3/15 Sheba AMPS 124; +6 144;+7 124;PMPS 140

[Bron and Sheba (GA)]

http://www.felinediabetes.com/FDMB/threads/3-14-sheba-amps-138-3-307-8-156-pmps-160.134495/PMPS
Another good day yesterday with lots of green last night.

She had that funny thing again last night where she went into the LB and tried to wee but couldn't. It was after a poop again so don't know if they are connected. I only saw her do it once this time. Later I caught a wee and tested it. Nothing much showing up except she had alkaline urine. Not sure why as she is on a high protein diet and no changes, except I am using a MC food with some fish in it to control the drops. Have been using it though for a week or two. She had alkaline urine at the vets a few months ago as well but it has been acid since. I will mention it to the vet when we go tomorrow for the 4th cartrophen injection.
Generally she looks fine. Looks like she is getting used to the very low numbers and no bouncing (anti jinx) for days. Her preshots are also much lower generally than they were

 

[tiffmaxee]

Nice start for Sheba. I hope you see more green this cycle.

 

[Vyktors Mum]

Beautiful AMPS

 

[Bron and Sheba (GA)]

Thanks tiffmaxee and Serryn. I'm really happy with how Sheba is progressing.

tiffmaxee asked: 'That 160 is not actually too high considering the stress of a vet visit. Max was in the 200's and takes amlodipine. it's primary high BP. It's good that there is rarely protein in the urine. Why metacam?'

Sheba previously had a reading of 180 and when she was showing protein in her urine the vet put her on benazapril for that. Benazapril also can help with blood pressure sometimes and it did with Sheba so it is helping with 2 issues.

Re the metacam. I know this is a contentious issue
In June last year Sheba was having a lot of trouble with her mobility. Some of it was from peripheral neuropathy but not all. We were unaware of her spinal arthritis until she had an Xray for something different and it showed up. I had read about metacam and was not too keen on it but agreed to try it because Sheba couldn't go on the way she was. Bupe sent her to lala land and we do not seem to have it in liquid form out here anyway. Only bupe tablets which are hard to give as they have to stay in the mouth to dissolve and take ages and either the tablet is swollowed or spat out. Compounding meds here is very expensive......medications in general are much more expensive out here than in the US.
The metacam out here is specifically for cats and is used a lot by vets. My vet is very cautious with it and is aware I don't like it much. However, the difference it made to Sheba was nothing short of amazing. Her mobility improved a huge amount and her pain levels obviously dropped and her insulin needs dropped too. I am ashamed to say I was unaware she was in pain before that.
In January I stopped the metacam because she had a slightly pink vomit and I was worried it was from the metacam. She was fine for a few weeks but gradually began to stiffen up, become less mobile, was miserable and her blood sugars went up.
If you look at her SS you can see around the 2/10 her BSLs are higher and by the 3/1 ( a week after restarting it again) her BSLs are improving and her mobility was improving. There is no doubt in my mind that pain raises Sheba's BSL a lot. I know no-one likes metacam in the US. I think maybe it is a stronger dose there or not specifically for cats? There are risks in giving it for sure, but all meds have some risks (some more than others of course). I am giving the smallest dose I can to keep her pain at bay....which is a half of what she could have and I am heading back down to what it was before I stopped it...a third of the dose. She has regular blood tests to monitor things and I make sure she is well hydrated and has it with food. All these things help minimize the risks. At the end of the day I just felt quality of life trumped everything.
We are also in the middle of a course of cartrophen injections to see if they help. I wish I had done a before and after video of her..
Bron

 

[Wendy&Neko]

Sheba seems to be pretty relentless in her evening greens. Neko did that to me once for a stretch of a few months. The good news is that Sheba is seeing lots of green and getting over her bounces really quickly. And she seems to be flattening out quite a bit.

I can't remember - do you have an autofeeder for Sheba? I'm just wondering if there's some way you could use it to get longer stretches of sleep at night. Use the autofeeder for MC at +4/5 to slow the drops. The one thing I don't like about Levemir, is those later nadirs in the middle of the night. Sheba's nadir seems to be later if she goes up quite a bit after PMPS. Neko has a variable nadir too, and it's later if she goes up after PS and earlier if her before bed test is closer to the preshot value. Anyway, I found it useful to try to find those kind of patterns. I use my before bed test to try to figure out when she might be lower and I need to test. That way I get longer stretches of sleep. I'm not always right.

 

[Bron and Sheba (GA)]

Yes Wendy, Sheba also has two different active cycles since being with FDMB. If she has a big spike she comes down more gradually. If she has a small spike closer to preshot, she comes down more aggressively. I am really happy with how she is going. She has improved so much since being with you.
When I look back on the last year, her main problem has been the bouncing. High, dropping, reacting, back up high.......my vet, who I think is really good and progressive and open to new ideas, had never heard of bouncing. They sent Sheba's bsl to a specialist in diabetes and they said it was somoghyi and to lower the dose which did nothing but make her pee more. I found out about bouncing on FDMB! I wish I had joined a year ago

It is amazing how quickly one feels comfortable with low preshots having done it once! It was a massive hurdle for me but seems easy now

Yes, I do have a timed feeder. Sheba loves it and almost hugs it at night. I put it close to her bed. It has 6 compartments in it and I put a broth ice block in each with a few tiny pieces of steamed chicken. I set it hourly from midnight. I find if I do this, she doesn't vomit froth or water in the morning from an empty tummy. One night I heard her come into the bedroom and then race out and down the stairs like a bolt of lightning. Then I heard my voice calling her on the feeder. She had heard the click before the voice

That is a good idea, I could put in some MC as you say into the feeder. But I would have to feel comfortable it was safe to do that. I guess it takes practise and knowing what she will do. Up until now she has been completely unpredictable. Last night I thought I was going to get a good nights sleep but from 2am she just went down. And once she is low I don't like to leave it 2 hours as I know how she can drop.
At 5am when she was 4.1 I gave her some MC, rechecked at 6am then slept til 8. I just hoped she wouldn't go back down. Maybe I could do as you say at +4/5 but get up a few times and test to see if it works, then I might feel safe to leave her. What do you think?
Thanks Bron

 

[Wendy&Neko]

At 5am when she was 4.1 I gave her some MC, rechecked at 6am then slept til 8. I just hoped she wouldn't go back down. Maybe I could do as you say at +4/5 but get up a few times and test to see if it works, then I might feel safe to leave her. What do you think?

It really is about learning what works for your cat. And it does take a while observing to see what that is. Darn cats keep on insisting on going low at night instead of the day when it's easier to observe! I've often given Neko a couple tsp of higher carb food to "abort the cycle" or get her high enough up I can sleep.

 

[Bron and Sheba (GA)]

Great PMPS of 140. She has done so well since we joined the forum. Thank you so much! I had all but given up ever getting her regulated or down into normal numbers.

Sheba seems to like the night time for going lower. On the days I have to go out and leave her, I am pleased she goes low at night, but on the nights I have to get up numerous times I am not so pleased. No pleasing me is there! But I am not complaining at all, I am just a bit tired Actually I was so tired by the end of last night I wasted 3 test strips . I forgot to push two of them in before putting on the blood and the third one I didn't make sure there was enough blood on the ear before proceeding to put it on the strip!

If you abort the cycle, does it ruin the next few days or do things stay on track? At what part of the cycle do you give the higher carb to abort the cycle and how can you be sure the numbers will not go back down a bit later in the cycle...or do you get up to check later? Sorry for all the questions....just trying to understand it all
Thanks
Bron

 

[julie & punkin (ga)]

Carbs from canned food only last a little while in a cat - that's why when you're bringing up low numbers you have to recheck every 20-30 minutes or so for a couple of hours after you've stopped feeding HC. The same principle is going to apply when you're aborting a cycle - depending how carb sensitive your cat is and how much carbs you gave, you might see the effect for a few hours, but i doubt it would last more than 3-4 at the most. So I wouldn't worry about it messing things up for the next cycle.

The rest of your question is going to be experimentation of how Sheba reacts to carbs. I didn't use Lev so will let @Wendy&Neko give you an idea about when the timing might be right for giving HC. For punkin, I'd have looked at how fast the drop was from the previous test and done some mental math to say if he continued dropping at that rate, how low would he be at +5.5 or so, when he fairly consistently had his nadir. Looking at Sheba's ss for the night cycle of 3/14, she was dropping at somewhere around 50 points per hour between +3 and +7. If I'd wanted to sleep with the 104, knowing that Sheba has a later nadir, I'd have carbed at +7/104.

Actually, a drop that fast (50 points/hr) can trigger another bounce, so you might try feeding to slow down the drop, as soon as you see it's that fast, when she's doing this next time.

Cats don't drop at a consistent rate per hour, and not everyone likes looking at that, but when someone pointed it out to me it was one of those AH HA moments - now I can do some predicting about what will happen! Punkin was a very predictable cat, so it worked for us. I'll let you figure out if it helps you or not.