Can an "acceptable" low number still be cause for concern?

[Kim&Buddy]

Hi everyone,

I'm noticing a change in Buddy's eating habits and I could use some objective feedback. I find myself swimming with this new experience and obsessing over everything

Buddy starts Lantus tomorrow presumably if his numbers are in a safe range. His BG levels have been for the most part declining and as a result, I've been able to lower his dose of glipizide by half (see spreadsheet ). This morning he was at a pre-dose of 104 so I didn't give him anything. (120 is the threshold for giving him medicine.)

But I'm concerned. Buddy is a grazer. With the exception of right when he became diabetic and when I first adopted him and he was eating "kitty crack" (high carb wet food), he has always been a grazer.

The past couple of mornings he's been crying for food. The same thing with the past couple of evenings when I get home. Last night, he inhaled his food at 6:00 pm (pre-meal BG = 133) and again at 9:00 pm with what usually is the feeding that carries him through the night. The two nights before that, he was eating more quickly as well. (Sorry to say it never dawned on me to get readings at 9:00 pm.) This morning he cleaned his plate soon after feeding him and when I brought him back from the vet for his adequan shot, I gave him another 1/4 can so he would have something to eat throughout the day. He inhaled that too. In addition, I scooped a large clump from his litter box this morning but don't know if it's because he urinated in the same place twice or if it's more urine output than usual. No behavioral changes that I've observed.

My new vet did have me reduce his food intake from 2 cans a day to 1.5 cans a day but that was well over a week ago and he was fine with the change. (He had gained a little weight and she wants to get him back around 14 pounds.)

Three questions:

Is there any chance that this morning's 104 is deceiving and there could be something going on?

Can I be overreacting and this merely be a delayed response to the reduction in food?

My inclination is to head home at lunch today and give him more food thinking it's not healthy for him to go from 8:00 am - 6:00 pm without food. Good idea?

 

[Ann & Scatcats]

Re: Can an "acceptable" low number still be cause for concer

If he is hungry all the time and needs to gain weight, why did the vet reduced his daily 2 cans to only 1.5? That seems odd to me.

I feed Simba 2 to 3 cans of wet m/d throught a 24 hour period. He needs to eat and gain weight too. I serve it to him by 1/2 a can each serving, even in the middle of the night, so he always have food on his plate.

We use insulin so I am not familiar with glipizide but it seems very probable that the 104 is due to the reduced food.

Yes, do go home and feed him more. He is hungry

 

[Kim&Buddy]

Re: Can an "acceptable" low number still be cause for concer

Sorry for miswriting - Buddy is actually higher (14.75) in weight and given his size, my vet wants to get him down to 13.75.

 

[Hillary & Maui (GA)]

Re: Can an "acceptable" low number still be cause for concer

Personally, if this were my cat, I would be feeding more and worry about the weight issue later on. I would also test to see what the BG's are doing and if there is any need for concern.

I know when Maui was getting regulated, she could eat 2 - 2 1/2 cans of FF at one time. While yes she lost a lot of weight, prior to diagnosis, my main concern was making she ate enough and wasn't starving for food. After a couple weeks, she stopped needing to eat this amount of food and reduced her intake down to 1- 1 1/2 cans per meal and yes she is a grazer, so I leave the food out all day.

 

[Julia & Bandit (GA)]

Re: Can an "acceptable" low number still be cause for concer

Are you feeding 1.5 3 oz cans a day or 1.5 5.5 oz cans a day? If you're feeding 5.5oz cans, then I think reducing to 1.5 cans from two for his size is perfectly reasonable. I probably would have gone to 1.75 cans a day before going down to 1.5 to see if he was losing weight on that first to insure he didn't drop weight too fast, but I don't think an 2-3 oz reduction for his size and ideal weight is out of line for the vet to recommend. In fact, it's some of the best advice she's given so far and I wish she had started you with the weight loss instead of the glip. It's difficult to know for sure, but I have the feeling that the glip may have actually been responsible for his high 100s, low 200s because it was damaging his pancreas. I say this because his blood sugar is slowly coming down as you lowered and eliminated the glip dose.

EDIT--I see from his SS he's eating SD Friskies, so the amount of food is fine. You will have even better results with a food that has a higher protein content (above 45%), but still low carb. I can't remember why phosphorus was a concern for you (if he doesn't have CKD then you don't need to worry about it--phosphorus has nothing to do with urinary tract disease), but Merrick's Cowboy Cookout and Surf and Turf are both above 45% protein, less than 5% carbs, and have less than 250 mg/100kcal that is recommended for CKD cats. Grammy's pot pie is also >45% protein and low phos, but it has 8% carbs. He should tolerate the 8% fine, but you'll want to keep an eye out just to make sure he's not carb-senstive and the 8% is raising his BG. Merrick's has much better quality ingredients than Friskies, which is very important for CKD cats because it reduces the amount of protein metabolism residue, which is just as important in managing CKD as low phosphorus. (Just a side note--Bandit can eat the Grammy's Pot Pie at 8% without an increase in his BG, but he can't eat any Friskies without raising his BG, even though it's lower in carbs. He is sensitive to the carbs from grain, and Friskies contains rice.)

I just want to point out that Buddy's diabetes is subclinical right now, so feeding recommendations aren't the same as when a cat has high, uncontrolled blood glucose and dropping weight. Normally we say feed as much as you can because clinical diabetics are not metabolizing their food properly, but this is not the case with Buddy. Considering Buddy's numbers on and off the glip, I think it's a very good idea to see if his numbers lower on their own with the weight loss before you start insulin. If the glip was causing higher numbers, losing a lb could mean that he can maintain a normal range on his own without insulin. If his numbers are all below 250 and mostly in the 100s, then I would wait to start insulin and see what the dieting can do first.

Bandit was carrying around an extra pound (he was at 14lbs) when he went into remission the first time, and as a result his numbers without insulin stayed within the 100-160 range--a little higher than normal. Once I got him down to 13 lbs (his ideal weight), his BG has stayed within the 60-120 range. He's now at 13.5 lbs, but the half pound he gained is muscle because of our switch to a higher protein food, so he's still at a healthy weight and maintaining a 60-120 range.

If Bandit doesn't eat at least 4 times a day, the "I'm STARVING" crying won't stop until I give in and feed him more. So I space out his feedings evenly 6 hours apart. You can do the same, or even more frequently than that (at one point I was feeding every 4 hrs, some with my auto feeder). Just don't increase the overall amount of food per day. So if you're feeding 1.5 cans, split it between several small, frequent meals, like 2 meals of 1/2 can and then 2 snacks halfway between of 1/4 can if you feed 4 times a day, or 6 meals of 1/4 if you feed 6 times a day. He'll actually think he's getting MORE food. They don't have to be spaced exactly apart, but try not to go for long periods between meals.

Check out p. 217-218 of the AAHA diabetes guidelines for more information about diet recommendations for subclinical diabetes.

 

[Kim&Buddy]

Re: Can an "acceptable" low number still be cause for concer

Actually it was the new vet who recommended the reduction in food (1.5 - 5.5 oz cans), not the glip doc. ARGH!! ohmygod_smile

Had a great conversation with the new vet today and we've decided to have him off medication other than his arthritis medicine for the next several days. She doesn't feel comfortable having him come straight off the glip and right onto the Lantus. Plus, he's at a level where we can conceivably do a wait and see. I'll do a curve over the weekend. This practice has a 24 hour emergency line where you can have access to one of their vets. So if something goes wonky over the weekend, I can make a call and they can help intervene. That's a big relief right there.

She did ask me to adjust my spreadsheet numbers to reflect AlphaTrak readings. She has no problem with me using the Relion, but wants to be able to quickly talk apples to apples. There was a 45 point difference between the two meters. (My Relion came in 45 points lower than the AlphaTrak). So Buddy's numbers aren't as pretty as they once were, but there is still the downward trend. She wants me to target the 100-250 range, the lower the better.

If I can remember back to the early super crazed days, I was trying to find a food that would help manage his diabetes while at the same time reduce his risk for returning urinary crystals. I most likely read something somewhere about phosphorous and mistakenly connected it with crystals. Sorry, the days are all blending together.

Unfortunately right now, Friskies is all that fits my budget. Once I can get a better handle on things, his insurance finishes reimbursing me, etc., then I look forward to exploring higher quality foods. I'll definitely keep Merrick in mind. I haven't had a chance to look into the feeders. I think you had given me a link to the one you use. I do want to be able to spread out his feeding. As someone who has blood sugar issues (I'm hypoglycemic), I know how important it is to spread meals out throughout the day!

I did receive unexpected, wonderful news yesterday. There's a good chance Buddy's insurance company will cover 90% of the cost of the meter, test strips, syringes, and lancets. That's in addition to the Lantus sitting in my refrigerator. :mrgreen:

Thanks for referencing the subclinical. I'll do more reading up on it!

 

[Julia & Bandit (GA)]

Re: Can an "acceptable" low number still be cause for concer

I'm so glad the new doc knows what she's doing! I am a tiny bit concerned that doing an arbitrary conversion to alphatrak numbers will skew your data, so I think that's a weird and cumbersome request for her to make. As long as you know that low is below 50, normal is 60-120, and the renal threshold is 240--then you have all the information you need to interpret his data from a human meter. I don't understand why a vet would insist on making the data less reliable. But.....no vet is perfect and if this happens to be the one thing the new vet doesn't have quite right, I would just let it go based on the other good advice she's given you! Do keep your actual numbers charted as well though so that you have your original data recorded.

And I completely understand the food thing--I've been there! I actually can't afford to get Merrick's at the price PetCo charges for it, but you can get crazy discounts if you use their store locator on their website and find a locally owned store near you that sells it.

What about something with a better protein/fat content in the same price range as Friskies? Check out the numbers on Binky's chart for 9 Lives, which are lower in fat: http://binkyspage.tripod.com/CanFoodNew.html. Just make sure that you read the ingredients--some 9 lives flavors now contains soy and/or wheat flour and you do want to avoid that (Like the Turkey & Giblets).