Frequent bounces; very low dose; vet suggests going OTJ

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Kerrie & Winnie

Kerrie & Winnie

Member Since 2015
Winnie has never been on a dose higher than 1 unit and lately has been on .5 or .25 units. Her BGs are all over the place at both doses and there's rarely a pattern to them. My vet is suggesting going OTJ for a few days to see what happens. She says the dose she's on right now (0.5) is so low that she can go cold turkey. Dunno how I feel about that. But we've tried 0.25 and she still bounces so I don't know what else to do. Any advice?
 
It looks to me like she needs insulin. My Max bounced for a year before he was tightly controlled. When he had a nadir of 60 he was taken off insulin for three weeks. I had to resume insulin. When your cat had normal numbers she bounced because she's not used to being there. Many cats bounce until they get used to normal numbers. I found that feeding slightly higher carbs to keep Max from dropping too low helped him get regulated.
 
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I can't understand why your vet's suggesting stopping insulin. With those numbers, that would be asking for trouble. What we need to do is figure out how to get the bouncing under control. I like Elise's suggestion of feeding slightly higher carbs when it looks like he's dropping too low or too fast.

Are you testing for ketones? With all those high numbers, it's a good idea to test regularly. Ketones can sneak up on you.
 
Just wondering how you are feeding Winnie?
How many times a day? Just at shot time?

I also agree that this does not look like a cat that is ready to go OTJ.
 
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tiffmaxee said:
I fed the curve. If he was dropping too low I'd feed 9%
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Just wondering how you are feeding Winnie?

I feed Winnie Friskies paté, at shot times, and also mid-day and before bed.
Lisa Pierson's list says the patés are 7-11% carbs so if that's correct, 9% would not be "higher carb" in Winnie's case. But maybe it's all relative.
My vet said she hadn't seen a cat so poorly regulated on Lantus. She thought it was "worth trying" the OTJ. I am not feeling very hopeful about it but I can't think that all this bouncing from green to black is doing her any good either. I guess I'll try it for a few days and see what happens. If no success, then I'll have to try again to get the bounces under control.
Thanks!
 
I have to agree with the others - Winnie doesn't show anything to indicate she's ready to go OTJ at all, and honestly, I think trying it would be a big setback.

FWIW, lots of cats stay bouncy despite being on insulin. Every cat is different....just the nature of the beast.

How is Winnie feeling and acting - does she have the 5 Ps (peeing, pooping, purring, preening, playing)? If she is feeling well, then you are on the right track. Remember to look at the whole cat, and not just the numbers!

How old is Winnie's insulin? If it's old, another thought would be that it is pooped out and you need new juice.
 
Kerrie

I'd like to share Gracie's story with you because it is identical to Winnie's.

When Gracie had been on insulin about the same time as Winnie and was at about 1u and bouncing, I saw an internal medicine vet specializing in cats and she told me that I was "killing" Gracie because she didn't need insulin and was having Somogyi rebound. She wanted me to immediately stop insulin.

We were already members here and I posted, just as you have, with what the vet said. Thankfully, I chose to listen to the experienced members here and not the vet. I did try to lower her dose and she did just what the members here said would do...she went up into high numbers and stayed and I had to take her dose up again to start seeing improvement.

And guess what? Gracie was diabetic for 5.5 years.

I'm not saying that Winnie will never go off insulin. I'm just saying the vet was completely wrong as many of them are. They don't see spreadsheets like ours and so they don't understand the patterns. They also believe in Somogyi and most of us here understand it has been shown that it doesn't occur in cats.

What you are seeing, and what Gracie...and most of the cats here do at one time or another....is normal bouncing. I did get Gracie's dose down very low as well and she would still bounce a bit from time to time.

But....after well over six years of being here and looking at hundreds of spreadsheets, I can tell you Winnie is not ready to go into remission. She needs insulin. Her patterns are nothing like cats ready for remission. That's not to say you can't get her there but she isn't ready yet.

What you risk by stopping insulin as you have is that when you do see you need to restart it, it likely will require that you take the dose back up higher than 0.5u to get her doing well.
 
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The fancy feast pates are 3%. If feeding 9% tgen try 15% when the drop is too much and will create a bounce or reduction. Trader Joe's turkey and giblets worked as a middle carb for us.
 
Amy&TrixieCat said:
How is Winnie feeling and acting - does she have the 5 Ps (peeing, pooping, purring, preening, playing)? If she is feeling well, then you are on the right track.
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She's been doing great! Playful, good hind leg strength, good coat, losing a tiny bit of weight lately though.
 
In the Where You Can Find post, there are a couple of links to posts on Somgyi vs. bouncing. There has been recent research that Somogyi is very rare in cats on long lasting insulin that have been increased slowly and carefully, as is done with either SLGS or TR here. Somogyi is a response to too much insulin, seen in those cases where the vet starts the cat on too high a dose, or increases are done without monitoring (unwarrented increase) or by too large an increase at once. Bouncing is the cat's body's reaction to either either lower numbers than they are used to, or fast drops in blood sugar. Using higher carb food to feed the curve (also described in the Where Can You Find post), can help ease the fast drops.

Looks like Winnie loves to bounce. So did my Neko. We have several cats here on quite tiny doses that like to bounce. All you can do is keep trying find a dose where they spend more time in normal numbers and get used to those lower numbers so their body doesn't freak out when it sees them.
 
Wendy&Neko said:
In the Where You Can Find post, there are a couple of links to posts on Somgyi vs. bouncing
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Thank-you for that! That's a great article. And thank-you for the explanation in your post. I'm convinced!
I'm also convinced, based on the overwhelming consensus, that I should put Winnie back on insulin.
And the third thing I'm convinced of is that this community knows WAY more about feline diabetes than my vet does. Maybe more than any vet does!
So now my question is: She's missed 2 doses - last night and this morning. Tonight, do I put her back on the dose she was at - 0.5 units?
 
A number of us have spent literally years learning about and caring for diabetic cats. That's hands on experience few vet's have. At one point I was thinking of switching vet's shortly after Neko's diagnosis to find one that knew more, so interviewed another one that had a diabetic. Turns out her cat passed, probably from a hypo. I stuck with my vet because she was willing to work with me and learn together.

I think I would go back to 0.5 units, she was getting some blue nadirs but not too low.
 
PMPS tonight was 337 and +3 was 249. Who knows what will happen tomorrow but so far, so good. Thanks all, for putting us back on course! I feel SO much better tonight than I did last night.
 
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