Jessica & Conan
Member Since 2016
Previous posts:
- http://www.felinediabetes.com/FDMB/threads/2018-04-16-conan-tresiba-insulin-degludec-update.194256/
- http://www.felinediabetes.com/FDMB/threads/2018-04-11-conan-tresiba-insulin-degludec-update.194017/
- http://www.felinediabetes.com/FDMB/threads/2018-04-07-conans-first-day-on-insulin-degludec-tresiba.193815/
In my previous update I mentioned that Conan had lost his appetite. After about 3 days on metoclopramide (.2ml subcutaneous injection 3x/day), which brought us to last Thursday 4/19, he had improved significantly, at which time I stopped the medication. His appetite continued to improve steadily, and by yesterday was totally back to normal, as was his general demeanor. Since last Wednesday he has been eating his usual amount of food - though for a few days I had to feed him in multiple small meals. Now he's back to his usual voracious self and eating large meals again.
Unfortunately, however, the Tresiba experiment seems to have stalled. For a few days while he was sick (and eating almost nothing), his daily numbers were in the blues and greens. As soon as he began eating normal amounts, though, he went back into the pinks - and pretty much stayed there constantly. There were a few occasional yellow readings, but mostly pink, pink, pink.
Last Wednesday night, after my previous suppositions (discussed in prior updates) that the insulin was wearing off after 12 hours continued to be confirmed, I decided to go to BID dosing. I kept the same amount for each dose - I had been giving him 2U in his daily dose, and I switched to 2U twice a day. This was the approach that made sense to me (and it's what I did when I switched to TID dosing with Levemir). For Conan at least, the insulin is only lasting 12 hours or less, then after that, his numbers go back up to their baseline "un-medicated" state, and the insulin seems to be totally gone from his system. There's no sign of any depot effect (though I can't be certain there isn't at least a small one). So each dose is entirely independent of the one before. It would make no sense (at least or so my reasoning goes!
) to split his prior 2U dose and give him 1U twice a day, because a 1U dose is completely ineffective for him.
So he's now been on BID dosing for 6 days, and I've been able to get some good curves, though the last two days I haven't been able to test much after the morning dose (I've tested much more regularly after the PM dose).
And the results have been... TERRIBLE. It looks almost as if he's getting no insulin at all - so much so that I actually drew a dose and squirted it onto my fingers just to make sure I wasn't making a mistake drawing from a pen! (And I've actually been tempted to try a dose out of a different pen just to double check, though it seems highly unlikely this pen could have "deteriorated," since I've only had it a few weeks and have handled it carefully and kept it scrupulously refrigerated - as the Tresiba instructions call for).There's no bouncing around, no real spikes - just relatively consistent pinks, higher after meals, lower in the morning - which is what I think I'd get if he weren't getting any insulin at all! I am utterly baffled by this!
Three days ago I increased his dose from 2U to 2.25U - and I thought maybe I was seeing a slight change, since I got a few readings in the high yellows, but they went right back to the pinks. Tonight after 3 days at 2.25 I've increased the dose yet again, to 2.5U, since I'll be around for the next few days to monitor.
I have to admit to being somewhat discouraged, and perplexed, by the seeming ineffectiveness of the insulin - though at least its effect is certainly consistent! The difficult part, though, is that it's hard to be sure it's even having an effect, since this BG levels remain fairly consistent even at the end of the cycles, when the insulin has (presumably?) worn off.
I'm not prepared to give up yet - if this increase doesn't work, I'll try at least a few more increases. It is true that for humans the Tresiba dose is often around 80% of the Lantus dose, and when I stopped Lantus at a 2.75U dose I had definitely not yet reached an effective dose. So perhaps it makes sense that this dose isn't high enough. But I'm not feeling quite as optimistic about the Tresiba as I was at the beginning!
- http://www.felinediabetes.com/FDMB/threads/2018-04-16-conan-tresiba-insulin-degludec-update.194256/
- http://www.felinediabetes.com/FDMB/threads/2018-04-11-conan-tresiba-insulin-degludec-update.194017/
- http://www.felinediabetes.com/FDMB/threads/2018-04-07-conans-first-day-on-insulin-degludec-tresiba.193815/
In my previous update I mentioned that Conan had lost his appetite. After about 3 days on metoclopramide (.2ml subcutaneous injection 3x/day), which brought us to last Thursday 4/19, he had improved significantly, at which time I stopped the medication. His appetite continued to improve steadily, and by yesterday was totally back to normal, as was his general demeanor. Since last Wednesday he has been eating his usual amount of food - though for a few days I had to feed him in multiple small meals. Now he's back to his usual voracious self and eating large meals again.
Unfortunately, however, the Tresiba experiment seems to have stalled. For a few days while he was sick (and eating almost nothing), his daily numbers were in the blues and greens. As soon as he began eating normal amounts, though, he went back into the pinks - and pretty much stayed there constantly. There were a few occasional yellow readings, but mostly pink, pink, pink.
Last Wednesday night, after my previous suppositions (discussed in prior updates) that the insulin was wearing off after 12 hours continued to be confirmed, I decided to go to BID dosing. I kept the same amount for each dose - I had been giving him 2U in his daily dose, and I switched to 2U twice a day. This was the approach that made sense to me (and it's what I did when I switched to TID dosing with Levemir). For Conan at least, the insulin is only lasting 12 hours or less, then after that, his numbers go back up to their baseline "un-medicated" state, and the insulin seems to be totally gone from his system. There's no sign of any depot effect (though I can't be certain there isn't at least a small one). So each dose is entirely independent of the one before. It would make no sense (at least or so my reasoning goes!
) to split his prior 2U dose and give him 1U twice a day, because a 1U dose is completely ineffective for him.So he's now been on BID dosing for 6 days, and I've been able to get some good curves, though the last two days I haven't been able to test much after the morning dose (I've tested much more regularly after the PM dose).
And the results have been... TERRIBLE. It looks almost as if he's getting no insulin at all - so much so that I actually drew a dose and squirted it onto my fingers just to make sure I wasn't making a mistake drawing from a pen! (And I've actually been tempted to try a dose out of a different pen just to double check, though it seems highly unlikely this pen could have "deteriorated," since I've only had it a few weeks and have handled it carefully and kept it scrupulously refrigerated - as the Tresiba instructions call for).There's no bouncing around, no real spikes - just relatively consistent pinks, higher after meals, lower in the morning - which is what I think I'd get if he weren't getting any insulin at all! I am utterly baffled by this!
Three days ago I increased his dose from 2U to 2.25U - and I thought maybe I was seeing a slight change, since I got a few readings in the high yellows, but they went right back to the pinks. Tonight after 3 days at 2.25 I've increased the dose yet again, to 2.5U, since I'll be around for the next few days to monitor.
I have to admit to being somewhat discouraged, and perplexed, by the seeming ineffectiveness of the insulin - though at least its effect is certainly consistent! The difficult part, though, is that it's hard to be sure it's even having an effect, since this BG levels remain fairly consistent even at the end of the cycles, when the insulin has (presumably?) worn off.
I'm not prepared to give up yet - if this increase doesn't work, I'll try at least a few more increases. It is true that for humans the Tresiba dose is often around 80% of the Lantus dose, and when I stopped Lantus at a 2.75U dose I had definitely not yet reached an effective dose. So perhaps it makes sense that this dose isn't high enough. But I'm not feeling quite as optimistic about the Tresiba as I was at the beginning!
But from reading the threads regarding Tresiba I was able to gather that it did work as a once a day insulin...for one cat. The others had to dose BID. I feel like the general consensus was that it was flat and predictable but ultimately the benefits didn’t make it preferable to most due to the high cost compared to the L’s. They pulled Tresiba from the market in Germany I think in 2016. Don’t worry, it wasn’t a safety issue, it was a cost dispute, Germany wanted some proof that it was a better insulin over the L’s to justify the higher price and they were not satisfied. It became a stalemate and Novo Nordisk decided to pull out of the market there rather than lower the price. 
When they don’t feel great, it usually shows in the SS in either higher or lower than usual numbers. Always higher ones over here! 
This is true with some humans as well. Took my daughter on a plane when she was a baby and I was so worried about her screaming and crying the whole way, my pediatrician suggested to give her some Benadryl...to make her calm and sleepy... it made her crazy and wired instead! 
I asked about this at her next visit and the ped said, yeah, it can have the opposite effect on a few! 
Of course, if your cat is flat and has tons of duration on the L’s, it wouldn’t be worth it. The takeaway from the German experiences and one of the reasons why I shared it, is at least you know the insulin is safe and does work to tightly regulate cats. 
.