04/04 Ducia PMPS lower than usual, 1U , +1 214, +3 299 ; +6 315 Is it bouncing? Time to increase?

[Tanya and Ducia]

Hello everyone,

Ducia has finally seen the Internal Medicine Specialist and had some blood work done. The one I have at hand is in SS/ LAB; the other one is due later on this week. I would greatly appreciate if someone with blood work knowledge can comment on the new LAB results. There are improvements from her blood work done month ago.

The good news is that Ducia is no longer anemic.

But now she has heart murmur the reason of which is unknown at this time.

The vet thinks that her current 1U Lantus dose is good and that I should keep it. On Friday Ducia weight was 8.6 lbs and it was suggested that she stay between 9+ and 9.5 lbs.

One of the liver enzymes is elevated. And her cholesterol is high, 232.

What type of diet should I feed her to control her cholesterol?

Ducia currently eats Friskies Classic Pates, 1 ½ 5.5 ounces in 24 hours. I will be cutting down to 1 and ¼ (per vet) or probably to just 1 can a day. She is post DKA, needs calories. Will one can be sufficient? Her favorite is 6% carbs, 174 Kcal and 361 Phosphorus (it's not too much, is it?).

If she has high cholesterol should I switch to another brand?

I haven’t tried many canned food brands yet. She seems to have mixed feelings for the Nature Variety Instinct Grain Free– chicken or beef/liver formula – may or may not eat.

The vet strongly advised us against raw food. She also mentioned that several clinics she knows are not admitting patients if they are only raw diet fed. She said this trend might be spreading across the nation.

We were thinking of ordering whole rabbit as per Dr. Pierson blog. Would that be a good move for Ducia and her high cholesterol?Or would a raw foo be in agreement with her suspected pancreatitis/ fatty liver? I thought that feeding raw AND canned LC might be good idea. But, again, we just started to deal with FD five or six weeks ago.Too new to know.

Thank you for your thoughts!

 

[Bobbie And Bubba]

I am going to tag @Marje and Gracie as she is the BW specialist here on the boards and she can help explain the BW to you.

 

[Tanya and Ducia]

Hello,
and thank you!

 

[Wendy&Neko]

First thing, could you make the column on the Labs tab with the reference ranges a little bit wider. It's cutting off the top end of the range when I look at it. It also helps if you colour the out of range values, as you did this last time. To me, Ducia's labs aren't bad. Her cholesterol is barely out of range at the high end. I wouldn't go changing food to try to fix it. Especially since she needs to gain a little weight, I would keep giving her the higher amount of food until she gets to her ideal weight. Weigh her periodically to see if she's reaching her target weight. Often unregulated kitties can have higher cholesterol and Ducia's cholesterol is down compared to last time.

Onto the heart murmur - there really is no way of finding out the cause of the heart murmur without an echocardiogram. A lot of heart murmurs are benign and caused by aging. Did the vet say what grade the murmur was? It's on a scale of 1-5 with lower being milder.

I'm going to disagree with the IM vet on a couple of things. First, the 1 unit dose isn't doing anything for Ducia. Most vets get nervous when they see green numbers in a spreadsheet, but that's because most people aren't home testing like you are. Neko's IM vet was the same, but we agreed to disagree on that one. To me, it looks like Ducia failed her reduction and should go back up to 1.25 units.

The vet strongly advised us against raw food. She also mentioned that several clinics she knows are not admitting patients if they are only raw diet fed. She said this trend might be spreading across the nation.

I don't get vets that think this way. Neko's primary vet wasn't a fan of raw but of course they sold vet "prescription" food. Neko's acupuncture vet and IM vet were fans of raw food. Cats are obligate carnivores - before humans they survived on raw and before the advent of dry food for the convenince of humans in the last century, cats survived on raw. Thankfully in Canada, the trend is towards raw, not against it. I think you'd be fine introducing raw, but maybe you'd want to start with chicken which is generally an easier protein to start them on.

There is a tie between fatty food and pancreatitis - in dogs. It has not been shown in cats. If you are worried about it, use chicken breast raw as it is less fat than thighs. If instead of raw you'd like to try some higher quality canned in addition to the Instinct, try Ziwipeak, the Tiki Cat chicken options or Weruva. Be careful that some of the Weruva varieties are lower calorie than others.

 

[Tanya and Ducia]

I'm going to disagree with the IM vet on a couple of things. First, the 1 unit dose isn't doing anything for Ducia.

We reduced her on 03/30 AM after she shown 40 at +4 the day before.
I thought we should keep it for a week.
Another thing is that maybe I give her too much food or too often? She now has a habit of snaking after tests. I give slightly smaller PS portions and she asks for more in about an hour or hour and a half instead of two hours.

 

[Tanya and Ducia]

I think you'd be fine introducing raw, but maybe you'd want to start with chicken which is generally an easier protein to start them on.

I agree about chicken but we do not own a grinder yet.
The only reason we thought tried with the rabbit is that it comes double-fine grind, ready to consume. I am not even sure she will eat rabbit.

 

[Wendy&Neko]

I get chicken ground from my exotic meat butcher - he gets organic hormone free chicken and will grind it fresh for me. Whole Foods is another source.

On the dose, I had thought you were on TR, but I see the signature says "SLGS?". I'm not sure what that means?

 

[Tanya and Ducia]

I'm going to disagree with the IM vet on a couple of things. First, the 1 unit dose isn't doing anything for Ducia.

We were given a discharge paper that reads
1) Appropriat level of BG 120 - 350 .
2)Less than ideal : 90 - 120; administer half dose of Lantus if eats more than 50%.

For me personally, 90 to 120 would be a golden mean, an ideal.

 

[Tanya and Ducia]

I get chicken ground from my exotic meat butcher - he gets organic hormone free chicken and will grind it fresh for me. Whole Foods is another source.

On the dose, I had thought you were on TR, but I see the signature says "SLGS?". I'm not sure what that means?

I thought I was on TR. But it might be to difficult for me.
I need some more time to think about it.

 

[Wendy&Neko]

We were given a discharge paper that reads
1) Appropriat level of BG 120 - 350 .
2)Less than ideal : 90 - 120; administer half dose of Lantus if eats more than 50%.

First thing to remember is that they are probably referring to lab values, or what is more likely what you'd see on an AlphaTrak. On a human meter, those numbers would be lower. Second thing, over 300 is NOT appropriate! You'll have to decide if you want to follow that vet's suggestions for dosing. But with a cat with DKA in the recent history, I would be very reluctant to lower the dose for a shootable number of 90-120.

You test more than enough for TR. The biggest items you'll have to consider is how long you want to hold the dose, and the reduction point. If you have any questions, feel free to ask.

 

[Tanya and Ducia]

Thank you so much Wendy!
I have very stupid question: Ducia was 116 at +8, ate 1 Tbs 6% and went to sleep. I try to test her not as often as I used to.
I don't want to wake her up, so I plan not to test until +10 and then at PMPS.
What are the chances that in her sleep, right now, she would not go as low as, let's say, 40?

Last time she went down to 40 she was alert but absolutely none symptomatic. I had very good reasons believing that she was at around low - mid 100s.

 

[Tanya and Ducia]

You'll have to decide if you want to follow that vet's suggestions for dosing.

No.
That just don't make any sense.

 

[Wendy&Neko]

I think you are fine waiting on the testing. The rate she's dropping seems to be slowing down.

I have woken Neko up in the middle of the night to catch the 30's. But the reason I tested was because it looked like she was going lower. Ducia should be OK until +10.

 

[Tanya and Ducia]

But the reason I tested was because it looked like she was going lower

How did you know she was lower? What exactly in her sleep was alarming?

 

[Marje and Gracie]

I actually would check her at +10 or +11 because she's clearing a bounce and might keep dropping into PMPS.

I agree with every single thing Wendy said:

• She needs a dose increase (you test plenty for TR and I see no reason why you can't do it if you can test 6-8 times a day like this).
• Diabetic cats often have high cholesterol and hers is pretty mild compared to many I've seen so I wouldn't even worry about it and certainly wouldn't change diet because of it.
• For a cat that's had DKA, you aboslutely do not want her any higher than 120-150 on a human meter; even though cats in normal numbers can get DKA, it doesn't happen often. You want her as much in normal numbers as possible.
• I absolutely disagree with your vet that the trend in the US is not to feed raw. I actually speak with more and more vets who now support raw feeding and I believe raw feeding is at an all time high based on the garbage commercial pet food companies put in food; we are seeing such high rates of inflammatory bowel disease and lymphoma in our kitties and it's likely primarily due to diet.

Wendy and I both, and others, use the Food Fur Life EZ Complete. You just buy ground meat, add the powder, and water. I also buy my meats already ground at the local butcher or Whole Foods but many people buy the same ground meats they eat from the supermarket.

I'll take a look at her labs and be right back.

 

[Wendy&Neko]

How did you know she was lower? What exactly in her sleep was alarming?

She was sleeping as normal. But over time I got to know Neko's patterns and my before bed test said she'd be lower in a few hours, so I set an alarm.

 

[Tanya and Ducia]

Hi,
Ducia PMPS is 127.
She ate 2 Tbs 6% Frieskies + 1 tsp 8% Soulistic.
I normally prefer not to shoot if below 150.
However, I did so before - during the day when someone was online on the Board and I was helped.
Should I hold until she is risen or should I shoot now regardless?
The dose is 1 U.
Should I give 0.75?
She does drops at around + 2.45 - + 3.5,
Thank you

 

[Tanya and Ducia]

I gave Ducia the full dose, 1 U after a good meal.
Will be monitoring closely.
I have MC 14-17% and higher LC 9% at home.
Was it a right call?

@Wendy&Neko

 

[Wendy&Neko]

Paws crossed for a quiet night. If you are nervous, you can get a +1. If she drops early you can feel a little bit higher carb food to slow her down.

 

[Tanya and Ducia]

Paws crossed for a quiet night. If you are nervous, you can get a +1. If she drops early you can feel a little bit higher carb food to slow her down.

Thank you!
I think I will have to test every hour now.
I will offer a little 9% snack at +1.

 

[Wendy&Neko]

Good luck. I can't stay with you tonight.

 

[Tanya and Ducia]

Thank you Wendy,
good night.

 

[Tanya and Ducia]

She needs a dose increase

Hi,
we decreased because she went 40.
Her last Am cycle was good, or so I thought.
Her PMPS today is lower than usual.
Do you still think she needs decrease?

 

[Marje and Gracie]

The only thing I see on the labs that needs to be watched is her ALT. I see it's headed down from thenlast test so that is excellent!

 

[Marje and Gracie]

Hi,
we decreased because she went 40.
Her last Am cycle was good, or so I thought.
Her PMPS today is lower than usual.
Do you still think she needs decrease?

I think she needs an increase back to 1.25u. The 40 was several cycles ago and she hasn't looked very good since so I think she needs to go back up.

 

[Tanya and Ducia]

I think she needs an increase back to 1.25u. The 40 was several cycles ago and she hasn't looked very good since so I think she needs to go back up.

OK, thank you.
I'll watch how is her today cycle going.

 

[Tanya and Ducia]

The only thing I see on the labs that needs to be watched is her ALT

I know that ALT is one of the liver enzymes. I am not sure what it actually does. But in any case food is my only tool. Is there any specific foods - like less fat more meat, or raw that would help up with the ALT recovery?
Another enzyme - AST is also used to be higher but OK now.

 

[Tanya and Ducia]

Good morning,
After a much lower than usual PMPS Ducia had the PM cycle in Yellows, as if I forgot to make the shot. I was worried giving her the full dose last night, I thought she was going to be droping to the lower numbers yet.
Is she bouncing from the Blue numbers earlier in the AM cycle?
Is her reduction failed and she has to get back to 1.25U?
Thank you for your thoughts.

 

[Nan & Amber (GA)]

Yes, I think the general opinion is that it's time to try 1.25U.

That was a pretty good vet report, considering all Ducia has been through recently-- you are doing a wonderful job caring for her! How is she feeling/acting these days?

 

[Tanya and Ducia]

Good morning, Nan,

Thank you ,

Ducia seems to be doing well. Her energy levels, her daily activity are incomparably better.

I have mixed feelings about vet's visit.

The blood work is good, I am happy it has been done. Her anemia was a serious problem.

But the vet also gave some odd and confusing statements such as "cats are not made to eat raw food, there are many great varieties that are commercially available", or "it is unlikely that her DKA returns if you are testing urine at home then do it once week only" and "BG readings from 90 - 120 are less than ideal for her, contact us if she has them consistently". For me it is exactly ideal. And she feels/acts good in low-mid 100s.

We were treated with utmost respect and care, and were presented with free case of canned diabetic food by Hills Rx diet. I couldn't find the carbs content as yet so Ducia hasn't tried it, I think it is too high in carbs.

I will increase her dose tomorrow morning.

I was so genuinely expecting a drop this +3 that I had too much and couldn't sleep a wink and now I am totally exhausted. I think I should try to get some sleep now, before AMPS.

Is Ducia still bouncing? I mean her Yellow night. I cannot believe for how long can a bounce go. ..

Wishing you and Amber very good day!

 

[Nan & Amber (GA)]

Glad to hear that Ducia seems to be feeling well!!!!

The thing about the vet's advice is... OK, they don't want you to test ketones very often, but... they can't stop you from doing it! What I've seen around here is that cats who have one DKA episode are said to be more prone to ketones in the future. What's the harm in testing ketones more than once a week, other than the fact that it makes you feel like a crazy cat lady for following your cat to the litterbox? It's not a lot of trouble, and it gives you an early warning if things are starting to go downhill.

As for the other stuff, I also find the comments about raw food puzzling/inconsistent with other vets I've talked to. I also agree with you about Ducia's numbers being fine in mid-low 100's-- I think part of the issue there is that vets are more used to pet meters than human meters, so 90-120 is closer to hypo territory on their mental scale. Not only does Ducia feel better in that range on a human meter, those are numbers that are going to help her pancreas heal.

Bounces can last up to three days, I'm sorry to say! Though looking at Ducia's spreadsheet, hers seem to be shorter than that-- she's getting to low blues regularly, then bouncing for a day or so, then back to the nice blues again. Hopefully this will be a short one!

 

[Tanya and Ducia]

What's the harm in testing ketones more than once a week, other than the fact that it makes you feel like a crazy cat lady for following your cat to the litterbox?

I am intended to test at every opportunity unless Ducia protests which is unlikely.

The thing about the vet's advice is

Unfortunately for me I realized that I am going to take the vets advises with a grain of salt from now on. It was nice to live in the fantasy land where vet's opinion was a kin to a universally good and reliable rule. I hate to sound ungrateful to the vet, she was extremely good to Ducia and us, but I have unpleasant vague feelings that she wanted to comfort me more by guessing what I , an obviously anxious type of CG, wanted to hear.

Bounces can last up to three days, I'm sorry to say!

I will increase to 1.25 tomorrow AM. Given, of course, that today cycles are surprise-less.
I looked again at the TR dosage instructions:
f underweight which Ducia still slightly IS than it is actual weight of 3.9 kg x 0.25U = 0.975 (1U). That's what she is receiving.
Why don't we have better number from her? What's in the way?

 

[Marje and Gracie]

I know that ALT is one of the liver enzymes. I am not sure what it actually does. But in any case food is my only tool. Is there any specific foods - like less fat more meat, or raw that would help up with the ALT recovery?
Another enzyme - AST is also used to be higher but OK now.

Sorry to just get back to you.

Her ALT is improving so I'd just monitor it. There aren't any specific foods to improve ALT but you can give supplements that might support the liver. One is Denamarin but it's efficacy depends on giving it on an empty tummy and the pills are a bit large. You can also talk to your vet about giving milk thistle which is my preference because my vet carries it and it's easy to administer.

 

[Jill & Alex (GA)]

I looked again at the TR dosage instructions:
f underweight which Ducia still slightly IS than it is actual weight of 3.9 kg x 0.25U = 0.975 (1U). That's what she is receiving.
Why don't we have better number from her? What's in the way?

Hi Tanya! The TR dose instructions you've quoted above are for a newly diagnosed kitty just starting out on insulin. They no longer apply to Ducia since she's been on insulin for awhile now.

Since hindsight is always the best sight, we can go back to 3/29 to analyze what has happened since then and why. Going forward, this information should help you when making dose adjustments.

First of all, this is a given and something to be remembered with Ducia especially:
The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

On 3/29, Ducia dropped to 40 @ +4. You fed 1 tablespoon 6% and within 16 minutes she was 48. She was up to 68 (a very nice number) thirty minutes later @ +4.5 and you gave 1 teaspoon 9% food. She came up 28 points quite easily within 30 minutes time. That was awesome. When dealing with low numbers, generally speaking you want to achieve a 10 - 20 point rise. Over the next two hours you were able to steer her numbers with low carb food and without a lot of effort.

At that point, there were a few dosing options and paths to consider before administering the next shot:

• Maintain the 1.25u dose one more time before reducing the next morning to "shoot through the bounce" (which you did).
  • Immediately take the dose back up to 1.25u as soon as you see the reduction has failed to avoid glucose toxicity from setting in.

• Reduce the dose to 1u since Ducia "earned" a reduction (which you did the next day)
  • Immediately take the dose back up to 1.25u as soon as you see the reduction has failed to avoid glucose toxicity from setting in.

• Going forward and since you test a lot... Make a conscious and deliberate effort to feed the curve to avoid Ducia dropping too low in order maintain the 1.25u dose since it was relatively easy to pull her numbers up quickly. With avoiding ketones in mind... this technique would allow you to get as much insulin into the her as safely as possible in an effort to keep ketones at bay. I understand a drop below 50 indicates a reduction earned in the protocol guidelines, BUT "rules" and "guidelines" are often thrown aside when dealing with a kitty who has recently been throwing ketones.
  • Monitor carefully and wait for Ducia to stabilize on the dose and/or drop below 50 three times before taking the reduction to 1 unit.

This is not a criticism. Let's use what has happened as a learning experience. The reduction failed and glucose toxicity set in. When this happens, it's not unusual for kitty to end up on a higher dose than before all this happened in order to break through any glucose toxicity. Hopefully, the current dose of 1.25u will bring her back into green numbers, but if not, don't hesitate to take the dose up again if necessary. Generally speaking, you don't want to hold a dose longer than 3 days if it's not pulling her numbers down.

There aren't any specific foods to improve ALT but you can give supplements that might support the liver. One is Denamarin but it's efficacy depends on giving it on an empty tummy and the pills are a bit large. You can also talk to your vet about giving milk thistle which is my preference because my vet carries it and it's easy to administer.

Just our experience: Denamarin was quite effective with Alex. I gave it to her 4 - 5 hours after her last mini-meal of the day and 2 hours prior to her evening meal at the PM shot time. I didn't find the pills to be large. I gave Alex a little water to wet her whistle, pilled her, and then followed with 4 - 6 mL water. It was pretty easy.


Edited to add: A relevant thread - Oldtimer Alex Update & Ketone Awareness thread

 

[Tanya and Ducia]

New thread 04/05

http://www.felinediabetes.com/FDMB/...eft-in-the-syringe-again.175903/#post-1933382