Advice wanted

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coconut8

Member Since 2012
I have been treating Maria for diabetes for 2 months. Was on Lantus and needed to keep going up until I reached 6 units, 2 times a day, and the BG numbers started to get high and flat. I thought something else might be wrong, so test showed a urinary tract infection and she has been on Clavomox for 2 1/2 weeks now.

So, then we switched to Levemir and started that on May 5th. Started with 1 unit to see how that would work. During the week, I was only able to check pre-shot, and got readings in the 300's to low 400's.

Yesterday, I did a curve, and the readings every two hours were ranged from 352 to 472, so did not really see the insulin working.

Last night, she did was not her usual ravenous self, seemed lethargic,

This morning, I see that she threw up her food from yesterday, just kind of laying there, would not eat, and BG at 551!

I called my vet, and he advised giving her 2 units of Levemir and testing her BG in an hour to see what happens.

Any other advice?

Ilene
 
Do you have Ketone test strips? She needs to have her urine checked ASAP. Sounds very much like DKA (diabetic ketoacidosis) and the history of a recent UTI makes that even more suspicious.

If you don't have test strips, I would take her to the vet as soon as possible (meaning this morning), and if you do have test strips and you can't get a urine sample in the next hour or so, I would still take her in. DKA is serious and if she's in it, they'll need to sort out her electrolytes,pH and dehydration ALONG WITH insulin. It's a fine balance, that they need to do together. If it is DKA, her potassium will be way off, and insulin drives potassium back into the cells and for a cat with a significant imbalance, this can begin to affect the heart, other muscles, etc. Insulin alone without addressing the other issues (electrolytes, pH, dehydration) can just add to the problem.

If you do have strips and the ketones are only "trace amounts", insulin will probably be just fine. Any more than "trace", especially with the UTI, high blood sugars, I would insist on blood work and go from there.

I'm so sorry you are going through this, but this is a big one. DKA is very, very serious and needs to be addressed or identified as soon as possible!!!
 
If she is currently being treated for a UTI, with high BGs and vomits and acts sick, please either get ketone test strips and test her urine or take her to an ER clinic that could test her for ketones.
 
Just tested her 1 hour after the 2 units, and it read "HI" which means over 600. I'm going to give it another 30 minutes and test again, and if it's still so high, take her to the ER.

Ilene
 
At this point Ilene, I wouldn't be so concerned about her blood sugar......if it's DKA, her blood sugar is irrelevant right now. Ketones is your priority test with blood work a very close second.
 
I'm so glad (((IIlene))).....

Keep us posted and let us know if we can help. DKA is a scarey event and many of us have been through it. Our thoughts are with you.
 
Well, I brought her to the ER and they hospitalized her.

Tests so far say ketones okay, BUN high, heart and liver seem a little enlarged, breathing rate up but heart rate down a little.

They are going to put her on IV fluids and other meds as needed. I will call them at about 5 PM for any updates.

Thanks for caring!!!!!

Ilene
 
High BUN means she is dehydrated. By ketones "okay" does that mean there were none or just slight amount? Did they do an ultrasound? Also, did they mention the possibility of pancreatitis? Pancreatitis is very painful for cats. It requires a specific blood test for definitive diagnosis.

Glad to know this may not be DKA. Sending healing vibes to Maria and a :YMHUG: to you.
 
If you can ask them at 5pm other blood results....that would be helpful. The different electrolytes can tell alot about what is going on.

Elevated BUN can certainly be from dehydration as Vicky indicated.....you would also see some other electrolytes affected from hemoconcentration.
If the kidneys were the problem the creatine level would be elevated as well.
The fact that the liver and heart are enlarged is interesting and makes me wonder about congestive heart failure (CHF).

Let us know what they say and hopefully we can help steer you in the right direction for follow up!

P.S. I am so glad you took her in and even more relieved it is not DKA!
 
coconut8 said:
I have been treating Maria for diabetes for 2 months. Was on Lantus and needed to keep going up until I reached 6 units, 2 times a day, and the BG numbers started to get high and flat. I thought something else might be wrong, so test showed a urinary tract infection and she has been on Clavomox for 2 1/2 weeks now.

So, then we switched to Levemir and started that on May 5th. Started with 1 unit to see how that would work. During the week, I was only able to check pre-shot, and got readings in the 300's to low 400's.

Yesterday, I did a curve, and the readings every two hours were ranged from 352 to 472, so did not really see the insulin working.

Last night, she did was not her usual ravenous self, seemed lethargic,

This morning, I see that she threw up her food from yesterday, just kind of laying there, would not eat, and BG at 551!

I called my vet, and he advised giving her 2 units of Levemir and testing her BG in an hour to see what happens.

Any other advice?

Ilene
Click to expand...

Hi Ilene,
I am so glad for your taking her into the ER; with such high numbers and big changes in how she was acting plus vomiting, I would have done the same.

Now, you were at 6u of Lantus BID and changed to Lev, but I am not sure why you dropped back to only 1u. Normally, when switching from Lantus to Lev, it's advisable to go no less than 50% less, or maybe 75% is better. While some cats may need a bit less Lev, they often end up at the same dose, but with longer lasting coverage and a much more gentle curve. Without knowing her diet or other health issues, I would have said that the high numbers, lethargy, etc was all due to the big drop of insulin.... I experienced the very same thing with my Oliver when I was advised here that he was getting too much insulin, and I started him back at 1u. It was UGLY.

I am so hoping that there are no health issues found for the high numbers, no DKA, no ketone issues, no UTI, etc.

I can't comment on the high dose of Lantus; you may want to think about having her tested for acromegaly and also IAA if you find she is just dehydrated and really does need the higher dose.
This suggestion is based on the assumption that you are feeding a low carb wet food with carb 10% or less because dry foods and wet with gravies are a major culprit in causes for high dose needs for most diabetic cats.

It would be most helpful if you were to be able to connect a spreadsheet with the BG numbers you have so that people will be able to see how you worked your dose increases, and how the Lantus was working, or not working. Seeing the numbers in a sheet can be very telling to others....
To know the road ahead, ask the man coming back.

While hoping that Maria is OK, with no issues to be causing the high BG, I think you would be good to bump up that Levemir dose and do a few curves.

If you need help with setting up a google spreadsheet, just shout and someone can give you a hand.

ETA: enlarged organs are a sign of acro, just in case it has not been mentioned to you by others.

For pancreatitis, there is a test, so if they have already drawn blood for other testing, I wonder if it's too late for them to do a fPLI test to rule out pancreatitis. For pancreatitis, treatment is always a pain med (get buprenex), Pepcid AC is good for upset stomach, and SubQ fluids. You can get a kit from the vet and get the vet to show you how to give them.... you will see coconut perk up like a dried out flower after it's watered; the change is incredible when they get dehydrated. Also, you can mix water into her food, (I am hoping it's wet food), as my Oliver never drinks plain water from a bowl, so I mix half water half wet food for him.... he thinks it's gravy and laps it up before he eats the food!
 
Just my 2 cents on possible HCM (hypertrophic cardio myopathy - or enlarged heart): Beau has had HCM for over 10 years - since he was 3 and long before his diabetes diagnosis.. It is treatable, usually with something like Diltiazem, which Beau has been on ever since. Just know that it isn't the end of the world.

First step with the high insulin dose and possible enlarged heart and liver would be asking for the acro test.

Still sending healing thoughts and prayers her way and hoping she is feeling better and can come home very soon.
 
ER vet thinks it might be heart disease from the x-rays, and will show the x-rays to the cardiologist on Monday to see what he thinks and whether Maria should have a EKG or something else.

Does not want to give fluids for dehydration because it looks like there is fluid in lungs....so, complicated, and not good at this point.

Will be putting in a feeding tube down throat.

We have very good specialist vet care here in Northern Virginia.

Ilene
 
Good point about the heart, Sheila; I have no experience with HCM, and I have been lucky with my 2 acros with no organ illnesses.

When you arrange for the acro tests, please also get the IAA test done because the tests themselves are NOT expensive; only $59 and $15 or something like that, so having 1 blood draw and 2 tests done from shipping - the shipping cost to MSU and vet part of the deal is the bigger cost...


IAA Test
IGF-1 (Acro) Test

Some cats have just acro, like my Shadoe; some have just IAA, like Pattie/Harley; and some have both, like my Oliver.
 
coconut8 said:
ER vet thinks it might be heart disease from the x-rays, and will show the x-rays to the cardiologist on Monday to see what he thinks and whether Maria should have a EKG or something else.

Does not want to give fluids for dehydration because it looks like there is fluid in lungs....so, complicated, and not good at this point.

Will be putting in a feeding tube down throat.

We have very good specialist vet care here in Northern Virginia.

Ilene
Click to expand...

Hi there Ilene,
Waving up at you from Virginia Beach :) You're probably hearing way more than you wanted to hear. I have had 2 cats with HCM, one was dx an acro, the other was never tested for acro, but was high dose. As the heart shows signs of strain (fluid buildup), it tends to reduce their insulin requirements. I expect since there is fluid present that your specialist may start something like plavix to reduce that, and other meds to control clotting, for instance. I do have an off the wall suggestion, just so I don't forget later - heart kitties are often very sensitive to heat, and with you being in NoVA, heat is coming. You may want to keep an eye on the in-house temperature and/or even have a summer haircut for Maria. Heart disease itself can be quite manageable, and I echo the acro test idea once you get the heart checked out and get that treatment going, especially if you see the insulin needs returning. One step at a time, sending lots of hugs for you and Maria!
 
PS: Jess and Earl on FDMB is perhaps the most knowledgeable of all of us re: heart issues. If you have questions after diagnosis, be certain to track her down! She is a tech who works in veterinary cardiology. I am sure there is an official name for that, I just call her REALLY SMART AND HELPFUL. :D
 
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