Advice on plan for Sir Thomas

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3catHousehold

3catHousehold

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Group -

I read through Darlene' s posts in her thread "Week One completed!" and everyone's comments and found comfort in the similarity to Sir Thomas' situation with the 400's ps. We're 5-6 weeks post diagnosis and onset of insulin treatment (no DKA and one test with negative ketones this wknd). I'd appreciate any advice/comments on my plan at this point.

Last night I dropped back down from 1.5 to 1 unit BID. I tried out the wet food popsicles overnight last night and they were gone by morning (hoping Sir Thomas got one of them). I did my first curve today - every 3 hours - and got a flatter chart, even though the numbers are higher. I also decided to leave out the wet food popsicles every night at bedtime and every day regardless if we're around or not to try to get him on a more regular eating schedule. This means us feeding him before his a.m. and p.m. shots and the two servings of frozen food (probably one extra serving 2-3 hours before his p.m. shot if we're around), so 4-5 feedings every 24 hours. The other thing I'm going to change is feeding him 15-30 minutes before each shot (we weren't being consistent with this before and I think mostly feeding him after his shot). I'm hoping this might help at least a little bit with his roller coaster ups and downs.

I was thinking of duplicating my glucose test curve from today on either Wednesday or Thursday to compare the numbers. He was getting pretty wary of me by the end of the day today with all of the needles and fussing (maybe waiting til Thursday will give him a little more time to recuperate and not start hiding from me?).

I've ordered the U-100 syringes and have the conversion chart so that if it looks like I should increase his dosage, I will be able to do it in smaller increments. I'll likely leave him at this dose for 7 days before making a change, barring a need to adjust more urgently.

Planning to get ps numbers on the non-curve days and maybe a +6hr number if I can, none of which I had been doing daily. I have my fingers crossed that taking this new run at it, with more intensive testing will get us to where he needs to be faster (even him out and hopefully at some lower numbers).

Thanks for any comments or suggestions.
 
I agree staying with the 1u for a short time, the +6 earlier #'s are worrisome, so the 1u is reasonable until you have an idea how the insulin works in his body. Feeding him before his am/pm shots will raise his BG #'s. If you are afraid he will not have enough in his stomach for the insulin because he is throwing up, there are many ways to handle that. You can give him 1/4 of a 10mg. pepcid 10-15 mins. before food. Most of us test, feed and shoot while the cat is eating .... usually they don't even notice. Also, for cats that are not used to wet food, it is good to mix water in with the food (good for their kidneys also) and makes the food easier on the stomach. I get such satisfaction out of adding the extra water, let's clean everything out! Also, boiled chicken or fish, all meat baby food, your choices are endless for easy stomach food.

I'm tired so not sure if I'm answering all you are saying but it seems that he is sensitive to insulin, so you are going to need to be careful when he is throwing off high numbers, not to overact. Feeding a cat well that is not regulated is a good thing but feeding right before you test ..... is throwing off your numbers. Most of us find that our cats understand we are trying to help, just talk to him and I know it sounds crazy but I tell Payne everything I am doing and why I'm doing it. Give the ProZinc time to work. I think you are doing well.
Nancy and Payne (who likes being talked to ......)
 
My understanding is you need to withhold food for a period before the bg test, I try to pull my cats dishes and hour of two before, if there is anything left in them ;)
I am not sure what the exact time is but that’s what we do here.
 
Hi Jen, and welcome! Good job testing and getting your spreadsheet up. I think I read something about kibble in your notes---even a little dry food can really raise the bg numbers---is it possible to eliminate that? Like the others said, feeding before testing (unless it is just before testing) gives you higher BG levels. Unless you are really concerned about your cat not eating enough, it would be better to withold food an hour or so before testing. Keep posting and asking questions, we like being able to help.
 
Welcome! Like the name - he must be very distinguished.

I think you have the right idea -more smaller, frequent meals. And feeding overnight may help bring down your morning numbers. I agree with others that you want to be careful feeding closer than 2 hours or so before the test. I know this sounds contradictory - that the food overnight can support the pancreas and help keep the numbers lower for that morning test but that food can also raise that morning number. Food tends to temporarily raise a number in a diabetic, in the first hour or so after eating. So if you feed too close to the test, it can be the food "talking" and the number could seem higher than it actually is.

One way to help with this is to use an automatic feeder. If you have multiple cats, leave out the popsicles to snack on most of the night. Maybe the last popsicle feeding could be in the feeder, then the door shuts 2 hours before the planned testing time. I know this might be tricky but it might help?

Those 6 hour numbers will really help fill out the picture. Your two low nadirs at 1.5 might support trying 1.25 When you get the 100 syringes, that might be an option.

You are definitely offering a treat with each test, successful or not? And wet lo carb treats? Lo carb treats Is getting the blood hard or is it that he complains?

You are doing great - trying lots of different things. Work on getting rid of all the kibble. And keep asking questions.

This forum is pretty busy in the am and the pm. There are not as many people as on Health - particularly in the middle of the day or night. If you ever need immediate help, post over on Health also.
 
Thanks to everyone for reading and commenting. One thing to clarify - I was talking about starting to feed him before I give him his insulin NOT before I test him. So, I will test, then feed, then give insulin is what I was thinking if that makes sense (I am trying to be more mindful of not feeding him the 2 hours before his insulin shots).

We are doing treats or food or catnip after each medical interaction to try to reward him, success or not. We bought some of the freeze-dried treats to try and he's not a big fan, so more experimenting needs to be done there.

He was primarily a kibble eater before his diagnosis (with wet food as treats). He does prefer the wet food, so he will eat and fill up on that if offered. He's always had a lot of anxiety and issues around food being available ever since I adopted him (no reliable source in the past?) and with the other cat, I've reduced the amount of dry food being released by the automatic feeder now that we're feeding primarily wet food, but I do still have it in the house.

We'll see how today and tomorrow goes.
 
Oh, forgot to add -- Nancy mentioned adding water to the wet food . . . I had read that in several places here and tried it several days ago. It was a huge hit with all of the cats so we do it with each feeding now. And it got them to pretty much lick their bowls clean most of the time instead of leaving dry crusty chunks for me to clean out later:)
 
Just wanted to say hello. I'm sure you're already figuring out that you've come to the best place for help with your diabetic cat. This forum and following the great advice/protocol really helped me turn my cat Max's health around. You are doing really good with the changes you'd like to make. Like others have mentioned, I would try to totally ween out the dry food. Every cat is different. My cat is pretty sensitive to carbs, so even a small amount of carbs raised his BG #'s and his #'s really improved when I finally went to only low carb wet food. Max was really hard for me to test at first. I was worried it was hurting him, but it turned out to be more that he's a cat and hates doing what someone else wants (in this case hold still). Give lots of love and treats. People kept saying the testing would get easier, but I wasn't sure. After about two weeks Max seemed to pick up on the routine and is much easier to test now, although by no means perfect. I also got better at testing and getting a good poke with practice.
 
It sounds like you are doing well. One of my clan (ten cats) would eat the wet but yearned for crunch .... I would open a bag of dog food and he was there begging. I use chicken livers/gizzards/hearts as treats to help clean the teeth and buff up Payne but civvie Tommy was not happy, still no crunch. I found a shredded dried chicken breast with omega 3's by Catswell, called Vitakitty. Well, died and gone to Heaven! In fact everyone likes so much that we buy it by the case and are on a regular delivery schedule :)

I have always said that the water in the wet food is by far my favorite suggestion ...... flip_cat I still give Payne Sub Q fluids daily and I remember I read "somewhere" that if you give SQ fluids and feed dry food, it doesn't get you ahead, maybe still behind. Now, I hate needles but I give six shots (Payne is on a very complicated regime to not DKA again ......) daily and the long SQ needles give me the willies :cry: but I do it all because I love her. If I did it for nothing that would piss me off .....

A few years ago we had a beloved little girl with severe kidney disease and we gave her SQ daily but she was on a "premium dry food" so we thought we were doing good ....... we did give her an extra 2 years with the SQ fluids BUT her eyes were sunken and she was almost always dehydrated. I think what if we would have known how good the wet is for them, especially adding the water???? How much longer would she have lived and how good for the other cats?!! I see people in the store buying dry and I need to bite my lip ...... most people don't get it, until ...... they have to.
Nancy and Payne (feeling good .... glad to be back on pzi :)
 
Just a little venting of frustration . . . had the phone consultation with the vet this a.m. She wasn't happy with me lowering his dose or doing it without waiting to talk to her first. We've had a great relationship and rapport over all of my cats check-ups and health issues for nearly 15 years. This level of tension between us feels very uncomfortable and I'm not sure if it's going to permanently change things between us or not.

I don't understand why all vets don't start us out with the U-100 syringes for the U-40 insulin so that we can make smaller incremental changes from the very beginning and measure them much more accurately. We've gone from 1 unit BID to 2 units BID to 1.5 units BID over 5 weeks or so. Then I went back down to the 1 unit BID to be able to do more testing and then move up in smaller jumps from there if need be. It seems my vet is most concerned with that +6 number even though the ps #'s were staying in the 400's on 2 units BID and 1.5 units BID. Just starting out on the 1 unit BID again, the ps #'s are in the 300's and the middle numbers are in the 200's and low 300's -- flatter, with lower peaks.


My big question -- What's more important to nail down first: a green +6 # or numbers throughout without as many peaks (even though the #'s may be higher)? Is there one method or another that's had more success?


My vet seems to remain in that first camp (she's unhappy that he wasn't under 250 at all yesterday on the 1 unit BID and would've preferred continuing his #'s at the 1.5 units BID, though my note would be that he was close and they're all way better than the 512 he was diagnosed with).

Based on our experiences so far, I lean more toward the latter (I also never would've jumped all the way from 1 unit BID to 2 units BID if I knew what I know now).

Just looking at my limited testing from early on, I don't think we were going to get the ps numbers out of the 400's with 1.5 or 2 units. We had the low +6 numbers, but the ps numbers never really came down. On just the first day of testing at the new 1 unit level, the ps #'s are already coming down to the 300's. My hunch is that his ideal insulin dose is somewhere between 1 and 1.5, which is what I told the vet. She didn't agree or offer an alternative educated guess for where she thinks we should head, so I'm not sure what she's thinking on this. We agreed to keep it at the 1 unit BID for about 1 week, with testing and consult on the numbers and next steps at that point.


P.S. On the dry food issue: I have a cat eating special wet & dry food for kidney disease (going on 2 years) -- Thomas will eat this dry if he can get at it and we do a good job keeping it away from him, but occasionally he outfoxes us. I also have another girl cat that's healthy. We've had an automatic dry feeder in the house for 4-5 years now (the feeder cut down on a lot of Thomas' anxiety about food availability). They all did primarily eat dry for most of their lives. I've taken the vet's advice and information from all of you into account on the wet vs. dry. At this point, I'm just not prepared to become an all wet-food household. I've greatly limited the amount of dry since Thomas' diagnosis, and given the choice between the two, he'll eat the wet. I'm just not comfortable banning the dry food completely. I think it's okay for them to have some dry food as part of their diet. I don't know if there are others on FDMB that take this position or not. I realize I'm in the minority here. I'm just trying to do what I think is best for my cats, their overall health and our household.


Thanks for "listening" to my rant. Feeling pretty beaten down, exhausted and lonely with all of this . . .
 
I know what you are dealing with concerning that uncomfortable vet feeling. It’s easy to feel beaten down, I did. I struggled with it for 3 months and ended up changing vets. You’ll just have to feel it out for awhile and do what you think you need to on that. Some people recommend just not telling your vet how often you test, etc, if they just don’t get it. It’s a tough call but you will know what you have to do eventually.

Two things that work great for us and might be helpful to you fwiw...(and I see now you do one of them already)

We add water to our wet food here, I started doing it after my one cat had a uti a few years back. (I just posted this on Kim’s thread too) I add water and mash with a fork until the canned food comes to the consistency of pudding. It was rec’d by my current vet and has worked well for my cats and my Mom’s.

Also, for low carb treats we bake skinless boneless chicken and then cool and cut into 1/4” chunks, freeze lightly on a cookie sheet, then ziplock bag and freeze. We work off of the bag for a few weeks for treats. We buy the giant pack of chix when it goes on sale and once we bake and bag it, it lasts in the freezer for a long time.
 
In my experience, it is not uncharacteristic of doctors to get ruffled if their authority is questioned (I apologize to any doctors on this board who I might be offending--I do know it is not true of ALL doctors). THey are often disdainful of internet info (not without cause). If this is a vet you have worked well with for years, I would try to find a way to work it out. Good vets are gold.
 
How can you feel lonely with all of us! :lol: Everything you are feeling is natural and part of the growing process ..... every decision you make, at the time you make it, is for the best for your kitty. If you second guess what you do too much ..... it can hinder future growth.

I have just recently changed from a university vet to a private vet hospital, for some of the reasons you have mentioned. He was a great vet, I loved having all the services in one place and the 24/7 of it all BUT I was looking at the whole cat 24/7 and learning new stuff but he wanted to do it more by the book and didn't want to talk about treatment. MY CAT, NOT YOUR CAT ..... so in the beginning because she was so sick I went along with it but I wanted to try new things, he didn't. I really feel because I wasn't a partner with her treatment in the beginning, is why she DKA'd two more times, that is just sad to read but it's true. I missed small things, things I immediately know now. I want my vet to work with me, to trust my decisions also. I kept her stable for 19 weeks and when I finally did change vets, I forgot to trust my gut and she went into DKA again but this time I had a vet who was my partner and we changed everything the way I wanted ..... and it worked.

It will get better ....
Nancy and Payne (feeling on top of the world!)
 
"My big question -- What's more important to nail down first: a green +6 # or numbers throughout without as many peaks (even though the #'s may be higher)? Is there one method or another that's had more success?"

Great question. I hope you will get several responses on this. My idea is that it depends on the cat. ( I know, I know - everything depends on the cat and every cat is different.) But I think the cat determines this. Some cats will give really nice nadirs (like Darlene and Jack and Sue and Samwise) but high preshot numbers. Some cats are pretty flat across the board. I think you have to see which camp Sir Thomas falls in and work from there.

You work with varying the dose. Food plays a huge part in this process - small frequent meals even during evening hours if that works or strict mealtimes if that works.
 
Of course you have to make your own decisions about what is best for your cat, and that may include feeding dry food. While it is true that most of us have tried to eliminate dry food--- there certainly are people on this board other than yourself who for various reasons still feed some dry. If you are interested in Dr. Lisa's article about it, it can be found at http://catinfo.org/
 
Jen, my cat was just diagnosed April 1 & I know what you mean about feeling down, alone & exhausted. I've already had one person at work say " you just need to put that cat down"! Ugh....I knew that was gonna happen! And I know others are thinking it but just not saying it to me! Thank goodness we both found this board!

Nancy, are you using the shredded chicken breast as a treat or actually making it a meal? I have a 4 yr. old male is a food hog & I'm wondering if I could put some of that in his bowl & take the dry stuff up? I'm trying to transition off the dry stuff.

Barbara
 
Barbara, the Vita Kitty is a snack, not a meal. Although you can get several kinds of crunchy like treats and sprinkle them over the wet. Oliver loved Bonito flakes which we could sprinkle on top. Purebites is another dried chicken snack that can be crushed over the wet. Also some cats go crazy for FortiFlora. Here is what our "resident" vet says about it:

"Try a product called FortiFlora. Most cats LOVE FortiFlora and this has recently become my favorite trick. This is a probiotic made by Purina but you are not going to use it for its probiotic properties. You are just going to use it as a flavor enhancer. The base ingredient in FortiFlora is animal digest - the very substance that makes dry food so very enticing to cats. The directions say to use 1 package/day - and you can use this much if you want to - but this amount is not usually necessary. You may only need ~1/4 of a package - or less - with part mixed into the food and part sprinkled on top of the food just as you would use."

Have you sure read Dr. Lisa's site on transitioning difficult cats from dry to wet: www.catinfo.org
 
Thank you for all of the replies and comments - I truly appreciate it. I'm still feeling physically exhausted today without much new to add. We'll see how the rest of the week goes. Fortunately, the cat seems to be doing well - feeling fine and up to his normal activities.
 
As long as Sir Thomas is doing well - happy and eating and purring and peeing. That is all good news. Hang in there - we are holding on to the rope for you and we won't let go!
 
Thanks Sue. He is doing all of those things and I'm feeling better too. He seems to have settled at the high 300's for ps's and right at 200 for the +6 on the 1 unit BID. I'll keep periodically testing until the next vet phone consultation early next week. I'm happy with the highs not being so extreme and think a slight nudge up in insulin (~1.2 units BID) next week may do the trick to really get him where he needs to be.
 
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