2/5 Sandy AMPS 163, 120@+2, 47@+4

Liza do you think you could put what food you feed into the remarks column of the SS if it isn’t too much trouble?
For example for the PMPS you would write “PMPS FF13% more than 2 oz.” then add what you feed at +1 +2 etc.
That way we can look at the BGs and the food intake and carbs and that tells us a lot.
If it’s only written in the thread it gets lost over time. Thank you

 

Hi Liza, I'm glad to see that Sandy stayed flat after I left you. Bron and Gill gave you excellent feedback. Sometimes seeing what % carbs works or doesn't work gives you information for next time. Just getting some things organized for my crew this morning, then I'll pop back to see how you are going.

ETA that also includes coffee for me, since I've had to come back to correct about 5 spelling mistakes.

 

I see 97@+1
No food bump so I would give some high carb food snack now....that is 17 to 18% or over . and test +2

 

Hi am back, I was just sorting lunch out

We will have to see.
What would ideally would happen is that he stay in normal numbers for a week and then all being well he could start a trial.

I see with the +1 he is slightly lower, so no spike in BG after his Breakfast, more flat than drop.
Do you think you could give him some MC now for a snack, (12%-15% I believe you have) or HC
scan him after 30min. See what he is doing, incase we need to stall him with something a bit higher in carbs.

 

Hey Lisa,
How are you doing? Checking in for the +2

 

Not good, he dropped to 47, again. I tried to feed won’t eat, I waited scanned again and now he is too low to read. It s just saying LO which means the reading is now under 40

 

Try rubbing a little syrup on his gums to buy you some time, it gets to work more quickly

 

Rub a couple of drops of syrup on his gums if he won't eat.

 

How is he acting?
will he eat some of the kibble?
Try raising the bowl, on some books perhaps, if he is feeling a bit nauseous that can help. putting their heads down can make them feel sick

 

He’s acting sluggish but I fed again and he ate some this time. About 2 table spoons of ff turkey in gravy. Now he’s laying in a sunny spot

 

did he get syrup in that. I understand the turkey in gravy is 13% ish
Did you give syrup on his gums?

 

Yes put it on his gums

 

to summarise the feeds

pmps almost a whole can (13% carbs).
+1 97 snack??? what
+2 47 syrup on gums
+2.5 40 ???2 table spoons of ff turkey in gravy 13%

Can you confirm and edit please thanks.

 

Correct. The +97 same ff food. It’s the only thing I can get him to eat besides the pate and dry food.

 

When he drops below 40 especially when he is early in the cycle, and especially Sandy.
13% is not enough carbs.
As that is the only thing that he will eat you need to bump the carbs up by adding some syrup to the food. mixing it in.

From your response above he had a bit of syrup in the gums but none in the food?

I would scan him again about 15min after the last scan and snack so +2.45 (in about 5 min by my reckoning)

 

Just scanned him right now he just hit the +3 mark, he came up to 52.
And yes syrup on his gums not on food.
I put it in his food yesterday when this happens and he wouldn’t eat it. I opened another can of food for him to eat at the point.
So this time I just put it on his gums. Not sure if that what made him come up or the food he ate. Going to scan him every 1/2 hour.
I just gave him some dry snacks and he ate them.

 

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%

Ok if he will eat another teaspoon or two of the 13% with a drop of honey I would give that to him now.
If he refuses that perhaps try a couple of teaspoons of kibble.
It's early in the cycle and we just want to give him a good bump of carbs

 

if it is corn syrup it can make them feel icky if you use too much. I used to use honey, and add it to 24% carb food on days like this.
(George wasn't veery sensitive to carbs)

That usually gets absorbed quite quickly, but equally it can wear off quickly too.

Excellent

Could you scan him 15 minutes after +3 so at +3.25

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%
• +3 50 , had some kibble

 

Sorry I must of missed this message. Sorry I haven’t put it on the SS sheet these past couple of days. It’s been really stressful and I haven’t gotten much sleep. These drops have been going on for few days now and because of it I’m up monitoring him for hours on end and just trying to get food into him to raise his numbers.
I had been mixing the kibble because I was trying to keep his numbers above 200 so that he wouldn’t drop down into the 40’s. It was only a small amount I was mixing in wet to get him to start eating. After I was told to stop doing it I stoped. The last day was feb first. I can see on the SS that after that his numbers came lower. Which is great but now his drops are lower.
It’s like I’m caught between two walls.
He needs to stay on insulin because of the recent DKA, but the only way I was managing that was to keep him above the 200.
His body doesn’t seem to be needing the insulin but he needs to stay on it I understand but then these drops.
I can’t win

 

Ok

 

No problem, I know it's been incredibly tiring for you.
That's why I was just recapping them in the post, so everyone can follow, and it doesn't add to your workload, you can add it to the SS later.

That is what I was wondering. I think it has changed his insulin needs, and why we have seen this shift. We have seen a members kitty go from 5u to no insulin in just 24hrs (he was only stealing a few bits of kibble of the civies)
It is better that he is not having kibble regularly. (use it if you have to like today).

He is very recently diagnosed, did he just get sick? or did he have steroids just before or some infection that triggered the diabetes, and then DKA? (am I right in thinking pancreatitis has been mentioned?)

rock and a hard place

He may have started producing his own insulin.

One other question, When was he fitted with the Libre??

 

Ok

jan 8th I took him for a sick visit he was stuffy and had mucus. I was told he had a kitty cold. I voiced my concern that his gums looked pale, see looked dehydrated to me. He wasn’t eating or drinking much, just sitting over the bowls. Vet told me they need their smell to eat, sent me home with antibiotics. This only made him extremely dry, his nose was so dried up, no more mucus, and he was breathing through his mouth. I called again and was told keep giving him the antibiotics.antibiotics only made him more dehydrated. Vet told me at that point his glucose was 480 so he was probably a diabetic made another appointment to confirm.
It never dawned on him, glucose 480, he has an infection this could be bad.....I never knew this until after the fact as I know nothing about diabetes.
4 days in and I was rushing him to to ER, diagnosed with DKA. Spent 5 days with 24/7 care. He was so bad 2nd day I made decision to put to sleep. That night his blood improved slightly so I kept trying. Now here we are.

 

thanks for the background.
Poor Chap, and poor you!
So he's doing better, and you have had a very very steep learning curve with DKA and Diabetes.


What is he at his +3.5 scan?

 

Liza, you are doing an amazing job, I'm sorry to read some of the history, what a tough journey for both of you so far

Hoping you can get a test shortly.

 

Just saw the update on the SS

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%
• +3 52 , had some kibble
• +3.5 49 some syrup or honey on gums and some food (maybe the 13% if he'll have it if not give him a little kibble)

 

Was 49. I also added in the food on SS.
Now is is sleeping so I’m going to get him to eat at moment, but he looks ok. His +4 is coming up in 7 minutes I will post it in SS

 

Thank you I’m trying but I have fallen asleep couple times when I shouldn’t because I’m so tired and I know something bad will happen if this continues this way. I’m falling asleep just about anywhere right now it’s ridiculous ☹️.

 

Tested for ketones as well, negative

 

brilliant thanks

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%
• +3 52 , had some kibble
• +3.5 49 kibble.
  

YAY!!! thats what we like to see

What time is it there?
You must feel like you are in the twilight zone after the few days you have had.

 

Yes I sure do. It’s 10:50am. I know the cycle he’s in says pm, but it’s because his am got bumped to pm because of the delays I had to do.

 

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%
• +3 52 , had some kibble
• +3.5 49 kibble.
• +4 40 ???

rub some syrup on gums and some more kibble.

How much is having?

 

He just dropped again to under 40, runner some more syrup on his gums and gave him some honey. Trying to get him to eat

 

Morning. I was confused about your time zone. I’m 3 hours behind you.

 

scan him again in 15min dont wait for 30

 

Ok. I scanned and waited 5 minutes to see how accurate the read was and both times just says LO

 

was

was that just 5min after you rubbed syrup on his gums?

 

maybe rub a little more on his gums.

How does he seem?

 

At this point I think his body just doesn’t want the insulin. I was told ff pate. Numbers drop
use 8% carbs . Numbers drop
Med carbs. Numbers drop.
I don’t think this is a good idea to keep giving him insulin if his body is not agreeing to it.
Seems the only thing keeps his numbers up is dry and even at that his numbers were dropping to 60 at some points.
can I just try ff pate and gravy and see how his numbers are with no more insulin?
I know it’s dangerous but isn’t this dangerous also?

 

It was same just say low which means just hadn’t risen to a high enough number to read. I just scanned hi. Again and it bumped him up to 48

 

I am thinking he is trying to tell us this.

He needs insulin, but it doesn't matter if the insulin is the one his body is producing, or that being injected.
He is very newly diagnosed, and possibly after he has got over his acute infection his pancreas has recovered enough to go solo, especially now you have reduced the carb load. Yes both things are risky.

The kibble will take a little longer to get into his system. so that's possibly the syrup, scan him in 15min.

How is he feeling

 

He looks like he’s sleeping but he’s not his eyes are open. Just looks sluggish. He only had about 1 teaspoon of kibble. I think this was my last try. I can’t keep doing this to him. He’s been dropping in low numbers after **** consistently. So now I know it’s not insulin from previous cycle staying in his body.

 

He is definitely doing things his own way, it is often hard to know how the kitty will respond to such a small amount of insulin. As Gill said, there may be some things kicking in now, and we can see that he is having a hard time staying up above 50 even with the carb intervention.

 

Yes I understand just this extra insulin he doesn’t need. When I skipped the dose he didn’t drop. So I’m just not going to give this to him anymore. I feel like I’m hurting him more than helping

 

Yes and when I skipped a dose yesterday he was fine on his own. I know it’s too soon because of the DKA but this just isn’t working. I e gotten the food I’ve been told, have followed directions and Sandy is just doing it in his own. I m not going to give him next dose. I can’t keep doing this to him. If the ketones creep I’ll deal with that and getting fluids into him if I have to. These low numbers are too much too often. I can’t deal with this every cycle and I know he can’t either because he’s getting down and I’m shoving syrups in his mouth.
I feel like I’m doing to things that will just cancel themselves out if I stop both.
Giving insulin drops his number
Giving syrup to raise his number

 

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%
• +3 52 , had some kibble
• +3.5 49 kibble. teaspoon
• +4 40 syrup/
• +4.25 lo syrup / 5-10min later 48

do you think you could offer him another teaspoon of kibble, if it was almost an hour ago that he had some.

I see +4.5 60!

I understand how you feel, when you skipped he didn't drop but he wasn't in a normal numbers range. It may just have taken him a time to get the dry out of his system again.
I don't think you are hurting him, the added insulin support to the pancreas will be helping it heal. Though perhaps he's fed up of his bean helicoptering.
With the way this cycle has gone I think that you have to try and see if he is done with insulin. Keeping an eye on his food intake, BG and more importantly ketones. and see if he will go OTJ and stay there.

thats a long way of saying I think you should try a skip, next dose and lets perhaps take the next step and try an OTJ trial.

 

I agree wholeheartedly with Gill, sometimes when they are done with insulin, they make an emphatic point about it. Most kitties go through a gradual progression or reduced doses, but Sandy seems to have other plans.

 

I know he was checked throughly and I even asked them to do a scan. He has no issues with his pancreas that I was told of. I asked for bloodwork to check everything. I’m not sure how all these organs work, but I can’t physically stay up monitoring 24/7 like I have been for too much longer. He’s going to have a drop and I’m just going to sleep through one of them at some point. He’s going to be on the ff pate and I’ll see how his numbers are. Probably will not be in normal range but what dose can I give under a drop? I really don’t want to keep injecting him if this is what keeps happening

 

I gave him some honey which is why I thing he got that boost. I’m trying to feed him now but he’s not interested. He’s had good meals so far. His +5 is coming up in 15 minutes I just scanned again and he’s at 55

 

Yes I’m skipping next dose, he had some kibble this cycle so that may stay in his system again now. So I’m going to push to the next cycle to skip as well, I’ll keep checking for ketones as well, I’ll do another later on today.

 

Well the pancreas is the prime organ responsible for the production of insulin, more particularly the Beta Cells. The high glucose was and indication of this. He may have been prediabetic and the infection triggered the diabetes, which as the infection clears, then they can returns to normal on their own or with a little help from insulin injections. The problem was is that he wasn't eating and got dehydrated as well... perfect DKA storm.

That's good he's eaten. keep offering the food.

I have to nip out to walk my dogs now.
Christie is here with you. I'll see you in an hour or two when I've finished the walk and feeding the dogs, chickens and cats.

It might, but we can keep that in mind.

 

I understand how stressful this is, let's give no insulin a try and continue to test for ketones. How does that sound? Until then, we will have to keep an eye on this cycle a little while longer, okay?

 

Yes sounds good. I just scanned him he’s at 50 so the honey has probably wore off. He is sitting in the sun at the moment and is taking a nap. I’m going to scan him every 20 minutes so I catch if he drops below that. He’s not interested in eating right now but maybe he will get hungry soon.

 

Okay he's holding steady, no treats or food given then, with either +4.5 or the +5 test?

Recap:

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%
• +3 52 , had some kibble
• +3.5 49 kibble. teaspoon
• +4 40 syrup/
• +4.25 lo syrup / 5-10min later 48
• +4.5 60 no intervention
• +4.75 55 no intervention
• +5 50 no intervention

 

No nothing

 

I'd like to keep him above 50 to where we can get some consecutive tests without intervention, but I think he may dip again. Let's see where he is at 20 minutes after the +5, that will tell us if the syrup isn't in the system anymore. As you have come to experience, the numbers can bobble around a little.

 

Yeah that happened he’s down to 44 now

 

I'd like to see if he will eat a little, since he's had nothing but syrup since +3.5 so if you can offer him some of the kibble or MC food. If he doesn't want any, then you'll need to rub a little of the syrup on his gums again. I think you said he doesn't like the syrup in the food.

 

Gave him the gravy stuff he just licked some of the gravy for didn’t eat any of the meat. I’ll do the syrup again

 

Or if he likes the taste of one of the other FF varieties, then try and add a little syrup to that and mix it well, see if that trick might work.

 

The more gravy, the better, that is where the carbs technically are anyway. I'd like a little food in his belly as well, but I don't always get everything I want

 

Recap:

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%
• +3 52 , had some kibble
• +3.5 49 kibble. teaspoon
• +4 40 syrup/
• +4.25 lo syrup / 5-10min later 48
• +4.5 60 no intervention
• +4.75 55 no intervention
• +5 50 no intervention
• +5.25 44 some gravy, no food, syrup

 

he went up to 63 @+6

 

Excellent, time to breathe a little, you're doing great Liza. How is he doing? Still sleeping in his sunny spot?

 

I moved him so I could get him to eat and put syrup on his gums but yep he went right back to the spot. He just seems tired. Hopefully he will pure up when his number goes up.

 

I always worry when Maverick gets sleepy, but then I compare how he is acting to my other non-diabetic cat, who also is sleeping, and I worry a little less. Hoping he'll stay flat or continue a little to rise, since we're mid-cycle now. Maverick usually gets super perky when he is in the 50s, but not always. I'm so glad you have the Libre, that helps keep an eye on things, as much as it is at the expense of your sleep at the moment

 

Recap:

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%
• +3 52 , had some kibble
• +3.5 49 kibble. teaspoon
• +4 40 syrup/
• +4.25 lo syrup / 5-10min later 48
• +4.5 60 no intervention
• +4.75 55 no intervention
• +5 50 no intervention
• +5.25 44 some gravy, no food, syrup
• +6 63
• +6.5 74

 

Yes it’s nice having it. This is his last day for this one so I have to put in the next one on. I just don’t feel super comfortable pricking his ear when I can’t even get a reading on the meter I have. At +6.5 he is at 74. He usually starts steadying out at +7 or +8. Hopefully he has no more drops from now. I’m over here taking 10 minute naps between scans and I fall asleep right away so that how tired I am. I will scan again in 30 minutes at +7

 

• pmps almost a whole can (13% carbs).
• +1 97 snack??? 13% carbs
• +2 47 syrup on gums
• +2.5 40 ???2 table spoons of ff turkey in gravy 13%
• +3 52 , had some kibble
• +3.5 49 kibble. teaspoon
• +4 40 syrup/
• +4.25 lo syrup / 5-10min later 48
• +4.5 60 no intervention
• +4.75 55 no intervention
• +5 50 no intervention
• +5.25 44 some gravy, no food, syrup
• +6 63
• +6.5 74

Nice to see those consecutive tests rising, am I right in thinking that the last time he had food or syrup was at +5.25?
Little stinker dropping again!

 

Yes you are right and he’s sleeping sleeping with no interest in food. Just scanned at +7 and he’s back down at 65

 

Hoping the +7.5 stays in the 60s, or goes back up, I usually am not too fussed when numbers bobble around between 60-70s, since it has been I think by my calculation 2 hours since intervention. Usually when you get to the end of the cycle and a couple of consecutive tests where the numbers have stabilized over 50, then you can relax. I say usually, because nothing Sandy does has been according to the playbook.

 

Ok he just went o his food bowl and started to eat. mom going to scan him again in 25-30 minutes then

 

That's great, I'm glad he's eating! Did you catch a reading now? If he's stayed flat or rising and now eating, I think you can get some sleep.

 

I agree it would be good to see if he was still in a 'normal' range before that food take effect. Then you would know you could take a break, till ambg (pmbg really)

 

I didn’t. But I just took his +8 and he at 80

 

Fabulous! Doing some serious happy dancing for you. Gill will be by to give you some information, glad he's on the way up now.

 

Sorry, I should add, you can go to sleep

 

Fantastic.

OK both of you can take a break.

Let's try and get you straight on the SS.

Start out a new line 2/6 and when you get his test at 6pm(ish) (his usual shot time) (or whenever is a good time for breakfast and dinner for him, if that's a bit later that's OK) pop that result in the pmps column.
Write NS in the dosage column.
and lets see if he stays green tonight.
If he does come up to blue or a bit higher (he might with the extra carbs he has had), don't worry about that.

Going forward, regular small meals spread throughout the day work best, it's easier on the pancreas and keeps them more level. George is in remission he gets a main breakfast and dinner 8am/8pm then snacks at +3 +6 +9. This keeps him level, if for some reason he misses a snack (doesn't use his autofeeder) his BG spikes a we bit. So we kept him on this regime of 3 hrly meals/snacks to keep his BG level. I tried 4hrly intervals a while back, but I felt that he had a tendency to be a bit higher.
main meals at 8am are about 3ounces and snacks about a 1 1/2 tsp, he is a big lad (6.75kg)

So let's see how he does tonight, and what he is at in the morning.
Just monitor tonight and tomorrow, and if he gets to green and stays there, then let's start the trial once he has settled., l would like to let him settle down after all this shenanigans.
Crucial that there is no kibble and no temptations from now on. Stick to the Freeze dried treats and his LC food (below 10%)
Let us know if you are having trouble with him eating.

With Sandy and his history, you will need to monitor a few things,

• ketones (minimum once daily but preferable twice a day, ketones can develop quickly, at any sign that he is off you want to be thinking to test)
• food intake
• BG
• DKA symptoms ( here is some info on DKA covers everything you need to be watchful of, and we are here for any doubts questions that may arise)
• other signs of infection/inflammation or stress

How does that sound?

With any luck we will get him started on his OTJ trial Monday morning (all my gang are keeping paws and fingers crossed).

 

Ok sounds good. I will start over tomorrow. Thank you for the info that gives me a plan as far as food and times and see where it takes him.
Thank you for all your help

 

I managed to get 1/2 sleep but during the day I don’t have much time to sleep as I have more fur kids in the house.
Hopefully is Sandy is good tonight I’ll get some needed sleep
Thank you for your help

 

No problems, it has been our pleasure, you've been a real trooper.
Start a new thread for tomorrow, this one has got really long

hope they haven't been feeling too neglected.

 

Hi Liza
Just waking up and having a quick look at how the cycle went before I feed my hungry crew who are circling waiting for breakfast.
You did a great job getting him back up to good numbers and keeping him there with Gill and Christie’s help.
I’ll be back when I’ve fed my lot.

 

Hi Liza,
How are things going? You have had quite a busy day keeping Sandy up over 50. You had a great team helping you.
He is certainly on a mission.
You and Sandy have come such a long way since he first got sick with DKA.
I hope you can get some well earned rest now.

With everything that has been happening I haven’t asked you how you Mom is going with COVID? Is she any better?

Here is the thread from main health which I don’t think was linked for continuity https://www.felinediabetes.com/FDMB/threads/cat-recovering-from-dka.241784/?_params=Array

 

Liza we have been talking to @Marje and Gracie about Sandy and we think at this point it is not quite time to start an OTJ trial.
What we would like to do is give him several cycles with no insulin and see how he goes...and if he can maintain normal numbers and keep having negative ketones

Test him preshot then feed as normal and test again around +3 or +4 and then at pm preshot, test and feed again and test once during the cycle again. Give him his normal snacks during the cycle making sure he is getting enough food.

There is one thing we would like you to do if you can please, and that is give him a +9 meal each cycle of normal low carb food.
This is because when the pancreas is kicking in, which we think is happening with Sandy, feeding a +9 meal helps bring down the preshot BG.
If he is showing he can stay in normal numbers, we can then start the OTJ trial.
Can you note the +9 meals in the SS each time you give them please so we can see it. Thanks Liza.
How does that sound to you?

 

Hey Lisa... how are things going?. Haven’t heard from you so are a bit concerned.
How is Sandy eating?
Have you taken any BGs today?
I hope you have managed to get a well earned sleep

 

Hey! How is it going Liza?
Hope all is well.
Keep us posted.

 

Good morning. I am checking in to see how it’s going too. Please update us when possible. We worry.

 

Please be sure and start a new condo, Liza. Thank you!

 

Hi Bron, my mom is good, thank you for askig. Thankfully the only symptom he got was a low fever for 1 night. No other symptoms at all, she finished her quarantine and is back to work.
I managed to get some sleep (a lot actually), and my husband watched over Sandy and was scanning hi. To leave sure he was ok. The sensor stopped working last night and I picked up another this morning and placed it on him. Then I went back to sleep.
The 3 scans today were really good so I don’t know what’s going on but I’m praying things will stay this way and Sandy’s body continues to do this on his own.
He walked around the house a lot today while I was sleeping and even played around with some catnip toys.

 

I’m sorry everybody. Thank you for checking in and for your concerns. I slept a lot and my husband watched over Sandy. I did show him how to put numbers on the SS so he did that for me. He doesn’t know how to get into the forum so I figured I’d wake up and post but I just slept and slept. This all finally got the best of me.
My husband just let me sleep, and didn’t wake me up sonde Sandy was ok.
Ketone test was negative. Sandy has had about 2 ounces of food so far and some freeze dried snacks.
I will start a new thread

 

Very happy to hear from you and know that Sandy is eating well, playing and staying in normal numbers . And negative ketones.. YAY!! That’s great news.
And I’m so glad you have managed to get such a good sleep.
That’s so good your Mom is better!

Yes, please start a new thread. We will watch for it. Bron