? Dosing HELP please: Lola 11/18 AMPS 108

Jade_Leah

Jade_Leah

Member
After a weekend of very high readings, Lola's BG was at 108 AMPS. I spoke to her vet who advised to still do the injection but to drop down to 3 units from the 5 he had me bump her up to on Saturday. This felt wrong but I didn't know what else to do so I gave her the 3 units. Then the office of her specialist called back after I'd emailed them over the weekend and basically told me not to do any spot checks in between dosage adjustments (he had told us to take her from 4 to 4.5 units and then do another BG curve in 10-14 days). I feel like I am being led astray as two different vets are telling me two different things and I just want to help my girl be well. I have attached the spreadsheet I've been working on.



https://docs.google.com/spreadsheet...XPawFDQ2OQFHdUlCOn5w6qwIMBY/edit?usp=drivesdk
 
Please test her starting at +2 or even earlier since she was so low.

You need to start getting a few night time tests as we are only getting half the picture. Reading into the spreadsheet, I believe she was bouncing and started breaking the bounce last night in the p.m. cycle and that is why she was so low this morning. She may bounce again today and go very high. We do not like bouncing, but at least it will protect her from dropping too low. In the meantime, your job is to test her frequently and make sure that she isn’t dropping too low.
 
Suzanne & Darcy said:
Please don’t listen to anyone who tells you not to test her blood glucose. Please test her today as much as possible. Do you have high carb food on hand if needed — and honey or Karo (corn syrup) to raise BG?
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Hello! Thank you so much for your response and willingness to help. I was appalled that the specialist I was set up with to get Lola's diabetes/CKD/pancreatitus figured out would be against frequent testing. It also sounds like he would've told me to give her the full 4.5-5 unit dose this morning even after the 108 reading. This is so deeply upsetting and discouraging to me.

I am going to test her every 2 hrs today. We see her regular vet at 1:30 as I want another blood panel after her numbers were so high over the weekend (want to check her kidneys) and I planned on getting her sub q fluids for good measure. Do you think there's any harm in doing the sub q? I'm getting ready to test her now and will comment again once I do.

I have high carb food and dextrose if needed.
 
Since we don’t know what happened last night, she actually could have been lower than the 108 you saw this morning. See how she was trending down at +9 and +11? After that she probably kept trending downward all the way to AMPS (or lower and then came up at AMPS and now is in the pink and will most likely go back into black.)


Are you testing for ketones at home? It would be good to start— and we can talk more about that later. But do you have the vet test for Ketones either in the urine or the blood whichever way they prefer. We don’t want her to go into DKA.
 
Aside from checking her BG often and trying to find a new specialist (her regular vet is fine but her case requires someone with more experience in my opinion) what shoukd I do for her today? Should I continue giving her the same dose of insulin (she was on 5 units since Saturday) at 9pm even if her BG is low? I read about how bouncing works but I'm not entirely sure I understand what it means for her and her dosage. I've been deep diving on the forum the try to learn as much as possible but I fear I'm failing her. What would've been the better thing to do when her AMPS was 108 vs giving her 4 units as her regular vet suggested?

Edit: I ordered ketone strips and they should arrive soon! I also ordered a relion meter as the alphatrak 3 strips are so costly
 
Do you have copies of her labs that I can see? If not, ask the vet for them today. She was not hospitalized for DKA was she? What are you feeding her? You should be feeding her a low phosphorus food because of the chronic kidney disease. It does not necessarily need to be one of the prescription renal foods, but it should be low in phosphorus. Depending upon how bad her kidney values are.
 
Jade_Leah said:
Aside from checking her BG often and trying to find a new specialist (her regular vet is fine but her case requires someone with more experience in my opinion) what shoukd I do for her today? Should I continue giving her the same dose of insulin (she was on 5 units since Saturday) at 9pm even if her BG is low? I read about how bouncing works but I'm not entirely sure I understand what it means for her and her dosage. I've been deep diving on the forum the try to learn as much as possible but I fear I'm failing her. What would've been the better thing to do when her AMPS was 108 vs giving her 4 units as her regular vet suggested?

Edit: I ordered ketone strips and they should arrive soon! I also ordered a relion meter as the alphatrak 3 strips are so costly
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That’s perfect about the ketone strips excellent. Let’s talk more about the bouncing and everything else this afternoon, OK?
 
If Lola were my cat, I would not go back up to five units at all right now. Let’s talk about her dose this afternoon as well. We don’t have enough data on her yet to be doing a five unit dose. Especially when she could have dropped quite low last night. I would not exceed three units for her and even that may be too much when she’s not bouncing, but we don’t really know yet. She was started at a very high dose that we would not recommend doing here with a newly diagnosed diabetic cat Especially if ketones are not present.
 
Anyway, I would like to talk with you this afternoon some more and I have to run now or I’m going to be late for my appointment but I will be talking to you later. OK? if you have any other questions just post them here and I’ll be able to pop in and hopefully answer them but as far as talking to you at length this afternoon is what I would like to do.
 
Suzanne & Darcy said:
If Lola were my cat, I would not go back up to five units at all right now. Let’s talk about her dose this afternoon as well. We don’t have enough data on her yet to be doing a five unit dose. Especially when she could have dropped quite low last night. I would not exceed three units for her and even that may be too much when she’s not bouncing, but we don’t really know yet. She was started at a very high dose that we would not recommend doing here with a newly diagnosed diabetic cat Especially if ketones are not present.
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Story time.

We actually started Lola out at 1 unit and followed up with a weekly nadir check and if the number was still high we increased a unit. It went on like this until we were up to 6 units and at that point I requested a full blood panel. That is when her poor kidney values were discovered. Her creatinine was at 4 and it was suggested that I get her to the ER for an ultrasound and intravenous fluids. She ended up being there for 3 days and while on fluids her BG was regulated for the first time ever. They had one instance where she dropped below 100 BG and they considered her hypoglycemic and therefore gave her dextrose and cut her insulin down to 3 units. She was on 3 units for a couple of days, which is when I finally got the hang of home testing (which I had been told was really hard to do and not to bother) and saw her numbers were high and reported that to my regular vet. He had me increase to 3.5 units and did another blood panel. Her values were slightly higher than they were when she was on IV fluids but nothing terrible. The 3.5 wasn't doing the trick over the next week. We then saw the specialist a week later who advised that we should increase to 4 units and switched her to Hills kidney food (or whatever she will actually eat) and kept her on the aluminum hydroxide and requested I do am at home BG curve, which I did. Based on the results the specialist advised to increase her dose to 4.5 units as of last Wednesday. Thursday was when her BG really began amping up and I was corresponding with my regular vet via email all weekend. He had me do another BG curve on Saturday and after that is when he told me to increase to 5 units.

I'm sorry for the wall of text, but wanted to explain fully what's been happening and just got a break from work long enough to be able to type it all out.

I hope you make it to your appointment on time! Thanks again! I look forward to talk to you.

Editing to answer your other questions:

Lola was not hospitalized for DKA. It was for her elevated kidney values. While there she was diagnosed with CKD and (asymptomatic) pancreatitus.

Labs: I'm not sure how to attach labs but when I have time I can input what I have into the spreadsheet unless there is an easier way to show you

Food: She is currently eating a combination of Hills kidney dry food (trying to transition to wet but she is very keen on crunch) and whatever wet food she will eat. I'm offering her: Weruva BFF play pates that were listed as low phosphorus on another thread here, Sheba pate, Hills wet kidney food.
 
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Doing a curve on a day, for example, when the cat is bouncing and in all high numbers for the whole curve will not be useful information for adjusting the dose because it will appear that the cat is not responding to the dose of insulin and is staying completely high perhaps even with no discernible nadir at all. Bounces can last for up to six cycles – – so three days – – although not every cat will stay high in bounce for that long of a period of time. Some do.
 
So does this make sense? Conceivably, you could run a curve or get a whole bunch of tests both day and night for up to six days in a row and see that the cat is just in, say, red and black without going down much at all, and then you are deceived into thinking that the cat needs more insulin, but then the cat breaks the bounce and the number start dropping down… and they could drop too low, if the insulin dose has been increased and increased because of the high numbers recorded during the bounce.
 
Also, tell me which renal foods you are feeding and I will find the carbs for you OK? We just need to know we may need to adjust insulin accordingly of course if the renal foods are required. I had to feed those to my own diabetic cat at one point as well. Although if you are using the renal foods, you probably will not need the aluminum hydroxide powder, although I would like to know what her phosphorus levels have been before categorically stating that. If they were very high, you would probably see facts in her walking hind leg weakness, not being able to jump up on things, etc. I hope this is coming out OK because I keep thinking about you and I’m text talking, which is something I almost never do because I don’t like it
 
Finally, and I’ll leave you alone for a while and let you have time to process… and also get to your vet appointment… I just wanted to say welcome to our forum, and I am so glad that you found us – – although I am very sorry that you’ve been having these difficulties with your dear sweetie, Lola. I sometimes get this backwards because my brain kicks into gear and I am so focused on trying to help that I first forget to say welcome! So welcome to the FDMB. I am very impressed with how you have gone ahead and taught yourself how to do the BG testing, and that you have been reading and educating yourself on all of this and that you set up your spreadsheet and all the rest you are off to a really good start.
 
Suzanne & Darcy said:
Also, tell me which renal foods you are feeding and I will find the carbs for you OK? We just need to know we may need to adjust insulin accordingly of course if the renal foods are required. I had to feed those to my own diabetic cat at one point as well. Although if you are using the renal foods, you probably will not need the aluminum hydroxide powder, although I would like to know what her phosphorus levels have been before categorically stating that. If they were very high, you would probably see facts in her walking hind leg weakness, not being able to jump up on things, etc. I hope this is coming out OK because I keep thinking about you and I’m text talking, which is something I almost never do because I don’t like it
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Everything that you're saying makes sense 100% and is more helpful and useful than $6k worth of vets have provided. I can NOT for the life of me figure out what the heck is going on with her and how to fix it, so your input is invaluable!
 
Well FWIW, Lola appears to be anemic (low red blood cells/hemoglobin-Hgb, hematocrit -Hct). In the species I treat, and I BELIEVE in cats, low hgb throws off the glucometer readings. They will read higher than the level truly is (the AT3 lets you set a warning for this but is set as OFF in default).
This could result in numbers reading higher on the meter than they actually are, resulting in higher doses of insulin than needed, and leading to hypoglycemia.

I can explain how to turn the “low hgb/hct” icon on but since these labs are fairly recent I suspect she is still anemic…I hope they checked for that at your vet appointment

edit: anemia can also affect HcbA1c test results in humans making that value higher than it actually is …this is a test for long term glucose control. I don’t know if it can affect fructosamine (the analogous test for cats). The vet may know or they may need to ask the lab
 
I forgot to mention the anemia because it's always mentioned as an aside and something they think could be caused by the unregulated BG and/or the CKD/pancreatitus. The vets are watching HGB and the specialist had mentioned that if by the time she gets her next labs with them (11/25) she is still anemic, there is a medication we can try. I, myself, how no clue how to go about fixing the anemia.
 
Jade_Leah said:
I forgot to mention the anemia because it's always mentioned as an aside and something they think could be caused by the unregulated BG and/or the CKD/pancreatitus. The vets are watching HGB and the specialist had mentioned that if by the time she gets her next labs with them (11/25) she is still anemic, there is a medication we can try. I, myself, how no clue how to go about fixing the anemia.
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Chronic illness can make humans anemic —I leave it to the vets to figure a solution but I mention it to you because your meter is not accurate if she’s anemic. It will give a higher number than she really is. if they use a meter in the ER or your vets office it will also read inaccurately. The lab test itself should be reliable but meters are inaccurate for anemic cats. So if the increases were based off meter readings they perhaps shouldn’t have happened (I’m not a vet)
 
To set up the Hct alert on AT3: hold the C button until it turns on. The first choice is if you want Bluetooth (bt) auto on. Use M button to select. Next will be Glu High alert. Use C button to toggle on or off and M to select. Next is Glu Low alert. Last will be Hct alert. Toggle C button to select On and M button to set. Then turn off meter. If Lola is anemic along with the glucose number you will see an Hct icon this tells you that her actual number is probably lower than the result you see
 
Has she been put on an antibiotic? It looks like she has/had an infection with increasing and elevated white count, neutrophils and globulins.
 
Suzanne & Darcy said:
Has she been put on an antibiotic? It looks like she has/had an infection with increasing and elevated white count, neutrophils and globulins.
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With the specfPL (I forget their lab name for it) high it looks like pancreatitis was in the mix. I wonder how much that affected her initial glucose and how much anemia is now affecting her meter readings
 
She was given antibiotics at the hospital but not since. They don't seem to think there is an infection. I know that they have tested her urine and done cultures multiple times now and aside from one event with a UTI in August, they have come back clear. I'm asking that if we see an increase in white count, neutrophils and globulins yet again that we regroup and consider putting her on a broad spectrum antibiotic just in case that's what we're dealing with. I'm not sure if that's the right thing to do or not. My vet seems baffled by her case.
 
SmallestSparrow said:
To set up the Hct alert on AT3: hold the C button until it turns on. The first choice is if you want Bluetooth (bt) auto on. Use M button to select. Next will be Glu High alert. Use C button to toggle on or off and M to select. Next is Glu Low alert. Last will be Hct alert. Toggle C button to select On and M button to set. Then turn off meter. If Lola is anemic along with the glucose number you will see an Hct icon this tells you that her actual number is probably lower than the result you see
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If she is anemic and the anemia generates falsely high readings, how exactly do you or your vet or anyone else figure out the correct dosage of insulin?
 
I see her anemia is kind of borderline where most vets are considering treatment. Have they spoken with you about ESA treatment like Darbepoetin? If Lola were my cat, I would start her on B-Complex vitamins as soon as possible. You can take a good B-Complex vitamin like Jarrow B-Right and split it into tenths and put it into small gelatin capsules (size 4 works - you can go even smaller with a size 5, but hon it’s hard enough to get the powder into a size 4. It doesn’t fill the size 4 capsule so there’s still some room to put in other medication, if needed. The B-Complex vitamins can help raise the HCT a bit and keep it from dropping lower. If it’s not enough then you can start the ESA treatment if the HCT continues to drop.
 
Jade_Leah said:
She was given antibiotics at the hospital but not since. They don't seem to think there is an infection. I know that they have tested her urine and done cultures multiple times now and aside from one event with a UTI in August, they have come back clear. I'm asking that if we see an increase in white count, neutrophils and globulins yet again that we regroup and consider putting her on a broad spectrum antibiotic just in case that's what we're dealing with. I'm not sure if that's the right thing to do or not. My vet seems baffled by her case.
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I think that is a wise idea on your part because, with a diabetic cat in high numbers, you do not want to risk a DKA brought on by an infection. How os her appetite and energy level? No fever? How many days was she hospitalized?

More later…
 
Jade_Leah said:
If she is anemic and the anemia generates falsely high readings, how exactly do you or your vet or anyone else figure out the correct dosage of insulin?
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The actual lab test (not meter) will be accurate. I’d ask the vet how to interpret meter readings although I don’t think there’s a reliable way. You won’t like what I’m about to say but there is the old fashioned method: decades ago, before we had meters, a starting dose was calculated and used rather blindly. I was told “give this twice a day, check his urine for sugar and ketones” and off I went, pee sticks and insulin in hand, until his next vet visit.
I don’t consider this ideal. I’m just saying a lot of caution should be used in meter readings in an anemic cat. Perhaps someone here has had a cat in that category, or the specialist or general vet has treated one.
In humans we correct the anemia
 
Suzanne & Darcy said:
I see her anemia is kind of borderline where most vets are considering treatment. Have they spoken with you about ESA treatment like Darbepoetin? If Lola were my cat, I would start her on B-Complex vitamins as soon as possible. You can take a good B-Complex vitamin like Jarrow B-Right and split it into tenths and put it into small gelatin capsules (size 4 works - you can go even smaller with a size 5, but hon it’s hard enough to get the powder into a size 4. It doesn’t fill the size 4 capsule so there’s still some room to put in other medication, if needed. The B-Complex vitamins can help raise the HCT a bit and keep it from dropping lower. If it’s not enough then you can start the ESA treatment if the HCT continues to drop.
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When they did her ultrasound it revealed enlarged kidneys and the pancreas showed signs of either past or current pancreatitus. They saw no sign of cancer or anything else.

I don't remember what he called it, but ESA treatment sounds like what the specialist was talking to me about trying if the numbers indicating anemia are persistent. I will look into thr B vitamin complex you mentioned. I feel like I'm becoming a google scientist with all of my tricks and tools

Lola's appetite is good but she has never been a particularly active gal, so it's harder to say with energy levels. She seems brighter and more chirpy than she was pre-hospitalization. No fever! She is back to enjoying laying in front of the open front door and trying to beat up the dog (she hates his guts). She was in the hospital 4 days and 3 nights.

At our 1:30 vet visit they did a blood panel, sub q fluids & checked her BG which was at 411. He fully supports me switching to a human meter and is interested in what information I gather here, which is honestly refreshing. I'm glad he wants to learn as much as he can and figure out my weirdo baby cat.

He didn't seem super concerned about anemia impacting her BG readings, but then again he just might not have the experience.
 
Looking at human articles there have been some attempts at mathematical corrections to meter readings for use in the ICU. This won’t help bc cat blood doesn’t equal human blood. I did find this (below) but a bunch of caveats: it was a very tiny number of test subjects and they were dogs—done by a vet in her clinic and from that she came up with a formula. IMHO this isn’t super reliable but I give it to you in case you want to look at it and discuss with your vet. In the meantime I’d say meter readings show you a trend but I would use caution relying on them as they may be higher than true value
https://vetgirlontherun.com/podcast...irl-veterinary-continuing-education-podcasts/
 
Jade_Leah said:
He fully supports me switching to a human meter and is interested in what information I gather here, which is honestly refreshing. I'm glad he wants to learn as much as he can and figure out my weirdo baby cat.

He didn't seem super concerned about anemia impacting her BG readings, but then again he just might not have the experience.
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Since human meters tend to read lower than the actual number, perhaps that will balance the anemia some…but I’d still use caution increasing a dose based on a meter while she’s anemic. Good luck with your special girl!
 
Jade_Leah said:
When they did her ultrasound it revealed enlarged kidneys and the pancreas showed signs of either past or current pancreatitus. They saw no sign of cancer or anything else.

I don't remember what he called it, but ESA treatment sounds like what the specialist was talking to me about trying if the numbers indicating anemia are persistent. I will look into thr B vitamin complex you mentioned. I feel like I'm becoming a google scientist with all of my tricks and tools

Lola's appetite is good but she has never been a particularly active gal, so it's harder to say with energy levels. She seems brighter and more chirpy than she was pre-hospitalization. No fever! She is back to enjoying laying in front of the open front door and trying to beat up the dog (she hates his guts). She was in the hospital 4 days and 3 nights.

At our 1:30 vet visit they did a blood panel, sub q fluids & checked her BG which was at 411. He fully supports me switching to a human meter and is interested in what information I gather here, which is honestly refreshing. I'm glad he wants to learn as much as he can and figure out my weirdo baby cat.

He didn't seem super concerned about anemia impacting her BG readings, but then again he just might not have the experience.
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I have had a diabetic cat with CKD and anemia. I just took my ReliOn meter readings at face value. He wasn’t severely anemic, however — not to the point of receiving the Erythropoietin Stimulating Agents yet.
 
Suzanne & Darcy said:
I have had a diabetic cat with CKD and anemia. I just took my ReliOn meter readings at face value. He wasn’t severely anemic, however — not to the point of receiving the Erythropoietin Stimulating Agents yet.
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In a small study done on dogs primarily to compare human to pet meters they noted that in anemic dogs the human meter was closer to true lab values, and in non anemic the pet meter was closer. So the difference in human and animal blood may cancel out the algorithm calculating glucose based on normal hct. I’d still be a little :nailbiting: but if Methos drops his hct any lower I might switch to human.
 
Jade_Leah said:
I forgot to mention the anemia because it's always mentioned as an aside and something they think could be caused by the unregulated BG and/or the CKD/pancreatitus. The vets are watching HGB and the specialist had mentioned that if by the time she gets her next labs with them (11/25) she is still anemic, there is a medication we can try. I, myself, how no clue how to go about fixing the anemia.
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The B-Complex will help, but if it drops much lower you will need to take action.

The CKD is probably the number one cause of anemia. It is very common. Then there is also the anemia of chronic disease.
 
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Jade_Leah said:
When they did her ultrasound it revealed enlarged kidneys and the pancreas showed signs of either past or current pancreatitus. They saw no sign of cancer or anything else.

I don't remember what he called it, but ESA treatment sounds like what the specialist was talking to me about trying if the numbers indicating anemia are persistent. I will look into thr B vitamin complex you mentioned. I feel like I'm becoming a google scientist with all of my tricks and tools

Lola's appetite is good but she has never been a particularly active gal, so it's harder to say with energy levels. She seems brighter and more chirpy than she was pre-hospitalization. No fever! She is back to enjoying laying in front of the open front door and trying to beat up the dog (she hates his guts). She was in the hospital 4 days and 3 nights.

At our 1:30 vet visit they did a blood panel, sub q fluids & checked her BG which was at 411. He fully supports me switching to a human meter and is interested in what information I gather here, which is honestly refreshing. I'm glad he wants to learn as much as he can and figure out my weirdo baby cat.

He didn't seem super concerned about anemia impacting her BG readings, but then again he just might not have the experience.
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These are good signs… especially going after the dog! ;)
 
I really wish we had data to find out what was going on during all these dose increases. :( But now that you are recording tests we can help her. I don’t know that I would increase back up to 5. If you want to because the vet insisted on it, please don’t shoot 5 and not get tests - even at night. With regard to the evening cycles, try to get a +2 and if it is very much lower than PMPS then get some further testing done …. Set an alarm or something to wake up and get another test. Tonight she will probably still be in the bounce (and maybe will be for a few days,) but it would be good to start getting into the habit of getting that +2 and recording the BG.
 
Just doing a quick fly by to say hello and welcome to FDMB. It’s the best place you never wanted to be.

Whenever you see an unexpectedly low number, it’s a good idea to re-test. Every once in awhile we get a wonky test strip or something goes wrong, so it’s worth double checking the number.

I’m pondering the finding of enlarged kidneys. I’m thinking pyelonephritis (kidney infection/inflammation) can sometimes cause enlargement and that urine cultures don’t always grow anything. But I’d think there would be other symptoms perhaps, maybe fever or inappetance? I had a cat with suspected pyelonephritis many years ago and I believe we treated with a broad-spectrum antibiotic (which did help in his case). In most of my CKD cats, we’ve seen small and/or irregular shaped kidneys. Perhaps @Suzanne & Darcy or @SmallestSparrow have insight?

I'm also curious about the consequences (if any) of a history of both Senvelgo and Bexacat, particularly whether there’s any possible (short term perhaps??) impact to the kidneys. I’m not familiar with that but might have to do some reading.
 
Suzanne & Darcy said:
I am confused. You said you gave 3 units this morning, but the spreadsheet now says 4 units which I am sure it did not say this morning. :confused:
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I did not mean to change the dose to 4. I was messing around with the spreadsheet and made an error, sorry! Updating it now. Her shot is at 9pm!

Her regular vet suspects that the CKD is the cause of the anemia as well, but only time will tell. Or if an antibiotic clears those numbers up, I suppose! I am ordering the B complex you suggested as well as the little gel capsules. I am still struggling to understand (as are the vets) why her BG wasn't able to be anywhere near controlled until her hospital stay and then was climbing again after that. The only differences were the IV fluids she was on for those 3 days and the antibiotic they gave her while there, which was Unasyn. We increased the dose by 1 unit a week, but we were only testing her BG +6 at the one week mark when I took her into the vet, so I have no idea what her numbers looked at outside of that. We did this until she was all the way up to 6 units. That and the rest of what led us to the hospital and what happened while there and after is in my comments above, so I'm sure you saw but I can reiterate if that will be helpful! I'm going to go back into the spreadsheet and add in the random readings I did starting on 11/5. She came home from the hospital on 11/4 with a followup with one of their specialists being on the following Monday 11/11. There was only one day that she was anywhere close to controlled when we brought her home and the lowest she ever got then was 117. Maybe her BG was never controlled because the 1 unit per week increase wasn't the right move by the vet, but I am concerned that it's the CKD/pancreatitus preventing the insulin from working properly. Any thoughts?

She is doing well at the moment. I had to leave the house for a bit but just got home with the pup (he's 8 months now and has been a wild ride for all creatures in the house, namely the human mom). I just did a reading at her BG is at 443. Both the regular vet and the specialist are telling me to go back to/stick with the 4.5 units she was on for a couple of days before her numbers went into the 600s on Saturday and her regular vet had me go to 5 units. Do you think the 4.5 that she was acclimating to before the madness of the last few days is a good idea? I'll be testing her again before her 9pm dose.
 
JL and Chip said:
Just doing a quick fly by to say hello and welcome to FDMB. It’s the best place you never wanted to be.

Whenever you see an unexpectedly low number, it’s a good idea to re-test. Every once in awhile we get a wonky test strip or something goes wrong, so it’s worth double checking the number.

I’m pondering the finding of enlarged kidneys. I’m thinking pyelonephritis (kidney infection/inflammation) can sometimes cause enlargement and that urine cultures don’t always grow anything. But I’d think there would be other symptoms perhaps, maybe fever or inappetance? I had a cat with suspected pyelonephritis many years ago and I believe we treated with a broad-spectrum antibiotic (which did help in his case). In most of my CKD cats, we’ve seen small and/or irregular shaped kidneys. Perhaps @Suzanne & Darcy or @SmallestSparrow have insight?

I'm also curious about the consequences (if any) of a history of both Senvelgo and Bexacat, particularly whether there’s any possible (short term perhaps??) impact to the kidneys. I’m not familiar with that but might have to do some reading.
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I just posted an update. In the future I'm going to retest when she's that low! There was only one day that she was anywhere close to controlled when we brought her home and the lowest she ever got then was 117.

As for the possible kidney infection/inflammation, I wondered if this would be the case but I assumed that since her previous UTI showed up in a urinalysis/culture that another UTI/kidney infection would've shown up one of the 5 (5!!l) other times she has been tested for them since then.

I don't want to sound like a conspiracy theorist but I am pretty convinced that the CKD/pancreatitus is the product of her being on Bexacat. She contracted a UTI (found this when she started urinating everywhere, the inappropriate urination which only stopped for a month after she had been treated and now it has been going on for a couple of months again) and had a full blood panel done at that time and there was no sign of elevated kidney values or anything pointing to issues with her pancreas. This UTI was successfully treated. This was in August. I was becoming more and more disenchanted with the Bexacat as it had given her soft stool for months and never resolved her extreme thirst and urination and towards the end was barely keeping her BG controlled before stopping entirely. I wish I had pushed harder to stop the Bexacat sooner. I even went to a highly recommended vet for a second opinion and she suggested I keep her on it. I have a lot of regrets. My poor girl.

@Suzanne & Darcy @SmallestSparrow this comment contains information about her urinating inappropriately that I hadn't included before because I was so overwhelmed by everything else!
 
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Methos developed pancreatitis on Bexacat, and it’s listed as occurring in the study cats, but I do note that diabetes is a major risk factor for pancreatitis. Of course pancreatitis can be a risk factor for diabetes. But I agree that there are a LOT of risks with Bexacat and I wish Methos could have stayed on it as his tumor makes it very unlikely I will ever get his diabetes under control with insulin. I suspect Methos had pancreatitis twice before when his symptoms were diarrhea and loss of appetite/vomiting but wasn’t tested then. I blamed the Bexacat for a rise in Methos’ BUN BUT have since determined it’s his spiranolactone that’s responsible.

if Lola has a uti and it’s not being appropriately treated that can worsen her diabetes. uTI s are common in diabetics (because of the sugar in the urine) and should always be suspected if glucose goes out of control

I hope they find an appropriate antibiotic for her—it sounds like you’re saying she still has it? Or not?
 
Do you happen to have a specific gravity on her urine?

I hear you on the Bexacat. It’s always hard to know whether the new thing on the market is as great as it’s made to sound. One of my vets immediately suggested Bexacat or Senvelgo for my most recent diabetic cat despite the fact that she was in DKA (a big no-no with DKA) and that I’d had 3 diabetics prior and was well versed in FD, testing, dosing, etc.
 
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