After a brief 6 weeks honeymoon, Arancino's numbers have suddenly shot upwards; he likely had a good helping of HC food meant for his sib civ on Christmas day, and I fear that that messed up his pancreas again (I checked his BG every 5 days, but he uncharacteristically threw up during the night, which was an alarm bell for me). His numbers are still high after 2 days (see updated spreadsheet - TLDR: on Lantus from July to November; all his numbers below 8 mmol/L on alphatrak during his remission, in the last 48h all numbers higher than 10 mmol/L), so this morning I decided to give him 1u and see how that goes. For the moment, I'd rather wait and see - taking Arancino to the vet's office is very stressful (not for me, for the cat - he had CK values so high last time on his blood tests I feared he had a heart attack!!! Joking, but not so much), and giving him pills involves 1) a purrito, 2) struggling out of the towel, and 3) polysporin for the scratches. I hope I am not overreacting; cats are supposed to be dealing with high BG better than humans, but is this behaviour common with Lantus? Although I have a good background in biology, this is not really my field, and this is my first sugar cat so I have limited experience managing the disease. Any advice/comment is welcome (I am aware I tend to overreact).
We would not have taken him off the juice here. We increase and decrease in .25 increments and even take them down to a drop before stopping insulin. We look for all numbers between 50-100 on a human meter 68-slightly higher on the AT for a strong remission. Any chance he might need a dental or have a uti? I don’t think I would start with 1.0 but see what others think.
Here’s your condo from yesterday. We link them. I will read it but noticed that Sienne responded. Let me read. Be back. https://www.felinediabetes.com/FDMB...f-spike-after-remissison.240612/#post-2707402
Thanks for the quick reply! Normal non-fasting BG range on the alphatrak is 5-8 mmol/L, or 90-144 mg/mL (3-6 mmol/L fasting) according to the papers I've read, thus my conclusion he was likely in remission. I agree I should have tapered his dose more slowly, but as I said, this is my first cat with diabetes, and I was not sure what to expect. It is possible that he has some other health issues; I'll keep an eye on him, but so far he's been playing, eating and using the litterbox regularly. Dental problems are common in FIV+ cats, but he had most of his teeth removed last year, and they were fine at last checkup in October. UTI is also possible, but I don't see any signs of that so far. Would you restart with a lower dose than 1unit? The vet started him on 2 units BID in August, but I had to lower it quickly as he went very close to hypoglycemia (at nadir) at the beginning of the treatment. I'll test him again in 30-45 minutes or so, so I'll know how he reacted. Most of his BG spikes correspond to his vet visits
I’m going to tag the mods to see what they think about the dose. How much does he weigh? @Marje and Gracie @Wendy&Neko
That would be misleading because those readings are without insulin from 2 days ago (26-12). I only gave insulin today (28-12). Confusing? I know, I apologize.
Could you please edit the subject line, then to put today’s BGs? We can always go back and look at the other ones on his SS. Plus we have your narrative to refer to. Thank you. I agree with Elise that he wasn’t ready for remission when you stopped the insulin. But that’s not exactly how it works with diabetic cats Look at Henry’s SS. He’s in beautiful, normal numbers but nowhere near ready for remission. Look at China’s SS and specifically Jan-Jun, 2018. The goal is to get the dose down to just a drop by them earning reductions. Once they are in all normal numbers and earn that last reduction, then we start a trial. Starting over at 1u was fine. Just monitor him so we can see if the dose needs to go up or down. Also....what is custom dosing and why are you doing that instead of TR or SLGS? A newly diagnosed cat (FD under one year) and especially one who was off insulin for a while shouldn’t need custom dosing. He will do better if you choose TR or SLGS, but, honestly, if you can eliminate the dry food from his diet, I’d urge you to try TR and see if we can help you get him into remission. BTW...Henry also ate LC dry and you can see the change in his SS when it was eliminated. Finally, if you can PM me, I can set the SS up with a new tab for 2021. We always ask a new SS tab be started each year so they don’t get so long.
Now I need to clarify, lol. Did you get a reading before you shot? Did you shoot 1.0this morning? If so, change the title. If you did not give insulin then AMBG is correct. Marje and I cross posted. Hi Marje.
Arancino was on 0.5 u once a day for two weeks before I stopped it completely for a trial. Henry is still at 2 u BID, that's a completely different picture! Most vets recommend 0.5 u decreases, so that was the smallest dose I considered. I guess I used a SLGS approach and moved down slowly as his BG stabilized (I cannot prick Arancino as often as the TR protocol requires) - because every cat is different, I just followed what the numbers told me. Last changes were discussed with his vet. I was switching the cats to wet food when all three of them got sick at the same time (including two months of assisted feeding) - it was more important to get them to eat, than what they ate, so the plan got pushed back (I was also too exhausted to care). The plan is slowly moving forward, but Arancino has trouble eating wet food - I also have a cat with chronic pancreatitis - any switch has to be slow so that I can catch whether his pancreas is not happy. Life isn't all black and white :-(
Did you look at China’s SS? I would disagree that “most” vets recommend 0.5u decreases. I’ve seen much to the contrary here. I would also say that there aren’t that many vets that manage to get cats into successful and long-term remission while, here, we have a long history of doing so. Thank you for clarifying as it is not clear from his SS that you were doing SLGS. Yes, ECID but that doesn’t mean that a specific, consistent approach to FD isn’t warranted or that making adjustments with no plan or guidance works. One concern I have is that shooting blindly can get you into some real trouble with potential hypos. I can’t even tell you how many people have woken up to an AMPS that, if they had shot insulin blindly, the cat would have hypoed. I have yet to see a cat here not adapt to testing and there have been some that were quite opposed to it at first. Testing is how you keep him safe. TR “requires” four tests a day. The main reason any member can’t do TR is if the cat is eating dry food. Thanks for the info. It was just a suggestion and I hope all the cats are better now. Having had 13 cats over my lifetime, and times of several cats with different issues, I understand there are times of challenge. I certainly wasn’t suggesting life is black or white I was suggesting that if he could eat an all canned or even balanced raw diet, he could benefit from TR.
Points taken. I can assure my approach is very consistent with the SLGS guidelines - I just adapted the protocol to the situation at hand, and I test the cat as often as I reasonably can - this is a cat that scares the hell out of two of his vets and needs 4 people to restrain him for blood collection. I want to stay on his good side if this is for the long term. Weighing the pros and cons here I feel I can "shoot" blindly if I am around to monitor him (and by now I have enough data points collected to know his reaction). The BG range in the spreadsheets seems to be reporting the values for fasting glucose, so not really applicable to "free-range" cats. From: "Managing feline diabetes: current perspectives": "Fasted blood glucose concentration in cats is ~3.0–6.5 mmol/L (117 mg/dL) when measured using a portable glucose meter calibrated for feline blood after overnight hospitalization and withholding food for 18–24 hours." It is not reasonable to have normal values between 3 and 5.5 mmol/L over 24h - the cat must eat! Raw diets for FIV+ cats are discouraged, because raw food diets tent to have a higher bacterial count than cooked food, which may put them at higher risk of infection (that's not a problem for immuno-competent cats). So that is a no-go for Arancino. The transition to wet food is necessarily a slow one because one of the cats cannot skip meals... I doubt it will be ever achieved in my lifetime.
I’d like to preface my remarks by saying that we have alot of “lurkers” on the board. By that, I mean people who sign up because they have a diabetic cat but they aren’t ready to post yet. They read and try to learn just from that standpoint. That’s why it’s very important that experienced members make sure what they write is done so carefully, and, if it pertains solely to a specific cat, it is stated so others understand it’s advice for that specific cat and not to be used with another. Likewise, when we see someone post information that is not only incorrect but also borders on being dangerous, we have the responsibility to speak up. It is not my goal to argue but it is my goal, as always, to impart knowledge to keep your and others’ cats safe. I read that you have a background in biology. I have a BS in biology & chem and an MS in biology and taught anatomy & physiology at the university level for several years. So, when our Gracie was dx, I thought that, as a scientist with a solid knowledge of A&P, this would not be a difficult journey. I was quickly reminded of an adage from graduate school to keep us humble: “you don’t know what you don’t know”. Thanks to some amazing members who stayed after their kitties had passed, I quickly learned that FD is more an art than science. However, it’s imperative that we remember that insulin is a hormone and not a drug. Believing you can predict how it will always behave is a mistake. My goal here is to pass on knowledge to keep you and your kitty, and those of others, safe. I truly believe you believe this but, looking at his SS, your approach is not nor has it been consistent with the SLGS guidelines. If you would like me to get the other two moderators on here to look at his SS and independently give you the same opinion, I’m happy to do so. While it is true that the SLGS method is a guideline and there is some room to modify, we would never suggest that be done for a newly diagnosed cat where there is so very little data on which to base a decision. I am absolutely not being snarky when I tell you that this statement tells me you do not have any knowledge of how Lantus works and you don’t even have the data to explain his onset, nadir, and duration. You don’t have the data to know if he gets any carryover or overlap. Basically.....you don’t know what you don’t know. I am solely saying this because I am truly worried about the danger to which you are exposing Arancino. Pick your battles...yeah, I get that. I absolutely do but the battle you should pick is to test him before each and every shot and at least one other time during the cycle. At the bottom of this response, I have linked a video for how one of our other members learned to test her cat, Junior, who was a large cat and who drew blood even before she could attempt to test him. She was committed to winning that battle to keep him safe and, as it turns out, Junior decided testing wasn’t so bad. I’ve heard so many people say what you’ve said that I can’t even begin to give you an estimate of the number but I’ll tell you that they find out quickly that it’s not a true statement that you can shoot blindly and tell by the cat’s reaction how he’s doing. There was a member who came on not long after us and she was able to get her kitty tightly regulated. But when it became evident he was not going into remission, she just settled for regulation in the 100-150 mg/dL range but his BG was so consistent and flat that she got complacent. For years. She tested, actually more than you do but not enough. She decided to run a curve one day and he was in mid-blue all day so they decided to give him insulin and go out for dinner. When they came home, he was non responsive in a pool of his own vomit and urine. They rubbed karo on his gums and rushed him to the ER where his BG would not register on a meter. Eventually, they got a 22. Sadly, he didn’t make it. She had years and years of data; she knew her cat’s patterns. She could tell you his onset, nadir, and duration. I also knew my kitty very, very well. And I tested alot. One night, she was at 120 when I went to bed, I fed her 10% and got up two hours later, tested her and she was at 60. I fed her 10% food, retested in 30 minutes and she was at 25. Happy as a little clam....no symptoms, purring up a storm, not ravenous. As well as I knew her, and as many times as she had been in the 20s and 30s with no symptoms, I was shocked she was at 25. No vet would have been able to tell she was that low. If you only take one thing away from my posts to you, please let it be that you need to test him before every single shot and once during the cycle. Not true and we don’t use the term “free-range” cats here so I’m not sure exactly what you are referencing. But, the ranges on the SS are not fasting glucose ranges. If you have any understanding as to how the pancreas works, then you would also understand that a diabetic cat that is eating can have normal glucose values. Look through SSs. There are many of them. This statement is taken out of context (also, it is considered very helpful here when you quote a document, that you link it so members don’t have to search for it). The authors were discussing screening of cats for FD in relation to vet stress. I did find it interesting they also stated (the bold is mine): Your little buddy has often fallen in that range and so I’m very glad that you have restarted his insulin. And I hope that you will take to heart and start testing as I’ve suggested. I wasn’t suggesting that you transition him or any of your cats to a raw diet. I was just conveying the requirements for TR. Here is the link to the video on testing a fractious cat: Please let us know how we can help.
I have a PhD in clinical biochemistry, hence I happen to know how insulin works, and how specifically how Lantus works. I thought biochemistry in medical school for two semesters, so I guess our education and experiences match somewhat. Thanks, keeping my cat safe is my priority. Yours seems to pass judgement without knowing me at all. This is your opinion, and as I said, I have the background to understand how it works. I would never leave my cat unattended if I have not taken pre-shot glucose readings. I am not a fool. If he even remotely looks sleepy at an unusual time, I test. I just wanted to point out that the range on the spreadsheets is very conservative. The section I quoted reports normal values after hospitalization and fasting, as reference values; the discussion about stress starts soon after; the full section: "Diagnosis is made based on blood glucose concentration; however, currently, there is no commonly accepted lower cut point for diabetes in cats, with values of ≥180–288 mg/ dL (10–16 mmol/L) reported as diagnostic. Fasted blood glucose concentration in cats is ~3.0–6.5 mmol/L (117 mg/dL) when measured using a portable glu- cose meter calibrated for feline blood after overnight hospital- ization and withholding food for 18–24 hours Screening blood glucose (measured on entry to the consult room) has an upper reported cut point of 166 mg/dL (9.2 mmol/L), showing the potential effect of stress on diagnosis of diabetes in cats. Acute stress can markedly increase glucose concentrations within 5 minutes and may last for 3 hours or longer. Strug- gling can increase glucose concentration on average by 74 mg/dL (4.1 mmol/L) and up to 195 mg/dL (10.8 mmol/L)." Papers is attached. You're free to interpret that as you wish. I take that as the best guess for "normal" range using the instruments I own.
Thanks for your post. Sounds like you have it all under control, then. I truly wish you the best with your kitty.
Since you like papers, you might like this one: Glycemic Status and Predictors of Relapse for Diabetic Cats in Remission The last quote you included somewhat underestimates the effect stress can have on a cat's blood glucose. My non diabetic once measured over 220 at a clinic (and 53 at home on my human meter the next day). We had one member who's can was on at OTJ trial but hated car rides, soared to over 400 after a long commute ride, then back to normal BG the next day. For what it's worth, sometimes a visit to the vet has the opposite effect. My girl Neko generally was lower BG at the vet. At this point it's not really important why your kitty lost remission, but that he did. Unless there are underlying conditions or inflammation/infection that could be treated and help him back towards remission - which is why we recommend vet visits when a cat's numbers go up again. It's unlikely one helping of HC would throw him out of remission. We do sadly see some cats back from remission, some years later, some months. The reasons vary widely. But we have found that the longer a person can safely give insulin in the first remission, the better the odds of staying in remission. And the quicker you can get him back regulated again and safely, the better the odds for a second remission, again, provided there are no underlying complications. It may seem like we keep harping on getting blood tests before shots, but that's based on experience of what we've seen here. My girl had the bad habit of occasionally and seemingly randomly giving me numbers in the 40's first thing in the morning. With no visible signs that it was different from any other morning. I always waited until it was safe to give insulin. Going by behaviour was also not a good indicator of blood sugars. I'd be lucky if I got a clue she was low with her sitting by the fridge or near her testing spot. Many times I didn't even get that.
JoAnne, please don’t ever be complacent about testing before every insulin shot. You may think you are safe by just looking at Arancino and judging he is in safe numbers but you are not. I have had Sheba in the 20s with no signs or symptoms at all. By the time cats start showing hypo signs and symptoms they are dangerously low. If you give an insulin dose to Arancino without testing, when he is already in low numbers, you will have no forewarning that you need to be checking the BGs early in the cycle or feeding him some food to help bring the BGs up higher, and the first warning you will have is Arancino staggering around or seizing on the floor and by this time he will be in very serious trouble.
Hello Testing is so very important. have you considered an implantable monitor? A bit of my background- At the time our boy came into our home he was an intact male who spent his first approximately 5 years as a stray on the city streets of southwest Baltimore. Day 1 we discovered he was FIV+, had an URI and conjunctivitis. Day 2 we found out he was diabetic. I then landed here at the FDMB. After about 8 months of struggle he was found to have IAA (insulin auto antibodies). The result was 84% - which is extreme insulin resistance. He was the last cat anyone ever imagined would go into remission. After 21 months on insulin he did just that. He remained in remission for the rest of his life (6.5 years). My $0.02- The bottom line is that since February of 2008, 456 diabetic kitties have gone into remission using the recommended methods found here at the FDMB. That is fact. I’m assuming you came here to learn how best to treat your cats diabetes. If that’s the case why not roll up your sleeves dive in and give these proven methods a fair chance? No advanced degrees required, just an open mind, the willingness to learn and for safety sake the ability to follow directions.
If you want to throw credentials around, I'm game. I've been on a medical school faculty for 30+ years. I still am on faculty. I've also been on FDMB since 2009. I chose to stay and pass the help I received forward after Gabby crossed the Bridge. Like Marje and Wendy, we accepted the Moderator role because of experience and dedication to this endeavor. Frankly, your cat's spreadsheet scares me. Like in medicine, the basic principle here is "First, do no harm." From what I can see, you are basing decisions on insufficient information. However, that is your choice and you're the person holding the syringe. We will do our best to offer the guidance that has caused 456 cats using Lantus to go into remission. What I've also observed over the 12 years I've been here is that if you keep giving, "Yes, but...." answers, members will take their good will to those who are willing to have a reasonable discussion or ask questions that help them to understand FD. Marje was one of those people who despite a solid grounding in physiology and having been the caregiver for many cats asked a lot (truly a lot) of questions. FWIW, we have vets come here to learn how to use Lantus. We have vets recommend that their clients come here to learn how to use Lantus with their cats. I would like to think that we do know what we're talking about.
Hi I'm Gill, My George is in Remission has been since 2016, he's fallen out of remission a three times, once because of his teeth, second time he got sick (suspected pancreatitis) vet gave a steroid injection and sent his BG to the moon, 3rd time he had some infection (I think he got bitten fighting with one of his younger room mates). We had a couple of incidents of him getting into dry food, which he recovered from spontaneously, in part because this hasn't been a regular occurrence (all the cats including some farm cats are on a wet LC diet so there is no risk of George, who is very resourceful, getting into HC kibble). This is why when cats fall of the wagon we often suggest a check up to rule out infection or inflammation as possible causes, if your other cats have HC food, you may need to step up security around the feeding regime. (vet wants one of my cats to start on a renal diet for some of his meals, I'm dreading introducing it because I know George is really sneaky, it's not easy managing multiple health issues) I got him back into remission, and I have always taken the reductions very slowly (within TR guidelines), first time he went into remission on4/12/2016, it took him about two months to get from 0.50u BID to no insulin, take a look at his chart for that period, his range (even allowing for a difference in meters) significantly lower than the numbers you were getting (even allowing for difference in pet and human meter) and was incredibly well regulated at that point, BG not varying by more than 20mg/DL / or 1.1mmol. Experience on this board tells us that the strongest remissions are often those where where the insulin support was continued for as long as it was safely possible. I believe George has benefitted from this approach and it has allowed him to be resilient in his remission. Sorry but this made me giggle, when George tested low (in the 30's and 20's) he was usually at his most active. He was sleepy when his BG was high. I knew that for definite because I tested a lot (excessive, but I was home, I could monitor, George didn't mind, and it gave a lot of data to allow aggressive dosing with complete confidence). I'm not sure that I would have been able to tell if I had been testing at the levels I see from the SS. if there is one thing that we have in boat loads here is experience with managing FD, folk with a wealth of experience from all walks of life and all around the globe. Vets, Human Doctors, scientists, Nurses, IT workers, stay at home mums and dads, teenagers, Students to name but a few, the one thing we all share is a love for our kitties and a willingness to help and support each other through all of it. It really is 'All about the Cats'. It seems you got upset at the advice and comments you got, I hope than when you have had some time to digest you can take them in the spirit in which they were given. I have no doubt that George would not be here today, aged 21 were it not for many of the folk that have posted on your thread today.
