1/11 Asia PMPS 164, +4 93

http://www.felinediabetes.com/FDMB/threads/1-10-asia-pmps-118-1-114-2-5-81.189412/

Asia had a nice run last night, she tried to go visit her shark friends she has become so fond of in the wee hours. I tried to give her just gravy since it gave her such an incredible number rise in the am cycle. Gave her a whopping 6 point rise in 40 minutes and then a tiny bump more after that. I relented and broke out the Karo when she went back down to 59. She’s a different cat at night, that’s all I can say.

Trying to figure out why she feels the need to rocket up between +9 and AMPS, it’s an uphill battle all am cycle to bring that number back down, recently. One theory is loss of duration and the other is her pain meds are wearing off too soon. She’s getting bupe twice a day, .075 seems to be a good dose for her, I just don’t know how long it’s suppose to last or much about how it works. I know some people do every 8 hours instead of 12, do you lower the dose for every 8 hours? How does that work? Will see vet tomorrow but wanted to get some thoughts about that ahead of time.

I have created a civvie monster. Toki, who before Asia had diabetes, was always a grazer, has decided to start eating her food in one sitting (a much larger portion than what Asia gets at any one time) and she has decided that she wants to be fed 12 times a day like Asia too, not happening! I think it’s the parm cheese. Food equals parm treat to her. I’ve decided I will give her the regular am and pm meals and if she wants to scarf them down, that’s her problem. I will give her a tiny snack once or twice a day, similar to the amount of Asia’s meal, but without cheese. If she’s actuslly hungry, she will eat it. If she’s just looking for cheese, she’ll have to be disappointed. What have I done?

 

I’ve also realized these “food bumps” after shot time are not food bumps at all, she’s just continuing to rise before onset. The reason this doesn’t seem to happen as often in the pm cycle is because she gets a pretty predictable double dip at the end of the am cycle and I am usually shooting a falling number there. So it’s definitely not the probiotic and I don’t know why she doesn’t get double dip in the pm cycle, but it seems uncommon there.

@Marje and Gracie seem like a good read? Any thoughts/suggestions about pm cycle? Her latest meal is a +9 there (it’s even smaller than the other overnight foods), mostly for safety since I need some sleep but also because she will puke going too long without food in her system (roughly 4-5 hours).

 

Some info on Bupe regarding the duration
http://www.vasg.org/b_drugs.htm
iv) Duration of effect is influenced by dose
(1) 3 to 4 hours at 0.010 mg/kg (0.005 mg/lb) dose
(2) 6 to 8 hours at 0.020 mg/kg (0.010 mg/lb) dose
(3) 8 to 10 hours at 0.030 mg/kg (0.015 mg/lb) dose
(4) 10 to 12 hours at 0.040 mg/kg (0.020 mg/lb) dose

She's usually lower at night, and I am guessing you are steering, on the remarks I can see that occaisionally you are using Karo/gravy but are you also steering with LC? Is she perhaps getting more food/carbs in the pm cycle? Is that putting the brakes on the insulin? and affecting duration so by the time she's at PS the numbers are on the rise??

Don't know what you do if anything about that.

 

Nice cycle last night!

Maybe she's a werecat...? Curious to see responses to your bupe question and the pre-AMPS rise.

 

Many kitties are.

What is the bupe for?

What is the typical, non intervening feeding schedule and amounts?

 

Thanks for the bupe info. I will have to give it a proper read and do the maths when I get home today.

So steering with LC...doesn't really happen for her? She doesn't get a food bump and her Radcat is LC, or no carb rather, it does nothing to bring her numbers up as far as I can tell. HC gravy also does little to bring her numbers up, at least 1-2 tsp of it does little, 20 points at *best* and not typically that on a falling number.

My go to has been a tsp of whatever gravy as a conduit for Karo syrup. Honey didn't seem to bump her up much either, Karo does. I give 1-3 drops depending on what hour and what number I am dealing with.

On my SS those dog ears that are for notes? They aren't actually notes, I use them to get a visual reference on food interventions, so if you see one, it means gravy and most likely gravy and Karo were used, and the comments column spells out what.

She absolutely gets more food at night because auto feeder gives me some peace of mind to sleep here or there and she usually goes low at night so she's requiring food/carbs. She has a dramatic peak most of the time, all the numbers on either side look awesome, but she really wants to dip below 50 on an active pm cycle and would if I let her.

She still tried to go that low on a lower dose, but all the other numbers increased dramatically, it wasn't cutting it.

 

The bupe is for arthritis and oral pain relief as a bonus. She needs more teeth extractions, I'm still deciding if that is safe and in her best interest, the two teeth she has in the back do bother her.

This is what her eating schedule looks like in the PM:

PMPS +1 through +3 food on demand (give a tsp or two, if she eats it all and wants more, I give her more). She can take it or leave it, she's a nibbler and not a gorger.

Auto feeder tiny meals (1-2 teaspoons) at +5, +6, +8, +9. +9 is her smallest meal, tsp or less, but she needs it so she doesn’t get stomach acid barf.

All these meals are rad cat (no carb) with the exception of Karo/gravy food interventions which usually occur PMPS through +4/+5 depending on her numbers. Intervention feedings are exact same except I add tsp gravy with 1-2 drops of Karo typically, where needed. It's usually a once a cycle thing, sometimes twice.

 

How do the regular amps feedings that differ with PMPs
feedings? If at all?

 

+1 through +7 ish is free feed on demand. If bowl is empty, I add another tsp or 2. I give a snack around +9 which recently has been 1-2 tsp of tiki cat velvet mousse with her b vits added in. She eats less in latter am cycles than pm, for sure.

The auto feed portions overnight are less about her needing food that often and more about me worrying she will be low and not have access to food, I want it to be an option if she needs it. She usually eats them all gone except sometimes skips one of her meals entirely, not sure which one, haven't been paying attention.

 

I see Asia is keeping you on your toes again. In my experience, bupe dosing is an ECID thing. I would think a large dose would last longer, but I'm not sure. When my civvie Callie (GA) had stomach cancer, I gave her bupe every 8 hours and ended up giving her a .015 ml dose. I hope you can figure out if the pain meds are wearing off and effecting her numbers.

 

Will update SS and numbers when I get home, I didn't forget to do it, but daughter is monitoring her since this morning. Her most recent number is 97 and it's taken her 5 hours to get there.

 

Daughter had to leave at +5 in advance of when I would be returning with other daughter, Asia was at 97 so I said give her a half tsp of gravy (which she heard as 1 tsp, or maybe not, she's unsure), seemed to really slow her down. She probably would have done fine, but I didn't know for sure how soon we could get back and we were 40 mins away by train. Will never trust that that adorable face...not when it comes to FD stuff anyway.

 

Her a.m. cycles look like a “normal” cycle with a bit of a food spike. Her p.m. cycles are variable. Occasionally, she gets a tiny food spike but, more often, she is flat or lower at +1.

Cats don’t always consistently get a double dip. The things that I wonder are at play in the non-double dip a.m. cycle are:
--additional food she gets in the p.m. cycle and the kind of food she is getting is messing with her duration
--dawn phenomonen
--the AMPS is always the last number to come down as the dose is decreasing

You can try to change up the +9 snacks, perhaps. Is there any way she will eat just a few morsels of freeze dried chicken or other very low carb freeze dried meat instead of raw? I know the raw is purported to be zero carb but their website shows all but the lamb as “not determined” (I’m assuming that is what n/d means). However, the foods have gelatin and psyllium and so they have to have “some” carbs in them. I just wonder if it is affecting her numbers that late in the cycle and the only way to know is to try something different. I understand the important of her having food in her tummy. If a freeze dried treat is out of the question, what about the same food you use in the a.m. cycle that doesn’t seem to bump her when given at +9 (Tiki cat). If you try that and her pattern is the same, you can rule out food.

Sometimes, we can experiment to find out why and sometimes we just have to say “I don’t know”. But it’s worth a try to do a little experimentation first.

 

What makes you say food spike as opposed to numbers on the rise from loss of duration before onset? The reason I ask is that she eats food many times a day and it doesn't ever seem to have a noticeable impact if she eats vs when she doesn't (I.e. Fed when she's coming down, she continues to go down, fed when she's on the rise, she continues to rise). With the exception of gravy in mid am cycle seems to send her up quickly and have little effect under similar conditions in the pm cycle (because: cat).

I haven't been getting as many pm +10s as I'd like due to general lack of sleep, but the ones I do have show she's on quite an incline to AMPS before getting food.

I have the freeze dried chicken treats, I will try that for her +9, she used to get very excited for them pre diabetes, now sometimes she ignores them, they are tricky for her to chew with the lack of teeth thing but I think her 2 remaining teeth have been bothering her more since September-ish and that's probably why. I think if she's hungry enough, she will work it out.

If she doesn't eat those, I will try the tiki cat next, but as far as she knows, tiki cat tastes like nasty b-right and I don't want her to know it actually doesn't! I guess I could give b-right to her at +9 pm instead of +9 am if I needed to.

 

@Gill & George @Sandy and Black Kitty @carfurby @Marje and Gracie

Thank you all for your feedback and helping me try to figure this stuff out. You all are so kind!

That's one for each of you, or 4 per person, your pick!

Looks like tomorrow won't be so cold, just rainy, so it should be an easier walk to the vet with this old lady cat.

 

Asia didn't get her double dip in the cycle today at least not in the am cycle. PMPS 164, +1 148. I really feel this is double dip vs early onset and double dip started at +13 (PMPS +1).

When she has a double dip before or by +12 or +13, her numbers decline in +1 and +2, makes sense. When she doesn't seem to have a double dip, +1 seems to be much higher. I hope I'm reading this right, but it's really seeming this way to my eyes.

 

How about free feeding the top of the cycle and auto feeding the bottom half of the cycle at +5 +7 +9 , both AM and PM ?

What prompts you to intervene?

 

I will try that food adjustment and see if it makes a difference.

What prompts me to intervene is Asia will likely go below 50 in the pm cycle if I don't, so I feed HC if there is a big drop early in the cycle or if she's within 20 points of 50 in +1 through +5, that's the only reason (besides if she actually does go below 50 of course.

She has a combination of things that happen in the pm cycle that are, from best we have figured so far, double dip falling number meets early onset (+1/+2), sometimes with a big drop (more than 40ish points in an hour) thrown in to keep things interesting. She gets a fair bit of momentum early on. She seems to do it regardless of dose often times? And all a lower doses seem to do currently is skew all the other numbers higher.

Just an aside, I have found anecdotal evidence in humans of something known as the "Lantus low" and I feel like this could be Asia's experience. Here's just one example:

"The whole time I was on it--about a year--instilled a deep fear of lows that took me a very long time to overcome. The lows were not the normal kind of low, where you feel shaky, but you take a couple glucose tabs and you're okay in five minutes. These were deep, rushing lows, where I would take the injection and 20 minutes later my reading would plummet--even as I ate glucose and candy to try and keep up. I would even purposely elevate my reading to take Lantus...and it would still plummet."

 

I know how that is! We have a few twice-a-day cats and a few frequent-small-meals cats, and a couple of the cats work really hard to join both groups! There used to be a free-fed contingent, too ... but a few abusing a privilege ruins things for everybody.

 

Hahaha! How many cats do you have? I'm afraid of the cats outnumbering the hoomans scenario, they are tricksters and will plot against you...especially in larger numbers.

I don't know what I've done to these cats, they were always blasé about food until this FD stuff came into the picture. Toki is going to need an intervention and a support group soon!

 

Hi Stacy, I just read through Asia's condo. Wow! I have no advice, only hopes that you'll be able to get it all figured out!

Have a good evening. Amazing about the change in eating habits of both kitties!

 

We have nine. It's the ninth one who has tipped things from kind of complicated to very complicated since she arrived last autumn. She was a stray momma cat who was accustomed to dining family style, and she still wants to do that--if someone has their face in a bowl, she needs to have her face in that bowl, too. That's very annoying to some of them, and tends to drive timid Felix away. They feel the same about when she tries to hold them down and give them baths.

 

You are correct and the reason why you might see a food spike at +1 is because it is the end of the cycle when duration is up. So she isn’t getting the carryover from night to morning as she is from morning to night.

 

She just wants to mommy them! That is so cute.

 

The oral methyl b12 came today, it looks white in the cap but makes her food a bright pink. I tasted it and it has no taste really, I put it in her radcat, she didn’t even notice! Woohoo!!!

Cycle tonight is very ho hum, I think that’s her way of saying I needed a night of better sleep, point taken.

 

Yum has diabetes and CKD. She was having stomach acid barf every morning, especially after her bowel movement. I really think slippery elm bark has helped with that. She gets 200 mg of SEB mixed in with each of her 2 main meals. She was free feeding, but because she has become so ravenous I now portion the meals out. She hasn't really caught on to auto feeders. (She would rather expertly tear at my heart strings with her eyes and voice.) Since I started the SEB, I rarely see any morning foamy barf, even though she goes 8 or 9 hours without food overnight.
Pepcid AC worked the one night I tried it as advised by the vet, but it was hard to pill her and SEB seems much safer.