? Coming off of insulin -**vet update**

Hi all,

I have posted about this in a couple of my condos...
Essentially, even on a tiny tiny drop of insulin Lily is threatening to drop into the hypo zone.
I wonder if there are any DKA folk who can weigh in on whether I should try diet control for a little while. A trial, as such. I would be diligently monitoring BG and ketones and if needed I would be going straight back on the insulin. I just can't keep having her drop her numbers so low. It isn't fair on her or me tbh.

Anyway, I hope someone out there can advise on whether this is a silly idea or not. When I talk about shooting a drop, I literally mean push plunger in tight into vial, release and shoot what's in the needle. Tiny, yet she is still a low girl in need of HC food to keep her numbers out of hypo range. Getting to my wits end and need to do something to make us both more comfortable.

Thanks

Becka

 

@Meya14 any thoughts for Becka?

 

What is the carb level you are currently feeding her? If it is below 5%, you could slightly increase that, maybe by mixing, to keep it safer for her. This might be a situation where one of the Rx diets with the supposed slow release carbohydrate could actually be helpful. A tiny amount of that mixed in might help soften the drop and stabilize her numbers.
Have you a blood ketone meter? I'd hesitate to try no insulin without a blood ketone meter at this point due to the DKA history.

Just saw Andy's note below. If you're already feeding a higher carb amount, maybe swapping a bit for the slower digestion Rx diet would help level the drop out. (Its a guess.)
OR, if she'll eat even lower carb and you've a ketone meter, you could try it.

 

I think she's feeding 12-13% at PS, BJ

 

14% three tins a day and then 2x 2% tins. I will call the vet and see if I can borrow their ketone meter tomorrow...

 

Have you had liver values checked? Everything ok with her liver?

If she has had recent weight loss or is very thin, I would hesitate to withdraw the insulin. Being thin makes cats very sensitive to insulin as the liver stops releasing sugar from the fat stores (that aren't really there anymore). If she needs to gain weight, then I would increase carbs even past the medium carb, and allow for weight gain before getting off insulin completely.

If you think that low weight isn't an issue, and liver values are ok, then you can try to withdraw the insulin and make sure that you test ketones at least 1-2x a day for 2 weeks or so, then once a week for another 2 weeks. Also, if you are able weigh your cat weekly. If she throws any ketones or loses even a little weight, that is a sign her body needs the insulin. Remember, insulin's main job isn't really to lower the blood sugar, it's main job is to allow sugar into the cells to use as energy, and to allow the body to store energy for later use. Lowering the BS is just a side effect of this process.

Also, that seems like a good amount of food she is eating , are they the small tins or larger ones? If she is eating more than she should for her size, you might want to get her checked for thyroid conditions (both hypo and hyper can cause increased food needs, and changes to blood sugar)

 

IMHO, I wouldn't take her off insulin until she earns the reductions to 0.1u and then off. The numbers to ight could be depot from the 0.25u dose or you could be drawing closer to that dose still than you realize. I don't know how you could consistently draw a dose that is 0.05u less without using calipers so I think it would be likely you are still drawing a 0.25u dose.

 

Just thought you guys should also know as from abour 3 or 4 days ago lily has moved to an all wet diet. Had been having some hills or royal canin dry for diabetics up until then.

It's not very clear on the ss, you have to look in the note but on the evening of 3/13 Lily was on 0.25u and dropped to 41 thus earning the reduction to 0.1 which Becka took on the morning of 3/14.

 

bump

 

I have been pushing the plunger tight to the end then releasing. Literally, I can't draw up any less, so am fairly sure it is not 0.25. There is like half a tiny drop when I push hard on the plunger. I can't reliably measure but I know it is not anywhere near 0.25.

Do you have any advice for getting smaller amounts than the plunger push?

 

Hi,

Her liver values were normal back at the end of February so I believe her liver is okay. I could get another blood test done at the vets if needed though. She lost a lot of weight (1.5kg) with the DKA but appears to be gaining it back again. The reason I have been feeding so much is that if I don't we end up going deep sea diving so I am medium/high carbing every day I am injecting yet her values are still lowering (last night she had so much gravy you could squeeze her and it'd come out of her pores and still kept scaring me until +8 when she got up to 110 and I was still wary of sleeping). As it is, she was only in the 150s when I woke this morning. I appreciate this could be the depot. I'm calling my vet today to discuss where to go with this.

 

My concern is that I really can't tell where her numbers are. She's bouncing around. When a kitty is still bouncing like this, there's a good chance discontinuing insulin won't be successful.

 

Hi,

I think you are absolutely right. I just feel a bit at the end of my tether with all of this. Talking to the vet later and it may be I feed a higher carb meal and give more insulin but I would have to be around to supervise so we shall see what the vet says. Maybe I have to just give the dose I'm giving and keep feeding her the gravy for now....

 

Spoke to the vet, who is going to put her on anti inflammatories. We are going with once a day 0.25 as he thinks she is making her own juice...

 

Please find out what the vet is suggesting. If it's an NSAID, please do not give Lily metacam. It's got an FDA black box warning due to causing renal failure in cats. If the vet is suggesting omega-3, that's entirely different.

Once a day dosing typically doesn't work -- you get more bouncing since numbers will skyrocket after 12 hrs if insulin is still needed. The numbers you were seeing yesterday, unless you were giving lots of HC, were good.

You may want to try using digital calipers to measure her dose. It will allow you to be consistent and to more accurately measure small doses.

 

She

she had a tin and a half of high carb last night and was still not very high. She is going on loxicom, which is meloxicam. So the reason the vet thinks lily is producing her own insulin sporadically is that her numbers are so all over the place.

 

Meloxicam is metacam, It can cause acute renal failure. I would strongly discourage your using this with Lily. In the US, an FDA black box warning is just short of having the drug pulled off the market. I would never use it with one of my cats.

 

What is the reason the vet wants to put Lily on an anti inflammatory? Also has she gained back weight?

 

Hey Becka, Metacam is not a good thing for her to be on. When I told my vet to mark Bubba's chart to NEVER give it, he agreed that it would never be given to a cat. Have your vet RX something different, please.

Hope you weren't too exhausted today after last night. I totally understand where you are coming from. After I left you last night, I was up a lot with Bubba steering him with food after going into the greens and not knowing how low he would go since his nadir is very late. It does make for a very cranky bean the next day.

 

The

vet thinks that Lily may have some inflammation and it is stopping her pancreas from releasing insulin all the time. Apparently. What are other anti inflammatories that are safer?

 

She is holding her own ish so far. Yes she has slightly higher values than I would like but is not climbing half as fast as I thought she would.

 

I am not sure what a safe anti inflammatories are. Maybe some of the others will weigh in to answer that. Glad she is holding today and not climbing too fast that is good after last night.

 

Yeah. I'm very happy with the fact she has had no dose today but is coming up slowly. She is probably clearing the depot but we can have a reset tomorrow.

 

Usually pancreatitis (inflammation of the pancreas) is diagnosed by marked increases in the pancreatic and liver enzymes (regular blood work), an ultrasound and the specific fPLI test. I don't know if any of these were done in order for the vet to come to the decision that the pancreas is inflamed?

Quite often steroids are used to treat pancreatitis, but this increases the blood glucose levels and with a recent DKA experience it may not be the best approach.

 

I have no idea what has and hasn't been done. The vet is umming and ahhing about the anti inflammatories and just mentioned them...he is calling later today.

 

Although there is a possibility that there is pancreatic inflammation personally I would be hestitant about treating Lily as such on a whim. The metacam has black box warning concerning its use in cats and steroid anti inflammatory meds are a bad choice for a cat that has had DKA. I assume you had blood work done recently. I would ask the vet if there is any indication of pancreatic inflammation showing in the amylase and lipase, which are two of the pancreatic enzymes that are elevated in cases of pancreatitis

 

How is your little fishy today? You must be exhausted too

 

Hi if your vet is thinking pancreatitis is an issue, here's a link to info including signs and symptoms and treatment options, tests to confirm etc, may be useful to you before you have a discussion with vet later today.

http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

 

He had a beautiful green run last night and he is bouncing today. I am exhausted, I kept going back to bed after shot and test. Didn't get up to stay until 11 AM EST. And I am still tried. This bouncing after the green runs is a new thing..........does give Mama a break.

Perhaps what Sienne said below could be a much better option for the anti-inflammatory.

 

Judging from what this link says I can say that she has no clinical signs of pancreatitis. Glad you get to have a little rest, even if it is because of a bounce!
Makes me wonder why he wants to give her anti inflammatories...

 

Hi Becka,
No advice from me but just my personal experience. Don't want to be too controversial here but Metacam in the UK, France (where I live) and Australia is a different solution (O.5 mg/ml) to that used in the U.S. and therefore does not carry the same black box warning. Crystal has been taking it for a couple of months and it has helped her and I know Bron used it successfully with Sheba. As long as Lily has no kidney problems at the moment, it's worth considering. The RVC in London recommended it for Crystal after I emailed them with her complete history (she is an acro kitty). I hope you find an answer to Lily's problems soon.

 

That is actually a great help! And good advice re: the anti inflammatory. Really. Thank you very much! glad your Crystal has benefitted from this.

 

In the US Metacam is approved for cats only as a one time injection following surgery. The injectable dose in the US is 5mg/ml which is many times higher than the dosing used in the UK. I am concerned with a treatment being given when there is no definite test results saying that pancreatitis actually exists

ETA The version in the UK was actually developed specifically for use with cats unlike the US version


http://www.fda.gov/downloads/Animal...edAnimalDrugProducts/DrugLabels/UCM422148.pdf

 

Just got off the phone with the vet and he confirmed that he has done some reading around the loxicom and he doesn't want to give it as he says it is contra indicated and in his own words 'can have some pretty undesirable side effects'. He wants a blood test to check for signs of infection and then go from there.

 

That is great that your vet did further research and decided against it. Doing some further testing would definitely be a good approach.

 

I just love this board! With everyone from around the world and adding their knowledge!

 

You have a great vet!! And yes, this board is a wonderful community.

 

And thanks to you guys he says my info on her BG is the most thorough he has ever seen. He also said it helps him to read the notes I write next to each day.

 

HI Becka,

Just in case you or your vet are interested, here is the attachment the RVC sent me back in November about the use of Metacam. It's mainly to do with pain management for arthritic cats but it's an interesting article nevertheless. Your vet sounds a keeper, one who is willing to listen and work with you for the good of your Lily.

I use the liquid form of Metacam, given once a day over food - Crystal has no problem licking the plate clean.

 

Thank you ... I will squirrel this away!

 

Are you still giving higher carb food all the time right now?

It's been a nearly month since her DKA, I'm wondering if it's time to try to go to low carb food and see what the insulin needs are at that point. What do you think about it? Will she eat low-carb?

At this point, I'm thinking out loud, not suggesting it. Just wondering. I'd like to see what others say.

 

Well today I have been feeding low carb because I missed her shot this morning. She has brought herself down today she was 313 then down to 297 ...she is spluttering tiny bits of her own insulin into the mix...

 

Usually it takes spending some quantity of time in green numbers for the pancreas to be able to heal. I'm not sure that Lily has spent enough time there. No way to know. A cat ready to go off of insulin will typically be in the 50-80 range, with everything under 100. They've usually stopped bouncing, although not always. I would keep giving her insulin as long as I could to help her get into a solid remission.

 

by the way, sorry for not answering the tag from Gill on your condo yesterday. I've had a fever and don't think the best advice comes from there, so I wasn't on the board yesterday at all. Fortunately it's gone today.

 

I too have been wondering this. With Lily coming down into the low greens while on the higher carbs foods I wonder how she might do with a low carb diet with insulin adjusted accordingly

 

She is starting back on insulin tomorrow but I skipped her shot today as she is prone to sharp drops and was at 151.

 

I thought it was the depot clearing for her but this afternoon she brought herself down...

 

The way Lantus works, typically when you start with a lower preshot number you end up with a lower, flatter cycle overall. It doesn't mean that the cat will not drop low, although that can happen. I think her sharp drops are from starting at higher numbers. Look back at March 8, another amps of 151, which you shot and was followed by a cycle that was pretty flat as well. Whenever you can monitor, take advantage of the opportunity to continue giving her shots.

I wrote an explanation of "shooting low" a while ago for someone else. Take a peek here and see if it makes sense to you. The way Lantus works when you shoot high numbers versus how it works when you shoot lower numbers is very counter-intuitive, but it helps to see examples of it at work.

 

I'm glad your fever broke

 

thanks.

 

Sorry, will reply more fully soon.

 

Hi, yeah, I appreciate that lantus creates nice flat curves but Lily only got one of those! And then I had to feed high carb all night because she had too much insulin in her system. Shooting low for me, in the past, has resulted in hypo and after the night we had skipping the shot was something I felt we both needed. I have been feeding 2% carb all day and she has stayed majority yellow. I know this isn't ideal but it also isn't like the crazy stuff we have seen before. She starts the insulin again tomorrow.