4/2 Pumpkin AMPS 327 +4 324 +6 311 +8 305 PMPS 356

[Jacques and Pumpkin]

https://felinediabetes.com/FDMB/threads/4-1-pumpkin-amps-354-4-291-6-285-pmps-310-2-290.275970/

No yellows this morning, but we got close.

Been doing a lot of reading about acromegaly. The higher these doses get, the more I wonder about the way Pumpkin's snoring got much louder in the past year or so. She's had a bit of a snore for a few years, but in the past year it got so loud I had to start wearing earplugs to sleep. (Unfortunately, I sleep much better when Pumpkin sleeps on top of me, which is very inconvenient when your cat is a loud snorer).

Guess we'll keep monitoring and increasing for another ~week and then talk to the vet about next steps.

She wasn't very happy with the testing today so I had to give her some alone time. It looks like all is forgiven again.

 

[Jacques and Pumpkin]

Also, the next increase would be due tomorrow evening, but that's right before a three day stretch of being away all day for work.

My wife is getting back from an out-of-state gig on Monday. She hasn't learned how to test Pumpkin yet, but I think Pumpkin is used to the testing enough that she'll allow someone other than me to do it.

I'm thinking we see if my wife can manage a test or two during the day, and if so we increase when she's ready to test. Otherwise, I'm wondering if it would be better to wait until Wednesday or Thursday to do the increase so I can be home for some of the days right after (I work from home Mondays and Fridays).

Snoring away while dreaming of chasing mice:

 

[Jacques and Pumpkin]

@Wendy&Neko there's a chance Pumpkin's regular vet gets in touch with me about next steps when he's back from vacation on Monday. Probably his next steps will be to wait and see, but if he's ready to get going I'm not gonna suggest holding out for a higher dose.

I'm looking at the AAHA guidelines (https://www.aaha.org/aaha-guidelines/diabetes-management/troubleshooting/) and it looks like they recommend:

• Evaluate for dental disease
• Repeat CBC and urinalysis
• Total T4
• specPLI (I assume this is the same as fPL)
  
• TLI
• B12/folate
• SDMA
• Diagnositcs for HAC (not sure what exactly)
  
• IGF-1

Anything else I should be asking for, or anything from the list that seems unnecessary?

 

[Jacques and Pumpkin]

A bit higher than the last few cycles on the PMPS. I guess I should count myself lucky that PS going up by 40 is Pumpkin’s version of a curveball so far.

 

[Bandit's Mom]

I'm thinking we see if my wife can manage a test or two during the day, and if so we increase when she's ready to test. Otherwise, I'm wondering if it would be better to wait until Wednesday or Thursday to do the increase so I can be home for some of the days right after (I work from home Mondays and Fridays).

I remember that you can't get tests after AM+1 from Tue to Thu, but I'm not sure I would wait to increase considering Pumpkin is flat and high. Especially if your wife is home to watch her and feed her. It will indeed be great if your wife can start testing her occasionally. Especially once Pumpkin starts seeing better numbers

 

[Jacques and Pumpkin]

I remember that you can't get tests after AM+1 from Tue to Thu, but I'm not sure I would wait to increase considering Pumpkin is flat and high. Especially if your wife is home to watch her and feed her. It will indeed be great if your wife can start testing her occasionally. Especially once Pumpkin starts seeing better numbers

We’ll stay on schedule unless Pumpkin miraculously starts posting better numbers.

I’m hoping my wife will be able to help with the testing. pumpkin is my cat and there are a lot of things she’ll only allow me to do. Which is very sweet, but also inconvenient for things like diabetes management. Hopefully she’s distracted enough by eating and comfortable enough with the process that we can make this work.

 

[Wendy&Neko]

Diagnositcs for HAC (not sure what exactly)

Hyperadrenocorticism, also caused Cushing's disease. It is the less likely of the trio with acromegaly (hypersomatotropism) and insulin autoantiboties (IAA). Often characterised by larger bellies, hair loss and in later stages skin tears. It is caused by one of three things: a tumour on the pituitary, a tumour on the adrenals, both of which cause overproduction of cortisol, third cause is overmedication with steroids.

Of the list above, I would prioritize dental, then IGF-1 and IAA testing. Possibly also T4 if it had been over six months since last tested and it was on the higher side of normal last test. But you had it tested in January so not now. Spec fPL is for pancreatitis, and you'd likely see her off her food if that was happening. GI conditions (TLI B12/folate) don't cause that much insulin resistance. I wouldn't bother with SDMA either, her urine specific gravity improved at the later test, and the rest of her recent kidney values were pretty good.

As for the snoring, it really depends on the cat. At the time of Neko, it was my other cat that snored, not her.

I think it'd be great to get your wife on board with testing. It took a few months before my husband would do the same, but like you said, at that point the cat is used to it and knows that treats come next. I also agree with Bhooma, her nadirs are high enough I think you can keep up the increases.

 

[Jacques and Pumpkin]

Hyperadrenocorticism, also caused Cushing's disease. It is the less likely of the trio with acromegaly (hypersomatotropism) and insulin autoantiboties (IAA). Often characterised by larger bellies, hair loss and in later stages skin tears. It is caused by one of three things: a tumour on the pituitary, a tumour on the adrenals, both of which cause overproduction of cortisol, third cause is overmedication with steroids.

Of the list above, I would prioritize dental, then IGF-1 and IAA testing. Possibly also T4 if it had been over six months since last tested and it was on the higher side of normal last test. But you had it tested in January so not now. Spec fPL is for pancreatitis, and you'd likely see her off her food if that was happening. GI conditions (TLI B12/folate) don't cause that much insulin resistance. I wouldn't bother with SDMA either, her urine specific gravity improved at the later test, and the rest of her recent kidney values were pretty good.

As for the snoring, it really depends on the cat. At the time of Neko, it was my other cat that snored, not her.

I think it'd be great to get your wife on board with testing. It took a few months before my husband would do the same, but like you said, at that point the cat is used to it and knows that treats come next. I also agree with Bhooma, her nadirs are high enough I think you can keep up the increases.

Thanks, this is super helpful!

One additional thing that's been bugging me in Pumpkin's water consumption. Because the standard spreadsheets aren't nerdy enough for me , I've been graphing Pumpkin's BG levels. Whether I graph the average of all the measurements, just the nadirs, just the pre-shot, I see the values coming down over time (after applying a moving average to smooth out day-to-day and meter variations). The pre-shots are the most stubborn, but they've trended down as well.

But, when I graph her water consumption, it's been trending upward a bit! It's just gone up by a bit, but it's definitely not down. I would expect as the BG numbers drop there's less glucose to spill out into the urine, and therefore less glucose to flush away, and therefore less urine. But I'm seeing the opposite if anything. A study referenced by the AAHA guidelines and by the ISFM guidelines is summarized in the ISFM guidelines as correlating urine volume to daily average BG, but I can only read the abstract which doesn't go quite that far.

I'm wondering if maybe the transition to a very high protein diet is counteracting the effects of the lowered BG in terms of urine volume? Or maybe we won't see any changes until we cross the renal threshold? I guess if it's the latter case I don't understand the mechanism (to be fair there's a lot I don't understand...)