? 11/8 Ivy Amps 58, +3 47 L, +6 135, +9 106, Pmps 154, +2 85, +3 53 Libre (Need less insulin?)

[Staci & Ivy]

11/7/24
Amps 58 Libre

Well, it’s been quite a 24 hours. Ivy has been in very active cycles and overnight. She was low greens on the Libre and I was feeding her pretty much every half hour all through the night. Very exhausting of course.

I took another reduction this morning down to 3.25 units.
I think it’s the second or third reduction this week.
I can’t figure out what’s going on and why all of a sudden she’s having such active cycles and it’s taking me so much food to just hold her steady, which isn’t really working very well.

I used to give her 12.5% of her homemade lamb diet and that would bring her up immediately and now it’s not even doing anything.

I started giving her 20% gravy fancy feast and even that’s not doing anything, even added karo, but no spike.

Does anybody have any ideas why she would suddenly be not reactive to higher carbs and why she seems to be needing less insulin. ???
I guess it’s a good problem to have. I just need to figure out how to manage it.
@Marje and Gracie @Wendy&Neko @tiffmaxee @Christie & Maverick
Thank all, have a safe day

 

[Staci & Ivy]

Another question, should I have tried to drain her depot perhaps? And if she is still low all day long maybe try a 1/2 dose tonight to do that??

 

[Jack & Mopem'sMom]

Oh man....I don't have any good advice, just hoping she steadies off...safe surfing this weekend!

 

[Marje and Gracie]

Another question, should I have tried to drain her depot perhaps? And if she is still low all day long maybe try a 1/2 dose tonight to do that??

I know you are doing custom dosing but, for example, with TR, we would only reduce the dose when the BG is under 40 (long-term diabetics on a human meter) and one of her LOs on the L was 56 on the C. You don’t show one on the C for the LO on the L today. What is your reduction point with the Libre under your custom dosing (sorry I don’t remember but might be good to put at the top of the SS).

I don’t mean to give a “cop-out” answer but based on the variation you typically get between the C and the L, I wonder if she’s even been in the range where she needs more than the 12.5% carbs? You might be holding her in the 90s on the C with the 20%.

IMHO, I see no need to drain her depot. And you have to be cautious of taking so many back-to-back “unearned” reductions or she might stall out on you and the dose need to go back up.

If she levels off here, try to go back to your regular feeding and see what she does this morning cycle before you take any more reductions would be my suggestion.

 

[Staci & Ivy]

Oh man....I don't have any good advice, just hoping she steadies off...safe surfing this weekend!

Thanks, Christine. She’s been challenging lately.

 

[Staci & Ivy]

I know you are doing custom dosing but, for example, with TR, we would only reduce the dose when the BG is under 40 and one of her LOs on the L was 56 on the C. You don’t show one on the C for the LO on the L today. What is your reduction point with the Libre under your custom dosing (sorry I don’t remember but might be good to put at the top of the SS).

I don’t mean to give a “cop-out” answer but based on the variation you typically get between the C and the L, I wonder if she’s even been in the range where she needs more than the 12.5% carbs? You might be holding her in the 90s on the C with the 20%.

IMHO, I see no need to drain her depot. And you have to be cautious of taking so many back-to-back “unearned” reductions or she might stall out on you and the dose need to go back up.

If she levels off here, try to go back to your regular feeding and see what she does this morning cycle before you take any more reductions would be my suggestion.

Hi Marje, thanks for your input. I appreciate your perspective.
It’s really been more of a QOL (Quality of life) decision to reduce her lately.
She’s just been running too low (no, not under 40, but lower than I’d like her to be) and causing the Libres to fail multiple days in a row, plus she’s not coming up with higher carbs so I gave her several reductions.
I try to normally not reduce her unless I set 50 on a handheld meter.
(I did update my SS so that reduction is more clear.)

I’ve not had to give back to back reductions like this and just don’t know why she’s all of a sudden seeming like she needs less insulin.
I will need to try to figure out a higher carb solution if it is needed, I just can’t figure out why suddenly the carbs I have been using aren’t working anymore.

Of course it could be something to do with her thyroid situation, interfering, who knows??

Many thanks!!

 

[Marje and Gracie]

Hi Marje, thanks for your input. I appreciate your perspective.
It’s really been more of a QOL (Quality of life) decision to reduce her lately.
She’s just been running too low (no, not under 40, but lower than I’d like her to be) and causing the Libres to fail multiple days in a row, plus she’s not coming up with higher carbs so I gave her several reductions.
I try to normally not reduce her unless I set 50 on a handheld meter.
(I did update my SS so that reduction is more clear.)

I’ve not had to give back to back reductions like this and just don’t know why she’s all of a sudden seeming like she needs less insulin.
I will need to try to figure out a higher carb solution if it is needed, I just can’t figure out why suddenly the carbs I have been using aren’t working anymore.

Of course it could be something to do with her thyroid situation, interfering, who knows??

Many thanks!!

She is a long-term diabetic and you do have to consider your QOL issues so no criticism if you decide to reduce again. It’s hard to say why her response to food has changed as many variables can affect the BG and certainly any changes to her thyroid.

I will say it’s not an anomaly to see a cat suddenly start earning reductions faster than before or not responding to foods they previously responded to.

Unfortunately, each of us has to find what works for food and managing the BG and it often changes. I wouldn’t feed her more than every half hour as it takes that long for the food to impact the BG. And I’ll just throw out there, for others reading, the obvious that if your kitty is below 40 on a human meter, you need to do whatever is necessary to bring the BG up.

Thanks for updating the SS so those helping will have additional info.

 

[Madeline528]

11/7/24
Amps 58 Libre

Well, it’s been quite a 24 hours. Ivy has been in very active cycles and overnight. She was low greens on the Libre and I was feeding her pretty much every half hour all through the night. Very exhausting of course.

I took another reduction this morning down to 3.25 units.
I think it’s the second or third reduction this week.
I can’t figure out what’s going on and why all of a sudden she’s having such active cycles and it’s taking me so much food to just hold her steady, which isn’t really working very well.

I used to give her 12.5% of her homemade lamb diet and that would bring her up immediately and now it’s not even doing anything.

I started giving her 20% gravy fancy feast and even that’s not doing anything, even added karo, but no spike.

Does anybody have any ideas why she would suddenly be not reactive to higher carbs and why she seems to be needing less insulin. ???
I guess it’s a good problem to have. I just need to figure out how to manage it.
@Marje and Gracie @Wendy&Neko @tiffmaxee @Christie & Maverick
Thank all, have a safe day

Good morning, Staci!
Sorry, you had such a challenging night. I hope Ivy activity slows down and she settles with this reduction.
I understand the not knowing why. Butch was also not responding the same to the carbs that I would usually give him, and it was extremely challenging to keep him steady.
Wishing that your day becomes much calmer, and you have a safe day.

 

[Mikanmama (Mikan GA)]

Hi Staci,
Ivy's keeping you busy and worried! When she gets a "go-mode", she just goes!
Hope this reduction can steady her better. Might take a few cycles before you see the effects?
I do think the QOL issues, both for the kitty and caretaker, are very very very important, particularly when we are in it for such a long time.
Where to strike the balance is a tough question and I don't think there is a single answer that works for everyone.
It probably takes some trial and error.
Hope Ivy calms down and you get to enjoy the day, Staci!

 

[carfurby (GA)]

 

[Staci & Ivy]

She is a long-term diabetic and you do have to consider your QOL issues so no criticism if you decide to reduce again. It’s hard to say why her response to food has changed as many variables can affect the BG and certainly any changes to her thyroid.

I will say it’s not an anomaly to see a cat suddenly start earning reductions faster than before or not responding to foods they previously responded to.

Unfortunately, each of us has to find what works for food and managing the BG and it often changes. I wouldn’t feed her more than every half hour as it takes that long for the food to impact the BG. And I’ll just throw out there, for others reading, the obvious that if your kitty is below 40 on a human meter, you need to do whatever is necessary to bring the BG up.

Thanks for updating the SS so those helping will have additional info.

Thanks again, Marje. It is interesting that with that Libre, once I would feed higher carbs (say 12.5%, within about five minutes, I could see her glucose rising on the Libre). It never took 30 minutes or so to see the rise. It was pretty immediate.
However, lately as I mentioned, I’m just not seeing a rise when I’m using that 12% or even 15 or the 20% the past week.)

I need to try to find some kind of food that will bring her up if it is needed. I have to figure out something that’s either 25 or 30% carb and just try to experiment to see if that will pull her up. She’s always been not very responsive to carbs, but it’s much more evident right now. So I can’t figure out why, and maybe we’ll never know.

 

[Staci & Ivy]

Good morning, Staci!
Sorry, you had such a challenging night. I hope Ivy activity slows down and she settles with this reduction.
I understand the not knowing why. Butch was also not responding the same to the carbs that I would usually give him, and it was extremely challenging to keep him steady.
Wishing that your day becomes much calmer, and you have a safe day.

Hi Madeline, yeah, it was quite a night. I know you can relate to these overnight cycles lately. It’s a huge punch in the eye, isn’t it? The exhaustion is real.
I’m so thankful she finally stabilized, probably because I gave her a lower dose today. But of course her Depot is gonna need to stabilize over the next few days and then we’ll see where we are. Hope you and Butch are having a safe and calm day.

 

[Staci & Ivy]

Hi Staci,
Ivy's keeping you busy and worried! When she gets a "go-mode", she just goes!
Hope this reduction can steady her better. Might take a few cycles before you see the effects?
I do think the QOL issues, both for the kitty and caretaker, are very very very important, particularly when we are in it for such a long time.
Where to strike the balance is a tough question and I don't think there is a single answer that works for everyone.
It probably takes some trial and error.
Hope Ivy calms down and you get to enjoy the day, Staci!

Hi Kit, I hope I’m getting her dosing in a better way so she can stop doing these extended periods of diving. I just can’t keep replacing the Libre‘s on a daily basis. It’s so much trauma for her and for me and especially because she doesn’t want me to be poking her ears. It’s just bad all around when she goes into these very low cycles. I do need to figure out a higher carb food to see if I can help. I did go to the store today and I don’t think I had any real success. I bought a couple things and I’ll sit down with them and look at them against the list to see if anything matches up Well. Part of the problem is a lot of the names of the foods have changed since the list was written, so it’s hard to know if you’re comparing apples to apples on the list.
And I agree, there needs to be some kind of a balance that goes on because we need to be healthy enough and rested enough to be able to take care of them and not completely sleep deprived every single day, or we can’t give them our best.
Thanks for your support as always. Hope all is well in your house.

 

[Heike & BInie]

Hi Staci,

oh no, you must be so stressed out! Especially with the food not bringing her up as you are used to and being scared another sensor crashes.

You know I am not an expert but I wonder, if her pancreas splutters a bit and she produces more insulin herself. But it is just a wild guess. I am happy QOL is part of your decision matrix, it simply has to if you want to manage this disease long term. I hope you get some more qualified ideas by our experts.

So I can imagine finding a store brand food is difficult, because Ivy is sensitive to some foods? Do you have an online calculator to calculate the carb content? I never heard people mention it on the board, that they use online calculators. So you don't need any lists. I can give you a German site with a calcultar or I can simply calculate it for you. Please let me know, if I can help you to find the right brand for Ivy. You know, I love to do research and a free weekend is coming.

I send you positive vibes and many, many hugs. I am sure you need them today!

 

[Staci & Ivy]

Hi Staci,

oh no, you must be so stressed out! Especially with the food not bringing her up as you are used to and being scared another sensor crashes.

You know I am not an expert but I wonder, if her pancreas splutters a bit and she produces more insulin herself. But it is just a wild guess. I am happy QOL is part of your decision matrix, it simply has to if you want to manage this disease long term. I hope you get some more qualified ideas by our experts.

So I can imagine finding a store brand food is difficult, because Ivy is sensitive to some foods? Do you have an online calculator to calculate the carb content? I never heard people mention it on the board, that they use online calculators. So you don't need any lists. I can give you a German site with a calcultar or I can simply calculate it for you. Please let me know, if I can help you to find the right brand for Ivy. You know, I love to do research and a free weekend is coming.

I send you positive vibes and many, many hugs. I am sure you need them today!

Hi Heike, it was quite a stressful night. The biggest stressor was at the food is not bringing her up when I needed to, so that’s a problem. I do need to find some kind of food that will cause the reaction that we need when she does drop low

I guess I do need to try to learn how to use one of those online calculators. I know that they do exist so that you can figure out the carb content.

It seems the lists are somewhat out of date and some of the things that were on the store shelf when I looked today were not on the list.

I’m sure the names of foods are changing all the time. Thank you for the offer of help. I really appreciate it.
Maybe I will have you send me the link and I will also have to look for one online and see if I can figure out what foods would be higher than 20%.
That might work for Ivy since the 20% is no longer working. Very frustrating

Hope you and Binie had a good day and she is still doing well. I’ll have to check on you guys. It’s been quite a day around here.

Sending you lots of hugs back. Hope you have a peaceful night.

 

[Wendy&Neko]

Does anybody have any ideas why she would suddenly be not reactive to higher carbs and why she seems to be needing less insulin. ???

Marje has given you some excellent suggestions. As to why she might, at this point in time, need a bit less insulin, there can be several reasons. One is the hyperT, which can cause a type of insulin resistance. If you get it under better control, that can mean less insulin needed. Has she had any inflammation/infection that has gotten resolved? Maybe her IBD is better controlled now? That's another source of resistance. Has she lost any weight?

Another thing to keep in mind is the depot. The larger depot can influence 4-6 cycles after a reduction. The 3.75s unit dose may still be a factor. However, with SLGS we don't do anything different as a result. Not sure what you are doing with custom dosing.

 

[Diane Tyler's Mom GA]

Hi Staci, I hope you can find some higher carb foods . I tried googling it and had no luck. I'll keep looking

 

[Staci & Ivy]

Marje has given you some excellent suggestions. As to why she might, at this point in time, need a bit less insulin, there can be several reasons. One is the hyperT, which can cause a type of insulin resistance. If you get it under better control, that can mean less insulin needed. Has she had any inflammation/infection that has gotten resolved? Maybe her IBD is better controlled now? That's another source of resistance. Has she lost any weight?

Another thing to keep in mind is the depot. The larger depot can influence 4-6 cycles after a reduction. The 3.75s unit dose may still be a factor. However, with SLGS we don't do anything different as a result. Not sure what you are doing with custom dosing.

Hi Wendy. I’m not actually sure yet we have the hyperthyroid under any control yet. We’re still working on trying to find the right dose to bring her T4 down. We will have lab work again in two weeks as we’ve been doing it on a monthly basis and we’re not there yet. But maybe we are making some difference.
As far as inflammation I don’t really know if anything has become resolved in that regard. And I don’t know about the IBD either. She has not lost any weight.
So I just can’t figure out why all of a sudden she would need less insulin and, I really can’t figure out why the carbs that have been working to bring her up for such a long time or suddenly not working.
It’s pretty scary when the carbs that you know worked are suddenly not working and you don’t know what to use to bring her up if needed. Very stressful.

Thanks for your input. I appreciate it.

 

[Staci & Ivy]

Hi Staci, I hope you can find some higher carb foods . I tried googling it and had no luck. I'll keep looking

Thanks, Diane, I appreciate it you’re so good at finding that kind of stuff, so if you do just let me know.
You’re the best
I hope you have a wonderful night.

 

[Diane Tyler's Mom GA]

Thanks, Diane, I appreciate it you’re so good at finding that kind of stuff, so if you do just let me know.
You’re the best
I hope you have a wonderful night.

I definitely will

 

[Karen and Chispa (GA)]

What a stressful day, on top of an already too stressful week!!! I have no answers, except to say that you are a first-rate, top-of-the-line cat mom, and I know you will keep Ivy safe while you figure this out. I hope you can also get some sleep.

 

[Seth&Bell]

Dang, that's a rough night/week, Staci. Truly hope you get some sleep tonight, the feeding every half hour on a PM cycle is a nightmare... Ivy's spreadsheet is looking really really good, but I've found there's an inverse relationship with really good cycles for my cat and my own sanity, especially on the PM side.

 

[Staci & Ivy]

What a stressful day, on top of an already too stressful week!!! I have no answers, except to say that you are a first-rate, top-of-the-line cat mom, and I know you will keep Ivy safe while you figure this out. I hope you can also get some sleep.

You bet, Karen. It looks like tonight will be a repeat of last night with me on the sofa in the basement with my girl.

She’s low again tonight and it’s only +3. I’m hoping at some point she’ll come back up again and I’m hoping that the depot will drain so that we can actually see where the dose leads her.
Maybe she’s just requiring lesson insulin. It’s really the first time in two years that this is happening, so it’s throwing me for a loop.

I hope you and Chispa are having a nice calm Friday night and have a nice relaxing weekend ahead

 

[Staci & Ivy]

Dang, that's a rough night/week, Staci. Truly hope you get some sleep tonight, the feeding every half hour on a PM cycle is a nightmare... Ivy's spreadsheet is looking really really good, but I've found there's an inverse relationship with really good cycles for my cat and my own sanity, especially on the PM side.

It’s been quite a week, Seth. I’m ready for a good sleep, but alas, not looking like that’s in the cards for me tonight. It’s looking like another marathon overnight. I know you understand how rough these nights are
I hope you and your girls are doing well and things are much calmer in your house

 

[Seth&Bell]

Gah sorry, Staci, she is really dropping here recently. You get a free pass to be reallllllly cranky tomorrow.

 

[Diane Tyler's Mom GA]

Thanks, Diane, I appreciate it you’re so good at finding that kind of stuff, so if you do just let me know.
You’re the best
I hope you have a wonderful night.

Hey Staci the only thing I can think of is to look on Tanya 's site for the carbs ,says it's based on dry matter

https://felinecrf.org/canned_food_usa.htm

@Staci & Ivy

 

[Heike & BInie]

Hi Heike, it was quite a stressful night. The biggest stressor was at the food is not bringing her up when I needed to, so that’s a problem. I do need to find some kind of food that will cause the reaction that we need when she does drop low

I guess I do need to try to learn how to use one of those online calculators. I know that they do exist so that you can figure out the carb content.

It seems the lists are somewhat out of date and some of the things that were on the store shelf when I looked today were not on the list.

I’m sure the names of foods are changing all the time. Thank you for the offer of help. I really appreciate it.
Maybe I will have you send me the link and I will also have to look for one online and see if I can figure out what foods would be higher than 20%.
That might work for Ivy since the 20% is no longer working. Very frustrating

Hope you and Binie had a good day and she is still doing well. I’ll have to check on you guys. It’s been quite a day around here.

Sending you lots of hugs back. Hope you have a peaceful night.

Hi Staci,

I just had a look and there are lots of carb calculators on English websites and it seems, that you also have all the information on the packages of the cat food you need for it. Very easy to use! The lists are very often not up to date because the recipes got changed all the time.

Here is one calculator I found:

https://www.walkervillevet.com.au/blog/carbohydrates-levels-cat-food/

If you go on the Chewy website you find all the information listed under the food.

Hope that helps!

 

[Staci & Ivy]

Hi Staci,

I just had a look and there are lots of carb calculators on English websites and it seems, that you also have all the information on the packages of the cat food you need for it. Very easy to use! The lists are very often not up to date because the recipes got changed all the time.

Here is one calculator I found:

https://www.walkervillevet.com.au/blog/carbohydrates-levels-cat-food/

If you go on the Chewy website you find all the information listed under the food.

Hope that helps!

Thank you Heike, I will give it a look! I appreciate your time and energy

 

[Staci & Ivy]

Hi Staci,

I just had a look and there are lots of carb calculators on English websites and it seems, that you also have all the information on the packages of the cat food you need for it. Very easy to use! The lists are very often not up to date because the recipes got changed all the time.

Here is one calculator I found:

https://www.walkervillevet.com.au/blog/carbohydrates-levels-cat-food/

If you go on the Chewy website you find all the information listed under the food.

Hope that helps!

Thank you, Diane, I will peruse this information! Many thanks for your time!

 

[Staci & Ivy]

Hi Staci,

I just had a look and there are lots of carb calculators on English websites and it seems, that you also have all the information on the packages of the cat food you need for it. Very easy to use! The lists are very often not up to date because the recipes got changed all the time.

Here is one calculator I found:

https://www.walkervillevet.com.au/blog/carbohydrates-levels-cat-food/

If you go on the Chewy website you find all the information listed under the food.

Hope that helps!

When I use this calculator link….the Fancy Feast Gravy Lovers Beef Feast In Roasted Beef Flavor Gravy (which. Dr Pierson’s list says is 20%
Comes back with 14%
Here is a screen shot to show the data put in (so maybe that’s my issue, I am only giving her 14% carbs based on wrong or old data.

 

[Heike & BInie]

When I use this calculator link….the Fancy Feast Gravy Lovers Beef Feast In Roasted Beef Flavor Gravy (which. Dr Pierson’s list says is 20%
Comes back with 14%
Here is a screen shot to show the data put in (so maybe that’s my issue, I am only giving her 14% carbs based on wrong or old data.

View attachment 71377​

Hi Staci,

yes, maybe that is the problem. I checked the numbers again with the German calculator and it is also 14 %. Sometimes they change the recipe and the list has old data. That is why I always use this tool. Good you might have found the problem! That was easy!

 

[Diane Tyler's Mom GA]

@Staci & Ivy
@Heike & BInie
I'm glad Heike confirmed the carbs, Thank you Heike , me and Staci were talking about this

 

[Staci & Ivy]

@Staci & Ivy
@Heike & BInie
I'm glad Heike confirmed the carbs, Thank you Heike , me and Staci were talking about this

It looks like Dr Piersons list doesn’t use guaranteed analysis data, which is printed on the can. And that is the data I put into the calculator so it is not matching Dr Pierson‘s list. So I don’t know how to compare. It’s not apples to apples because they are different formulas being used.

 

[Heike & BInie]

It looks like Dr Piersons list doesn’t use guaranteed analysis data, which is printed on the can. And that is the data I put into the calculator so it is not matching Dr Pierson‘s list. So I don’t know how to compare. It’s not apples to apples because they are different formulas being used.

Hi Staci,
I looked at Dr. Piersons website and I understand that the declaration in the US on the can is not accurate and she has different data. I looked it up at the Chewys website and it really says "min" and "max", which I find super strange. Here, we have an exact declaration. So you are definitely right, you can not compare this 100 %. But somehow it sounds to me unlogical that it should be allowed to declare a food with "min." and "max." and than have an around 30 % difference in carb content. If I ever do online dating in the US, I will write I am 28 years old (min).

Now I understand, that no one ever mentioned the calculators in this group.... Sorry I brought you on a maybe not so helpful track. Even though, I would see if a change in food (another 20 %) makes a difference. The recipe might have changed.

I am sorry, this is all so complicated.

 

[cecile & bella]

There is a very good post by @Marje and Gracie here, about calculating carb content:
https://www.felinediabetes.com/FDMB/threads/calculating-calories-from-carbohydrates.205128/

 

[Staci & Ivy]

There is a very good post by @Marje and Gracie here, about calculating carb content:
https://www.felinediabetes.com/FDMB/threads/calculating-calories-from-carbohydrates.205128/

Thank you Cecile!

 

[Staci & Ivy]

Hi Staci,
I looked at Dr. Piersons website and I understand that the declaration in the US on the can is not accurate and she has different data. I looked it up at the Chewys website and it really says "min" and "max", which I find super strange. Here, we have an exact declaration. So you are definitely right, you can not compare this 100 %. But somehow it sounds to me unlogical that it should be allowed to declare a food with "min." and "max." and than have an around 30 % difference in carb content. If I ever do online dating in the US, I will write I am 28 years old (min).

Now I understand, that no one ever mentioned the calculators in this group.... Sorry I brought you on a maybe not so helpful track. Even though, I would see if a change in food (another 20 %) makes a difference. The recipe might have changed.

I am sorry, this is all so complicated.

Hi Heike, I’m glad you sent me that calculator. Very helpful.
But I know the Dr. Pierson list doesn’t used the GA data.

So I’m just not sure how to be sure what to use.
If I use a GA calculator, such as the one above, the can says it’s 14%.
Can we trust that conclusion??? Who knows. I surely do not

 

[Christie & Maverick]

Hi Staci - I’m not sure how much valuable input I can offer above and beyond Marje and Wendy’s feedback. You and I have chatted on past posts particularly in the beginning about Ivy’s patterns on the Libre. I think you’ve done an excellent job of understanding her patterns, albeit I will say I find it hard to establish the need for HC since in many cases when you’ve had Lo on Libre it often consistently was equating as you have reflected on your SS to often times low blues on hand held. (The more recent 56 on Nov 6th aside). So I guess on the idea that HC isn’t bringing her up, I’m not sure if that’s true, unless you have in the past experienced a significant jump, let’s say from green to blue on Libre within 1/2 hour of giving HC? I see less bouncing so that’s a good thing.

I will also share from my own personal experience over the years that I oddly find around this time of the year Maverick’s insulin needs come down. It’s happened every year and I honestly have no explanation why. That probably doesn’t help you a whole lot other than for me to say sometimes because there are so many variables that influence things there just isn’t an explanation that is easily found where you can say a-ha!

 

[Staci & Ivy]

Hi Staci - I’m not sure how much valuable input I can offer above and beyond Marje and Wendy’s feedback. You and I have chatted on past posts particularly in the beginning about Ivy’s patterns on the Libre. I think you’ve done an excellent job of understanding her patterns, albeit I will say I find it hard to establish the need for HC since in many cases when you’ve had Lo on Libre it often consistently was equating as you have reflected on your SS to often times low blues on hand held. (The more recent 56 on Nov 6th aside). So I guess on the idea that HC isn’t bringing her up, I’m not sure if that’s true, unless you have in the past experienced a significant jump, let’s say from green to blue on Libre within 1/2 hour of giving HC? I see less bouncing so that’s a good thing.

I will also share from my own personal experience over the years that I oddly find around this time of the year Maverick’s insulin needs come down. It’s happened every year and I honestly have no explanation why. That probably doesn’t help you a whole lot other than for me to say sometimes because there are so many variables that influence things there just isn’t an explanation that is easily found where you can say a-ha!

Hi Christie, it’s so nice to see you here. I haven’t seen you in the longest time

Yes, I have noticed a difference in that what I thought was 20% carb and was the fancy feast gravy, lovers beef, used to bring her up very quickly. (On the Libre I could see a spike within a few minutes, a much shorter time than 30 minutes)
Now, nothing happens when I use it, she just stays exactly where she is at a lower number. So there’s that difference.

it’s very interesting that you have noticed patterns with Maverick that sound like they may be seasonal.

This is my third fall season with Ivy having FD and this is the first time I’m encountering this sudden shift where I seem to need less insulin in a rapid period of time.

Of course I wasn’t dealing with hyperthyroid before March 2024, so clearly there’s been physiological changes with her.

I appreciate your giving me your experience here. Thanks for taking the time to stop by. Hope you are doing well.

 

[SmallestSparrow]

All my usual “I’m not a vet” disclaimers etc but this article describes a rare complication of severe hypoglycemia from methimizole caused anti-insulin antibodies. It seems these antibodies bind to the insulin, then at a later point release from the insulin, allowing a sudden huge spike in insulin (As a combination of the insulin that was injected but bound and is now released , Any additional insulin injected, and any insulin produced by the body when it wasn’t recognizing the injected insulin.) and a resulting hypoglycemia. I apologize if this makes no sense my thumbs are covered in deep cracks, so I have to dictate, and the only things im used to dictating are op reports. I don’t know if this is related to Ivy‘s problems, or even if this happens in cats, it’s not common and humans. but if the problem persists, maybe ask your vet about it, I know from Methos’ tumor how difficult it is to have a cat whose blood glucose never responds in the direction you expect.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4973408/

I Will try to come back to this tomorrow, when I can type a little more freely.

edit: The human patient described in this article was not on insulin. Yet she was discovered to have severe hypoglycemia that was very hard to treat didn’t respond being given carbohydrates, and when it did, she became hypo again as soon as they stopped, giving her extra carbohydrates. Which sounds a little bit like Ivy. tomorrow when I’m not sleep deprived, I’ll see if I can find some examples in humans who are using insulin who have this problem, but I don’t think that a combination of hyperthyroidism and diabetes is very common. So finding a complication of the treatment of those might be difficult. in addition, humans usually opted for radioactive iodine treatment, rather than anti, thyroid medication’s

 

[Staci & Ivy]

All my usual “I’m not a vet” disclaimers etc but this article describes a rare complication of severe hypoglycemia from methimizole caused anti-insulin antibodies. It seems these antibodies bind to the insulin, then at a later point release from the insulin, allowing a sudden huge spike in insulin (As a combination of the insulin that was injected but bound and is now released , Any additional insulin injected, and any insulin produced by the body when it wasn’t recognizing the injected insulin.) and a resulting hypoglycemia. I apologize if this makes no sense my thumbs are covered in deep cracks, so I have to dictate, and the only things im used to dictating are op reports. I don’t know if this is related to Ivy‘s problems, or even if this happens in cats, it’s not common and humans. but if the problem persists, maybe ask your vet about it, I know from Methos’ tumor how difficult it is to have a cat whose blood glucose never responds in the direction you expect.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4973408/

I Will try to come back to this tomorrow, when I can type a little more freely.

edit: The human patient described in this article was not on insulin. Yet she was discovered to have severe hypoglycemia that was very hard to treat didn’t respond being given carbohydrates, and when it did, she became hypo again as soon as they stopped, giving her extra carbohydrates. Which sounds a little bit like Ivy. tomorrow when I’m not sleep deprived, I’ll see if I can find some examples in humans who are using insulin who have this problem, but I don’t think that a combination of hyperthyroidism and diabetes is very common. So finding a complication of the treatment of those might be difficult. in addition, humans usually opted for radioactive iodine treatment, rather than anti, thyroid medication’s

Wow, Colleen. Thank you so much for bringing this article to my attention. That’s really terrifying that that’s what could be happening is that there’s a problem between the insulin and the methimazole causing the problem.
It does seem that this change has happened since our last methimazole increase, which was given on 10/23.
When I look at my spreadsheet, I see that’s when I pretty quickly started giving her reductions, so there does seem to be a direct correlation.

I really appreciate your bringing this to my attention.

i’ve reached out to my vet’s office via email this morning and hoping I will hear from him early this week.
I’m not really sure how to proceed but suddenly things have gotten very complicated.

Part of the issue is Ivy is such a difficult patient and I’ve already had several offices. Who do the 131 treatment tell me she is not a candidate due to her fractious personality, diabetes, kidney issues and the fact that she may not eat on her own while she would have to be left there and they would not be able to give her hands-on treatment if it were needed.

I’m feeling even more anxious as things seem to have gotten even more complicated

 

[Marje and Gracie]

All my usual “I’m not a vet” disclaimers etc but this article describes a rare complication of severe hypoglycemia from methimizole caused anti-insulin antibodies. It seems these antibodies bind to the insulin, then at a later point release from the insulin, allowing a sudden huge spike in insulin (As a combination of the insulin that was injected but bound and is now released , Any additional insulin injected, and any insulin produced by the body when it wasn’t recognizing the injected insulin.) and a resulting hypoglycemia. I apologize if this makes no sense my thumbs are covered in deep cracks, so I have to dictate, and the only things im used to dictating are op reports. I don’t know if this is related to Ivy‘s problems, or even if this happens in cats, it’s not common and humans. but if the problem persists, maybe ask your vet about it, I know from Methos’ tumor how difficult it is to have a cat whose blood glucose never responds in the direction you expect.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4973408/

I Will try to come back to this tomorrow, when I can type a little more freely.

edit: The human patient described in this article was not on insulin. Yet she was discovered to have severe hypoglycemia that was very hard to treat didn’t respond being given carbohydrates, and when it did, she became hypo again as soon as they stopped, giving her extra carbohydrates. Which sounds a little bit like Ivy. tomorrow when I’m not sleep deprived, I’ll see if I can find some examples in humans who are using insulin who have this problem, but I don’t think that a combination of hyperthyroidism and diabetes is very common. So finding a complication of the treatment of those might be difficult. in addition, humans usually opted for radioactive iodine treatment, rather than anti, thyroid medication’s

Actually, it is quite common to see cats with both FD and hyperthyroidism. We’ve had many, many over the years here that required felimazole (or MMI) and insulin. The thyroid group Staci and I belong to also has cats with both conditions.

Very interesting article but I honestly do not believe it applies here. Thank you for sharing it, though.

 

[SmallestSparrow]

Wow, Colleen. Thank you so much for bringing this article to my attention. That’s really terrifying that that’s what could be happening is that there’s a problem between the insulin and the methimazole causing the problem.
It does seem that this change has happened since our last methimazole increase, which was given on 10/23.
When I look at my spreadsheet, I see that’s when I pretty quickly started giving her reductions, so there does seem to be a direct correlation.

I really appreciate your bringing this to my attention.

i’ve reached out to my vet’s office via email this morning and hoping I will hear from him early this week.
I’m not really sure how to proceed but suddenly things have gotten very complicated.

Part of the issue is Ivy is such a difficult patient and I’ve already had several offices. Who do the 131 treatment tell me she is not a candidate due to her fractious personality, diabetes, kidney issues and the fact that she may not eat on her own while she would have to be left there and they would not be able to give her hands-on treatment if it were needed.

I’m feeling even more anxious as things seem to have gotten even more complicated

I’m so sorry I didn’t mean to make you anxious—and extra sorry I’ve been so tied up with methos i haven’t been here until now today. Please don’t worry. It is probably not the methemizole —wiser folk than I have pointed that out—so try not to worry about it. Hopefully it’s just as others said that correcting the thyroid sometimes results in less insulin resistance and all you would need is a reduction in insulin dose. In humans it’s a very rare complication of taking methimizolw and who knows if it even happens in cats—common things are common we like to say in medicine—it just struck me because it seemed to come on suddenly and pretty hard and you seem to be an old hand at controlling diabetes —when a patient of mine who usually could handle their chronic disease suddenly couldn’t I added rare things to the differential since I could assume the easy common things the patient would have handled.

my other boy had I-131…unfortunately the cat who never in his life passed on a meal refused to eat afterwards and ended up hypothyroid now as a result.

I hope Ivy rights herself soon—my fuzzy toed boy sends his regards to your fuzzy toed girl. And again my apologies for scaring you

 

[Staci & Ivy]

I’m so sorry I didn’t mean to make you anxious—and extra sorry I’ve been so tied up with methos i haven’t been here until now today. Please don’t worry. It is probably not the methemizole —wiser folk than I have pointed that out—so try not to worry about it. Hopefully it’s just as others said that correcting the thyroid sometimes results in less insulin resistance and all you would need is a reduction in insulin dose. In humans it’s a very rare complication of taking methimizolw and who knows if it even happens in cats—common things are common we like to say in medicine—it just struck me because it seemed to come on suddenly and pretty hard and you seem to be an old hand at controlling diabetes —when a patient of mine who usually could handle their chronic disease suddenly couldn’t I added rare things to the differential since I could assume the easy common things the patient would have handled.

my other boy had I-131…unfortunately the cat who never in his life passed on a meal refused to eat afterwards and ended up hypothyroid now as a result.

I hope Ivy rights herself soon—my fuzzy toed boy sends his regards to your fuzzy toed girl. And again my apologies for scaring you

Hi Colleen, please don’t apologize, I really do appreciate your making me aware. It’s better to question something that’s not obvious and rule it out.
I sent an email to my vet just to have a discussion with him anyway.
I really need to let him know what’s happening anyway so it’s perfectly fine and you’re probably right. It’s probably that she just needs to have the insulin adjusted and I’m doing that by lowering her dosing and we’ll see what happens.
So thank you again and please don’t feel bad. I’m not upset at all. I appreciate you and your kindness for paying attention and giving suggestions.

I’m sorry to hear your other kitty who had the I131 ended up with hypothyroid. How is that working out? Is he doing OK? And is that condition being managed OK? Are you still happy that you did the I 131?
I know you have your hands full with me so whenever you have a moment to respond is fine no rush at all.
Sending you lots of hugs and love for all your kitties and especially Methos

 

[SmallestSparrow]

Hi Colleen, please don’t apologize, I really do appreciate your making me aware. It’s better to question something that’s not obvious and rule it out.
I sent an email to my vet just to have a discussion with him anyway.
I really need to let him know what’s happening anyway so it’s perfectly fine and you’re probably right. It’s probably that she just needs to have the insulin adjusted and I’m doing that by lowering her dosing and we’ll see what happens.
So thank you again and please don’t feel bad. I’m not upset at all. I appreciate you and your kindness for paying attention and giving suggestions.

I’m sorry to hear your other kitty who had the I131 ended up with hypothyroid. How is that working out? Is he doing OK? And is that condition being managed OK? Are you still happy that you did the I 131?
I know you have your hands full with me so whenever you have a moment to respond is fine no rush at all.
Sending you lots of hugs and love for all your kitties and especially Methos

It’s still a many years work in progress w/ Muz but I’m still glad I did the 131–in theory less side effects from taking synthroid than taking methimazole; he was on methimizole longer than planned bc covid shutdown began the week he was to get tx, and my state was early to shut down and late to reopen. It was like doing a drug deal when vets reopened after the hard shut down—handing kitties off in parking lots with six feet between us…I would have waited for a less chaotic time but his wbc started to drop and we never could get a good dose (either too little or too much, similar to Methos’ insulin)

if Muz weren’t such a butt head about pills synthroid would be a snap…he can suck a pill pocket off leaving a pristine pill behind. It’s also been a problem finding the right dose of synthroid —complicated bc cats aren’t usually hypothyroid so lab tests don’t have TSH values and T4 isn’t reliable bc I’m now splitting his dose since he vomits the higher doses. Always something. The sad thing is he was a bit overweight (he loves food) and with strict diet and an exercise wheel I’d gotten him perfect. Since the 131 he’s become fat and I live in dread of him becoming diabetic—but he might do fine, my view of insulin is colored by two Cushings cats where they bounce between too high and too low with no reason

it is funny at the vet, it took a long time for the desk staff to understand why he was coming at 4 hours post pill (they’d book me like most cats coming for a thyroid test until I read about the correct timing)—I started to have to ask them “how many hours post pill do you book dogs? Do that for Muz”. The vet and I laugh that both my boys have “dog” diseases

I hope Ivy is better and that you got some sleep. I think the last time I slept more than 3 hours was July and I’m way too old for that last few weeks of getting less than three hours total in 24.

 

[Staci & Ivy]

It’s still a many years work in progress w/ Muz but I’m still glad I did the 131–in theory less side effects from taking synthroid than taking methimazole; he was on methimizole longer than planned bc covid shutdown began the week he was to get tx, and my state was early to shut down and late to reopen. It was like doing a drug deal when vets reopened after the hard shut down—handing kitties off in parking lots with six feet between us…I would have waited for a less chaotic time but his wbc started to drop and we never could get a good dose (either too little or too much, similar to Methos’ insulin)

if Muz weren’t such a butt head about pills synthroid would be a snap…he can suck a pill pocket off leaving a pristine pill behind. It’s also been a problem finding the right dose of synthroid —complicated bc cats aren’t usually hypothyroid so lab tests don’t have TSH values and T4 isn’t reliable bc I’m now splitting his dose since he vomits the higher doses. Always something. The sad thing is he was a bit overweight (he loves food) and with strict diet and an exercise wheel I’d gotten him perfect. Since the 131 he’s become fat and I live in dread of him becoming diabetic—but he might do fine, my view of insulin is colored by two Cushings cats where they bounce between too high and too low with no reason

it is funny at the vet, it took a long time for the desk staff to understand why he was coming at 4 hours post pill (they’d book me like most cats coming for a thyroid test until I read about the correct timing)—I started to have to ask them “how many hours post pill do you book dogs? Do that for Muz”. The vet and I laugh that both my boys have “dog” diseases

I hope Ivy is better and that you got some sleep. I think the last time I slept more than 3 hours was July and I’m way too old for that last few weeks of getting less than three hours total in 24.

I had the same experience during Covid with my vet. Handing off Ivy to a vet tech in a parking lot 6 feet apart and the vet coming out to talk to me 6 feet apart in the parking lot, so it sounds like we had similar situations there. I’m sorry that you had to deal with a procedure during that time.
It was truly stressful on so many levels.

Do you use Hemopet for the TSH level testing? I think they are the only lab that tests for TSH (I’ve used them and sent blood serum there)

https://hemopet.org/wp-content/uploads/2024/03/TEST-REQ-FORMandINSTRUCTIONS-2024.pdf

I am having Ivy tested 4 hours after giving her transdermal methimazole dose. Thank you for mentioning that time frame.

I’m sorry to hear that Muz has gained weight since his I131. I wonder why that is the case? Do you have any ideas?

I have been told by two clinics that they would not do the procedure on Ivy. I think I’m going to have to do another round of investigating.
I’m just really concerned with giving methimazole over time. It’s really not the best solution but she’s such a pain in the butt difficult cat, nobody really wants to touch her, plus all her comorbidities makes it difficult. Especially with the diabetes and having to give insulin and being prepared to have to intervene if she were to go low or have a hypo.

I know you have your hands very full with your kitties. You’re such an incredible cat mom. I give you so much credit.
I agree with you. The sleep deprivation is wicked.
I’m sorry you also haven’t slept since July and yes, I am also too old for this.
My stamina is just not there for not sleeping, so this is especially rough on me. Sadly, I can totally relate

 

[SmallestSparrow]

I had the same experience during Covid with my vet. Handing off Ivy to a vet tech in a parking lot 6 feet apart and the vet coming out to talk to me 6 feet apart in the parking lot, so it sounds like we had similar situations there. I’m sorry that you had to deal with a procedure during that time.
It was truly stressful on so many levels.

Do you use Hemopet for the TSH level testing? I think they are the only lab that tests for TSH (I’ve used them and sent blood serum there)

https://hemopet.org/wp-content/uploads/2024/03/TEST-REQ-FORMandINSTRUCTIONS-2024.pdf

I am having Ivy tested 4 hours after giving her transdermal methimazole dose. Thank you for mentioning that time frame.

I’m sorry to hear that Muz has gained weight since his I131. I wonder why that is the case? Do you have any ideas?

I have been told by two clinics that they would not do the procedure on Ivy. I think I’m going to have to do another round of investigating.
I’m just really concerned with giving methimazole over time. It’s really not the best solution but she’s such a pain in the butt difficult cat, nobody really wants to touch her, plus all her comorbidities makes it difficult. Especially with the diabetes and having to give insulin and being prepared to have to intervene if she were to go low or have a hypo.

I know you have your hands very full with your kitties. You’re such an incredible cat mom. I give you so much credit.
I agree with you. The sleep deprivation is wicked.
I’m sorry you also haven’t slept since July and yes, I am also too old for this.
My stamina is just not there for not sleeping, so this is especially rough on me. Sadly, I can totally relate

Muz gained weight because he’s old and doesn’t get much exercise (esp lately bc I’ve been too busy to make him and he doesn’t run around with Methos anymore. And because he ran hypothyroid for many months as everyone assumed his thyroid would wake up. Don’t mourn not being able to do the 131–there is a risk in older cats, including that it can worsen kidney status …one of the requirements was recent kidney function testing. Sometimes as I’ve struggled to get a dose of synthroid that works (and worry about his weight gain or a bump in his BUN) I think “should have left you on methimazole”. Grass is always greener.
incant keep straight the time requirements —so I rely on the desk staff…I’ve just learned to make sure we do what dogs do (because dogs usually are hypothyroid)

I’m sure Ivy doesn’t mean to be a pain in the butt (do you use gabapentin for vet visits?)—and I’m in awe of how well you manage her care.

Here’s to us sleeping tonight!

 

[Staci & Ivy]

Muz gained weight because he’s old and doesn’t get much exercise (esp lately bc I’ve been too busy to make him and he doesn’t run around with Methos anymore. And because he ran hypothyroid for many months as everyone assumed his thyroid would wake up. Don’t mourn not being able to do the 131–there is a risk in older cats, including that it can worsen kidney status …one of the requirements was recent kidney function testing. Sometimes as I’ve struggled to get a dose of synthroid that works (and worry about his weight gain or a bump in his BUN) I think “should have left you on methimazole”. Grass is always greener.
incant keep straight the time requirements —so I rely on the desk staff…I’ve just learned to make sure we do what dogs do (because dogs usually are hypothyroid)

I’m sure Ivy doesn’t mean to be a pain in the butt (do you use gabapentin for vet visits?)—and I’m in awe of how well you manage her care.

Here’s to us sleeping tonight!

I wish I felt comfortable with the methimazole as the solution for her. I know what you mean about the grass is always greener and it does scare me about the hypothyroid situation. Everyone says hypothyroid is much easier to deal with than the hyperthyroid and having to give medication and have the testing constantly.
Obviously, there are so many factors to consider with the treatment, but it just may not be in the cards for us given her temperament and the diabetes, etc.

No of course Ivy doesn’t mean to be a complete pain in the butt. It’s her personality. She’s always been like this and yes, I do have to medicate her with gabapentin and trazodone the night before and in the morning of a visit, so it’s a whole thing. Been doing it for many years. Even when sedated, she is able to be completely fractious. many times they’ve also had to give her an injectable sedation on top of my pre-medication. She’s just that wicked. I’m sure she’s terrified and that’s how she manifests her fear. Poor thing.

That’s very sweet of you to say (as a care giver) but you are managing multiple cats and many difficult conditions so, my head is off to you as well. You are truly a warrior, Colleen

 

[Marje and Gracie]

Muz gained weight because he’s old and doesn’t get much exercise (esp lately bc I’ve been too busy to make him and he doesn’t run around with Methos anymore. And because he ran hypothyroid for many months as everyone assumed his thyroid would wake up. Don’t mourn not being able to do the 131–there is a risk in older cats, including that it can worsen kidney status …one of the requirements was recent kidney function testing. Sometimes as I’ve struggled to get a dose of synthroid that works (and worry about his weight gain or a bump in his BUN) I think “should have left you on methimazole”. Grass is always greener.
incant keep straight the time requirements —so I rely on the desk staff…I’ve just learned to make sure we do what dogs do (because dogs usually are hypothyroid)

I’m sure Ivy doesn’t mean to be a pain in the butt (do you use gabapentin for vet visits?)—and I’m in awe of how well you manage her care.

Here’s to us sleeping tonight!

I wish I felt comfortable with the methimazole as the solution for her. I know what you mean about the grass is always greener and it does scare me about the hypothyroid situation. Everyone says hypothyroid is much easier to deal with than the hyperthyroid and having to give medication and have the testing constantly.
Obviously, there are so many factors to consider with the treatment, but it just may not be in the cards for us given her temperament and the diabetes, etc.

No of course Ivy doesn’t mean to be a complete pain in the butt. It’s her personality. She’s always been like this and yes, I do have to medicate her with gabapentin and trazodone the night before and in the morning of a visit, so it’s a whole thing. Been doing it for many years. Even when sedated, she is able to be completely fractious. many times they’ve also had to give her an injectable sedation on top of my pre-medication. She’s just that wicked. I’m sure she’s terrified and that’s how she manifests her fear. Poor thing.

That’s very sweet of you to say (as a care giver) but you are managing multiple cats and many difficult conditions so, my head is off to you as well. You are truly a warrior, Colleen

Having had to deal with hyperT, MMI and hypoT, levothyroxin, I’ll take the hypoT every day as the long-term effects of hyperT and MMI are worse as the hyperT is not cured and will progress. Once the correct doses of T4/T3 are found for a hypoT cat, they do quite well and most tolerate the meds extremely well.