? 7/29 Chispa - Custom dosing?

Karen and Chispa (GA)

Karen and Chispa (GA)

Very Active Member
Good morning everyone, and happy Monday -

I've been wondering lately if it is time to design a custom dosing protocol for Chispa. I've been following the vet's recommendations since January, when he pleaded with me to give up TR and aim for numbers that essentially correspond with SLGS. This has had a couple of benefits: first, she used to meow loudly and for extended periods -- sometimes correlated with lower numbers and sometimes not -- and she hasn't done that since changing to SLGS. I take it to mean she's more comfortable at higher numbers. The other advantage is a selfish one, in that I worry less and have more freedom. But I want to do what's right for Chispa, bottom line.

The downside of SLGS is that she is "more diabetic." She's lost a lot of weight -- she used to be a steady 13.5-14 lbs.; now she's down to just over 11. This could related to her IBD/SCL, but she's had that for a few years and it never affected her weight (thanks to prednisolone?). The other sign is that she drinks at least 2X more water than she did while on TR, and I am going through pee pads like there's no tomorrow -- she doesn't always make it all the way to the litterbox, and the volume of urine is trememdous. This can't be good for her kidneys.

She's been on an all-rabbit diet for the last few months and it seems to be working well for her. The food is too high in phosphorous to be appropriate for a CKD cat, though, which may be contributing to the problem -- but I don't want to experiment with changing her diet until she stabilizes on chlorambucil.

I feel like I should be able to figure this out on my own, but I can't. I need help. @Wendy&Neko and anyone else who has insight into managing FD+IBD+CKD*, could you please let me know your thoughts?

*Now that I say it out loud, it sounds like an awful lot for one kitty -- but she's been so remarkably healthy (and hefty!) up to now that I feel like I just need to tweak something to get her back on track.
 
Karen and Chispa said:
I don't want to experiment with changing her diet until she stabilizes on chlorambucil.
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SCL kitties don't need any special food, unless they also have IBD. You should be able to switch food anytime. Chlorambucil doesn't impact food choices.

Karen and Chispa said:
anyone else who has insight into managing FD+IBD+CKD*, could you please let me know your thoughts?
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No clue why the vet wanted you to follow SLGS. I did TR with the above combo + acromegaly + heart conditions. Though the IBD was more likely SCL, which I think it is in Chispa's case too? My goal was to keep Neko under renal threshold as much as possible, which for her was around 220 on a human meter. In order to achieve that goal with Neko, that meant nadirs in the 70's. Your mileage per cat will vary, you have to find out what works for your cat.

What were you thinking about for custom dosing?

As far as weight goes, how many calories is she getting per day? Rabbit can be a low fat meat, maybe she needs more calories? Or continuing weight loss could just mean the SCL isn't controlled yet. Hopefully weight loss is slowing down?
 
Hi Wendy -- Thanks so much for your response. So the vet's concern with TR was that "one day of inappetence could be the end of her." I told him that I tested at least once in every cycle, that I used high-carb food to keep her safe if I had to go out, that we use digital calipers for accurate dosing, that I have a hypo emergency kit, that hundreds or maybe thousands of people around the world are doing this successfully, that I have amazing help available online literally 24/7, etc. etc. -- he was having none of it. His main concern is with keeping Chispa in absolutely safe numbers (his preference would be above 120, though he said he could live with 100) no matter what. I agreed to do it his way because he was so very adamant, and he's been a great vet (internist) in all other respects. And of course many people here are using SLGS, so it seemed worth a try.

I do think Chispa's IBD is more likely SCL at this point. Her weight loss has been slow but steady since January. I just looked at the rabbit pate -- it's 152 calories per can, and she eats on average maybe 1.5 to 2 cans a day. Less when it's hot, as it has been. She seems to be allergic to chicken and turkey, and possibly duck, which limits the options for low-phosphorous food (I've been through Tanya's and Dr. Lisa's food databases dozens of times). I'd like to try quail, but I don't want to rock the boat until the chlorambucil kicks in.

I wasn't aware of renal threshhold at all -- would you mind elaborating on that briefly? She's been spending considerable time above 220 lately. I'm just thinking maybe there is a compromise of nadirs between TR and SCL that would put less of a strain on her kidneys, while also keeping her safe and comfortable (I do not miss the insistent yowling at low numbers). Maybe I should aim for 80s?
 
To protect the kidneys you want the bg to be under renal threshold most of the time. You could try taking reductions under 80 or better yet 70 and see if that works for you I think. You would add custom dosing, reductions at whatever number you decide upon and see how it goes.
 
Renal threshold number varies by cat, it can be mid 100's to mid 200's on a human meter It's the point at which their kidneys start to spill extra sugar into the urine, but it also means the kidneys are working extra hard trying to clear the sugars out. You will also see them peeing more frequently as a result, which is what you are seeing. There are a couple ways to figure it out for Chispa. You can get Ketodiastix, which also measure sugar in the urine. When you get a urine sample, test it, and also get a blood test. Note that urine data can be a couple hours delayed from blood, so you have to estimate where the BG might have been a couple hours previous. Instead of that method, I used to test Neko's BC before and after vet visits where she was getting urinalysis done, and did the same estimates of where the BG was and compared that to whether or not she had sugar in the urinalysis.
Karen and Chispa said:
I'd like to try quail, but I don't want to rock the boat until the chlorambucil kicks in.
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Don't know why you want to wait, as I said above, food choice makes no difference with SCL/chlorambucil. Other fattier meats she might be able to eat include lamb. Fattier mean means she needs less volume to get the same number of calories. There is also at least one low P beef option from Weruva (Steak Frites).

What makes you think she was allergic to chicken and turkey? Are you sure it was an allergy and not initial stage of SCL? Remind me again if you had a biopsy done - that's the only way to say what you are dealing with. And knowing that, you will know how to treat.

Karen and Chispa said:
one day of inappetence could be the end of her.
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I had many days of inappetance with Neko once her diagnosis with SCL and heart condition - both those plus kidney disease can cause inappetance. Ondansetron and Cerenia were my friends. As well as syringe feeding. Often if I got a couple syringes in, her tummy would feel better and she'd eat more herself. As long as I got at least 2/3 of her needed calories in her, I was Ok to keep shooting full dose.

As far as customizing, SLGS is designed so that you can customize once you know your cat well. That means her response to carbs as well as patterns on insulin. You could try 80 as a reduction point and see how it goes. If not good enough, try a slightly lower number.
 
@Wendy&Neko and @tiffmaxee, thank you both for your responses; much appreciated.

Wendy&Neko said:
Renal threshold number varies by cat, it can be mid 100's to mid 200's on a human meter It's the point at which their kidneys start to spill extra sugar into the urine, but it also means the kidneys are working extra hard trying to clear the sugars out. You will also see them peeing more frequently as a result, which is what you are seeing. There are a couple ways to figure it out for Chispa. You can get Ketodiastix, which also measure sugar in the urine. When you get a urine sample, test it, and also get a blood test. Note that urine data can be a couple hours delayed from blood, so you have to estimate where the BG might have been a couple hours previous. Instead of that method, I used to test Neko's BC before and after vet visits where she was getting urinalysis done, and did the same estimates of where the BG was and compared that to whether or not she had sugar in the urinalysis.
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I do have Ketodiastix and I just put one next to the litterbox to be ready. So am I understanding correctly that you correlate the level of glucose shown on the Ketodiastix with her BG via ear poke and from there figure out what BG numbers correlate with spilling extra sugar into the urine?

Wendy&Neko said:
Don't know why you want to wait, as I said above, food choice makes no difference with SCL/chlorambucil. Other fattier meats she might be able to eat include lamb. Fattier mean means she needs less volume to get the same number of calories. There is also at least one low P beef option from Weruva (Steak Frites).
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I did look at lamb, knowing that Ivy (@Staci & Ivy ) is on a lamb-only diet, but the ones I found were too high in phosphorous.
I'm sticking with rabbit for now because if I changed the food and she started vomiting more frequently, we wouldn't know if it was the food or the chlorambucil not working.

Wendy&Neko said:
What makes you think she was allergic to chicken and turkey? Are you sure it was an allergy and not initial stage of SCL? Remind me again if you had a biopsy done - that's the only way to say what you are dealing with. And knowing that, you will know how to treat..
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I did not have a biopsy done, so we are really just guessing. I thought it was IBD because it went on for so long with no other signs such as weight loss, and different foods (esp. chicken) seemed to make her vomit more frequently. Her fur would also get spiky looking when she wasn't feeling well. But of course there's no way to know for sure that it wasn't the onset of SCL, as you say.

Wendy&Neko said:
I had many days of inappetance with Neko once her diagnosis with SCL and heart condition - both those plus kidney disease can cause inappetance. Ondansetron and Cerenia were my friends. As well as syringe feeding. Often if I got a couple syringes in, her tummy would feel better and she'd eat more herself. As long as I got at least 2/3 of her needed calories in her, I was Ok to keep shooting full dose.

As far as customizing, SLGS is designed so that you can customize once you know your cat well. That means her response to carbs as well as patterns on insulin. You could try 80 as a reduction point and see how it goes. If not good enough, try a slightly lower number.
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Very good to know. I will start with 80 and also try to figure out her renal threshhold. Thanks so much for all of this information -- I am (we all are) so lucky to have you as a resource.
 
@Wendy&Neko
An update: I was able to test Chispa's urine with the ketodiastix about half an hour before her PM shot. It was negative for ketones, but the glucose reading was off the charts (the darkest brown of the colored squares). I've never seen that before -- in the past when I've tested it's been in the green range. I need to fix this ASAP. She must feel like crap. :arghh::arghh::arghh:
 
Karen and Chispa said:
So am I understanding correctly that you correlate the level of glucose shown on the Ketodiastix with her BG via ear poke and from there figure out what BG numbers correlate with spilling extra sugar into the urine?
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Yes, but know there can be a couple hours from when the sugar in her blood makes it into the urine. The urine may be testing what her BG was two hours previously.
 
@Wendy&Neko
The 1.5 dose finally kicked in: she was 89 at +5. Now if she would only tinkle so I could test her with the 'stix! Alas, she seems committed to napping and enjoying the breeze by the window ...

ETA: She tinkled almost right on cue, two hours after the 89! The Ketodiastix showed "trace" glucose. This is amazing -- so different from last night!! So now we know that she is not wildly spilling sugar at 89 and I feel like I've got the hang of it. I'll keep testing until I find that magic renal threshhold number.

Empowered!! :D:cat:
 
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@Wendy&Neko Good evening! Another update: Chispa started the PM cycle at 201 and then conveniently waited almost 2 hours to tinkle. This time, the Ketodiastix read 1/2 (++). So, another question: Does the glucose reading have to be ZERO on the Ketodiastix?? Her renal threshold is below 89 if so …
 
I doubt her renal threshold is that low. If she tinkled two hours after the 201, then that 201 in her BG might represent the glucose in her urine 2 hours later when you tested it. Meaning renal threshold under 201. Typically renal threshold can be down to mid 100's.
 
Wendy&Neko said:
I doubt her renal threshold is that low. If she tinkled two hours after the 201, then that 201 in her BG might represent the glucose in her urine 2 hours later when you tested it. Meaning renal threshold under 201. Typically renal threshold can be down to mid 100's.
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Thanks, Wendy. So is a "trace" reading (like she had at 89) considered OK, or should it really be zero?

She hasn't even made it into the blues today, so no more data points, alas. I think she must still be bouncing from yesterday's 89.
 
At her test when her BG was 89, what you were seeing was the urine glucose as a result of the 150 two hours previous, not real time at 89. If you had tested urine two hours after the 89, it might have been zero.
 
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