Reduce or Discontinue?

[Buddy & Henry]

Newbie here! Buddy (12 y/0, Neutered Male, DSH) was diagnosed with diabetes just after the Christmas holiday after being overdosed on a TOPICAL steroid. We started him on Lantus 29 Jan and D/C the steroid a week prior to that. He had a normal BG in Nov--so we are dealing with less than 60 days of uncontrolled diabetes prior to insulin. We are using a Lantus pen and started with 1unit--a week later, after a curve at the vet, he went up to 3u. We put him on canned M/D--1/4 can 4x a day. I was doing random home testing with Accucheck and at 4 weeks of 3u he dropped into the 40's. This was right before we were scheduled to be out of town and we were worried about him becoming hypo while we were gone. We reduced his Lantus to 1u and were getting readings in the 80s. We had our pet sitter keep him at 1u while we were gone. He has now been at 1u every 12 hours for 11 days. We are still getting very BGs with highs in the 80s and lows in the 70s. What should I do now? Continue at 1u per day? Try taking him off and see what happens? Or reduce? We have only been using a Lantus pen so I will need to buy the materials to do 1/2 and 1/4 doses but am willing to do this if experienced folks think it is what I should try. Also, Buddy has lost some weight, is more active, and his coat feels better than it has in several years. Looking forward to the wisdom of the crowds here on FDMB! Thank you.

 

[Chris/China (GA)/Garfield]

Do you have our spreadsheet program? It's really a very valuable tool that help us to help advise you

How often is Buddy tested?

It does sound like he's doing well, and generally, we reduce them slowly down to .1 unit so we give the pancreas as much support as possible before removing the insulin

What kind of food had he been on? The M/D isn't one of our favorites (especially since it's so expensive, a little higher in carbs than we use and not any better in quality)

If he was on dry before, the improvements in his coat and condition could very well be just from switching to a canned food. The extra water does great things for our kitties!

 

[Sienne and Gabby (GA)]

It sounds like you're keeping records of your home testing. Would you be able to share your results? Most of us keep spreadsheets with our test data so we can see the big picture of how our cats are doing.

I would definitely recommend getting syringes that are in half unit increments. We don't recommend using the pens with the needle tips since they are not particularly accurate in smaller (i.e., 1.0u) doses and you can't measure in anything but whole units. Kids and kittys need syringes! We try to keep a cat on insulin as long as possible in order to provide a kitty's pancreas as much support as possible while gradually reducing the dose -- hence the need for syringes. If Buddy's BG numbers are within a normal range (50 - 120 with most of the numbers below 100) for a week, you can then reduce the dose by 0.25u. This allows for a gradual taper of the dose.

 

[Buddy & Henry]

Chris and China, Sienne and Gabby--thank you for your quick responses. I do not have the spreadsheet program so I will look around the forum and find it. Right now, I am only testing 1-2 times a day and not at all when we have been gone. So as I suspected... Buddy and I need to get more comfortable with testing and do some at home curves.

He was previously on a dry cat food for what we thought were allergies and prior to that he had been on M/D dry. For now, I'm going to stick with M/D canned as I am not living in the CONUS/48 states and a reliable supply of the proper food has been an issue. I know that I can get M/D canned...

I just contacted my vet for a phone consult and will arrange to get the syringes and needles. I will increase testing and then follow the advice of slowly tapering by .1u or .25u. As soon as I have some better numbers I will share them with you.

I look forward to hearing more from others. Thank you!

 

[Chris/China (GA)/Garfield]

Here's "How to create a spreadsheet and link it to your signature" so you don't have to look through the whole message board to find it. Setting it up isn't hard and after that, all you do is fill in the blanks as you get tests in! If you have any problems though, just let us know...we have several people who can set it up for you and then transfer it to your ownership

If you look at the spreadsheets of a lot of other members (in the signature line) you'll see what they look like. Some of us are pretty addicted to testing...LOL

It's important to always get tests before shots. You wouldn't shoot insulin into your child without knowing their blood glucose was high enough and it's the same for our kitties.

During the AM cycle, if you can get a test somewhere mid-cycle, that's great too. Depending on your schedule, even a test as you go "out the door" and come back in will help. On the PM cycle, we like to at least get a "before bed" test so just in case they're going too low, you can set an alarm to check on them later.

If it's impossible to get a midcycle test during the day, get the pre-shot tests and the "before bed" test at night and then on days off, do curves (every 2-3 hours for 12-18 hours) and it'll really help to see how Buddy is doing

It sounds like he may very well be a "transient diabetic" and will be able to go OTJ (Off the Juice) soon!

 

[tiffmaxee]

Welcome. The stickies will tell you the protocol. In a nutshell we reduce by .25 unit when in normal numbers for two weeks. If they drop under 50 they get an immediate reduction. It sounds like your cat won't need insulin for long but of course that will depend on the data and how the reductions work. We always test before injecting and at least a test between +5-7 if at all possible. I look forward to seeing the spreadsheet.

 

[julie & punkin (ga)]

Hi Henry! Cats that have become diabetic from steroid use often are able to go into remission once their blood sugar gets controlled. It sounds like Buddy might be headed that way.

One thing that is important to know is that as you've kept his blood sugar in normal numbers, the pancreas can begin to heal and sputter back to life. As it begins putting out insulin, you will need to reduce the amount you are shooting so that he's only getting the addition amount injected that he actually needs. You've done a great job of taking care of him already - i'd just encourage you to be aware that his insulin needs are very likely to decrease now since he's being in normal blood sugar range. So although 1unit has been great for him in the past, it will likely become too much for him in the future.

If you want help figuring out how to proceed, there are many people here who can help - just keep asking questions.