Out of Remission after 2.5 years, need expert guidance please

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JennC & Diago

JennC & Diago

Member Since 2018
Hi All - It has been 2.5 years since my cat has needed insulin. When he was first diagnosed we made a diet change and he quickly achieved remission within two weeks after two hypo events, diet change, and I think the steroids made their way out of his system. During the last 2.5 years we've been through IBD and FLUTD diagnosis and many supplements and medications.

Within the last week I noticed my boy urinating more often during a 24 hour period and drinking more. I was testing him every month and he went to the vet at the end of July for a U/A, all clear. Tested his BG mid-July and he was in the 70's. Tested him 8/28 and got a 488 on our glucose reader. I asked the vet to call in Novolin N since this insulin helped him go into remission so quickly in 2018 and it's cheaper. I told her we'd change to prozinc if he needs insulin long term. The only change we've made is he got one Greenies pill pocket the day before 488 and we started Fluoxetine transdermal on 8/2.

My question is around dosing and AMPS and PMPS numbers. The vet and I agreed to start at 1u. I performed a curve on day 2 of insulin and his nadir was 260. I thought I should increase to 1.5, however I noticed the next AMPS his reading was "HI" and after his second dose of 1.5 his nadir was down to 114 after +4 after the AMPS of "HI", so clearly this dose is too high given how much he dropped from a AMPS of HI to a +4 of 114.

After jumping back on the board I realized I should have started him at 0.5u. I feel horrible and stupid that I changed his dose, I was just hoping to get him feeling better quicker. I can tell he did not like the quick drop today. If the AMPS and PMPS continue to be into the 500's once he's been on 0.5u for a week does this warrant an increase if we're still getting those high numbers. I plan to perform another curve in 7 days to see what his nadir is again on the lower dose. I'm just trying to figure out this dance again, it's been a long time and lucky for us we didn't have to do it long. As far as I know there is no health reason for him to have the high numbers. Even when he had a minor infection, his glucose numbers were never over 500. Hoping for guidance on dose, numbers, when we should increase, decrease. Thanks so much in advance!
 
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Hello Jenn - sorry to hear you're back at the sugar dance!

Was a fructosamine done before starting insulin? Are his teeth in good shape? That can throw a cat out of remission. Is he still on low-carb food?

I would definitely stick with the 0.5u for now. You want to hold the dose for a week before determining if he needs to move up to 0.75u.
As a refresher for you, be sure to test early and often on Novolin. It's awesome that he went into remission on it the first time but it's a nasty insulin to work with, as you can see already with that steep drop. I would get tests in at +1, +2, +3, and +4 when you can because that's when the plummet happens most often. Remember that bouncing is a thing that happens with those steep drops, and can take up to three days to clear. Give him a snack at +1 and maybe +3 to keep the insulin from dropping him too fast.

You sound like you've retained a lot of info already so pardon me if you knew most of that. ;)
 
@Panic, no we didn't have a fructosamine completed on him. At the end of July his UA showed no glucose at all. So, thankfully it seems he hasn't been having the high numbers very long. His teeth are good, he had a dental last year and no extractions or issues. I'm so worried about these high 400, 500, and HI readings. He's only had those a very few times in 2018. He's still on low carb food, we've never changed since he went into remission. I'm wondering if these steep drops are causing him to bounce which is why I dove right back into the sticky notes on the site. I realized I started him too high and that drop today was awful. I noticed him going back to his food bowl often during the drop so I knew he wasn't feeling good.

So, if after a week we complete another curve and still see those 400-500-HI readings, increase up to 0.75u and repeat another 7 days? As I mentioned if he has to be on insulin for awhile, I'll be switching to Prozinc or something that gentler and keeps him lower for longer. The curve I completed yesterday had him at 289 at +5 and then back up to 413 at +6, 578 at PMPS and then HI this morning. So, it's definitely not one we'll stay on long term, just praying that it puts him back into remission like before.
 
That's interesting. Maybe I just haven't seen it before but that's a big spike in so little time. If he was fine in July I'd be really interested to see a fructosamine for the past few weeks ...

400-HI readings usually indicate bouncing. Bouncing can happen even when there's a 100 point drop in an hour, or BG drops 50% in the same cycle, so you're probably just seeing effects of that right now.

JennC said:
So, if after a week we complete another curve and still see those 400-500-HI readings, increase up to 0.75u and repeat another 7 days?
Click to expand...
Initially yes, though I might make a thread to ask for input before increasing again. Not sure what your schedule is, but if you could get a few spot checks in early in the cycle, you'll have a better idea of what's going on rather than just one curve day after a week.

I'm going to tag @Deb & Wink to peek, she's a smart cookie with Novolin too. She may not be on until tomorrow night though!
 
I agree @Panic, very odd indeed. I tested him mid-July and his BG was 74. The only thing I can think of that we did was I gave him one Greenie Pill pocket the day before his number spiked but who knows how long he really was having those high numbers. I wouldn't think one Greenie Pill pocket could cause the increase especially over several days so far. Nothing else seems out of the ordinary that I can think of. He started fluoxetine early August for inappropriate urination. I didn't think it caused an increase of BG, we've tested before and it didn't have much impact on his BG in 2019.
 
Welcome back although I'm sorry for the reason. Try to remember what worked for kitty once may not be the best now. Kitty has changed and may just need a change now. I'm glad you are open minded on the subject!
BTW would you mind sharing kitty's name? He sure is a cutie.:bighug:
We too hope this is just a brief visit to insulin land.BUT are glad you are here now.
jeanne
 
Have you looked at the Sticky BEGINNER'S GUIDE TO HUMULIN N/NOVOLIN N/NPH to refresh your memory on NPH and dosing?
Remember, you want to wait 60 minutes between feed and shoot with NPH insulins.
Plus, they usually only last 6-8 hours in cats.

So you need to test and find when Diago has his nadir, and when the insulin quits working for him.

What food are you feeding him? You say low carb, but not which ones.
What other medications is he getting, besides the "kitty prozac" (the fluxetine)?
https://felinediabetes.com/FDMB/threads/beginners-guide-to-humulin-n-novolin-n-nph.231593/
 
Hi @Deb & Wink, I did a curve the second day of insulin and noticed a huge drop in his numbers at +4. I tested yesterday morning and he was "HI" and at +4 he was 114. That's when I jumped on here and read the sticky and realized we should have started with a 0.5u dose.

We do Fancy Feast chicken classic and dr. Elseys clean protein chicken. No other meds at this time.
 
Yeah, I'm afraid this isn't for him. Debating on Prozinc to see if it is gentler and last longer? I really don't want to switch to Lantus or Levemir given the cost. He's been my little money pit the last two years with all of his health issues. I do want him to feel better and I hate seeing the 592 tonight. I'm planning to get a +3 tonight to see how low he dips. I'm just tired of this roller coaster and we just rejoined it. :(
 
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