Diarrhea started then low numbers, need advice

Chelon Nickolette

Chelon Nickolette

Member Since 2019
Hi - Sadie has had very bad diarrhea the past two weeks and right when it started her numbers started to drop and bounce a bit. I have consistently been skipping shots due to low numbers, and when I do shoot she goes very low mid cycle. After last week's curve I decreased her insulin .25 to 2 units. She is due for another curve tomorrow. I took her to the vet this week and just got a call with her lab results and the vet said she seems to have inflammation but no other concerns just from the labs. She suggested I give her a fiber supplement for the diarrhea. After reviewing her spreadsheet, the vet said her insulin is too high and I should immediately go to 1 unit. I know this goes against the SLGS but wondered what admins thought. Also any ideas on why she would all of the sudden get the worst diarrhea of her life when her labs are mostly good and nothing has changed at home, diet, etc.? Notes on diarrhea and appetite in Remarks column.
 
My favorite remedy for diarrhea is a specific probiotic, S. bollardii. It's magic (for cats and humans). I linked the brand I buy from Amazon.

This is a great post on handling diarrhea in cats. It also gives information on dosing S. boulardii. They suggest starting with half of a capsule twice a day. I usually start with 1/4 of a capsule twice a day unless the problem is severe.

Slippery elm bark is also recommended. I've not used it but people swear by it.
 
Sienne and Gabby (GA) said:
My favorite remedy for diarrhea is a specific probiotic, S. bollardii. It's magic (for cats and humans). I linked the brand I buy from Amazon.

This is a great post on handling diarrhea in cats. It also gives information on dosing S. boulardii. They suggest starting with half of a capsule twice a day. I usually start with 1/4 of a capsule twice a day unless the problem is severe.

Slippery elm bark is also recommended. I've not used it but people swear by it.
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Would you say that’s also a good overall probiotic for cats as well?
 
The brand S. boulardii I have used is Florastor. You can get it on Amazon cheaper than CVS drugstore. You can put it into the food as it is quite tastelesss.

Another brand that is much cheaper than Florastor is Jarrow. The only thing with that formula is that is is very bitter tasting because of something called MOS that is added. You would have to mix it into water and syringe it because of its bitter taste.

I use Slippery Elm Bark(SEB) along with the Florastor and get great results. If you go to foodfurlife.com and link on their links you’ll see one for diarrhea and using S. boulardii and SEB .

ETA: oh Sienne provided you with the link. Great info! These woman who own this company are so knowledgeable and kind with their time whenever I have called or emailed them with questions.
 
Wendy&Neko said:
So lately you have been shooting 2 units, but just once a day? That definitely means her dose needs to be reduced. Any time she goes below 90, she also needs to have her dose reduced. I think 1 unit is a good place to start.

Tagging some people who know brand names for US solutions for diarrhea. @Sienne and Gabby (GA) @Bobbie And Bubba
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So when you say anytime she goes below 90 it needs to be reduced do you mean if her amps or pmps is below 90 or her nadir? Because I know you reduce when the nadir goes low but I thought that was after one week maintaining the dose.
 
Chelon Nickolette said:
So when you say anytime she goes below 90 it needs to be reduced do you mean if her amps or pmps is below 90 or her nadir? Because I know you reduce when the nadir goes low but I thought that was after one week maintaining the dose.
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Dosing is based off how low a dose is taking a pet's blood sugar, so you are right there. But If I saw a AMPS that was under 90, I would assume it was likely lower before since the BG tends to rise closer to the next shot time.
Reductions are SLGS or TR are taken immediately for drops under the threshold number - 90 for SLGS/50 for TR.
Increases are the dose change made after a week on SLGS...sooner with TR.
 
Chelon Nickolette said:
So when you say anytime she goes below 90 it needs to be reduced do you mean if her amps or pmps is below 90 or her nadir? Because I know you reduce when the nadir goes low but I thought that was after one week maintaining the dose
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If you see 90 at any time, you reduce immediately if following SLGS.

With TR you may or may not reduce immediately if you see an under 50. If following TR, you may delay reductions a cycle to help with the bounce, or if you have a cat that doesn’t hold reductions well, or if you have a cat that has been diabetic over a year.

I also would not assume a preshot of 90 means the cat was lower before hand. ECID, each cat is different. My girl often nadired at preshot time.
 
Wendy&Neko said:
If you see 90 at any time, you reduce immediately if following SLGS.

With TR you may or may not reduce immediately if you see an under 50. If following TR, you may delay reductions a cycle to help with the bounce, or if you have a cat that doesn’t hold reductions well, or if you have a cat that has been diabetic over a year.

I also would not assume a preshot of 90 means the cat was lower before hand. ECID, each cat is different. My girl often nadired at preshot time.
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Ok, so just so I'm clear, even if the nadir is below 90 I decrease? Would you mind looking at her spreadsheet now and letting me know what the next dose should be? I'm concerned she'll go back up in BG once her diarrhea is under control...if that ever happens at this rate. But I do have the s. bollardii probiotic recommended arriving today so we'll see if she improves. Also, when I am not giving her a shot should I still be doing her weekly curve?

Thanks in advance!
 
Chelon Nickolette said:
Ok, so just so I'm clear, even if the nadir is below 90 I decrease? Would you mind looking at her spreadsheet now and letting me know what the next dose should be? I
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Yes, if you see a number below 90 at any time, you reduce by 0.25 units. As for current dose, I would stick with not giving insulin. This is the fourth day without insulin, all the depot is gone, Sadie's pancreas is doing this all on her own. Should her numbers start to rise, post again for suggestions on what to do. In the mean time, just enjoy the numbers she's giving you. A couple tests a day is fine as long as she remains green. Just test at your normal AM and PM times. If her numbers start to rise well over 100 for a couple tests in a row, then you can think about doing a curve.
 
Wendy&Neko said:
Yes, if you see a number below 90 at any time, you reduce by 0.25 units. As for current dose, I would stick with not giving insulin. This is the fourth day without insulin, all the depot is gone, Sadie's pancreas is doing this all on her own. Should her numbers start to rise, post again for suggestions on what to do. In the mean time, just enjoy the numbers she's giving you. A couple tests a day is fine as long as she remains green. Just test at your normal AM and PM times. If her numbers start to rise well over 100 for a couple tests in a row, then you can think about doing a curve.
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Sorry, I forgot to respond, but thank you!
 
Just in case it helps, my kitty Snickers had terrible diarrhea for months when we first got her. Nothing worked, not the probiotics we tried, not the meds the vet gave us. Anyhow, what finally helped was switching her to a rabbit wet food and adding this stuff called Luxolite from a company called Vitality Science. I still use the Luxolite (it's a liquid and you mix it in with their food). I use their probiotics too. I'm not totally convinced their probiotics help, but they don't hurt. I definitely think the Luxolite helped though, and definitely switching to rabbit helped. Just my two cents :)
 
Given you are 7 days without insulin, I think we should formally declare this an OTJ trial. :D Here are the instructions, ignore the first point. You are already on day 7.

Start the trial on the next green pre shot.

If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!

Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

After 14 days of no insulin, we have a party!!

Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.

Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), test his/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!

Good luck with the trial!!!
 
Wendy&Neko said:
Given you are 7 days without insulin, I think we should formally declare this an OTJ trial. :D Here are the instructions, ignore the first point. You are already on day 7.

Start the trial on the next green pre shot.

If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!

Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

After 14 days of no insulin, we have a party!!

Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.

Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), test his/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!

Good luck with the trial!!!
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Hi and thank you for all of that information - for some reason I didn't see an email saying I'd gotten a new message so I hadn't read it until now. Sadie's numbers were good for nearly 14 days but then last night it went up over 100 points and I had to give her a shot. I didn't know what to do so I gave her 1 unit and this morning it is much lower. I don't know what happened to make her bg rise so much. It went from green to low blue a couple days before but then yellow. The only thing that changed on the day that went yellow is I had started feeding her Dr. Elsey's again, which I'd taken away when she got sick to see if it was contributing to her diarrhea. Could that have brought her bg up? What do I do now? Thank you!
 
Chelon Nickolette said:
Hi and thank you for all of that information - for some reason I didn't see an email saying I'd gotten a new message so I hadn't read it until now. Sadie's numbers were good for nearly 14 days but then last night it went up over 100 points and I had to give her a shot. I didn't know what to do so I gave her 1 unit and this morning it is much lower. I don't know what happened to make her bg rise so much. It went from green to low blue a couple days before but then yellow. The only thing that changed on the day that went yellow is I had started feeding her Dr. Elsey's again, which I'd taken away when she got sick to see if it was contributing to her diarrhea. Could that have brought her bg up? What do I do now? Thank you!
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PS I was too scared to put out any Dr. Elsey's this morning so she doesn't have any today.
 
Next time you get a high number, post here for help on the dose. I think 1 unit was too much, especially since you didn't have any further tests last night.
 
Do you mind taking a look at my spreadsheet? What are the criteria for going into remission? When she's gone higher is when I fed her the Dr. Elsey dry food. I've been trying it off and on to see if it was really affecting her bg. You can see when in the notes. I'm not sure if it's been a coincidence or if it really is the food. But I'd love to hear what you think of her numbers.
 
Given it's three weeks since her last shot, I think we can say she is currently in remission. Our OTJ instructions listed above, say two weeks in normal numbers, so you've done that and more. Congratulations!
 
Wow! Thank you so much! I'm so happy and proud of my girl! What do you think about the Dr. Elsey's food? Have you ever heard of it affected bg?
 
Do you mean the dry food? Not a fan of dry food of any kind - just not good for cats. I have heard of at least one other kitty whose numbers were negatively impacted by the Dr. E. dry.
 
Yes the dry food. When she had diarrhea and I stopped feeding it to her is when her bg went down and I've introduced it a few times here and there since for a day or two and her numbers always went up.
 
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