2/6 Dusty, PMPS 388. Help reading numbers?

[Michelle & Dusty]

Hi all, I've been away from the board trying to keep my head above water with the craziness of the school semester...but I'm having a devil of a time making sense of Dusty's BG levels. I started a new vial of Lantus about two weeks ago and then increased her dose from 1.5 to 1.75 last weekend. Since switching, her BG numbers have been generally higher than at the 1.5 dose. More than this, though, she is showing fairly normal (though highish) cycles in the PM cycle but her morning cycles have been pretty uniformly high and flat. I've been able to run home to test several times this week, so I've got more of her AM numbers than I've been able to get in the last several weeks.

Any ideas about why her AM numbers would be jumping up? I mean, this morning they jumped *100 points* from her AMPS to her +2. Could it be a bounce from her PM numbers? Maybe they're dropping very low at +6 or +7? Or could she just be taking a long while to settle into this dose? My vet and I puzzled over it during my visit today and we could come up with nothing.

Things that may be relevant:
(1) She's just finishing up week four of antibiotics for a UTI.
(2) I found a lump on one of her nipples which, today, my vet identified as a mast cell tumor. She's going in tomorrow to get it removed and they'll test it to see if it's likely to have spread. (It's on the skin, and she had a benign one on her ear about two years ago...so the vet is optimistic.)

Thanks for any insight you might have!

 

[Shelly/Boots]

Hello Michelle,
Sorry I didn't see your post earlier. Your answer to the HB's sugars is
most likely the combo of the AB & the tumor. The tumor might be inflamed.Boots had a benign tumor in her mouth that was inflamed.
It really shot her BS's up. AB's send Boot's BS up too. In fact she's
on them right now and I had to raise her insulin dose because of the H. BS's. I'm sure the experts will chime in, but this has been my
experience.

 

[Michelle & Dusty]

Hi Shelly, thanks for the insight! I'll keep an eye on her levels this next week (when she'll finally be done with the ABs and will have had this tumor removed), and hope things get a bit more normal. nailbite_smile

I hope both you and Boots are doing well!

 

[Sienne and Gabby (GA)]

Unless you're using an antibiotic that's a liquid and the base is sugar syrup, the AB shouldn't effect BG numbers. In fact, if the infection is being cleared up by the antibiotics, numbers should drop. Did the vet get a sterile urine sample (i.e., used a needle to get urine) and run a culture to know what kind of bacteria was present?

If the mast cell tumor causes inflammation, then that could raise numbers.

What it does look like is that Dusty may be bouncing off of the blue numbers in the PM. While it looks like Dusty is in a very safe range when you stop testing, you don't know how much more the numbers are coming down. It's quite possible that Dusty then bounces off of the blues and then clears the bounce in a cycle.

If this were my cat, I wouldn't hold the dose for as long as you're holding it. If numbers aren't in the normal range (or close), if you hold the dose overly long, you risk glucose toxicity developing. When this occurs, your cat gets used to the higher than desirable range and treats it as the new "normal." This makes it harder to get the numbers to come down and may set up some bounciness.

 

[Michelle & Dusty]

Thanks (as always!) Sienne!

The AB is in pill form, though she has been getting it with a pill pocket. She's been asymptomatic for at least three weeks, but the vet said she still saw traces of blood in the urine when I brought in a sample after the first two week course of AB. I had just brought in the sample, so it definitely wasn't sterile. If there is *still* blood in the urine after this next collection then I'm going to press either for a sterile sample or for an xray to make sure these aren't stones or some other thing causing the blood. I worry that it would be something else, since she's been asymptomatic for so long.

As for bounciness - things are probably going to get pretty wonky for the next few days because of Dusty's surgery and resulting pain/pain meds, but I'll definitely plan to get some later PM numbers to see how she's falling. In general my plan has been to increase on the weekends when I'm sure I'll be around and available to get up in the middle of the night. (So I was going to increase this weekend to 2u. Though I'm not entirely sure what I'll do now that Dusty is getting this tumor removed. Perhaps wait a few days to see how the numbers shake out.) I didn't realize that the longer she stays at high numbers, the more susceptible she is to glucose toxicity..I'll be rethinking holding the dose for a week rather than the recommended six cycles. (I held the 1.5 for a VERY long time...part of that was because she was sick for some of it and her numbers were wonky. Then the semester started and I didn't want to change things up initially. And then, finally, I had gotten a new vial of Lantus and so wanted to see how that would affect her numbers before increasing her dose.)

Super many thanks for your insight, Sienne. You're really a godsend!

 

[Sienne and Gabby (GA)]

Re. pain meds - I'd ask the vet for buprenorphine rather than any of the non-steroidal anti-inflammatory drugs (e.g., Metacam/meloxicam). There is an FDA black box warning on Metacam for causing renal failure in cats.

I agree that you may not want to increase dose with the surgery. Anesthesia can lower BG levels so you'll want to be attentive to he numbers so you don't get caught off guard if they drop.

Are you using allergy formula pill pockets? They are FD friendly whereas the regular pill pockets contain corn syrup. If there's still blood in Dusty's urine, it may be that the problem isn't a UTI. It may be sterile cystitis. Dr. Lisa has great info on urinary tract issues on her website. Sterile cystitis isn't treated with AB. Glucosamine, like in Cosequin, is typically what's used.