? Glucose Spiking and Need Advice

[Michele Morrissey]

A month ago our cat Fitzy was diagnosed with diabetes after sudden weight loss and lethargy. Vet did blood and said he had "triad disease" gave a bunch of meds and sent him home. I brought Fitzy back to vet everyday for three days as he was getting very dehydrated and no better. On last day vet said he did not fit the profile of a diabietic cat but since it is one of the causes of Triad he did give vetsulin as last ditch effort. Fitzy was still going downhill the next day so we brought him to the animal emergency clinic where they diagnosed diabetes and that he was in ketosis (did x rays and saw no tumors or anything unusual). After a week in the hospital they sent us home with Lantus at 1 I/U (cat is 11 lbs) 2/a day (they said the vetsulin was not working). He did well for the first week, mostly staying between 100 and 350 and a couple of times glucose went as low as 60 (we home test twice a day). The next week we brought him back to regular vet for check up and noted that glucose levels were increasing and level am pm were sometime going to 500 or more. Since at the time of the 6 hour check at the vets office the glucose level was 178 the vet said to leave insulin level alone. Since then glucose levels continued to increase and sometime the meter read high (over 600), so we slowly over a week and a half increased to 1.5 I/U (vet phone consultation). Because I felt our vet was being a little cavalier we brought him to another vet who tested two hours before the next shot and found the level at 400 and said to increase to 2 I/U. I also asked to test for a urinary tract infection because I heard that can increase glucose (and he was found to have one at the vet emergency clinic) and she said he did have one. She gave him a shot of Covenia for the infection and sent us home. Four days later and on 2 I/U per day , Fitzy's glucose levels are increasing not decreasing. He is testing over between 500 and over 600 pretty consistently. So today I started a glucose curve. >600 at 8 with shot, 553 at 9, 404 at 10, now at 12 noon it came back >600. Has anyone had any experience like this or thoughts? He is on the Purina Dietetic Management wet (at emergency vets suggestion). I think he is drinking more than he should be otherwise appears pretty much ok at this point.

 

[Lisa and Smoky]

If you change your prefix on thread to 911 more eyes will be focused on your post. Just something I learned on this site.

 

[Alexi]

So your cat is currently on Lantus?

Can you post the starting dose, the numbers you were getting and the times each day and when the dose was increased, by how much and the numbers you have been getting on the bigger dose. What sort of meter are you using and what are you feeding?

 

[Michele Morrissey]

If you change your prefix on thread to 911 more eyes will be focused on your post. Just something I learned on this site.

Thanks I'll try.

 

[Michele Morrissey]

So your cat is currently on Lantus? Yes he is on Lantus.

Can you post the starting dose, the numbers you were getting and the times each day and when the dose was increased, by how much and the numbers you have been getting on the bigger dose. What sort of meter are you using and what are you feeding?

When we took him home from the vet hospital he was on 1 I/U (8 am and 8 pm) he stayed on that for the first two weeks I think and then it was increased to 1.25 and I think he was on that for about 5 days when it was increased to 1.5 which he was also on for about 5 days. This past Weds. October 5 we increased to 2 I/U at the advice of a new vet. He was also diagnosed with a UTI. I have posted an excel spreadsheet with the numbers. The first page is my attempt at a glucose curve from yesterday. The second page is from today (we were out for 6 hours). The last page is all the readings we have taken since we brought him home. We were testing before each shot (did not realize we should have been testing at the Nadir until I stated doing more reading). I have put the approximate dates for each dosage under the relevant columns of the spreadsheet. Thanks for any thoughts.

 

[Michele Morrissey]

Oh and we are using the CVS Advanced glucose monitor.

 

[Sharon14]

Hi Michele, sorry you are having such problems getting Fitzy regulated. If you set up our spreadsheet, it will be easier for us to help you.(if you need help setting it up, just ask)
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Getting those nadir tests will help us to see if Fitzy is going low and bouncing or needs more insulin.
A UTI can increase BG's and Convenia is not the best antibiotic for UTI's. Be sure to test for ketones, especially while BG's are so high and an infection is present.

 

[MrWorfMen's Mom]

Your vet gave Convenia which is an long acting antibiotic meant for skin infections so there is a good possibility that it has not cleared up the UTI and possibly caused a bacteria overgrowth. How was the UTI diagnosed?

The proper way to diagnose/treat a UTI is to get a sterile urine sample via cystocentesis and culture it to determine the offending bacteria and what antibiotic the bacteria is sensitive to. Unfortunately, vets seem to be grabbing the Convenia for everything these days probably out of a desire to make life easier for the caregiver and cat. In reality though, they are not doing you and more importantly, your cat, any favours taking this short cut.

The problem now is that while the Convenia may initially kill off some offending bacteria it also kills off non-offending bacteria leaving more opportunity for any other bacteria present to multiply. That makes it even more difficult to determine the offending organism. It may be necessary to take another shot in the dark with another broad spectrum antibiotic because a sterile urine sample/culture now may or may not clearly identify the offending bacteria.

FYI, many if not most of us here will not allow our vets to give Convenia under any circumstances as it has been linked to some pretty serious side effects in some pets. It stays in the system for an extended period of time and unlike other antibiotics, if there is an adverse reaction to it, there is no way to counteract the adverse effect other than supportive care because unlike other meds which you just stop giving, there is no "off-switch" for the Convenia.

It's difficult to see what might be going on with the readings you have on your spreadsheet to date. If we could get you to set up one of our spreadsheets and plug in the readings you have taken to date, showing roughly when in each 12 hour cycle the readings occurred, it would be helpful. Sharon provided the link to the spreadsheet instructions in her thread above.

THIS DOCUMENT explains how to use the spreadsheet as we don't deal in clock times but rather with readings immediately prior to insulin shots (AMPS aka AM pre-shot and PMPS aka PM pre-shot) and then the number of hours post shot each reading was taken. We do this because our members are all over the planet in different time zones so dealing with cycles makes it easier to see what is going on with kitty. All you have to do is plot in numbers and the spreadsheet does all the work so while it may look complicated, it really is very simple. If you need any help setting this up, just holler and we'll get you all the help you need.

One other thing, can you please remove the 911 from the title and replace it with a "?". I realize you were asked to add it but the 911 prefix is meant for emergency use when a kitty is in imminent danger/distress (e.g extremely low BG reading or potentially life threatening situations) and the caregiver needs immediate advice/assistance to keep kitty safe. While you definitely need assistance to get Fitzy sorted out and feeling better, and we will help you do that, Fitzy thankfully is not in any immediate danger right now.