Sam's Second Month on Tresiba

[Sam & Esse]

Hello

Sam's now been on Tresiba two months as of July 13th. I couldn't be happier with his progress! After six months of scuba diving to sky diving bounces on Levemir I was feeling rather hopeless... and Sam wasn't feeling well, period. After six weeks on Tresiba, Sam was regulated! Yay! It probably can't be considered tight regulation; I'm using an AlphaTrak to monitor him, and numbers under 100 worry me a bit since there's less cushion to the take action number. There's been a couple of readings above 150 (the AT2's normal BS upper limit) but every number has been in the blues (or greens!).

I'm a bit ashamed to admit that midday testing has gone to the wayside. The extreme heat has affected my health, and Sam and I both are doing our best just to make it through each day. Next week the AC guys are coming, and that should help. Even with the high indoor temps and humidity, though, Sam's numbers have been nice. He's even started playing a bit again. Last night he spent a good fifteen minutes attacking my Comfy Sack. And when I dared peek my head over the edge – that got attacked too

I find I want to preachify on the glories of Tresiba, but will limit myself strictly to Sam's progress updates. I think Tresiba may end up being a useful insulin for other cats, but there's simply not enough information right now to be able to casually recommend it. Most parents of newly diagnosed sugar kitties need the structure of the protocols created for the other insulins. For the near future, Tresiba will likely be considered a last resort for cats that are simply not responding favorably to other insulins. Since there's so little documentation on its use in felines, veterinarians have very little reason to consider it. In my area, Boehringer Ingelheim is heavily marketing Prozinc. Calling around, it was a bit sad how few local vets were even familiar with Lantus. I suppose I was lucky, in that my vet trusted my independent research on Tresiba. Either that, or he figured Sammi was doomed regardless...

It would be interesting to see how well a cat can do on Tresiba following true Tight Regulation protocol. I'm once again hopeful that Sam might one day go into remission, but I know his chances are reduced because of my personalized dosing strategy. That's okay with me, since he's currently both happy and healthy and I know I'm doing the best that I'm capable of.


On a more personal Sammi note: I finally found a slicker brush he'll tolerate. More than that, he loves it! We now have happy-purr grooming time. Sam cleans his shoulders and chest, and he says Momma is in charge of brushing everything else. So I run the damp paper towel along his flank, brush brush brush in short, light strokes, and everything is perfect in Sammi's world. ...And it only took seven years to find a brush that's acceptable. I really, really love this cat!

 

[Jill & Alex (GA)]

Wow! What an improvement! I can certainly understand why you'd want to yell the virtues of Tresiba from the rooftop! Sammi sure is looking good!!!

I think Tresiba may end up being a useful insulin for other cats, but there's simply not enough information right now to be able to casually recommend it. Most parents of newly diagnosed sugar kitties need the structure of the protocols created for the other insulins. For the near future, Tresiba will likely be considered a last resort for cats that are simply not responding favorably to other insulins. Since there's so little documentation on its use in felines, veterinarians have very little reason to consider it.

That's pretty much how Levemir use started on the FDMB. Caregivers who felt they weren't getting anywhere with other insulins tried Levemir as a last resort. It'll be interesting to see what happens with Tresiba.

Love your picture of Sammi! He looks so proud and happy! Such a handsome kitty.


Thank you so much for the update! We can learn a lot from following along on your adventure.

 

[Cheryl and Yoda]

Hello. My name is Cheryl. I am new to FDMB. I have an 11 year old female named Yoda who has been diabetic for over 2 years. I too would love to sing the praises of Tresiba. Yoda has only been on Tresiba for one week, but all I can say is, WOW, what a difference!

A bit of background. Yoda experienced a brief honeymoon period shortly after being diagnosed in 2016, when we thought she was trying to go into remission, on Lantus. But instead, she slowly became unstable on Lantus, bouncing like Sam. We very briefly tried Prozinc (human recombinant) but she remained unstable. On to Levemir, which Yoda was on for a year, but again, bouncing like Sam. She would bounce from the 40’s - 490. Lowering her dose only resulted in her sitting in the 300’s - 400’s for days, with very brief excursions to the 100’s or 200’s, then back up again. As a side note, Yoda would get tiny scabs at her injection sites while on Lantus. That reaction did not occur with the Levemir. But I had gotten so discouraged with the bouncing. I felt nothing could be done. Until I read about Sam’s and Conan’s success with Tresiba. So, off to the vet I went with printouts of your threads in hand. Fortunately, my vet had just been to a conference where they gave a lecture on both Tresiba and Toujeo in cats. So my vet was willing to try Tresiba with Yoda. The lecture said Tresiba seems to last about 11 hours in cats, and thanks to your threads, I was comfortable starting Yoda out on twice a day dosing.

We started at 1 unit BID, and I was using the pen and pen needle to inject. But after only 2 doses, she shot up to the 400’s. So I increased her to 1.5 units BID, and back to using syringes to draw up the dose. The improvement was almost immediate. For 2 days she ranged from the 80’s - 200’s. Then WOW! Her curves flattened in a way I have not seen since that honeymoon period back in 2016. She spent 2 days in the 50’s- 110, with one nadir of 44. So I dropped her dose to 1.25 units BID. She was then in the 50’s - 90’s, with one high of 162. Then today, after 4 shot cycles of 1.25 units, while being mostly 50’s - 80, she hit a nadir of 33 (no symptoms). So tonight I am trying dropping her dose to 1 unit fat BID. I am not sure if 4 shot cycles was enough to truly evaluate 1.25 units, especially since that dose is just a guesstimate, and who knows when trying to eyeball that dose how much she was actually getting. I don’t feel that she is ready to go down to 1 unit yet. So we will see where the 1 unit fat takes her.

But again I say WOW to the results from Tresiba so far. And I want to thank you pioneers for being brave enough to try Tresiba, and for sharing your stories and results here. You and Tresiba have given me new hope that stability can be achieved for my sweet Yoda kitty.

Thank you.

 

[Sam & Esse]

Hi Cheryl and Yoda!

I'm so happy to hear that Yoda is starting to regulate on Tresiba! That you struggled for two years with three different insulins is heartbreaking. I was at the point of crying for Sam daily, and that was after only six months. Your patience and dedication is amazing.

Fortunately, my vet had just been to a conference where they gave a lecture on both Tresiba and Toujeo in cats.

Also amazing is your vet having just attended a conference that covered Tresiba! Do you happen to know what conference it was? It would be wonderful if a transcript of that particular lecture was made publicly available. It might help convince other veterinarians that Tresiba can be a viable option for tricky diabetics. Or maybe all diabetics, not just the hard to treat ones

I'm glad my posts about Sam were helpful. And welcome to our teeny-tiny Tresiba community It sounds like Yoda is responding beautifully to the change. It's wonderful that you're seeing so much improvement in just a week. That's actually one of the things I'd been very curious about. With Sam, it took two weeks to notice any (good) difference, and if I'm remembering right it took Jessica about the same two weeks with Conan once she moved him to BID. So I'd started to wonder if that was normal for Tresiba, or a complete coincidence.

Please keep us updated on Yoda's progress if you're able! Knowledge is power, but more importantly knowledge is the power to help our sugar kitties. & I'd love to see a pic of your Yoda, I imagine she's an absolutely lovely girl

 

[Sam & Esse]

Thank you so much for the update! We can learn a lot from following along on your adventure.

You're welcome, and thank you for the forum! I feel a little bit more comfortable posting here, where there's not as much traffic -- or at least where it's not as fast moving. I'm a really slow writer But I eventually get my thoughts together.

And thank you for your kind words about Sam He is my happy boy, and king of all he surveys. As long as it's on this side of the fence.

 

[Cheryl and Yoda]

Hello Esse, and thank you for the welcome. Your Sam sure is a handsome boy. I am glad to hear he is finally enjoying his brushers. I finally figured out how to add Yoda’s avatar, so you can see what she looks like (I am not very computer savvy).

I can’t remember which conference it was my vet attended, but I will try to find out. I know it was a major conference held by a professional veterinary organization. My vet attended it in June. Since they have to pay some bucks to attend those professional conferences, I doubt they would allow the notes to be made public. But perhaps veterinarians can access the notes for a fee. I know if they paid to attend the conference, they have access to the notes from all the lectures for free, even if they missed that lecture. I will see what I can find out.

I can’t say I blame the vets for not being up to date on all the diabetic treatments for cats. Most of this stuff is so new for humans, let alone for cats or dogs. My vet said she is certainly learning a lot about diabetes, thanks to Yoda. And I have been an RN for 29 years but feel I am just now really starting to learn about diabetes because of Yoda. I am longing for the day when some drug company invents a “Freestyle Libre” type monitor for cats and dogs so we don’t have to poke our precious babies 8 times a day to figure out where their BG is. That “Freestyle Libre” is the coolest invention, and so much cheaper than a continuous blood glucose monitor (and smaller). But unfortunately it is only calibrated for humans, and you can’t adjust the calibration like you can on a continuous BG monitor. My vet said her friend tried it on a cat but it didn’t work (for anyone who was considering trying it for their cat).

I do have to tell you that Yoda’s last creatinine was 1.7. That means she has officially tipped over the line into chronic kidney disease. I know in my heart that the past year and a half of bouncing BG’s hastened her across that line. I don’t blame myself or my vet for that. We certainly did the best we could with the information we had at each point in time. But it just goes to show how important tight regulation is, if you can achieve it.

I do hope that Jessica and Conan see these posts so that they too will know how they are helping others. And I will keep you posted on Yoda’s progress.

 

[Cheryl and Yoda]

Well, Yoda did not like her dose of 1 unit Fat. In her second shot cycle, she rose back to the 200’s. I increased her back to 1.25 units, and after 2 shots she is back down to normal(118). But the really good news is, she did not bounce into the 300-400’s like she always did with Lantus and Levemir. And, she quickly came back down to normal when I went back up on her dose. Such a difference from the other insulin’s.

It seems to take only 2-3 shot cycles to see where her numbers will land after a dose change on the Tresiba. Still so far so good!

 

[Sam & Esse]

Hi Cheryl

Oh, Yoda is darling! Are those white whiskers and a little white tummy? She certainly looks like she knows how to relax (and take up several cushions doing so). I am sorry to hear her creatinine is elevated. Is there any chance the number was influenced by slight dehydration? I know that until I got Sam regulated, he was always a bit dehydrated, and that affected some of his tests.

I agree that something like the Freestyle Libre would be such a benefit for sugar cats. I know I read about a few people on the board that tried them with their kitties, but they hardly lasted any time at all and got increasingly inaccurate before coming off. And I think there'd been trouble with the stick'em glue used on one cat, something along the lines that it took off a bit of skin as well What we do to our poor kitties to keep them well, and they still love us and give us purrs and headbutts, it's really amazing.

Well, Yoda did not like her dose of 1 unit Fat. In her second shot cycle, she rose back to the 200’s. I increased her back to 1.25 units, and after 2 shots she is back down to normal(118). But the really good news is, she did not bounce into the 300-400’s like she always did with Lantus and Levemir. And, she quickly came back down to normal when I went back up on her dose. Such a difference from the other insulin’s.

Glad that a bounce or rebound was averted during the fat 1u trial. I know that sliding scale dosing is not particularly popular on the different insulin support forums and with the various dosing protocols, but gosh... it's working for Sammi With Sam it took about a month for the Tresiba to really start leveling him out; maybe this next week Yoda will settle in more firmly while steering away from the lime greens

We finally got the AC mini splits installed in the house yesterday, and today has been so nice! Instead of 85 to 89 degrees inside, it's been a nice 78! And the humidity from the swamp cooler has been sucked right out! Sam is loving it Wants to know why I didn't do it sooner.

@Jessica & Conan We wanted to let you know how very much we appreciate you pioneering the way with Tresiba, and documenting Conan's and your journey so well. Without your posts, I don't know if I would have been brave enough to switch Sam over. I'd like to think I would have been, but the reassurance your posts provided has been invaluable. Thank you!

 

[Kris & Teasel]

Thank you to all of you for posting. This is very interesting to follow - says she with one of the trickiest cats ever!

 

[Cheryl and Yoda]

To Sam and Esse, Hurray for air conditioning! Yes it is possible dehydration can be affecting Yoda’s kidney values, but usually that affects BUN more so than creatinine. So at best she might still just be borderline. I am prayerful for her. After Yoda’s bounce to the 200’s, as I mentioned, she dropped back to the 100’s after I increased her back to 1.25 units, but then she rose to the 300’s for about 12 hours, until I increased her back to 1.5 units again. Then she quickly returned to the 50-130 range. She used to bounce into the 300-400’s for 2-3 days on the Levemir. So even though I got very discouraged with that 300 bounce, it didn’t last long and she never hit the 400’s, and responded much better and smoother to the increased Tresiba dose, unlike Levemir. And since then, she has had a 6 day stretch of totally normal BG’s (50-130)! I can’t remember when or if she has had such a perfect stretch of numbers in over a year and a half. So I am still singing the praises of Tresiba.

I do have to intermittently tweak her dose slightly. She seams to need mostly 1.25 units BID, but occasionally I have to drop her to the 1 unit Fat. I did that this morning again because she hit the 40’s twice overnight after 9 shot cycles of the 1.25 units. But the 1 unit fat does not seem to be a dose that she can hold at, then she seems to need 1.5 units for a couple doses after I try to decrease her to 1 unit fat. So there is still close monitoring and occasional tweaking that needs to be done with the Tresiba, but the results are overwhelmingly better than when she was on the Lantus and Levemir.

In Yoda’s case, there is clearly better overlap happening on the Tresiba at Q12hour dosing compared to Levemir and Lantus. I think that is why her curves are flatter. It is funny, but we are told that bouncing is to be expected, and that it is a somewhat normal part of the healing process. But perhaps is is not normal at all. Perhaps we just haven’t had an appropriately effective insulin to offer our cats, and perhaps that is the reason they bounce. Perhaps we would find that if we had a more appropriate insulin for the cat’s physiology, that bouncing should not and would not occur! And perhaps Tresiba is an insulin that is more appropriate for the cat’s physiology. Only time will tell.

To Kris and Teasel, I am sorry to hear Teasel has also had one of those unstable courses. Teasel was diagnosed at around the same time as Yoda, and has been on the same three insulin’s as Yoda with multiple trials on Lantus, like Yoda. I can only tell you that for Yoda, Tresiba seems to be outshining all the other insulin’s.

And Esse, I know sliding scales are not popular, but it’s not what is popular that is important. It is what works for your particular kitty that is important, and I am glad to hear you have found a formula that works for your Sammi. Perhaps if there is more overlap with Tresiba, it is an insulin that is more tolerant if slight fluctuations in dosing?

 

[Sam & Esse]

Hi @Kris & Teasel

You and Teasel have had quite the time of it! Long hopeful stretches of green/blue/yellow then those pesky pinks jump in. The repeated bouts of DKA must complicate things tremendously. I hope that in time enough data is collected about Tresiba that it might become an option for kitties like Teasel. Wishing you both the very best, and thank you for all the help you provide on the board!

 

[Sam & Esse]

In Yoda’s case, there is clearly better overlap happening on the Tresiba at Q12hour dosing compared to Levemir and Lantus. I think that is why her curves are flatter. It is funny, but we are told that bouncing is to be expected, and that it is a somewhat normal part of the healing process. But perhaps is is not normal at all. Perhaps we just haven’t had an appropriately effective insulin to offer our cats, and perhaps that is the reason they bounce. Perhaps we would find that if we had a more appropriate insulin for the cat’s physiology, that bouncing should not and would not occur! And perhaps Tresiba is an insulin that is more appropriate for the cat’s physiology. Only time will tell.

Too true. All the available insulins are struggling against cats' crazy-fast metabolisms. It's curious that ProZinc wasn't designed (formulated?) to be longer acting, since it was created specifically for cats. The classic ProZinc "smile" curve looks good when a person is first learning about FD, then a half-year or more into actively trying to treat diabetes you start wondering why those upward climbs are necessary at all... I know that the hope is that eventually the PS#s will come down, but I'm curious what the actual percentage rates are of successful regulation with ProZinc? Guess I just can't wrap my mind around the fact that a feline-specific insulin doesn't work better in most cats than human-specific insulin, since (I think) Lantus was being used off-label with cats while ProZinc was being developed. --I by no means think ProZinc is a bad insulin, just that it could have been better but for some reason isn't. Perhaps some future version of it will be longer acting.

I hope Yoda is doing well and staying away from the lime greens for you. I have noticed with Tresiba that Sam's a bit harder to pull out of a low number. He's not hypo by any means, but he can certainly lap up the Karo and stay in the 60s Wish he'd give HC food a try during those situations, but he's always been a picky cat -- and since I got rid of all the culprit kibble, there's nothing HC in the house he's willing to eat. Except Karo. That he ecstatically licks up from the syringe. Silly boy!

I actually had to laugh at myself yesterday. Sam's PMPS came in at 122, and I actually said, "Why are you so high, Boo?" Then I realized what I'd just said, and gave a quick but extremely heart-felt prayer of thanks, since just a few months ago that number would have been in the 300s, or 400s, or worse. Sammi's happy, and he's started playing again, tearing through the living room attacking the furniture, toy mice, stray toes... At this rate, I might have to start wearing socks again for protection

 

[Cheryl and Yoda]

Hi Essie. It does seem that the cat’s crazy fast metabolism makes it hard to get flatter curves with all the insulin’s. The only Prozinc available in my area is human recombinant. So while it is FDA approved for use in cats, it was not designed for cats, and therefore does not take into account their crazy fast metabolism. But I still get much flatter curves with Tresiba than with any other insulin. So I don’t think Yoda metabolizes the Tresiba as fast as she does the other insulins, or else the absorption of the Tresiba is much more steady and predictable than the absorption was with the other insulins, and therefore keeps her more stable.

I am so tickled to hear how great Sam’s numbers have been for you on Tresiba! I was wondering why, though, you are giving Karo for BG’s in the 60’s? Especially when people who test their non-diabetic cats, even after eating, will get BG readings as low as the 50’s. (Or am I misunderstanding what you said?).

When Yoda goes into the 40’s, I feed her the fancy feast chunky varieties (5-9% carbs, depending on which source you look at). And when she hits the 30’s, I feed her some from one of the fancy feast blue cans (these are the Florentine or shredded varieties, the ones that do not contain rice, 11-16% carbs, depending on which variety you pick). That will usually bring her BG’s right back up.

But it is so great to hear Sam is playing again. That is a sure sign of a happy cat who is feeling good. And we both have much reason to celebrate and give prayerful thanks that we are no longer seeing those dreaded 300-400’s anymore. Yeah Tresiba!

 

[Sam & Esse]

Hi Cheryl

I hope both you and Yoda are doing well! As I understand, even though ProZinc is a human recombinant insulin, Boehringer Ingelheim specifically designed it for felines. BI also claims a 10-14 hour duration Our cats must not have read BI's marketing material. Why the company didn't use actual feline DNA... that would be an interesting internal memo to read. Did they try to insert the feline DNA into the specialized yeast cells and fail, or did BI figure they knew how to do it with human DNA so that's what they stuck with? Either way, I totally agree with you about seeing flatter curves with Tresiba.

It's not that I'm picking on ProZinc; I just can't help comparing it to Tresiba because both insulin types utilize zinc for their "mechanism of protraction". And I only use that phrase because that's what the Tresiba site calls it. The video Novo Nordisk
put together demonstrating the mechanism helped me to understand it a little better. For anyone interested in the video it can be found here. I do give BI giant kudos for linking to felinediabetes and mentioning this message board from their ProZinc site; I hadn't noticed that before. Now all they need are snazzy videos describing the science behind their insulin

I was wondering why, though, you are giving Karo for BG’s in the 60’s? Especially when people who test their non-diabetic cats, even after eating, will get BG readings as low as the 50’s. (Or am I misunderstanding what you said?).

I'm using an AlphaTrak (pet-specific) meter, and the take-action number for it is 68. So if Sammi hits below that, especially early in the cycle, I have to be a bit heavy-handed. There was a study done on three pet-specific meters (and one human, whole-blood meter) a while back, and the AT consistently read slightly higher BG#s than actual lab values showed. The AT also read outside the acceptable error range of 20% something like 7% of the time for cats. It did even worse in dogs. Here's the study, it's in pdf format. I do not know if the AT2 has the same problem, but I figure better safe than sorry

I do wish Sam would eat MC and HC foods; they'd be better for him than Karo -- but he's a picky, fussy cat. He hates gravy. He hates chunks. He hates change, period. And I made the tragic (yet incredibly funny) mistake of feeding him his wet food by hand when weaning him off the kitten formula way back when he was a wee little rescued feral. 7 years later -- and I'm still feeding this big hunka-hunka hungry love by hand. He won't eat from a bowl. Goodness knows I've tried over the years, but he'd rather not eat than reduce himself to eating from the cat food bowl. I probably should have never admitted that lol!

 

[Cheryl and Yoda]

Hi Essie. If BI wanted to make a prozinc insulin specifically for cats, why did they not go with an animal source protamine zinc insulin, which, as Elizabeth Hodgkins stated in her book “Your Cat”, “is by far the most effective form of insulin available for use in the diabetic cat today. Beef and pork insulin molecules more closely resemble natural feline insulin and give the greatest response for the lowest dosages in the vast majority of feline diabetics.” Of course, as you said, our cats clearly did not read BI’s marketing materials, and they probably did not read Dr. Hodgkins book, either.

Thanks for the video link to Tresiba’s mechanism of action. I wondered how it worked.

That was an interesting study on the glucose meters. However, my two alphatrak2 meters did not read that study. Both of my meters consistently read about 15-20 points lower than the actual lab values when tested on the same blood sample, except when Yoda’s BG is very high (high 400’s), then my meters read as much as 50 points lower than the actual lab value. But they have both always read lower than the actual lab value. That is probably why when she reaches the 40’s, she is fine (well, hungry). And the two times that I ever saw her hit the 30’s, she was talkative, and insistently hungry, but otherwise fine. But even though she has never had a serious hypoglycemic reaction, I don’t want her going into the 40’s, and especially NOT the 30’s! Because you are right . . . Better safe than sorry!

So Sam hates change . . . Sounds like a kitty after my own heart!

 

[Bellasmom]

Is treseba expensive?

 

[Sam & Esse]

Is treseba expensive?

Hello

I get Sam's Tresiba from Mark's in Canada. For the 5-pack of pens, shipping, and the insulated box it's right around $235.00. So, a bit more than Levemir and Lantus, but in my mind it's roughly the same price A bit of a bonus that levels the price (to me) is that Tresiba can sit out at room temperature for 8 weeks. So with Sam's current dosage, if by some chance I forget and leave a pen out on the counter -- I know I can safely finish off that pen before the insulin goes bad. Or if I need to travel with the boy, I don't need to take extra precautions to keep the pen refrigerated.

 

[Bellasmom]

Hello

I get Sam's Tresiba from Mark's in Canada. For the 5-pack of pens, shipping, and the insulated box it's right around $235.00. So, a bit more than Levemir and Lantus, but in my mind it's roughly the same price A bit of a bonus that levels the price (to me) is that Tresiba can sit out at room temperature for 8 weeks. So with Sam's current dosage, if by some chance I forget and leave a pen out on the counter -- I know I can safely finish off that pen before the insulin goes bad. Or if I need to travel with the boy, I don't need to take extra precautions to keep the pen refrigerated.

Thank you