12/26 Kevin AMPS 157 +1 158 +2 184 +3 150 +5 170

Marie & Kevin

Marie & Kevin

Member Since 2022
https://felinediabetes.com/FDMB/threads/12-25-22-kevin-amps-263-2-269-6-262-10-277.272243/

Please see previous post for further information. Looking for advice on two problems I am having.

First, some days like 12/24, Kevin will have a pretty decent curve overall but then the next day on 12/25 he becomes uncontrolled all day and never hits a decent nadir. I do not know why this happens. Yesterday I was cooking/cleaning a lot which can upset him. I also got scared of the lower glucose and did feed him a little more kibble than usual.

Second, when he does reach a nadir as he did on 12/14, 12/15, 12/17, 12/18, 12/24, 12/26 he seems to reach it at the time of the next AM dose which always really scares me. He will fast overnight bc he has eaten all his dry kibble for the day and this might contribute to the drop by the AM. I know Lantus is dosed more on nadir and it does not start acting right away but it also confuses me why we then check a pre shot level and stall. Any help on this point will be much appreciated surrounding when to stall, etc
 
Marie & Kevin said:
https://felinediabetes.com/FDMB/threads/12-25-22-kevin-amps-263-2-269-6-262-10-277.272243/

Please see previous post for further information. Looking for advice on two problems I am having.

First, some days like 12/24, Kevin will have a pretty decent curve overall but then the next day on 12/25 he becomes uncontrolled all day and never hits a decent nadir. I do not know why this happens. Yesterday I was cooking/cleaning a lot which can upset him. I also got scared of the lower glucose and did feed him a little more kibble than usual.

Second, when he does reach a nadir as he did on 12/14, 12/15, 12/17, 12/18, 12/24, 12/26 he seems to reach it at the time of the next AM dose which always really scares me. He will fast overnight bc he has eaten all his dry kibble for the day and this might contribute to the drop by the AM. I know Lantus is dosed more on nadir and it does not start acting right away but it also confuses me why we then check a pre shot level and stall. Any help on this point will be much appreciated surrounding when to stall, etc
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Tagging
@Bron and Sheba (GA)

and Elise
@tiffmaxee

I know Marie has asked these same questions on her 2 previous post but didn't get an answer :cat:
The intro post
https://felinediabetes.com/FDMB/thr...stion-for-vet-in-atlanta.272117/#post-3027953
 
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Hi Marie
Are you thinking of swapping Kevin over to a low carb wet diet?
The dry food you are feeding is a high carb food which means you are unlikely to get regulated unless you are giving a lot of insulin.
How is his appetite? With DKA in the past you need to make sure he has plenty to eat. And regularly.
I would save some of the food for the pm cycle instead of giving it all in the am cycle. We don’t want him fasting for the 12 hours if possible. It is better for all FD kitties to eat during all the cycles.
The fasting overnight could be contributing to the lower amps at times. But every cycle is different and until a kitty is regulated that will be so.
The nadir can move around ….it can be early, in the middle of the cycle or late in the cycle.
If possible what I would do is try and swap over to a low carb wet diet or if he refuses to eat wet then look at the low carb dry options.
Then see how the cycles look. But you will need to be aware that by feeding a lower carb diet, the BGs can drop a lot, so you need to be vigilant.

Re stalling:
If you get a lower than normal number at preshot you stall, don’t feed and test again in 20 minutes to see if the BG is rising. I would also post and ask for help. Looking at the SS I can see you have shot 125 and 111.
 
Hello Bron,

Thank you so much for your help.

Are you thinking of swapping Kevin over to a low carb wet diet? Yes I am. This group made me aware of how high the carbs are in his diet and once I get a new freestyle placed and a vet prescription, I plan to place him on the wet purina pro DM as Dr. Pierson listed this as containing 6% carbs. I chose this diet bc he does have a h/o urinary crystals and it will offer him protection. Kevin has never liked wet food but I am going to try my best using Dr. Pierson's advice on switching cats over. This will probably be in the next 3-4 weeks. I need the Freestyle Libre for this as Kevin still attacks me when I go to do checks on him so I cannot achieve a close 1-2h monitoring at this time. I am working on helping him through this.

How is his appetite? With DKA in the past you need to make sure he has plenty to eat. And regularly. He has a very good appetite. He acts starving throughout most of the day as he is not used to the new limit on his food (I was not measuring his food before and letting him free feed). As soon as I put out his food, he will eat every last piece so I have had to divide it throughout the day every 2 hours to prevent him from eating it all so fast. He is also overweight (current 19.6lbs but was 23lbs when this all started) with a goal weight of 17-18lbs per vet as he is a larger cat.

I would save some of the food for the pm cycle instead of giving it all in the am cycle. We don’t want him fasting for the 12 hours if possible. It is better for all FD kitties to eat during all the cycles. Thank you. I will probably have to wake up throughout the night to achieve this as once I put food out at bedtime he goes and eats it all right away. Do you recommend a certain brand of a timed feeder so I can help him keep his food throughout the night?

Re stalling:
If you get a lower than normal number at preshot you stall, don’t feed and test again in 20 minutes to see if the BG is rising. I would also post and ask for help. Looking at the SS I can see you have shot 125 and 111. Yes I did give insulin at 125 and 111 however the vet had me reduce the doses those times to 6U and 4U and then return to his normal 9U that evening and the next day. That part has left me confused as I know a quick reduction like that can then send his numbers all over the place and make it difficult to interpret. I will post on this thread if I come across numbers I am not comfortable with.

Again thank you so much for your help
 
Marie & Kevin said:
Yes I am. This group made me aware of how high the carbs are in his diet and once I get a new freestyle placed and a vet prescription, I plan to place him on the wet purina pro DM as Dr. Pierson listed this as containing 6% carbs. I chose this diet bc he does have a h/o urinary crystals and it will offer him protection. Kevin has never liked wet food but I am going to try my best using Dr. Pierson's advice on switching cats over. This will probably be in the next 3-4 weeks. I need the Freestyle Libre for this as Kevin still attacks me when I go to do checks on him so I cannot achieve a close 1-2h monitoring at this time. I am working on helping him through this.
Click to expand...
Just do the transition slowly as we don’t want to upset his tummy


Marie & Kevin said:
has a very good appetite. He acts starving throughout most of the day as he is not used to the new limit on his food (I was not measuring his food before and letting him free feed).
Click to expand...
How much are you restricting his food?


Marie & Kevin said:
away. Do you recommend a certain brand of a timed feeder so I can help him keep his food throughout the night?
Click to expand...
The petsafe 5 is a good feeder and a great way to feed cats at night so they don’t eat it all at once.


Marie & Kevin said:
Yes I did give insulin at 125 and 111 however the vet had me reduce the doses those times to 6U and 4U and then return to his normal 9U that evening and the next day. That part has left me confused as I know a quick reduction like that can then send his numbers all over the place and make it difficult to interpret. I will post on this thread if I come across numbers I am not comfortable with.
Click to expand...
Yes stall, and then post. Change the subject line to reflect your need for help.
Sometimes we need to give a lower dose instead of skipping but let’s see how it goes.
You are doing well looking after him
 
Bron and Sheba (GA) said:
Just do the transition slowly as we don’t want to upset his tummy



How much are you restricting his food?



The petsafe 5 is a good feeder and a great way to feed cats at night so they don’t eat it all at once.



Yes stall, and then post. Change the subject line to reflect your need for help.
Sometimes we need to give a lower dose instead of skipping but let’s see how it goes.
You are doing well looking after him
Click to expand...


I am feeding him 1 cup of the Royal Canine Glycobalance a day. It is what the back of back suggests feeding for an 18lb cat at ideal weight. He is currently 19.6lbs but the vet wanted me to use the 18lb amount as that is his goal weight. He also has very limited mobility at this time as he developed pretty bad diabetic neuropathy throughout the last few months so he is definitely not active.


Thank you - I will look into the petsafe 5 feeder. I will also post to the thread for lower pre shot numbers
 
From yesterday
Marie & Kevin said:
I am trying my best to start glucose checks on him but he even attacks me when I give the insulin despite treats (he is super sweet otherwise).
Click to expand...
This quote leapt out at me. For many cats on higher doses of Lantus, the acid base of Lantus starts to sting. I've actually seen a few cats on lower dose do the same. What we typically suggest to cats that get to higher doses, especially if reacting during the shot, is a switch to Levemir insulin. It's very similar in action to Lantus, though the onset and nadir do tend to be a bit later. Of course the nadirs can end up about at +12, so you do have to get used to shooting lower numbers. My Neko started walking away at shot times with Lantus, but just purred through the Levemir shots. Some people also find Levemir has a longer duration, leading to somewhat flatter cycles.
 
All automatic feeders can be used for wet foods as well.

Are you still testing for ketones in the urine? I can’t see any results in the remarks column of the SS. If you are not doing any more tests I would recommend testing a few times a week with a history of a DKA and an unregulated kitty.

I can recommend Levemir which Wendy has just mentioned. Sheba was much happier on it than Lantus.
 
Wendy&Neko said:
From yesterday

This quote leapt out at me. For many cats on higher doses of Lantus, the acid base of Lantus starts to sting. I've actually seen a few cats on lower dose do the same. What we typically suggest to cats that get to higher doses, especially if reacting during the shot, is a switch to Levemir insulin. It's very similar in action to Lantus, though the onset and nadir do tend to be a bit later. Of course the nadirs can end up about at +12, so you do have to get used to shooting lower numbers. My Neko started walking away at shot times with Lantus, but just purred through the Levemir shots. Some people also find Levemir has a longer duration, leading to somewhat flatter cycles.
Click to expand...

Oh wow, I never knew that could be happening. I am in the process of looking for a third vet to help me with all this but as soon as I find one, I will suggest a change. Thank you
 
Bron and Sheba (GA) said:
All automatic feeders can be used for wet foods as well.

Are you still testing for ketones in the urine? I can’t see any results in the remarks column of the SS. If you are not doing any more tests I would recommend testing a few times a week with a history of a DKA and an unregulated kitty.

I can recommend Levemir which Wendy has just mentioned. Sheba was much happier on it than Lantus.
Click to expand...

I had not been testing for ketones in the urine as this was something the vet never asked me to do. I have seen it posted throughout this forum and did purchase a urine collector tray from amazon to help me capture his urine when he goes. It will arrive on Wednesday. I currently have the "CheckUp Strips" at home that do a full urinalysis.
 
Thanks for the link. It looks like a handy long spoon. I think some people here use a low tech non telescoping version of something like that.

Looking forward to some spreadsheet update, to see how he did today. Also, the dose units is missing the PM cycle of the 26th.
 
Wendy&Neko said:
Thanks for the link. It looks like a handy long spoon. I think some people here use a low tech non telescoping version of something like that.

Looking forward to some spreadsheet update, to see how he did today. Also, the dose units is missing the PM cycle of the 26th.
Click to expand...

I've updated my spreadsheet. My FreeStyle ended daytime on 12/27 so now I am left trying to obtain blood samples. I attempted twice this AM and had not enough blood come out with a 28g lancet and then Kevin flicks his ears and starts trying to bite me so I cannot milk the blood out. So my two attempts this AM were unsuccessful. His freeze dried treats came in the mail today so I am going to try again. I feel like if it only took one stick, he would let me do it but that hasn't been my luck so far. I will keep you updated
 
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