? 12/13, Mai, PMPS 75, Question on "normal / healthy BG range"

[Mai & Dad]

Hello all,

Xiaomai's BG hits 75 PMPS today. Likely we will see a bounce soon but I do want to understand how to handle low BG better when (and hopefully if) we finally get there. And I will of course test his BG hourly going forward until it's clearly steady or trending upwards.

My question is :

1. The TR guide post says the normal BG range of a healthy non-diabetic cat is within 50~80. But when I search this on the internet, I get 80 to 120 instead consistently. Is there a special reason why we consider the normal range to be between 50 and 80 here?

2. Is it correct that unless he earns a reduction (i.e., below 100 most of the time and nadirs between 50 and 80 for three days), I will continue to add his dosage? What if his nadirs are consistently within 50 and 80, but we are still seeing a curve instead of a flatten one?

3. I remember one of our members on here told me that given his DKA history (09/2023, x2), I should never skip a dose. What if the PS number is lower than 50?

Thanks!

 

[Bandit's Mom]

1. The TR guide post says the normal BG range of a healthy non-diabetic cat is within 50~80. But when I search this on the internet, I get 80 to 120 instead consistently. Is there a special reason why we consider the normal range to be between 50 and 80 here?

Our dosing protocols and ranges are based on a human meter and the normal range with a human meter is 50-100 mg/dl (not 50-80). Vets and labs use the range for pet meters which is higher at 68-120 mg/dl or so.

2. Is it correct that unless he earns a reduction (i.e., below 100 most of the time and nadirs between 50 and 80 for three days), I will continue to add his dosage? What if his nadirs are consistently within 50 and 80, but we are still seeing a curve instead of a flatten one?

Here is the sticky that covers earning reductions. Mai is a long term diabetic so you would follow those rules for earning a reduction.
Reminder: *earning* reductions and starting OTJ trials

Wrt dosing, I will tag @Wendy&Neko since she is our go-to person for high dose kitties.

Link to your previous post:
https://www.felinediabetes.com/FDMB/threads/11-13-mai-amps-384-6-344.295685/

 

[Mai & Dad]

Our dosing protocols and ranges are based on a human meter and the normal range with a human meter is 50-100 mg/dl (not 50-80). Vets and labs use the range for pet meters which is higher at 68-120 mg/dl or so.


Here is the sticky that covers earning reductions. Mai is a long term diabetic so you would follow those rules for earning a reduction.
Reminder: *earning* reductions and starting OTJ trials

Wrt dosing, I will tag @Wendy&Neko since she is our go-to person for high dose kitties.

Link to your previous post:
https://www.felinediabetes.com/FDMB/threads/11-13-mai-amps-384-6-344.295685/

Hello again! Thank you for the response and how have you been? Hope everything has been well?

 

[Wendy&Neko]

Hello again. How is Mai doing and feeling? Cats are so much more than their numbers. What did he think of those normal green numbers? Also, have you done ketones tests lately?

I've tested 3 non diabetic cats, 2 of mine and one of a friends. Two were in the low 50's, one was 49. One got to higher number when on steroids, but still in the range we say here is normal.

By the way, when we see a dose that gives green, you should be holding the dose longer, for 10 cycles at least. To see if he'll come back to green after the bounce is over. You went up a little too soon at 13 units. With that 75, I wouldn't rush up to 15 as soon as it listed in the spreadsheet.

As far as reduction goes, I sometimes suggest some strategies, based on why a cat is on a higher dose. Any luck yet in finding a vet willing to do the IAA and IGF-1 (acromegaly) tests. Any vet seeing the current dose should be all over figuring out why. Maybe they'd give you a referral to an internal medicine vet if they won't do it themselves?

When a cat has a higher dose, they also have a larger depot, and depending on why needs the higher dose, we might have a better idea of what might happen next.

If a preshot is below between 40 and 49, do NOT feed and wait 15 minutes and test again. If up above 50, then you can shoot. You want to see if he's coming up on his own. More information on handling those low preshots in this Sticky Note:
Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers

 

[Mai & Dad]

Hello again. How is Mai doing and feeling? Cats are so much more than their numbers. What did he think of those normal green numbers? Also, have you done ketones tests lately?

He is acting normal and doing relatively well. Though it is a constant struggle. After finally getting him to poo normally, he is now having a pretty severe constipation issue on grain-free food, even with his probiotics and fiber twice a day. I am now feeding him pumpkin puree twice a day as well.

I've tested 3 non diabetic cats, 2 of mine and one of a friends. Two were in the low 50's, one was 49. One got to higher number when on steroids, but still in the range we say here is normal.

By the way, when we see a dose that gives green, you should be holding the dose longer, for 10 cycles at least. To see if he'll come back to green after the bounce is over. You went up a little too soon at 13 units. With that 75, I wouldn't rush up to 15 as soon as it listed in the spreadsheet.

That is good to know. The reason why I decided to move forward is because if you look at his history coming from 5 to 14, I tend to give him time at each level. But the issue was, he would then just stay high after the bounce and never really come back down. I have been pushing a bit faster since it seems to help him stay low.

As far as reduction goes, I sometimes suggest some strategies, based on why a cat is on a higher dose. Any luck yet in finding a vet willing to do the IAA and IGF-1 (acromegaly) tests. Any vet seeing the current dose should be all over figuring out why. Maybe they'd give you a referral to an internal medicine vet if they won't do it themselves?

The vet issue was indeed the main reason why I couldn't have it done right away. At this point though, I am also hesitating a bit myself. Since last year, and his two DKAs, it has been pretty rough for us, and the other cats, even for my family. He stayed in the ED for 4 days, then ICU for 17 days, then we were practically at the vet every other week if not every week for more than half a year. The BG issue was never solved and then we had to deal with the diarrhea issue (literally close to six months, liquid everyday). Even if you look at the last month, I feel like the only progress we made, was that he hasn't had a 400+ for a month, which, is not even true anymore (411 PMPS). I did an analysis on his BG, for the last two months, while his insulin went up from 5 to 14, and switching from 15% carb food to LC food, his AM BG didn't even decrease statistically. It actually went up by 0.6, which is nothing ofc, at his level.

Financially, physically, and mentally, it has been overwhelming. Therefore, I am just not mentally ready to "have" more hiccups. I know this is not the best way to look at it. Whether I test or not, it will not change the outcome. But even if I do test, if it is IAA, I will just shoot it away as I am doing now. And if it is IGF-1, honestly I think my therapist might have to move in within me and she better finds her own before she goes depressed and crazy. But seriously, I don't even know if I want him to go through radio-therapy. My grandpa had lung-cancer and was stable until he had his first radio-therapy. Circumstantial, I know, but I also don't feel like putting him through it.

 

[Wendy&Neko]

Whether I test or not, it will not change the outcome. But even if I do test, if it is IAA, I will just shoot it away as I am doing now. And if it is IGF-1, honestly I think my therapist might have to move in within me and she better finds her own before she goes depressed and crazy. But seriously, I don't even know if I want him to go through radio-therapy.

There is a newer treatment available now for acrocats, called cabergoline. It is a liquid medicine given daily, or every other day. It helps most cats, most go to lower doses, and with acro symptoms reduced. We've even had a few go OTJ. Make that 5 now I think with the latest report from Kokkinoulis in Greece. It was not available when Neko was diagnosed. No anaesthesia, no travel required. In a survey of caregivers of acros, cabergoline rated quite well, almost the same as SRT. Although Neko had SRT, I was glad I did it, cause her quality of life was improved a lot, and for longer. But you can't treat unless you know what you are dealing with.