Newbie Roy-Requests Bounce Reduction Assistance

Status
Not open for further replies.
L

Lauren & Roy

Member Since 2012
Hello Everyone,

Good labs at Vet! However, bouncy numbers with full Lantus dosing.
Roy got some good news this morning at the vet; No ketones! His one strong kidney still powering forward with 2.3 creatinine. PCV holding at 26. Will watch him maintain strength before giving Aranesp.

Food was daily 120 kd/120dm for past 3-4 days. Today went to 200 dm/40 given high b/g. May go to interim recommendation of 180/60kd to soften transition. When we returned from vet, I fed Roy about 10 ml less than usual and have been giving water in e-tube throughout the afternoon.

Gave Full Does of Lantus last night and got a 109 @ +5.5. Was concerned and gave about 10 ml more of food than usual and level shot up to 505 before we went to vet. Upon return was above glucometer. So, I gave food, then 1.0 insulin, and rest of food for total of about 45-50 instead of 60 ml. Supplemented with more water to support the kidney w/such high b/g.

What causes such a great bounce? Was it the extra 10 of food or would feeding at +4 instead of +5.5 have produced more stable results? Roy's nadir appears to be in the +4-+7 range.

Question: Should food be slightly reduced and fluids increased with very high bounces and b/g?

Question: Does the time the food is given in the cycle affect stability? For example, I fed Roy 70 ml at his +5.5/109 b/g; would it have been better to feed 60 @ +4/preventatively? His food spikes in past have only been up about 50 when not near insulin. When I give him food and insulin, they go up about 200 points.

Are the increases all food-driven or is the insulin elevating the b/g?

Thank you to All!
Appreciated receiving the food info and the Lantus dosing protocol; very useful.
I am Inspiried to see so many lucky kitties in the good colors with such smart & loving care.
Greatly appreciate your knowledge & generosity.
Please keep my little guy Roy in your best science and, of course, your prayers.
Thank you.

Lauren & Lucky Roy
 
Hi Lauren:

Could you please go to your initial post today, open it, click on "edit" and then change the subject line to read: "5/14 Roy AMPS 750 +4 519 ???" You can also click on the ? button above the subject line...then click on "submit". Once your question has been answered, then go back to the initial post for today, open it, click edit, and take the ???? off the subject line and click the button next to "none". That way people won't keep coming on to answer questions. But...don't take it off if you still have questions or if your question has not been answered. Thanks!

So...we like to time feedings as much as possible to be done prior to the nadir so it doesn't continue to slow the insulin down after nadir. However...our mantra here is Every Cat is Different...ECID. Some cats free feed wet food all day and never have an issue with it affecting their BG. I think the feeding....what he is fed...has to be between you and your vet because of his condition. No one here would want to advise you without significant input from your vet on what is ok for him to eat. We can tell you that k/d and d/m are too high in carbs (and really have undesirable ingredients) for a diabetic and that other foods exist that are lower in carbs, have higher quality proteins, and may not be quite so high in phosphorus as many foods. But still, they are going to be higher in phosphorus than k/d.

As some said yesterday, we don't know his phosphorus level and whether the binder is preventative (which usually you would not do with a CKD kitty....but Roy is different). I would love to see you talk to your vet about other possibilities for feedings that have lower carbs and somewhat less phosphorus and see what he thinks. Also, I think the recommendation yesterday for you to contact Dr. Lisa Pierson is an outstanding one. She is a feline nutritionist and has worked with alot of diabetic and renal kitties.

Two things cause bounces: fast drops and low numbers the kitty's liver is not accustomed to. The numbers don't have to be super low...just lower than what feels normal for the liver. The liver then releases counterregulatory hormones and glucagon to raise the BG to a number where it feels "safe"....a number it is used to. Kitties often bounce until they don't and there is no tried and true method that keeps them from bouncing. If a kitty is a diver from high numbers, there may be some food management that can be done to help that but we need several weeks data on a kitty before we'd start looking at whether there is a need to control that.

I'm not comfortable recommending that you reduce his food and IMHO, reducing his food won't affect his BG and bounces. It's more likely timing of food given. Some of the increases could be food driven since the food is pretty HC. But bouncers can bounce pretty high.....ECID.

I believe that 109 last night triggered another bounce and the HC food possibly contributed to how high it went. Because he got pretty close to green, this 1u dose might be a good one for him. But let's see what others think as well.
 
Hi Lauren, welcome to Lantus Land! Wow, your Roy is one bouncy kitty. Boing, boing boing! Thpse bounces are no fun and unfortunately there's not a lot to do but wait them out. Hence, patience pants are worn quite often around here. Eventually, almost all kitties quit bouncing but it just takes time, like maybe weeks or months. One thing is to be consistent with the insulin dose, same dose, every 12 hours. That 109 @ +5.5 is a great nadir. Roy, let's get back to that ok?
Liz
 
Lauren sent me a PM last night and I forgot to re-post the information I provided.
Right now, I wouldn't worry about bouncing. Bouncing is normal. Roy's body is just not used to lower numbers -- like that 167 last night. I suspect that Roy is experiencing glucose toxicity, which sounds worse than it really is. Basically, all it means is that his body has become used to spending time in high numbers. As a result, when his numbers come down, his body isn't used to it. The more time he spends in lower numbers, the less he will bounce. If you looked at the first page of Gabby's numbers, you'll see she was a champion bouncer.

Given Roy's kidney situation, I would suggest having a frank discussion with your vet. I would also suggest posting this question on the Health board. There are several vet techs that frequent Health and they may be able to provide some insight. My experience is that vets are a bit clueless when it comes to feline nutrition. They get a great deal of their information from the sales people from Hills or Purina. The prescription foods are not good sources of high quality protein. They are mostly animal by-products. In addition, the vets make a good deal of money by selling you prescription food! When Gabby was diagnosed, my vet pushed feeding either DM or MD. After finding FDMB, all the prescription food went back to the vet's office and we talked about how I could buy a lower carb commercially available food that was better quality at less than the cost of the Rx food. She was fine with my using either Fancy Feast or Wellness. However, Gabby does not have kidney issues.

If it's affordable, another consideration is a phone consultation with Lisa Pierson, DVM. She has a practice in California and an excellent website on feline nutrition. She is a wonderful resource on food and has customized diets for several cats here. Roy's situation is somewhat unique and I would not want to give you bad advice.

The challenge is that if you lower the carb content of what you're feeding (i.e. ditching the KD), you will most likely see Roy's BG numbers drop. Right now, it's like you're feeding him cookies with his burger. If you get Roy in better numbers, once you start to reduce the KD, you will need to reduce his insulin. Frankly, it's easier on the nerves to raise the dose than to have to adjust it downwards because insulin needs are rapidly decreasing.

I suspect that the KD is not appreciably lower in phos than several of the other foods that are available and that the phos binders make it a moot point.
Click to expand...

I do not look at bouncing as a bad thing -- especially at this point in Roy's FD adventure. Bounces are a normally occurring protective function. As Roy gets more accustomed to spending time in lower numbers, the bounces will, hopefully, become less of an issue. I think if you open most of our SSs, you'll see that many of our cats have gone though what we euphemistically refer to as Liver Training School.
 
Hi Lauren,

I just wanted to welcome you to LL and say hi to you and Roy. I'm sorry he's having such a bad bounce. The good thing is that they usually don't last too long. Most bounces are over in a day or two, though Racci had one once that went on for weeks! She kept bouncing off her bounces until I thought she'd never stop. :lol: I'm sure the 109 did it to Roy, as Marje said, and it will be over soon. There really isn't anything you can do but wait them out until he gets used to lower numbers.

Once you have some history of tests it will be much easier to see what direction Roy is moving in and the dosing pros will be able to help you more. I believe we have other kitties with renal issues also and their beans may be able to advise on food. I wouldn't change amounts the vet told you though unless it's to what Dr. Lisa says is good.

Welcome again!
Melanie & Racci
 
I do find it interesting that he is on k/d and binders. That is not the norm unless kitty is really in advanced renal failure but I don't know the vets reasoning.

Actually the kidney diets are pretty much lower on phosphorus than most of the non kidney diet low phosphorus foods. K/d is about 0.38% P on a DMB and the closest non prescription food is at 0.5% P on a DMB. However, when you are looking at those foods which are also low carb, you are looking at higher P levels. For instance, Before Grain 96% Beef (1 or 2% carbs) is 0.79% P on a DMB. Merricks Cowboy Cookout (5% carbs) is 0.84% P on a DMB. It's best for a CKD kitty to have less than 0.5% P on a DMB but many strive to keep the P in food under 1.00% on a DMB. There are some low P Friskies foods (around 0.5%) but I have no idea what the carbs are.
 
Status
Not open for further replies.
Back
Top