Starting a new thread as requested but basically he was on insulin for a very short time but so unstable both extremes his Libre tag was just reading HI he was off the scale mainly in the day I was lucky if he got to mid teens mmol but he stayed late teens and early twenties for the majority of the day he was on two shots a day varying dosages to try and get him under control his last dose age was 2IU he’s a Maine coon too so big … at night he went the other way very very low and a rapid decline numbers dropped so fast he’s had different Libre tags and they all reported the same… been weeks up with him every night stopping him going into a hypo …both ways hi and low very scary… so the vet said we need to do something for him … she got in touch with the manufacturer they advised he was a suitable candidate because he hadn’t been on insulin that long… tested for ketones a week before treatment … stopped insulin the day before on advise of the manufacturer and the vet they were in discussions about him… I was very nervous because of ketoacidosis but went ahead felt like he couldn’t carry on as he was… from the very first dose about 30mins -1 hour he was in the green… and it’s stayed that way for 5days… I’m checking for ketones in his urine every day at 5am before he has his next dose … so far clear for ketones … even if there is a trace treatment stops immediately and he goes back on insulin… I’m still very wary and not taking anything for granted and I’m monitoring the heck out of him… I’m keeping his Libre tag and I’m fitting another when that goes not taking anything chances with him but the improvement has been somewhat remarkable his fur his personality all back he’s eating well no loose stools so hope it continues 5days in so early days but I’ll keep you all updated … hope everyone has a good day
There are a couple of points with regard to what you were seeing when you were using insulin. My comments are tentative since we don't have any blood glucose readings for your cat and I don't think you mentioned which insulin you had been using. With insulin, if a cat's blood glucose drops into low numbers, numbers that are lower than what his body is used to, or the drop is fast, there is a strong likelihood that what you will then see is what we call a "bounce." The blood glucose number spike up into a high range. The drop in numbers triggers a release of a stored form of glucose along with counterregulatory hormones that cause the sharp increase in blood glucose levels. This rise can last for as long as 3 days. For the dosing methods that we use, there is a point at which an insuln dose reduction is indicated. If you were seeing numbers in the teens, then your cat's dose needed to be reduced. The other issue is the Libre. It has been very helpful for many of our members but like any new device, it has its pros and cons. The pros are obvious. What many of our members report is that when they compare the lower readings on a Libre with a hand held meter, the meter reads higher. What we've learned is the Libre readings are consistently lower than a meter in the lower ranges. While if you don't have a meter for the purposes of comparison, you do want to take action and use higher carb food to intervene. With all of the above, we don't have enough data to know if the same holds true with Senvelgo. We don't know about bounces and there is nothing that discusses dose changes. We don't even know if remission is possible with the newer, oral medications.
"Sienne and Gabby thank you for your guidance and information, it is greatly appreciated... he was on Prozinc I did look at the spreadsheet but couldn't make head nor tail of it brain isn't working too good after weeks of no sleep and then he went on senvelgo so didn't know what to do?... my vet kept trying different doses but nothing was stabilising... this went on for weeks wildly seesawing... I wondered if he had Brittle diabetes but I'm no expert and that was from googling desperately trying to find answers. The teens is in mmol measurement from UK... he was 504mg/dl down to as low as 50mg/dl in the night... My vet was worried because they would have to up his insulin as he was staying too high the majority of the day last dose was 2iu... but with the higher dose she thought this would mean the hypo events could potentially be worse and thought he was more at risk carrying on with insulin... nothing made sense with him there was no pattern one time in the day it switched he went really low for a few hours and then sky high like the bounce you described... he's on low carb high protein diet... I also noticed him looking a bit off colour after insulin don't know if it can make them feel a bit ill seemed to affect his appetite too. I'm new to all this so any advice information is so helpful its a steep learning curve... I decided to try this new medication out of desperation to be honest and on the advice of my vet, well two I got a second opinion as well... I'm just praying its the right move... poor little guy has gone through so much and he means so much to me... all my cats do I have 3... I lost my husband 3yrs ago he died of Covid over a painful 3 month period and they was with me through all that... but Amos especially he knew I was suffering and every time I had to phone the hospital which was always bad news he'd come sit on my lap as I cried... they mean the world to me and I will do everything I can to help Amos. Thank you again for this community and your help.
One factor to keep in mind is to take care of yourself. While I've been known to comment that, "Sleep is vastly overrated," if you are too sleep deprived or not up to your usual level of functioning, it doesn't matter how devoted you are to your cat(s), you won't be able to take care of them in the way you ordinarily would. Add a family tragedy where you may still be grieving, and being overwhelmed is understandable. And adding to the above, I don't think there's a member here who wasn't completely overwhelmed when their cat was diagnosed with diabetes. I know I was and I'm very comfortable with most things medical. The ICU vet that diagnosed Gabby never showed me how to give a shot, never discussed home testing, and just handed me a prescription. I think they assumed that since I can speak medical, that I was either a nurse or MD. Like you, Google became my friend and I found FDMB. In other words, most of us understand and empathize with your experience. If I had to guess, Amos may have been started on too high of a dose. Unless there's some other issue going on, we tend to be conservative with starting doses because if the dose is too high, numbers plummet and it can set up bouncing along with panic attacks in the caregiver. The good news is your vet listened to your concerns and worked with you. The observations you made about Amos (looking a bit off, loss of appetite) could be due to the effects of too high a dose but there's really no way to tell at this point. If the Senvelgo is working, stick with it. I'm glad you're testing. We've had people who have successfully used this medication. We've also had a a few members where the outcomes were not successful and I tend to put the responsibility on the vet. (We were very concerned about ketones and kept raising that concern and the vet shrugged it off.) My understanding is that there are some differences in how Senvelgo is being used in the UK vs the US. I haven't a clue why that's the case but if we make suggestions, please either check the package insert (or online information from the UK manufacturer) or talk to your vet. The research I did was based on journal articles (which would be the same regardless of the country) and the US distributor. Please let us know if you have questions. We're here to help.
Your words really resonate with me and it is such a help and a comfort to be able to talk to others going through the same thing… but after the initial shock and getting myself educated as much as I can and this group has been pinnacle in that I feel like there are positive steps and to just take one day at a time with him… thanks again and I’ll definitely post an update wether he stays on Senvelgo or goes back on insulin… I did two pee tests on him today both are clear and my vet is taking ketones very seriously she said one sniff even a trace we stop immediately…so fingers crossed
I would expect no *measurable* bounces with an SGLT2 (senvelgo/bexacat) as they are reducing blood glucose in a different way. Even if the body tried to react and increase glucose the kidney would let it all flow away. Which is why there should be normal glucose levels after a week or so—the only (very crucial) question is, was the body able to use any glucose before the rest got lost in the urine. That said, I imagine the body would try to produce more glucose if it saw lower levels but I don’t know a way to see that until it resorts to burning fat and produces ketones
I have an opinion on that…perhaps I will check out the think tank to see if that’s the place to express it
I hope Amos continues to do well and it’s great that you’re checking ketones religiously. You may want to consider checking blood occasionally in addition to urine—it takes longer for ketones to appear in urine and it takes significantly more to be read as positive—blood testing would give you the earliest warning possible that ketones are present. In cats on insulin urine testing gives plenty of time to react and treat the impending DKA. cats on SGLT2 inhibitors can have more rapid progression to DKA so an earlier/more sensitive warning system might be good. I realize strips are expensive so you could use urine for all the time and do blood spot checks or anytime Amos seems a bit off his usual
SmallestSparrow That’s so helpful he’s been in the green from the get go and now I know why thanks to you …. I’m checking for ketones every single day and will continue to do so for a long time yet as I’m so worried anything happening to him…sometimes I do twice a day if I think he looks a little off better safe than sorry… I always check it before I give his next dose too so we have a little routine now I get up early in the morning fill a separate tray with the Katkor beads and more often than not he pees straight away he loves a clean litter box and is always the one to hop on first then he gets a small treat after so he’s associated it with something nice…the testing blood for ketones can I do that at home or is that a vet visit… Im also checking his weight as I know they lose weight at first but if he keeps losing that’s another sign things aren’t going accordingly
Good it seems like you’re keeping a close eye on him. You may want to print out the drug insert and mark the section on euglycemic DKA—just in case you need to see a vet other than your usual in an emergency. They should all know that a cat on an SGLT2 inhibitor can be in DKA despite normal blood glucose. But I wouldn’t rely on that (some may not be up on the new drugs or it may be a sleep deprived night doc) so in case you ever find yourself in an ER at 2 am being told “it’s not DKA because his glucose is 100” you will be ready. Which hopefully you will never have to do. I hope Amos continues to do well
You can check for blood ketones at home with a hand held human or pet meter. There are several makers for humans, at least one for pets. Strips are crazy expensive for both so I’m not telling you to do it daily let alone several times a day—that you can do with the urine strips especially since you’re finding it easy to get urine from him. But occasionally, or if he seems sick, or if a urine test result was difficult to read (I always found negative and trace to look the same but I have trouble with colors) or he’s sick but won’t pee—then it will be worth its weight in gold. I bought a precision Xtra (human meter) because they didn’t have pet meters for ketones yet. It was what my vet recommended of the human meters (and I noticed what the pet ER used when I took him there). Centrivet makes a pet ketone/glucose meter and while I just bought one I haven’t used it yet (combination of being busy and I hate the size/weight of it kind of large for my child sized hand). There may be other pet brands there are definitely other human brands. You use them like you are doing for BG—prick ear and test drop of blood.
SmallestSparrow That’s really helpful thank you I’m definitely getting one of those which one would you recommend then the human one or the Centrivet one… I fully believe in having all the backups in place I feel better in myself too when I have all that in place and it is a good idea if one day he won’t pee at the time of day I want him too … tested again today and again Zero ketones and eating ok too so I’m happy about that for now
SmallestSparrow Thank you so much this is unbelievably helpful and explains so much … he got diabetes from what they thought was taking prednisone steriod tablets he instantly came off them but didn’t go into remission I suspect from what my vet said he won’t now but I did wonder about the remission side of things and how do I know if the Senvelgo is working other than he looks better in himself and no ketones for risk of ketoacidosis and that also explains to me why my vet says it’s not possible to have a hypo event… still don’t know if I’ve made the right decision time will tell but he does look a little more like his old self and if we need to go back on insulin so be it I’m more educated now as to what’s what so won’t seem as scary… honestly this site is a godsend thanks again
I don’t recall if you were having trouble testing your kitty’s blood but this is what I’d suggest while he’s on senvelgo: use the time to make any food and exercise adjustments necessary to maximize his chances at lowering his blood sugar —it will be easier to do now than if he needs to change to insulin. Get proficient at testing blood. Not only so you can test for ketones if it’s really important to know the blood value, but if you need to change to insulin it will be a piece of cake to do testing. (When Methos changed from Bexacat the testing was the only thing that didn’t send me into a crying fit). If you don’t already know how to give an insulin shot, ask for instructions and practice (don’t have to inject but practice finding a good spot, lifting the skin, etc)—you will have more skill and confidence if you do need to change and he will be used to his mom rummaging around in his fur after a meal. Read some of the entries of folks who are working and managing their cat’s diabetes. Check out your local area for any other pet parents with diabetic cats as sources of advice and support. Another potential resource: when I first started giving Methos insulin I was an emotional wreck—his BG wasn’t budging, his ketones were edging up, I was certain it had to be I wasn’t giving his insulin correctly (turns out I need, as @Wendy&Neko calls them, patience pants…or was it @JL and Chip ) but I had a cat sitter who was also a vet tech (often the case) and paid her to come for a few visits, first to give shots just so I could know he actually got insulin and then see what his sugar did (wow, sugar didn’t budge for them either…maybe it’s NOT me), and also I got to watch her technique, then she watched me do it. If you don’t already have a sitter who can give shots you might research if there are any (for future reference) or ask at your vets office. Just so if he does need to change you aren’t suddenly trying to find someone (I was hysterical when I called my sitter, she spent more time reassuring me than the time giving the shot) in short, consider this a temporary reprieve and prepare for what right now seemed an insurmountable problem. If he never needs insulin then yay and if he does, you’ll be able to take it in stride. Keep up the good work monitoring ketones. Be sure to get lab tests often on his liver, kidney, and pancreas function as well as electrolytes (an isolated rising amylase was the first sign of trouble for Methos). I hope Amos continues to do well.
Yay no ketones. Keep it up Amos! I think because the centrivet one is new most clinics/vets are more used to the Precision Xtra but there could also be other human meters with less expensive strips (precision xtra strips are almost $5 each from Abbott, cheaper on Amazon). I don’t recall the price of the centrivet ones but I think it was not as much and more like 1-2$ a strip…still pricey. I haven’t used the centrivet meter yet, probably will try it today as my Abbott strips are running low. It’s slightly larger and I have small hands but it should be fine. unlike glucose I don’t think there is a difference in values you’d get from a pet or human meter for ketones—I’m switching only bc I got frustrated with abbot tech support. To avoid that frustration doNOT ever tell tech support for a human meter (glucose or ketones) that it’s being used on a cat. Anyway since Abbott knows I have a cat using it they refuse to help if problems. And…$5 a strip.
SmallestSparrow That’s great advice and thank you I want to do everything I can for him …I’m ok giving him insulin shots and getting blood from him he’s super chilled lets me do anything… I know they wasn’t supposed to start Senvelgo if on insulin but he was on Prozinc for a very short time the vet was so concerned with the seesawing he was going extremes of both ends hi and low she had meetings with the drug company and a few different vets and they all concluded he was still an ok candidate and that he was more at risk of a hypo on insulin so we tested for ketones for a week before and he stopped insulin a day before . The thing that was stressing me out was the risk of a hypo they scared the hell out of me saying it’s so dangerous but now I know the sensor reads low and I prefer the prick test as it’s more accurate so I think I’d stick with prick test and as you said giving him a low card diet if he goes in insulin… I definitely feel more ready for the fight so to speak
Two things, I hope that was prednisolone, not prednisone. And second, steroid doses should be tapered down to nothing instead of stopped immediately. I hope that's what is what happened.
Wendy&Neko No that’s not what happened they tried to do that but he ended up in emergency with ketoacidosis so everything stopped immediately or he would of died he spent the night in intensive care didn’t know if he’d make it but he pulled through this happened very quickly they sent me home when I said I wasn’t happy they told me to wean him off but the next day he was exponentially worse I rushed him back immediately they put him on fluids so much they nearly stopped his heart it was an absolute nightmare all from taking steriod tablets prescribed by the vet of which I did raise concerns a month in because he lost weight and they just ignored me
Sorry to hear about the crisis! That sounds scary. Neko had to go on budesonide instead of prednisolone because of her heart condition. So, your kitty was in ketoacidosis originally and now on Senvelgo? Please keep up regular ketones tests. I hope they stay negative.
I’m taking no chances with him the ketoacidosis last time was definitely uncontrolled diabetes I’ve no idea how long or when he started to develop it he was on steroids for over 3 months… I’m checking for ketones everyday day 10 and zero signs so far also bought I blood ketone monitor it’ll be coming in a few days from the advice on here… Centrivet one… it was on the advise of two vets to try Senvelgo because he was very unstable but I’m not taking any chances with him I’m monitoring him very closely
