Sam & Esse
Member Since 2017
Hello 
June 13th marked Sammi's one month anniversary on Tresiba. I thought I'd post a bit on how he's doing; general impressions, worries and triumphs, along with a touch of past history for a bit of perspective.
When Sam was first diagnosed he was put on ProZinc. That lasted just over 3 weeks. Although everything I read said a cat shouldn't feel ProZinc, Sam absolutely did. He fought the shots, and as the weeks went by the skin along his back started twitching violently for hours after shot time. I requested a Levemir prescription from my vet, since I figured if Sam was feeling the ProZinc that badly, Lantus was definitely out of the question. Although my vet had no previous experience with Lev, he agreed to the medication change as long as I brought Sam in for monthly fructosamine tests... Yeah, those didn't happen.
Sam accepted the Lev better; shot time became easier. But while Lev had better duration than ProZinc, Sam was still metabolizing the insulin too quickly. And he bounced. Boy, did he bounce. Getting the flu in December derailed any plans of regulation; January started showing some promising numbers — but only mid-day. Preshots just about had me in tears. Then the dives started. Poor Sam was all over the place.
I knew Sam had some bad teeth; when I took him in for his six-month follow up I asked the vet if he'd clear Sam for a dental (he'd previously wanted Sam regulated) and if he'd consider prescribing Tresiba. After enduring a bit of a rant over me not holding doses for six days and over-testing at home (which, lol! I'm not able to test near enough), the doctor cleared Sam for his dental — pending blood work, including fructosamine that I reluctantly agreed to — and a move to Tresiba after Sam's dental work.
So... Sammi is now toothless. If the way he's started gnawing on me is any indication, he approves of the change. Otherwise, his only other health problem is being overweight. Got the Tresiba from Mark's in Canada after a small snafu (I have a feeling someone at the vet's office was "misplacing" the Rx request forms) and started Sam on a token dose in case of an immediate allergic reaction.
Dose increases were far faster than any protocol would approve; I was getting panicky that the insulin wasn't working/had gotten too warm/was bactine-scented water... However, at 3.5u improvement became apparent. 3.75u had been Sam's tipping point on Lev, and it looks like that holds true with the Tresiba.
Differences I've noticed with Tresiba?
1. Sam's a lot more level on it. Less bouncing, not bouncing as high, and clearing bounces faster for the most part. The blue squares look so pretty on his SS.
2. Dose increases likely take longer than 6 cycles to demonstrate full efficacy.
3. I am clueless about the depot. How long does it take to fill? How long to deplete? Is there even a depot, and if there is, is it anything like Lantus or Lev? Right now I'm leaning towards Tresiba having an extended duration, but there's something other than a traditional depot in play. I do not have the knowledge or the testing info needed for any sound answers.
4. Sam has no problem at all with the injection. Zero fussing, and a few times he's actually come into the kitchen when he's "Ready for your mojo?"
5. When at a "good" dose, Tresiba can both pull down high BG numbers and keep them fairly level; ie, when I had to skip a dose, Sam came back down smoothly and relatively quickly.
6. There are far less occurrences of bubbles when drawing the Tresiba dose from the pen, and when there is a bubble it's much, much easier to get out than it was with Lev.
7. Tresiba may be more forgiving of rapid dose changes. For medical reasons PM testing isn't something I can do often; instead, I decrease dose to hopefully keep Sam safe. On Tresiba Sam's numbers may wobble a bit but still look okay; Lev, I could tell it had a negative impact.
Questions it will take a larger user base to answer:
1. When confronted with a low preshot #, traditionally the advice is to stall without feeding and retest in 20 or so minutes, repeatable for up to an hour. If Tresiba is holding numbers steady, and the duration extends several hours past preshot time, this method may not be applicable.
2. Hypo treatment. If Tresiba does have a longer duration for particular cats, is there a possibility that the standard two hours of safe, non-food-influenced BG#s might not be long enough to predict if the cat is actually safe?
3. Since Tresiba comes in a u200 as well as a u100 formulation, could it be an option for high dose cats? A regular u100 syringe could hold a total of 60u instead of the 30u we're used to.
4. When used in cats, is Tresiba a depot insulin? Or should it be considered an extra-long lasting in-and-out insulin? Or will it prove to be another case of ECID?
I think that about covers everything I've thought about during the last month. Sam's SS should be viewed with the knowledge that I'm not following an established protocol, and that risks were taken that probably shouldn't have been. For people that have considered switching to Tresiba, I thought that being able to see how another cat is doing on it might be helpful. I hope it is, at least
June 13th marked Sammi's one month anniversary on Tresiba. I thought I'd post a bit on how he's doing; general impressions, worries and triumphs, along with a touch of past history for a bit of perspective.
When Sam was first diagnosed he was put on ProZinc. That lasted just over 3 weeks. Although everything I read said a cat shouldn't feel ProZinc, Sam absolutely did. He fought the shots, and as the weeks went by the skin along his back started twitching violently for hours after shot time. I requested a Levemir prescription from my vet, since I figured if Sam was feeling the ProZinc that badly, Lantus was definitely out of the question. Although my vet had no previous experience with Lev, he agreed to the medication change as long as I brought Sam in for monthly fructosamine tests... Yeah, those didn't happen.
Sam accepted the Lev better; shot time became easier. But while Lev had better duration than ProZinc, Sam was still metabolizing the insulin too quickly. And he bounced. Boy, did he bounce. Getting the flu in December derailed any plans of regulation; January started showing some promising numbers — but only mid-day. Preshots just about had me in tears. Then the dives started. Poor Sam was all over the place.
I knew Sam had some bad teeth; when I took him in for his six-month follow up I asked the vet if he'd clear Sam for a dental (he'd previously wanted Sam regulated) and if he'd consider prescribing Tresiba. After enduring a bit of a rant over me not holding doses for six days and over-testing at home (which, lol! I'm not able to test near enough), the doctor cleared Sam for his dental — pending blood work, including fructosamine that I reluctantly agreed to — and a move to Tresiba after Sam's dental work.
So... Sammi is now toothless. If the way he's started gnawing on me is any indication, he approves of the change. Otherwise, his only other health problem is being overweight. Got the Tresiba from Mark's in Canada after a small snafu (I have a feeling someone at the vet's office was "misplacing" the Rx request forms) and started Sam on a token dose in case of an immediate allergic reaction.
Dose increases were far faster than any protocol would approve; I was getting panicky that the insulin wasn't working/had gotten too warm/was bactine-scented water... However, at 3.5u improvement became apparent. 3.75u had been Sam's tipping point on Lev, and it looks like that holds true with the Tresiba.
Differences I've noticed with Tresiba?
1. Sam's a lot more level on it. Less bouncing, not bouncing as high, and clearing bounces faster for the most part. The blue squares look so pretty on his SS.
2. Dose increases likely take longer than 6 cycles to demonstrate full efficacy.
3. I am clueless about the depot. How long does it take to fill? How long to deplete? Is there even a depot, and if there is, is it anything like Lantus or Lev? Right now I'm leaning towards Tresiba having an extended duration, but there's something other than a traditional depot in play. I do not have the knowledge or the testing info needed for any sound answers.
4. Sam has no problem at all with the injection. Zero fussing, and a few times he's actually come into the kitchen when he's "Ready for your mojo?"
5. When at a "good" dose, Tresiba can both pull down high BG numbers and keep them fairly level; ie, when I had to skip a dose, Sam came back down smoothly and relatively quickly.
6. There are far less occurrences of bubbles when drawing the Tresiba dose from the pen, and when there is a bubble it's much, much easier to get out than it was with Lev.
7. Tresiba may be more forgiving of rapid dose changes. For medical reasons PM testing isn't something I can do often; instead, I decrease dose to hopefully keep Sam safe. On Tresiba Sam's numbers may wobble a bit but still look okay; Lev, I could tell it had a negative impact.
Questions it will take a larger user base to answer:
1. When confronted with a low preshot #, traditionally the advice is to stall without feeding and retest in 20 or so minutes, repeatable for up to an hour. If Tresiba is holding numbers steady, and the duration extends several hours past preshot time, this method may not be applicable.
2. Hypo treatment. If Tresiba does have a longer duration for particular cats, is there a possibility that the standard two hours of safe, non-food-influenced BG#s might not be long enough to predict if the cat is actually safe?
3. Since Tresiba comes in a u200 as well as a u100 formulation, could it be an option for high dose cats? A regular u100 syringe could hold a total of 60u instead of the 30u we're used to.
4. When used in cats, is Tresiba a depot insulin? Or should it be considered an extra-long lasting in-and-out insulin? Or will it prove to be another case of ECID?
I think that about covers everything I've thought about during the last month. Sam's SS should be viewed with the knowledge that I'm not following an established protocol, and that risks were taken that probably shouldn't have been. For people that have considered switching to Tresiba, I thought that being able to see how another cat is doing on it might be helpful. I hope it is, at least
I'm not sure how long this will go on for. I'm just thrilled that it's held true for this past week, and I'm learning to work with it. I haven't been brave enough to shoot a full dose on a lower pre-shot. Instead, I've developed a tiny sliding scale for dosing of a quarter unit leeway, and when I am shooting a low number, I make sure that I wait to take my own night time meds until I know Sam's safe. I have no idea if it's the right thing to do, but it seems to be mostly working. So far. Knock on wood.