4/21 - Nova - AMPS=162, PMPS=117, +1=83, +3=56, +4=65

[Dawn & Nova]

yesterday's condo

WCR:
Well Nova was pretty talky this morning.. She had non-stop opinions for me during the morning routine. I expected to need a little bit of balls of steel this morning to shoot, instead I had balls of "oh Nova.. you are hilarious with your cute little curve ball" ..

Random stuff:
Nova's doctor tracked down an internal medicine specialist that was "in the know" about the hot topics in regards to Jerry and Nova.. Well with Jerry, he's weird, marching to his own drummer that guy..

Was some interesting Nova discussions.. at least to me.. it seems that FD is a hot topic at all the big medical conferences, but for quite a while it's basically been the same ol same ol.. minor changes from conference to conference.. until quite recently.. it seems to be accepted by the medical community (that is active at conferences anyways ).. that there are a lot more similarities between human and feline diabetes than previously thought.. a big one being that cats can have different types of diabetes.. (this confused me, I thought this tid bit was pretty obvious shortly after my own research began.. but it sure does explain the lack of an availability to do c-peptide tests on cats)..

This doctor brought up some interest things for me to consider in regards to Nova specifically.. I hadn't yet discussed with her doctor my plan to try to give Nova's pancreas a little bit more of a vacation.. and then coax it into turning on by nudging her insulin dose down.. and the specialist actually had the same idea but with a different approach than I had considered.

I'm about to say a bad word here.. let's see if the forum software blanks it out .. the suggestion was brought up, to try glipizide. Whoah now.. easy peoples.. my initial reaction too was "What? No way!".. having had it ingrained in my brain the uber evils of this pill..

But then I started giving it some thought.. with the absence of the ability to test Nova's pancreas function.. maybe a short term dosing strategy of glip would provide information on the potential of Nova's pancreas.. maybe it's not all that much different than sneaking her dose down and seeing if she figures it out herself.. either method is making her pancreas work before it's "ready" (before I've seen the low BG numbers)..

More reading and thinking about that to do.. in the mean time.. going to continue trying to find ways to try to reduce Nova's need for insulin or increase her efficiency in using it.. fatty acids are up there on the list of things I have found that I think may help.. and that idea was well received by her doctor.. continuing to consider Nova's weight.. although we're not seeing an awful lot of signs of the insulin resistance that would be expected with an overweight cat.. there's too much information about the effects of obesity on diabetes in people to ignore this as a contributing factor.

The specialist suggested trying to train Nova to walk on a treadmill (I've seen videos of it working, but my mental image of Nova in that situation is comic strip worthy ).. both for her weight.. and because exercise has been shown to reduce resistance and increase insulin sensitivity in people.

 

[OptOut]

Re: 4/21 - Nova - AMPS=162

I'm about to say a bad word here.. let's see if the forum software blanks it out .. the suggestion was brought up, to try glipizide. Whoah now.. easy peoples.. my initial reaction too was "What? No way!".. having had it ingrained in my brain the uber evils of this pill..

But then I started giving it some thought.. with the absence of the ability to test Nova's pancreas function.. maybe a short term dosing strategy of glip would provide information on the potential of Nova's pancreas.. maybe it's not all that much different than sneaking her dose down and seeing if she figures it out herself.. either method is making her pancreas work before it's "ready" (before I've seen the low BG numbers)...

Be sure to research carefully...I've heard that glip ruins the pancreas; that if you give it, the pancreas will never heal. (Not saying I heard right, but that's what's in my head).

I enjoy reading the stuff you think about (and asking questions and thinking is certainly NOT the same as doing). While the protocol we follow seems to be the absolute best for most kitties, it doesn't work for all of them (in particular, the "bouncers"). If people are not allowed to pose questions and learn w/o being "run out of town", we never learn anything new. Of course, the learning may simply be explaining why an idea is wrong, but that can be done nicely.

 

[Pat+Raja+Shadow (GA)]

Re: 4/21 - Nova - AMPS=162, +3=121

I found this site: http://www.peteducation.com/article.cfm ... 30&aid=200
And it stated this about glipizide:
"Some insulin production is necessary for glipizide therapy to be effective. Cats generally respond to glipizide therapy within 4-6 weeks of starting treatment. Adverse effects may include hypoglycemia, vomiting, and liver disease. If the cat does not respond to glipizide, the clinical condition of the cat could deteriorate and the cat could develop ketoacidosis."

Glad to hear that Vets consider FD a hot topic and that they are looking into the similarities in humans and felines. Very interesting post Dawn! Thanks for sharing that with us all....you are amazing!

 

[Roni and Moonie]

Re: 4/21 - Nova - AMPS=162, +3=121

Dawn, Nova is so so on the right track!! 118 cats OTJ cant be wrong...Why not try it--keep going as you are, & then see if something else works?? You are already here, working the protocol--Sorry I do Not understand why you would rock the boat..
Because the vet says....They have some theories, they did some studies(about time)..
Please reconsider continuing here & see what happens--We :YMHUG: :YMHUG: :YMHUG: you & want the best for Nova.
You can always do somehing else if you choose..

 

[Sarah and Buzz]

Re: 4/21 - Nova - AMPS=162, +3=121, +4=92

Good numbers today for Nova! Interesting things the vet brought up, definitely some food for thought. You mentioned "continuing to consider Nova's weight" and I looked in her profile to see how much she weighs but didn't see it. How much does she weigh? Just a curiosity thing on my part, as I've never heard anything from you about her weight.

 

[Dawn & Nova]

Re: 4/21 - Nova - AMPS=162

Be sure to research carefully...I've heard that glip ruins the pancreas; that if you give it, the pancreas will never heal. (Not saying I heard right, but that's what's in my head).

Yeah that's what I have heard too.. need to learn more about how it does that.. my guess is that it burns the pancreas out by making it work too hard.. which I would suspect is also a risk of reducing without seeing really clear signs of the cat being ready..

<snip>cats generally respond to glipizide therapy within 4-6 weeks of starting treatment<end of snip>

This is an area I plan to definitely look more into.. I wouldn't want to do 4-6 weeks of a medication like that.. "respond to" is vague and could be anywhere between shows any measurable signs of change, and being regulated... there may also be safer/better/etc alternatives that just aren't commonly used in cats yet.. it's a big avenue of investigation.

Like I said.. lots of other less invasive things to try first.. supplements, dose tweaks, weight and exercise for starters.. but I'm not willing to rule anything out completely without careful consideration. Nova's doctor and I discussed it and sort of left it at a "lets see where things are in 3 or 6 months and discuss it again"..

How much does she weigh?

15.5 pounds. 3.5 pounds overweight. I say she's fat all the time!

Dawn, Nova is so so on the right track!! 118 cats OTJ cant be wrong...Why not try it--keep going as you are, & then see if something else works?? You are already here, working the protocol--Sorry I do Not understand why you would rock the boat..
Because the vet says....They have some theories, they did some studies(about time)..
Please reconsider continuing here & see what happens--We :YMHUG: :YMHUG: :YMHUG: you & want the best for Nova.
You can always do somehing else if you choose..

I've been on the Nova Protocol for a while now.. and have done it with the guidance and approval of people here. The Tilly Protocol is a FANTASTIC starting place and guideline, and an excellent reference when it's not clear whether to do one thing or another.. but most of the cats who have been around here (or on the site it came from) for a little while.. aren't following it to a T.. and I haven't interpreted it, or it's implementation here, to be strict. It even specifically states that it works well for the majority of cats, but not all.

We have many cats on fat or skinny doses, cats who get smaller increases/decreases than 0.25U and wait for numbers lower numbers than the protocol states for reductions.. cats who stay on a slightly higher dose and feed through the lows to try and maintain better numbers to give the pancreas a break.. and many examples I am forgetting.

The Tilly Protocol also exists because people thought there has to be a better way, there has to be more they could do for their cat.. the idea that there is "a treatment protocol" and that's the end of that.. is why so many cats end up here so messed up. Vets not keeping up with advancements (either not able or not willing).. and not being willing to consider alternatives.

Anyways, that's why I want to "rock the boat". It's not possible for me to be able to be a part of this community, to read your condo's each day, grow to care about each of you AND your animals, and not want better for all of us.

As Boo so beautifully said:

asking questions and thinking is certainly NOT the same as doing

 

[Sienne and Gabby (GA)]

Re: 4/21 - Nova - AMPS=162, +3=121, +4=92

The results of the study noted below run counter to the information that your vet provided. The study points out that more than half of the cats had FD symptoms that worsened with glipizide. More importantly, only 7 of the 50 cats improved. This is not a significant finding that would, in my mind, recommend the use of glipizide.

In addition, a PubMed search only turns up 10 articles on glipizide use in cats and most of the research is prior to 2000. I somehow don't think this is a cutting edge area of research.

[J Am Vet Med Assoc. 1997 Mar 15;210(6):772-7.
Intensive 50-week evaluation of glipizide administration in 50 cats with previously untreated diabetes mellitus.

Feldman EC, Nelson RW, Feldman MS.

Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis 95616, USA.
Abstract

OBJECTIVE: To evaluate use of the oral hypoglycemic drug glipizide in diabetic cats. DESIGN: Prospective study. ANIMALS: 50 cats with recently diagnosed but untreated diabetes mellitus. PROCEDURE: Each cat received glipizide (5 mg, q 12 h) for 16 weeks. Medication was not given during the subsequent 16 weeks; then glipizide treatment was repeated. Each cat was evaluated prior to treatment and at 2, 4, 8, 12, and 16 weeks during each of the 3 phases: blood samples for serum glucose and insulin determinations were obtained every 2 hours, from 8 AM to 6 PM. A preprandial blood glycosylated hemoglobin percentage was determined for the first sample obtained at each visit. RESULTS: During the first 22 weeks of the study, diabetes worsened in 28 of the 50 cats, which then were disqualified from the study and treated with insulin. Of the remaining 22 cats that improved clinically, 7 had corresponding metabolic improvement in each diabetes-related parameter assessed and did not become hypoglycemic. Six of the 22 cats became hypoglycemic. Glipizide was discontinued, and diabetes did not recur. Serum glucose concentration did not improve in 6. Three cats had metabolic and clinical improvement during initial glipizide treatment, but had recurrence of the disease during repeated treatment; glipizide was discontinued and insulin was administered. None of the 50 treated cats died, and observed morbidity was mild and transient. Transient anorexia and vomiting were observed in 8 cats, and 4 became transiently icteric with abnormal liver enzyme activities. CLINICAL IMPLICATIONS: Trial use of glipizide is feasible in diabetic cats of owners who are unable or unwilling to administer insulin

 

[Dawn & Nova]

Re: 4/21 - Nova - AMPS=162, +3=121, +4=92

The results of this study noted below would suggest would appear to run counter to the information that your vet provided.

It's possible I may not have clearly explained what the discussion about glip was.. it was never suggested, and I'm NOT considering it as a treatment for FD.

Although beta-cell stimulation has shown great success in humans as a starting point for treating type 2 diabetes, in ADDITION to diet and exercise.. and is often tried in people before insulin therapy.. cats are usually a lot worse off when the problem is discovered, and I don't think that this would be a sound treatment avenue for most kitties.

The discussion was is there a way to use glip (or some alternative), in addition to insulin therapy, in a small dose and safe way to evaluate how much of the pancreas is capable of producing insulin? It was a idea suggested by a doctor Nova's doctor spoke to, when they talked about our inability to find any way to do a c-peptide test.

 

[Jill & Alex (GA)]

Re: 4/21 - Nova - AMPS=162, +3=121, +4=92

just a suggestion...
you'd probably receive a lot more feedback on using glipizide in addition to insulin therapy if you cross-posted on think tank. i think there's also quite a bit of discussion about glipizide on the "old" fdmb. although, if i remember correctly, most, if not all of the discussion centered on the use of glipizide rather than insulin therapy. might be worth taking a look though.

 

[Dawn & Nova]

Re: 4/21 - Nova - AMPS=162, +3=121, +4=92

I'd also like to add.. just so that I know it's really clear that I'm not running around popping random pills into my cat..

If I could find some safe (and let me be clear, there IS a heavy emphasis on safe) and empirical method to determine whether or not she has little chance of remission.. my goals for her would change from taking as much load off her pancreas as possible so it can heal, to keeping her below the renal threshold.. and lessening her risk of hypo (similar to the goals of acro/etc).

The reason we decided to leave it on the drawing board and re-discuss if she has been on insulin for approx 1 year, is because we don't know that this method would be safe (or we would have already tried it ).. but considering, discussing and researching it may bring forward an idea or method that we can be relatively certain is.

If Nova, after a year since dx, is still insulin dependent.. that may be enough of a "go at it" for me to want to consider more aggressive methods to determine her pancreas function. Of course my goals for her may change at any time between then and now because I determine that the risk of keeping her really low no longer outweighs the possible reward for both her and I, or she goes OTJ . It's something I re-evaluate every day.

 

[Lisa and Do Lou (GA)]

Re: 4/21 - Nova - AMPS=162, +3=121, +4=92

I asked about glip in the beginning and pretty much all 3 vets I talked too where I work said it does not work and it can ruin the cats pancreas as Sienne mentioned so be very careful if you decide to use it we do not even carry it at our hospital

 

[Dawn & Nova]

Re: 4/21 - Nova - AMPS=162, +3=121, +4=92

Yeah our vet doesn't carry it either, and if they did, whooo would they get an ear full from me . Should have heard the "talk" I gave Nova's doctor about the RC "diabetic" dry.. I count those bags on the shelf to make sure none have been sold each time I go in.. and grill her to make sure it isn't prescribed it to any diabetic cats (so far, so good! ).

Actually, I had a severe phobia of needles when Nova was dx.. I BEGGED for any alternative to needles.. she very specifically told me that was an alternative, but she wouldn't prescribe it to Nova because it wasn't very successful.. and I just had to "get over it".. haha. Ah.. tough love.

Edit: Sigh.. I can't type or speak English very well today.

 

[Sienne and Gabby (GA)]

Re: 4/21 - Nova - AMPS=162, +3=121, +4=92

Nova is doing really well. She is dealing with FD at her own pace. I'd encourage you to not set deadlines or cut off dates. There are any number of cats here who went OTJ after 2 years. The odds are more in your favor within the first year. That's all -- in your favor. More than a year doesn't mean that remission isn't possible. You could get a very accurate test of Nova's beta cell activity today only to find out that she's dramatically improved in 6 mos. Would having given up in the interim done you or Nova any good? Nova is more than the sum of her numbers. That's what's important.