Cadmium's BG- AMPS: 393, +7.5: 328, PMPS: 483, +2: 300, +4.5: 162, +5.5: 155

Previous thread: https://www.felinediabetes.com/FDMB/threads/cadmiums-bg-crosspost-trace-ketones-detected.271265/

Made a new thread as the previous one was getting rather long. Here is where I will be posting his info, so everyone is up to date and kept in the loop with how he's doing. I think I'll just edit this main post to have his readings for multiple days, instead of having them in the replies.

12/02/2022
AMPS: 427, 0.75U, whole can w water added. Dr J approved of this dose change as well
+2: half can, ketones - negative
+3: 325
+5.5: 309
+6.5: 335
PMPS: 474, 0.75U, whole can, ketones - trace, he took a longer nap today from his bad knee acting up so he didnt have as much water, which i think might be why they returned. He has fully regained back the weight he lost before starting his treatment, and is now 11.8 pounds!
+3: 184, we are on hypo watch. making sure he finishes his dinner + half can.
+4: 163
+5: 212

12/03/2022
AMPS: 407, 0.75U, whole can
+2: half can
+2.5: ketones - negative
+3.5: 233, encouraged him to eat by hand feeding and he finished his food!
+5: 237
snack at approximately +8
+10: 488, I suspect a bounce
PMPS: 474, 0.75U, whole can
+1: 339, we got a diver again. I'm trying to figure out the best way to preserve the rest of his 15% can after I give him a spoonful
approx +2: gave spoonful of 15% food, followed by half can of normal low carb food as snack
+3: 280
+4: 241

12/04/2022
AMPS: 480 , 0.75U, whole can
+1.5: 401
(play session)
+2: 405, half can
+3: 266, helped him finish his can
+4: 250, gave snack
[out of the house working at event, roommate was checking on him]
+9: 483, my guess was due to roommate being unable to check glucose he didn't know that Cadmium got pretty low OR the snacks I gave him before leaving didn't slow his dive enough, and he bounced.
PMPS: 437, 0.75U, whole can. reviewing insulin handling guides in case it is user error on my part
(play session)
+1: 443
+2: half can
+3: 370
+6: 365

12/05/2022
AMPS: 480, 0.75U, whole can
+2: half can
+3: 388
(play session, trying to have him finish his food)
+5: 358
+6: 382
PMPS: 397, 0.75U, whole can, constipation. Was able to assist by stimulation (thanks Kitten Lady!) Going to need to get some pumpkin puree and laxatives for him.
+2: 382, I am out of bonito flakes for his treats so testing is stressing him out.
+3: ketones- negative! half can given a bit late as I was wanting to see if we needed it or not and he was still finishing his full can earlier.

12/06/2022
AMPS: 467, 0.75 U, whole can
Last night he was also showing signs of his ear infection returning, he is prone to having yeast infections of his ears. Has been for years, usually flares when he eats something grain based! Thats why he was on a grain free diet before his diagnosis. Started his antibiotic ointment regimen last night, applying it x2 a day for 7-10 days.
+3.5: 287, even with multiple attempts!
+7: 460, ketones- negative
+8.5: HI. Virbac C.E.T. Enzymatic toothpaste (poultry flavor) has dextrose in it. I do NOT recommend this for diabetic cats. Discovered this after the fact.
PMPS: 426, 0.75U, whole can
I have never been happier to see a number in the 400s.
+1: ketones- negative!
+2: half can
+3: 251!!
+4.5: 241!!

12/07/2022
AMPS: 438, 0.75U, whole can
+3: half can
+4: 230
+6: 381
PMPS: 429, 0.75U, whole can, ketones- negative
+1.5: 295
+2: half can
+3: 166, ketones- negative, zoomies! He got a snack of a couple of pre cooked frozen shrimp that I thawed under running water, enjoyed them a lot.
+6: 306

12/08/2022
AMPS: 494 (I did break a bowl shortly before AMPS so might be influenced by stress), 0.75F to test if he needs his dose adjusted, whole can
VOMITED 15 MINUTES AFTER DOSE, still has appetite, advice appreciate- he has eaten a couple of shrimp as a snack
+1: gave new can, been getting him to eat it by slowly handfeeding him
+4: 241, partner is out to get supplies to help w constipation
+6: 367, ketones- negative. we now have supplies to assist with constipation, gave miralax as one of my vets instructed at beginning of dx as he seemed to be in pain.
+8.5: 435
+10: 393
PMPS: 390, 0.75U, whole can, ketones- negative. Was able to have a bowel movement without much straining too!!
+1: 385, even with him finishing most of his dinner and me needing to take multiple attempts to get enough of a sample
+2: 370
+3: 245, half can
+4: 225
+6: 321

12/09/2022
AMPS: 439, 1U, ketones- negative, whole can. I decided to bump up the dose after all, because I believe he is starting to show signs of neuropathy and to follow the regimen of SLGS. Vet approved of increase. Received dose 30 minutes late as I overslept this morning.
+2: 305, half can
+3: dasuquin
+4.5: 219, encouraged him to keep eating his half can.
+6: 251
+8: 381, partner attempted to test his glucose multiple times and was unable to get a reading. I attempted a few times myself and was able to get one.
+10: 400
PMPS: 417, 1U, whole can
+2.5: 262, making sure he finishes his dinner
+3: 221, preparing his half can now. If he continues a rapid drop like this from topical steroid use being discounted, I might apply his ear ointment so he won't have a hypo while I'm asleep and unable to help.
+4: 173
+5: 161
+6: 220

12/10/2022
AMPS: 421, 1U, whole can
+3: half can, 286
+5: 250
PMPS: 405, 1U, whole can, ketones- negative
[Due to really needing some rest to finish recovering from being sick, my partner will be doing tests for Cadmium's nadir and giving him his half can. This post won't be updated until later, as I will be asleep!]
+4.5: 183
+6: 193

12/11/2022
AMPS: 416, 1U, whole can
Did not give half can for AM cycle as he hasn't been finishing those, still has good appetite and eats other portions fine. Cutting back on testing (unless needed for ruling out/monitoring hypos) until I can perform a curve in two weeks post steroid exposure.
+6: 257
PMPS: 405, 1U, whole can
+2: half can
+3: 205
+5: 198

12/12/2022
AMPS: 510, 1U, whole can. ketones- negative
+6: 229
PMPS: 468, 1F unit, whole can. Gave slightly bumped unit to try and break the 400s pattern, but he is still having a curve to his values so hopefully it will not set off any bounces.
+1: 442
+2: 339
+3: half can
+4: 195

12/13/2022
AMPS: 393, 1U, whole can
+7.5: 328
Play session, has started jumping vertically to try and reach his toy!! He hasn't done that in years! Activity level vastly improved.
PMPS: 483 (avg of 3 readings), 1F unit, whole can. Gave fattened dose as it seemed to really help him last night, he had a lot of energy to burn.
+2: 300
+3: half can
+4.5: 162
+5.5: 155

After tonights readings I will be starting a new thread, as this one is getting rather long.

Link to new thread

 

Usually, people will put the BG readings for the day in the title of the thread, and just update it until it gets too long and then just delete the old ones and add the most recent ones. That way, anybody checking up on Cadmium can see very easily what is happening in the cycle.

 

Oh I didn't know that! Thanks!

 

Does dasuquin advanced cause problems for diabetic cats, considering it has glucosamine hydrochloride? Those are what his joint health supplements are, and they help with his arthritic knee. I'm thinking maybe his arthritis is having a flare up, and that may be partially why his sugars are being so rowdy... His vet clinic sold the capsules to me, but that was before we knew his diagnosis. He received a capsule earlier today, but I want to know if that should be discontinued and the vet clinic is currently closed. Some articles say it can help with inflammation, but others say it can make his blood sugar drastically worse.

 

I haven’t heard of either Cosequin or Dasequin raising blood sugar. In fact, the vet at ADW diabetes supply recommends these two products. I gave cosequin to my diabetic boy with no effect on BG.

 

Oh thank goodness, because his left knee does get better with it. Apparently the main complication that can happen is with prolonged use, as it can theoretically make insulin resistance worse? Not sure if that is accurate, but he would only get it occasionally anyways.

 

@FrostD @Suzanne & Darcy @Bron and Sheba (GA) He went from PMPS of 474 to a +3 of 184, I plan on testing hourly if not more, and watching his symptoms while I make sure he finishes his dinner. Apparently not too fond of chicken and liver I guess, I'll swap it out if needed. If he goes into hypo, then he will have the toolkit brought out.

 

Have you given him a snack? When the BG drops like that you can feed the drop so it doesn’t drop too fast or too low.
How long until the next test…I will watch for it.

 

I did give him a snack and he was being stubborn because he didnt want to leave the radiators! Got him to eat most of his food, including the additional half can. He did also have a snack when the others had dinner, too. His +4 was 163

 

So it is slowing down which is good. Well done giving him the snacks.

 

Thank you, I'm glad I got him to eat. Now he's doing the classic 3am zoomies, little man please don't run yourself into hypoglycemia!!
Next reading will be taken in approx 15 minutes by the way

 

Alright, we are out of the extreme drop and hes starting to come back up, +5 is 212

 

Following the same pattern as two nights ago except not bouncing back up so high…yet. And hopefully he won’t.
I think you are safe to go to bed.

 

That was actually not a bad cycle, except that he did drop so precipitously and triggered a bounce. ProZinc is not always the gentlest of insulins. Let me make sure I am understanding everything, he ate food at pre-shot time and then he ate another half can of food at +2 (it says half can in the +2 cell on the spreadsheet). Is that correct?

 

He was given the food, but didn't eat all of it until approximately +3. My concern was just how quickly he was dropping, and the fact that it was almost 300 points! Wanted to make sure he didnt dive any further, so thats why he was on hypo watch.

 

Definitely! You did well to test him as much as you did. It was too fast of a drop (setting up the bounce.). That’s why I asked about the feeding schedule. If he is going to be a “diver” then you may need to go with higher carb food in the early part of the cycle. What is the carb percentage of the food you were giving him last night? You may want to try feeding him a higher end carb food (up to ten percent carbs) or, if that doesn’t work, a medium carb food closer to 15 percent. You will be able to find out how carb sensitive he is and how he responds to different percentages of carbs. You can try a medium carb snack around his onset time - at least by +2. Just a teaspoon or tablespoon of food should do it. It’s a lot of trial and error with cats who are divers.

 

I was also thinking part of the reason why he had a smaller bounce was because by then he finished all of his food, which in total was a little under a whole can and a half? Ish? And that the "bounce" was actually from the food itself? Dunno. The carb percentage of the food he ate last night was 3%, but I have some 15% on standby for when he plummets and is dropping into territory I am not all too thrilled about (between 50-70) and likely will go past it. He also has honey, nutri-cal gel (which has a base of corn syrup) and lots and lots of treats to encourage appetite.

It seems when he's diving he has the same problem I have when my sugar starts going low, forgetting that food exists! He will act like he's not hungry until I introduce a small piece of the food to him and get him to eat that, then he realizes he's hungry and starts eating from the bowl. For me and my hypoglycemia, its particularly bad first thing in the morning- so it helps me to have a snack before I can actually sit down and have a meal. I call this "waking my stomach up." If I try to force myself into eating, it feels like I am eating badly mixed lumpy pancake batter and its very difficult to swallow it down!

But yeah, that sounds like a good idea for him, especially for the night cycle. If not a higher carb meal portion, then maybe a higher carb treat? I'll need to look into it.

 

It’s “feeding the curve,” and I think when it looks like he’s going to drop fast that you can try a teaspoon of the 15 percent to see if it slows him down (he doesn’t do this when he’s bouncing but at other times when the insulin is able to work properly.). Bounces are caused when a cat’s blood glucose either (1) drops really quickly- e.g., 100 points in an hour - for some cats more and some cats less; or (2) drops to any level that the cat’s body is not used to. Cats can bounce even from a number that’s not particularly low. If a cat is used to spending most of its time in pink numbers, it’s body may perceive a yellow number as a threat. That’s just an example. It’s very individual to each cat as to what numbers cause a bounce. A lot of cats will bounce from being in the blues - but, as I said, it can happen in any numbers that the cat is not used to.

Bouncing is a protective mechanism where the cat’s pancreas and liver dump stored glycogen and other counter-regulatory hormones that will act to raise BG and save the cat from a hypoglycemic episode. By the way, bounces can last up to 6 cycles. Frequently, as progress is being made, the cat is able to clear bounces more quickly. Sorry that explanation was so wordy. I’m typing on my phone right now, which makes it difficult to see what I wrote before and I hope I’m not being too repetitive.

 

All that you've said makes perfect sense, it was more just he tends to bounce far more dramatically so I was wondering if part of it was him eating that was causing his glucose to come back up! I would definitely say a drop of 290 would set off a bounce for sure. I really appreciate you making sure I understand everything about a bounce though, it helps me stay prepared for his sake. I think I have also heard a bounce described as a "panicky liver" when the glucagon is released for lowered numbers that are not hypoglycemia, but the liver thinks it is.

I've also noticed his sleep schedule has changed with his feeding schedule, he tends to sleep more during the day and gets especially playful at night. He had really intense 3am zoomies last night! It has been so long since he had them, I wasn't expecting that to return but I am glad it did :')

 

I wanted to say though, having said all this, is that you have done amazingly well at getting up to speed on testing and everything in a short time. You’re a quick study. I’m very optimistic for Cadmium.

 

Zoomies are a great sign! I love hearing that.

 

Thank you so so much ;o; I've been really worried that I haven't been doing "enough" for him somehow, or that he is having setbacks due to my errors... It can be really hard taking care of a condition that can be easily serious for an entity that cant really speak to you and tell you plainly how they feel. I am still extremely thankful that it is not something immediately considered "fatal" though, but can be managed if you just pay attention. That's why I am very annoyed with Dr K (one of his vets) telling me that I am testing far too much and changing too many factors out of anxiety. A lot of those changes were approved by his colleague, Dr J too! I'm trying to adapt to his needs, and initially thought the insulin levels were too high- but now I know its because he's a diver. His condition can change rather dramatically and suddenly!

Cadmium has had kitten-like energy back, its amazing to see. Last night he spontaneously started playing with a mousey toy that was on the floor!! And played for a very long time with his wand with strings on the end! I'm so glad that he's feeling better.

 

But yes, for clarifications sake, he is given a whole can at each pre-shot. I test, give him his food, and then I wait until he has gotten through a good portion of the food (at least half) and while he's doing that I inspect the insulin and prepare the dose. I inject his dose into his scruff. I then watch to make sure he finishes that whole can but if he's not particularly interested/sleepy I can either work up an appetite by playing with him, or encourage him to eat by hand feeding chunks at a time. Sometimes he's not particularly interested in food due to constipation, so he might get a small bit of pure pumpkin puree (less than a spoonful) or playing helps things move along. At two hours as that's when he tends to start wanting to settle in for a nap, thats when he gets an additional half can. If he was snoozing and hears me open the can and doesn't perk up, thats a sign to me to check his glucose again if he also doesn't respond to me bringing the food to him and having him smell it. Sometimes his joints bother him too much to come eat, so I come over to him!

In total he gets 3 cans a day, plus the rewards for glucose testing, and a small low carb snack at 6:30pm as thats when the other cats are fed. To test his alertness I use silvervine sticks and his favorite toys, as well as seeing if he reacts to my voice, bonito flakes bag being shaken, and pets.

Bare minimum glucose tests are AMPS, PMPS, and somewhere around the midpoints of each. I will perform additional tests to see if he's having symptoms of something going on, or if he's just doing basic cat things, lol.

 

Update: he has finished his whole can for dinner, and at +1 hes at 339 (from PMPS of 474) so I am going to attempt to feed the curve as suggested earlier in the thread

Not entirely sure if this worked, as I fell asleep and my alarms failed to wake me up for me to do further tests. His glucose did get pretty high the next morning though, so I don't know if I will continue this strategy with carb content that high

 

Y'all..... the vet that did my insulin demonstration told me to only roll the vial if you can see that its started to settle. didnt make it clear that you're supposed to roll it every time for the stuff you CAN'T see.

at least he did say to not shake it??? but oh my god. at least i caught it for Cadmium's PM dose tonight, so we will see if thats the problem with his regulation

 

Yep, with ProZinc, you are supposed to gently roll the vial back and forth a few times before drawing the insulin out of the vial. That's not the same with depot insulins, by the way (Lantus, Levemir) which don't require shaking or rolling. I always rolled mine because the paper insert in the box told me to. Don't think the vet ever told me anything -- but I started with Vetsulin, then ProZinc, then Lantus, then Levemir.

 

I'm starting to wonder if that the ketones production was potentially due to the insulin not being mixed correctly, and that 2 cans might be all that his stomach can handle after all. He had an exceptionally hard time with finishing that additional half can for his AM cycle, but did finish the full can. Tonight maybe I'll offer the half can dependant on his appetite. Also, when I tested his ketones today, the strip turned gray? Does this mean that the strips may have gone bad? @Bron and Sheba (GA)

 

Did you stick it in the litter? Or in the urine stream? Gray isn’t one of the colors on the color chart, as I recall! LOL! Are the strips past expiration date?

 

In the stream! And nowhere close to the expiration date, and definitely not on the chart!! Thats what was so confusing to me, like "what the heck does that mean?!"

Hmm.... now that I'm thinking about it, maybe it's one of the strips that I accidentally took one too many of to try and test him, and because it was out of the bottle for a bit it expired. It does say to make sure to close the bottle again to not allow exposure to air. Oy.

 

Well, that is true. They do say to keep in tightly closed bottle. Well, just try again another time and we shall see

 

Last night I got a successful test that didn't turn gray this time! It was negative

 

Excellent. So the strips are good... just not the grey one!

 

Bumping up because we have hit blues again!!

edit: I am holding his little head in my hands, speaking directly to his endocrine system- dude its okay to have your blood sugar in the 100s. Calm. Down.

 

Can you change color of the text in the blue cell from black to white? I can’t see that nice blue number.

 

Fixed! Sorry I usually have his spreadsheet in dark mode and forgot blues get white text

 

He has been struggling with constipation lately but is still making bowel movements, so maybe that contributed to the vomiting? Like if his system is slowed down and he ate a lot too fast it made his stomach purge it? Pumpkin and miralax have definitely moved up the priority list if that's the case.

I have also been able to get him to eat a bit more, but slower and pacing him by only giving tiny bits at a time. I do want to make sure he has something in his stomach by +2 or +3. Have updated his vet about this, waiting for a call back.

 

His clinic got back to me over text message, and they said that as long as he isnt vomiting frequently and still seeing some bowel movements, that we are on the right path. I was advised to give doses as recommended for at least another 24hr for another doctor to look over and see what we should do regarding his dose.

 

Per SLGS, since you have held the dose for one week, after 14 cycles (so tomorrow morning) I would increase by .25 units since his nadirs at this dose have been above 150.

 

Dose increased to 1 unit after all and I talked it over with the vet, she felt it was a good idea and I briefly explained the dosing regimen of SLGS. She found it to be a good idea. I also mentioned the B12 therapy for neuropathy people have been discussing, and she finds it very interesting and wants to look into it. Theres also apparently a new pain medication thats being introduced soonish that is a once a month injection that the doctors are having meetings about how to implement. She thinks Cadmium might need insulin long term, but we will see. For now, we are just trying to fine tune things for him to best assist.

I feel kind of crummy though that he was initially on that full unit dose at the start of his treatment, and I'm concerned that I slowed him down because of lowering his dose and not knowing that his dives were influenced by other factors.... Sighs. I also feel crummy to begin with, as I have the flu.

 

Somehow I managed to forget the fact that my eczema treatment for particularly bad flares is literally a fairly strong corticosteroid ointment. Will make sure I will not use it anywhere near Cadmium or his belongings, and will ensure thorough washing before I interact with either. He seems to be sensitive to topical steroids alone, considering how yesterday his glucose started to rise after Gentizol ointment was applied.

 

Hi there. You’re doing very well. Don’t get down on yourself! I’m glad your vet seems to be one of the more reasonable ones around. I’m sorry you are sick. Hope you will kick it soon! This feline diabetes is a marathon and not a sprint. Sigh. And as for the Gentizol, at least that’s not a long-term/permanent med for Cadmium, bit just for flares?

 

And perhaps the vet was referring to Solensia injections for arthritis pain in cats? We have people on the Board who are using it in their cats, and people who are still getting Adequan injections as well. It has been approved in Europe for some time and only recently is becoming available for cats in the U.S. It’s here now, although may need to be special ordered.

 

Yep, just for flares!

That sounds right, but not 100% sure.

Also I have made a pretty interesting realization, I'm about to share a post to the main forum because of how bizarre it is- its about my eczema treatment and side effects! Heres the link.

 

Just finished reading through the whole thread. Hopefully, keeping the steroids away from him will help.

 

Many cats drop lower at night, and he generally appears to be one of those who do.

How does he seem to be feeling lately?

 

Oh, and I totally agree with you about essential oils, ointments, scented candles, etc. I don’t use any of this stuff anymore. A lot of it is toxic to cats. I’m very careful about what is on my hands because I touch my cats and they will then, in turn, lick themselves. My husband was also prescribed that triamcinalone acetonide cream for a serious skin problem brought on by the COVID vaccine. I’m always reminding him to wash his hands after he rubs that steroid cream on!

 

He has been doing better, he's been playing and zooming like nothing is wrong even when he's approaching close to 150 at his nadirs! Occasionally though the time his insulin does take full effect (seems like 3hrs for him) he gets a little cranky and wants a short nap. But he still gets intrigued by his toys and has appetite, I think he's more just not used to the speed of the drop which is why I'm trying to test around 2-3 hours in. Getting him to eat helps him feel better, he just doesn't always remember to check his bowl, but doing better about that. Now I just need to set the bowl next to him instead of breaking the pate apart and hand feeding him. Nadir is around 5-6 hours in. And has been getting more energy overall in comparison to when it was in the reds and blacks.
It's the daytime when he acts very exhausted and will try to take naps for longer periods of time and go into deeper sleep stages (he starts twitching from dreaming) but I feel that's partially my fault. I have been waking him a lot to do tests at night because I'm worried about him dropping too low.

That steroid cream is no joke!!

I do use some candles still, but usually I keep the cats out of the room anyways when I use them because they have tried to smack the literal flame before! Having multiple chronic migraine having folks in one place tends to mean I avoid a lot of scented candles, but if it is it'll be very lightly scented. Permanent rule is no matter what, if I'm using a candle it cannot have citrus, because I know that can be really bad for them. No lilies in the house, either.

He also has been keeping his weight on him still! So even if he's really thirsty, peeing in the litterboxes a bunch, with a big appetite, apparently the lack of losing weight tends to point towards steroids causing those symptoms instead of diabetes. Those symptoms have been improving though, and I'm glad about that!

 

I think you are making real progress. Is he at his ideal weight now, or below it? Do you want him to gain or lose weight— or neither?

 

He's at his ideal now, and we want to maintain that weight. He suddenly dropped to 9.4 pounds from 11.6, and we want him to stay at around 11.

 

Finally got a number that wasn't 400+ for AMPS!!!

 

Hooray. I see your note about holding the dose for two weeks per vets. I would not do that myself, unless something changes and he starts going down. I would hold the dose for one week (14 cycles) or a maximum of 10 days. The few blue numbers he's had have been over 150. He needs to get out of the dangerous numbers that are hard on him and his kidneys.

 

It's due to AAHA recommendations following steroid exposure. From what I understand, steroids can keep glucose artificially elevated for a while and then cause really bad hypos once it lifts. Raising insulin can make that risk of a bad hypo more severe. I can of course check in with the vet after one week if it seems that he's not getting more appropriate numbers though! Reductions will also be made if there's a hypo, of course.
This is the troubleshooting guide I am referencing by the way: https://www.aaha.org/aaha-guidelines/diabetes-management/troubleshooting/
And it would only be a total of two weeks, including the days since the one marked "day 1"

 

Well yes, we want to keep him safe!

 

Looking at my personal medical records, it seems I was initially prescribed the steroid ointment back at the beginning of May 2022. That means he was likely exposed intermittently (based on my flares and frequency of use) for around 6-7 months. And of course my flares get the worst on the backs of my hands, using my fingers to apply it.... So that meant if I pet him at all while the ointment was on, it would get all over his fur, allowing him to groom and therefore ingest the steroids- without me realizing the effect it could have on him....
Poor guy :'(

 

Well, that was quite a long time. I'm glad you realized this was happening.

 

I see the 1F dose got him into a little blue again last night. Will you continue with the 1F dose then this morning?

 

Yeah for the time being, until he has a reading below 75 or shows a reason to increase the dose. His morning reading just now was 358, which is definitely an improvement!