Pig 5/14: pmps 240; +2 225; +7 163; +8 156; +10 133; amps 125; +2 133

Discussion in 'Lantus / Levemir / Biosimilars' started by LuvinThisPig, May 24, 2018.

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  1. LuvinThisPig

    LuvinThisPig Well-Known Member

    Joined:
    Dec 8, 2017
    Yesterday's

    Ugh on long days of work... This = no testing. Or not nearly enough as I would like. However, given his pmps I do not think he even got close to the lagoon. *sigh* His Acro hunger is back for the first time in a very long, long time. He is back to his camp in front of the refrigerator.

    A few things I need to address:

    @Wendy&Neko you said:
    As to this, I could not agree more. The thought had already crossed my mind when I was scouring the earth for reasons as to the sudden incline. Ruling out any post SRT reactions, there was not a whole lot left, but diet being one of them. I made the move very slowly and in fact, he was only getting maybe 1 oz of raw a day (2 frozen 'ice cubes' - one in the morning and one at night). I am baffled as to how the raw could be causing the increase to BGs… But, for a good reason am I baffled.

    1. He has no constipation whatsoever. His bladder is of perfect size and cannot be felt when prodding the abdomen. Also, his upper GI feels very loose and not at all distended or swollen. In short, he is 'squishy' from just below the ribs all the way into the hips with no sign of bloating.

    2. His poop. His poop tells me a lot. Where diarrhea has been a chronic issue since he was a kitten, his stools have began to form and become far more solid than usual. They are not normal by any means, but most of this seems to be attributed to neurological issues as Dr. Fidel concurs. (However, let us say he was having a reaction to food, the presence of food related diarrhea would go unnoticed considering the neuro related diarrhea already in play). Furthermore, his push seems to be getting better as well, as strange as this sounds. The output he just had, even given its semi-soft state, was very easy for him to move out. No struggle. The presence of the little black flakes that have been attributed to a mild food sensitivity have disappeared for the first time in forever. His poops do not have any smell at all, really. And, they are taking on a much healthier color. Not just the color of whatever silly canned food he has eaten recently. Basically, his poop points to a normal and (slightly) healthier digestive process. This would not be the case if he was having a sensitivity issue with it, would it???

    3. His breathing is always elevated after eating the canned food (I am this crazy to watch for hours), any canned food. Whereas after eating raw, his breathing stays level. This says to me that there is something that is causing abdominal discomfort in the canned food.

    So, what gives? Could this really be a diet issue or is it more likely the tumor ramping up? Would it make sense for it to respond in this way to SRT. Like the radiation just really pissed it off? I would not imagine it would work that way, but I suppose all is possible..

    He did throw up a tad tonight before pmps, but I think this was more about the fact that he had just used the bathroom. See, with no tail and limited feeling back there, he often gets excrement on his hind end. Then he cleans his hind end. Every once in a very long while he will clean himself on an empty tummy and what he cleans off with irritate his belly. It was a small little patch and he was done. No dry heaving or struggling.

    Regardless, I pulled the raw for now to eliminate it as a factor until I can further address diet.

    Tagging @Sienne and Gabby (GA) for advice on diet...
    I have been slowly reading through all the info on the IBD kitties page, but it is taking time obviously. I am curious. While I would not consider Pig to be in a dietary crisis by any means, I am wondering if using the intro diet (poached pork or chicken) would be beneficial at this point. He has diarrhea all his life and his vet and I have tried everything. Even Dr. Fidel in WA chalks a lot of that up to neuro issues associated with the Manx. However, in light of the recent increase to BGs, I am wondering if it is related to the reintroduction of raw. However, none of that makes sense given the clues listed above...

    Also, I want to get the Renew Probiotics, but which one?? I am looking for 40-50 billion CFUs, correct?

    Do you feel a raw diet of pork would be better to start with as he has had very limited exposure to this protein?

    He is not diagnosed full blown IBD, but it is a diagnosis of exclusion and there is no definitive one but biopsy. However, his very recent US did not show what Dr. Fidel considered a full blown case. I also realize, this is a bit delusional on my part as what is beginning is quite capable of becoming something far worse. I need to head this off now.

    I believe that is all for now... I know I have missed something, but will post it when I remember it. :p
     
  2. Stacy & Asia

    Stacy & Asia Well-Known Member

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    For what it’s worth, here’s what I see regardless of diet in play. I can’t quite figure out exactly where the radcat came on the scene and how much he is or isn’t getting in relation to other foods, but it seems you still don’t feed it exclusively so you can see if these things match up or not...

    The last really good dose I see is 52 and 49 units (49 units wasn’t very long so it’s hard to say if that was a good dose or just depot from the 52). You started tapering off his dose around there sans earning a reduction (absolutely not a criticism, and I know acros and the huge depot change the decisions on that slightly, just purely an observation). Once the dose tapered off before SRT, he stopped having the long stretches of green with the dose of 45 units going forward. A little bit of depot hiccup around SRT and then you settled on 40 units and numbers slowly started creeping up from there. IMO 40 units was an unproven dose to begin with. While you saw an occasional (high) green with it, that happens randomly to many people on a dose too low and thus they keep it longer hoping the greens will come back again and often they do not come back more than randomly/occasionally. I don’t know how much longer the depot lasts at this many units, but not crazy to think several days if not a week or more longer than for cats on much less insulin.

    Dr Bernstein references a study with regular insulin that illustrates this point (granted, this is humans, so if/how it applies to cats will likely vary):

    Given the clinical signs and improvements with the diet switch you stated, I was be hesistent to think the diet is the problem, and even if it is the issue regarding insulin needs, as counterintuitive as that would be, I don’t think it’s something to jerk back on because it seems to agree with his digestion/elimination very well and that is super important. Meaning, if it were my cat, I would see if I could dose the insulin around the otherwise positive diet switch rather than change the diet to meet the insulin needs as a first step rather than visa versa.

    It could be possible that he just needs more insulin for the time being unrelated to the diet and the SRT. I don’t know too much about acro and SRT, but what I have understood is that insulin needs can drop dramatically following SRT...or not. Some cats it takes longer to make an impact. You also have to keep in mind that the type of SRT Pig had is slightly different from the type other cats here have had, I don’t know how much that is a factor but there are more unknowns regarding tumor shrinkage and timelines, etc. because the data pool here is smaller. It already looks to me that the reductions before SRT were not quite getting him in the range you wanted, I know that was intentional for your trip, but just saying maybe it should have been temporary for the trip and he needed to go back up again post SRT until he proved otherwise just as many do in prep for a dental which also promises to lower insulin needs. Check out Shmee who had a dental on 5/3 to see what I mean:

    https://docs.google.com/spreadsheet...6YRFsoUsqW2G5ip1I7-SN--3ahRjzsm4PLsaA/pubhtml

    Additionally, because he is sitting rather comfortably in yellows, it may take an increase that eventually takes him up higher than an amount that was suffice before just to get the numbers under control again.

    Hopefully @Wendy&Neko can weigh in if I got anything wrong in there regarding acro/SRT but that’s what my eyes see looking at your SS and while the diet switch is one possibility and food for thought, there can be other explanations.

    I use the renew life probiotics with Asia. I use the ultimate flora “extra care” 30 billion when she is on antibiotics and the “everyday” ultimate flora 15 billion when she isn’t as a daily supplement.

    Really awesome all the positives you noted with the diet change. The poop thing alone is incredible to me given that’s been a lifelong issue with him! :) I know you’ll figure this out and Pig will keep being amazing!

    :bighug::bighug::bighug:
     
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  3. Olive & Paula

    Olive & Paula Well-Known Member

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    Hope your figure this out. Pig is amazing though.
     
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  4. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I am a big fan of the raw diet, for the reasons you listed above and more. My question, from what you quoted from me was, has anything else changed, including meds? If nothing has changed, then he just needs more juice. The depot isn't built yet for the 45 unit dose, so patience is needed. When you have added R, you have seen blue, so that's a good hint that more juice is the ticket.

    You took him down to be safe for the trip, mission accomplished. Let's see what 45 can do with the full depot, six cycles, and go from there, following the protocol.
     
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  5. LuvinThisPig

    LuvinThisPig Well-Known Member

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    I totally agree. When we started making the reductions it was a bit like chasing the increases. We were trying to get him into the high green, low blue for the trip, but every single reduction did almost nothing to produce that effect. I strongly feel, just as when giving a BCS, that the larger depot he had simply allowed the smaller doses to play out as if a normal cycle. As in, regardless of dose, the depot was large enough to support even the smallest amount. For a while. So, considering the above mentioned test, I feel this is absolutely a major possibility. In fact, I feel it is a very large part of it. However....

    I tend to agree with you here. Entirely. He needs to be entirely raw fed. This I will not argue. I have every intention to move him to raw, but it might be that he needs a different protein or perhaps the probiotics will help with this.

    What does confuse me is the 'why' of the situation. I don't give him raw last night with BID and his numbers come careening down. Granted, this would be the third cycle on the 45u dose, but he never really shows an impact that early. Typically, he matures on a dose around the fifth cycle. Not to mention, the R was far more effective last night than it has been in days. Another granted, I started him on a lowered dose of R than per my scales. However, this was because when I dosed R in the first cycle following SRT he reacted very strongly to it. He will react to a dose then build a tolerance. I dosed after SRT to take this into consideration. So, when re-adding the R, I did so slowly. But, up until last night, the R did not even phase his BGs at all. It did help to pull him down into a higher blue as Wendy noted, but there was no typical decline.

    So, if his the clinical signs all point to a healthier digestive process, then why the increased BG levels? Could it possibly be a matter of what becomes digestively available? Considering that cats have one of the shortest digestive tracts in the animal kingdom, if the food he is eating has a lowered percentage of digestibility, would this not mean that what food and/or nutrient byproducts of said food are less available to his system, thus leaving less to interact with the insulin? Basically, the raw is far more digestible.. So, what the insulin needs to counter act would be more. However, there is nothing to even think this could or would be possible given the compositional differences in the food. I.e. - no carbs / some carbs.

    I do not think I can say he is having a reaction to the raw at all, based off the poo signs. But, what about it is causing his numbers to climb? When I take the raw (still feed the same amount of food - just not raw) he rapidly climbs back down the BG ladder... I am just at a loss. I will say that after putting him on the raw his behavior was far more lethargic. Granted, any behavioral changes that I link to the raw would be purely anecdotal considering the elevated BG...

    Absolutely. This thought was already in my head. See conversation of depot above... I think, he will need time to rebuild that up before I will see those great level runs like before. I firmly believe that a lot of his stability is owed to the action of that huge depot he had going. SRT and post SRT has drained that.

    Yes! Thank you! I was toying with the 'extra care' for daily use, considering the chronic diarrhea.... But, perhaps I will purchase both and give them a trial, starting with the 'everyday'.

    I certainly hope I can. I want him raw fed, period. Looks like I will just meet the need... :bighug::bighug::bighug:
     
  6. LuvinThisPig

    LuvinThisPig Well-Known Member

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    :bighug: Thank you! It is a puzzle, for sure! But, you are right... This boy is just amazing and if I can't figure it out, he certainly will tell me what I am doing wrong... :p
     
  7. LuvinThisPig

    LuvinThisPig Well-Known Member

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    I could not agree more! But, what about it would cause such a dramatic increase in numbers? I did not give it to him last night and the results were very dramatic. This was only the third cycle on the 45u and up until the removal of the raw... Nothing was really touching his numbers. At least, not the way he normally plays out...

    No. Nothing has changed. Only the raw. One change at a time... But, even considering how fast he dropped back to lower blues with the exclusion of it? I just feel like something is off. It could simply be my overacting 'spidey senses' malfunctioning also... :oops:
    Okay... I will look at giving raw again tonight. Unless, we decide otherwise. I just cannot get over the fact that as soon as I pulled the raw he declined so suddenly. Maybe I am wrong, but something does not seem right about the situation... I just do not know what... ??? :(
     
  8. LuvinThisPig

    LuvinThisPig Well-Known Member

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    I think it is important to let both last night's pm cycle and this morning's am cycle play out in full before making any decisions on diet. I am not changing dose and did not give R this morning. This will help to eliminate any other mitigating circumstances.. I may be way off in this and this cycle may in fact creep back up... But, its too coincidental..

    Granted, I do not think the 40uL was a good dose and for the reasons that @Stacy & Asia mentioned above. However, his range has quickly realigned with where he was just post-SRT, when we got home. I imagine that the 45uL will be a decent dose, if not a step below the final need. However, to see such a sudden increase and continued increase with the introduction of raw followed by such a dramatic decrease with the exclusion of it.... Something is off.

    I do not think it is the fact that it is raw. Not at all. He did fine on it before (save for constipation issues). However, perhaps it is a reaction to the specific protein itself. I am almost willing to bet, and a lot is feeling from my gut and Pig, that what he needs is a gentle introduction to the raw itself. As in, his gut is in need of some healing. I am looking at purchasing a white meat form of raw. Most likely the pork given he has had very little exposure to this. I am buying both probiotic varieties that both Stacy and @Sienne and Gabby (GA) mentioned.

    My best guess is this. I start him very slowly on RadCat pork raw. I also very slowly include the probiotics. Perhaps, not together. I give him several weeks to 'heal' that gut wall and then several more proteins will become tolerable to him..

    I think at this point, perhaps his GI is a bit irritated (even if he is not showing the signs...???) and needs some baby stepping into health.

    To be honest. I am a bit panicked (as I am sure we all can tell by now... :oops::oops::oops:) because I feel like I am back at square one with no knowledge about what to do. I do not want to do anyting that will be detrimental to his health and every time he eats that canned food I see his GI reacting in my head and slowly moving towards SCL... But, every time his BGs go up I see him moving towards CKD and heart damage in my brain. I am sorry, guys. Not trying to be nutso here. I am just so freaking lost as to what is happening and I cannot find any supportive evidence to calm me down... Research is failing me right now.
     
  9. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    There is research behind the TR dosing protocol. Build the 45 unit depot, see what it does to the numbers, then try any other changes. I totally get the panic. :bighug: The hardest part at this point is sitting on your hands. It takes time to see the impact of changes.
     
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  10. LuvinThisPig

    LuvinThisPig Well-Known Member

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    You are right, of course.. I need to follow the research. My heart gets in the way.

    Do you suggest continuing the raw or holding off?
     
  11. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    If you just removed raw today, I would add it back in. His numbers were starting to come back last night as the depot was building.
     
  12. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Sorry it's taking me so long to respond. I'm traveling.

    For some cats, any change in food can have an effect on BG numbers. It can take a couple of weeks for a kitty to adjust to a raw diet.

    What proteins have you been feeding? Chicken (and probably turkey by extension), beef and fish are the ones that cats are typically most allergic/sensitive to. I would look to novel proteins. If you were giving Pig canned venison vs a raw protein such as chicken, it may be that the venison caused numbers to drop because it was truly a novel protein. Prior to be diagnosed, I had been feeding Gizmo only chicken and turkey. He occasionally had beef. After he was diagnosed, I started feeding him raw pork or lamb. He also gets some canned ZiwiPeak (either venison or lamb and rabbit). He gets ReNew Ultimate with his food. When he came home after his biopsy, I also was giving him S. bouilardi. I've since tapered that off as he's had no problems with diarrhea or loose stools for quite some time.

     
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  13. LuvinThisPig

    LuvinThisPig Well-Known Member

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    Thank you! The thing that trips me up is that the canned food is chicken and turkey, while the raw is venison... But,the canned food is what is bringing his numbers down..?? So, he eats canned food (high allergens like chicken and turkey) and his numbers decrease while his digestion becomes worse. Whereas he eats raw venison, his numbers increase, but digestion is on point... Oye! He confuses me... But, time will tell the whole story I suppose..

    I am going to get pork raw and the probiotics and make the switch. I feel strongly this is the way to go...
     
  14. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    If you just moved to canned food today, it's not what is bringing his numbers down, it's the dose.
     
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  15. LuvinThisPig

    LuvinThisPig Well-Known Member

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    Typically he gets raw BID and canned in the auto-feeder. I recently moved him to raw BID + 1 meal during the day, with can to supplement the rest. I wanted the transition to be slow and gentle. On last nights pm cycle I pulled all raw and fed only the Weruva Fowl Ball that he had for several months prior to returning to raw. He ate only that on last nights pm cycle and today's am cycle. I gave him raw with BID tonight. I marked his SS so that there is a visual.

    I am really not trying to be difficult or argue with anyone... I am just relaying my observations in the hopes that someone sees something that I do not. I certainly hope that it has nothing to do with food and it is all dose... I hope that I am severely mistaken.
     
  16. Stacy & Asia

    Stacy & Asia Well-Known Member

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    However you work it, it should become obvious soon enough. Once the depot fills, you’ll see if the dose makes a big difference (already looks to be) and then you can add back the raw and see if it changes anything. I can’t for the life of me figure out why lower carb food would increase numbers, make them fluctuate more, sure, but not make them consistently higher. Sienne is probably on to something that just any sort of change or adjustment can show up in BGs and it can probably go either way too, just like some cats go higher at the vet and some go lower.

    I hope you sort it out soon and very excited to continue following Pig’s post SRT journey. :)
     
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  17. LuvinThisPig

    LuvinThisPig Well-Known Member

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    Agreed. I am baffled. I gave raw at BID tonight and marked the SS... I am hoping that I am wrong. But, already there was a 100 point difference between pmps. (dose considered)

    His +3 is sans food. The depot is filling and pulling down the #'s some, but not as significantly as the 2 cycles without the raw. I am so lost here because this sort of defies all logic. However, if we take the carb count out of it and consider other factors maybe something is there... One thing to consider, when I give the Weruva I blend it with water. I feed 3tbs of this mixture BID and 1 to 2 tbs of it between meals. This means that his meals with the Weruva are being measured post water added, where as the raw is pre water. Meaning, overall he gets more actual food and carbs on a raw cycle than on a canned cycle. This alone would effect the #'s. Furthermore, I also feel that the fact that the raw is more digestible means that more is absorbed and more or for the insulin to mitigate. It makes sense. One passes right through with little benefit. The other actually digests.

    Really, it could be something as simple as the added density of the raw is proving a bit more strain to digest, which for Pig would be a big deal considering the oddity that is his GI tract... I could be anything really. I don't necessarily think it is a reaction or sensitivity, but I do think there is something there... Something to it and I want to figure it out...

    Do I plan to quite raw because of this? Do I think the raw is bad for him? Absolutely not. In fact, I tend to agree with you. We continue to feed the raw and simply raise the dose to meet the need. Given his digestive signs, there is not contestation to that at all.... I just don't understand it. But, I will know more after these next few cycles...

    Thank you! Yes... I am very excited to see his reductions! But, regardless of anything else, at the end of the day I am just excited to see him feel better. After all, this is all for him!

    Thank you for listening to my crazy woman ramblings...
     
  18. Idjit's mom

    Idjit's mom Well-Known Member

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    :bighug: A hug for a not so crazy momma bean.
     
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  19. Stacy & Asia

    Stacy & Asia Well-Known Member

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    100% agree with Lou. If being perceptive and concerned for your cat’s well being makes you crazy, you are in great company around here! :joyful:

    :bighug::bighug::bighug:
     
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