Discussion: Insulin Absorption

[Jill & Alex (GA)]

The beginning of this discussion (the first 18 posts) will be rather disjointed. Unfortunately, the conversation ended up spanning two threads without a new thread being set up as I suggested, but I think I moved enough posts for you to get the gist.

I've pulled the pertinent posts from these two threads:

• 2/9 Silver - where the discussion began
• 2/9 Jones - where Tracey continued the discussion

Generally speaking, the subject is insulin absorption and what factors may influence it's absorption. Please cite references to support claims when applicable, note anecdotal evidence and/or if comments are based on observation.

 

[Elizabeth B]

I know this might not be a popular recommendation; but if you continue to see him nadir this late in the cycle - or possibly not at all, it might be worthwhile to pull his fructosamine. Now, there is a lot of debate regarding the value of that test when doing home testing, but when there is ambiguity in the data, that overall reading could help you identify whether an increase, decrease, or hold is in order.

It seems there is no discernible curve and if he wouldn't throw those weird greens every once in a while, one might believe an increase was in order. (He has yet to really nadir in the month of February, regardless of history, the most current data might say not enough insulin.) However, if he's caught in a cycle of chronic rebound and periodic drops, a decrease is in order. (On 1/20 there is a potential bounce and that pattern is repeated 1/22, 1/26, 1/30. Chronic rebound could, in theory, last this long and he could even be hiding drops throughout non-testing times OR he could be in the "flats.") Conflicting strategies and differing risk.

The issue of absorption was first brought up here -------> This is a long shot, but do you think absorption could be an issue? Do you rotate injection sites? Or could we note where the injection was given and maybe identify an absorption pattern? (you may have talked about it in the past, but it's sometimes difficult to review history in this format.) I'm just trying to think of anything we could eliminate.

 

[Juliet]

I know this might not be a popular recommendation; but if you continue to see him nadir this late in the cycle - or possibly not at all, it might be worthwhile to pull his fructosamine. Now, there is a lot of debate regarding the value of that test when doing home testing, but when there is ambiguity in the data, that overall reading could help you identify whether an increase, decrease, or hold is in order.

It seems there is no discernible curve and if he wouldn't throw those weird greens every once in a while, one might believe an increase was in order. (He has yet to really nadir in the month of February, regardless of history, the most current data might say not enough insulin.) However, if he's caught in a cycle of chronic rebound and periodic drops, a decrease is in order. (On 1/20 there is a potential bounce and that pattern is repeated 1/22, 1/26, 1/30. Chronic rebound could, in theory, last this long and he could even be hiding drops throughout non-testing times OR he could be in the "flats.") Conflicting strategies and differing risk.

This is a long shot, but do you think absorption could be an issue? Do you rotate injection sites? Or could we note where the injection was given and maybe identify an absorption pattern? (you may have talked about it in the past, but it's sometimes difficult to review history in this format.) I'm just trying to think of anything we could eliminate.

Nadir is the lowest point in the day and right now that appears to be late in the cycle. For some cats that is the case. Will find out where that is over the weekend.

 

[Elizabeth B]

Actually, that's a popular misconception. Nadir corresponds with insulin peak. When a curve is normal, nadir is absolutely the lowest point in the day; however, when you find abnormal curves or lack of insulin effectiveness, it's not the case.

 

[Tracey&Jones (GA)]

@Elizabeth B - so are you thinking that due to possible absorption issues that is why we are seeing "a reverse or non" curves so to speak? Which would explain the odd low number being thrown out. However, he is generally going down in numbers overall, or is this just due to a higher dosing?

Even if a curve is normal, are you saying the nadir is always typically in the middle some where for Lantus? Like the 4-8 hour mark?


Just trying to flesh out the idea in my head and get what you are trying to tell Juliet. I can take this off line if you feel I am hijacking your thread Juliet.

 

[Tracey&Jones (GA)]

Copied over from Juliet's posting from today in order to continue the discussion.


@Elizabeth B - so are you thinking that due to possible absorption issues that is why we are seeing "a reverse or non" curves so to speak? Which would explain the odd low number being thrown out. However, he is generally going down in numbers overall, or is this just due to a higher dosing?

Even if a curve is normal, are you saying the nadir is always typically in the middle some where for Lantus? Like the 4-8 hour mark?


Just trying to flesh out the idea in my head and get what you are trying to tell Juliet.

 

[Elizabeth B]

Ok. Let me start with the golden rule of ECID and a reminder that insulin is a hormone not a drug. This means that results are going to vary. They will vary from one cat to another, they will vary from one day to another, and they can even vary because a bird looked in the window at your cat wrong one day. Biological systems and hormones...ugh. With that said, we can better understand what causes variations in order to help predict our own cat's response.

For instance, administration can be impacted by at least four items: location of injection (scruff/flunk/side), depth of injection (needle size), tissue scarring (lipohypertrophy), and body condition (hyrdration). It is thought that injections in the belly/side will be absorbed faster than the scruff, due to blood flow. This has been hotly contested (like everything diabetes), but the idea that location matters is generally accepted. For those who had long term diabetics and use the scruff, scarring or lipohypertrophy, can become an issue. Insulin is not absorbed well from those areas. We're not talking it doesn't work, but it's less effective. So, you may see movement, but it might be inconsistent. The best way to move forward is with data. Let's say you decide to test the side/belly as an area. Keep food, exercise, injection timing the same and switch from right to left sides of the belly for a few days. Next, holding all other things constant (or as constant as possible) try another general location. You can also do a mini trial with needle length. If you can move throughout the body or switch needle size without any noticeable trends, you can put absorption on the bottom of the suspect list.

I looked at Jones' numbers and your detailed notes, well done! If I had to make an educated guess, I'd say your biggest challenge with consistency in response to insulin would be food. Jones is really giving you a run for your money. If I were you, I'd try adjusting just one thing at a time (super hard to do, I know). However, if you change his CBD and his food, you'll be left wondering if it was the food or the CBD. I know that's difficult to do because we want them better and want them better, NOW!

 

[Tracey&Jones (GA)]

want them better, NOW

Thank you for your comments. Yes ECID, always keep that one in mind.

So, Jones, shots are in the scruff area - more the shoulder area. Right shoulder morning and left shoulder at night. He was so skinny to start with, there was no fat to work through but he has a little more to his body now.

And yes, food is the issue. When I get something that works for his IBD then I need to work the dose. Then he has developed a bad habit of diving and bouncing. Then he goes off the food. It is a circle for sure. Lately has just been about the food he will eat and what carb % that is. Trying to do little changes, like this morning by dropping the tsp of science diet to see if I get any better movement.


When I saw your comment, it just made me think, if maybe that is one more piece of the puzzle or something I should put in my tool belt to check out one day.


He is also on the prednisolone, which makes me sometimes wonder if that is why we get a "mid cycle" bump vs the nice curve.

 

[Elizabeth B]

Thanks for the comments @Bobbie And Bubba

drop the numbers without increasing the dose

One way to amp up insulin response is with exercise. (In fact, I was told by multiple vets it was the best way to battle insulin resistance.) We actually put Hamilton on the treadmill (at our own peril) and those days we got blues even on the lower dose. We decided it just wasn't something we could keep doing because he hated it, so we had to nix it. But just 5 -10 minutes of good exercise used to bring him down very consistently. I'm not sure if Jones would be up for leash training or if you had other ways to get him moving, but it's something I know from experience works AND science very much supports it.

That's also a big chunk of prednisolone. Was Jones' diabetes steroid induced?

 

[Tracey&Jones (GA)]

Was Jones' diabetes steroid induced?

Yes it was. He was on a really high dose when the IBD/pancreatitis first reared it's ugly head. We went down to 1/4 tab once daily (1.25mg). The FD improved but the IBD didn't. My vet went on maternity and we referred to an IM vet from the regular clinic. He took him back up in dose of pred. We doubled the dose a couple of times and are back to 5mg daily (1/2tab BID). Jones has responded well, finally started to gain back weight. He has lost an extreme amount of muscle mass. His head and back end have really nothing to them. It seems he has developed some arthritis as well in the back end. I was told he would not regain that muscle mass and that the steroid would actually create more muscle wasting. Catch 22 on that situation. We did try other steroids in the beginning but it didn't help.

I feel I have been chasing my tail since we did the increases. Remission is not my goal, but lower blues and high greens are.

 

[Stacy & Asia]

More to add to this discussion is the role food plays in what insulin does, or doesn’t do. Before Asia started with the recent Miss Piggy behavior, she was eating a decent amount of food, but very little bits at any one given time. I couldn’t get a food bump out of her for the life of me. Since she started eating her food all in one go, I’m still feeding her the same amount, spread out over the day, but eating 10 bites at once vs 2 bites every 10 minutes over an hour makes a huge difference in insulin response. Food bumps are no longer a problem.

To add to that, I would imagine if you feed two large portions, twice a day, and you are feeding when the last shot has waned and before the next shot kicks in, you are really going to struggle to get the numbers down with Lantus and Lev in particular. Conversely, how long does that food last? As in, if you up the insulin to compensate for the large food spike, are you assuming the spike lasts past nadir? If it does not, that number could really plummet mid day without food, right?

I give Asia a nod to a meal at preshot times, just to make sure she’s eating, and I give her a better portion at +2 so I’m not spiking the number too much before onset (unless she has a low preshot, in which case I give her a larger meal to compensate). Asia is fasting, ish, towards the latter half of the cycle. I give her one tiny meal just to keep the acid at bay, but her numbers start to come down, I assume from double dip, but fasting surely helps with that. When Asia was off her food as well when she was fasted for her ultrasound, her numbers went down, down, down with no end in sight without the help of Karo. So it’s a balancing game, the amount of insulin needed is very much correlated to the amount of food they are eating, what kind of food they are eating, when they eat it, and when they don’t.

As well as absorption and the other issues discussed, potency comes in to play too. How your insulin is stored, how it was handled in shipping (for disturbing reading on that subject), and how you deal with it at home are all play in as well. If you predraw syringes, especially with Lantus being acidic, it is labile, there is the plastic of the syringe which probably isn’t built to handle long term exposure to acidity, the lubrication which is probably silicone based, the rubber like material of the plunger, not to mention any contamination and bacterial growth. People predraw syringes for various reasons, I imagine it’s routine for blind diabetics to work with predrawn syringes, but it has not been, as far as I know, systematically studied and not with Lantus in particular. It could go cloudy and you’d know something is up, but that probably happens after a day or two and who knows how potent it is or isn’t before it becomes cloudy and has obviously gone off.

Good discussion topic, thanks for bringing it up, lots of useful stuff here.

 

[Tracey&Jones (GA)]

I would imagine if you feed two large portions

Good point on the food. I have found Jones more sensitive to carbs the longer he has been FD. Jones is free fed actually. The only way he eats really well. Plus that leaves food out while I am at work. With the 3 civvies each has there own feeder (two are hoovers). The sureflap feeders is the ones we have. He will eat a bit for breakfast (about a 1/4 of his food if I am lucky) then he snacks all the way to +6 (anywhere from 1/4 to 1/2 of his food). Then he usually leaves the rest and may or may not snack around the +10/10.5 mark. From observation, that is pretty much his MO on a regular feeding day.

potency comes in to play too

Good point. I can only verify what I do in the handling of the insulin once it is in my home. I have not pre-drawn the insulin before and the most it sits in there is about 20mins which I am assuming is around standard for everyone. If I have ever questioned the potency I have started a new pen to test, but have never proved that the insulin was the issue.

 

[Stacy & Asia]

Good point on the food. I have found Jones more sensitive to carbs the longer he has been FD. Jones is free fed actually. The only way he eats really well. Plus that leaves food out while I am at work. With the 3 civvies each has there own feeder (two are hoovers). The sureflap feeders is the ones we have. He will eat a bit for breakfast (about a 1/4 of his food if I am lucky) then he snacks all the way to +6 (anywhere from 1/4 to 1/2 of his food). Then he usually leaves the rest and may or may not snack around the +10/10.5 mark. From observation, that is pretty much his MO on a regular feeding day.



Good point. I can only verify what I do in the handling of the insulin once it is in my home. I have not pre-drawn the insulin before and the most it sits in there is about 20mins which I am assuming is around standard for everyone. If I have ever questioned the potency I have started a new pen to test, but have never proved that the insulin was the issue.

Ever notice any differences on days where he is really hungry or perhaps not eating as much as usual?

Read the article in think tank at your own risk. It’s a bit maddening. There’s enough variables at play without having to wonder which potency pen you’re uncapping every time you get a new one!

 

[Tracey&Jones (GA)]

If he is really hungry it seems the numbers go up for the food bump as he actually eat all the food by +6. I have noticed a bigger food bump as well when I went to the Friskies as it is 4-5% carb vs. the 1% of the Rawz he was getting before. Then you add in all the dives he likes to take now and again....


Jones has been keeping me on my toes for sure. Just hope I can drop these yellows soon.


FD is a dance with a living creature with so many curves, corners, bumps, failed attempts etc. Love him more every day though . All my pets have taught me something...with Jones it is patience and that 1+1 does not always equal two. For an accountant - that is huge!

 

[Tracey&Jones (GA)]

I think Jones is looking good with out the HC topper.

See what a tsp of HC can do? Hope this continues his PMPS was 117!

is with exercise

I am not surprised by that. Activity is linked to a lot of positive results in both humans and our companion animals. I will have to think on how to get him moving 5-10 minutes during the AM and PM cycle without shaking the temptations bag.

(for disturbing reading on that subject),

That was an interesting read, thanks for the link, I didn't see that one posted.

 

[Elizabeth B]

I feel I have been chasing my tail since we did the increases. Remission is not my goal, but lower blues and high greens are.

Ooof. That’s a tough, tough mix. Here I thought CKD and diabetes was difficult. Any time food moves through the system faster than anticipated, absorption is going to be an issue and from what I understand, diabetes is more predictable than IBD. So, the higher dose of pred makes sense if it can help regulate his food intake. Once you find that new normal to make his tummy happy, you’ll get those blues and greens. Try not to rake yourself over the coals in the meantime.

I started my career as an accountant, so I completely understand. The numbers always tie out in that world. You can even find that missing penny in a million dollar bank rec. Bilogic systems don’t care about our spreadsheets. You can drive yourself crazy second guessing every detail. Keep chasing that diet. You’ve got this!

 

[Elizabeth B]

Ever notice any differences on days where he is really hungry or perhaps not eating as much as usual?

Read the article in think tank at your own risk. It’s a bit maddening. There’s enough variables at play without having to wonder which potency pen you’re uncapping every time you get a new one!

Even more infuriating for us, is that while [human] insulin manufacturers will replace ineffective insulin for humans, they will not for cats/dogs. They don’t care if their poor production/shipping results in regulation interruption as it’s not “FDA approved” for cats/dogs. Funny how that doesn’t impact the price we pay for it. In a pinch, we were forced to buy 5 pens from a pharmacy that were all bad. We’re still recovering from that budget killer.

My husband and I have decided we need to create a home testing kit for insulin potency. It’s shocking that the best solution currently is suddenly falling out of regulation!

 

[Myagi (GA) and Heidi]

@Myagi and Heidi

I am sure Jill will do that as soon as she can. It was bit of an eye opener as I was just trying to understand the reverse/non curve concept and reasons for it outside of a bounce (absorption issues) and how to read that is a SS, that lead to the potency issues which just blew my mind. Never really stopped to think about that there could be such an variance never mind the transportation concerns from the factory.

The concept of insulin as a replacement hormone and not a drug is easy to remember in the sense "it is a hormone" and as such is not as easy and taking a pill and tada something is fixed. It is more complex then that in a on the ground context - carb %, stress, appetite etc. Then you add in the variables of absorption, potency, insulin handling before you got it, etc...the mind really starts to bend a little.

Just a few days ago there was discussion in Myagi's thread of scruff vs shoulder absorption and, ya, the mind boggles. I actually saved that discussion to his ss cause there was a lot of good stuff to revisit. Feeding the curve etc. Never too much food fur thought!

 

[Tracey&Jones (GA)]

Just a few days ago there was discussion in Myagi's thread of scruff vs shoulder absorption and, ya, the mind boggles. I actually saved that discussion to his ss cause there was a lot of good stuff to revisit. Feeding the curve etc. Never too much food fur thought!

I read your thread that you mentioned - good read. So to add to the equation is "how to feed the curve" which also affects the effectiveness of the dose that cycle. Then there was the links to the low carb vs. lower carb conversation. ECID really kicks in now, as how carb sensitive your cat is found out by carefully experimenting and observation.


These may not be factors of absorption but part of the puzzle on how to get the most out of your dose.

 

[Stacy & Asia]

how carb sensitive your cat is

Just to add another layer of complication to that, they can change how carb sensitive they are over time. As well, they can have different carb sensitivity depending on the cycle. I can get Asia up really high during the day with the same amount of carbs that would only bump her up a little bit at night. If she has a certain momentum on a cycle, it's more tricky than when she just dips somewhere, but it's not coming fast and furious with carryover from the previous cycle.

The really useful part for me is recognizing what kind of cycle I'm dealing with and intervening accordingly. Sometimes it's quite obvious, other times not.

 

[Jill & Alex (GA)]

Another interesting discussion on feeding higher carb foods: Deliberately Going Higher Carb.
Obviously not for every cat, but something one may want to think about...

 

[Myagi (GA) and Heidi]

There's definitely a lot experimenting required. I noticed Stacy using karo more with Asia than mc or hc. I get frustrated with hc bumping too much and some mc great and others not enough and all the wasted food when I can't afford to waste food, so I've been trying the karo fur steering vs strictly emergencies. So far so good. Seems to let him surf without dive.

I've been trying out the location absorption theories and so far with Myagi no love on making difference. Was going to slow the amps cycle and speed up the pmps cycle. Lol. Silly me, it's his dance.

Food wise I was always doing 3 and less carbs until recently. Myagi seems to have much more green on 6 carb and the 12 carb I like for bumping, doesn't really bump but helps surf.

I can't even contemplate the potency issue...

 

[Stacy & Asia]

Another interesting discussion on feeding higher carb foods: Deliberately Going Higher Carb.
Obviously not for every cat, but something one may want to think about...

Very interesting. That's how diabetes was largely treated once upon a time, and still is, by many vets with high carb rx diets. Depends on the needs of the cat, I suppose. DKA would make a lot of sense, the pancreatitis angle is interesting too. Common thread I'm seeing is many of these problems are caused by inflammation...

 

[Steph & Quintus & L & O]

think on how to get him moving 5-10 minutes during the AM and PM

What moving will he do spontaneously? If I do have to exercise Quintus (who has really bad arthritis and tends to move as little as he can), I know I can carry him downstairs and he will want to go back to his couch, walking up and home. Then I can carry him down again...

 

[Stacy & Asia]

There's definitely a lot experimenting required. I noticed Stacy using karo more with Asia than mc or hc. I get frustrated with hc bumping too much and some mc great and others not enough and all the wasted food when I can't afford to waste food, so I've been trying the karo fur steering vs strictly emergencies. So far so good. Seems to let him surf without dive.

It was hard for me to consider offering Asia a variety of different foods. Asia is a creature of habit and she's also not very food motivated. She's always been a "this is my food and I don't want to eat anything else" kind of cat. She will eat the gravies, she likes those a lot, but she won't touch the meat that comes with any of them, like you, I don't like wasting that food for financial reasons and more. I also carefully researched and settled on her diet before FD and I really didn't want to get in to a situation where she would prefer a "junk food" over her regular food and refuse her regular food in protest.

I like that I can measure Karo more precisely and get an idea of how much does what, I can make it MC or HC depending on what is called for. The food that sustains her is her regular food and Karo is just a small addition that won't fill her up. I'm not at all crazy that it's corn based, I tried using honey first, but it just didn't give the same response as Karo, not even close for her, ECID. At the end of the day, I think you have to make certain compromises, especially when you see the benefit is outweighing the negative side.

 

[Steph & Quintus & L & O]

Another interesting discussion on feeding higher carb foods: Deliberately Going Higher Carb.
Obviously not for every cat, but something one may want to think about...

Very interesting. Based on my ECID-one-data-point I'd been thinking along the lines that there was a lot of obsession with "as little carbs as possible" in the food. And I remember reading somewhere (where?) that some cats seemed to do better on "slightly more carbs" than 0 carbs.

 

[Jill & Alex (GA)]

I've been trying out the location absorption theories and so far with Myagi no love on making difference. Was going to slow the amps cycle and speed up the pmps cycle. Lol. Silly me, it's his dance.

Alex was normally very cooperative, but not about shot locations! I valued my life too much to shoot her anywhere but the scruff. It really wasn't a problem. At one point I did notice a little bit of scarring, but solved that problem quickly after reviewing and correcting my injection technique. I always used syringes with short needles, although it's said you'll see better absorption with longer needles.

Alex was extremely carb sensitive and yet did best when fed foods with 4% - 5% carbs. That *could* mean 10% - 12% to another cat... depending on the carb sensitivity of the cat. IMO, mini-meals and when they were fed made a big difference with Alex... so much so that I divided her food into "x" amount of portions per day and noted how many portions and when they were fed by using asterisks in the corresponding cell on her spreadsheet. That way I could see how food affected each cycle (if it did) at a glance. Placing the info in the "Remarks" section doesn't give you that visual.

And a note about trying new foods... many, many years ago many of us noticed it may take a cat a week or two to "adjust" to a new LC food. For example, Alex's BGs would often go up for a bit when introduced to a new food, but then would come back down within a week or two. Again, it's one of those ECID things! I've been seeing most give up on foods too quickly in recent years.

Very interesting. That's how diabetes was largely treated once upon a time, and still is, by many vets with high carb rx diets. Depends on the needs of the cat, I suppose. DKA would make a lot of sense, the pancreatitis angle is interesting too. Common thread I'm seeing is many of these problems are caused by inflammation...

IMHO, it's all about finding what works for YOUR cat. There are no cookie-cutter solutions. Although, not sure they were talking about anything higher than 18% which when you're talking about dry food... it isn't all that high.

At the end of the day, I think you have to make certain compromises, especially when you see the benefit is outweighing the negative side.

YES! Truer words have never been spoken.

Very interesting. Based on my ECID-one-data-point I'd been thinking along the lines that there was a lot of obsession with "as little carbs as possible" in the food. And I remember reading somewhere (where?) that some cats seemed to do better on "slightly more carbs" than 0 carbs.

Places you may have read something along those lines:

• Feeding Low Carb vs Lower Carb Foods

• Carb sensitivity - thoughts

 

[Stacy & Asia]

Very interesting. Based on my ECID-one-data-point I'd been thinking along the lines that there was a lot of obsession with "as little carbs as possible" in the food. And I remember reading somewhere (where?) that some cats seemed to do better on "slightly more carbs" than 0 carbs.

I haven't seen the as little carbs as possible here specifically, I think the idea is just switch to low carb and that could be 1-10% carb foods. Some cats do better with more carbs than zero carb. The low carb thing makes sense from the perspective that carbs are sugar, if you are feeding a cat too much sugar, diabetes is going to be a risk (assuming the cat is a type 2 similar to what is seen in humans). If pancreatitis, acro, Cushings, steroids, etc. are the root causes for diabetes, it's a different story, sugar is still sugar, but it's not the whole picture.

I really think more importance should be placed on trying to figure out why a cat became diabetic because how you treat is slightly different depending. Asia was already on a low carb food, a diet change wouldn't address her problems. I'm pretty convinced now, with hindsight, that pancreatitis made her diabetic. I would have aggressively treated the pancreatitis right away, had I known. I don't think vets are much concerned with why. I asked 4 different vets "why did she get diabetes, this doesn't make sense" and genetics was about the only answer I got, the others were shoulder shrugs. Pancreatitis didn't come up as a possibility, not once.

 

[Stacy & Asia]

IMHO, it's all about finding what works for YOUR cat. There are no cookie-cutter solutions. Although, not sure they were talking about anything higher than 18% which when you're talking about dry food... it isn't all that high

Excellent point, even "high carb" canned food is probably still LC when compared to most dry foods.

And right about cookie cutter solutions, if it were true, all of our cats would be perfectly regulated if not OTJ in short order from diagnosis! A lot of what works that has stuck around is probably a bell curve situation, it works well enough for the majority of cats that are somewhere in the middle and not so much for the outliers...but the outliers bring the innovations, don't they?

 

[Jill & Alex (GA)]

A lot of what works that has stuck around is probably a bell curve situation, it works well enough for the majority of cats that are somewhere in the middle and not so much for the outliers...but the outliers bring the innovations, don't they?

Ha! Isn't that the truth!

 

[Jill & Alex (GA)]

so are you thinking that due to possible absorption issues that is why we are seeing "a reverse or non" curves so to speak?

I little bit about on reverse or non-curves...

In this forum, we're talking about Lantus and Levemir. Because of the depot, the action of these insulins is cumulative by nature... meaning one dose builds upon the next or affects the next. You're not going to have these perfect "smile" curves that everybody seems to be looking for every cycle. You'll see numbers bobble up and down and/or inverted curves and/or flat curves. Until a kitty becomes tightly regulated you'll see waves of action spanning over the course of 3 days (6 cycles). Eventually these "waves" become smaller and smaller and if you're lucky, become non-existent to the point where you'll see the long flat curves Lantus and Levemir are known for.

Seeing these odd looking cycles I've described above is a normal part of the process and it's all about the typical action of these insulins...

Edited to add: That's assuming there's no BIPO (big insulin poop out) / lack of duration at that dose.

 

[Steph & Quintus & L & O]

If pancreatitis, acro, Cushings, steroids, etc. are the root causes for diabetes, it's a different story, sugar is still sugar, but it's not the whole picture.

I really think more importance should be placed on trying to figure out why a cat became diabetic because how you treat is slightly different depending.

Yes, I completely agree with that!

I'm pretty convinced now, with hindsight, that pancreatitis made her diabetic.

This would not be surprising -- as this was Quintus's case, I spent a lot of time reading about pancreatitis, and the general vibe I get is that it's hard to diagnose (though thank goodness for SpecFPL), can be largely unsymptomatic and go unnoticed, and very probably under-diagnosed.

FWIW my civvie had an acute episode of "something", the two main candidates for diagnosis (that we'll never have because it's over) being some stomach bug or pancreatitis, and her BG definitely shot up during it. Numbers and graph on the second and third tab.

 

[LizzieInTexas]

I get is that it's hard to diagnose (though thank goodness for SpecFPL), can be largely unsymptomatic and go unnoticed, and very probably under-diagnosed.

You (and others?) may find this interesting. I sure wish I knew when it was written. I was researching the GI Assay requirements and ran across this. A lot of it is over my knowledge level but still interesting (at least to me). I looked for a publish date and couldn't find one - I would like to know how recent this info is.

TAMU Pancreatitis Information Confused about Lipase Assays?

While I am sure Gizmo has Pancreatitis I am not sure it was the disease or the treatment (steroids) that pushed him into FD.

 

[Steph & Quintus & L & O]

@LizzieInTexas wow, super interesting! Particularly the part about specificity and sensitivity of Spec fPL. I understand the numbers to mean there is a very low chance of false positives, though there’s a possibility of false negatives particularly in mild/sub clinical cases.

 

[LizzieInTexas]

@LizzieInTexas wow, super interesting! Particularly the part about specificity and sensitivity of Spec fPL. I understand the numbers to mean there is a very low chance of false positives, though there’s a possibility of false negatives particularly in mild/sub clinical cases.

I found this very interesting too..

https://vetmed.tamu.edu/gilab/research/cobalamin-information

Cobalamin Deficiency in Gastrointestinal Disease
In animals with reduced cobalamin absorption, regardless of the cause, it is reasonable to expect that eventual depletion of cobalamin body stores will occur and cobalamin deficiency will ensue. As all cells in the body require cobalamin for single carbon metabolism, it has been hypothesized that cobalamin deficiency may actually contribute to the clinical signs and manifestations of gastrointestinal disease in some patients. Studies of radiolabelled cobalamin in cats have demonstrated that the half-life of this compound is significantly reduced in cats with gastrointestinal disease.

While the serum concentration of cobalamin is used diagnostically, the reactions catalyzed by cobalamin dependent enzymes occur in the mitochondria, making it difficult to assess the state of cobalamin availability in the patient. Tissue-level deficiency of cobalamin is associated with an increase in the urinary and serum concentrations of an organic acid called methylmalonic acid, which is an alternative product of a cobalamin dependent pathway within the mitochondria. Using this compound as a marker of cobalamin deficiency, we have been able to demonstrate that cats and dogs with very low serum cobalamin do indeed have a significant tissue-level cobalamin deficiency (Figure 2). Interestingly, in cats, there was no change in serum concentrations of homocysteine (see Figure 1). Elevation in homocysteine is expected with cobalamin deficiency due to reduced methionine synthase activity even in the face of extreme cobalamin deficiency. In dogs, preliminary evidence suggests that there is an increase in serum homocysteine concentration with reduced serum cobalamin concentration.

 

[Bobbie And Bubba]

This discussion really sparked my interest especially when @Elizabeth B talked about scarring or lipohypertrophy. It got me thinking how I just about always shoot around the shoulders, rotating with each shot. I have only shot the scruff about 3-4 times in the 2 years I have been giving Bubba insulin.

So, last night I decided to shoot the scruff. He jerked away as if I hurt him and I wasn't sure if it were a FS. Well, +3.25 he popped me a 55!. Usually his PM is much more flat than his AM cycle. It has my antennae up about scarring and absorption and I shot the scruff again this AM. I will start incorporating that site into the locations I shoot.

 

[Myagi (GA) and Heidi]

This discussion really sparked my interest especially when @Elizabeth B talked about scarring or lipohypertrophy. It got me thinking how I just about always shoot around the shoulders, rotating with each shot. I have only shot the scruff about 3-4 times in the 2 years I have been giving Bubba insulin.

So, last night I decided to shoot the scruff. He jerked away as if I hurt him and I wasn't sure if it were a FS. Well, +3.25 he popped me a 55!. Usually his PM is much more flat than his AM cycle. It has my antennae up about scarring and absorption and I shot the scruff again this AM. I will start incorporating that site into the locations I shoot.

I too think the scarring and absorption is important to note and make adjustments for. While Myagi did not have a slower response to the amps scruff shot, on the occasion that I shot a left shoulder area previously untouched, he also flinched and had a rapid onset and very active cycle. I haven't gone back there (chicken ), but I should I think I should try to incorporate that area for pm cycles, which are quieter for Myagi. Hmmmmmm

 

[Tracey&Jones (GA)]

they can change how carb sensitive they are over time

That is very true. I wish I could read Jones' cycle better.

What moving will he do spontaneously? If I do have to exercise Quintus (who has really bad arthritis and tends to move as little as he can), I know I can carry him downstairs and he will want to go back to his couch, walking up and home. Then I can carry him down again...

Good question. He was never much of a playful kitty. And I think he is developing arthritis issues along with his muscle atrophy issues. DS does spontaneously pick him up and put him down and that makes him walk back to his roost at least.
I was just trying to think of a way to get the heart beating a little faster. Open to suggestions. I know the benefits of exercise. I was actually part of a study on the affect of exercise and how well a patient handles cancer treatments. I hate exercising but I go to the gym twice a week!

Ever seen those cat treadmill circles? LOL Jones and I could work out together.

 

[Tracey&Jones (GA)]

While I am sure Gizmo has Pancreatitis I am not sure it was the disease or the treatment (steroids) that pushed him into FD.

Our initial vet was testing his glucose from the start almost. Every BW done that was something she looked at. She commented a few times that it was higher than normal. By the time we went from suspected pancreatitis to IBD dx was about 4 months. DX FD 2 months later roughly.

Right now, I am pretty sure he would be in remission if not for the steroids.

 

[LizzieInTexas]

Our initial vet was testing his glucose from the start almost. Every BW done that was something she looked at. She commented a few times that it was higher than normal. By the time we went from suspected pancreatitis to IBD dx was about 4 months. DX FD 2 months later roughly.

Right now, I am pretty sure he would be in remission if not for the steroids.

I wish there was an easy way to find my first post here. It is the first episode of panc and FD. I think the 2 month time frame is about correct. July 2016 to October 2016.

 

[Shoeskitty-GA]

I wish there was an easy way to find my first post here. It is the first episode of panc and FD. I think the 2 month time frame is about correct. July 2016 to October 2016.

Link to your intro post here:

http://www.felinediabetes.com/FDMB/...titis-ckd-newly-diag-and-now-diabetes.161957/

It's easy to find old posts. Just go to your profile page and click on postings and keep going to older messages until you get to the last page of them.

 

[LizzieInTexas]

Link to your intro post here:

http://www.felinediabetes.com/FDMB/...titis-ckd-newly-diag-and-now-diabetes.161957/

It's easy to find old posts. Just go to your profile page and click on postings and keep going to older messages until you get to the last page of them.

Thanks. I had forgotten it was his 2nd panc flare. His first was in 2015.