New Member (May 30) - When to consider hospitalization?

[Laura and Sam]

Hi everyone! Thanks for such a great community - it is so impressive to see how helpful and knowledgeable people here are.

My cat, Sam, is what you might call a "complicated kitty" due to previous health issues that have him on steroids. He was diagnosed with FD near the beginning of May, but we're really struggling to see any improvements and last week we determined he also has a bladder infection. The vet is now recommending overnight hospitalization to get his insulin regulated ($$$$$!!!!), but the more I read here the more I feel like there are things we could be doing (like reducing carbs, switching insulins). The question is at what point do I hit the panic button and decide to turn him over to a hospital? His spikes in the evening are over 30mmol/L measured with an AlphaTrak2 meter.

Some of the details:
- he's on caninsulin, started at 1U but when the first curve done at 10 days of treatment showed him even higher than where we started the vet upped him to 2U.
- we've been feeding Hill's canned food 2x per day and dry food open feeding; based on what I've read today I'm pulling out the dry food and will probably transition to a different wet food when he finishes what we have.
- His numbers are very high (his spreadsheet is posted in my signature), but he does show the expected pattern of dropping about 4 hours after insulin.
- when he's over 30mmol/L he shows signs of neuropathy
- he also has skin issues that we haven't been able to get to root cause on for a couple of years (hence the steroids) which have flared up
- he's on day 7 of antibiotics to treat a bladder infection; he is peeing a little on himself 3-4 times a day but does make it to the litter box for the majority of his pee
- weight seems to be consistent from when we started treatment (he had lost ~3 pounds from late December to early May)
- his urine analysis for the bladder infection didn't indicate a problem with ketones, but I haven't tested at home since (I'm thinking this is also a next step for us)

Appreciate your help and insight - we're in a fortunate position that we can manage to afford hospitalization if it really is the best thing, but I hate the thought of putting him through that stress and discomfort if it's not an emergency and we could get him on track at home.

 

[Nan & Amber (GA)]

If he's still eating and drinking well, I don't see a reason to hospitalize Sam. Overnight wouldn't be enough to regulate him in any case, and the numbers would be inflated from the stress anyway. Much better to adjust the dose based on your home BG numbers!

That said, I'm worried about a couple things. One, please don't change the food all at once. For some cats, that change causes insulin needs and BG to plummet, sometimes to an unsafe level. Sam's on a reasonably high dose of a hard-hitting insulin, so for safety's sake you want to go slow on a food transition, monitoring BG the whole time.

Second thing you already mentioned, I would definitely go ahead and get the ketostix to start testing for ketones. Hopefully Sam isn't ketone-prone, but right now he's got a major risk factor with the infection, and if he is ketone-prone it wouldn't take much more (a skipped shot, a few skipped meals) to push him over.

Now that you're home testing, you want to make sure to test (at least) before every shot, to make sure it's safe. It's a good idea to get at least one more test between shots, too, to get an idea of how low a given dose is taking him. For Caninsulin, we want to find a dose that takes him into the blue numbers, but not below that (for safety). Other insulins, such as Lantus or Levemir, have a somewhat gentler action. Would your vet be willing to consider changing insulins?

I'll let others weigh in with more, but let me finish by saying Welcome!!!!

 

[Ale & Bobo & Minnie (GA)]

I agree with everything Nan said and I’d ask about switching to Lantus or prozync. vetsulin or caninsulin was developed for canines, hence the name, and not all cats do well on it.

I’m also wondering if the steroids and bladder infection are not keeping the numbers high for now

great job on home testing and setting up your ss! Can you do us a favor and also set up your signature? It’s easier to see your cat’s medical history that way instead did having to go up to the beginning of the thread or asking you over and over again. Here are instructions for that:

http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

 

[Sienne and Gabby (GA)]

Issues like a low carbohydrate food (no kibble, especially for a kitty with bladder infections!) are key to getting your cat in better numbers. You want to select foods that are under 10% carb and most folks here feed about half that percent of carbs. As Nan suggested, a gradual transition will help to avoid numbers plummeting and a tummy upset due to a food switch. FWIW, DM is really made of poor ingredients. For what you're spending on that food, you could be feeing your cat a top of the line, human grade cat food. Adding water to. your cat's canned food will also help with the bladder infection.

Please have a discussion with your vet about the insulin choice. Caninsulin was developed for dogs. Cats have a faster metabolism. Caninsulin (it's called Vetsulin in the US) is not an appropriate insulin for a cat. In fact, the American Animal Hospital Assn does not recommend its use for treating feline diabetes. They recommend either Prozinc or Lantus. This is a link to the 2018 guidelines if you want to share it with your vet.

Please also keep an eye on your cat's numbers. the antibiotic may drop them. Did your vet happen to get a sterile urine sample (i.e., by inserting a needle into the bladder) and then do a culture and sensitivity? It's the only way to be certain your cat is getting the proper antibiotic to address the infection. You should be seeing some improvement after a week. Bladder infections (vs a UTI) can take longer to treat, though.

 

[Ale & Bobo & Minnie (GA)]

An antibiotic will bring the BG numbers down not up? I was hoping Minnies elevated numbers since hospitalization were linked to one of the meds or the antibiotics

 

[JL and Chip]

I’m curious about the skin issues. Can you describe a bit more — symptoms, etc?

 

[Lisa and Witn (GA)]

An antibiotic will bring the BG numbers down not up? I was hoping Minnies elevated numbers since hospitalization were linked to one of the meds or the antibiotics

The elevated readings are probably related to the infection. As the antibiotics help clear it, you will probably start to see the readings also lower.

 

[Laura and Sam]

If he's still eating and drinking well, I don't see a reason to hospitalize Sam. Overnight wouldn't be enough to regulate him in any case, and the numbers would be inflated from the stress anyway. Much better to adjust the dose based on your home BG numbers!

That said, I'm worried about a couple things. One, please don't change the food all at once. For some cats, that change causes insulin needs and BG to plummet, sometimes to an unsafe level. Sam's on a reasonably high dose of a hard-hitting insulin, so for safety's sake you want to go slow on a food transition, monitoring BG the whole time.

Second thing you already mentioned, I would definitely go ahead and get the ketostix to start testing for ketones. Hopefully Sam isn't ketone-prone, but right now he's got a major risk factor with the infection, and if he is ketone-prone it wouldn't take much more (a skipped shot, a few skipped meals) to push him over.

Now that you're home testing, you want to make sure to test (at least) before every shot, to make sure it's safe. It's a good idea to get at least one more test between shots, too, to get an idea of how low a given dose is taking him. For Caninsulin, we want to find a dose that takes him into the blue numbers, but not below that (for safety). Other insulins, such as Lantus or Levemir, have a somewhat gentler action. Would your vet be willing to consider changing insulins?

I'll let others weigh in with more, but let me finish by saying Welcome!!!!

Thanks Nan! He is definitely still eating and drinking well - no coaxing required to get this guy to eat 100% understand about not changing food all at once - I figure first step will be eliminating the dry food, then work on switching over his wet food. With changing the food I'll be testing very regularly to watch what happens with it.

Picked up the ketostix today, along with a human BG meter - planning to calibrate the new one against the last few tests using the old one. Hard to believe the cost difference!

And for sure I'll be talking to my vet about the choice of insulin.

 

[Laura and Sam]

I’m curious about the skin issues. Can you describe a bit more — symptoms, etc?

Bald spots and dry, flaky skin are the usual features, mostly around the shoulders/throat/back and top of head. They are now running in distinctive bands. He also has brown scabby looking spots on upper parts of his ears - this developed during the past week. Earlier this year I was using a wet food with a lot of fish and it got worse, so I figured fish may be something that irritates his system and started avoiding it as an ingredient in what he's eating.

 

[Ale & Bobo & Minnie (GA)]

The elevated readings are probably related to the infection. As the antibiotics help clear it, you will probably start to see the readings also lower.

that makes total sense thanks!

 

[Laura and Sam]

Issues like a low carbohydrate food (no kibble, especially for a kitty with bladder infections!) are key to getting your cat in better numbers. You want to select foods that are under 10% carb and most folks here feed about half that percent of carbs. As Nan suggested, a gradual transition will help to avoid numbers plummeting and a tummy upset due to a food switch. FWIW, DM is really made of poor ingredients. For what you're spending on that food, you could be feeing your cat a top of the line, human grade cat food. Adding water to. your cat's canned food will also help with the bladder infection.

Please have a discussion with your vet about the insulin choice. Caninsulin was developed for dogs. Cats have a faster metabolism. Caninsulin (it's called Vetsulin in the US) is not an appropriate insulin for a cat. In fact, the American Animal Hospital Assn does not recommend its use for treating feline diabetes. They recommend either Prozinc or Lantus. This is a link to the 2018 guidelines if you want to share it with your vet.

Please also keep an eye on your cat's numbers. the antibiotic may drop them. Did your vet happen to get a sterile urine sample (i.e., by inserting a needle into the bladder) and then do a culture and sensitivity? It's the only way to be certain your cat is getting the proper antibiotic to address the infection. You should be seeing some improvement after a week. Bladder infections (vs a UTI) can take longer to treat, though.

Thanks for the link to the guidelines, really appreciate it! I'm definitely watching those numbers closely while he's on the anti-biotics; thanks for the guidance about seeing improvement after a week, I was getting worried with not seeing much action but it's just been a week today; I still have a week left in his scrip. The vet did do a sample with culture etc. to confirm the infection.

 

[Laura and Sam]

I agree with everything Nan said and I’d ask about switching to Lantus or prozync. vetsulin or caninsulin was developed for canines, hence the name, and not all cats do well on it.

I’m also wondering if the steroids and bladder infection are not keeping the numbers high for now

great job on home testing and setting up your ss! Can you do us a favor and also set up your signature? It’s easier to see your cat’s medical history that way instead did having to go up to the beginning of the thread or asking you over and over again. Here are instructions for that:

http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Thanks for the tip on the signature - added a little more info in there

 

[Liang & Nathan]

Bald spots and dry, flaky skin are the usual features, mostly around the shoulders/throat/back and top of head. They are now running in distinctive bands. He also has brown scabby looking spots on upper parts of his ears - this developed during the past week. Earlier this year I was using a wet food with a lot of fish and it got worse, so I figured fish may be something that irritates his system and started avoiding it as an ingredient in what he's eating.

Google "feline eosinophilic granuloma complex (EGC)" and see if your cat has the symptoms.

Nathan had feline eosinophilic granuloma complex 9-10 years ago and was on steriods and antibiotics. But once the medicines stopped, the symptoms came back. Finally we used Erythromycin Ointment to treat him and symptoms were gone.

 

[Laura and Sam]

Took a look at that - doesn't quite fit (there isn't the redness or lesions quite like in the photos) but I appreciate the suggestion!

 

[Laura and Sam]

Further update this evening... Had a chance to test ketones and all is still good on that front. One bit of good news to be grateful for!

 

[Sienne and Gabby (GA)]

Good news about no ketones!!

If this is a kidney infection, it can take much longer to treat. With a UTI, usually a 2-week course of antibiotics if a culture and sensitivity has been done is fine. (Sometimes the bacteria can be stubborn.) With a kidney infection, sometimes it can take as long a 6 weeks and some cats need antibiotic support for life. It sounds like your vet is on top of things but you'll want to get a urinalysis at 1, 3, and 6 months to make sure the antibiotic has knocked out the infection.

 

[Lisa and Witn (GA)]

Good news about no ketones!!

If this is a kidney infection, it can take much longer to treat. With a UTI, usually a 2-week course of antibiotics if a culture and sensitivity has been done is fine. (Sometimes the bacteria can be stubborn.) With a kidney infection, sometimes it can take as long a 6 weeks and some cats need antibiotic support for life. It sounds like your vet is on top of things but you'll want to get a urinalysis at 1, 3, and 6 months to make sure the antibiotic has knocked out the infection.

I agree.