? Could this be remission?

[EmilyT]

My cat Spence was diagnosed less than 2 months ago, and honestly we’re still getting the hang of things… but his BG is self regulating and I’m not sure what to do (or not do) until my vet is back from holidays.

Spence has been his old self again, no excess urinating, normal appetite - even playing like he’s un-aged by years. We had a fur-shot morning insulin dose a few days ago and I was shocked that his evening BG hadn’t spiked. Then in the middle of the night a day or two later, right at about his usual nadir timing, he was crying out and acting sort of frantically hungry. I got up right away and gave him a “bonus dinner” and he ate and was fine but in my sleepwalking-haze I boneheadedly didn’t think to check his BG. In the morning I realized he may have been hypo because even after a bonus middle of the night meal his BG was suspiciously low.

I did most of a glucose curve a few days ago WITHOUT insulin, because with the holidays I knew I couldn’t have as much focus on him as I wanted and I felt like his pancreas had kicked in again… he stayed between 90-113 without meds.

Could this be remission? Are those BG readings low enough to skip insulin, or am I risking his remission by skipping doses? I really don’t want to mess this up!! Thanks so much

 

[Bron and Sheba (GA)]

Hi Emily and Spencer and welcome. Let me have a look at the spreadsheet and I will be right back.

 

[Bron and Sheba (GA)]

Hi Emily,
Here are your previous posts for continuity
https://www.felinediabetes.com/FDMB...and-difficulty-with-food.295595/#post-3219578
https://www.felinediabetes.com/FDMB...er-dark-soft-pate-confirmation-please.295664/

For us to be able to tell if Spencer still needs insulin, we need to see a lot more tests during the cycles.
The dosing is based on how low the dose takes Spencer, not what the preshot is.
Looking at his spreadsheet, there is only one day in the last 12 where there are tests done during the cycles.
And you have none taken during the pm cycle when cats often drop lower.

There is no doubt he is doing very well for a newly diagnosed cat.
What type of feed are you feeding him?
Is he eating well now?
Are you offering him snacks during the cycles as well as the 2 main meals before the insulin doses?
We recommend giving cats a couple of snacks during every cycle during the first half of the cycles. A snack is a teaspoon or two of low carb canned food.

To get a strong remission, we recommend dropping the dose down gradually until you are only giving a drop of insulin. If you just stop giving it when he is having, for example 1.5 units, he may not get a strong remission and it is much harder to get them back into remission a second time. And giving the insulin longer (but safely) supports the pancreas longer as it heals.

I am going to ask @Suzanne & Darcy to have a look at Spencer’s dose and see what she thinks is best to do moving forward. She is a ProZinc user and I am not. I the meantime, could you try and get at least one test on every cycle (am and Pm cycles) so we can see what is happening please?

 

[EmilyT]

Thank you Bron and Sheba!
I should also note our BG is using AlphaTrak, so the values are higher than what we’d probably see on a human meter (I just did what the vet said at diagnosis, before I found this amazing group).

 

[Bron and Sheba (GA)]

Thank you Bron and Sheba!
I should also note our BG is using AlphaTrak, so the values are higher than what we’d probably see on a human meter (I just did what the vet said at diagnosis, before I found this amazing group).

Yes I could see you are using an Alpharak meter.
Spencer is doing very well for a newly diagnosed cat. Let’s see what Suzanne thinks.

 

[EmilyT]

Spence is eating no problem now! He’s on Fancy Feast Classic/Pate. He gets a 3/4-one full can in the morning and evening (around 75kcal) plus 1/4 can mid-day at about +5 or +6 after his shot. He also gets two churus during the day, in the first 1-2 hours of each cycle usually, and about 1/2oz of dry food available to him overnight, so he’s snacking a bit throughout both cycles.

His evening curve hasn’t been as well monitored because his insulin is 9am/9pm and I’m sleeping during most of it. I didn’t realize they often drop lower in the evening cycle… I’ll definitely be doing a ton of testing again now that we seem to have such a big change. I also updated my spreadsheet via phone so I’ll get online and do a proper update with the previous month or so of data where there was more in-cycle testing. We’ve kinda been in a more laid back pattern with primarily testing pre-shot because it had been consistent until just before the holidays (I’m not complaining about improvement! But would’ve been easier to be on top of not during such a busy time haha)

 

[EmilyT]

I’m so happy to hear things look good to you too! I’ve been cautiously optimistic but I’m at a loss of what to do and want to make sure I’m doing the best things I can for him!

Thank you!!

 

[Suzanne & Darcy]

Hi Emily! When was the last time Spencer had a dose of insulin? If we want to make sure he is either in remission or perhaps on the cusp of remission, we need you to test and verify things. Please test every morning and evening at the normal preshot times. Then test about two hours later. If you can, also get a test later about when his normal nadir would be. If you do this for a few days then you can change the timing of the mid-cycle tests — one day get a +4 and another a +8 or whatever you can do. If he’s not staying mostly in the green, we may want to give a very low dose to assist his hopefully healing pancreas.

 

[EmilyT]

Hi Emily! When was the last time Spencer had a dose of insulin? If we want to make sure he is either in remission or perhaps on the cusp of remission, we need you to test and verify things. Please test every morning and evening at the normal preshot times. Then test about two hours later. If you can, also get a test later about when his normal nadir would be. If you do this for a few days then you can change the timing of the mid-cycle tests — one day get a +4 and another a +8 or whatever you can do. If he’s not staying mostly in the green, we may want to give a very low dose to assist his hopefully healing pancreas.

It’s been a couple days without insulin. Normally I’d have reached out to my vet, but they weren’t open and we’ve had non-stop family things happening, and I didn’t expect his BG to be staying so low so I thought I’d be playing it hypo-safe by skipping one or two and here we are

Should I maybe drop down to 1 unit, or do you think 0.75, while I’m doing testing and figuring out where we’re currently at? I feel like I’ve already dropped the ball on this and want to get us on a good track asap

 

[EmilyT]

Hi Emily! When was the last time Spencer had a dose of insulin? If we want to make sure he is either in remission or perhaps on the cusp of remission, we need you to test and verify things. Please test every morning and evening at the normal preshot times. Then test about two hours later. If you can, also get a test later about when his normal nadir would be. If you do this for a few days then you can change the timing of the mid-cycle tests — one day get a +4 and another a +8 or whatever you can do. If he’s not staying mostly in the green, we may want to give a very low dose to assist his hopefully healing pancreas.

Also I need to say how incredibly grateful I am for this forum and your help and support. I’m not fully past the overwhelmed stage and I’d be feeling so completely over my head without this group

 

[Wendy&Neko]

Could I ask a favour of you? Could you put either NS (no shot) or "skip" in the Units cell of the spreadsheet when you didn't shoot. That way we know this was a deliberate skip and not just forgetting to enter the data.

I agree with Bron. Spencer is doing very well. Keep doing the twice daily testing you are doing. So far his numbers are in the normal range for that AT. I don't think Suzanne is suggesting starting any dose as high as 1 unit or even 0.75 units. Let's just see how he does as is the next while.

 

[Suzanne & Darcy]

Yes. If his numbers are staying in the greens and low blues with no insulin, do not give him any insulin at all. If his numbers start going back up out of the normal range then we can talk about how much to give. Keep feeding the low carb wet food, of course.

 

[EmilyT]

Could I ask a favour of you? Could you put either NS (no shot) or "skip" in the Units cell of the spreadsheet when you didn't shoot. That way we know this was a deliberate skip and not just forgetting to enter the data.

I agree with Bron. Spencer is doing very well. Keep doing the twice daily testing you are doing. So far his numbers are in the normal range for that AT. I don't think Suzanne is suggesting starting any dose as high as 1 unit or even 0.75 units. Let's just see how he does as is the next while.

I’ve added in 0s - it seems like it has to be a number from my phone, but I’ll put in “skip” if I’m able to from the computer. Thank you!

 

[EmilyT]

Yes. If his numbers are staying in the greens and low blues with no insulin, do not give him any insulin at all. If his numbers start going back up out of the normal range then we can talk about how much to give. Keep feeding the low carb wet food, of course.

Ok! With the AlphaTrak, what numbers should I be watching for to trigger a low dose?

I’ll be updating my spreadsheet as we go, and if there’s anything that looks like it’s out of his latest normal I’ll message back on here right away too you guys are the best!! Thank you!

 

[Wendy&Neko]

what numbers should I be watching for to trigger a low dose?

Let's see if he can keep it under 150 on that AT3.

 

[Suzanne & Darcy]

How’s it going? I was checking in on y’all. Can you update the spreadsheet. I’m excited to see the numbers!

 

[EmilyT]

How’s it going? I was checking in on y’all. Can you update the spreadsheet. I’m excited to see the numbers!

I’ve been trying to get extra tests in, but I’m not at my best right now. We’re in the middle of renovations that we’re juggling through all the holiday family stuff and to be honest my life is bananas and Spence is stressed with all the banging and sawing and things going on, so I’m trying to balance extra testing with not causing him distress.
I’ve updated the tests for the last couple days, and I got one closer to the end of a cycle as well as closer to the start and nadir. It did go up a bit but then came back down too.

I feel like I should be giving him a small amount of ProZinc but haven’t. And I’ll keep spot testing and trying to get a few of the key tests more regularly too! I’m sorry, you’ve been extraordinary and I haven’t (yet)!

 

[Suzanne & Darcy]

Try to keep up with the morning and evening BG (AMBG and PMBG) at the normal preshot times. If you can document 14 days of normal numbers without insulin then we can officially declare Spencer in remission as a diet-controlled diabetic.

 

[Suzanne & Darcy]

Here are the official OTJ Trial Instructions: You’ve kind of already started Of course, this is written for a human meter so we have to give a little more leeway in the numbers for a pet meter. Just do your best and we will see how it goes. Looks good today.

OTJ TRIAL INSTRUCTIONS
• Start the trial on the next green pre shot.
• If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
• Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
• After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.

Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), testhis/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!

 

[EmilyT]

Here are the official OTJ Trial Instructions: You’ve kind of already started Of course, this is written for a human meter so we have to give a little more leeway in the numbers for a pet meter. Just do your best and we will see how it goes. Looks good today.

OTJ TRIAL INSTRUCTIONS
• Start the trial on the next green pre shot.
• If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
• Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
• After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.

Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), testhis/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!

AMAZING! Ok, I’ll keep (or get) really on top of testing at pre-shot times and through both cycles and keep close watch and my fingers crossed! Thank you thank you thank you