Normalized BG levels?

[AggyBear]

At the beginning of December Agatha + I started to see consistently lower BG numbers. One or two spikes of 105 or 103 but ever since then it's been any of these: 53, 67, 94, 87, 63, 57, 88, 62, 58, 68, 53, 90, 75, 52, 54, 53, 71, 44.

Just tested her now and it was 44. It's been a rough couple of months. I will try to put it in a nutshell. About 3½ months ago Agatha started to get what I thought was a flare of pancreatitis and I started with preventative meds immediately. Long story short, it took nearly 3 months of her being in pain and drinking + urinating so much I thought my house would float away! She was going outside the litter box every single day and I had to clean it up every single day. Finally realized that she had a UTI, got her and I biotics and finally buprenorphine and that night! she stopped peeing outside the box. Things normalized but on November 10 I was home all day and observed that she was feeling quite poorly and had a distant look in her eyes. I thought I was reading too much into it because she had been doing so much better. I didn't really know what to do so I just tried to make a quiet space for her. It was around 10pm when I picked her up to examine her. Immediately I noticed her gums were very swollen. I have never seen anything like this on her and I immediately freaked out. Uncontrollable crying. I called my vet and he gave me a call about 20 minutes later. I already had the Benadryl out crying over her. He said to give her half a pill and to check in with him the next day. I gave it to her and let her be in about 2 hours later the swelling was gone. Have no idea what that was about.

Fast forward to the beginning of December and her BG numbers dropped drastically. For the past week and a half I have continue to test once or twice a day and the numbers are well below 100. No environmental changes as far as I can know and I'm the human in the house lol! She's in very good spirits, she looks amazing, she comes to see me where I am in the house more often, eats good, drinking water and litter box habits are all good.

Around November 14 I stopped entering information on my spreadsheet. All of the recording information was very typical of any of the previous months. I reached a breaking point in my brain (stress overload) and just couldn't log it anymore. I tested and shot just as diligently as I always have. I know this will not be helpful in understanding why Agatha's BG numbers have appeared to normalize. I did several curves with her but the flares seemed to always mess things up. I have a nagging suspicion that I was giving her too much insulin the whole time and that's why her numbers hadn't really ever improved, it looked like they were always bouncing. I really really really hope that's not the case--- because then I fear I could've caused all the pancreatitis flares and UTIs? I read that diabetic cats get UTIs when their blood glucose is too high.

This took me two whole weeks to sit down to write, I appreciate all of you so much and I hope to hear from you soon, any ideas or thoughts as to what is going on and if these numbers are good? And what else I can do to continue caring for my sweet Agatha. -Sammy + Aggy

Here are two pictures of my pretty girl on November 22nd:
https://photos.app.goo.gl/ZCFGecSzg3H1Nkj29
https://photos.app.goo.gl/j4nuVipwwLjArf9p9

 

[AggyBear]

I'm going to tag @Deb & Wink @Bron and Sheba (GA) @JanetNJ @Butters & Lyla @Pabs&Ro @Marje and Gracie

 

[FrostD]

Welcome back! Beautiful kitty

Few thoughts - is 0.5U her "standard" dose now? 44 is a little lower than we like to see, even with the more aggressive dosing method. I'd reduce her to 0.25U (at most) going forward.

I'd hazard a guess a lot of things were in play - the infections, systemic stresses, glucose toxicity - that were keeping her numbers higher. Once those were taken care of and glucose toxicity broken a bit, her insulin needs came down. As she spends more time in green her pancreas is also healing and lowering insulin needs.

Its hard to say if dose was too high or not given there weren't a ton of midcycle tests, but I do see a few missed reductions. She did like to bounce that's for sure! So I think a combination of the missed reductions/sliding scale dosing/skipped shots was just inconsistency that led to inconsistent numbers as well (not a criticism, just a statement of what I see on SS)

As for the UTI - remember that when BG is over renal threshold (usually somewhere between 200-300 mg/dL but every cat is different) sugar spills into urine. Bacteria feed off that sugar and can very easily lead to UTI. It's nothing you did or didn't do, regulation is the best way to avoid those but can be difficult depending on each person/cat's situation

 

[AggyBear]

Few thoughts - is 0.5U her "standard" dose now? 44 is a little lower than we like to see, even with the more aggressive dosing method. I'd reduce her to 0.25U (at most) going forward.

She hasn't gotten insulin since the beginning of the month. Those numbers are not influenced by the exogenous insulin.

I do see a few missed reductions.

I wish I had known I could've reduced. I wonder if there's a sticky for that.

It's nothing you did or didn't do, regulation is the best way to avoid those but can be difficult depending on each person/cat's situation

Thank you again for your help + quick response! I didn't know these things about the UTI conditions.

 

[FrostD]

She hasn't gotten insulin since the beginning of the month. Those numbers are not influenced by the exogenous insulin.

I wish I had known I could've reduced. I wonder if there's a sticky for that.

Thank you again for your help + quick response! I didn't know these things about the UTI conditions.

Oh ok that's awesome she's in remission then! I misunderstood.

The reductions are covered in the ProZinc Dosing sticky in the ProZinc forum, here. Not that it matters now, but depending on which method you chose you would have reduced any time she went under 90, or under 50.

Yep, don't beat yourself up. Diabetes often comes with a whole host of other troubles, just look at my signature All we can do is the best we can at the current moment in time!

 

[AggyBear]

I didn't think it was possible, for her to go into remission (except when we first got diagnosed, I thought I might have her whipped into shape and a couple weeks... Was I wrong!)! What causes them to go into remission + what can I do to keep her there?

 

[Bron and Sheba (GA)]

Hi Samantha, good to hear from you and Aggy.
I saw your post earlier but had to go out to appointment but I see Melissa has answered you.
Did Aggy ever have DKA? I thought she did, but I could be wrong.
Are you still continuing with a low carb diet? She will always remain a diabetic…just a diet controlled one. So always feed a low carb diet forever.
I would also test her every day for a couple of weeks if she has just gone off insulin. And then weekly.
If you could manage to put in the data moving forward so we can see how she’s going, that would be good.
Bron

 

[AggyBear]

Did Aggy ever have DKA?

No she didn't!

Are you still continuing with a low carb diet?

Yes! I have been feeding Friskies pate since diagnosis. I would love to get her on a different food though, it's basically the lowest quality food possible. It smells metallic, nasty food coloring... Can anyone recommend other options that are a little bit more economic?

I would also test her every day for a couple of weeks if she has just gone off insulin. And then weekly.

I have been testing once or twice daily. Absolutely, I will enter the information. Thank you so much!

 

[Bron and Sheba (GA)]

No she didn't!

That’s good. I remember when you joined. Must have got you mixed up with someone else.

Yes! I have been feeding Friskies pate since diagnosis. I would love to get her on a different food though, it's basically the lowest quality food possible. It smells metallic, nasty food coloring... Can anyone recommend other options that are a little bit more economic?

I don’t live in the US so have no idea of prices but have a look at THIS FOOD CHART

I have been testing once or twice daily. Absolutely, I will enter the information

Thanks. That would be great.
Hope you both have a very happy Christmas and holidays

 

[JanetNJ]

Congratulations on the remission. Very exciting! Continue to test a few times a month to make sure she's still in it.

 

[Pabs&Ro]

Pleased to see Aggie is doing much better. Well done you. Happy Christmas.

 

[Sienne and Gabby (GA)]

I wonder if the gum issue was due to an allergy. Benadryl would have had the effect of reducing swelling to to an allergic reaction. She could have gotten into something.

As far as food, Friskies and Fancy Feast pate style are the most economical, low carb foods. Other brands like Weruva, Tiki Cat, and ZiwiPeak are higher quality but much more expensive. You could consider a raw diet. There are pre-mixes you can add to raw food that will make it nutritionally complete (e.g., FoodFurLife).

The thing to remember with a cat that's in remission is that your cat has become a diet controlled diabetic. The diabetes didn't go away. Any source of stress including inflammation or infection can push numbers higher.