12/9 Tessa AMPS 356 +2.3 53 vet wants us to pause insulin?

[tessa's mom]

Previous thread: https://felinediabetes.com/FDMB/threads/12-8-tessa-amps-186-7-361.271626/

We did decide to try 1.75 units today and maybe that was a bad idea. Her BG dropped like a rock.

She threw up at 9:20am (+2.3) and her BG was 53 so we called the vet and they asked us to bring her in to check her out and get her some anti-nausea medication. I checked her BG with a ReliOn Premier Classic at 9:37am and it was 72. We only have 1 car so my husband came home from work and brought her to the vet and she's there now.

I know that she wasn't in hypoglycemia range and that running to the vet was probably overkill but better safe than sorry! I have a feeling that the vomiting was probably food related because I tried something new with her today but I can't be 100% sure.

 

[tessa's mom]

Hmm, so my husband just texted me and the vet wants us to pause her insulin for the weekend. The vet said it could have been an overactive pancreas and she's recovering. They want us to keep scanning over the weekend and bring her in on Monday to check her out again.

Has anyone ever heard of this before?

 

[Skye & Jackson]

@Bron and Sheba (GA) @Bandit's Mom @tiffmaxee

Tagging in some people who know better than I. I’ve only been doing this about two months longer than you. I can tell you though that it takes time. And patience. Oh so much patience. I’m still having trouble getting Jackson regulated.

Looking at Tessa’s spreadsheet though, I see that she had some nice blues yesterday morning, yellows the night before… and then of course she bounced later in the day. I wouldn’t normally expect an increased dose to have such a fast effect especially while in bounce state - typically for Jack it’s a day or two before I see results because the new depot has to build up. Is it possible you got the shot a little into the muscle? From my own studying, that can cause Lantus to act more like R.

If it were my kitty though, I certainly wouldn’t pause insulin unless kitty stayed low. Where the numbers go I believe predicates everything about how much to give, but unless numbers stay really low it’s never a multiple-dose stop.

By the way, the Libre will actually read exact amounts up to 500, you just have to actively scan it to do so and not rely on just the graph (my graph maxes out at 350, so that’s really an issue for me!). At least with the reader; I haven’t tried the app because I have other people helping scan him while I’m at work. Also, it does tend to read 20 to 30 points lower then the BG from an ear stick when he gets down below 60-70. Just so you know, because knowing that might help to forestall some “he’s hypo!” panics that I’ve been through. I probably still end up treating actual 70 more like it’s 50, more than I should…

 

[tessa's mom]

@Bron and Sheba (GA) @Bandit's Mom @tiffmaxee

Tagging in some people who know better than I. I’ve only been doing this about two months longer than you. I can tell you though that it takes time. And patience. Oh so much patience. I’m still having trouble getting Jackson regulated.

Looking at Tessa’s spreadsheet though, I see that she had some nice blues yesterday morning, yellows the night before… and then of course she bounced later in the day. I wouldn’t normally expect an increased dose to have such a fast effect especially while in bounce state - typically for Jack it’s a day or two before I see results because the new depot has to build up. Is it possible you got the shot a little into the muscle? From my own studying, that can cause Lantus to act more like R.

If it were my kitty though, I certainly wouldn’t pause insulin unless kitty stayed low. Where the numbers go I believe predicates everything about how much to give, but unless numbers stay really low it’s never a multiple-dose stop.

By the way, the Libre will actually read exact amounts up to 500, you just have to actively scan it to do so and not rely on just the graph (my graph maxes out at 350, so that’s really an issue for me!). At least with the reader; I haven’t tried the app because I have other people helping scan him while I’m at work.

The way my husband explained it is that this vet (a different one than the one who diagnosed Tessa and I trust this vet more than the other one, honestly) thinks that she might not even have diabetes so she wants us to try no insulin just for today, tomorrow, and Sunday and see what the numbers are. Then we'll bring her in Monday morning as soon as they open for them to check her BG with their equipment and look over her numbers and if she needs insulin, we'll start again.

Maybe my husband misunderstood what he was being told though, it was the tech who was relaying the info from the vet.

I don't think the shot went into the muscle but it's possible. My husband gave her insulin today and he does it less frequently than I do.

My Libre doesn't tell me anything above 400 even when I'm scanning her manually (believe me, I scanned her hourly the first day lol). I use the app though so I guess that's why I can only see up to 400.

 

[Skye & Jackson]

The way my husband explained it is that this vet (a different one than the one who diagnosed Tessa and I trust this vet more than the other one, honestly) thinks that she might not even have diabetes so she wants us to try no insulin just for today, tomorrow, and Sunday and see what the numbers are. Then we'll bring her in Monday morning as soon as they open for them to check her BG with their equipment and look over her numbers and if she needs insulin, we'll start again.

It would be wonderful if she doesn’t actually have diabetes! That’s a subject I will need someone a lot more experienced to weigh in on though.

My Libre doesn't tell me anything above 400 even when I'm scanning her manually (believe me, I scanned her hourly the first day lol). I use the app though so I guess that's why I can only see up to 400.

I haven’t tried using the app, simply because it limits readings to one person (one phone), and I work sometimes long hours so Jack’s Libre has to be scannable by other family members. But that’s an interesting piece of information, especially since I’ve seen app screenshots from other people and they show up to 500 on their graph! I wonder if there are different versions?

Honestly, the one-person app thing is the main issue keeping me from upgrading him from the 14-day (old) version to something like the Libre 3. The 3 is smaller and supposedly more accurate, but it is app only, no reader unit available. I’ll be really frustrated if still doing this when the Libre 4 comes out; they’re working on ketone readings being available too!

 

[tessa's mom]

It would be wonderful if she doesn’t actually have diabetes! That’s a subject I will need someone a lot more experienced to weigh in on though.



I haven’t tried using the app, simply because it limits readings to one person (one phone), and I work sometimes long hours so Jack’s Libre has to be scannable by other family members. But that’s an interesting piece of information, especially since I’ve seen app screenshots from other people and they show up to 500 on the graph! I wonder if there are different versions?

Honestly, the one-person app thing is the main issue keeping me from upgrading him from the 14-day (old) version to something like the Libre 3. The 3 is smaller and supposedly more accurate, but it is app only, no reader unit available. I’ll be really frustrated if still doing this when the Libre 4 comes out; they’re working on ketone readings being available too!

I hope that one of the CGM companies comes out with a pet version that stays on longer, uses better glue (Tessa's skin is red where her old one was removed), has the option for more than one caregiver to scan with their phone, has larger ranges for the danger alarms, and has the option for the numbers to be automatically sent to a vet if you choose to do so. I'd even pay more than what I already pay lol.

 

[Skye & Jackson]

I hope that one of the CGM companies comes out with a pet version that stays on longer, uses better glue (Tessa's skin is red where her old one was removed), has the option for more than one caregiver to scan with their phone, has larger ranges for the danger alarms, and has the option for the numbers to be automatically sent to a vet if you choose to do so. I'd even pay more than what I already pay lol.

The ability to set any custom numbers for the alert ranges would be extra useful, yes! And the multiple phone thing. I think the Libre numbers actually can be sent to a vet, my vet mentioned it, but I haven’t got it set up so can’t tell you exactly how.

I bought Vetbond glue to use on Jack’s sensor, when I started putting it on myself. The sticky pad it comes with won’t last long otherwise. Lately I’ve started having to reapply it around the edges when it starts to lift up every few days, because if he can get his teeth into the edge he will (and has) yank it off. He currently has a scab in one spot from the last one because he took skin with it! I was so upset; I try to take such care in taking them off and he just yanked! He’s definitely feeling sassier; he totally ignored it for over a month…

If you are taking them off yourself, I have found that a careful soaking of the edges of the sensor pad, and then gradually underneath, with coconut or other kitty-safe oil really helps in loosening and removing the glue. Like everything else with diabetes, it takes patience. I will put a sensor on one side and activate it before starting the removal process on the other side, and as long as it takes to remove it gently, I will let it take that long (as long as Jack doesn’t “help”). It does need to be in a different spot, not the same one twice, to avoid skin damage.

 

[tessa's mom]

The ability to set any custom numbers for the alert ranges would be extra useful, yes! And the multiple phone thing. I think the Libre numbers actually can be sent to a vet, my vet mentioned it, but I haven’t got it set up so can’t tell you exactly how.

I bought Vetbond glue to use on Jack’s sensor, when I started putting it on myself. The sticky pad it comes with won’t last long otherwise. Lately I’ve started having to reapply it around the edges when it starts to lift up every few days, because if he can get his teeth into the edge he will (and has) yank it off. He currently has a scab in one spot from the last one because he took skin with it! I was so upset; I try to take such care in taking them off and he just yanked! He’s definitely feeling sassier; he totally ignored it for over a month…

If you are taking them off yourself, I have found that a careful soaking of the edges of the sensor pad, and then gradually underneath, with coconut or other kitty-safe oil really helps in loosening and removing the glue. Like everything else with diabetes, it takes patience. I will put a sensor on one side and activate it before starting the removal process on the other side, and as long as it takes to remove it gently, I will let it take that long (as long as Jack doesn’t “help”). It does need to be in a different spot, not the same one twice, to avoid skin damage.

I've just had them put on at the vet, I think if we get another one I'll try it myself because maybe they're just too rough with removing them.

 

[Skye & Jackson]

It wasted me one to figure out how to do it right. But it may be worth it. Certainly the removal at home can be done with more time/patience.

 

[tessa's mom]

I've been reading through other threads of people whose vets told them to stop insulin and everyone is telling them not to do it! So now I don't know what to do. I really do trust this vet, she used to be our main vet until my husband's day off changed and we were shifted over to the newbie (she's only been a vet for a year!). We always called her the cat whisperer because she was so good with our old cat who passed away. She was there every step of the way through is cancer diagnosis and she did everything she could to make his quality of life as good as possible until it was time for him to pass.

So my gut is telling me to trust the old vet and listen to her but I am afraid that it's a mistake to take Tessa off insulin this soon even if it is only for a weekend. All of this is so bad for my anxiety.

 

[Bandit's Mom]

So she was 85 on the Libre at +2 and 53 on the Libre 20 mins later when she threw up? Did she eat again after that? Or was the BG at 9:37 of 72 on the ReliOn without any food?
Was the vomiting scarf and barf? When did she eat before the barf? I wonder if she was gobbling food because she was dropping and ate too quickly?

How is she doing now? Is she home? What are her numbers like? Why did the vet think she needed anti-nausea medication?

We have had cats who got diabetes because of steroids (is Tessa one of them?) as well as cats who have switched to a low carb diet zoom down the dosing ladder. Tessa might be one of them but so far, it doesn't look like she is ready to go off the juice. In fact, she hasn't even earned a reduction per TR.

If she doesn't have ketones, there is no danger in pausing insulin, if you are so inclined. The only downside is that you could see glucose toxicity setting in if her numbers remain high. I would not stop insulin. Depending on her numbers today, I would either continue with 1.75U or go down to 1.5U if she drops below 50.

 

[tessa's mom]

So she was 85 on the Libre at +2 and 53 on the Libre 20 mins later when she threw up? Did she eat again after that? Or was the BG at 9:37 of 72 on the ReliOn without any food?

I downloaded the data from libreview to give a complete look at that hour when she dropped low: 85 at +2 (9am), 67 at +2.25 (9:15am), my manual scan of the Libre was 53 at 9:21am, 67 at +2.5 (9:30am), 70 at +2.75 (9:45am), 81 at +3 (10am). My manual reading of 72 was at 9:37am so the Libre seems pretty spot on. The vet BG number was 92 at 10am so a bit higher than the Libre number but I think that's fairly normal for them to be different, right?

I did give her a small amount of medium carb food at ~9:25 because I was panicking about her numbers going even lower (the Libre had a down arrow on it which indicates dropping BG) but I didn't let her eat much because I was afraid she'd eat and then run under the bed. She probably ate a teaspoon of food before I scooped her up and brought her into my office and closed the door.

Was the vomiting scarf and barf? When did she eat before the barf? I wonder if she was gobbling food because she was dropping and ate too quickly?

I don't think it was scarf and barf, she barely ate any of what I put down at 8:30am. She may have already been nauseated by that point. She nibbled a bit of the food (Tiki Cat) and then went to the living room and laid down on the rug (one of her favorite spots). She was there for about 45 minutes when I came in to get the reading. It was kind of coincidence because I was looking for her to scan her Libre and I noticed her licking her lips and then she started puking.

How is she doing now? Is she home? What are her numbers like? Why did the vet think she needed anti-nausea medication?

Yes, she's home and seems fine, it was a very quick trip to the vet. She was back within 20 minutes. Her most recent Libre reading was 114 at +4.5 (11:30am). The vet gave her Cerenia as a precaution, they were concerned that if she didn't keep food down she might become hypoglyemic. She ate some Friskies pate when she got home and now she's in my office in her little cardboard house. She seems fine albeit annoyed that she had to go to the vet.

We have had cats who got diabetes because of steroids (is Tessa one of them?) as well as cats who have switched to a low carb diet zoom down the dosing ladder. Tessa might be one of them but so far, it doesn't look like she is ready to go off the juice. In fact, she hasn't even earned a reduction per TR.

If she doesn't have ketones, there is no danger in pausing insulin, if you are so inclined. The only downside is that you could see glucose toxicity setting in if her numbers remain high. I would not stop insulin. Depending on her numbers today, I would either continue with 1.75U or go down to 1.5U if she drops below 50.

No, she did not get diabetes because of steroids. She hasn't been on them in the 2 years we've had her. She does have some sort of digestive issue that causes intermittent diarrhea. She was eating a prescription dry food (Hill's i/d) just before she got sick. She was doing fine and then became lethargic, started drinking a ton of water and peeing a lot, and wasn't eating all her food (huge red flag for her). We started giving the canned version and things improved but she wasn't back to normal so we made the initial vet appointment where the vet found her high glucose levels. A repeat BG and urinalysis a few days later was what gave them the diabetes diagnosis. I don't think her fructosamine was ever checked.

She was also treated for a UTI on the day we started insulin, she was given Convenia which I don't like but I did not know they were going to give it to her until it was too late. Luckily she had no reaction to it.

My husband is adamant that we listen to the vet but I'm not so sure. I am so overwhelmed and feel like such a failure.

 

[tessa's mom]

Here's her Libre graph so you can see just how fast her BG fell today. I was shocked!

And here are all her past graphs: https://imgur.com/a/sy7veDe

 

[Wendy&Neko]

I agree with Bhooma. Tessa's spreadsheet doesn't look like a cat ready to come off of insulin. It does look like a cat who is getting closer to a fitting dose of insulin. Just so you know, a cat that is getting ready to come off of insulin would have a spreadsheet of mostly greens, with the odd low blues. Right now, insulin is bringing down her numbers, her pancreas can't do it by herself.

Since Tessa hasn't seen green numbers yet (congrats on those first ones!), there is a good possibility she'll bounce. Bounce plus stopping insulin would give her some really high numbers. Just to warn you if you do decide to do an insulin break.

 

[Sienne and Gabby (GA)]

If you're going to listen to the vet, listen until AMPS tomorrow. I'm going to bet Tessa is back in high numbers.

Here's what I'm seeing. Tessa is bouncing to the moon every time her numbers drop into the 300s or below. Her liver and pancreas are not used to being back in lower, let alone normal range numbers. As a result, those organs are releasing a stored vorm of glucose along with counterregulatory hormones which cause the resultant spike in numbers. The bounces are annoying! They are not dangerous.

Basically, Bhooma, Wendy and I are saying the same thing. Tessa is nowhere near regulated yet. If you're following TR, those green numbers are a good sign but not anywhere close to being dangerous or dose-reduction worthy.

 

[tessa's mom]

I agree with Bhooma. Tessa's spreadsheet doesn't look like a cat ready to come off of insulin. It does look like a cat who is getting closer to a fitting dose of insulin. Just so you know, a cat that is getting ready to come off of insulin would have a spreadsheet of mostly greens, with the odd low blues. Right now, insulin is bringing down her numbers, her pancreas can't do it by herself.

Since Tessa hasn't seen green numbers yet (congrats on those first ones!), there is a good possibility she'll bounce. Bounce plus stopping insulin would give her some really high numbers. Just to warn you if you do decide to do an insulin break.

If you're going to listen to the vet, listen until AMPS tomorrow. I'm going to bet Tessa is back in high numbers.

Here's what I'm seeing. Tessa is bouncing to the moon every time her numbers drop into the 300s or below. Her liver and pancreas are not used to being back in lower, let alone normal range numbers. As a result, those organs are releasing a stored vorm of glucose along with counterregulatory hormones which cause the resultant spike in numbers. The bounces are annoying! They are not dangerous.

Basically, Bhooma, Wendy and I are saying the same thing. Tessa is nowhere near regulated yet. If you're following TR, those green numbers are a good sign but not anywhere close to being dangerous or dose-reduction worthy.

Thank you all so much. Would it be OK if we try going back to 1.5? I'm trying to talk my husband out of pausing the insulin and he's not sure about it but I think I could might be able to talk him into going back to 1.5 units.

I'm kind of wondering if we didn't give her enough time to clear the bounce from 1.5...

 

[Bandit's Mom]

Thank you all so much. Would it be OK if we try going back to 1.5? I'm trying to talk my husband out of pausing the insulin and he's not sure about it but I think I could might be able to talk him into going back to 1.5 units.

I'm kind of wondering if we didn't give her enough time to clear the bounce from 1.5...

Yes, you could try 1.5U. Maybe that single cycle of 1.75U was enough of a nudge into better numbers!

 

[tessa's mom]

Yes, you could try 1.5U. Maybe that single cycle of 1.75U was enough of a nudge into better numbers!

Thank you, I think that's what I want to try tonight. It's a much better alternative than dropping to zero. Now I just gotta convince my husband and then figure out how to tell the vet that we didn't follow their instructions...

 

[tessa's mom]

With a bit of hindsight, Tessa's numbers actually look pretty good today. I wish I hadn't freaked out and ran her to the vet. This dang Libre is a blessing and a curse lol. If I hadn't seen that down arrow with the 53 reading this morning maybe I wouldn't have panicked so much.

Also, I'm going to stick with foods I know she does OK with because I think the reason she puked was because I gave her something different. Her "sister" (I adopted them as a bonded pair but they're not related) is going through a picky phase so I've been trying different foods each day and letting Tessa have the leftovers, as long as they're low carb.

 

[tessa's mom]

My husband called the vet and spoke with the tech he saw this morning and asked about not pausing the insulin over the weekend. She was hesitant and suggested that we at least withhold tonight and don't give insulin in the morning if her preshot number was in the 200s and to call them with her numbers in the morning. Her numbers don't usually drop very much at night so we went ahead and gave her insulin tonight anyway (1.5 units). If by some chance her numbers do drop overnight, we'll figure something out. If we have to fib to the vet, we will. I'd rather keep her on insulin.

 

[Bandit's Mom]

We have all panicked at our first green

Looks like she decided to clear the bounce this morning after all and the increase added to the downward momentum. Not surprised to see she bounced to the moon after that dive and the greens!