4/3 Help Lost Control of BG New Question Added

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Julie and Eleanor (GA)

Julie and Eleanor (GA)

Member Since 2012
Eleanor has been diabetic and on Lantus for four years. She goes up and down the dosing scale but spends the most time at 3.5 units. She had gone down to 1 unit and stayed longer than usual, her numbers started coming up and I started slowly increasing the dose, but she reached a point where her BG quit coming down. She is now at 3.75 units.
I don't know what to do, keep increasing the dose, reduce the dose, or what. I put her labs up on her SS but couldn't get the date to enter, it is 3/23/16.
I need some experienced eyes on this!
I hope this makes sense, I am not well plus I am exhausted!
 
When I look at Eleanor's labs tab I just see the ranges but I don't see Eleanor's results....maybe it's just me?

What did the vetty say about her health? Are her teeth in decent shape, or does she need a cleaning? Is there any sign of an infection? Any change in diet?
 
I don't see the lab results, either.

The questions that were raised above are the same that I thought of -- any medical issues (UTI, need for a dental -- which is one that often throws cats out of regulation), any changes, other cats in the house who eat dry food or any contraband, etc.

The other possibility is that you were holding doses too long and a bit of glucose toxicity developed. I realize that you were usually within the parameters of SLGS but it may be that Eleanor does better if doses aren't held quite as long.

 
Thank you everyone. I'll see if I can figure out why the lab results are not showing! The WBC was slightly high as well as the leukocytes, that was why she was started on the antibiotic. Also the CK is elevated.
I did start a new insulin pen, twice actually, one after I got floaties in the one I was using, and again - a brand new pen from a different lot etc on 3/13.

Eleanor had stomatitis and had all of her teeth removed in 2011.
When I had her into the vet last month to rule out infection as the cause of her high BG, her mouth, lungs, everything was good, vet took ear swabs to check for infection, took a fecal swab to check for bacteria/parasites, all were negative.
Urine showed only a trace amount of blood and of course high glucose.
Do you all think I should just continue increasing the dose?
 
Sienne and Gabby (GA) said:
I don't see the lab results, either.

The questions that were raised above are the same that I thought of -- any medical issues (UTI, need for a dental -- which is one that often throws cats out of regulation), any changes, other cats in the house who eat dry food or any contraband, etc.

The other possibility is that you were holding doses too long and a bit of glucose toxicity developed. I realize that you were usually within the parameters of SLGS but it may be that Eleanor does better if doses aren't held quite as long.
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Sienne, no dry or contraband! My other kitty eats the same as Eleanor (Fancy Feast Classic), no people food..no changes.
 
Gill & George said:
On your ss notes it says that she had trace blood in urine, I think that can be indicative of a UTI. I believe that can cause BG to go up.
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Yes, it can, that is why she was started on the antibiotic. She has three more doses of antibiotic left, I don't know what to think, her BG should be going down by now if it is caused by infection - I think.
 
Can you still see trace blood in her urine, even after 6 days of antibiotic? (or maybe trace blood can only be detected by the lab in a urinalysis?). Anyway, perhaps check with your vet tomorrow with regard to the efficacy of the antibiotic. It might not be the one that is best suited to Eleanor's condition.

I hope all will turn out OK. Can't advise on dose, sorry!

Ella & Rusty
(cross-posted with the above)
 
Julie and Eleanor said:
Yes, it can, that is why she was started on the antibiotic. She has three more doses of antibiotic left, I don't know what to think, her BG should be going down by now if it is caused by infection - I think.
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I have no experience with dealing with this personally, but I think that with some antibiotics people have noticed that the antibiotics themselves can make the BG go up. Do you know if the AB's are sugar free?

Hopefully someone with experience can help you with this.
Ella & Rusty & Stu(GA) said:
Can you still see trace blood in her urine, even after 6 days of antibiotic?
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My vet checks for trace blood with a keto stix type test, so perhaps this is how it's been detected, I think the blood trace was noted 6 days ago and then the AB's were started.
 
Ella & Rusty & Stu(GA) said:
Can you still see trace blood in her urine, even after 6 days of antibiotic? (or maybe trace blood can only be detected by the lab in a urinalysis?). Anyway, perhaps check with your vet tomorrow with regard to the efficacy of the antibiotic. It might not be the one that is best suited to Eleanor's condition.

I hope all will turn out OK. Can't advise on dose, sorry!

Ella & Rusty
(cross-posted with the above)
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Yes, the urine has to be checked by the lab. I will be checking back with the vet!
 
[QUOTE="Gill & George, post: 1643062, member: 1372raisehexperience with dealing with this personally, but I think that with some antibiotics people have noticed that the antibiotics themselves can make the BG go up. Do you know if the AB's are sugar free?

Hopefully someone with experience can help you with this.

My vet checks for trace blood with a keto stix type test, so perhaps this is how it's been detected, I think the blood trace was noted 6 days ago and then the AB's were started.[/QUOTE]
Eleanor has had Orbax in the past and it did not raise her bg, her BG came down on it don't know if that was just infection clearing. I will see if urine can be checked in office.
 
As I understand it, only a C & S (urine Culture & Sensitivity) can determine which antibiotic is best suited to treat a urinary tract infection. The vet must send a urine sample to the lab, and the sample itself must be taken by cytosentisis (a needle into the bladder) so that the sample is not contaminated by outside bacteria.
Ella
 
Ella & Rusty & Stu(GA) said:
As I understand it, only a C & S (urine Culture & Sensitivity) can determine which antibiotic is best suited to treat a urinary tract infection. The vet must send a urine sample to the lab, and the sample itself must be taken by cytosentisis (a needle into the bladder) so that the sample is not contaminated by outside bacteria.
Ella
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Also once a kitty has been on antibiotics a urine culture cannot be done for 10 days after finishing the antibiotics or the results may not be accurate.
 
I went ahead and raised the Lantus dose to 4u. PS 334. Eleanor feels bad today, she was doing so well it breaks my heart to see her like this again, like when she was first diagnosed.
She had a liquid stool. She has had diarrhea off and on, vet wants a Stool Panel but I don't have the money for it. Vets thought she had pancreatitis and it sure looked like it but she hasn't had vomiting, pain etc since I divided her meals up so she has 1/4 every three hours. I thought the occasional diarrhea was related to pancreatitis, but I don't know. I don't know anything any more.
 
Julie and Eleanor said:
I went ahead and raised the Lantus dose to 4u. PS 334. Eleanor feels bad today, she was doing so well it breaks my heart to see her like this again, like when she was first diagnosed.
She had a liquid stool. She has had diarrhea off and on, vet wants a Stool Panel but I don't have the money for it. Vets thought she had pancreatitis and it sure looked like it but she hasn't had vomiting, pain etc since I divided her meals up so she has 1/4 every three hours. I thought the occasional diarrhea was related to pancreatitis, but I don't know. I don't know anything any more.
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My heart goes out to you. I know the frustratio of not knowing why the numbers won't come down.


My kitty has chronic pancreatitis (very high readings on two separate fPLI tests) and has for over 14 months. During that time he has had only 2 minor attacks and one acute attack. He has never vomited or had indications of pain. The two minor attacks required one shot of SubQ fluid, and one shot of cerenia. The more acute required SubQ fluid, cerenia and buprenorphine for several days/ With Tuxie the only sign I have is when he does not clean off his plate, He is a food vacuum and if he doesn't eat everything in sight then I know there is a problem.

Sending lots of healing vines and ((HUGS))
 
Tuxedo Mom said:
My heart goes out to you. I know the frustratio of not knowing why the numbers won't come down.


My kitty has chronic pancreatitis (very high readings on two separate fPLI tests) and has for over 14 months. During that time he has had only 2 minor attacks and one acute attack. He has never vomited or had indications of pain. The two minor attacks required one shot of SubQ fluid, and one shot of cerenia. The more acute required SubQ fluid, cerenia and buprenorphine for several days/ With Tuxie the only sign I have is when he does not clean off his plate, He is a food vacuum and if he doesn't eat everything in sight then I know there is a problem.

Sending lots of healing vines and ((HUGS))
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Thank you so much for your reply. I am very teary right now.
Does Tuxie have diarrhea due to the pancreatitis?
 
Julie and Eleanor said:
Thank you so much for your reply. I am very teary right now.
Does Tuxie have diarrhea due to the pancreatitis?
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When he had his acute attack a few weeks back he had a couple of runny poops...I wouldn't call it diarrhea, but his normal poops are well formed so it was unusual for him.

One thing I can mention though. Tuxie had a UTI and was treated for it and it cleared up fine...I thought. About 4 days after he finished the ABs it came back again and he had to go through another round of ABs at a higher dose. The first round cleared up the running to the litter box and small amounts of pee, but as I said it did come back again. He was originally on zenequin 12.5mg for 10 days and the second round was Zenequin 25mg for 14 days, which did the trick.

It is so very frustrating when our kitties are not themselves and we can't find the right answer. :bighug:
 
Tuxedo Mom said:
When he had his acute attack a few weeks back he had a couple of runny poops...I wouldn't call it diarrhea, but his normal poops are well formed so it was unusual for him.

One thing I can mention though. Tuxie had a UTI and was treated for it and it cleared up fine...I thought. About 4 days after he finished the ABs it came back again and he had to go through another round of ABs at a higher dose. The first round cleared up the running to the litter box and small amounts of pee, but as I said it did come back again. He was originally on zenequin 12.5mg for 10 days and the second round was Zenequin 25mg for 14 days, which did the trick.

It is so very frustrating when our kitties are not themselves and we can't find the right answer. :bighug:
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I think Eleanor has an infection that the Orbax isn't getting to. I requested something else when the vet prescribed the Orbax. Clavamox and Amoxicillin make her vomit and the vet said there aren't really any other antibiotics for cats.
 
Julie and Eleanor said:
I think Eleanor has an infection that the Orbax isn't getting to. I requested something else when the vet prescribed the Orbax. Clavamox and Amoxicillin make her vomit and the vet said there aren't really any other antibiotics for cats.
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Zenequin (marbofloxacin) is one of the "gold standard" antibiotics for UTIs. As my vet says she would rather use the "big guns" and clear it up. Both my kitties have used Zenequin with UTIs and done fine without any upset stomach problems. The time Tuxie had to do a second round he really should have been put on 25mg rather than 12.5mg because of his weight.
 
I hope I am not out of line adding to this so late, but I went ahead and increas ed the dose to 4u pm, but I don't know what I am doing, I don't know if I should continue with that dose now or go back to 3.75, I am doing a sort of modified SLGS. Eleanor feels so bad tonight, I feel like any decision I make will be wrong. I guess no one can help me with this, I guess its up to me but thought I would ask any way.
Also refresh my memory on how to link this condo with tomorrow's condo.
Note - I shoot 3 am and 3 pm MST.
 
to link this to tomorrows condo, copy the URL on your browser bar, click on the paperclip icon and paste the link in the box that appears, then click on the button that says insert.

Hope that makes sense
 
Hi Julie.

You test enough for TR, but you say you are following SLGS (modified). With SLGS, you are supposed to wait a week to increase, but with TR you do it after six cycles, which you have done. I don't know what to tell you. Looking at Eleanor's SS, I think the increase was warranted. If I were ignoring the guidelines and speaking of my own cat, I'd say keep this new dose and see what it does. You are there with Eleanor, and as we say, you hold the syringe. Only you can make that ultimate call. That said, I hope some other veterans will weigh in with their thoughts.
 
Tricia & Cinco & Harvey said:
Hi Julie.

You test enough for TR, but you say you are following SLGS (modified). With SLGS, you are supposed to wait a week to increase, but with TR you do it after six cycles, which you have done. I don't know what to tell you. Looking at Eleanor's SS, I think the increase was warranted. If I were ignoring the guidelines and speaking of my own cat, I'd say keep this new dose and see what it does. You are there with Eleanor, and as we say, you hold the syringe. Only you can make that ultimate call. That said, I hope some other veterans will weigh in with their thoughts.
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Thank you, I really appreciate your feedback. I feel so lost!
 
I would have increased in your shoes and I would keep increasing aggressively - after every 6 cycles/3 days until you see some movement.

Sending vines for Eleanor
 
My Neko lost her regulation late last summer. I know how frustrating and worrying that can be. :bighug::bighug: There are many things that can cause it, with Neko it was her acromegaly tumor coming back. I had to just keep on increasing as fast as I safely could. I had to go from 3U to 7U in under 4 months. I agree with Tricia, I think you should keep this dose and see what it does for her. Good luck.
 
Wendy&Neko said:
My Neko lost her regulation late last summer. I know how frustrating and worrying that can be. :bighug::bighug: There are many things that can cause it, with Neko it was her acromegaly tumor coming back. I had to just keep on increasing as fast as I safely could. I had to go from 3U to 7U in under 4 months. I agree with Tricia, I think you should keep this dose and see what it does for her. Good luck.
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Thank you Wendy.
 
I agree with Tricia that you should hold this dose now that you have increased it. I do not think you have overdosed her. Your increases have been slow and systematic....and small just as the guidelines suggest.

I don't see anywhere that she could be going lower on you and bouncing back up....she's just suddenly high and flat.

We've seen this happen with some cats before. For example, Trixie did it to Amy at one time for no apparent reason and Amy had to systematically take her dose up to the breakthrough dose again. Recently, Doodles has gone from all blue and green to flat pink and yellow. He was diagnosed with hypertrophic cardiomyopathy and congestive heart failure. The meds have caused his numbers to go even higher. Also, at members' suggestions, Karen had him tested for IAA and acromegaly and his IAA test came back high meaning he is now making antibodies against the insulin so it is not available to him to bring the numbers down.

As Mary Ann said, one of the symptoms of perhaps a milder case of pancreatitis is just not eating or being less interested in eating. I would talk to Dr. T about this. I think you are better to spend your money on a specfPL test than a stool sample.

If she were my cat, I would continue to systematically raise the dose as you have been doing until the numbers start down. The only other option is to have more diagnostics done. If she is not acting like she feels well, that might need to happen sooner rather than later. If she does have some kind of infection going on, you do not want to risk DKA. Also...I would test ketones every day if it were me...at least until her numbers are coming down.
 
Marje and Gracie said:
I agree with Tricia that you should hold this dose notu have increased it. I do not think you have overdosed her. Your increases have been slow and systematic....and small just as the guidelines suggest.

I don't see anywhere that she could be going lower on you and bouncing back up....she's just suddenly high and flat.

We've seen this happen with some cats before. For example, Trixie did it to Amy at one time for no apparent reason and Amy had to systematically take her dose up to the breakthrough dose again. Recently, Doodles has gone from all blue and green to flat pink and yellow. He was diagnosed with hypertrophic cardiomyopathy and congestive heart failure. The meds have caused his numbers to go even higher. Also, at members' suggestions, Karen had him tested for IAA and acromegaly and his IAA test came back high meaning he is now making antibodies against the insulin so it is not available to him to bring the numbers down.

As Marythis wsee where, one of the symptoms of perhaps a milder case of pancreatitis is just not eating or being less interested in eating. I would talk to Dr. T about this. I think you are better to spend your money on a specfPL test than a stool sample.

If she were my cat, I would continue to systematically raise the dose as you have been doing until the numbers start down. The only other option is to have more diagnostics done. If she is not acting like she feels well, that might need to happen sooner rather than later. If she does have some kind of infection going on, you do not want to risk DKA. Also...I would test ketones every day if it were me...at least until her numbers are coming down.
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Thank you Marje. Ketones have been negative.
What is the test for IAA called? Suggestions for other diagnostics?
Problem with that is I don't have the money for tests. Maybe if I just keep increasing the dose this will straighten out.
I can not see where she could have bounced either but was concerned that I was just not seeing it.
 
Julie and Eleanor said:
Thank you Marje. Ketones have been negative.
What is the test for IAA called? Suggestions for other diagnostics?
Problem with that is I don't have the money for tests. Maybe if I just keep increasing the dose this will straighten out.
I can not see where she could have bounced either but was concerned that I was just not seeing it.
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I believe that is what it's called. They usually run two tests....one for IAA and another called IGF-1 for acromegaly. The blood has to be sent to Michigan State University.

The other which is done by Texas A&M or IDEXX if Dr. T uses that lab is specfPL for pancreatitis.
 
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Neko has both IAA and acromegaly. IAA is insulin auto-antibodies. I think it would be unlikely to be the case in Eleanor.
 
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