Newly diagnosed Coco - AMPS 561

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shortbusruss

shortbusruss

Member Since 2023
Hello, I *think* I have Coco's spreadsheet linked correctly, but I am using the tablet version of Google Sheets, but my wife's and my Google accounts are linked, and when I click on it, it makes me choose one of our Drive accounts so we'll see. Also, the how-to does not match the user interface I get when using the tablet app. There is no "publish to web". There is only "make available to anyone with the link", which is what I chose.

First, Coco just started on ProZinc a week ago here in Germany, as he started on Caninsulin, and it took a few months of extreme frustration with his all over the place numbers until I found this forum, and figured out that he was only getting about 6 hours of coverage during a 12 hour cycle. We have been trying to get more blood draws, but this is all fairly new to us. We are seeing *some* better numbers, but have not nailed down his nadir yet, and not sure when /how much we should be feeding him, based on a 4kg body weight, and an ~5-6kg optimal body weight.

Based on how much he is urinating when his blood sugar is extremely high, I am hesitant to give him any food before his numbers come down, post AM shot. This morning, I gave him 1.5 units to try to bring him down from a 561 AMPS. I am planning on giving him his first meal at around +2.5. (I am not really sure why I did not shoot him more last night, but I did not want to make massive movements, but I likely should habe shot 1.25 and not 1 last night. He is literally starving all the time, and will eat 400 grams+ of food per day if we let him (at 4kg body weight), and still want more. I know the goal is to feed him when his numbers are more in the 80-150 range, so he actually gets energy from the food, and will be more satisfied. As it is, and from the looks of his litter box, it seems that he is just peeing out all the sugar from the food he does eat, if we give him his food at the same time we give him his AM shot, as from the newer numbers, he does not seem like he is hitting acceptable numbers until at least +5 - +7.

The vet started him on 1 unit twice a day, and I have bumped him up to 1.25 after about 5 days, just based on not seeing the numbers I would like. The lowest number he has hit in the past week is 104, but we have not done a full 12 hour glucose curve yet. On Caninsulin, he has had both hypo, and hyperglycemic episodes, where he was confused, stumbling. As I have learned more about his condition, I have gotten better, and he has not had any episodes in the past 6 weeks or so, even on Caninsulin. Though, before I found this forum, I had resorted to giving him more than 2x shots per day while on Caninsulin. I found this forum and took him to a different vet last Friday, and got a full blood work done, and specifically asked for him to be changed to ProZinc.

His labs came back fairly solid, and he is not spilling ketones. Just high glucose in the urine. But he does have some dental issues that need to be addressed once we get back from vacation.. He had some lesions on his gums and gingivitis, but this seems to habe gotten a little better in the past week. New vet gave him some pain medication liquid fed by mouth once a day, and not seeing his mouth looking so bad, but his breaths still smells quite bad. I never had a problem with him licking me and kind of liked it, and now, not so much. He is constantly trying to lick me, and I know that is a stress reliever for him, so I don't know if his chronically high blood sugar is a sign of stress due to him "not getting enough food", and I should feed him more? He is getting minimum 300grams food daily, up to 342grams.

He seems to be fairly active and alert.. Just hungry all the time. He is on Animonda Integra Protect Diabetes food (wet bags, as he will not eat canned food or pates. This is not a dry food..) which I believe is ~4% carbs? And for full disclosure.. We are going on vacation on Saturday, and a very conscientious coworker will be watching him. He has agreed to test him 1x AM and 1x PM, and I am just going to have to do my best to give him some good guidance on how much to feed, and what to shoot AM/PM, plus what times to give him food in between AM/PM meals. My intuition says to feed him ~130 grams AM, 130 grams PM, with ~130 grams portioned out in smaller meals AM +2, +4, +8 or so. Honestly, I am just guessing here. It seems like a lot of food for his weight, but he is simply ravenous due to the uncontrolled blood sugar. I think advising my coworker to stick with 1.25 units 2x a day, as long as AMPS / PMPS are not any lower than 100mg/dL is what I am going to do, barring any different advice here.

This has been a harrowing experience navigating this new diagnosis, and we had a fairly uneducated vet at first who was "puzzled" as to why Coco's numbers were all over the place on Caninsulin. It seems to be getting a bit better, but unfortunately our options are limited for the next two weeks, as we will not be around to monitor as close as we would like. Any advice would be appreciated. I will do my best to relay his babysitter AM/PM numbers into his spreadsheet while on vacation.
 
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Tested +7, +8, and put some notes in spreadsheet about what he has eaten today so far in AM 12 hour cycle. I load up his food with lots of water, and he drinks his water immediately, and then absolutely inhales his food. 212 grams of food in 7 hours (for a 4kg cat), and at his +7 feeding of 85 grams, he absolutely scarfed down his food, with no break. At +8, he is licking his completely empty bowl like he wants more food. I am kind of at my wit's end, trying to figure out where in the cycle to feed him, to give him at least some semblance of satiety.

I see multiple people have viewed this thread... Can I get someone to confirm they can see the spreadsheet?
 
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I can see the spreadsheet. I'm also going to ask one of the other moderators to take a look to make sure all is as it should be (@Marje and Gracie).

I'm guessing your in the UK from the food you're feeding Coco. I hate to tell you this but the Animonda is approximately 31% carbohydrate. We consider under 10% low carbohydrate. There are typically very few dry foods that are low in carbohydrates. I'd love to see if you can get your cat on a better/low carb diet. However, I would not do this until you're back from vacation. A change in diet will likely drop Coco's blood glucose numbers and your coworker wouldn't be equipped to handle that without a lot of support. I'm going to check around and see if we have any members in Germany who may have ideas about food.

A few things to consider. When a cat has been diagnosed as diabetic, we never know how long they have been diabetic. Their body gets used to being in higher blood glucose ranges. As a result of being treated with insulin, when numbers drop into a better range, their body overreacts. The liver and pancreas respond by releasing a stored form of glucose along with counterregulatory hormones. This causes blood glucose to spike. This is exactly what you saw on the 10th when Coco dropped to 196 and then zoomed to 600. It's incredibly annoying to us but it is part of the process.

I'd strongly suggest that you start to get at least a test every night before you head off to bed. Without at least a "before bed" test, you have no way to know if your kitty is in safe numbers. Further, without any PM tests, you're missing half of your data.

Withholding food because your cat is starting the cycle in high numbers is not really accomplishing much. Well, it's probably annoying Coco. (My cats know when meal time is!!) Prozinc takes some time to work. In a worst case scenario, numbers are high, for whatever reason they are coming down, you give insulin but no food and the numbers start to bottom out. Cats like predictability. It's best to try to keep shots and meals on a reasonable schedule. It's also OK to feed Coco more until his numbers are better. With high numbers, the end product of her metabolism (i.e., glucose) is floating around in her blood and not getting into the cells. As a result, he's hungry all of the time. Once he's better regulated, he won't be starving.
 
Thanks for the response. But, can you clarify about the food? I am actually in Germany, feeding him the Animonda diabetic formula, and online calculators say this food is around 4%. It's not a dry food. It is a wet food, "in a bag". Sorry for not clarifying. He refuses to eat canned food, full stop. He will literally starve, and go into hunting mode and go into the basement desperately searching for anything else to eat, rather than eat a canned food, or a pate. Leaving us pretty much only the option of wet food in individual bags. This food is not one of the jelly or gravy heavy options. It pretty much looks like meat chunks, with a very slight amount of gravy/jelly, but not like the gravy/jelly options we have tried before. It is wet chicken and turkey flavors, in a bag, with 85 gram serving size per bag.

https://www.zooplus.de/shop/katzen/...tes/1903535?origin=hopps&q=animonda&i=1&ro=20

Analytische Bestandteile

HuhnPute
Rohprotein 8.0 % (Protein)
Rohfett 4.0 % (Fat)
Rohfaser 0.2 % (Raw Fiber)
Rohasche 2.2 % (Raw Ash)
Feuchtigkeit 81.0 % (water)

Am I missing something here? I actually ran this food through multiple carb calculators, and they all seem to agree on the 4% carbohydrate numbers. This one puts it at 4.6% carbs, 86 calories per 100grams, for a minimum total of ~300 calories a day that we are currently feeding him. And higher than that if I give him 400grams a day. From what I have read, he *requires* about about 200-250 calories a day. He's not really gaining weight, so it again, seems like he simply urinates all the extra calories out as sugar. I am definitely open to education on this, though. I thought I was taking the appropriate measures to educate myself, and evaluating his food properly.

http://felinenutritioncalculators.com/carbcalorie.html

One of my other options is the Kattovit Diabetic food, but numbers look similar. (Well, actually 1.8% carbs) I can try this later on. I know there are other, non expressedly labeled as "diabetic" foods, but I am not a native German speaker, and it has been a challenge to find a decent food.

https://www.zooplus.de/shop/katzen/...88?origin=hopps&q=kattovit diabetes&i=2&ro=20
analytical components

ChickenSalmon
Crude protein 8.0 %
Crude fat 4.0 %
Crude fiber 2.0 %
Raw ash 2.2 %
calcium 0.25 %
phosphorus 0.2 %
humidity 82.0 %
Strength 1.5 %
metabolizable energy 73.0 kcal/100g
Total sugar 0.6 %


And as far as feeding him more... How much more? 5-6 bags a day? A half of kilo+ of food per day for an 8kg cat? That seems like a lot of food, and despite what I *think* is a low carbohydrate food, if you feed them 30%+ food than they require per body weight... That is more total carbs, right? Which puts up back where we started, having to try to outrun the carbs with insulin.

I don't know, though. It seems the more we feed him, the higher his blood glucose goes? I am willing to try, though, but it will have to wait until we get back from vacation. For now, based on these numbers, are we thinking 1.25 units 2x day is a safe place to be? (Assuming the calculators are correct, and this is an acceptable food...)
 
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shortbusruss said:
Thanks for the response. But, can you clarify about the food? I am actually in Germany, feeding him the Animonda diabetic formula, and online calculators say this food is around 4%. It's not a dry food. It is a wet food, "in a bag". Sorry for not clarifying. He refuses to eat canned food, full stop. He will literally starve, and go into hunting mode and go into the basement desperately searching for anything else to eat, rather than eat a canned food, or a pate. Leaving us pretty much only the option of wet food in individual bags. This food is not one of the jelly or gravy heavy options. It pretty much looks like meat chunks, with a very slight amount of gravy/jelly, but not like the gravy/jelly options we have tried before. It is wet chicken and turkey flavors, in a bag, with 85 gram serving size per bag.

https://www.zooplus.de/shop/katzen/...tes/1903535?origin=hopps&q=animonda&i=1&ro=20

Analytische Bestandteile

HuhnPute
Rohprotein 8.0 % (Protein)
Rohfett 4.0 % (Fat)
Rohfaser 0.2 % (Raw Fiber)
Rohasche 2.2 % (Raw Ash)
Feuchtigkeit 81.0 % (water)

Am I missing something here? I actually ran this food through multiple carb calculators, and they all seem to agree on the 4% carbohydrate numbers. This one puts it at 4.6% carbs, 86 calories per 100grams, for a minimum total of ~300 calories a day that we are currently feeding him. And higher than that if I give him 400grams a day. From what I have read, he *requires* about about 200-250 calories a day. He's not really gaining weight, so it again, seems like he simply urinates all the extra calories out as sugar. I am definitely open to education on this, though. I thought I was taking the appropriate measures to educate myself, and evaluating his food properly.

http://felinenutritioncalculators.com/carbcalorie.html

One of my other options is the Kattovit Diabetic food, but numbers look similar. (Well, actually 1.8% carbs) I can try this later on. I know there are other, non expressedly labeled as "diabetic" foods, but I am not a native German speaker, and it has been a challenge to find a decent food.

https://www.zooplus.de/shop/katzen/katzenfutter_dose/kattovit/high_fibre/982888?origin=hopps&q=kattovit diabetes&i=2&ro=20
analytical components

ChickenSalmon
Crude protein 8.0 %
Crude fat 4.0 %
Crude fiber 2.0 %
Raw ash 2.2 %
calcium 0.25 %
phosphorus 0.2 %
humidity 82.0 %
Strength 1.5 %
metabolizable energy 73.0 kcal/100g
Total sugar 0.6 %


And as far as feeding him more... How much more? 5-6 bags a day? A half of kilo+ of food per day for an 8kg cat? That seems like a lot of food, and despite what I *think* is a low carbohydrate food, if you feed them 30%+ food than they require per body weight... That is more total carbs, right? Which puts up back where we started, having to try to outrun the carbs with insulin.

I don't know, though. It seems the more we feed him, the higher his blood glucose goes? I am willing to try, though, but it will have to wait until we get back from vacation. For now, based on these numbers, are we thinking 1.25 units 2x day is a safe place to be? (Assuming the calculators are correct, and this is an acceptable food...)
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Just a comment on the food. The values you plug into the calculator must be the “as-feds” or “dry matter basis” values. I don’t know how the companies in Germany list these components on their foods as, when i lived there, I had US food shipped over to us. In the US, what is required on the can is “guaranteed analysis” which you cannot use accurately to compute the % calories from carbs. If you can find out what the as-feds or DMB numbers are by calling the companies, then the calculator you used is acceptable, especially for as-feds. Typically, if a food has gravy, it’s a higher carb food.

To maintain an “ideal” weight, an indoor cat needs about 2-3% of its weight in calories. So if he’s 4 kg, 4kg x 1000 g/kg =4,000 grams x 0.03 = 120 calories if he’s active (I used the 3%). An unregulated cat will eat more but if you try and spread his food out in minimeals given at preshot (PS), +1, +2, +3, it might help him more. Any food you give him after +6 is going to start potentially shorten his duration with the insulin (you can see how quickly his BG shot up today after you fed at +7). If he’s absolutely starving after +6, try to feed him super low carb freeze dried treats that are basically 0% carbs. He should not eat in the two hours before his shot (unless his BG is lower) to keep from influencing the PS BG. Is he at an ideal weight or underweight due to the diabetes? If he’s underweight, I’d use the formula above to calculate the calories he needs for his ideal weight. This post (click on dark blue to left) might address some of your questions about feeding him as much as he will devour.

I’m going to send you a private message about the spreadsheet. Just look in the upper right corner of this page next to your user name for “inbox”. You’ll probably see a letter over top it. Just click on “inbox” and you’ll see my message. Thank you.
 
This link UK Cat Food List lists foods also available in Europe. You want foods with carbs less than 10%. I think what you are feeding is what we call pouches.

Is your meter a human one?

You should take a look at our Prozinc / PZI forum, especially the Sticky Notes including the one on dosing methods.
 
Here's a multiresponse to the questions asked -

He is using a human meter. Measurements in mg/dL.

I believe he is underweight for his size. He was at 15lbs or so at his fattest... Now he is around 9lbs (4kg). He lost a lot of weight, very fast as he started to express diabetic symptoms. He feels very thin, and you can feel his ribs.

I *was* following the food list here at https://www.diabetes-katzen.net/info_basics_futtersorten.html before we started bouncing around on different foods because of his poor response to Caninsulin. We actually have quite a few Aldi "Catchet Classic" pouches left over from the last batch of food we tried, before we got him on ProZinc. That forum is basically a Germany clone more or less, of this site, and gives a lot of the same advice. Many of the UK foods are not on this list, or the ones that are, are pate only, which he refuses to eat.
 
Hi there, from Spain, but I often shop at zooplus, a lot of the foods in the UK list are available on zooplus.de .

Pouches of the top of my head are catz, feringa, some of the Aldi pouches are also low carb (not all) the info for the ones that are are in the link Wendy gave you.

George was also ravenous all the time when unregulated it, stealing anything from Spanish omelette to blueberry jam on toast! It does subside as he gets better regulated.

The Animonda integra Diabetic is LC as is the Katovit. George doesn't eat those but I have come across them.

I think Thrive also do some pouches now, may be worth taking a look at those.
Have a look at Almo Nature as well thet did do a lot of pouches back in 2016, their range has changed quite a bit, but there may be something suitable there.

It helps to have a bit of variety with the soft food, as they can sometimes tore of just one flavour.
 
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Gill & George said:
Hi there, from Spain, but I often shop at zooplus, a lot of the foods in the UK list are available on zooplus.de .

Pouches of the top of my head are catz, feringa, some of the Aldi pouches are also low carb (not all) the info for the ones that are are in the link Wendy gave you.

George was also ravenous all the time when unregulated it, stealing anything from Spanish omelette to blueberry jam on toast! It does subside as he gets better regulated.

The Animonda integra Diabetic is LC as is the Katovit. George doesn't eat those but I have come across them.

I think Thrive also do some pouches now, may be worth taking a look at those.
Have a look at Almo Nature as well thet did do a lot of pouches back in 2016, their range has changed quite a bit, but there may be something suitable there.

It helps to have a bit of variety with the soft food, as they can sometimes tore of just one flavour.
Click to expand...

Good to hear the Animonda Diabetic and Kattovit are low carb. He has not tired of them yet, so I will continue on with them as mainstays until I can get him regulated, and then transition to the Catchet Classic (as it was specifically recommended by the German Feline Diabetes forum..) and other stuff I have laying around that I think are LC, and see if there is any negative response. We spent quite a bit on canned food only to find out he will not eat them, so we have about $100 of food sitting in the basement of varying brands.

ZooPlus.de has been good for the Animonda, and has Kattovit available even cheaper than that, and much cheaper than getting from Fressnapf in-store.

The main issue has been getting my wife on board. She feels sorry for Coco, and wants to feed him when he is hungry. I have had to be adamant about the fact that overfeeding him is driving his blood sugar up, making him hungrier, and he is not getting energy from what he eats anyways when his blood sugar is sky high, so really, what is the point of feeding him a lot more calories than his weight justifies? I think she is coming around, as I explain the importance of him getting most of his calories while his BG is dropping, rather than in the second part of his cycle, which will eventually bring his average BG down as we get his dosage dialed in, which will make him less hungry, etc.

I do feel we are making some progress, as his BG was down to 225 or so PM +3. She is giving him ~42 grams of food, and that's it until morning AMPS check. I am gonna have his petsitter go with 1.25 units 2x daily, dependent on what AMPS/PMPS are. Too many reds/blacks with 1 unit.
 
So, everybody...

Given that we are taking him to the petsitter tomorrow, and we need to give a dosage plan based on AMPS/PMPS only, do you think this is good guidance to give to his sitter, based on what you see in the spreadsheet?


AMPS 400+ , shoot 1.50 - feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks
AMPS 200 - 400 , shoot 1.25 - feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks
AMPS 150 - 199 shoot 1.0 - feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks
AMPS 80 - 150 (not likely to happen) shoot .75, feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks
AMPS < 80, don't shoot, feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks

PMPS - We need some plan for giving him a larger amount of food, as there will only be a few hours in between PMPS and them going to bed...

PMPS 300 +, shoot 1.25, feed 85 grams after shot, 85 grams +2
PMPS 150 - 300 shoot 1.0, feed 85 grams after shot, 85 grams +2
PMPS 80 - 150 shoot .75, feed 85 grams after shot, 85 grams +2
PMPS < 80, don't shoot, feed 85 grams after shot, 85 grams +2

IF you have time to reply soon, that would be great, as I need to give him a plan before morning, as I am on night shift right now, with a few hours to go...
 
shortbusruss said:
So, everybody...

Given that we are taking him to the petsitter tomorrow, and we need to give a dosage plan based on AMPS/PMPS only, do you think this is good guidance to give to his sitter, based on what you see in the spreadsheet?


AMPS 400+ , shoot 1.50 - feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks
AMPS 200 - 400 , shoot 1.25 - feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks
AMPS 150 - 199 shoot 1.0 - feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks
AMPS 80 - 150 (not likely to happen) shoot .75, feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks
AMPS < 80, don't shoot, feed 42 grams after shot, 42 grams + 2, 42 grams +6, after that until PMPS, only dried meat-only snacks

PMPS - We need some plan for giving him a larger amount of food, as there will only be a few hours in between PMPS and them going to bed...

PMPS 300 +, shoot 1.25, feed 85 grams after shot, 85 grams +2
PMPS 150 - 300 shoot 1.0, feed 85 grams after shot, 85 grams +2
PMPS 80 - 150 shoot .75, feed 85 grams after shot, 85 grams +2
PMPS < 80, don't shoot, feed 85 grams after shot, 85 grams +2

IF you have time to reply soon, that would be great, as I need to give him a plan before morning, as I am on night shift right now, with a few hours to go...
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My concern is we don’t have much data to go on and especially little at night to know what he’s been doing. It’s one thing if a member has been here a while and has data. But I’m not comfortable saying this is a good plan or not with the data at hand. Things can change quickly with a dose and I don’t want to see your cat hypo because I agreed this was a good plan or, conversely see him go into DKA because he didn’t have enough insulin.

While it can be done and has occasionally been done here, we typically don’t use sliding scales even with PZ. I wish I felt more comfortable advising you on this but, as a Moderator, even I am not and I don’t think either of the other two would be either.

I am sorry; I’d like to help but this has to be your decision.
 
Marje and Gracie said:
My concern is we don’t have much data to go on and especially little at night to know what he’s been doing. It’s one thing if a member has been here a while and has data. But I’m not comfortable saying this is a good plan or not with the data at hand. Things can change quickly with a dose and I don’t want to see your cat hypo because I agreed this was a good plan or, conversely see him go into DKA because he didn’t have enough insulin.

While it can be done and has occasionally been done here, we typically don’t use sliding scales even with PZ. I wish I felt more comfortable advising you on this but, as a Moderator, even I am not and I don’t think either of the other two would be either.

I am sorry; I’d like to help but this has to be your decision.
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Okay, thank you. I think I am going to go with advising our petsitter to go with a straight 1 unit 2x daily, and the feeding advice above, and give him access to our spreadsheet, and we will continue to monitor his AMPS and PMPS numbers while on vacation, and give advice to them based on that. We have kind of been all over the place on his feeding time/amounts, so a little more caution is warranted.
 
shortbusruss said:
Okay, thank you. I think I am going to go with advising our petsitter to go with a straight 1 unit 2x daily, and the feeding advice above, and give him access to our spreadsheet, and we will continue to monitor his AMPS and PMPS numbers while on vacation, and give advice to them based on that. We have kind of been all over the place on his feeding time/amounts, so a little more caution is warranted.
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I would lean on the side of caution but see if they will check his urine ketones every day. Will they be able to contact you? If so, if he stops eating or drinking and becomes lethargic, he needs to see a vet immediately.

Please also be sure they have high carb food and syrup in case he shows signs of hypoglycemia. You can also show the petsitter how to post here, if necessary.

Have a safe trip and I hope you will post here when you get back.
 
Marje and Gracie said:
Please also be sure they have high carb food and syrup in case he shows signs of hypoglycemia. You can also show the petsitter how to post here, if necessary.
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I think this is a great idea, I gave my petsitter access to my FD boardand showed her how to post, so she could post for help when we were away. Although we were on touch daily, and George and I had quite a lot of data I felt happier knowing she had the back up of everyone here in an emergency if for some reason she couldn't get hold of me.
 
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