? 11/29 Bandit PMPS 59 - should I shoot?

Hi

My 11 year old female spayed tuxedo cat has recently been diagnosed as diabetic (a month back). Our vet wanted to try out Glipizide and we did that for a couple of weeks but to no avail. He suggested that we start her on Mixtard 30/70 (1 unit a day) but we convinced him that we would prefer to use Lantus since she is a graze eater and Lantus would be gentler. Her blood sugar was in the range of 330-420.

She presently weighs 10 lbs (4.6 kgs) and we started her on 1 unit of Lantus twice a day 3 nights back. We have not yet done a full blood glucose curve since we were waiting for her to finish a week on Lantus.

Bandit is a graze eater and eats through the night - usually does not eat anything during the day. We are still trying to transition her to wet food - she is a picky eater and does not take well to any change (in all aspects of life!). She is still largely on kibble but we manage to get her to eat wet food when she is quite hungry.

Her PMPS yesterday was 240 and today it is as low as 59 (she hasn't eaten anything all day as is the case with her since she only eats at night)!
She has completed only 6 cycles (3 days) of Lantus (1 unit twice a day).

As advised on the forum, we have not given her PM shot and have fed her a meal. We will continue to check her sugar for the next 3-4 hours (its 8pm in our neck of the woods).

I wanted to know what we should do? Do we skip the PM shot and give her usual AM shot of 1 unit? She would have eaten all night (as per her MO).

Do we reduce her insulin dose from tomorrow?
Is it possible that 1 unit a day would be sufficient for her?

Sorry to ramble on like this. Would really appreciate some advice.
Our vet is a genius but I suspect he doesn't have too much experience with feline diabetes/Lantus

Thanks a billion
Bhooma

 

Welcome, Bhooma.

That 59 earns a reduction to 0.75 units even if you are seeing higher numbers. The higher numbers are a "bounce" from the low 59, a number that Bandit's body is not used to and sees as a crisis.

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Since Bandit is still eating some dry food, you would take immediate action and a reduction the next cycle if Bandit drops below 90.

It would really help us to help you if you could get a spreadsheet set up. We are fairly data driven. If you need help setting it up, there are people here who can help.
FDMB Spreadsheet Instructions:

• Please set up a Google Spreadsheet as soon as possible. Always keep spreadsheets up-to-date! Valuable time may be lost looking for information when a spreadsheet is not up to the minute.
• If you have not been able to transition your kitty off of DRY food yet, please note it on your spreadsheet and in your signature. A dry food diet will often require higher doses of insulin to bring numbers down. Having this information plainly visible will help us help you.

Understanding the Spreadsheet/Grid

 

Hi Red & Rover

Thanks for the prompt response. We have only just started Bandit on Lantus (3 days ago) and were aiming for the Start Low Go Slow method. We haven't done a blood glucose curve yet and were waiting for 1 week to do the curve as well as start the spreadsheet. But I will get started on that right away.

Bandit shows no signs of hypoglycemia except she's really hungry (but she has been displaying polyphagia thanks to diabetes). She has eaten a spoonful of dry kibble.

We have not given her the PM shot which was due 1.5 hours back.
PMPS was 59 and after a spoonful of kibble and 2 hours, it is now 126.

So do we skip the PM shot today and give her an AM shot of 0.75 units?
She eats all night (grazing) and pretty much nothing during the day.

I am sorry I don't have enough data, but we will be checking her blood glucose at frequent intervals tonight.

Thanks again
Bhooma

 

There are 2 threads going so here is a link to the other thread. I have responded there in regards to your question about tonight's shot.
http://www.felinediabetes.com/FDMB/threads/11-29-bandit-pmps-59-should-i-shoot.222289/

I would skip tonight's shot and give 0.75u tomorrow providing pre-shot in the AM is 150 or more. When giving insulin ,it is however important to know that kitty will eat if need be even if it isn't her usual habit to eat much during the day. Once you get more data then you can lower the no shot limit gradually to monitor how Bandit reacts.

 

Thanks for linking the threads and apologies again for the duplicate (I guess there is no way I can delete that one?)

Bandit typically eats from 9pm to 7am. She is still on kibble and is a graze eater.
Given that she eats nothing for most of the day, would it work if we give her only 1 shot of Lantus per day - say 1 unit around 9pm along with her first meal of the "day"?

She eats next to nothing post her AM shot (that has been the case for the last 3 days) and that is why such a low PMPS number.

 

Lantus works best with consistent dosing twice daily. While there are humans who use Lantus once daily, it's extremely rare for a cat to do well on one shot per day as their metabolism is faster than a human's and the insulin just doesn't last a full 24 hours. Once daily shots sets up a roller coaster effect of highs and lows that can make the cat feel unwell and make it difficult to see how well any dose is working so that appropriate adjustments can be made. It's odd that your kitty doesn't want to eat during the day as most diabetics are ravenous until their BG is better regulated. I take it you have no problem getting Bandit to eat before his PM shot.

It's interesting that PMPS yesterday was 240 but only 59 tonight so it seems unlikely the low today is just from lack of food during the AM cycle. Did Bandit uncharacteristically eat during the day yesterday?

Perhaps you could put down a little less food for Bandit overnight and he night be hungry enough to eat before his morning shot. Just a thought.

 

Bandit rarely eats during the day. She does so only if she hasn't eaten during the night for some reason. And she will NOT let us sleep if we deny her food at night. She is not a big eater and like I said, she doesn't adapt to change very well.

Last month, when we tried a little aggressively to change her diet, she just stopped eating for 3 days and we had to give her saline! So we are reluctant to make any sudden changes to her diet again. She has also lot weight and continues to display severe clinical signs (excessive urination and thirst) and we are hoping to first stabilize her with insulin before we attempt any changes in her diet. We would like her to regain the weight she lost.

We have only just started her on Lantus (3 days back) - so could the explanation for the fall in PMPS BG today be on account of her "depot" still building up?

Her BG has gone from 59 to 126 in 2 hours with one spoon of kibble. Not sure if that is on account of the food or is a hypoglcemic rebound/bounce.

I have set up her spreadsheet. Very little data to go on thus far since we've just begun with Lantus.

 

Her BG is up to 335 now. +4 after the 59 and after 1.5 spoons of kibble.
Guess this is the rebound/bounce as a reaction to the low BG

 

The zoom up in numbers also shows you that her insulin shot from last night is wearing off. Goes to show that one shot per day will not work well.

 

Hey there and welcome. The only thing I would add is that next time you are presented with a lower pre shot number , stall 30 minutes without feeding and retest to see if BG has come up to a safe number.

Since you are new to Lantus you will want to not shoot under 150 until you have gathered more data. Eventually that number will lower.

 

What does one do in terms of regulating food? Bandit is not a large eater per se, but ever since diabetes, she is quite ravenous. Do I let her eat as much as she wants? She is still on kibble and has lost weight that she needs to regain.

I am concerned that her lopsided schedule of eating (eating for a few hours at night but hardly during the day) will cause her BG to fluctuate wildly - high in the mornings after a night of food and really low during the day/by the evening (PMPS) because of no food or little food between AM and PM shots.

 

An unregulated diabetic cannot process their food properly and therefore they are often always hungry and need more food than normal to maintain their weight or gain back lost weight. You can feed Bandit more food than you normally were but best to split it up into several servings per day rather than only feeding at shot times. Many folks feed 4 or even 6 times a day. Even if Bandit doesn't eat much during the day, leave food out for her to eat should she feel the need.

I notice on your spreadsheet that there was no pre-shot BG test before the AM shots on the 28th and 29th. It is really important to always get a pre-shot test to determine whether it is safe to give insulin or not. It is also important to get mid cycle tests whenever possible to see how low BG is dropping on a given dose of insulin as dosing is based on lowest BG. At night, a test at +2 or +3 post shot is helpful and at a minimum, a test before bed to keep Bandit safe.
Since there was no pre-shot or mid cycle tests for the AM cycle on the 29th and BG was only 59 at PMPS, it's possible BG could have dropped even lower than 59 at some point and now the higher BGs you are seeing are the combined result of a bounce and the PM skipped shot.

What kind of kibble is she eating?

 

Yeah, we've goofed-up in assuming that there would not be such a precipitous fall in BS so soon after starting Lantus. We were taking fewer readings expecting that Lantus would take 3-5 days to build a "depot". We were planning to do a full curve over the weekend. We wanted to spare her the what-we-thought-were "unnecessary" pokes till then.

The other goof-up has been in not feeding her between her AM and PM shots. We will correct both mistakes from hereon - take AM, PM and mid-cycle readings for the next few days though readings are bound to be elevated because of the post-hypoglycemia bounce.

As far as kibble goes, we live in India and food options are next to non-existent. Bandit was on Whiskas dry food (40-50 gms per day) all her life till her diagnosis. We don't have any options as far as low carb (less than 10%) kibble is concerned and even fewer options for wet/canned food.

We had a choice between:
(a) Farmina N&D Grain-free food - claims to have low glycemic index but has potatoes instead of grain! 82% proteins & fats and 18% other ingredients. 4204 kcals/kg
https://www.farmina.com/in/cat-food...rain-free-feline/148-fish-&-orange-adult.html
https://www.farmina.com/us/cat-food/n&d-prime-feline/145-chicken-&-pomegranate-adult.html

(b) Farmina Vetlife Obesity - which they claim is for cats with DM too. 3122 kcals/kg. More carbs than the Grain-Free food, but our vet thought potatoes would cause BG to spike more than corn gluten and whole oats!
https://www.farmina.com/in/cat-food/farmina-vet-life-feline/83-obesity-feline.html

Could really use advice on which of the above would be better.

Bandit refuses to eat wet food. We are still trying to get her to eat it when she's hungry but she doesn't eat more than a spoonful! And its not like we get great wet food here either

 

My girl was a kibble addict (no low carb kibble here in Canada either) who eventually got hungry enough one day to pilfer some of her non-diabetic brother's perfect diabetic food when I didn't get up to fill her bowl fast enough. She got switched cold turkey that day with only a few final standoffs for pre-shot meals. I had been trying to switch her since she was a kitten. In the end it was her decision....not mine! I know the frustration of trying to transition them only too well.

From the data on the website, it looks like both the fish & orange and chicken & pomegranate are about the same at roughly 25% carbs based on the analysis provided. You could contact them for As Fed/Dry Matter percentages which may or may not be what they have posted. I'd stick to the chicken variety rather than fish only because of the concern over mercury these days. The obesity feline variety is definitely higher in carbs.

With a limited selection of cat food to choose from, have you ever considered a raw diet or making your own? There is information at https://catinfo.org/ that provides info on nutrition and recipes for homemade food.

 

Take a look through the UK food chart.
Then go to amazon.in
If the formulations are the same or similar, some of the Sheba varieties are okay, as are the Whiskas jellies.
Or as @MrWorfMen's Mom mentioned above, raw is an option.

 

Bandit refuses to eat Whiskas wet food. I've tried both Sheba and Me-O wet food with her. The challenge is that she likes it as an occasional treat but not as regular food. I think it's the texture she doesn't care for. She barely eats a spoonful of it. She would need to consume a much much larger volume of wet food (since it's 90% moisture) to get the same number of calories as dry food. And it doesn't help that she's a graze eater. Can't leave wet food lying around!

Anyway, for now I just want to stabilize her on insulin with existing kibble. We had a bad scare last month when we tried too many things together and she just stopped eating.

In the kibble options that I have, would you suppose that a grain-free, lower carb but higher calorie kibble that has potato/sweet potato would be better than a lower calorie but higher carb kibble which has grain instead of potato?

 

I forgot to add that I'm vegetarian. Have been all my life! Have no experience with buying or cooking eggs/fish/meat! I'm worried that I wouldn't even know when they go bad etc.

 

Wet food will last for awhile but of course that would depend on temperatures too. Hopefully you can find some canned wet food that Bandit will eat. It's possible to freeze wet food in ice cube trays and leave it out for eating later as it thaws. There are also auto feeders that will take an ice pack to keep the food chilled.
For now, Bandit has to eat so you adjust the insulin accordingly.

 

We live in Mumbai. It's quite warm and humid here most of the year. I've noticed that Bandit almost never comes back for seconds of the wet food like she does for kibble. Anyway, for now the focus is on getting her BG to regulate with the existing food and then try and change her diet.

Her AMPS was 409 and mid-cycle was 406. We are expecting higher numbers on account of the rebound/bounce after yesterday's hyperglycemia.

Have fed her some kibble during the day too. Let's see. Hopefully, these highs should pass in a couple of days. Fingers crossed.

Thank you all for your advice. It's such a relief to have someone to turn to with your million worries and questions!

 

Is there anything one should do when a cat suffers rebound hyperglycemia? Or should one just continue with shots and ride it out?

Sorry, not done with the questions as yet!

 

Unfortunately, there is nothing to be done. It's a natural biological occurrence over which we have no control. Just stay the course and it will pass. Bounces can last as long as 6 cycles (3 days).

I notice you did not reduce the dose to 0.75u. Since you are following SLGS, Bandit earned a reduction because BG dropped below 90. You may have given the old dose due to the higher pre-shot today but that is not necessary and if the bounce breaks suddenly could cause BG to drop very low again.
I'd definitely drop the dose to 0.75u for tonight's shot.

 

Yes, i did continue with the previous 1 unit dosing. I reckoned that the unusually low number yesterday was on account of her not eating anything all day. nothing at all between AM and PM shots. even with the AM shot, she ate just a spoon of wet food. so she had had practically nothing to eat between say 6am and 8pm yesterday. the situation was similar the previous day when we recorded a 240 PMPS number.

from today, we have started giving her something to nibble on through the day (like she does at night) and also taking mid-cycle readings. hoping to get a few less wonky readings post the bounce to see if dosage needs to be reduced.

am i wrong to follow this line of thought?

p.s. i'm only not sure about how much to feed her. she is more hungry now and eats a lot more - and she's never been one to overindulge - more an eat to live kitty. after yesterday's low, i don't want to deny her food.

 

Her PMPS is 299 today. That's over a 100 point drop from mid-cycle (6 hours ago).

 

The bounce may be breaking so just monitor her.

On the food front, feed her what she will eat but watch her weight. DIabetics cannot utilize the food they eat properly so feeding more than usual right now is quite OK.

 

Yes, will test her at +3 before we hit the sack. And lay out enough kibble for her for the night.
Will also test her more frequently over the next day or two to see if the dose needs to be reduced.

She has lost a lb or so and was never overweight (11.5 lbs at her heaviest). Would like her to get back there and would also like to see a reduction in her clinical signs.

THANKS AGAIN FOR PATIENTLY RESPONDING TO MY QUESTIONS!