Is Gizmo ready for OTJ?

Hi All,

Gizmo started having some really good numbers at the beginning of August. Then we went on vacation (8/7) and the numbers went even lower (157 being the highest, but lots of low 100's and 70-90). Because I knew my pet sitter would be unavailable during the day to retest I had set my dosing instructions for a lower (safer) level for the pet sitter. Turns out Gizmo only got one shot while I was away. Because she wasn't eating well (at least according to the pet sitter... I'm beginning to think that Gizmo snuck back and finished her food at a later time, but I've got 5 cats so it's impossible to tell for certain). The rest of the time she was OTJ. We got back on 8/22, and I still haven't given her any insulin. Because I didn't understand why the numbers were going low, and I thought she wasn't eating, the sitter took her to my new vet (the old one retired just a week before I left on vacation), and she had a fructosamine test which came back at 384 on 8/13. I have 2 questions:

1) I've heard of stress causing glucose to go high, but can a cats glucose also go low when stressed?
2) I've seen a lot of stories about cat's going OTJ, but I haven't managed to find a link to a discussion that would help me determine whether or not she should be OTJ.

 

I think you may need a small dose of insulin for a bit longer to get a strong remission. I will ask @JanetNJ as she is a Prozinc user

 

i'm not really sure. he's naturally getting in those greens but did have a couple of higher numbers.

 

When are you feeding him? Are you giving snacks throughout the day and nights?
Can you try giving a snack at +9 in both cycles to see if that brings down the preshot please?

 

@Bron and Sheba (GA)

Gizmo is fed at AMPS, AMPS +6, and PMPS 1 can of fancy feast pate. Recently she has been walking away before finishing, but then I find her finishing our other cats food (also fancy feast pate), and sometimes back at her own dish. Since it's all the same food, I don't know if she's exerting dominance or what.

This weekend I can try a snack at +9 to see how it goes. Not sure that's sustainable, but it will be interesting to see.

 

I started the snacks at +9 ps on Friday afternoon. She does eat, but I am not seeing a reduction in PS values. She still has not had any insulin since 8/9. She's now more solidly blue than green. Advice?

 

I guess Gizmo made the decision for me. AMPS this morning was 191. I gave her 0.2. Guess we'll see where she goes from here. I was so hopeful.

 

Good call. I think a low 0.25 dose is needed. We want those numbers lower.

 

So, I guess I'm back to my original posting question. How low can you safely dose a Gizmo? Unfortunately it appears that she isn't ready for OTJ, but her PS numbers are pretty low. I plan to do a curve this weekend, but what should I try giving her when her numbers are like this? Stick with 0.2 or go with DS?

 

what is ds? Don't shoot?

I like the 0.2 when it's over about 115. If it's like 100-115 ish maybe just give a drop. 0.1. If it's a green preshot, stall for an hour and see what is doing. If it's still green, skip.

 

Sorry... I think I found that in someone else's post and it was probably a drop dose, but I didn't remember the exact term, and assumed it was drop shot. By DS I meant getting as little into the syringe as I could, and still give a dose of some kind.

 

Oooh ok. I hadn’t heard that term. It’s fine to use that if you want. Or you could put 0.1

 

So all of a sudden Gizmo is in the yellows again. No idea why, but she is now eating all of her food at once and not walking away and coming back at a later time. Should I increase the dose from 0.2?

P.S.- I also removed DS from spreadsheet and just put 0.1

 

I wouldn't worry about 1 reading. Do the 0.2and see what the number is in 5-6 hours

 

+6=77. Glad I stuck with the 0.2 Thanks!

 

@JanetNJ & @Sienne and Gabby (GA) & @Bron and Sheba (GA) and any others that have advice:

Gizmo went through a bout of diarrhea and appeared to be losing weight. When I took her to my new vet (my old vet retired) on 9/16 he suggested perhaps trying no insulin for a while. I wanted to get a good curve while she was consistently on a 0.1 dose, so we compromised, and I kept her very consistent 9/17-9/25 (skipped one dose because her glucose level was 88 at PMPS on one day), and did a curve 9/24-9/25, and then went OTJ. She has an appointment for bloodwork and urinalysis on Wednesday. My questions:

1) My vet is just graduated and doesn't have a lot of experience with diabetic cats. Are there any specific tests I should request besides the bloodwork (which I'm not sure what will be included besides fructosamine) and uranalysis?
2) Should I do a curve on her this weekend?
3) What do you think her numbers so far OTJ?

 

I would not be comfortable offering information about stopping insulin without more spot checks. Getting a curve really doesn't answer the question -- it's a snapshot of one day vs seeing the full picture. You need to get at least one test during both the AM and PM cycles in addition to your pre-shot tests in order to know where the numbers are, if there's bouncing, if you're cat is in safe numbers, etc. It's especially useful to know if the nadirs are in normal range. At this point, you're still seeing pre-shot tests that are outside of normal range. You want to see more green on Gizmo's spreadsheet. Looking at the PMPS numbers from when you stopped insulin, it looks like numbers are edging back up.

Many vets are not comfortable with seeing normal range numbers for a cat on insulin. As a result,, they will suggest stopping insulin prematurely which can result in the kitty not maintaining the remission. The vets are apprehensive since most of their clients don't home test and they are concerned about the cat becoming hypoglycemic.

A fructosamine test is not a part of routine blood tests. It may be helpful. If you were testing a bit more, it would be unnecessary. A urinalysis is not a blood test. Typically, it's when the vet uses a needle to get a sterile urine sample from your cat's bladder. (It's called a cystocentesis.) If you look at the Labs tab on your spreadsheet, you entered lab (blood) data a year ago. It should be similar but it may vary depending on where your vet sent the sample. I'd encourage you to make sure your vet is getting a senior panel -- any cat over 10yrs old should have a senior panel done.

 

Thanks for the info. I'll try to get a few more numbers this weekend, and make sure to ask for a senior panel.

 

@Sienne and Gabby (GA) & @JanetNJ ,

I think the curve on Saturday looks pretty good, and she'd been off of insulin for a week by then. Thoughts about what I should be trying to work with the vet? Her numbers seem about the same as when she was getting the 0.1 dose.

 

Good luck!

 

@Sienne and Gabby (GA) & @JanetNJ ,

My vet says she's not diabetic now, and perhaps never has been (?!?!?). We have some insulin still (although it's been open for several months), but he definitely won't prescribe any unless she exhibits clinical signs of diabetes again. What do you think? Should I let her remain OTJ and just monitor? I added all of the lab work information to her chart. When do I start to worry that she needs to go back on? How often should I monitor? I am in a location where I could go to another vet (although I don't know if I'd have any more success getting insulin). This vet is very young (graduated in 2020), and has just taken over the practice from my old vet, who decided to retire at the grand age of 80.

 

Well definitly was diabetic from those numbers. Sounds like your vet isn't used to cats that go into remission. So I'd still test at least a couple times a week, and then after a couple months go to at least once a week. If he falls out of remission you want to be able to catch it quickly.

Is officially remission when he's in normal range (50-120) without insulin for at least 2 weeks.

 

Like Janet, I'd be very curious what your vet considers normal BG for a cat. -The reference ranges that are on lab print-outs or mentioned in journal articles are typically about 75 - 170. However, these are values from a serum chemistry analyzer which gives similar readings as an Alpha Track meter. The range we use is 50 - 120 based on a human meter. I'm guessing the vet isn't able to think outside of the box and given that your Relion meter reads lower than an AT or serum chemistry analyzer, he's misinterpreting your results.

The numbers over the last day or so look like they're edging up. I would suggest that if you're seeing higher numbers, give Gizmo a tablespoon of LC food and see if his numbers drop back down. That would be a sign that his pancreas is working. You may need to give him snacks.

 

@Sienne and Gabby (GA) ,

What do you mean by LC food? Gizmo has been on fancy feast pate for a year now. And for what it's worth, I was feeding Gizmo 6 am, noon, and 6pm and my vet was very much against any feeding except at 6 am and 6 pm. I did ask the vet about what were reference numbers - and he basically said that anything over 159 is clinical, but that since cats are known to go higher under stressful situations (i.e. the vets office), that he wouldn't agree to giving more insulin unless Gizmo's numbers were much higher and/or she's exhibiting clinical signs of diabetes. He even went so far as to suggest that Gizmo wasn't ever diabetic, and the numbers reflected could be due to the somogyi effect.

Thanks for all your help.

 

If you see the numbers trending up, like the 170 on 10/6, a little bit of food may stimulate the pancreas to produce insulin which will pull the numbers down.

Your vet is incorrect with regard to Somogyi. (This is a soapbox issue for me so sorry in advance for the rant.) Somogyi was first proposed and published in 1938 by Michael Somogyi is a local (St. Louis) medical society journal. This is not research that ever made it into a mainstream medical journal. It was based on a very small sample of human and NOT on an insulin such as Prozinc or Lantus. The results of his research have never been replicated and at best are controversial and at worst, the equivalent of an urban legend. Roomp & Rand (2015) looked for the presence of chronic Somogyi rebound in diabetic cats being treated with Lantus. They could not find any evidence of Somogyi in the 55 cats and over 10,000 glucose curves they examined. The take away is that Somogyi does not exist in cats that are prescribed Lantus. I suspect there would be similar results with Levemir and Prozinc.

 

Thanks for the rant! That's good information. Even if the Somogyi effect was real, everything I've read indicates that an hypo (or at least near hypo) event needs to occur prior to an upswing, and I just don't see that in Gizmo.