? 1/5 Snuggie (acro): Spreadsheet review and dose advice requested

Hello and happy new year, FDMBers!

I hope you all had a lovely holiday season and that Santa Paws was good to all your kitties!

I'd like a spreadsheet review and dose advice, please. Acro-cat Snuggie was doing well at 8u in early December, but his blues were high and he spent quite some time in the yellows. I decided to increase his dose to get into lower blues and see fewer yellows. (NOTE: I'm not striving to get him into lots of greens. The fear of hypo was too much for me, so my plan is to make sure he spends lots of time in blues and low yellows).

Once i increased his dose, his numbers got worse. We are now up to 12 units. I have seen a few blues in the first few cycles of a dose increase, but I'm seeing far too many pinks and reds.

He was Dx with a UTI in mid Nov and was on Orbax for 6 weeks. The vet saw the bacteria in the microscope (urine was drawn w sterile needle/cysto). We sent it out for C&S but the lab wasn't able to grow anything. His BGs started to decline shortly after we started the antibiotics, but then they went up again. I will take him back to the vet once the antibiotics are out of his system, but I'm wondering if maybe his dose is too high? I know that's usually not the case with acro cats, and I know the acromegaly complicates all of this so I will cross post this in the acro group, but just curious about the expert thoughts here.

Thank you!!

@Wendy&Neko @Suzanne & Darcy @FrostD

Last post: https://felinediabetes.com/FDMB/threads/11-18-acro-snuggie-update-newly-dx-uti.255631/#post-2878671

 

Not sure that you've been missing low numbers that would indicate his dose is too high. I do see the odd cycle where you can't get a mid cycle test, and would stress the importance of those every cycle if you are going to increase every 6 cycles. Also, 12/26 there was a fur shot, which starts the cycle count over, but you increased after 5 cycles. 12/30 he was coming down into AMPS but there weren't further tests until +8. He then bounced, possibly broke the bounce AM of the 1st, but there were no PM mid cycle tests that night and bounced again. If you have the time, I might do a bit more testing on a cycle where he might be breaking a bounce. Patience and data are your friend.

A couple things I can think of as possibilities. One is that the acro tumour has taken off and is pulsing causing his dose needs to increase. Second is that Orbax wasn't the right antibiotic to treat the UTI. Since they couldn't culture the bacteria, it's hard to say whether Orbax was the answer. How is he acting otherwise? Litter box habits good? And finally, he could have some glucose toxicity now.

Link to post on the acro forum.

 

Thanks Wendy! I'll be honest, his relationship/trust with me has deteriorated with all the testing, and he's not being as patient with the pokies (pulling away, not letting me get his ear, etc) so I am trying to keep it to a minimum, but I hear what you are saying. I'll be sure not to skip the mid cycle tests for data's sake, especially when considering dose changes, and I'll try for a few timeframes other than his usual low hours. I have been in the mindset of "as long as he's safe" but, I get the nuance when he's not cruising along at a good dose. I know he has sometimes nadired at or after the next shot, so yea. Thanks for the reminder!

I had the same thoughts as you for your second paragraph re: tumor growth, and orbax. His litter box habits have been fine (normal for a diabetic with CKD) but i am going to schedule a vet appt for him next week to check. I think he hides any discomfort VERY well. His bad UTI earlier in May only surfaced after he had been using the hallway carpet for his litter box. This one in Nov. was a gut instinct on my part based on a few 'smaller volume pees' in the box.

As far as glucose sensitivity, you think because he's been at higher numbers for so long? How will we break that or will it just resolve on its own once either the tumor or the UTI calm down?

Thanks again!

 

The "cure" to glucose toxicity is usually more insulin to break through the resistance. Meaning, once he starts seeing good numbers again.

 

Thanks again Wendy!

we have a vet appt scheduled for next week, hopefully it’s something as simple as his UTI didn’t clear.