2/22 - General questions on feline diabetes!

Bouncing
Is bouncing a function of the dose? That is, do cats bounce less or more as you go to higher doses? Do they clear bounces faster as they get higher doses of insulin?

Neuropathy
Does methyl B12 help or is it mainly BG control that helps resolve hind leg neuropathy? At what levels of BG does it resolve? BG less largely less than 100?

Renal Threshold
Is how much? 230 or 280? By human meter?


Gastroparesis
Do diabetic cats also suffer from Gastroparesis?
(From Wikipedia: Gastroparesis, also called delayed gastric emptying, is a medical disorder consisting of weak muscular contractions (peristalsis) of the stomach, resulting in food and liquid remaining in the stomach for a prolonged period of time. Stomach contents thus exit more slowly into the duodenum of the digestive tract.
Symptoms include nausea, vomiting, abdominal pain, feeling full soon after beginning to eat (early satiety), abdominal bloating, and heartburn. The most common known mechanism is autonomic neuropathy of the nerve which innervates the stomach: the vagus nerve. Uncontrolled diabetes mellitus is a major cause of this nerve damage; other causes include post-infectious and trauma to the vagus nerve.)

 

Interesting discussion regarding bouncing

 

With Blaze, his hind leg neuropathy was pretty bad at diagnosis but once we got him on insulin and changed his diet, it completely away.

As for bouncing, that is just the body’s natural reaction to lower numbers. When they’re so used to sky high numbers, their body freaks out with anything that is lower and the body releases extra glucose to get the BG up again. Eventually it calms down and the bounces ease up. Their body starts getting used to the lower numbers and realize they don’t need to release the extra glucose. Every cat is different, some cats bounce for a long time and some cats get the hang of things right away. Blaze was very bouncy I’m the beginning but his body has finally figured out that these lower numbers are not a bad thing!
I don’t have experience with gastroparesis though, I hope someone with more experience can help you with that.

 

I guess that didn’t really answer your question. I don’t think bouncing is dose related, I think it’s just the cats body reacting to Bg’s that their body is not used too. Blaze would bounce at any dose he was given, for quite some time. Now we’re at 0.25U and he’s staying in all blues and greens with no bouncing. His body just got used to the lower Bg’s finally and his pancreas figured out these numbers are good and it doesn’t need to release the extra glucose to bring him back up.

 

Thanks for writing back. Do you remember how long it took Blaze's neuropathy to go away? Also, I was looking at Blaze's SS and found that you held doses for a long time - not increasing every 3-5 days like they do in TR. Was there a reason for that? That seemed to have worked for him and he began to see better numbers on the same dose.

 

You’re welcome! I would say that within the first month or two, his neuropathy resolved. I know that others have given supplements to help the neuropathy though, when it didn’t resolve sooner. I hope someone with experience with that will chime
in soon to give you info on that.

As for holding doses longer, Blaze is a weird cat that usually takes up to 10 cycles to really see the affects of a new dose. He used to bounce like crazy and it would take days for his body to calm down and actually show what the current dose was doing. I also work Monday through Thursday and am usually gone until PMPS, sometimes I can run home
on lunch to grab a test, but not always, so I wasn’t comfortable giving increases on weekdays when I wouldn’t be home to monitor, or on week nights when I couldn’t be up all night to test if needed. So I did things a little differently to work with my schedule. And I like to give Blaze 10 full cycles on a dose before I consider increasing. Also, Blaze LOVES to go lower at night, so I held the 0.5U for quite some time because we would get busy in the evenings and was getting into 50’s, so I didn’t have a lot of room to go back up. So I let him do his thing since he was staying in all blues and greens, and eventually he earned a reduction. Same with the 0.25U, he was doing pretty good but not good enough, so someone suggested I try a fattened 0.25U dose to get him into more greens and it’s been working. I hope that makes sense. I just do things a little differently with Blaze since he takes his time getting to work on a new dose. I don’t like to take the risk of getting him into too low of numbers because I didn’t give him a full ten cycles on a new dose.

 

thanks for the detailed reply! i'm still trying to find my feet around bandit. she seems far far weirder than blaze!

 

Really informative thread. Thanks for sharing this, Sandy.

 

Gastroparesis or low gut motility is caused my many things....surgery and anesthesia, antibiotics and infections, pain and then so pain medications, inflammation and electrolyte imbalances... I would not say specifically that it is "caused " by diabetes -or at least that was not how it was explained to me when I was working in veterinary medicine.
Probiotics and smaller more frequent meals usually help improve gut motility.

 

Also found these on bouncing ( from that same post about myths on TR debunked from yesterday), I found some of this helpful as I think what I see as an bounce sometimes is really just losing regulation or perhaps some glucose toxicity.

One other note:

Every high number is not a bounce! Numbers go down, numbers go up. Often I see people comment that their cat is bouncing, when really they are just seeing the natural rise at the end of the cycle or a food spike. Other times I see people whose cats are stuck (really stuck) in a high pattern who think it's a bounce.

And this one that talks about bounces and explains failed reductions:

If I'm understanding it right the "High" BG that indicates it's a bounce is due to the "numbers dropping low, dropping fast, or dropping by a large amount"...so when we talk about bounces here, it's because we see a higher number soon after any one (or more) of those things
A "high BG after a dose reduction due to low BG" isn't necessarily a bounce (although there can be a bounce involved ALSO due to the low BG)

When they drop too low and "earn" a reduction, if they don't return to "typical" numbers for that cat, it's not a bounce....it's a failed reduction

example....cat drops to 40 and earns a reduction ......the next cycle they're in the high 200's....THAT part is a bounce and has nothing to do with the fact you just reduced the dose.....if the cat doesn't return to what would be "normal" numbers for them, then the reduction failed

 

Renal threshold is ECID. Sorry, it does depend on the cat so you will have to figure it out. With my girl, around 230 on a human meter. I have also seen some people report it be mid to upper 100's for their cat. There are a couple ways to find out. The easiest is to get some Ketodiastix, that also test for glucose in the urine. Renal threshold is the point at which extra glucose is peed out. So you test BG and urine at the same time to see if you can figure it out. I used to test Neko's BG just before everytime she went in for a urinalysis which also measures glucose in the urine.

Cats bounce until they don't. Lots of good references and quotes above.

Gastroparesis - water helps makes things move. Diabetic cats can be dehydrated if they are peeing a lot or not drinking enough water for their diet.

 

thanks @Si am cat mom and @Wendy&Neko

The only problem Bandit has had in the past was one instance of GI motility when she stopped eating for 3-4 days. Vet gave her an enema and prescribed Perinorm (Metoclopramide - Reglan in the US?). It just made me wonder if diabetes could cause gastroparesis too - not that I have seen any signs of it. Bandit drinks a lot of water - always has. Fortunately, she has stopped the excessive peeing in the last month, thank God. It's my civvie, Budge who doesn't drink enough water and I have started adding wet food to hear diet to compensate. The wet food here is only moisture. A 3oz pouch only has around 40kcals!

I think I have read-up almost every sticky on bouncing, TR & dry foods etc etc on FDMB. Unfortunately, that has not given me the ability to figure out if Bandit is bouncing or just going into higher numbers with the dose going "stale" by day 6/7 of holding it. Maybe a bit of both. Haven't seen any improvement in her numbers when going from 1.7 to 2.5 so I don't know if its because of bouncing or whether she just needs more insulin. Or there is an improvement and paranoid/hyper me is not able to see it!