Possible remission but having concerns

Jennybags123!

Jennybags123!

Member
My cat Calvin has been off insulin since 1/8/25. However, even though his numbers are mostly greens with a couple blues, he is acting unwell. He doesn't want to get up off the bed, he will eat if I bring it to him or if I set him on the floor I can sometimes coax him into the kitchen to eat. He seems very lethargic and seems weak at times. He gets muscle twitches or jerks occasionally. He has been sleeping non stop except to eat. He will get up to pee or poop but that's it. He was playing and acting great until this last week or so. Please help! I don't understand what's going on! Shouldn't he feel good with lower BGs?
 
How is Calvin. I see he had great numbers yesterday and did he eat a little more? It looked like he did from the information in your Remarks. I know we talked a lot about possibilities yesterday in our conversation. I am just wondering if there has been any change in his energy level or behavior?
 
Hello, sorry I haven't updated the ss, I'm having some issues with my own health since yesterday. Calvin seems a little perkier this morning. He woke me up last to eat and again this morning he was up early to eat which is a good sign. No test results yet unfortunately. He ate well this am and has had a snack. He's resting now, but seems more alert than he has been. I will try to update the ss. His BGs are great today.91 and 84 so far. Thanks for your concern and ideas. I will ttys.
 

Oh no. I hope you will feel better soon. All this stress has probably made you vulnerable to illness. It sounds encouraging that Calvin feels better. :( Maybe it’s as we had hoped… that he needed more time to adjust to the lower BG.​
 
I hope so. He just dropped down to 54 unexpectedly. I had given him an Apoquel tablet because his skin allergy seemed to be acting up the last couple of days. I wonder if it had some effect on his BG. I will have to do some research on this. He just ate some FF and seems fine. He is laying on the rug, one of his spots that he likes, so that's a good sign in my book, off the bed!
 
Hello, quick update. Calvin seems to be feeling better. He's eating regularly, getting up, acting like himself. However, I am stressed because twice in the night he dropped to 54BG and so the Libre alarm went off. I told myself that I don't have to give carbs or honey unless he drops below 50, which he hasn't done, but the stress of worrying that he's going to keep dropping when that alarm sounds is wreaking havoc with my sleep and my nerves. What should I do? I can't change the BG alarm range on the sensor. I don't know how to deal with this. He's dropping low during the day as well. Usually a couple times a day. Any ideas? I'm exhausted and so stressed.
 
This is fantastic news about Calvin! I am really happy to hear it. It’s just like we hoped … that he just needed to get used to the normal numbers. I am sorry the Libre alarm is going off and keeping you up. You most definitely should NOT give him any high carb food or any other HC stuff. He literally cannot go into a state of hypoglycemia because he is not on insulin anymore.
That is a problem with the Libre cgm. It does this to our members all the time, and when the cat IS on insulin they get very worried. This is the reason why a handheld glucometer is important to have and use. Right now, the Libre is simply alerting you to the fact the Calvin is in normal healthy typical cat BG numbers. Our OTJ trial instructions say that after 14 days in normal numbers we declare that the cat is in remission (is a diet-controlled diabetic.) Calvin is almost there. It depends if we count the days where we don’t have data because he wasn’t wearing the Libre, but since he picked right back up in normal numbers when he got a new Libre, I think it’s fair to say he was in normal numbers for those days, too. If you had a handheld backup meter that you could use on Calvin, you could compare it with the Libre.

How often is the Libre going off? All day and night? And you cannot silence it? If there was a way of silencing it, I would do it — and I would scan it periodically… that’s all.
 
Just so you can read them, here are the official OTJ Trial Instructions There’s important information in there for the future. You will want to make sure he stays in remission so you will need a way to periodically check his BG to make sure he stays in remission. I would encourage you to learn how to test his BG after this Libre kicks the bucket or falls off.

OTJ trial instructions:
  • 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.

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), testhis/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!
 
I am sure you are not believing me about the normal BG numbers for a cat! Please don’t give him anything to raise his BG. We don’t want to mess anything up for Calvin’s remission. I am really excited now — especially since you told me how he’s feeling and acting now! He’s going to feel so good and be so healthy now! I am happy for you both… but I do feel very sorry for all of your stress and worry. I totally understand that! Calvin has been in uncharted waters for you and then he was acting ill. I certainly have been worried about him, too because of that. I do feel very relieved! I his Insulinoma test is going to come back negative!
 
Can you explain how he can't have a hypoglycemic attack because he's not on insulin? I thought that low blood sugar was low blood sugar regardless of the source? Naturally occurring or insulin? I can silence the alarm for six hours at a time but I was afraid he would become possibly hypoglycemic and I wouldn't know it. So it's not possible to have hypoglycemic symptoms if you're not on insulin? I had no idea.
 
I thought that because of the low carb food maybe his numbers were dropping too low. I do believe he will regulate eventually, but it does still seem possible to go too low if he's just not catching up yet? I don't mean any disrespect, I truly am just trying to work this out in my mind. I know you have a lot of experience with all of this. I need it to make logical sense to me. I'm so afraid to trust that this is happening and make a mistake.
 
Jennybags123! said:
Can you explain how he can't have a hypoglycemic attack because he's not on insulin? I thought that low blood sugar was low blood sugar regardless of the source? Naturally occurring or insulin? I can silence the alarm for six hours at a time but I was afraid he would become possibly hypoglycemic and I wouldn't know it. So it's not possible to have hypoglycemic symptoms if you're not on insulin? I had no idea.
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Well no, in a normal cat, they can’t go hypo if they’re not on insulin. Now, we’ve been very cautious because of the speculation about the insulinoma. So until we know for sure that he doesn’t have an insulinoma, we can’t be sure, but I don’t see any evidence of it on his spreadsheet - none at all. With an insulinoma, the BG should drop dangerously low after a meal. I don’t see that. I know we need to wait, but right now he’s staying completely in normal healthy BG.
Is he still doing the twitching?
 
No he's not been twitching that I've noticed. I'm sorry to be a pain, I'm just so fearful it's really making me crazy. We wouldn't be where we are if we hadn't followed your advice, so I don't know why I'm struggling with this.
 
Jennybags123! said:
No he's not been twitching that I've noticed. I'm sorry to be a pain, I'm just so fearful it's really making me crazy. We wouldn't be where we are if we hadn't followed your advice, so I don't know why I'm struggling with this.
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It’s totally okay! And you are NEVER a pain. I am sure I would be feeling exactly as you are right now. In fact, I know it. After all, you know Calvin best and you love him more than anyone else! I completely understand! I have seen some cats go into remission very quickly, but it’s not the everyday story. I’m not sure I would trust it if Calvin were my baby. And his behavior has been alarming with the extreme lethargy. We have both hoped it was just that he wasn’t used to the lower numbers that came on so suddenly. If he were dropping into 30s and having symptomatic hypos, I would be really worried. Right now, I am feeling optimistic. I do worry about you not getting any sleep though! Soon, you will have the test results and I pray they will be good.
 
Thanks for understanding. I'm trying to weigh the facts that I have and the risks. I know Calvin has never dropped below 40, EVER when being monitored. He acted fine, even then. That was when he was on Novolin, early on. I know he has acted fine even in the low 50s.I know he has always come back up from the low 50s, he's never continued to drop. He was fine even when we couldn't monitor his numbers. I'm going to try silent mode tonight. I usually wake up in the night anyway, so when I do, I will check on Calvin to put my mind at ease. I might not be able to keep it silent all night but I think I need to try facing my fear. Thanks for the support and encouragement. ❤️
 
Jennybags123! said:
Thanks for understanding. I'm trying to weigh the facts that I have and the risks. I know Calvin has never dropped below 40, EVER when being monitored. He acted fine, even then. That was when he was on Novolin, early on. I know he has acted fine even in the low 50s.I know he has always come back up from the low 50s, he's never continued to drop. He was fine even when we couldn't monitor his numbers. I'm going to try silent mode tonight. I usually wake up in the night anyway, so when I do, I will check on Calvin to put my mind at ease. I might not be able to keep it silent all night but I think I need to try facing my fear. Thanks for the support and encouragement. ❤️
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You need to know he’s okay. I would also wake up and check on him. Let me know how he is in the morning.
 
Good morning, Calvin is doing well. I checked him in the night and he was fine. He just ate breakfast. I was able to sleep, thankfully! I will lyk as soon as I get the results from the blood test. Thanks again for the support!
 
That’s great to hear (both that he was fine and that you got some sleep!!) Did you record any numbers last night? Is he eating well this morning? Interested in his food? Up and about?
 
His numbers are good this am, 72 before food. Looks like he dropped overnight, looks close to low 50s, hard to tell without a scan. He is up and about, just gave him his squeeze treat with the Apoquel in it. He's been very itchy the last few days. He only ate a TBSP for breakfast, but he ate a lot last night, so that's probably why. I'm trying to offer food every couple of hours. He seems ok with that.
 
How’s that Apoquel? I’ve certainly never given that to my cats although I do have some with serious allergic dermatitis. I have one on Atopica right now and his fur is starting to grow back after 1 month on Atopica. We are ready to start tapering it down to every other day or twice a week.
 
Well the Apoquel has worked well for Calvin for the most part. I was desperate to find something that would calm his itchy skin and did my own research and found that it had been used in cats with some success. I asked my vet if we could try it and it worked! We don't know what he is allergic to, but he has times when he's not bothered at all and other times when he just can't stop licking and biting. So, I think it's worth a try. He started on one tablet once a day and eventually I was able to wean him down to half a tablet once a day and then off of it completely when he's not itchy. Some animals seem to need to be on it for life. That's what they usually tell you, anyway. However, he had a bad time in the fall and the Apoquel didn't help at all, I don't know why, and so I made the decision to have the vet give him a steroid shot, which calmed everything down, but apparently caused the diabetes. I knew it was risky, but when you are watching your pet suffer and nothing is working you do what you think is best. I feel very fortunate that Calvin is coming out this as well as he is.
 
Yes. Except no more steroids for Calvin! His pancreas just needed some insulin support for a while to heal and start working again!
 
Never again! I noticed today that when his BG dropped, he was laying on his sensor. I wonder if some of the low readings are from compression. It would make sense. Regardless, he has always rebounded. He hasn't dropped below 50. I will ttys. Have a good night!
 
Now that you mention it, other members have noticed wacky readings when their cats were lying on their Libre sensors. I am trying to remember who it was @Samantha Styles? Samantha, I know he’s gone OTJ now (and I hope he is still OTJ!) but didn’t this happen when Twix was lying on his sensor? You got a really low reading?
 
Jennybags123! said:
Never again! I noticed today that when his BG dropped, he was laying on his sensor. I wonder if some of the low readings are from compression. It would make sense. Regardless, he has always rebounded. He hasn't dropped below 50. I will ttys. Have a good night!
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Yes it is probably from compression—this happens in humans if they put pressure in the area. This is because the sensor is reading the fluid within the tissue not blood. So putting pressure will deprive the sensor of the fluid.

I think @Suzanne & Darcy reassured you but if it helps to hear from an MD: the hypoglycemia we worry about with diabetics happens because they have too much insulin WHICH WE PROVIDED. The body will not over produce insulin except in the case of extremely rare tumors and if that’s the case the blood sugar would remain low not come and go. I will repeat, despite the misconception of some, people (and cats) won’t dangerously lower their blood sugar on their own. They may feel weak if not eating, but their glucose will not go dangerously low.

human meters are designed to read glucose in humans. Because glucose is stored differently in cats blood compared to humans, human meters (including the libre) provide a falsely lower number when reading cat blood—it reads lower than the actual number you would get if tested in a lab. The number on the meter is not really the number if blood was lab tested.

Adding to this, the Libre tends to read low numbers even lower than hand held human meters (and even lower still if pressure is out on the sensor area).

congratulations on him being in remission
 
SmallestSparrow said:
Yes it is probably from compression—this happens in humans if they put pressure in the area. This is because the sensor is reading the fluid within the tissue not blood. So putting pressure will deprive the sensor of the fluid.

I think @Suzanne & Darcy reassured you but if it helps to hear from an MD: the hypoglycemia we worry about with diabetics happens because they have too much insulin WHICH WE PROVIDED. The body will not over produce insulin except in the case of extremely rare tumors and if that’s the case the blood sugar would remain low not come and go. I will repeat, despite the misconception of some, people (and cats) won’t dangerously lower their blood sugar on their own. They may feel weak if not eating, but their glucose will not go dangerously low.

human meters are designed to read glucose in humans. Because glucose is stored differently in cats blood compared to humans, human meters (including the libre) provide a falsely lower number when reading cat blood—it reads lower than the actual number you would get if tested in a lab. The number on the meter is not really the number if blood was lab tested.

Adding to this, the Libre tends to read low numbers even lower than hand held human meters (and even lower still if pressure is out on the sensor area).

congratulations on him being in remission
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Hey Colleen, you’re everywhere! ;) I hope you’re well and Methos is doing all right. Yes, I believe that Calvin has gone into remission, but we had discussed insulinoma and Calvin has been tested. I don’t see signs of it and am very optimistic that the results will be negative. I’m just so happy that another of our ProZinc kitties has gone into remission. It’s been a good gear in that respect (2024.)
 
Thanks so much for the information! I am feeling reassured and more confident day by day. I have difficulty trusting in my decisions and the support from this group has really helped! It's hard when you read conflicting information or worse, when you hear it from your vet. Thank you both for your help! Calvin thanks you too!❤️
 
Hi, just checking in. Calvin is doing well. I put a new sensor on so I will check his levels later this evening. He has been acting very well the past few days. I called the vet for his test results and they are waiting on an assessment from the testing company. Hopefully tomorrow I will hear something. I just want to make sure it's negative. Hope you are well, ttys.
 
Thanks for the update of the spreadsheet! His numbers look really good!! Is he feeling well? I was going to write you today to ask if/when the test results would come in… but I didn’t want to be a pest!

when did you put the new sensor on?
 
They didn’t tell you anything? Argh! Oh well, I know that they have to wait on the lab to send the results.
Meanwhile, Calvin looks to be doing great. Did you scan his Libre today? I am hoping we can document this beautiful remission! You should not need another Libre after this one, as long as he stays in these same beautiful green numbers and very low blues. How does he seem to you? Appetite? Activity normal? Litter box use? Happy?
 
Hi, sorry, trying to keep up with the ss. Calvin is acting ok. A little low energy today, I think he might be having trouble with another hairball. He is eating, no litter box problems. I hope I hear from the vet Monday. I will keep you posted. Thanks for checking in.
 
Well, Calvin scratched off his sensor again, so, I am resigned to trying to get blood samples. I attempted it today, I poked his ear and I could see a tiny bit of blood but it wasn't enough to read, apparently. It didn't become a drop, I don't know why. I will try again tomorrow. Any tips are welcome, I've watched so many videos and the cats are always so calm and just sitting there. Calvin is not calm and he hates having his ears touched. I will keep trying, but this is very difficult for me.
 
Jennybags123! said:
Well, Calvin scratched off his sensor again, so, I am resigned to trying to get blood samples. I attempted it today, I poked his ear and I could see a tiny bit of blood but it wasn't enough to read, apparently. It didn't become a drop, I don't know why. I will try again tomorrow. Any tips are welcome, I've watched so many videos and the cats are always so calm and just sitting there. Calvin is not calm and he hates having his ears touched. I will keep trying, but this is very difficult for me.
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If you put a little vaseline on his ear, it will help it bead up. Also, you can take your finger/thumbnail and gently scrape the blood onto that and test the blood right from the bead on your fingernail.
 
You may need to just try acting like you are going to get a test - get everything set up in a particular spot … maybe a spot he likes, but definitely one where you will be able to maneuver…. and just touch or massage his ears for a minute or a few seconds even and then just pop a treat into his mouth. Every time he lets you touch his ears, give another low carb treat like a pure bite chicken treat or boiled chicken piece.
 
Massaging or warming his ears will help. Also don’t use the super fine lancets at first. A cat’s ears will start to bleed a lot more easily after a while.
Sorry I didn’t see this message on Sunday evening. I think I was helping another member who is new to low numbers… I stayed up until 2:30 a.m. Monday morning helping her.

I actually stopped by your thread this morning to see if there was any news on Calvin’s test.
 
Hi, no, no word yet. I called the vet again, waiting for a phone call with the results. I'm still struggling to get a blood test to check Calvin's BG. He's acting fine, eating well, playing. I just want to know what his numbers are for peace of mind. I got one drop of blood, once, and the monitor said it wasn't enough! I was so disappointed! I haven't been able to get another drop since. I will keep trying.
 
Hi, I'm still waiting to hear from the vet. I did have them send the test results to me as well as Calvin's most recent bloodwork results. Is there a way for me to share the screen shots here?
 
Have you had any luck with the testing? How many days has it been now since Calvin had the blood drawn for the insulinoma test? It’s crazy.
 
Hi, no luck with the testing. I received the test results from the vet but no explanation as to what they mean. I'm trying to figure it out on my own but I haven't found the right information yet. His fasting insulin was 7.2. His fasting glucose was 91. The ratio between the two was .08. The notes at the bottom of the page says "The slight numerical decrease of insulin is unlikely to be of significance in the absence of hypoglycemia or hyperglycemia. These results could reflect normal homeostasis of insulin and glucose metabolism for this individual." I'm taking this to mean that Calvin's pancreas is working normally. Any thoughts?
 
It does sound like they are saying that Calvin is normal — that the results are normal for him and unless he actually has hypoglycemia or hyperglycemia there’s nothing wrong with those test results. You should definitely get a clarification from your vet.
 
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