? 12/3 - Bandit - AMPS 327 - REALLY NEED HELP!

This is my third post in as many days. Sorry about that!

Bandit seems to have had another post-hyperglycemia bounce (I think!). I know this cannot continue and I really could use help!

(link to my previous post
http://www.felinediabetes.com/FDMB/threads/11-29-bandit-pmps-59-should-i-shoot.222283/)

These are the challenges (which I'm sure every new diabetic mom has faced!):

(a) She is still on high carb (20-25%) dry kibble. Have managed to get her to eat the occasional meal of wet food when she is hungry and hope to transition her completely with time. But it is very slow WIP. She is a really picky eater and will stop eating if I attempt to make a hasty transition.

(b) The bulk of her eating is at night - between 11pm and 4am (with the occasional nibble at 9pm and 8am) and the dry food really makes her BG go up (350 or so despite the insulin). Try as I might I have yet to be very successful in getting her to eat during the day (she just wants to sleep all day inside her "security" cupboard).

(c) As a result, her BG like her eating is all wonky - very high at night and very low in the day. So the PM dose of 1 unit is too less (for a night full of dry kibble) and her AM dose is too high because she barely eats during the day.

(d) She just got off a 3 day bounce yesterday, only to have her BG go as low as 73 (AMPS +10) despite nibbling on some kibble during the day (again, not too much since she doesn't want to eat). Her PMPS was 126 and rising so we gave her her usual PM shot of 1 unit. Also because we knew she would eat through the night and her BG would go to 350-400.

Logically, I know the solution is to get her to eat regularly through the day and ultimately transition her to wet food. That will take its own sweet time but meanwhile her BG is swinging wildly!

What do I do?

Is today's high BG reading a bounce? An unwarranted one? I doubt she fell to below 50 yesterday since she did nibble on kibble (once i sensed that her BG was falling in the second half of the AM cycle I ensured she ate a few pieces of kibble at regular intervals).

Do I continue with the existing dose of 1 unit or reduce it to 0.75 even though that will be too low for her PM cycle?

Should I give her 1 unit at night and nothing during the day - even though that is not advised?

I will attempt to limit her eating at night over the next few days (or should i say sleepless nights!) in the hope that she will then eat more during the day but I really doubt that will happen. Still, I will try.

Sorry again to flood this board with my posts!

P.S. I haven't been able to find a needle smaller than 1 ml. Tried everywhere. That will have to wait till I manage to get some from the US or UK. So dosing below 1 unit is going to be quite the guesstimate!
(http://www.felinediabetes.com/FDMB/...syringe-smaller-than-1ml.222393/#post-2486748)

P.P.S We haven't got around to doing a full glucose curve yet. She got hyperglycemic on Day 3 of starting insulin and just as she was clearing the bounce yesterday, she seems to have bounced again. Have been tracking her BG more regularly over the last 2-3 days. Today is her 7th day on insulin.

 

Hi Bhooma
First of all, please don’t apologise for posting. That is why we are here.... to help you. And posting every day is what most people do.

Looking at the SS, for a cat 7 days into the journey, those numbers are not terrible. Especially given that Bandit is eating high carb dry.

It can be a challenge getting dry addicts off dry. Maybe change you subject line and ask for tips on how to change from dry to wet.
Have you tried crumbling a bit of the dry over the top of some canned food?
Have you tried a raw diet?

If you are following SLGS you earned a reduction down to 0.75 with the 73 at +10 yesterday. However I’m going to tag @Wendy&Neko about the reduction because it is probable she only went below 90 because she won’t eat during the day.

Don’t worry too much about the numbers at this point. Cats numbers do vary during the day and night especially when they are not regulated. If you look at other SS you will see how numbers can go up and down.

Bouncing is very normal, especially in a newly diagnosed cat. Some cats bounce more than others.

Are you home most of the time to test or do you work outside the home?

 

Hi Bron, thanks for the detailed response!

What I am feeding Bandit is the lowest carb dry food I could find in India (my previous thread has some posts on that, so I did not repeat). I have read up the catinfo website for transition from wet to dry and I hope to achieve it in time (fingers crossed!).

However, till then, my problem is that on the existing insulin dosage Bandit's BG is high at night and very low during the day - triggering bounces. And it is entirely due to the fact that she eats very little during the day - if anything at all. While munching on carb-heavy kibble at night. She doesn't over-eat but the kibble is making her sugar spike.

I was just wondering whether there is anything I should do (in terms of shooting or otherwise) to bring some semblance of balance to her BG while I change her diet as well as her eating schedule (both of which will take a while). Cannot see her swing from 50 to 400 again and again like this!

I am home and can monitor her as required.

 

I'm wondering whether freeze dried raw food is available in India. It has more crunch which many kibble kitties seem to enjoy but it's low carb. There are a very few low carb dry foods available in the US. I have no idea if they are available outside of the US.

I know you're worrying about the swings in Bandit's numbers. Bounces happen for most cats. Bouncing is a normal response to lower numbers. A diabetic cat gets comfortable the higher ranges and when insulin brings numbers down, your kitty's body reacts by releasing a stored form of glucose along with counter-regulatory hormones since your cat's liver and pancreas are responding to what is presumed to be a dangerous hypoglycemic situation. It's not hypoglycemia, it's numbers your cat's body is no longer accustomed to. In other words, bounces are annoying to us but ot dangerous.

 

The problem is that her numbers continue to remain high at night despite the insulin (she probably needs a higher dose with kibble) and are dropping too low during the day on the same dose (due to no food) and i'm wondering if there is anything to be done about that!

Maybe there is nothing to do but persevere (keep same dose?) while she slowly changes her diet and eating patterns?

 

Once things calm down a bit for you this morning could you please modify your title to include your kitties name, etc. Posting every day is wonderful, but with the number of posts we have it's so nice to be able to see at a glance, the date, cats name and AMPS - after that questions are fine.

Like this: 12/3 Bandit AMPS ### That would be wonderful! Thank you so much!!

 

Done!

 

What about giving her some cooked chicken for something to snack on overnight? Is that a possibility

 

I know leaving out wet food can be problematic for you due to temperature. Perhaps you could try freezing some wet food in an ice cube tray and leaving out a cube or 2 (depends on size) to gradually thaw overnight along with a little less dry. Since Bandit likes to eat at night, maybe she'd be more willing to eat the wet food as it thaws if that was part of the food available overnight.

I know from experience that transitioning can be a royal pain and sometimes you have to try to outsmart them and make them think the wet food is THEIR idea rather than yours.

 

I see that today she is high all day, and going lower at night, in spite of her eating habits. Any chance of a +5 tonight? She seems to be going down rather rapidly. What you have been seeing is bouncing. This dose has gotten her to a 59, I think you need to reduce the dose.

 

You could try Dr Elsey's 4% carb dry food available on Amazon.

 

Dr. Elsey's is only available in the US as far as I know. Can't get it Canada. Bandit and Bhooma are in India so likely not available there either.

 

@Wendy&Neko, Bandit goes low in the day because she doesn't eat. Is high at nights because that's when she eats - dry kibble. Though of late, she has begun to eat more wet food. Not enough though. Anyway, baby steps.

She has munched some kibble and wet food through the night, so I doubt she fell below 100 even though her PMPS +3 was 146.

Her AMPS this morning was 386! 1 unit seems less for nights of eating and low for days of not eating!

Do you think I should reduce her dose?

 

Also, how often can i test her BG without doing damage to her ears? Poking her 5-6 times a day for several days back-to-back makes me cringe!

@Penelope and Mačka and @MrWorfMen's Mom , Dr. Elsey's is not available in India. I have switched her from Whiskas kibble (which had 40% carbs) to Farmina Obesity formula which has 25% carbs. Strangely, it looks like Farmina Grain Free kibble which has around 20% carbs increases her BG much more because it has potato/sweet potato - so the kind of carbs also matter!

@MrWorfMen's Mom, Bandit has begun to eat more wet food since yesterday. We left out some wet food and some kibble (less than usual) and she ate the wet food too. How do you freeze wet food in ice cubes without the whole freezer smelling of it?

 

When I look @Sue and Luci's spreadsheet it looks like there are lots of pokes https://docs.google.com/spreadsheet...vLq9TPidFRXh4jJ8-od8yQ0OI8yhwovp4tvkE/pubhtml.

What I've learned has come off of @Marje and Gracie's info: http://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/#post-1377750

Maybe there is some info there to help?

 

There is no limit on how often you can test Bandit. If a kitty is in low numbers, it can be necessary to test every 20 minutes until BG comes up to acceptable levels and that can sometimes take a few hours.

It's good practice to rotate sites (alternate ears and position on ear). As long as you don't poke the vein, apply pressure for a few seconds after each test to avoid bruising, there should be no problem. Kitties have far less nerve endings in their ears than we do in our fingers so they don't experience the discomfort humans do poking fingers. Making sure the ear is warm and using a lancet gauge 26 or 28 also makes it easier to get a good sample with one poke.

If kitty's ears seem to be getting irritated, you can apply Polysporin or Neosporin antibiotic ointment. Not sure what the equivalent product would be called in India.

 

Apparently, when I enter my French address, they say they do ship internationally. Could be worth a try?

 

@MrWorfMen's Mom, Bandit's ears aren't looking irritated but I just worry that I am poking her too much! :-(

 

I know Dr. Elseys has other products like litter that is available in Canada but when I inquired about having the food shipped to Canada, I got no response so figured they don't ship here. That may be because of our pet food border regulations (you'd think pet food was a national security threat!) so it may be different elsewhere. Never hurts to inquire.

 

@Penelope and Mačka I just checked the Dr. Elsey's website and on the shipping page it says they don't ship to locations outside the US.
https://www.drelseys.com/return-policy/ What website were you using?

 

Bandit has been north of 300 all day. With very little food going in. She did have a few pieces of kibble 2 hours before the PMPS reading - maybe that's why it's at 348.

Don't know what I am doing wrong. Should I change the insulin dose? Or should I just maintain the dose and wait for her body to get used to it? We are on Day 8 today.

@Wendy&Neko , @MrWorfMen's Mom , any advice for me?

 

Bandit has dropped as low as 59 on the 1u dose at which time the dose according to SLGS would have been reduced to 0.75u. That said, I know reducing doses in 0.25u increments is difficult for you right now due to the syringes you are using. Bandit is dropping into the dark green and blue which is great even though pre-shots are still high. I wouldn't increase the dose at this point.

Hopefully you can source some syringes with 1/2 unit markings but as an alternative as mentioned earlier, calipers might be your best option for being able to consistently draw up a slightly smaller dose.

I think a lot of what you are seeing in those higher numbers is bouncing from the lows that Bandit has become unaccustomed to. I really don't think the kibble can be entirely to blame. Yes the kibble will raise BG but a few pieces vs. a full meal shouldn't make that big a difference.

 

The 59 was a freak number because she hadn't eaten anything at all that day between AM and PM shots. She fell to 73 again a couple of days back. But she just doesn't eat very much during the day which is why her days numbers are so low.

So you would be recommend that I reduce the dose to 0.75?

 

On the night cycle of the 3rd, Bandit dropped to 146 by +3 which may have been her low point for the cycle or her lowest point could have occurred later and if it did, you don't know how low she went. While some of what you are seeing may be the difference in her day and night appetite, and she ate more wet food that night which may have helped bring her BG down, I'm still not convinced the food totally explains her numbers.

If you can, then yes, I reduce the dose to 0.75u and see how she does especially if you are trying to reduce the amount of kibble in her diet. Easier to increase dose again if need be than to have Bandit dropping too low.

 

OK. I have been unable to get my hands on a syringe less than 1ml here. It's just not available. Till I get the callipers and figure out dosing with that, I guess I should continue with the 1 unit dosing?

Btw, at what point does the cat's body adjust to the swings and stop bouncing? Never?

 

Kitties bounce until they don't. Some gradually stop and others bounce all the way to remission. Every cat is different. It's still early in your journey and while Bandit appears to bounce some, he by no means is the best bouncer we've seen around here. Some cats go from green to black on their SS in a heartbeat. Some cats clear bounces quickly and others take their time. Patience, as difficult as it is for us, is key.

As long as you can monitor sticking to the 1u should be Ok but if Bandit co-operates eating more wet food the dose will likely need to be reduced. The other option would be to practice letting out consistent drops so you can draw up the 1u and then "skinny" the dose by a couple/few of drops. It's more important to be consistent than to be totally accurate and that may be the easiest way right now.

I did some checking online for diabetic resources in India and was quite surprised to find syringes don't seem to be available at any online shop that I could find but the selection of glucometers was easy to find. I did find a website for the M.V. Centre for Diabetes that seems to have locations in several places although I didn't see anything in Mumbai. You may have already checked but I wondered if calling them and asking about sourcing the syringes would give you any better leads. There has to be some way to do the small doses babies/children would need.

 

THANK YOU for the detailed replies!

On the syringe front, I've spoken to several chemists, doctors, pharmacists (who checked with the India distributor for BD) and even manufacturers of syringes here and all of them said they haven't heard of a syringe smaller than 1ml.

Will try and get my hands on the 0.3 cc syringe with half unit markings as soon as possible from the US or UK. Till then, will monitor Bandit closely. Like you rightly pointed out, patience is key!

Am using an insulin pen right now, but will also try the skinnying method with a syringe.

Thanks again!

 

Interestingly, I found a blog by a young woman with diabetes who travelled extensively through India. She suggested in her blog that BD products were available so I then checked BD India and was shocked to see there were no 3cc syringes offered on their website.
I assume you checked with your vet? I would think they would have smaller syringes available for veterinary use and they do make specific veterinary insulin syringes. Just a thought.

 

Checked everywhere. With vet, veterinary pharmacy, BD distributor...no luck. All pharmacists/syringe manufacturers clueless about what syringes are used for children. None of them have seen or know of a syringe smaller than 1ml!!

 

If you have a diabetic clinic you can contact, they may advise what children use. Also here is a link regarding using calipers that you may find helpful.

http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

I bought my calipers at a hardware/construction store.

 

Except yesterday she was high all day, broke her bounce and went lower at night. I think the patterns you are describing are more because she's bouncing, than because of her food consumption. Bouncing is perfectly normal in newly diagnosed cats. Annoying, but normal.

Yes. In your previous post, Bron suggested a place you can order syringes that ships to India. Time for that order.

In the mean time, you can skinny the dose. Fill the syringe to 1 unit. Rotate the plunger so you get a drop out. Try to count how many drops are in one unit with consistent drop sizes. You might want to practice this on a used syringe and coloured water or juice first. Then when you dose, fill to one unit and remove 1/4 of the drops you counted. Calipers are a relatively recent thing, people used to count drops.

 

It is expensive by US standards (not so much by Canadian standards). Delievery "around" December 17.
https://www.ubuy.co.in/search/index...lin-syringes-31g-3-10cc-6mm-100ct/store/store

 

Thank you, @Wendy&Neko and @Red & Rover (GA) . A friend coming from the US is bringing me some!

Meanwhile Bandit is at 385 this morning. Looks indeed like a bounce.

 

It was Amazon...