Recent HYPO and not feeling well

Jenni

Member Since 2015
Hello everyone,

I'm back with another "situation". Last weekend Smudges went into hypo. He was in obvious distress and when I tested him, his BG was 29! I gave him some Karo and rushed him to emergency. They gave him dextrose. I took him home and thought everything would be back to normal but he was puking daily and had diarrhea. He clearly looks like he doesn't feel well. Blood work shows nothing unusual except elevated BUN 54 and Creatnine 2.6. In July, BUN was 47 and Creatnine was 2.7. They told me this was a sign of early kidney disease.

So a few months ago I started giving him fluids 3x/week but he didn't seem to tolerate well. He also refused to eat wet food more and more and then completely stopped. I switched him to Dr. Elsey's Clean Protein per a suggestion on this forum. He loves the food but it is high in calories according to the vet. I've tried to persuade him to eat wet food at least some of the time but he has never really liked wet food and refuses to eat more often than not. He also pukes regularly when he does so he's just been on the kibble for a few weeks now.

I gave him Cerenia and Metronidazole the last three days so the vomiting and diarrhea have stopped. Also started Pepcid every 12 hours. There is some improvement in his demeanor but he still clearly doesn't feel well. Emergency vet recommends an ultrasound to check pancreas and other organs. She also thinks he should be on a prescription kidney food.

I've changed vets a few times this year because I just haven't felt comfortable with previous doctors. I think I have a good vet now--have only seen her once. The emergency vet is the first to say a kidney food diet is more important than low carb to treat the diabetes because kidney food could possibly reverse or slow down the kidney disease. This goes against what other vets suggested. It is my understanding that there are no foods which can address both kidney disease and diabetes. The emergency vet said there should be something out there but did not have any information.

So, I have no idea what to do next. Will talk to regular vet on Monday about how to proceed but last week she felt addressing the diabetes was more important. She recommended a maximum of 1/3 cup Clean Protein kibble per day--he needs to lose a little weight.

I've reduced his Lantus to .5 units 2x/day and plan to do a curve in the next couple of days to figure out appropriate dosage. I was hoping he would feel better by now (been a week) before I do that.

I would love some suggestions:
What wet food do I try in conjunction with Clean Protein? It's unlikely he will like any "kidney" prescription foods (or any other wet food for that matter). Had him on Wellness for a couple of years previously until he refused to eat it anymore.

Do I do a curve prior to him feeling better. I'm hesitant to increase his Lantus while he is not feeling better. I do test at least twice daily and his spreadsheet is current.

I need some advice, please!

Jenni
 
An elevated BUN can be due to being dehydrated as well as due to a high protein diet. His creatinine isn't that bad either.

Do you know what his phosphorus level is?

There are foods that are fine for both diabetes and CKD.....this sortable chart is a good place to start. Some people look for foods lower in phosphorus (like under 200) but generally, as long as it's under 300, it's considered fairly low in phosphorus.

You can also use phosphorus binders.

If you can get his complete bloodwork and add it to your spreadsheet labs, we have several people here who are really good at reading labs (like @Marje and Gracie but I think she's out of town with family this weekend)

If you can, it will help if you'll start testing him more often. Doing a curve is fine, but it only tells you what's going on for one cycle. If you can get mid-cycles on the AM cycle and at least a "before bed" test on the PM cycle, it will really help.

It's important to get tests on the PM cycle....at least that "before bed" one....most cats go lower at night so it's important for his safety as well as to see what's going on during that half of his life.
 
Was a urinalysis runtimes see if he is concentrating his urine and if he might have a UTI? Vomiting and diarrhea aren’t signs of early kidney disease but could be pancreatitis. The creatinine and BUN point to stage 2 kidney disease. Was he tested for pancreatitis? I’d do that before anultrasound. Many vets don’t suggest a kidney diet with early CKD any more and especially with a diabetic because they are high in carbs. It would be good to know the phosphorus level and if high a phosphorus binder can be added to a lower regular phosphorus food as Chris suggested. I would get a copy if labs and add them to your ss.
 
Okay, I've updated his spreadsheet with 3 lab results taken in June, July and last week. A urinalysis was done in June and came back normal. He is still not feeling well and definitely eating less since yesterday but he is still eating. His AMPS today was 130 which normally makes me happy but it is considerably lower than what it has been lately so I'm nervous given the hypo last week and his decrease in appetite. His +2 is 114 (about 1 hour ago). He is drinking normally.

Was hoping to try some wet food but I just don't want to push it until he feels better. I'd rather he eat kibble than nothing at all. I like to keep him on a quality diet and have tried a few different kinds from the suggested listed--all have the same result. If I can get him to even try it (which is a battle) he often pukes afterward or quickly loses interest and refuses to even a little.

Something different is going on with him in the last week because he was doing great before the hypo event. I plan to talk with our vet tomorrow about how to proceed. Wondering if giving the fluids again will help or make him feel worse at this point.

Very frustrating--I just want my kitty to feel better!
 
Good catch on that 29 last weekend! That must of been quite scary!

I understand you not wanting to increase the insulin while he isn't feeling well and I take it he still isn't eating well for you? I saw in your diet notes several throw ups after eating beef. Bubba can not eat beef at all and throws up within 20 minutes of eating some, so that is off the table for him.

Is his diet primarily dry kibble at this point? If that is all you can get him to eat, Young Again dry is very low in phosphorus. I am not sure where you are located ,but they don't deliver to Canada.
 
His diet is all kibble (Clean Protein) right now and has been for about 2 weeks. He was puking regularly after the wet food and refused to eat it most of the time. I didn't want to stress him out anymore so we are on a "break" from wet food right now. I am hoping to find a kind he will like but he has just never been a fan of wet food and has a sensitive tummy. Until about a month ago, he was eating a low carb Wellness wet food in addition to kibble. We recently switched to Clean Protein which is low carb but high in calories. Until he got sick a week ago, he wanted to eat all the time and it was difficult limiting him to 1/3 cup.
 
@Bobbie And Bubba Clean Protein is also low carb.

You didn’t list the urine USG which would show if he’s concentrating his urine. The only other thing I see is the eosinophils and lymphocytes which show that there’s inflammation. Looks like definitely stage 2 CKD.

When Max was first diagnosed with pancreatitis, he would only eat dry food. I’ve no idea if that is what this is but manywith pancreatitis report their cat just doesn’t feel right. If the test for it is normal then I would get the ultrasound.
 
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@Bobbie And Bubba I see. I do think Clean Protein is also low phosphorus but I could be wrong. I would hesitate to change food while he’s not feeling right. I’ve also noticed many get loose stool from YA. JMHO
 
@Bobbie And Bubba I see. I do think Clean Protein is also low phosphorus but I could be wrong. I would hesitate to change food while he’s not feeling right. I’ve also noticed many get loose stool from YA. JMHO
I agree, I wouldn't fix if it isn't broke. If in the future a lower phos is needed, it is something to keep in the back of her mind. It is 183 /100kcal
 
@Bobbie And Bubba I see. I do think Clean Protein is also low phosphorus but I could be wrong. I would hesitate to change food while he’s not feeling right. I’ve also noticed many get loose stool from YA. JMHO
I will not be changing his food again at this time. He likes the Clean Protein and it is good for him. Unfortunately, it is ridiculously expensive too!

I feel like I shouldn't have given him a shot today. Tested below 80 2 hours ago so I gave him a little Karo and testing again 1 hour later--BG was 80. The unpredictability of this disease and how he is feeling right now scares the daylights out of me....

I am not seeing USG on the urine results. Do you mean specific gravity? That is 1.020. The report looks very different from others I have. Here is what is listed:
PH, PRO, GLU, KET, UBG, VIL, BLD, SPECIFIC GRAVITY and some notes showing NSF regarding crystals, casts, cells, bacteria, and RBC
 
How is pancreatitis tested?
It’s a blood test and if your vet uses IDEXX they do it. Mine used Antech and it was sent to IDEXX. Tests in the U. S. I don’t know where you live. It’s the SpecfPL. They have an in house test, the SNAP, which only gives a positive or negative result. So if he’s in the gray zone you wouldn’t know.
 
Had to take him back to emergency to stay overnight. He hardly ate anything today and his BG kept decreasing. They recommend doing an ultrasound vs. just testing for pancreatitis. According to the doctor, the test for that is unpredictable and an ultrasound will give a much better picture of other possible causes for his illness this week.

I can't remember the last time I slept without my kitty curled up next to me.....this is really hard :-(
 
:bighug::bighug:

Is a board certified radiologist doing the uktrasound I hope?

BTW, Max completely stopped eating when diagnosed with pancreatitis. He had two ultrasounds plus the blood test. First ultrasound was done by a traveling vet. Found everything BUT pancreas. Second one said everything normal BUT he had pancreatitis. Blood test showed pancreatitis as well. If I had not gone for a second opinigone for a second opinion, he would have had unnecessary exploratory surgery. Your vet is right that the test isn’t always reliable. Diabetes and even kidney disease can give a false positive.
 
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OMG, I went to Walmart today to buy more Relion Micro strips and was told they were discontinued! WTH?! Been going through a lot of strips lately and low on supply. While searching for answers online I came across posting on this site about the discontinuation. I had no idea this was happening and now I'm in a panic.

Some people posted that the strips for the Arkray Glucocard 01 meter are the same as the Relion Micro. Is this accurate?

I need strips fast and do not want to order online unless I'm absolutely certain they work with the Micro. Otherwise, I will have to try another meter. If that is the case, I don't know what to do!

HELP!
 
Is this what works with Micro?

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Smudges is home from emergency but is still not feeling good. His ultrasound cannot be done by internal medicine until Wednesday. So, I'm hoping to just keep him stable. Dr. said last week's hypo could be the cause of why he hasn't been feeling well and that it can take some time for kitties to fully recover. Thankfully, this has only happened a couple of times in the last few years but he has never reacted this poorly before. Of course, now he is 17-1/2. If the ultrasound doesn't reveal any potential causes, not sure what to do. I'll cross that bridge when I get there.

I was instructed to only give .5 units of Lantus if BG is >250. Just tested him at 312 but I'm on the fence about giving him any since he is not eating a normal amount....
 
Since I am low on strips, not sure if I should just switch to a different meter. Looks like Relion Prime requires more blood but I'm uncomfortable not having more strips this week. Too much stress right now--I need some good options.
 
As long as you don’t mind ordering on line I would get an Arkray from ADW. The strips really can be used with your meter. I never had any issues.
 
I am really hesitant to buy them from ADW. The CSR didn't have any information about the strips working with Relion and they cannot be returned after opened. With my luck, they wouldn't work.

Relion Prime test strips are considerably cheaper. I'm just concerned about the amount of blood needed. Sometimes Smudges gives me way more than I need; other times not...
 
Also concerned about reading variances using another model. Even small differences can impact decisions about dosing.
 
I am really hesitant to buy them from ADW. The CSR didn't have any information about the strips working with Relion and they cannot be returned after opened. With my luck, they wouldn't work.

Relion Prime test strips are considerably cheaper. I'm just concerned about the amount of blood needed. Sometimes Smudges gives me way more than I need; other times not...

@Jenni Not sure where you are located but I switched from Relion to Kroger's OnSync. It takes very little blood and is very affordable. I've been very pleased. I compared with my remaining Relion strips and the numbers were very close on the low end. On the higher end, bigger gaps but that is no surprise with the 20% variation allowed by the FDA. If you look at my spreadsheet a few weeks back, you can see where I recorded both numbers for comparison.

Good luck with everything. Definitely bad timing to have to be going through the stress of purchasing a new meter.
 
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