Advice please! Bounce?

A

Alana & Fatty

Member
Hi everyone,

Hope it's okay I started a new thread on a different topic. My dear Fatty has had a rough few weeks -- big jump in kidney values (diagnosed with CKD September 2020) and his first ever (that I know of) pancreatitis flare. We switched him to a new kidney food that is higher carb to try to reduce his kidney values, and that has worked out so very well this far. Pancreatitis seems to be on the mend too.

I have had trouble home testing but just tried using the actual lancet and am thrilled at how much easier it is! Since I am just figuring this out and he was well-regulated pre-kidney food, my spreadsheet is very sparse. In response to his new higher carb food and some high BG readings, our vet suggested several increases (from 1.0 BID progressing to 2.5 BID). I'm wondering if Fatty might be bouncing, especially if his lil pancreas has calmed down a bit (I've read transient insulin resistance can be an issue with a panc flare, but I'm very new to this). Since switching his food and upping his insulin dose, his numbers were high 20s low 30s and I couldn't detect a difference between 1.0 unit and 2.5 units in his readings, though I admit I was having such a hard time checking so I don't know if he was going low at other times.

Checked this morning less than 3h after his early morning meal, and his BG was 12.2 -- had been 31.8 last night. I will try and do another curve tomorrow, but I'm wondering if anyone might take a look at our very patchy, very new spreadsheet (link in signature).

Someone very kindly gave me a list of low carb, low phosphorous foods suitable for CKD and diabetes, so I am investigating those, but trying to work with this renal food at the moment because his kidneys were really struggling 2 weeks ago and he's doing so much better now. I know high carb is not ideal but I am trying to manage several different things, so please don't yell at me ... :)

Thank you!
 
I'm sorry I'm just now seeing this!

I'm tagging @tiffmaxee because I'm not sure there are many PZ users with pancreatitis experience.

So normally I'd say it looks like a bounce, but I don't think so. It's a low dose, the food is higher carb, and he's got a lot of other stuff going on.

Id hold the 2.5U unless Elise thinks otherwise.
 
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Hi! Yes, I saw the 12.2 AMPS this morning and two weeks ago the vet said to go from 1.0 BID to 0.5 BID when the AMPS was 11. I didn’t feel comfortable giving him 2.5U when his reading was so much lower (relatively) than what I had been seeing over the last 6 days, though I haven’t been able to collect as much data as I wanted.

I left a message with my vet and she will call me tomorrow so hopefully that will be useful. I can’t understand why there wouldn’t be much difference at all between +6 readings at 1.5 vs 2.5u. So confused ...
 
tiffmaxee said:
I don’t know how to dose pz
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I thought that might be the case, I'm not sure anyone in PZ forum does? I just don't know how pancreatitis affects BG.

Alana - if you're going to keep the high carb food for a bit, I'd keep the 2.5U instead until you get another curve or he goes below 90. I'm going to amend my earlier post to say the same. I read your post as you're dropping back down to 1U because you thought the vet was too aggressive. I just saw your updated messages about the reduced dose, which is perfectly fine!
 
Alana & Fatty said:
Hi! Yes, I saw the 12.2 AMPS this morning and two weeks ago the vet said to go from 1.0 BID to 0.5 BID when the AMPS was 11. I didn’t feel comfortable giving him 2.5U when his reading was so much lower (relatively) than what I had been seeing over the last 6 days, though I haven’t been able to collect as much data as I wanted.

I left a message with my vet and she will call me tomorrow so hopefully that will be useful. I can’t understand why there wouldn’t be much difference at all between +6 readings at 1.5 vs 2.5u. So confused ...
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I suspect it's a combination of a few things:
- The food is probably the biggest culprit. I know you're working on it!
- Dose increased too quickly. Usually PZ dose is only increased every 3-5 days or so, and by 0.25U. This gives Fatty time to adjust to dose changes.
- Possible bounce, but it's hard to say without the PS data.

I will say this - if/when you decide to change food we're going to have to be very careful with the dose. He could easily drop a few hundred points just from food, and we don't want to be giving such a high dose that he hypos.
 
Hi all -- thanks so much for your responses. I just checked his BG (2h after meal) and it reads HI -- that's new and really scary. I am at a loss. I gave him 1.0U last night but I'm thinking he needs more this morning. I have no idea how to dose him when the readings are so high. Maybe yesterday morning was a fluke?
 
Alana & Fatty said:
Hi all -- thanks so much for your responses. I just checked his BG (2h after meal) and it reads HI -- that's new and really scary. I am at a loss. I gave him 1.0U last night but I'm thinking he needs more this morning. I have no idea how to dose him when the readings are so high. Maybe yesterday morning was a fluke?
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Hold the dose even with HI readings; it just means the value was outside the range of your meter (so probably 600+). It's scary but he'll be ok. Your standard dose is 2.5U, that's what you want to stick with.

Did you get a PMPS last night?

Anything could have happened yesterday morning, with the higher carb food in the play he maybe just didn't eat much of it the prior night? Or the timing of the PM dose vs when he ate overnight just happened to result in lower AM BG. I wouldn't try to change feeding schedule or anything right now, aside from making sure he has food available near nadir.
 
Thanks Melissa. He's acting normal (drinking from the tub, but that's his new normal the last two weeks) and I just checked for ketones and he's negative, so phew. I am home all day (just casually holding a pee-soaked ketone strip in my Zoom Master's seminar, no biggie) so will try to check him in an hour and going forward.

He likes to eat every 2h or so it's hard to get a reading when he hasn't just eaten. He was losing weight with CKD so I have been letting him eat when he wants, which is frequently but on a pretty steady schedule (including overnight, oof).

Seriously, thank you for your help. He got diagnosed years ago but since he was in remission for so long, then regulated on low carb Fancy Feast, I feel like I'm brand new!
 
Alana & Fatty said:
Thanks Melissa. He's acting normal (drinking from the tub, but that's his new normal the last two weeks) and I just checked for ketones and he's negative, so phew. I am home all day (just casually holding a pee-soaked ketone strip in my Zoom Master's seminar, no biggie) so will try to check him in an hour and going forward.

He likes to eat every 2h or so it's hard to get a reading when he hasn't just eaten. He was losing weight with CKD so I have been letting him eat when he wants, which is frequently but on a pretty steady schedule (including overnight, oof).

Seriously, thank you for your help. He got diagnosed years ago but since he was in remission for so long, then regulated on low carb Fancy Feast, I feel like I'm brand new!
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No problem!

Am I reading correctly that you don't withhold food 2 hrs prior to the PS test? That's something you'll want to do for sure, we want the PS data to not be influenced by food, at least for now.

As for during the day/night, doesn't matter if he's had food or not! Test whenever you want. We actually want to see what his numbers are doing during the cycle as he's eating.

A lot of people choose to keep track of meals in the Remarks section, what the % carb was, the amount and time eaten. Since he's on higher carb food that might help us understand the numbers better, but sometimes it's just not possible/it can be a lot of added work.
 
Eep, I haven't been withholding food before the PS test. I will do that tonight and going forward. Is 2hr usually long enough to clear a BG spike after eating? He was eating 22% carb kidney food October - mid January (and regulated on 1.0 unit BID, was told to reduce to 0.5 BID the day he got diagnosed with a panc flare) but later that day he switched to 40% renal food, which is causing all this panic. I just did his +1 shot and he's still high ... which is understandable ... patience ... I will start putting his food into the comments thing. Yesterday I was hopeful he was bouncing but today I'm freaking! Gotta love this stay-at-home order for letting me continuously monitor my little dude.
 
Alana & Fatty said:
Eep, I haven't been withholding food before the PS test. I will do that tonight and going forward. Is 2hr usually long enough to clear a BG spike after eating? He was eating 22% carb kidney food October - mid January (and regulated on 1.0 unit BID, was told to reduce to 0.5 BID the day he got diagnosed with a panc flare) but later that day he switched to 40% renal food, which is causing all this panic. I just did his +1 shot and he's still high ... which is understandable ... patience ... I will start putting his food into the comments thing. Yesterday I was hopeful he was bouncing but today I'm freaking! Gotta love this stay-at-home order for letting me continuously monitor my little dude.
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We'll get it figured out!

2 hrs may not be enough to clear high carb food, but it will at least give us some consistency in the preshot numbers and a place to start.
 
Okies. With his CKD, I've become used to feeding him as frequently as he wants (and he pokes me in the face until I get out of bed to feed him). Time to retrain both of us! :)
 
Just want to double check - @JanetNJ , you're the only one off the top of my head with CKD experience, though I know there are others. It's ok for Alana to withhold hold food for the 2 hrs before preshot, correct?
 
Alana & Fatty said:
Okay wonderful, thank you. He's wanting to snack right now but I'm so nervous to feed him with this dreaded HI on my glucometer.
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Feed him, it's ok lol Remember that diabetic cats don't process food the same way, especially when unregulated. My cat eats about one 5.5oz can more a day right now. If they're not eating right, they're also at higher risk for ketones/DKA.

Once we have a few days of data, we'll be able to adjust the dose. Given the high carb stuff, he may stay high for a bit until we get higher doses.

I know you mentioned you're looking at the other food options; I'd prioritize that right behind the home testing. Low carb would mean lower doses and we can hopefully hit the ideal dose and get his numbers down more quickly. But again, don't make any drastic food changes, it would be a slow phase out while keeping am eye on BGs
 
I am going to see if he's interested in a gradual transition back to the 20% renal food he was on from October - mid January (and regulated on 1.0U) ... I also just read a post about someone's BG getting stuck while on Zeniquin (which he started when he started the high carb 40% renal food). More questions for the vet!

Still reading HI, but it's only been 3h since his morning shot.
 
Alana & Fatty said:
Okay wonderful, thank you. He's wanting to snack right now but I'm so nervous to feed him with this dreaded HI on my glucometer.
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I was just looking at your spreadsheet. Looks like you lowered the dose, but I don't see anytime that he went low enough to earn a reduction. I would go back to 2.5, but get a preshot test each time, and at least one mid cycle test. A before bed test would be helpful too.
 
Alana & Fatty said:
I am going to see if he's interested in a gradual transition back to the 20% renal food he was on from October
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That Renal food is way too high in carbs. My cat is diabetic with ckd as well. You need a low carb, low phosphorus food. I feed weruva. Here's some of the foods she eats.


Weruva slide and serve pate foods Family Food (.97 phosphorus and 0 carb). Also Jeopurrdy Chicken (0.97 P 6.1 carb)

What a Crock 0.71 phosphorus and 8 carb lots of gravy so she loves it.

Goody stew shoes 0.71 phosphorus, 8.5 carb. This one is a big hit

Weruva Steak Frites (0.57 phosphorus 5.5 carb although I take out any big pieces of potatoes to try to limit the carbs just a bit)

Weruva LA isla Bonita - phosphorus 0.77 carb 4.5 (used to like, not a favorite anymore)
Glam and punk 1% carb, 0.93 phosphorous.

Weruva paw lickin chicken 3.3 carb 0.82 p and
Press your lunch 5.9 carb. 0.82 phosphorous

Bff play Laugh Out Loud chicken and lamb 7.7 carb, 0.82 phosphorous

BFF play destiny (chicken and duck) 0.87 phosphorus 7.7 carb

Bff play chicken cherish 0.71 phosphorus 7.6 carb

Bff play best buds chicken and beef 7.9 carb 0.9 phosphorus

Bff play chicken Checkmate. 7.7 carb 0.7 phos

New favorite On the Cat Wok 3.8 carb 0.74 phos
 
JanetNJ said:
Looks like you lowered the dose, but I don't see anytime that he went low enough to earn a reduction
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This is my attempt to quote your post ... hope it works. Yes, now I see I was wrong, and poor Fatty is dealing with the fallout. I thought the 12.2 (220) AMPS was too low to give him the 2.5U, since 2 weeks prior, the vet suggested I reduce his dose to 0.5 (he had been on 1.0 BID for months) when his AMPS was 14.7 (198). I'm hoping he at least drops out of HI today ... debating calling the vet because I don't expect her to call before 7pm when the clinic is closed.

JanetNJ said:
Here's some of the foods she eats.
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Do you supplement these with B complex and/or B12, phos bind, etc.? My concern with switching back to a low carb food is that even with a couple days back on Fancy Feast a few weeks ago (not eating due to panc, I know now), his kidney values jumped up so much.
 
Alana & Fatty said:
This is my attempt to quote your post ... hope it works. Yes, now I see I was wrong, and poor Fatty is dealing with the fallout. I thought the 12.2 (220) AMPS was too low to give him the 2.5U, since 2 weeks prior, the vet suggested I reduce his dose to 0.5 (he had been on 1.0 BID for months) when his AMPS was 14.7 (198). I'm hoping he at least drops out of HI today ... debating calling the vet because I don't expect her to call before 7pm when the clinic is closed.


Do you supplement these with B complex and/or B12, phos bind, etc.? My concern with switching back to a low carb food is that even with a couple days back on Fancy Feast a few weeks ago (not eating due to panc, I know now), his kidney values jumped up so much.
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Fancy feast is high in phosphorus and is good for diabetes but not good for ckd. The weruva has many flavors under 1 percent phosphorus. I do give b 12 methylcobalamin, b complex, and sub q fluids 2-3 times a week. Can you post the most recent labs?

220 is a safe shot number. We tell new people to stall under 200. Really important to get those preshot tests and a mid cycle number.
 
Janet, you are my hero today. His most recent labs are in his spreadsheet. Also wondering, and I'm sorry if this is an unfair/inappropriate question, if your kitty was reading high over 3 checks today, would you be comfortable keeping him at home? 30 mins from now will be +5 and if it still says HI I might try to take him in. Maybe I'm being a spaz but I'm so concerned.

Fatty does get 100ml subqs daily (just gave them to him now), plus 4mg Cerenia daily, 2.5mg Fortekor daily, B12 cyano injection weekly, and Zeniquin at night (day 16 or something of that).
 
Alana & Fatty said:
Janet, you are my hero today. His most recent labs are in his spreadsheet. Also wondering, and I'm sorry if this is an unfair/inappropriate question, if your kitty was reading high over 3 checks today, would you be comfortable keeping him at home? 30 mins from now will be +5 and if it still says HI I might try to take him in. Maybe I'm being a spaz but I'm so concerned.

Fatty does get 100ml subqs daily (just gave them to him now), plus 4mg Cerenia daily, 2.5mg Fortekor daily, B12 cyano injection weekly, and Zeniquin at night (day 16 or something of that).
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There's nothing they can really do about a HI reading except give insulin. It's high because she wasn't getting enough insulin. Are you testing for ketones at home? If there are any ketones, THAT'S when you need a trip to the vet.

Had a look at the labs... looks like she's stage 3. Its' about where my cat is now too. (Mine is ALMOST stage 3) Your cat's phosphorous levels look pretty good. :) Good that you are giving sub q's. How is his anemia doing? They didn't do an hct with the last labs? You could put b complex/b 12 in the food as well.
 
JanetNJ said:
Are you testing for ketones at home?
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I checked for ketones both times he peed this morning (negative each time) and will continue to do so.

I freaked after getting the fourth HI reading and noticing he was getting pretty lethargic ... popped into the vet and by the time she saw him (+7), his BG was 31.8 (569) -- still so high but definitely lower than the HIs, which are somewhere above 33.3 (600) on my meter. She said his hydration and vitals were good and he was acting pretty bright (of course, as soon as I take him in ... hehe). She gave him a little shot of a fast-acting insulin to drop him down a bit and he perked back up to his normal self. I will do the PM preshot before returning to 2.5U. I am kicking myself for giving him 1.0 yesterday! Maybe 2.5 really is the dose that's going to kick start his numbers again and I got too excited and reduced when I shouldn't have. Now I know for next time.

We are also trying a different antibiotic, Clavaseptin. I exchanged messages with a very lovely and helpful person here who said her kitty's BGs stayed high and flat while on Zeniquin, so it's worth a shot.

JanetNJ said:
Had a look at the labs
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Thank you! Yes, stage 3 ... his CREA and BUN are way better than they were mid Jan, thank the kitty gods. I am loving his phosphorous levels lately! That's this freaking kidney food. Good for phos and crea and bun, bad for BG. Vet said his HCT/HGB is "holding steady" from the last time, but she ran the test separately so I don't have the labs. We got bloodwork today so I will update when I receive that. To clarify, do you put B12 and B complex in kitty's food in addition to a B12 injectable, or instead of?
 
Alana & Fatty said:
I checked for ketones both times he peed this morning (negative each time) and will continue to do so.

She gave him a little shot of a fast-acting insulin to drop him down a bit and he perked back up to his normal self I will do the PM preshot before returning to 2.5U. I am kicking myself for giving him 1.0 yesterday! Maybe 2.5 really is the dose that's going to kick start his numbers again and I got too excited and reduced when I shouldn't have. Now I know for next time.
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Live and learn! So much of this is trial and error, so don't be too hard on yourself.

Be sure to note this in the Remarks column. Do you know how much and/or what insulin she gave? Did she give any guidance on tonight's shot?

Since she gave a short acting insulin, the nadir is very likely to be exactly at your preshot time. Fast acting insulins usually nadir +4 to +6...and if she saw him at +7 that's right at your preshot time. So he'll kind of double-dip... he'll hit the nadir from what she gave, probably climb back up just a bit, then drop again as your shot comes into play.
 
FrostD said:
Do you know how much and/or what insulin she gave? Did she give any guidance on tonight's shot?
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The vet gave him 1.0U Humulin R. I just did his PMPS and he's 27.1 or 488 (I know the red cell in the spreadsheet isn't good, but it's certainly better than black!!!), and this is 5h after the vet gave the Humulin R. She said to go ahead with the 2.5U if he's above 20, so I did. He ate two meals between the vet visit and now, the latest 2h ago.

With this morning's dose, I know it caused some movement by +7 (down to 31.6 or 569)-- not sure how much because he was just reading HI (somewhere above 33.3 or 600) before that. That's heartening because yesterday it just seemed to go up and up.
 
Alana & Fatty said:
The vet gave him 1.0U Humulin R. I just did his PMPS and he's 27.1 or 488 (I know the red cell in the spreadsheet isn't good, but it's certainly better than black!!!), and this is 5h after the vet gave the Humulin R. She said to go ahead with the 2.5U if he's above 20, so I did. He ate two meals between the vet visit and now, the latest 2h ago.

With this morning's dose, I know it caused some movement by +7 (down to 31.6 or 569)-- not sure how much because he was just reading HI (somewhere above 33.3 or 600) before that. That's heartening because yesterday it just seemed to go up and up.
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Ok good! I just wanted to make sure she gave some sort of guidance and you weren't walking blindly into a "double dip" sort of situation.
 
Numbers today were so much better! And to celebrate ... I just gave him a partial fur shot :banghead: !!! I think most of it went in. I hope most of it went in. Crap crap crap.
 
I laughed a bit harder than I should have...it's a rule of the universe, fur shots come when you really don't want them!

It looks like the Humulin + PM shot last yesterday gave him enough of a "zap" to bring him down quite a bit, so hopefully only in the 300s/400s tomorrow morning.
 
Hahaha. Seriously! Maybe I've just been giving him so many needles lately between insulin and BG checks and subq fluids that he's just sprung a leak.

At least if he's high tomorrow I know he can come down ... yesterday morning I was afraid his BG was going to continue to go up forever.
 
Aaand he's HI. Sigh. Aci1`<<< hahaha. I was about to type "Acting peppy" but he walked on my keyboard.

Question (and I will proceed conservatively and with caution and very regular monitoring): what do you think about me cutting his normal (renal high carb) food with low carb Fancy Feast today as a bit of an encouragement out of the blacks? I would heavily phos-bind it and do another curve to see how low he gets, but maybe it would help. I'm hesitant to try him on Weruva at the moment because I know he's used to FF and can tolerate it without GI upset.

Good news: his entire AM shot went into his body, phew.
 
Alana & Fatty said:
Well, AMPS and PMPS were HI (over 33.3 or 600), but got down to 14 or 252 at +5.5. I don't know what to think about that!
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Means the insulin is doing it's job!

I do think you're ok to start slowly transitioning food. The nadir is nowhere near the reduction threshold of 90, and I'd rather reduce BGs through diet vs dose increase.

The pdf in this post covers how to do it, but to be completely honest I'm not sure how the CKD will affect things so can't comment on the phos-bind. It might be worth it to try straight to Weruva (no FF) if that's what you want long-term...he might reject the Weruva simply because he's used to FF.

When I transitioned Mr Kitty (see June 2020 spreadsheet) I had intended to do it slowly...but he likes his wet food I started with 1/4 can wet in AM and again in PM, and had intended to increase by 1/4 can every few days while keeping a close eye on him. He stopped touching his dry food, so I kind of just had to roll with it while testing as much as I could.
 
Oh my gosh, no need to apologize!!!

Seems Weruva is hard to find where I am, but I will try the specialty pet store tomorrow. Smart thinking about skipping Fancy Feast -- knowing him, he will probably want to just stay on that because he goes bananas for it!

In the meantime, I did just get a few cans of a higher protein lower carb (but still not low carb) kidney food to tide us over.
 
Do you make sure to give the insulin shot as far away from the subq fluids location as you can? So they don't interfere with each other.
 
I usually do insulin 9-10am and pm, and fluids around 2-5pm, though I am just about to do fluids now (insulin will be at 10:30). Forgive my ignorance -- how would they affect each other?
 
I did not mean far apart time wise. I meant location on the body, farther apart. So Subq fluids are usually given in the scruff. If you shoot the insulin in the same location, you could be shooting into the fluid area, which could slow the absorption of the insulin. Which could cause more erratic BG numbers.

Don't know if it could disrupt the chemical composition of the Prozinc insulin. I just remember being on an IV drip for fluids, and needing a different IV line for another drug in a different location for myself when I was in the hospital.

Can have an even more pronounced effect when using a depot type insulin, the L insulins. As the fluids do disrupt that "depot" storage area underneath the skin.
 
I have so much to learn -- thank you for this. I have been putting everything into the scruff! I will try to do his insulin in his hips, or at least the other side of his shoulders. Usually his fluid lump is down around his armpit or absorbed by insulin time, so hopefully that mitigates some of the effects, but I will do better to rotate from now on.

Thank you!
 
Alana & Fatty said:
I have so much to learn -- thank you for this. I have been putting everything into the scruff! I will try to do his insulin in his hips, or at least the other side of his shoulders. Usually his fluid lump is down around his armpit or absorbed by insulin time, so hopefully that mitigates some of the effects, but I will do better to rotate from now on.

Thank you!
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If you scroll most of the way down this post, it shows different locations (it's in the Lantus forum but I couldn't quickly find it elsewhere on FDMB).

But Deb makes a great point - I have a significant chemistry background...while I can't say if it alters the insulin itself, it would prevent it from being used as well if the subq fluids are still hanging around at shot time.
 
Oh perfect -- thank you all! He definitely has some scar tissue in his scruff (from me and also from my other kitty -- they are wild boys) that sometimes makes it hard to get the insulin shot in, so this is very helpful. Between his B12 injections, subqs, and insulin, I'm sure his scruff could use a break.
 
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