Hello Again (previous thread reached 100 posts) | Feline Diabetes Message Board - FDMB

Hello Again (previous thread reached 100 posts)

Scully's latest blood work. We are to discuss with the vet tomorrow.

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I see some possible signs of infection, including a borderline high white cell count and borderline high neutrophils along with the elevated globulins. Of course it also could simply be inflammation, including the suspected IBD.
Her Creatinine is still within normal limits, although trending toward the upper limit. Her urea is elevated. Many things can affect urea, including the hydration status of the cat at the time the blood was drawn. The less hydrated, the higher the urea. Her SDMA value has gone down significantly. Since SDMA is supposed to be a marker for kidney disease, make what that you will. I’ve never really trusted that test to be a very good indicator of future kidney disease. In my own cats, it fluctuates around and I haven’t had a cat with kidney disease for four years now. Admittedly, it does rise after they’ve been diagnosed with kidney disease. It’s worth just keeping an eye on it at this point and making sure she stays well hydrated. You’ve already taken a positive step in that direction by feeding her wet food and eliminating the dry food. It makes quite a difference.

Of course, Scully would choose to go quite low in her glucose on a day she was going to the vet! It’s no wonder they are alarmed. Just make sure they know you have reduced the dose and are monitoring her cycles closely.

I know the vet had raised concern about elevated protein last time. Dietary protein does not raise blood total protein or globulin concentrations in healthy cats. Blood total protein (albumin + globulins) reflects liver production, immune proteins, and loss or gain from disease processes — not dietary intake of protein.

An elevated total protein driven by high globulins points to increased immune/inflammatory proteins (chronic infection, inflammation, immune-mediated disease, or certain cancers). Dietary change is not a cause.

She doesn’t seem really anemic because her Hematocrit is adequate. Her Mean Cell Hemoglobin Concentration is low but her reticulocytes (immature red blood cells) are adequate so she is producing enough. There are many reasons for reduced hemoglobin in the cells. It can be as simple as needing to supplement iron.

Was a urinalysis done? That is really the most straightforward way to check kidney function (and for infection). If her Urine Specific Gravity is adequate then her kidney function is not impaired.
 
I noticed she did have pancreatitis the last time her bloodwork was done. Since that is an inflammatory condition, I would expect it possibly explains the some of the blood results.
 
Her PMPS was quite low this evening, 11.2. A surprise as her sugars began the day quite high.

I will test her every hour or two until it begins to increase.
 
And finally…. Oh my…. She is starting out the evening cycle with a rather low PMPS reading. I am afraid you will need to monitor the cycle tonight as well. Please check her at +2 to see if it’s quite a bit lower than her PMPS. I wish I knew what time that would be so I could check back in here. Let me think… are you on London time? That would be 6:33 p.m. right now.
 
Jelltex said:
Her PMPS was quite low this evening, 11.2. A surprise as her sugars began the day quite high.

I will test her every hour or two until it begins to increase.
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Good. perfect. Our messages to the same effect just crossed paths. I was trying to calculate your local time so I would know when the +2 test would be. We may want to do some strategic feeding. I was so busy examining your bloodwork that I hadn’t had time to check her spreadsheet recently.
 
I’m not sure at this point it’s worth putting her under all that stress to do a urinalysis then. I never heard of it taking such a long time to get a sample via cystocentesis (needle in the bladder.). Although you said she doesn’t have a litter tray indoors? She goes outside? So you may not have the opportunity to observe litter habits that could indicate a urinary tract infection. Not that I am suspecting one at this point. Like I said, it’s probably not worth stressing her that much.
 
I will check her again at +4 and +5 if needed.

Thanks for your reply to the blood work. What I remember the vet saying is slightly different to what Jools remembers. I am pretty sure of my memory, because I wrote it down at the time. We were advised against any more wet food due to protein. As I have said time and time again, the vet was pushing against stopping dried food.

Anyway, we are here now, and that is a good place. With thanks to you for your clear language, explaining things.

Scully is sleeping now, but looks up when we walk about, so she is doing OK.
 
Well, it ended up being a nice blue cycle tonight. I am pleased!

Her weight gain is proof of her improving health. I know it must really make you happy to see her return to normal activity levels and activities (poor mice!) You have made good choices for her. I don’t see anything too alarming in her bloodwork— just things to monitor.
 
Scully was asleep on my office chair this morning, still sleeping. Another positive change. Previously she would be waiting, desperate for food.

Last night I wanted to make sure her readings didn't go too low.

Now I know that's the pattern, I will be less concerned. That PMPS of 11.2 was alarming, much lower than any other PMPS.
 
The vet may not be 100% happy with the methods, but is happy with the results that your guidance has provided.

I don't think she has seen owners who were taking diabetes in their pet that seriously.

Scully is going to have an antibiotic shot next week for a probable infection.

Do you think the doses of insulin needs reducing at all?
 
No. Not based on her current BG numbers she has not earned a reduction. Remember, normal blood glucose for a cat is between about 50 and no more than 120 (so 2.8 and 6.6 your numbers). We want to keep her as close to that range as possible. We have two options in dosing methods here that can be followed (although even these can be customized.) The Start Low Go Slow Method (SLGS) and the Modified ProZinc Method (MPM) which allows for tighter regulation of BG. People usually choose which they want to follow based on their schedules, goals for their cat (remission versus regulation) and their comfort level. Of course everyone is nervous at first when they see lower numbers, but the goal is to be able to shoot lower preshot numbers over time as data is gathered to support safely doing that (by tracking the nadirs.)
 
Jelltex said:
Scully is going to have an antibiotic shot next week for a probable infection.
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I did, as I said, notice a few markers for a potential infection? Is she unable to take oral antibiotics in any form (liquid? tablets?)

The reason I ask is that the long-acting antibiotic injection can be risky. It’s called Convenia here in the U.S. It’s Cevofecin and is in the cephalosporin class of antibiotics. Perhaps Scully has had these before? It is approved for use in skin infections. I have used it in feral cats who could not be pilled. In the interest of full disclosure and informed consent, I am attaching a link to an article written by a vet who used to be quite active on this forum, about risks associated with this antibiotic injection. If the cat has a negative reaction to the shot, your options are limited as the injection stay in their bodies for some weeks.
Convenia- long term antibiotic: Is it worth the risk?
 
You always have the option of shooting a reduced dose for the cycle if you have an extremely concerning preshot number. Then after the reduced dose is given you gather some test data to see if it was too much, not enough, or about right.

Another option when encountering a lower than expected preshot number is to stall (do not give food) and wait about 30 minutes to an hour to see if the cat’s numbers are rising at the end of the cycle as the insulin is wearing off. This does mess up the shot times though. It’s not always rising because the cat also hasn’t eaten for a while which can help to keep BG lower.
 
We had a relaxed day today regarding testing, as the last two have been so intensive.

Message received regarding the dosage levels.

I will test at +4 tonight, just to be sure of her sugars.

Have a great weekend.
 
Suzanne & Darcy said:
Remember, normal blood glucose for a cat is between about 50 and no more than 120 (so 2.8 and 6.6 your numbers). We want to keep her as close to that range as possible
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@Jelltex if you’re still using an AlphaTrak meter (as shown in your signature) I think Suzanne meant between approximately 70 (not 50) and 120. That would be around 3.8 for the low end of your numbers.

Human meters run lower than the AlphaTrak, hence the 50-120 reference if using a human meter.
 
@Jelltex if you’re still using an AlphaTrak meter
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Yes, we still use AlphaTrak, its te one we can trust with Scully's condition, after our previous meter gave wildly variable readings, so much so we could not trust any readings.

Scully was 26.5 at AMPS this morning, but didn't eat all food put out and is now sleeping in the autumnal sunshine.
 
JL and Chip said:
@Jelltex if you’re still using an AlphaTrak meter (as shown in your signature) I think Suzanne meant between approximately 70 (not 50) and 120. That would be around 3.8 for the low end of your numbers.

Human meters run lower than the AlphaTrak, hence the 50-120 reference if using a human meter.
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Thank you. Mea culpa. Correct on the AT meter
 
Suzanne:

I have to go away for three days from tomorrow.

Jools will input Scully's test readings.

I won't have access to the message board, but will get e mails if you post something. If there are any, I will replay that to Jools.

Hope this makes sense.

Despite today's readings, Scully has been very mellow, slept a lot, not demanded food, and this afternoon was still sleeping when it was time to test PMPS and inject.

She didn't eat all her meal.

All good signs.
 
Scully's numbers have been all over the place this week.

Generally, she's in a good place, relaxed and happy.

Occasionally, like today, she is like she was before I joined the message board: she is obsessed with food, not helped by her regurgitating her breakfast soon after eating it. And since she demands food all the time.
 
I’m not surprised with those high numbers that she’s feeling poorly. I am sorry to hear this though. First thing to do is to try to catch her and test for ketones. I know she goes outdoors, but I believe you have been able to do this before. If she seems lethargic or is vomiting a lot I would take her to the vet.

Otherwise, I would take her dose back up to 2.75. Then I would always get a +2/2.5 test to see if she’s dropping significantly and whether she is or not I would make her eat a small meal at +2 and another at +4. With this we hopefully will prevent her from dropping to the point where she needs a reduction again (we would just be spinning our wheels.)
 
Other than you being away for those days this week, she hasn’t had any dietary changes or other changes that you can think of? She’s still eating a wet food diet of low carb food with no dry food, correct?
 
Did you see this that I wrote above?

I’m not surprised with those high numbers that she’s feeling poorly. I am sorry to hear this though. First thing to do is to try to catch her and test for ketones. I know she goes outdoors, but I believe you have been able to do this before. If she seems lethargic or is vomiting a lot I would take her to the vet.

Otherwise, I would take her dose back up to 2.75. Then I would always get a +2/2.5 test to see if she’s dropping significantly and whether she is or not I would make her eat a small meal at +2 and another at +4. With this we hopefully will prevent her from dropping to the point where she needs a reduction again (we would just be spinning our wheels.)
 
Also, my only hesitation about raising her dose is that there have not been any tests during the p.m. cycle and we don’t know for certain whether she has been dropping low at night and then if it could be causing her morning BG to be higher.

She is occasionally having a blue nadir but not a low one.

If you can increase to 2.75 and provide the +2 and +4 small meals and get a test or two at night, I think she would be better off.

My only other concern is that the Convenia injection she had was not the correct antibiotic or that it didn’t agree with her in some other way. But I am just thinking out loud and trying to think of everything and anything.
 
If you can increase to 2.75 and provide the +2 and +4 small meals and get a test or two at night, I think she would be better off.
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We will increase the dose tonight.

We are waiting to have a conference with the vet regarding antibiotics and the possible issues you raised, so she has not had it yet. The problem we have with the liquid one, is that previously, we couldn't be sure we got all the dose in her mouth, as she struggles so.

I will do +2, +4 and if needed +6 tonight and going forward.

Oddly, she often demands food, and appears ravenous, if we go to sit down, she will come and join us and settle down. So, part of the issue is habit. She sees or hears either of us in either the kitchen or utility room, she thinks its food time, as that's where we feed the cats.
 
Jelltex said:
The problem we have with the liquid one, is that previously, we couldn't be sure we got all the dose in her mouth, as she struggles so.
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I totally understand this — with liquid antibiotics, my cats spit out about half of it (or fling it on me, the wall, etc.) I generally ask for tablets, which, with a “pill shooter” I can get into them (although I have one cat who would take my fingers off just to get his mouth open.). He’s a very nice cat otherwise.
 
Not a typo.

But there is a reason.

I think we have been over-generous in feeding Scully through the day. Sometimes more than a mouthful, so wanted a day where we went back to being better, and seeing her readings then. We got a blue number at +6 during the day.

We will increase it tonight.
 
Okay. Sometimes you have to try things. I did see the 175 on her spreadsheet and was happy to see it — although it is higher blue, it’s still a good trend (and as you say she felt better and was happier!)

As for the snacks, I thought you wanted her to gain more weight? Usually a teaspoon or two of food is enough for the snack for the purpose of smoothing out the cycle, but if she’s in high numbers at the time of the snack, then her body may just actually need more food.
 
As for the snacks, I thought you wanted her to gain more weight?
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We do. But also thought that too much food would counteract the insulin.

Truth is we were giving more than a tea spoon. Its a learning curve for us, as I thought lower numbers would reduce her appetite.
 
When she is in more consistent low numbers her appetite overall should be reduced, that’s correct. You are right about the food which can somewhat overwhelm the insulin (even if it’s low carb food.) It is good to give her the amount of food she needs to eat (to gain weight in this case) and spread it into the number of meals she eats each day….. and if that’s more than a teaspoon or two, so be it. We can compensate with the insulin. As you have already seen, the timing of the meals is the most important thing— that and keeping it low carb.

Edit to add: when I mentioned a teaspoon (above) that is not to say it’s the maximum amount to give…. It’s probably the minimum needed to help keep Scully from dropping too quickly in the first several hours of the cycle.
 
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