? Charlie AMPS 335 PMPS 280

Sarah & Charlie-cat

Sarah & Charlie-cat

Member Since 2022
Hey, y'all.

We're still struggling with high numbers and increasing insulin doesn't seem to be moving the needle. His high and low numbers today were only 55 points apart.

Vet wanted us to increase the insulin more aggressively, so I've been trying to follow TR and testing more. She also wanted us to decrease the prednisolone from 10 to 5, which felt too aggressive and since his numbers look like they went up and not down, I went to 7.5. I dunno, I guess I'm scared to reduce the pred because in February, he seemed like he was doing so well and then everything fell apart and he got so much sicker.

We have an appointment with the internist vet next Thursday. I'm going to ask about switching to Budesonide, but other than that, I'm not really sure what else to ask for/talk about. Any advice welcomed

I hope it is more useful than the oncologist that charged me 1000 to do bloodwork and an ultrasound (which would be like 200-300 at our regular vet!). And one of our other cats has a 4000 surgery coming up at K-state, which feels like a racket. They also charged me 1000 for blood work and a fine needle aspiration, which my vet could have done for a few hundred as well. After August, my paycheck is going to go back to just covering the basics, and I'll have to start repaying my student loans again. Summer classes and summer research have helped, but it's all gone to vet bills and credit cards, which are all still maxed out, and I worry about what will happen if he gets sick before next June! <hyperventilating>
 
Is Charlie on any other things for his IBD? Usually a good probiotic (Visbiome for example) and psyllium husk powder mixed in his food are needed. I see early reference to Proviable. Is he still getting that? Visbiome is a good choice because you need less of it.

I notice the comments about getting Zofran into him. You can actually get it as an injectible, which might be easier to give.

The other big thing that leaps out to me is that you are missing test data for some of the PM cycles.

The link to your last post here: https://felinediabetes.com/FDMB/threads/6-20-charlie-amps-297-pmps-411-dosing-help.278767/
 
Thank you for linking my last post, I always forget!

I try to get Proviable into him once a day, or every other day. I haven't tried psyllium husk powder on its own, but it is in the new Viva complete cat and I think in Fetching Food (his shipment of that comes tomorrow since his Viva was delayed). He doesn't have diarrhea often. He hasn't been constipated since I got him off Darwin raw turkey. But I can get some psyllium and add it to his food. I was going to try Kitty Biome Gut Restore, but it's another pill and it says don't break it open, and he spat it out three times tonight so I think that was another expensive thing that gets thrown out.

Getting both Zofran and Cerenia into him has been a battle lately. We switched to a pill from liquid Zofran, since at least if he spits the pill out, I can shove it back in. He bit or scratched me tonight. He was so mad! I think ear paste Zofran was an option? I think we'll try that next time. We might have to do injectable Cerenia, but he also was giving me guff tonight getting his shot. I think he's not enjoying being poked. He tried to run away from his fluids today and I just ran after him with the bag. Luckily it stated in.

PM cycles are hard. I stay up as late as I can to get a test at 10 or 11 at least. But those middle-of-the-night tests and early morning tests... I can plop food down in a bowl (because he won't eat out of the auto feeder while his slave is around, but he can stand next to it and meow?) and go back to sleep most of the time but being awake enough to test him results in me not going back to sleep, and me not getting enough sleep is a disaster. I also can't nap so I can't really make it up. It is literally one reason I decided not to have kids. I haven't figured out a way around it to fill in some of those things. Getting another Libre on him would be one way. But he's been so high, it just isn't accurate at the ends. The nightrider allows you to add a manual test so you can see the difference between the Libre and the glucometer, but it requires a very frequent battery change so we couldn't triple wrap it on him and it wouldn't stay on him. More expensive things that haven't work.
 
Can you get a test 2-3 hours after his PM shot time? That be enough to give a clue that he's going to dive down on a cycle. And let you know if you need to test more, or leave higher carb food out.

As for fluids, have you ever looked at this? https://www.ezivharness.com/
 
I have been trying to get +3s. Just now at +2.75 hours he was 319. Up almost 40 points from his pre-shot number. In the past 2 weeks, I've managed 11 PM +2 or +3 tests and 10 of those have been higher than his pre-shot. Which doesn't make any sense to me. Even if he's just eaten. He's pretty much always just eaten except the two hours before his shot times.

His day time numbers come down some, but not a lot, 30-60 points. In the beginning he would drop more like 90-100 points during the day.

He's up to 4.75 u... And it doesn't seem to be doing anything.
 
Maybe the switch to budesonide, if you can get that, would help. In the mean time, a cat needs however much insulin they need.
 
I keep trying to remember that. I just wonder how much he needs. It's frustrating to look back and see blues and greens from before. Like remember that one hypo scare? Those were good times. He felt better then too. And slept through the night without yowling about being hungry

Asking about trying budesonide is at the top of my list for next week.
 
He was even higher this morning, still need to get that into the spreadsheet. I supposed there's no way to know what is going on in the middle of the night without checking. But it seems like he drops during the day and then spends all night going up.
 
Hi all,

We're still struggling with high numbers that don't seem to be budging. Would appreciate any thoughts on the below continuing saga of vet visits.

We went to the internist vet this week. They want to do a ton of diagnostics. And they want to do them all fasted and I was like then he needs to be at the hospital because I am not spending the whole night with a screaming cat while I have a panic attack that he develops DKA.

GI Panel (done in the end of May, which is what suggested large cell lymphoma, which was the only thing communicated to me by our regular vet, but I don't see the point in repeating)
Fructocimine (I can't see the point since I have plenty of data to show he has uncontrolled diabetes)
Abdominal ultrasound (again??)
Urinalysis (I believe it was done at the oncologist in June and was unremarkable, the only thing she said to me was his urine was plenty concentrated)
Regular blood work so they can sedate him to do sampling.
FNA of his pancreas and cytology of anything they find in there (I have mixed feelings... maybe it would tell us something but risks greater inflammation to his pancreas. If he had pancreatic cancer, he would probably be dead. He does not have symptoms of a pancreatic cyst, like fever etc.)
I would like to know if he has either small or large cell lymphoma but without a biopsy off pred, we can't definitively know that.

She also referred us to a nutritionist at Colorado State University. She is avidly anti-raw-food. She also would want to put him on atopica, which potentially could help, but also potentially has shitty side effects? But he couldn't be on raw food because risk of toxoplasma infection, and other infections. I think he's been doing better on raw food, frankly, and while I am willing to try homecooked, I am also put off by her stance and that of CSU on raw food.

She also wants me to not check his midpoint and PM +3s (the latest that I can possibly do without turning myself into a brain-dead zombie, and frankly, I already am barely able to do my job) and only due curves. I explained why we were taking a more aggressive approach and she was like, well cats can't be controlled, they can't go into remission, 200s is fine. The many cats in remission here would suggest that is codswallop, as would the folks who post their spreadsheets with blues and greens. And then she wants me to give her an hourly curve on a workday prior to our next appointment. I have a dissertation defense the morning she wanted me to do... so that's not happening. Also, that's crazy. She also thinks because he eats 8 times a day that he will never have normalish numbers. He is eating food that is essentially zero carb, so I can't imagine that it is spiking him all that much and he clearly needs to eat more because of everything and couldn't possibly eat half a pound of food in two sittings anyway.

All I want is a protocol for like, this is when we know we can taper his pred. This is how to handle it if he's starting to develop ketones. Here is how to address an IBD/pancreatitis flare. Am I going to do fluids daily for the rest of his life? I don't know that I want a ton more diagnostics that are not going to maybe give us more information for a treatment plan. Not to curse it but he hasn't thrown up in 3 weeks. He hasn't had a hairball in over a month. His poops are big because he eats so much, but look like poops and they look like the fur is going in the correct direction. He has gained back 2 lbs since March.

I feel defeated. If I do all of this diagnostics, if he has another flare and needs to be hospitalized, there won't be any money for that.
 
Sarah & Charlie-cat said:
GI Panel (done in the end of May, which is what suggested large cell lymphoma, which was the only thing communicated to me by our regular vet, but I don't see the point in repeating)
Click to expand...
GI panel does not suggest large cell lymphoma. It can tell you there is a problem with the GI system, but it could be IBD or small cell lymphoma. What were the results? Are you supplementing anything like B12. I don't see a reason to repeat the test either. I liked my vet, and I was always able to ask her "what would you do differently with the results of this test?". If nothing, then no need for the test. No fructosamine needed. When was his last ultrasound? Did they see a problem with his pancreas? Can you post the results? Concentrated urine is good, means his kidneys are working well.

I had a cat that got pancreatic cancer. It was pretty quick.

Large cell lymphoma means a mass, they should be able to see that on the ultrasound. Thickened bowels could be either IBD or small cell lymphoma.
Sarah & Charlie-cat said:
she was like, well cats can't be controlled, they can't go into remission, 200s is fine.
Click to expand...
Wrong, wrong, wrong! Do continue the PM +3's and mid cycle where you can. If you keep that up, you won't need to do a curve.

FYI - Neko was on raw food, her internist called it the best food for her. Vets have different opinions on raw. I wouldn't bother paying for a nutritionist consult.

Did you give insulin the yesterday morning? The spreadsheet shows blank in the units. The way he's going, I think he'll need an increase after tomorrow. When we get to 5 units, we suggest going up by 0.5 units at a time. Think of the increase as a percentage of the total dose. The larger the dose, the larger the increase.
 
We have been testing and doing insulin. I have been on the struggle bus with not sleeping and depression. I have the numbers in our meter and need to get them entered into the spreadsheet.

I did go up to 5.5 yesterday. I'm not gonna hold a dose that isn't enough! And it is clearly not enough.

I need to get back to the B-12. He was giving me a hard time with that now that he's also getting fluids and bigger insulin doses. But I have it and will try to get it on board. The previous GI panel showed too much B-12 and not enough folate & vit D. Which was not communicated to me. The results suggested vit D. supplements. Again, not communicated. But I need to get back to adding egg yolk to his food to help with that. Our vet saw felt a mass and saw it on ultrasound in the end of May and ordered a GI panel that came back saying suggested LCL and pancreatitis. The oncologist we saw in June didn't find anything! Which doesn't make any amount of sense to me. I know we increased his pred but having it vanish in 3 weeks?!

No one has given me the results of tests, except the ER vet. and the GI panel. Even when I asked for Charlie's records, I only got photocopies of scribbled notes, no test results. Some of which is stuff that was never communicated to me, which is infuriating. I do believe the oncologist did a urinalysis, otherwise, why would she have commented on the concentration of his urine?

I agree, no GI panel, fructosamine or urinalysis. I am on the fence about letting her poke his pancreas. Again, if it was cancer, he would probably be dead by now. And he just doesn't have symptoms of cysts. He had a month of Batryl after his last hospitalization and I think a week or two after the last one.

I also don't think it is worth paying a nutritionist either. I have Alnutrin and can certainly add it to cooked chicken. Our vet was fine with raw and said, oh yeah, we have another IBD kitty mom who calls those bunny burgers. Digging into the research, what the scientists are putting out is no less 'biased' than they accuse pro-raw feeders of being. There doesn't seem to be agreement on how to measure what good outcomes would be vs. poor outcomes. One wrote, essentially, we think that there are human outbreaks of e. coli and salmonella related to raw feeding but no one will look for it in the statistics, but we think they're there. I am also well aware of the way professional organizations serve as powerful gatekeepers of what knowledge is produced, and what questions are even pursued. Because I'm part of several.

So, I just really don't feel like I trust this person at all.
 
I especially don't think I trust her when she was like cats can't be regulated and you'll never get him regulated if you feed him that often.

He is not losing weight, he has gained it back, he clearly needs to eat this often. He couldn't possibly eat as much as he's eating in two servings
 
Spreadsheet updated. Again, I feel like his numbers are going up but I don't really see evidence that they are due to bouncing, unless he's dropping later in the afternoon than I normally test or in the middle of the night when I have a really hard time testing.
 
You own the test results, you paid for them. I would call the front office and insist that they send them to you. I get mine vial email.

It's useful to add comments in the Remarks section when things change that can impact his blood sugar, like doubling his prednisolone dose.
 
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