12/24 Ziggy AMPS 241 Help Please

[Ziggyloveforever]

Hey everyone Ziggy and I are back. Although his fructosomine test was considered non diabetic he has significant amounts of glucose in his urine and we home BG test we get numbers like 241 after a two and a half hour fast. How much insulin would you shoot with a reading like 241 after two and a half hours of no food ? It took us about 30 min to get the reading so there was likely some stress involved this is continuously overwhelming and confusing especially when his fructosomine tests have improved. 4 weeks ago he had a fructosomine of 312 and just last week he had a fructosomine test of 277 yet the vet still wants me to give insulin but only once a day they’re saying he is pre diabetic and they want to try and regulate im so lost

 

[Bandit's Mom]

Hi Gen,

The normal range for blood sugar for a cat is 50-100 mg/dl on a human meter, so 200+ is well over normal.

Is Ziggy still on Hill's I/D?

Your SS shows 0.25U in the AM for the last 3 days. Is that what he's been on?

 

[Ziggyloveforever]

Hi Gen,

The normal range for blood sugar for a cat is 50-100 mg/dl on a human meter, so 200+ is well over normal.

Is Ziggy still on Hill's I/D?

Your SS shows 0.25U in the AM for the last 3 days. Is that what he's been on?

yes I’ve just updated the spreadsheet it took me a few days to remember how to operate through this forum !! I have given 1/4 insulin the past few days I kept a log of it so I could transfer when I figured this all out. He is no longer on hills I/d he’s on now on rayne clinical nutrition kangaroo and his dexamethasone shot has been reduced to .15cc which I think I just updated sorry for the confusion

 

[Bandit's Mom]

Lantus does not stay in a cat's system for 24 hours since their metabolism is much faster than humans. They need twice a day dosing for insulin. You could try 0.25U twice a day.
Is it a lot of effort to test him?

@tiffmaxee

 

[Ziggyloveforever]

Lantus does not stay in a cat's system for 24 hours since their metabolism is much faster than humans. They need twice a day dosing for insulin. You could try 0.25U twice a day.
Is it a lot of effort to test him?

@tiffmaxee

It is much harder than last time as his ears have significant scar tissue built up from a long term transdermal medication the vet even struggled to test his ears and wound up just taking from the leg vein im sure I’ll get better at it and they said the ear capillary should respond if I keep poking we’ve been doing daily massages and pricks but only get blood from the ear 1 out of 6 times if that but I can tell the spots I’ve been going in have become more responsive even in the last few days

 

[Bandit's Mom]

Here are some testing tips posted by another member:
https://www.felinediabetes.com/FDMB/threads/9-9-bailey-amps-117-5-62.252712/#post-2851043

If you can get 4 tests a day (1 before each shot and 1 mid-cycle), you can follow the TR protocol which is more aggressive but can help you get Ziggy to a good dose faster. We follow 2 dosing protocols here. TR (Tight Regulation) and SLGS (Start Low Go Slow).

SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90 mg/dl (on a human meter). The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50 mg/dl (on a human meter). The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.

 

[Ziggyloveforever]

Here are some testing tips posted by another member:
https://www.felinediabetes.com/FDMB/threads/9-9-bailey-amps-117-5-62.252712/#post-2851043

If you can get 4 tests a day (1 before each shot and 1 mid-cycle), you can follow the TR protocol which is more aggressive but can help you get Ziggy to a good dose faster. We follow 2 dosing protocols here. TR (Tight Regulation) and SLGS (Start Low Go Slow).

SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90 mg/dl (on a human meter). The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50 mg/dl (on a human meter). The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.

At this point I think we have to do the start low go slow until the capillaries in the ear have responded fully I’m having a conversation about libre freestyle put in but due to his FIV positive status and him also being on immunosuppressive steroids my vet is very hesitant to install libre freestyle so for now can you tell me more about the start low go slow protocol and how and when they test ?

 

[Ziggyloveforever]

At this point I think we have to do the start low go slow until the capillaries in the ear have responded fully I’m having a conversation about libre freestyle put in but due to his FIV positive status and him also being on immunosuppressive steroids my vet is very hesitant to install libre freestyle so for now can you tell me more about the start low go slow protocol and how and when they test ?

he’s been completely switched to low carb wet food and we are also waiting on a home cooked diet from the nutritionist that takes all his health issues into consideration while the wet food is a low carb it’s not up to diabetic standard I believe it’s 17% carbohydrates but the ones I tried that were below 10% gave him terrible diarrhea almost immediately , he stopped eating completely and refused to touch it and I can’t risk an IBD flare up either it’s a really hard balancing act I’m very hopeful the nutritionist will give me a diet that Will be good for all his medical conditions

 

[Bandit's Mom]

can you tell me more about the start low go slow protocol and how and when they test ?

With SLGS, you hold a dose for a week and then do a curve to evaluate the dose. The only tests you get are twice a day before you give a shot. If he drops below 90 mg/dl, you decrease the dose.
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

he’s been completely switched to low carb wet food and we are also waiting on a home cooked diet from the nutritionist that takes all his health issues into consideration while the wet food is a low carb it’s not up to diabetic standard I believe it’s 17% carbohydrates but the ones I tried that were below 10% gave him terrible diarrhea almost immediately , he stopped eating completely and refused to touch it and I can’t risk an IBD flare up either it’s a really hard balancing act I’m very hopeful the nutritionist will give me a diet that Will be good for all his medical conditions

So the Rayne Nutrition Kangaroo is 17% carbs? Any idea what ingredient in the low carb food triggered his diarrhea? If you have identified a protein that works for him (say kangaroo), you could look for low carb foods with that protein? Usually it's the wheat in the higher carb foods that causes issues. Have you tried feeding raw?

A change from a higher carb diet to a low carb diet could also improve his numbers and reduce his insulin requirements significantly, so you want to watch out for that when you make a food change.

 

[Ziggyloveforever]

With SLGS, you hold a dose for a week and then do a curve to evaluate the dose. The only tests you get are twice a day before you give a shot. If he drops below 90 mg/dl, you decrease the dose.
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)




So the Rayne Nutrition Kangaroo is 17% carbs? Any idea what ingredient in the low carb food triggered his diarrhea? If you have identified a protein that works for him (say kangaroo), you could look for low carb foods with that protein? Usually it's the wheat in the higher carb foods that causes issues. Have you tried feeding raw?

A change from a higher carb diet to a low carb diet could also improve his numbers and reduce his insulin requirements significantly, so you want to watch out for that when you make a food change.

Unfortunately it’s not as simple as just a protein for him other additives such as gaur gum ect trigger a reaction he hasn’t seemed to have a problem with the proteins so far it’s another additive and it’s been really hard to figure out which one…

 

[Ziggyloveforever]

Which is why we went for a nutritionist she won’t put any additives or preservatives in our diet plan and we can target all of his issues simultaneously

 

[tiffmaxee]

This is my big fear with one of my cats with skin allergies. I feed raw and so it is likely protein induced.

Can you test from the paw pad? Some do it successfully but none of mine seem to have ever liked their paws played with so I don’t know how that would go.

I would try .25 twice a day or even .10 twice a day if he’s not a good eater. You would need to test at pm too though. Then feed a little hourly. With glucose in his urine he’s diabetic. I know Lyla has tried Epoquel and cyclosporine and a homemade diet as well for Butters with varying success. She’s back using cyclosporine. Have you tried either?

 

[Ziggyloveforever]

Oh wow no I’ve never heard of cyclosporine or epequol what are those ?! Unfortunately due to his FIV status I can’t prick the paw pads just last month he had a ruptured abscess on his foot from the tiniest little play scratch from my other kitty he’s extremely sensitive and he’s got cushion foot which is common in FIV positive cats I wouldn’t risk it that’s the last place I can poke unfortunately

 

[tiffmaxee]

Typo there. apoquel is a dog medication for skin allergies that apparently is used off label now for cats. Cyclosporine is a vet RX used for cats and dogs. You can google them.

 

[Ziggyloveforever]

Typo there. apoquel is a dog medication for skin allergies that apparently is used off label now for cats. Cyclosporine is a vet RX used for cats and dogs. You can google them.

ahh my baby has IBD not skin allergies so unfortunately he needs steriods

 

[tiffmaxee]

Atopica is the cat version of cyclosporine and can be given with steroids. My mistake. I saw the ear issue and assumed.

 

[Ziggyloveforever]

Atopica is the cat version of cyclosporine and can be given with steroids. My mistake. I saw the ear issue and assumed.

No thank you so very much for your help and time j appreciate it immensely with any luck maybe that information will help someone else and you never know it may help Ziggy one day too if he has a bad reaction to food and it does irritate his skin any and all information is welcomed appreciated and cherished thank you so much !

 

[Sienne and Gabby (GA)]

(@Bandit's Mom) Bhooma gave you slightly incorrect information. With SLGS, you need to test at pre-shot time and get at least one additional test during both the AM and PM cycles. You need the additional tests since Lantus dosing is based on the lowest number in the cycle.

It's curious that the fructosamine is low but Ziggy's numbers are in the diabetic range. I wonder if it's a matter of the steroids raising his BG numbers.

 

[Ziggyloveforever]

1. It definitely has to be somewhat steroid induced and probably exaggerated due to his ongoing battle with pancreatitis which he has recovered a lot from knocks on wood but our ultra sound last week revealed the inflammation is still there although symptomatically he’s doing better. There’s also trace amounts of protein in his urine im unsure if that has anything to do with diabetes though it’s so strange because not only is his fructosomine low but it seems to have improved so to be seeing numbers like this is so confusing to me. I know that if I get him regulated and can keep him regulated until we attempt to switch him over to budesinode im giving him the best chance though so I just need to do my best to understand his curve is there anyway adding urine glucose testing can help in addition to the start low go slow protocol ?

 

[Ziggyloveforever]

So just so I understand the protocol fully .. Let’s say I give him insulin at 9am I would need to test again (6 hours after) then before next shot and 6 hours after that ? So 4 tests in total ?

 

[Ziggyloveforever]

I’m also stressing him out a lot with home testing and many recent vet visits this all started to pop up after a very long vet visit at the specialist we were there for almost 5 hours so it seems like that may affect it also ?

 

[Bandit's Mom]

With SLGS, you need to test at pre-shot time and get at least one additional test during both the AM and PM cycles.

With SLGS? My understanding was that the additional tests were a requirement for TR, but just a suggestion for SLGS. That people followed SLGS when they couldn't get more than preshot tests and/or fed dry food.

 

[Ziggyloveforever]

With SLGS? My understanding was that the additional tests were a requirement for TR, but just a suggestion for SLGS. That people followed SLGS when they couldn't get more than preshot tests and/or fed dry food.

i sure hope so I’ll certainly try to get 4 tests in but I’m not sure I’ll be able to get that from him I don’t get blood every time I poke

he gets so hungry after insulin I’ve never seen him eat so much in his entire life. I had a very set feeding schedule for him especially with IBD and multiple medications. It’s like he’s eating in time and a half. What he normally eats and then plus half of that if not more !

 

[Ziggyloveforever]

Well after a few hours off and on of trying to get a BG we can’t get it .. I warmed the ear up I massaged and used the flash light to see the vein like always it seems like I’ve blown the vein on both ears ? Where you normally see the thin line it looks bruised and battered is there anyway a urine glucose strip can help me asses what to do ?! SOS

 

[Ziggyloveforever]

It is not time for insulin. Last dose was given at 9:30am so at all 4:30 pm I was trying to see how it affected him m. It is 6:10pm now we’ve been at it almost two hours… if his urine glucose stick reads significantly lower now does that count for anything ?

 

[Chris & China (GA)]

Hi Genn! Glad to see you over here from the FB group!

we are also waiting on a home cooked diet from the nutritionist that takes all his health issues into consideration while the wet food is a low carb it’s not up to diabetic standard I believe it’s 17% carbohydrates

I'd like to see what the nutritionist is putting into the food that makes it so high carb. Are you in any IBD groups? There's one on Facebook called "Raw Feeding for IBD cats" that I highly recommend. I don't know why he'd need something that would be that high in carbs just because of IBD and FIV.

Great to hear you're having at least some success with testing! As I told you in the FB group, it can take a week or two of poking before enough capillaries grow into the area to make it easier to get that precious drop of blood but it will happen!

is there anyway a urine glucose strip can help me asses what to do ?! SOS

Not really. What time do you usually shoot? I thought I saw somewhere that you shoot at 9am/9pm? If that's the case, there's nothing you really need to do right now.

 

[Ziggyloveforever]

Oh okay I thought I was supposed to test 6 hours after to see how low it would get too if I’ve blown a vein in the ear does that mean I wont be able to get blood later ? What do people do when they can not get blood ? I’ve been struggling alot to get it and his ears are looking bruised and battered especially under the flashlight the once thin line is blown out completely

 

[Chris & China (GA)]

if his urine glucose stick reads significantly lower now does that count for anything ?

Not really. The problem with urine glucose is it can only tell you if he's been above renal threshold some time since the last time he peed. Now if the glucose is lower than the last test, that would mean that he spent less time over renal threshold (which is good) but it still wouldn't tell you how high (or low) he went since the last time he peed.

Renal threshold is the point where the kidneys can no longer filter out the excess glucose in the bloodstream so the glucose spills over into the urine. It can be anywhere from about 150 to about 280...it depends on the cat.

 

[Ziggyloveforever]

Not really. The problem with urine glucose is it can only tell you if he's been above renal threshold some time since the last time he peed. Now if the glucose is lower than the last test, that would mean that he spent less time over renal threshold (which is good) but it still wouldn't tell you how high (or low) he went since the last time he peed.

Renal threshold is the point where the kidneys can no longer filter out the excess glucose in the bloodstream so the glucose spills over into the urine. It can be anywhere from about 150 to about 280...it depends on the cat.

Okay so it he hasn’t peed in a while that wouldn’t be a great sample I see what you’re saying it ranges to much to really know… does the ranges on the urine dip stick mean anything ? Like if it’s trace positive (light green) or dark positive (dark brown) could that help me asses I’m afraid I’ve blown both veins and will have a real problem testing again at 9 when I do need to shoot

 

[Chris & China (GA)]

if I’ve blown a vein in the ear does that mean I wont be able to get blood later ?

Not necessarily....and yes, while it would be good to have a mid-cycle test, if you can't get it, you can't get it. Most cats, if their glucose is too low, will become almost frantic for food. I always knew when China was too low by the way she acted about wanting food. It was different from the usual "Hey mom isn't it 2 minutes past my usual dinnertime"? begging.

Don't aim for the vein. Poke a little beside it. Make sure you apply pressure to help prevent bruising but if it is bruised, it will heal. It'll just take a little time

 

[Chris & China (GA)]

Like if it’s trace positive (light green) or dark positive (dark brown) could that help me

Sort of. If it's "trace", that would mean that since the last time he peed, his blood glucose was low enough that his kidneys were able to filter out most of the excess glucose. That's better than having it "high" which would mean his blood glucose wasn't very well controlled at all since there's still so much glucose getting into the urine.

 

[Ziggyloveforever]

He unfortunately hasn’t gotten any lower than dark green ranging from 1/2 to 2 or more with urine stick. Trace is 1/10, second best is 1/4 and then 1/2 1 and 2. He’s been very very hungry after insulin eating more than he ever has and we only started three days ago and we’ve been doing insulin only once a day because of my lack of success getting blood.

 

[Chris & China (GA)]

He’s been very very hungry after insulin eating more than he ever has

That concerns me that he may be dropping too low so he's more frantic for food.

You might want to try a smaller dose than even .25....maybe 0.1

 

[Ziggyloveforever]

Okay will go to .1 because it’s scary how much he’s been eating to be honest what do I do if I can’t get a BG before nighttime shoot ?

 

[Sienne and Gabby (GA)]

You do your best. Like Chris said, you don't want to aim for the vein. If you hit the vein, chances are your testing spot will look like an episode of CSI. You want to aim for the area between the vein and the edge of the ear. Make sure you're using a wider gauge lancet if you're having trouble drawing a drop of blood (e.g., a 28 gauge). You can use a thinner gauge (e.g., 30) once Ziggy's ear is easier to poke.

The other thing that can help with testing is for you to be calm. Cats pick up on our mood. If you're getting intense about getting a test, chances are that Ziggy will get squirmy. Just talk your way through the test by telling Ziggy what a good boy he is, that he's going to get treats, etc. Some people sing to their cat. Whatever works!

Do you have copies of Ziggy's labs that you can post on the Labs tab of your spreadsheet?

 

[Ziggyloveforever]

I do have copies of all his labs, I’m assuming you mean fructosomine tests ?to upload do I just click upload file .. also thank you guys so much for being so patient with me … the problem is even when I do hit the main vein I get no blood..he is just bruised and battered although it didn’t bleed .. I’ve only gotten blood once today and it was just barely enough for the meter even in the main vein I hit that main vein a million times and nothing no CSI barely even a drop !

 

[Sienne and Gabby (GA)]

Actually, I meant all of his labs -- or the recent ones that you have.

 

[Ziggyloveforever]

Absolutely can do ! Should I include ultrasounds ? Or just CBC urinalysis and fructosomine

main question is how do I do that on here ? Upload a file doesn’t seem to possible it’s telling me I don’t have permission

 

[Chris & China (GA)]

main question is how do I do that on here ? Upload a file doesn’t seem to possible it’s telling me I don’t have permission

Upload a file doesn't work for any of us at the moment.

If you look at your spreadsheet, you'll see a tab labeled "LAB". You just transfer the numbers from your copy to the spreadsheet

 

[Ziggyloveforever]

Will do thank you so much I’m sorry I had kitty medication time I’ll get to that right now

 

[Ziggyloveforever]

We’re redoing his blood work and urinalysis the 27th but I’ll put in his one from last month for now do I have the option to do both like once I get new results for comparison?

 

[Chris & China (GA)]

do I have the option to do both like once I get new results for comparison?

You can put the date at the top of one column and then when you get the next bloodwork done, put that date at the top of another column so yes, you can compare! It's handy! If you look on China's spreadsheet, you'll see I had several columns of labwork

 

[Ziggyloveforever]

Oh that’s amazing I see now just got everything uploaded! Hopefully after taking care of the mycoplasma his WBcs go down and his RBCs go up

 

[Chris & China (GA)]

Up here, put the date of the labs

 

[Ziggyloveforever]

Up here, put the date of the labs
View attachment 63270

Oh sorry Chris thank you so much for the heads up and thank you so much for being patient with me

 

[Diane Tyler's Mom GA]

Hi Gen, I hope the testing gets better

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops

 

[Ziggyloveforever]

I’ve literally been trying all day, evening and night to get a BG reading. I’ve used warm socks I’ve done massages i went high I went low I went fast I went slow I went in straight on an angle I used a lancing device back to lancets it went right through his ear a few times and still no blood the ears are collapsed with scar tissue this really isn’t going to happen no matter where I go even with a lancing device it just won’t bleed

 

[Ziggyloveforever]

He sits still for it all he’s the best he gives me no trouble at all I’m able to try for about 30 minutes to 45 at a time without him even budging I don’t even think he can feel it his ears are pretty damaged from the compounded transdermal medication do I just need to give the two veins that blew out time ? I can see they blew out because I always use a flashlight when I poke

 

[Sienne and Gabby (GA)]

Gen --

When the labs were drawn back in November, did Ziggy have an infection? Unless you mis-typed, his WBC was very high. The neutrophils were likewise elevated but that may be a response to the steroids. It also looks like Ziggy was anemic (low RBC, platelets, and hematocrit). Has this been addressed?

 

[Ziggyloveforever]

Gen --

When the labs were drawn back in November, did Ziggy have an infection? Unless you mis-typed, his WBC was very high. The neutrophils were likewise elevated but that may be a response to the steroids. It also looks like Ziggy was anemic (low RBC, platelets, and hematocrit). Has this been addressed?

Ziggy is anemic due to a rare blood parasite which infected his RBCs he’s at the tail end of treatment for now hoping that brings his WBC count down significantly ! He also was in the beginning stages of a severe battle with pancreatitis, hoping the blood work were going in for tomorrow shows improvement although his ultrasound from December 17th still showed severe inflammation of the pancreas