Nelson - Reaching Remission?

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CatMomWendy

Member Since 2012
I have a 14 YO male named Nelson who we adopted last Sept. From what I was told, he was diagnosed at age 9 and was fed dry food. He came to us eating dry food. After joining here and reading various sources, I started him on all wet (FF Classics), freeze dried and raw. We have bounced up and down with dosages and we always pre test before shots and when I am home, I try to run a curve occasionally. I know someone will ask me for the spreadsheet but I don't use that. I record all in a book because I just don't use our computer as it is just much easier to record in his notebook. He is on Lantus.

We were on a vacation 2 weeks ago and had someone testing a few times during the week. We got a report that he was low mid day (54 on the meter but we know our Relion is about 30 points low so really about 84). We reduced dose from 1 unit to 1/2 unit that night and then 3/4 unit until we got back two days later. We got another report the next day his number at the PM shot was 74 (about 104). We were driving and happen to hit a dead zone at the exact wrong time and I couldn't respond to their text for about 20 minutes. They went ahead and gave him a dose (3/4 unit) while waiting for me to reply. By the time I could answer, the dose was already given. I talked with the pet sitter who was spending the night and she monitored him all night and pushed gravy foods and even a little dry because I was very concerned. He never showed any signs of hypo that night. When we returned the next day we resumed testing AM and PM. This past week has been a continued reduction in dose and now we have had several stints where his AM number was too low to dose. We went from Wed AM through Fri AM with no shots. His pre shot numbers were crawling up just a little each time and on Friday night when he reached about 155 (185 for real), I gave 1/4 unit. Now we are several more days and the pre shot numbers have been running 85-115 (really 115-145) with a slow increase each test. If the meter value goes up to about 150 again, I would do another small dose of 1/4 unit.

He hasn't been eating as much as normal and I am concerned about that but otherwise, he acts 100% normal and is happy. I caught just a little bit of urine this am on a ketone strip and it was normal although I don't know if it was really enough (he pees against the side of the box so I rubbed the strip on the drips...not sure if that is accurate). I made a vet appointment for him tomorrow night (Tuesday). Since this is all new to me (remission?) I just wanted to make sure I am not missing something else. During our vacation, Nelson was 100% separated from dry food and kept in a room by himself unless someone was there and could pick up the dry left out for the other cat population (only way we can manage long term time out of the house is to free feed the others while the diabetics (I have 2) are kept separate). He is really good at finding the pieces of dry food the others drop or leave under normal circumstances so by being isolated completely from dry for a week might have made the difference....at least that is my speculation. We try diligently to not leave any dry out when unattended but we aren't 100% successful every time and he does score a few pieces now and then. The rest (6 others) are fed a mix of dry and wet but with 8 total, there is no way I can feed all wet 100% of the time. We only feed dry when we monitor them but as I said, they drop pieces or walk away leaving some and the diabetics come by like vacuums to pick it up if we don't react immediately.

So after all of that, does it seem that Nelson could be reaching remission? If so, where can I turn to read about how to manage that (testing regimen, what to watch for, etc.?
 
First, here are some glucose reference ranges used for decision making using a human glucometer:

< 40 mg/dL
- Treat as if HYPO
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers.
(May even go as low as the upper 30s; if not on insulin, this can be safe.

> 150 mg/dL
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

180 - 280 mg/dL
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Second, it would be helpful to do a curve - from morning test or pre-shot test if insulin is given, until 12 hours later, take a test every 2 hours to see what his body does across the day.

There often is a rise about 2 hours after eating a large meal, or one with higher carbs, about 2-3 hours after it was eaten. Feeidng frequent small meals helps divide the workload for the pancreas, which may help it function more normally and reduce any spikes.

An Off The Juice trial is going without insulin and keeping the numbers between 40-130 mg/dL for 14 days. The best way to know if it can be done is to try it.
 
Thank you for the reply BJM. Yes, I do feed many small meals throughout the day. Nelson and my other diabetic eat between 5-6 times on an average day and maybe an extra time on weekends. I alternate between wet, raw and freeze dried (Stella and Chewy's, f.d duck hearts and f.d. chicken breast). Between our vacation (which took weeks to plan and prepare for the diabetic's care along with the care of a kidney failure cat), working full time, and summer time weekend events, I haven't been home for 12 hours in a row (and conscious) to do a curve. I do do curves if I am home but there hasn't been a day since this started about 10 days ago where I could fit one in.

As I mentioned, I am taking him to the vet on Tuesday just to make sure nothing else is going on. I will monitor the readings and see how long he can go before needing insulin again. I never thought I would get near attaining remission with Nelson so I was just looking for a little insight into how to manage that and make sure I was on the right track. Thank you.
 
Sorry, I don't know who/what Mr. P is?

Nothing out of line at the vet except maybe a little bacteria in his ears (unrelated) which we have treated before. We had the vet run a fructosamine test and we will probably get those results back today or tomorrow. Our meter read 145 at the vet so we bumped him with 1/4 unit last night (he hadn't had insulin since Friday AM). This AM he was 67 (our meter reads lower than actual numbers and we will compare that amount again when we get the test results back) so back to no insulin. He was very relaxed and purring while being examined and afterward (we had our other diabetic along for his 6 month senior wellness check up) so I don't think the office visit stresses him out. He is a very low key guy and I joke that he is like the cat that ate the pot brownies.
 
Yes- MR P is the pancreas. And we want him to stop by for visits and even as a permanent house guest :-D .

MRS P is something else altogether and I hope Nelson doesn't have that problem :lol: .

Good for him to be so relaxed at the vet. Obviously a lovey-dovey and I bet they were catnip pot blondies as cats aren't supposed to have chocolate :shock: :lol:
 
Well Mr. P must be working since Nelson's frutosamine results were great! His number was 293. This is the first time I have had a fructosamine test run so I didn't know what that meant. The vet said a range of 300-350 is considered an "excellent" range. Reaching 250 would indicate "prolonged control." It looks like we are on the right track with getting Nelson's pancreas to wake up. So to answer my own question...it looks like Nelson is perhaps reaching remission! Doing the happy dance and only hope it continues.
 
Re: the spreadsheet. I only access the net through an iPad and haven't been on our computer in months. Can't save a spread sheet on the iPad and not sure if it works with Google docs? Does anyone else use the Google doc only using an iPad? I know nothing about Google options.
 
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