9/25 Oberon +9.25 258, AMPS 157, +1 138, +2 117, +11 96, PMPS 115, +1 191, +2 200, +4 240 vet update

Lisa & Oberon

Lisa & Oberon

Member Since 2020
yesterday: ketones up in the evening; brief ER visit (fluids, Cerenia): https://www.felinediabetes.com/FDMB...-ketones-2-7-possible-dka-3-404-6-325.235837/

Quick summary of yesterday: Ketones were 2.7 at PMPS and he vomited up dinner, so I took him to the ER. Vitals were fine; they didn't do any labs. They said I needed an internist and theirs is out for 2 weeks, so recommended another place further away. They gave him fluids and Cerenia for the nausea and I brought him home overnight. Calling the other vet asap this morning.

Heading into another dip (157 at AMPS); my guess is he's going to bounce right back up as usual. Gritted my teeth and went ahead and gave him the shot. (Shoot low to maybe stay low?) Figures he's low the one day I'm taking him to the vet. ("I know it's low now, but really, it's high!")

It looks like the combination of the dip and last night's fluids have brought his ketones back down... 1.2 at AMPS. Still not good, but better than last night.

Once thing I realized overnight is that when he came back upstairs from using the litter box late last night, he cleaned himself a lot more than usual. Thought at first it was just nerves from being at the vet, but now I'm wondering if he's licking himself there because it's painful, not because he's cleaning. UTI? That would explain a lot.
 
I'm sorry to hear that he wasn't well last night.

Yes, Lisa, you did the right thing - it's important to get that blood glucose under control as it's the reason for the ketones - his kidneys are working hard because of the high blood sugar - so hopefully this lower number is a good sign of improvement. Keep an eye on him so that he doesn't drop too low today. I hope he'll eat a little something and that the Cerenia helps with the nausea.

Sending you prayers and feel better vines this morning! Keep us posted! :bighug::bighug:
 
I’m glad you gave the insulin. That’s very important if there are ketones in the picture. And get him to eat as much as he will tolerate. That also helps keep ketones at bay.
good luck at the vet. Please keep us posted.
 
Internists are fully booked until November (!), but since he's got ketones they're getting him in by way of the ER. Heading out as soon as I can get myself organized. They want me to email his records instead of sending a physical copy, so I have some scanning to do.
 
Doesn't it just figure that Oberon gives signs he is heading to the beach today. Keep on testing him if you can.
Will be keeping an eye out for any updates. Good luck at the vet.
 
Tested right up until I walked out the door, and tried to impress on the tech just now at dropoff that he's dropping fast and needs food, and that this low isn't "normal" for him and he'll probably bounce back up soon. Hanging out in the lot now waiting to hear back after initial triage. I think I'm going to be proctoring an online exam from my car this morning. o_O
 
Talked to the ER vet. BG is 86; they'll feed him and keep an eye on it. Ketones are nice and low. They want to do an ultrasound and they'll check for a UTI. Later the internist will review everything I gave them and the tests (ER vet was most impressed with all of my records) and we'll take it from there. I'd head on home, but my class starts in 5 minutes so I'm stuck in this parking lot for a while longer.
 
Wow, my boy has a lot going on. He's doing well, eating and BG is staying low but not too low. Here's the scoop:

Ultrasound:
liver, gall bladder, spleen all ok
pancreas shows signs of pancreatitis; could be from episode in July and not active, but uncertain
adrenals are somewhat enlarged (Cushing's?)
couldn't find his left kidney (shrank? or wasn't born with it? no prior ultrasound for comparison)
right kidney maybe shows signs of inflammation and shrinkage (CKD?)
GI tract thickened, signs of inflammation (IBD?)

Waiting for urinalysis (results tomorrow) and urine culture (results in a couple of days)

Current plan:
pick him up this evening (home in time for evening Lantus)
fluids, Pepcid (injectable), and Baytril (liquid) over the weekend
Stick with current Lantus dose for now, continue BG and ketone testing

Monday:
drop off after morning Lantus dose
all-day test for Cushing's
fructosamine, B12 (IBD could cause malabsorption), IGF (acromegaly) tests

Later:
teeth could stand cleaning but aren't bad- hold off while we get a handle on everything else
hold off on IAA testing for now
possible endoscopy later to biopsy GI
may think about changing insulin
 
Just got home and got a +11 BG (96!). He's ravenous, so maybe against my better judgement I gave him a little bit of food just now. PMPS could be interesting.
 
From the vet paperwork: BG at the vet was done every 2 hours between 10 and 4: 82, 79, 92, 92. That's on the vet's meter and I'm guessing it's venous, not capillary blood. Any thoughts on how that would compare to my human meter, or how I should then plan for his evening dose?
 
He's 115 at PMPS. Coming up a little, but he also ate a little. Ketones are 0.9, so that's an improvement. Do we think I'm ok to give him the full dose? Stall and test in 20 min? I have supplies (honey, LC, MC, HC foods, plenty of strips, etc.). I'm also exhausted after the past couple of days but could stay up to monitor.
 
I think you can shoot as long as he is eating and you will be awake enough to monitor tonight. There is a chance he may bounce.
 
I will comment more later, but get the IAA test done at same time as IGF-1, It is a very cheap add on when done at the same time. I have seen several kitties come back negative for acromegaly, and then the caregiver needs to get more bloodwork and wait again for results.

Did Vet have a human or pet meter?
 
Wendy&Neko said:
I will comment more later, but get the IAA test done at same time as IGF-1, It is a very cheap add on when done at the same time. I have seen several kitties come back negative for acromegaly, and then the caregiver needs to get more bloodwork and wait again for results.

Did Vet have a human or pet meter?
Click to expand...

Thanks, I'll see if I can get the vet to do both tests.

Not sure about the meter. I would guess feline. but I don't know for sure. His foreleg is shaved, so I'm assuming they drew blood from there, for what that's worth.
 
Lisa & Oberon said:
adrenals are somewhat enlarged (Cushing's?)
Click to expand...
Cushings is caused by either a pituitary tumour (different than that one that causes acromegly), an adrenal tumour (less common), or can also be caused by steroids (also not common). Cushings cats commonly have a pot belly and thinning fur on the tummy too, and at later stages other skin issues.

What is the thought on changing insulin?
 
I just realized that with everything going on today I completely forgot that he was actually supposed to get a dose increase tonight. Does today's surf plus the fluids, etc. that he's been getting change that? Or should I increase his dose tomorrow? I'm inclined to wait and see what happens if he stays at 4.5 a little longer.
 
Ditto what Wendy said about getting the IAA test.

Do you know if they did a UCCR (urine cortisol:creatinine ratio) test?

Also to the best of my knowledge, Cushings is more typically pituitary-dependent rather than adrenal dependent. Does your cat have thin or paper-like skin that tears easily?

Just curious, but what Cushings testing are they planning? ACTH stimulation? Dexamethasone Suppression?
 
Wendy&Neko said:
Cushings is caused by either a pituitary tumour (different than that one that causes acromegly), an adrenal tumour (less common), or can also be caused by steroids (also not common). Cushings cats commonly have a pot belly and thinning fur on the tummy too, and at later stages other skin issues.

What is the thought on changing insulin?
Click to expand...

Yeah, Cushing's seems less likely to me (and there's so much other obvious stuff going on), but with the enlarged adrenals she wants to rule it out.

I only talked to the ER vet, who relayed things from the internist, but the internist's notes say to consider switching to PZI if everything else tests normal and he keeps having ketones. I haven't had a chance to think that through at all yet. (Also need to read up on CKD, IBD, and other stuff, but I don't have the brain power for it tonight and maybe it should wait until we have confirmed diagnoses anyways.)
 
JL and Chip said:
Ditto what Wendy said about getting the IAA test.

Do you know if they did a UCCR (urine cortisol:creatinine ratio) test?

Also to the best of my knowledge, Cushings is more typically pituitary-dependent rather than adrenal dependent. Does your cat have thin or paper-like skin that tears easily?

Just curious, but what Cushings testing are they planning? ACTH stimulation? Dexamethasone Suppression?
Click to expand...

Dexamethasone supression. Don't know yet what urine tests they ran; I'm getting those results tomorrow.
 
No on the increase with those greens, doses with green nadirs we hold 10 cycles.

PZI? Going backwards. Especially if he's not a low dose kitty. There are ways we can battle ketones, and that's using Humulin R to take the edge off. It's a fast acting bolus insulin that can lower the numbers enough to give Lantus (or Levemir) better numbers to work with. There are people here who are experienced using R (including myself) who can help you learn how to use it.
 
Wendy&Neko said:
No on the increase with those greens, doses with green nadirs we hold 10 cycles.

PZI? Going backwards. Especially if he's not a low dose kitty. There are ways we can battle ketones, and that's using Humulin R to take the edge off. It's a fast acting bolus insulin that can lower the numbers enough to give Lantus (or Levemir) better numbers to work with. There are people here who are experienced using R (including myself) who can help you learn how to use it.
Click to expand...

Thanks; should have reread the TR protocol.

With luck he'll clear the ketones now that BG seems to be coming down a bit more and he's getting fluids, and PZI won't even be an issue. I'll discuss the Humulin R idea with her if it comes up.
 
If you talk to the vet about R, we use very tiny amounts and proceed very slowly and cautiously.

Paws crossed those ketones are in the rear view mirror now.
 
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