? Can somebody advise on Bo’s numbers?

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You certainly can try stopping insulin for a few days, but I would not recommend it. If his pancreas is starting to function a little better, the insulin helping to keep him in better numbers will support his pancreatic healing. He is not yet in normal non-diabetic cat blood glucose numbers or “diet-controlled” diabetic cat BG numbers. He doesn’t have the green normal numbers on his spreadsheet except when he received insulin support.

When did he stop eating the dry food? Can you make a prominent note on your spreadsheet indicating when that happened? I think some of the improvement (lower BG without insulin) that you have seen is a result of stopping the dry food.

I understand the situation with your vet. Isn’t this the same vet who had you giving too much insulin? I’m trying to recall. . Anyway, more later…. I have a crazy morning. I started writing this message at 5:30 a.m. and need to send now - 4 hours later.
 
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Vets don’t fully understand remission. As Suzanne said, his pancreas needs insulin to continue to heal. There’s a chance his numbers will get worse if you stop insulin too soon. I’d listen to the folks here, especially if this is the same vet who is responsible for the hypo. I got Bobo on remission without ever seeing or consulting a vet about it. I knew what to do because of this forum and I was guided by the folks here. I strongly advise you against it. As we said before, vets know very little about feline diabetes.

What low carb treats have you tried? You could leave some wet food in an auto feeder for him overnight. Did you get one?
 
I agree that you should not leave him without insulin for too long (unless his numbers are predominantly green.) I do understand if you just want to give it a test for a day or two in order to see what happens - to satisfy yourself on that point. I can certainly understand that. I have seen people try stopping insulin too soon, and have frequently found that the numbers creep up. In some cases, it was because a vet said the cat was in remission; in other cases, insulin was stopped due to a traumatic family event that precluded testing/monitoring or even keeping a sane schedule. But the numbers crept back up again.
 
Suzanne & Darcy said:
Hey Jessica - I see that you tried the .10 dose this morning and he has a beautiful green on his spreadsheet! I like that. Will you be able to get another test or two in for this cycle? I’m excited to see that 86 on there!
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Suzanne, she posted pics of the syringe. Can you make sure she knows where .1 is? I couldn’t find a pic but I know I’ve seen it here posted before
 
Yes I didn't want to stall too long in making my decision. So I decided that after 3 cycles in a row with no insulin and him remaining around 7 that I should try the 0.1 to see if I'm able to coax him more into the green.

I will admit I am pretty anxious about it though. He went a touch below 90 today with just the .1 unit. I was nervous about injecting tonight but I left extra wet food in his auto feeder just in case. It's past my bedtime but I'm a bit anxious to sleep. I'm fighting the urge to get out of bed and do a +3 bg test tonight as well.
 
Here are the descriptions and photos of tiny doses.

Fine dose gradations:
  • 0.5U = exactly half a unit
  • 0.4U = skinny 0.5 touching the line
  • 0.3U = skinny 0.5 with daylight under the line
  • 0.2U = fat zero with daylight over the line
  • 0.1U = fat zero barely touching the line
Pictorial guide using a U-100 syringe marked with half units:
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Jessica + Bo said:
Yes I didn't want to stall too long in making my decision. So I decided that after 3 cycles in a row with no insulin and him remaining around 7 that I should try the 0.1 to see if I'm able to coax him more into the green.

I will admit I am pretty anxious about it though. He went a touch below 90 today with just the .1 unit. I was nervous about injecting tonight but I left extra wet food in his auto feeder just in case. It's past my bedtime but I'm a bit anxious to sleep. I'm fighting the urge to get out of bed and do a +3 bg test tonight as well.
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He looks to be in perfectly safe numbers. The guideline of 90 is really for people who are unable to test as much as you usually do — also it’s for new people whose cats don’t always respond as quickly to insulin as Bo has (also his diet change to low carb was a huge factor.) I think if you want to get him into remission that you should read up about MPM and strongly consider following it. Things could get intense for a few weeks, but it would hopefully lead to remission. By intense, I mean the testing and managing cycles with food — I do not mean putting Bo in danger! With MPM, you would want to keep him at 50 or above and mostly in green. So going below 90 is not dangerous but we do not want drops below 50 for a cat on insulin. Cats who are not on insulin frequently hang out in the 40s, but they can’t hypo because they’re not on insulin.
 
Bo threw up last night. He wasn't too low at the +2 check but I have no idea if he ended up dropping too low last night. He didn't touch the food in the autofeeder.

He snacks on his breakfast all day but he tends to eat his dinners all in 1 go. So I'm not sure how differently his numbers look through the night compared to the daytime numbers.

I did give him .1 this morning but I'm not sure what to do about tonight
 
Does he have any history of nausea and vomiting, like maybe IBD? If you have Cerenia, it could be good to give him some for the vomiting. Let’s see how he does today and I hope he starts eating soon? Have you ever tried baby food or tuna?
 
Ale & Bobo & Minnie (GA) said:
Does he have any history of nausea and vomiting, like maybe IBD? If you have Cerenia, it could be good to give him some for the vomiting. Let’s see how he does today and I hope he starts eating soon? Have you ever tried baby food or tuna?
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Not really, he's only thrown up once since starting the insulin and it was early on before I started testing amps and pmps consistently.

Am I still supposed to dose him if his numbers are good? I skipped tonight's dose since he's lower tonight than last night, and I can't be sure he didn't throw up due to hypoglycemia last night.

It feels counterintuitive to dose him if his numbers are already good. Especially since he still drops so much even with .1u. He went down from 140 to 70 at +3 with .1u today. I think I need some guidance on future doses.
 
I’ve never heard or seen here a hypo causes vomiting. Remember he’s in safe numbers if he’s above 50. You’re seeing less of a curve and more of a flat line now. When they get to the lower numbers, you typically don’t see sharp drops. Let’s get @Suzanne & Darcy input. I see you reduced to a drop. I think I had told you how to measure that right?
 
Ale & Bobo & Minnie (GA) said:
I’ve never heard or seen here a hypo causes vomiting. Remember he’s in safe numbers if he’s above 50. You’re seeing less of a curve and more of a flat line now. When they get to the lower numbers, you typically don’t see sharp drops. Let’s get @Suzanne & Darcy input. I see you reduced to a drop. I think I had told you how to measure that right?
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His vet told me that was a symptom to look out for with hypo.

Yes you told me how to measure. I inserted the syringe into the insulin bottle. Pressed the plunger and just let it go so that it sucks up one tiny drop.

I also have a used syringe that I've been using as a tester with water (not to inject), just so that I could visualise the difference in quantity between the .1 and 1 drop.
 
If Bo had dropped into hypo territory last night (below50) you would have had a high AMPS today due to his body releasing stored glucagon and adrenaline, cortisol and growth hormone in order to bring his BG up in response to the low BG. There are so many things that cause cats to vomit. Anyway, Bo’s AMPS was not high, so I think you should have gone ahead with the .1 dose, but I understand your hesitation and it will be good to see how he does. I would not have reduced due to the 70 yesterday. That is the kind of normal number he needs to be in and that he will be in if he goes into remission.
 
Oh. I forgot to say that there’s no significant difference between his AMPS today and his AMPS yesterday— when you take the 20/25 percent meter variance into account. So I am pretty convinced he would have been fine on the .1 unit dose. Let’s keep our fingers crossed though, for another great cycle today!

How is he feeling now? Has he been nibbling through his breakfast as normal? No vomiting? My cat Ginger has been ill the last few days and was vomiting up everything (even with Zofran and Cerenia) including her medications. Then she would not eat (almost nothing) for two days. So I understand. And yesterday I had to leave town and spent 6 hours on the road and five hours working — I am in recovery mode today— vegging out. Although I will have to drag myself to the grocery store later. Thank goodness Ginger has eaten two small meals this morning and has kept her meds down (with her supplements in the food, too!) because otherwise we were heading to the emergency vet service today.
 
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