2/22 Sebastian PMPS Somewhere Between 174 and 414 +1 389 +3 290

Yesterday's craziness

Sebastian's all good today. No more vomit overnight and he ate some more. He's been active this morning too, which is good since he's been pretty lethargic all week. Just took a reading and he's at 352, bit higher than lately but normal for the DM Dry he had last night.

I'm going to pull back on the daily curve readings and the diet changes for the immediate future until we get the vomiting sorted out. I want to get him back on the DM Dry for a few days so that I can accurately monitor for appetite changes. I'll be walking back the shot times to his normal schedule, going to do 15 minutes each cycle. I also want to go back and review all the materials on the site to make sure I have all my protocols in line. I definitely need to review the lancing stuff. I've always done his paw but I'm finding it's very difficult to get enough blood to satisfy the human meter so I need to learn how to do the ear.

And thank you for the clarification on the 2 hours. That was what I remember reading and what I had been doing, we have automatic feeders and I had them set to pull the food 2 hours before meal/shot times.

My name's Justin btw, I updated my username. I'll definitely post daily, at least once in the morning and once in the evening, regardless of how many readings I'm doing just to keep everyone updated on how he's doing.

 

Hi Justin, I see you're in Apopka! Hope your visit to the vet is successful today...and happy to see there's no vomiting so far today I see you've been getting some excellent advice. Just stopping by your thread today to wish you and Sebastian well. There's lots of support here.

We're in Naples - so 'just down the road'...sorta

I hope you get some answers. Reminded me of @Giomax when you were talking about all the vomiting - poor Max has had a terrible time of it lately...his mom just got an ultrasound for Max this week. Gotta get to the bottom of that issue.

Keep us posted Have a good day!

 

Hey Justin, what a night for you! I hope that you can get answers to the vomiting problem. I think getting the fPLI is a good idea. Glad he is acting better this morning. Did you go back up to 7 units this morning since he is eating?

Keep trying with the ear testing. To get the ears to "learn" to bleed, you can rub the ear for a few seconds or some peeps put a little rice into a small sock and tie it up and microwave it for about 30 seconds . You just want the sock to be warm not hot and then hold it on his ear for a minute. After testing for a while the ears will start to bleed faster for the test.

Keep us posted after the vet appointment.

 

Looks like a spoke too soon, he vomited right before mealtime.

But then after a few minutes he went and ate some. I am planning to go back to 7u, assuming he's able to keep the food down.

 

Hope you get answers from the vet AND meds if you don't have them already. My civvie Tux just went through a bout of vomiting and not eating. I lost a kitty many years ago to pancreatitis and hepatic liver because of a practice bungling. So when Tux started I was on it so fast but the lackadaisical attitude of the ER and vet is what really t'd me off. And by then it was going on 48 hrs of not eating.

Stick to your guns and get answers and meds if needed.

 

Hi Justin,
that was quite a night for you I hope you get some answers from the vet today, and sending continued prayers and vines for Sebastian.

Personally I wouldn't go back there, having made the progress to remove it from his diet. Unless it was the absolutely only thing he would eat.
It might be a good idea to have some HC wet food on hand which was suggested, Like the Fancy Feast Gravy lovers and also some all meat baby food that you could give, it's easy on the tummy and a lot of folk use it with a lot of success when their kitties are having similar problems.
I think it's more likely that the vomiting is related to another bout of Pancreatitis, that started a few days ago and hasn't cleared up completely, it can take them a while to recover, it's tough dealing with the uncertainty as they didn't do the correct test for it.

Absolutely while he is running high you don't need to be testing him every 2-3hrs, but I would still aim to get a couple of tests in both the am and pm cycles, and especially keep checking those ketones twice daily if he continues with the high numbers, vomiting.
Perhaps a +3 ish and +6 ish following up if you find he hits blue or numbers drop suddenly. While he is not well it is still important to keep an eye on those BG's

I know you felt yesterday that the 110 was out of character for Sebastian, but I just wanted to say that I don't think it necessarily was. The day before you got a 198@+6 which you recorded as 212 because you averaged readings out, but in any case the day before yesterday he spent quite a bit of time in yellow dropping to a high blue/low yellow before zooming up in the pm, that increase in numbers you saw by pm looked like a bounce, which, as I think it was Sandy, explained can happen when kitty spends a fair bit of time in numbers that they are not used to. That bounce, to my eyes, looking at the ss appeared to start to clear yesterday morning dropping from pink to yellow, and you can see that the trend in BG was that it was falling as the cycle progressed, when they clear bounces they can do so quickly and gather quite a bit of momentum, so that 110 was certainly a believable number. Since he was also having trouble with the vomiting that may also have contributed to the number dropping due to lack of food in his tummy.

Paws crossed he keeps his food down today and ketones remain out of the picture

 

I agree with Gill about the dry food. We have a lot of success with all meat baby food when Bubba has gone off his feed for different reasons it gets him going again. The baby food is all meat and water and is very bland and easy for them to digest which helps to give them system a break . Once he starts eating again, if he is still tentative, I will "ice" his wet food with a little of the baby food to get him interested. Just remember, it has to be all meat and broth baby food, not the baby food meals with rice and vegetables.

 

Okay I'll pick up some of that all meat baby food today and give that a try. I don't want to pull back fully on the diet either, at this point I don't really think it was the Dr Elsey that was setting him off because he had been eating in in varying amounts the whole week prior with no issues. So I'm going to put that back out.

He ate a bit right before we went to the vet and hasn't thrown up since, which is going on two hours now, so that's good and he just ate a bit more when we got home.

As far as the actual vet visit, they were about as helpful as usual., which is to say not very. They did a physical exam and his breathing, heart rate, and temperature are all normal. No abdominal pain. They did a urinalysis, results here, and it also has some of the preliminary results from the urine culture they did on Sunday which so far is negative. Everything looks about as would be expected. Not entirely sure about the 1+ ketones and how that correlates to the blood reading of 0.2 that I got last night, the vet didn't know either. Not sure if there's some conversion or urine concentration going on or if it's an actual increase but either way the 1+ is still below the trace 5 on the stick. They didn't offer any theories as to why he was vomiting but they gave him another cerenia shot and some sub-q fluids, and they recommend I continue to administer the oral cerenia at home for the next few days and they set me up with a bag of fluids so I can do it at home for the next few days also. So basically, treat the symptoms and monitor.

I asked about the fPLI and she said she didn't think the results would really change anything. She basically said the options right now are either treat and monitor or hospitalize and the symptoms didn't look like hospitalization was necessary. But I had them run it anyways because I'd rather have it and not need it than need it and not have it. So we should get those results back a little later today.

I'll plan on getting a +3 and a +6 BG and I'll check for ketones when I do the +6 and possibly again before bed depending on what I see.

 

So they just contacted me about the fPLI
"The fPLI is slight positive - the test is read by evaluating two blue circles, when the right one is darker than the left (control) that's a positive. In Sebastian's case both are the same blue intensity making it slight positive"

I asked if that's normal for an existing case of pancreatitis or if there's something we should be doing about that.

 

Sounds like a plan.

I'm glad he seems better today. I hope that he continues to improve.

maybe someone that's had this test done or understands how it works can offer insight, 'slight possitive'????

 

+3 is 438. Pulled the DM Dry and put the Dr Elsey back out, he ate a little of it. Wife is picking up some baby food and HC gravy on the way home. We'll hang on to the HC for hypo and give the baby food a try a little later. Still haven't heard back from the vet on what exactly those fPLI results mean.

 

I'll also add that he's more awake today. He's not sleeping on his boat and is instead just sitting here staring at me. I'm not entirely sure which one I prefer.

 

That actually sounds like a snap test. With the fPLI test, you should get a number.

 

Got a response from the vet re the fPLI
"I think we need to evaluate his clinical signs, if we can't get the vomiting under control with what we are doing at the moment or if he worsens, then we should consider hosp w/IVF to address hydration and continue injectible cerenia and/or any other meds for example pain meds if needed. Diet is also important to consider, for cases of pancreatitis I recommend diets that are low in fat; for cases of diabetes, patients should be on a diet for that; now, he has a combination of diseases and the pancreatitis is probably secondary to the diabetes. He was on the Purina DM diet, if he could go back to that."

I just checked the food chart, Purina Pro DM is 52% fat, Wellness Core is 57%, and I'm not sure what the Dr Elsey is.

 

Just read up on it, yeah sounds like they did the snap test and they'd have to actually send a sample off to get a value. Pretty sure they don't have another sample to send off.

 

FYI, you don't need a diet low in fat for cats. That's another myth and it's not true. One of my civvies had pancreatitis and I didn't change his diet. I just stocked up on cerenia, ondansetron, and bupe for the bad episodes.

 

I figured. The fact that they're recommending the DM for diabetes in the first place tells me they're not up to speed on everything.

 

Morning Justin

It seems to me they might not have done the test correctly or understood how to read it. It would be like doing a home pregnancy test and saying it’s a “slight positive”. I agree with Mandy about the fat. It is well known that for dogs with a propensity towards pancreatitis, a low fat diet is necessary. Not so for cats.

When your wife gets the baby food, you want to be sure it has nothing in it but meat and meat broth; no vegetable broth. The on,y one I know that is like this is Beechnut.

I don’t know if anyone has posted my Primer on Pancreatitis for you. I’ve also done a post on Testing and Shooting Tips which might help you with the testing. And, lastly, if you haven’t very given subq fluids at home, here’s the video we did for FDMB members with all the details on how to make it easier.

I hope I didn’t confuse you last night with the feeding. It’s the same concept as not feeding two hours before shot time. We want to be sure you don’t shoot a food spike. Once you have fed while stalling, then we need to wait about two hours to be sure you aren’t shooting s food spike then as well. The more data you get on Sebastian, the more you’ll be able to have flexibility with that. If a kitty is not at all carb sensitive and gets no spike from food, then there’s a bit more latitude but you have to have the data to show that.

I would also agree you should make every effort to get rid of the dry. He’s been diabetic a long time with two episodes of DKA. He could be doing much better with the right diet, right dose, and appropriate testing.

I hope he feels better today.

 

My wife went to the store and got the Beechnut food, she made sure it was all just meat and broth. We got mostly chicken, some turkey, and some beef. We also picked up FF Gravy if we need it.

We put some of the chicken down and he ate some of that and some more Dr Elsey for lunch. He hasn't thrown up since before we left for the vet.

I think the transition to wet food might be a little problematic right now, he just doesn't want to be consistent in what wet food he'll eat and with the DKA history I don't want to risk him not eating, but I'll work at it. In the meantime I'm going to give him only Dr Elsey and no DM, since he has no trouble eating that. That's what I was doing earlier in the week when his numbers were coming down so we'll get at least some progress there.

I'll check out the pancreatitis and sub-q vids, I already saw the testing and shooting one and am going to brush up on that. Thank you for those.

I think I got the feeding timing straightened out. I wasn't super clear on what "shoot a food spike" meant. Basically we don't want to see artificially high numbers from feeding and give him too much insulin as a result, right?

I think he's doing pretty well now. Other than the vomit this morning everything else seems normal, he's not hiding or acting sick, is walking around and talking, digging into my wife's purse to chew on napkins, etc.

 

+6 is 446. Weight is good, actually up a couple ozs today which I'm happy about.

 

Have you looked at catinfo.org ?

Dr. Lisa Pierson DVM has put together information about what felines should and should not eat.

The bottom line is that even the cheapest canned food is better than any dry food on the market.

 

Excellent on all!

I’ll explain about food spike. When you feed Sebastian, the carbs in the food will usually raise his BG within 30 minutes especially
at the end of the cycle when the insulin is wearing off. We deal with this a lot when members are stalling and waiting for the BG to come up high enough to safely give insulin.

If food is fed two hours before shot time or even while stalling, and you retest the BG 30 minutes later, the BG is likely going to be higher. If you then give insulin, once it onsets at about +2, the BG can come down quite a bit and the caregiver find it takes a lot of HC food to keep the BG in safe numbers.

Not every cat gets a food spike every time in this kind of situation. But since we know the chances of it happening are fairly good, why set the CG up for a long night? It’s safer to let the carbs deplete and the BG come back down before giving the insulin.

It’s also why when you come up to preshot, you always want to test before you feed. You want an accurate number of what you are really shooting and where that “might” lead you at midcycle. And it’s also why if there’s a delay of more than 30 minutes after you test and before you give the shot, you should test again. A BG can drop a lot in 30 minutes especially if kitty is clearing a bounce.

Sebastian didn’t really get much of a food spike. We often see the food spike if we test at +1 and he had none so I felt more comfortable in you giving insulin but I was also concerned his numbers might drop when he onset at +2. It just took longer for the dry food carbs to kick in...which we do anticipate.

Lots to learn! But we are here to help and answer questions. I’m glad you’ve got supportive therapies there and he’s kept the food down.

 

Okay, so I think I've been doing my pre-shot readings wrong then. I feed him at 7AM/PM, so what I've been doing is: pull food at +10, 2 hours before feeding (5am/pm), feed (7am/pm), wait 30 minutes and take preshot and then immediately dose (730am/pm). If I'm understanding you right, I need to pull the food a little earlier than 2 hours before, maybe +8 or +9, need to move my pre-shot readings to just before he eats, like 6:55am/pm, and then wait only 15-20 minutes between feeding and dosing instead of 30?

 

The first thread you cite above, where you saw numbers like fifteen and thirty minutes, is about the test-feed-shoot cycle. After you have tested to make sure it is safe to give insulin, then you want to get some food in the cat before shooting. You may or may not want to wait between feeding and giving the shot. What's important is that the cat doesn't wind up with a shot of insulin on an empty stomach. The answers you see in that thread are from two people whose voices I've come to trust.

 

I don't even know what the PMPS is. These test are going to break my brain. I did 5 tests, because I really have no idea what his range should be right now. I got 208, 311, 174, 414, 277. Like, I don't even know what to do with this.

 

+1 389, ketone reading Lo (<.1) Oh and no vomiting since this morning either.

 

The only way I could shoot BK was while he had his head in the food bowl, so by default after testing, feed and shoot happened all at once.

Because Lantus is slow acting, you do have some wiggle room.
Lets say you test/feed/shoot and then for some reason your kitty throws up the whole meal. As long as you get food into him before onset, its OK.
This scenario is one example of the importance of figuring out when Lantus onset is for your kitty.

 

Yes you’ve been doing it incorrectly. And yes, you should pull food two hours before you get a preshot, test, feed,and then shoot within 15-20 minutes.

In agreement with Sandy, the typical process is to pull food two hours before the preshot test, test, and then feed while,shooting so the kitty is “busy” eating while you are giving the shot.

The other thing about letting him eat after midcycle, unless it is a small portion of a LC treat like a single ingredient freeze dried meat, is that you are shortening the duration of the insulin. An analogy is if you are driving up to a stop sign and before you get close to it, you slam on the brakes so you never make it to the intersection. If you just take your foot off the accelerator and glide to the stop sign, then you’ll make it.

You’ll get better duration out of the insulin by not feeding after nadir unless he’s running low and you need to give food to keep the BG in a safe range.

As Sandy said, Lantus doesn’t onset until about +2 and Levemir +4. Unlike the shorter acting insulins where you must have food in board before you shoot, Lantus and Levemir are more “forgiving”. While it helps to have food on board before +2, and most CGs do feed a preshot, it’s not critical to be sure kitty eats immediately when they are being fed.

 

+3 is 290

I had no idea. So I really need to figure out when his nadir is, and I'll probably need some help with that. He eats most of his food at feeding time but not all and then will finish the rest up at "lunch" which is pretty consistently around +6 (1pm, don't know about night cycle).

 

Yes, you should know his onset, nadir, and duration by studying his SS as you get more data. He hasn’t been back on Lantus long enough yet to really determine those things.