Glucose Toxicity

[Bobbie And Bubba]

Does anyone have any experience in either of these methods to break though when numbers won't drop?

Various methods through this "glass floor" have been tried, to varying degrees of success. One way is to continue gradually raising insulin dosage until the tissues pick up the insulin and start absorbing glucose, then quickly back off to a lower dose. Another is to "jumpstart" the process with a fast-acting insulin or a deliberately high dose of the regular insulin, then quickly back off to a lower dose. Another is to reduce the carbohydrate content of the food further, or to eliminate dry food entirely (even low-carb dry food), thereby presenting less of an obstacle for insulin effectiveness and reducing insulin needs. Aggressive attempts to break glucose toxicity are best regarded as dangerous and should be addressed in close partnership with a diabetes-experienced veterinarian.

 

[Squalliesmom]

I read that same article. I would think the first method, if at all feasible, is something that should be done at the vet's, with staff on standby for a probable serious hypo. I think eliminating all dry food is a great idea, it really worked for Squallie; I'm convinced he would not be where he is now without my aggressive campaign to completely remove dry food from all my kitties' diets.

 

[SpecklesandMe]

I don't have experience with any of that but wanted to say that I hope Bubba's okay! Sending healing vines!

 

[Sue and Oliver (GA)]

Answered on ProZinc.

 

[granadilla]

Oh Bobbi. It hasn't been easy with Bubba lately, has it? I'm sorry to hear you're dealing with this. I don't know anything about it so I'll just offer support and hugs.

 

[Bobbie And Bubba]

Oh Bobbi. It hasn't been easy with Bubba lately, has it? I'm sorry to hear you're dealing with this. I don't know anything about it so I'll just offer support and hugs.

Thanks Shane! After the surgery was behind us, I thought it would get easier. Wrong! The Bubster has his own wacky agenda.

 

[Carol & Murphy (GA)]

I'm confused what they are saying about even low carb dry food - does this mean that Young Again despite near zero carbs, is still bad?

 

[Julia & Bandit (GA)]

I'm confused what they are saying about even low carb dry food - does this mean that Young Again despite near zero carbs, is still bad?

Yes, it can be for some cats. Dry food, even the lower carb ones, must use some kind of binder to hold the food together during the manufacturing process. Because of this, these foods typically have a higher glycemic index than canned foods with equal or higher carb contents. We push low carb foods here because typically low carb=low glycemic, except when it comes to the low carb dry foods. Many diabetic cats can see a significant increase in their BG that they won't see with lower glycemic canned food. For example, Bandit can eat different flavors of Weruva canned at 9% carbs with no negative effect on his BG, but if he eats just a few pieces of EVO dry at 8% carbs, we see a spike of about 100 points in his BG.

Also, the low carb dry food still has the problem of being chronically dehydrating--Diabetic cats already are seeing strain on their kidneys, so they need to be kept as hydrated as possible to avoid kidney and urinary tract issues, and a cat eating dry food never makes up the loss of that moisture in their food at the water dish, no matter how much you see them drink. That's why I don't recommend any dry food unless it's an absolute last resort because the cat has repeatedly refused multiple attempts to transition it to canned food.

I freeze food and use auto-feeders for my cats when I'm not home to feed them, and it works great! Not a whole lot less convenient than dry food.

 

[Sharon14]

I just started giving Colin some YAZCM, and haven't seen a difference in his BG's. I did see them go up when I gave him some Evo dry. I don't give him much, and he still gets mostly canned food, but it seems to satisfy his hunger so much better. We'll see if this holds over time.

 

[Julia & Bandit (GA)]

Also, I think Young Again is being a bit duplicitious with its "Zero Carb " claim. There's no way it's actually zero carbs, because that's impossible, because it would be a powder if it didn't have a starch binding it together. If you look at the dry-matter analysis YA released (I haven't actually ever seen as-fed values for them anywhere), it says zero digestible carbs. That means (unlike all the other brands that include their total carb content, like EVO), they are excluding carbs from sugar alcohol and fiber in their count. You see this same phenomenom in highly processed, packaged foods marketed to humans as "low carb", when in fact they have quite a high carb content from fibers that have been added to reduce the total "net" carb count. While there hasn't been studies done on cats with these types of "stealth" fibers, most human nutritionists agree that they do not have the same impact on blood glucose levels as naturally ocurring fiber, and this can have a detrimental effect on the blood glucose of human diabetics. That's why there are people rallying for more transparent labeling when it comes to these carbs that don't get reported as carbs.

Just some food for thought! (Pun intended).

 

[Carol & Murphy (GA)]

thanks Julia - I really wasn't aware of that I had thought YA= low carb wet. I agree with Sharon however. - I had bad luck with Evo, but YAZC hasn't affected Murphy's #, as far as I can tell. Murphy will be hungry less than 1 hour after eating ~ 3 oz of canned food - but about 20 kibbles of YA and he's good for several hours. I'll have to pay closer attention to this

 

[Julia & Bandit (GA)]

thanks Julia - I really wasn't aware of that I had thought YA= low carb wet. I agree with Sharon however. - I had bad luck with Evo, but YAZC hasn't affected Murphy's #, as far as I can tell. Murphy will be hungry less than 1 hour after eating ~ 3 oz of canned food - but about 20 kibbles of YA and he's good for several hours. I'll have to pay closer attention to this

The problem is you won't know exactly how much it could be effecting his BG until you stop feeding it for a period of time. What you think is "good" control could possibly be even better control without the food if the YA is raising his BG an average of lets say, 20-50 points per feeding vs. the 100 or more you might have seen with EVO. I've seen a diabetic cat that got pulled out of remission and needed insulin again because the owner started feeding YA zero carb, and went back into remission after they went back to all canned and a short course of insulin, and I've also seen a diabetic cat in remission that (as far as I still know, I haven't seen that person in some time) had normal BG on YA. The thing is, you won't know which yours is until you reach that point, so unless there's a really, really good reason you need to feed it, it's best to just ditch the dry, IMHO, and save yourself the headache of dealing with it and its potential effects on BG.

Also, there's still that chronic dehydration issue. Which is incredibly important and gets overlooked constantly. Especially with older cats that are likely to have some form of early stage CKD, even if it hasn't shown up in their bloodwork yet (CKD typically doesn't show up in bloodwork until the cat has lost more than 2/3 of their kidney function--you want to head it off before you get to that point). And urinary tract infections can cause high BG.

 

[Carol & Murphy (GA)]

I was just thinking mostly wet plus a little dry in between meal. As I said, with just wet alone, Murphy is always hungry. He's hungry an hour after eating half of a 5.5 oz can I'll keep a close watch of any difference when he does get a little dry -- Evo most definitely raised his sugar A LOT.

 

[Jill & Alex (GA)]

Also, I think Young Again is being a bit duplicitious with its "Zero Carb " claim.

Some FDMB members have since calculated out the percentage to be 5% carbs on the YAZC.

 

[Julia & Bandit (GA)]

@Carol & Murphy How many times a day do you feed? I found that feeding my cats 4x a day (with a low carb snack/treat now and then, like the Fancy Feast Purely, a few spoonfuls of weruva or some freeze dried treats) was the magic number to keep them from acting hungry outside of meal times. Typically, I've found mine aren't really hungry if they are begging outside of meal time, they just want treats or snacks and then are fine. I freeze food and set an autofeeder for when I'm at work or need to feed during bed time, and it works great. The cool thing about auto feeders is that you can set them and feed as many times a day you need to keep your cat happy. I realize this doesn't always work with households with more than 2 or 3 cats, but you can also leave extra soupy canned food or frozen food nuggets out as well if you have more cats than you can accommodate with auto feeders.

And I want to say, I know there's a lot of YAZC feeders here and I'm not trying to criticize anyone's treatment plan if it's working well for them. But my experience has led me to believe that dry=typically bad news for diabetics (or in general), even if it's low carb, which is why I'm not a fan.

 

[Julia & Bandit (GA)]

@Jill & Alex (GA) Yup, sounds more right to me. I figured it was probably lower than EVO, but no way is it actually zero carbs.

 

[Netty N.]

Can you link to that article Bobbie? I hope someone with experience will respond to your post - I'm very curious too.

 

[Chris & China (GA)]

I think it's from a Wiki article on Glucose Toxicity

 

[Jill & Alex (GA)]

Does anyone have any experience in either of these methods to break though when numbers won't drop?

Yes, some.

One way is to continue gradually raising insulin dosage until the tissues pick up the insulin and start absorbing glucose, then quickly back off to a lower dose.

Randi's Max was gradually brought up the dosing scale mostly in increments of 0.25 unit. She had to take Max up to 6u bid before seeing a marked break through. After successfully causing a break through at 6u you can see not only see how rapidly Max came down the dosing scale, but his spreadsheet also illustrates the dramatic and rapid reductions taken in an effort to stay ahead of him and maintain control in order to keep him safe.
Max's spreadsheet can be found here: https://docs.google.com/spreadsheets/d/1j0aIMEQZN-jbTzu36sxdaQMoVrDNSlyIrcrYTWrg64o/pub?output=html

Another is to "jumpstart" the process with a fast-acting insulin or a deliberately high dose of the regular insulin, then quickly back off to a lower dose.
(emphasis mine)

I haven't seen anyone use this technique in quite awhile and when I did I can't say it was done with what I would describe as a "a high dose" of the basal insulin. What I did see was shooting a little higher dose (up to 0.25u) of the basal insulin on a higher BG number and then immediately backing the dose down to the regular dose at the next shot. I looked to see if I could find any spreadsheets to use as examples, but I couldn't. I'm not even sure anyone would record it on their spreadsheet because it wasn't something that was normally done or talked about if you did do it. In other words, it was frowned upon with the depot insulins... while at the same time not a big deal for PZI users who were used to adjusting dose amounts often from shot to shot. However, I have heard of vets jump-starting the process with high doses of the basal insulin (sometimes frequent doses), but it's not a technique I would ever suggest for home use. Vets are prepared to deal with hypoglycemic episodes in their clinics quickly and more efficiently than we can at home. We cannot respond as quickly or effectively if problems arise.

As far as using fast-acting insulins go...
I've only seen them (mostly R, occasionally N) used by Lantus, Levemir, and PZI users as a bolus with the intent of bringing a cycle down 50 - 100 points so the basal insulin had a lower number to "grab onto"... thereby lowering the entire cycle. This has always been considered an advanced technique on the FDMB because if not executed properly can be very dangerous. It's also not a technique for every cat. The response of some cats isn't conducive to the use of a bolus insulin. If a caregiver is having difficulty bringing down BG numbers, I strongly suggest discussing as well as seeking guidance from those who are experienced in it's use before attempting it yourself. I've never used N, but a teensy-tiny 0.1u dose of R had the ability to bring Alex's BG numbers down well over 100 points in a single cycle (and she's not the only cat who has had that same response)! I would be remiss if I didn't mention one never, ever wants the nadirs of a basal insulin to coincide with that of the bolus insulin. Seriously, R or N (preferably R) is a good tool to have in your toolbox as a bolus insulin, but should initially be used under guidance only.

 

[Bobbie And Bubba]

Yes, some.

Randi's Max was gradually brought up the dosing scale mostly in increments of 0.25 unit. She had to take Max up to 6u bid before seeing a marked break through. After successfully causing a break through at 6u you can see not only see how rapidly Max came down the dosing scale, but his spreadsheet also illustrates the dramatic and rapid reductions taken in an effort to stay ahead of him and maintain control in order to keep him safe.
Max's spreadsheet can be found here: https://docs.google.com/spreadsheets/d/1j0aIMEQZN-jbTzu36sxdaQMoVrDNSlyIrcrYTWrg64o/pub?output=html

I haven't seen anyone use this technique in quite awhile and when I did I can't say it was done with what I would describe as a "a high dose" of the basal insulin. What I did see was shooting a little higher dose (up to 0.25u) of the basal insulin on a higher BG number and then immediately backing the dose down to the regular dose at the next shot. I looked to see if I could find any spreadsheets to use as examples, but I couldn't. I'm not even sure anyone would record it on their spreadsheet because it wasn't something that was normally done or talked about if you did do it. In other words, it was frowned upon with the depot insulins... while at the same time not a big deal for PZI users who were used to adjusting dose amounts often from shot to shot. However, I have heard of vets jump-starting the process with high doses of the basal insulin (sometimes frequent doses), but it's not a technique I would ever suggest for home use. Vets are prepared to deal with hypoglycemic episodes in their clinics quickly and more efficiently than we can at home. We cannot respond as quickly or effectively if problems arise.

As far as using fast-acting insulins go...
I've only seen them (mostly R, occasionally N) used by Lantus, Levemir, and PZI users as a bolus with the intent of bringing a cycle down 50 - 100 points so the basal insulin had a lower number to "grab onto"... thereby lowering the entire cycle. This has always been considered an advanced technique on the FDMB because if not executed properly can be very dangerous. It's also not a technique for every cat. The response of some cats isn't conducive to the use of a bolus insulin. If a caregiver is having difficulty bringing down BG numbers, I strongly suggest discussing as well as seeking guidance from those who are experienced in it's use before attempting it yourself. I've never used N, but a teensy-tiny 0.1u dose of R had the ability to bring Alex's BG numbers down well over 100 points in a single cycle (and she's not the only cat who has had that same response)! I would be remiss if I didn't mention one never, ever wants the nadirs of a basal insulin to coincide with that of the bolus insulin. Seriously, R or N (preferably R) is a good tool to have in your toolbox as a bolus insulin, but should initially be used under guidance only.

Thanks so much for all this great information! It is certainly something I would not do on my own. We have an appointment with a new vet on Monday, hopefully one who is more Feline Diabetes to date. I will discuss this with her. It's good to know that there are resources out there in the event that I can't get Bubba's flat cycles to stop. Again, thanks for all this good info, I appreciate the time you took to share it.

 

[Bobbie And Bubba]

The problem is you won't know exactly how much it could be effecting his BG until you stop feeding it for a period of time. What you think is "good" control could possibly be even better control without the food if the YA is raising his BG an average of lets say, 20-50 points per feeding vs. the 100 or more you might have seen with EVO. I've seen a diabetic cat that got pulled out of remission and needed insulin again because the owner started feeding YA zero carb, and went back into remission after they went back to all canned and a short course of insulin, and I've also seen a diabetic cat in remission that (as far as I still know, I haven't seen that person in some time) had normal BG on YA. The thing is, you won't know which yours is until you reach that point, so unless there's a really, really good reason you need to feed it, it's best to just ditch the dry, IMHO, and save yourself the headache of dealing with it and its potential effects on BG.

Also, there's still that chronic dehydration issue. Which is incredibly important and gets overlooked constantly. Especially with older cats that are likely to have some form of early stage CKD, even if it hasn't shown up in their bloodwork yet (CKD typically doesn't show up in bloodwork until the cat has lost more than 2/3 of their kidney function--you want to head it off before you get to that point). And urinary tract infections can cause high BG.

This is interesting as I just started giving Bubba 1 tbsp. a day to round out his caloric intake from wet food. I started 2 days post surgery. So for me to stop it now and see if it makes a difference would be mute because we are in the process of slowly raising his dose again. It would probably not show me anything if I stopped it now because I wouldn't know if it were the YA or the increase in insulin that brought his numbers down. It will be a good experiment when he is regulated.

 

[Bobbie And Bubba]

Also, I think Young Again is being a bit duplicitious with its "Zero Carb " claim. There's no way it's actually zero carbs, because that's impossible, because it would be a powder if it didn't have a starch binding it together. If you look at the dry-matter analysis YA released (I haven't actually ever seen as-fed values for them anywhere), it says zero digestible carbs. That means (unlike all the other brands that include their total carb content, like EVO), they are excluding carbs from sugar alcohol and fiber in their count. You see this same phenomenom in highly processed, packaged foods marketed to humans as "low carb", when in fact they have quite a high carb content from fibers that have been added to reduce the total "net" carb count. While there hasn't been studies done on cats with these types of "stealth" fibers, most human nutritionists agree that they do not have the same impact on blood glucose levels as naturally ocurring fiber, and this can have a detrimental effect on the blood glucose of human diabetics. That's why there are people rallying for more transparent labeling when it comes to these carbs that don't get reported as carbs.

Just some food for thought! (Pun intended).

This is from their website for why they are different. They say they use no plant fillers, is fibers different?
http://www.youngagainpetfood.com/the-difference.html

 

[Bobbie And Bubba]

Also, I think Young Again is being a bit duplicitious with its "Zero Carb " claim. There's no way it's actually zero carbs, because that's impossible, because it would be a powder if it didn't have a starch binding it together. If you look at the dry-matter analysis YA released (I haven't actually ever seen as-fed values for them anywhere), it says zero digestible carbs. That means (unlike all the other brands that include their total carb content, like EVO), they are excluding carbs from sugar alcohol and fiber in their count. You see this same phenomenom in highly processed, packaged foods marketed to humans as "low carb", when in fact they have quite a high carb content from fibers that have been added to reduce the total "net" carb count. While there hasn't been studies done on cats with these types of "stealth" fibers, most human nutritionists agree that they do not have the same impact on blood glucose levels as naturally ocurring fiber, and this can have a detrimental effect on the blood glucose of human diabetics. That's why there are people rallying for more transparent labeling when it comes to these carbs that don't get reported as carbs.

Just some food for thought! (Pun intended).

This is from their website for why they are different. They say they use no plant fillers, is fibers different?
http://www.youngagainpetfood.com/the-difference.html

 

[Bobbie And Bubba]

Randi's Max was gradually brought up the dosing scale mostly in increments of 0.25 unit.

How do I shoot 0.25 units? Is there a syringe that has that increment marked? Or are people just eyeballing it on a U40 syringe?

 

[Carol & Murphy (GA)]

How do I shoot 0.25 units? Is there a syringe that has that increment marked? Or are people just eyeballing it on a U40 syringe?

I just eyeball a U40 with half unit markings

 

[Carol & Murphy (GA)]

This is interesting as I just started giving Bubba 1 tbsp. a day to round out his caloric intake from wet food. I started 2 days post surgery. So for me to stop it now and see if it makes a difference would be mute because we are in the process of slowly raising his dose again. It would probably not show me anything if I stopped it now because I wouldn't know if it were the YA or the increase in insulin that brought his numbers down. It will be a good experiment when he is regulated.

Bobbie - I am going to try not to give Murphy any YA today to see if it makes a difference. But I do tend to have faith in the YA company-

 

[Sharon14]

How long would you have to go YA free to be sure it's the food change and not just 'one of those cycles'?

 

[Bobbie And Bubba]

I just eyeball a U40 with half unit markings

Thanks Carol, I have been wondering how peeps were doing it.

 

[Bobbie And Bubba]

Bobbie - I am going to try not to give Murphy any YA today to see if it makes a difference. But I do tend to have faith in the YA company-

I started giving him 1 tbsp. again on 10.31. He was post surgery and I saw no hikes. Let me know if you see any difference.

 

[Carol & Murphy (GA)]

How long would you have to go YA free to be sure it's the food change and not just 'one of those cycles'?

good point - don't know - I may just do for this cycle

 

[Julia & Bandit (GA)]

This is from their website for why they are different. They say they use no plant fillers, is fibers different?
http://www.youngagainpetfood.com/the-difference.html

They say they don't use plant proteins as fillers. They don't say anything about using them as fillers for carbs. Just by using the term "digestible" carbs in their dry matter analysis, that tells you there are other sources of carbs in the food, and they're just not reporting them all in that number.

Bobbie - I am going to try not to give Murphy any YA today to see if it makes a difference. But I do tend to have faith in the YA company-

You would need to stop feeding it more than a day to see if it has any effect on his BG. I would say you might be able to tell from a few months or so worth of numbers, maybe, if the cat is well regulated. But I don't know why you would want to experiment if it's within your means to just cut the food out and not worry about it. The cat I knew that came out of remission on YAZC had normal numbers for almost a month before his BG started slowly creeping up on the food. And he was in remission so that creep was easy to spot. And despite discontinuing the food, his BG continued to creep up for another few weeks until he went on insulin again, and then went back into remission. The effects of carbs/higher glycemic foods isn't as simple as, I feed my cat this food, it raises his BG x points, and then it goes away (even though sometimes we can see that fast and easy cause/effect relationship in certain cats with certain foods). Every cat is different, and how dry food contributes to glucose toxicity in the cat is also going to be different and possibly present itself over an extended period of time.

Also, and I can't say this enough, the carb level has nothing to do with the fact that ALL dry foods, including the low carb ones, present other health problems down the road (especially for senior cats) that have nothing to do with the BG. Let's say I wanted to experiment and start feeding Bandit YAZC tomorrow, and despite the risk of him coming out of remission on it, after 3 months or so his BG is still ok. Even then, I still shouldn't feed it to him. Because he's 13, and we need to think about his kidneys and urinary tract health, as he likely does not have full kidney function at this stage of his life.

I'm not saying YA is a "bad" company out to harm our diabetic cats. (I would say that about Hills, but that's a different rant.) I am saying, however, that 1. not all diabetic cats can handle low carb dry food and it's hard to tell if the cat is one of those that can handle it without potentially impeding your cat's course of treatment, and 2. even if your cat is one of the ones that handles it fine, the dry food is bad for diabetics anyway because of the effect it has on the cat's kidneys and urinary tract. And there is a need in the market for a low carb dry food for those special cases where the cat literally won't eat anything else, or other special circumstances where it's absolutely necessary and those health risks are worth the benefit (e.g. it's better the cat has an increased risk of kidney damage than starve to death). But if you're not one of those circumstances, then I don't see the point of feeding it.

 

[Jill & Alex (GA)]

Thanks so much for all this great information! It is certainly something I would not do on my own. We have an appointment with a new vet on Monday, hopefully one who is more Feline Diabetes to date. I will discuss this with her. It's good to know that there are resources out there in the event that I can't get Bubba's flat cycles to stop. Again, thanks for all this good info, I appreciate the time you took to share it.

You're welcome!
Good luck with the new vetty-bean! Give a holler if you need some help...

 

[Carol & Murphy (GA)]

Bubba - 214!!!! go, baby