Unusual Day of Testing

@Marje and Gracie, @JanetNJ, @Panic Today was an unusual day of testing. Started high, then went lower, then went higher then went lower. I'm not done with the testing yet but I have never seen this before? Was the 278 at +6.5 a fluke?

 

Is it possibly due to food? Fairly big increase for food though.

Usually when I get a weird number like that I test again to double check.

 

I agree that I should have rechecked the test. I had just made a reduction to her insulin last night so I thought maybe that was why her numbers were so high at +6.5. I should have rechecked the 278 at +6.5 and also the 179 at +9. I guess I will know more when I do her PMPS. I don't think it was the food but always something to think about. Thanks, FrostD!

 

No harm! Just based on testing history nadir usually seems to be right about the 6 hr mark, so I'd have expected it to be lower, definitely a data outlier from my perspective but the others you tagged might have different ideas.

The new vial might make a difference, but based on your recent data I don't think the old one had lost efficacy.

Some days I wonder if the spiders in the basement are actually 0% carb

 

I know, it was so weird to get that high number during what is typically around her nadir. I should have used better judgement and retested. It is so difficult to get blood from her ears now. I don't know why but I never had to stick her this many times to get a good test. Will work with rubbing the ears but she didn't like the rice sock.

 

Hi Summer and Susie!

Not sure where that 278 came from yesterday but it could have been a bad strip or something freaked her out and rose her BG? I'd think maybe the strip was off more than anything but I wouldn't be too concerned for a one-time thing. She is doing really good so far.

A couple suggestions for you, by no means dealbreakers or anything, but you might consider putting the shot "times" in your description instead of in the AM/PMPS cells, it makes it a little harder for us to read at a glance. The time isn't really relevant for us. Another thing I'm seeing is a lot of seafood - nothing wrong with it diabetic-wise but most of us avoid seafood as a regular meal. Dr. Pierson touches on why in her chart:

Most of us feed the poultry variety from FF Classics. Course if Susie is allergic or what-not, you do you, but just wanted to point that out!

 

Thank you, Panic. At first I thought the 278 was a quirk at 6.5 but I just got a 222 at 7.7 so maybe not. I'll test again +9 and see if she continues to go up or goes down again. She did just have a reduction in insulin so that may be why she is getting higher numbers. I would prefer to put the shot times in the AM/PMPS cells. It is just easier to look across the chart to see what time I want to test next i.e. +5 hours after shot time, etc. Thanks for the info on the fish. I just bought more but will try to space them out and then only give to her occasionally. Unfortunately, they are a major staple of the Fancy Feast Classic Pates and I have been looking for variety. I appreciate hearing from you.

 

How often are you feeding her? Another option is feeding past nadir can cause the insulin to "burn up" quicker, though it wouldn't cause an increase and then another dip during the cycle, it would just cause the BG to raise earlier and stay that way until next pre-shot.

 

She only gets one can (3 oz) of Fancy Feast in the early morning and then again after PMPS. I do give her whole life treats throughout the day when testing or if she gets really, really hungry prior to dinnertime.

 

Is she underweight at all?

Either way we strongly encourage multiple meals during the cycles, it's harder on the pancreas to just have two large meals. With Vetsulin we usually recommend food at onset, usually 1-1.5 hours after insulin, then a couple more times before nadir. This also helps slow the drop of BG to be a little more gentle, especially on a harsher insulins. I'd give my girl 4 meals per cycle (8 per day).

 

Okay, so please give me a plan. Look at Susie's spreadsheet and tell me when I should feed and how much. I only have Fancy Feast. I have been unable to determine nadir. It varies (inter-day variability?). If Susie were your cat when would you feed and how much? I really need some help here. By the way, I will be switching to Lantus in about 35 days. I already have the approval from my vet and he is working with me to get a good price. I have the syringes but just had to reorder Vetsulin because I waited to long to get the Lantus transition into motion.

 

I might do something like mini meals at +1.5, +3, +5, +6 as a rough guideline. You can of course adjust it if you find the meal times need to be tweaked to cater to her cycles. I'm basing this off that Susie looks like she onsets around +1.5 to +2, and nadirs around +6.

When Panic was still with me, she would get mini meals at +2, +4, and +5, but of course if she was running low we would feed additionally as-needed, sometimes every half hour, so don't feel like that's a strict schedule or anything.

Very glad to hear you'll be switching to Lantus! Did you look into Marks Marine Pharmacy? They sell Lantus at a third of the cost than the US.

When Susie changes to Lantus, her onset and nadir may change to something else, so you may end up feeding at +2, +4, +6, or something like that. Also note that onsets/nadirs can change in general, it's never set in stone.

With mini meals, you just feed their regular food. If Susie is willing to eat more than 2 cans of FF (unregulated diabetics often need 1.5-2x the amount of food regulated cats do) get another can and split it for mini meals. I would also have zero carb treats (usually baked chicken) after nadir if they were still peckish.

 

She is not underweight. The last time I weighed her she was 14.16 lbs. She is slowly loosing weight which the vet wanted. He wants her down to 10 lbs but I think that is too much. She is not a small cat but not large either.

 

I'll go with your plan but might not do the +5 mini meal. I usually lie down between 10:00 and 11:30 in the morning. I hope these mini meals do not weaken the insulin. She is usually the most hungry prior to AMPS and I really have to give treats in the afternoon because it has been hard for her to go the 12 hours before a main meal. Hopefully, the mini meals will have curb that hunger. Yes, I looked at Mark's Marine and was going to buy the five pens from them but my vet said he thinks he can get me a better deal at a local pharmacy. I need to verify that with the pharmacy because I don't want to run out of time, again, with the transition. Thank you, Elizabeth.
Than

 

I would not consider Susie to be unregulated. I’d say she is regulated. Here are the definitions of regulation:

• Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
• Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
• Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
• Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
• Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
• Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]

I would suggest that Susie only be fed the number of calories she needs to maintain her ideal weight since she is regulated. There is an interesting discussion in this post on feeding kitties as much as they want.

 

I was surprised the article from Long Beach Hospital said the following: "Increasing the complex carbohydrates and fiber in the diet will minimize the rise in blood glucose level as the body digests this food. The food we recommend for this is called Hills W/D. This allows for less fluctuation in blood glucose and easier treatment with insulin. In addition, since many of these cats are obese, the higher fiber will help minimize this problem. Dietary therapy might be all that is needed for the obese cat with NIDDM. A cat that is underweight from diabetes mellitus should not be put on a high fiber diet. Since this disease is prevalent in older cats this change in diet might be met with resistance. In these cases mix the higher fiber food with its regular diet to get some advantage of the higher diet. Do not feed foods that contain excess sugar like semi-moist canned foods."

I thought the Hill's W/D was too high in carbohydrates. I know the dry is. Also, the article says I should store the insulin on its side in the refrigerator to help with mixing. I thought it needed to be upright.

I agree about not overfeeding. I gave Susie three small mini meals yesterday at +1.5, +3.7 and +6.5. She threw up between the +6.5 meal and the next test. Maybe it was too much. I think I'll just give her a mini meal once or twice a day but not after nadir. She is always so hungry in the afternoon that it is hard for me to stretch her main meals, and injections, out the full 12 hours although I know I should. I do supplement with treats and it helps a little but she still wants dinner earlier than recommended. I know when I switch to the Lantus that I will not be able to feed and shoot early.

 

Hill's w/d is too high in carbs for a feline diabetic.

* UK dry formulation: 35.5% kcals from carbs ('as fed' analytical constituent data here)

* UK wet formulation: 24.1% kcals from carbs ('as fed' analytical constituent data here)

There follows a real-world example of the effect on BG levels of w/d (dry formulation) and the effect of its subsequent replacement with low carb wet food. As I posted on one of your earlier threads, the AAHA 2018 cat and dog diabetes management guidelines specifically recommend a low carb, wet diet for feline diabetics.

Below is an excerpt from Saoirse's spreadsheet in the early days of her treatment. The practice we were registered with insisted that she had to be on w/d Dry, and that no other food could be even considered for a feline diabetic. Insulin was Caninsulin (aka Vetsulin). Saoirse was underweight when they prescribed the food so not only did they prescribe a food that was essentially kitty cornflakes for a severely diabetic feline but at the same time they were adamant she eat a food that purportedly facilitates weight loss for a cat that needed to regain weight. (We moved to a different veterinary practice shortly after Saoirse was diagnosed.)

BG readings below were taken with an Alphatrak 2 meter. You will need to look at the actual numbers rather than the cell colours because I used a custom colour coding scheme in Saoirse's spreadsheet. (TL;DR version: dark reds and oranges bad, mid and dark greens good, bright red very close to or below lower bound of normal reference range given to me by my vet for use with the Alphatrak.)





Saoirse went from being "a true diabetic with no hope of ever achieving remission" (according to one of the IM specialists at a leading vet school with whom our vets consult for their diabetic patients) to a cat with a real chance of achieving remission - all within the space of three weeks. The data upon which that specialist based her assessment was in the upper section of the graphic above, when Saoirse was on 3IU Vetsulin BID and tanked up to the gills on what was effectively kitty sawdust. The data below the shaded line blasted her assessment out of the water. The most disturbing thing to come out of the consult is that the IM specialist made no suggestions whatsoever about trying any alternative treatment protocol. Saoirse was just consigned to the heap.

The shaded row indicates the day that Saoirse started her diet transition (10 July) from w/d Dry to low carb wet food. As is clear from the spreadsheet, removal of w/d Dry from her diet led very quickly to a massive improvement in Saoirse's BG levels and a slashing of her insulin needs.

While there is much useful information in the Long Beach articles, there are a number of things that are questionable, not least their position on the use of oral hypglycaemics.


Mogs
.

 

It is not only sad but disturbing when vets recommend the Hill's W/D. My vet did too. He said the wet and dry would be a good food for her. I printed a document that stated the carbs were too high in this food and was going to give it to him but changed my mind. I didn't want to insult his intelligence but surely he knows. He told me that his clinic has an agreement to sell Hill's because the food can be returned if need be so maybe that is why they push it. Because they have an agreement to sell. Disturbing. Saoirse certainly did better with the transition to low carb wet food. Susie has been on it since she was first diagnosed so I believe her diet is a good one. Fancy Feast Classic Pate and Whole Life Chicken treats. I'm going to watch her numbers the next few days and feed at least one mini meal during the day prior to nadir. I know I need to test at night. I have a problem where if I get up at night I cannot go back to sleep. No excuse for me as I am retired. Hopefully, I can get back to some blue numbers soon or I may need to increase the Vetsulin back up to 1.25 units. Thank you, Mogs.

 

Ok so 10 does seem drastic. Let's say 12 is a good size. 12x 20 is 240. Each can of ff is about 85- 90 calories (varies with flavor). Keeping in mind that diabetic cats often need extra food, I would give three cans a day. A can in the am, half can at lunch, a can in the pm, and a half can before bed.

 

No eed to get up in the middle of the night unless you suspect she's dropping low. I do a. Amps, a mid day test, pmps, and a before bed test usually +3-4

 

Does your cat eat spiders?

 

Just gave 1/4 a can at +2. Will give another 1/4 can around +5 or +6 then a whole can for dinner and 1/2 can before bed. She has been throwing up few times recently. Usually at night but the other day it was around +6. I wonder what this means.

 

If she were getting lower numbers I would make myself get up in the middle of the night. I do not want to go through a hypo with her. It was a nightmare for Shelley and Oliver the other night.