2/10/2020 "New Member" Is my kitty in remission?

[Lupe & Patch]

I want to thank everyone in advance for all your help. This website and reading everyone's stories and advice has helped me out so much!

Before you read my spreadsheet please know that I only gave Patch insulin in the first entry, 12-24-2019.
The rest of the numbers have all been entered with no insulin shot.
I have been following the rule of no shot if it's below 200

Here's Patch's story and the reason why I stopped giving him his shots.

Patch was diagnosed 11-2017 and was prescribed 3 units of Vetsulin twice a day. During that time I knew nothing about feline diabetes and followed the vet's instructions blindly. The first year Patch had a seizure, he was rushed to the ER, and he pulled out just fine. The ER doctor recommend to stop giving him insulin. Took Patch to his vet and he said that was nonsense! Keep him on 3 units.

In September of 2019 he woke up blind! I gave him some food and little by little he gained his sight back. That's when I started reading about hypoglycemia! And I switched to 2 units a day and also switched vets!

New vet was alarmed to find out about his seizure and temporary blindness. She did blood work on him and told me the results showed he was getting too much insulin and to switch to 1 unit twice a day and come back in one week for a curve.

Went back for a glucose curve. She called me with the results and told me at first she thought he was getting too much insulin, his number was very low, but them his numbers looked ok so it was fine to keep him on 1 unit. That just didn't sit right with me. Something about it just made me feel so uneasy.

And that's when I found this forum!
I switched him to pate only food. (he was on dry food all his life. even my new doctor prescribed hills science diet, which I never touched). I started feeding him only twice a day. And I bought an AlphaTrack!

First night testing him - Food at 7pm and 1 unit of vetsulin. Tested him at 10PM and his number was 56! I was so alarmed, but he was ok and the next morning I decided to not shoot him if his number was below 200.
And that is where we are now.

We had a major setback last week!
His numbers were so good and I got a bit too comfortable and I thought I could go back to dry food and feeding him whenever he wanted and his number was 331! I was so devastated! But I went back to feeding him twice a day, only pate and his numbers went down.

Here's my big question. Am I doing ok with not giving him his shot?
Is it ok if his numbers are never in the 80's?
If 120 or higher - is his pancreas working harder than it should?
Should I go back to the vet for a blood test?
Should I test more often?

Thank you so much again. This forum has helped me out so much!

 

[Larry and Kitties]

I would just continue to test and not give insulin unless BG is >150 a lot of times and BGs after the high number would not be too low as to risk going too low if insulin was given. My Nala's (in remission))AMPS can be as high as in the 130's but the subsequent PMPS can be in the 60's. At first I was upset by the relatively high AMPS but now I know a high PMPS is normal for Nala.

 

[Deb & Wink]

When cats here go OTJ, diet controlled, into remission, we give our members this set of guidelines to help them keep their cat there.

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."

You just learned one of the big no-no's. Feeding higher carb food.
With the recent high numbers, a fructosamine done at the vet will be misleading. Better to give your kitty 2-3 weeks back on the regular diet to see what the BG (blood glucose) readings are.

One way to monitor your cat's blood glucose at home is to test at your normal pre-shot time (even if you are not giving insulin). Then if BG > 100, test again at +3 to +4. That is about how long it takes to see if the insulin Patch's own pancreas is producing is enough to counteract the effects of the food. Test am and pm, no food for 2 hours before the "pre-shot" test times.

Very much like you would do if you are trying an OTJ trial.
Instructions for that are here:
OTJ Trial instructions (These are the criteria we use when following an OTJ Trial.)

These instructions have references to the numbers on a pet meter, such as the Alphatrak you use. May be a bit outdated, but the best I have for you.

Here are the instructions for an OTJ trial: If on Lantus or Levimir, depot has to drain first before trial starts, about 3 days or 6 cycles. No depot with in and out type insulins (NPH, Vetsulin/Caninsulin, Prozinc).

If you are posting in the Lantus/Levimir forum, please start a new thread each day which says ‘[Cat name] OTJ trial Day 1 BG xx’ (where xx is the BG reading for that cycle PM), then day2,3 etc. If you are posting in the Main Forum, we don’t require you or need you to do that separate post for each day. In fact, if you have never posted before over in the Lantus/Levimir forum or use a different insulin, you are fine staying in the Feline Health (Welcome & Main Forum). We’ll cheer you on!

1. Test at your normal AMPS and PMPS times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas). The morning test is now called the AMBG. The evening test is now called the PMBG.

2. If your cat is green (0-99 mg/L human meter, 0-130 mg/L pet meter, 0-5.5 mmoL) at your normal test times, no need to test further until the next "PS" time, just feed small meals and go about your day. If the numbers are blue or higher (100-199 human meter, 130-230 pet meter, 5.5-11 mmoL), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

3. After 2 weeks, if everything is looking good, we have a party! And boy, do we party hearty.

Do you think you would be able to do that OTJ trial type testing for Patches?

 

[Lupe & Patch]

Most definitely!
Thank you so much for your help.
I have been wondering how to find out if his pancreas is working correctly.
This is exactly what I needed.
I learned the hard way how important his diet is and I won't be making that mistake again!

Since I started testing him, almost 2 months ago, most of his numbers have been in the blue. We have only had a few green numbers. So it does worry me that maybe he might need just a bit of juice.
But the OTJ trial will help me out a lot.
I will keep feeding him his wet food and the following weekend I'll do the OTJ trial. I won't be able to do it this weekend.
Even if the numbers show that he needs some juice at least I will have all the info I need to start slow.

I can't wait to show everyone the results. Fingers crossed.

I have another question. It's a food question.
Patch doesn't always finish his can of food in one sitting. And hours later he's hungry and asking for food. Is it safe to feed him at 7PM (his usual time) and feed him the rest of his can before bed?

 

[Chris & China (GA)]

Patch doesn't always finish his can of food in one sitting. And hours later he's hungry and asking for food. Is it safe to feed him at 7PM (his usual time) and feed him the rest of his can before bed?

The only time it's important that he doesn't eat is the 2 hours immediately before shot times so you get a number that's not influenced by food.

I'm sure he'll appreciate having a late night snack!

 

[Deb & Wink]

I have another question. It's a food question.
Patch doesn't always finish his can of food in one sitting. And hours later he's hungry and asking for food. Is it safe to feed him at 7PM (his usual time) and feed him the rest of his can before bed?

Absolutely. Diabetic cats often do better on more than the 2 meals a day vets recommend. Smaller meals are less stress on the pancreas.

Even if the numbers show that he needs some juice at least I will have all the info I need to start slow.

We can offer some dosing suggestions for the Vetsulin when you are ready.

Of course, always check with your vet.

 

[Lupe & Patch]

Seeing everyone's green numbers gives me so much hope!
If the numbers do show that he does need insulin I want to start him on Lantus.
From reading in this forum I have learned Lantus is less aggressive than Vetsulin.
Thank you all for your advice and support!!