1. Summer and Susie

    Summer and Susie Member

    Joined:
    Dec 20, 2020
    https://felinediabetes.com/FDMB/threads/4-6-susie-258-amps.245790/#post-2774794

    I decided to stay with the same lantus pen. Susie had a couple of "lower-than-normal" blues last night.
    After reading Dr. Pierson's article on antibiotics for diabetic cats I decided to ask my vet for a compounded, flavored liquid antibiotic. I don't know what he is going to say but I don't like the fact that convenia stays in the body a lot longer than two weeks and Dr. Pierson does not recommend it. Susie also has the swallowing issues and I absolutely do not want to be trying to pill her - for anything. I just wish Dr. Lisa could have actually made a recommendation. I did send her site a Facebook message.

    Made an appointment with an Internist who deals a lot with cats and has experience with diabetic cats. I can't get in to see him until 4/22. Just hope he can help me determine where her infection is that is leading to the high blood test results. She has not been active at all lately and simply wants to stay in my bedroom most of the day.

    Wishing everyone a good day.
     
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  2. Christie & Maverick

    Christie & Maverick Well-Known Member

    Joined:
    Aug 1, 2017
    Try and also put things into perspective. You are still so early in this journey, so it is only natural to lack some confidence, and we all want our kitties to be safe. You are doing a great job of gathering data, and with time, you may find that you get a better sense of how Susie is responding, and what her patterns typically are. Hope you get some good feedback from the specialist about the source of her infection, not knowing what might be causing the infection must be a huge source of stress for you.
     
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  3. carfurby

    carfurby Well-Known Member

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    Feb 19, 2012
    Sending prayers. :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
     
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  4. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    I'm sorry that Susie hasn't been herself. Dr. Pierson probably can't recommend an antibiotic unless she knows what type of infection you are dealing with... you know... for a kidney infection... this kind is best ... for a dental infection... this is a good one. I did have a consultation with Dr. Pierson once (a paid one). She is great. You have enough on your plate with this and the upcoming internist visit (paws crossed that will be valuable). Good luck for getting the right antibiotic. We're all so concerned about Susie!
     
  5. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    The not knowing is a huge source of stress. How can you provide the right antibiotic if you don't know what is infected/inflamed? I am new at this but I'm still scratching my head, almost daily, with what Susie is doing. The last couple/few days she was high. Last night and now at +4 she had better numbers. On 4/4 she had a really good day. Everything is so whacky. I just don't know what I am doing differently to influence her levels. This house is almost always quiet and I feed her pretty much the same food so why the ups and downs? Anyway, as you said. This is a journey and I have a long way to go.
     
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  6. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    Thanks, Carla. Nice to see the 187 and 185 for Furball. Gives you kind of an adrenaline rush when you see the blues doesn't it?
     
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  7. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    Did you meet Dr. Pierson personally or consult over the phone or Internet. That is great. I'll be she was helpful. Yes, it is hard to determine the antibiotic she needs without knowing where the source of the infection is. I guess you just have to go with some kind of broad spectrum.
     
  8. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    I was not home a lot yesterday and so never saw the post. I think almost everyone is scared of low numbers at first. I didn’t start off testing at home because nobody I knew who had diabetic cats did. My vet had me come in for a nadir check every few days. I remember getting scared when I was there the second week and the nadir was 60 at +7. My vet wasn’t concerned at all! I bought a meter and brought it there to test it at his next check n case I saw signs of a hypo. Max was taken off insulin too soon for about 3 weeks as my vet felt he was going into remission. He wasn’t. When he went back on insulin I became a testaholic.

    I do think Susie needs an increase. You do want to try to keep her under renal threshold plus you don’t want insulin resistance by holding a dose too long. You definitely test enough to catch her from going too low. So when you are ready take her up to 2.25.
     
    Last edited: Apr 8, 2021 at 8:30 PM
  9. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

    Joined:
    Jul 24, 2019
    You are correct Summer, about Susie needing a broad spectrum antibiotic until the source of infection is found. Sometimes that takes care of the infection, and the source isn't found because the broad spectrum worked. That's both great and a little unnerving, but it can happen. Since your appt isn't until 4-22, I hope you get something now for little Susie, which I know you are working on!

    And I think you know that infection can influence BG numbers, usually raising numbers.
     
  10. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    Beautiful blue there mid-cycle! I do hope she settles down for you and that she starts to feeling a little better. Sorry you have to wait so long to find out what's ailing her as far as a source of infection is concerned.

    I hope she continues to slide down on those blood sugars for you though. One less thing to stress about :)

    Have a good day!
     
  11. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    I consulted with Dr. Pierson on the phone. I learned a lot, and she had lots of helpful information applicable to all cats.

    You know, Darcy periodically seems to get infections, and we really don't know what they are. The only symptom is usually that he stops eating (or eats very little) and he seems "off." Sooooo.... I take him to my vet.... we do a CBC ... his white count is elevated.... we start antibiotics... usually Baytril.... he gets better... starts to eat...perks right up.... I take him back for another CBC about 3-5 days after stopping the antibiotics and his white count is back down to normal I don't like it, but don't know what else to do at this point. All of his other blood work is normal (even when I add on the chemistry panel, which I did not do this last time because it's always normal lately, and I didn't want to spend any more money). So we really don't know what causes this to happen. I don't like not knowing. He already had two abdominal ultrasounds done last year (one when he was DKA and one a few months later to re-check everything, especially his liver) and we did the fine needle aspiration of his liver. But I have no idea why this happens to him (that he gets sick from time to time). It bothers me -- this not knowing.
     
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  12. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    I know! It's so crazy... I guess that's why they call it the sugar dance. I have been trying to explain to my husband since Darcy was diagnosed that it's not "linear," i.e. I give x units of insulin to my diabetic cat... his blood glucose drops to x units and he stays there.... and I just do this every day. I wish it were a linear function! Too many variables in the feline body, I guess (I wish it were just insulin + food and all stays nice and predictable!) I understand!
     
  13. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Cats are not like diabetic dogs or people unfortunately who do respond like we wish they would. The only better thing about cats and FD is if you are one of the lucky ones they can become diet controlled.
     
  14. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    I think almost everyone is scared of low numbers at first.

    Boy, I'll bet that is the truth for almost everyone, Elise.

    I do think Susie needs an increase. You do want to try to keep her under renal threshold plus you don’t want insulin resistance by holding a dose too long. You definitely test enough to catch her from going too low. So when you are ready take her up to 2.25.

    Elise, Susie had a 151 at +4 and a 111 at +6. Shouldn't I be holding her dose with a 111 at nadir?

    Thanks to all who responded. I finally received an email from Dr. Smith, the internist I am going to see on April 22. He does not feel convenia is bad for a diabetic cat or any cat that cannot take oral meds so I called my vet and said if he can't get me a compounded, flavored liquid antibiotic I would go with the shot. Dr. Smith also said Susie may not have an infection but may have an inflammation. I just hope this guy is legit and I'm not going from the fire to the frying pan.
     
  15. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    Tell Mr. Darcy to get his act together and stop costing you so much money ;) Just kidding. I know you love him.
    I think my vet is upset with me that I criticized his wanting to use convenia. Sometimes, I stick my feet into my mouth big time. I left a message that I would go with the convenia if he can't get me a compounded, flavored liquid antibiotic but I haven't heard from him all day and Susie needs something soon. His staff was a little "icy" with me when I called.
     
  16. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    You get a kind of "high" when you see a number that pleases you.
     
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  17. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    @tiffmaxee, @Christie & Maverick, @Sue and Luci

    With my nadir at 111 today and a 151 @+4 shouldn't I be staying at the 2 units (according to TR). At least for a little while? I am surprised she went back to the beach today after the high numbers the last couple of days but don't know what to do. Maybe she was still bouncing from 4/4. I will listen to what you all think I should do.
     
  18. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    I'd be ready to move on to 2.25 if I were you - however with that being said - are you able to monitor? Do you have plenty of strips for testing and MC/LC and HC foods on hand?

    She briefly visited the beach - nice medium blues and briefly visited a slightly lower blue - the goal here is to get more green time in the healing lagoon.

    You're still within a nice window of high possibility of remission - the first 6 months to a year. I do wish I could have done more with Luci during those first 6 months...perhaps our window wouldn't have closed...but it's long gone now and the hope of remission for Luci has diminished...

    However, you have a chance at it!

    Be brave and increase...you've held this dose long enough and she's not getting enough insulin yet to push her along to better numbers.

    That is my recommendation - let's see what the others have to say?
     
  19. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    Just wait until you get the shoot that green at AM or PM pre-shot time! It's exhilarating to shoot the greens!!
     
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  20. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Summer

    I saw your discussion about antibiotics on 4/6. FWIW, I agree with @Suzanne & Darcy. Convenia is not a broad spectrum antibiotic. Also, I had a substitute vet working for my vet who gave it to Gracie without asking me and she went into anaphylactic shock. Once that antibiotic is in, it’s in and the effects can be very long lasting which is not good if the cat is sensitive to it or if it’s being used for the wrong reason.

    Clavamox is a very good, broad spectrum antibiotic. It can make some cats nauseous but I’ve had several cats that could take it for 14 days with no issues at all...Gracie was one do them. I would be cautious about using Baytril. It is primarily used to address things like kidney infections but if it is given at the wrong dose, it can cause neurological problems. So...I’d try to stick with something like clavamox. Be sure she has food on board as that will help with upset tummy issues.

    Clindamycin is good for oral infections.

    If you decide to go with the flavored, compounded antibiotic, be sure they do not put any sweetener, even artificial like maltodextrin in it...because they usually do when they flavor it.
     
    Last edited: Apr 8, 2021 at 2:45 PM
  21. Christie & Maverick

    Christie & Maverick Well-Known Member

    Joined:
    Aug 1, 2017
    Well let's see if I can help and perhaps try and talk through what I'm thinking :). Here's what I see. We're on 11 days on 2u. There was a little movement, on 4-Apr which is excellent, and you handled it well, she gave you a sign she might drop, with that +2.25 test, and you got another test (yay :D), fed a little LC and she came back to blues. Don't forget, using food to control a drop early in the cycle is an excellent tool available to you. So far, it seems that LC did the trick.

    I think she tried to break the bounce from the 91 on pm cycle of 5-Apr, but she didn't get as low as the number that started the bounce. She came down a little today, but I think for the most part you've given 2u a good amount of time to see what it can do. Most of the rest of her cycles, she is spending time in higher numbers, and you test well-enough to be able to see what her onsets are, her nadirs, and how much duration she is getting from this dose.

    I've been known to linger over doses, wondering whether if I give it a couple more cycles, I'll get into overall better ranges. I end up needing to increase. From what I see when I look at Susie's SS, the patterns would be such that I would want to increase, if it were me. Hope this helps.
     
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  22. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    Or terrifying. Will go to 2.25 tomorrow morning. I am able to monitor and have my took kit ready and plenty of strips.
     
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  23. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I agree with @tiffmaxee, @Sue and Luci, and @Christie & Maverick .....unless you see green today or tonight, it’s time for an increase. I say “or tonight” because some members prefer to increase in the morning in case kitty drops in response to the first increase. Maybe Susie will or maybe she will get a bit of NDW so, your choice.

    Bounces typically clear sometime within six cycles. Does that mean you have to wait all six cycles before increasing even if you know she needs an increase? No, you don’t have to wait as long as you don’t increase on the cycle that she’s clearing the bounce only because that can make for a very, very active cycle. We generally suggest new members wait six cycles if the bounce hasn’t cleared before then because they don’t have data but you do. Once a member builds data, use it, and increase the dose when it needs to be even if she’s bouncing ...again, as long as you don’t increase on a bounce clearing cycle.

    I would have increased the dose on 4/5 in the pm cycle or the very next morning. Why? Because when she cleared the bounce, she didn’t get back I to green numbers and her one green nadir on this dose was fairly high.
     
  24. Summer and Susie

    Summer and Susie Member

    Joined:
    Dec 20, 2020
    Going to 2.25 units tomorrow morning. As I told Sue, I have the time to monitor, I have the toolkit and I have the strips. "No time like the present" right folks?
     
  25. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    Thanks, Marje. Good to hear from you. I am so grateful for everyone on this site encouraging me. Just a little frightened because her numbers are so unpredictable. I'm also hoping to either get her a shot of convenia tomorrow at the vet or get some kind of compounded, flavored liquid antibiotic tomorrow. I know you folks don't like convenia but I have to get something for her soon and she has had the convenia before with no adverse side affects (that I know of).
     
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  26. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    Good point about the compounded flavored stuff. Sometimes they put sweetener in there that can really mess up blood glucose. I've seen this happen with other diabetic cat parents.
     
  27. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    At this point I will be lucky to get anything. I think my vet is furious with me for questioning his convenia decision. I have not heard anything from him all day and Sus needs an antibiotic. For infection or inflammation.
     
  28. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    That is terrible. If your vet is that big of a jerk, I'd get a new vet... I know, this is not the time.... I'd probably get the antibiotics from him and get all my records and get a new vet (after I got all the records). Of course, you've already got the internist appointment set up for 4/22. I'm so sorry. Surely it is unethical of him to prescribe nothing (or drag his feet). Hopefully, he just is having a busy day and you will hear something soon. What time do they close? I'd be calling over there again before closing time to inquire about my antibiotics.
     
  29. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    If that's true it is completely unprofessional and uncalled for! You're the client, the paying customer and whether or not he 'likes' your questioning his recommendation - and remember it is just that a RECOMMENDATION - not the gospel, not law...and it's up to you - an informed client - to decide to take his recommendation or not...

    I find it appalling that any health care professional of any kind can be allowed to be 'furious' with anyone - not professionally anyway!

    I would as Suzanne said - be showing him the door (or in this case you don't have to go back thru his door -ever again)...find another vet post haste!
     
  30. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    I pissed him off, Suzanne, and now I am not hearing from him. It is my fault that I get so "block headed". I can understand his anger with me but surely he must see that Sus needs something.
     
  31. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    It is all my fault that he did not get back with me and I don't blame him, in a way. I think that we need these vets - whether we agree with them or not - and I need to learn to shut my mouth about things I do not agree with. Who else is going to help me now if he refuses? I'll call first thing in the morning and say I want to schedule the convenia shot for Sus and see what happens. I hate losing this vet office but if I do I only have myself to blame. It is so late to start over with a new vet regarding Sus. I hope I can "grovel" myself out of this tomorrow.
     
  32. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    They are closed. Closed at 6:00.
     
  33. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    It is not your fault. Unless you were rude or something, then the vet is in the wrong and not you. There is nothing wrong with saying that you would like another antibiotic. There is one vet near my house that is convenient, and is very nice, and relatively inexpensive. When it is something very simple and I want my cat to be treated by him, I take a cat there (never Darcy, he's too complicated). I can't tell you how many times he's suggested Convenia shots. He's really big on them... I think it's because of the type of clientele that he has. They just aren't going to pill their cats and they're the type who take the vet's word as the absolute truth/last word on everything. Every time he suggests the Convenia shot, I say that I am not comfortable with them and I would like to try an oral antibiotic instead. He always lets me have what I want. He doesn't get mad.
     
  34. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    Aren't there any other vets in your town? I think you should try to get some liquid antibiotics from them tomorrow and really need a new vet. A vet with that big of an ego that a client cannot say that they'd prefer to not have the antibiotic injection is a danger to Susie.
     
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  35. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    And Susie had a Convenie injection a few weeks ago and the only thing that happened is that he liver enzymes got much worse (and the neutrophils).
     
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  36. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    Yes. It could be inflammation (usually the white count itself would be elevated) and I do not believe Convenia is anti-inflammatory (like say Metronidazole or even Cerenia, I believe).
     
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  37. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    In answer to your questions, I was rude with my vet. Yes, Sus had a Convenie injection on March 2nd. It was to clear up her red spots on her belly and it did work and her spots are gone. I can be very "hot headed" at times and I think I have really blown my contacts at this vets office. Granted, I have not always trusted them, especially with my Maddie last July when we (the ER hospital) thought she had a brain tumor but my vet did not detect it. I would not mind switching vets but I think this is a horrible time to do it. Sus needs antibiotics now (I think). Whether she has an inflammation or an infection I just can't leave her hanging because of some stupid comment I made to my vet. As I said, I will call first thing in the morning. I will suck it up and try to get her a convenia shot and I will take it from there. Thanks, Suzanne. Sus is going up to 2.25 units first thing in the morning.
     
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  38. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    I hope the increase will work well for Susie!
     
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  39. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    Yes, liver enzymes, or ALT, did go higher. ABS Neuts were incredible but the Internist that I will be taking her too said they were not "sky high" as I suspected. Sometimes I feel like I am going from the fire to the frying pan with these vets.
     
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  40. Butters & Lyla

    Butters & Lyla Well-Known Member

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    May 30, 2020
    Best of luck with the increase for Susie tomorrow, Summer! Butters was constantly petering out at a dose for a while. I'd see blues on it, and then nothing but yellows and pinks, and had to keep increasing for a while before I consistently saw better numbers. I hope Susie comes down on the new dose.
     
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  41. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Good luck with the new dose. Max had elevated ALT levels but my vet said it’s not concerning unless a minimum of double the high normal range. With Max it coincided with pancreatitis flares.
     
  42. Summer and Susie

    Summer and Susie Member

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    Dec 20, 2020
    I am worried about pancreatitis and the fact that my vet could not find her pancreas, on her March 2nd ultrasound, has always concerned me.
     
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  43. Margaret (and Pearl)

    Margaret (and Pearl) Member

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    Dec 23, 2020
    You pick a thorough, safe, broad-spectrum antibiotic. Like Veraflox. Not many of them out there that will tackle infections all throughout the system.
     
  44. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    To get the best results you need a Board Certified Radiologist to do the ultrasound. Let me tell you a brief story. When Max got sick when he was 10 and his sister was losing her battle with intestinal lymphoma, Max had an ultrasound done by a traveling vet who only did ultrasounds. He found all kinds of things wrong but said nothing about pancreatitis. His recommendation was exploratory surgery. I went back to my original vet to see if he felt an endoscopy would suffice or he needed exploratory surgery. His response was that he was not convinced he needed either. He wanted his radiologist to do another ultrasound and he wanted to run a SpecFpL and pancreatic enzyme panel. The diagnosis was pancreatitis. His enzymes were normal. He did not need surgery and never had cancer of any kind. I had brought the disc from the first ultrasound but my vet said it was worthless as it only shows what the vet centered on. Paying for two ultrasounds in a week did not make me happy but far better than exploratory surgery. An ultrasound is only as good as the person who does it.
     
  45. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    Yes. I have been pondering over the high absolute neutrophil count, which is outside of normal range as well as the eosinophils (another white blood cell) and now her overall total white blood cell count is also outside of the normal limit. I hope it's just an infection and will clear up with the appropriate antibiotic. I am very sorry for you, since I know you must be anxious now about Susie and are having vet problems.
     
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