Foyi's journey

I would have continued with the .5 unit dose for this evening and monitored him. I would not change the dose unless he earned a reduction. Some cats need just a small amount of insulin. His spreadsheet looks so good though! I am really excited about it.
 
And here are the OTJ Trial Instructions for going off insulin (Off the Juice/OTJ). Foyi may or may not be ready for a full OTJ Trial, but for future reference.


OTJ trial instructions:
  • Start the trial on the next green pre shot.
  • If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
  • Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
  • After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.

Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), testhis/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers,it's time for a visit to the vet!
 
Suzanne & Darcy said:
Spoke with your regular vet about the Rapamycin?
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It was the reaction I expected, they recommend to wait for the results of the clinical trial and for Rapamycin to be licensed in the US.

I am inclined to get it from the US vet and try it. A bit nervous though about a possible rise in BG especially if we have stopped the insulin, but I will probably be using a libre sensor anyway.
 
Suzanne & Darcy said:
I would have continued with the .5 unit dose for this evening and monitored him. I would not change the dose unless he earned a reduction. Some cats need just a small amount of insulin. His spreadsheet looks so good though! I am really excited about it.
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I wasn't sure what to do but opted for the reduced 0.25u on the precautionary principle as his BG is consistently normal now. If the numbers are good, then I'll keep him on that dose for the next 3 days and then stop and keep monitoring.

Thanks for sending the OTJ guide. If I only get a few blues, do I do nothing? And if I get yellows, do I start shooting again a small amount (say 0.5u)?
 
I found Dr. Kevin Toman to be easy to talk to once I submitted my cat’s records. He actually had a lot of questions and was interested in a lot more than just Ginger’s heart disease— he was taking a “whole cat” approach — so I think he will have information for you regarding the Rapamycin and diabetes. I do think that, if possible, it’s better to start the Rapamycin earlier rather than later since HCM is progressive. It can be stable for a long time in some cats though. I did have a cat with stable HCM for some years. She passed away from a different cause. Nevertheless, I know you want to do everything you can.
 
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fpa said:
I wasn't sure what to do but opted for the reduced 0.25u on the precautionary principle as his BG is consistently normal now. If the numbers are good, then I'll keep him on that dose for the next 3 days and then stop and keep monitoring.

Thanks for sending the OTJ guide. If I only get a few blues, do I do nothing? And if I get yellows, do I start shooting again a small amount (say 0.5u)?
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If you see higher blues and some yellows then, yes, we would restart the insulin probably at .25 units (hard to say since we are just speaking hypothetically.). Anything over 120 is not what we want. There should be predominantly green numbers on his spreadsheet.
 
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And I am LOVING those greens on the .25 unit dose. This is great. Just keep tracking it. If the Libre alerts you to low BG, just test with your regulator glucometer because the Libre is notorious for giving alarmingly low readings in the lower end of things.
 
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Suzanne & Darcy said:
And I am LOVING those greens on the .25 unit dose. This is great. Just keep tracking it. If the Libre alerts you to low BG, just test with your regulator glucometer because the Libre is notorious for giving alarmingly low readings in the lower end of things.
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Thank you very much again for all the help and guidance. It's a lovely sea of greens at the moment and so far today his BG is even lower than yesterday despite the dose reduction. I plan to pause the insulin shots on Monday and hope for the best.
 
His PS numbers were too low last night and this morning (~60) so decided to stop the insulin and so far it's still green.

His daily average BG has been decreasing steadily despite the rapidly decreasing insulin amounts. The daily averages over the last 13 days are: 227, 173, 146, 139, 135, 132, 130, 110, 95, 92, 85, 79, 58.

Fingers crossed his pancreas has started producing insulin properly again and this is not a fluke.
 
And a beautiful sea of green today thus far! :D I was just checking up on him. I am really happy! Your vet will be too, I am sure. I will keep checking periodically. After two weeks of zero insulin, we consider him a diet-controlled diabetic (in remission.) Cats are such amazing creatures.
 
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Suzanne & Darcy said:
And a beautiful sea of green today thus far! :D I was just checking up on him. I am really happy! Your vet will be too, I am sure. I will keep checking periodically. After two weeks of zero insulin, we consider him a diet-controlled diabetic (in remission.) Cats are such amazing creatures.
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I am super happy as well (so far at least). He gets extra cuddles, play and time outside!

I think I'll remove the libre sensor in 2-3 days time and take glucometer readings 2-3 times a day. He's been wearing a (custom) jumper 24/7 in order not to rip off the sensor for more than a month now!

A bit worried that the rapamycin could raise his BG, but we'll see. It sounds like it will take 1-2 weeks to arrive anyway.
 
Suzanne & Darcy said:
Thank you. I see beautiful green today! :D
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KSHfrDz

 
Hello! I am so happy to see how well Foyi has been doing. I’ve been checking every few days on his spreadsheet (and smiling at those greens). I know you started Rapamycin. I am sure you will be checking his BG frequently. I really hope he will be all right with it.
 
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Thank you Suzanne, no impact on his BG so far from the rapamycin, so I am cautiously optimistic.

Also it could be a coincidence, but Foyi was a bit off on Friday and Saturday (eating less and sleeping more), but perked up after taking the rapa on Saturday afternoon and has been fine since then.
 
Well it is something new for him so his body needs to adjust. It’s good that he seems to be over it now. I am so optimistic about this. Did you tell your cardiologist that you were using it? Since I first talked to you about Rapamycin, the FDA here in the U.S. has given conditional approval for the use of Rapamycin (Sirolimus) for use in asymptomatic cats with HCM.
https://www.fda.gov/animal-veterina...-drug-management-ventricular-hypertrophy-cats
 
I did inform the cardiologist, she was against the idea until more studies were available, but I chose not to wait for that based on the limited science available and the record of Dr K.

Good news about the FDA approval, I did notice in that article that the guidelines is not to be used with cats with pre-existing diabetes, but I guess Foyi is in remission now anyway. I think I would have used it even without a remission as it looks promising in terms of stopping or even reversing HCA and I think BG could be managed with insulin.

Fingers/paws crossed that it won't affect his BG and it will be effective, I plan to have him do a heart scan in 5 months time.
 
fpa said:
. I think I would have used it even without a remission as it looks promising in terms of stopping or even reversing HCA and I think BG could be managed with insulin.
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I completely agree with this. I noticed the thing about not using in cats with FD, but we already knew from your talk with Dr. Kevin that it would potentially raise BG.
 
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Suzanne & Darcy said:
I completely agree with this. I noticed the thing about not using in cats with FD, but we already knew from your talk with Dr. Kevin that it would potentially raise BG.
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I just read the full FDA publication (which is basically a review of the limited literature on rapamcyin) and it says this:

"One cat in the 1X group developed diabetes mellitus which went untreated, and the cat presented in diabetic ketoacidosis and died of acute cardiac arrest. Based on this finding, felycin ®-CA1 should not be used in cats with pre-existing diabetes mellitus."

So their guideline to not use rapamycin in diabetic cats is based only on one cat in one study which developed diabetes during treatment and was left untreated (no insulin given) and developed DKA and died. This looks like an over-reaction to me, I think a warning about the risk of rapa raising BG would be more appropriate.
 
Agreed! How ridiculous. Any cat who is untreated is at a high risk of DKA and death. Poor cat. Nobody would treat it with insulin.
 
Yeah I find it strange that they chose not to intervene as if they didn't know what would happen with untreated diabetes.

I just hope this doesn't stop people and vets from trying rapamycin in diabetic cats with HCM. A warning about BG and requirement to monitor it (even once a week!) would be much better I think.
 
fpa said:
Yeah I find it strange that they chose not to intervene as if they didn't know what would happen with untreated diabetes.

I just hope this doesn't stop people and vets from trying rapamycin in diabetic cats with HCM. A warning about BG and requirement to monitor it (even once a week!) would be much better I think.
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I agree. I am going to speak with my vet about it. Last year she said she didn’t know much at all about Rapamycin when I asked if she would prescribe it. So I have been keeping her up to date on developments. They should just make mention of the possibility of elevated BG. The client can monitor the cats glucose and can make the decision to discontinue the Rapamycin or to treat with insulin.
 
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