? 3/20 Yum AMPS 518 +5 378 +8 537 PMPS 545 +4 439

[MJW]

Oh Yum...What is going on?

1. Lantus is interacting with lasix? They do interact "moderately", but I don't know how much.
2. Physical stress from UCM? I doubt this, because her respiratory rate is normal.
3. Cabergoline has stopped working? I beed to go back to every day instead of every other day dosing.
4. Her kidney infection did interact with her zoom down the dose ladder, when the cabergoline took effect. Her dose collapsed to almost nothing after 8 units, when she stopped eating. Maybe her new dose is somewhere between 8 and nothing.

She is very hungry and gaining weight. She lost a lot at the hospital, so the weight gain is not bad,
Her water consumption is increasing again.

 

[Stacy & Asia]

Yum has been through so much and she's such a fighter. I know it must be frustrating to see those numbers after how well she was doing before the hospital. She will get back, it will take a bit to play around and figure out how the meds interact. I hope you find the magic dose again soon!

 

[Teresa & KitKat]

Yum has been through so much and she's such a fighter. I know it must be frustrating to see those numbers after how well she was doing before the hospital. She will get back, it will take a bit to play around and figure out how the meds interact. I hope you find the magic dose again soon!

I am glad that Yum, is at home.

 

[Doodles & Karen]

So many things going on and you're doing a great job. Good to hear about her appy and gaining some weight. Keep doing what you're doing with her dose and hopefully you'll find that magical one again soon. Sending vines and prayers for you both

 

[LuvinThisPig]

What a beautiful fighting girl! Both of you have been through so much and I am in awe of you! You do so great with her... She will get back, I just know it!

 

[MJW]

AMPS + 8 537!!! Why?
She gets blood work done tomorrow.
I have to start thinking about using R again.

 

[MJW]

Does it make sense the effect of the lasix could be increasing? I decreased the dose by 50% over the past week (on Thursday/Friday).
Drugs.com shows this interaction

MONITOR: The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics, estrogens, gonadotropin-releasing hormone agonists, human growth hormone, phenothiazines, progestins, protease inhibitors, sympathomimetic amines, thyroid hormones, asparaginase, copanlisib, danazol, diazoxide, isoniazid, megestrol, omacetaxine, pegaspargase, phenytoin, temsirolimus, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes.

MANAGEMENT: Caution is advised when drugs that can interfere with glucose metabolism are prescribed to patients with diabetes. Close clinical monitoring of glycemic control is recommended following initiation or discontinuation of these drugs, and the dosages of concomitant antidiabetic agents adjusted as necessary. Patients should be advised to notify their physician if their blood glucose is consistently high or if they experience symptoms of severe hyperglycemia such as excessive thirst and increases in the volume or frequency of urination. Likewise, patients should be observed for hypoglycemia when these drugs are withdrawn from their therapeutic regimen.

 

[MJW]

I want to take her to 2.5 this evening. I know it breaks the rules. I need to retest her IGF-1, to make sure I don't need to add octreotide to her cabergoline.
Steroids cause permanent hyperglycemia?
Does lasix cause permanent hyerpglycemia?

 

[Bobbie And Bubba]

I am sorry that she is showing you such icky numbers right now. I hope the BW will shed some light . @Doodles & Karen , I think I remember the lasix raising Doodles numbers or interfering some how? Maybe all the hospital stress needs to settle down some more. Do I remember that she didn't get any insulin while in the hospital? Maybe the depot needs to get reestablished.

Sending you hugs

 

[Doodles & Karen]

@Doodles & Karen , I think I remember the lasix raising Doodles numbers or interfering some how?

Yes when we first started with the injectable form. Once I switched to the compounded chewables that settled down a bit. Ultimately switching to Lev was the game changer with the IAA.

 

[Doodles & Karen]

Lasik will not cause permanent hyperglycemia. It’s an in and out medication. His bg would go up because of recurring fluid which is when we increased the Lasik to every 6 hrs for 3 days to knock it down. I worked close with his cardiologist and not recommending you do anything without consulting Yums cardiologist. Did they say to cut the Lasik dose? Good luck with the BW tomorrow. Might want to add a chest X-ray too.

 

[MJW]

I am sorry that she is showing you such icky numbers right now. I hope the BW will shed some light . @Doodles & Karen , I think I remember the lasix raising Doodles numbers or interfering some how? Maybe all the hospital stress needs to settle down some more. Do I remember that she didn't get any insulin while in the hospital? Maybe the depot needs to get reestablished.

Sending you hugs

She was on her lantus in the hospital. They overdosed her once with 5 units instead of 0.5 units, but...they always dosed her.

 

[MJW]

Yes when we first started with the injectable form. Once I switched to the compounded chewables that settled down a bit. Ultimately switching to Lev was the game changer with the IAA.

Levemir has the same drug warning interaction with lasix as does lantus. No difference reported there.

 

[MJW]

Lasik will not cause permanent hyperglycemia. It’s an in and out medication. His bg would go up because of recurring fluid which is when we increased the Lasik to every 6 hrs for 3 days to knock it down. I worked close with his cardiologist and not recommending you do anything without consulting Yums cardiologist. Did they say to cut the Lasik dose? Good luck with the BW tomorrow. Might want to add a chest X-ray too.

Yum is no longer in congestive heart failure. She does not have fluid in her lungs or chest. The lasix is a preventive measure. She was on it by IV in the hospital and now I give it to her orally once every 12 hours. She just had a chest X-ray on Thursday.
You are saying Doodles' BG went up when he was in CHF: yes, that happened to Yum too, due to systemic stress. Today she is not in systemic stress.
Was Doodles on lasix long term on a daily basis? Did that cause a marked increase in his insulin dose?

 

[Doodles & Karen]

She just had a chest X-ray on Thursday

That's great news! Glad that got rechecked

Was Doodles on lasix long term on a daily basis? Did that cause a marked increase in his insulin dose

Yes Doodles was on a large dose of Lasix 30mg BID and sometimes 3 times a day for almost a year. He also had advanced HCM. The increase in dose was because he was tested positive for IAA at 78%. Yes, Lev has the same interaction with Lasix as Lantus. We think the switch to Lev helped breakthrough the antibodies associated with IAA.

I noticed big spikes when using Lasik as an injection in the beginning. We switched to the compounded Lasix chews and it seemed to help those big spikes. There were many things happening at the same time so it's speculation. Lasix did not have any effect on Neko's numbers.

 

[MJW]

Lasix did not have any effect on Neko's numbers.

@Wendy&Neko do you remember Neko's lasix dose?
I am giving Yum 6mg in a liquid every 12 hours. I wonder if 3mg every 6 hours would be allowed and make a difference. I am giving her medicines 4 times a day, as well as the 2 insulin shots. Wow. 30mg is a lot. Of course I am sure Doodles was much bigger than Yum.

 

[MJW]

Odd it has become dramatically worse today. She has been on the same lasix dose since Friday, which is when I cut it in half from her hospital discharge dose last Monday. Maybe something else is going on. I haven't checked her respiratory rate since this morning. Good thing we already had a visit scheduled with the vet for tomorrow morning.

 

[Wendy&Neko]

do you remember Neko's lasix dose?

2.5 mg every other day. ECID (each heart is different too) - I wouldn't dose Yum by what Neko got. Neko got liquid Lasix. It had no impact on her BGs. Like Karen, I followed the cardio vet to the letter. A distressed heart had a much worse impact on her blood sugar numbers.

Did the vet suggest you stop the chlopidogrel? I had a civie pass from a clot - no way I wanted to go there again.

Steroids cause permanent hyperglycemia?
Does lasix cause permanent hyerpglycemia?

No. Karen's Doodles came down when she switched from injected Lasix to oral. Neko showed no effect. Neko had no BG effect from the budesonide. The civie had a little bit of an effect from pred, from hanging in the 50's to the 70's. Cats here go down to their regular insulin dose once they taper off of steroids. Why are you thinking steroids? I would run that by the cardio vet. Neko's heart could not handle pred but could budesonide.

I'm glad you held the dose. A blue was only 3 nights ago. I'd hold this dose 6 cycles.

 

[MJW]

2.5 mg every other day. ECID (each heart is different too) - I wouldn't dose Yum by what Neko got. Neko got liquid Lasix. It had no impact on her BGs. Like Karen, I followed the cardio vet to the letter. A distressed heart had a much worse impact on her blood sugar numbers.

Did the vet suggest you stop the chlopidogrel? I had a civie pass from a clot - no way I wanted to go there again.

No. Karen's Doodles came down when she switched from injected Lasix to oral. Neko showed no effect. Neko had no BG effect from the budesonide. The civie had a little bit of an effect from pred, from hanging in the 50's to the 70's. Cats here go down to their regular insulin dose once they taper off of steroids. Why are you thinking steroids? I would run that by the cardio vet. Neko's heart could not handle pred but could budesonide.

I'm glad you held the dose. A blue was only 3 nights ago. I'd hold this dose 6 cycles.

Yum is on 6 mg twice a day, Neko 2.5mg every other day. Big difference. I will ask my vet about 3 mg 4 times a day.
I thought steroids permanently damaged cats and made them permanent diabetics. I was worrying that furosemide might do that too.
I can just increase her dose to cope with the furosemide, but what if this isn't due to the furosemide. If it's her acro, I need to add octreotide in with the cabergoline. I need to know what is behind these high numbers to take the appropriate action.

Right now I can't successfully dose Yum with the clopidogrel. I discussed it with the critical care vet. We agreed the pimobendan and the furosemide were the most important. The oral liquid clopidogrel makes her drool foam, an amazing amount of foam. Right nowI can't get even a tiny gel capped pill forced down her with all the liquid meds. I will discuss alternatives with the cardiologist on April 2. Maybe when I get rid of the antibiotics and possibly more of the lasix, I could successfully pill her. Maybe she will stop fighting the meds eventually. Maybe a transdermal gel would work. Yum has started sleeping in her carrier instead of near me, the medicine monster. She has made me start to chase her a few times.

 

[Wendy&Neko]

Some meds can be compounded into chew treats. Maybe that would work?

Higher IGF-1 doesn't cause higher BG's, that's the growth hormone. Not sure what value there is in retesting IGF1. Yes there are some side effects it would be good to control, like soft tissue growth.

Good luck at the vet tomorrow.