Help needed interpreting Cher's high numbers, please

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Jancol & Cher

Jancol & Cher

Member Since 2017
Hi Everyone
Just wondering if someone is able to help interpret Cher's SS and offer any suggestions as to how best manage her BG levels.

I did post originally on the Main forum but it was suggested I post here.

Basic Medical History 2017:
Pancreatitis and Ureteral Stones (Subcutaneous Ureteral Bypass) 20 Feb
Pancreatic cyst
IBD diagnosed via Endoscopic biopsy 13 Jun
Prednisolone 5mg BID commenced 15 Jun to treat IBD
Diabetes diagnosed 22 Jun
Hills ZD Diet for IBD (high in carbs)

Diabetes managed by IM Vet:
22 Jun - Lantus 1 unit daily - ceased Lantus 24 Jun - possibly in remission
26 Jun - Prednisolone reduced to 7.5mg daily
29 Jun - Lantus 1 unit BID restarted - increased to 2 units BID 30 June
14 Jul - Prednisolone reduced to 5mg daily
24 Jul - Lantus increased to 3 units BID
5 Aug - Lantus increased to 4 units BID
21 Aug - Prednisolone reduced to 2.5mg daily
30 Aug - Lantus reduced to 3 units BID

Our IM vet prefers that BG levels be tested for curves only.
My preference is to test before shots and whenever necessary
I have just read today that when PS levels are low, the shot should not be withhold. Unfortunately I have withheld the shot thinking this was the safest thing to do!

With the reduction of the Prednisolone, the BG levels appeared to be coming down, however when I gave Cher her AM shot on 29 Aug, the area around the shot bruised suddenly and then for the remainder of that day, the levels rose until the PM shot was given. Then the numbers fell dramatically at +3 PMPS, continuing to fall until they reached 61 (3.4). This was when I made the decision not to administer the shot. Then the numbers rose with a vengeance.

After this episode, I took Cher to the specialist centre but as our IM vet is currently in Britain, his colleague examined her. She was uncertain about the bruising and did a ProCyte Haematology test which came back OK.

With regard to the rise in BG levels, it was suggested the Lantus may not have been working as it should have been, due somehow, to the bruising.

It was decided the Lantus should be reduced by 1 unit BID from 4 units to 3 units as the reduction in Prednisolone appeared to be lowering the BG levels. I thought of only dropping the Lantus by .05 units but I felt that when I did the new curve on Monday and sent it through to the relieving vet, that she would not appreciate the fact that I had not done what she requested.

We have also discussed with Cher's regular IM vet, that the ZD food is very high in carbohydrates and that we would like to look at changing her food to perhaps 'Raw' or something lower in carbs but he does not support this. He feels that her IBD is more of a priority than the diabetes and she needs a hydrolyzed protein diet. I do agree in that if the IBD is aggravated by a diet change there will possibly be a major problem with trying to get her to eat.

Hoping that someone can help put our little girl back on the right track as she has been struggling with bad health since February.

Thanks,
Jan
 
We have lots of cats here that are dealing with IBD as well as diabetes

As long as you're feeding high carb foods like the "prescription" foods, you're going to have a much harder time controlling the diabetes. There are medications that don't effect the BG as much that can help with the IBD but the main thing is finding out what she's sensitive to and that just takes a lot of detective work on your part. Fish is a common protein in cat food, but it's also a common problem for IBD.....Same with chicken and beef!!

Finding a novel protein (something she's never eaten before) would be what I'd try and see how she tolerates it. Protein sources like rabbit, kangaroo and venison are some to try. There are also some limited ingredient diets for IBD but I'm not sure if you have access to them in the UK
 
It sounds like you both have really been through - and are still going through - a really rough time. I'm so sorry to hear that! I can't give you any advice on your particular issues as I'm still new and learning, myself.

I will just mention one thing from my own experience, in case it's useful for you re: vet's response to testing. Is there a specific reason why the vet doesn't want you to test? My specialist vet also said I didn't need to test and - I think - still thinks I'm a bit of a nut to test as I do. But we had a hypo incident which ended up with Girlie in hospital for a week, and I decided I never wanted to go there again. I wanted to make sure she was safe - especially before a shot.

I now share the FDMB SS with the vet (though she doesn't know I'm getting advice from FDMB - she always agrees with it, though, and is impressed by how knowledgeable I've become! :p). My vet LOVES all of the data and discussing it with me now, thank goodness. I honestly don't know why vets would be against testing unless they had some medical reason. It certainly doesn't hurt the cat, and the data I get really helps me understand how Girlie is reacting to food and insulin and how to best help her. The only negative is the money I have to spend on test strips and lancets, but that's a small thing compared to the satisfaction I get in knowing that she's safe and I'm learning what I need to know. (PS If you look at my SS the past two days, I'm doing a lot more testing that usual because of her circumstances at the moment).

I hope this doesn't come across as telling you what to do! I looked at your SS and saw that you also do a fair bit of testing. I just wanted to support you in that decision and to offer you lots of support for what you're going through. I hope more experienced people here can give you advice, especially on the carb issue in your special circumstance. :bighug::bighug::bighug:
 
Re: the bruising in the shot area: are you rotating where you shoot? I find that that helps with Girlie... I found the "shot placement and overlap" section of this sticky really helpful, and I printed the pic of the cat and tips out for reference. I always shoot my AM shot on her left side and my PM shot on her right side, and I try to think of where I shoot as the face of a clock: start the week at noon and move an hour or so forward (if I'm able to be that specific - can't always do that). I have no idea, though, if that would help with the bruising or if the bruising is a result of your kitty's complicate medical issues. I'm so wishing you luck with everything! :bighug:
 
I used the send my ss to my IM weekly. He showed it to his third year students every time one was there when I was. He said I managed Max's fd better than any of his other clients. All that I learned here.
 
Hi Chris
We know she is sensitive to both chicken and fish but not sure about beef. She is a very fussy eater.

Her vet started her off on Hills AD via an E-tube after her SUB surgery and pancreatitis attack as she was not eating at all. She did not tolerate this well and was then put onto the Hills ZD.

However since her diabetes was dx, we have discussed our concerns frequently with her vet regarding the high carbs (35%) contained in the food but it was his opinion that Cher would have considerable IBD problems with any food other than hydrolyzed. He had experience with raw diets and felt we should continue with the ZD now that her IBD was stable.

My instinct is to try a novel protein food albeit against the vet's recommendations although it is very scary because I know what we went through to get her eating again and stabilised after the IBD saga. We tried for over two months then reluctantly we started the prednisolone which helped the IBD inflammation but probably caused the diabetes. Her prednisolone has been reduced to 2.5mg per day but it would be wonderful if she could cease it altogether in the future.

I will revisit alternative foods and approach him (vet) when he comes back from leave. I did also ask him if there was a substitute for the prednisolone but from memory, I think he said this was the best medication for Cher. I will mention it again.

Thank you for your information and suggestions, Chris
 
Other novel proteins you can find in some canned foods are lamb and duck. Ideally find something called limited ingredient. So many manufacturers put more than one protein in the food. I fed raw to my IBD guy. It was much easier to find proteins he could eat.
 
Girlie's mom said:
It sounds like you both have really been through - and are still going through - a really rough time. I'm so sorry to hear that! I can't give you any advice on your particular issues as I'm still new and learning, myself.

I will just mention one thing from my own experience, in case it's useful for you re: vet's response to testing. Is there a specific reason why the vet doesn't want you to test? My specialist vet also said I didn't need to test and - I think - still thinks I'm a bit of a nut to test as I do. But we had a hypo incident which ended up with Girlie in hospital for a week, and I decided I never wanted to go there again. I wanted to make sure she was safe - especially before a shot.

I now share the FDMB SS with the vet (though she doesn't know I'm getting advice from FDMB - she always agrees with it, though, and is impressed by how knowledgeable I've become! :p). My vet LOVES all of the data and discussing it with me now, thank goodness. I honestly don't know why vets would be against testing unless they had some medical reason. It certainly doesn't hurt the cat, and the data I get really helps me understand how Girlie is reacting to food and insulin and how to best help her. The only negative is the money I have to spend on test strips and lancets, but that's a small thing compared to the satisfaction I get in knowing that she's safe and I'm learning what I need to know. (PS If you look at my SS the past two days, I'm doing a lot more testing that usual because of her circumstances at the moment).

I hope this doesn't come across as telling you what to do! I looked at your SS and saw that you also do a fair bit of testing. I just wanted to support you in that decision and to offer you lots of support for what you're going through. I hope more experienced people here can give you advice, especially on the carb issue in your special circumstance. :bighug::bighug::bighug:
Click to expand...

Hi Girlie's Mom

The reason why Cher's vet doesn't want me to test is "You will become paranoid and will be testing all the time". The other IM vet (young female) whom I saw on Wednesday, doesn't encourage testing either, not sure why though. She suggested implanting some sort of glucometer into Cher which could later be downloaded. We don't have a problem
with testing, in fact like most members here, I would not be game to inject unless I knew the levels. I was told Cher wouldn't go into a hypo whilst she was on the prednisolone however on Wednesday when her levels fell to 3.4, I was so glad I was able to keep testing to see them rise up. I wouldn't have known that she may have been heading for a hypo.

I am not sure I would be game to show Cher's SS to our vets as I don't know how they may react. I was pleased to see your SS as most other SS's I have seen seem to be minus the black and red colours. I hope your Girlie is doing OK?

Re the bruising I think I may have been holding her skin (and muscle?) very firmly and possibly bruised the area. Usually I pull up her loose skin to make the tent but this time the skin didn't appear to be as loose as she was sitting in the hunched position on all fours and the area was a bit lower than I usually select. Not sure what happened but I still feel really bad bruising the poor little girl! The bruise was almost the size of a 50 cent piece. The vet didn't know what could have caused it but I feel it may have affected the action of the insulin as her levels appeared to rise as though she had not had a shot. Not sure if that is possible?? The vet also said I may have hit a capillary but there seemed to be too much bruising for that.


Thank you for the information on "shot placement and overlap". I will print out the pic of the cat and tips.
 
Jancol said:
I did also ask him if there was a substitute for the prednisolone but from memory, I think he said this was the best medication for Cher. I will mention it again.
Click to expand...

The medication I've seen used here is Metronidazole....it's "steroid-like" but it's not usually absorbed the same way steroids are so doesn't usually have the effect on the BG that prednisolone does

There's another one but at the moment my brain can't come up with it....starts with a "B" I think

A good probiotic can help too. I know lots of people use Ultimate Flora (available at WalMart) but there are a million probiotics out there.

Here's some good information on diet too:

Diet. This is a big one, especially with eosinophilic and lymphoplasmacytic IBD. There are three primary diets we will use, hypo-allergenic, grain free, and grain free with minimal preservatives.
§ Hypo-allergenic diets. These are prescription diets designed for cats with food allergies. There are two types, novel protein diets and hydrolyzed diets.

· Novel protein diets. These are diets that do not contain any ingredients found in any over the counter foods. Since your cat cannot have an allergy to something they have never been exposed to, they cannot be allergic to anything in these diets.

· Hydrolyzed diets. These diets use chicken as the meat source, but they break up the chicken in a process called hydrolyzation into such tiny particles, that they cannot physically stimulate an immune response. These diets do tend to use rice as a carbohydrate source. While rice is considered a low allergen, it is still possible, so we will usually only try these diets if your cat will not eat one of the novel protein diets.

§ Grain free diets. Following the thought process that cats are carnivores, and not designed to eat grains, these diets are primarily meat based, with no corn, wheat, or rice present. We will see cats with mild symptoms of IBD respond very well to these diets.

§ Commercial raw food diets. Since it is almost impossible to find a commercial over the counter diet that is preservative free in a dry or canned form, and since you will need to do a LOT of work and have a LOT of ingredients to make a balanced home cooked diet, we started trying commercial raw food diets with amazing results. We have had cats with confirmed by biopsy IBD that had severe IBD and significant symptoms that had to be on very high doses of steroids just to have some quality of life. Many of these cats had a complete reversal of signs and symptoms by going to an exclusively raw food diet, and were able to either come off of all medications, or at the very least, drastically reduce their medications.

· Now, there is a lot of controversy over raw food diets and potential salmonella contamination. We have been using the only commercial raw food diet available over the counter that developed a high pressure pasteurization system to try and eliminate that risk, and as of yet, have not had any adverse problems.
 
Metronazodile is not a substitute for prednisolone. Is has anti-inflammatory properties. It can be used in conjuction with pred, or is often used first before going to pred, which is how my civie took it. Budesonide is the alternative to pred that is suggested for diabetic kitties or those with heart conditions that cannot take pred. My Neko was both, so she got budesonide. It is still a steroid, but with localized action and not as much, if any, impact on blood sugars.

For diet, see the ibdkitties website I referred to on your other bost. It also has a good selection on probiotics to use.
 
Wendy&Neko said:
In this post of yours, I made some comments, http://www.felinediabetes.com/FDMB/threads/9-2-help-interpreting-chers-high-numbers.183285/
Click to expand...

Hi Wendy

Apologies for not responding sooner! and thank you for your helpful comments.

Regarding the bruising - no she has not previously had any bruising caused by the shots. I am thinking it may have been the way I administered the shot in that I pulled not only the skin up but perhaps some of the surrounding area also? I really don't know what happened but I certainly hope it never happens again! I will be very gentle and particular in future. The bruising has now subsided thank goodness!

When I phoned the vet about Cher's BG level going down to 3.4 and also mentioned the bruise, she asked me to bring her in for blood testing as she was worried that something was going on in her body. However after testing, she said Cher was fine but she didn't divulge what she was worried about. Do you know the name of the other condition that causes diabetes and also bruising about which you spoke?

Thank you for the information regarding the syringes, I will follow that up as I would rather know the exact dose I am giving rather than guesstimating. At the moment I will leave Cher on the 3 units as prescribed by the vet on Wednesday, as I will be doing a curve on both Monday and Tuesday to send through to her as requested.

Yes the food issue .... it is a major concern for us. We hate that it is so high in carbohydrates and we would dearly love to find something more suitable to replace it with but as the vet has said, we also have the issue of the IBD and we are reluctant to upset the apple cart as it took so long for Cher to stabilise on the food. In fact, I feel it was the Pred that did the trick. We were so reluctant to commence it only doing so in desperation.

Vet wants to try to regulate the BG by trying to increase/maintain the insulin dose and reduce the prednisolone. However, we feel if we find a novel protien diet or raw, which suits Cher, her BG levels may drop and/or she may go into remission (don't think the vet sees this happening though). We will revisit this topic when he returns to the specialist centre. I will look at the available foods again and gather together relevant info. I am not familiar with Ziwipeak but will look at it, thank you.

I had previously queried if the Budesonide would be a better choice than the Pred for Cher but was informed Pred was the better one for her.

I note one of your kitties had IBD which changed to SCL. After Cher's endoscopy, the vet sent her biopsies to a lab in Michigan as there was uncertainty regarding whether there were cloned cells in her biopsies. I think there was concern that they might have been lymphoma cells but when the tests came back apparently all was well. We received a copy of the report but we couldn't make head nor tail of it! So fingers crossed that her IBD doesn't to into SCL.

Thank you, Wendy, for your help and interest.
 
The other condition is called Cushings. It's rarer in cats than dogs but typically you see multiple skin tears or bruises and a pot belly, possibly with hair loss.

Ziwipeak is from New Zealand. It may not be available where you are. It has good quality lamb and venison options.

I am glad you had the endoscopy and a definite diagnosis. Neko could not due to her heart so all we were going by was the ultrasound. She had either severe IBD or SCL. Budesonide helped her. She wasn't really vomiting or diarrhea due to certain proteins, so it was probably SCL.
 
Oh no - I didn't realise that you were in Australia, too, and that Wendy had referred you to me re: 1/2 unit syringes. I get mine from the UK, from Hyperdrug: www.hyperdrug.co.uk
You want to order the BD Microfine Insulin Syringes 0.3 ml (pack of 100) Item: BDMICROFINE03ML, Price: 15.88 UK pounds. I just ordered five more boxes of 100 syringes from them. Please let me know if you'd like to try them; I'm happy to post you some from Sydney. As a plus, Girlie prefers these to my original 1 unit syringes; I think the thinner, shorter needles work better for her.
BD_micro_0.3.gif

I also ordered some Fortiflora, which we can't find here in Australia. Ask @Wendy&Neko and @Chris & China first whether that might be something you might want to try with your cat. Again, when I get it, I'm happy to send you a couple of sachets if you want to try it. I haven't used it before, but I thought I'd order some just to have on hand. Dr Pierson (who created the food chart so many use here) talks about using that as an appetite stimulant even after its probiotic features might have expired.

Also, re Ziwipeak: I wasn't sure how my cats would take to them, so I just wanted to get a can or two of each to try first. You can order individual cans from www.petstock.com.au or my pet warehouse. If you do decide to try Ziwipeak, just one caution: go slowly. My moggie had no problem with it, but for some reason, I went too quickly and I gave too much when I first tried it with Girlie, my Burmese, and we ended up with some really unpleasant poo issues... I love the ingredients and the way it's made, though, so I'm hoping that Girlie can decide she likes it and her tummy does, too. Then again, it could have had something to do with the other meds she's taking for her constipation (Cisapride and Osmolax). Who knows!

Please do let me know if I can be of any help in any way. My name's Darrah. :)
 
Wow - looking at the posts from @Chris & China and @Wendy&Neko : all I can say is, "wow". You're in good hands, but this all sounds like a lot to take in.

I test a lot, but it makes me confident, not paranoid! I think your vet is being a bit silly, to be honest. I'm glad you test as you do.

I've had a bit of a nightmare since Girlie was diagnosed, but nothing like what you're going through with your Burmese. I didn't think we'd ever break through the black numbers barrier, but we finally have, thanks to my following the advice here. One of the problems we've had is that she takes HUGE deep dives which then trigger huge bounces into black. I was truly beginning to despair, and then Girlie broke through the other side recently. I just hope she can stay there for a change...

Again, get in touch, please, re: the syringes and/or the Fortiflora or anything else Australian. @Bron and Sheba is an Australian with a lot of experience who really, really helped me out and continues to help me out. I've sent you a conversation starter so you can contact me directly that way.

I found it challenging drawing the small doses. It's much easier, though, with my incredibly chic headset with magnifying glass with light
Inexpensive, has different sized magnifying glasses, and allows me to draw the dose and try to get it to the right amount and use both hands and see at the same time.
 
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