell us what we need to know.

 

And Rufus' numbers are generally inline with Quintus'. He is going higher now because of the Atopica. We'll have to see on Monday what the IM thinks. I am going to skip his Atopica tomorrow and see what happens.

 

Though if I’m not mistaken you’re using a human meter, so reading a bit lower than what you’d be reading with an AT?

You might find interesting some of the discussions around the time I stopped giving insulin to Quintus (there is disagreement in them): http://www.felinediabetes.com/FDMB/threads/1-2-quintus-no-juice-today-musings-on-treating-fd.188968/ not just about remission, so you have to hunt around a bit, but it’s in there

 

No, I am using an AT2. I'll take a look at that post

 

What happened to me once was that I went to a drugstore with a prescription for prednisolone and they gave me prednisone without asking me about the switch. Luckily I noticed the label and protested. The pharmacist said they were the same thing and it took a phone call to my vet to convince her that for cats it DOES make a difference. I had to special-order it because prednisolone isn't widely used in the US. Maybe that's why vets usually dispense it themselves. I think your 2nd vet is wrong and you need to assume the label is correct, and make sure you get actual prednisolone if Rufus ever goes back on pred.

 

That's for sure! Makes zero sense to me the nonchalance of it. It's drugs! I think it matters how its labeled!

 

Side note sort of: Interesting you mention a predicable rise in bg after Atopica. When I was on very high dose prednisone I saw the same rise and fall in my bg and found with keeping my carb intake as low as possible during the peak action of the pred I could keep my bg to halfway reasonable levels. I wonder if a very small dose of insulin timed to have peak effect at the same time as the Atopica peak effect might be possible, or maybe splitting the dose am and pm which I also found very helpful. Just a thought to maybe take to your vet.

 

Can you just give a small dose 1x per day? As long as he's under 200 if not TOO worried i think.

 

I just had a thought. I could be wrong, but I'm pretty sure he isn't eating as much during the middle of the night. Maybe just give the Atopica to him at 8 or 9 pm instead??

 

That seems like a possibility. Not eating as much is certainly lower carb.

 

Very interesting discussion. Would running a fructosamine test help?

 

Well, Rufus hasn't had Atopica for 28 hours, but his BG is up to 223. I know that the half life of Atopica is 6 to 40 hours, but he was going down and now back up so not sure if I can blame the Bg numbers fully on Atopica. He will not any wet food right now, so he's eating 30% carb kibble.

 

Ah, well I think you might like Quintus's SS! I felt bad about the blue initially but then I remembered that if I were testing him with a human meter he would probably be all green, and I got over it.

 

That was exactly my thinking, if he's in the blues it's ok with me. Hopefully in mid to lower blues. But now we are getting up in the low yellows. Kibble and meds are to blame

 

Yeah, yellow is a bit high

 

I'm still testing Mark occasionally and do keep his spreadsheet up to date. We stayed with the AT2 the entire time because he seemed to be heading towards remission and I didn't think we needed to switch monitors if he were going OTJ. Unless he goes back on insulin, we will stick with the AT2. He seems to be handling remission well. He's been on a daily antihistamine since mid-February, which does not seem to be negatively affecting his BG.

He wasn't real strong in the greens when we went OTJ but he had been hitting some low numbers in the evening then bouncing up in the morning. Since we were unable to test at all during the day, I was afraid of him having a hypo while we were at work. When we did the OTJ trial, I was home for a week so I could closely monitor his behavior/BG and was prepared to get him back on insulin very quickly if needed. I'll be home again for a few days at the end of this week and will try to do a curve to fill in his spreadsheet a bit.

I had no idea his spreadsheet could still be helpful to anyone. That's good to know.

 

In case anyone is interested, I did a curve on Mark yesterday (in remission since Nov 2017, testing with AT2). His spreadsheet is up-to-date.

 

Very interesting post.

I'm curious why more people don't try "Natural" meds before using drugs? My cat a few years ago had melanoma on this lip I had surgery done but it came back .He stopped eating.

Someone suggested Slippery Elm , I tried it & it worked amazingly well. It helped with nausea , vomiting & Diarrhea.My kitty continued to eat good till the day he died from the cancer. I still use the Slippery Elm on my cats now.

This article explains how it works : https://draxe.com/slippery-elm-for-pets/

I've also used CBD oil for my cats ,for pain & to increase their appetite. It also works Very well. Contrary to what some people believe it's legal to order in all states & it Does NOT get anyone High.

 

Insulin is quite "natural" as it is the hormone that the pancreas secretes... and that it is not secreting enough of when diabetes shows up.

 

@Stephanie & Quintus

I was not referring to the insulin. If you read my post you'll understand.

 

JoyBee, there are many, many people here who use SEB, CBD oil, both or many combinations of natural supplements (myself included, look at Asia’s SS in the Med/Supplements tab). Some use them exclusively, many use in conjunction with allopathic medicines. FD is a complicated disease and several cats here have comorbidities that require “big guns”. I don’t think anyone sets out to give their cat a bunch of drugs and many start out trying a more natural approach until it is not enough.

 

I totally agree about the heart emojis! I've been jonesing for one of those several times lately. I'm about to fish one out of the old Windows Char Map...

 

Oh my word! I'm laughing... I think Sean might want to change the title of this thread to "Acceptable remission BG numbers plus a little bit of this & a little bit of that" since we've managed to touch on such a wide range of topics besides the original topic of discussion... Atopica, symptomatic vs non-symptomatic hypos, AT OTJ SSs, YA dry food, steroids, antihistamines, high dose conditions, lymphoma, "natural" meds, and last, but not least... emojis!!! LOL!

 

New thread title "Everything but the kitchen sink"!!