? 3/9 - Gen, AMBG 96 - still working on the "food" thing

[Allie & Gen]

Saturday/Yesterday

Good morning, friends. I hope you're all having a calm Monday, and that your kitties are surfing safely.

I'm working from home today, currently from bed with Gen curled up on my feet. He definitely seems a bit brighter/in less discomfort this morning, which is good to see.

I decided to skip his shot this morning. I know the depot is a mess at this point, but last night I gave him a 2/3 dose (1u) and he dove from the mid-300s down to the low 50s; I got up in the middle of the night to syringe feed him a bit more beef puree baby food mixed with water to prevent hypo. Right now I'm mostly focused on getting him eating again, though I'll continue to monitor his BG. We'll see where we are by PM shot time.

He's still not really eating this morning. I gave him a small plate of the shredded, boiled chicken, mixed with a little warm water and a dash of FortiFlora. He sniffed with apparent interest (unlike the way he was with food last night - he'd just sit there stone-faced or try to move his head away when I presented him with something), but ultimately had a few nibbles and that was it.

I'm not sure how best to proceed. I know we should go slowly, but I'm not sure about the best pace or methods. Should I plan to syringe feed more? Maybe with some actual cat food? I have a couple more jars of the baby food left, not sure if I should get more ... I'm going to email my vet an update about everything that happened this weekend, though given her usually packed surgical schedule (Mondays are extra busy for whatever reason) I don't know how long it will take to get back to me. The hospital ER and IM vets didn't give me an email option and I don't particularly feel like calling them, especially as I really do have to do some work today.

If anyone has advice, I am wiiiide open, with gratitude. (One thing I probably won't do, alas, is "the liver shake." I just don't trust that I can source liver that is safe to feed raw.)

Also, my deepest, shyest thanks to the people who donated to Gen's GoFundMe (posted in the Fundraising channel). You guys are too generous and I don't really know what to say, so "thank you" will have to do.

Sorry I haven't had a chance to check in on any of your sweet cats in a few days! I hope I can find time later; honestly, I miss all of them.

 

[xelo y sinver]

 

[Allie & Gen]

View attachment 77258

I have a couple of cans of that, yeah (that and the Royal Canin Recovery, which is similar). He wouldn't touch either yesterday. I could try again today, or try syringe feeding it ...

 

[xelo y sinver]

Look, this pâté seems to have good ingredients. Can you get it there?

I have a couple of cans of that, yeah (that and the Royal Canin Recovery, which is similar). He wouldn't touch either yesterday. I could try again today, or try syringe feeding it ...

If I were in your situation, I would try syringe feeding. I already did it with my cat. The problem is that if she doesn't eat, she'll die of starvation. You have to try everything and not let time pass. The cat needs to eat and drink. I know it's frustrating; I went through it and wanted to go crazy, but I always thought I did everything I could.

 

[Jessica & Indy]

Glad that Gen is at least eating a little and is showing interest in food today at least. I have no advice, just lots of loves!

 

[Allie & Gen]

Look, this pâté seems to have good ingredients. Can you get it there?

If I were in your situation, I would try syringe feeding. I already did it with my cat. The problem is that if she doesn't eat, she'll die of starvation. You have to try everything and not let time pass. The cat needs to eat and drink. I know it's frustrating; I went through it and wanted to go crazy, but I always thought I did everything I could.

Yeah, I just don't want to overdo it and make him vomit again. I think his tummy is pretty tender.

 

[Allie & Gen]

Gen got up for a brief walk around a little while ago. I just checked, and he ate a little more of the shredded chicken all on his own!

 

[Albert & Xander]

Yay! Hoping his improvement continues I've never syringe fed, but maybe could be a good idea to give him a bit slowly throughout the day. I know its a difficult balance of getting enough in him, yet not upsetting his stomach with too much.

 

[squeem3]

There's an email address of you go to the Internal Medicine page of the hospital's web site. It most likely goes to a secretary but they'll be able to help.

Look into Carnivore Care: Critical Care Food for Carnivores | Oxbow Animal Health Amazon and Chewy both sell it.

 

[Mary & Jude]

Related to the sniffing food but not eating, when Jude does that, he's nauseated. If it were me, I would save the syringe feeding for when I absolutely need it--at shot time. I'm so glad he's eaten a little on his own. Come on, little fella! We're all pulling for you to get better.

 

[Allie & Gen]

He finished off most of the chicken, so I've set out more for him. He had a couple nibbles of that, wandered around a bit, and has settled down again. For now I'm leaving him to his own devices. My biggest concern is that I don't have the opportunity to be home keeping an eye on him every day; I may call out tomorrow if necessary, but there's only so much of that I can do.

 

[Allie & Gen]

Related to the sniffing food but not eating, when Jude does that, he's nauseated. If it were me, I would save the syringe feeding for when I absolutely need it--at shot time. I'm so glad he's eaten a little on his own. Come on, little fella! We're all pulling for you to get better.

Mary, how do you work out how much to syringe feed him? I don't have a good sense of how to figure that out. I gave him almost two jars of the beef baby food last night all told (with a lot of water mixed in), but that involved me having to get up in the middle of the night to give more. (I wasn't going to force him to take more than he wanted in a sitting.)

 

[Mary & Jude]

Mary, how do you work out how much to syringe feed him? I don't have a good sense of how to figure that out. I gave him almost two jars of the beef baby food last night all told (with a lot of water mixed in), but that involved me having to get up in the middle of the night to give more. (I wasn't going to force him to take more than he wanted in a sitting.)

I have typically only syringe fed Jude his regular FF pate food, so I try to get at least half of a 3 oz can (watered down) into him before I give his shot. I don't syringe feed between shots because it's not usually necessary. He does not like to be syringe fed, so it's always a struggle, but, as you well know, if I can't get food into him, I don't feel comfortable giving his insulin.

 

[Staci & Ivy]

HI Allie, I am glad to see Gen is eating some on his own. That's great!
I gave Ivy the A/D when she had p-titis for one or maybe 2 meals last year.
She really liked it and I found it was very easy to syringe feed. It mixed with a little water easily in a bigger syringe.

(You can always cut the tip with a knife very carefully (on an angle) to give you a little wider expelling tip and go very, very slowly, to the side of his mouth. Give him time to calmly swallow)

Yes, messy, but whatever.

I'm not sure what amount is needed, I'd say whatever he is willing to allow you to feed him. Just try to get that nutrient dense nice, soft and smelly food into him to keep him eating.
They also say parmesan cheese is a good topper if he will be enticed by that.

You could see if he will lick some off of a spoon. Try anything.

Sending many vines and good wishes, we are all pulling for you both!

 

[tiffmaxee]

When I syringe fed I gave no more than 2 syringes at a time. Have you tried Gerbers ham only baby food?

 

[Allie & Gen]

When I syringe fed I gave no more than 2 syringes at a time. Have you tried Gerbers ham only baby food?

Nope, only the Beechroot beef. I'll look into that, but I think maybe sticking with the Hill's a/d and Recovery would be a good idea for this evening.

 

[Gill & George]

Have you seen the video of assisted feeding? I found it helpful. Like Elise I only gave a little at a time maybe 15ml (3 35ml syringes)
I would also typically assist feed food that wasn't his usual, to avoid him developing an aversion.

Take it slowly, but try to get some food into him. Little and often.


Syringe feeding tips and video link

 

[Briana + Binx]

You have been through so much in the last week!! I hope Gen continues to improve and finds his way to his food more and more as the days go. I wish I had more advice or options for feeding/food, but sending healing vines in absence of that

I know in your other post you said the vet was concerned with the target numbers and Gen’s in clinic BG and I can say the IM we just saw for Binx also said the same thing, he was at 103 and she was worried. His urine also had no glucose in it, which is a sign that his numbers have been below renal threshold and I’m taking that as a positive. Just wanted to let you know it’s a shared experience and you can feel okay going with whatever you’re comfortable with Just the same as opting to skip a dose, like you have been. You know Gen best!

 

[Allie & Gen]

I love how helpful everyone around here always wants to be. I already syringe fed Gen successfully last night, you guys! (And I did in fact watch that video awhile back, @Gill & George - when I was contemplating this possibility and ordering the big syringes and such - it was indeed very helpful, highly recommended. I bought the beef beechroot specifically because I wasn't normally feeding him beef.) I was a little nervous about it but honestly, apart from being a bit messy it was fine. And I came prepared with towels!

I wasn't sure I should do it today, since he was feeding himself, but he definitely wasn't eating enough to shoot or to get much nutrition.

It's fascinating, really, he put up with all of that, but he fights like a demon when I try to give him the teeny dose of liquid mirtazapine. My arm is bleeding and even though I had a syringe of water to try and help wash it down, I suspect he managed to bring it all up again in that thick, gooey saliva like they do. I'm glad I did the feeding first (he got about half a can of Hill's a/d mixed with a little warm water.)

I'm starting to wonder if I could get the mirtazapine liquid into some empty capsules. I'd probably have better luck getting it into him that way. He's very grumpy/possibly not feeling so great now, poor boy. (I hope I didn't give him too much food. It didn't seem like that much, but now I'm wondering.)

 

[Allie & Gen]

I know in your other post you said the vet was concerned with the target numbers and Gen’s in clinic BG and I can say the IM we just saw for Binx also said the same thing, he was at 103 and she was worried. His urine also had no glucose in it, which is a sign that his numbers have been below renal threshold and I’m taking that as a positive. Just wanted to let you know it’s a shared experience and you can feel okay going with whatever you’re comfortable with Just the same as opting to skip a dose, like you have been. You know Gen best!

Numbers below the renal threshold are definitely a positive!

Thank you for the support. I honestly was thrown for a loop by how vehement this vet was. The idea of not shooting unless he's over 200-250 seems so bizarre. It was so clear that she was coming at the subject in good faith/based on what she believes from her studies and even experience with the diabetic cats she's seen, and I think as much as anything I was frustrated that she wouldn't engage with the fact that there are evidence-based protocols that contradict her and that I wasn't just speaking from some kind of misguided magical thinking, if that makes sense.

I think I'm going to go over some of the more recent peer-reviewed guidelines for diabetes care that I've found on the board (like the 2025 iCatCare consensus guidelines and this 2018 National Institutes of Health publication), and maybe dig around a bit and read up more, maybe get into the original study behind TR. It's not that I don't think we know what we're doing, but now that I do have Gen's BG in a much better place overall, I want to take the time to do a little more research and be able to talk data with these medical professionals a bit more convincingly. (I know I don't have to, and maybe it's silly, but also - I'm a professional science communicator, for Pete's sake. ) Plus, I have been a little worried about all the lower-50s and limes; I'd really be a lot happier if I could get Gen's nadirs into the 70-90 range more, and I want to dig into some research about hypoglycemia with FD.

 

[Allie & Gen]

Goodnight!

 

[Briana + Binx]

I think I'm going to go over some of the more recent peer-reviewed guidelines for diabetes care that I've found on the board (like the 2025 iCatCare consensus guidelines and this 2018 National Institutes of Health publication), and maybe dig around a bit and read up more, maybe get into the original study behind TR. It's not that I don't think we know what we're doing, but now that I do have Gen's BG in a much better place overall, I want to take the time to do a little more research and be able to talk data with these medical professionals a bit more convincingly. (I know I don't have to, and maybe it's silly, but also - I'm a professional science communicator, for Pete's sake. ) Plus, I have been a little worried about all the lower-50s and limes; I'd really be a lot happier if I could get Gen's nadirs into the 70-90 range more, and I want to dig into some research about hypoglycemia with FD.

I think this is totally fair!! I’ve considered many times switching Binx to SLGS over the last year because at times TR can be exhausting and it requires so much of ourselves. It’s easy to get obsessed with the numbers, especially when they start doing well! I can’t speak to any research, but they do say cats can hang around in higher than normal numbers and it has less overall impact on them and I know we have some kitties here that blue and yellow are their normals versus blue or just green. You just have to do what’s best for both of you and I think taking some time to read up and reevaluate certainly isn’t going to hurt! You’re doing great (and I’m glad the syringe feeding went well)

 

[squeem3]

It's hit or miss with ER vets sometimes. Sometimes you get a really good one, sometimes one who isn't. Maybe that vet was just having a bad day. Vets are under a lot of stress, especially ER ones. Hopefully Gen won't need to go back to the ER anytime soon and, if he does, you get a better vet

What does your vet say about the ER vet's insistence on not giving insulin unless bgs are over 200?

 

[tiffmaxee]

I think it depends on your goals as to which method you pick. A second remission is harder to achieve. If regulation is your goal you no reason to do strict TR. Just my opinion. With so much going on you need to consider your health. It is possible to go back and forth between the two methods depending on your situation but not to combine the two. What I mean is don’t pick and choose between the two methods but follow one or the other. The only SLGS tweak suggested that I have seen when needed is to tweak the reduction number a little, under 70 instead of 90.

For any lurkers that is NOT a suggestion for cats new to insulin, typically less than a year unless there are special unique situations . These methods are tried and tested and do work and keep cats safe.

 

[Jessica & Indy]

I think it depends on your goals as to which method you pick. A second remission is harder to achieve. If regulation is your goal you no reason to do strict TR. Just my opinion. With so much going on you need to consider your health. It is possible to go back and forth between the two methods depending on your situation but not to combine the two. What I mean is don’t pick and choose between the two methods but follow one or the other. The only SLGS tweak suggested that I have seen when needed is to tweak the reduction number a little, under 70 instead of 90.

For any lurkers that is NOT a suggestion for cats new to insulin, typically less than a year unless there are special unique situations . These methods are tried and tested and do work and keep cats safe.

I'm so tempted to go back to SLGS with a lower reduction. Like, I don't mind a day where he hits the 50s because he didn't eat as much or something (like there is an obvious reason he is low) but I don't want to increase if he is having a day that is all in the blue. I'm happy/ecstatic with blues. TR is also ridiculously stressful. Indy is also almost 18 years old....his pancreas might just be tired at this point. Granted he is only one 1u so it is still working at least a little bit.

 

[tiffmaxee]

I'm so tempted to go back to SLGS with a lower reduction. Like, I don't mind a day where he hits the 50s because he didn't eat as much or something (like there is an obvious reason he is low) but I don't want to increase if he is having a day that is all in the blue. I'm happy/ecstatic with blues. TR is also ridiculously stressful. Indy is also almost 18 years old....his pancreas might just be tired at this point. Granted he is only one 1u so it is still working at least a little bit.

I totally understand. Max was never going to go into remission due to his chronic pancreatitis and if I knew what I know now I might have done what you are contemplating . He was 19. I don’t think I would have been happy with anything over mid blues though.

 

[Allie & Gen]

I'm not rethinking what dosing protocol I use at this time, just stepping back to review the research data available about safe and preferred BG ranges in cats generally (both diabetic and non-diabetic). When a vet acts as though it's terrifying that I'm trying to get my cat to a place where he's under 100 at all times, and she at least thinks she knows what she's talking about based on both research and experience ... some of what she said seems patently absurd, but I still want to make sure I have a better handle on things. When Gen was up in the 300s/400s all the time, I was very distracted by how scared I was about that, and I didn't spend as much time understanding the underlying science as I would like to.

I would really love to get Gen back into remission, though right now managing his GI stuff feels more urgent as long as his BG is reasonably regulated. Hard to have one without the other, anyway, I suspect. (One thing I'm sure that ER vet was wrong about - thinking he was in remission just because he was in the mid-100s on an empty stomach. Just what I've been seeing over the last few days makes it obviously wrong.)

 

[Allie & Gen]

It's hit or miss with ER vets sometimes. Sometimes you get a really good one, sometimes one who isn't. Maybe that vet was just having a bad day. Vets are under a lot of stress, especially ER ones. Hopefully Gen won't need to go back to the ER anytime soon and, if he does, you get a better vet

What does your vet say about the ER vet's insistence on not giving insulin unless bgs are over 200?

Haven't discussed that with her yet. I'm trying to schedule a formal telehealth call so I can discuss some of this with her directly, instead of through emails that get answered inconsistently due to her intense schedule. But I want to do some more reading first, too, and get talking points in order.

 

[Jessica & Indy]

I'm not rethinking what dosing protocol I use at this time, just stepping back to review the research data available about safe and preferred BG ranges in cats generally (both diabetic and non-diabetic). When a vet acts as though it's terrifying that I'm trying to get my cat to a place where he's under 100 at all times, and she at least thinks she knows what she's talking about based on both research and experience ... some of what she said seems patently absurd, but I still want to make sure I have a better handle on things. When Gen was up in the 300s/400s all the time, I was very distracted by how scared I was about that, and I didn't spend as much time understanding the underlying science as I would like to.

I would really love to get Gen back into remission, though right now managing his GI stuff feels more urgent as long as his BG is reasonably regulated. Hard to have one without the other, anyway, I suspect. (One thing I'm sure that ER vet was wrong about - thinking he was in remission just because he was in the mid-100s on an empty stomach. Just what I've been seeing over the last few days makes it obviously wrong.)

Yeah the remission comment blew me away.

 

[tiffmaxee]

If you look at the spreadsheets of cats in remission that do monthly checks you will see many have bg well under 100. Did you keep track of that for Gen when in remission? We should continue on your new thread instead of here if anything more added so as not to confuse things.