Guidance

[Charlotte&Brioche]

Hello all,

Brioche has been doing fairly well, however he has been in the 80-120 range when it is time for his dose. I haven’t felt comfortable giving him his insulin when he’s that low, and I try stalling but I don’t want to mess up his consistency too much so I’ve been skipping his doses if he’s under 120. I just want to make sure this is the correct thing to do.

Also, I’m considering looking for another opinion as my vet has insisted on holding brioche at 4 units even though he’s getting well below 80 when I give him that dose, so I’ve been following the advice of the forum and adjusting his dose accordingly. She also gave me very little information when I started him on his treatment. All I was told was that he needed to get his shot after he ate, and it should be about 12 hours apart.
Not sure if I’m being dramatic or if I should consider looking into a different practice.

Any advice is extremely appreciated.

 

[Sienne and Gabby (GA)]

In case no one linked you to our Beginner's Guide to Vetsulin, this post should be helpful.

You have been doing great! My one observation is that you have missed opportunities to lower Brioche's dose. From the information in the link:

The general guidelines for making dose changes are:

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit.

Brioche is spending what appears to be a good amount of time in normal numbers. I'd suggest getting one or two tests in between your pre-shot tests to make sure that the numbers are consistently this good. With Vetsulin, I'd be very reticent to give a shot if the pre-shot numbers are in normal range (50 - 120).

Our general strategy with a lower than expected pre-shot number is to not feed your cat and wait approx. 20 minutes and re-test to see if numbers are rising. However, Brioche has not been getting insulin intermittently for several days and you don't have any mid-cycle tests to have a sense of whether the cycle is looking consistently as good as it seems. We try to systematically lower the dose so there's not an abrupt discontinuation of insulin so you're providing as much support for what is clearly a healing pancreas as possible.

As for changing vets, many vets are not well schooled when it comes to managing feline diabetes. Depending on your vet's practice, your vet may be more familiar with treating diabetic dogs or hasn't stayed up with the research. (For example, the American Animal Hospital Assn hasn't recommended Vetsulin for treating feline diabetes since 2018.) Changing vets is really a judgement call. If you're confident that your vet is good at treating everything besides Brioche's diabetes, if it were my cat, I'd consider sticking with the vet and listen to the members here with regard to your cat's diabetes. If in general, you don't have a great deal of faith in the vet, start looking! We do have a post on what to look for in a vet.

 

[Charlotte&Brioche]

In case no one linked you to our Beginner's Guide to Vetsulin, this post should be helpful.

You have been doing great! My one observation is that you have missed opportunities to lower Brioche's dose. From the information in the link:
Brioche is spending what appears to be a good amount of time in normal numbers. I'd suggest getting one or two tests in between your pre-shot tests to make sure that the numbers are consistently this good. With Vetsulin, I'd be very reticent to give a shot if the pre-shot numbers are in normal range (50 - 120).

Our general strategy with a lower than expected pre-shot number is to not feed your cat and wait approx. 20 minutes and re-test to see if numbers are rising. However, Brioche has not been getting insulin intermittently for several days and you don't have any mid-cycle tests to have a sense of whether the cycle is looking consistently as good as it seems. We try to systematically lower the dose so there's not an abrupt discontinuation of insulin so you're providing as much support for what is clearly a healing pancreas as possible.

As for changing vets, many vets are not well schooled when it comes to managing feline diabetes. Depending on your vet's practice, your vet may be more familiar with treating diabetic dogs or hasn't stayed up with the research. (For example, the American Animal Hospital Assn hasn't recommended Vetsulin for treating feline diabetes since 2018.) Changing vets is really a judgement call. If you're confident that your vet is good at treating everything besides Brioche's diabetes, if it were my cat, I'd consider sticking with the vet and listen to the members here with regard to your cat's diabetes. If in general, you don't have a great deal of faith in the vet, start looking! We do have a post on what to look for in a vet.

Great, thank you. I appreciate all of the information. What should I be doing instead of withholding the shot? I’ve been waiting about 30 minutes and retesting but his numbers usually don’t rise. Also, this may be a dumb question but I’m not sure how I would keep the vet yet listen to the advice here. Just because she’s been recommending me to hold the dose and such but here it’s recommended to drop .25 anytime he goes under 80. So if I were to tell her I was going against her advice I’m not sure how that would work, maybe I’m misunderstanding.

I will definitely make sure to test him more frequently in between cycles. I have been working a lot to accommodate the vet bills, so I have minimal home time, but I will make it a higher priority.

 

[Sienne and Gabby (GA)]

You asked a good question!! It really depends on how close you are in communication with your vet about dosing. The easy answer is to not tell your vet. To be honest, Brioche looks like he's heading toward remission so it may be a moot point until you tell your vet that your cat hasn't needed insulin for a couple of weeks.

I would not give your cat 3.5u of insulin. Brioche has been in normal numbers with no insulin whatsoever. If numbers don't rise and are in a normal range, I would be very cautious about giving insulin at this point. Vetsulin is harsh and fast acting. If you're not home to monitor and you're giving 3.5u, I'd be worried about where your cat's numbers are heading. The PM numbers in the 80s are numbers that indicate the need for a dose reduction. I'm tempted to suggest you hold off on giving Brioche any insulin given what the numbers look like.

 

[Red & Rover (GA)]

If you don't give insulin and switch out the dry Purina DM (not low carb) for low carb snacks, I'm betting you will see an all green spreadsheet.
A bit of tuna or cooked chicken will do for snackage. There are also freeze-dried single ingredient treats you could try. Orijen, I believe, it one brand. Look for a single ingredient. And bye-the-bye, the freeze-dried dog treats are cheaper in the long run than the cat ones. Just break them into smaller pieces.

 

[Charlotte&Brioche]

If you don't give insulin and switch out the dry Purina DM (not low carb) for low carb snacks, I'm betting you will see an all green spreadsheet.
A bit of tuna or cooked chicken will do for snackage. There are also freeze-dried single ingredient treats you could try. Orijen, I believe, it one brand. Look for a single ingredient. And bye-the-bye, the freeze-dried dog treats are cheaper in the long run than the cat ones. Just break them into smaller pieces.

I need to update that! He has been on fancy feast for the last few weeks, and I think that change is what made him start improving. I will cut out the purina food.

 

[Charlotte&Brioche]

You asked a good question!! It really depends on how close you are in communication with your vet about dosing. The easy answer is to not tell your vet. To be honest, Brioche looks like he's heading toward remission so it may be a moot point until you tell your vet that your cat hasn't needed insulin for a couple of weeks.

I would not give your cat 3.5u of insulin. Brioche has been in normal numbers with no insulin whatsoever. If numbers don't rise and are in a normal range, I would be very cautious about giving insulin at this point. Vetsulin is harsh and fast acting. If you're not home to monitor and you're giving 3.5u, I'd be worried about where your cat's numbers are heading. The PM numbers in the 80s are numbers that indicate the need for a dose reduction. I'm tempted to suggest you hold off on giving Brioche any insulin given what the numbers look like.

I’ve been withholding insulin for 4 days, and his numbers have remained normal. I did a 12 hour curve yesterday and his numbers didn’t drop below 80/90.

thank you for answering my other question

 

[Charlotte&Brioche]

You asked a good question!! It really depends on how close you are in communication with your vet about dosing. The easy answer is to not tell your vet. To be honest, Brioche looks like he's heading toward remission so it may be a moot point until you tell your vet that your cat hasn't needed insulin for a couple of weeks.

I would not give your cat 3.5u of insulin. Brioche has been in normal numbers with no insulin whatsoever. If numbers don't rise and are in a normal range, I would be very cautious about giving insulin at this point. Vetsulin is harsh and fast acting. If you're not home to monitor and you're giving 3.5u, I'd be worried about where your cat's numbers are heading. The PM numbers in the 80s are numbers that indicate the need for a dose reduction. I'm tempted to suggest you hold off on giving Brioche any insulin given what the numbers look like.

I had a question about the possible remission. I gave the vet a curve I did and she wanted me to stop insulin. I haven’t been able to give him any for about a week since his numbers have been in a normal range. The vet said some cats can be managed with diet and I assume that’s kind of what remission is? I’m not really sure. I don’t know when I could consider him to be at that stage, and how frequently he needs to be tested and such.

 

[Sienne and Gabby (GA)]

When a cat is in remission, we consider that cat a diet controlled diabetic. Unlike with humans, a cat's pancreas can heal but the possibility exists for the cat to fall out of remission. High carb food or an illness or inflammation which causes higher levels of stress hormones can throw a cat out of remission. The most common cause of a cat falling out of remission is the need for dental work.

An OTJ ("off the juice") trial consists of not giving your cat insulin for a 2 week period with the cat being in mostly normal numbers. At this point you could start counting days beginning on 6/2.

 

[Charlotte&Brioche]

When a cat is in remission, we consider that cat a diet controlled diabetic. Unlike with humans, a cat's pancreas can heal but the possibility exists for the cat to fall out of remission. High carb food or an illness or inflammation which causes higher levels of stress hormones can throw a cat out of remission. The most common cause of a cat falling out of remission is the need for dental work.

An OTJ ("off the juice") trial consists of not giving your cat insulin for a 2 week period with the cat being in mostly normal numbers. At this point you could start counting days beginning on 6/2.

Okay, thank you. If the OTJ trial goes well what are the next steps from there regarding blood sugar testing? Is it still necessary to check him as frequently?

 

[Sienne and Gabby (GA)]

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), test his/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!