Bert quick update - UK clinical trial at RCVS

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Joleo

Member Since 2014
Firstly, I'm really happy to say that Bert was accepted onto the clinical trial last week, and they found no underlying problems when they did their screening tests - hurray! I was away so my husband took him up to Potter's Bar on the train, left him in for two nights, and collected him minus a huge amount of his fur. Shaved in so many places for catheters and ultrasounds, poor love.

He was randomised to get PZI - they've had more success with remissions on this than on the glargine so far. He's been on it for 9 days so far, and this week I noticed that I started having to say "Get down, Bert!" again - he was always prowling around the kitchen worktops and table looking for food, and I spent half my day telling him to get off. It was actually quite nice to start doing it again.

I'm doing my first curve today, and I can post the full thing later (I can convert the numbers then too), but so far today:

AMPS: 10
+2: 8.3

Compare this to the last can insulin curve I did:

AMPS: 26.2
+2: 19.7
+4: 7 (and then he started going back up!)
Awful, awful numbers! At the RCVS, they monitor them constantly for 24 hours and his numbers were better than that (possibly because he'd been on the new dose a bit longer?), but still not great.

We also came home with needles, test strips, lancets, and cans of food, all of which makes up for the travelling costs, though tbh, the fact that Bert already seems better is reward enough. They are still recruiting as far as I know, so if you can face the travelling, it's a great opportunity. https://www.facebook.com/RVC.Diabetic.Remission.Clinic - happy to answer any questions, and massive thanks to this board for alerting us to the trial!

Will be back later to post the full curve!
 
Hi Jo,

Wow! Am absolutely thrilled to hear about Bert's improvement!

Joleo said:
...He was randomised to get PZI - they've had more success with remissions on this than on the glargine so far.
I'm doing my first curve today, and I can post the full thing later (I can convert the numbers then too), but so far today:

AMPS: 10
+2: 8.3
Click to expand...

And those are lovely numbers, too! What a difference!

Is the PZI you're using 'Hypurin bovine PZI'?

Eliz
 
We have a nifty spreadsheet grid to store your test numbers in a shareable Google Drive file
Instructions are here.

Once you get your spreadsheet set up or when you look at someone else's signature link, this'll make more sense!

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Hi Everyone,

Sorry it's been a while since I posted an update! Bert's been back to the clinic again, and has come home with a lower dose (now 1u of PZI) so things are definitely going in the right direction.

The curve was going really well, until my husband managed to fling some canned tuna from the tin onto the floor which was scarfed by Bert in nanoseconds. Obviously as the curve shows he's really sensitive to any extra food, but in one way it was nice, because that's how he used to be - we used to joke that he was a bit like having a dog. He's also started jumping up onto the counters again, which used to be annoying but now makes me happy because he'd stopped doing that.

Interestingly on the clinic's fb page they have posted some research of theirs that "identifies a difference in the satiety gene (DNA make-up) of cats that get diabetes", which makes sense to me because Bert has always eaten anything and everything that wasn't nailed down.

We did a mini curve a couple of days after that, and because he went so low, Ruth reduced his dose to 1.5 at the clinic. He still went low on his 24hr monitoring though, so she has sent him home on 1u, and I've to do another curve at the end of this week. So far he seems fine.

hope your kitties are all doing well!
 
Hi Jo,

Thanks for the update. It's great that Bert is acting more like his old self! :smile:

Congrats on the hometesting.
That's a lovely response to the PZI.

(It looks like there were some low numbers there at the peak of the cycle on a couple of the days, so I'm relieved the dose was reduced... Phew! nailbite_smile )
That 2.2(41) on 06/07 may have given Bert's body a bit of a fright, because his blood glucose level seems to have bounced up high (rebounded) as a result of that.
Which meter are you using, Jo; Alphatrak or 'human' meter? If you got that 2.2(41) on an Alphatrak then that will have been a hypoglycemic number (and could still have been, for some cats, even if it was on a 'human' meter (my own cat has shown hypo symptoms just after my getting a BG reading of 2.6 on my human meter. But some cats don't show symptoms until the hypo is advanced.).

The normal blood glucose range for a cat is approximately (depending on which source the info comes from) 2.7 to 7.2. But it may be a little higher or lower than this in some cats.
The Alphatrak reads a little higher than human meters. (Compared to my One Touch Ultra the difference is about 1mmol at lower numbers. So, I know that a reading of 2.7 on my OTU would be around 3.7 on my Alphatrak.)

Are you able to test Bert's blood glucose before each shot? (Strongly recommended. You may find that, on occasion, Bert's blood glucose is too low for him to be given insulin.)
And have the RVC suggested an initial 'no shoot' number for you? ie, a blood glucose number below which you don't give insulin?
Our general advice here for those new to feline diabetes is to not give a shot if the preshot blood glucose level is below 11(200). But that is just until sufficient data is collected to show how the insulin is working in the cat's body.

Do you have a 'hypo kit' available in the event that Bert's blood glucose drops too low? (The kit can be as simple as having liquid glucose and plenty of spare test strips available. But some folks give higher carb food as well as or instead of the glucose, depending on the situation.)
Also, if it looks like the blood glucose may be going to drop too low it's often possible to stave that off by giving snacks to raise the blood glucose level.

Any chance we can get to see a pic of Bert, Jo...? cat_pet_icon

Eliz
 
hi Jo, that's encouraging,

I hope Angel gets the pzi, thought to be honest it sounds like they are both better than caninsulin. Angel has never overeaten, he's always been active and gone outdoors. But he obviously has the fat gene coz somehow he crept up to 8.4 kilos!!! He was down to 5.8 and on maintenance when he developed diabetes.

Bought the Times on Sunday and was hoping there would be pics of Bert, think you have to pay to see the video of him. How is he coping with the stardom?
x
 
Thanks Elizabeth - I've been testing Bert on the new dose today and he's not going so low, (preshot 12, +4 8.7) but I couldn't do a full curve because I had a school trip with my boy. I use an alpha trak (purple one).

I do have hypo stuff - easy to get to honey for bad cases, but also food with gravy, and umpteen snacks from the bad old days. He wasn't showing signs really, but I gave him a few snacks on both occasions to bring it up.

Anyway, Ruth lowered the dose & she'll have today's numbers, and he's back in on Monday. Testing before every shot isn't always practical, but I might start to do it when I can. Whenever he's discharged we get a full discharge sheet with results from the hospital stay, and what she wants us to do/look out for, and they are really happy to talk on the phone if we're concerned.

Oh, forgot to say last time that his fructosamine had dropped by 100 points in a fortnight - why is this not readily available to all diabetic cats? She did say that he's doing better at this point in the treatment than most of the other cats, which is why she asked for some extra testing this week. Iirc they have 13 cats on the study & 3 are otj.

She hasn't mentioned a no shoot number, no. Will check. However I asked if he could continue on this insulin if necessary after the trial end and she said yes, so that is a relief.

Got my fingers crossed for Angel - it's a faff getting there, but the treatment is so good it's worth it!
 
Joleo said:
Testing before every shot isn't always practical, but I might start to do it when I can.
Click to expand...

I know testing can be a faff. But you now have this wonderful skill at your fingertips, and can use it to try to keep Bert safe.
And testing before each shot can be a lifesaver. Literally.... Many of us have done preshot tests only to find out that our cats were in normal blood glucose numbers. nailbite_smile

And regarding hypo, you can't necessarily tell by looking at a cat that their blood glucose is too low.
Some cats show symptoms of hypo early on in the process. Some show symptoms when the hypo is moderately advanced. But some cats show no symptoms at all until the hypo is advanced. A cat can look perfectly fine one minute and be seizuring the next. (This happened not long ago to another UK member here).
Absence of symptoms does not mean absence of hypo. If the numbers are low it's important to bring them up to a safe level even if there are no hypo symptoms.

Eliz
 
Thanks Jo, so glad he is doing well.
I'm hoping (for me as well) the more you test the quicker it will be, so hopefully you'll be able to test him pre shot.
xx
 
Oh, I didn't realise 'faff' was just a UK word!
BJ, thanks for the links. That stuff about the Queen Mum's breakfast really made me laugh. :lol:

Here's a couple of examples from my own life...

First example
This happens a lot in our household.
DH and I are going out and need to be somewhere on time. I stand near the front door waiting for DH. DH approaches but then suddenly realises he has something, or even a number of things, that he has to do before we can go out. Examples include; changing shoes, getting a jacket, changing a jacket, looking for the 'other' pair of glasses, looking for a piece of paper (with important name or address or phone number...), going to the shed, going down the garden, putting out the rubbbish, checking the computer, getting a drink, making a sandwich... We have a very short conversation that usually goes like this:
Me to DH: Chris, stop faffing about. We're going to be late.
DH: Yeah, yeah....

Second example
I bought some toeless yoga socks to keep my feet a bit warmer during class. (For those who don't know what these are I'll quickly explain that these are like a sock equivalent of gloves, but with the finger/toe sections cut off near the base).
When I got to the class I rolled out my mat, sat down, and proceeded to try to put the toeless socks on. I'm alway nervous at the start of class and that made it harder. In fact, I suddenly realised that everyone else was starting into their 'Sun Salutations' and I was still on the floor trying to get the correct toes into the correct holes in my socks...
I stopped using them because, although potentially useful, they were too much of a faff to put on.
Actually, I gave them to DH. He really likes them.... :lol:

Eliz
 
It's true, us UKers use 'faff' a lot. Not sure of origins but it would be fun to make some up!

Jo - only just joining this thread, am not always here much, so this is just to say well done for all your efforts and progress. It's so heartening to see things like this and shows other people that there is hope...

Paws crossed that it all carries in in the right direction...

Diana
 
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