New member! Q's about BG toe pad testing + remission

Hi all,
I have been poring over these threads since my cat Mo was diagnosed one month ago and it has been SO helpful. I'm still confused about a few things though. He's been on Budesonide for IBD for the past 7 months and when I finally found a food that eliminated his chronic diarrhea (Hill's I/D Dry) back in February, his blood sugar rose so high over the next month, he had to be hospitalized at the beginning of April with BG over 800. I felt as though the food was the main culprit since within a month he developed diabetes but his internist brushed it off and said he was just old and overweight. She reduced the steroid to the lowest possible dose at that time.
First question is this: Despite multiple tries, I can't seem to get enough blood from his ear to get a reading so I've been using his toe pads (he doesn't seem to mind at all though he does flinch a bit when the device makes that clicking sound). I try to switch feet and use alcohol wipes but is it ok to do this multiple times a day? He looks uncomfortable when he walks but I don't know if that's his arthritis or pain from the pricks.
My other question is about remission. As soon as I read about how high the carbs were in his dry food I switched to I/D wet. On 2 units of Glargine every 12 hrs. his readings were pretty steady (last at-home BG curve a week a and a half ago was 121, +3 105, +6 113, +9 165, +11 161). Now I'm transitioning him to a low-carb wet food (Hill's W/D) and he's eating less so I dropped it to 1 unit 2 days ago for fear of hypoglycemia. Spot checks were 114 3 hrs. after am injection, 133 3 hrs. after pm injection last night and 119 this morning before injection. Might this be the beginning of remission if he needs less insulin, or does it take a few days for their bodies to adapt? Can remission happen this quickly with diet change and reduction of steroid? He is also steadily losing weight (2 lbs. in the past month). I will try to work on the spreadsheet but I was overwhelmed by it last night when I tried to make one. TIA

 

I'm not sure the alcohol wipes are good in the long term and hydrogen peroxide has it's own set of problems. I know poking holes in a cat's ear can look gruesome but I cringe to think what our five walk through every day. It is literally a toilet.
Sorry I can't help with the rest, you and Momo will get through this. We're all in the same leaky boat.

 

It isn't that it looks gruesome to prick the ears, it just doesn't work. I've tried all the tricks mentioned in these threads but it won't produce a big enough droplet for the machine to detect. Why aren't the alcohol wipes good in the long germ?

 

Alcohol and hydrogen peroxide can both dry out the skin. I once had 11 pins in my wrist, so relieved to not have a cast. I was told I could get it as wet as I wanted but was better off to use soap and water instead of hydrogen peroxide.
It's not just you, I could only get blood from Noah's left ear and it was either textbook perfect or I shredded his ear, no in between. I won't pretend to know what's best for the pads, my knowledge there is all from human orthopedic adventures. Hope you can make it work!

 

Thank you, I will keep trying with the ears because I'm worried he'll get some sort of infection on his toes from the litterbox funk. Good to know I'm not alone in this, thanks again for your input! Navigating this has been really stressful as I'm sure you can relate.

 

I forget more than I care to share but have never forgotten that first month. I can definitely relate. Our first sugar cat would jump on the table ready to go but Noah was beyond nervous. I laid out everything in front of him so no surprises and sang Hush Little Baby. The rule is there are no rules, whatever works for you.
Sorry about the toilet remark. It's stating the obvious which is borderline condescending.

 

Previous post
https://felinediabetes.com/FDMB/threads/food-recs-for-ibd-diabetes.261861/
Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up

Here is a video one of our members did
VIDEO: How to test your cat's blood sugar

 

I can ask one of our members to set up your spreadsheet, look for a message from her in your inbox up top
Her name is Bhooma
@Bandit's Mom

For you to read ,understanding the spreadsheet
https://felinediabetes.com/FDMB/threads/how-to-use-the-spreadsheet.241653/

 

Thank you so much for this information! Any help, especially with the spreadsheet would be greatly appreciated so I'll keep a look out for that message.

 

I had the same issue with getting blood from my kitty's ear. The microwave heat pad did the trick. I also rub his ear as it is warming up. Getting that sweet spot as the picture detects is key. It is very close to the edge of the ear. I do it freehand (it's very easy) and I read to angle the lancet as you poke (so not going through the ear). That helped too. As the picture indicates, there are more blood vessels near the top of the ear so aim for there. And you must squeeze (milk the ear). Good luck!

 

@Bandit's Mom
Hi Bhooma could you please PM @Ali Momo’s mom and set up her SS for her I told her to look for your message in her inbox
Thank you Bhooma

 

Hi Ali after Bhooma @Bandit's Mom contacts you and your spreadsheet is set up can you enter the test numbers you already have , also there are 2 dosing methods to choose from when using glargine , they will tell you when an increase or decrease is due, you can always ask for advice if you're not sure
Here is the link so you can read about it.
Just want to let you know that if you are feeding any dry food you would have to follow SLGS method. I see in your post above you are feeding Hills W/D wet I did a search on here and I see that 2 members have said it's 25% carbs which is too high for diabetic kitties
I see in your first post you said Moses has the beginning of kidney disease, can you please add that to your signature. Is he still on steroids
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

@Ali Momo’s mom

I see in your first post (introduction post) you said Moses has the beginning stage of kidney disease you might want to check out the Weruva food. I don't know if these are suitable for IBD kitties


You want the metabolizable energy profile percentage of carbs to be less than 10%, and the phosphorus which Weruva lists in Minerals to be less than 250 mg per 100 cals. So you have to look at two different places in the Weruva charts.
https://weruva.com

When you go to the weruva site and click on one of the pic of the food , click in Detailed Nutrition information

Also here is a list of foods for diabetics/kidney disease that was posted by one of our members
Here is a list of some of the food
As far as the food goes
For kitties with kidney disease and diabetes



. First number is carb percentage, second is mgs of phosphorus/100 cals, all less than 10% carb and less than 250 mg phos:

Weruva Truluxe Steak Frites can 6% 118
Weruva Cats in the Kitchen La Isla Bonita can 3% 166
Weruva Cats in the Kitchen Pates Meowiss Bueller pouch 7% 174
Weruva Truluxe Glam 'N Punk can 0.6% 180
Weruva Cats in the Kitchen Fowl Ball can 4% 180
Weruva Classic Pates Jeopurrdy Licious pouch 4% 187
Weruva Classic Pates Family Food pouch 0% 191
Weruva Cats in the Kitchen Pates Cattyshack pouch 9% 211
BFF PLAY Tuna & Salmon Shhh... pouch 3% 223
BFF PLAY Tuna & Turkey Totes! pouch 2% 226
BFF PLAY Tuna & Chicken Chill Out pouch 2% 226
Weruva Cats in the Kitchen Pates Cat to the Future pouch 8% 235
Weruva Cats in the Kitchen Pates The Breakfast Cat pouch 9.7% 235
Weruva Classic Pates Meal of Fortune pouch 8% 236
Weruva Cats in the Kitchen Lamburgini can 8% 236
Weruva Cats in the Kitchen Double Dip can 8% 248

YOU WANT CARBS UNDER 10% AND PHOSPHORUS IDEALLY LOW 200's OR LESS

 

Your Previous post ( introduction post )
https://felinediabetes.com/FDMB/threads/food-recs-for-ibd-diabetes.261861/#post-2936660

 

I read in your post above thatv you are transioning to Hills W/D Wet?
I found this posted by 2 of our members about the Hills W/D wet

The canned W/D is about 25% carbs as well as having some pretty lousy ingredients, including my personal pet peeve ingredient they laugh

The wet Hill's W/d is still 26% carbs when diabetic cats only need 10% carbs or less.

The W/d food is also meant for weight LOSS, and many diabetic cats have already lost plenty of weight before diagnosis and do not need to lose more.

By the way when adjusting doses we increase or decrease by 0.25 units at a time not whole units. Do your happen to have the syringes with half unit markings? They make it easier to adjust doses.
If not I can suggest where to buy them

@Ali Momo’s mom

 

Sorry! I'm only just seeing these messages/tags. I have sent you a PM with the details I need to set up the spreadsheet.
Welcome to FDMB!

 

Thanks for all this information! I looked up the carb content on multiple sites and they all said the Hill's W/D wet food is under 10%. My vet suggested I try to keep him on this because he does need to lose some weight (he still has a voracious appetite and is 19lbs.) and it's formulated for digestive issues as well. So far his diarrhea hasn't come back but there are supply issues I just discovered with this food so I will probably have to transition him over to one of these other foods you listed. His kidney values were all great at his last check up so I'm not as worried about that. He is still on the steroid (Budesonide) but the vet brought it down to the lowest possible dose once he was diagnosed with diabetes.

 

Now that I read I should have reduced by 0.25 units at a time instead of whole ones, I'm wondering if I should keep him at 1 unit or bring it up a bit to 1.25? He's been at 1 unit now for the past 4 days but his chart is mostly blue. Should his numbers be green when he's taking insulin/is that ideal?

 

I will tag some members for you to look at your spreadsheet about the dose

Ali has just read the dosing methods and chose SLGS using Alpha Trak
Can you just add to your signature the Hills W/D is wet


@Wendy&Neko

@tiffmaxee

@Bandit's Mom

@Suzanne & Darcy

@Bron and Sheba (GA)

Adding
@Sienne and Gabby (GA)

Can someone look at her SS and suggest a no shoot number for Ali she's new to all of this

Ali
Normal on a pet meter is 68-120
With a pet meter reductions are taken if under 68

Wendy, Elise, Bhooma, Suzanne and Bron just want to make sure this is correct about the pet meter and reductions
Thank you

 

Can someone check out the carbs for the Hills W/D wet

I did a search and found this posted by 2 members about it
I read in your post above thatv you are transioning to Hills W/D Wet?
I found this posted by 2 of our members about the Hills W/D wet

The canned W/D is about 25% carbs as well as having some pretty lousy ingredients, including my personal pet peeve ingredient they laugh

The wet Hill's W/d is still 26% carbs when diabetic cats only need 10% carbs or less.

The W/d food is also meant for weight LOSS, and many diabetic cats have already lost plenty of weight before diagnosis and do not need to lose more.



@Wendy&Neko

@tiffmaxee

@Bandit's Mom

@Suzanne & Darcy

@Bron and Sheba (GA)

 

Sorry to tag you again, just not sure if you all saw them

Please see #18
Thank you ladies



@Wendy&Neko

@tiffmaxee

@Bandit's Mom

@Suzanne & Darcy

@Bron and Sheba (GA)

Also tagging
@Sienne and Gabby (GA)

 

The Hills w/d carb content is 26.4 % which is very high carb
Here is the website for you to see. Scroll down and click on the ‘average nutrient and caloric content’ to find the number of carbs.
https://www.hillspet.com/cat-food/pd-wd-feline-canned
If your kitty needs to lose weight, there are other ways of doing this apart from feeding a diabetic cat with 26% carbs which I think is most unsatisfactory.

I think if you swapped to a low carb food, under 10% carbs, your kitty would most likely drop down to needing very little, if any insulin. At the moment you are only giving 1 unit and feeding 26% carbs.
However do not do a swap of food to low carb without the help of someone experienced here as the BG will most likely drop up to 100 points and you would risk a hypo.

If you are doing SLGS, you need to reduce the dose to 0.75 units at the next dose please, because the BG dropped under 90

The normal numbers for a pet meter for a cat are lowest point 68 and there has not been enough studies done to say conclusively what the upper BG is but it is higher than 120 and closer to 150.

 

Thank you Bron
@Bron and Sheba (GA)

 

Thanks for your reply. I will work on switching him to a more low-carb food that hopefully will not cause an IBD flare up (of course the only two foods that have fixed his diarrhea so far are the Hill's I/D and W/D formulas).
But the dry matter vs. as-fed #'s really throw me off. I know the carbs are high on a dry matter basis but I read that the carb content for the W/D wet is 7.26% on an as-fed basis. Can you clarify the difference?

 

Also, I'm still trying to differentiate between TR and SLGS. Is it that TR is mainly just a lot more BG testing and you can feed them several times a day? I will have to return to the office next month so I won't be able to test so frequently at home.

 

@Bron and Sheba (GA)

@tiffmaxee

@Wendy&Neko

@Sienne and Gabby (GA)

 

SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50. The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.

I was looking at your SS in the remarks section about feeding
We feed our cats more than just twice a day. The bigger meal first thing in the AM and PM then smaller meals during each 12 hour cycle
Maybe @+2, then @+4 ,same thing during the night cycle
We only withhold food 2 hours before testing AMPS and PMPS

 

Thanks--so I picked the right protocol it seems.

@Bron and Sheba (GA) so should I reduce to 0.75 for his AM shoot or skip it altogether since he was @ 179 this morning?

 

I added this don't know if you saw it

I was looking at your SS in the remarks section about feeding
We feed our cats more than just twice a day. The bigger meal first thing in the AM and PM then smaller meals during each 12 hour cycle
Maybe @+2, then @+4 ,same thing during the night cycle
We only withhold food 2 hours before testing AMPS and PMPS

When you go back to work next month you can get an automatic feeder and set times for it to open so Mono can eat

 

I would reduce it to 0.75 this morning and monitor as you have been doing

SLGS
Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

 

Yes. With SLGS reduce to .75.

I wonder if you have tried a novel protein to see if what you were feeding caused the IBD? That means one Momo has never eaten before? There are so many single protein foods to try. How long has he been on budesonide? For some cats it raises the bg but not most. I’d try and find a low carb food that will work again if you haven’t tried one.

I’m in California as well.

 

@tiffmaxee
Hi Elise what do you think a good no shoot number is for her.
She PM me and did read don't shoot if the BG is under 200
Looking at her SS the numbers don't look that bad, she's been getting greens but what do I know
@tiffmaxee

Also see #32

 

OK thanks, just gave him the reduced dose. I tried lamb in the past as well as beef. About a decade ago I thought he had an allergy to chicken so I tried raw (projectile vomit with that one) and at least 20 different wet and dry foods. Last fall, I got every possible test done to try to figure out what it was (ultrasound, biopsy) and the vet diagnosed him with IBD and referred him to a specialist. That's when things started to go downhill because she threw a much higher dose of Budesonide at him and pushed antibiotics for 12 weeks. She suggested Royal Canin Hydrolyzed Protein/Renal Support and diarrhea never went away for months until out of desperation I tried I/D. Wish I had known about carbs then Haven't tried rabbit yet so I think that's my next one. Trying to figure out if I should do Dr. Elsey's dry food since it's LC or try raw. Any opinion on that? He's been on Budesonside since Sept. 2021.

 

Since you are home for this month can you monitor as much as necessary? I’m thinking if yes you can shoot any number over 120 since you have shot as low as 119. With meter variance of 20% those are the same. If lower at preshot STALL. DON’T SHOOT, and test again in 20-30 minutes to see if the bg is on the way up. Then post asking for dosing advice and put that in your subject box with the question mark prefix.

Dr. Elsey’s dry would be my last resort as they all contain chicken and because I think if a lc wet can be found Momo might very well become diet controlled. Have you ever considered raw? I saw in a previous condo Wendy suggested that. With EZ Complete you can control the protein but it does contain chicken liver. Small Batch and Primal both make raw rabbit and venison. Primal makes pork. If in So. Cal are you close to a Centinela Feed?

 

Yes I can monitor closely. I will look at the primal rabbit and am willing to drive anywhere to help this poor cat! I drove 70 miles to Riverside last week to get 12 cans of W/D since it's out of stock everywhere else.

 

Are you in Orange County? Are you familiar with Centinela Feed? They carry Primal and Small Batch.

 

@tiffmaxee I'm in LA and there are a few Centinela Feeds around here. There's a small pet store nearby that also carries it. I found something on Chewy that looks similar so I will compare them. I honestly don't know which is worse at this point--an IBD flare-up with diarrhea or diabetes. My first inclination is get him into remission asap (fingers crossed!) even if that means he will be having digestive issues for the foreseeable future. But I don't know and the vet's office still hasn't called me back.

 

Centinela has lots of sales so you can often get the food 15-30% off. I love that store. I’m on the Westside and buy all my food there. You want the frozen but could try freeze dried to see if your cat will eat it. Freeze dried is more expensive and venison is impossible to break up. I have to put it in a mini food processor and grind it. I have a bag around in case I forget to take food out of the freezer. In my opinion IBD is more important to control than fd. You dint want it to morph to small cell lymphoma.

 

I think Elise meant to say STALL DON'T FEED or give insulin and test again in 20-30 minutes to see if the BG rises up on its own . Then post asking for dosing advice and put that in your title such as
? AMPS # STALLING NEED DOSING ADVICE or if it's PMPS post the same
Just checking
@tiffmaxee @Ali Momo’s mom

 

That’s what I wrote. Stall and don’t shoot. Don’t feed either. Post for dosing advice. If either amps or pmps is too low, that’s what you do first.

 

Ugh my vet finally called back (well her assistant did, of course, because I'm learning specialists here don't talk to you directly unless you fork over a $250 examination fee each time). Anyway, she looked at the spreadsheet I emailed her office and told me to go back to 1 unit of insulin for the next 5 days until I can do another curve and call her office with the numbers. Any ideas why she would say this when he's looking stable on the lower dose over the last 2 days (highest has been 152 and I had an 87 at +3 today. The assistant couldn't explain, other than to say the dr. said I shouldn't made dosage changes without consulting with her first (I had called the office on Friday but she never called me back). She also said I don't need to check his insulin so much, even after I explained that I switched to a lower carb food. Am I overreacting in my fear that his #'s might be too low if I increase it by even 0.25? I have to work all day tomorrow so I won't be able to monitor for hypo.
@tiffmaxee
@Diane Tyler's Mom
@Bron and Sheba (GA)
@Bandit's Mom

 

You are not overreacting. With a nadir of 87 if following SLGS you would decrease to .50. With TR you would hold the dose at .75. I strongly suggest you do not increase. Momo is seeing really good bg numbers, especially since you are using a pet meter which reads higher than a human meter. Your spreadsheet says SLGS so a decrease has been earned.

 

Thanks for validating. I assumed I had to wait a week if the nadir was that low but I should decrease it after one day using SLGS? I've been trying to understand how this all works...does the insulin make their cells or pancreas "lazy" (if that makes sense?) Is it good to lower the dose to see if the body can steadily maintain it? Does it do harm (cause the body to become dependent on it) to keep him on it for a prolonged time when the numbers are lower like this?

 

With SLGS any time you see a bg under 90 a decrease is earned. Then you hold 7 days and decide whether the dose is working. The drop under 90 might be because the higher dose of 1.0 is still influencing this cycle though as it’s on,y been 3 cycles. So the reduction might not work. We will need to see. Since there was a food change it might be fine. If you were following TR we would not reduce. That’s a difference between the two methods.

A cat needs as much insulin as he needs. We dose based upon how low a dose takes a cat. You want to find the dose that keeps your cat in nadirs between 90-150. As he stays in more normal numbers the pancreas heals and less and less insulin is needed. It is not a question of becoming dependent on a dose. You want a dose that keeps him in safe as normal as possible numbers and hopefully he will become diet controlled and no longer need insulin. Does that make sense?

 

With SLGS you decrease the dose immediately if the BG drops under 90.
With SLGS you wait 7 days to do an increase, if it is needed.
The insulin supports the pancreas while it heals. It does not make it lazy.
The BG numbers and the nadir…the lowest point in the cycle…..is what governs an increase or decrease. A cat needs as much insulin as it needs. All cats need insulin to survive. If the pancreas can’t supply it, then we give it via a syringe. So one can’t say they might become dependant on it….that is like saying humans can get dependant on oxygen…..we need it to survive.
I would recommend you follow either SLGS or TR and that will tell you when you need to increase, decrease or stay with the same dose.
Keep asking questions.

 

Yes, this makes sense. Thank you for explaining! I feel more confident in not increasing the dose as the vet suggested. Taking him in for a check up anyway on Tuesday so will discuss further with her at that time. You all are lifesavers!