? Thoughts on increasing dose or changing food?

[Kelly and Buddy]

@LizzieInTexas @Bobbie And Bubba @Sienne and Gabby (GA) @Jill & Alex (GA) @Chris & China

Just thinking ahead and would love to hear your thoughts about how I should proceed with Buddy. During the week, I can't get much data but the numbers I am getting are higher than I would like them to be. So, if I'm going to make any changes, I would prefer to do it on Friday night so I have a couple of days and nights that I can monitor regularly to check for hypo.

Here are my thoughts/questions for you all:

1) When I went to straight FF before, his numbers went really low and I could never get in 2 shots a day. Should I try giving doing 1/2 FF and 1/2 Friskies and keep this dose for another week and see if his numbers go down?

OR....

2) Should I keep his food the same and increase his dose to .5 units?

3) Buddy still acts like he is starving all the time. He cries constantly and is a chronic counter surfer and other pet bowl scavenger. If anybody moves toward the kitchen or the room he stays in at night, he beelines to the counter or door begging for food. He currently gets one large (13 ounces) of Friskies a day (spread into 4 meals; I've tried 3 meals too and he still begs constantly) but I can not get any weight on him. He is still a skeleton at about 8.5 pounds (should be about 14). He's hyperthyroid but regulated.

SO, should I feed him more? I worry that will drive is BG up but it kills me that he is (or thinks he is) hungry all the time. Or is this still all because he isn't regulated?

I appreciate any advice you all can offer.

 

[Sienne and Gabby (GA)]

He's hypothyroid? It's usually hyperthyroid where cat's lose weight. If he's hypothyroid, is he getting too much of his thyroid medication? That would cause his weight to be down. Another possibility is exocrine pancreatic insufficiency. Cats won't metabolize their food properly and will require a supplement to help them do so. I believe the lab test is an fTLI.

I would suggest experimenting over the weekend when you have the opportunity to see how either of the options you noted work. It would be good if you could monitor Buddy's numbers given that ordinarily, you're not home during the day.

 

[tiffmaxee]

I think she meant hyperthyroid according to her signature but let’s see. EPI usually happens after having pancreatitis for a long time. Was an fPL ever done? Is stool normal? My bet like Sienne’s is the medication may need to be adjusted.

I too would experiment with food. If you can monitor a lot over the weekend I would steer the cycles with food. JMHO.

 

[Kelly and Buddy]

He's hypothyroid? It's usually hyperthyroid where cat's lose weight. If he's hypothyroid, is he getting too much of his thyroid medication? That would cause his weight to be down. Another possibility is exocrine pancreatic insufficiency. Cats won't metabolize their food properly and will require a supplement to help them do so. I believe the lab test is an fTLI.

I would suggest experimenting over the weekend when you have the opportunity to see how either of the options you noted work. It would be good if you could monitor Buddy's numbers given that ordinarily, you're not home during the day.

MAJOR TYPO on HYPO...Buddy is HYPERthyroid. I guess I just had hypo on my mind.

 

[Kelly and Buddy]

I will try mixing the food and see what happens. You'll probably be getting calls for help this weekend.

I desperately need to order a box of syringes but I am afraid to commit to a particular brand because everyone I've tried has had issues. The Walgreen's syringes I just bought have a funny arc of insulin at the top and it's almost impossible to use calipers. I wasted 5 syringes tonight because I could not find a syringe that looked right. I hope I dosed him correctly but am a bit concerned. What was supposed to be .25 was just barely above .5. I was SO FRUSTRATED and spent almost 30 minutes trying to determine what the proper dose should actually be and I still don't feel good about it.

Have you all had this experience? If so, where do you measure the "top" of the insulin when it is dome shaped and there is definitely insulin above the "0" mark. I've added a picture of this below; it's not great but I hope you can see the dreaded "dome". Arghhh...

Do you a particular syringe you trust and recommend?

 

[Kelly and Buddy]

Wish I could see it this easily when I'm trying to get two drops in, LOL.

 

[Bobbie And Bubba]

Hey Kellly, sorry I was offline all day. To answer a few of your questions, first, about the syringe discrepecency, it is a problem for many of us and that is why lots of us went to using calipers. Once you get the calipers set for your syringe ( all the calculations are different for different syringes, just try and ignore the markings and rely of the calipers to get the correct dose. Some of these syringes can be off by .25 - .50 of a unit! It is maddening.

I am assuming that the photo of the syringe you posted was the Walgreen syringe? If so , I see what you mean with the "arc" I use Walmart brand, Relion. The plunger is straight across which make reading where the dose is easier. Any syringe with a straight across plunger should be easier to read.

As far as the food amount and him being hungry all the time......how much does he weigh? How much should he weigh? Here is a food formula to give you an idea of how much to feed. Consider the kitty's age and activity level to go higher or lower.

Use the ideal weight of the cat. Is he underweight and he needs to gain, use the amount of weight that he should be in the formula. It is 13 X ideal weight + 70 = calories a day. Using a 10 lb cat as an example, it would be 13 X 10 = 130 + 70 = 200 calories a day plus or minus for age and/or activity level.

The Friskie 5.5 oz are about 154 calories a can depending on the flavor. 2 cans a day would be 11 oz and around 208 calories. Add another 2 oz to reach 13 oz and that would be about 264 calories to hit approximately 13 oz. See where his ideal weight falls into this formula, and perhaps he needs a bit more food?

I know with my civvie cat that is hyperT at 12.8 lbs was eating the same amount as my 18 lb Bubba and not gaining weight. Even though his T4 levels were showing he was in the middle of normal, it's only been recently that he is slacking off on eating as much. My point is, are you sure he is regulated?

I agree with the others to get a curve in this weekend, so you can see truly what the dose is doing. He could be going lower during the day and bouncing up by the PMPS test . Then you have more data to support whether or not to increase.

Which Friskie food are you giving him? They are not all created equal in the carbs department so double check the flavor against the food chart to make sure it is one that is under 10 carbs. If it is, you might want to give all FF one day this weekend and see how the numbers go and the next day, all Friskies and see how the BGs do. It sometimes takes a little experimenting with food working with the insulin. Some cats are extremely carb sensitive and a few % could cause havoc with he BGs. Check out the below link.
http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

[Kelly and Buddy]

Hey Kellly, sorry I was offline all day. To answer a few of your questions, first, about the syringe discrepecency, it is a problem for many of us and that is why lots of us went to using calipers. Once you get the calipers set for your syringe ( all the calculations are different for different syringes, just try and ignore the markings and rely of the calipers to get the correct dose. Some of these syringes can be off by .25 - .50 of a unit! It is maddening.

I am assuming that the photo of the syringe you posted was the Walgreen syringe? If so , I see what you mean with the "arc" I use Walmart brand, Relion. The plunger is straight across which make reading where the dose is easier. Any syringe with a straight across plunger should be easier to read.

As far as the food amount and him being hungry all the time......how much does he weigh? How much should he weigh? Here is a food formula to give you an idea of how much to feed. Consider the kitty's age and activity level to go higher or lower.

Use the ideal weight of the cat. Is he underweight and he needs to gain, use the amount of weight that he should be in the formula. It is 13 X ideal weight + 70 = calories a day. Using a 10 lb cat as an example, it would be 13 X 10 = 130 + 70 = 200 calories a day plus or minus for age and/or activity level.

The Friskie 5.5 oz are about 154 calories a can depending on the flavor. 2 cans a day would be 11 oz and around 208 calories. Add another 2 oz to reach 13 oz and that would be about 264 calories to hit approximately 13 oz. See where his ideal weight falls into this formula, and perhaps he needs a bit more food?

I know with my civvie cat that is hyperT at 12.8 lbs was eating the same amount as my 18 lb Bubba and not gaining weight. Even though his T4 levels were showing he was in the middle of normal, it's only been recently that he is slacking off on eating as much. My point is, are you sure he is regulated?

I agree with the others to get a curve in this weekend, so you can see truly what the dose is doing. He could be going lower during the day and bouncing up by the PMPS test . Then you have more data to support whether or not to increase.

Which Friskie food are you giving him? They are not all created equal in the carbs department so double check the flavor against the food chart to make sure it is one that is under 10 carbs. If it is, you might want to give all FF one day this weekend and see how the numbers go and the next day, all Friskies and see how the BGs do. It sometimes takes a little experimenting with food working with the insulin. Some cats are extremely carb sensitive and a few % could cause havoc with he BGs. Check out the below link.
http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Yes, the syringe I posted is the Walgreens syringe. The weird thing is the top of the plunger is flat but, for some reason, the dome still forms on the top of the insulin. I hate going into my weekend of "experimentation" without a good feeling about my syringes. Maybe I will try the Relion syringes because I can get them tomorrow. Just to clarify, are you saying that you can easily (well, as easily as can be expected) read both the top and bottom of the insulin band?

Also, I measure the initial one unit from where the plunger stops when pushed to the top to the 1 unit mark, is that correct? Again, that seems a bit weird since that ends up being a larger one unit measurement than any other unit on the syringe, if that makes sense. Maybe my syringes are just poorly made.

 

[Kelly and Buddy]

Bobbie,

Thanks for all your information. Buddy is about 8.5 pounds and should be about 14. He gets one large can of Friskies Turkey and Giblets (which I originally pulled off the food chart because it was only 5 carbs). The can says it has 424 calories so, by the formula above, a 15 pound cat should only need 300. So, basically, I'm feeding him the calories for a 20 pound cat, assuming I did the math correctly!! Yet, he is still so skinny.

He's had 2 thyroid tests since April and both tests showed he was regulated; he has been this hungry since the onset of the diabetes so I thought maybe it was because his diabetes wasn't regulated but nothing has improved, even after his numbers have dropped.

I agree with you and suspect he does drop during the day. He did last weekend but, overall, his numbers still seemed high. I will play around with the food this weekend and keep his dose the same (especially since I'll be getting new syringes). After tweaking his food, I can look at dose adjustment next week if he's still regularly in yellows. You know I'll be reaching out to you for advice when that time comes.

I am going to call his vet tomorrow and ask if they can fax his lab results to me so I can post them here.

Have a good night! Hopefully, you won't hear from me in the morning.

 

[Bobbie And Bubba]

Just to clarify, are you saying that you can easily (well, as easily as can be expected) read both the top and bottom of the insulin band?

Yes, the Relion plungers are straight across and with using the calipers, I feel I am getting a fairly accurate dose.

So that green dome only appears with insulin in the syringe? I haven't seen that before. If that's the case, then you could be under dosing him if you are reading the top of the green rather the top of the black plunger. But, I am not familiar with these syringes and can only tell you my experience with the Relions. All the syringes can have variances with how accurate or inaccurate the markings are, but as I said in an above post, ignore the markings after you have your calipers set for your syringes. Remember, if you switch syringes, you will need to recalculate the calipers.

 

[Kelly and Buddy]

Arghhhh...I am so frustrated. I went to Walmart to get Relion syringes. I am one of those people who really likes the 1/2 inch needle because it is much easier for me to know I get the needle in. Walmart is discontinuing them (many thanks to all the heroin junkies out there) and they did not have them in any other brand. I called Kroger, they had 1/2 inch needles but not 1/2 units. I ended up having to go back to Walgreen's and buy the syringes that I hate AND get them in the 5/8 inch because the 1/2 inch I ordered weren't in yet (even though they were supposed to be in yesterday). Regulation is bad enough but his syringe issue is killing me. LOL. I guess I'll order BD online and hope I like them.

I kept Buddy at his regular dose (well, his intended regular dose...who knows with these horrible syringes) but split his food to 1/2 Friskies and 1/2 FF. We'll see what happens. I will do a full curve tomorrow and hope for at least a small drop with the food change. Fingers crossed.

 

[Bobbie And Bubba]

For whatever it's worth, I really like the short needles, ( 5/16) and the reason is that I have shot all the way through more easily with the longer needles. I have done it with the shorter ones too, but it happened more with the longer ones.

Good luck with the curve tomorrow.

 

[Kelly and Buddy]

Thanks, Bobbie. I have never shot through with the long but I feel like I never really get the short ones in. It's funny how we all have our preferences. I may have to warm up to short because it is almost impossible to find the 1/2 inch need with 1/2 units.