Livvy - could this be a very bumpy discover of remission?

[Livvy's Lady]

Our poor cat Livvy has been on insulin since about mid-April. She's an older cat, and she has other complications (possible meningioma on her right for brain to name just one).

She seemed to really go downhill over the past few days. Until then, she was generally pretty happy, although she always had lethargy and excessive urination and drinking, no matter what we seem to do with her insulin.

We had her in for an ultrasound last Wednesday, and an adrenal gland test and full kidney panel last Thursday. These didn't reveal anything obvious as an explanation.

Our vet called today, and he believes that she may be in diabetic remission. She's on 2.5 units of Lantus twice per day. The thing that's baffling me is that her home blood glucose test show her results to be on the high side. On the other hand, the vet said that she has zero sugar in her urine, and he believes that this supports the notion of her being in diabetic remission.

Of course, we want to believe this explanation. But I'm so confused about how a cat could be in diabetic remission, but not show low home blood glucose test results. This is very confusing to me.

Her present symptoms include staggering, shaky limbs, lethargy, and her eyes look sort of sunk in and very dull. But her blood sugar is high (her spreadsheet is up to date). For example, she was 277 at AMPS today.

We are to reduce her insulin to one unit per dose starting with this afternoon's dose.

I have any of you heard of such a thing as this before? A cat in diabetic remission and his blood sugar still appears high in home blood glucose tests?

Thank you!!!

 

[Camille and Cyclone]

Negative urine tests only show that the cat's bg is mostly staying under the renal threshold, the level at which excess glucose is eliminated in the urine, which in cats is around 200-280. It does NOT mean she's in remission.

 

[Wendy&Neko]

On the other hand, the vet said that she has zero sugar in her urine, and he believes that this supports the notion of her being in diabetic remission.

Not true. A cat who's blood sugar is well controlled, will have the blood glucose below renal threshold, and thus no sugar in her urine. My Neko often had zero sugar in her urine test results.

Rather than lower her dose, I would get a few more tests in to see if it's a good dose. We strongly recommend testing each AM and PM before you give insulin, so you know it's safe to do so. And some spot checks in the middle to see how low the dose is taking her and if it's still a safe dose.

Her present symptoms include staggering, shaky limbs, lethargy, and her eyes look sort of sunk in and very dull.

Staggering can be a sign of hypo. If you see that, I would test her blood sugar immediately.

 

[Livvy's Lady]

Negative urine tests only show that the cat's bg is mostly staying under the renal threshold, the level at which excess glucose is eliminated in the urine, which in cats is around 200-280. It does NOT mean she's in remission.

Ok, this makes sense and is helpful. Thank you.

 

[Livvy's Lady]

Not true. A cat who's blood sugar is well controlled, will have the blood glucose below renal threshold, and thus no sugar in her urine. My Neko often had zero sugar in her urine test results.

Rather than lower her dose, I would get a few more tests in to see if it's a good dose. We strongly recommend testing each AM and PM before you give insulin, so you know it's safe to do so. And some spot checks in the middle to see how low the dose is taking her and if it's still a safe dose.

Staggering can be a sign of hypo. If you see that, I would test her blood sugar immediately.

AMPS and PMPS have been ~250. Seems high, not low/hypo. +4 has been ~120-150. Not low. Maybe her nadir is at +2 or +6...??? Maybe somigy? I have a little knowledge, and that can be dangerous.

 

[Gill & George]

Hi there, and welcome to LL

AMPS and PMPS have been ~250. Seems high, not low/hypo. +4 has been ~120-150. Not low. Maybe her nadir is at +2 or +6...??? Maybe somigy? I have a little knowledge, and that can be dangerous.

Looking at the ss if this represents all the tests/monitoring, then it's impossible to say whats going on.

Cat's can have their nadir (lowest number in the cycle) anywhere form +1 to PS, George, for example, nadired as early as +2 and as late as +12. With just the sporadic data you have been getting it's entirely possible that you have been missing some lows. If you do notice those symptoms you described above I would definitely test immediately, as they sound similar to the symptoms of symptomatic hypo.

Going forward and in an attempt to figure out how good this dose is for Livvy, I'd suggest some systematic testing to see what's going on in each cycle.

• Start by always getting an amps and pmps (I can't emphasize enough how risky it is to shoot blind, my dad was a diabetic, he would never have shot himself without testing his BG first, just too dangerous)
• if you can try getting a +2 in the am and pm cycle. (if the +2 is a lower than PS then you should try to get a +3 aswell as the lower +2 can be indicative of an active cycle and BG may be continuing to drop for a number of hours yet)
• and try getting another test in somewhere between +5 and +7 (in the pm cycle try to always get a test just before bed, whenever that is)

If you started doing that over the next couple of days I think it will become much clearer what you need to do with the dose, and if he is indeed on too much insulin it will soon become apparent. I see you are using the Alphatrak, just want to remind you that if you see a number below 68 (or indeed very close to 68) that's the point where her Blood glucose levels will need to be boosted, by using higher carb food (or adding syrup to regular food)

If you look at George's ss, and look back to when he went into remission, you can see that we systematically followed TR protocol, reduced the dose when he earned reductions and continued insulin support (just a drop of insulin), you can also see that his numbers were flat and all green as he got closer to being in remission, that's how we would ideally see a kitty get into remission,, though some cats have different ideas, we wouldn't normally take a dose of 2.5u and stop it overnight.

Any more questions/doubts fire away.

ETA if you find the cost of the AT strips prohibitive, you may want to think about using a human meter, a lot of us use human meters, and they are a perfectly acceptable/useful tool for managing FD, since the cost of the strips can amount to quite a lot, it can be a real cost saving.

 

[Livvy's Lady]

Hi there, and welcome to LL


Looking at the ss if this represents all the tests/monitoring, then it's impossible to say whats going on.

Cat's can have their nadir (lowest number in the cycle) anywhere form +1 to PS, George, for example, nadired as early as +2 and as late as +12. With just the sporadic data you have been getting it's entirely possible that you have been missing some lows. If you do notice those symptoms you described above I would definitely test immediately, as they sound similar to the symptoms of symptomatic hypo.

Going forward and in an attempt to figure out how good this dose is for Livvy, I'd suggest some systematic testing to see what's going on in each cycle.

• Start by always getting an amps and pmps (I can't emphasize enough how risky it is to shoot blind, my dad was a diabetic, he would never have shot himself without testing his BG first, just too dangerous)
• if you can try getting a +2 in the am and pm cycle. (if the +2 is a lower than PS then you should try to get a +3 aswell as the lower +2 can be indicative of an active cycle and BG may be continuing to drop for a number of hours yet)
• and try getting another test in somewhere between +5 and +7 (in the pm cycle try to always get a test just before bed, whenever that is)

If you started doing that over the next couple of days I think it will become much clearer what you need to do with the dose, and if he is indeed on too much insulin it will soon become apparent. I see you are using the Alphatrak, just want to remind you that if you see a number below 68 (or indeed very close to 68) that's the point where her Blood glucose levels will need to be boosted, by using higher carb food (or adding syrup to regular food)

If you look at George's ss, and look back to when he went into remission, you can see that we systematically followed TR protocol, reduced the dose when he earned reductions and continued insulin support (just a drop of insulin), you can also see that his numbers were flat and all green as he got closer to being in remission, that's how we would ideally see a kitty get into remission,, though some cats have different ideas, we wouldn't normally take a dose of 2.5u and stop it overnight.

Any more questions/doubts fire away.

ETA if you find the cost of the AT strips prohibitive, you may want to think about using a human meter, a lot of us use human meters, and they are a perfectly acceptable/useful tool for managing FD, since the cost of the strips can amount to quite a lot, it can be a real cost saving.

Thank you for your comments. Because of Livvy's brain tumor and delicacy, we are not following TRP.

For the past few days, the tests that I've done were during her recent symptoms (staggering, weakness, lethargy).

All of her readings are high, always above possible hypoglycemia. Despite that, none of our vet's has wanted to raise her dose beyond 2.5 (other than in the first few weeks of treatment, pre-meter).

I feel that our vet must be misinformed about cats with diabetes always having sugar in their urine.

Our vet had us drop her dose to 1 unit starting last night. She was over 300 at +5 last night. AMPS today she was at about 240. (I haven't recorded these two numbers yet, so sharing from memory.)

My husband and our vets are all opposed to testing before every shot, citing that it causes stress and unnecessary pain. I get it, but I'm in your camp on this. That said, Livvy's BG hasn't been dangerously low at any test.

She doesn't seem any better at all at 1 unit. Some Fancy Feast with gravy last night didn't have any effect.

We think that her brain tumor and other issues are so bothersome that maybe she is giving up. We just adore her and are heartbroken that we can't make her feel better.