Bebo Update 8/27 - Stop Insulin?

Update 8/27 few posts down-
His BG read 12.0 on Alphatrak pre-feed after skipping 4 doses of his 1U Lantus! What to do now??


Orig Post-
Bebo was diagnosed august 12 with his original blood test reading at 650+(33~+)


He has only been on 1 unit of lantus insulin every 12 hours for 9 days. We did not start glucose reading until yesterday (Aug 24).

At the vet check with Alphatrak at +2 his first BG read 6.5. At home at +6 it read 5.8. At +9 I had trouble getting the blood poking for 10 minutes and the reading was 9.9 (vet said could be cause stressed).

So the vet said to stop his insulin for the night and check tomorrow preshot.

His morning preshot time was 9.1. The vet is not available til 3 hours after his shot is due so I gave him his 1 unit of insulin then.

When vet contacted me vet said I could have not given the shot, but it’s ok to start now. The instruction is to stop insulin tonight and get a BG reading tomorrow at his usual morning shot time but don’t shoot and wait for vet to reply.


It is wonderful to hear that Bebo could be going into remission so quickly but I’m just looking for reassurance that it is safe to completely stop his insulin so rapidly with these data?

Thank you for any reply!!!


Extra:

At diagonosis he was drinking and urinating 7+ times a day. On the day we started insulin he just completely stopped all that drinking and only urinates 2 times a day.

He is still severely constipated (going once 3-4 days) even though I started the 1/8 tsp of Miralax in his food.

We switched him from Whiskas dry food to Friskies Pate since starting the insulin.

He is still 6kg, has not gained any weight.

 

Did your vet do a fructosamine test? Strange but glad he may not need insulin...Hold on for more replies.

 

Thank you for replying!
Yes, from what I can read the fructosamine test at diagnosis read 673 umol/L and negative ketone in urine.

 

Would you be willing to set up a spread sheet? There's help available if you need it. I think folks will have a better idea of whats going on if they could see Bebos progress with a spread sheet if you are interested? You can find how to do that here:
FDMB SPREADSHEET INSTRUCTIONS.

 

Hiya,

Great to see Bebo doing so well. Yes, early remission is possible. Some cats actually go into remission with diet change alone (switch from high carb to low carb).

Even without giving any more Lantus, it will take several cycles for the depot to drain so it will probably be several days before you can truly determine how well Bebo might be able to regulate his BG levels on his own without insulin support.

Under the Roomp-Rand published Tight Regulation dosing protocol used here at FDMB, a cat on 1 unit heading for remission would be stepped down in increments of 0.25 units of Lantus at a time. Each reduced dose is held until the nadir BG level either stays in the lower part of the normal BG reference range for a week, or if it falls below a defined minimum value at any time. Rinse and repeat, until the cat hopefully achieves remission.

If Bebo's numbers trend upwards after cessation of Lantus treatment as advised by your vet, he may need insulin support a little longer - possibly at a dose smaller than 1 unit - to give the greatest chance at a strong remission that will hold.

Are you using an Alphatrak meter to check BG levels at home?


Mogs
.

 

So an update..... I tested this morning before feeding at his former preshot time Bebo’s BG read 12.0.

By now Bebo has skipped 4 consecutive doses of his 1U Lantus. He just went out to sit in the yard now so his energy level is not too bad despise high BG.


Yesterday morning when I notified the vet his 8.7 reading the vet said to stop insulin for the day and will give me further instructions in a few hours and I waited til the vet is closed and no instructions yet.

So now I don’t know what to do...? I don’t want to start from zero again just because vet decided to stop his insulin too abruptly. Please help...!

The vet will be open after 2 hours but the chances of me getting to talk to the doctor and not the clueless receptionist is pretty thin, could be another couple hours.

Since I can’t get instructions from my vet at reliable timings I’m almost considering to dose on my own doing what Critter Mom mentioned, something like 1U once a day for a week then reducing to 0.75U once a day for a week, gradually on my own? (I’m always keeping close eyes on him since it’s still quarantine.)

(I did a spreadsheet record of 4 days, I’m not testing enough but it’s dreadful making him bleed, I tend to pierce too deep and his ears are bruised already)

 

Unfortunately testing takes practice. If you are hitting a vein that can cause bruising. Adding a dab of Neosporin pain relief can help that. I cant remember the name of the same thing outside the US... Polysporin? I think? Someone here will know. Also if you put pressure on the spot you pricked that helps also.

I cannot give dosing advice so hold on for more replies.

 

Thank you. I hold his ears for a minute after.

I saw the sweet spot diagram but his ears are black and can’t see anything there. I have been using the only visible vein on his inner ears but began to worry: Can I prick the same spot over and over?

 

I was never THAT accurate. So I cant really say. In the healing process at first I would think different spots would be better.
BUT AS ALWAYS hold on for more replies!

 

Hi Serena Jan,

I suggest grabbing a few more tests today to check if the 12.0 is an outlier or whether Bebo's numbers are starting to trend back upwards now that the Lantus depot has been draining for a few cycles. To be considered in remission a cat should remain in the normal BG range continuously for a period of 14 days without insulin. (A very small number of higher outliers in that time are OK.)

If the numbers are above 8.3 on an Alphatrak then those are above the BG normal reference range for a cat.

If the numbers are trending upwards Bebo might still need a little support from the Lantus. If he does need to go back on Lantus I suggest you discuss with your vet starting at lower dose (e.g. 0.25IU). The little bit of extra support would give the beta cells in Bebo's pancreas more time to rest and hopefully recover more function, and that in turn could lead to a more solid remission. At the moment, only the 6.5 and the 5.8 readings have been in the normal BG range (3.9-8.3mmol/L on Alphatrak, as advised by my vet). Two normal readings does not a remission make, but you do need to be extra cautious and vigilant if administering insulin when a cat is close to becoming diet-controlled and running in the lower part of the normal range more often.

I'd also suggest that if Bebo does need to go back on insulin that you test more frequently now that his BG regulation has improved, and also that you take the wise safety precaution of having a well-stocked hypo toolkit in case the need might arise to steer Bebo's numbers during a cycle.

I understand that you're a bit nervous about the testing but hopefully members here will be able to quickly help you refine your testing technique ASAP. I'll send you some tips in another post.


Mogs
.

 

You may want to print this out FOR your vet.
So he doesnt think we a re a bunch of internet wackos

Mogs i hope you dont mind me saying this.

 

Some resources:

Home testing links and tips

Testing and injection tips


Here's that diagram of the sweet spot:





Even if you can't actually see the marginal ear vein (MEV), it is possible to hit the 'sweet spot' successfully. It's the area between the edge of the ear and the MEV. It's only about a millimetre or two in width. If you aim as close as possible to the edge of the ear with your lancet tip you should hit the sweet spot and miss the MEV. (Hitting the MEV can cause bruising, as you've observed.) It is much, much easier to hit the sweet spot by holding the lancet itself and 'freehanding' the poke, rather than using a lancet device. It helps you to see much better where you're aiming and also gives you better control.

Here is the method I used. Perhaps it might give you some ideas to add to your own testing technique.

1. Fold a sheet of kitchen paper in four lengthwise and cut it up into 1" strips. You will use these to cushion and support the ear during the test.
   
   
2. Put a thin film of Vaseline or Neosporin ointment (not the cream!) onto the edge of the ear to help the blood sample bead up instead of wicking into the fur. (Wipe off any excess.)
   
   
3. To get a blood sample you need to increase the blood flow to the ear, so make sure the ear is really, really, really warm (but not hot) - especially in the early days of testing. (Note: With repeated 'poking', more capillaries form in the test area, so it becomes easier to get samples reliably.)
   
   
4. Once you have the testing area of the ear well warmed, wrap a strip of folded kitchen paper round your index finger then place finger under the sweet spot area of the ear you're testing to support it during the poke.
   
   
5. Use your thumb and middle finger to lightly but firmly grip the ear and paper strip in place so that the edge of the ear is taut but not overstretched; the little bit of tension will make it easier for the lancet to break the skin surface (and it helps to keep kitty's head from moving around too much).
   
   
6. Hold the lancet with the bevelled edge of the point facing upwards. Try using the lancet freehand, at a slight angle to the ear, not perpendicular (easier to see where you're aiming and also makes skin prick easier).
   
   
7. When it comes to the actual poke, prick the sweet spot on the edge of the ear in a similar way to how you might quickly prick a balloon with the tip of a needle to make it pop.
   
   
8. When using the glucometer, bring the test strip to where it j-u-s-t comes into contact with the blood droplet and hold it there. The strip should then 'sip up' the amount it needs to run a valid test. Most meters beep or give a visual cue to let you know that enough blood has been collected on the strip.
   
   If your cat is a wriggler, try collecting the blood sample on the back of your (clean) fingernail and test it from there.
   
   
9. After the test, fold the paper strip over the edge of the ear and apply gentle pressure to the test area for about 15-20 seconds to minimise bruising.
   
   
10. Keep praising your cat throughout the process and reward with a favourite diabetic-friendly treat.

With a bit of time and practice you'll be able to work out a technique and a routine that works best for you and Bebo.


Mogs
.

 

You're the boss of you, Jeanne.


Mogs
.

 

that could be dangerous.

 

Thank you so much Mogs for such informative posts!!!

Ahh my vet told me 4-10 reading on Alphatrak was normal.

The vet just replied by e-mail and she advise still no insulin and do more testing til tomorrow then she can decide on dosing.
She says she is leaning towards 1U Lantus every 24 hours for Bebo.

Yes will do a reading in 2hours and before dinner if reading still above 10 I am leaning towards just giving him the shot then..... or I let him sit one more night on high BG like vet said

 

SMH I'm not a dosing helper but even I know Lantus is dosed BID

 

If it was my cat I would start at a lower dose and work up to 1 unit in small steps if necessary. Also, starting on a lower dose may allow you to give Lantus twice a day (BID). As Jeanne notes above, Lantus does work better with consistent 12/12 dosing (but you would need to get some mid-cycle tests during the PM cycle as well as the AM cycle).

From an orthodox standpoint, yes, but I've used SID dosing of Lantus when Saoirse only needed a tiny, tiny amount of insulin support during the daytime cycle when she was close to remission (she naturally ran low enough at night without the PM dose). Off-piste, but it worked for us.


Mogs
.

 

I failed getting blood twice today but finally just went ahead and poked the edge of his ear blindly at +1 feeding time. It read 9.9. Will do one more tomorrow morning pre-feeding. If it reads the same ~10 will try suggesting to vet a .25 or .5 dose twice a day. Thank you two for the support and info. Really appreciated