3/20 AMPS Tony 204

Tony’s person

Tony’s person

Member Since 2020
Reposting here. I’ve also posted on regular forum. I’ll delete that one.
Spreadsheet in signature.
My cat Tony was 90 last night at PMPS. He ate and I retested and he was 100 at +1. I did not give insulin, especially because the night before he was super low (46) out of the blue. when that super low reading (46) came in on Thurs PM I withheld insulin, and did high carb intervention. He came back up and was actually higher than normal yesterday morning. Nevertheless, I lowered his AM dose yesterday from his usual 1u to .75u due to the low reading the night before.
So that means he has had only .75u since the two mornings ago. (Thirsday morning and it’s now Sat morning). No shot Thurs night or Fri night.
This morning he is 130. Again, with no insulin last night or the night before (just .75u yesterday morning.)
Do I withhold insulin again this morning? He ate his Hills KD breakfast ok and now I’m debating whether insulin would push him too low again??
Btw, he had a near hypo event two weeks ago, but that was totally my fault (accidental overdose). He spent 30 hours at vet hospital and recovered just fine. Never actually went hypo, but I’m paranoid about pushing him there. Please advise. @Bandit's Mom @Wendy&Neko @tiffmaxee
 
I just responded on your post on main asking you to come here. I will link that one after I write here. Can you monitor all day if necessary? Do you have plenty of strips and high carb food? On the other post I was suggesting .50 but think .25 might be a safer option. He’s barely been over normal bg.
 
Hi Tony's Person,

Here's your last post, as we like to have an idea of what's been going on with Tony before dealing with the new day's questions: https://www.felinediabetes.com/FDMB/threads/morning-advice-really-low-bg.244892/#post-2763366

If you're not sure whether or give a shot, we usually ask everyone to withhold food and then test again to see if the numbers are going up or down. Did you feed him before or after the shot? 130 is a safe number to shoot, but only if you're prepared to monitor him with a supply of test strips and high carb and/or honey/Karo syrup.

Hill's KD is very high in carbs. I know it's good for his kidney disease, but a lot of us here who have CKD cats opt to feed lower carb foods with lower phosphorus instead of renal foods to keep the BG levels low. You might find Tony not needing insulin if you went the low carb food route like the Weruva you are occasionally feeding.

Elise and I cross posted. She's the pro, and you're in good hands. Good luck!
 
If you shoot you will need to get a +1 and +2 and feed a little food with each result. What you feed will depend upon the bg result. Before we decide Don’t shoot yet. I need to explain more.
 
Since you already fed him we can’t get another test without food and it’s been over 20 minutes. Please test again now.
 
PerfumedCatMom said:
Hill's KD is very high in carbs. I know it's good for his kidney disease, but a lot of us here who have CKD cats opt to feed lower carb foods with lower phosphorus instead of renal foods to keep the BG levels low. You might find Tony not needing insulin if you went the low carb food route like the Weruvak
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Understood. I actually posted on FB page today about that, asking about people’s experiences with YA zero mature For diabetic/CKD kitties. I too would love to get him off of KD and I think he may go I to diabetic remission. But his Creatinine has worsened a lot since diabetes diagnosis and so I’m nervous about that. Not sure if that worsening was from temporary switch to FF after diagnosis or from the DKA that he has before diagnosis.
 
Just retested. 204. This is about an hour after eating breakfast - Hill KD wet pate.
So ...seems I should shoot. How much?? .75u or .5 or .25??
 
Ok. Will do., .25u Thank you!! I fed because I was nervous...thought that if he was 130 in AM without dose the night before that he might be dropping. But I will need the advice and stall next time and wait for advice. Thank you!
 
Tony’s person said:
Understood. I actually posted on FB page today about that, asking about people’s experiences with YA zero mature For diabetic/CKD kitties. I too would love to get him off of KD and I think he may go I to diabetic remission. But his Creatinine has worsened a lot since diabetes diagnosis and so I’m nervous about that. Not sure if that worsening was from temporary switch to FF after diagnosis or from the DKA that he has before diagnosis.
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The FF might have been a culprit as that's very high in phos. Is Tony only eating dry? Can you switch him to just wet food? Not sure about the phos levels in YA. There are people who say their cats have achieved remission on YA, but if he's CKD he needs lots of hydration which he could get from wet food. You might find his kidney values improve if you give him something like Weruva Jeopurrdy Licious, which is low protein and low phos, and only 4% carb. My Ruby liked it until I put her on a raw diet using boneless meats and EZ Complete.
 
Last question ... how do I enter these results onto my spreadsheet? Meaning, his true AMPS is now 204 but the test which was closest to his regular dosing time was 130..so I’m not totally sure where to put each number to reflect what has transpired this morning. Does the 204 go into AMPS slot and the 130 into +10 from last night, even though it was not actually 10 hours from last nights test?
 
I just saw your FB post. What stage CKD is he? I was giving subQ to Ruby just once a week and she's Stage 2, and her internist said don't bother. I water her food down to a 1:.5 ratio, so if I give her 1 ounce of food she gets .5 ounces of water with it. The weruvas all have a lot of moisture already so this is just adding more to it.

You can add the as "130 @+12" in the +11 column and use the 204 as his AMPS, maybe?
 
PerfumedCatMom said:
The FF might have been a culprit as that's very high in phos. Is Tony only eating dry?.
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Actually, he eats only wet normally, and has done since his CKD diagnosis a few years ago. He was staying really stable for a long time with mild CKD but since the diabetes diagnosis his creatinine has worsened (doubled). But, his phosphorus is totally in normal range. Other electrolytes are good as well. I did try Wuvera Steak Frites. He didn’t love it. I can try that other flavor you recommend. The YA was just a thought as a complimentary food to perhaps balance between his KD and other but with something I know he’ll like because he loves dry and never gets it..unless he eats from his doggie sisters bowl, which he does when I forget to pick it up! His doggie sister eats his wet food and he eats her dry. It’s a game they play! Neither one of them are huge eaters overall, but they seem to like making my life crazy with keeping track!
 
PerfumedCatMom said:
I just saw your FB post. What stage CKD is he? I was giving subQ to Ruby just once a week and she's Stage 2, and her internist said don't bother. I water her food down to a 1:.5 ratio, so if I give her 1 ounce of food she gets .5 ounces of water with it. The weruvas all have a lot of moisture already so this is just adding more to it.

You can add the as "130 @+12" in the +11 column and use the 204 as his AMPS, maybe?
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I’m not sure of staging parameters, but his creatine is 3.6 and his BUN is 46. SDMA was 13 (normal, oddly) and his electrolytes are fine. The vet definitely wants him on sub-q and I do believe it has helped him feel better. He drinks a lot of water - not diabetic driven..he is a pure bred Bengal and has always loved water. But he also seems to get dehydrated easily. Maybe bengals like water because they need more of it??
 
Tony’s person said:
I’m not sure of staging parameters, but his creatine is 3.6 and his BUN is 46. SDMA was 13 (normal, oddly) and his electrolytes are fine. The vet definitely wants him on sub-q and I do believe it has helped him feel better. He drinks a lot of water - not diabetic driven..he is a pure bred Bengal and has always loved water. But he also seems to get dehydrated easily. Maybe bengals like water because they need more of it??
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Tony's a beautiful kitty. :) Ruby's recent SDMA was also normal but it's not a great metric unless you look at BUN and Creatinine at the same time. Ruby won't let me give her subQ--I have to hire a vet tech to come to my house to do it, so when the internist said she didn't need it, I was happy.

I would still avoid the YA because there are a lot of wet food options available as per that list. We don't know how it will affect his kidney levels, plus kibble causes a multitude of other problems that you don't want a 19 year old cat to develop.
 
Another reason to get off the KD food, from Helen of felinecrf.org:
If you are dealing with both diabetes and CKD, it is more important that the diabetes should be regulated, and in fact once this is achieved, you may find the CKD improves too...Even if your cat's CKD is more advanced,Keys to management of diabetes in cats(2011) Little S Presentation to the 36th World Small Animal Veterinary Association World Congress states "Current recommendations support the use of a high protein (> 30% DM), low carbohydrate (< 40% DM) diet for management of feline diabetes." A protein level of 28-35% DMA is often recommended for CKD cats so I would aim for a protein level of around 35% DMA for a cat with both conditions if your vet agrees.
Excerpted from https://felinecrf.org/diabetes.htm
 
I had to go to pharmacy for myself and then to other end of town to tend to my horse, who also has some health issues going on. I’ll test as soon as I get home, in about an hour. Thanks.
 
@tiffmaxee Just got home and tested. 166 at +4. He seems to be in good spirits. I have to go out again now but am going to give him a touch of wet food so that I’m sure he’ll continue to be ok while I’m gone. When I return in a few hours I’ll test again.
I’m assuming that since I didn’t give AM shot until 11am my time I can’t give PM until any earlier than 10:30pm? tia.
 
Tony’s person said:
@tiffmaxee Just got home and tested. 166 at +4. He seems to be in good spirits. I have to go out again now but am going to give him a touch of wet food so that I’m sure he’ll continue to be ok while I’m gone. When I return in a few hours I’ll test again.
I’m assuming that since I didn’t give AM shot until 11am my time I can’t give PM until any earlier than 10:30pm? tia.
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Good. Was a little concerned as if I knew you needed to leave I might have had you skip and definitely would not have suggested more than .25. Yes shot time will be at 10:30 p.m.

With DKA in the past I don’t like skipping though.
 
Thanks. He seems to be doing just fine now. I’ll check again later when onetime home and again before evening shot, of course.
At the time of his diagnosis (Oct 2020) nobody said DKA per se. But at his standard check up earlier this week the vet referenced “since he was DKA at time of diagnosis” in reference to his CKD and what might’ve affected it. So I don’t really know if he was or wasn’t. But his bg at that time was off the charts and he was soooo sick. The Alphatrak2 couldn’t get a read half the time as he was higher than 700 (or 750...I don’t recall upper limit of readings).
With Lantus and Team Tony caring for him he’s pretty steady now in the blue. Past few days and week have been unusual roller coaster. Perfect timing with an emergency visit to vet foe dog and several vet visits for the horse. My fur babies are far exceeding my mortgage! But they’re worth it...
 
Tony’s person said:
+7 and he was 210. Tonight I’m thinking of doing .5u. But that won’t be until later since his morning shot was so late.
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I think that either .75 or .50 is fine and then see what happens after 7 days provided a reduction is not earned.

You aren’t testing enough for TR. With SLGS you hold the dose for 7 days and then do a curve. If there’s a drop under 90 a reduction is earned.
 
Thanks. He was 147 just now at PMPS. I’m going to feed and then shoot 0.5u. He has come down since +7 (210) so I don’t want him to drop too low overnight while I’m sleeping.
He does seem to have odd pattern of reaching his nadir much closer to end of cycle than midway. I’ve noticed that before when we’ve had days that we were testing more.
Regardless, 0.5u feels safer given the past few days’ events.
Agreed that we can’t do TR. besides fact that my schedule doesn’t allow for such frequent testing, I’m just not willing to poke him with needles that many times a day. He is an older guy and at his age. I’m happy with his relative stability if it stays around 120-160. Plus, TR is not workable for us because he does need the high carb KD food for his CKD.
Let’s hope tomorrow isn’t such a roller coaster. Thanks for all your help today!!
 
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