? Question about insulin dosing 2/1

NadineTheodore

NadineTheodore

Active Member
Hello all,

I went to the specialist yesterday, I am still waiting on results and she did an ultrasound to review further...She advised kidneys were on larger size upon physical exam but would require ultrasound to understand better. If they are enlarged (larger then previous time) she suggested aspirating them mentioning worst case scenario renal lymphoma. To be honest---I am completely against this as my husband was also biopsied and it came back inconclusive twice and it does hurt A LOT. The reality is, if it is lymphoma, I am not sure what I can do? However, doesn't diabetes also cause kidney size to inflate???? I am OKAY with testing but at the same time I don't think it's fair to poke and probe Theodore. He doesn't understand and the travel is always very stressful on him.

She did mention Theodore's anemia is more likely due to his various issues (diabetes, megacolon, FIV, etc). His flora was likely thrown off before dental surgery which caused all these megacolon issues to start for us.

Now most importantly regarding the diabetes, she did say she wanted to try putting us on short and long lasting insulin. Has anyone tried that? Essentially this would mean two shots instead of one. Given Theodore's personality, it's easily to administer since he's a total sweet heart.

Previous post:

https://felinediabetes.com/FDMB/threads/theodore-bouncing-pms-653.286048/#post-3147297

@tiffmaxee @Wendy&Neko
 
I haven't heard of type 2 diabetes causing growth of kidneys. Organmegaly (organ growth) is a side effect of acromegaly, which can also cause diabetes. Given his numbers and size of dose, I'd be more inclined to test his IGF-1 (acro test) than poke his kidneys again.

There are a small handful of us who have used two types of insulins. It would be the L (Lantus or Levemir) and R (Regular) insulin. It's an advanced technique that we suggest for kitties with ketone issues/recent DKA and those with secondary conditions requiring higher doses. It need extra monitoring, and the help of someone experienced with R to help you closely. There is a lot to learn about using R, and more importantly, to learn about when not to use it.

Why the reduction to 4.5 units last night?
NadineTheodore said:
His flora was likely thrown off before dental surgery
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Is he on regular probiotics? If so, which one.
 
Wendy&Neko said:
I haven't heard of type 2 diabetes causing growth of kidneys. Organmegaly (organ growth) is a side effect of acromegaly, which can also cause diabetes. Given his numbers and size of dose, I'd be more inclined to test his IGF-1 (acro test) than poke his kidneys again.

There are a small handful of us who have used two types of insulins. It would be the L (Lantus or Levemir) and R (Regular) insulin. It's an advanced technique that we suggest for kitties with ketone issues/recent DKA and those with secondary conditions requiring higher doses. It need extra monitoring, and the help of someone experienced with R to help you closely. There is a lot to learn about using R, and more importantly, to learn about when not to use it.

Why the reduction to 4.5 units last night?

Is he on regular probiotics? If so, which one.
Click to expand...
@Wendy&Neko He's on forti flora :)

Reduction was just because I think it was filled with air bubbles and I was having a hard time getting rid of it even though I flicked. I don't want to over fill.


Apologies had a long day but finally got a doctor to call me regarding his results and actually his kidneys remain pretty much same size as his previous stay with the hospital back in June 2023! Hooray that's positive?

June 2023:
Left 4.4cm - mild pyelectasia (.3cm)
Right:5.4CM - mild pyelectasia (.22cm)

Now:
Left: 4.45cm in length - no pyelectasia
Right: 5.19cm in length with mild pyelectasia (0.2cm)

Report really showed no changed except spleen which was mildly enlarged and course but that could mean various things.

Just to clarify Theodore did not get aspirated, I was referring to my husband previously as I know it hurts from his experience that he shared. I have no plans to do this to Theodore. They did take blood to consider testing him for acro. Now they are suggesting it. The other thing they are saying is they think he might be going hypo at night and putting a Libra on him would be really helpful.

LINK FOR HIS RECENT VISIT
https://drive.google.com/file/d/1dfuhdFqJdLLMqzY1RhcQBebvj6oeKNp6/view?usp=sharing

Also worth noting B12 didn't seem to change RBC values however they stated the Reticulocytes improved, I don't understand as the name on my previous blood work looks different then here along with normal values. She did say he is creating lots of new baby RBCs....

This is all very confusing but it looks like I will try and get us a Libre...again....and a cat onesie perhaps to try and keep him from throwing it off :) on Monday there Internalist will call and ask regarding proceeding with acro test which blood was already drawn for.
 
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NadineTheodore said:
He's on forti flora
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No, I meant is he on a real probiotic? Forti flora is only on strain and not enough, it is good as a flavour enhancer though. I give Visbiome to my kitty, but some of the Renew Ultimates are good too. Cats need multiple strains of probiotics and lots of them.

Where you have +3 tests at night, it's enough data to say he's not going low at night.

You want more than just the B12 to help his anemia (HCT value). More information here: https://www.felinecrf.org/vitamin_b.htm#which_types
Baby reticulocytes means regenerative anemia, a good thing. The question now is why is it down?
 
@Wendy&Neko She felt it was a result of one of his other issues (FIV, more likely uncontrolled diabetes.)

I agree regarding the no hypo at night. I've tested him before at 5am with no issues. I will look into Visbiome! That link also is great! Thank you. I think it will be worth while rechecking blood values in a month or 6 weeks to see where he's at along with acro test. Just not sure what my options will be if he does in fact test positive.
 
Uncontrolled diabetes does not cause anemia.

A lot of people have been using cabergoline (compounded liquid medication) with good results. We've had a few have cats go OTJ, but more important lower dose and fewer symptoms, better quality of life.
 
Ah! Yes i believe they will call me Monday to confirm if they are to send it his blood for acro testing. The specialists are gone weekends . We were just waiting to see what ultrasound said first. I assume labs closed weekends anyway so best to send out Monday anyway since it’s on ice to Michigan?
 
NadineTheodore said:
what does OTJ stand for?
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Off the juice (juice=insulin)

Re: low iron
My husband used to have great iron levels, but after Oct 21, when we had the twenty20 ailment, my fasting glucose became elevated and my husband's hemoglobin started decreasing about five months later, May 22. IDK, but Leo was diagnosed diabetic, Dec 21. Again, IDK.
I know it's known about glucose increasing after covid for some people. I have found studies about the iron issue in long covid. Is this my husband's issue? IDK, but it seems weird. Trying to get to the bottom of all this for him with gastroenterologist & hematologist, but it's taking so long!

I hope you can get answers soon without painful diagnostics for Theodore. It seems there is a lot of knowledge and experience here that can help guide you to guide the veterinarian(s).
 
Another example on low iron (Theodore's problem is low hematocrit), a friend had suddenly low iron about a decade ago. Turned out it was cause by a new onset gluten allergy. Go figure, took over a year to figure it out.

The blood for acro testing has to arrive at MSU by Tuesday cause they start the test on Wednesday. Otherwise they hold onto it for a testing the following week. I timed mine badly, got to wait an extra week for results.
 
Wendy&Neko said:
Another example on low iron (Theodore's problem is low hematocrit), a friend had suddenly low iron about a decade ago. Turned out it was cause by a new onset gluten allergy. Go figure, took over a year to figure it out.

The blood for acro testing has to arrive at MSU by Tuesday cause they start the test on Wednesday. Otherwise they hold onto it for a testing the following week. I timed mine badly, got to wait an extra week for results.
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@Wendy&Neko Thank you! I will let them know I want it shipped out so it's there by Tuesday the latest.

Theodore's family vet also brought up a great point, I didn't get any light on why his protein to creatinine ratio is so high, any thoughts given we have the ultrasound results and anything else I should ask for? This is very overwhelming, he's lucky he's so cute:cat:

Oh---Forgot to ask. Vet asked me why I am giving my cat fancy feast pate, I thought it was diabetic friendly? Is it not? I always read Fancy Feast pate is fine for cats and I do give it because he will eat it. I tried tiki but they were a little finicky. Open to suggestions
 
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FF pate is low carb.
Thr quality of ingredients are not the best, though, plus phosphorus is on the higher side. I'm finally using my sample of EZ Complete today, so hoping both of our kitties like it. I expect they will as I know they love fresh chicken! I'll feel better about the quality of their food. We'll see!

ETA: our kitties never liked Tiki or Weruva.
 
Proteinuria can be an early sign of kidney disease. There are actually several reasons for proteinuria, which is why more diagnosis is needed so proper treatment can be done. Neko had proteinuria because of her kidneys, and that change could have been because of the acromegaly. Proteinuria is not uncommon in acros. I think I asked about his blood pressure when we talked about this before. It's also linked to one of the reasons for proteinuria.

There are lots of diabetic friendly options that are not Fancy Feast. This list here has foods that are kidney and diabetes friendly, it's the CKD Diabetes list.
 
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