6/29 Khloe AMPS 428, +2 399, +5 210, +6 161 [STILL INCREASE DOSE?]

Sara & Khloe

Sara & Khloe

Member Since 2026
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1st: She’s in a big bounce right now. But I assume if she doesn’t get down to low 100s or greens today or tonight, then it’s increase 0.25 tomorrow?

2nd: I received her old labs from February when she was diagnosed with FD. And from what I can tell, it was recommended to investigate further for the protein in the urine. Haven’t received a phone call from my vet yet but when I do, I’ll mention the further testing I’d like to do to see what is causing the litter box nightmare. Luckily, no pees outside the box today so far but this is probably jinxing it.

(Note that my vet said her labs looked fine when we got the results back but did mention that he thought the lab accidentally forgot a decimal or something on one result. I assume he was referring to the Triglyceride. Which is.. crazy high)

I also see some comments about pancreatitis and hyperthyroidism. From my simple google search, here’s the clinical signs I’ve noticed in her that go with these 2 things.

- She occasionally licks her lips when eating, which I’ve heard is a sign of nausea.
- She was begging for food often but it has toned down some. Human food is still something she begs for tho.
- Extreme vocalization, specifically at night. You can see I’ve noted this a few times in the SS and there have been times I’ve forgot to write it down.
- She started FD at 13 pounds, has moved up and down alittle over the last few months with the most recent weight being 12.2 pounds on 6/27 (I feed her 266 calories a day but she doesn’t always finish every single meal)
- and of course, the main thing I’ve noticed is not using the litter box to pee.

I’ll have to spend some time today adding all this info to her SS but for now I’ve attached images of the PDF so I could block out the private information.

Any thoughts on the labs of things I should investigate further? I know we need to do a cystocentesis with culture & sensitivity to rule out UTI but anything else I’m missing?
 

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Hi Sara,
I will comment on things I have learned with Ivy, since she has hyperthyroidism and has had pancreatitis.
Keep a close eye on the T4, right now it was 1.2 (back i February). Normal range.
The extreme vocalization can be a sign of this issue.

Pancreatitis, yes, her level was high. Was she not eating? Did she have loose stools?
Lip smacking is a sign of nausea, you are correct.
Was it treated at the time?

It's really good to have meds on hand if she tends to get pancreatitis....ondansetron, Cerenia and mirtazipine (in case you ever need them. The best thing is to treat with these meds immediately and it can stem the flare up quickly). Ondansetron is a generic human med, you can get at any pharmacy cheaply.
The others are pet meds (chewy carries them) and you need a script from your vet to get them). *Usually cheaper than from your vet.
Buprenorphine for pain is very very helpful, most vets won't dispense unless they have a flare going on (some actually will dispense to keep at home, my vet won't as it's a controlled substance).

I also suggest Jarrow S. Boulardii (for loose stools, it's very helpful).

Hope this helps! :bighug: :bighug:
 
Staci & Ivy said:
Pancreatitis, yes, her level was high. Was she not eating? Did she have loose stools?
Lip smacking is a sign of nausea, you are correct.
Was it treated at the time?
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Hey Staci, thanks for your insight.
When those labs were taken, she had extreme hunger and was eating her entire bowl (she was on a free feed dry diet her entire life until I learned better).
She did not have loose stool either.
The nausea was not treated.

The only time she had loose stool was on Bexacat. But as soon as she stopped taking it, the loose stool immediately disappeared. (The labs were taken before Bexacat was started)

I bookmarked your message so I can come back to those meds if need be. Looks like at least one was already suggested to me so nice that it can work for multiple things.
 
The issue with the protein in urine is that it is too late to run the UPC ratio. You’d need to do another urine sample and urinalysis and have the vet add on urine protein:creatine ratio. The USG looks good, she’s concentrating urine nicely. That’s one indication of kidney function. Kidney values of BUN and creatine are normal, did the vet say anything about the BUN/creatine ratio being high? With the acute pancreatitis, I believe that it is possible that might have contributed to protein in urine. It’s possible the 2+ protein in urine was a one off, so I’d probably just watch in case it happens again at next lab work and urinalysis. Either @Wendy&Neko and @Marje and Gracie can help clarify.

Good luck with the increase tomorrow, unless Khloe decides to surprise you tonight.
 
My vet always suggested a second test a while later if results were off, in case it was just a one time occurrence. And didn't get concerned about running the UPC ratio until Neko got to a +3 on the urinalysis. Has Khloe ever had her blood pressure tested?

You might find it handy to enter the labwork results on the Labs tab of the spreadsheet. I find it a really good tool for spotting trends. Since Neko, the non diabetics have also had Labs tabs.
 
Wendy&Neko said:
My vet always suggested a second test a while later if results were off, in case it was just a one time occurrence. And didn't get concerned about running the UPC ratio until Neko got to a +3 on the urinalysis. Has Khloe ever had her blood pressure tested?

You might find it handy to enter the labwork results on the Labs tab of the spreadsheet. I find it a really good tool for spotting trends. Since Neko, the non diabetics have also had Labs tabs.
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I think I'll go ahead and have them do bloodwork again in early July to see how she's looking.
No, she's never had her blood pressure tested. I'll mention having that done too when I hear from my vet.

and will do! Good idea to do that for my civvie too.
 
Did you ask about the urine collection method? The test for the UA says the type is "not stated." A cysto is the best diagnostic tool for UTI. My vet looks for the presence of blood, protein, epithelial cells and bacteria. If any of those are elevated, he sends the specimen away for a culture and sensitivity. If Khloe is urinating outside the box, there is likely a reason. It might be something health related, or it might just be behavioral.
 
Mary & Jude said:
Did you ask about the urine collection method? The test for the UA says the type is "not stated." A cysto is the best diagnostic tool for UTI. My vet looks for the presence of blood, protein, epithelial cells and bacteria. If any of those are elevated, he sends the specimen away for a culture and sensitivity. If Khloe is urinating outside the box, there is likely a reason. It might be something health related, or it might just be behavioral.
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My vet never contacted me today so I'll call again tomorrow. I'm defiantly going to have a cysto done even if she had one back in Feb. She hates car rides so I want to get any tests she needs in one visit. Hopefully I can get this poor girl feeling better asap.
 
Sara & Khloe said:
My vet never contacted me today so I'll call again tomorrow. I'm defiantly going to have a cysto done even if she had one back in Feb. She hates car rides so I want to get any tests she needs in one visit. Hopefully I can get this poor girl feeling better asap.
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I wouldn’t worry about the Precision PSL test for pancreatitis. It’s very inaccurate. My vet said she has seen it totally normal for cats who obviously had pancreatitis and, like my completely healthy girl, one time it came back with a crazy high number.

My cats often had 2+ urine protein but they also eat a homemade balanced raw diet. I don’t think there’s a rush but next time you have labs done, get the senior panel which includes the superchem, cbc, T4, and urine. They usually hold onto the urine sample for a day or so if the urine protein came back high, you could have a urine protein:creatinine ratio done right away.

Feline diabetics usually have high triglycerides but hers are really high. I have had Antech make errors on labs. Something to watch.

Insofar as peeing outside the box, have you changed litter or where you have it located? Any changes to her other daily habits ?
 
Connie & Moonie said:
Go Khloe!!! That was a really nice run of blues last night. She must have sensed a dose increase was coming.

It feels like a green is just around the corner 💚 - honestly with meter variance she might have already been there. She got to 102!
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Sorry to bump this again! But now I’m conflicted if I should do the increase this morning. I’ve already held for 10 cycles but she had a nadir of 102 twice at this dose.

Hmmm… I know you’re new too. Hopefully a mentor is up this early 😅
 
@Tim & Pookey Hey Tim, I’m so sorry to tag you but you’re the only one I see active this morning. Do you suggest I proceed with the increase this morning after a nadir of 102 last night and she had one other 102 nadir during the dose hold?

I’m about 15-30 mins behind on insulin time so again, sorry for the tag!!
 
TR says: "when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing."

102 is a good number. But I'm looking at the plural use of the word nadirs. You've been on 2.5U for 10 cycles. So even if you consider meter variance on the 102 and say its a green, I would think you'd still be wanting to see more of those kind of numbers as opposed to just the occasional.

If she were my cat I'd increase by 0.25U to 2.75U. You test enough to keep her safe and I'm sure you have the supplies.

Or, if you're more comfortable, one more cycle at 2.5U while you wait for Christie and them to respond won't be the end of the world.
 
Tim & Pookey said:
TR says: "when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing."

102 is a good number. But I'm looking at the plural use of the word nadirs. You've been on 2.5U for 10 cycles. So even if you consider meter variance on the 102 and say its a green, I would think you'd still be wanting to see more of those kind of numbers as opposed to just the occasional.

If she were my cat I'd increase by 0.25U to 2.75U. You test enough to keep her safe and I'm sure you have the supplies.

Or, if you're more comfortable, one more cycle at 2.5U while you wait for Christie or them to respond won't be the end of the world.
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Ok thank you so much Tim!! I already have the syringe loaded with 2.75

Again so sorry to tag you! Very very much appreciate you!
 
Sorry getting caught up! Obviously I’m super new (and not qualified to be giving advice) but for whatever it’s worth, if Khloe were my cat I would have increased too. Personally I’m trying to go for green nadirs in the hopes that brings blue preshots, so I would have gone for it. Plus you’re so good about testing and monitoring and have done a lot of carb sensitivity testing at this point so you can always bring her up :)

Good luck with the dose increase today!!! I’m excited for you two 💚💚💚
 
Sara & Khloe said:
Sorry to bump this again! But now I’m conflicted if I should do the increase this morning. I’ve already held for 10 cycles but she had a nadir of 102 twice at this dose.

Hmmm… I know you’re new too. Hopefully a mentor is up this early 😅
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Sorry I am not up that early. 😉

@Tim & Pookey gave the correct advice. When you are seeing blue nadirs, we hold the dose a total of ten cycles which you did. If we are not seeing any green nadirs in that timeframe, it’s time to go up.

Good luck with the increase.
 
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