New Member: Remission already?!?

[BreezyJ]

Hi all!

First off, the information you all have shared has helped me treat my new diabetic cat and avoid any life-threatening emergencies. Endless thanks to you all.

I’m finally posting to ask about remission.

Critter name: Kitty
Diagnosed: Around 1 month ago
Fructosamine: 489, I believe
Meter: ReliOn
BG after diet change alone: ~250
Insulin type: Prozinc 2x daily, 0.5units
Time on insulin: Less than 1 month

We started on 2u once a day and saw dips that were too low, over swings that were higher than BG on diet alone, and we didn’t achieve long enough control. Over two weeks, we bumped down twice - once under vet guidance and two more times on the information here. Finally settled at 0.5u 2x daily about a week ago.

With that dose, we have had some decent control with nadirs between 90 and 130 and pre shot staying around 220-280. But we also had some weird outliers. One morning he was 167 pre-shot, rose to 199 so I shot. And the nadir for that was 175!!!!

At that point I called the vet to ask if she thought switching to lantus might be better. She said she thought waiting just a little longer would be beneficial and I agreed. Little did I know, that morning was his last insulin shot.

Since then, he has remained between 130 and 157 WITHOUT INSULIN. When I see 150, I expect it to rise so I can shoot. But then it goes down to 130! We have skipped 4 doses now.

My question: Is this the start of remission? Should I be giving ANY insulin to support remission? What ranges are considered remission on relion meter?

 

[Tim & Pookey]

Welcome, nice job so far! Normal ranges we look for with ReliOn are 50-100 mg/dL with occasional numbers over 100 mg/dL.

It would be helpful to have some data, ideally in a spreadsheet format used here. Here’s a link on how to set that up and some other information we need. Help us help you.

 

[Sienne and Gabby (GA)]

Welcome to FDMB.

We consider normal blood glucose levels to be in the 50 - 120 range. From that perspective, I think your kitty is doing great but isn't ready for remission yet. We make dose changes in 0.25u increments or smaller. As such, when a cat's numbers drop below 90, the dose is reduced. We encourage reducing to the point that your cat may be getting a literal drop of insulin before stopping insulin entirely. In so doing, you will be providing support for your cat's healing pancreas and hopefully ensuring that this will allow for a strong remission.

 

[BreezyJ]

Thank you for your reply!

Hmm. So I read that I shouldn’t really be giving insulin if the preshot BG is below 200 and 180 if I have enough data to know how he’ll respond. It doesn’t feel safe to administer insulin at 130. Seems iffy at 150 even. Am I wrong? Is it safe since I’d only be shooting 0.25u?

I’ll try to get everything in the spreadsheet just so everyone can see what we’re working with.

 

[Sienne and Gabby (GA)]

I'm going to tag Suzanne (@Suzanne & Darcy) as she's had more experience with Prozinc users than I have.

We tend to be conservative when it comes to getting new members comfortable with shooting lower numbers. A couple of questions, though.... It looks like your cat's fructosamine was in a diabetic range. Was there anything medically going on around the time your cat was diagnosed? Any infection or inflammation can cause a rise in blood glucose numbers. Even something like your cat needing a dental due to gingivitis can cause numbers to be higher. Since you don't have a spreadsheet yet, how did Kitty do with a diet change? What are you currently feeding?

My inclination would be to first see how low numbers have gone on the 0.5u dose. You also have options if the preshot number is lower than your comfort level:

• Don't feed your cat and stall. Wait 20 min or so and then retest. If numbers are still lower, repeat the process.
• Shoot a reduced dose
• Skip the dose

Whether you opt to shoot may depend on whether you are available to monitor.

 

[BreezyJ]

How he was diagnosed:

He wasn’t playing as much and just seemed off, not quite as lovey. We missed it for several weeks, attributing the change to our own health struggles and not being able to play with him as much(his love language is playtime and he gets a little moody if he hasn’t been played with enough). As we got better, he didn’t. He didn’t want to play more and that was just NOT like him. No other health issues besides definitely needing a teeth cleaning, but, for financial reasons, we are triaging and treating the diabetes at the moment.

We got him to the vet immediately and his BG was 350 ish. We asked the vet for 1 week to change his diet and exercise to see if we could get his numbers better. My mom makes their food from scratch. Whole chickens in insta pot, taurine and lysine supplements. She cooks them different types of fish for breakfast and dinner. They have epigen 90 for kibble and she strictly measures carbs. We tried the fancy feast recommended but noticed that his numbers seemed a little elevated on it (only time we got over 300). We tested once to twice a day during that 1 week and only twice had a number higher than 270ish.

But, to encourage remission, we opted to start insulin after that first week of trying just diet. On 0.5, we have dropped to 71, 72, 75, 85 (I believe - going off memory at the moment as I’m away from his numbers). He seems comfortable in the 70s but no lower. Very lovey in 70s and 80s, too sleepy any lower. I’m too nervous to give insulin, even at a lower dose, in the evening if he is below 200 because I physically cannot continue staying up to check his nadir and then be up to administer the next dose. Maybe he can move back to 1x a day just in the morning so I can monitor for dips?

I will speak with the vet either Mon or Tues, but you guys have honestly just gotten us to this point. Our vet can’t be here for every question but you all have been so amazing and helped us through a very chaotic time.

I’ll get the numbers in the spreadsheet tonight. Thank you all!

 

[CORKY]

Thank you for your reply!

Hmm. So I read that I shouldn’t really be giving insulin if the preshot BG is below 200 and 180 if I have enough data to know how he’ll respond. It doesn’t feel safe to administer insulin at 130. Seems iffy at 150 even. Am I wrong? Is it safe since I’d only be shooting 0.25u?

I’ll try to get everything in the spreadsheet just so everyone can see what we’re working with.

Corky uses ProZinc since diagnosed going on 3 1/2 years, I shoot even at the 80s BG, and he definitely is not on remission (see Spreadsheet below) he will be a life long diabetic, ProZinc is a great insulin. It is overwhelming at first trying to take it all in, but we are here to help you, as Sienne explained, the doses are increased or decreased in increments of 0.25units, if your cat has just recently been diagnosed it is too early to tell, keep posting us someone will always be here to step in in your concerns, it is important for diabetic cats to have a diet of wet can food between 0-10% carbs, (NO KIBBLES) they can contain up to 28 % in carbs, most of us members enjoy Fancy Feast Pates, below is a Drs Food chart and a Carb calculator, you should also have what is called a HYPO KIT, this should include some medium carb food between 11-15%carbs and some High carbs between 16-24 carbs between 16-24% also some KARO syrup or Honey, this is to be used if BG goes below 50, We can assist you to regulate the BG to a safe number with food, the Karo and Syrup is for a quick fix. It is great you are home testing, testing before dosing is very important, you do not want to shoot on a low BG especially as a beginner, I know by experience is scary, feeding two main meals prior shooting and 2-3 snack during the day, to keep the insulin in check, testing several times a day is important to be able to monitor how the insulin is working through the day, you are in the right place, this is an amazing Forum with amazing knowledgeable member in dosing, and how to treat a diabetic cat, and Welcome to FDF
Cat Food Nutrition Calculator | Elizabeth C Scheyder
NEW FOOD CHART CHECK CARBS/ FF

 

[BreezyJ]

Edit: I see now what you meant about shooting at 80 after seeing his spreadsheet, sorry!

“You give insulin at 80 BG PRESHOT?! I thought that was super dangerous. But obviously every cat is different and you have tons of data for Corky.”​

Epigen 90 is a kibble with 10% carbs and they get just a couple teaspoons as a treat. We see no spikes with it but do see spikes with the fancy feast pates with supposedly no carbs. Not sure why, but ECID I suppose. All homemade food plus the low carb kibble as a small treat throughout the day definitely seems to work for us and keeps Kitty and the other 4 cats from feeling like they are being deprived while still controlling BG for Kitty.

I think I will reduce the dose to 0.25u for the morning and I’m thinking I’ll try shooting if he is around 150 or higher since he never gets close to that 200 threshold anymore but clearly still needs a little insulin. Thoughts?. I already have a hypo kit on hand with honey and karo and I’ll make sure someone can be around him all day to monitor. I’ll skip the evening dose unless he’s 200 or over since I can’t monitor to see how low he goes anymore.

Thank you all!

Will have numbers in spreadsheet tonight if anyone wants to check back

Corky uses ProZinc since diagnosed going on 3 1/2 years, I shoot even at the 80s BG, and he definitely is not on remission (see Spreadsheet below) he will be a life long diabetic, ProZinc is a great insulin. It is overwhelming at first trying to take it all in, but we are here to help you, as Sienne explained, the doses are increased or decreased in increments of 0.25units, if your cat has just recently been diagnosed it is too early to tell, keep posting us someone will always be here to step in in your concerns, it is important for diabetic cats to have a diet of wet can food between 0-10% carbs, (NO KIBBLES) they can contain up to 28 % in carbs, most of us members enjoy Fancy Feast Pates, below is a Drs Food chart and a Carb calculator, you should also have what is called a HYPO KIT, this should include some medium carb food between 11-15%carbs and some High carbs between 16-24 carbs between 16-24% also some KARO syrup or Honey, this is to be used if BG goes below 50, We can assist you to regulate the BG to a safe number with food, the Karo and Syrup is for a quick fix. It is great you are home testing, testing before dosing is very important, you do not want to shoot on a low BG especially as a beginner, I know by experience is scary, feeding two main meals prior shooting and 2-3 snack during the day, to keep the insulin in check, testing several times a day is important to be able to monitor how the insulin is working through the day, you are in the right place, this is an amazing Forum with amazing knowledgeable member in dosing, and how to treat a diabetic cat, and Welcome to FDF
Cat Food Nutrition Calculator | Elizabeth C Scheyder
NEW FOOD CHART CHECK CARBS/ FF

 

[Sienne and Gabby (GA)]

I was a Lantus user with Gabby. With Lantus, the mantra is "Shoot low to stay low." For cats using the Tight Regulation Protocol, which was developed based on clinical research that was published in a leading veterinary journal, we shoot any number above 50. The pharmacology of Lantus is different than most other insulin. However, I'd encourage you to stop by the Prozinc forum and look at some of the spreadsheets of the cats there. Even with Prozinc, many members are shooting numbers that are similar to those with cats on Lantus.

We don't suggest shooting that low until you have confidence in your ability to manage low numbers. Seeing low numbers can cause more than a little anxiety in most new members. Figuring out how your cat responds to high carb food, which is used to steer the curve back to solid numbers, takes some getting used to.

 

[CORKY]

You give insulin at 80 BG PRESHOT?! I thought that was super dangerous. But obviously every cat is different and you have tons of data for Corky.

Epigen 90 is a kibble with 10% carbs and they get just a couple teaspoons as a treat. We see no spikes with it but do see spikes with the fancy feast pates with supposedly no carbs. Not sure why, but ECID I suppose. All homemade food plus the low carb kibble as a small treat throughout the day definitely seems to work for us and keeps Kitty and the other 4 cats from feeling like they are being deprived while still controlling BG for Kitty.

I think I will reduce the dose to 0.25u for the morning and I’m thinking I’ll try shooting if he is around 150 or higher since he never gets close to that 200 threshold anymore but clearly still needs a little insulin. Thoughts?. I already have a hypo kit on hand with honey and karo and I’ll make sure someone can be around him all day to monitor. I’ll skip the evening dose unless he’s 200 or over since I can’t monitor to see how low he goes anymore.

Thank you all!

Will have numbers in spreadsheet tonight if anyone wants to check back

@Suzanne & Darcy
Please understand that it has been 3 years of getting to know Corky with diabetes, and at first if Corky's BG was 150 not only would I not leave my house, but I would bombard this Forum when the time for dosing was near, I was told by the Vet when he was hospitalized that a diabetic cat's normal BG was between 200-300, which is was not true, I was misinformed, and he also had the Libre sensor which made a nightmare, in this journey, you have been directed to @Suzanne & Darcy, she will be able to help you with dosing, with her guidance, monitoring and teachings in this matter along with other well known members I have been able today to shoot in these low numbers, I am an obsessive tester, it's been a habit from the start and not everyone can do this, so yes, I shoot low but 80's for ProZinc in not low, but this event was done with time and understanding and coaching, I do not recommend as a newbie to do this, or reduce or increase on your own, it takes several cycles and data accumulated to be able to do this, and not skipping doses is very important, so when in doubt posts us, before shooting so we may assist you if needed

 

[Diane Tyler's Mom GA]

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