AMPS = 477!

[Melissa and Celle]

Against advice, I lowered the dose rather than raising it. This just looks too much like bounce to me, UTI or not. This is based on
(1) As I raised the dose (albeit slightly to 1.35), I got a better initial response but a steeper curve.
(2) I would guess that the effect of the UTI on her sugar must be starting to subside by now; at the very least it's hard to see how it could keep making her numbers worse.
(3) My best guess now for what is happening is that she's had the UTI for a while. Possibly it developed slowly, which might explain why increasing the dose from 0.5 to 0.6 to 0.7 to 0.85 had virtually no effect. So maybe we passed up the right dose somewhere along the way, and now that the UTI is subsiding we're overdosing again.

Tell me why this is wrong! I know everyone wants me to increase the dose, but it isn't working.

Does anyone have experience with how long it takes for BG to start to return to normal following the start of antibiotics?

 

[Vicky & Gandalf (GA) & Murrlin]

Against advice, I lowered the dose rather than raising it. This just looks too much like bounce to me, UTI or not. This is based on
(1) As I raised the dose (albeit slightly to 1.35), I got a better initial response but a steeper curve.

The one thing which leads me to think you might be right, is that she drops within 3 hrs of dose, not a lot but it is a decline.

(2) I would guess that the effect of the UTI on her sugar must be starting to subside by now; at the very least it's hard to see how it could keep making her numbers worse.

If it's not the right AB to treat the type of infection, it may not be working well enough. What AB is it?

(3) My best guess now for what is happening is that she's had the UTI for a while. Possibly it developed slowly, which might explain why increasing the dose from 0.5 to 0.6 to 0.7 to 0.85 had virtually no effect. So maybe we passed up the right dose somewhere along the way, and now that the UTI is subsiding we're overdosing again.

Tell me why this is wrong! I know everyone wants me to increase the dose, but it isn't working.

Does anyone have experience with how long it takes for BG to start to return to normal following the start of antibiotics?

The dynamic of fighting higher numbers that won't come down with dose increases is complicated. Add the infection to that and it's even more so. At least you didn't drop the dose to less than 1U.

Besides the infection and ketone risk (please tell us if you've been able to get the strips and test, I cannot emphasize how important ketone testing is now!) a process called glucose toxicity sets in once they've been at high BGs for a while. http://petdiabetes.wikia.com/wiki/Glucose_toxicity The only way to combat it is to raise the dose. It's difficult to tell if that's what's going on, she is getting some response and it's pretty much the same at each dose.

Bottom line is - you are learning and making decisions based on your observations. I applaud that! I am only worried about lowering the dose because of the ketone risk at this point.

How long is the AB to be given? I hope it is at least 14 days. We have found over the years that treating UTIs in diabetic cats sometimes takes longer than it would in a less immune compromised cat. It may also mean the AB is taking longer to work overall, to answer your question about that.

 

[Melissa and Celle]

If it's not the right AB to treat the type of infection, it may not be working well enough. What AB is it?

The antibiotic is Baytril. On Saturday she did not even seem to be trying to make it to the litter box. Now she's getting to the box, but still sometimes going with her bum outside (which she seems to do much more when she has an infection). So maybe a small sign that she's improving.

I'm a little unclear on the plan for the antibiotic now. I thought initially it was to be for 3 weeks. We first tried a compounded formula that came with 21 days supply, but that didn't go over well at all, and we weren't sure how much she was able to spit out. So then we got pills, but they only gave me a 14-day supply.

(please tell us if you've been able to get the strips and test, I cannot emphasize how important ketone testing is now!)

No (sorry to say), I haven't gotten strips yet. I'll try to get them today. Do you know if I would get an accurate reading from the litter that gathers outside the box in the plastic trays we have to catch litter scatter?

 

[Sheila & Beau GA & Jeddie GA]

I don't know, but it makes me nervous to decrease the dose when she has an infection. I don't see a lot of difference in the numbers from 1u to 1.25u, I mean that they are getting worse. Yes, there was the 477 this am, but she's been in the 400s and upper 300s a while now - since .6u.

I would like to see 1.25u allowed to settle more. She started to get some action from it last night and that may have set off the 477. Given time those 400s might come down, but she may need another increase after a few days. Now is not a good time to let her sit in high numbers. There isn't the luxury of that as long as she has an infection brewing.

She was clearly getting rebound from 2-3u and the DM dry. I think we thought starting over at .5u would stop those swings and them the dose could be incrementally raised - you had also dropped the dry. I am not sure that you passed over the best dose. Sometimes, the dose has to be raised until it breaks through the glucose toxicity. Then the numbers start to fall and the dose can be slowly reduce along with the falling numbers. Peggy's Mickey is the best example of that I can think of. He was up to 3.5u and is now at 1u or 1.25u.

 

[Melissa and Celle]

PMPS = 340. So I stuck with 1 unit for the shot. Of course, one reading doesn't mean much, but better than getting another reading in the 400s.

I got ketone test strips and tested the urine that had landed in the litter tray outside the box. Not sure if that's OK, but results were negative.

 

[Vicky & Gandalf (GA) & Murrlin]

PMPS = 340. So I stuck with 1 unit for the shot. Of course, one reading doesn't mean much, but better than getting another reading in the 400s.

I got ketone test strips and tested the urine that had landed in the litter tray outside the box. Not sure if that's OK, but results were negative.

The urine outside the box in the tray should have been fine. That's actually very convenient of her to pee partly out of the box like that! And smart of you to have a tray there to prevent soiling.

Yea for no ketones! And yea for 340!!!! Hope she stays there, well gets better than that, but yes, it is better than 400.

And Baytril is a good antibiotic. I have had Gandalf on it several times as it's one he tolerates very well. After my experience with Doxycycline, I am never doing a -cycline based AB ever again! Yes, Baytril should be given for 14 days, so that should be fine.

 

[Melissa and Celle]

The urine outside the box in the tray should have been fine.

Just to be clear, it had been sitting there for a while, so if it needed to be fresh, that's a problem.

I'm just curious if the recent numbers give you any additional thoughts? The 215 last night makes me think again that 1.25 units was too much. And maybe 1.0 units is still too much given the 437 this AMPS? I'll get more numbers tomorrow.

I notice that her PMPS seems to always be lower than the AMPS no matter the dose. Is this normal to have the AM and PM cycles differ? It seems like it complicates interpreting numbers. I don't really know when she eats for either cycle.

 

[Vicky & Gandalf (GA) & Murrlin]

Melissa,
I have to leave in a few minutes, don't have time, but I have some thoughts on recent numbers. Will be back this afternoon. Try to get some more spot checks today if you can.

 

[Vicky & Gandalf (GA) & Murrlin]

OK, so she dropped to 215 by +3 on 1U after a preshot of 340. She's definitely getting action off the 1U, so stay with that for a while. She will either do one of 2 things, gradually go down in preshot and nadir values or she will begin to not get any action and remain higher. The latter would probably mean she's getting too much insulin, but the former would mean the AB is working and the dose is either about right or it still could be too much.

We usually caution about dose during a course of antibiotic because as the AB resolves the infection, the need for insulin may decrease. Because the infection may have been present for a while we should not rule out lowering the dose based on little or no response to lower doses previously. Lower doses might have worked better earlier had there not been something brewing. It's hard to say for sure.