Newbie Curly Sue's Journey!

[LiznSue]

Hey guys, this is Curly Sue's journey. Curly Sue is 14 years old and was diagnosed with diabetes on August 6th, 2019. She was subsequently diagnosed with CKD 2 weeks later. She's on vetsulin and has been rotating between foods to find the right one. Vet originally put her on royal canin glycobalance dry and she had 3 dehydration crashes. She finally got switched to royal canin select protein PV wet food as she's apparently got idiopathic BD. I started mixing in water with her food so she finally stopped crashing. It's a very expensive food (with the amount she's eating, it's costing about $180 USD a month which is crazy) but I've been looking at switching her to Tiki Cat or Weruva. I'm not home testing as of yet because my baby is a little aggressive and grumpy when I'm touching places she doesn't like.
One major issue she was having when she crashed the first time was a severely distended abdomen. Vet couldn't figure out what was causing it, but it was suggested that she had an enlarged liver or pancreas, pancreatitis, or possibly cancer. On her most recent blood test results, she had very high WBC and low RBC. Her BUN was high but her creatinine was average. The size of her abdomen has been shrinking since I started her on the new food, however. She has started eating a bit less as of this week so I'm not sure if it's good or bad in regards to her diabetes or CKD. Her sugars were averaged at about 217 on her last vet visit. I'm wondering if her BUN would go down since she's not as dehydrated?
Thanks for reading! Can post lab test photos if need be.

 

[Idjit's mom]

Hi again Liz. I wanted to offer this as you aren't testing yet because Sue might not be receptive, this might help. By member Chris & China (GA)

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Here's something I wrote up for others for testing...maybe it'll help you too!

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.

Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

For new kitties, using a heavier gauge lancet is also really helpful. A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

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[Chris & China (GA)]

Can post lab test photos if need be.

If you post your lab results, @Marje and Gracie is a whiz at interpreting them in English so they can be understood better.

A high BUN can be caused by dehydration and a high protein diet....if the Creatinine is normal, there's probably nothing to worry about

The high WBC usually indicates some kind of infection though.

 

[LiznSue]

@Marje and Gracie You have been summoned for interpretation. Thank you in advance! T_T Her BUN went down 6 pts from when I had her blood gas done 2 weeks prior. These results are from 8/24.

 

[Chris & China (GA)]

You have been summoned for interpretation.

She's not on as much as she used to be, but she usually checks in later in the evening...but don't worry...she'll see the tag and get back to you ASAP

 

[Marje and Gracie]

She's not on as much as she used to be, but she usually checks in later in the evening...but don't worry...she'll see the tag and get back to you ASAP

@Marje and Gracie You have been summoned for interpretation. Thank you in advance! T_T Her BUN went down 6 pts from when I had her blood gas done 2 weeks prior. These results are from 8/24.

And here I am!!!! I’m also reachable by PM as I get those notifications to my email. Then I can pop on the condo.

How was CKD diagnosed? I don’t see an SDMA and her creatinine is normal. As Chris said, BUN can be elevated due to dehydration or high protein meals. I usually focus on many other parameters than BUN when looking for CKD like creatinine, phosphorus, calcium, potassium, hematocrit.

Her USG is showing her urine is dilute. While this can be an early sign of CKD, it also depends on the time of day it was done. The more water one drinks, the less concentrated the urine is. If my vet wants to tell if a cat is able to concentrate the urine....which is the most important thing...then she does a USG on the first urine specimen of the day. You can free catch it and fun it to the vet or you can get a handle held refractometer from Amazon and check it when you want (be sure to calibrate it).

I would also see about having a urine protein:creatinine ratio done because she’s got protein in her urine. Cats other than those with CKD can have proteinuria.

I’m not worried about her elevated cholesterol and triglycerides.....that’s seen often with FDs. Her Precision PSL is high; this test is Antech’s supposed equivalent to IDEXX’s specfPL but it’s not nearly as good. My vet doesn’t put any stock in it.

Of most concern is her low hematocrit and RBCs. She is just on the edge of anemia. When you say she has “idiopathic BD”, are you referring to IBD (inflammatory bowel disease). If so, how was that diagnosed? If she was diagnosed by endoscopy and biopsy, it raises a flag to me wondering if she has any potential internal bleeding especially with the distended belly (was it hard?)...but she’d likely be a lot sicker. It might be worthwhile to have the HCT rechecked and if it’s not going up, I’d do more tests. Your vet might be able to just get a small sample and run a hematocrit in her office but I’d be very watchful of that.

 

[LiznSue]

The idiopathic part is quoted from my vet in an email. Not sure if she meant inflammatory or what. I never had any specific tests or biopsies done for it so I'm honestly not quite sure where that came from. Curly used to be a nuke and puke cat. She'd wolf her food down in the morning and barf it up shortly after. That's really the only thing I can think of? I also don't believe there was an SDMA test done. Her belly was definitely tense but didn't seem rock hard.
Here's a urinalysis they did when I took her to the ER vet when she was in crisis a couple weeks prior though it really doesn't seem helpful. I've also noticed she has sleep apnea. She's always been a snorer.

 

[Marje and Gracie]

The idiopathic part is quoted from my vet in an email. Not sure if she meant inflammatory or what. I never had any specific tests or biopsies done for it so I'm honestly not quite sure where that came from. Curly used to be a nuke and puke cat. She'd wolf her food down in the morning and barf it up shortly after. That's really the only thing I can think of? I also don't believe there was an SDMA test done. Her belly was definitely tense but didn't seem rock hard.
Here's a urinalysis they did when I took her to the ER vet when she was in crisis a couple weeks prior though it really doesn't seem helpful. I've also noticed she has sleep apnea. She's always been a snorer.

You are right...it’s not helpful

How many units of insulin is she getting at each shot and what is her BG like? We really need you to do a SS here as soon as you start testing and post it if we are going to be able to help you.

would you describe her as pot bellied even though the swelling has gone down? Does she have large feet or have you noticed any changes in the size of her head or jaws? Any weepy eyes?

 

[LiznSue]

She's getting 3u 2x a day. I've been adjusting it a little because I've been worried she's going hypo. I tried testing her today but I'm so nervous and didn't manage to prick her. I'll have to read over some of the tips because she's a very bitey cat and doesn't like the poking. She'll let me know she doesn't want something to happen lol.
She still got a bit of a belly but I don't think I'd necessarily call it potbellied at this point. She definitely has a bit of goo in her eyes too. I think the weepy you mean is looking like they're crying, eyes welled up with water?

 

[Idjit's mom]

Liz, could you set up the spreadsheet so we can see how you have been adjusting the insulin dose? I know you are just starting to test, but with the ss set up, when you get those results you can just plug them in too.

Testing is definitely a process of practice and patience. There are the tips and videos here, plus lots more on YouTube. Hopefully Sue is going to learn that this process isn't that bad, and you will gain confidence and not be so nervous. Gawd..you should have seen my hubby and me trying to learn to test! Combination of Laurel & Hardy meet the Keystone Cops! Trying to find a place where both of us were comfortable and could see and I could actually reach the cat ear, the lancing device fell apart in my hand on our second attempt. DH holds Idjit (he's a big long strong cat) and I do the testing. I am "mature" so close eye work and good light needs extra consideration, and I only have two hands/arms. Plus, in my own opinion, DH should be able to read my mind and sit/position himself and cat properly and hold him still for the testing process.
We worked it out (DH survived, barely) and now we do very well. Except when DH is not reading my mind again. LOL

 

[Chris & China (GA)]

I only have two hands/arms

I often wished for an intelligent octopus!!


@LiznSue ….if you'd like some help setting up our spreadsheet, feel free to send me a private message by clicking on my name and choosing "start conversation"