Hi all! It's been several months since I have posted. I probably should have requested advice more often, but life has been a bit crazy. I feel kind of guilty to be honest. Charleston has been consistently getting his dose decreased. He's down to .25U right now. He also lost another pound and is now at his ideal weight per the vet. I've been slowly getting comfortable shooting lower and lower numbers. In the beginning I wouldn't give him insulin if he was less than 300 (my vet's number), and now we've worked our way down to 150 as his no shoot number. He's been below that at almost every shot time for the last week or two, which means lots of skipped doses. He got blood and urine testing done last week and everything looks good - no glucose or ketones in his urine. No ketones from my home testing either. My vet has access to my spreadsheet, but hasn't given very clear guidance on what to do at this point other than "keep doing what you're doing." It doesn't seem to me like he's ready to come off insulin completely, but I'm trying to figure out what to do next. I've been using SLGS, but thinking maybe I should switch to one of the alternative Prozinc dosing methods? I work from home, so can pay very close attention to his BG. Or maybe he should get an even smaller dose than .25U? Any advice is appreciated. One other thing worth noting - he's got a mast cell tumor on his ear and is going in for surgery on Wednesday to have it removed. He'll be getting his teeth cleaned as well. We're not sure if the tumor is cancerous yet, but will find out after a biopsy. Poor dude is having a rough year health wise. Thank you!
Looking at the SS, I don't think that Charleston is quite ready to get off insulin either. There are 2 smaller doses you can give, smaller than the 0.25U dose. Those would be 0.1U and "some insulin" otherwise known as 1 drop. Really hard to measure those smaller doses with the U40 syringes. Still hard to measure those small doses even using U100 syringes and the U40 to U100 conversion chart. Basically, you multiply the U40 insulin amount by 2.5 to arrive at the amount of insulin to draw up in a U100 syringe. You would want to get U100 syringes that are 3/10 cc volume (30 units), with 1/2 unit markings on the syringe barrel. You still have to eyeball, or make your best judgement of those tiny amounts. Practice with some colored liquid, or juice at first to measure out those smaller doses. A used syringe works just fine for practicing. Sending vetty vines for Charleston's surgery this week. Let us know how he does.
@Lisa and little @Deb & Wink Thank you both! His surgery went great (aside from him REFUSING to wear the cone of shame afterward), and he is all healed and recovered now. His tumor was benign, so that's great news. Though because of various factors and lack of getting good margins, it may come back and we'll keep monitoring it. Even though I thought he wasn't quite ready to take him off insulin completely and was ready to give him the "some insulin" doses, my vet did recommend that I stop giving him insulin after his surgery. It's hard getting different advice from my vet than I get here (and several times I did follow the advice I got here anyway). But, I did go ahead and stop giving him insulin completely on December 17. I've been checking his BG periodically and he's consistently in the 70s and 80s. I'm not sure if I can say he's normalized or in remission yet (I think I saw somewhere he has to maintain normal BG without insulin this for 4 weeks?), but I'm very excited about this. When he was diagnosed in April, his BG was 551 and his fructosamine was 445, and my vet at the time told me she had never seen a cat with those kind of numbers go into remission. I don't think he could have made this much progress without the information I've learned from this forum, especially the dosing advice I have received from @Deb & Wink, and the encouragement to monitor his BG closely and adjust doses based on SLGS. So, huge thank you!!! Now I just hope things continue to go well He's a very happy kitty. Here is a picture of him in his Christmas sweater for good measure.
Oh my goodness! Not that long! It's only 14 days (28 cycles, each cycle being 12 hours, so 2 cycles in a day) in normal numbers to consider a cat OTJ (off-the-juice, insulin being the juice) and "in remission". Charleston is now diet controlled. He's still diabetic, but doesn't need insulin right now. CONGRATULATIONS on having an OTJ (off-the-juice) kitty! Charleston looks awesome in his holiday sweater. Looks like that sweater would have been a good substitute for the cone of shame. Hope he continues to be well and the surgery sounds like it was a huge success. Here are some tips to stay OTJ (off-the-juice, insulin being the juice) 1. Never feed dry - not even treats. (freeze dried is ok, Dr. Elsey's chicken flavor is ok.) If you change wet food types, be 100% sure the new food is also low carb and same low carb % as your current food. Some cats are very carb sensitive and an increase from 3-6% to 8-10% can spike the BG’s. Don’t feed if you aren’t sure! 2. Weigh every 2 weeks to 1 month to watch for weight changes. Too much of a weight gain can cause loss of remission. Too much of a weight loss alerts you to other issues, such as hyperthyroidism. 3. Measure blood once a week, indefinitely if possible. You want to catch a relapse quickly. Some people only do checks every 2 weeks to a month. BG checks can sometimes alert you to other issues. 4. No steroids or oral meds with sugar - remind your vet whenever giving you any medication. Always double check. (Steroids may be needed for other medical issues. But remind your vet your cat is a diabetic, diet controlled.) 5. Monitor food intake, peeing and drinking. If increasing, a sign of losing remission. Or another medical condition like Hyper-T or kidney disease. 6. Regular vet checks for infection such as dental , ear or UTI. And get them treated quickly! 7.Continue to ketone test even if your cat is OTJ. Ketones can develop if the cat’s pancreas is not producing enough insulin, or burning off too much fat if your cat is not eating properly and other reasons. If your cat does fall out of remission you need to be more aggressive and resolve issues/ back on insulin as soon as possible as the window for a second remission is tight if any. Pancreatitis, hyperthyroid, dental issues are the most common reasons cats fall out of remission. "Once a diabetic, always a diabetic." They are simply diet controlled.
Thank you @Deb & Wink! Appreciate the tips for keeping him OTJ and plan to follow all of them. You're the best
