It’s been a while that I’ve posted news about Buddy. He’s doing well, and he is happier and more active than anytime in the past few years!
Summary of the past three months:
- End of January 2024, a CGM recheck showed his blood sugar was trending high.
- Close monitoring of his behavior in relationship with his blood sugar showed that his anxiety surrounding food coincides with his blood sugar rise, and immediately after he starts eating, his BG drops. He vocalizes loudly when he gets hungry and becomes very stressed.
- >>> Cortisol appears to be a significant driver of his blood sugar increase.
- After a few days on the CGM, his blood sugar remained elevated, and I restarted insulin – hoping to re-kickstart his own insulin production, by keeping his BG in normal range and save what could be saved of his remaining beta cells #glucotoxicity
- We used injections of insulin glargine for about 3 weeks – initially once per day, then once every other day – one unit only.
- His BG came under control but was definitely elevated. Mid of February, we paused injections – a risk/benefit calculation.
- We were away for 2 weeks, and he had been holding his own alright.
- He reacts surprisingly drastically to glargine/Lantus – quick onset and short insulin action 6-8 hours. Insulin glargine is “supposed” to have a flat action curve, and last 12 – 24 hours. But for some patients it does not work like that. He seems to be one of them. Without CGM, we would not know that.
- We used some new strategies to keep him from removing his sensors, and the few omnipods he used. (Harness and Thundershirt)
- It helped tremendously, to keep the appliances on the cat for the entire time (+14 days on two of his FreestyleLibre sensors, and full 3.3 days on his omnipods.
- It helped to allow the shaved areas to regrow his hair – and protect his skin from his thorny rough tongue and extended time with abrasions and potential infections.
- When we returned in late February, his blood sugar was high. I restarted intensive treatment, including several Omnipods.
- This time, Buddy was on iAPS and Omnipods starting Tuesday March 5, 2024 until just after midnight Tuesday March 12, 2024 – a good week.
- He was wearing a CGM starting February 28, for a month. The weekly and daily curves are below.
- After a week on iAPS, we switched to occasional glargine injections. 1 IU is very challenging to draw up, and I started researching alternative insulins.
- Then, Buddy went back into remission. So far so good. ❤️❤️❤️
- When/if he has to go back on insulin, we will find a solution that works for him.
- Omnipods and iAPS are awesome to keep him under tight control, but Omnipod pose some challenges. (Fairly large areas of his skin must be shaved, and the pods last max 3 days 8 hours)
- Long term, it would be best if he did not use pods consistently, but would get away with one injection per day. With glargine, that does not seem to be in reach.
- Using an injectable insulin that does not cause him to drop precipitously with a short duration of insulin action would help. There are some candidates.
- Potentially, we could use one of the newer very small pumps that use infusion sets (small adhesive footprint compared to Omnipods), coupled with a ThunderShirt or modified harness to help him carry the small pump.
- We had tried out a 5series Medtronic pump, but I only had straight infusion sets (MIO), and they don’t work for him – he needs an infusion set that inserts in an angle, like Omnipods do.
- In other great news – he has lost weight (safely, over many months), and he looks great. Today, his weight was 14.610 lbs, down from 17.6 lbs a year ago.
- 13 months after his initial diagnosis, it had become clear that he was back to being able to manage his blood sugar with his remaining beta cells.
- Next CGM check is planned to be in May. I am trying to find some libre3, as they are small, and if he is not using iAPS, they would work perfectly.
Here are the daily curves. Remember – the insulin dose is for U10 diluted insulin – so we must divide the number by 10, to know the actual dose in IU.
