? 02/05 - Bandit - labs - lipemic sample?

We had a round of blood tests scheduled today for Bandit. The lab could not run the tests saying the blood sample turned out to be "lipemic".

They suggested that we get a fasting blood sample for thyroid, serum cortisol and insulin/glucagon tests that our vet had ordered.

Wondering how on earth to get a graze-eater like Bandit who is on insulin to "fast" for a blood test!

Any advice on how many hours she would need to go without food for these tests? The lab technician was most unhelpful on that count. Our vet is not easy to reach on the phone!

This really sucks. I don't want to put her through another round of torture of drawing a blood sample.

 

Oh boy I never thought about that ! Your right that would be hard to get a diabetic cat not to eat for a few hours ? How in the world ? I hope someone on here can help you . I would like to know too how it’s possible . Have a great day !

 

You probably need no food for at least 8 hours, 12 hours is preferable. The best you can do to keep Bandit safe would be to skip the shot the cycle prior to the blood test.

 

I'm sorry about the labs...may I ask what are the blood tests for?

 

my vet wanted to rule out other reasons/conditions for insulin resistance. we never did a thyroid profile at the time of diagnosis 3 months back.

my vet is a genius but not an expert at diabetes. i think bandit is making progress - albeit not at the pace I would have liked. not sure if 2 units is considered a high dose. but at least she is down to the yellows and no longer symptomatic (excessive thirst and urination) and also re-gaining weight slowly.

she doesn't have any other symptoms and has always been a healthy cat till this diabetes diagnosis.

 

Ming’s blood is always, as every lab tech from IDEXX has said, “grossly lipemic”.

lipemic blood shouldn’t interfere with most tests checking the thyroid. Do you know the specific test?

What is the insulin resistance test you’re running? For acromegaly, it should be fine. For IAA, lipemic blood is no good. I believe the Cushing’s test does need a fasted sample but don’t quote me on that!

With what I’ve learned on FDMB in mind and judging from your recent values on Bandit’s SS, I don’t really think Bandit needs to be tested for those insulin resistent tests yet. But, if you have the opportunity to know something for sure, it’s better than not knowing

 

Yes, the only reasons the tests are required is if one considers her insulin resistant. Based on her current dosage of 2 units, I'm not sure whether they are required or not.

 

2u is not considered high dose and to my eye Bandits ss is not one that makes me suspect current active IAA.

 

Thanks!! Let me put the labs on hold for now and see where Bandit goes in the next few weeks. In any case, I don't want to put her through the fasting and blood collection torture right away.

 

Getting her thyroid check wouldn’t be a bad idea and shouldn’t require fasting.

 

I would like to get her thyroid checked. But the lab guys here (in Mumbai, India) seem to think fasting is needed. I know that for human thyroid profile they insist on fasting.

Anyway, will wait a couple of weeks. Don't want to put Bandit through it quite so soon.

 

I agree with others, his numbers at this point don't look like a cat with Insulin resistance. I think part of your problem will have been the higher carb kibble, now you've swapped to Young again, it should improve. FWIW I would still look at wet if there is a chance you can transition Bandit to that, that would be my next move. (An all wet diet would allow you to follow TR and you would be able to adjust the dose more frequently, so you will be able to get bandit more quickly to a good dose)

Keep sticking to the SLGS, while on the dry though, holding the dose and re assessing weekly, adjusting if the numbers warrant it.

We haven't had to fast George in Spain

 

Thank you! It's a relief to hear.

There are almost no cat food options here in India - let alone low carb ones. Bandit has ABSOLUTELY refused to eat the wet food available here and all of them are so mositure heavy that she would need to eat over a pound of wet food in a day to get 200-220 calories! The ones we get here are intended to be an addition/supplement to a dry food diet.

I'm actually getting the Young Again kibble from the US! As also the half unit syringes!!

I'm thinking I will try some hybrid of TR and SLGS - increase dose every 5 days rather than 7 - If it becomes clear without any doubt that an increase is required.

 

I thought that might be the case for you I seemed to remember earlier posts when you discussed this. I guess the only other option would be a homemade diet? There's plenty of info on that In Dr Lisa's site

At the moment you do seem to be making progress with SLGS

 

Yup. Have discussed my cat food woes before on the forum

The other reason why wet food and probably, a home made diet will not work is that Bandit is a grazer. Nibbling through the day and night. Food will spoil when left out in the sauna that is Mumbai!

Anyway, won't bore people here, going over the same things again!

Hopefully Bandit will soon see blues if not greens. I'm fed up of the yellows. Patience and deep breaths!

 

Same here in Spain.
George isn't a grazer, so that makes it easier, he has set meals (he would just gorge himself otherwise)
But with my other kitties, who are grazers, the spoiling of food, is certainly in issue in our summers.

I'm glad you managed to get the LC dry for him then, make sure he drinks plenty, thats really important for him, we have a water fountain that really stimulates their thirst reflex

You do realise that on SLGS guidelines those greens last night warrant a dose reduction to 1.75u. On slgs a drop below 90 on a human meter is a reduction. I know he is yellow now, but that looks like a bounce from those greens his little body is not used to. When that bounce clears he will likely come out of those yellows. It looks to me that his bounces have been clearing every 3 to 4 cycles.
You did accidentally shoot 4u just a 2 cycles prior to those greens, so it is possible that those greens last nigh have been influenced by the depot readjusting following that 4u shot.

I'm not suggesting you change anything now, but rather wanted you to just be alert to the possibility, especially with the food change, with the dry I have seen the BG in cats that make the swap to YA take a few weeks before the lower carb food is reflected in their diet.

 

For what it's worth. Ollie never fasted for anything other than a dental.

She just had senior panel done with thyroid and she did not fast. It was also done at 4 pm. She's had IGF x2, pancreatitis test a few times, probnp, ultrasounds, echos, xrays all done without fasting or sedation. Don't know if it's right or wrong, it's just what was done.

My opinion, 2 units isn't that high at all. Ollie was up to 9 units twice a day when we found out about the acro. As of today she is 4.75 units.

 

Yup, Bandit has always guzzled water. Even pre-diabetes. So not getting enough hydration was never a problem with her.

I am aware that a drop below 90 warrants a dose reduction per SLGS and we did take a couple of those soon after we transitioned her to YA. But those failed and we had to go back up and even increase further. I have found that Bandit shows a rare and random green, especially soon after a dose increase but then there are no signs of lower numbers after that. She isn't even consistently in the blues. That makes me think that she needs to go higher and not lower with the rare drop below 90. I don't want to lose momentum by taking a dose reduction on account of one green number, especially since you have to hold the reduced dose a week and then each increase for a week. Am I mistaken and taking Bandit to higher doses than she actually needs?

I am assuming that the drop to green last night was on account of that 4u shot a couple of nights back and will wait to see where the 2u dose takes her after the depot adjusts.

She is one bouncy cat and has spent more time on higher numbers thanks to bounces rather than lower numbers. And with her being a grazer and eating only when she pleases, I have had no luck managing her curves with food!

Thanks for taking the time to look at her SS!

 

Really relieved to hear everyone say that 2u is not a high dose and she doesn't yet look she's insulin resistant. Will plod along and hope that she shows better numbers soon. Thanks

 

I'm not see that on the SS, I see more green and blue than perhaps you are.

Lets start 26 January.
she saw mid blue in the am, back up to yellow then midblue at pm +3 dropping almost 100pts, she may have dropped more that evening, but no follow up till morning, I'm seeing a blue cycle that pm (perhaps with a splash of green) I suspect you are seeing yellow. Truth is neither of us know for sure, not without a follow up test, I would have got one at +4 that night, she may have bounced from the sharp drop, but she could just as easily have dropped steadily into a nice blue green cycle before a rise later in the cycle.
27th Jan
started the morning in yellow dropped into blue swiftly 120pt drop by +3. still blue later at +5, may have surfed the blues for a few hours, or may have risen sharply into yellow (you don't know, no follow up)
The pm cycle, is possibly a bounce cycle, makes me ask, what is he bouncing of? well he might have spent quite a bit of time in blue that morning, triggering a bounce, or he may have dropped into green the night before and this is a delayed bounce.

28th Jan
am cycle still bouncing, flat yellow cycle
pm cycle started in yellow, still yellow at +3 but dropping, I think he started to clear the bounce here

29th Jan
AMBG mid blue, signals 'I am clearing the bounce'
and sure enough he does and he drops to 59. spends all morning in green
PMBG in yellow drops to 73 you give HC kibble. numbers come up, this is not a bounce this is most likely the kibble talking. Unfortunately the kibble can stay in his system for much longer than a wet HC food (in my experience when George has got into contraband it can be a good 48 hours before he's back to normal, this can vary from cat to cat and depend on the kibble I suppose)

January 30th
AMBG in mid yellow could be bounce or just a shortened duration brought about by the addition of HC kibble early in the cycle. Interestingly he drops to 190 by +4, I wouldn't be surprised if he saw lower blue that cycle before coming back up at pmbg/ or he may have bobbled about in low yellows that cycle, without the data, it is impossible to say.
Pmbg in yellow and that PM cycle looks like a bounce cycle

jan 31
ambg still bouncing
pmbg still in yellow, by +3 he has dropped 150 pts bounce clearing,
NB on a bounce clearing cycle it is important to find out how low the dose is taking the cat, so if at all possible follow up the testing, which you did with a +4 he had dropped 10pts so flattish, but still early in the cycle, I would have got another test either a +5 or +6 to see if he was truly done with the dropping that cycle.
Feb 1
AMBG still in blue flat from the last test at +4, I think that indicates that it is probable that you missed his nadir that cycle (they can nadir/lowest BG at any point in the cycle)
PMBG pink new bounce, higher than normal BG, makes me think that it's very possible he dropped to Green the previous night, at the very least he spent 14hrs below 200.

feb 2nd
ambg yellow, still bouncing in the am cycle
pmbg still yellow, dropped 70pts a +4, hmm could this be bounce clearing??? Quite possibly, but again I thin you missed the nadir on this cycle, I 'see' at least mid to low blue numbers after that 177

Feb 3rd
ambg he's bouncing, this reinforces my suspicioun that he saw more blue/green the previous night.
PMBG we have the 4u, then the 2u the next morning the inconsistent dosing can lead to wonky numbers, so yes that next green cycle could well be a result of that.

But..... it's not like he was in a sea of yellow before, there is a lot of blue in there and a significant amount of green.
Is he bouncing? sure he is, but he's not a big bouncer, I have seen a lot worse.
In any case, whether he bounces or not your dosing has to be based on how low the dose is getting him, you ignore the bounces. So you ignore those flat yellow bounce cycles and look to how low the dose is taking the cat.
On SLGS this means nadirs under 90 earn a reduction. If you are going to 'customize' the dosing method, it's crucial that you follow up on those drops and are 100% sure of how low the dose is taking your cat. At the moment, for me, there are too many unknowns, for you to know for certain how low the dose has taken Bandit.

Talking you through the week of that 1.75u dose, I do not see him just hitting a random green and then just being in yellow, yep he is spending time in yellow, but those bounces are clearing reasonably quickly, and I suspect you have missed some lower numbers, where he has nadired later in the cycle.

Please understand this is not a critisism of your testing or monitoring, but rather an observation when I look at the data on the SS.
If you are able to I would endeavour to fill in those gaps,

 

Wow! What a amazing, thorough review of his SS! I think I say this every day but what a wonderful resource this group is! That is a lot of work and you should feel good about the help you provide!

 

Not at all. We suggest when people get to 6 units they get tested for secondary endocrine conditions (acromegaly and insulin auto antibodies) that some people call high dose conditions. The initial Cushings test is a urine test, so no fasting required there. Hyperthyroidism can also cause a form of insulin resistance. As can other conditions causing inflammation or systemic stress, such as heart conditions, kidney conditions, pancreatitis and bad teeth.

I was lucky that my vet worked later in the day, and I would take Neko in just before PMPS, so usually had a good six hours fasting, providing there were no low numbers. That was always good enough for blood work. But she also had blood work done sometimes when she'd eaten a couple hours previously. Never a problem.
Some cats just seem to be more lipemic than others.

I would strong recommend you not mix and match the dosing methods. There is a reason we have the guidelines in each dosing method, and it's for safety. You might want to read this post on why we don't combine or mix and match dosing methods. Actually, the entire post has some good myth busters in it.

 

A Reduction can be reversed as soon as evidence that it didn’t hold appears. . Like a fur shot, or back to back fur shots (which I by the way have done ..) you are trying to catch up from a mishap. It does also reset the cycle count

 

REALLY REALLY appreciate your taking the time to go through Bandit's SS in such detail. I HAVE missed several lows at night. I always seem to pick a bounce night to test in the early AM. I will now step up my game as far as testing goes. I think I need to read your post several times so I don't make the same mistakes again!

 

Thank you I will keep this is mind. My only concern with SLGS is the requirement that a single drop below 90 requires a reduction and that reduction be held for 7 days even if it has failed. I am just concerned about Bandit swimming in glucose. Until recently, she was highly symptomatic and quite dehydrated from frequent urination (despite the amount of water she guzzled). So I didn't want to lose momentum by taking a reduction which wasn't absolutely necessary. I see your point of view of safety too.

 

I was told that I would need to hold the reduction for a week, which is why I am now reluctant to take reductions unless Bandit consistently sees lower numbers. I thought she wasn't but maybe I need to test more frequently.

I would stop testing once she heads higher because it is very rare for her to dip subsequently (unless she is clearing a bounce). She usually starts dipping at +2 and rising by +5 and heads higher till +8/+9 after which she dips a little at the end of the cycle.

 

P.S. Thank you all again! I would like feedback and criticism. I am only too happy if someone can show me the right way. Very often it feels like I am stumbling in the dark and without the right tools. Pet care is nearly non-existent here in India. I am fortunate that I have the means and the connections (friends and family) to procure stuff from the US.

A friend of mine here in Mumbai who has a diabetic cat is still feeding him 27% carb kibble and shooting him without testing him. I really don't know what other parents of diabetic kitties are doing here!

 

You can make modifications to SLGS, once you know your cats reaction to insulin and carbs. Such as lowering the reduction point a bit. Just don’t mix and match with Tight Regulation.

 

Will do. Does you feel that Bandit is on a higher dose than she should be on? How would I know if she were?

Do cats on kibble (even zero carb ones) require more insulin? Are they harder to regulate than those entirely on wet food?

Is remission unlikely with kibble and therefore with SLGS? I read on one of the threads that the aim of SLGS is regulation while that of TR is remission!