Case:Tilly

Tilly:Feline
Female domestic shorthair
Tilly
Born	Oct-1996
Dx	Mar-2004
Oral meds	None:
Regulated	Feb-2005
Regulated between 80 and 200
Aimed for nadir at 80, as much time as possible <200 with Ultratard, testing BGs weekly. With Lantus I pushed her into the normal range, testing BGs more often.
Remission	Mar-2005
Insulin	Lantus

Tilly's Diabetes Homepage

Lots more, including a tight-regulation protocol for Lantus/Levemir and links to the newest feline diabetes research papers, at Tilly's Diabetes Homepage.

Mar 2004: Diagnosis and Caninsulin

Tilly was diagnosed in March 2004. Two months previous to diagnosis, she had received a depot cortisone injection for an itchy spot on her ear. In retrospect I think Tilly was in a very bad state and had many of the symptoms of early ketoacidosis. I used Caninsulin for 8 months. This insulin was a disaster for Tilly because of its short duration and steep curves - her overall condition, after an initial improvement, slowly became worse and worse. I began testing for ketones in Tilly's urine on a weekly basis when I tried the start low-go slow approach with Caninsulin. I should have started testing for ketones much sooner, but it took me a while to figure out that I need to do this. Tilly developed ketones at very low doses.

Aug 2004: New Vets and Low-Carb Diet

An important component in Tilly's success was her excellent Canadian vet whom I found 5 months into her illness and who advised me via regular phone consultations. Additionally, I switched vets in Germany too. My Canadian vet easily pursauded me to ban all kibbles. I was extremely strict with Tilly's diet, starting in August 2004, sticking to high-quality very low-carb_diet. Tilly was also a free-feeder, although with Caninsulin I tried to make sure she had a big meal at shot time. I supplemented her diet with taurine because I've read research papers showing beneficial effects on kidney function, blood lipid and glucose values.

Nov 2004: Ultratard

After 8 months of Caninsulin we gave up and we switched to ultralente Ultratard (very similar to Humulin U) which was a great improvement, although it worked very variably from day to day: Tilly started looking better, she gained weight, had reduced thirst and hunger and was more active. By February 2005, I was in the process of decreasing the dose because she required less insulin.

I never practiced tight-regulation with Ultratard. I dosed BID, aiming for a nadir of 80 and as much time as possible under the renal threshold of 200. However, I did aim to get as much overlap as possible and tried to dose consistantly, even at low pre-shots. I tested BGs once per week, or more often if Tilly was ill or some other factor was abnormal.

Mar 2005: Lantus and Remission

Finally I switched to Lantus, because of the new research showing high remission rates. I used the dosing recommendations found in the literature. This insulin finally seems to have given Tilly the duration she needed to push her into remission. Tilly went into remission in March 2005, in less than one week of switching to Lantus. I never expected Tilly to go into remission so quickly.

With Lantus the dosing situation was slightly different: I was braver, pushing Tilly into the normal range and testing more often. This change in procedure was due to a learning process on my part, the fact that Lantus was shown to have more even BGs and fewer hypoglycemic events in the literature and that I was using the Lantus protocol which said to continue giving insulin for at least 2 weeks. I didn't quite manage to reach two weeks, because my decision was to stop giving insulin when Tilly had a BG of <50 with just a drop of insulin.

Today

Tilly continues to do very well, with very stable normal BGs between 60 and 80. The highest I've measured since April 2005 is 88. I now test Tilly's BG about once a month, watch how much she urinates closely and monitor her weight. I continue to feed low-carb (in fact, I recently switched to raw) and avoid cortisone. I had her blood tested for kidney function in November 2005 and all the values were normal. At the same time, she was also (finally) diagnosed with the tooth disease FORL. She has had it since she was a kitten, but until recently I didn't have a vet who did the necessary tests for her to have a proper diagnosis. However, having few teeth left doesn't appear to affect her quality of life.

February 2006.