Hi, everyone! Been lurking for a bit and reading extensively-- what an incredible wealth of information and support! I'm trying to determine next steps for my 11-year-old Maine Coon, Zen.
We've been following TR as much as our vet is comfortable, and his neuropathy got really bad for a bit. He started on Zobaline last week and is already showing improvements. My only source of worry at this point is what seems to be really unpredictable BG. Here's his spreadsheet-- pay closer attention to anything after 5/12, which is when we finally got him all the way off of dry food.
It seems like it's getting harder and harder to predict when he's going to go borderline hypo. My questions:
Zen's story so far, for context:
We've been following TR as much as our vet is comfortable, and his neuropathy got really bad for a bit. He started on Zobaline last week and is already showing improvements. My only source of worry at this point is what seems to be really unpredictable BG. Here's his spreadsheet-- pay closer attention to anything after 5/12, which is when we finally got him all the way off of dry food.
It seems like it's getting harder and harder to predict when he's going to go borderline hypo. My questions:
- I know ECID, but is this even remotely expected? Does this look like we're creeping toward an OTJ trial, or is he just entirely too unpredictable?
- It looks like 1 unit might be too much for him when he's only on the Tiki Cat (we made the switch from DM to Tiki Cat exclusively yesterday when he was too low to dose yesterday morning), but 0 units doesn't seem like it's enough (unless we think his liver panicked from the previous borderline hypo event). We're still within the window of the last reduction, so I don't want to reduce again unless we think it's necessary...
Zen's story so far, for context:
- Diagnosed with Hypertrophic Cardiomyopathy: June 2019
- Diagnosed with Diabetes Mellitus: March 2021
- He came down with Diabetes very suddenly. His labs and prognosis from his yearly checkup and echocardiogram in Feb 2021 were all absolutely beautiful, though he'd started to lose weight a bit more rapidly than we liked, so the vet asked us to change his food out from Science Diet Perfect Weight (dry food, and SO high in carbs) to something a little higher in calories so we could put some meat back on his bones. I'm sure it was a very stressful day for him, and so when we got him home and switched the food (Science Diet Sensitive Stomach), all of a sudden he had diarrhea and wasn't eating. We put him back on his old food and still wasn't getting better, so we called the vet and got an antibiotic for the stomach bug we all thought he had. He continued to deteriorate, and when I showed up at the vet on March 17th, he was well into DKA. So, he spent a few nights in the hospital, but the hospital vet really believes that he's a good candidate for remission. When we got him home, it still wasn't clear whether this was truly Diabetes or if maybe it was actually a bout of acute pancreatitis that threw his numbers way out of whack. We put him on Tiki Cat when we got home, but the vet specifically asked us to feed him ProPlan DM wet and Hill's m/d dry, so we've been doing that for quite some time. When we switched him to DM and Hill's m/d dry food exclusively, it became clear that he was definitely diabetic, but clearly quite sensitive to the insulin (glargine/Lantus). .5U was too much for him, and the vet didn't really want to venture into .25U territory. We tried him on NPH for a while, but were largely unsuccessful. (Peaks too high; nadirs too low to increase.) So, we switched him back to glargine/Lantus, and he's been fairly predictable, if not still way too high for most of the time he's been on it.
- Along the way, his usual vet at the specialty place had to go on a leave of absence, so we started working with a new vet. She's just a good, but a bit more tentative about increases than we were used to. She doesn't really like to see anything much below 100 because of the possibility of going hypo. The previous vet was okay with much lower nadirs in the name of getting him into tight regulation as quickly as possible (obviously avoiding hypo to the best of our abilities).
- Then the neuropathy started...and got much worse VERY quickly. We were starting to wonder if Zen's quality of life had permanently deteriorated, and the vet didn't give us great news when she told us that he may not bounce back from the neuropathy even if we get his numbers under control, and she honestly didn't feel like it was likely that we were even going to be able to get him into tight regulation. But, one of her previous patients (obviously a frequenter of the board) had told her about Zobaline, and she recommended it to us as a last resort. We started giving it to him and saw improvements within the week. We also had started introducing Tiki Cat mousse into his diet toward the beginning of the month (replacing one of the cans of DM with two packets of mousse).
- Sometime during the first week of May, we started weening him off of the dry food at night. This had a significant impact on his BG throughout the day, but still not enough to not require an increase. We snuck him up to 2.2U on 5/13 but then, he started to get too low to dose in the mornings. (He doesn't eat overnight unless we put down dry food, and we're really trying to avoid that entirely.) So, we decreased his dose back to 2U, and he still had a hypo event (Alpha Trak read 37 on 5/15), when we dialed him back to 1.5 after that, he was still too low to dose one morning (5/18). When he was too low to dose on 5/18, we made the decision that we should go ahead and trial Tiki Cat exclusively to see if we can keep him from spiking too terribly over the course of the day. He still spiked, but then, he hit the floor again on 5/19, after breakfast and 1U.
We found an interesting outlier when he went hypo on the 15th-- the Alpha Track was actually lower than the Libre at that point.
