01/26 BuddyM: AMBG 132 | +3 63

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Mariette, Jan 26, 2021.

  1. Mariette

    Mariette Member

    Joined:
    Nov 15, 2020
    Previously
    https://www.felinediabetes.com/FDMB...ial-day-10-amps-145-4-68.242013/#post-2727480

    Buddy had a few bites at 5am. A little more than yesterday. But the AMBG remains persistently high. We'll keep trying this maybe for a week or so and see if we can get it under control. If not, I might start him back on a drop of insulin with some 6-8% carb food.

    @Marje and Gracie continuing our conversation about TR and my concerns for repeated hypo episdes I found this article which outlines risks to the body:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784865/

    Brain:
    There is a possible association between repeated episodes of severe hypoglycemia and long term cognitive dysfunction.

    In human autopsy studies, of patients dying after an episode of severe hypoglycemia, as well as in animal models, the superficial layers of the cerebral cortex, hippocampus and caudate nucleus, were reported to be affected.[51] More recently, Bree et al., reported that severe hypoglycemia causes damage in the cortex and the hippocampus regions and the extent of damage was closely correlated to the presence of seizure-like activity.[52]


    Heart:
    Hypoglycemia has profound effects on CV function. Acute hypoglycemia provokes sympatho-adrenal activation and release of epinephrine which in turn stimulates hemodynamic changes by increasing cardiac rate and peripheral systolic blood pressure, reducing central blood pressure and peripheral arterial resistance and by increasing myocardial contractility, stroke volume and cardiac output.[56]

    Counter regulatory:
    Several counter regulatory responses are induced by hypoglycemia including a decrease in pancreatic beta-cell insulin secretion, an increase in pancreatic alpha-cell glucagon secretion, an increased sympatho-adrenal response with acute plasma increase in adrenaline and norepinephrine, as well increased secretion of ACTH/glucocorticoids.[68] Hypoglycemia is associated with increased values of inflammatory markers including C-reactive protein, interleukin (IL)-6, IL-8, tumor necrosis factor -α and endothelin-1[69] that may result in endothelial injury and abnormalities in coagulation resulting in increased risk for CV events.

    Eyes:
    Animal studies and in-vitro studies, have reported that a decrease in glucose concentrations was associated with reductions in retinal sensitivity,[72] reduced viability of all retinal cell types,[73] retinal cell death,[74] loss of vision, reduction of retinal responses, increased retinal degeneration[75] and cone cell death.[76] More recently, Khan et al., demonstrated that acute effects of hypoglycemia in human eye led to significant reduction of central retinal function and contrast sensitivity.[77]

    This article actually defines severe hypo starting at 40 mg/dl.

    hyporange_IJEM-17-819-g001.jpg

    hyporisks_IJEM-17-819-g006.jpg
     
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  2. Hercule's mum

    Hercule's mum Well-Known Member

    Joined:
    Jul 27, 2020
    Hi Mariette,

    Interesting study! My vet did mentioned that recently she wrote a paper forsome qualification and people from royal vet college told her that agressive management is no reccomended....

    The study you mention is in humans though, so I am not sure how the numbers translate to cats? I have the checked hercs civvie buddy, and she usually cames around 3, so that would suggest she would be in mild hypo which I don't think it is possible?
     
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  3. Mariette

    Mariette Member

    Joined:
    Nov 15, 2020
    Yes, it's human focussed. It's not easy to find extensive studies being done on cats. It's a good enough correlation I think. Personally I believe that we need to be even more cautious with management in animals because they can't communicate how it's affecting them. And they don't get given a choice in the dose of insulin they're getting.

    To your point though.. the human numbers defining when the hypo starts is probably off for cats.
     
  4. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    Nice to see Buddy's number come down.
     
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  5. Mariette

    Mariette Member

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    Nov 15, 2020
    Thank you Carla! I hope it continues to improve. :cat:
     
  6. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Cats react so differently as diabetics than dogs or humans. I see cats that go off insulin having bg constantly under 50 so I’m not sure whether the human based studies apply or not. Many test their civvies and find the same. They sure don’t when it comes to pancreatitis for example or the use of some meds.
     
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  7. Mariette

    Mariette Member

    Joined:
    Nov 15, 2020
    I can imagine that it could be the case.

    But do we have studies that confirm that there is absolutely no danger in repeatedly sending cats into a hyplogycemic state? If we say that TR has all these safety nets then we would need that.
     
  8. Hercule's mum

    Hercule's mum Well-Known Member

    Joined:
    Jul 27, 2020
    Why do you think TR in particular sends cats into hypo repeatedly? What value would you think is a hypo for cats?
    Partuclarly curious on your vies after stumbling on Hercs at 50 @+11.....
     
  9. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Thank you. While this does pertain to humans as you noted and those with symptomatic hypos, I have often wondered about the effects on cats when they are getting into lower numbers. We used to have members here with long-term diabetics that would allow them to surf in the 40s but, as a biologist, I was always concerned that there could be some long term effects that were not immediately noticeable. While we generally save the term “hypoglycemia” here for low BGs with symptoms of any kind, I have seen the effects on cats that have experienced those episodes and it’s tragic even when they live. Of course, the difference, too, is that we are checking cats on human meters and so you wouldn’t expect them to be as low on a pet meter. BUT, I have also seen a few cats that were actually into BGs on a pet meter that were way too low.

    In addition, we often see cats here, ones that are in remission and even civvies that the CG just tests, where the BG is often in the 40s. We had one kitty here, in remission, named Tuffy, and when her mom would do her monthly BG testing, Tuffy would even be in the 30s on a human meter. :eek:

    Thank you for explaining further because I wasn’t aware he was showing signs at even a 71. I firmly believe in listening closely to the CG who is not only very bonded with the kitty but also is very intuitive about them. I respect your observations and conclusions. While I’ve only seen a couple cats in this forum over the years who experienced hypo symptoms in the 50s-60s, that doesn’t mean that a specific cat could have these symptoms at even higher BGs. With Buddy having FIV and who knows what else, anything is possible. With that in mind, we just have to find a solution for Buddy that keeps him safe.

    I’m very sorry to say that I don’t know specific foods that would work. I haven’t fed canned food to any kitty but Gracie since 2013; my other two have been on homemade balanced raw since they were kittens (once is 10, one is 4). In the earlier years, I fed Gracie Wellness but then switched to ZiwiPeak to avoid the gums and caregeenan as well as other undesirable ingredients. However, ZiwiPeak has changed their formula again since Gracie crossed in 2015 and I don’t know what their % calories from carbs are and, honestly, their food costs a fortune now. Perhaps put a “?” in your subject line and at the end of his BGs, ask “6% FOODS?” and see if anyone can give you some ideas. My apologies but I’d have to go through Dr. Lisa’s list, too, and I wouldn’t have a clue what Buddy might eat.

    Thanks for getting that test early this morning and then feeding. So we know now that, at least last night but I suspect every night, Buddy’s pancreas is not able to bring his BG down which tells me he needs a little more support. You can keep trying the food at +9 but I’m wondering if you can just bring the auto feeder into wherever he sleeps. I always kept Gracie’s near our bed and she would get down about 10 minutes before it went off each night, eat her snack, and then climb back in bed. Of course, I worked with her during the day a few times when we first got it so she could figure out the noise meant food. It only took three times and she had it down pat!

    We can try this limbo for a short time but I don’t want to see his BG get any higher than 120-140 before we seriously try a drop of insulin and it might be that we only give it to him in the morning and see how he does. Let me know what you think and where you want to go from here.
     
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  10. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    You posted this about the same time I posted the above. Keep in mind that we are not sending cats into a hypoglycemic state with TR. We see very, very few cats here that do and only one...maybe two...where the CG was following TR and testing/feeding, Of the ones I’ve seen, it’s been a case where the CG wasn’t testing because the vet told them not to or the cat had been doing well for a long time and they got a bit complacent. We’ve seen many cats in the 40s and even my girl dipped into the 30s (no symptoms) but i tested alot, caught it, and got her up right away. She never showed symptoms. Again, remember that a 40 on a human meter can be a 68 on a pet meter. If you look at Gracie’s SS, there is a tab that I did for human/AT meter comparisons. Once when I got a 38 on the ReliOn, she was 76 on the AT (a very safe number). Usually, if she dropped in the 30s on the ReliOn, she was above mid 50s on the AT. Not ideal but not scary either. I did those comparisons for members to show them how there is not a consistent equivalent between human and pet meters.
     
    Last edited: Jan 26, 2021
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  11. Mariette

    Mariette Member

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    Nov 15, 2020
    This thread is a continuation of the previous thread of my discussion of TR for Buddy in the beginning of the year and how I reduced his dose.

    I'm sure that TR works well bringing most cats down the ladder. I've seen it on lots of spreadsheets. My intention was to keep Buddy on TR because he did really well on it for the increases. But I strongly felt I needed to reduce him faster than TR allowed because alarm bells were going off in my head. My point was just to reduce Buddy in particular along TR protocol I would have had to send him into a hypo state every cycle to be able to earn reductions. I had a very tough time bringing his bg up on 1/7 on a dose that was a lot smaller than TR would have allowed me to shoot.
     
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  12. Mariette

    Mariette Member

    Joined:
    Nov 15, 2020
    Buddy being wobbly when he tested 71 was a mystery to me too. Maybe he was being dramatic and trying to tell me the insulin was making him feel bad. He's not shown anything like that since he's not getting shots even though he drops below 60 sometimes. Now when he's lying down his head is up. He's not sitting with the head lowered like he's in pain on the days where I noted he was 'huddled'. He hasn't lost his balance or appeared wobbly either. To be honest I am not 100% sure all of those were strictly hypo symptoms, but he was certainly not feeling well from about +3 on for the days I was reducing him.

    Thank you very much for your other thoughts and suggestions. I can try and find a spot by the bed for the autofeeder. That could help settle him after eating too, because at the moment he thinks we're up for the day when I take him into the kitchen at 5 :cat:

    If we give the drop of insulin only once a day, can I ask why in the morning and not at night? Buddy's always been a bit higher with the night cycle. Or do you think it would be given super early morning and not the usual 8am I used to give it?
     
  13. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    The huddling sounds like nausea. I wonder if he just didn’t feel well but we don’t want to be dismissive.

    I hope the auto feeder near where he sleeps helps. Your question is a good one on when to give one dose a day if we went that way. I honestly don’t think there is a wrong answer. If you give it in the evening, you still might see a higher BG in the morning if he doesn’t get good duration. If we give it in the morning, he’s already up there.

    IMHO, giving a drop every 12 hours and feeding a higher LC food is the best, initial approach. We can start that as soon as you are ready but, as I said earlier, if he starts trending up more at AMBG, we need to get on the insulin right away.
     
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