When to do a trial with no insulin?

Discussion in 'Lantus / Levemir / Biosimilars' started by Laura Nels, Jul 31, 2015.

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  1. Laura Nels

    Laura Nels Member

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    Jun 3, 2015
    First, apologies for not being able to give most current numbers on spreadsheet, my computer is not accessing google drive right now. Vivian has been on lantus since diagnosed w/ steroid induced diabetes beginning June. She struggles with intestinal disease, so getting her off pred has not been possible so far, we're working on some other options, and she has transitioned to a low carb diet. My question is, when is it advisable to try a cat like Vivian on no insulin? I have not given her insulin (she was at .2U) since Wed a.m. and her numbers have been between 82 (wed a.m.) and 105 (this a.m.). I'm not really clear on the protocol for getting her down to no doses. I should note that I am not at all comfortable giving her insulin when she's at 82 because Lantus brings her way down by four hours out - not sure where to go from here.
    Is there harm in giving her no insulin unless the BG gets higher than it is now?
    thank you
    Laura
     
  2. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    If she makes it 2 weeks with no insulin and numbers in that range, she will be officially off the juice. Give it a (non) shot and see what happens. At worst, you'll need to get her back on the insulin.
     
  3. Laura Nels

    Laura Nels Member

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    Jun 3, 2015
    Thank you BJM. At what BG number would you get her back on insulin?
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Take it day to day and post the numbers. If green at when you normally would test , don't test for 12 hours. If blue feed and test three hours later to see if she comes down to green. That means the pancreas is working. Someone will post all the directions for a trial but those are the basics. Good luck!
     
  5. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    I'm not comfortable with suggesting that you stop insulin. In part, shooting lower numbers may be fine and Vivian may stay above 50. Looking at your spreadsheet, it's hard to know how she's doing since you've been adjusting the dose or skipping on a daily basis -- at least up to 7/20. There are also no PM cycle tests and cats will often experience lower numbers at night.

    I think Elise's suggestion that you post Vivian's numbers in a thread on a daily basis will help us to get to know Vivian and how she's doing on Lantus. You also have the option of further lowering her dose. If you look in the "New to the Group" sticky at the top of the board, there are photos of microdoses.
     
    Jill & Alex (GA) likes this.
  6. Laura Nels

    Laura Nels Member

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    Jun 3, 2015
    Ya, the spreadsheet looks pretty funky, and as I said, is incomplete - several of those evenings Vivian got insulin and I didn't record it, sorry. I don't do blood testing at night - too tired. But why would I want to "shoot lower numbers"? I am not at all comfortable playing the odds of whether or not a dose of insulin is going to make her hypoglycemic. I'm not up to monitoring at night and I often don't see her from 7 a.m. until 5 p.m. so if anything I err on the side of playing it too safe and keeping her numbers a little higher. My vet has told me not to test her daily, she said only test her when I do curves and only do curves a week or two after changing doses - I don't buy that either. So I'm kind of treading water between the vet who says don't test and you guys who say test all day and all night long. What I'm looking for is a guideline. Is 80-105 a range that is low enough for the cat to be off insulin? Is 120 a number that is too high for Vivian to be off insulin?
    Thurs a.m. she was at 82 - I thought that was low enough to be off insulin
    Thurs p.m. she was at 105, Fri a.m. the same 105 - I thought that was low enough to be off insulin but wasn't too sure.
    I'll check her again at 6
    thank you
    Laura
     
  7. granadilla

    granadilla Well-Known Member

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    Jun 13, 2015
    Laura, are you using a human or pet glucose meter? That makes a difference since the pet meters read higher than the human meters. My understanding is that they don't need insulin if they're between 50-120 on a human meter.

    Take a look at the Glucometer Notes in @BJM 's signature. That will break down the numbers for you about when it's safe to shoot or not. Good luck keeping her off insulin!
     
  8. Laura Nels

    Laura Nels Member

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    Jun 3, 2015
    6 pm: BG 103
     
  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    I know you've been managing Vivian's diabetes for a couple of months and obviously, she's doing OK. For many of us who are using Lantus, the basic premise is, "Shoot low to stay low." If you look at many of our SS, there is counterintuitive information. If a cat can drop from 300 to 150 in a cycle, then it stands to reason if you shoot when BG is 100, you will be fighting to keep numbers from tanking -- right? That's the counterintuitive part. While numbers can certainly drop, more often what you see is that when you shoot low, BG "surfs" along in the normal range. This is due to a Lantus curve being "flat." Take a look at many of our SSs and you'll see this. The larger issue is whether your goal is to keep Vivian regulated or if your goal is remission.

    Is there any way you can get a test in before you go to bed every night? If you're out of the house for most of the AM cycle, getting whatever data you can during the PM cycle is doubly important.

    No one is going to argue with you with regard to keeping your kitty safe. If you don't understand a suggestion or it seems illogical, let us know. We want to make sure you are making decisions based on as much information as you need.

     
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  10. granadilla

    granadilla Well-Known Member

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    Jun 13, 2015
    Rock on, Vivian! 3 days down, 11 to go (to make it to the 14-day mark with no insulin and to be officially considered OTJ)!!

    Even if she has a test where she's a little bit above 120, I don't think I'd shoot. I'd wait and see how she was a couple of hours later since a slightly higher test could be caused by stress like a vet visit. (Obviously if it was a lot higher, I'd shoot.) Hopefully this means her pancreas is getting with the program! Good job getting her to this point, especially while she's still on steroids!
     
  11. Tina & Sammy

    Tina & Sammy Well-Known Member

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    Jan 7, 2010
    The bottom line is you have to do what you feel comfortable with. If you are transitioning to LOW carb food and Vivian's numbers are under 120, I say try a 14 day trial of No Insulin and see how it goes. She is already only one step above where you would normally start a trial anyway, and if you are removing the higher carb foods then that might just need the boost that she needed.

    If her BG starts trending upwards you can always start insulin again. If you are forced to start insulin again then it sounds like the SLGS - Start Low Go Slow Method is probably what you want to stick with.

    If you decide to try a trial just remember to test Vivian at her normal shot times to make sure she is under 120. If she is over 100 it is a good idea to test a few hours after food to see if her numbers are back under 100. If she is under 100 at the normal shot time then you don't have to test again until the next normal shot time.

    Good luck with a Trial. Post each day the AMBG and PMBG so everyone can cheer you on.
     
  12. Laura Nels

    Laura Nels Member

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    Jun 3, 2015
    6 a.m. 116 BG
    trending upward
     
  13. granadilla

    granadilla Well-Known Member

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    Jun 13, 2015
    We're you able to test her again a couple hours later, after she had some food? 116 isn't bad, as long as she comes back down and doesn't keep going up. Is she constipated right now? Straining can raise BG, and since she's an IBD kitty, something is always going on in their poor bellies....

    Good luck and keep us posted.
     
  14. granadilla

    granadilla Well-Known Member

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    Jun 13, 2015
    And don't fret -- if she has to go back on insulin for a little while, she may be able to go off it again when you get her on Budesonide instead of pred.
     
  15. Laura Nels

    Laura Nels Member

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    Jun 3, 2015
    Vivian's BG was still at 116 when I tested later in the morning, no testing since as I was away overnight and she was in the care of her other person who hasn't mastered the one person BG testing, It's a handful but recently it's been easier than it probably should be. I get the feeling she would fight harder against it if she were feeling better. Vet emailed, has order budesonide for intestinal inflammation to switch her to and try to get her off the pred. Hope she does ok, she's have very mixed results in the litter box even with pred and is quite low energy. Will test soon
     
  16. Laura Nels

    Laura Nels Member

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    Jun 3, 2015
    6:45 p.m. BG 108
     
  17. Vyktors Mum

    Vyktors Mum Well-Known Member

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    Nov 15, 2011
    It's best to update the subject line in your original post or start a new post with her numbers each day or the updates are likely to be missed. Good luck.
     
  18. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    Serryn's right - we encourage everyone to start a new post every day. When a post gets long it becomes unmangeable.

    I wasn't sure if anyone had mentioned yet or not, but it takes a couple of weeks of consistent poking the ear for tests and then you'll get blood every time. I think that's what you're talking about, that your partner maybe couldn't get blood to test? In any case, as you poke, the ear will grow more capillaries and then they'll bleed with every poke.

    Hang in there - everything gets easier as you move ahead. Vivian is on such a tiny dose that if you can get to shooting the same dose every 12 hours, with the drug switch, she may be able to have her pancreas heal. Many kitties here use the Budesonide - I hope Vivian does great on it!
     
  19. Laura Nels

    Laura Nels Member

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    Jun 3, 2015
    So I will end this thread -
    Vivian was at 108 BG this morning and I'm going to consider her good unless she goes above 120 -
    She has been very inactive, just not wanting to move so I ended up taking her to see the vet this morning.
    Urinary infection - treated with Convenia - hopefully she'll feel better soon.
    Also some pain meds and something to coat any ulceration in her stomach/intestines that is causing bleeding - she is anemic
    Poor Vivian can't get a break
    Anyway, thanks
    Laura
     
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