9/28 Saoirse AMBG 4.8-Nausea after Stopping Insulin. Ideas?

[Critter Mom]

Hello all,

Saoirse has responded really well to her Lantus treatment and is on the third day of her OTJ trial. Here's the link to her condo on the Relaxed Lantus Board:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=126041

There are daily 'mini-condos' in Saoirse's spreadsheet under the detailed log tab. (Alphatrak glucometer.)

Her BG numbers are very good so far but she is becoming increasingly nauseated and consequently is finding it more difficult to eat. She has been taking the following meds and prior to cessation of Lantus treatment these were working well for her:

Famotidine 2.5mg SID (c. 1/8 tablet, given last thing at night).
Ondansetron 2mg BID
Cyproheptadine - have been giving between a sliver and 1/8 tablet once or twice a day as needed (appetite was improving OK but the cypro potentiates her other meds). Max dose per vet Rx: ¼ tablet max 3x/day.


Saoirse was doing amazingly well and looked/behaved as though completely rejuvenated for the last 2 weeks of her Lantus treatment. Now the effect of the meds is waning the longer she is off insulin. Exactly the same thing happened when she stopped Caninsulin treatment. Her clinical signs are not as good today (getting through food but lip licking, subdued/bit depressed/bit lethargic. Coat not so soft/glossy. Hid for a time this afternoon.) I gave her the 1/4 tablet of cypro a while back and this has helped a bit, but the effect is not as strong as recent tiny doses were before insulin was stopped.

I think that her stomach acid levels may be increasing since she stopped insulin. Has anyone else had this problem when their cat starts to go into remission? If yes, is it a temporary situation while the body adjusts to 'flying solo'. If so, how long does it take for things to settle down?

Saoirse got very, very ill within a week of stopping Caninsulin. I am desperate to keep my girl from a repeat of that now that she has stopped Lantus. (Note: Lantus was tapered down.) I'd really appreciate it if anyone who has had similar issues with their cat(s) could share their experiences and any advice on what I can do to help Saoirse would be very, very much appreciated.

 

[BJM]

Re: 9/28 Saoirse AMBG 4.8-Nausea after Stopping Insulin. Ide

With chronic pancreatitis, she may need to continue on those meds for a while or even indefinitely.

If you believe it is too much acid, 1/4 of a Pepcid AC may be used about 20 min before eating to see if it helps.

 

[julie & punkin (ga)]

Re: 9/28 Saoirse AMBG 4.8-Nausea after Stopping Insulin. Ide

I believe famotidine is the generic form of Pepcid, so you wouldn't give both.

I'm really confused by her spreadsheet - it's both in AT and in mmol. Are there US numbers in there somewhere? I'm not complaining, just saying that i don't have a clear picture of what i'm looking at.

what i can tell is the dose - typically people following TR go down to 0.1u dose before going off of insulin and it looks like you went off at 0.25u. I don't want to suggest anything dose-wise because i'm not clear on the BGs i'm looking at, but I would just mention that a smaller dose is possible. The smallest dose is a small drop created by pushing hard on the plunger, inserting the needle into the insulin and releasing the plunger. The vacuum created by the plunger will suck in a very small drop. YOu can practice to see what that looks like.

I haven't ever heard of this reaction when going off of insulin, but that doesn't meant it doesn't happen. It sounds like she's having pancreatitis symptoms.

 

[Marje and Gracie]

Re: 9/28 Saoirse AMBG 4.8-Nausea after Stopping Insulin. Ide

I think it is just coincidence that she gets sick when you stop insulin.

Even at the 0.25u dose, she didn't earn a reduction under the TR protocol. It's possible that the numbers you've seen since you last shot are due to the insulin depot and its also possible that she might start to trend up.

I agree that her symptoms sound like pancreatitis. I would probably start her back on a drop of insulin bid and see where she goes.

 

[Critter Mom]

Re: 9/28 Saoirse AMBG 4.8-Nausea after Stopping Insulin. Ide

Hi Julie,

I'm really confused by her spreadsheet - it's both in AT and in mmol. Are there US numbers in there somewhere?

Thank you for looking at Saoirse's spreadsheet. I'm sorry it's confusing. Since receiving your reply, I've added an additional sheet with US numbers now. It's the last tab on the right. The colour coding has a key at the top of the spreadsheet and it's set to match the Alphatrak meter, not human meters, because I found it confusing to work with Alphatrak numbers that should be in the green range displaying in blue. I've also split the standard blue range into pale green/teal values because it helped me to monitor Saoirse's downward trends more safely. (I have PTSD and have difficulty 'computing' information on the fly.)

... typically people following TR go down to 0.1u dose before going off of insulin and it looks like you went off at 0.25u.

To clarify, the dose was less than 0.25 IU. The plunger was touching the zero graduation mark on the syringe. I have to manage Saoirse's treatment against a backdrop of limitations imposed by my own poor health. At her current numbers, it is not safe for me to continue giving her insulin because I cannot guarantee being able to monitor her if she goes very low. (Mel helped us a few nights ago when I was really struggling.) Have there been other members who were not able to follow TR to the letter at the lower numbers who successfully managed their cats into remission? I'd like to learn more about any issues they encountered and what techniques they used to address them.

I haven't ever heard of this reaction when going off of insulin, but that doesn't meant it doesn't happen. It sounds like she's having pancreatitis symptoms.

LIsa's cat, Tisha, had a pretty much identical reaction just recently. (Tisha has pancreatitis, too, btw.)

Saoirse has only experienced eating problems since since starting insulin therapy. Before that she was almost asymptomatic pancreatitis-wise. The diet change may be a major contributing factor in Saoirse's case, as I had to transition her from dry. That said, the first sign of any problems started while she was still on dry food. I have been struck by the number of caregivers who have posted on the Feline Health board in the few short months since I joined FDMB whose cats have developed inappetence / GI problems after starting on insulin.
confused_cat

 

[Critter Mom]

Re: 9/28 Saoirse AMBG 4.8-Nausea after Stopping Insulin. Ide

Thanks for replying, Marje.

I think it is just coincidence that she gets sick when you stop insulin.

On both occasions, the speed of deterioration in clinical signs has been very similar. As I outline above, her clinical signs of nausea / inappetence only emerged since commencing insulin treatment. At least this time, she's got some medication support.

Even at the 0.25u dose, she didn't earn a reduction under the TR protocol. It's possible that the numbers you've seen since you last shot are due to the insulin depot and its also possible that she might start to trend up ... I would probably start her back on a drop of insulin bid and see where she goes.

Thank you for the dosing advice. For now, I'm going to see how her numbers hold up. As I outlined in my previous post, I have major health difficulties that impose restrictions on my ability to monitor Saoirse (especially on the PM cycles where she tends to run low). I need to keep Saoirse safe.

 

[Marje and Gracie]

Re: 9/28 Saoirse AMBG 4.8-Nausea after Stopping Insulin. Ide

Sounds like a plan but if she starts trending up, best to get her back on insulin so you don't have to take her up too much.

 

[Critter Mom]

Re: 9/28 Saoirse AMBG 4.8-Nausea after Stopping Insulin. Ide

Absolutely, Marje. :smile:

 

[Critter Mom]

Re: 9/28 Saoirse AMBG 4.8-Nausea after Stopping Insulin. Ide

BJM, thanks for your reply, too. (Thought I'd already replied to you - V V tired.. )