? 7/18 Ivy 212, +2.5 170, +4.5 125, +8 210, Pmps 194, +3 154 Libre Question Labwork

[Staci & Ivy]

7/17/24
Amps 212

Yesterday was super weird in that Ivy began the day in green (Libre, so higher on a handheld meter) but went up to pink and stayed there all day. She did come down overnight finally to blue on the Libre.
This morning it appears she’s moving down, in the right direction, but we shall see.

I have a question about lab work and when everyone has labs drawn in the day.
I usually do it early in the morning (around 9 or 10 AM, which is +3 or +4.)
I feed her at 6 AM. Her blood has been very lipemic (which is very fatty). She eats a fatty diet of lamb. Her triglycerides were high as a result, we assume. I’ve read lipemia can throw off certain blood values by having a very lipemic blood sample.

The higher the number, the more likely for other blood values to be inaccurate. Marked lipemia can falsely elevate your pet’s bilirubin and hemoglobin readings, and falsely decrease your pet’s blood electrolyte ion readings (=sodium, chloride, phosphate, calcium and, to a lesser degree, potassium).
https://vetspace.2ndchance.info/why-is-my-dog-or-cats-blood-lipemia-index-high/?amp=1

I don’t want to fast her if labs are done in the am since I need to feed, give insulin then go to the vet).

I saw @Wendy&Neko commented the other day to Heike that she would take Neko for labs around +9.
If I did that, she would have a longer time without food as long as the cycle was a higher one with no snacks needed past +3.

My big concern would be that Ivy would then be sedated later in the day for an afternoon blood draw and I don’t know if she would be interested in eating her meal a few hours later (with gabapentin in her system, which she needs for vet and labwork).

If she wouldn’t eat at the next meal, then I wouldn’t be able to give her insulin.

I guess if that were to happen in the worst case scenario, I would have to just skip that next shot and get back on track the next morning.
I’ve never tried a late in the day blood draw.

Any thoughts?

Thanks all. Have a safe day

 

[Bandit's Mom]

Bandit had the same problem of lipemia and I could rarely fast her for very long. I found that if I could fast her for 4-5 hours, the sample was not lipemic. She used to eat more at night than in the day so I would schedule blood collection for the afternoon or early evening, when I could get 4-5 hours without food.

 

[Staci & Ivy]

Bandit had the same problem of lipemia and I could rarely fast her for very long. I found that if I could fast her for 4-5 hours, the sample was not lipemic. She used to eat more at night than in the day so I would schedule blood collection for the afternoon or early evening, when I could get 4-5 hours without food.

Thanks, Bhooma. Interesting to hear this. My vet never suggested a change of time of day for the draw

My other concern is the issue of Ivy maybe not wanting to eat her next meal a few hours later due to sedation and appetite. I’ve never tested this approach and its impact on giving insulin a few hours later.
Any thoughts?

 

[Jack & Mopem'sMom]

Hope you get some answers from the experienced members here--interesting aspect of the bloowork that I've never considered for Jack. I'll be following to see what everyone has to say. Hope Ivy finds her way back to dark green for you soon. Sending hugs!

 

[Mikanmama (Mikan GA)]

Hi Staci,
Nice descending cycle for Ivy!
Very interesting questions. Fasting issues scare me to no end. Do you think fasting affects FD cats differently than non FD cats? Trying to strike the right balance between feeding, shooting, and doing the labs gets complicated!
Hope you find answers that are suited to your situation, Staci.
Wishing you a calm and peaceful day!

 

[Karolina & Nestle]

Hello Staci and Ivy!
A nice sunny start for her and she's coming down nicely. Looks like her and Mikan are hanging out #besties

Hopefully you get some answers from the experienced members.
Wishing you both a nice Thursday

 

[Marje and Gracie]

7/17/24
Amps 212

Yesterday was super weird in that Ivy began the day in green (Libre, so higher on a handheld meter) but went up to pink and stayed there all day. She did come down overnight finally to blue on the Libre.
This morning it appears she’s moving down, in the right direction, but we shall see.

I have a question about lab work and when everyone has labs drawn in the day.
I usually do it early in the morning (around 9 or 10 AM, which is +3 or +4.)
I feed her at 6 AM. Her blood has been very lipemic (which is very fatty). She eats a fatty diet of lamb. Her triglycerides were high as a result, we assume. I’ve read lipemia can throw off certain blood values by having a very lipemic blood sample.

The higher the number, the more likely for other blood values to be inaccurate. Marked lipemia can falsely elevate your pet’s bilirubin and hemoglobin readings, and falsely decrease your pet’s blood electrolyte ion readings (=sodium, chloride, phosphate, calcium and, to a lesser degree, potassium).
https://vetspace.2ndchance.info/why-is-my-dog-or-cats-blood-lipemia-index-high/?amp=1

I don’t want to fast her if labs are done in the am since I need to feed, give insulin then go to the vet).

I saw @Wendy&Neko commented the other day to Heike that she would take Neko for labs around +9.
If I did that, she would have a longer time without food as long as the cycle was a higher one with no snacks needed past +3.

My big concern would be that Ivy would then be sedated later in the day for an afternoon blood draw and I don’t know if she would be interested in eating her meal a few hours later (with gabapentin in her system, which she needs for vet and labwork).

If she wouldn’t eat at the next meal, then I wouldn’t be able to give her insulin.

I guess if that were to happen in the worst case scenario, I would have to just skip that next shot and get back on track the next morning.
I’ve never tried a late in the day blood draw.

Any thoughts?

Thanks all. Have a safe day

First, you can’t compare Ivy to Neko or Bandit for many, many reasons the primary one being the amount of sedation Ivy needs.

We’ve discussed this before and I suggested you fast her, get the earliest vet tech appointment possible (for blood draws alone, we don’t see the vet and the techs can do it at 7:30) and then shoot/feed when you get home. I’d ask if you can just have a tech draw the blood at the very first appointment of the day and see if that allows you to fast her and shoot late. Or, if you really want an accurate test, just skip the a.m. shot.

While Bhooma’s idea is a good one, I don’t think you would be comfortable shooting and feeding at AMPS and then not feeding again until after a blood draw at +5 or so.

At any rate, skipping a shot either cycle isn’t a big deal since she’s not had ketones. I always felt it was easiest for Gracie to fast her, get the earliest blood draw appt at 7:30, then come home and T,F,S.

 

[Staci & Ivy]

Hope you get some answers from the experienced members here--interesting aspect of the bloowork that I've never considered for Jack. I'll be following to see what everyone has to say. Hope Ivy finds her way back to dark green for you soon. Sending hugs!

Thanks, Christine. So many questions always. So much to question and learn as things change. What I used to do as my norm somehow doesn't necessarily work anymore with FD in the mix.

 

[Staci & Ivy]

Hi Staci,
Nice descending cycle for Ivy!
Very interesting questions. Fasting issues scare me to no end. Do you think fasting affects FD cats differently than non FD cats? Trying to strike the right balance between feeding, shooting, and doing the labs gets complicated!
Hope you find answers that are suited to your situation, Staci.
Wishing you a calm and peaceful day!

HI Kit, I know what you mean. It's a complex set of issues and difficult to manage it all. Very thankful for the resource of others who have been through this before we came along and share their experiences with us.
Hope you are having a calm day, too

 

[Staci & Ivy]

Hello Staci and Ivy!
A nice sunny start for her and she's coming down nicely. Looks like her and Mikan are hanging out #besties

Hopefully you get some answers from the experienced members.
Wishing you both a nice Thursday

Hi Karolina, Ivy does like to twin with Mikan. 2 trouble makers at times. Good thing they are cute.
Trying to figure out all of the complex situations never ends. Just trying to have a plan in place so we can best manage it all.

I hope you get home early to spend the night with Nestle and Peanut. I am sure they have missed their Mama

 

[Staci & Ivy]

First, you can’t compare Ivy to Neko or Bandit for many, many reasons the primary one being the amount of sedation Ivy needs.

We’ve discussed this before and I suggested you fast her, get the earliest vet tech appointment possible (for blood draws alone, we don’t see the vet and the techs can do it at 7:30) and then shoot/feed when you get home. I’d ask if you can just have a tech draw the blood at the very first appointment of the day and see if that allows you to fast her and shoot late. Or, if you really want an accurate test, just skip the a.m. shot.

While Bhooma’s idea is a good one, I don’t think you would be comfortable shooting and feeding at AMPS and then not feeding again until after a blood draw at +5 or so.

At any rate, skipping a shot either cycle isn’t a big deal since she’s not had ketones. I always felt it was easiest for Gracie to fast her, get the earliest blood draw appt at 7:30, then come home and T,F,S.

Hi Marje,
The vet wants an appointment with Ivy so we are combining that with a blood draw. I don't want to have to sedate her for 2 separate appointments and go on different days.
Even at 7:30 am I would be more than 2 hours past her shot time by the time I got home to feed and shoot the insulin.

I think this time we will try a +9 (3 pm) appointment, which would be about 6 hours past any food and see how she does. And if she wants to eat when it's meal time I will give her shot. (If not I would just skip a shot for one cycle).

She's complicated for sure.

I appreciate your thoughts and suggestions. Maybe if there's another time we just go for labs alone...we can visit the idea of what you are suggesting.

 

[Marje and Gracie]

Hi Marje,
The vet wants an appointment with Ivy so we are combining that with a blood draw. I don't want to have to sedate her for 2 separate appointments and go on different days.
Even at 7:30 am I would be more than 2 hours past her shot time by the time I got home to feed and shoot the insulin.

I think this time we will try a +9 (3 pm) appointment, which would be about 6 hours past any food and see how she does. And if she wants to eat when it's meal time I will give her shot. (If not I would just skip a shot for one cycle).

She's complicated for sure.

I appreciate your thoughts and suggestions. Maybe if there's another time we just go for labs alone...we can visit the idea of what you are suggesting.

Just remember there have been cycles when you’ve fed 12% most of the cycle to keep her BG up. Seeing the vet at +9 can complicate that. It seems better to me, if you want a fasted test, to skip the a.m. shot so you can fast her and see the vet at his earliest appointment. JMO.

 

[Staci & Ivy]

Just remember there have been cycles when you’ve fed 12% most of the cycle to keep her BG up. Seeing the vet at +9 can complicate that. It seems better to me, if you want a fasted test, to skip the a.m. shot so you can fast her and see the vet at his earliest appointment. JMO.

You’re right about the feedings, good point.
And I’ve had to do the same in some overnight cycles too (which is even less fun).
I suppose whichever cycle I go in I could give a reduced dose so that gives less of a chance of a low cycle, which would then require feedings carbs to keep her from going too low.
What do you think of that strategy?

 

[Wendy&Neko]

If she wouldn’t eat at the next meal, then I wouldn’t be able to give her insulin.

Not true. Even cats who cannot eat because they are getting anaesthesia can get at half dose. Insulin does more than combat carbs in her food.

I suppose whichever cycle I go in I could give a reduced dose so that gives less of a chance of a low cycle, which would then require feedings carbs to keep her from going too low.

Due to the nature of the depot, the first part of the cycle with a reduced dose can act like you had given full dose. Skip would be safer.

 

[Staci & Ivy]

Not true. Even cats who cannot eat because they are getting anaesthesia can get at half dose. Insulin does more than combat carbs in her food.

Due to the nature of the depot, the first part of the cycle with a reduced dose can act like you had given full dose. Skip would be safer.

Hi Wendy, so you are saying skip the am dose. Have labs done at +9, and if she won’t eat her meal a few hours later at insulin time, give 1/2 dose?
I just want to confirm what you are suggesting.
Thank you @Wendy&Neko

 

[Wendy&Neko]

Not exactly. I am saying that if you have an earlier appointment, you can fast her in the AM and skip the shot or half dose, if you are worried about her going low that cycle. If you have a later appointment and she won't eat her meal, then you could still give half dose. You don't need to both skip the AM dose and reduce the PM. Also keep in mind that Lantus doesn't onset for a couple hours after the shot, so you have time to get her to eat.

 

[Staci & Ivy]

Not exactly. I am saying that if you have an earlier appointment, you can fast her in the AM and skip the shot or half dose, if you are worried about her going low that cycle. If you have a later appointment and she won't eat her meal, then you could still give half dose. You don't need to both skip the AM dose and reduce the PM. Also keep in mind that Lantus doesn't onset for a couple hours after the shot, so you have time to get her to eat.

I’m sorry but I’m still confused.

My appointment is at +9 (3 pm). I normally feed & shoot at 6 am.

My plan could be to feed her normally in the am at 6 am and either give 1/2 dose or skip (so she doesn’t go low that cycle so I don’t have to feed snacks past +3.)
Then she wouldn't have food past +3 (she would be fasted for 6 hours when she has labs at +9).

Then when we get home and it’s dinner time (and if she’s not too sleepy from the gabapentin & trazodone she needs for the appointment) I will feed dinner.

IF she eats, I give her regular Lantus full shot.
IF she won’t eat dinner, give 1/2 shot or skip.
(I know Lantus doesn’t onset for up to 2 hours, but when she’s sedated sometimes she’s just not interested in food, so I don’t know how she will react to food and have to have a plan for dose I am shooting, in case she won’t eat even up to 2 hours after shot).

Sorry If I’m being confusing or not clear. Please let me know if this makes sense and is a correct plan.
Thanks again @Wendy&Neko

 

[Staci & Ivy]

Not exactly. I am saying that if you have an earlier appointment, you can fast her in the AM and skip the shot or half dose, if you are worried about her going low that cycle. If you have a later appointment and she won't eat her meal, then you could still give half dose. You don't need to both skip the AM dose and reduce the PM. Also keep in mind that Lantus doesn't onset for a couple hours after the shot, so you have time to get her to eat.

Update:
Scratch the above plan. I did some research and find that since she’s hyperthyroid and we are testing her T4 and TSH, I need to have her tested 4-6 hours after applying the transdermal medication. (I apply med around 6 am) That complicates things more.

I moved the appointment back to 10 am (+4).
So I can fast her overnight. And skip her insulin that am so she doesn’t need a meal and +1,2,3 snacks.
(Then plan to feed her if she will eat upon returning home.)

Is there any merit to a reduced dose the night before to reduce the depot, or not necessary since I would skip the am dose and she theoretically shouldn’t drop low and require any food??
Thanks again, Wendy.