5/15 Tessa AMBG 232 +4 263 +8 263 - out of remission, starting dosage?

[tessa's mom]

Last thread in Lantus subforum: https://felinediabetes.com/FDMB/threads/4-21-tessa-ambg-128-3-150-pmbg-116-back-on-insulin.289051/

It's been 2 weeks since she got her bad teeth removed and her numbers continue to climb so I am pretty sure she's out of remission at this point and we are going to start her back on insulin.

The vet recommended starting her at 0.5u but I am not sure if that's a good or bad dosage to start back on.

I couldn't find any specific guidelines of where to start for cats who dropped out of remission. I can only find the starting dosages for newly diagnosed cats. Do I follow that formula (0.25 unit per kg of the cat's ideal weight)? If so, that would put her starting dose at 1.36u which I assume we round down to 1.25u?

Or should we err on the side of caution and stick with 0.5u or go even lower? There's a chance that she's still in pain and/or has inflammation from her recent tooth extractions and that is causing her elevated BG.

I have to admit that I'm feeling really depressed and angry at myself because I should have caught all of this earlier. I should have insisted on a dental when the vet said she had "mild gingivitis" at her checkup. I have read that a second remission is very unlikely and that the window is very tight and I feel like I screwed up and missed my window. I love Tessa with all of my heart and she's worth every bit of stress I'm going through but I'm so not looking forward to this.

 

[Bron and Sheba (GA)]

Here is your recent post on main after the dental
https://www.felinediabetes.com/FDMB...f-dental-work-brings-her-bg-back-down.289521/
I think I would restart at 0.25 unit as her BGs are not very high. You can always increase. See what others think.
Yes second remissions can be hard to achieve. I couldn’t get Sheba back into remission after she fell out but I’ve seen several that have gone back into remission…some more than once… so don’t lose hope.

 

[Wendy&Neko]

2 weeks should be enough time for the inflammation to be over. Did she get a follow on check from the vet after the dental to make sure no infections?

Cat coming out of remission tend to need to get up to or even above their max dose the first time on insulin, which was 2 units for Tessa. Though we've seen the odd one need a bit less. I wouldn't start too low a dose. Second option if you start low is to fast track. The sooner you can get her back into tight regulation, the greater the chances of a second remission. You will need to be aggressive, but safely so, with the increases. How closely can you monitor when you start the insulin back?

We have a few kitties here now that came out of remission. Tango just started his second OTJ trial yesterday. I've also seen a small number of kitties on their third OTJ trial. You might want to look at the spreadsheets for Nestle, Kit Cat, Tansi, GuMung, Dallas. I always like looking at Jill&Alex (author of the Sticky Notes) spreadsheet - she had a couple instances of falling out of remission. Jill tried to make the spreadsheet a teaching tool and had lots of comments.

 

[tessa's mom]

2 weeks should be enough time for the inflammation to be over. Did she get a follow on check from the vet after the dental to make sure no infections?

Cat coming out of remission tend to need to get up to or even above their max dose the first time on insulin, which was 2 units for Tessa. Though we've seen the odd one need a bit less. I wouldn't start too low a dose. Second option if you start low is to fast track. The sooner you can get her back into tight regulation, the greater the chances of a second remission. You will need to be aggressive, but safely so, with the increases. How closely can you monitor when you start the insulin back?

We have a few kitties here now that came out of remission. Tango just started his second OTJ trial yesterday. I've also seen a small number of kitties on their third OTJ trial. You might want to look at the spreadsheets for Nestle, Kit Cat, Tansi, GuMung, Dallas. I always like looking at Jill&Alex (author of the Sticky Notes) spreadsheet - she had a couple instances of falling out of remission. Jill tried to make the spreadsheet a teaching tool and had lots of comments.

Yes, she had a check yesterday. Vet said no signs of infection and her mouth was healing well.

I think she still shows some signs of pain after eating if food gets stuck in her stitches and when I give her chin scritches she gets a wide-eyed look and her ear twitches a little bit. Maybe her lower jaw is still a little sensitive because she had several bottom teeth removed in the same area though. She was on gabapentin but took her last dose yesterday morning.

I can monitor very closely during the day but not as close at night. I can test her hourly during the day if I need to haha but I can usually only get as late as +2 or +3 at night. I do have some Libre sensors left from last time that I could put on her in a pinch but I'd rather avoid those because they're not that accurate at low numbers anyway which is the main reason I'd even want to use one.

I will take a look at those spreadsheets, thank you. I had found a few of those on my own but not all of them.

 

[tessa's mom]

I think I'm just gonna go with the 0.5u that the vet recommended. I can test her a lot tomorrow and I'll stay up a little bit tomorrow night to at least get a +3. I got my calipers set up for precise dosing so hopefully things will go smoothly in the morning.