oral med. treatment

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ayline82

Member Since 2012
Hello,

Last time I wrote here was when our vet gave me Humilin to shoot my Kitty twice a day and went on vacation. I was alone with syringes and Humilin in my hands, and of course, I refused to give her shots under those circumstances. It was also the time I started to try to learn to hometest. I am doing it very well know with the help and tolerance of my Kitty.

I decided to change my vet, and after an interview, I went to another vet. He also consulted a professor for the diagnoses and treatment. The other had diagnosed Kitty with diabetes only by looking at the BG at the vet, nothing else. The professor made a complete check-up with ultrasound and all the blood tests. Good news: Kitty has no other health problem (he saw in the ultrasound that her liver is a little bit fatty, although its not a fatty liver disease and there were no symptoms of it, so it was an early diagnoses for her liver and we also treat it with vitamins now) and her diabetes is not a complicated one, as the professor says. Her fructosamine was checked. Her BG was always between 300-350 during the day, not higher (only with diet change). The prof. told us to give her wet food and the vet told us to ignore the BG measured at the vet and encouraged hometesting!!!!!!

For 2 days, we gave her only vitamins and low fat wet food. Her BG lowered from 345 to 280. The 3rd day they started to give her pills for diabetes (2 mg. onece a day). The next day she was 250. It's been almost 2 weeks now, and this morning her BG was 187. I know and I read that pills are not a good idea and most of the time cats do not respond to them and giving pills is a waste of time but I think she is responding well to the oral tablets. At least for now.

I asked them when I should decide that tablets are not working as Kitty's BG is always at the same level and what the other alternative will be if it does not work (I wanted to see if they will give us insulin, or they will insist on giving something that obviously won't work). They told me to bring Kitty there again after a month, they will have blood and hormone tests to see Kitty's reaction to the treatment, and we will sit down and talk about alternative treatments together considering Kitty's and my conditions. So, as far as I understand, they want to start slow, and see the effect of the diet change and the pills for a short time. They seem to know what they have been doing (for the first time Ive met a vet who knows about hometesting and wet food for diabetes treatment), they are full of detailed explanations for my questions and their first treatment for only a week seems to work well for Kitty (she is down from 345 to 187 already). I also told them that I read pills might cause liver damage. They said it is true if it is used for a long time. This, I think, means they are not planning to use pills for a long time.

However, I have a question. I hope you can help me. I test Kitty's BG early in the morning before she has breakfast. That's always the lowest value of the day (today 187). I realize during the day, it is never that low. In the evening, it is always around 300-320. I know BG rises after food intake, but does it rise so much? Yesterday it was 220 in the morning, and in the evening (after she eats 2 more meals during the day) it was 319. 100 points in between!! This morning at 8.30 it was 187, and 15 minutes ago at 12:30 it was 280. Are these values normal? I also have to say that Kitty has a habit of not eating one at a time. She eats a little and goes away, then comes back and eats a little more. For example, she finished the meal I served her this morning at 9:00 at 12:00 in the afternoon. I tested her at 12:30 and it was 280.

I hope I managed to explain my question well. In summary; is it normal to have a difference of 100-120 points between the BG values tested in the morning and in the evening? I don't give her shots, just 2.5 tablets a day (before she eats breakfast, after I test her).

Thanks in advance
 
Re: responding oral med. very well

I'm sorry, but I know nothing about the action of the pills. I don't know of anyone on the board who uses pills instead of insulin, though there might be.

When you give insulin, the insulin is given with food. The action on the blood glucose is a curve on a chart, with the highest numbers at the start and end and the lowest in the middle. You can see an example here:
 

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Re: responding oral med. very well

Hello, its my understanding that Glipizide (the pills) works by forcing the pancrease to produce more insulin and down the road the pancrease will get tired and stop altogether. So at that point you will need to start on insulin and using the glipizide could reduce the chance of your cat going into remission. I've only been doing the sugar dance myself about 7 months so I'm by no means an expert. The numbers that your seeing 180 early then up to 300 later in the day - make me think the glipizide isn't working a full 12 hours. I personally think those numbers are too high and that it would be better to start insulin therapy - working toward remission. However each cat is different and perhaps your kitties numbers will come down more. Jan
 
Re: responding oral med. very well

But I didn't say Kitty's numbers are normal and she is not diabetic anymore?? Im just saying Shes responding well to her first treatment in the past 10 days?
 
We are just concerned because, in our experiences, insulin is the best way to control diabetes. And we think there is a limited window, in most cats, for healing the pancreas and getting the cat into remission. We have had a few people who started with the pills before coming on this site, and in every case I know of, once they switched to insulin they got much better results. I wonder if you could lower the time frame for the experiment of the pills to two weeks rather than a month and if your vet would agree.

It is difficult, I am sure, because it sounds like you like this vet and they do support home testing and the diet change. We can just give you the best advice we have based on the hundreds of cats we see on this site.

Pallid said she had contacted you. Were you able to get together? I would think it would be very good to have another person in Instanbul with a diabetic cat to discuss things with.
 
Yes we talk with Pallid on the phone. Her cat also switched to insulin from oral med. She has been of great help.
 
Glipizide is not recommended for use in cats. It might work for a short period, but it ends up over taxing the pancreas and worsening the diabetes for the long term. See p. 218 (4) of the AAHA diabetes guidelines where it states:

Oral hypoglycemic drugs, combined with diet change, are only indicated if owner refuses insulin therapy or is considering euthanasia. These agents are not considered appropriate for long-term use.
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Insulin therapy, on the other hand, allows the pancreas to rest and heal, and with the correct type of insulin (Lantus, Levemir, or Prozinc) and a low carb, canned diet, the majority of newly diagnosed cats will reach remission (insulin no longer needed). Even if your cat is one of the lucky ones it works for (it only works in 20-30% of cats), your best case scenario is that you'll have to administer the pill for the rest of your cat's life. More likely it will only postpone the need for insulin while slowly damaging the pancreas further, and increasing your chances that insulin will be needed for the rest of the cat's life. I would urge you to discontinue the glipizide and begin insulin therapy immediately.

I understand your vet consulted with a professor about the glipizide, so I would provide your vet with this article to challenge that professor with: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885761/. Vets that still prescribe glipizide for cats usually basing their decision on older and/or human research are not aware of the danger of using it with cats.

I've also attached an article for you to print and give to your vet--it discusses the 84% remission rate for insulin therapy with Lantus (and Levemir works the same way), and outlines the treatment guidelines for Lantus and Levemir.
 

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It looks like you changed your kitty's diet to wet food just prior to starting the glip? That is likely a big factor in the reduced numbers.

As others have said, glip works by forcing the organs to work harder, which will cause them to burn out. Insulin assists them while they can rest and possibly heal, giving a chance of remission. The end results could be that in the short term you don't need to give insulin, but in the long term your chance at remission is lost and you will be required to use insulin to keep your kitty's numbers in a safe range instead of the possibility of a short round of insulin, change of diet, and then remission. The longer diabetes is treated with something else, the less effective the insulins are at gaining remission. I think Lantus has somewhere around 70-80% remission in newly diagnosed cats, where it is only 20-30% in cats that have been treated for some time prior.

Needles can be scary. I used to pass out at the sight of them. My vet told me to sit down before I passed out 3 times in our meeting to learn how to give shots. The first few times testing and shooting Smokey were done with very shaky hands and very little blood in my brain followed by me laying on the couch to recover. Now it is all second nature to both me and Smokey. You can do it.
 
I agree, you can do it.

The needle part isn't as bad as we imagine it.
You are only poking a very small needle under the skin.

You've had a bad splinter before , haven't you? The kind where you have to keep digging deeper because you just can't get that
last bit out.

It's not like an allergy shot which goes into muscle. It's just under the skin which you pull away from the body so that you don't
hit anything else.

I had a huge phobia of needles. I had so many surgeries as a child, I would get hysterical thinking about it, anticipating it.
I actually can't stand white shoes ( athletic/tennis shoes) because that's what all the nurses wore.

I'm giving my cat shots. And I think I was really bad at it the first week but we got past it and I "think" i'm doing okay now. She sits there waiting for it ( and the treat)
And listening to all those giving great advice here, it's because of them, that Shadow and I are doing so well.


I sure wish you could give it a try. If it's really horrible after a couple of weeks, you can alway go back to the pills.
No one is telling you that you will lose ground if you postpone the pills but you could miss your window for remission if you postpone
the insulin shots.
 
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