10/22 Lily 211@+1.5

Morning! Lily is doing well this morning at 211. Hope for a great day for her and everyone!

 

Hi Sally,

Great to hear Lily's doing well!

Looks like Lily got a bit of a food bump from her brekkie, although not quite as big as the last couple of AM cycles. I'd suggest testing again at +3.


Mogs
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She is 179 at +3

 

And down she goes.

How long till you're due to leave for FIL's, Sally?


Mogs
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Leave at noon which is in 1 hr 15 min

 

I'd suggest testing 30 mins before you leave. That way you'd have time to feed Lily if her BG needs a bump and check again to make sure her numbers have come up OK. Does that work for you?


Mogs
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Yes, I can do that! Thx!

 

Lily is 175 at +4. I think she will be ok for an hour and I will check her when I get home, don’t you?

 

She's evened out for now so I think she should be OK for that time. Grab another test when you get back. If you're at all uncertain, you can give her a little snack of LC food before you go.

Keep safe, and my best to your FIL.


Mogs
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Lily is 211 at +6.

 

Hi Sally,

Nice 'n' steady. (((Lily))) I'd suggest grabbing a +9 and, assuming all's good at that point, do next test at PMPS. Sound like a plan?

Out of curiosity, did you give Lily any extra food before you popped out? (Just wondering whether there might be any food influence in the +6.)


Mogs
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Yes, sounds good. No I didn’t give her anything. Thx Mogs!

 

Mogs! I just talked to the doctor about Lily and she said looking at her spreadsheet that it looks like she is going into remission. She told me to discontinue the insulin for about a week and continue to do the BG checks and then resend her the spreadsheet for her to evaluate. She thinks she will be good with just the low cal diet. What is your thinking on this?

 

I think Lily's pancreas is starting to show hints of recovery and that she stands a very good chance of remission (anti-jinx) but I think she has a little way to go yet.

On odd occasions you might see a cat which has been running the vast majority of the time in the low 100s drift down into remission numbers when insulin treatment is suspended. I've yet to see it happen in a kitty whose BG levels have been mostly higher than that. Getting to the stage where a cat can spend enough of the day in the normal reference range to support recovery of the pancreas beta cells is nigh on impossible with Vetsulin for safety reasons (as you've seen) and a kitty can get 'stuck' with preshots mostly in the low 200s and nadirs not low enough or long enough to get the pancreas all the way. (Can happen but it's really uncommon.) I understand from Deb (of Wink fame) that Prozinc users can hit a similar problem but in that case the cats are in the blue range and aren't quite able to get safely into the greens (the target for remission). However, a cat which has spent a long enough time in low blues stands some chance of drifting down the rest of the way. [ETA - With Lantus it is possible to tightly regulate the cat to keep it in the normal range for most if not all of the day. This provides the optimum internal environment to support potential recovery of beta cells and also resets the cat's system to recognise normal numbers again.]

Maybe Lily might surprise us, but based on her data I think she still needs more time on insulin, hence my suggestion about the Lantus.

Given that your vet has advised that you should suspend insulin treatment and monitor, then the best I can suggest is:

1. Test AMBG and PMBG at the same time as normal.

2. Test at +1 and +2 after each feed (morning and evening) to capture how high food elevates BG each day.

3. Do 1 or 2 random tests at other times in the day which suit your schedule.

4. If numbers stay solidly stuck above 120 (top of the normal range) or start noticeably trending upwards go back to the vet as soon as you notice, don't wait for the week. (Don't want to lose the progress Lily has made.)

5. If the vet then advises reinstating Vetsulin treatment I'd suggest holding out for a Lantus Rx.

Do you have any questions about anything, Sally? And what do you yourself think?


Mogs
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PS:

If the diet change alone was going to be enough then Lily would already be in remission, if the cats we see here to whom this happens are anything to judge by. (They tend to go into remission almost immediately.)


Mogs
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I like your plan and will do that. The vet said that it was perfectly normal for cats to run in the mid 200’s, so not sure about that. I almost went ahead and told her to give me the prescription for Lantus anyway but thought better of it.

 

Your vet is effectively saying to you that it's acceptable for Lily to remain an UNREGULATED diabetic!!!!

This is not OK.


Mogs
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If it's so OK for a cat to run in the 200s then why did your vet bother to prescribe any insulin in the first place??????




Mogs
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When she did Lily’s bloodwork her BG was 423. I guess I will probably need a new veterinarian.

 

That's something, I guess. I was working from the spreadsheet data, and with the exception of a few bounces into the pinks Lily has not run higher than the 200s. If the 423 was from a spot check or a blood draw at the vets then that could have been elevated temporarily by stress (can raise BG above the baseline level at which a kitty would normally be running when at home by amounts in 3 figures).

Hopefully you won't need to switch vets. Let's see how Lily goes, and if she does need a little bit longer on insulin you'll have the evidence from your testing to take back to the vet.

(((Sally)))




Mogs
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Yes, it was from a blood draw at the doctors office. Thanks Mogs! Don’t know what I would do without your great knowledge!

 

I'm only a conduit, Sally, passing on what I've learned from many other members here.

While I think of it, keep an eye on Lily's appetite, water consumption and pee volume during the trial period. Also monitor her coat condition. (Standard secondary monitoring for feline diabetics.) If at all possible it would be helpful to you if you could measure how much water she drinks each day. (Cats in higher numbers tend to drink more.)




Mogs
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Yes I will try to monitor water intake but I hardly ever see them at the water bowl. When she was sick with her UTI I noticed her drinking but not since then. So if she is at the water I will know something is off! I put quite a bit of water in their wet food to help with that.

 

That's exactly it, Sally.

BTW, I just went back to review some of your early posts from just after Lily was diagnosed to refresh my dreadful memory of where she was at then. Going back over early events can be helpful.

1. Because Lily was eating a high carb diet at time of diagnosis that would also feed into the high BG result from your vet's test.

2. Given that it's now several weeks since Lily completed the transition to her low carb diet it's not likely that further improvements in BG levels will be seen going forward as a consequence of the diet change.


Mogs
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Thanks Mogs! I guess time will tell. And I hope for the best.

 

Fingers and paws crossed in the Shire...




Mogs
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Hi Sally,

Hope all is going well with yourself and Lily.

I've been following Lily's progress on her spreadsheet. Been thinking about secondary monitoring. This is a bit of a real long-shot suggestion given that you've got six cats, but if there was any way you could test Lily's urine for glucose at some point during this phase it would be helpful to you and your vet. (Keto-diastix or equivalent strips should be available at Walmart and regular pharmacies.) Looking at Lily's numbers, I think they might be hitting the renal threshold (where glucose starts getting excreted in the urine). A urine test positive for glucose would confirm that.

For info, according to the Merck Veterinary Manual, on a pet meter the renal threshold typically falls between 250-290mg/dL (varies from cat to cat). Pet meters return a higher number than human meters when measuring cat BG levels. I don't have a defined renal threshold range for human meters but around the 200 or higher would definitely be in the right ballpark to look.

If testing isn't possible then no worries. It's nice to have, not need to have.


Mogs
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Helpful link:

Tips for collecting urine samples


Mogs
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Hi Mogs! Is this something the vets office can do? I use 2 litter robots for the cats and with those this doesn’t look possible.

 

That would be a bit problematic alright, Sally.

For general info, a vet could try to get Lily to express a sample but it would be an OTT thing to do just for a urine glucose test. In an ideal world the easiest way would be to check BG using a pet meter but readings taken at the vets are usually compromised because BG becomes temporarily elevated by travel/vet stress.

As I said above, it was only an idea - nice to have, not need to have. I shouldn't worry about it further.

Have a grand evening.


Mogs
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Thanks Mogs, hope your evening is good too.