No insulin for 2 weeks. Not sure if I’m right

Kiera

Kiera

Member Since 2021
I need some advice and wanted to share my story:

For the past 2 weeks or so I have not been giving any insulin. A big jump from the previous month that I was giving 2u, twice a day. When Bailey was first diagnosed his numbers were very high. Sadly, I think he had diabetes before I realized for well over a year.

I didn’t know about home blood tests, so I was shooting blind (a term I recently learned).

The only type of testing I was doing was urine strips for ketones and glucose. Ketones were always negative. Glucose was always the highest possible amount.2000+ During this month, the vet didn’t suggest I come in. Didn’t mention curves. Didn’t seem to be concerned whatsoever. So I thought I didn’t need to be.

We did a diet change the same time we started insulin. This was my mistake. The vet made no mention of diet change. However, after talking to the pharmacist she informed me that diabetic cats should not have dry food or high carb wet food. I was doing both of those things. I thanked her and fixed it immediately. No more dry food. Only wet fancy feast pates.

Then, one day (after several weeks on insulin) my cat started to act off. Lethargic and just not himself. Ravenous appetite, glossy eyes, hiding in weird places and staring at things that weren’t there (at least nothing I could see). He would stumble sometimes standing up.

This lasted a few days and I started to worry. (keep in mind at this point I had never heard of hypo. My vet never made any mention of it. I even called my vet the 2nd day the symptoms persisted and he didn’t seem concerned which didn’t sit right with me). I did research, found this site and started blood testing right away.

I don’t know if it’s relevant but during those days he was acting strange the urine strips did a complete 180 degree flip and went from the highest reading to negative. My vet told me that what good news and to continue with insulin. However, the symptoms started to worsen and I began to question his competency. I decided to do some research and found you guys. Honestly, I think I found this site just in time and was a lucky that something horrible didn’t happen. I was outraged to learn about hypo from strangers instead of my vet who I trusted. I do think Bailey was at the very least mildly hypo for a few days. Scary!

My very first ever home test three hours prior to giving PM insulin was 65. Food influenced. At this time, I had never posted on here and didn’t know how it worked. So I just made a decision on my own and skipped insulin that night.

Basically, since then I haven’t been giving his injections. Based on the advice of a few awesome people on here, I was giving a very small amount for a couple days but then I stopped.

His numbers are borderline green and blue. I don’t know if they’re low enough for me to constantly be withholding insulin or consider him in remission. I don’t want him to relapse. However, I constantly replay the events in my head of when he was acting weird and how one more injection could’ve been fatal.

Now I’m terrified of hypo. Bottom line, I was hoping for advice on whether or not I should keep withholding insulin or perhaps begin again with a very small amount?
 
Lots of greens with a few blues here and there. Awesome! I'm not able to give advice but I'm sure someone will be on here soon. Good luck! :)
 
Hi Kiera. Nice to see you again. Good job testing. I do think Bailey is in remission. I would like to see just a few night tests around +3-4. I’m going to give you the otj directions so you know what to do now and what to look for going forward. Congrats.
 
Instructions for starting the OTJ trial
Start the trial on the next green pre shot.
If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.
Good luck with the trial!!!
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!

Like I said to be extra careful it would be good to get a few tests later at night.
 
tiffmaxee said:
Instructions for starting the OTJ trial
Start the trial on the next green pre shot.
If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.
Good luck with the trial!!!
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!

Like I said to be extra careful it would be good to get a few tests later at night.
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Thank you!! So basically, you want me to test PMPS and then at +3 or +4? I don’t feed snacks. The only thing he gets besides fancy feast pates is a little cheese or a very small amount of fat free milk after tests as a reward. I know people say that cats don’t tolerate lactose. However, it’s never caused even the slightest problem.
Plus, it’s the only thing that works for testing. So it is what it is. Probably not great that he gets a small amount of cheese at least once a day. The milk is once or twice a week. We are talking a couple teaspoons. He won’t eat any other treat. Not even meat. He’s so weird. I have an impossible time testing without it.

Do you think this is hurting him? Cheese is low carb but I use cheese sticks (like string cheese that you can’t pull off in strings) and there’s 19% saturated fat in them. Granted I only pinch a piece off of the top and break it into smaller pieces so it’s not like he’s getting anywhere near that amount but I still worry sometimes. I eat way too many of those things now myself. LOL.

For feeding in general, I let him eat as much as he wants. Whenever he wants. He grazes and never eats full meals. So food is always out for when he wants. If the bowl is empty (or more often, gets hard and has to be tossed), I replace it with fresh food.

Full disclosure, since I haven’t been giving insulin I have not been great about making sure he doesn’t eat two hours prior to testing. Do you think that makes a big difference? When he eats it’s usually only a few bites at a time. At least half of my AMPS and PMPS are after 2 hours of no food. I know this because he spends most of his time sleeping so I wake him for the tests. He stays in the same spot and is easy to monitor.
 
tiffmaxee said:
Kiera, are you giving a snack at +8-9? That might bring down the amps to green.
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What’s weird is that his numbers are staying in the 80s-90s. Shouldn’t there be some fluctuations during the day if everything was working correctly. I just did his PMPS. It’s 91. I don’t think he ate recently but I can’t be positive. I will be better about this going forward. Promise.
You mentioned if he started showing symptoms of diabetes again to make note of it. What if he has a symptom that never went away? He pees swimming pools. I definitely don’t notice him drinking as often as before so I don’t understand why he’s still peeing so much. Problem is, I didn’t pay attention to his urinating habits prior to all of this. So I don’t know what’s normal. All I know is that I clean the litter box every single day. After 24 hours it’s always full. It’s easier to clean because it’s not as sticky but I still doesn’t seem normal.

I was expecting him to act a lot different once he was no longer hyper. However, I have noticed very little change. He’s not getting up a million times a day and night to drink. He’s not eating all the time like he was.

The problem could simply be that he is at least 12 or 13 years old (maybe more—he was a rescue). He sleeps A LOT. I know that happens with age. It also could mean arthritis and other age related concerns.

Basically, I am a horrible cat mom because it took me over a year to put it together that he had diabetes. I brushed everything off as he was just getting older. Looking back, I can’t believe I was so stupid and let him suffer for so long. I didn’t know he was.

I don’t know what I’m supposed to be looking for or how I know if he feels OK. He’s often hesitant to jump up and down on things and I got stairs for my bed. This is one of the symptoms that led me to figuring out he had diabetes… but again could be arthritis. How do I know if he’s in pain. I ask him all the time but he refuses to talk to me. LOL. Wouldn’t that be nice if he could…
 
To bring down the Ambg and pmbg a snack of a couple teaspoons of lc 3 hours before often works. . If he eats two hours or less before the first test it will be food influenced. That would explain the blues at Ambg. Knowing that makes it even more likely he doesn’t need insulin. The pancreas if functioning properly will bring down the bg 3-4 hours after eating.
 
tiffmaxee said:
To bring down the Ambg and pmbg a snack of a couple teaspoons of lc 3 hours before often works. . If he eats two hours or less before the first test it will be food influenced. That would explain the blues at Ambg. Knowing that makes it even more likely he doesn’t need insulin. The pancreas if functioning properly will bring down the bg 3-4 hours after eating.
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Truthfully, it’s possible all of his tests were not food influenced. He mostly eats throughout the afternoon. However, I wasn’t watching so I can’t know for sure either way. I will be more careful. It just seems a little odd to me that his numbers stay so consistent throughout the day whenever I test. You would think I would see a curve. Or do you only see a curve on insulin? I guess I don’t know what a non-diabetic’s numbers would look like. Do you? I realize he will never be a non-diabetic but just for comparison
 
tiffmaxee said:
Even with insulin when tightly controlled most are fist green with occasional very low 100’s.
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Isn’t it weird the way his numbers don’t fluctuate? You told me to get +3 and +4. So the first night I got a +4 and the number was higher. Then last night I got a +3 and it was basically the same as PMPS. What does that mean?

It’s also still bothering me how much he pees. I don’t see him drinking as much as he used to (a very noticeable change). Yet he still pees swimming pools (large amounts at once). The litter box is completely full every night when I clean it. I don’t think everyone has to clean the box every single day… but I don’t have a choice. I think it’s the largest size box. At least according to Chewy.

One other thing is that he’s biting at me when I’m petting him occasionally and he never used to do that. Logically, I would think that would be an indicator of pain. However, there’s no pattern to it… No specific spot that seems to cause the behavior. Maybe he doesn’t like me as much because of the ear pricks or maybe he’s getting annoyed easier as he gets older. He’s extra clingy these days too. Just thought I would mention it in case it’s relevant. After all, I missed the signs of diabetes for so long that I’m ashamed. So in case I’m ignoring something else I shouldn’t….
 
My girls are young and I have to clean the boxes multiple times a day. They dint drink water but I wonder if it’s due to their all raw diet. Bailey is definitely in remission. Did you notice on his bloodwork if his creatinine and BUN were normal? Normal bg on a human meter is 50-100 or 120.
 
tiffmaxee said:
My girls are young and I have to clean the boxes multiple times a day. They dint drink water but I wonder if it’s due to their all raw diet. Bailey is definitely in remission. Did you notice on his bloodwork if his creatinine and BUN were normal? Normal bg on a human meter is 50-100 or 120.
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The blood work showed normal ranges for BUN and Creatine. However, he did have other flags besides glucose.

The flags were the following: triglycerides 284 (normal is 25-160), Lymphocytes 11 (normal 20-45), Absolute Eosinophi 1482 (normal is 0-1,000), Albumin 4.1 (normal 2.5-3.8), cholesterol 230 (normal 75-220), NA/K RATIO 28 (normal 32-41), SQUAMOUS EPITH 4-10 (normal 0-3).
Also the following are all supposed to be negative but he had:
Struvite Crystals 2-3
Calcium Oxalate Dih 4-10
Calcium Oxalate Mon4-10
Amorphous Crystals 11-20
Fat Droplets 4-10

No clue what any of it means? Is there something I should be worried about?
 
tiffmaxee said:
My girls are young and I have to clean the boxes multiple times a day. They dint drink water but I wonder if it’s due to their all raw diet. Bailey is definitely in remission. Did you notice on his bloodwork if his creatinine and BUN were normal? Normal bg on a human meter is 50-100 or 120.
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That’s ok if you don’t know what the blood results mean. I don’t either. What’s really bothering me lately is how much Bailey is sleeping. That’s all he wants to do. I don’t know if it has to do with his glucose finally being in the normal range or if something else is going on.
I don’t have a vet I trust anymore. Plus, after just a month ago spending almost $400 on insulin, the vets appointments, lab tests, syringes, glucose meter, testing supplies, urine strips, the list goes on… I can’t afford a vet. I haven’t paid the credit card bill for all the stuff I just mentioned yet.

Do you think I should be worried about how much he’s sleeping?
 
Crystals in the urine is not normal. It’s unusual to have more than one kind I would think. Max blocked when he was around 5 and a vet pierced his bladder leading to a life and death surgery to repair it. You say Bailey is peeing a lot so the crystals are not blocking. Are those results from your test strips or the vet? If the test strips ignore them. Cats sleep more as they age.
 
tiffmaxee said:
Crystals in the urine is not normal. It’s unusual to have more than one kind I would think. Max blocked when he was around 5 and a vet pierced his bladder leading to a life and death surgery to repair it. You say Bailey is peeing a lot so the crystals are not blocking. Are those results from your test strips or the vet? If the test strips ignore them. Cats sleep more as they age.
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So the test for the urine was done in the lab. However, I don’t know if my sample was contaminated by the way my vet had me collect it.

I sucked it up with a syringe from the litter box after he urinated. He had me replace the litter with aquarium gravel so the urine wouldn’t get absorbed. It was hard to get and I kept moving the pebbles to find some to suck up. I drove it over after collecting. Could a piece of a pebble register as a crystal? I didn’t think they were the same type of substance. That’s probably a dumb question.

I don’t understand what crystals are? Are they a diabetes related thing?

Are crystals the only worrisome part of the abnormal test results? I don’t know what the other stuff means. I wish I could re-test the urine without going through my vet. After everything, he doesn’t seem qualified to have a vet license
 
tiffmaxee said:
Read this. I think you are likely right about your vet.
https://vcahospitals.com/know-your-pet/urinalysis
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Thanks. I guess I have no way to know for sure if the results are accurate or not. I would have to retest. I wish I could afford it. If I notice any issues with him urinating, I will have to. Do you happen to know any warning signs I should watch out for that would indicate he actually had crystals? He’s in the litter box for a long time sometimes but I’ve never noticed him not being able to urinate. I will have to monitor more closely to be sure
 
I never noticed Max straining in the box but he on'y went twice a day as he was young and eating more dry than canned food. One night he didn’t urinate and didn’t in the morning either. I rushed home from work and found him cowering and in distress. I rushed to the vet but my vet was busy. I had no idea how serious this was. It was near closing and the vet sent me to the ER after she pierced his bladder. Didn’t tell me and didn’t call the ER as promised. It was touch and go all night to get him stabilized. I took him to my vet’s office in the morning for surgery. It was a week of back and forth from ER at night and my vet in the morning. I never knew about blocking or crystals until then. It’s very easy for a male to block so just watch for signs of straining. Cats hide things so well. I had no clue anything was wrong!
 
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