10/11 Jack AMBG 423 : Day 3 of 4: Insulin Moratorium

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JacksDads

JacksDads

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Link to 10/10: The 2nd Day of Jack's Insulin Moratorium

Morning. Yoshi here. So looking back at the past week of spot checks: 10/4 to 10/6 looks very similar to 10/8 to 10/10. Only that 10/4 to 10/6 has numbers that are all a little higher. Typically - you'd expect numbers with 0.0u to be a little higher than numbers with 0.1u, no? Actually, :idea: maybe the change to small meals kept Jack in the 300s yesterday.

The biggest worry is if Jack starts going red to black... nailbite_smile but if he's staying purple - that's better than red and black, right?
So at +10 (2 hours before AMBG), I found Jack licking the bottom of the to-go box from Chinese take-out I had last night that was sitting on the coffee table. :o He maybe got a few licks - but luckily I didn't leave much for him to scavenge :roll: I know even a few licks of Chinese food sauce has a load of sugar in it - but Jack likes adding more pieces to his glucose puzzle.

Libby and Lucy said:
part of the point of the experiment is to see what Jack's body is doing. The other part of the point is to see if he can manage without insulin. If he really didn't need the insulin and he was getting it anyway, he might bounce like that. If his pancreas is working, then we can use food as insulin. Small meals can stimulate his pancreas to produce insulin and bring the numbers down, just like exogenous insulin would. The numbers he has been having imply that his pancreas is working at least some of the time, so we want to get an idea of how well it works, and we want to see if we can stimulate it to work more often. The GOOD news (at least in my opinion) is that from yesterday's data, it does look like Jack is bringing his numbers down after food. Let's hope he can keep it up (down). :mrgreen:
Click to expand...
So I assume we will find out how his pancreas is doing from his blood work on Friday (Does blood work usually show pancreas function?) I don't want to start 'analyzing' too much, but if he stays in the purples, maybe that just simply means the insulin is helpful? And if he dips - then, that means - the food's helping? Funny that food can both be a blessing and a curse - increasing numbers initially, but (hopefully) in the long run making his glucose levels drop. Not exactly sure how - I know Libby explained it as letting Jack's body kick in and start doing the work to produce his own insulin. At the least, it comforts me that we now have a syringe that can measure 0.01u when we decide what to do after the Moratorium is over (on Wednesday).
 
After the food, if the pancreas is working, it goes into action sending out insulin which cause a drop in the numbers after 3 hours...or 4 hours, depending. Raja gets lower numbers if I wait and test at +4 after eating.
BTW, the 423 is actually a red....
Are you able to do a test at either +3 or +4 this morning?
 
Chinese food has cornstarch in it too! What a carb lovers bonanza -- sugar and cornstarch!!

The pancreas tests that you get from blood work tell you about overall pancreatic function. They won't tell you how well the beta cells (the cells that produce insulin) are working, though. Usually, blood tests involve amylase and lipase (although, these tests of pancreatic enzymes are unreliable in cats and shouldn't be interpreted in isolation). The one test that is specific to the pancreas is fPLI or spec fPLI. Elevated levels on this test reflect the presence of pancreatitis. Jack would be having a lot of other symptoms (nausea, vomiting, not eating, looking unhappy and like he's in pain -- 'cause pancreatitis is painful) and it sounds like he's acting just fine, especially if he's stealing Chinese food.

If you think about how your body works, when your blood sugar drops a bit, it signals the brain that you're hungry. You eat and blood sugar rises which then sets of a chain of responses to metabolize the food that you've just eaten. One of those responses is that the beta cells in the pancreas release insulin. (The pancreas also released enzymes to aid in digestion -- amylase and lipase). Insulin aids in the transfer of glucose from the bloodstream into the cells where it's needed. In a diabetic, the beta cells aren't functioning properly so the glucose remains in the blood. Since glucose doesn't get into the cells, your cat is hungry all the time and despite eating a lot, loses weight until exogenous insulin is supplied via injection. As the pancreas heals, the beta cells may begin to function properly again and start to release endogenous insulin. Food acts as a trigger to stimulate the beta cells to do what they are programmed to do. So, if numbers are running high, feeding may act to stimulate a functioning pancreas to release insulin which then brings numbers down.
 
Hey all, Jose here checking in for the evening
Jack seems to have been cruising the pinks today. Amazing--I've been worried that we would be spending the past couple of days in the high reds or blacks--but even if he isn't plopping down into the greens by himself just yet at least we've got something that looks like stability.
 
ok, now, i don't get it.
i remember because of bad bounces you were advised to stop insulin to see what happened. and jack seemed to be bringing himself down somewhat after food. but i'm concerned that we now have multiple days of higher numbers (realize day 3 of 4 must mean you're stopping after day 4?), and wondering why he's not back on insulin.
could it be that he just isn't responding well to lantus? there's no guarantee every cat will do well on it. if that's the case, maybe try levemir? someone might have a cartridge to sell or give you to try it.

regardless of whatever else might be going on with him to cause higher numbers and a strong response to injected insulin, i'm concerned that he's now gone without insulin for 3 days. i do remember someone mentioned checking for ketones at this time but hoping someone else will step in and advise going back to insulin even if it means changing something up to hope the response won't be as extreme.
 
Jose:
Just did a spot check for Jack--for the first time since the moratorium we've measured him in the yellows! I know that with the margin of error and all it isn't conclusive, but I'm still gonna be happy for him right now.
 
chriscleo said:
ok, now, i don't get it.
i remember because of bad bounces you were advised to stop insulin to see what happened. and jack seemed to be bringing himself down somewhat after food. but i'm concerned that we now have multiple days of higher numbers (realize day 3 of 4 must mean you're stopping after day 4?), and wondering why he's not back on insulin.
could it be that he just isn't responding well to lantus? there's no guarantee every cat will do well on it. if that's the case, maybe try levemir? someone might have a cartridge to sell or give you to try it.

regardless of whatever else might be going on with him to cause higher numbers and a strong response to injected insulin, i'm concerned that he's now gone without insulin for 3 days. i do remember someone mentioned checking for ketones at this time but hoping someone else will step in and advise going back to insulin even if it means changing something up to hope the response won't be as extreme.
Click to expand...

So despite the #s being on the high side, it was suspected that part of the issue was that we were seeing some very inconsistent and difficult to interpret numbers because of Jack possibly having extended bounces as a result of the insulin sending him too low. We were advised to give him 3-4 days to let his system even itself out before resuming insulin even if the numbers got into the scary high ranges. Tomorrow is the last day of the trial and hopefully there will be people chiming in then (and of course your feed back will be welcome) to help us interpret the information that we've gotten and decide what course of action to take from there.

Despite being a bit more of a nudge with regards to asking for food, I will say that overall Jack seems to be doing much better the past couple of days than in the week or so preceeding. He doesn't seem to be having severe energy crashes, and he's generally much more of his perky, talkative self.

We're working on getting a workable way to check for ketones--he's not an easy cat to sneak up on in the litterbox.

Are there other signs we can look for to help us gauge if he may be entering ketoacidosis? Are there symptoms or warning signs other than high blood glucose?

-Jose
 
Do you only have Jack using the litter box? I was told of a way to test for ketones without catching the cat in action. You would first need to test some clean, fresh litter - make a little slurry or paste out of this clean litter and check it on a ketone stick. If this clean litter tests negative for ketones (your control) then you can take one of Jack's fresh peeballs from the box and test it. Good luck!
 
yes, if you get a negative result when testing clean litter in a little water, next time you wait for jack to finish peeing (right before he covers his pee up) and stick a strip into the wet part to check for ketones.
 
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