Possible bounce or illness induced?

Puddensmom

Puddensmom

Member
Pudden was diagnosed with CKD on 8/7/18. She is very ill and came out of remission. I started her back on insulin on the 25th. Because I am still not convinced these are stress numbers I started her on a low dose of .25 She seemed to be responding ok so I continued with that dose. After a few cycles I was getting 300's still so I upped it to .50 yesterday. If you look at her spread sheet I got a 289 yesterday PMPS. After shooting the .50 she seemed to stay flat, but today this AMPS was 495! The highest she has been. I shot her at the lower .25 dose again just in case. Could this be a bounce? It's hard because I never know if it's related to the kidneys. She is having a lot of issues one being possible fluid retention and her pm fluids were skipped yesterday. I don't know if dehydration could be a factor here.

Thank you!

-Lindsay
 
I can't really speak to the CKD aspect of her condition, but as far as the insulin and BG, it does not look like a bounce to me. It looks like insufficient insulin. Often when there are other health issues, the BG will rise. It can feel like those aren't real numbers because they are caused by inflammation or infection, but they still need to be treated as what they are since high BG can further stress the body. Insulin support can at least help Pudden in that aspect while her body works to manage the other stressors. I would encourage you to go ahead and increase the dose back up to 0.5u tonight, and then if you don't see any BG numbers under 200, increase to 0.75u in the morning, and then again to 1u in another three cycles. It may take a little bit to get Pudden's body to start to respond to the insulin again since she's been off of it for so long. Please continue to post and we can help coach you through this. I know you've done this all before, but it can be helpful to have people walk through it with you, especially while you're managing her other help problems as well.

I'm so sorry she's come out of remission. It's so hard to add this to the mix of things you're dealing with, but know that you're not alone!
 
Djamila said:
I can't really speak to the CKD aspect of her condition, but as far as the insulin and BG, it does not look like a bounce to me. It looks like insufficient insulin. Often when there are other health issues, the BG will rise. It can feel like those aren't real numbers because they are caused by inflammation or infection, but they still need to be treated as what they are since high BG can further stress the body. Insulin support can at least help Pudden in that aspect while her body works to manage the other stressors. I would encourage you to go ahead and increase the dose back up to 0.5u tonight, and then if you don't see any BG numbers under 200, increase to 0.75u in the morning, and then again to 1u in another three cycles. It may take a little bit to get Pudden's body to start to respond to the insulin again since she's been off of it for so long. Please continue to post and we can help coach you through this. I know you've done this all before, but it can be helpful to have people walk through it with you, especially while you're managing her other help problems as well.

I'm so sorry she's come out of remission. It's so hard to add this to the mix of things you're dealing with, but know that you're not alone!
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Thank you so much. It is so nice I am not alone and have help through all of this. I upped her back to the .50 this morning. She had to go to the vet today for some tummy issues. She was given gabapentin as a sedative. When I checked her for her PMPS she was 524! I gave her .75 because it is a night shot and I am afraid to jump up to 1 unit when I wont be able to stay up and keep an eye on her.

Is there a reason that she could suddenly be going up so high since starting insulin? I know a vet visit can make BG go up, but Pudden's BG never much reacted that way after the vet in the past. I worry this is a result of the kidney failure and perhaps a bad sign of what's going on internally.
 
It's possible she has some other infection/inflammation going on, but I don't know that CKD itself really causes numbers like this. That might be a good question to ask out on the Main forum. I know there are a number of people who have cats with both conditions. They might have better insight for you with that.

Do you have any idea/hunch how long ago she came out of remission? Did her numbers get checked when she got the CKD diagnosis? How long ago was the last dental? What were the tummy issues that lead to the vet visit today?

And all of that aside, it could just be that the diabetes has reemerged and she just simply needs more insulin to get it back under control. Sometimes it's just a cat being a cat. :cat:
 
She came out of remission only 2 weeks ago. The numbers are climbing really fast. She was 217 at diagnosis. She is having issues with constipation and I trying to get her miralax dose right. She has been very distended and so I too her in to see if it could be fluid retention, but thankfully it was only gas build up.
 
Puddensmom said:
She came out of remission only 2 weeks ago. The numbers are climbing really fast. She was 217 at diagnosis. She is having issues with constipation and I trying to get her miralax dose right. She has been very distended and so I too her in to see if it could be fluid retention, but thankfully it was only gas build up.
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Discomfort from constipation can be adding to the numbers. I know how you're feeling. My cat was in remission for a year and then suddenly fell out. :/

How advanced is the ckd?
 
JanetNJ said:
Discomfort from constipation can be adding to the numbers. I know how you're feeling. My cat was in remission for a year and then suddenly fell out. :/

How advanced is the ckd?
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She is in stage 4 and has lost 85% of her kidney function. She is anemic as well which is most likely from gi bleeding. She is getting omeprazole for it. She is very ill, but did seem to perk up the last few days. I was hoping maybe if I got her diabetes under control she would start to feel better, but now with her numbers going up so high I am worried.

She did have a uti but it was taken care if with an antibiotic. Her tummy troubles are for sure really bothering her. She alternates between constipation and diarrhea because I can't seem to find the right miralax dose since adding phosphorus binder.

Poor Pudden. It's a lot and I feel so bad.
 
Puddensmom said:
She is in stage 4 and has lost 85% of her kidney function. She is anemic as well which is most likely from gi bleeding. She is getting omeprazole for it. She is very ill, but did seem to perk up the last few days. I was hoping maybe if I got her diabetes under control she would start to feel better, but now with her numbers going up so high I am worried.

She did have a uti but it was taken care if with an antibiotic. Her tummy troubles are for sure really bothering her. She alternates between constipation and diarrhea because I can't seem to find the right miralax dose since adding phosphorus binder.

Poor Pudden. It's a lot and I feel so bad.
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I'm sorry. My cat Zimmy went from stage 2 to deaths door in a week. I suspect he had a bleed. We did two infusions but they did nothing. So sorry your kitty isn't doing well. How bad is the anemia?
You can add pumpkin in addition to the Miralax
There's a great group of people on Facebook called Cats with Chronic Renal Failure that may be helpful.
 
JanetNJ said:
I'm sorry. My cat Zimmy went from stage 2 to deaths door in a week. I suspect he had a bleed. We did two infusions but they did nothing. So sorry your kitty isn't doing well. How bad is the anemia?
You can add pumpkin in addition to the Miralax
There's a great group of people on Facebook called Cats with Chronic Renal Failure that may be helpful.
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I'm so sorry you lost Zimmy to this horrible disease.
I've been getting a lot of help from the Tanya ckd group. They're wonderful and Pudden probably would have already been gone if it weren't for them. Her HCT dropped from 37 to 22 in two weeks. It's mild, but the drop was severe for such a short time. She was on sucralfate, but it made her throw up and exasperated the constipation. She took it for the recommended weeks time so I'm hoping the omeprazole will help to continue the healing of the ulcers.
 
I think the number of issues you're dealing with explain the high numbers. When the body is under stress (inflammation or infection), the BG typically rises. I think being more aggressive with the dosing might bring her down at least a little. I'm glad you're working with Tanya's group. They are amazing.
 
Djamila said:
I think the number of issues you're dealing with explain the high numbers. When the body is under stress (inflammation or infection), the BG typically rises. I think being more aggressive with the dosing might bring her down at least a little. I'm glad you're working with Tanya's group. They are amazing.
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Yes I think you are right. I got a 465 this morning and shot .75, two hours later she is only down to 365. I will hold the dose one more cycle tonight and then up it to 1 unit tomorrow morning as I'm sure the amps will still be crazy high.

I remember her first insulin shot ever back in 2016 she dropped from over 600 to 120. She then proceeded after that to have terrible numbers for several weeks. So it looks like this time that nice drop to 140 on the 25th was the same kind of reaction.
 
You can safely raise the dose tonight unless you've seen some numbers today to indicate otherwise. The mid-cycle numbers are still high enough that the increase shouldn't put her in any danger.

It is so hard during the second diagnosis. I kept trying to compare it to my cat's first diagnosis, but the second time around it's a very different dance. Although it's a nice symmetry that Pudden gave you that same dramatic response on the first dose! Hopefully you'll start to see some better numbers with the increases.
 
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