Critter Mom
Member Since 2014
*** LONG POST ALERT ***
Hi all,
Saoirse' s doing quite well, I'm pleased to report. I haven't been posting updates because not much is changing with her, but after reading some of Mel's comments in another thread I thought it might be helpful to others to share some of the reasoning behind how I've chosen to manage her diabetes treatment at the moment and the results of my treatment choices.
Firstly, as some of you already know I have PTSD which means I have major problems with fatigue. I also have problems with paralysing fear because the condition tends to leave a person in a state of constant dread that something awful is about to happen. Both of my issues have presented challenges in treating Saoirse's diabetes. Because of the intense fear, I can't even attempt to sleep until I know that she is in safe numbers. This has made my fatigue worse. Because of the fatigue, sometimes I have passed out with exhaustion and not set out her timed feeds. The long fasting periods have caused significant spikes in Saoirse's blood glucose levels (and made me feel like a complete fink for letting my girl down.
)The fatigue was getting so bad that I was starting to pass out during the day as well and I was becoming increasingly frightened of giving Saoirse insulin at all because I could not guarantee staying awake to monitor her.
Although Saoirse's numbers are very good, I am not going to attempt an OTJ trial for the time being for the following reasons (not in any particular order):
1. My goal for Saoirse's treatment is a solid remission, not a rush to get off insulin. Saoirse recently had a major pancreatitis flare-up. Her symptoms have improved immensely but she still gets off days. I want to give her pancreas some insulin support for a little longer (she still needs anti-nausea meds).
2. On the first OTJ trial, Saoirse's numbers started drifting upwards and could very easily have gone outside the euglycaemic range. Her clinical signs showed deterioration after only a couple of days (coat condition was first to go). When Saoirse's numbers were bobbing along at the top of the euglycaemic range, her appetite was very sluggish and she needed regular administration of an appetite stimulant in order to eat (cyproheptadine). My gut feeling was that it was too soon to withdraw insulin support. Most important of all, Saoirse is W-A-Y happier and her clinical signs are very significantly better when her BG is in the lower part of the euglycaemic range. I want to give her body more time to get used to lower numbers and hopefully establish a lower glucose homeostasis set point.
3. My feeding screw-ups were somewhat serendipitous. Home testing revealed that Saoirse's blood sugar spikes badly if she fasts for more than a couple of hours and this has been valuable from a diagnostic perspective. I have been researching this, and as best as I can make out from what I've read, this phenomenon may be due to residual insulin resistance in her liver. Because her liver is not detecting the insulin properly, instead of just topping up her blood glucose between meals when levels get lower, it doesn't know when to switch off glucose production and dumps a shed load of it into her bloodstream. It pushed her levels above the top end of the TR target range AND the euglycaemic range. I hoped that by continuing with insulin her liver's insulin sensitivity might improve.
4. We will shortly be moving to a new house. This will be very stressful for Saoirse (and her bean) and I don't want to risk a setback in her recovery due to the upheaval.
With very tightly controlled feeding and because she is an indoor-only cat, Saoirse's regulation is good and through testing I've learned that she has a tendency to run lower at night. I can monitor her OK during the daytime. Therefore, the solution I have arrived at that works for us is SID dosing of a small amount of Lantus. I eased up the dose from zero in tiny increments until I got to an amount where she doesn't go too low during the daytime when the insulin is active in her system but where there is enough carryover to work with her own metabolism to keep her numbers satisfactory during the night.
So far, Saoirse's 7-day average BG is slowly but steadily trending downwards. She stays in very good numbers most of the day (mid to lower part of TR target range) with the exception of fasting-related hepatic glucose dumps. The size of the BG spikes from glucose dumps are starting to reduce. Saoirse's appetite is better at the lower numbers - she's learning how to be hungry properly again and hasn't had an appetite stimulant for weeks. (Still needs a little nudge from her person to eat now and again, but a big improvement). Saoirse's need for anti-nausea meds is reducing gradually (I think the insulin itself upsets her tummy a little). Saoirse's house-moving, stressed-out bean's increased anxiety problems are negatively affecting her mood somewhat, but not her BG levels. Saoirse's other clinical signs are good and there are additional subtle improvements (like the way she lies when she's relaxing). Coat and body condition are very good. Best of all, my darling girl purrs much more these days! cat_pet_icon
Given that Saoirse's numbers made it possible, switching to SID saved my health from deteriorating further and has helped me to safely reintroduce Saoirse's system to numbers in the lower part of the TR target range. My plan is to get the house move over, then follow the TR guideline for dose reduction/tapering off insulin based on the criterion of ALL of Saoirse's test numbers being in the TR range for 7 days in a row. I am also investigating options for supplements to improve Saoirse's liver function and insulin sensitivity. Any suggestions?
The above does not constitute a recommendation for treatment. It's just an example of how every cat and every caregiver is different and how I found a way to overcome our particular challenges. I am so grateful to all who contribute to FDMB because I have learned so much here. In particular, my heartfelt thanks go to Mel for helping me to gain the confidence to use the data I have gathered and the knowledge I have acquired in order to adapt the SLGS and TR protocols to develop a treatment method that is specific to our needs.
Hi all,
Saoirse' s doing quite well, I'm pleased to report. I haven't been posting updates because not much is changing with her, but after reading some of Mel's comments in another thread I thought it might be helpful to others to share some of the reasoning behind how I've chosen to manage her diabetes treatment at the moment and the results of my treatment choices.
Firstly, as some of you already know I have PTSD which means I have major problems with fatigue. I also have problems with paralysing fear because the condition tends to leave a person in a state of constant dread that something awful is about to happen. Both of my issues have presented challenges in treating Saoirse's diabetes. Because of the intense fear, I can't even attempt to sleep until I know that she is in safe numbers. This has made my fatigue worse. Because of the fatigue, sometimes I have passed out with exhaustion and not set out her timed feeds. The long fasting periods have caused significant spikes in Saoirse's blood glucose levels (and made me feel like a complete fink for letting my girl down.
)The fatigue was getting so bad that I was starting to pass out during the day as well and I was becoming increasingly frightened of giving Saoirse insulin at all because I could not guarantee staying awake to monitor her. Although Saoirse's numbers are very good, I am not going to attempt an OTJ trial for the time being for the following reasons (not in any particular order):
1. My goal for Saoirse's treatment is a solid remission, not a rush to get off insulin. Saoirse recently had a major pancreatitis flare-up. Her symptoms have improved immensely but she still gets off days. I want to give her pancreas some insulin support for a little longer (she still needs anti-nausea meds).
2. On the first OTJ trial, Saoirse's numbers started drifting upwards and could very easily have gone outside the euglycaemic range. Her clinical signs showed deterioration after only a couple of days (coat condition was first to go). When Saoirse's numbers were bobbing along at the top of the euglycaemic range, her appetite was very sluggish and she needed regular administration of an appetite stimulant in order to eat (cyproheptadine). My gut feeling was that it was too soon to withdraw insulin support. Most important of all, Saoirse is W-A-Y happier and her clinical signs are very significantly better when her BG is in the lower part of the euglycaemic range. I want to give her body more time to get used to lower numbers and hopefully establish a lower glucose homeostasis set point.
3. My feeding screw-ups were somewhat serendipitous. Home testing revealed that Saoirse's blood sugar spikes badly if she fasts for more than a couple of hours and this has been valuable from a diagnostic perspective. I have been researching this, and as best as I can make out from what I've read, this phenomenon may be due to residual insulin resistance in her liver. Because her liver is not detecting the insulin properly, instead of just topping up her blood glucose between meals when levels get lower, it doesn't know when to switch off glucose production and dumps a shed load of it into her bloodstream. It pushed her levels above the top end of the TR target range AND the euglycaemic range. I hoped that by continuing with insulin her liver's insulin sensitivity might improve.
4. We will shortly be moving to a new house. This will be very stressful for Saoirse (and her bean) and I don't want to risk a setback in her recovery due to the upheaval.
With very tightly controlled feeding and because she is an indoor-only cat, Saoirse's regulation is good and through testing I've learned that she has a tendency to run lower at night. I can monitor her OK during the daytime. Therefore, the solution I have arrived at that works for us is SID dosing of a small amount of Lantus. I eased up the dose from zero in tiny increments until I got to an amount where she doesn't go too low during the daytime when the insulin is active in her system but where there is enough carryover to work with her own metabolism to keep her numbers satisfactory during the night.
So far, Saoirse's 7-day average BG is slowly but steadily trending downwards. She stays in very good numbers most of the day (mid to lower part of TR target range) with the exception of fasting-related hepatic glucose dumps. The size of the BG spikes from glucose dumps are starting to reduce. Saoirse's appetite is better at the lower numbers - she's learning how to be hungry properly again and hasn't had an appetite stimulant for weeks. (Still needs a little nudge from her person to eat now and again, but a big improvement). Saoirse's need for anti-nausea meds is reducing gradually (I think the insulin itself upsets her tummy a little). Saoirse's house-moving, stressed-out bean's increased anxiety problems are negatively affecting her mood somewhat, but not her BG levels. Saoirse's other clinical signs are good and there are additional subtle improvements (like the way she lies when she's relaxing). Coat and body condition are very good. Best of all, my darling girl purrs much more these days! cat_pet_icon
Given that Saoirse's numbers made it possible, switching to SID saved my health from deteriorating further and has helped me to safely reintroduce Saoirse's system to numbers in the lower part of the TR target range. My plan is to get the house move over, then follow the TR guideline for dose reduction/tapering off insulin based on the criterion of ALL of Saoirse's test numbers being in the TR range for 7 days in a row. I am also investigating options for supplements to improve Saoirse's liver function and insulin sensitivity. Any suggestions?
The above does not constitute a recommendation for treatment. It's just an example of how every cat and every caregiver is different and how I found a way to overcome our particular challenges. I am so grateful to all who contribute to FDMB because I have learned so much here. In particular, my heartfelt thanks go to Mel for helping me to gain the confidence to use the data I have gathered and the knowledge I have acquired in order to adapt the SLGS and TR protocols to develop a treatment method that is specific to our needs.
