Willow dosing

Suzanne & Darcy said:
Here’s what I wanted you to read. Some cats really do better in BG numbers with a few more carbs (but still low carbs under 10 percent). I have seen it help a few of our ProZinc cats. Hopefully you can find some foods she likes that will help.

https://felinediabetes.com/FDMB/threads/feeding-lowest-zero-carb-vs-lower-carb-foods.144220/
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I have read this before! I remember how some people were saying their cat's pre-shot numbers came down with some more carbs. She's so picky about wet food so I'll start experimenting! I have a list of the ones she likes, and most are 0 carbs. Before diagnosis, she always had some pumpkin puree on her wet food each day, and I'm curious if reintroducing a small amount might be a good idea. She really loves pumpkin.
 
How do you feel about the increase? She’s had some decent blue numbers, but I feel like it’s not a huge difference between the 2.0 numbers and the 2.2 numbers. The preshot numbers are more pink now than red.

Any luck with some new foods?
 
Suzanne & Darcy said:
How do you feel about the increase? She’s had some decent blue numbers, but I feel like it’s not a huge difference between the 2.0 numbers and the 2.2 numbers. The preshot numbers are more pink now than red.

Any luck with some new foods?
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As far as new foods, the only thing we've done differently is added the pumpkin back in. What I've noticed is that it makes her cycle WAY more gentle & predictable. At +2 she's right around the same as her PS value but then dips down gently and comes back up for PMPS, almost the same value as AMPS. It's ideal to have the +2 be about the same or dipped just a bit lower than pre-shot, right? Without carbs she would sometimes drop so fast and I think that's why she had so many pre-shots in the red. Since adding the pumpkin back in, we haven't had a red pre-shot at all. She also has a ton of energy the past few days which makes me happy to see. Pumpkin is considered a LC food, right? I think just adding that little bit in has helped tremendously. I've also noticed her nadir is trending futher towards the +6 which is good. Want the nadirs lower so maybe another increase is in order. She's had a few in the 120s but then some have been higher 100s. Thoughts? We're on the 6th day at this dose. Thank you so much for checking in.
 
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Suzanne & Darcy said:
How do you feel about the increase? She’s had some decent blue numbers, but I feel like it’s not a huge difference between the 2.0 numbers and the 2.2 numbers. The preshot numbers are more pink now than red.

Any luck with some new foods?
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Just got a +4 and it's 91! So encouraging to see. Maybe I don't increase yet?... and hope for more greens. The past few days she's been acting like a kitten :) Wish I had been able to get the +2 today to be able to compare to the other days, but Thursday mornings I go to pilates.
 
Yesterday she had a flat/high cycle, followed by a good cycle with a good nadir. Thinking of starting a new ProZinc vial. This vial has lasted just over 3 months but I'm curious if this is typical to start seeing unregulated cycles when it might be time to start a new vial.
 
I've noticed, lately, Willow will have high/flat cycles during the day, but in the evening her cycle is really great. I thought it was maybe happening because of the ProZinc vial, so I opened a new one but it's happened again the past two days. Evening cycles have been great. Does this just happen sometimes or is there a reason for a recurring, flat daytime cycle?
 
@Suzanne & Darcy made an appointment for Willow to go to the vet on Monday, the soonest they could get her in. The past 24 hours she's been periodically holding one of her ears down and scratching it with her back paw. I wonder if she has an ear infection or bad tooth... also could be contributing to higher mid-cycle numbers lately.
 
I have been pondering her numbers this morning.
I think it’s a good idea for them to actually take a smear from her ears and look at it under a microscope. For a diabetic cat, they sometimes prescribe ear treatments that have a steroid component to them, which does drive up the BG numbers. If they have an alternative, I would try that.
 
Kate & Willow said:
I've noticed, lately, Willow will have high/flat cycles during the day, but in the evening her cycle is really great. I thought it was maybe happening because of the ProZinc vial, so I opened a new one but it's happened again the past two days. Evening cycles have been great. Does this just happen sometimes or is there a reason for a recurring, flat daytime cycle?
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Is there any difference between what and how much or the timing of when she eats in the day and what/when/how much she eats at night?
 
Lots of cats have lower numbers at night, but I will say that her differences seem to be more dramatic than many cats I have seen.
 
Suzanne & Darcy said:
Lots of cats have lower numbers at night, but I will say that her differences seem to be more dramatic than many cats I have seen.
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It's definitely weird. Her BG isn't coming down today at all. I'm not sure if waiting til Monday is okay or if it's better to take her to an urgent care today. Other than her ear, she's acting normally. Playing, etc. Not eating a lot today, though.
 
It could be that her body just reacts to the lower night time numbers with higher daytime numbers. A lot of the AMPS and PMPS are very similar. That is super frustrating to see. Do you have another cat whose food she could sneak/steal?

It’s hard to decide. She is a lot higher than usual today (not even coming down into yellow). If you wait, you may be stuck with higher BG all weekend. And Willow may be uncomfortable all weekend.
 
Suzanne & Darcy said:
It could be that her body just reacts to the lower night time numbers with higher daytime numbers. A lot of the AMPS and PMPS are very similar. That is super frustrating to see. Do you have another cat whose food she could sneak/steal?

It’s hard to decide. She is a lot higher than usual today (not even coming down into yellow). If you wait, you may be stuck with higher BG all weekend. And Willow may be uncomfortable all weekend.
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Do we not want similar AMPS & PMPS? I'm not sure what you mean. Just want to be sure :)
She's the only cat living here... so she's not sneaking food.

Suzanne & Darcy said:
Does she eat the pumpkin during the day or night?
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She has a little pumpkin at both AMPS & PMPS! Which makes the differing cycles all the sudden even more weird. Makes me think it's something else entirely. Wasn't the insulin vial, food routine is exactly the same...
 
Kate & Willow said:
Do we not want similar AMPS & PMPS? I'm not sure what you mean. Just want to be sure :)
She's the only cat living here... so she's not sneaking food.


She has a little pumpkin at both AMPS & PMPS! Which makes the differing cycles all the sudden even more weird. Makes me think it's something else entirely. Wasn't the insulin vial, food routine is exactly the same...
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I just wanted to make sure about any other cats/food.

About the AMPS and PMPS, yes it’s fine for them to be similar— I only meant that it’s interesting that she “starts from the same place” and ends up so much lower at night.

I don’t think it’s anything you are doing if she’s eating exactly the same each cycle and we can’t think of anything else. There aren’t many cats that I ever recommend giving a different dose to in the a.m. and the p.m., but it may be something we want to consider very slowly and carefully. If it does bring her daytime numbers down, then her PMPS may be lower and we don’t want her dropping too low at night. So at first we would need to monitor extra carefully.

Right now, your priority is to get sweet Willow’s ears checked out before we consider changing anything.
 
Suzanne & Darcy said:
I just wanted to make sure about any other cats/food.

About the AMPS and PMPS, yes it’s fine for them to be similar— I only meant that it’s interesting that she “starts from the same place” and ends up so much lower at night.

I don’t think it’s anything you are doing if she’s eating exactly the same each cycle and we can’t think of anything else. There aren’t many cats that I ever recommend giving a different dose to in the a.m. and the p.m., but it may be something we want to consider very slowly and carefully. If it does bring her daytime numbers down, then her PMPS may be lower and we don’t want her dropping too low at night. So at first we would need to monitor extra carefully.

Right now, your priority is to get sweet Willow’s ears checked out before we consider changing anything.
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Ohhh okay I get what you meant about the AMPS & PMPS. I agree completely. I've been so confused as to how she starts at the same place and has such different cycles. But since this is a recent thing in the past week or so, maybe it is an infection/inflammation or something. I will maybe take her to the urgent care in a little bit rather than waiting til Monday for an appointment with her regular vet. If she has an infection I definitely want to get it taken care of ASAP! Thank you Suzanne <3
 
Suzanne & Darcy said:
Did you take her to the urgent care?
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I did! My partner and I took her in around 4pm. They did take a smear from both of her ears and looked under the microscope, saw no infection. All of her other vitals were really good. They took a look at her teeth, and did note that she has a bad molar, which I knew already. I think maybe that tooth is bothering her and causing some discomfort near her ear (it's on the same side). I'm gonna call her vet tomorrow and get the dental scheduled ASAP. She didn't have a fever and the vet thought she looked really healthy other than the teeth. They gave her a Convenia injection (which I remember is not the best since some cats have a bad reaction to it, but she has had Convenia previously in 2021 when she had a dental and did okay). She already seems to be feeling a little better and ate a really good dinner just now. Her PMPS was 315. Going to go ahead and give her the full dose. And hope she keeps her appetite up while I get the dental scheduled. Maybe it really is just her teeth causing the high daytime BGs lately?
 
I’m glad to know she’s okay. If the tooth were causing higher BG, I would expect it to be causing it to be higher during both the day and the night. But we will find out after the dental. I don’t know why vets use Convenia for teeth. It’s a cephalosporin antibiotic and isn’t the best one for oral bacteria. But at least you know she was okay last time she had one. That is a relief and hopefully it will help her some before she can have the tooth removed.
 
Hi @Suzanne & Darcy just wanted to say hi and give you a little bit of a Willow update :cat:
She's still having some cycles where she stays kind of high/flat, but then will have a great cycle. Back and forth.
We have her dental scheduled- it's next week on Thursday (2/27). I really hope the dental and possible extractions help her BG regulate a bit better. The 2.2u seems to still take her to some great greens some cycles so I'm hesitant to consider an increase until we see how her numbers are after the dental. Thoughts?
She had her pre-surgical bloodwork already two days ago and we got the results. Everything was good and cleared for her dental, but her SDMA came back positive for the first time...
The past couple of days she has been turning her nose up at her Young Again kibble. She always ate it fine but recently she is refusing it. I still had some Dr. Elsey's from before so I started offering her some of that as well and she goes straight for it so I don't think it's about the texture of the food or it bothering her teeth. I'd love to keep her on the Young Again because I know it's lower phosphorous whereas the Dr. Elsey's is higher and now that her SDMA was positive I'm worried about her kidneys.
I'm really hoping the dental helps get these cycles more regulated. Her little body has been through it.
I hope you've been taking good care! Thank you for all that you do for us on the forum.
 
@Suzanne & Darcy we are preparing for Willow's dental on Thursday morning and I've been in communication with her vet about fasting, insulin, etc.
I'm curious- is it customary for cats to take Gabapentin before the procedure? My vet recommended Willow take some the night before and the morning of the dental. I'm nervous since she will be fasting. Willow does very well at the vet, just doesn't like the car ride. I think the vet is thinking it would be helpful so the stress doesn't spike her BG, but I don't think it will spike a ton? I don't remember giving her Gabapentin before her last dental in 2021, although she was not diabetic at the time of course.
Her vet recommended fasting from 12am the night before. I sent her a screenshot of the AAHA protocol, and she said if I prefer to feed Willow a small meal around 4-6am, to let her know and then she'd want to administer Cerenia in that case. She also said she would test Willow's glucose after her 7:30am arrival and give a reduced dose if her BG was high. I let her know about our 8am/8pm schedule and she was willing to stick to that. Is adding the Gabapentin too much on her body, especially with a fast?
I'm extra nervous for this dental so I just want to make sure I'm covering my bases.
 
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Kate & Willow said:
. I sent her a screenshot of the AAHA protocol, and she said if I prefer to feed Willow a small meal around 4-6am, to let her know and then she'd want to administer Cerenia in that case.
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I know she wants to prevent any vomiting in order to avoid aspiration pneumonia. So that’s why she’s recommending the Cerenia if Willow will have any food in her stomach.
 
Kate & Willow said:
Not at all- she's very docile with them!
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If she (the vet) is trying to prevent motion sickness in Willow, then I would think she would suggest a good dose of Cerenia for the car ride. I have only used that in my cats who always vomit on car rides. The dose for motion sickness prevention os higher than the usual dose.
 
And I only have given Gabapentin before a vet visit to a cat who is absolutely insane at the vet (and to my heart kitty who was not allowed to be under any excess stress.)
 
In her email she said "I think that giving Willow a sedative the night before and the morning of her dental might make her less anxious. Stress can elevate the blood glucose."
In the past Willow's glucose has only been slightly elevated at the vet- I'm thinking of her 4 trips to the vet & urgent care vet already this year and she does fine.
I'm comforted to hear that it's not a usual thing to give Gabapentin when she's not a super stressed cat at the vet...
 
Kate & Willow said:
In her email she said "I think that giving Willow a sedative the night before and the morning of her dental might make her less anxious. Stress can elevate the blood glucose."
In the past Willow's glucose has only been slightly elevated at the vet- I'm thinking of her 4 trips to the vet & urgent care vet already this year and she does fine.
I'm comforted to hear that it's not a usual thing to give Gabapentin when she's not a super stressed cat at the vet...
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I don’t know if I would try the full 50 mg. It’s not considered a super high dose, but some cats are more sensitive to Gabapentin than others and we don’t know about Willow. Did she give you tablets (they’re usually compounded at such a low dose) pr liquid?
 
I have taken the small tablets that are 50 mg. Compounded tablets and halved them before to just give a small dose to a cat who didn’t need much. For longer car rides, I have used 50 mg. the night before a visit and 50 mg. two hours before the scheduled vet appointment time. It takes two hours for the full effect of the Gabapentin.
 
Suzanne & Darcy said:
I don’t know if I would try the full 50 mg. It’s not considered a super high dose, but some cats are more sensitive to Gabapentin than others and we don’t know about Willow. Did she give you tablets (they’re usually compounded at such a low dose) pr liquid?
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She left liquid at the front desk of the vet office if I want to do liquid, but I still have Gabapentin tablets from one of her last urgent care visits when she had conjunctivitis but I never gave her any Gabapentin then. So I can either use these pills (they're 50mg each, I could split them?) or pick up the liquid. Do you think i should give it to her or ask the vet if it's maybe okay to not give it??
I live about 2 miles away from the vet, so it's not a long car ride luckily.
 
Kate & Willow said:
She left liquid at the front desk of the vet office if I want to do liquid, but I still have Gabapentin tablets from one of her last urgent care visits when she had conjunctivitis but I never gave her any Gabapentin then. So I can either use these pills (they're 50mg each, I could split them?) or pick up the liquid. Do you think i should give it to her or ask the vet if it's maybe okay to not give it??
I live about 2 miles away from the vet, so it's not a long car ride luckily.
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Sure. You could ask the vet if it’s really necessary. It doesn’t sound like she really is the kind of cat who needs it. It sounds like the vet is really more worried about her BG spiking. If it hasn’t happened before then it may not happen this time. I would be more concerned about it dropping too low than a temporary high.
 
Another thing to consider is that Gabapentin can cause lower blood pressure which isn’t something you want for a cat who is going to undergo anesthesia. I was reading in one of my veterinary publications recently about this issue with Gabapentin. And now I am thinking about how when they are under anesthesia their blood pressure can drop — the vet is supposed to monitor blood pressure during the procedure to prevent it from dropping too low (which can damage the kidneys.) Will they put Willow on IV fluids before, during, and after the procedure. It’s not necessarily routinely done, but they will do it if you request it. I frequently request it for my senior cats (it costs extra, of course) for blood pressure protection and also just to keep them well-hydrated and support the kidneys. Did they give you a detailed estimate? It would show on there everything they plan to do.
 
Suzanne & Darcy said:
Another thing to consider is that Gabapentin can cause lower blood pressure which isn’t something you want for a cat who is going to undergo anesthesia. I was reading in one of my veterinary publications recently about this issue with Gabapentin. And now I am thinking about how when they are under anesthesia their blood pressure can drop — the vet is supposed to monitor blood pressure during the procedure to prevent it from dropping too low (which can damage the kidneys.) Will they put Willow on IV fluids before, during, and after the procedure. It’s not necessarily routinely done, but they will do it if you request it. I frequently request it for my senior cats (it costs extra, of course) for blood pressure protection and also just to keep them well-hydrated and support the kidneys. Did they give you a detailed estimate? It would show on there everything they plan to do.
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Thank you so much for this info!! It's confirming my gut feeling of not wanting to give her the Gabapentin. I just emailed the vet to see if she's okay with me not giving it to her. I do see "fluid administration- intra-op" on the estimate- not sure what the intra-op means.
 
Suzanne & Darcy said:
Sure. You could ask the vet if it’s really necessary. It doesn’t sound like she really is the kind of cat who needs it. It sounds like the vet is really more worried about her BG spiking. If it hasn’t happened before then it may not happen this time. I would be more concerned about it dropping too low than a temporary high.
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I keep going back and forth with Willow's vet, ugh. She brought up how Willow's BG was spiked when I took her in for her pre-surgical bloodwork but it was in the morning before her ProZinc had on-set, which I explained to her. She was 353 that morning at AMPS and then 408 at the vet. Then she said we shouldn't run into a problem with her blood pressure dropping low on this dose of Gabapentin and that it would be a concern with a higher dose. I'm not sure what the right thing is for Willow at this point.
 
Kate & Willow said:
I keep going back and forth with Willow's vet, ugh. She brought up how Willow's BG was spiked when I took her in for her pre-surgical bloodwork but it was in the morning before her ProZinc had on-set, which I explained to her. She was 353 that morning at AMPS and then 408 at the vet. Then she said we shouldn't run into a problem with her blood pressure dropping low on this dose of Gabapentin and that it would be a concern with a higher dose. I'm not sure what the right thing is for Willow at this point.
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I think Willow is going to be okay, but I understand your anxiety. How much insulin will you give her in the morning before she goes?
 
Suzanne & Darcy said:
I think Willow is going to be okay, but I understand your anxiety. How much insulin will you give her in the morning before she goes?
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Thank you... I feel like I'm such an anxious Cat Mom o_O
We ended up picking up the liquid Gabapentin. I was worried about her getting too sedated and not eating so I spoke with the vet and she recommended I do 25mg at 9pm, another 25mg at 11pm, and then 50mg at 6am before we take her in. So far Willow seems comfy/okay but she's only had that half dose so far.
The vet will be doing the insulin in the morning- she said she will give a reduced dose if Willow's BG is high when she comes in, which I assume it will be since it'll be right around AMPS. I did ask her if she would be sticking to our 8am/8pm schedule and she said that'd be no problem. In your experience, do the vets give a half dose or so? Or does it just depend on each vet and each cat? She did ask me to print Willow's SS and bring it in, so maybe she will be using that as a guide.
 
I see Willow had a nice green the other day on that 2.2 fat dose. I will be thinking of you and Willow today and I will say a prayer fpr Willow’s procedure to go very smoothly.

I don’t know what your vet will do with regard to the insulin. Does she even know how to draw a 2.2 or a half dose for that matter using a U-100 syringe instead of the usual U-40 syringes that are used with ProZinc. If not, Willow could be overdosed with insulin. I wish that you would just give Willow a reduced dose yourself this morning. That makes me so nervous.
 
Suzanne & Darcy said:
I see Willow had a nice green the other day on that 2.2 fat dose. I will be thinking of you and Willow today and I will say a prayer fpr Willow’s procedure to go very smoothly.

I don’t know what your vet will do with regard to the insulin. Does she even know how to draw a 2.2 or a half dose for that matter using a U-100 syringe instead of the usual U-40 syringes that are used with ProZinc. If not, Willow could be overdosed with insulin. I wish that you would just give Willow a reduced dose yourself this morning. That makes me so nervous.
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Thank you for your prayers, they are so appreciated!
I did explain to the doctor that we use the U-100 syringes with a conversion chart and emailed it to her. I told her she could use a U-40 if she preferred but she said to bring the U-100 since that's what we do at home. I will write it down for her again on our spreadsheet so she has a hard copy/reminder too!
 
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