? Newbie: 8 y/o in remission since Dec 23 but showing some signs...

[MustachedMalarkey]

As mentioned in the title, on December 23rd, we received the amazing news that, after just six weeks on insulin, my cat has gone into remission. He had been receiving 2 units of ProZinc twice daily.
(When diagnosed his BG was 28mmol (504 mg/dL) and his fructosamine was 517. No sign of DKA at that time)

In the week leading up to his remission, we noticed a series of dangerously low blood glucose readings (hypo episodes) during a 2-day home curve, prompting us to reduce his insulin dosage to 1 unit instead of 2. Despite this, he continued to experience hypoglycemia even at the lower dose.

After consulting with the vet the following day, we were advised to pause his insulin and monitor him closely. His recent fructosamine had dropped to 307, so, combined with the low BG curve and that result, she felt he was in remission.
We were instructed to resume half a unit only if his blood glucose exceeded 9.0mmol (162mg/dL) and to contact the vet if that happened.
​

During the past 2 weeks off insulin, his glucose levels remained steady between 5.3mmol and 6.4mmol (95.4mg/dL to 115/2mg/dL) His energy has been high, occasionally even seeming almost hyperactive. He's been chatty, social, cuddly, active and vibrant. His diet consists of a mix of low-moderate-carb (<6%) and zero-carb canned food (no dry food) with added warm water, and he doesn't seem to be drinking from his bowls anymore and prefers his "soup". And his appetite was good, he would wake me up demanding his breakfast and finish it all at once, no problem.
I'd been checking his glucose at different times. Every time, his levels had been stable. Overall, things appeared to be going well...until this weekend.

In the last couple days his appetite has fluctuated, he's not waking me up demanding breakfast, and finishes a small portion of his usual meal. So that's different, along with his energy levels, they've been up and down too. He's started hiding on and off, and being less social and cuddly. His glucose levels are still in the 5.5mmol (99mg/dL) range. He's urinating pretty normally, 2-3 times a day, and still plays a little bit when offered.. he just seems off.

It leads me to wonder if stopping the insulin so abrubtly was maybe not a good idea? Is this normal for a cat in remission to have a suddenly varying appetite and energy and act lethargic at times? I literally just commented to my partner last week that he was looking the healthiest he's looked in years, acting as though he was 5 years younger, and then bam, he throws me a curveball.
Trying not to panic as I realize I'm still very new to this (1st diagnosis was in November) and I can't assume a couple of sleepy days mean he's sick again. I'm a bit worried he has a secondary illness of maybe pancreatitis or DKA or something?

I plan to contact his vet today but I thought I'd pick some experienced brains here on this excellent forum, and at least ease my panic.

 

[Bron and Sheba (GA)]

The first thing I would do is check his urine for ketones. You can do this by buying a bottle of Ketostix from a pharmacy. There should be no ketones.
I would also ask the vet to do a fPL spec test to check for pancreatitis.
It is not normal for him to be lethargic and have reduced appetite without a cause I would not think, so I think it is wise to have him checked out.
We recommend reducing the dose of insulin from 1 unit, to 0.75, 0.5, 0.25 to a drop before stopping insulin to get a strong remission.
However if his BGs are staying under 5.5 I would not restart insulin at this point.
Let us know how you get on at the vet.

 

[MustachedMalarkey]

Unfortunately, all the vets are out today, but I can take him to a different clinic where they aren't familiar with him. They mentioned that a vet from our regular clinic will call me back tomorrow.

Last night, I gave him some extra carbs just to be safe, as he seemed a bit "hypo" even though his blood glucose was in what the vets would consider the "perfect" range. I've noticed that whenever his BG drops to around 5.5mmol (99mg/dlL), he tends to get sluggish.. and when he was going full hypo while on insulin one of his "tells" was that he would hide.

This morning, his BG was 6.9 mmol (124.2 mg/dL), so I gave him a low-carb breakfast after testing. His reduced appetite could just be him being picky with his food. When I swapped it for something he preferred, he ate more. He’s just not acting as ravenous as he had been.

As of this morning, he's been quite lively, chirping at birds and playing with his toys. No signs of hiding so far. I plan to get testing strips and check for ketones today.

I'm wondering if his ideal BG range might be in the low 6's, and that perhaps he was just too low at 5.5? Do some cats have specific personal BG ranges? FYI: I use an AlphaTrak3 with the matching test strips, it's brand new and calibrated to cats.

 

[Bron and Sheba (GA)]

If he is not getting any insulin he won’t go ‘hypo’. A cat has to be on insulin to drop into dangerously low numbers so there is no need to feed any higher carb food to him.
A cats normal BGs if you are testing with an alphatrak meter are appropriately 68-150
Offer him snacks throughout the day and evening as well as the 2 main meals