? 06/01 Teja AMPS 177, +3 121

[Malia]

https://www.felinediabetes.com/FDMB/threads/05-24-teja-amps-400-4-400.290382/#post-3181902

Hello Everyone, I am in need of help. I met with Teja's internal med vet on 05/30 and we discussed Teja in detail. At the time that we met, Teja had just gone up to 3.5 units. Teja's internist and I looked at her charts in the app and she said Teja could handle 4 units. So yesterday, we went up to 4 units, from 3.5 units. It is a big jump, but Teja went into blues consistently yesterday for the first time. And in the evening, even with her steroid, she remained in blues.

However, today, Teja just really isn't interested in eating as much. In fact, she is eating about 1/4 what she would normally eat. The internist said that this could be because her cells have enough insulin to use the food she is taking in. But Teja typically eats a little bit throughout the day. Today, that is not the case. In fact, she didn't eat that much before her insulin shot. So I don't think she is getting enough glucose for the amount of insulin that she is getting. She is trending lower.

Her internist stated I should let her drive and when she wants to eat, let her eat. And if she gets to 50, then we will reduce her dose. That scared the crap out of me.

So, should I let her just not eat throughout the day like she used to? Just let her eat when she wants to? And let her glucose just drop? And if it reaches 50, then reduce her dose to fit the amount of food that she is eating? Or should I push foods throughout the day, at every 2 to 4 hours like we used to so she can have enough glucose in her system to use the insulin?

I don't know what to do as this is the first time Teja has been this low (in the 100s). She is sleeping comfortably for the first time in a long time, but is completely irritated at me for trying to get her to eat food. This is such new territory for us, as we have been in the higher numbers for most of our time since we are struggling to get managed.

Are there any stickies on this behavior? Is this sleepy/non-hungry behavior normal or is this indicative of something being wrong?

Help!

 

[Wendy&Neko]

I'm surprised at the 1/2 unit jump, so soon after the increase from 3.25 units. That is effectively a 0.75 unit change.

First question, do you have a backup blood glucose meter that you can use to check the Libre values? Since you are still feeding high carb food, and following SLGS for dosing, you would reduce the dose when she goes below 90. Below 50 is the reduction point for kitties following Tight Regulation. It is always good to check the low numbers of the Libre with a hand held meter. The Libre often reads lower than the hand held meter so she may or may not be as low as you think she is.

Next question, how many total calories per day was she eating the previous week, compared to today?

Is this sleepy/non-hungry behavior normal or is this indicative of something being wrong?

Cats sleep a lot, plus she's 17 years old. Maybe she finally feels better in blue numbers. A cat that is better regulated also will not need to eat all the time because they are able to process their food properly. From our Health Links forum, you might want to read this post that explains the role of sugar and insulin in the cat: What is Feline Diabetes?

 

[Malia]

I'm surprised at the 1/2 unit jump, so soon after the increase from 3.25 units. That is effectively a 0.75 unit change.

Yea, this was me caving to Teja's internist. She was certain that upping her dose to 4 units was where we needed to be. So I said "okay". I just wanted Teja to feel better and be out of those high numbers that were making her miserable. She is an older lady with many conditions, so I just wanted better numbers for her. I was weak.

First question, do you have a backup blood glucose meter that you can use to check the Libre values? Since you are still feeding high carb food, and following SLGS for dosing, you would reduce the dose when she goes below 90. Below 50 is the reduction point for kitties following Tight Regulation. It is always good to check the low numbers of the Libre with a hand held meter. The Libre often reads lower than the hand held meter so she may or may not be as low as you think she is.

I do have a Relion glucometer that I have used only once to learn how to use it. I have it handy, just in case.

Next question, how many total calories per day was she eating the previous week, compared to today?

Her nutritional vet has stated that she should be eating about 207 kcal/day. Which has worked out to be about 1 and 1/4 can of d/d (189 kcal/5.5 oz can) or 1 and 1/3 can of the PR (146 kcal/5.1 oz can). I toggle between the two cans because some days she will prefer one over the other. That said, when she was higher, she was eating more that the 207 kcal/day. Now, I am going to say that she is eating about 1/3rd of what she should be eating of the two. I tend to throw out more than she eats, because it gets dried out or has sat out too long and she isn't interested. She needs to eat that 207kcal/day, but she is eating about a third of that. So I am wondering, could there be something wrong?

Cats sleep a lot, plus she's 17 years old. Maybe she finally feels better in blue numbers. A cat that is better regulated also will not need to eat all the time because they are able to process their food properly. From our Health Links forum, you might want to read this post that explains the role of sugar and insulin in the cat: What is Feline Diabetes?

I haven't read this sticky yet, thank you for sharing. This is exactly what I was looking for to understand this change. Let me read this a bit more in full. Thank you!

 

[Wendy&Neko]

Might be interesting to test that 98 with the Relion so you get an idea how the Relion and Libre compare. Seen lots of inconsistencies between Libres and people's various other meters.

How much does Teja weigh? My 14.5 lb (maine coon cross) needed about 220 calories per day to maintain her weight. The amount of needed calories also depends on activity level and metabolism.

Is Teja getting any anti nausea medications? With IBD and CKD, sometimes they need a little help with nausea. I'd add a little water to her food, if you aren't already. That helps prevent the drying out and gives them needed extra water

 

[Malia]

Might be interesting to test that 98 with the Relion so you get an idea how the Relion and Libre compare. Seen lots of inconsistencies between Libres and people's various other meters.

She is actually going up from that now. She ate (yay!) about 20 minutes before that, so what she ate brought her up. She is at 111 now. If she gets back to double digits, I will do a check. When I did my initial test of the relion glucometer (I bought one specifically because of this forum), the libre2 said 250 and the relion said 270. Which of course made me just a bit frustrated, but now I know and I have a relion glucometer and 200 strips. I don't want to run out.

How much does Teja weigh? My 14.5 lb (maine coon cross) needed about 220 calories per day to maintain her weight. The amount of needed calories also depends on activity level and metabolism.

I weigh Teja daily to monitor her. Today, she weighed in at 12.36 lbs. She goes between 12.1X to 12.3X lbs and typically has been 12 lbs. Her nutritional vet says she should be 9.4 lbs. So she is carrying around an extra 3 lbs. So her 207 kcal/day actually allows for her to lose a bit of weight slowly over the next few months. She is a smaller cat who has is over weight, even with her CKD and IBD. She has always been an eater, even when she is sick, she eats.

Is Teja getting any anti nausea medications? With IBD and CKD, sometimes they need a little help with nausea. I'd add a little water to her food, if you aren't already. That helps prevent the drying out and gives them needed extra water

She actually gets cerenia and pepcid daily. She typically gets 4mg of cerenia and 2.5mgs of pepcid daily. I upped her cerenia a few weeks ago to 6mgs to help with her steroid tapering. We just adjusted her dose to 1mg of prednisolone to once daily in the evening (starting on 05/30/24). We are going to do that for 2 weeks. Then we will reduce her dose to .5mg once daily in the evenings for 2 weeks. When we get to this point, we will do bloodwork and a quick ultrasound to make sure she is good to discontinue the steroid. We just adjusted her dose down from 1mg of prednisolone twice daily because I was forgetting to give her the morning dose (it was at 5am). Oh shoot, I bet this adjustment is the reason she isn't eating as much. Prednisolone makes her have an appetite, but now she isn't getting it in the day time, only at night. Oh wow, this is why she isn't eating as much! Oh I feel like such a bad pet parent, I completely forgot about this change, yikes! Wow Wendy, thank you for getting me thinking about all of this, I wouldn't have connected this dot if you had not brought this up! Thank you!

 

[Malia]

Might be interesting to test that 98 with the Relion so you get an idea how the Relion and Libre compare. Seen lots of inconsistencies between Libres and people's various other meters.

So I got another 98 at the 5pm (+7) reading. I gave her some d/d and she ate a bit, about 1/8 of a can. At 5:30 she gets her cerenia/pepcid and prednisolone, so I like to make sure she doesn't take that on an empty stomach. After she ate, I saw the 98 so I went to grab my relion to test. Lol, Teja didn't cooperate. It took us about 15 minutes to get a sample to test. The relion gave me a 119. Then I did checked the libre2 and it gave me a 143. What the heck?

 

[Wendy&Neko]

I upped her cerenia a few weeks ago to 6mgs to help with her steroid tapering.

That's under dosing. Cerenia is typically 2 mg/kg of cat or about 1 mg per pound. She's getting half what she could. That's for the oral version. Injectable dosing is half that of the oral, some vets dose the pills same as injectable. If nauseous, she might need more.

Good to hear you might have a solution to the appetite. Is she eating better at night?

The Libre gives you a value that is about 15 minutes behind that of the Relion, as it's not taking blood glucose. This video explains this in better detail: Why Sensor Glucose Won't Always Match Your Blood Glucose

 

[Malia]

That's under dosing. Cerenia is typically 2 mg/kg of cat or about 1 mg per pound. She's getting half what she could. That's for the oral version. Injectable dosing is half that of the oral, some vets dose the pills same as injectable. If nauseous, she might need more.

Wow, this I didn't know. I thought 8 mgs was the max. This actually makes me feel way more comfortable with upping her cerenia dose. I think I will go up to 8 mgs tomorrow to see if it helps more. Thank you for sharing this with me, I had no idea!

Good to hear you might have a solution to the appetite. Is she eating better at night?

Most nights, yes, she will wake me to get more food that is from a newly opened can. She doesn't like when her food is left out for too long and gets dry, so she will wake me to get more. She is spoiled, and I don't discourage her. I have thought about getting a timed feeder for her, but she really hates cold food. So this is just what we do, lol.

However, last night she didn't really wake me because she was sleeping herself. Last night was the first night of lower numbers for her and I think that maybe she just felt good and relaxed for the first time in a long time. And today, there was a lot of sleeping too. So maybe there is a combination of things going on. My little old lady cat was feeling good for the first time in a while and decided to do what she does best, and sleep.

The Libre gives you a value that is about 15 minutes behind that of the Relion, as it's not taking blood glucose. This video explains this in better detail: Why Sensor Glucose Won't Always Match Your Blood Glucose

That absolutely makes sense! The sensor isn't about the numbers at that moment, it tracks the trends. If you want to know the glucose of the moment, go with a glucometer. I get it. I was a bit concerned that there was such a dramatic difference between the two, but now I understand why. I am glad that I have the Relion for the moments when I need a BG at that moment.

Hey Wendy, thank you for following along with me today. I really appreciate it. This is the first day where Teja has been blue for most of the day, aside from a couple of greens. So of course, I was worried and didn't want to be alone, just in case. I have my sticky up for low numbers and had a can of higher carb food, just in case. And it is just Teja and myself here at home, so nothing to do but worry and have anxiety, lol. Thank you for being a voice of reason for me today.

I am worried about the insulin gestapo with Teja's dose and her lower appetite. Am I wrong to think that if she is eating less, that the 4 units might be too much? At least until she starts eating a bit more normally, with an increased cerenia dose?

I was also thinking of asking Teja's vet about some transdermal mirataz, just to get her through the first few days of the prednisolone adjustment. Is there anything posted on the site regarding mirataz? Is mirataz safe for diabetic kitties? Is there a way to search some of the stickies or database?