Bexacat - First day

[acaro7]

Hi everyone,

My first post here.

Last week I took my lovely 5 year old babyboy Carlos to the vet, as I had noticed he's been getting skinny in the past few months.

First time he gets a blood exam and it turns out he's diabetic.

It was a shock to me, but then a lot of the symptoms make sense now that I've spent more than a week only thinking about this and researching as much as I can.

The doctor I took him to prescribed him with Senvelgo, but I was skeptical of it, since it came out a couple of months ago and there's no reviews on it.

I had bad luck with this doc, as I could not get much info about anything.

I did research on my own and questioned Senvelgo to the doc, and it seemed he didn't know much about it and I just didn't feel comfortable with him, as everything was rushed and I did not get much explanation about everything.

So I looked for another doctor and found one who is fantastic.
Felt comfortable with her and she knew what she was talking about.

She prescribed Carlos with Bexacat and I feel more comfortable as I've heard good reviews of it.

Anyways, I'm starting treatment today, Day 1, and would really appreciate ANY tips, info, recs, or anything really from fellow owners that have gone through this and more specifically, Bexacat.

I'm attaching Carlos's exam results and a lovely pic of him.


Thank you all!

 

[Red & Rover (GA)]

Tagging @Hercules And @Sienne and Gabby (GA)

 

[Diane Tyler's Mom GA]

Tagging Suzanne to take a look at Carlos's Labs
@Suzanne & Darcy

 

[Diane Tyler's Mom GA]

You can check out this post about Bexacat,

https://felinediabetes.com/FDMB/threads/bexacat-anyone-have-kitties-on-this-med.282118/#post-3110486
This is her initial post regarding her cat. There's a search bar at the top right side on this page, if you search "bexacact" you'll find several other posts. You will see the word Bexacat highlighted in blue ,so go through any posts you see with Bexacat highlighted in blue

 

[Diane Tyler's Mom GA]

Tagging @Sue and Luci

 

[Bron and Sheba (GA)]

@acaro7
It looks as if your kitty has several issues going on which I will let @Suzanne & Darcy comment on, but I can see Carlos has ketones in the urine.
I would get back to the vet asap about this and ask about starting Carlos on insulin straight away because ketones in the urine can lead to the much more serious and deadly Diabetic ketoacidosis (DKA) if ketones are not addressed immediately.
I would also get him to eat as much food as you can get him to eat and encourage fluids as well. With ketones the treatment is insulin, food and fluids. Don't let your vet fob you off and say it will be fine because ketones in the urine can rapidly lead to DKA which is very expensive to treat and a very serious illness.

 

[Larry and Kitties]

What did the vet say about the low hematocrit and RBC and red blood cells in the urine. The high reticulocyte count tends to indicate the body is responding to the low RBC by making more RBCs.

Both Senvelgo and Bexacat are sodium-glucose cotransporter-2 (SGLT2) inhibitors and are from corresponding human diabetes drugs. They work to reduce blood glucose by preventing the reabsorption of glucose via the SGLT2 cotransporter in the proximal tubule of the kidney. Normalization of blood glucose reduces glucose toxicity and peripheral insulin resistance in cats with residual endogenous insulin production.

One possible advantage of Senvelgo is that the dose can easily be adjusted since it is a liquid. The SENVELGO dose is 0.45 mg/lb of body weight (1 mg/kg), once daily regardless of blood glucose level. The dose may be administered directly into the mouth or with a small amount of wet food.

 

[acaro7]

URGENT!

I’m at the ER right now.

Carlos got weaker and lost appetite and visibly seems like he doesn’t feel good.

I’m attaching exams from today.

I’m at the ER and they’re giving me an estimate of about 7K-8K to hospitalize for 1 to 2 days.

If I can’t afford this please any suggestions on alternate immediate treatments would be a blessing.

Is there any other options to stabilize him?

I have a hard time believing what this doc says.

 

[acaro7]

 

[plumsteal]

(Not an experienced member, but hoping to provide information that will help.)

DKA (which is what your receipt suggests is the diagnosis) is an emergency. It can’t be treated at home. It’s the illness Bron mentioned a few comments above yours. Here is some additional reading about DKA.

I’m not sure why your vet prescribed Bexacat when poor Carlos was already positive for ketones. Bexacat increases the risk of DKA.

 

[Sienne and Gabby (GA)]

Treatment of DKA is a legit emergency. It can be a life threatening condition although there are many cats who have recovered, mine included.

Often a vet hospital will give you an over estimate of cost, or at least that's been my experience. A cat really does need 24/7 monitoring with DKA and they are generally running frequent blood tests to deterimine if lab values are returning to normal. Your cat will also need to be on IVs.

You may need to look into Care Credit to help with the costs.

 

[Wendy&Neko]

Unfortunately, risk of DKA is increased in cats on Bexacat. He'll need to start insulin ASAP. More details in the FDA note on Bexacat.

 

[Bron and Sheba (GA)]

I'm very sorry to hear Carlos is unwell but I'm very glad you went to the ER.
As the others have said he will need IV therapy and insulin started straight away. And the electrolytes need attention as well as I can see the potassium is low....Although it is very hard to read the results from today.
The DKA has been caught early so hopefully he will make a full recovery.
Please keep us posted.
Once he gets home we can help you with things moving forward.

 

[manxcat419]

The ER vet is telling you the truth. The person to be annoyed with is the vet who did the original blood work. Carlos had a high anion gap (acidosis) plus urine ketones on that blood work - so he was already either in DKA or very close to it. None of the oral treatments should ever have been recommended. The really surprising thing is that he's battled on for over a week with those issues before becoming obviously sick.

 

[acaro7]

Thanks for all replies, I’m really upset with vets and disappointed how they can prescribe the oral medication despite the warning and me triple checking with them.

I’m at the ER now, he’s been here overnight w fluids and all, but no insulin yet because his glucose levels are normal, my guess is the bexacat.

They will probably recommend to leave him for a day more or so, but the bills are excruciatingly expensive.

My goal is to take him home today and continue to take care of him at home.

He’s got a freestyle monitor on him, so that can help for home monitoring.

Any tips or advice?

 

[manxcat419]

I’m at the ER now, he’s been here overnight w fluids and all, but no insulin yet because his glucose levels are normal, my guess is the bexacat.

That's definitely the Bexacat - it's a known risk with this type of medication and isn't meant to be used in cats that are showing signs of DKA on diagnosis. Can they not give insulin and fluids with dextrose at the same time to bring the ketones down?

My goal is to take him home today and continue to take care of him at home.

I know ER care is horribly expensive, but I really don't think it's a good idea to bring him home while he still has ketones. Especially with the Bexacat in the mix (and it's new enough that we don't quite know yet how it will affect the progress of a DKA), I would have them treat until they're sure the DKA is over. Later on, once he's doing OK and is home I would be going right back to that first vet and asking them to cover at least part of the ER bill. They messed up by prescribing him something that was contraindicated for his individual case. That's why he's in the ER now. Obviously get him better and home before taking on another battle, but I would not let them just walk away from that mistake.

 

[Diane Tyler's Mom GA]

I agree with @manxcat419 about going back to the first vet and ask them to cover at least half of the ER bill

 

[Angus13]

I'm just catching up on the board, and am so sorry to see your troubles with your cat. My 13 year old male has been on Bexacat since April of this year and has done well, but it is definitely not for every diabetic cat. Your original vet really screwed up, and it's awful that your cat and your finances are paying the price! I hope that things are getting better for Carlos by now.