Rebecca M
Member Since 2023
Hi everyone - so many of you were invested in Yahiko and trying to help me, so I wanted to come here and post an update, also for educational purposes. Previous thread: https://www.felinediabetes.com/FDMB/threads/yahikos-progress-his-moms-anxiety-lol.284636/ .
Yahiko is doing wonderful and has gained a little under a pound back. I know many of you felt REALLY strongly about me increasing his insulin and were feeling a little frustrated with me because I didn't; I just wanted to explain, in more coherent words now that I'm less panicked, what I saw in his spreadsheet that stopped me and how I confirmed I was right.
When I was active on here in December, he was fresh home from the ER and experiencing massive, volatile fluctuations in his BG every single cycle - he was going well over 500 2 hours after each meal, then plummeting down in a matter of hours towards 100 or lower, and I was interrupting that drop by feeding him. For many of you I think that sent a lot of red flags that his insulin dose actually wasn't high enough yet and that I needed to be a bit braver and more assertive and let it get lower rather than feeding him partway through and stopping it from an accurate nadir. I completely understand why those of you with so much experience saw that pattern and thought that; NO hard feelings whatsoever.
But what I was beginning suspect was that he was bouncing. Still only a week out from DKA, his body was panicking when he was going so low so quickly and releasing a ton of glucose into his bloodstream about 12-14 hours later - so I was getting those extreme highs, and then the insulin would win and he would plummet back down and continue the cycle. I realized that the lows were going lower and the highs were going higher and tested my hypothesis on December 20th (you can see in his spreadsheet) by giving him a bit less food for dinner so that his BG wouldn't go up as high, and also giving him less insulin so his BG couldn't go as low. And, lo and behold, the bounce was stopped. Though his numbers were still high-ish in the 300s, I held steady there and it began to resolve after a few days. (For whatever it's worth, he's still on Fancy Feast-only, and I discovered just from observing his bowel movements that some of his food allergies are due to beef and turkey, and potentially tuna - he's therefore only on the chicken FFs right now).
I also restarted him on the budesonide on the 22nd because he was having a lot of diarrhea and gas, his bowel movements were a bit pale (which I figured could be equally from the stress on his liver of the nonstop hard bouncing or pancreatitis, which he has had in the past and which would make sense despite clear bloodwork), and his BG was really unpredictable which suggested poor absorption to me (the reason he was put on budesonide to begin with). 12 hours later his BG went WAY up and I took him off of it, thinking he must be one of the cats for whom it increases blood sugar. But a few days later I got brave and decided to start him on 1/4mg (1/4 his usual dose) and see what impact it had - I wanted SOME in him helping his IBD/pancreas, and I figured if I could just find the amount that would help absorption while figuring out what insulin level he needed to stay regulated, it might work. And here is the pattern that I discovered, which has held true for him since (and he is now fully regulated at 1mg once a day): with every dose increase, the budesonide DOES raise his BG for about 3 days, from between 4 to 12 hours after giving it to him. The first day it is a mild increase. The second day is a more moderate increase. The third day is a VERY mild increase, and then it returns to normal. After 2 days of normal, I increased him to 1/2, same pattern, then 3/4, same pattern, and now he's on 1mg and last night was his first "normal" BG (and day 4 - so, same pattern).
Yahiko is extremely insulin-sensitive, so much so that the vet was convinced he had a tumor or something but it turns out he does not. You'll notice from his spreadsheet he is currently getting between 0 and .25u of insulin twice per day. I am having to do EXTREMELY precise measurements with needles that have half unit increments. I know the layman's rule is that 1 unit should lower BG by about 100; that isn't the case for him. I began tracking his calories trying to work out a pattern and there is one, loosely, but ultimately it seems that giving him .1 to .15 is enough to keep him in beautiful numbers each day, but if I give him 0, his BG will sometimes push towards 300. When he drops to around 100, I give him a very small amount of food to get him back up there - my goal right now is to keep him VERY tightly regulated and increase his chances of remission, which are looking pretty good right now (Dx 6 weeks ago). Even if he doesn't, that's fine - this is manageable and obviously I'm his momma so I'm gonna fight for him. But this is working beautifully for us right now.
He doesn't have a typical glucose curve. I know it sometimes looks like he does but it's because I give him food at around 100 and then it climbs back up. In reality, he sometimes has a monophasic curve (goes up after eating and then just continually goes down for the remainder of the day until he eats again - and sometimes quite dramatically down, at that), and sometimes has a mountain curve (the inverse of a normal curve so his lowest number is pre-shot and then he goes up and comes back down to his lowest at pre-shot again, which to my understanding is still healthy and okay, his body is just interacting with the insulin a little differently than the standard). His BG is consistently higher at night which I also understand from my research to be pretty standard.
Now that he is getting so little insulin, his potassium SEEMS to be stabilizing, and that's great news because even low doses of the spironolactone were making him soooo dehydrated. I wouldn't call it stable yet because the fluctuations are there and I do still have him on about 1/4 once a day in the mornings (PLEASE do not copy this if you are reading this! he is a very finnicky guy with really sensitive responses to medication) but he hasn't had low or high potassium (fingers crossed) so I think this is a good path for him. I want him off of it entirely.
Last blood test, his creatinine was down to 1.6 from what I thought was his new baseline of 1.8 to 1.9, which is just incredible. His BUN is still on the high side and sometimes higher than others, but I think that's from the chronic dehydration due to the spironolactone. I am still giving him subQ fluids each day with B vitamins (no potassium).
I test his ketones at least once a day (and he also has been getting full blood panels 1-2x/week) and he has always been negative. I have urine strips but it's easier to just do the blood tests with the Keto Mojo GK+, which I also use sometimes to verify his BG. I also use the Reli-On premiere and he has a Freestyle Libre; he's on his 4th or 5th one (and wearing a shirt, as you can see in my new profile pic, because he likes to try to rip it off with his teeth - thanks, Yahiko) and certain ones are just wildly inaccurate on him, and the blood prick on his ear is usually enough to get a reading from both glucometers, so 4x a day (pre-shot and 2-hours post, and then around 2-3AM or PM if needed to verify how low he's going) I do all 3 and take the middle reading. On only one occasion, the ReliOn was the odd one out - the Freestyle Libre was giving me 96, the Reli-On gave me I think 122, and the KM GK+ gave me 103. The KM GK+ surprisingly seems to be the most accurate out of all of them; it is consistently the middle reading of the 3 and generally helps me figure out which one is the odd one out.
I can't really think of anything else for now. I continue to track his spreadsheet every single day privately, and I record his meds, calorie intake, digestion, etc. This is an invaluable tool and I'm so grateful to all of you for it. But it was too much pressure for me to deal with the scrutiny of his spreadsheet being public, and what I've ultimately discovered is that he's an enigma and my best tool is my research, my instinct, and his trusted vet's input. I will definitely come back if I have more questions, and I see this website pop up ALL the time while researching and massively appreciate the incredible wealth of resources you have here.
Shorthand version of above:
1. No ketones since release from ER on 12/17/23
2. Very insulin sensitive, 0 to 0.25 is the sweet spot for now. His curve is not standard but is documented in feline diabetes research and he seems to be moving rapidly towards remission, so I'm not worried about it at this time.
3. Budesonide only impacts his BG slightly and in short amounts when I increased it by .25 at a time, now stable at full dose
4. Spironolactone still dehydrating but potassium stabilizing
5. Based entirely on bowel movements, I was able to eliminate turkey, beef, and tuna from his diet. (Side note: he IS on the Proviable and it does seem to be helping. The spironolactone gives him diarrhea; the paste, despite the maltodextrin, keeps his BMs firm. Hoping to get him off of it when he's off the spironolactone.)
6. He is eating well without the appetite stimulant and has gained almost a pound back.
Quick guide to his spreadsheet: I added calories eaten during the meal under the insulin at each shot to help myself establish patterns, and it was MASSIVELY useful. All of the numbers with the little black top right corner indicate when I fed him a small snack, usually about 1/3 of a can of FF, to stop him from going too far below 100.)
Thank you for caring about him and me!
Yahiko is doing wonderful and has gained a little under a pound back. I know many of you felt REALLY strongly about me increasing his insulin and were feeling a little frustrated with me because I didn't; I just wanted to explain, in more coherent words now that I'm less panicked, what I saw in his spreadsheet that stopped me and how I confirmed I was right.
When I was active on here in December, he was fresh home from the ER and experiencing massive, volatile fluctuations in his BG every single cycle - he was going well over 500 2 hours after each meal, then plummeting down in a matter of hours towards 100 or lower, and I was interrupting that drop by feeding him. For many of you I think that sent a lot of red flags that his insulin dose actually wasn't high enough yet and that I needed to be a bit braver and more assertive and let it get lower rather than feeding him partway through and stopping it from an accurate nadir. I completely understand why those of you with so much experience saw that pattern and thought that; NO hard feelings whatsoever.
But what I was beginning suspect was that he was bouncing. Still only a week out from DKA, his body was panicking when he was going so low so quickly and releasing a ton of glucose into his bloodstream about 12-14 hours later - so I was getting those extreme highs, and then the insulin would win and he would plummet back down and continue the cycle. I realized that the lows were going lower and the highs were going higher and tested my hypothesis on December 20th (you can see in his spreadsheet) by giving him a bit less food for dinner so that his BG wouldn't go up as high, and also giving him less insulin so his BG couldn't go as low. And, lo and behold, the bounce was stopped. Though his numbers were still high-ish in the 300s, I held steady there and it began to resolve after a few days. (For whatever it's worth, he's still on Fancy Feast-only, and I discovered just from observing his bowel movements that some of his food allergies are due to beef and turkey, and potentially tuna - he's therefore only on the chicken FFs right now).
I also restarted him on the budesonide on the 22nd because he was having a lot of diarrhea and gas, his bowel movements were a bit pale (which I figured could be equally from the stress on his liver of the nonstop hard bouncing or pancreatitis, which he has had in the past and which would make sense despite clear bloodwork), and his BG was really unpredictable which suggested poor absorption to me (the reason he was put on budesonide to begin with). 12 hours later his BG went WAY up and I took him off of it, thinking he must be one of the cats for whom it increases blood sugar. But a few days later I got brave and decided to start him on 1/4mg (1/4 his usual dose) and see what impact it had - I wanted SOME in him helping his IBD/pancreas, and I figured if I could just find the amount that would help absorption while figuring out what insulin level he needed to stay regulated, it might work. And here is the pattern that I discovered, which has held true for him since (and he is now fully regulated at 1mg once a day): with every dose increase, the budesonide DOES raise his BG for about 3 days, from between 4 to 12 hours after giving it to him. The first day it is a mild increase. The second day is a more moderate increase. The third day is a VERY mild increase, and then it returns to normal. After 2 days of normal, I increased him to 1/2, same pattern, then 3/4, same pattern, and now he's on 1mg and last night was his first "normal" BG (and day 4 - so, same pattern).
Yahiko is extremely insulin-sensitive, so much so that the vet was convinced he had a tumor or something but it turns out he does not. You'll notice from his spreadsheet he is currently getting between 0 and .25u of insulin twice per day. I am having to do EXTREMELY precise measurements with needles that have half unit increments. I know the layman's rule is that 1 unit should lower BG by about 100; that isn't the case for him. I began tracking his calories trying to work out a pattern and there is one, loosely, but ultimately it seems that giving him .1 to .15 is enough to keep him in beautiful numbers each day, but if I give him 0, his BG will sometimes push towards 300. When he drops to around 100, I give him a very small amount of food to get him back up there - my goal right now is to keep him VERY tightly regulated and increase his chances of remission, which are looking pretty good right now (Dx 6 weeks ago). Even if he doesn't, that's fine - this is manageable and obviously I'm his momma so I'm gonna fight for him. But this is working beautifully for us right now.
He doesn't have a typical glucose curve. I know it sometimes looks like he does but it's because I give him food at around 100 and then it climbs back up. In reality, he sometimes has a monophasic curve (goes up after eating and then just continually goes down for the remainder of the day until he eats again - and sometimes quite dramatically down, at that), and sometimes has a mountain curve (the inverse of a normal curve so his lowest number is pre-shot and then he goes up and comes back down to his lowest at pre-shot again, which to my understanding is still healthy and okay, his body is just interacting with the insulin a little differently than the standard). His BG is consistently higher at night which I also understand from my research to be pretty standard.
Now that he is getting so little insulin, his potassium SEEMS to be stabilizing, and that's great news because even low doses of the spironolactone were making him soooo dehydrated. I wouldn't call it stable yet because the fluctuations are there and I do still have him on about 1/4 once a day in the mornings (PLEASE do not copy this if you are reading this! he is a very finnicky guy with really sensitive responses to medication) but he hasn't had low or high potassium (fingers crossed) so I think this is a good path for him. I want him off of it entirely.
Last blood test, his creatinine was down to 1.6 from what I thought was his new baseline of 1.8 to 1.9, which is just incredible. His BUN is still on the high side and sometimes higher than others, but I think that's from the chronic dehydration due to the spironolactone. I am still giving him subQ fluids each day with B vitamins (no potassium).
I test his ketones at least once a day (and he also has been getting full blood panels 1-2x/week) and he has always been negative. I have urine strips but it's easier to just do the blood tests with the Keto Mojo GK+, which I also use sometimes to verify his BG. I also use the Reli-On premiere and he has a Freestyle Libre; he's on his 4th or 5th one (and wearing a shirt, as you can see in my new profile pic, because he likes to try to rip it off with his teeth - thanks, Yahiko) and certain ones are just wildly inaccurate on him, and the blood prick on his ear is usually enough to get a reading from both glucometers, so 4x a day (pre-shot and 2-hours post, and then around 2-3AM or PM if needed to verify how low he's going) I do all 3 and take the middle reading. On only one occasion, the ReliOn was the odd one out - the Freestyle Libre was giving me 96, the Reli-On gave me I think 122, and the KM GK+ gave me 103. The KM GK+ surprisingly seems to be the most accurate out of all of them; it is consistently the middle reading of the 3 and generally helps me figure out which one is the odd one out.
I can't really think of anything else for now. I continue to track his spreadsheet every single day privately, and I record his meds, calorie intake, digestion, etc. This is an invaluable tool and I'm so grateful to all of you for it. But it was too much pressure for me to deal with the scrutiny of his spreadsheet being public, and what I've ultimately discovered is that he's an enigma and my best tool is my research, my instinct, and his trusted vet's input. I will definitely come back if I have more questions, and I see this website pop up ALL the time while researching and massively appreciate the incredible wealth of resources you have here.
Shorthand version of above:
1. No ketones since release from ER on 12/17/23
2. Very insulin sensitive, 0 to 0.25 is the sweet spot for now. His curve is not standard but is documented in feline diabetes research and he seems to be moving rapidly towards remission, so I'm not worried about it at this time.
3. Budesonide only impacts his BG slightly and in short amounts when I increased it by .25 at a time, now stable at full dose
4. Spironolactone still dehydrating but potassium stabilizing
5. Based entirely on bowel movements, I was able to eliminate turkey, beef, and tuna from his diet. (Side note: he IS on the Proviable and it does seem to be helping. The spironolactone gives him diarrhea; the paste, despite the maltodextrin, keeps his BMs firm. Hoping to get him off of it when he's off the spironolactone.)
6. He is eating well without the appetite stimulant and has gained almost a pound back.
Quick guide to his spreadsheet: I added calories eaten during the meal under the insulin at each shot to help myself establish patterns, and it was MASSIVELY useful. All of the numbers with the little black top right corner indicate when I fed him a small snack, usually about 1/3 of a can of FF, to stop him from going too far below 100.)
Thank you for caring about him and me!