12/14, Bell, AMPS 345 +2 441 +7 355 PMPS 355

Seth&Bell

Seth&Bell

Very Active Member
Yesterday

A day of deep breaths... I am starting to think that the antibiotics weren't the reason for that golden cycle on 12/11. I'm not sure what that means for Bell. I will probably need to take her back in to the vet on Monday? I could see if they could culture her urine. On the original visit the vet didn't seem super confident she even had a UTI, she felt like she had a clean urine draw and the blood in there was not from the needle, but who knows. I also don't really know what goes into diagnosing a UTI, so I wasn't prepared with good questions. I don't see any other symptoms of a UTI besides the peeing a lot, but her numbers are also really high, so it could just be that.

I am wondering if the increase to 5.25 and then 5.5 was the real reason for that cycle. I pulled back to 5 units when I saw the low cycle because I assumed it was the antibiotics and I was worried that she was going to continue to really drop. I've been on at least 5 units since 12/7 and the only blues/greens I saw were during that temporary increase. Tomorrow night will be the 10th cycle on 5 units after the good cycle, so following Wendy's advice, assuming she doesn't hit greens tomorrow, I'll increase to 5.5 units on Monday morning.

I am kinda wondering if I should hold off on the vet visit until I see 3 cycles on 5.5 units. I don't want to have multiple factors impacting her BG at the same time like this last week. I also don't want to wait too long if Bell is having discomfort from a UTI. Maybe I'll do a vet visit on Tuesday afternoon so that any new antibiotics/meds will be after the 5.5 units have a chance to build up the depot. Sorry, I am thinking out loud/future casting again, but it helps me to have a gameplan.

Just to summarize the multiple factors Bell had around that good cycle:
1) Started 1 round of the pill form of Clavamox the evening before the good morning cycle on 12/11.
2) Switched to the liquid form of Clavamox the morning of 12/11 (could one form of the same drug be not as effective as another?)
3) AM of 12/10 upped her dose from 5 to 5.25. PM of 12/10 upped her dose to 5.5 based on Wendy's advice.

Phew! I apologize for the novel, I'm sure I sound like a nut.

One final factor: I am off work til Jan 2nd (woohoo!!). So I will be fully available to dote on Bell (and monitor her closely :)) for 3 weeks or so. If there is anything that requires my full attention on Bell, this period would be good for that (not pushing anything here at all, just putting the info out there).

Thank you, kind cat people
 
I am the queen, and you shall do my bidding, peasant. First decree: bring me the tuna fish!
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Nothing wrong with having a game-plan, I’m guilty of that too. Helps me to not be totally surprised when something does happen…

Does Bell have higher BGs during vet visits? If so, I’d be tempted to not stack two things at once. But I am new here, so just thinking out loud with you :)
 
Yeah I think she does spike due to the stress. On her blood test that day, she was in the high 400s, which is really high for her. Then she slid down into that wonderful cycle. I really appreciate it, Tim. I think changing one thing at a time is the way to go.
 
Seth, you’re going an amazing job with Bell, as her loyal servant.
I totally relate to making a plan and having an idea of where we are going.
You’re asking all the right questions. Hoping those with more experience can weigh in here.
Btw, how did she get up so high in this photo?? Quite a jumper! :smuggrin:

Bell will be so happy you are home for a while. That’s great news. (What do you do to earn the $$ to be Bell’s personal servant?)

I hope the next increase brings her back better numbers again :cool::D

Have a calm night and enjoy your sweet girls :bighug::cat::bighug::cat:
 
I’m going to get Minner’s urine cultured this week just to rule it out. Cleaning her privates is the only potential sign, but she grooms a lot all over so who knows. I think UTI’s can be subtle w/o many symptoms. They can also have many symptoms, like frequent litter box visits. In my untrained opinion, the urine culture is the only way to really know. Plus, it identifies the type of bacteria so the most suitable antibiotic can be prescribed. I would think 7 days are needed, but I’m not a vet.

I totally defer to the seasoned wisdom of long time members … but if you are already going to vet and have the budget, I wonder if running bloodwork and also getting the IAA and IGF-1 tests done would make sense. I thought I had read that getting up to a dose of 6 units without regulation was the time when insulin resistance would need to be considered. Minner has high IAA, but negative IGF-1. I’m having IGF-1 retested b/c Wendy shared with me that a study in UK showed that testing for IGF-1 sooner than being on insulin for 73 days had higher chances of false negative. Minner had only been on insulin about 30 days at the time.

My vet has told me he is not concerned about Minner having ketones with her numbers being below 300. Wendy told me she has seen kitties here with ketones in the 200s. So I bought a blood ketone meter because I’m not able to easily get Minner’s urine for testing with ketostix. I did try. Since I already prick her ear to test blood glucose with Relion meter, I just grab the ketone meter and stick the strip in the remaining blood sample bubbled on her ear. Two for one. I did this for first time earlier this week. In case you are interested, this is ketone meter I bought … link to ketone meter.

Minner is currently going through series of dose increases every 3 days / 6 cycles until we start to see serious blue, and hopefully eventually green. What I have generally noticed with her is that she’ll get lower numbers the day of the dose increase, but the following day her numbers get higher. This might be related to the depot (?). Then they come back down.

I hope Bell’s numbers come back down soon. I want to see what our seasoned advisors say about waiting to go back up to 5.5 or doing it right now at her next cycle.
 
Thank you so much for all that information, Laura! I had bloodwork done at my vet visit last week, but I’m assuming looking for IAA and IGF-1 take a specific test? I’m embarrassed to admit I don’t know what those are… if you have links to any good overviews, I’d be interested in them!

I have been able to consistently get urine ketone tests for Bell, and they’ve all looked good. I should just get a blood tester tho.

Thank you for the overview on UTIs. I think a culture makes the most sense. My vet is so expensive as it is (I dropped $500 on bloodwork and urine testing and meds my last visit) that I would rather just spend more and have confidence in what we’re up against as opposed to throwing different meds at it every week.
 
I’m with you on the diagnostics. I try to think about what we would do differently based on the possible outcomes of a given diagnostic. That helps me decide if its worth the cost.

I am currently learning about IAA and IGF-1. I had these tests done early on (30 days after starting insulin) b/c I was in shock that a 4 year old cat (now 5) could get diabetes. Acromegaly is a condition caused by a benign tumor on pituitary gland that causes liver to secrete insulin like growth hormone (IGF-1). This hormone causes diabetes that often requires high insulin doses. I believe IAA often accompanies acromegaly but not always. There is a forum here for acromegaly and IAA with info and links. If Minner’s IGF-1 turns out to be high, then I will start deciding on a treatment plan … a CT can find/see the tumor to confirm diagnosis and there is radiation (srt) that can shrink it. There are members here who have had success with this. Anyway, one step at a time. I think acromegaly is an insidious condition, lurking and building over time, with diabetes being a key symptom.

I think it is possible for Minner to have IAA (the antibodies against insulin), but not have acromegaly …. But I don’t know this with 100% certainty. I’ve searched for studies and info and read a lot, but nothing is strongly conclusive. I’ve been advised that the antibodies can eventually be overcome with aggressive insulin dosing, and that they can subside after a period of time, maybe a year. But no guarantee. This all means regular glucose testing is critical to keep Minner safe. No way to predict when these antibodies may relent or be overcome.

These tests were expensive. The Michigan State University lab website shows the pricing. I think about $80 for IGF-1. Problem is, my vet uses IDEXX who sends to MSU. So now you have cost for my vet visit snd blood draw / packaging followed by IDEXX middle man. I probably had to pay 4x when all said and done. My vet doesn’t think Minner has acromegaly and he didn’t think IAA of 77 meant much. I love my vet, but he’s human and isn’t an expert in everything, he works with me and is a good general advisor, but he hasn’t seen a lot of feline diabetes, so I do a lot of research and bring things to him to evaluate etc. I digress … :)

Bell caught my attention b/c of her diagnosis timing (same as Minner), closer to her age, and seems to have increasing insulin needs like Minner. I assume she is on all low carb wet food (less than 10% carbs). It took 4 months to break Minner’s dry food addiction, and now she eats only Fancy Feast classics pates and 100% meat treats.
 
Ahhhh thank you so so much, Laura! I hope you get to the bottom of what is going on with Minner.

Bell is on all low carb fancy feast pates. I switched her immediately upon diagnosis and that's all she's been eating since.

I have read a bit about acromegaly, but I didn't connect that to the IGF-1 hormone.

I do have a question about IAA without acromegaly. Does the treatment change if I'm already following TR? Does knowing a positive/negative diagnosis change the treatment protocol of TR? Maybe you would be willing to get more aggressive on dosage increases knowing there is a resistance barrier you need to push through...

Thank you again for watching out for Bell :bighug:
 
More reading for your consideration: https://catinfo.org/feline-urinary-tract-diseases/#Urinary_Tract_Infection__
bluesunshine said:
I do have a question about IAA without acromegaly. Does the treatment change if I'm already following TR? Does knowing a positive/negative diagnosis change the treatment protocol of TR? Maybe you would be willing to get more aggressive on dosage increases knowing there is a resistance barrier you need to push through...
Click to expand...
Neko had both IAA and acromegaly. Acro by itself is more common than in conjunction with IAA, and IAA by itself is possible but the least common. Not all cats with any of those combinations have high doses, but cats of 6 units and above, on a low carb diet and no other issues like needing a dental, have a high chance of having one or both of those conditions. There is no treatment for IAA besides time and insulin. Following TR vs SLGS is best, as you do need to be as aggressive as you safely can do. Ditto for acromegaly. For both those conditions, I would take extra precautions when the dose is going down.

Not all vets have accounts at MSU - the tests are much cheaper if they do rather than going through Idexx. We've had one or two members get the vets to do the blood draw, then send them by themselves.
 
As always, thank you so much Wendy. Helpful article on UTI. The specific gravity point prompted me to lookup for Minner from her 20-Nov urinalysis and it was 1.054, so according to that article it means LT 1-2% chance she had UTI at that time. Protein was 2+ and glucose 1+.
bluesunshine said:
Maybe you would be willing to get more aggressive on dosage increases knowing there is a resistance barrier you need to push through...
Click to expand...
Seth, this is spot-on for me. Look at how long I dosed Minner in the 4.x range with ongoing yellow and minimal blue. Then when I’d get a mid blue number I would panic and often squeak down her dose. Once I copied Minner’s IAA result in a forum post here and Wendy responded to it with insight, Neko experience, and how to combat it, I got more aggressive and have been increasing her dose within the protocol and advice boundaries (and set alarm to chk her behavior in middle of night!!) It’s still scary for me so I test a lot and have started posting daily because the forum team (especially Wendy - thank you) watches and help a TON. Today is cycle 1 at 7U. Eeeeeek !!
Wendy&Neko said:
For both those conditions, I would take extra precautions when the dose is going down
Click to expand...
I hope I get to this stage soon (?), but right now I don’t remember what this means. Maybe that once you “pierce the veil” the resistance can subside quickly or be more dynamic?
Wendy&Neko said:
We've had one or two members get the vets to do the blood draw, then send them by themselves.
Click to expand...
This is a great idea that did not cross my mind and could save hundreds of dollars (seriously). I am now going to see what all this entails to setup a personal account and what I need to do to properly get the sample from vet to MSU. Thank you for everything!
 
Seth, sorry to keep writing novellas. I get focused on a problem or question and the brain won’t stop. I looked at Bell’s labs from 10-Dec. She is hypercalcemic. Minner’s mom had ideopathic hypercalcemia. I could tell when it was at 12, even tho some cats won’t show it until higher. She developed calcium mineralizations you could see on xray. Higher fiber diet seemed to manage it …. but she didn’t have diabetes and the associated diet restrictions. So … might be worth asking about if your vet didn’t mention it.

Also noticed the high cholesterol. I’ve never in my life of having cats ever noticed or had reason to pay attention to cholesterol on their bloodwork results. It’s only been in recent past of studying acromegaly that I saw a study that said you can see some bloodwork indicators associated with acromegaly, high cholesterol was one of them. My guess is other things can do this too, I’ve never really looked into it. Sharing as observations in case you are still going in to see vet in near future.
 
oh no no no this is super great! I appreciate all the information, sincerely.

Re: UTI: That article was very helpful. I agree vets seem to just throw antibiotics at any issue these days. Especially after reading that, I'm not convinced bell even has a true UTI, and if she does, who knows if we are on the right antibiotic. I will push for a culture to rule it out or prevent info on which antibiotic to choose.

Re: IAA and acromegaly: You've both really given me a lot to chew on with this. I really hope Bell doesn't have one of those, but it is what it is regardless of what I hope for :rolleyes:. My natural instinct towards treatment is to be as aggressive as I can be, Wendy often has to remind me to chill out a bit and be patient :) (thank you Wendy). So I'm not sure if a positive diagnosis would change how I'm currently handling Bell's treatment. Sounds like the main difference would be handling dose reductions... I'm assuming once the insulin barriers have been broken an IAA or acromegaly cat will start really plummeting. Sounds like a good idea to start doing some reading into that subforum.

I think my current plan will be to see what a dosage increase to 5.5 does for her (can we repeat that really good cycle on 12/10). Then let that dose increase establish a depot. If that doesn't some improvements (or maybe even if it does) talk to the vet on Tuesday/Wednesday to get a urine culture. If all else fails and Bell hits >6 units, start gameplanning for an IAA/IGF-1 test, although I'm still not sure if a positive result would change my current path. I need to read up on the radiation part for acro cats. Phew!

@Wendy&Neko: Do you think I can increase to 5.5 units tonight? We're on cycle 8 after the greens and the last 3 have been all pinks and reds :oops:. In the last day Bell has rapidly increased the amount of water she is drinking and seems pretty lethargic to me. I missed my urine ketone test this morning, but I'll try to get one during the day.

Thank you all so much!
 
Hi Seth, I am so sorry her bg isn't going in the right direction. I would highly recommend to do a culture, to get clarity if an antibiotic is needed and if she is on the right antibiotic. You can even free catch the urine and bring it to the vet without stressing Bell. At my vet I pay for a culture around 135 Dollar. I feel it is a good investment, before giving an antibiotic "in the blue" which might not help but brings the danger of building resistancies.

I really hope the next days bring some clarity, solutions and peace of mind.

I love how systematically you think in all directions and I think it is great to write it down. And like that, people have the chance to contribute and give helpful adivce. I am so happy that you are free for the next three weeks to take care of all this. Taking care of this situation is stressful enough, you don't need an overload of job obligations besides that.

Sending you hugs! All paws and fingers are crossed! :bighug::bighug::bighug:
 
Time for a 12/15 thread. ;)
bluesunshine said:
I think my current plan will be to see what a dosage increase to 5.5 does for her (can we repeat that really good cycle on 12/10). Then let that dose increase establish a depot. If that doesn't some improvements (or maybe even if it does) talk to the vet on Tuesday/Wednesday to get a urine culture. If all else fails and Bell hits >6 units, start gameplanning for an IAA/IGF-1 test, although I'm still not sure if a positive result would change my current path. I need to read up on the radiation part for acro cats. Phew!

@Wendy&Neko: Do you think I can increase to 5.5 units tonight? We're on cycle 8 after the greens and the last 3 have been all pinks and reds :oops:. In the last day Bell has rapidly increased the amount of water she is drinking and seems pretty lethargic to me. I missed my urine ketone test this morning, but I'll try to get one during the day.
Click to expand...

Let's not put the cart before the horse on the IAA/IGF-1 test. There are also more than just SRT as treatment now - that was it when Neko got her diagnosis. Focus on what else could be causing inflammation/infection and eliminate those first.

As far as the increase goes, it's been six cycles since last green and no joy with bounce over. Forge ahead on the increase.
 
Fwiw I’d consider doing the culture earlier rather than waiting until mid-week. With the holidays labs will be short staffed, shipping can be delayed, vets can go on vacation. Cultures take 72 hours to become final. If it’s an infection you don’t want to wait on knowing. IMO you also don’t want to wait on treating but since you don’t want to do two things at once you could choose which takes priority. Delaying knowing doesn’t really help (if I understood why you’re delaying, maybe I don’t).

good luck at any rate!
 
What Colleen said. The dose increase can be done in parallel with figuring out if she has an infection that needs treating.
 
Does the liquid Clavamox contain sugar?
Just an idea. Otherwise, I was thinking the same thing, another antibiotic and a dose increase can go together, you will see what she needs anyway.
:bighug:
 
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