12/21 - Gen, PMPS >400

[Allie & Gen]

Yesterday

Couldn't post this morning because I was running around making last-minute food for a Solstice potluck at a friend's house.

So ... he hasn't even made it into the yellow, these last two cycles. I'm inclined to think an increase is a good idea at this point, but would be grateful for input.

He's clearly not feeling great. He never came to my room last night, which is unusual. I also found some more recent dry blood on his cheek this morning, which I wiped. I'm so, so glad we see the vet tomorrow.

I'm leaving my first post here for readability and will respond to a few people from yesterday below.

ETA: He still isn't pooping. I've started giving him Miralax in his food; also, this morning was the last dose of antibiotic (they said 10 days, but they seem to have given me an 8-day supply).

 

[Allie & Gen]

Twice now, Gen has hit below 90 on that Libre. Normally that would mean reduce with SLGS. But without a backup test with a BG meter, it's hard to say whether that was really below 90. I know that's what you are dealing with. Maybe looking around at some of the other caregivers with Libre only situations using SLGS and see if they've tweaked their reduction point. Libre is usually lower than BG meter, but we've also seen some cases where it is not. Keep in mind, safety first.

Some brief nice numbers followed by high is not uncommon with cats with insulin resistance, which can be caused by dental inflammation or infection. I hope you have a good vetty appointment next week.

One of the things I'll be getting from the vet tomorrow will be gabapentin capsules. IF I can get Gen to take a dose mixed in with his dinner, I may try to do a manual blood test. (They'll do one at the vet of course, but additional stress will be a factor.) This may be a bit of a long shot, especially given everything I'm juggling, but it would be nice to have the comparison, certainly.

Insulin resistance ... yeah, that does seem like it might be a factor here, huh. I'm not sure what that means for treatment (I know there are resources, I'm just really tapped out tonight and can't process a wall of text, I'll try to read up tomorrow if I can). I would be grateful for any wisdom or pointers there.

Thank you for your input!

 

[Allie & Gen]

I’ll add perhaps a few more things to consider. In the early December dosing that you mentioned, you had jumped up from 0.75u to 1.25u so at that time, when Gen dropped to greens after 8 cycles, the reduction to 1u would have made sense. I’ve shared some of my thoughts previously on bouncing and on some of the challenges with Libre, but do appreciate that it allows caregivers who can’t manually test some good visibility on BG that they wouldn’t have, so even just for that reason I like it. I will say, since you mentioned that Gen is a grazer, is that you are home with him for the holidays, you may want to see about experimenting with feedings early in the cycle, at +1, +2, +3 to help slow BG drops a little. Steep drops and/or hitting numbers the cat isn’t used to will lead to bouncing. So take for example the cycle that started the last bounce, Dec. 18th. Steep drop into +2, pink preshot to blues. Because you have the Libre, you can see he came down to yellow already at +1, so if you see something similar, feed a couple teaspoons of his usual LC. Same again at +2 and +3. It can help to flatten out the curve, and sometimes with bouncy kitties, it’s a good strategy you may want to try. More info here 8/10 TASHIE pmps=HIGH! +Questions***

I agree that at some point, in the absence of handheld checks at lower numbers, one does need to decide what number on the Libre they want to use in order to take a reducie. I like Wendy’s suggestion to compare what others with Libre testing generally see. The good news is that there are many more Libre users these days, some short term, some long term.

There can often be variables which influence BG, including how the insulin is absorbed/used, carb sensitivity of the cats, fluctuations in carb content in the food, when the food is fed, and possible infection among other things.

I’m glad you are going to see the vet, although it’s good to hear Gen seems to be feeling ok on some fronts at least, like interest in eating. I’d be more concerned if he’s not eating, since that combined with infection/inflammation can increase risks for ketones. Still worth mentioning to vet, and whether they can run a urinalysis. And, if the vet is inclined to run some blood work, you may want to ask about getting a pancreatitis test. If your vet has a Catalyst One In-House Analyzer, they can add it, and it gives you a number, not just a yes/no like the old SNAP fPL. Vets used to have to send the blood out for a spec fPL to get a diagnosis of pancreatitis.

I feel like I’m missing something else, but I suppose I’ve given you enough food for thought for the time being

With your staggered feeding suggestion, I guess that would mean feeding a smaller amount each time (including his first feeding), yes? I am not wholly confident that I can get him to come eat on command, even if I do so, but I could try it. (This would be easier after my trip, when we're back home and not dealing with other distractions.)

In re: deciding on a number for reductions with the Libre ... just at the moment, it feels like a moot point, but you're right. And I'm not sure. If I could get a better handle on him in general, that would help! As would being able to do some comparative testing. But it feels very much like we're going in the opposite direction right now, anyway.

I took a ketone test a few days ago (forgot to note it on the spreadsheet, apologies - I jumped at the chance when I saw that he'd just left a fresh stream of urine in the bathtub - and it was negative. The vet did one on our last visit; also negative. I'll ask her to do one again tomorrow. And I'll ask about the pancreatitis test, too.

Thank you.

 

[Allie & Gen]

I don't have any helpful advice to offer but wanted to drop in and say I was impressed by the additional nadir chart!
As a data analyst, I can't help but create extra spreadsheets in addition to the standard one to try to look for trends

Have a great weekend Gen and Allie

Heh, thanks. I just thought it would be helpful to see those numbers in direct comparison. There have been other things I've thought about trying to track, but in spite of being someone who uses spreadsheets for a lot of things, I've been a bit too overwhelmed/tired to do much extra data analysis yet. I'm delighted that someone else here has both the impulse and the wherewithal!

I have been thinking about making a page in my spreadsheet to cleanly compare the meter numbers to what the Libre was showing at the same times, this might be the motivation I need to do it. I'm not very handy with analyzing data like Allie and Albert but maybe just getting the data would be a good starting point.

Edit: I added a tab--I was only able to export Contour data from Sept-now, will have to play around with the meter to see if I can manually locate older data.

Lauren, you are amazing. Thank you! I am a bit too wiped out to be able to make much sense of it just now, but this is a helpful and kind thing and I appreciate it! I'm sure other Libre users do/will as well.

 

[Mary & Jude]

One of the things I'll be getting from the vet tomorrow will be gabapentin capsules. IF I can get Gen to take a dose mixed in with his dinner, I may try to do a manual blood test. (They'll do one at the vet of course, but additional stress will be a factor.) This may be a bit of a long shot, especially given everything I'm juggling, but it would be nice to have the comparison, certainly.

Insulin resistance ... yeah, that does seem like it might be a factor here, huh. I'm not sure what that means for treatment (I know there are resources, I'm just really tapped out tonight and can't process a wall of text, I'll try to read up tomorrow if I can). I would be grateful for any wisdom or pointers there.

Thank you for your input!

You can do a search on this platform for the taste of Gaba capsules, but I hear it's bad. If you are unable to pill Gen, you might ask your vet his/her opinion about the taste first before paying $$ for something you cannot use. Vets often have liquid Gaba, BUT the version they have often has xylitol in it (as does the version at the local pharmacy), which is not good for diabetic cats. We have ours compounded, without any added sugar/sugar substitute, and Jude takes it with little issue. Wedgewood Pharmacy is one a lot of folks use, but they have to send it to you, so it takes time. Fortunately, we have a local compounding pharmacy, but it takes them a couple of days to get the script filled.

 

[Wendy&Neko]

Regarding dose, I'd increase tomorrow unless he see low blues/greens tonight. BTW, constipation can also cause higher numbers. Miralax, do your work!

Ditto what Mary said about gabapentin. I recently had to give it to kitty at home, and the vet strongly suggested pills due to the taste of alternative formats. Have you ever give Gen chicken hearts? - see Mary's siggy. Purebites is one maker. My kitty also goes nuts for them. I wonder if you could make a little hole in a heart piece and stuff a pill in. I gave gaba in a pill pocket piece, followed immediately by Churu. Even hubby managed that!

Insulin resistance means something else is preventing the insulin from doing it's job. I suspect in Gen's case he needs that dental to overcome it.

 

[Allie & Gen]

You can do a search on this platform for the taste of Gaba capsules, but I hear it's bad. If you are unable to pill Gen, you might ask your vet his/her opinion about the taste first before paying $$ for something you cannot use. Vets often have liquid Gaba, BUT the version they have often has xylitol in it (as does the version at the local pharmacy), which is not good for diabetic cats. We have ours compounded, without any added sugar/sugar substitute, and Jude takes it with little issue. Wedgewood Pharmacy is one a lot of folks use, but they have to send it to you, so it takes time. Fortunately, we have a local compounding pharmacy, but it takes them a couple of days to get the script filled.

We tried liquid gaba a few days ago, and apparently it tasted horrible or something, because he ate two bites and then hid under the bed, and refused to eat any more of his food.

I don't have time to get something compounded before our trip at this point (we leave Tuesday), so I'm really hoping the powdered stuff might not taste too awful, especially if I mix in a good amount of his freeze-dried tuna. I kind of doubt I'll be able to get any sent to my parents' place by our return journey on Sunday, either, given that it's Christmas this week. :/

 

[Allie & Gen]

Regarding dose, I'd increase tomorrow unless he see low blues/greens tonight. BTW, constipation can also cause higher numbers. Miralax, do your work!

Ditto what Mary said about gabapentin. I recently had to give it to kitty at home, and the vet strongly suggested pills due to the taste of alternative formats. Have you ever give Gen chicken hearts? - see Mary's siggy. Purebites is one maker. My kitty also goes nuts for them. I wonder if you could make a little hole in a heart piece and stuff a pill in. I gave gaba in a pill pocket piece, followed immediately by Churu. Even hubby managed that!

Insulin resistance means something else is preventing the insulin from doing it's job. I suspect in Gen's case he needs that dental to overcome it.

I really hope the Miralax starts working! And that he isn't pooping somewhere sneaky. He's never done that before, but this has been a time of unprecedented things.

I can't pill Gen; mixing medication with his food has been the only effective way I've been able to give him oral medication. I'm not sure how a chicken heart would work - he'd try to chew it and probably wind up spitting some of it out, and I'm not sure how a whole pill would go down that way. (I also am very leery about any raw poultry after learning of several cats who contracted bird flu from their commercial raw food last year, several of whom died.) The last time we tried a pill pocket, he dropped pieces of it. I don't know ... I will discuss with my vet, maybe she'll have some thoughts.

Yes, I am inclined to suspect the same, re: Gen's dental issues, especially with the recent abscess. I just am not sure if there's something I can do to fight the resistance in the meantime - guess it's just taking increases when called for, at least for now?

 

[Mary & Jude]

Also, for clarification, the chicken hearts are freeze dried. You can easily find them at a pet supply store—I get the ones marketed to dogs—they are the same as the ones for cats, but cheaper.

 

[Allie & Gen]

Also, for clarification, the chicken hearts are freeze dried. You can easily find them at a pet supply store—I get the ones marketed to dogs—they are the same as the ones for cats, but cheaper.

I think freeze dried carries the same potential risk as raw, in this instance, but I haven't actually researched it and could be wrong. (There isn't enough information out there about bird flu in general, much less specifically in cats, though, so I'm just really cautious.)

 

[Mary & Jude]

I think freeze dried carries the same potential risk as raw, in this instance, but I haven't actually researched it and could be wrong. (There isn't enough information out there about bird flu in general, much less specifically in cats, though, so I'm just really cautious.)

You’re 100% correct. Freeze drying doesn’t kill bird flu.
It’s a risk we’re willing to take since most poultry farms exterminate entire flocks when bird flu is discovered.

 

[Allie & Gen]

You’re 100% correct. Freeze drying doesn’t kill bird flu.
It’s a risk we’re willing to take since most poultry farms exterminate entire flocks when bird flu is discovered.

That's fair! It's not a risk I've been willing to take at this point, after seeing a friend of a friend on social media chronicle her cats' illness (from their food). I hope we'll get a better handle on the disease at some point.

 

[Wendy&Neko]

You could also try cooked meat as something to hide a pill in. I find my kitty doesn't chew it a lot, and the pill goes down quickly. Especially once she spots the Churu chaser coming towards her. Neko was also a hard one to pill. I crammed as many meds as I could fit into a blank gel cap and used a pill shooter. I imagine you've tried most of the tricks.

 

[Albert & Xander]

I hope you get some helpful information at the vet tomorrow. Feel better soon Gen!

It's been awhile since Xander had a bout of constipation, but it does make him feel pretty crummy (and I think higher numbers as well)

 

[squeem3]

You can buy freeze dried organ meat in rabbit and other proteins. I'm not sure how you would hide a pill in it, though.

I hide Leroy's pills in one of civvie's Raw Bites.