Charlie update today's numbers in the 400s

[EllieKozak]

Another frustrating day in the escapades of Charlie. He is more perky today but his numbers are sky high again. Haven't been able to check ketones yet today. He is starting to eat more of the LC as opposed to the hc he had only been eating this weekend. I gave him 2 u of r at amps and then again at +6 but it hasn't seemed to do a thing. I will bump him to 5 u lantus tonight but I don't know why today it seems like he's not evfn responding to the insulin. Yesterday was heaven. He still had profuse blow out diarrhea (going on 4x in the last 5 hours) and is still on metro and fortiflora. Negative for pancreatitis and gi panel came back normal. Very discouraged today.

 

[julie & punkin (ga)]

he sounds like he must feel awful - blow out diarrhea multiple times a day could really dehydrate him. I can't help but think he needs something else besides the metronidazole and the fortiflora for this. Has his stool sample been examined to see if he's got something like C Diff? Punkin developed that after a long run of clindamycin and it sounds like what you're describing. If you haven't had a stool sample analyzed, I would do that asap. What does the vet say about this continuing diarrhea?

Are you giving him SubQ Fluids at home? With that level of diarrhea, he should probably be getting sub-qs every day.

This cycle looks like a bounce from yesterday's yellow numbers. I think you could be giving a larger dose of R at pmps tonight if he's still in the 400's. I'd go with 2.5u-3.0u, assuming you are able to monitor.

Can you set an alarm to check him in those wide open areas of the spreadsheet between pm+4 and +11? That's 7 hours of no data. Right now, this little guy is essentially in the Intensive Care Unit of the hospital at your house, and you're the primary doc.

One more question - are we certain your insulin is good? were both the Lantus and the R bought from a pharmacy? how old is it? have you see-sawed the dose between the syringe and the vial/pen? I suspect it's not an insulin issue, because he's also not responding to the R, but thought i'd ask. There is a video about 1/2 way down the page here on how to draw a dose of Lantus/Lev from a pen or vial. It might be worth reviewing if you haven't yet. Both of these should not have been repackaged by your vet. Occasionally someone will show up here with insulin that's been repackaged by the vet, and since you work there i'm thinking that might be a possibility.

 

[Suzanne & Cobb(GA)]

Hi Ellie,

I agree with Julie. I would up your R dose tonight to 2.5u. If you can monitor him throughout the night, you could try 3u.

Check out Cobb's spreadsheet. I totally understand your frustration! Once you figure out what dose of R is needed to jump start the drop, you should see some action. I do think my you need more R to accomplish that.

~Suzanne

 

[EllieKozak]

I can't help but think he needs something else besides the metronidazole and the fortiflora for this. Has his stool sample been examined to see if he's got something like C Diff? Punkin developed that after a long run of clindamycin and it sounds like what you're describing. If you haven't had a stool sample analyzed, I would do that asap. What does the vet say about this continuing diarrhea?

Are you giving him SubQ Fluids at home? With that level of diarrhea, he should probably be getting sub-qs every day.

This cycle looks like a bounce from yesterday's yellow numbers. I think you could be giving a larger dose of R at pmps tonight if he's still in the 400's. I'd go with 2.5u-3.0u, assuming you are able to monitor.


One more question - are we certain your insulin is good? were both the Lantus and the R bought from a pharmacy? how old is it? have you see-sawed the dose between the syringe and the vial/pen? I suspect it's not an insulin issue, because he's also not responding to the R, but thought i'd ask. There is a video about 1/2 way down the page here on how to draw a dose of Lantus/Lev from a pen or vial. It might be worth reviewing if you haven't yet. Both of these should not have been repackaged by your vet. Occasionally someone will show up here with insulin that's been repackaged by the vet, and since you work there i'm thinking that might be a possibility.

He's had multiple fecals done and that GI panel was supposed to rule put any digestive issue. The diarrhea has been going on for about 3 weeks now. He started on metro started to improve then she switched him to tylan. Once it started getting bad again I put him back on metro (only on tylan 3 days). He's been exclusively on metro n ff since Saturday (ff since June).
I haven't regularly been doing the sc fluids when he was "stable" or should I say neg ketones. Since fri pumice been giving 150 ml lrs daily and he's still constantly at the water fountain.
When does a cat stop bouncing? That's all he does is bounce. The insulin was purchased fresh by me at target and cvs. Both within the last few weeks. I've been handling/storing properly.
Out of curiosity what needle size do you recommend? I'm wondering if the needle is too short (3/10 ml 8mm 31g)? I know they're not fur shots Bc I always inject w proper lighting and feel his fur afterward but the needle itself is tiny. Maybe it's not doing deep enough into the skin layers?? I'm so damn baffled as is everyone else. Again he's only 2 years old and was totally fine last June. It was like we went to bed and he woke up a diabetic. I'm very in tune to my cats. This happened in the blink of an eye.

 

[julie & punkin (ga)]

Here's a couple of posts that might be helpful to you: Giving Subq Fluids, Testing & Shooting Tips and Terumo Thinpro Syringes, which are the ones I used. Lots of people here like these particular syringes.

Cats stop bouncing when they become used to lower ranges of blood sugar numbers.

I've used different sizes of syringe needle lengths. You want to inject just subq, so it doesn't have to be long. Most of the time it's whatever people get used to.

Well, all we can do is keep moving forward. There will be a "right" dose for him - we just need to keep moving with his dose every 4-6ish cycles, depending on what he does, until he gets into better numbers.

 

[EllieKozak]

Thank you for the links. I just did his pmps which was 364. He ate well. Gave him 5 u and 2.75r but there's a slight chance the r may have been a fur shot. I want to cry. He sneezed at the exact moment I was giving the r. I think some of it went in but his fur was def wet. Of all times to get a fur shot why does it have to be while he's in crisis.

 

[Sienne and Gabby (GA)]

When was the last time you had a CBC run?

Also, what are you feeding Charlie? It's possible that diarrhea is being caused by a food allergy. Many cats are allergic to beef and seafood. You might want to try a novel protein or a raw food diet.

Another thought is to try a different probiotic. ReNew Ultimate is a pretty powerful probiotic that I used with Gabby when she had recurrent diarrhea. You give 1/3 of a capsule twice a day. You can find it at Whole Foods or GNC.

Aside from the bounce inflating numbers, if there's any infection or inflammatory process going on, it will raise numbers.

One other consideration, with a growing cat, growth spurts may effect how much insulin you need. When we had another diabetic kitten, every time he grew, which was almost weekly, he would need more insulin.

 

[Sandy and Black Kitty]

Hi there

Glad to hear Charlie is eating well. BTW, what is his ideal weight? Has he been eating any dry food?

Glad you upped the L dose.
Bummer about the furshot (never a good time for one). However better the R than the L - you can shoot more R at +6 if needed.

You mention multiple fecals have been done Do you know specifically which parasites your vet tested for and ruled out?
Here is a link to the "usual suspects" from Cornell University that is worth a look.
My mind goes to Giardiasis.

 

[EllieKozak]

When was the last time you had a CBC run?

Also, what are you feeding Charlie? It's possible that diarrhea is being caused by a food allergy. Many cats are allergic to beef and seafood. You might want to try a novel protein or a raw food diet.

Another thought is to try a different probiotic. ReNew Ultimate is a pretty powerful probiotic that I used with Gabby when she had recurrent diarrhea. You give 1/3 of a capsule twice a day. You can find it at Whole Foods or GNC.

Aside from the bounce inflating numbers, if there's any infection or inflammatory process going on, it will raise numbers.

One other consideration, with a growing cat, growth spurts may effect how much insulin you need. When we had another diabetic kitten, every time he grew, which was almost weekly, he would need more insulin.

When he isn't critical, normally he eats fancy feast seafood varieties. I've tried weruva, tiki cat, wellness, and the raw (natures instinct? Forgot the exact name) but he hates them all. He's been getting very picky lately. This weekend during his crisis I fed him anything he would eat, mostly dry fancy feast. He's now back to the ff but I have vee putting a little of the ff dry on too to entice him. I will look into the other probiotics. He just turned 2 in July so he's not technically a kitten. Thank you for your input and suggestions

 

[EllieKozak]

Forgot to mention a CBC was run first week in sept normal

 

[EllieKozak]

Hi there

Glad to hear Charlie is eating well. BTW, what is his ideal weight? Has he been eating any dry food?

Glad you upped the L dose.
Bummer about the furshot (never a good time for one). However better the R than the L - you can shoot more R at +6 if needed.

You mention multiple fecals have been done Do you know specifically which parasites your vet tested for and ruled out?
Here is a link to the "usual suspects" from Cornell University that is worth a look.
My mind goes to Giardiasis.

His ideal weight is about 11-12 lb. he was 12.5 at his heaviest. That was last November. He is back to eating his regular fancy feast but I have been putting a few morsels of dry on top to make sure he eats. The fecals that were done check for giardia, coccidiosis, whipworms, rounds, etc. Julie mentioned c diff. Not sure if that is part of GI lab I will check tomorrow at work. Thank you Sandy!

 

[julie & punkin (ga)]

try pulverizing the dry food and sprinkling it on - then he'll get less carbs than if it's the whole crunchies.

hmmm. well i think several of us feel pretty confident that there is some sort of infection/inflammation going on here. the diarrhea points to a gut issue. metronidazole is the typical one to sooth the intestines and most of the time works pretty well.

sienne's idea about a food allergy is a good one. Fish is a very common food allergy and even if it was ok before, allergies can develop. Are you open to trying one of the novel proteins? You can find them at locally owned pet food stores. That might be a possibility. Male cats often have urinary tract problems with fish too. The best site out there on cat nutrition is http://www.catinfo.org. It's run by a veterinarian who posts on FDMB sometimes. I'd take a look there, especially since it would be very reasonable to think his gut problems are related to something he may be eating.

the Sept CBC was completely normal? no elevated white blood cells? what about eosinophils? that seems so hard to imagine, as sick as he seems to be right now.

what is his breath like - just cat food or really bad?

Thanks for being so quick to reply today - it's going to take some detective work to figure out what's bothering him.

 

[EllieKozak]

try pulverizing the dry food and sprinkling it on - then he'll get less carbs than if it's the whole crunchies.

hmmm. well i think several of us feel pretty confident that there is some sort of infection/inflammation going on here. the diarrhea points to a gut issue. metronidazole is the typical one to sooth the intestines and most of the time works pretty well.

sienne's idea about a food allergy is a good one. Fish is a very common food allergy and even if it was ok before, allergies can develop. Are you open to trying one of the novel proteins? You can find them at locally owned pet food stores. That might be a possibility. Male cats often have urinary tract problems with fish too. The best site out there on cat nutrition is http://www.catinfo.org. It's run by a veterinarian who posts on FDMB sometimes. I'd take a look there, especially since it would be very reasonable to think his gut problems are related to something he may be eating.

the Sept CBC was completely normal? no elevated white blood cells? what about eosinophils? that seems so hard to imagine, as sick as he seems to be right now.

what is his breath like - just cat food or really bad?

Thanks for being so quick to reply today - it's going to take some detective work to figure out what's bothering him.

Will try the pulverizing trick! It would make sense that there must be an infection somewhere and I wonder if that's what keeps throwing him into dka? I'm still learning so much about this whole diabetic thing and the ketone thing is confusing. For instance, his numbers have been higher without him going into dka and when he does go into dka his numbers aren't horrific. I don't know the rhyme or reason that it occurs other than dehydration which I know canbe caused by the diarrhea. Is there a "magic number" that anything over starts producing ketones?

One of my biggest struggles with this whole thing is the food subject. The vet told me to stick w the lowest carb wet food. I go off the list by Dr Pierson on that cat info web page and have tried pretty much most everything in the list w 10% or lower carbs. His favorite is the trout ff. he normally eats 6-7 cans daily and still acts famished. But when he's in these "episodes" he gets really picky. I will try anyone's food suggestions but please keep in mind he dosent like the raw and dosent even like rotisserie chicken. He's a horse of a different color! But I'll try anything. We well the hills RX diets at work the rabbit and green pea or duck n sweet potato. Is that what you recommend or something ekse? I am pretty sure eos were normal. I will see if I can email myself his labs tomor and possibly upload to his profile. Is that possible? His teeth and gums look fabulous. No inflammation or tartar etc. Thanks again. His first appt w the internal med specialist is Wednesday. I cannot wait. Does anyone have any suggestions or questions I should ask? I want to get the best bang for my buck and use this appointment wisely. At the rate were going I don't know how much longer Charlie is willing to fight.

 

[julie & punkin (ga)]

A cat can develop ketones without having high numbers, but the recipe includes

Not enough insulin + not enough food + infection/inflammation.

We have had cats with higher blood sugar than Charlie's for longer periods of time and not had them develop ketones. And some cats just seem to be prone to them.

 

[julie & punkin (ga)]

As far as the food goes, it is a matter of just trying something else and seeing what he'll eat. The most important thing is to keep him eating.