Sam's First Year on Tresiba!

Discussion in 'Tresiba (degludec)' started by Sam & Esse, May 17, 2019.

  1. Sam & Esse

    Sam & Esse Member

    Joined:
    Oct 18, 2017
    Hello :bighug:


    I can hardly believe it's been a year since Sam started Tresiba! A year ago it seemed impossible that Sam would ever be regulated; now we're whispering behind our hands the magical "remission" word and keeping our fingers crossed. He still has a ways to go -- and he might not actually get there -- but he's currently at a .75u dose, and we never thought we'd get to this point. Yay!


    We switched away from the AT2 to a human meter a few months ago, although we have a vial of AT2 strips in reserve just in case. It's amazing to us how incredibly level Sam's BG#s are. I did set Sam's dose reduction number to below 60, since I have a deep suspicion that the Tresiba depot may very well be active for five, or even six days after a dose change. It's mostly a gut feeling, but it's keeping Sam safe :D


    Sam himself is doing good: very happy, very purr-y, and rolling in dust and debris every chance he gets! I've not yet been able to get a handle on his weight, however. He's getting between 211 and 247 calories a day, his latest weigh-in put him at 21.6 lbs, and I measured his sitting height from floor to the top of his shoulder at 15 inches and length from nose to base of tail at around 21 inches :confused: Maybe my math is all wrong, I just don't know... I'm going by the formula 13.5 times 15 (estimated perfect weight) plus 70 = 272.5 calories per day.


    I do, though, have an appointment with a new vet this upcoming Tuesday! Have my fingers crossed for this, as well lol! I'm hoping she can shed some light on this big big boy problem. Will also be discussing the rusting/graying issue with her. Right now I've figured he's getting roughly 43-45% of his calories from protein, but maybe he needs even a bit more. Otherwise Sammi is doing absolutely wonderful! I'll post lab results once I have them.


    Jill, I'm about at the point of trying to add raw in with Sam if he'll accept it. I was checking out the Food Fur Life website today :) Which reminded me that Sam's been on Tresiba for a year, and I should really let everyone know how he's been doing! But I like that the product can be added to cooked meat, since Sam loves himself some chicken (or salmon, or tuna, or tilapia... but I'm really trying to keep him to chicken).


    Since I can't get a current picture of Sam without him covered in what seems to be half the backyard, I'm putting up a picture of him as a kitten that I painted on a rock ;) Oh, I remember those day fondly!

    sammi kitten.jpg
     
  2. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Just got back from vacation... what an FANTASTIC update!!!

    Preshot numbers look great! You know me, I like to see a few more mid-cycle spot checks just to make sure he doesn't drop too low, but the few mid-cycle spot checks look good so far! :p I know I sound like a broken record, but safety is always my biggest concern.
    Given the circumstances, setting the reduction number a bit higher helps. I'm glad you did that.

    That's an interesting observation about the depot. If I wanted to be sure the Lev depot didn't come into play with Alex, I waited for 5 cycles after a dose adjustment. It really helps us know what to do next when we can identify these responses in our cats.
    You know, I've always found that formula to be far too generous for Alex. I know others have found the same. It's probably an ECID thing... almost like with humans. You might want to gradually feed a little less until you see some weight loss.
    43 - 45% of his calories from protein isn't bad. I think it's Dr. Lisa who says at least 40%. I'm kind of curious about the rusting, too.

    The best part of your entire post: "Sammi is doing absolutely wonderful!" I love it! :D
    I'll tell ya, that Food Fur Life EZ Complete is freakin' awesome! I used to make 30 pounds at a time of my own raw and add all the supplements in Dr. Lisa's raw food recipe, but not any more. Food For Life is so darn quick and easy! Now I make small batches often. Besides my cats being fed well... I now have my freezer back! It's nice to see people food in it rather than being filled with cat food! LOL! I've never tried it with cooked meat, but I know others have served it with great success!

    Love seeing his picture... even if it's on a rock! :)

    Thanks for stopping by with an update! It's so good to hear from you and I love hearing how Sam is doing!
    Please stay in touch...
     
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  3. Sam & Esse

    Sam & Esse Member

    Joined:
    Oct 18, 2017
    Hi Jill!

    I hope you had a wonderful vacation!

    Sam went to see his new vet today :joyful: I think everything went good. Everyone in the office was very, uh, impressed with what a big boy Sam is. The doctor's recommendation was to actually increase Sam's daily calories; she suggested 295 kcal per day for an ideal 15# weight (looking at the notes she made right now). But I don't think I can bring myself to do that :facepalm: She did think upping Sam's protein a bit more might help with the rusting (barring anything popping up in the blood work). So I just ordered the sample of the EZ Complete. Sam does still get 12 grams a day of Dr. Elsey's dry as a treat; I'll see if I can talk him into believing the EZ Complete works even better as a treat. (The doctor didn't like seeing the dry on his feeding list, not at all :blackeye: But she was very nice about telling me to ditch his remaining spoonful.) If I can't wean Sam off his sinful spoonful, perhaps I'll see if he'll accept an ounce of raw in place of an ounce of his Friskie's. That should also tip the protein balance closer to 50%. I think. Haven't done the math yet.

    This makes good sense. I'll try subbing in a bit of raw first (or partially cooked), then try cutting back from there once (if) the change is accepted.

    It was interesting that the doctor mentioned several times that some cats are just big. I'm not sure if she was just doing her best to make me feel better about my lack of progress with Sam's weight, or if she was picking up on my worry that something metabolic is going on with the boy... Or if, with her knowledge, Sam is a big boy and not as badly overweight as I fear. :arghh: Very doubtful about that, though lol!

    I'll be posting Sam's labs to his SS once I get them in a few days :rolleyes: Hopefully everything's still good!

    And I had forgot to mention in my update a bit of information that might be important about Tresiba. Sam was on the last pen of his first 5-pack when his dose went up to 2.25u. That pack of pens had an expiration date of October 2019, so they should have still been fine. However, when I started the first pen of the new pack (expiration in 2020) I had to decrease Sam's dose back to 2u immediately. It could be coincidence, or it could be that the insulin in the older pen was losing efficacy before its expiration date. It's something to look for in the future, as the pens in this newer pack get older. It might also have some bearing that I lost power several times last summer, and although I kept his pens as cool as possible, the slightly warmer temps on a few days might have affected the insulin later on, shortening its shelf-life.

    :bighug: And here is a pic from today, of Sam in his beloved yard after rolling in the dirt to wipe off all the nasty vet cooties :p Some of his rusting and greying is visible here. ...And lots of dust.
    sammi after first visit dr sanders - small.jpg
     
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  4. Sam & Esse

    Sam & Esse Member

    Joined:
    Oct 18, 2017
    Hello all! :bighug:

    Well, one of the vet tech's called me yesterday to tell me that Sam's labs look good, with the exception of high eosinophils. Suggestions were flea control medication, which I turned down because there's been zero signs of fleas, or fleabites (on any of the cats, or myself). A broad spectrum dewormer, which I'm considering, although there hasn't really been any indication of wormie-worms. A fecal exam, which so far Sam hasn't handed to me :p Maybe after the holiday weekend. She said it could be allergies, which would make sense since Sam's been having that problem with the rash/sores breaking out on his face and ears periodically -- but didn't offer any solution for that. Yet. Then near the end said that while the blood was at the lab that they could do a heartworm test, but that I had to let them know by the end of the day.

    There's no mosquitoes where I live; never seen one here in over 4 decades, certainly never been bitten by one, but I did a bit of quick research before calling back to decline the heartworm test. I figured since the tech didn't mention anything about basophils, I didn't need to worry about heartworm.

    Then I picked up the physical copy of his labs today... And I don't know if I made the wrong call for Sammi :( I've got all of the new labs entered in his SS, if anyone could take a look? @Marje and Gracie If you have the time to look, do you see anything concerning?

    I just can't help but be worried; his WBC differential doesn't seem quite right to me, but I am a worry-wart.
    There's also an ugly triglyceride number :facepalm: I have no idea where that came from. I'm... just going to ignore that one. Yep.
     
  5. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    I hope all is well with Sam and his bloodwork.:bighug: He’s a beautiful cat!

    Oh and I want to know where one has to live to have no mosquitoes or fleas! I have mosquitoes, fleas, fire ants, horseflies, deer flies, gnats.....pretty much anything that sucks blood or Injects venom. :confused::arghh:
     
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  6. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Here’s a quick assessment.
    Albumin: can be high from dehydration
    Triglycerides: can be high if he’s eaten recently. Usually an accurate triglyceride must follow at least a six hour fast.
    Monocytes: can be high due to stress from a vet trip and his are very mildly elevated.
    Lymphocytes: his are just barely low but definitely different than before. has he had any steroids recently?
    Eosinophils: so, yes, parasites but also allergies can raise this. Allergies to food or pollen, also asthma, etc can raise this. Other things as well such as IBD or mast cell tumors but it’s unlikely. A recent study (2018) done by the Winn Feline Foundation indicated the most common causes of increased eosinophils are (in this order): Internal or external parasites, feline allergic dermatitis, feline asthma, and eosinophilic gastrointestinal disease.

    My own cats have had elevated eosinophils and neither my vet nor I get too concerned about it because they are entirely indoor cats, we don’t have any fleas or mosquitos around here, and usually when we see it is in the springtime when there’s a bunch of stuff floating around and we have the windows and doors open.
     
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  7. Sam & Esse

    Sam & Esse Member

    Joined:
    Oct 18, 2017
    @Marje and Gracie Thank you so much! :bighug: This relieves much of my worry, and gives me a better idea of what to discuss with Sam's vet this next Tuesday. He does get supervised play outside, so I'll go ahead with the fecal test just in case, but he's in a middle of one of his bouts of getting little bumps/sores on his face, and the vet did write it down in her notes as allergic dermatitis. The only steroid he's ever gotten is in the topical Tresaderm; I last gave it to him at the end of February, then tossed the bottle because it was affecting his numbers more than I was comfortable with. I think I'll try my best to find out what he's allergic to, rule out intestinal parasites with the fecal exam, and then get a mini panel ran in... maybe six months?

    There is a note in the lab report that 'Albumin may be lower than reported due to a Hemolysis 2+, Lipemia 1+ but is still Abnormal.' But if it is a little lower, than it is probably about the same as his previous tests.

    Thank you again! Have a fantastic weekend and holiday!

    @Sharon14 :joyful: I hope so too; Marje explaining what the results might mean has me feeling much more positive now. :bighug: And one of Sam's nicknames is Mr. Handsome Pants lol! He's too funny, right after he gets brushed and he knows he's looking good ;) It's adorable, his catwalk strut.

    :eek: Yikes! I'm in the high desert, and I think there's just too little humidity for most of the year for the mosquitoes and fleas. Twelve or so years ago a neighbor did bring in poultry fleas, which were horrible. But after about a month and a half, they disappeared. The only critter I really worry about is rattlesnakes, but it's been years since I've seen one of those on the block, either. Well, and a tick still shows up occasionally. I'm not sure who drags them in; I always blame whichever neighbor has most recently gone camping :p
     
  8. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    You’re welcome!

    It’s not unusual for samples to be hemolyzed or have lipemia but it can affect some values. I wouldn’t worry about the albumin.
     
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  9. Sam & Esse

    Sam & Esse Member

    Joined:
    Oct 18, 2017
    :cat: I found an interesting article recently. Although I don't agree with their conclusion that Toujeo would be better for cats than Tresiba. Toujeo's duration was about 16 hours compared to Tresiba's 11... But that means Tresiba can be dosed twice a day for full 24 hour coverage, but Toujeo would likely only be given once a day for safety, and there'd be an 8 hour window of decreasing to almost no coverage :blackeye:

    https://ce.vetmed.ucdavis.edu/sites...pdfs/NotesGilor--WhatsNewInCanieAndFeline.pdf

    The Exenatide Extended-Release in cats section was worth a second reading. While for now it doesn't look like a feasible treatment for diabetic cats, I'm really interested in how it might possibly extend remission in diabetic cats. :confused: Then again, it might prove to be too much for a newly healed pancreas to handle. There are so many different things that have to be considered when treating feline diabetes -- it really is a monstrous, multi-faceted illness.
     
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  10. Sam & Esse

    Sam & Esse Member

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    Oct 18, 2017
    Since I've still been puttering around the internet looking to see if there's been any new research/studies/trials with Tresiba and extra-sweet kitties...
    https://www.stlouisvma.org/wp-content/uploads/GSLVMA-11.2018-Diabetes-Willis-Mahn.pdf

    A rather interesting power point presentation that took place at the end of last year. Wish I could have heard the full presentation :bookworm: I'd really like to know how, if Toujeo does eventually get prescribed to a diabetic cat (unlike the poor "purpose-bred non-diabetic cats" used in the study -- and that phrase actually brought me to tears) how an owner is supposed to measure out a dose of a u300 insulin. The presentation does go on about the supposed benefits of the pen needles over syringes, but as Sam just earned another decrease to .5u... pen needles just aren't the way to go when treating feline diabetes. I wish the researchers pushing this trend would take a step back and view the bigger picture. There's a page devoted to hammering in the fact that 60% of 1u doses by syringe are inaccurate -- but no mention made of how inaccurate that dose would be using a pen needle that's either improperly primed, or pulled too soon, or just didn't enter correctly. Let's see figures and research on that!

    :facepalm: Somogyi effect is now termed Insulin-induced hyperglycemia. And I think this also includes what the FDMB has known for well over a decade (or is it closer to two now?): Too much insulin can look like too little.

    Then, the part of the presentation that was a bit scary: 75% of hypoglycemic events are unrecognized, and that most events are associated with no clinical signs -- but may still lead to neuroglycopenia. I'll need to study up on that, but gosh, it doesn't sound good. I've read a few times over the past year on the board that if there's no signs of hypo, then it's just a low bg event. There's a need to monitor, and to steer, but it's not an emergency. Now I'm wondering if we need to worry a bit more about dips below the take-action threshold -- or if this is another case of the researchers making assumptions without the full facts or real-life experiences to back up the statement.

    Hmm. Me, I'm going to be celebrating Sam's dose decrease, and keeping my fingers crossed that it holds! Go Sammi!
    ...and, we might have managed to get a half a pound off of my dusty sack of Sammi potatoes :D That's a good start!
     
  11. Tracey&Jones (GA)

    Tracey&Jones (GA) Well-Known Member

    Joined:
    Dec 12, 2016
    Sam looks like my Libby. Her mane has gone brown as well and she now has 1 white whisker.

    Libby.JPG
     
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  12. Sam & Esse

    Sam & Esse Member

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    Oct 18, 2017
    Libby is beautiful! I hope we're able to figure out a cause behind our color-changing black kitties :) I've upped Sam's protein, but it'll be months at the soonest before I can tell if it's helping. Sam's new vet has no idea why so much white/grey was appearing, though.
     
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  13. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I'm glad Marje was able to look at Sam's labs and put your mind at ease!
    I also found this article interesting. All along I've been seeing similarities between what you've been finding with Tresiba and Levemir. It was good to hear the observation justified.

    I hope to see someone try Toujeo one of these days. I am very curious to see what kind of duration it offers our diabetic cats.
    My current understanding of Toujeo:
    Toujeo (U300 glargine) is supposed to last up to 40 hours in humans.
    • Study results are showing positive outcomes with U300 performing the same in controlling blood glucose as insulin glargine but with less hypoglycemia during the day and night.
    • U300 is based on the glargine molecule but requires a smaller volume of SQ injection
    • U300 demonstrates a flatter and longer PK/PD profile than that of insulin glargine
    • contrary to popular belief, U300 Toujeo and U100 Lantus doses are converted 1unit : 1unit (https://www.toujeopro.com/toujeo-insulin-dosing-and-titration-calculator)
    That sheds a new light on measuring from what we originally thought/assumed.

    It *sounds like* Toujeo is more concentrated (requiring less volume than Lantus) and the 'higher concentration' is what makes it last longer. Of course, I can't verify since I've yet to see it in use with diabetic cats.
    Using pen needles is known to be more accurate when drawing up to 5 units. However, as mentioned, not being able to make dose adjustments in increments of 0.25u is a problem when dosing our kitties. While I agree it's certainly possible/probable that up to 60% of 1u doses by syringe are inaccurate, you make good points wondering how accurate the dose would be using a pen needle that's either improperly primed, or pulled too soon, or just didn't enter correctly. Heck, we've even found measurable discrepancies in syringes themselves!
    Ha! Interesting.
    Hypo unawareness has also been a concern of mine from the very beginning of this journey with Alex. However, when processing the above, I think it's very important to take into account all protocols/methods geared to regulating our diabetic cats were written for use with meters calibrated for humans. That creates a bit of a cushion since human meters yield results lower than pet-specific meters. This can be especially important for those attempting to tightly regulate their cat's blood sugar.

    Cushion aside, it drives me crazy and I get upset when I see caregivers take a nonchalant approach when kitties are running in the 20s and 30s because the cat 'isn't showing any symptoms of a hypo'. As far as I'm concerned, when kitty is running that low it's time to get those numbers up and get them up NOW. Things can go south in an instant and neurological damage can be done before it's ever seen.


    Sam is looking great... BG numbers and down a half pound! How's his ear healing?
    I'm curious to see if upping the amount of protein in his diet takes care of the 'rusting'. When I was reading up on solutions to the rusting I came across info saying the white/grey is part of the aging process.
     
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  14. Sam & Esse

    Sam & Esse Member

    Joined:
    Oct 18, 2017
    Hi Jill :)

    I'd be very interested if anyone decides to try Toujeo in treating their diabetic cat. Measuring dose is the biggest hurdle I see. The smaller Toujeo pen is 1.5ml, and holds 450 units. So a unit of Toujeo is only a third of the size of a unit of Lantus. I liked the comparison drop sizes on the Toujeo site :joyful: A person would either have to be skilled with using digital calipers, or would need to use the pen needles and deal as best they can with changing doses a full unit at a time. I actually gave this quite a bit of thought. An insulin that minimizes hypoglycemia, and that has an extended duration, might (and I say this guardedly) be more forgiving of full unit adjustments.

    A very large positive that Toujeo has over Tresiba is that insulin glargine is already known to be safe and effective in felines. A bit odd, though, that it usually takes a higher dose of Toujeo to achieve the same (relative) level of control as Lantus. Then I began wondering if larger doses of Toujeo sting less than the same dose of Lantus, since there would be a smaller volume of insulin. I might go check out some of the human diabetic boards to see if this is mentioned anywhere :bookworm:

    :oops: I keep Sam's SS visible so people that are interested can see how he's doing on Tresiba, but I'm always worried that someone new (or newer) to FD will look at it and think that the minimum that I'm testing Sam is actually okay when it's not. I'm trying the best I can, but anyone that can test more, should. I've considered putting a warning on Sam's SS that only testing preshots isn't safe or acceptable if it can at all be helped... Good idea?

    I do wish vets weren't pushing the AT2 so hard. Over the past year I've noticed an increase in people posting because they're a little bit worried about their cats BG#, but it takes several posts (or several hours later) for someone to realize that it's an AT2 being used, and those "okay, not too low" numbers are actually an emergency. I'm so glad my new vet is fine with human meters. I told her I still have the AT2 and an unopened vial of strips in case of emergencies, and she said there was no need, she understood the different ranges because when she was treating her diabetic cat, a human home meter was all she had :D

    Thank you for asking! His left ear (and now his right) is taking a bit longer to heal than I'd like. I tried getting the Halo Cloud Nine salve, but Amazon and Chewy are both out of it, and my computer security isn't liking the company's website. When I try to go, it automatically closes the page saying it's detecting potentially harmful script. I'm blaming the recent changes Chrome made o_O For now I'm still using Neosporin and trying to keep Sam's ears clean, but he's not helping with his constant rolling in dust and debris. At least they seemed a little less sore this morning.

    In regards to his rusting, I figure I'll be patient and see if the higher protein has helped when he grows in his winter coat in November. Although I'm starting to feel like Sam's made the decision that he wants to be a ginger instead of a black cat lol!
     
  15. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    OR... one could try diluting Toujeo for ease in measuring.

    From the Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing sticky in the Lantus, Basaglar, & Levemir ISG:

    The manufacturers do not recommend diluting Lantus and Levemir. However, some human diabetics and caregivers of diabetic cats have diluted Lantus or Levemir without any apparent problems. See the section "Administration of small doses of glargine and detemir: dilution and insulin dosing pens" in the attached file, "Management of Diabetic Cats with Long-acting Insulin": management of diabetic cats.pdf

    DILUTING GLARGINE.JPG

    Personally, I wouldn't want to have to dilute the insulin prior to every shot, but it sounds like you'd almost have to. I think back to those early mornings when I was half asleep and feeling rather cross-eyed at that while I was attempting to draw a dose! o_O

    I wondered about the possible "sting" factor myself.
    I hadn't given it much thought, but good idea! At the very least it'll make some stop and think.
    You and me both!

    Everyone is so wrapped up in buying the best meter for 'accuracy'. They haven't yet reached the point where they realize 'accuracy' is not important... and they certainly don't believe you when you tell them... especially when their vet is also telling them otherwise.
    I recently found out Halo has discontinued making the salve. I'm really disappointed because I loved that stuff! A few members have been able to find a container or two left in stock at random places, but it's truly hit or miss. I hope his ears heal quickly!
     

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