Twix_Low AMPS Reading

Samantha Styles said:
Good points. I can try that. He doesn’t seem overly motivated to go to the food too many times each day, so the more snacks have been harder for me to get him to eat. I usually have to pick him up and put him at the feeder, or bring the food to him to get him to eat all his snacks. But less at breakfast may help.
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He likes having servants to bring the food! Ha ha!
 
Suzanne & Darcy said:
And the Libre says Lo again? Huh? I wish there was a ReliOn reading close to that time. Was he lying on the sensor again? How many days old is the sensor?
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I know. It’s a little frustrating it happens when I’m not home! If I were home this would all be easier and I could get manual tests alongside it. I haven’t even showed my husband how to do manual tests, he’s trying to be supportive but wasn’t in agreement with me at the beginning so I’ve been just handling this mostly on my own.

Twix was laying on it when it occurred and husband fed him and once he got off the sensor he went back up to the 50s. My husband was able to feed him quick then had to leave. He’s usually gone before I am so I kind of got lucky he was even still there today when I needed him to feed him. I receive constant readings at work now that I can mobile track him. Which is nice. But also anxiety inducing bc I’m 30-40 minutes away and I can’t always leave. Especially a day like today where my husband is not here with me so I don’t have coverage. Fortunately he’s back in the 50’s. But aye yai yai. He likes to keep me on my toes this boy!
 
Well, I am really proud of you for taking this all on and taking the bull by the horns and helping Twix. Where is the sensor located on him? His side? Does he wear a shirt over it?

If his PMPS isn’t higher than it was this morning (when his BG seemed to be dropping) then I don’t think you should shoot .25 again just to be on the safe side. We can always call it a failed reduction and go back up to the “last good dose.” There are two doses that are smaller than a .25 unit. There’s a 0.1 and a drop dose. I am going to attach a photo of the 0.1 unit dose. It’s amazing what a small amount of this hormone can do. Wait … before I attach a photo…. are you using U-100 syringes or U-40 syringes? I almost forgot. I have several people right now using U-100 syringes with ProZinc and using the conversion chart to dose. It does make it easier to do fine dose changes and at this point may really be what you need for Twix.
 
Suzanne & Darcy said:
Well, I am really proud of you for taking this all on and taking the bull by the horns and helping Twix. Where is the sensor located on him? His side? Does he wear a shirt over it?

If his PMPS isn’t higher than it was this morning (when his BG seemed to be dropping) then I don’t think you should shoot .25 again just to be on the safe side. We can always call it a failed reduction and go back up to the “last good dose.” There are two doses that are smaller than a .25 unit. There’s a 0.1 and a drop dose. I am going to attach a photo of the 0.1 unit dose. It’s amazing what a small amount of this hormone can do. Wait … before I attach a photo…. are you using U-100 syringes or U-40 syringes? I almost forgot. I have several people right now using U-100 syringes with ProZinc and using the conversion chart to dose. It does make it easier to do fine dose changes and at this point may really be what you need for Twix.
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Okay. What number are you considering as higher? Just so I can be prepared.

I am using the U-40's but they actually don't have the individual lines on them, they only have the 1-unit measurements. I've been able to be precise with my measurements because I can go off the numbers as indicators, so it's allowed for good consistency. The 0.25 was actually the most challenging for me and I had to keep a used syringe for reference with the dose marked to ensure the next ones were the same. But if I am going to start going lower I may need to get a syringe with more lines/measurements to maintain precision. Depending on what these drop dose measurements look like...
 
Oh. I can’t believe you’ve been getting along all this time with no half unit markings. Then each dose may be a little different?
 
Suzanne & Darcy said:
Oh. I can’t believe you’ve been getting along all this time with no half unit markings. Then each dose may be a little different?
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Well, I hope not! The numbers on the side of the syringe serve as indicators. For example, with my 1/2 dose, I position the bottom of the syringe plunger right on top of the "1" or "2". The numbers are consistent across all syringes, so they help guide dosing accurately. The same goes for 3/4 dosing; I align the plunger directly on top of the "1" line rather than the top of it being below.

I’m not sure if that explanation is clear, but I feel confident that I’ve maintained consistent dosing, as I know consistency is critical. I am less confident with the smaller doses, though, which is why I kept a syringe marked at 0.25 as a reference for future dosing accuracy. And if I'm going below that then I will want to find syringes with more markings to help ensure precision.
 
Here are what my U-40s look like, just for reference.
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I will leave you alone now! I’ve got to run out for several hours. I will look at Twix’s spreadsheet when I get home. Just think…. he’s doing so well that we are down to .25 units and now we are at least talking about even smaller doses! I’m excited.
 
Suzanne & Darcy said:
I will leave you alone now! I’ve got to run out for several hours. I will look at Twix’s spreadsheet when I get home. Just think…. he’s doing so well that we are down to .25 units and now we are at least talking about even smaller doses! I’m excited.
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I'm excited as well! I am trying not to get my hopes up too high, but this is feeling very optimistic! I really appreciate your help and your accessibility. It's keeping me sane and helping me feel more confident in making appropriate decisions!
 
Hmmm… I’m contemplating skipping him PM dose? He skirted at 50 most of the day today. Right now he’s at 108, however, I just learned he was left out a snack after the hubs left for a day and when he got home Twix finally decided to eat it (around 4:00pm), so I’m concerned the number isn’t very reliable.
 
Going on day 4 with no insulin, and he’s been self maintaining! Continuing to monitor to see how he does and keeping fingers crossed he stays in remission.

Now dealing with peeing outside of the litter box issues again and trying to get that under control & figure out what’s going on there. Other than that he’s looking better, more vocal and perky, and overall seems to be doing well.
 
What’s going on recently? Everything went black? No Libre? No backup tests? It looks like it’s back on now? I was just trying to check in and see how he is doing.
 
Hi Suzanne!

Just logged back in to give you an update. Twinkie boy is still in remission!!! :-) He gets random spot checks and has been staying in good levels.

He put on 3.5 lbs and is almost back to his healthy pre diabetic weight! His neuropathy is almost gone. You can tell he still has some in his toes and sometimes first thing in the morning. But he’s back walking on his toes, coming upstairs every night, & jumping up on things. His coat is healthier & he is his normal spunky, sassy self again.

We just rechecked his bloodwork and thyroid levels are good with his medication, and we’re adjusting him to thyroid meds 2x per day to see how he responds. He does have CKD. Combination of age and thyroid issues + mismanagement of hypothyroid at beginning all likely contributors.

But I’m continuing to monitor him, he does not seem to be in any discomfort, I have him on Weruva wet food (based off a list you provided me at one time) and he has a great appetite. Vets don’t want to adjust his food much more than what I have him on now bc they don’t want to risk diabetic remission. So just working on minimizing any more kidney damage, and keeping him as healthy and as comfortable as possible for as long as possible.

He is in a significantly better position than he was 3-4 months ago. Thank goodness! I know there are some CKD groups and I may wonder over to check them out.

Thank you again for all your help while I was working with him. Your assistance really made all the difference :-)
 
It’s really good to hear that Twinkie is still in reme. His last few days have been really nice and green. I am glad the ant helped and glad you got it taken care of. If his labs were drawn during the time he had a UTI, it’s possible they would look worse than they actually are. I’m sure you know that UTI untreated can also lead to a kidney infection. So I hope he’s feeling a lot better. What kind of antibiotics did you have him on? How were his kidney numbers? BUN? Creatinine? USG?
The best CKD group around is the one affiliated with the felinecrf.org website (which is a wealth of well-documented information.) The support group is great and the people over there are wonderful, knowledgeable, and caring. I have been a member for some years now, although I often don’t have time to go over there due to being here helping people :)
 
I don’t know why these notifications started filtering to my junk folder!? His infection was a while ago and affecting his glucose numbers. But he’s been in normal range for quite some time now and his test results were after that had passed.

His numbers from blood test on 12/10 were:
BUN 52
Creatine 4.2
USG - what is this? I don’t see it on the report?

I don’t know what any of these numbers mean but they don’t seem in range. My vet mentioned something about getting me with a kidney specialist so I need to follow up with him on that. I should pop over to the kidney group.

It was so consuming & overwhelming when he was sick that now that my heads above water it’s been hard to dive back into everything. But I def want to make sure I try to stay ahead of the kidneys the best I can. An issue is the hypothyroid can have direct effect on the kidney, etc. but I’m not the biggest fan of the thyroid group, however, I might need to try popping back in there.
 
Suzanne & Darcy said:
It’s really good to hear that Twinkie is still in reme. His last few days have been really nice and green. I am glad the ant helped and glad you got it taken care of. If his labs were drawn during the time he had a UTI, it’s possible they would look worse than they actually are. I’m sure you know that UTI untreated can also lead to a kidney infection. So I hope he’s feeling a lot better. What kind of antibiotics did you have him on? How were his kidney numbers? BUN? Creatinine? USG?
The best CKD group around is the one affiliated with the felinecrf.org website (which is a wealth of well-documented information.) The support group is great and the people over there are wonderful, knowledgeable, and caring. I have been a member for some years now, although I often don’t have time to go over there due to being here helping people :)
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Thank you for the CKD group info!
 
Samantha Styles said:
I don’t know why these notifications started filtering to my junk folder!? His infection was a while ago and affecting his glucose numbers. But he’s been in normal range for quite some time now and his test results were after that had passed.

His numbers from blood test on 12/10 were:
BUN 52
Creatine 4.2
USG - what is this? I don’t see it on the report?

I don’t know what any of these numbers mean but they don’t seem in range. My vet mentioned something about getting me with a kidney specialist so I need to follow up with him on that. I should pop over to the kidney group.

It was so consuming & overwhelming when he was sick that now that my heads above water it’s been hard to dive back into everything. But I def want to make sure I try to stay ahead of the kidneys the best I can. An issue is the hypothyroid can have direct effect on the kidney, etc. but I’m not the biggest fan of the thyroid group, however, I might need to try popping back in there.
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Those kidney values are too high. Do you have the reference range for the labs tests (tells you the low end and high end of what the lab considers to be the normal range?
 
Oh, the USG is the urine specific gravity. It is a measure of how concentrated the cat’s urine is. It is a numerical value like 1.03. The lower the number the less good of a job the kidneys are doing of concentrating the urine.
 
Any idea what Twix’s phosphorus value was? Did your vet tell you Twix has kidney disease- because those numbers look like it. You should look into feeding a lower phosphorus food like the Weruva BFF pates. I can give you a list of low carb lower phosphorus foods if you like (if I have not given it to you in the past.)
 
Samantha Styles said:
I don’t know why these notifications started filtering to my junk folder!? His infection was a while ago and affecting his glucose numbers. But he’s been in normal range for quite some time now and his test results were after that had passed.

His numbers from blood test on 12/10 were:
BUN 52
Creatine 4.2
USG - what is this? I don’t see it on the report?

I don’t know what any of these numbers mean but they don’t seem in range. My vet mentioned something about getting me with a kidney specialist so I need to follow up with him on that. I should pop over to the kidney group.

It was so consuming & overwhelming when he was sick that now that my heads above water it’s been hard to dive back into everything. But I def want to make sure I try to stay ahead of the kidneys the best I can. An issue is the hypothyroid can have direct effect on the kidney, etc. but I’m not the biggest fan of the thyroid group, however, I might need to try popping back in there.
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Is Twix thyroid not normal after the I-131 treatment?
 
Yes, the vet informed me he has CKD.

He mentioned that his hyperthyroidism could have been masking it. So we aren't sure if he had it before and it was noticed after we fixed his hyper, or if this is due to the mismanagement of his hypothyroid post-I-131. However, both are likely contributors. His thyroid is not normal post-I-131 treatment. He is in the small percentage of cats that went into hypothyroid and will require lifelong medications.

His I-131 specialist also thinks that the hypothyroid issues (and mismanagement of it at the beginning) contributed to his diabetes. The thyroid board had a lot of articles and research showing that twice-a-day meds are better for a majority of cats on hypo meds as it's better for their kidneys, so my vets were okay with us switching him to hypo meds twice a day. Once we got his medication correct for his hypothyroid AND I got his diet right, we started getting better control of his diabetes and got him into remission.

He is being fed Weruva BFF Hip Hip Hooray for Pate only. Once I read that the thyroid meds and issues can be a problem for his kidneys I switched to this brand based on a list you provided me previously to be kinder to his kidneys.

Let me see if I can upload his most recent lab results. I think I have access to a spread from the other discussion board, which I can try to get up to date on his lab results.

I don't have blood glucose tracking as I just have been doing random spot checks and not entering it into the spreadsheet as they've been good.

Specific Gravity: 1.019
Creatine: 4.2 (Reference range 0.5-2.4)
Alk Phosphatase: 16 (I'm not sure if this is what you were asking for with phosphorus levels?)
BUN: 52 (Reference range 14-36)
Bun/Creatine Ratio: 12
 
So all of his spot check glucose readings have been under 100? Or almost all of them anyway? I just want to make sure nothing has changed there.

I definitely would familiarize myself with the felinecrf.org website and join the group too.
How does Twix seem to you these days? Still eating well?
 
Correct, all of his spot checks have been below! But I will continue to spot-check more regularly. As he's continued to be good I have been spot-checking less frequently. His highest reading recently was at the vet and that was at 94. Which makes sense because he hates the vet and was likely nervous.

His neuropathy is not noticeable anymore! He's back to walking on his toes, he's running up and down the stairs, jumping up on things. Overall his coat, weight, and attitude are how he was pre-thyroid issues. I am continuing to give him the B12 pills I started for his neuropathy. His appetite is great, he's back to using the litter box, etc. He is definitely feeling better and acting more like his old pre-sick self.

I will be sure to check out this CKD group.
 
Hi Suzanne,

I just wanted to give you an update on Twix. He’s still in remission, his neuropathy has completely reversed, and he’s doing really well! He was diagnosed with CKD (not so much a surprise after everything), but we’re monitoring that closely and recently started giving him fluids to support his kidneys. Aside from that, everything seems normal for him. He is currently a happy and content old man.

We’re grateful to have gotten another year with him (since the start of his issues), and at this point, he doesn’t seem to be in any sort of decline, so I'm hopeful we still have a good amount of time left with him. I thought you’d appreciate the update, and we can’t thank you enough for helping us through his diabetic scare; it truly made all the difference.

Thank you,
Sam & Twix
 
It’s really good to hear from you, Samantha! I am really happy to hear that Twixie is still in remission and doing so well. It means a lot to me to know this. I am sorry it took me so long to reply! I have had my share of cat problems in addition to helping people here on the FDMB. I’ve had cats undergoing radiation and cats with unknown symptoms having liver problems and then unknown things on ultrasounds and a cat who is getting ready to have I-131 treatment next week and a cat, just today with a fever over 105 who is completely red in his ears and skin and appears to be having an allergic reaction to something. We just got home from the vet about half an hour ago. I had set myself a reminder to reply to your message at 9 p.m. tonight!

I’m sorry about the kidney disease. Cats can stay stable for a long time with CKD if they’re on a lower phosphorus diet and are well hydrated (wet food helps a lot with that as you know.) Do you check Twix’s BG periodically?

Let me ask you about the I-131 treatment. How did that go? What was it like? Anything that I should expect that I might not expect? I’m not looking forward to confinement afterwards, but after that we should be done with everything.

Thanks for your kindness in writing to let me know how Twix is doing. I hope you are doing well too. ❤️
 
Hi Darcy,

Sorry to hear you're having such a rough stretch with your little ones. Definitely sounds like you have your hands full!

Yes, that’s what we’ve been told, too. Twix is on a very specific diet and gets fluids to help. His levels have been holding steady, so we’ll see how he continues to do. I’m in the CKD group as well, though I don’t post much. I’ll probably check in there next time we do bloodwork. I actually don’t check his BG anymore outside of his labs; that’s a good idea, though. He tolerates the fluids well, but I try to prick him as little as possible.

The I-131 treatment went really well. The vet was sweet, and Twix did well staying there for the treatment. The confinement afterwards wasn't too horrible. It goes quickly, and honestly, I don't even remember it now. The problem came afterward when he went hypothyroid, and we didn’t catch it quickly enough. To make things worse, my vet had prescribed his hypothyroid medication incorrectly (only a few times a week, which really isn’t the way to go). That snowballed into other issues, diabetes, and even an E. coli infection. With your help, we were able to get the diabetes under control and get him into remission.

I do like my vet, and he even consulted with the radiation specialist when making decisions, but mistakes still happened. In a way, managing post–I-131 thyroid issues reminded me of diabetes: vets have the knowledge, but they’re not always well-versed in the nuances. You end up having to do your own research and apply both what they know and what you learn. I don’t think it’s uncommon for thyroid cases to be mismanaged, and I can understand how the mistake happened; it was just unfortunate, because for Twix, it came very close to being dire.

I ended up joining a thyroid group, and the info there was very helpful. Once I switched his thyroid meds to twice daily, he improved a lot. Honestly, the mediator can come across a bit abrasive, but the knowledge on the site is excellent, and I’ve seen her help catch hypo cases early. My vet isn’t a fan of all the tests she recommends, but has been supportive of whatever I decide. I have mostly stuck with the vet-recommended testing, while simultaneously pulling info from this site/chats. The articles and discussions really helped me feel more confident managing his care. And his behavior and actions seem to confirm he's feeling good.

If you want to check it out, here’s the link: https://groups.io/g/FelineThyroidManagement/messages

It might be a great resource for you. If I ever had to go through I-131 again, I’d definitely manage things differently from the start. For us, it’s meds for life now, not the outcome we hoped for, but you just do the best you can! Never knew a cat could get radiation treatment, have thyroid issues, or be diabetic. Now... I know. Haha.
 
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