? 4May2020/MAXI/Update/Renal Threshhold Question*

bambinaki

bambinaki

Member Since 2010
Last thread: http://www.felinediabetes.com/FDMB/...itis-test-freestylelibre.229126/#post-2566078

Hello-

I am very happy to report that the plan is for Maxi to come home this afternoon!

I don't have all the info yet on what the vet wants me to do at home, but I do know the vet in charge does not want me to continue cabergoline; she wants to talk about starting octreotide, and not in combination with cabergoline.

I am actually leaning toward not continuing cabergoline for 2 reasons:
I'm afraid it might have triggered the pancreatitis.*
It wasn't working.**

*One of the 3 cats in the only published study of caberline for acromegaly in cats developed pancreatitis.
**Granted, the dose might not have been high enough.

I would like to have your input on discontinuing the cabergoline.

Thank you.
 
Glad to hear he is coming home. Ollie has had p'titis before she started caber. P'titis is quite common in diabetic cats anyway. Friskies food caused p'titis in my previous cat, it's just one of those things no one knows.
 
bambinaki said:
Thanks, Paula.
So, it is the case that something *can* trigger pancreatitis?
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Anything and everything can trigger it. Remember the pancreas is under duress because of the diabetes. It's the acro causing the diabetes so the pancreas is most likely fine (not like non acros), but it's still affected.
 
Yeah Maxi comes home today! :joyful: I hope he'll be so much better now.
bambinaki said:
but I do know the vet in charge does not want me to continue cabergoline; she wants to talk about starting octreotide,
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Ask the vet for copies of research papers that show that octreotide works in acromegalic cats.. I personally would love to see them if it''s something that can help acros. However, I think all she will find are papers that it does NOT work to give any long term effects. I think I saw one paper showing it had very short term effect but failed as a long term solution. There's a reason it's not used anywhere and researchers in feline acromegaly are not trying it.

As Paula said, we see lots of cats with pandreatitis here, acro or not. Maxi had been on cabergoline for almost a month with no problems. There may be some cumulative effects but Maxi would be the first cat here to get pancreatitis from cabergoline. Plus he's on a smaller dose than most. As for the "it doesn't work", all of the studies out there were at least three months long. One month is not long enough to make any conclusions. I will note he was starting to finally see normal blood sugar numbers. However, the decision to continue cabergoline or not is yours. You know your cat best.
 
Wendy&Neko said:
Yeah Maxi comes home today! :joyful: I hope he'll be so much better now.
Click to expand...

Thank you!

Wendy&Neko said:
Ask the vet for copies of research papers that show that octreotide works in acromegalic cats.. I personally would love to see them if it''s something that can help acros. However, I think all she will find are papers that it does NOT work to give any long term effects. I think I saw one paper showing it had very short term effect but failed as a long term solution. There's a reason it's not used anywhere and researchers in feline acromegaly are not trying it.
Click to expand...

I will.

I saw that one paper about it, too; it says only works for 90 minutes to lower growth hormone (or something -- but definitely ineffective long-term according to this paper).

Wendy&Neko said:
As Paula said, we see lots of cats with pandreatitis here, acro or not. Maxi had been on cabergoline for almost a month with no problems. There may be some cumulative effects but Maxi would be the first cat here to get pancreatitis from cabergoline. Plus he's on a smaller dose than most. As for the "it doesn't work", all of the studies out there were at least three months long. One month is not long enough to make any conclusions. I will note he was starting to finally see normal blood sugar numbers. However, the decision to continue cabergoline or not is yours. You know your cat best.
Click to expand...

This is agonizing. I wish I knew with confidence what to do.
I do have to point out that Maxi's appetite was starting to decrease 2-3 weeks into the cabergoline. I attributed it to being tired of the new(ish) LC and low phos food, and I was also thinking it could be because of kidney disease. But since he wasn't throwing up or having diarrhea, I didn't think it was the cabergoline. In hindsight, I think it might have been the cabergoline.
That is a very good point about his blood sugar numbers going down. But it's completely unknown if that was due to cabergoline or due to increased Lantus, right?
 
bambinaki said:
I do have to point out that Maxi's appetite was starting to decrease 2-3 weeks into the cabergoline.
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Week 3 was also when he started to see blues, therefore more insulin getting into his cells and less food needed to keep him full. It's really hard to figure out direct causes. All you can do is try one thing for a while, before trying something else.
 
I saw in I think pharmaceutical info on octreotide the short term one you inject 3 times a day subq. The long term one is monthly and it said can only be given by vet and it's IM injection.

I will say no more about cabergoline other than I'm not convinced it was the cause. I do wonder if it being olive oil might have contributed to it though.
 
Hello friends-

Maxi got home about 2 hours ago. He has gone to hide under a bed twice. He has peed twice. He is behaving the same way with food. He seems very interested in eating but when I put his low carb low phos Weruva canned food in front of him, he takes licks and walks away, then goes back. I added Wellness canned and he seemed to like it better but still only licks. I gave him pure Wellness and he seemed to like that better but still the same - licks and away. I added some dry pieces with the same reaction. He's been to the water bowl 2 or 3 times.
I have not given in and given him pure dry, but soon I will try that to see what happens.
The vet said give only cerenia because it was working, but I gave ondansetron 1 hour ago anyway.

I am very frustrated.
 
I left the clinic without the 'official' copies of test results, but they have since told me they would e-mail them.

What I have is the summary they gave with the discharge papers:
hyperglycemia 245
May 1: creatinine 2.6 BUN 38 phosphorus 5.5 (range 2.9 - 6.3)
May 4: creatinine 1.3 BUN 35 phosphorus 6 (range 3.4 - 8.5) [different ranges because different analyses: one in-house, one IDEXX]
urine specific gravity 1.019, pH 5 absence of ketones and glucose*
GI panel fPL 25.8

*Does this mean his renal threshhold is above BG of 245?

I spoke with the vet since coming home and she assured me that he ate more than only licks of wet food today.
 
Olive & Paula said:
Were they feeding him something different?
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They were feeding him their dry food, which is different from what I feed him, and they were feeding him his canned food that I brought from home. (At least that's the wet food I think they were feeding him.)
 
FYI, I read something, that at least in humans, octreotide causes abdominal cramps, nausea and diarrhea in 50% of patients. A couple more references saying it's no good for feline acromegaly: Pet Place, and DVM 360. It is a drug that is used to treat acromegaly in humans, but ever there only shows results in 50-60% of patients. Would be interesting to hear how many acrocats this vet has successfully treated with octreotide.

Please eat Maxi!
 
Wendy&Neko said:
I read something, that at least in humans, octreotide causes abdominal cramps, nausea and diarrhea in 50% of patients. A couple more references saying it's no good for feline acromegaly: Pet Place, and DVM 360. It is a drug that is used to treat acromegaly in humans, but ever there only shows results in 50-60% of patients. Would be interesting to hear how many acrocats this vet has successfully treated with octreotide.
Click to expand...

This is very useful, Wendy. Thank you! I'm going to share it with the vet.

I asked the vet about her motivation for using octreotide for Maxi. I'm not using her words, but she said it's their go-to drug for acromegaly. She said it's in the endocrinology textbooks. Radiation is the best treatment, but for those who don't do radiation, she recommends octreotide. She said she hasn't treated many cases of acromegaly, but nobody has treated "many" cases of it. She says in her experience octreotide has good results, that based on her experience, results were successful in 50% of cases. She said it took from several weeks to months to work. She said she would look for research papers and send them to me later in the week.

I'm leaning away from octreotide.

Wendy&Neko said:
Please eat Maxi!
Click to expand...

Well, here's the story on that this evening:

(I've just copied the remarks in Maxi's SS.)

Maxi released from hospital PM/seems interested in eating but only licked food/drinking a lot/4:50pm 2mg ondansetron/6:15pm 12mg cerenia, 93.75mg clavamox/peed 4 times between 4:30 & 11:30pm (last 3 were small pees)/continues to drink a lot/hides under bed on & off/9:15pm I found 2 acorn-size drops of very soft poo on the floor in different rooms & found quite a bit more than trace amount of poo on Maxi's butt/9:30pm BG 327, 7u Lantus/9:45pm 100mg gabapentin/9:30-10:00pm ate 3-4 oz of canned mostly Wellness, walking away and going back - not his normal way of eating

I asked why antibiotics and vet replied to cover all bases in case there's any underlying infection tests didn't show.

Wendy, did you see my question in post #21 above about renal threshhold?
 
If there’s no sign of infection I would consider stopping clavamox. It could be making him nauseous. When Max first got pancreatitis he wanted only dry food. I think it’s because the canned made him nauseous when it first happened. Of course i don’t know for sure. Has he eaten since getting the ondansetron? I hope the answer is yes!
 
bambinaki said:
I left the clinic without the 'official' copies of test results, but they have since told me they would e-mail them.

What I have is the summary they gave with the discharge papers:
hyperglycemia 245
May 1: creatinine 2.6 BUN 38 phosphorus 5.5 (range 2.9 - 6.3)
May 4: creatinine 1.3 BUN 35 phosphorus 6 (range 3.4 - 8.5) [different ranges because different analyses: one in-house, one IDEXX]
urine specific gravity 1.019, pH 5 absence of ketones and glucose*
GI panel fPL 25.8

*Does this mean his renal threshhold is above BG of 245?

I spoke with the vet since coming home and she assured me that he ate more than only licks of wet food today.
Click to expand...
I’m not sure exactly what your question is but if it’s regarding the statement “hyperglycemia 245” it’s not a reference to renal threshold. Hyperglycemia is just high blood glucose which is anything above the normal range.

If you are asking about the urine specific gravity that just refers to whether he’s concentrating his urine. Normal USG is above 1.040 but he was on fluids so we’d expect it to be below normal.

The vet wouldn’t be able to tell you exactly what his renal threshold is. In general, it’s thought renal threshold is above 250 on a pet meter but ECID.

I’m glad he’s home and I hope he starts eating.
 
bambinaki said:
Does this mean his renal threshhold is above BG of 245?
Click to expand...
Was that on the AT or a human meter? There is a time difference between sugar in the blood stream and when it makes it to the urine. I'd want to see more than one data point.

If you want to continue the clavamox, I'd make sure to give a probiotic. The antibiotic can kill good tummy flora in the tummy, making him feel off. But 3-4 oz of canned is pretty good!

If Maxi got 7 units of Lantus for some cycles in the hospital, can you put those in the spreadsheet too? I'd like to see how long until the depot builds again. And also worth asking them for any BG test data they have. I suspect at some point you'll need to increase.
 
Marje and Gracie said:
I’m not sure exactly what your question is but if it’s regarding the statement “hyperglycemia 245” it’s not a reference to renal threshold. Hyperglycemia is just high blood glucose which is anything above the normal range.

If you are asking about the urine specific gravity that just refers to whether he’s concentrating his urine. Normal USG is above 1.040 but he was on fluids so we’d expect it to be below normal.

The vet wouldn’t be able to tell you exactly what his renal threshold is. In general, it’s thought renal threshold is above 250 on a pet meter but ECID.
Click to expand...

I was thinking that with a BG of 245 and absence of glucose in urine, we could surmise that his renal threshhold is over 245.
Marje and Gracie said:
I’m glad he’s home and I hope he starts eating.
Click to expand...

Thank you!
 
tiffmaxee said:
If there’s no sign of infection I would consider stopping clavamox. It could be making him nauseous. When Max first got pancreatitis he wanted only dry food. I think it’s because the canned made him nauseous when it first happened. Of course i don’t know for sure. Has he eaten since getting the ondansetron? I hope the answer is yes!
Click to expand...

I'm with you on taking antibiotics only if necessary, but the doctor thinks there could be an underlying infection and though I'm on the fence, I'm giving him the clavamox. I was more convinced about it since he has sneezed a couple times this morning.

Can you recommend the least bad dry food to give him?

Thank you
 
bambinaki said:
I was thinking that with a BG of 245 and absence of glucose in urine, we could surmise that his renal threshhold is over 245
Click to expand...
It depends. As I said before, there is a couple hours delay from sugar in the blood to urine. If Maxi was below 200 for a couple hours, then came up to 245 just before the urine was tested, then no, that 245 doesn't mean it's his renal threshold. It could still be lower than that and what you were seeing in the urine was the BG from a couple hours previously. If you really want to know, get some ketodiastix and test at home.
 
Wendy&Neko said:
Was that on the AT or a human meter?
Click to expand...

I don't know.


Wendy&Neko said:
I'd make sure to give a probiotic.
Click to expand...

He has pooed twice, both times diarrhea but not as runny, light-colored, or stinky as before hospitalization.

At this point what dose do you recommend for
RenewLife Ultimate Flora S. boulardii 6 billion 500 mg capsules
and for
RenewLife Ultimate Flora probiotic 15 billion capsules ?


Wendy&Neko said:
If Maxi got 7 units of Lantus for some cycles in the hospital, can you put those in the spreadsheet too?
Click to expand...
Yes


Thank you!

@Marje and Gracie
 
Wendy&Neko said:
It depends. As I said before, there is a couple hours delay from sugar in the blood to urine. If Maxi was below 200 for a couple hours, then came up to 245 just before the urine was tested, then no, that 245 doesn't mean it's his renal threshold. It could still be lower than that and what you were seeing in the urine was the BG from a couple hours previously. If you really want to know, get some ketodiastix and test at home.
Click to expand...

I ordered some of those, but what they sent me were the same sticks that test only for ketones. Could you please send me a link to the correct ketodiastix that test also for glucose from a reliable source?

I don't think his glucose was below 200. They always reported 200s to 400s.

Thank you
 
bambinaki said:
Could you please send me a link to the correct ketodiastix that test also for glucose from a reliable source?
Click to expand...
Since I'm in Canada, not sure we have the same sources as you. Where did you order from? I see Walmart carries them.
 
bambinaki said:
I was thinking that with a BG of 245 and absence of glucose in urine, we could surmise that his renal threshhold is over 245.
Click to expand...
Agreeing with Wendy: that is not necessarily a conclusion you can draw. There is a delay between BG and glucose in urine. You can’t really tell with just one test.

bambinaki said:
At this point what dose do you recommend for
RenewLife Ultimate Flora S. boulardii 6 billion 500 mg capsules
and for
RenewLife Ultimate Flora probiotic 15 billion capsules ?
Click to expand...
You can try the therapeutic dose on the S boulardi......1/2 cap bid.
When my cats have been in an a/b, I’ve given as much as 50-60b cfu/day.
 
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