Type 1 Diabetic

[KPassa]

Hello again! It's been a while.

Mikey was diagnosed at 6 months old and will always require insulin (currently Levemir). He is now turning 8 years old next month! I also adopted another diabetic, Finnegan, from DCiN 3 years ago yesterday. They are both doing great and their spreadsheets are (mostly) up-to-date for those curious.

The reason I'm posting after such a long time is I've encountered a new (good?) twist in Mikey's diabetic journey. He is a feral who will not let anyone else besides me near enough to test and shoot him. I have not traveled anywhere for more than a few days at a time for the last 7 years because of this (not a big deal; I've traveled a lot already and I don't mind being a homebody right now). He has never had ketones/is not ketone prone and he has never gone over 400, even when he was first diagnosed. In the past, Mikey has only gone 1-3 days with me absent and minimal testing/shots (if they can even test/shoot him).

I've recently started having to travel again a bit for work, no more than 5 days at a time. My niece is the only person Mikey lets near enough to test and shoot him...as long as I'm around. My first trip last August resulted in both Mikey and my niece being traumatized and Mikey going for 5 days with no testing and no shots. As you can see by his numbers, Mikey recovered pretty quickly.

I thought it was a fluke but then I had to travel twice at the beginning of this year. I told my niece to not worry about testing and shooting him since it was so traumatic for the both of them the last time and the same thing happened again:

It's been ~5 years since I've really kept up-to-date on the latest in the feline diabetes world so perhaps there have been changes he might benefit from. I know Mikey is a "non-standard" feline diabetic but I wanted to ask/share here to see if anyone has any thoughts about maybe adjusting his insulin protocol, using a different type of insulin, or even insight into how his body uses insulin. Maybe there are even some Type 1 human diabetics out there that might provide anecdotal info? Here are the questions I have been pondering:

• I don't like Mikey going without insulin but with my current job, minimal travel is required. What kind of long-term damage happens when he goes without treatment for 5 days with numbers in the 200-300s?
  
• Is the Levemir depot being used by Mikey's body? His numbers return so quickly to "normal" range after he's been off insulin for a week that there doesn't seem to even be a depot build-up
• Would Mikey perhaps be better suited to taking a fast-acting insulin to offset food vs. a depot insulin? Would this be something like a "mealtime" insulin?
  
• How do human Type 1 diabetics treat their diabetes vs. Type 2? Is there a big difference in treatment?
  
• Since Mikey is a lifer, would he be a good candidate for a glucometer implant and/or a pump? This would make things easier for when I have to travel. Do they even exist yet for cats?

I'm not planning on changing anything yet because things are working great but if perhaps there is an easier way of doing things or a way to level his numbers more, I would like to start researching different possibilities so suggestions are welcome.

 

[Wendy&Neko]

Hi Kay, long time. no see! It's great to get a Mikey update. I was thinking of you the other day as we have a couple new diabetic kittens over in the Feline Health forum.

Tagging @Tina Marie and Jan one of our members who is type 1 and might be able to help answer some questions.

I'll answer what I think I can.

What kind of long-term damage happens when he goes without treatment for 5 days with numbers in the 200-300s?

It means he's over renal threshold for a few days. Neko's IM vet said not to worry about a few days, as long it wasn't long term. You might have to deal with some glucose toxicity short term, but raising the dose can get over that.

• Is the Levemir depot being used by Mikey's body? His numbers return so quickly to "normal" range after he's been off insulin for a week that there doesn't seem to even be a depot build-up

• Would Mikey perhaps be better suited to taking a fast-acting insulin to offset food vs. a depot insulin? Would this be something like a "mealtime" insulin?

Yes, the depot is being used us while he's without insulin. I don't think a fast acting or just a bolus insulin would help. Most human diabetics I know use both a longer lasting insulin and the bolus for meals to get rid of the sugar spike.

Wouldn't it be cool if there were insulin pumps for cats! Here's a paper on it's use. I haven't seen anyone here yet use one. Some people have used the Freestyle Libre glucometer on their cats, with varying degrees of success. I think there is a post on Think Tank forum and you might find more posts if you search for the Libre. I think it would be. a good solution for trips where the caregiver cannot test, provided the cat keeps the meter on.

 

[Tina Marie (GA) and Jan]

Maybe there are even some Type 1 human diabetics out there that might provide anecdotal info? Here are the questions I have been pondering:

• I don't like Mikey going without insulin but with my current job, minimal travel is required. What kind of long-term damage happens when he goes without treatment for 5 days with numbers in the 200-300s?
  
• Is the Levemir depot being used by Mikey's body? His numbers return so quickly to "normal" range after he's been off insulin for a week that there doesn't seem to even be a depot build-up
• Would Mikey perhaps be better suited to taking a fast-acting insulin to offset food vs. a depot insulin? Would this be something like a "mealtime" insulin?
  
• How do human Type 1 diabetics treat their diabetes vs. Type 2? Is there a big difference in treatment?
  
• Since Mikey is a lifer, would he be a good candidate for a glucometer implant and/or a pump? This would make things easier for when I have to travel. Do they even exist yet for cats?

I'm not planning on changing anything yet because things are working great but if perhaps there is an easier way of doing things or a way to level his numbers more, I would like to start researching different possibilities so suggestions are welcome.

Hi Kay! The kitty in your picture is stunning - is that Mikey? You sure have thought things out, and have good questions. I'll be glad if anything I say is the least bit helpful. You are doing great, and I sure hope you can find the magic person or pet sitter to help give insulin when you are away. I can hope, even if it might seem impossible now.

One of the differences in T1 and T2 diabetes, is that T2s are mostly insulin resistant (needing more) and T1s are usually insulin sensitive (need less). The primary difference is that T1 is an autoimmune disease that attacks the beta cells in the pancreas. T2 can start as a metabolic disorder, leading to full blown T2. Treatment, IMO is much easier for T1s - insulin (basal/slow acting and bolus/fast acting). If I want carbs, I shoot a fast acting insulin. If a T2 on meds wants extra carbs, it's going to take their body a lot longer to process those carbs, than it will take my insulin to work. I believe many T2s would benefit from starting insulin earlier in their journey, instead of trying so many different drugs that are supposed to boost the pancreas. Unfortunately so many T2s feel using insulin is some kind of failure on their part.
I've often pondered if our plan here for our diabetic cats would work on T2 people, to get them into "remission". Low carb first - but you also can't force people to eat as LC as is often necessary. We can help our kitties by extra force, lol!

I have read that cats don't get the same long-term complications people can, if well controlled (kidney disease, heart disease, retinopathy, neuropathy) because of their shorter life span. Would be nice if true, but with your Mikey starting so young, I doubt what I read was referring to a lifetime, even if it's true about our older cats.
I have such great respect for you in your care for Mikey!! I do feel a kinship with him

As a T1 for over 40 yrs, I'm in better health than most might guess. I take 18 units of Lantus in the morning, and 1u of fast acting insulin for every 15 carbs I eat (and 1 unit of fast acting to lower BG 50 pts). I've used the pump in the past (uses tiny bits of fast acting insulin), but prefer my old fashioned way due to past malfunctions of the pump and supplies, and my need/desire to feel free of a medical device.

I am impressed at how skipping a few days doesn't take Mikey any higher than into the 300s, and that he can get back to good numbers quickly. A wild guess on Mikey, is that he produces "some" insulin. I just read a study that showed half of T1s who had the disease for 10+ years still produced a tiny bit of insulin.
Like Wendy, I don't see a need for any fast acting insulin. He looks good with his Levemir.

I never knew a thing about the depot before joining here, and have been using Lantus for many, many years. This cat site is better than multiple human sites!
Now, when I get back home, I'm going to slow down and carefully read the paper Wendy posted on pumps for cats.

 

[KPassa]

Hi Kay, long time. no see! It's great to get a Mikey update. I was thinking of you the other day as we have a couple new diabetic kittens over in the Feline Health forum.

Hi! I've missed being around here! I just don't have the time I used to.

I am definitely going to research the freestyle libre because this would be a lot better than the current method of crossed fingers and hoping for the best while I'm gone. As for the pump, it sounds like it's not quite ready yet for felines but I'm glad they're researching it.

One of the differences in T1 and T2 diabetes, is that T2s are mostly insulin resistant (needing more) and T1s are usually insulin sensitive (need less). The primary difference is that T1 is an autoimmune disease that attacks the beta cells in the pancreas. T2 can start as a metabolic disorder, leading to full blown T2. Treatment, IMO is much easier for T1s - insulin (basal/slow acting and bolus/fast acting).

Thanks so much for all of this information, Jan! Yes, I've definitely noticed this difference when it comes to Mikey (my T1) and Finn (my T2). Mikey's dosing and numbers have always been pretty consistent with slight variations across seasons while Finn is pretty unpredictable with some wild swings at times. Luckily, my niece has no problem testing and shooting Finn.

I have read that cats don't get the same long-term complications people can, if well controlled (kidney disease, heart disease, retinopathy, neuropathy) because of their shorter life span. Would be nice if true, but with your Mikey starting so young, I doubt what I read was referring to a lifetime, even if it's true about our older cats.

I have such great respect for you in your care for Mikey!! I do feel a kinship with him

This has always been my biggest fear. The longevity of cats living with diabetes is a huge unknown when it comes to Mikey since he was so young when diagnosed. I've been prepared since he was 6 months old that he might not be as long for this world because of that but he's already lived longer than other cats I've had who have passed quite young from other illnesses.

Here's Mikey all big and grown up now:

As a T1 for over 40 yrs, I'm in better health than most might guess. I take 18 units of Lantus in the morning, and 1u of fast acting insulin for every 15 carbs I eat (and 1 unit of fast acting to lower BG 50 pts). I've used the pump in the past (uses tiny bits of fast acting insulin), but prefer my old fashioned way due to past malfunctions of the pump and supplies, and my need/desire to feel free of a medical device.

I am impressed at how skipping a few days doesn't take Mikey any higher than into the 300s, and that he can get back to good numbers quickly. A wild guess on Mikey, is that he produces "some" insulin. I just read a study that showed half of T1s who had the disease for 10+ years still produced a tiny bit of insulin.
Like Wendy, I don't see a need for any fast acting insulin. He looks good with his Levemir.

Thank you so much for your T1 insight on how you use the fast acting insulin in conjunction with food! A big reason I wonder if it might be helpful for Mikey is sometimes I see such major food spikes that I wish I could give him a shot to counteract it. Or if I have to feed Finn a higher carb food to boost his numbers and Mikey gets into it. It doesn't happen enough and I think you're right that introducing a fast acting insulin into might be more work than it's worth. The Levemir keeps him fairly even with minimal monitoring whereas with a fast-acting, I would have to be able to test a lot more during the day than I currently can. (Althought, with COVID-19, my company is having everyone work from home for the next few weeks so I should be able to do a lot more testing.)

Thank you both so much for your responses! This has given me more to ponder.

 

[Tina Marie (GA) and Jan]

Oh Mikey is gorgeous!!! I am currently sitting with a Maine Coon who could be Mikey’s half brother!
I’ve been reading all about Michaelangelo.
I am so happy this little guy was taken in by YOU!
It’s a shame the Maine Coon is more susceptible to diabetes than most other cats. Quite amazing creatures.

I keep staring at Mikey's spreadsheet, and can't find anything that would show Type 1 instead of 2. (I'd be heading toward DKA with no insulin for 4 days, even with zero carbs.) It's time for me to study more - that's for sure. It is so interesting what you saw after 8 cycles of no insulin.

Could a vet run this test? So much to learn!!!

C peptide test for Type 1 diabetes
The C-peptide test may be ordered to determine how much insulin is being made by the pancreas. This information is useful because: It can help doctors tell the difference between type 1 and type 2 diabetes. In type 1 diabetes, the pancreas produces little or no insulin and little or no C-peptide.