? 12/13 Yum had lower nadirs at 3 than at 3.25. Should I worry?

[MJW]

Previous condo.
http://www.felinediabetes.com/FDMB/threads/12-12-yum-25-or-5-increase-tomorrow.187941/

Should I be worrying she still has an infection? Or maybe liquid poo is enough of a problem on its own to raise her numbers? We sent a urine sample out for culture 6 days ago. No result yet.

I am very sad we went from reds and blacks last spring to near remission in October to these high numbers again.

Oh well. That's the sugar dance. I just hope I optimize her well being.

 

[Sienne and Gabby (GA)]

Is Yum on any kind of antibiotic? It's likely what's caused the diarrhea. The metronidazole (aka Flagyl) shouldn't cause diarrhea and, in fact, it may help. When Gabby was having similar problems, it ended up that a week on this med didn't do the trick. I think we ended up having her on it for about a month. We tested for everything. One other thing to consider is whether Yum has a food sensitivity. Gabby couldn't eat beef or anything with gluten -- she would either vomit or have liquipoo. Many cats have a gluten sensitivity so you may need to read the food labels carefully. Many cats are also allergic to beef and fish. There are some kitties here that are allergic to poultry, as well. If you can pick up some cans of novel protein foods (e.g., ZiwiPeak has lamb and rabbit and is low carb but there are other brands that use novel protein -- duck, kangaroo, etc.) and see if the GI problems are improved, you can then slowly add back some of your regular foods and see if a food sensitivity/allergy is the issue.

I would stop giving FortiFlora. The contents changed not all that long ago and it's really not a useful probiotic. Many of us use ReNew Ultimate as a probiotic. It is very effective. I've found it at Whole Foods, GNC and online. I'd call your Whole Foods or GNC to make sure they stock it though.

I also think it's likely that Yum bounced off of the blue numbers.

 

[Marje and Gracie]

First response is to a question on yesterday’s condo.

She was at a horrible black 606 though this morning. I remember her rebounding to bad numbers on the 3rd day of a dose last spring too. That's why I asked whether I should do .25 or .5. That's why I wondered whether I should choose the most recent nadir or the lowest nadir of the 3 days. I fear I am not being aggressive enough. She still has liquid poo. Maybe that or its cause is affecting her BG.

I have 2 sets of calipers! They are put away for now, because BD's syringes have been a bit better recently.

On the 3.25u dose, she had nadirs under 300 and then she bounced. I would not be more aggressive right now unless she goes back up into red, pink, and black and stays there flat.

I’d watch today because that black number “might” be the high before the break meaning she might clear the bounce from those blues today.

Have you ever had a GI Panel done on her? I highly recommend it because it will test hr B12 and folate levels but also whether she might have exocrine pancreatic insufficiency (EPI) The importance of those tests is if her B12 is low, you could give her injections which could help with food absorption.

I would recommend using Saccharomyces boulardii for the diarrhea....it is really fantastic for that but it won’t work if kitty has low B12, has EPI, or has untreated hyperthyroidism. You would need to confirm the first two conditions with a GI Panel. Your vet would draw the blood and send it to Texas A&M University. She would need to check about fasting because there might be a six hour fast required for diabetic cats.

No matter how great the BD syringes might look to your eye, I guarantee you they are off from syringe to syringe. I used them for a while. Dosing consistency helps with the BG although I think that is only a very small part of this picture with Yum.

Second response is to today’s question:
No, I would not worry about her nadirs being lower at 3 than 3.25. It’s clear she needs more insulin. The focus should be on two things: what is causing the diarrhea and continuing with the increases per the protocol until she hits a breakthrough dose.

Yum’s occasional diarrhea and vomiting have been going on for quite some time. Have you had an ultrasound done to see if her intestines are thickened consistent with IBD?

 

[MJW]

Have you ever had a GI Panel done on her? I highly recommend it because it will test hr B12 and folate levels but also whether she might have exocrine pancreatic insufficiency (EPI) The importance of those tests is if her B12 is low, you could give her injections which could help with food absorption.

She is getting a weekly B12 injection because of her CKD and some decline in her hematocrit. Her weight is holding steady since she came home from boarding, despite the diarrhea.

I would recommend using Saccharomyces boulardii for the diarrhea....it is really fantastic for that but it won’t work if kitty has low B12, has EPI, or has untreated hyperthyroidism. You would need to confirm the first two conditions with a GI Panel. Your vet would draw the blood and send it to Texas A&M University. She would need to check about fasting because there might be a six hour fast required for diabetic cats.

My vet had me stop most of her supplements when we started the metronizadole. Since that has failed so far (after a first 7 day run), I started her on 5 billion CFU twice a day last night. Since she doesn't like the taste, I add water to make a paste---then smear it on her paw to be cleaned off. She has had 2 doses. How long should I wait before I start the metronidazole again? She is avoiding me because she doesn't like being pilled. Very sad. I've also restarted her on 200mg of SEB twice a day and 2x(1/8)t of Animal Essentials probiotic+enzymes. She also gets 300-400mg Al(OH)3 a day.

No, I would not worry about her nadirs being lower at 3 than 3.25. It’s clear she needs more insulin. The focus should be on two things: what is causing the diarrhea and continuing with the increases per the protocol until she hits a breakthrough dose.
Yum’s occasional diarrhea and vomiting have been going on for quite some time. Have you had an ultrasound done to see if her intestines are thickened consistent with IBD?

Her earlier diarrhea was due to her intolerance of red meat. It was yellow pudding poo and vanished when I switched her back to chicken. This new liquid poo came on when she was being treated with Orbax, so I am pretty sure it is antibiotic induced. It is brown liquid, very different from the food intolerance poo. I read vomiting by the litter box after a poo can be caused by straining. I am trying to not worry about the occasional litter box associated vomiting for now. They checked out her intestines and everything else with an ultrasound scan last spring.

Thanks for helping me with my Yum.

 

[MJW]

Is Yum on any kind of antibiotic? It's likely what's caused the diarrhea. The metronidazole (aka Flagyl) shouldn't cause diarrhea and, in fact, it may help. When Gabby was having similar problems, it ended up that a week on this med didn't do the trick. I think we ended up having her on it for about a month.

She was on Orbax. Did you try S. boulardii or just the metronidazole? One week on flagyl didn't do the trick for her either. I've stopped it to try other approaches.

We tested for everything. One other thing to consider is whether Yum has a food sensitivity...
I would stop giving FortiFlora. The contents changed not all that long ago and it's really not a useful probiotic. Many of us use ReNew Ultimate as a probiotic. It is very effective. I've found it at Whole Foods, GNC and online. I'd call your Whole Foods or GNC to make sure they stock it though.

I use the Fortiflora to tempt her taste buds. I will stop that. I got some Animal Essentials enzymes + probiotic. I will look at ReNew Ultimate. I might smear kefir on her paw, too. I don't think she has lactose intolerance, since cheese was always a favored treat with no bad consequences.

Thanks!

 

[Marje and Gracie]

Regular probiotics will not stop diarrhea. It has to be S. boulardi. Vitamin B12 shots are not helpful with CKD and anemia. It needs to be oral methylB12. Vitamin B12 shots are excellent for intestinal issues, appetite, etc.

I can’t tell you whether to restart the metronidazole. That would have to be through the vet. If she’s been off the orbax for a while, she shouldn’t still be having diarrhea.

I don’t mean to be too candid here but it’s always so easy for us to put our heads in the sand and believe everything is just fine (e.g. vomiting after being in the litter box). I think anything that occurs more than very occasionally (and I note she has had early morning frothy vomit), is indicative of an issue.

 

[MJW]

Regular probiotics will not stop diarrhea. It has to be S. boulardi. Vitamin B12 shots are not helpful with CKD and anemia. It needs to be oral methylB12. Vitamin B12 shots are excellent for intestinal issues, appetite, etc.
I can’t tell you whether to restart the metronidazole. That would have to be through the vet. If she’s been off the orbax for a while, she shouldn’t still be having diarrhea.
I don’t mean to be too candid here but it’s always so easy for us to put our heads in the sand and believe everything is just fine (e.g. vomiting after being in the litter box). I think anything that occurs more than very occasionally (and I note she has had early morning frothy vomit), is indicative of an issue.

Well, darn. Looks like I have to discuss the B12 shots with my vet again. The junior vet prescribed it after a brief perhaps misunderstood email exchange. I was already going to ask for the methyl instead of the cyano cobalamin they supplied. Her hematocrit did go up after I started it, but lots of other things were going on too.

Yum's BUN is extremely high. The junior vet thinks that is due to CKD induced stomach bleeding. I believe they felt the foam vomit on an empty stomach after using the litter box fit in with that theory. They prescribed Pepcid AC, but I am trying SEB first because Yum hates pills. Yum's 2 incidents of food vomit are brand new: I will discuss them with the vet. I think she is tired of my emails. The 2 civvies vomited all the time, until I gave them egg yolk. They did give me 2 piles to clean up today though. I stopped the egg yolk when I switched them to Yum's radcat. Sigh. Good thing they are all cute.

 

[LizzieInTexas]

You can test for gastro bleeding at home (Occult Blood Test for Gastro-Intestinal Bleeding)

http://www.felinecrf.org/diagnosis_other_tests.htm

You can get the test at most pharmacies or through Amazon (that is what I did) cost ~$20

 

[MJW]

You can test for gastro bleeding at home (Occult Blood Test for Gastro-Intestinal Bleeding)

http://www.felinecrf.org/diagnosis_other_tests.htm

You can get the test at most pharmacies or through Amazon (that is what I did) cost ~$20

My vet said tests for occult blood in cats are completely unreliable. She said we would have to do an endoscopy and she didn't recommend it. Did the test give you a positive or negative result for Gizmo? Another vet said the unusually high BUN might be due to the blood in raw food. My vet and the junior vet debated that but ultimately disagreed.

 

[LizzieInTexas]

Did the test give you a positive or negative result for Gizmo?

Negative. I am going to do it again next week when I am off. The test was recommended by one of the guru's over on the ckd forum. I just used some poo and put it in the toilet and followed the directions on the test.

 

[Wendy&Neko]

Another vet said the unusually high BUN might be due to the blood in raw food. My vet and the junior vet debated that but ultimately disagreed.

Neko ate raw for 4.5 years, some of it quite "juicy" - it did not give her an unusually high BUN. Her BUN was normal for three years on raw.

 

[MJW]

Neko ate raw for 4.5 years, some of it quite "juicy" - it did not give her an unusually high BUN. Her BUN was normal for three years on raw.

I did look at labs for cats on Radcat in the forum. I must admit I didn't see any BUN numbers as high as Yum's.

 

[Marje and Gracie]

My vet said tests for occult blood in cats are completely unreliable. She said we would have to do an endoscopy and she didn't recommend it. Did the test give you a positive or negative result for Gizmo? Another vet said the unusually high BUN might be due to the blood in raw food. My vet and the junior vet debated that but ultimately disagreed.

My two cats eat raw. My boy has been on raw for five years and my 18 month old since she was 12 weeks old. Both have normal BUN. Eating a high protein diet “can” increase BUN and that’s why you don’t look at it independently.

 

[LizzieInTexas]

Hoping for lower numbers for Yum this morning.

 

[MJW]

Hoping for lower numbers for Yum this morning.

Thanks. Unfortunately we are off to a red start. Her urine culture did come back negative.
Looks like the S. boulardii might have fixed her liquid poo though!!! I will post that under a separate subject line in case others are fighting liquid poo.