2/7/22 | Two-Two AMPS 358

TabbyCatMom

TabbyCatMom

Member Since 2022
Hello wonderful cat parents!

Two is going to be due for a two week Urine culture to see if her UTI is under control. I have been taking her BG regularly but I have not done a curve. Should I do this before her next appointment? Will we need to do a new Fructosamine test? Although I would spend a million bucks on my kitties, we have already dropped 3K on this last episode and her kitty insurance was not active so we couldn't get any reimbursements.

Any, her spreadsheet is mostly up to date. THANKS!!
 
I don’t see that you have picked a dosing method. By method on your ss you wrote the insulin used. If you can get some mid cycle test and som3 before bed test you won’t need a complete curve. At this point a fructosamine test is a waste of money. If you can get enough tests you will not ever need one as you have real time testing. Why did you skip the night of 2/4?
 
Thank you for your reply! I accidentally skipped it. :( Oh - I am a little slow on the up take. I need to follow a protocol! I'll take a look. I believe the go slow protocol is the one I want to go with. Any suggestions?
 
If you are able to test and not feeding any dry, TR has the best chances of remission. It will get her into better numbers more quickly as you can increase every 6-10n cycles. You need a minimum of 2 test besides the amps and pmps every cycle and more if the bg is dropping. The quicker you can get to regulation the better the chances of remission. It can be a little scary at first when you start to see lower bg but we have a rule here that if someone is shooting a lower number the person who suggests shooting sticks with them until testing can be stopped or finds someone to take over.

With SLGS reductions are taken under 90 and you hold the dose a full week unless there's another drop under 90. With TR the reduction number on the AT is under 68. If a reduction fails you can go back to the last good dose without needing to wait a full 7 days.
 
Just a technicality, SLGS or Start Low Go Slow is not a protoocol, but rather a dosing method developed here over time. Lots of people have followed it successfully, but it's not been studied by researchers and published like the TR protocol has been.

On the spreadsheet, if you accidentally or on purpose skip a dose, could you put either Skip or NS (no shot) in the dose cell. That way we know it's not just a missing entry. Not sure if you dosed last night either? Lantus is a depot insulin, relying on consistent shooting, so it makes a difference if a shot is missed, significantly delayed or reduced. So good for those of us making suggestions about dosing to know.
 
Thank you both very much for the insight.

Part of the reason I am a little scattered and all over the place is because Two Two had a UTI back in June and was actually peeing blood clots. At that time all of her numbers were normal and just six months later her blood sugar, creatinine and bun were elevated.

We also have two kittens (got them at 4 wks and now 11 months); that she is still adjusting to so she definitely has had some stress - though we are combating it with a lot of different tools.

However, I am still treating her UTI which ended up being E. coli after getting a urine culture. She may very well have had this infection since June and we are on the third antibiotic which is a Veraflox. Hoping it cures it. I’m doing two weeks and then getting her urine culture done again.

So when we found the elevated diabetes and kidney #’s, the doctor recommended kidney food, and of course I didn’t give it to her because it’s high carb i.e. hill K/D. l
Luckily I found this forum and now I switched her to all low phosphorus, low carb food and started giving insulin every 12 hours.

So I’m wondering, is it safe to do the TG protocol with a CKD Cat? I have subcutaneous fluids and I’m not sure that her kidney levels are so bad that she needs it but I’ve been giving her 50 mL every day or every other day when she lets me. She’s very finicky!

At some point I think someone on here was going to look at her kidney levels but it never happened and I sort of have been scrambling to get her blood sugar, insulin, and food regulated and it’s really just been challenging for me (I work full time, etc).

So I appreciate both of your help and I sure wish my vet would have been as supportive as you guys all are here. I’m just up in arms why they don’t give more support around insulin dosing/education, food and other stuff. I’m basically just on my own here - except for this life saving forum. So I just need to do some fine tuning.

Thank you!
 
You don’t list her USG from either urinalysis. The infection could be effecting her numbers. So start with SLGS and see how she does. It’s fine for cats with ckd to follow TR. You definitely want to get her under renal threshold and into bg at least under 250 to protect her kidneys.
 
TabbyCatMom said:
So I’m wondering, is it safe to do the TG protocol with a CKD Cat? I
Click to expand...
I was following TR for Neko, who had CKD, heart disease and small cell lymphoma, as well as acromegaly that caused her diabetes. So yes, it's doable if you are on all low carb wet or raw food.

I was about to ask about USG, but Elise beat me to it. Higher kidney values can be due to dehydration, and diabetics do tend to be peeing more. Did your vet suggest fluids? You do want to make sure the vet OK it and her heart is OK with fluids.
 
tiffmaxee said:
You don’t list her USG from either urinalysis. The infection could be effecting her numbers. So start with SLGS and see how she does. It’s fine for cats with ckd to follow TR. You definitely want to get her under renal threshold and into bg at least under 250 to protect her kidneys.
Click to expand...
I am not sure what USG is. Her urine culture showed E. Coli. I thought I put in the urinalysis data from the 29th. What values are you asking about specifically?
 
Wendy&Neko said:
I was following TR for Neko, who had CKD, heart disease and small cell lymphoma, as well as acromegaly that caused her diabetes. So yes, it's doable if you are on all low carb wet or raw food.

I was about to ask about USG, but Elise beat me to it. Higher kidney values can be due to dehydration, and diabetics do tend to be peeing more. Did your vet suggest fluids? You do want to make sure the vet OK it and her heart is OK with fluids.
Click to expand...

She was peeig a lot but it has lessened in the past week. I asked the Doc about her blood pressure but they did not get it. I was wondering if I should get my own BP cuff since her BP would be lower at home anyway? Thoughts? The Vet said it was OK but at this point I am not sure he is totally accurate b/c he gave us K/D dry food and wet food and said nothing about how this would effect her BG. She is only eating the foods on the CDK list given here and the CKD facebook group (Weruva chicken, steak frites, etc).
 
BP equipment for cats is quite expensive.

USG = urine specific gravity and is a measure of how well they are able to concentrate their pee. It's one of the early signs of kidneys not working as well.
 
Wendy&Neko said:
BP equipment for cats is quite expensive.

USG = urine specific gravity and is a measure of how well they are able to concentrate their pee. It's one of the early signs of kidneys not working as well.
Click to expand...
Yes, I found it! It is in normal range (: I added three lines to the bottom of her Urine analysis labs: bacteria, gravity and Urine culture. THANKS A MILLION!
 
Wendy&Neko said:
I was following TR for Neko, who had CKD, heart disease and small cell lymphoma, as well as acromegaly that caused her diabetes. So yes, it's doable if you are on all low carb wet or raw food.

I was about to ask about USG, but Elise beat me to it. Higher kidney values can be due to dehydration, and diabetics do tend to be peeing more. Did your vet suggest fluids? You do want to make sure the vet OK it and her heart is OK with fluids.
Click to expand...
Thanks again for this. Can you tell me what values to look at besides blood pressure to determine if she has heart issues? I hope the Vet would have pointed it out!
 
I am going to purchase Ketostix to test for ketones but my girl stared only peeing on the floor so now she pees on puppy pads. They actually catch pretty well. I wonder if I can use the pads to extract the urine? Thoughts?
 
No murmurs! So she's good there. Does this mean she should be OK for SubQ fluids? Not sure if her CKD is that bad. Her labs show stage 3 but I am wondering if they are high b/c of her UTI.
 
I agree with you but I am honestly not really sire my Vet has all the answers. For example I asked if I can give her the TR protocol and he said he does not recommend b/c she needs low protein food (aka high carb) to treat her CKD. However, her CKD numbers may be more elevated b/c of her UTI she has had on and off since June of last year. I just gave her sub Q fluids now and I think I am just going to do the TR. I know cats need protein and the old way of thinking is wrong i.e. low protein. However I am buying her wet food from the CKD list so it is less than 50% Protein I think anyway.
 
If you are going to go with TR can you please add that to your signature and SS

When you post on the lantus forum you should always put the AMPS number after his name and any other tests after such as BG number @+3 , or @+4 etc and PMPS in your title and like the previous days post to it.

Even if you don't have a question you should post everyday in case a member needs to go back to the previous days post.

Previous days post
https://felinediabetes.com/FDMB/threads/help-with-insulin-timing-still-new.258775/


https://felinediabetes.com/FDMB/thr...o-bg-438-at-3-skipped-amps-b-c-bg-225.258780/
 
Last edited:
www.foodfurlife.com
TabbyCatMom said:
I agree with you but I am honestly not really sire my Vet has all the answers. For example I asked if I can give her the TR protocol and he said he does not recommend b/c she needs low protein food (aka high carb) to treat her CKD. However, her CKD numbers may be more elevated b/c of her UTI she has had on and off since June of last year. I just gave her sub Q fluids now and I think I am just going to do the TR. I know cats need protein and the old way of thinking is wrong i.e. low protein. However I am buying her wet food from the CKD list so it is less than 50% Protein I think anyway.
Click to expand...
I hate to undermine your vet but I agree with what you acknowledged that a low protein diet for CKD cats is old school unless the kitty is in the very last stages. The last several years, the research has shown it’s important to feed a high quality diet with 30-40% calories from protein. Here is a good discussion with many literature citations to share with your vet. I’ve never fed my CKD a low protein diet and they’ve all lived a long time with stable CKD. This information comes from the gold standard on treatment of feline CKD called “Tanya’s Comprehensive Guide to Feline Chronic Kidney Disease”. There’s a lot of information to start digesting it slowly while her CKD is at a lower stage.

It’s way too soon to be giving subq fluids. They are typically not started until the creatinine increases over 3.5. There are many reasons for this but one is that scar tissue can build over time with the insertion of needles and once that scar tissue builds, it makes it hard to get the subq fluids in. Another reason, and it’s one of great concern, is overwhelming the heart. Before I started with daily subq fluids when my cats’ creatinine got over 3.5, I had an echocardiogram done so we could make sure the heart was of normal size and functioning properly. Absence of a murmur is not indicative of anything. a cat can have advanced cardiomyopathy and not have a murmur. Conversely, a cat can have a grade 5/6 murmur and no cardiomyopathy.

Four of the most crucial things with longevity with CKD are (1) keeping the phosphorus level as low as possible by feeding lower phosphorus foods and adding binders when the P level gets to 6, (2) keeping an eye on urine protein so if proteinuria develops, it can quickly be addressed, (3) staying ahead of anemia, and (4) checking the blood pressure and keeping it under control.

There is no reason why you can’t do TR with a CKD cat. It’s really apples and oranges. Of course, if a cat is at the final stages of CKD and is anorexic, there is no need to do TR. At that point, it’s all palliative care.

I don’t know if you are open to feeding a balanced raw diet but the one that many of us use here has lower P values (not low as that only comes with the renal diets) but certainly lower than most canned foods. The raw meat is a good source of high quality protein. Yes, it’s a higher amount of protein but there are a lot of people with CKD cats feeding it.
 
I also want to address her dosing and testing. I know you are just getting started but it’s important to test both cycles. If you are not getting any nighttime tests, you are missing half your data and many cats go low at night. It’s hard for us to recommend dose increases if we don’t know how low a dose is taking her.

You always want to get a preshot test. From there, it’s a good idea to get a +2 test each cycle. If the +2 is similar to or lower than the PS, the BG will likely come down and you can judge from there when to test again. At night, if the BG isn’t dropping, just getting the PS, +2, and before bed is very helpful.

TR will allow you to increase faster and get her out of these high numbers.
 
Diane Tyler's Mom said:
If you are going to go with TR can you please add that to your signature and SS

When you post on the lantus forum you should always put the AMPS number after his name and any other tests after such as BG number @+3 , or @+4 etc and PMPS in your title and like the previous days post to it.

Even if you don't have a question you should post everyday in case a member needs to go back to the previous days post.

Previous days post
https://felinediabetes.com/FDMB/threads/help-with-insulin-timing-still-new.258775/


https://felinediabetes.com/FDMB/thr...o-bg-438-at-3-skipped-amps-b-c-bg-225.258780/
Click to expand...

Thank you for this. I will include the numbers moving forward, not sure how to go back and edit the titles at this point.
 
Marje and Gracie said:
www.foodfurlife.com
I hate to undermine your vet but I agree with what you acknowledged that a low protein diet for CKD cats is old school unless the kitty is in the very last stages. The last several years, the research has shown it’s important to feed a high quality diet with 30-40% calories from protein. Here is a good discussion with many literature citations to share with your vet. I’ve never fed my CKD a low protein diet and they’ve all lived a long time with stable CKD. This information comes from the gold standard on treatment of feline CKD called “Tanya’s Comprehensive Guide to Feline Chronic Kidney Disease”. There’s a lot of information to start digesting it slowly while her CKD is at a lower stage.

It’s way too soon to be giving subq fluids. They are typically not started until the creatinine increases over 3.5. There are many reasons for this but one is that scar tissue can build over time with the insertion of needles and once that scar tissue builds, it makes it hard to get the subq fluids in. Another reason, and it’s one of great concern, is overwhelming the heart. Before I started with daily subq fluids when my cats’ creatinine got over 3.5, I had an echocardiogram done so we could make sure the heart was of normal size and functioning properly. Absence of a murmur is not indicative of anything. a cat can have advanced cardiomyopathy and not have a murmur. Conversely, a cat can have a grade 5/6 murmur and no cardiomyopathy.

Four of the most crucial things with longevity with CKD are (1) keeping the phosphorus level as low as possible by feeding lower phosphorus foods and adding binders when the P level gets to 6, (2) keeping an eye on urine protein so if proteinuria develops, it can quickly be addressed, (3) staying ahead of anemia, and (4) checking the blood pressure and keeping it under control.

There is no reason why you can’t do TR with a CKD cat. It’s really apples and oranges. Of course, if a cat is at the final stages of CKD and is anorexic, there is no need to do TR. At that point, it’s all palliative care.

I don’t know if you are open to feeding a balanced raw diet but the one that many of us use here has lower P values (not low as that only comes with the renal diets) but certainly lower than most canned foods. The raw meat is a good source of high quality protein. Yes, it’s a higher amount of protein but there are a lot of people with CKD cats feeding it.
Click to expand...
Thank you so much, Marje. This info helps a lot. I will mention the research to the Vet and see if he is open to it. Or maybe I just need to find another Vet?

In any case, I will stop the Sub Q fluids, I was eager to start and the Vet said "sure you can start now" - I was eager because I got my first kitten "Cotton" when I was 9 and then when I was 23 or so he needed subQ fluids so I just thought they all needed it.

At this point I am open to raw food but I want to start with TR and see how it goes. How do you feel about the fact that the UTI could be effecting her labs? Should I wait to start TR until her UTI is gone? I don't want to push it with the insulin then see a drop once the infection clears. I am not sure when I should start or what if I just start with adding .25 and holding for a few days? Also, will it be necessary to wake up in the middle of the night to take her BG during the increases of the insulin. Sorry if this is an obvious question. I actually have ADHD so my executive functioning is a bit challenging. So much info...and it's difficult to read and keep track of all the article and people commenting, etc. Thanks!
 
OMG - my Vet just called back and said in his opinion he thinks we should control the BG with insulin (I am assuming he just means for life) and control the CKD with food (i.e. protein <27%) b/c of toxins from protein will harm the kidneys. He said he had to ask an internist. He also does not acknowledge that her UTI may be contributing to her BG and kidney levels.

She will be getting a urine culture in 6 days. I understand E Coli is very difficult to treat and she has only been on Veraflax for 8 days. I am shooting for 2 weeks, then another urine culture. My gut is telling me to just possibly go up to 1.25 on the Lantus and hold - depending on her numbers and I will check during both cycles - until we get the culture back.

Question: when should I get more labs to look at her Kidney levels? She has had labs 1/6/22 and 1/29/22. THANK YOU ALL!!!
 
TabbyCatMom said:
Thank you so much, Marje. This info helps a lot. I will mention the research to the Vet and see if he is open to it. Or maybe I just need to find another Vet?

In any case, I will stop the Sub Q fluids, I was eager to start and the Vet said "sure you can start now" - I was eager because I got my first kitten "Cotton" when I was 9 and then when I was 23 or so he needed subQ fluids so I just thought they all needed it.

At this point I am open to raw food but I want to start with TR and see how it goes. How do you feel about the fact that the UTI could be effecting her labs? Should I wait to start TR until her UTI is gone? I don't want to push it with the insulin then see a drop once the infection clears. I am not sure when I should start or what if I just start with adding .25 and holding for a few days? Also, will it be necessary to wake up in the middle of the night to take her BG during the increases of the insulin. Sorry if this is an obvious question. I actually have ADHD so my executive functioning is a bit challenging. So much info...and it's difficult to read and keep track of all the article and people commenting, etc. Thanks!
Click to expand...
You’re welcome!

I definitely would not be giving her fluids yet. Infection can definitely cause the creatinine to be higher. I hope the antibiotic will help.

I would suggest you not wait until her UTI is resolved to start TR. It is expected that the infection would raise the BG. That means she needs more insulin to reduce the chance of developing ketones and DKA. If you are monitoring her enough, as the infection starts to resolve, you will catch it when the BG drops.

Read the sticky for TR at the top of this forum. You’ll see we generally hold doses six consecutive cycles, unless the BG drops below 50 on a human meter. The amount of the increase depends on where the nadirs are…above 300 or below. Please see my post #24 above regarding frequency of testing.
 
TabbyCatMom said:
OMG - my Vet just called back and said in his opinion he thinks we should control the BG with insulin (I am assuming he just means for life) and control the CKD with food (i.e. protein <27%) b/c of toxins from protein will harm the kidneys. He said he had to ask an internist. He also does not acknowledge that her UTI may be contributing to her BG and kidney levels.

She will be getting a urine culture in 6 days. I understand E Coli is very difficult to treat and she has only been on Veraflax for 8 days. I am shooting for 2 weeks, then another urine culture. My gut is telling me to just possibly go up to 1.25 on the Lantus and hold - depending on her numbers and I will check during both cycles - until we get the culture back.

Question: when should I get more labs to look at her Kidney levels? She has had labs 1/6/22 and 1/29/22. THANK YOU ALL!!!
Click to expand...
Sadly, I’ve gotten bad advice from board certified internists. :eek: I am certain there are some very, very good ones out there just as there are excellent general practice vets (I love mine). But….internists also sometimes specialize in different things. You would hope an internist would know a lot about treating every internal system but….not always.

I would be sure her UTI is completely gone before I retest her serum kidney chemistries.

I would increase her dose to 1.25u, get tests in as I suggest in #24 above. Hold that dose six consecutive cycles unless she drops below 50 at which time you’d reduce the dose back to 1u. If, after six consecutive cycles, she’s still not seeing some nadirs below 100, you’ll raise the dose again.

One last point: the SS shows you switched to a human meter but the SS is for a pet meter. It does make a difference when we are looking at the SS as the pet meter SS codes the BG differently. I sent you a PM yesterday about granting me editing rights so I can reformat the SS for you. The advice we give is only as accurate as the data on the SS. :)
 
I tried sending you our SS. Did you get it? I sent here:

I'll update SS now. I added a row that I switched to human meter but forgot to relable the top! THANK YOU!!!!!
 
Last edited:
You don't send her a copy of your SS ,didn't you get her private message
Marje needed you to grant her editing rights so she could change

I don't know if you can change it yourself but when using a human you need to change the the numbers up top where it is color coded
The dark green should be 50-99
The neon green should be BG <50

Where did you get that e-mail address from?
 
OOPS! Sorry for posting private info. She got it, thanks Diane. I will not post private info moving forward My mistake. Also, Marje - I changed the numbers but the color coding for <50 did not change so I assume I did not effect the formula. I won't try to change the SS formulas again either!!!
 
Diane Tyler's Mom said:
I don't know if you can change it yourself but when using a human you need to change the the numbers up top where it is color coded
Click to expand...
Thanks but they shouldn’t change it. When I reformat it for a human meter, I change that as well. Changing those numbers alone doesn’t do anything.

TabbyCatMom said:
Also, Marje - I changed the numbers but the color coding for <50 did not change so I assume I did not effect the formula.
Click to expand...
I sent you a PM. It’s all updated now. Thank you!
 
You must log in or register to reply here.
Back
Top