9/26, Susie, 287 AMPS, 240 @+2, 174 @+3

Summer and Susie (GA)

Summer and Susie (GA)

Member Since 2020
https://felinediabetes.com/FDMB/threads/9-25-susie-292-amps-274-2.253430/#post-2858096

I have already spoken to Adrienne (Dolly's Girl) but if anyone else has ever had the UPC test (protein:creatinine ratio panel) please let me know if you received conclusive information on what was wrong with your cat. What were you told? Or, were you just still left in the dark about the protein in the urine.

I increased Susie's insulin to 1.25 units last night. I put FF turkey & giblets in front of her this morning. She would not eat so I got some Friskie's turkey & gibblets and put that next to her other food bowl. She looked at both bowls, took a couple bites of the Friskie's then went back to the FF and started eating. She ate about 2/3 so I am feeling a little better.

I'm still debating my plans for her. Can probably get her in to my vet today for the urine sample and some fluids but might hold off and take her to the ER tomorrow when the Intern is in. I would rather avoid the ER due to cost but will watch her today.

UPDATE: I decided not to do the UPC test.
 
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Suzanne & Darcy said:
If you are not already overwhelmed :-( here is an article I was just reading for my own edification on the Urine Protein Creatinine Ratio test.
https://vcahospitals.com/know-your-pet/urine-proteincreatinine-ratios
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Good article, Suzanne. I don't think either one of my vets know how to do this test properly. The one I actually saw the other day said I needed to get a urine sample three days in a row. The one I spoke to on the phone said I only need one urine sample. According to the article I need three samples, taken two weeks apart, to get an accurate test. I wonder if that means I would be paying $151 for each sample. No way could I afford this. Also, the article says I might not get conclusive information from the results and further testing would be required. :eek: I think I am going to skip this test, try to get some fluids in her today or tomorrow and hope I can get her eating after the fluids. Did you get your sub-q materials directly from the vet or can your order online without a prescription? I did them before with my CKD kitty but don't remember all the details.
 
Thrivingpets.com has sub-q products but I don't know if a prescription is required for all items. I could not get the fluids there as the website said they don't ship them to Alabama. Florida may be different. I get mine from the vet. Huge mark-up, looks like. I use size 18 needles as it makes the fluids flow much faster than the 20s.
 
Bama Kitty Mom said:
Thrivingpets.com has sub-q products but I don't know if a prescription is required for all items. I could not get the fluids there as the website said they don't ship them to Alabama. Florida may be different. I get mine from the vet. Huge mark-up, looks like. I use size 18 needles as it makes the fluids flow much faster than the 20s.
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Thank you, Gina. I probably need a refresher course from the vet. I'll look at that site.
 
I am encouraged. :) As I said earlier, Susie had eaten most of her breakfast. Right after I got her +2 I gave her some PureBites and she was actually eating them. Then, she immediately went back to the bathroom and proceeded to eat more of her breakfast. I think the PureBites and the notorious Temptations :arghh: serve as an appetite stimulant for her. I will hold off on the Temptations unless she goes too low and I can't get her to eat.
 
I'm not sure why you want a UPC done. Your cat's kidney values are within normal limits. Even in the article that Heather linked, you would want the BUN and creatinine values to be elevated as an indicator. SDMA is a routine part of most blood panels that are sent to IDEXX for analysis. It can be predictive of early kidney disease if that's what you're worrying about.

Protein can be in the urine as a result of "spill over" of protein from the kidneys in diabetes. If it's persistent, kidney disease may be present. However, it's rare to see a UPC. Diabetes is hard on the kidneys which is why we emphasize that getting a cat's BG below renal threshold is important. You may want to review the IRIS staging guidelines for how renal disease is assessed.

I'm a bit confused by your SS. You didn't reduce the dose on 9/17 when Susie dropped to 47. You've also been holding eat 1.0u dose overly long 9/8 - 9/24) then fattened the dose on 9/25 and increased to a 1.25u dose today. You may see better results if you stuck with the TR guidelines.
 
Bama Kitty Mom said:
Thrivingpets.com has sub-q products but I don't know if a prescription is required for all items. I could not get the fluids there as the website said they don't ship them to Alabama. Florida may be different. I get mine from the vet. Huge mark-up, looks like. I use size 18 needles as it makes the fluids flow much faster than the 20s.
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Is this what you get? https://www.thrivingpets.com/lactated-ringers-inj-usp-1-liter-bags.html It is interesting to see that you can also inject it intravenously. I wonder how much you would use? I might have to look into this. Don't worry, folks, I won't do anything without my vets guidance. I give my dog Adequan and that is given intravenously.
 
You need a prescription for fluids. Most caregivers give fluids at home and it's a subcutaneous administration. Also, you need to be absolutely certain there are no cardiac issues. Giving fluids to a cat with heart disease can put the cat into heart failure.
 
Sienne and Gabby (GA) said:
I'm not sure why you want a UPC done. Your cat's kidney values are within normal limits. Even in the article that Heather linked, you would want the BUN and creatinine values to be elevated as an indicator. SDMA is a routine part of most blood panels that are sent to IDEXX for analysis. It can be predictive of early kidney disease if that's what you're worrying about.

Protein can be in the urine as a result of "spill over" of protein from the kidneys in diabetes. If it's persistent, kidney disease may be present. However, it's rare to see a UPC. Diabetes is hard on the kidneys which is why we emphasize that getting a cat's BG below renal threshold is important. You may want to review the IRIS staging guidelines for how renal disease is assessed.

I'm a bit confused by your SS. You didn't reduce the dose on 9/17 when Susie dropped to 47. You've also been holding eat 1.0u dose overly long 9/8 - 9/24) then fattened the dose on 9/25 and increased to a 1.25u dose today. You may see better results if you stuck with the TR guidelines.
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Thanks for your advice. I decided not to do the UPC. Like you say, Susie's kidney values are within normal limits. There are several causes for proteinuria which I'm sure you are aware of. I wasn't just interested in whether it was her kidneys. I wondered about infection, bleeding, hypertension (eliminated), high-protein diet, urinary tract infection, parasite, cancer and of course, the diabetes. I thought the UPC would be conclusive but apparently it is not. I think I eliminated the infection and urinary tract infection because her white blood cell count was normal. She had her blood pressure checked a couple days ago. It was good. Tested for fecal parasites - negative. I guess she could have worms in her lungs. I don't know about the cancer issue or high-protein diet. All of this started when she stopped eating normally almost two weeks ago. I don't know (and vet doesn't either) if it is nausea or something else and that is why I considered the UPC because of her appetite and also the protein in her urine since December.

I agree about me not following the TR rules. I did not reduce Susie when she dropped to 47 because she does not hold reductions well. I thought I might look for three drops on different days before reducing. It didn't happen. I have been wanting to increase her insulin for a couple of weeks but because she was not eating well I decided to hold off until I got her appetite in better shape. I didn't want her to drop and then not eat to bring numbers up. I decided last night that I just had to go ahead and increase her dose and pray for the best outcome - with her numbers and her appetite. I will look at your link. Thanks for stopping by. I appreciate your support.
 
Sienne and Gabby (GA) said:
You need a prescription for fluids. Most caregivers give fluids at home and it's a subcutaneous administration. Also, you need to be absolutely certain there are no cardiac issues. Giving fluids to a cat with heart disease can put the cat into heart failure.
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I'm pretty sure my vet would authorize the lactated ringers. I did the sub-q's with a previous cat who had CKD. Are there any test in her recent blood work that would indicate if Susie has a heart issue? Vet listened to her and said she sounded good but that is no affirmation in my opinion.
 
I buy all my Lactated Ringers solution bags and IV set up (tubing etc) from Chewy. I get the Vetivex brand. Now I usually order my needles from Thriving Pets because they carry the Terumo needles that are much sharper than other brands and they also carry the smaller sizes that I use. I won’t use the harpoon sizes that the vet tries to give me. They use them at the vet because they’re fast. I use only 20 gauge usually. 19 is the largest needle that I will use. Terumo makes these ultra thin wall needles that have a good flow rate. The man at Thriving Pets is helpful if you call him. I have also ordered Lactated Ringers solution bags from them. You need an Rx.
 
Summer and Susie said:
I'm pretty sure my vet would authorize the lactated ringers. I did the sub-q's with a previous cat who had CKD. Are there any test in her recent blood work that would indicate if Susie has a heart issue? Vet listened to her and said she sounded good but that is no affirmation in my opinion.
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Yeah. It’s probably cheaper to run the ProBNP than have a cardiac ultrasound. And besides not all vets are qualified to do the ultrasounds or know how to properly interpret what they’re looking at.
 
Sienne and Gabby (GA) said:
You need a prescription for fluids. Most caregivers give fluids at home and it's a subcutaneous administration. Also, you need to be absolutely certain there are no cardiac issues. Giving fluids to a cat with heart disease can put the cat into heart failure.
Click to expand...
I don't know that my vet was thorough in making sure Bama doesn't have heart disease. Vet suggested doing sub-q and told me to give 200mls when others here correctly told me no more than 10 mls per pound of body weight. Bama's current weight is 15.2 lbs. Glad to know about the heart tests.
 
Summer and Susie said:
Thanks for your advice. I decided not to do the UPC. Like you say, Susie's kidney values are within normal limits. There are several causes for proteinuria which I'm sure you are aware of. I wasn't just interested in whether it was her kidneys. I wondered about infection, bleeding, hypertension (eliminated), high-protein diet, urinary tract infection, parasite, cancer and of course, the diabetes. I thought the UPC would be conclusive but apparently it is not. I think I eliminated the infection and urinary tract infection because her white blood cell count was normal. She had her blood pressure checked a couple days ago. It was good. Tested for fecal parasites - negative. I guess she could have worms in her lungs. I don't know about the cancer issue or high-protein diet. All of this started when she stopped eating normally almost two weeks ago. I don't know (and vet doesn't either) if it is nausea or something else and that is why I considered the UPC because of her appetite and also the protein in her urine since December.

I agree about me not following the TR rules. I did not reduce Susie when she dropped to 47 because she does not hold reductions well. I thought I might look for three drops on different days before reducing. It didn't happen. I have been wanting to increase her insulin for a couple of weeks but because she was not eating well I decided to hold off until I got her appetite in better shape. I didn't want her to drop and then not eat to bring numbers up. I decided last night that I just had to go ahead and increase her dose and pray for the best outcome - with her numbers and her appetite. I will look at your link. Thanks for stopping by. I appreciate your support.
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I’m not making any recommendations on insulin but jist remember that if she does drop too low on you and won’t eat that you can syringe a karo/water mixture into the side of her mouth. A 50/50 mixture of about 1.5 cc worked well for me every time I needed it. Of course food is what we want but sometimes they won’t take it.
 
Bama Kitty Mom said:
I don't know that my vet was thorough in making sure Bama doesn't have heart disease. Vet suggested doing sub-q and told me to give 200mls when others here correctly told me no more than 10 mls per pound of body weight. Bama's current weight is 15.2 lbs. Glad to know about the heart tests.
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Yeah. I would never give a cat fluids on a regular basis before checking out the heart. For example, ER vet told me to give Ginger 150 mL fluids yesterday. Her breaths per minute were recorded at the bet as 50 breaths per minute! They should not be over 30. Today they’re up to 40. No fluids for her until I can get her a chest x-ray tomorrow (if we can hold out that long).
 
Bama Kitty Mom said:
I don't know that my vet was thorough in making sure Bama doesn't have heart disease. Vet suggested doing sub-q and told me to give 200mls when others here correctly told me no more than 10 mls per pound of body weight. Bama's current weight is 15.2 lbs. Glad to know about the heart tests.
Click to expand...
Yes, good info to know.
 
Summer and Susie said:
Wish I had known about the ProBNP when I had her at the vets.
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Sorry. I would have mentioned it except all of our talk was about the kidneys. You were concerned about them. But now that you have ruled out the kidneys, you’re thinking heart. It’s natural to worry about kidneys in cats! I always do.
 
My thoughts are with you guys. I am sorry I cannot weigh in or give any advice, but I'm hoping things settle down for you.
 
Suzanne & Darcy said:
Sorry. I would have mentioned it except all of our talk was about the kidneys. You were concerned about them. But now that you have ruled out the kidneys, you’re thinking heart. It’s natural to worry about kidneys in cats! I always do.
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No, I'm not worried about her heart in general. Only in regards to giving the fluids. I was thinking that if she is dehydrated that I should start to give her fluids a couple of times a week. Now, I should have her heart checked before I ask the vet about that. You didn't do anything wrong. I was never concerned about her heart before the conversation turned to fluids.
 
I just want to make an observation. You can have all the tests in the world done and everything may look normal. And a month later it's not. Physical parameters can change. OTOH, you can get skewed values and it's a bad test (e.g., a lipoic sample) or a temporary blip that self-corrects. A cat's appetite can change and often does once a cat is better regulated. All it means is that nutrients are getting into the cells and the cat isn't starving all the time due to diabetes. As I read through this thread, it just seems like you're looking for a reason that may not be there. At some point, you have to trust that your vet knows what he or she is doing and has had "hands on" your cat. If you don't trust your vet, that's another story.

If you're not going to follow TR, then you should be following SLGS. You can't pick and choose which aspects of TR you want to apply. It makes it a judgement call at every turn and, as a result, the dosing is rife with inconsistencies. In addition, a cobbled together method of dosing means that experienced members have no clue what you're doing and can neither offer help nor back-up your decision making.
 
Sienne and Gabby (GA) said:
I just want to make an observation. You can have all the tests in the world done and everything may look normal. And a month later it's not. Physical parameters can change. OTOH, you can get skewed values and it's a bad test (e.g., a lipoic sample) or a temporary blip that self-corrects. A cat's appetite can change and often does once a cat is better regulated. All it means is that nutrients are getting into the cells and the cat isn't starving all the time due to diabetes. As I read through this thread, it just seems like you're looking for a reason that may not be there. At some point, you have to trust that your vet knows what he or she is doing and has had "hands on" your cat. If you don't trust your vet, that's another story.

If you're not going to follow TR, then you should be following SLGS. You can't pick and choose which aspects of TR you want to apply. It makes it a judgement call at every turn and, as a result, the dosing is rife with inconsistencies. In addition, a cobbled together method of dosing means that experienced members have no clue what you're doing and can neither offer help nor back-up your decision making.
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I thought part of TR was waiting for three drops under 50 if your cat does not handle reductions well. Is this not correct?
 
Our Dolly Girl said:
I put FortiFlora on all of Dolly’s food. That’s how I got her switched to wet food in the beginning of her diabetes. I get good prices on it through ebay. Way too expensive from Chewys or Amazon.
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Thanks, Adrienne. I had some that was given to me for my dog. The prescription label said it was good until 10/22 so I sprinkled a little on. Susie seemed interested for a second then walked away. I checked the actual packet and they said use by 8/20 so maybe that was why Susie wasn't interested. I'm going to look on Ebay. Thanks for the warning about Chewy and Amazon.
 
Again, the problem is that you're doing things piecemeal. Yes, the 3 drops in the 40 - 50 range is a method. However, do you always listen to what others tell you or do you ask where the information is from? In this case it comes from the Tight Regulation Protocol for Lantus and Levemir that's on the German Lantus website. I suspect that the person who mentioned this to you didn't know where it came from either and it amounts to whispering down the lane. Frankly, I don't see any evidence of Susie not holding reductions. I do see evidence of micro-dosing when it's not necessary and not adhering to the dosing method you've chosen.

One of the fundamentals with using a depot insulin is consistency. Follow TR if that's what you want to use. Give the protocol a fair chance which means months of sticking to the guidelines.
 
Summer and Susie said:
Thanks, Adrienne. I had some that was given to me for my dog. The prescription label said it was good until 10/22 so I sprinkled a little on. Susie seemed interested for a second then walked away. I checked the actual packet and they said use by 8/20 so maybe that was why Susie wasn't interested. I'm going to look on Ebay. Thanks for the warning about Chewy and Amazon.
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The dog FortiFlora is different than the cat formula. I use expired because I use it as a flavor enhancer not a probiotic. It’s pretty much dry food dust with some vitamins and minerals, I believe. I learned about it from Chris R. on the Facebook forum.
 
Our Dolly Girl said:
The dog FortiFlora is different than the cat formula. I use expired because I use it as a flavor enhancer not a probiotic. It’s pretty much dry food dust with some vitamins and minerals, I believe. I learned about it from Chris R. on the Facebook forum.
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I got it at a very reasonable cost on Ebay. Some sites have it listed for so much more! Thanks for the tip. I got it for cats. We will see if she is more interested in her food when I receive it.
 
Summer and Susie said:
I got it at a very reasonable cost on Ebay. Some sites have it listed for so much more! Thanks for the tip. I got it for cats. We will see if she is more interested in her food when I receive it.
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Good luck. It was a game changer for us in getting Dolly to eat canned food, now she won’t eat her food without it (except mc and hc). This lady on eBay reached out to me, she had hundreds of boxes. She sold me 5 boxes for $30 + $5 shipping. They expired this year. I bought 2 more for $11 each. I just couldn’t see buying anymore and she finally sold out. Dolly was a dry food junky, Fancy Feast mostly. Our other kitty was diabetic as well. She got 2 shots of insulin daily along with a steroid shot and a ton of other meds. We took her to the vet every week to get her BG checked :nailbiting::nailbiting::nailbiting: neither the vet or us knew any better. Scary, really scary, looking back. Good luck!!! I hope she starts eating. Dolly is eating but no where near her normal amount.
 
Our Dolly Girl said:
Good luck. It was a game changer for us in getting Dolly to eat canned food, now she won’t eat her food without it (except mc and hc). This lady on eBay reached out to me, she had hundreds of boxes. She sold me 5 boxes for $30 + $5 shipping. They expired this year. I bought 2 more for $11 each. I just couldn’t see buying anymore and she finally sold out. Dolly was a dry food junky, Fancy Feast mostly. Our other kitty was diabetic as well. She got 2 shots of insulin daily along with a steroid shot and a ton of other meds. We took her to the vet every week to get her BG checked :nailbiting::nailbiting::nailbiting: neither the vet or us knew any better. Scary, really scary, looking back. Good luck!!! I hope she starts eating. Dolly is eating but no where near her normal amount.
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Wow, so much we have both have learned since being on this site. Tell me, do you still have your other diabetic kitty?
 
Just a FYI on the UPC ratio test. Neko's protein in her urine was high while her kidney values were still within range, so the vet suggested a UPC ratio to see if she had proteinuria. It was the first early sign of her CKD. And yes, that meant 2 UPCR tests a couple weeks apart to make sure it was repeated, then a third one after starting medication, to make the medication was working to keep her numbers in range. It is very important to control proteinuria. Here is the Tanya's website page on proteinuria. Without treating proteinuria, CKD can progress faster. But before treating, you need to know if Susie has proteinuria, which means getting the UPC ratio test done. And that does mean getting it via cysto. Neko once let loose just before the cysto procedure by the vet and they tested that urine anyway. It was way out of whack. Summary, the UPC ratio test was worthwhile for us. It got treatment for proteinuria started earlier, and gave me more time with her.
 
Summer and Susie said:
https://felinediabetes.com/FDMB/threads/9-25-susie-292-amps-274-2.253430/#post-2858096
I have already spoken to Adrienne (Dolly's Girl) but if anyone else has ever had the UPC test (protein:creatinine ratio panel) please let me know if you received conclusive information on what was wrong with your cat. What were you told? Or, were you just still left in the dark about the protein in the urine.
UPDATE: I decided not to do the UPC test.
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I want to urge you to rethink this. Sometimes there is a small amount of protein in the urine that just is not significant. My kitties often have 1+ protein in their urine but have, on occasion had 2+. If they do have 2+, you can bet I am 100% going to get a UPC done. In each case where they’ve had 2+ protein and I’ve had a UPC done, the UPC was normal meaning they did not have proteinuria. Moral: a slightly elevated amount of protein in the urine does not always equal proteinuria.

But, if the UPC does indicate proteinuria, you absolutely need to address it by doing the three test over two weeks. Proteinuria can be idiopathic meaning it’s not always known why it occurs if there is no indication of CKD. It’s not difficult to treat so why stick your head in the sand because if she is proteinuric, it absolutely needs to be treated.
 
Our Dolly Girl said:
The dog FortiFlora is different than the cat formula. I use expired because I use it as a flavor enhancer not a probiotic. It’s pretty much dry food dust with some vitamins and minerals, I believe. I learned about it from Chris R. on the Facebook forum.
Click to expand...
Summer and Susie said:
I got it at a very reasonable cost on Ebay. Some sites have it listed for so much more! Thanks for the tip. I got it for cats. We will see if she is more interested in her food when I receive it.
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Boy I hate to throw a kink in the works but Fortiflora has extremely questionable ingredients especially animal digest which could be sourced from euthanized animals which means it could have pentobarbital in it.


Heather82372 said:
Well after reading all of this Summer is probably more confused than ever about what to do. I know I am. lol :banghead: Sounds like out of 3 moderators 2 are for the test and 1 is not.
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:woot: I wouldn’t think of it as 2 out of 3 moderators because we aren’t speaking as moderators in this regard but based on our experience with proteinuria. Because Susie’s USG indicates she’s really concentrating her urine, I don’t see that impending CKD is the issue although I never say never.
 
Summer and Susie said:
Thank you, Alisa. Hope I am still getting your name right. How are your babies doing - FCC and Typewriter?
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Yes, thank you, that is my name. We are doing well. I appreciate you asking. They are both finding new places to curl up and hide because the weather seems to have shifted here.

I sure hope you and Susie manage to have a good sleep and equally good day.
 
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