? Need help regulating

1. 
   My Bo was diagnosed with diabetes on January 2nd. He also has IBD, which is currently under control. We still don't have his diabetes regulated. He is taking 1 mg Budesonide and 0.7ml Metronidazole for his IBD. The vet feels the Budesonide may be interfering with regulating his diabetes. Bo was on 2.5U of ProZinc twice a day until last night (Friday) when we upped his dose to 3U.
   
   He is eating Friskies pates, Nulo, and some ProPlan....all of which are low carb. He eats every 4 hours because he is soooooo very hungry lately and gets nauseous if I try to go longer than 4 hours between meals. Even then...he acts like he hasn't been fed in ages when it is time to feed him. The worst seems to be his 5:00PM feeding. He gets 3 oz at his two meals prior to injections. The other meals are only 1.1 oz each at +3 and +7 in AM and PM.
   
   His numbers lately seem to be all over the place. Any suggestions on what we can try?
   
   TIA!
   
   Pam

 

Hi Pam! Welcome to you and Bo!

The budenoside is probably helping keep his numbers up. We have another cat on here @Lisa and Smoky who is on budenoside. His numbers do seem to be high. It's possible he's got some insulin resistance going on...that can happen when a cat is in high numbers for awhile.

Have you read our beginners' guide and protocol? I think for now you may need to stay the course...but I might suggest dosing in smaller fractions..we often go up by .25 rather than .5 to avoid missing the ideal dose. Is that something you think you could do?

 

I agree with Rachael's suggestions on dosing in smaller amounts. Did your vet suggest lowering the dose for the budesonide to you at all? It may help to give 0.5 mg for a short time instead of the 1 mg. It's something you could talk to your vet about.
Smoky was stuck in higher numbers for a while. I had to lower his dose for a few weeks and work back up to a higher dose again. Smoky is not regulated yet and he was diagnosed in September. He had a terrible time while on vetsulin and it took him about a month on prozinc before he started improving. I know the high numbers are frustrating but it's still in the early days for you and Bo yet. Just remember that the sugar dance is a marathon and not a sprint. I have to tell myself that all the time. We are all here to help you to learn the steps to the dance. Heck, I am still learning a few of them myself. I'll tag @Kris & Teasel and see if she can help you out too. She has been a godsend and a huge blessing to me.

 

Hi Pam,
I agree with the comments that the budesonide is elevating Bo's BG. You'll probably have to dose around it because it's needed for IBD. There are many kitties here who have other conditions/meds that have to be considered when giving insulin.

I do think his dose will have to come up but we recommend raising by only 0.25 u at a time. You'll have to eyeball some of those doses. I agree with Rachel that he is probably a bit insulin resistant from being high so long. This is reversible by carefully increasing the dose every 3 or 4 cycles (the 12 hours from one dose to the next is one cycle) until you start to see more yellow, then blue and finally green on your spreadsheet. That can take some time because you can't rush the process.

Diabetic cats are always hungry until their blood glucose is better regulated. If he's not overweight you can feed him more food and more frequently.

 

Check out Smokys SS from 2016. He was in black, red, and high pink numbers for a few weeks starting at end of November.
He was not even taking a steroid then and that was before his diagnosis of IBD.

 

Hi,

I have read the beginners' guide and protocol. Bo has a follow-up appt today. I will talk to the vet about dosing at 0.25 instead of 0.5 intervals.

Thank you for your advice!

Pam

 

Hi,

We did lower his Budesonide dose to 0.5 for several weeks, but then he had an IBD flare, so we increased to 0.5 and 1 mg on alternating days. That didn't help, so we went back to 1 mg. However, at the time, he was not receiving the Metronidazole. That made all the difference with his IBD flare. The vet toyed with the idea of going back to alternating doses of Budesonide, but then decided to try 3U of insulin instead.

Thank you for pointing out it is a marathon, not a sprint. I just feel so bad for him and want him to be back to his healthy self again. I guess I'm not being patient enough. I have seen improvement with his weight and activity, but I worry about what the high numbers are doing to his organs, etc.

Thank you for your suggestions!

Pam

 

Hi,

I am going to talk to the vet today about raising his dose at a slower rate.

I worry about increasing his dose every 3 or 4 cycles, because that would mean doing it every 2ish days. I work full time as a teacher and wouldn't be able to be home to monitor for hypoglycemia. I increased his dose to 3U on Friday night and have been doing a BG every 6 hours. For some reason, his AMPS is super high but then hangs out in the 300's throughout the day. The only change throughout the day is that he gets his Metronidazole at 9PM. When I test him at +6 or +7 in the PM, his BG has already started to go up.

Thank you for your suggestions. I will talk with his vet about increasing every 3-4 cycles as well.

Pam

 

In general vets suggest larger dose changes than we advocate and tell you to hold a dose longer. Some of them don't recognize the bouncing phenomenon either. We also understand the conflict you feel when we say things that are different from what your vet advises - almost every one of us has been there.

If changing doses more frequently worries you, it can be done more slowly. Maybe you could do it on a weekend when you can be there to test more often. The thinking behind more frequent changes (after a kitty has been on insulin long enough to have adapted to a degree) is that staying too long at an obviously ineffective dose increases the chance of glucose toxicity building. This makes the cells less responsive to insulin because of the "toxic" effects of too much glucose in the bloodstream.

 

What is the bouncing phenomenon?

So, as far as changing him more frequently, how would I do it? Right now he is on 3U. So next weekend on Friday night, change to 3.25U? Then on Sunday change to 3.5U?

Thank you for your patience and help!

Pam

 

I wrote this for someone else about bouncing:

Here's how bouncing works:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
7. Many vets have little/no understanding of the bouncing phenomenon.

If/when you change dose we recommend 0.25 u increments so you'd go next to 3.25 u and hold it up to a week if that works better for you. Do as much testing as you can manage and consider late evening before bed if you can't get mid day tests in. After that week, raise the dose to 3.5 u if you haven't seen improvement on the spreadsheet. Hold for a week, etc. When you start seeing more yellow, some blue and eventually dark green on the SS you're very near the good dose for that point in time. The good dose is not static but rather a moving target.

 

Thank you so much!!!!

 

Bouncing occurs when the blood glucose drops lower than the cat's body is used to.
The liver releases stored up sugar which goes into the bloodstream and causes the BG to rise,sometimes very quickly. An example might be if the cats BG is usually in higher numbers ( 400's for instance) their body can become accustomed to that. When you start giving the cat insulin and his BG starts dropping into lower numbers than he is used to it causes him to "bounce" back into higher numbers.

Smoky did this a few times and I was advised to give him a lower dose for a few days to allow the bounce to clear his system. I'm not very good at explaining things so hopefully someone else will chime in about this. Hope this will help you out some.

 

Thanks Kris, I'm not all that great at explaining things.

 

Could this be why his AMPS numbers have been so high while the rest of his numbers are hanging in the 300s?

 

I spent my whole career as a science teacher doing it, Lisa!

 

Smokys BG is also higher in the morning.I think this is due to the effects of the steroid he is taking to treat his IBD. I have to implement a sliding scale dosing for him right now. A lot of kitties have lower BG's at night and higher in the am.

 

Maybe. However, I'd say that you have a little way to go to get closer to an effective dose so it might just be an "unregulated cat" pattern.

 

ETA: Of course! Bo is on budesonide too so that might be it.

 

Smoky was a nice dark green number for +6, BG was 79. I wonder if that is his nadir for today. That was an hour and 10 minutes ago that I tested him.

 

Smoky has been given metronidazole when he has an infection of some type. I didn't know it could be used to treat IBD as well. I will have to ask my vet about the possibility of doing that. Thank you for the info in that.

 

Lovely!

 

I'm making a list of new low carb, IBD and allergy free friendly foods with no chicken,fish,soy, or grains in them. Whew! What a task that is to do. I'm using Dr Pierson's newly updated food list. I'm so very grateful for her taking the time and all that work to do that.

 

We had tried everything with him on this last flare. We thought it could be pancreatitis, so we treated for that with fluids, Cerenia, Famotidine, and pain killers. We upped his Budesonide. There was some improvement, but he still wasn't quite himself. It was taking him 1 1/2 to 2 hours to eat 3 ounces of food. Ain't no one got time for that! I had to sit with him while he ate and repeatedly put him back in front of his bowl. I tried all the tricks of adding stuff to and on top of the food, but none of it helped.

I started thinking about what we had done for a past flare and realized that we had also used an antibiotic, which we hadn't used this time. I mentioned that to the vet, so we added it to his treatment plan. We originally started with 0.7ml twice a day. When that ran out, we stopped for about 3 days. Bo started going back to being a fussy eater, so we added the Metro back in but at only 0.7 ml once a day. He is now eating me out of house and home.

In fact, this morning, I opened a new can of cat food at 9:00AM and took out 1.1 ounces for his morning "snack". I forgot to put a lid on the open can and put it in the fridge because I was trying to protect him from the Roomba while he ate. (It kept heading right towards him.) At 11:30, my husband caught him on the counter helping himself. There is only about 2 ounces left in the can. I didn't give Mr. Piggie his 1:00PM lunch...but he hasn't complained. He is currently passed out in a food coma! LOL!

Pam

 

Oooooooooooh...can't wait to see this! We suspect Bo is allergic to chicken, but it is so hard to find foods that don't have chicken that he will actually eat. He has gotten soooooooo picky since he got sick with his first bout of IBD in July.

 

I'll see if I can send the link to you...if it works that is.

 

I can't get the link to work look under health links/ FAQ on this forum. You will see Dr Lisa Pierson's updated food chart on there towards the bottom. I downloaded mine from there.

 

Thank you!

 

You're very welcome. Our kitties seem to have similar health problems. See my signature at bottom of my posts.

 

Wow...they are very similar!!!

 

Show this to Bo:

 

Hahahah I love the cat bed one!

 

Baaaaaaaaaaaaaaaahahahahaha...he would NEVER get on one of those!!!

 

That is so hilarious

 

Hi Pam,
I just noticed that Dr Pierson has her new updated 2017 food list on the main health forum. I'm not sure if the one I told you about is the old one or not.

 

My kitty Leo also has IBD along with his diabetes that has newly been diagnosed. You might like to check Nature's Variety limited ingredients grain free single protein canned foods. They are supposedly high in protein and low carbs. I checked the ingredients and they look pretty good. Leo does his best with his IBD on a limited ingredient single novel protein. Duck preferably according to him. It gets tough when they can't have chicken, turkey, pork, fish, or beef anymore.

 

Smoky can have turkey for the most part.
I am trying new foods out for him right now. He has trouble with beef, duck, and venison so far. He won't eat pheasant, quail, or lamb so it's very frustrating to find something that he likes to eat. I even tried alligator.

 

Alligator?!? I didn't even know they made cat food out of that! Why don't they have mouse cat food?

 

Oh my! Alligator? Leo's specialist recommended kangaroo from some company in Australia but I just couldn't get myself to feed Leo a kangaroo. Rabbit was a good one for him but he tired of it too quickly.

 

Ha Ha! mouse cat food- great idea. Mouse cat food in a can for lazy cats. Sorry couldn't help myself! Just thought of how my Leo who is a bit lazy brought a mouse home and let it go in the living room. As he lounged on the couch yawning he watched me frantically trying to catch the mouse, then fell asleep while I'm yelling "Leo catch the mouse."

 

I've seen kangaroo is the specialty pet stores.

 

It may be worth trying.

 

He likes to eat rabbit sometimes.

 

Smoky is laying on my bed with the sun coming in the window. He is sunbathing and purring up a storm.