BG over 600 amps&pmps + Antibiotic Resistant UTI

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kdakus

Member Since 2013
Our 14 yr old sugarcat Dot losing weight and has just finished two courses of antibiotics (Clavaseptin then Zeniquin) after being diagnosed with a raging UTI about a month ago.

All urine draws have been done directly from his bladder and culture done last week shows gram negative bacilli.

In the few days since he finished his last course of antibiotics his AMPS & PMPS BG reading has shot up to over 600 (Meter reads HI) and his nadir is sitting at about 290.

We have been increasing his Levemir dose according to the tight regulation protocol and he is now on 4 units twice a day.

When he is on the antibiotics it seems to keep the infection down to a dull roar but not clear it up. The vet's only suggestion now is to try Sulfatrim for 2 weeks and test him at 12 days and probably continue for a total of 4 weeks.

Note: Dot's diabetes was diagnosed October 2013 and after switching from humulin to levemir he went into remission in just 8 days. He was completely OTJ from November 2013 to 1st week of June 2014

I am beginning to feel like we are torturing him and feeling at the end of my rope. confused_cat

Would like some feedback on if there is much hope the Sufatrim will work after Clavaseptin & Zenequin failed to clear the infection. The vet also gave the option of restarting either Clavaseptin or Zeniquin. :shock:

Thanks,

Karen
 
Thanks Larry,

I spoke to the vet over the phone since she was at a different location yesterday and she said that the bacteria from the culture could be treated with Clavaseptin or Zeniquin (already tried) or the Sulfatrim.

The Clavaseptin seemed to do very little, the Zeniquin did much better but there is concerns about prescribing it for more than 14 days at a time.

The Sulfamethazole & Trimethoprim (Sulfatrim) is the only one we haven't tried.

Karen
 
Not infrequently you need to administer the antibiotic for a month or more since it is a deep infection like a in a kidney. For my civi Stewart I had to administer it for at least 28 days.
How low does the BG get between shots?
What is dose and what is the insulin you are using?
 
Thanks Larry, I think that is definitely the key. I begged them to continue the antibiotics last week after the urine draw showed bacteria while the culture was being done but the vet was hesitant to leave him on Zeniquin that long.

His nadir is 15.9 (280) (+6) and when the infection was relatively under control we were getting numbers of 300-400 at amps & pmps and 180-200 at nadir.

Here's hoping we can get it under control!

Karen
 
Since the BGs are showing a good response and y have room for an increase, I would increase the does until the infections clears
 
You may need to step up to a veterinary internal med specialist, or get a consult from one. Look for a veterinary school nearest you to find someone.


Also, about 2-3 hours after the antibiotic, give a probiotic to replace the good bacteria that were wiped out by the antibiotic. This may reduce GI upsets such as diarrhea.
 
Dot is showing good response to the Sulfatrim so far. His amps was 272 this morning (yesterday 549, and over 600 the day before).
Keeping his dose at 4 units levemiram/pm and doing a curve today. His +6 this afternoon was a much better 178 so I think we're on the right track.
Thanks for your help! :-D
 
The peak action of Levimir insulin is usually later by a couple of hours than the nadir(peak action) of Lantus insulin. So people using Lantus usually test in the +4 to +7 hour time frame to find the nadir or low for their kitty. Since you are using Levimir, you might want to try testing in the +8 to +10 hour time frame to see how Dot BG's are doing then.

Good to hear the antibiotic seems to be helping. Hoping for continued improvement.
 
Thanks Deb, we have done several curves on Dot and he seems to hit his nadir between the 5-7 hour mark. We also have him on three feedings a day, one of them being right after testing at +6, so that might be prompting his BG numbers to rise earlier than they might if we only fed twice a day. (When we have checked his nadir overnight it was still around the +6 mark)

Thankfully, we seem to have turned a corner with both the UTI and his BG numbers. ;-)

Dot has gone from maxing out the meter at amps&pmps only 4 days ago to having STELLAR +6 readings of 77 (4.3 CDN) yesterday and today. We have our hypo kit on standby with the sudden dramatic drop in his numbers and did curves Sunday and yesterday to make sure he was safe. nailbite_smile

It would seem that the Sulfatrim is doing the job in tackling the Proteus Mirabilis they found in his urine culture. He is not being very cooperative in taking the meds but I am managing to get them down using a piller without too much fuss now that he is feeling better. We will be tracking very closely over the next several days to reduce the dose gradually as his numbers dictate while hopefully keeping him under 100 most of the time to starve out that nasty infection for good.

Karen
 
Karen, the main times we want tests without food is just the pre-tests....after that, it's actually easier for the pancreas to deal with small meals than big ones, so most of us feed small meals throughout the cycle (so take food up 2 hours prior to Pre-shot tests so that number isn't influenced by food)

It's one of those ECID things though (Every Cat is Different) ...some feed only at Pre-shot through +4 (so that by mid-cycle, when the insulin is started to wear off anyway, we're not adding more food), but some feed right up until +10

You just have to experiment and see what works best for Dot!

So good to hear she's finally responding to the antibiotic and that it's showing in her numbers too!

Could you go ahead and take the 911 off now? We like to save that for when the cat is having a medical emergency (like a hypo) and it looks like for now anyway, Dot's doing great!
 
Thanks Chris, I didn't know I could edit previous posts. I just removed the 911 icon from my initial post.
Karen
 
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