Ollie Update: Thread 3: Reducing Dosing

[Ollies Mama]

hi all,

Previous thread https://www.felinediabetes.com/FDMB/threads/ollie-thread-2-adjustment-25-may.277891/#post-3074282

Discussion around reducing 1UC to 0.2 and changing from UD40 1.0 ml syringes to U100, .3 ml syringes.

Last night trialled a micro-dose, numbers stayed up a bit, but at least it wasn't a significant drop as per when Ollie has 1UC.

Spreadsheet adjusted multiple times a day.

Vet check up today, post tooth extraction, infection control. Received final anti-biotic shot, Vet happy with his speedy mouth recovery, return to eating. Didn't discuss diabetes, it was a dental follow-up free consultation.

Query if numbers are suitable to stay on this 1/4 unit dose, or whether I should double it, to 1/2 half unit on /3 ml syringe.

Cheers
Cath

 

[Bron and Sheba (GA)]

I would stay with the same dose and see how it goes for a day or two. It is actually a 0.1 dose of the caninsulin so it should be recorded as 0.1 U in the SS not 0.2 ( which is what you are drawing up in the U100 syringe, but the dose is 0.1 of caninsulin.
Does that make sense?

 

[Ollies Mama]

Thanks for the clarification on the dose Bron. I've adjusted. Getting a nice smooth line along the top range. And Ollie is uber-affectionate.
I'm sure they communicate their comfort to us.

Have a good sleep tonight,
Cath and Ollie.

 

[Bron and Sheba (GA)]

I’m glad the vet was pleased with Ollie’s mouth. that is really good. Hopefully he can now concentrate on getting into good numbers and eating well.
See how this dose goes, now that he is eating better he may need a tiny bit more. Time will tell.
How did the exam go today?
Love the photo, by the way. Very cute.

 

[Ale & Bobo & Minnie (GA)]

That is an adorable pic!! He’s a tiger kitty now. Is his tail shaved too?

 

[Suzanne & Darcy]

hi all,

Previous thread https://www.felinediabetes.com/FDMB/threads/ollie-thread-2-adjustment-25-may.277891/#post-3074282

Discussion around reducing 1UC to 0.2 and changing from UD40 1.0 ml syringes to U100, .3 ml syringes.

Last night trialled a micro-dose, numbers stayed up a bit, but at least it wasn't a significant drop as per when Ollie has 1UC.

Spreadsheet adjusted multiple times a day.

Vet check up today, post tooth extraction, infection control. Received final anti-biotic shot, Vet happy with his speedy mouth recovery, return to eating. Didn't discuss diabetes, it was a dental follow-up free consultation.

Query if numbers are suitable to stay on this 1/4 unit dose, or whether I should double it, to 1/2 half unit on /3 ml syringe.

Cheers
Cath

What an adorable photo! Love the sweater. You have good news on his mouth healing!

 

[Ollies Mama]

I’m glad the vet was pleased with Ollie’s mouth. that is really good. Hopefully he can now concentrate on getting into good numbers and eating well.
See how this dose goes, now that he is eating better he may need a tiny bit more. Time will tell.
How did the exam go today?
Love the photo, by the way. Very cute.

hi, thank you, they are cute little sweaters from Bunnings, if you're keen.

Exam was stressful, three hours, but I'm hopeful..

He is eating more, yes. I made a typo though, I haven't increased his dose from 0.1.

 

[Ollies Mama]

That is an adorable pic!! He’s a tiger kitty now. Is his tail shaved too?

hi, no, his tail isn't shaved.

We moved from a cold winter state, to a hot tropical state on the beach so when he was having his previous dental clean, I had him clipped.
He has furry boots, tail and face, with some of his mane.

It's growing back now though, that was 6 months ago and he's typically a long haired cat.

 

[Ollies Mama]

General update!

I haven't increased his dosage, he is 0.1 UC.

He is doing well, although still got some respiratory issue (sneezing alot, sounds congested). His sinus are clear on examination of x-ray and vet associated those symptoms with infection recovery. I'm monitoring. He is also grooming alot, so I'm unsure if that's itchy fur coming back (especially when they shaved him for canula). He is licking all over, so I'm monitoring that for allergies - not sure.

I'm going to Sydney Sat 6 am, so he's overnight tonight in the Vet to monitor insulin intake. I pick him up Sunday morning. It's just an overnight trip/overnight stay.

He is eating more, more energy, leaping around the place like a little gazelle, super-affectionate. For example, he's sleeping on my pillow, kneading my long hair which is on the pillow. That's new. His poo are a nice healthy brown stool, he is drinking, his sores are healing and I still put the cream on them. No ketones.

Question: if he wants to eat more, should I support that? Or, to support regulation, should I only feed 12 hourly? I'm mindful of weight loss and thought to re-build, but not at the cost of dysregulation.

Thanks, as always,
Cath

 

[Suzanne & Darcy]

hi, no, his tail isn't shaved.

We moved from a cold winter state, to a hot tropical state on the beach so when he was having his previous dental clean, I had him clipped.
He has furry boots, tail and face, with some of his mane.

It's growing back now though, that was 6 months ago and he's typically a long haired cat.

Good his fur is growing!

 

[Bron and Sheba (GA)]

hi, thank you, they are cute little sweaters from Bunnings, if you're keen.

I tried to put Harry in a jumper last winter and he was most unhappy. So I won’t go down that path again unfortunately.

Exam was stressful, three hours, but I'm hopeful..

Here’s hoping for a good result!

I'm going to Sydney Sat 6 am, so he's overnight tonight in the Vet to monitor insulin intake. I pick him up Sunday morning. It's just an overnight trip/overnight stay.

Are the vets aware of the new dose?

Question: if he wants to eat more, should I support that? Or, to support regulation, should I only feed 12 hourly? I'm mindful of weight loss and thought to re-build, but not at the cost of dysregulation.

Definitely feed more often than 12 hourly. Feeding just 12 hourly is old thinking.
I would feed a good meal 30 minutes before the dose is due, than I would give him snacks at +2 and+5 and +7
A snack is a teaspoons or two of low carb wet.
It wont adversely affect regulation, in fact it will help it.

Cath, have you thought any more about swapping to optisulin insulin? I would really recommend you think about it as it is a much better insulin for cats.

 

[Suzanne & Darcy]

This is a good point about the new dose. I’m concerned that the vet will give the former dose of one unit.

 

[Suzanne & Darcy]

And I second everything Bron said about the feeding/snack schedule an, of course, about the Optisulin.

 

[Suzanne & Darcy]

And a blue preshot this morning! I hope the vets will give the correct dose and will also feed him or leave food out continually for him in his cage. Hope the will monitor his BG carefully.

 

[Ollies Mama]

I tried to put Harry in a jumper last winter and he was most unhappy. So I won’t go down that path again unfortunately.



Here’s hoping for a good result!

(thank you)

Are the vets aware of the new dose?

(They were but that was a few days ago - I have a summary written for his overnight care including that they won't be there to monitor his low dips, so don't over-dose him)

Definitely feed more often than 12 hourly. Feeding just 12 hourly is old thinking.
I would feed a good meal 30 minutes before the dose is due, than I would give him snacks at +2 and+5 and +7
A snack is a teaspoons or two of low carb wet.
It wont adversely affect regulation, in fact it will help it.

(he likes a snack, thanks - and this more attuned to our lifestyle)

Cath, have you thought any more about swapping to optisulin insulin? I would really recommend you think about it as it is a much better insulin for cats.

yes I'd very much like to try Optisulin. Will ask for that with a new appointment.

What are the pro's and con's of Optisulin? Is there a link I could read?

Thanks so much,
Cath

 

[Bron and Sheba (GA)]

Here is a link to the LLB page where people who use the depot insulins post..
https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
Have a read through the yellow stickies at the top of the page. They have a lot of information in them.

Basically optisulin (Lantus, glargine, Basaglar, Semglee) is a longer acting, more gentle insulin than Caninsulin and is recommended for cats.
It’s onset is around +2 so you don’t have to wait after testing and feeding to give the dose. The nadir is around +3 to +8 or 9 depending on the cat, but most nadir around +5 to +7.

It also means you can shoot lower preshots because of the later onsets.
It’s an excellent insulin to use if you are giving tiny doses as well so is great if the cats is heading towards remission.

It’s a depot insulin (you can read about that in one of the yellow stickies) and it initially takes 5 to 7 days for the depot to fill for you to see the full effect of the dose. After that if you increase or decrease the dose it takes 3 days for the depot to fill or reduce, depending on if you increase or decrease the dose. Don’t let this put you off at all, it’s just something to keep in the back of your mind.

It likes consistent dosing, not chopping and changing the dose unless an increase or decrease is needed.
It also needs to be given 12 hours apart so there is not as much leeway as the ‘in and out’ insulins, but I never found that an issue.

I’ve seen a lot of cats swap from Caninsulin /vetsulin to Lantus and they all settle down really well and usually get much better numbers.

 

[Ollies Mama]

hi all,

Ollie is doing pretty good. He stayed for two nights at the Vet Fri night and Sat am/pm and I collected Sunday morning. They monitored him, fed him, stuck to low dose, let him out for a walk, his personality was evident now that he's well so they enjoyed seeing him happy and well.

With my consent, they removed the sensor as it had approached it's life-cycle and they tested BG, watching the data too, and they're happy to say he's pretty stable. They recommended not replacing it and they're happy to keep the lower dose too. I explained why the lower dose and they get it. She didn't think there was a reason to monitor his BG at all - just stick with the snacks and low dose, she agrees.

This means I don't have any new data for the spreadsheet. I will try though and prick for blood here and there.

Because it was only a pick-up consult, I didn't get a chance to ask about new insulin. But I will have to do that soon. I have some reading to do until then.

Aside from that update, i'm just monitoring a skin condition he has now and doing some reading.

I found this thread where the picture looks very similar.
https://felinediabetes.com/FDMB/threads/cat-fur-and-skin-peeling-off.83729/


Cheers,
Cath

 

[Bron and Sheba (GA)]

Cath, I would strongly recommend you start hometesting if you are not going to put on another libre. Cats BGs only remain stable until they don’t. At some point and I can’t say if that will be sooner or later, but Ollie will need either more or less insulin and only testing every so often is like sticking your head in the sand, and playing Russian roulette.
Vets who don’t have a diabetic cat themselves and test frequently, have no idea how much a cats BG fluctuates.
Ollie is your cat and it is up to you to decide how you want to proceed.
I just want to say Ollie has a good chance of being able to go into remission and you need to be testing every day to get to that point. For a strong remission you need to give insulin for as long as is safely possible to support the pancreas as it heals.

 

[Suzanne & Darcy]

I agree with Bron. If Ollie is doing so well on a very small dose of insulin, it looks like he has a good chance of going into remission. But cats’ insulin requirements do change. One day he may be fine on the .1 dose and another day it may be too much (especially if his body is headed toward remission.). You don’t want to find out that the .1 dose is too much for Ollie by seeing him displaying hypoglycemic symptoms. The vet seems to be assuming that cats with diabetes always maintain a “steady state” where their insulin requirements stay the same. That’s not a safe assumption. This is the same vet who wanted to keep Ollie at 1 unit when it was pushing him quite low? I feel badly about being a wet blanket, but I just want Ollie to stay safe and keep healing.

 

[Ollies Mama]

Thanks to both of you. I tried pricking him and he bit me. He's much better now, which means he's more alert to me sneaking closer to him.

I'll keep trying to prick him.

 

[Bron and Sheba (GA)]

Let him eat something while you test him. Failing that, it would be worth while getting another libre to see if he's needing less, or more. He's only on a tiny dose and you don't want to miss out if he's heading towards remission.
Also just because he's on a tiny dose, doesn't mean he cant drop too low!

 

[Ollies Mama]

I'll try again today, when he's snacking. I tried again last night, while he was in a deep sleep on top of me. I have to hide any lancet, or meter as he knows. And yes, I have still got interest in another libre, and am researching how I can fit them myself. I would not like to miss the opportunity to have him go into remission.

He is eating more now too. And his urine is still free of ketones.

 

[Bron and Sheba (GA)]

Here is a link to libre information including how to apply your self
LIBRE INFORMATION

 

[Bron and Sheba (GA)]

When you are doing the hometesting, are you always doing it in the same place every time.? And always giving a treat every time you try whether you are successful or not?
I would try desensitising him by just rubbing his ears in the test place and then giving him a treat. Do this several times a day. Then if you are using a lancet device, I would rub the ears, and click the device and then give him a treat. He will soon learn to associate the place and the test with treats. Sheba used to come racing from wherever she was in the house when she heard me at the testing equipment as she knew it meant a treat.
@Din who lives in Australia, applies the libres herself, or her husband does. Maybe she will see this tag and give you some tips

 

[Din]

When you are doing the hometesting, are you always doing it in the same place every time.? And always giving a treat every time you try whether you are successful or not?
I would try desensitising him by just rubbing his ears in the test place and then giving him a treat. Do this several times a day. Then if you are using a lancet device, I would rub the ears, and click the device and then give him a treat. He will soon learn to associate the place and the test with treats. Sheba used to come racing from wherever she was in the house when she heard me at the testing equipment as she knew it meant a treat.
@Din who lives in Australia, applies the libres herself, or her husband does. Maybe she will see this tag and give you some tips

Hi Bron , love to help
Hi Ollie’s mom, first of all big hug and I really understand you might me on huge pressure/ stress what ever you call it. You are in angels hand here you will get all comfort and help from Bron and all other members .
We used to go to vet and spend 80 for set the Freestyle libre. But now my husband doing it and with the treats ( raw meow freeze dried chicken breast- 0 carbs) it’s super easy.

I’m at work now after go home I will send you a picture ,best place to set it. My vet nurse did on back of the neck (IT WILL STOP WORKING WITHIN A DAY) don’t use tummy area

If you want to keep it for 14 days you must need super glue. To be honest I don’t know it’s okay or not to use super glue.

I did buy vet tissue glue (35 dollars) but it didn’t work. ( it might be expired )

we use tiny few super glue drops on the sensor , before attach it to our girl, (NOT in the middle)

you must shave her hair first ( only the spot )

Clean from alcohol wipe then let it dry.
Then we open her treat bag to make her crazy.
Give one piece to eat.
Then few on my hand to cheat her .
While fighting with me to eat treats my husband attaching the sensor to her and hold it for 30 seconds to dry

then slowly need to remove the sensor cover ( I don’t know what it call )
Scan it - wait for one hour.

that’s it - super easy

 

[Bron and Sheba (GA)]

Din do you have trouble removing it when you use super glue?

 

[Din]

Din do you have trouble removing it when you use super glue?

No Bron , if use tiny drops it’s easily come out.

 

[Larry and Kitties]

If you want to keep it for 14 days you must need super glue. To be honest I don’t know it’s okay or not to use super glue.

I disagree and so do the members of :
https://www.facebook.com/groups/libreforpets
I and others usually get 14 days using Skin Tac after shaving and cleaning the area. "Super Glue" is not recommended at all since a slightly different formulation is used for medical applications in order to help prevent irritation.

"n-Butyl cyanoacrylate has been used medically since the 1970s. In the US, due to its potential to irritate the skin, the U.S. Food and Drug Administration (FDA) did not approve its use as a medical adhesive until 1998 with Dermabond (2-octyl cyanoacrylate)."
https://en.wikipedia.org/wiki/Cyanoacrylate
Even Vet Bond and similar medical grade Cyanoacrylates are not recommended since they can work too well and are make it hard to remove without damaging the skin. 16 days ago I helped another caretaker attach a Libre 3 and it lasted 14 days with shaving, cleaning and using Skin Tac.
https://www.amazon.com/Torbot-Adhes...19-be1b-33ce06f2d565&pd_rd_i=B00JWSDHJC&psc=1

 

[Din]

Thank you soo much for sharing this information Larry. I didn’t know that super glue is that bad. If possible please share which tissue bond glue bottle you used.

I have this one but it doesn’t stick at all. I will not use it again.

 

[Din]

@Larry and Kitties do you use glue inside the sensor before attaching it or outside corners after attaching it ?

 

[Larry and Kitties]

I used Vetbond in the past. The only problems were when the sensor was removed ssome skin was attached to the sensor vai the Vetbond and if nit careful putting the Vetbond near the out side you can get sme Vetbond oozing out and ends up glueing the sensor to the applicator. I had to carefully hold the sensor down when removing the applicator otherwise I would pull off the sensor. Now I just use Skin Tac after shaving and cleaning the shaved are. To clean I first use a little soapy water and let that dry. Then use alcohol wipe or two followed by the Skin Tac.

 

[Din]

I used Vetbond in the past. The only problems were when the sensor was removed ssome skin was attached to the sensor vai the Vetbond and if nit careful putting the Vetbond near the out side you can get sme Vetbond oozing out and ends up glueing the sensor to the applicator. I had to carefully hold the sensor down when removing the applicator otherwise I would pull off the sensor. Now I just use Skin Tac after shaving and cleaning the shaved are. To clean I first use a little soapy water and let that dry. Then use alcohol wipe or two followed by the Skin Tac.

Apologies I have missed this reply. Thank you So much Larry..!!!