Sam update 8-19-20

Discussion in 'Tresiba (degludec)' started by Sam & Esse, Aug 19, 2020.

  1. Sam & Esse

    Sam & Esse Member

    Oct 18, 2017
    Hello! :bighug:

    It's been a while since I've posted a Sam update... along with cute Sam pics ;)

    Sam's doing well! Back on April 20th, he got terribly ill. We suspect he might have been poisoned, either unintentionally -- or intentionally -- by the folks next door we politely call "The Bad Neighbors." The vet diagnosed him with a fever of unknown origin; the dreaded FUO. It was a knuckle-biting week, with Sam going in for IV fluids every day to try to bring his fever down. There was Exorcist-levels of vomiting, uncontrolled diarrhea, the ooze that had to be bathed from his bottom that he had no control over...

    But Sam pulled through! :bighug: Although he did briefly come out of remission. I restarted his Tresiba on 4-25, and by 5-11 he was once more OTJ. I was very glad to see that the Tresiba seemed to kick in immediately, unlike our first change-over from Lev back in 2018. Sam lost quite a bit of weight -- and he's making up for that, now :facepalm: I really need to cut back his Friskie's pate consumption, but I'm also kinda hoping he'll build back up some muscle in his back-end. I know I'm not able to put on muscle while losing weight -- and I don't know if it works the same for cats, but I'll give him another few weeks before cutting back on his calories once more.

    Here's some pics of Sam, and the two 'little' girls, Mia and Shadow. They love their Big Boy so much -- and Sam still hasn't gotten acclimated to there being kittens in *his* house.

    sam-coffeetable.jpg sam-mia-bed.jpg mia-shadow-toys.jpg

    Since Sam's illness, the rusting has come back with a vengeance. I've kind of given up on it, for now. He's still getting sores/crusting on his ears, and along his chin... I know it's not his food bowl, since Sam's been hand-fed since kitten-hood :facepalm: :oops: I'm fairly certain it's from contaminated dust outside. I wipe him off every time we come in from outdoor play. And he doesn't appreciate losing his dust. At all :p

    And on a more scientific-y note:
    Came across a fairly new study that was released back in April of this year.
    The effect of Insulin Degludec on glycemic control in diabetic cats over a 12-month period
    ^ Link goes to site :D
    Looks like it was originally published in The Journal of Veterinary Medical Science in June. The study only included 8 cats -- 5 newly diagnosed, and 3 that were already on insulin but poorly regulated (1 Lantus, 2 Lev). Considering that it appears there was absolutely no home monitoring going on (!) it looks like all the cats did well on Tresiba. It was a very encouraging read :bookworm: There was only 1 mild hypo event -- which seems like a small miracle with the lack of home testing.

    My biggest take-aways from the study:
    Improvement in serum GA was significant. ...I think that's a bit like the Fructosamine test? But not quite lol! At least the NIH claims serum GA is better than A1C -- for whatever that's worth :confused:
    I think all the cats gained weight on Tresiba? Great for cats that are underweight -- not so great for chonkers like Sam :banghead: But this is something I noticed for myself when Sam first started Tresiba. So anyone starting or switching to Tresiba needs to be aware of this side-effect.
    The researchers believe it may take a higher dose of Tresiba to achieve similar results to Lantus or Lev in regards to regulation. But the dose might be safer from life-threatening hypos than other commonly used insulins for FD; a much larger study will be needed to verify this.
    All 8 cats in the study were on a dry food diet. If the results were this good with dry food, imagine what they might be like on a low-carb canned/raw diet :eek:

    I do hope that other members of FDMB that haven't been able to regulate their cats with other insulins might consider giving Tresiba a try. Slowly but surely more research is coming out proving Tresiba is a perfectly good insulin for cats -- and that it can significantly improve regulation in cats that have had poor blood glucose control on other insulins.

    :( It just makes me a bit blue, when caregivers haven't been able to regulate their sugar kitties for over a year, and seem to settle for, "Guess my baby is doomed to be bouncy." Tresiba is a newer weapon in our arsenal against FD -- not necessarily better, but newer -- and I think it's worth a shot if other insulins just aren't working.

    :bighug: Lots of love and hugs to everyone. Stay safe! And love and scritches to all the kitties :cat:
  2. Sue and Luci

    Sue and Luci Well-Known Member

    Nov 3, 2017
    I've been toying with the idea of looking into this...

    Is there any more information about how to use it; what to expect, etc ?

    Luci has been on insulin for nearly 3 years now, first Lantus and now Levemir. I just cant get her to shake those yellow starts/stops.

    I'd love to get some direction or other information to read up on. I've got one pen of Lev left so I don't have to rush - I'd rather try to absorb some info on the how to's and then ask about getting some Tresiba for Luci and me to give that a go...maybe there's hope with this one??

    Thank you!
  3. Sam & Esse

    Sam & Esse Member

    Oct 18, 2017
    Hi Sue :)

    Most of the info on Tresiba is anecdotal, which is why I was so excited to see the Japanese study today :joyful: As far as I know, it's the first study that was actually dedicated to seeing how Tresiba worked long-term in diabetic cats. Other studies that used Tresiba were... less than helpful :banghead: But let me find a few links... I always tended to add them to my posts as I found them.
    :( There was an oral presentation comparing Tresiba to Toujeo given by Chen Gilor, DVM, PhD, DACVIM, but it looks like the handout notes have gone MIA. Basically, one dose of each insulin was given to six healthy cats, 1 week apart. Each cat was put on a glucose drip, their BG was taken every five minutes -- and it was concluded Toujeo acted longer and thus was a better candidate for once a day dosing in cats :mad: Everything about this "research" project makes me angry. The bare bones can be found here: Comparison of Pharmacodynamics Between Insulin Degludec and Insulin Glargine 300 U/mL in Healthy Cats -- goes to Event Scribe :)
    This was an interesting slide show that covered a bit of everything: Diabetes Mellitus (Do we really know what’s going on?) -- goes to a .pdf at It at least mentions Tresiba :rolleyes:
    Then there was the tiny Zurich study: Evaluation of 2 Insulin Preparations and Validation of a Continuous Glucose Monitoring System for Use in Cats --, put Tresiba into the Find bar of your browser, because this is a long, long page. Again, this study used healthy, purpose-bred cats (6), and their conclusion was sorta -- yup, it works :facepalm:

    And as far as I've been able to research -- this is it in the way of scientific study.

    I know that, for Sam, Tresiba was a mystical, magic medicine of strange and wonderful powers :D Other people haven't had quite as good of success, but still seem happier with Tresiba than other insulins they've tried. If you check out Sam's SS, you can see he started Tresiba 5-13-18, and by 6-4 it became very apparent that he was responding favorably. I'd say he started excellent regulation 6-20. Oh, and all of those reading are with the AT2 -- I didn't go to a human meter until 2019.

    Zeke's been bouncing far, far less, and not nearly as high; waves at @Meridith and Zeke I love looking at his SS to see how he's doing :joyful: It gives me a lot of joy that Zeke is spending most of his days below renal threshold. Sue, since you want to see Luci out of the yellows, I do think Tresiba might be worth a try for you. Looking at Luci's SS, she's regulated -- but could do with a longer lasting insulin.

    I think, especially now that the Japanese study came out, we can conclude that Tresiba is safe to use in cats, so I'm not sure if there's as much need to start Tresiba with a token dose to make sure there isn't a reaction. It probably doesn't hurt, but it's likely not needed, either :confused: Since Luci did have ketones, you would probably be better off starting on the same dose of Tresiba as you're currently using for Lev. You'll have a few days while the Lev depot depletes and the Tresiba depot builds; I would think by the fourth day you could follow TR protocol with little problem. I do think you'll want twice a day dosing; again, since there were ketones in the past, better not chance once a day dosing starting out.

    As long as you have a strong grasp of the dosing methods used for Lantus and Lev, and you know Luci's responses well, and you don't need much in the way of dosing advice, it should be reasonable for you to give Tresiba a trial run.

    Jessica documented Conan's beginning with Tresiba quite well. Conan did better on Tresiba, but it wasn't the miracle for him, as it was with Sam. @Cheryl and Yoda I know liked Tresiba, but eventually had to add in R, if I'm remembering right. I'm keeping my hands together that Zeke will get OTJ :kiss: There's a lot of good information in the older posts in this ISG, along with a lot of questions -- most of which we still haven't conclusively answered lol!

    @Meridith and Zeke , am I forgetting anything? Or if there's anything to add? My brain's a bit addled at the moment :p

    Sue, if you have any specific questions, or doubts, or anything, please let me know :bighug: Especially if you have a question about something on Sam's SS -- not everything made it into notes.
  4. Sue and Luci

    Sue and Luci Well-Known Member

    Nov 3, 2017
    I did take a close look at Sam's SS - and wow! Your start date was just before Luci was diagnosed...we were testing - well some testing - mostly wrestling about - and trying the low carb food thing first to see if the kibble was the cause of her high numbers. Finally we started Lantus in January 2018...and we've been at it ever since - switching to Lev in July 2019 - after so much time of the bouncie bouncies...I was willing to try to see if at least I could slow that down - and I felt that the Lev has been helpful in that department.

    But you're right on with the dose isn't holding for long enough - so that's kinda why I'm thinking/looking at alternatives. I'd heard just a tiny bit about Tresiba - mostly that it was a 'once a day' insulin - which doesn't matter much to me - I work from home, and I'm pretty much a home body anyway - and now with this crazy pandemic, well that's more true now than ever before - so I'm ok with twice a day dosing - I'd just love for her to give up those yellow bookends and well some days she just never gets down from her lemon tree nest at all...but when she does, she dives right on down into that I've got to be careful about watching her when she's surfing - she used to sneak by me all the time and go shark chasing...she's been a handful!

    So I do have one question - with the testing - I noticed that you didn't get any mid-cycle tests in after August 2018 - during the day or at night - I was wondering why...not at home? I know people that work can't get all those would be great if I could get a break from all the testing all day and half the night - but I dare not take my eyes off Luci - especially soon after she gets her insulin - she's just as likely to take off on a diving mission as not...I never know what she's going to I test pretty much up until early-mid afternoon - typically she turns around and starts marching right back up to the lemon tree during the afternoon and by PMPS is right back up there..

    Just wondering if that's an effect of the Tresiba or not?

    And then later he went into remission! OMG! After all that time!!!

    I've pretty much given up on hoping that Luci will go into remission - but OMG what a godsend that would be! This routine is exhausting...and I'm getting older, but with that said I've signed up for it...and I don't care for the I've accepted that this is what it is and we'll support her as long as she's a member of this family. Fortunately I have DH to help me out at night - he tends to be more of a night owl so getting another test or two in the PM isn't a big deal for us...

    I'll go and take a look at those studies...but if you think there might be a remote chance that Luci could at least level off and stop with the lemons I know it would be better for her - and that is good enough for me :)

    Thank you!!!
  5. Sam & Esse

    Sam & Esse Member

    Oct 18, 2017
    Hi Sue :bighug:

    So, for a bit of back history: When Sam was diagnosed, I learned right away to home test. Only, because of my night time meds, I couldn't test at night. :blackeye: I'm dangerous at night; stumbling, not-really-there zombie. There isn't even a chance at a before-bed test, because Sam's PMPS is my before-bed. If Sam's pre-shot was worrisome, I skipped my meds to try to get night tests -- but that couldn't be done often. Then my memory started going. I couldn't get Sam regulated with Lev -- and there was the very real possibility that I'd get to the point I couldn't take care of Sam, and there was no one who'd be willing to take him unless he was regulated. I'd given Lev six months, and basically switched to Tresiba out of desperation. My memory continued to worsen; I had family call to remind me about Sam's pre-shots and insulin, but I just couldn't remember to test mid-cycle :( Thankfully, with Tresiba Sam stayed very level; once regulation is achieved, BG stays pretty much level. Also thankfully, my doctor finally tested me for just about everything under the sun that could cause memory loss -- and it turns out I had a severe B12 deficiency :banghead: So fingers crossed, my memory isn't getting any worse now lol!

    One interesting table with the Japanese study, Fig. 2, shows a comparison of 4 of the cats glucose levels every 2 hours, at 3, 6, 9, and 12 months intervals of Tresiba treatment. By month 12, there's a very clear raise in BG to +4 (although a few cats dipped lower at +2, then rose at +4), then a gradual decline all the way to +10. The study warns "veterinary clinicians should be aware of hypoglycemic events between 8 and 12 hr after IDeg injection". In practical terms, I knew Sam's nadir was right around shot time -- give or take two hours -- after he'd been on Tresiba a few months, and that any movement would be minimal. This, too, was confirmed by the Japanese study, "temporal mean glucose concentrations between 0 and 10 hr in four diabetic cats suggested that IDeg induced continuous glucose-lowering effect without any pronounced peak effect, and indistinct peak effect was observed between 8 and 10 hr." That takes a lot of worry away over unexpected drops. That's not to say they don't happen at all; Sam did dip into the limes a few times when he first started Tresiba, but as time went on, he flattened, and flattened... and flattened lol! It's another nice thing shown by the study; even in month 12, there was improvement in BG level stability.

    I do wish, though, that we could see data for all the cats. But they only ran the 3 month interval curves on 4 of them.

    ECID, but I do think Tresiba is worth trying for Luci. For a while, you'd still need to get in scattered tests throughout the cycle; the nadir should gradually shift later, until it falls during pre-shot, or close to it. You'll need to make sure you're okay shooting low numbers; although it is a big no-no, I know both I and Meridith have shot on what would technically be a take-action number :oops: Just by a point or two, but still... very much frowned on. Never to be attempted by someone who isn't absolutely sure about what they're doing :nailbiting:

    I'd say, give Luci a three month trial on Tresiba (unless something unexpected happens and going back to Lev is needed). I think all of us that have tried Tresiba on FDMB knew by the three month mark whether Tresiba was an improvement or not :D I knew by the first month, and I could see improvement with Zeke's SS about 2 months in (although his pinks started clearing up sooner). Conan was complicated, but to me there looked to be a lot of improvement by the 5th week of starting. ;) And none of us began using Tresiba because our cats were easy to regulate :p Our kitties were all champions of the bounce house.

    Luci would be a bit different starting out, because you do have her regulated; she's just regulated a little too high :confused: And she has a bit too much movement down at times. For a sugar kitty that's well regulated on Lantus or Lev... I don't know if I would recommend Tresiba, because those cats wouldn't need longer duration. Going by Luci's SS, she could use a few extra hours of duration :bighug: Since she's at a .75u dose, you could start her at .75u Tresiba. But if the Japanese study is correct, you might be looking at an increase within the first week to 1u. Give the Lev 3 days to leave her system, then the Tresiba a few days to show what it can do on its own.

    I raised Sam's reduction point to 60 because of my lack of testing; I liked having a bit of safety margin. But with you being able to test Luci as needed, you could either stick with your current reduction points, or reset them to 1x under 50 until you get a better idea to how she's reacting to the Tresiba. It's all personal judgement calls.

    :bighug: And I really didn't think Sam would ever go into remission, that he'd been diabetic too long, and had been untreated too long before diagnosis. Never give up hope!
  6. Ti-Mousse (GA) and Pepe

    Ti-Mousse (GA) and Pepe Well-Known Member

    Dec 2, 2018
    Thanks for all the info! Very interesting ....
  7. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    May 18, 2016
    Lovely to hear from you. I'm sorry Sam and his humans had a rough go of it for awhile. Sam has always been one of my favourites.
  8. Sam & Esse

    Sam & Esse Member

    Oct 18, 2017
    :bighug: Thank you! I'm just so grateful Sam has mostly recovered, and was able to go OTJ again :joyful: Had my hands together a lot during those couple of weeks.

    Thank you for stopping by! :bookworm: I like research, and tend to share anything I find a bit interesting.

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