Introducing Bekah & Momo

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Bekah and Momo

Member Since 2021
Hi, my cat Momo will be 11 in a couple days. She's had CKD for 5 years, and last summer she got a UTI that sent her to end stage which we have aggressively been managing.

Earlier this year she started having glucose in her urine, but BG was normal. BG has been going up, we've gotten some high-ish readings at the vet (400+) one week, then lower the next (< 200). Home testing has been a challenge, and the 2 readings I got last weekend were 295 & 364, after multiple sticks.

So Tuesday they put a Freestyle Libre on her, sent me home with Prozinc with instructions to give 1/2 unit twice a day, which I HAVE NOT started.

Attached is the CGM report for yesterday and today. I'm sure I could get her levels down with diet, but she does not eat reliably due to CKD, and the IBD complicates things. She likes a food for a little while and then becomes averse. She is on TONS of meds for her CKD, including anti-nausea, anti-emetics, appetite stimulants, pain control, and so on. Also, Budesonide which I think could be playing a role in the diabetes, but not sure we have much choice to stop it.

Anyway, I wanted to introduce us and get any thoughts on the attached numbers from the CGM. I am thinking I'll start tomorrow morning.

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Hi and welcome Bekah and Momo,
Can you tell us what you feed Momo?
Quite a few people have FD kitties that also have CRD and others who need to use budesonide.
If you are not going to start using the insulin straight away I would recommend you test daily for ketones in the urine. This is because diabetic cats if they are not getting insulin can be prone to ketones and the best way to monitor for them is to test the urine with Ketostix which you can buy from Walmart or a pharmacy for about $12. Follow the directions on the bottle.
Ketones if left untreated can progress to DKA which is a very serious illness in cats.

If you could set up a spreadsheet and also your signature, instructions of which are in the link below, that would mean we can help you with the numbers moving forward.

Did Momo have a fructosamine test to diagnose the diabetes? That will give an average of the last few weeks BG levels and is a good test to diagnose FD.

HELP US TO HELP YOU Click on the blue letters for the link. If you have any trouble setting up the SS @Bandit's Mom will help you set it up. Just let us know.

I will tag a couple of members who use Prozinc
@Panic
@JanetNJ

HERE https://www.felinediabetes.com/FDMB...-the-prozinc-basics-please-start-here.164995/ is a link to using Prozinc

Here is the link to Prozinc dosing methods
https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/
Bron
 
Thanks, Bron.

I did set up my signature, is it not showing for you? I have a spreadsheet but have not started using it yet since I haven't started insulin. What is the preferred way to do that when using the Freestyle Libre, if I scan frequently throughout the day?

She eats whatever I can get her to eat. I don't know exactly what triggers her IBD because she had so many concurrent issues it's hard to tell if it's the food or the CKD or a pancreatitis flare. She generally doesn't get diarrhea, but the IBD diagnosis is based on some ultrasound suspicions, inflammatory indicators on bloodwork, and an acute episode of vomiting/diarrhea last fall after giving her some varied food options when she wasn't eating. It was really bad, and I had made an appointment for euthanasia but we were able to turn it around and the Budesonide seems to have helped. Specific options I give her are Merrick or Instinct rabbit, and glycobalance (not because of the diabetes, but because we stumbled upon it and found she likes it). When she stops eating she gets plain cooked turkey. FTR I've tried various home cooked and raw diets, too. She doesn't like fancy feast, though admittedly I haven't tried Friskies. She won't eat baby food or anything from the food list in the CKD group (if you're familiar) and we've tried nearly all of them. I have discussed a feeding tube with the vet more than once, that's the level of food aversion she has. I give her rx kidney fry dry food, mostly to have something low phosphorus that she'll willingly eat in her belly when I give her meds multiple times a day, because the phosphorus binder interferes with some of them.

She had a fructosamine test in June, it was 442 mg/dL (191-349 reference range). I plan to get the Ketostix this weekend, but do intend to start insulin tomorrow (Friday) morning.
 
Yes I can see your signature now thanks!
Well done setting up your SS. If you link it to your signature it will show there as well. Any trouble just let us know.
I would start using the SS now and adding any data you have already got. That would be really useful as we will then be able to see any changes the insulin makes.
Once you start giving the insulin this is the routine to follow:
Always test the BG before every dose of insulin. The am shot is called the AMPS (am preshot) and the PMPS (pm preshot).
Then because you have the libre you will be able to record multiple tests during the cycles.
Once you go back to the manual meter if you could get a couple of tests in each cycle , that would be good.

Have a read of the Prozinc dosing methods to get an idea of what you need to do. I’m not a Prozinc user and I’ve tagged a couple of Prozinc users but they could be asleep at the moment. Unless you hear otherwise from one of the Prozinc users, I would not give a dose if the preshot BG under 200 or maybe 220. You can reduce this number as you get more data.
If the BG is lower than recommended to give the dose….stall, dont feed and test again in 20 minutes to see if the BG is rising. And post and ask for help, You would change the subject line to something like..’stalling AMPS XXX HELP! That will get attention.

We suggest feeding a meal before all the shots, and during the cycle offer a couple of snacks during the first 1/2 (6 hours) of each cycle?
Make sure you have your hypo kit set up before starting insulin…..if you get a low number you don’t want to have to go looking for the right food,!

I do understand how hard it can be to get an IBD kitty to eat, having had one. Is the glycobalance the wet or dry food? The dry is higher in carbs than we like to see given.
Have she ever been given any antinausea medications such as cerenia or ondansetron to see if that helps with the eating? If she has any pancreatitis she could be nauseated.
When cats need to take a steroid we just work around that with the dose of insulin.
 
Bekah and Momo said:
Thanks, Bron.

I did set up my signature, is it not showing for you? I have a spreadsheet but have not started using it yet since I haven't started insulin. What is the preferred way to do that when using the Freestyle Libre, if I scan frequently throughout the day?

She eats whatever I can get her to eat. I don't know exactly what triggers her IBD because she had so many concurrent issues it's hard to tell if it's the food or the CKD or a pancreatitis flare. She generally doesn't get diarrhea, but the IBD diagnosis is based on some ultrasound suspicions, inflammatory indicators on bloodwork, and an acute episode of vomiting/diarrhea last fall after giving her some varied food options when she wasn't eating. It was really bad, and I had made an appointment for euthanasia but we were able to turn it around and the Budesonide seems to have helped. Specific options I give her are Merrick or Instinct rabbit, and glycobalance (not because of the diabetes, but because we stumbled upon it and found she likes it). When she stops eating she gets plain cooked turkey. FTR I've tried various home cooked and raw diets, too. She doesn't like fancy feast, though admittedly I haven't tried Friskies. She won't eat baby food or anything from the food list in the CKD group (if you're familiar) and we've tried nearly all of them. I have discussed a feeding tube with the vet more than once, that's the level of food aversion she has. I give her rx kidney fry dry food, mostly to have something low phosphorus that she'll willingly eat in her belly when I give her meds multiple times a day, because the phosphorus binder interferes with some of them.

She had a fructosamine test in June, it was 442 mg/dL (191-349 reference range). I plan to get the Ketostix this weekend, but do intend to start insulin tomorrow (Friday) morning.
Click to expand...
Weruva is a good choice for ckd/diabetes because they have many flavors that are both low carb and low phosphorus. Fancy feast and Friskies are a bit too high in phosphorus for a ckd cat unless you are going to add a binder like aluminum hydroxide. Glycobalance is high in carbs. Do you have a copy of her Bloodwork labs you could post? Do you give daily sub q fluids?
 
Bron & Janet,

I have ondansetron but it has never helped her. She takes:
  • Twice daily LRS sq fluids
  • Cerenia / Omeprazole / Mirataz
  • Niacinamide / Aluminum hydroxide
  • Renadyl (renal probiotic)
  • Cisapride / Miralax
  • Budesonide
  • Benazepril
  • Buprenorphine
  • B vitamins (oral and injectable) / Omega 3
Its a lot, but it's how we have maintained her quality of life, and she willingly participates in her treatment.

The glycobalance she eats is mainly wet. I have some dry but haven't given in a month or more. She will not touch Weruva.

Bron, are you saying not to start her insulin unless she is above 200? I am using the Libre for readings while I figure out the best way to get blood from her (ears are a no touch zone, paws don't bleed much) but if she tolerates it I don't mind paying to use it long term. So far she acts like it's not even there.

I have lab work, is there a way for me to post a picture from my phone?
 
Bekah and Momo said:
Its a lot, but it's how we have maintained her quality of life, and she willingly participates in her treatment.
Click to expand...
You are definitly doing everything you can. My cat CC was on a lot. Sub q's, high dose insulin, adequan, b 12, probiotic, methamazol.... But she was fine with it all too, and had a good quality of life.


While upload isn't working, you CAN copy and paste photos.
 
Well I started the insulin this morning. It was terrifying, she acted like she would eat pre-shot but then didn't eat much after, her numbers dropped fast but then she ate and they leveled out. Spreadsheet should be in my signature now.

I'm really not sure how to do this with her not eating reliably.
 
Bekah and Momo said:
Well I started the insulin this morning. It was terrifying, she acted like she would eat pre-shot but then didn't eat much after, her numbers dropped fast but then she ate and they leveled out. Spreadsheet should be in my signature now.

I'm really not sure how to do this with her not eating reliably.
Click to expand...
Make sure it's set to anyone with a link can view. I can't see it
 
Question - the spreadsheet is for a pet meter because that's what I have for backup but am primarily using the Libre. Should I be using a different spreadsheet?
 
JanetNJ said:
Make sure it's set to anyone with a link can view. I can't see it
Click to expand...
Great I can see it now! 99 isn't too low. If you plan on using a human meter once the Libre stops in a week or two then switch spreadsheets. If you plan on using the alpha then stay with this. They don't have to eat their whole meal preshot. My cats are all grazers. As long as there is a willingness to eat. Make sure you always have gravy food and honey or syrup just in case you need it. You could do a tiny bit under 0.5 if you are nervous. A skinny 0.5. Like 0.4. Ha
 
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