? Dosing HELP please: Lola 11/18 AMPS 108

Jade_Leah said:
les. I am still struggling to understand (as are the vets) why her BG wasn't able to be anywhere near controlled until her hospital stay and then was climbing again after that. The only differences were the IV fluids she was on for those 3 days and the antibiotic they gave her while there, which was Unasyn.
Click to expand...
I have three thoughts: there’s still an infection going on somewhere so was better in hospital bc of antibiotics; hydration helps, not only physiologically but if the patient is dehydrated meters can read artificially high; the readings of uncontrolled glucose were on a pet specific meter on an anemic cat (I’m interested to see how different her numbers will look on a human meter)
One or a combination of these may be part of the answer
 
JL and Chip said:
Just doing a quick fly by to say hello and welcome to FDMB. It’s the best place you never wanted to be.

Whenever you see an unexpectedly low number, it’s a good idea to re-test. Every once in awhile we get a wonky test strip or something goes wrong, so it’s worth double checking the number.

I’m pondering the finding of enlarged kidneys. I’m thinking pyelonephritis (kidney infection/inflammation) can sometimes cause enlargement and that urine cultures don’t always grow anything. But I’d think there would be other symptoms perhaps, maybe fever or inappetance? I had a cat with suspected pyelonephritis many years ago and I believe we treated with a broad-spectrum antibiotic (which did help in his case). In most of my CKD cats, we’ve seen small and/or irregular shaped kidneys. Perhaps @Suzanne & Darcy or @SmallestSparrow have insight?

I'm also curious about the consequences (if any) of a history of both Senvelgo and Bexacat, particularly whether there’s any possible (short term perhaps??) impact to the kidneys. I’m not familiar with that but might have to do some reading.
Click to expand...
Bexacat has kidney issues as a very common adverse effect (elevated BUN, elevated Specific Gravity, elevated SDMA…BUN being the most common of all side effects). One of 125 cats in the initial study developed CKD but…CKD is pretty common I think for older cats.

excellent point about retesting for an abnormal. The first time I had a PS below 100 I retested a half dozen times with two different AT muttering the entire time “this can’t be this can’t be” and then tried the human meter I use for his ketones (also tests glucose). But at other times I have actually gotten two widely different results so then I do a third …which is what Meter tech support says to do
 
SmallestSparrow said:
Methos developed pancreatitis on Bexacat, and it’s listed as occurring in the study cats, but I do note that diabetes is a major risk factor for pancreatitis. Of course pancreatitis can be a risk factor for diabetes. But I agree that there are a LOT of risks with Bexacat and I wish Methos could have stayed on it as his tumor makes it very unlikely I will ever get his diabetes under control with insulin. I suspect Methos had pancreatitis twice before when his symptoms were diarrhea and loss of appetite/vomiting but wasn’t tested then. I blamed the Bexacat for a rise in Methos’ BUN BUT have since determined it’s his spiranolactone that’s responsible.

if Lola has a uti and it’s not being appropriately treated that can worsen her diabetes. uTI s are common in diabetics (because of the sugar in the urine) and should always be suspected if glucose goes out of control

I hope they find an appropriate antibiotic for her—it sounds like you’re saying she still has it? Or not?
Click to expand...

Her UTI was in August and was treated and went away! She hasn't had anything show up in urinalysis or cultures since then but has been tested another 5x.
 
Also while doing those re-tests when you have a minute run a control test on the strips/meter although I’ve pointed out to tech support when they ask if I did it that that mostly checks the meter because a single bad strip wouldn’t affect the rest in the vial
 
JL and Chip said:
Do you happen to have a specific gravity on her urine?

I hear you on the Bexacat. It’s always hard to know whether the new thing on the market is as great as it’s made to sound. One of my vets immediately suggested Bexacat or Senvelgo for my most recent diabetic cat despite the fact that she was in DKA (a big no-no with DKA) and that I’d had 3 diabetics prior and was well versed in FD, testing, dosing, etc.
Click to expand...

I had no idea what specific gravity was until this moment but I found one result for it on her 11/1 testing and it was 1.019.
 
I re read the package insert and found this interesting and perhaps worth discussing with the specialist: two cats in the study developed immune mediated hemolytic anemia. Do you recall when I said one cause of elevated bilirubin in the species I treat is some forms of anemia? Hemolytic anemia is wha I meant—because something is breaking up the red cells the body can’t clear the resulting excess bilirubin. How long ago did you stop the becacat?
 
@Suzanne & Darcy just wanted to let you know that I've updated the spreadsheet with all of the data I had since I started trying to track. It looks pretty wacky until I I was testing pre shots and at the halfway mark was the way to go
 
Last edited:
I also was questioning the enlarged kidneys. I also have experience with CKD vats having smaller than normal kidneys. It is possible that there is a kidney infection. They don’t always show up in a urine culture and they can take a long course of antibiotics to eradicate (30 days or more.)
 
Jade_Leah said:
@Suzanne & Darcy just wanted to let you know that I've updated the spreadsheet with all of the data I had since I started trying to track. It looks pretty wacky until I I was testing pre ***** and at the halfway mark was the way to go
Click to expand...
Wow. You saw a blue of 116 on 3.5 units. That indicates that the dose should have been held right there and bounces should have been ignored. With SLGS, each dose is held for at least 7 days (unless a reduction os earned,) which gives ample time for a bounce to clear. If ketones were in the picture we would be more aggressive perhaps.
 
JL and Chip said:
I’ll also add that dry kidney food is notoriously high carb, which can also make BG run notably higher. The timing of adding that to the mix could conceivably contribute to what you’re seeing.
Click to expand...
Yes. We haven’t even gotten to diet yet or to feeding schedules. I was saving that for tomorrow . Of course, Lola eating well trumps everything and, in my opinion, kidneys trump BG because we can adjust insulin doses (although high carb dry food is a little more unpredictable than high carb wet food.)
 
Do you have today’s blood results? Is that in the google drive? I noticed an improvement in a lot of her kidney values over time. I was assuming that this was a result of the hospitalization/IV fluids.
 
Suzanne & Darcy said:
Wow. You saw a blue of 116 on 3.5 units. That indicates that the dose should have been held right there and bounces should have been ignored. With SLGS, each dose is held for at least 7 days (unless a reduction os earned,) which gives ample time for a bounce to clear. If ketones were in the picture we would be more aggressive perhaps.
Click to expand...

My timezone is EST.

I do not have her blood results, but should have them early tomorrow.

Her BG pre shot tonight was on the 490s and i gave her the 4.5 units. I shoot at about 9am and 9pm. I may need to shift to an hour earlier for each if i need to start doing a +2 PM reading more frequently.

I am a bit overwhelmed with information but I'm trying to take it all in. I wish that I had known about bouncing and testing and everything I've been learning today (and over the last couple of weeks) before messing with her dosages. I trusted the vets I was seeing and it is difficult to feel like I can't! If the 116 at 3.5 had been heeded is it possible she would now be regulated? And does this mean that the 4.5 both vets want her to be at will do her more harm than good? I am trying so hard to help my girl and feel I'm failing her so often. I will not stop trying, though!

I have been going non-stop since 6:50am and so I'm going to try to give myself some time to decompress. My key takeaways are:

-bouncing is a thing and that appears to be what happened/is happening
-3.5 was likely the correct dosage
-will be requesting that we give her antibiotics if her blood panel from today still shows anemia markers
-will continue to test BG frequently and at the soonest opportunity will get a +2 overnight reading

I am forgetting things but will be releasing this entire thread once I've had some sleep!

I see you said we can talk about food tomorrow, which I will make sure to be here for! I will also try to read more about the Bexacat.

Thank you all so much!
 
Last edited:
We can talk about everything tomorrow. I was afraid of you becoming overwhelmed. I usually deal with things more gradually and discuss the most urgent issues first, but many things kept popping up. I hope you will hang in there with us. :bighug:
Only one more thing I will say because you asked about it previously today. The bouncing…. You probably already know this, but bouncing is the term we use to describe when a cat reacts strongly to BG numbers that it is not accustomed to — if a cat isn’t used to being in yellow or blue or red (yep even red) numbers, its body may perceive these “lower” BG numbers as a threat and will release stored sugars from the liver and also hormones that will serve to raise the BG. It’s a kind of defense mechanism. The BG can be elevated for up to six cycles, but doesn’t necessarily stay elevated that long. I see cats who start out with very long bounces and gradually, over time, the bounces don’t last as long — this is a good sign of progress.
 
@Suzanne & Darcy this morning I decided to test Lola as soon as I woke up (and then before her shot at 9) and the meter only says "HI" which I haven't seen before and thought meant something was wrong with the meter, but it appears that it means the reading is so high it can't be read by the meter?! I tested twice to this result. Trying not to panic. She's behaving normally and wanting to eat. Is this an emergency? I plan on giving her the 4.5 units at 9
 
First, try not to panic—easy for me to say but you’ve got this. She’s acting normal so that’s a good sign. She hungry because she’s not able to utilize the calories she’s eating because of the DM but you’re fixing that. Hunger is a good sign.

While waiting for @Suzanne & Darcy —yes the AT says HI if number is greater than 750. Keep in mind her number is somewhat lower due to her anemia. If you haven’t already done so also do a control solution check on the meter and strips. Additionally there’s a small dot on the top of the strip at the point the blood is wicked up toward. This is a vent and the reason the instructions say “don’t put blood on top of strip” is because covering that vent can make readings high. So if you accidentally got blood on that vent retest. Also don’t touch the strip to skin, touch it to the top of the drop of blood —this prevents contamination of the strip.
All that said, her reading is probably high and Suzanne can tell you what to do. One thing I’ve seen them advise others is if you have your ketone test strips test for ketones. If you don’t have them yet that’s ok. I’ve seen many people here have high readings all day for several days. I would be a wreck. I’m a wreck with one high reading. Don’t be me.
You’re doing great and hopefully help is on the way soon. Again to get more attention (bc people who read this may not look at it again) start a new thread. Use the ? prefix, date, kitty’s name, and the problem

edit: maybe put AMPS >750 in the title

edit: I’d also consider asking your vet. Many here don’t and I think that’s a reflection of how accessible and knowledgeable the vet is—but I keep mine in the loop because if things go south and you need to take her in urgently they already have a heads up.
 
Last edited:
SmallestSparrow said:
First, try not to panic—easy for me to say but you’ve got this. She’s acting normal so that’s a good sign. She hungry because she’s not able to utilize the calories she’s eating because of the DM but you’re fixing that. Hunger is a good sign.

While waiting for @Suzanne & Darcy —yes the AT says HI if number is greater than 750. Keep in mind her number is somewhat lower due to her anemia. If you haven’t already done so also do a control solution check on the meter and strips. Additionally there’s a small dot on the top of the strip at the point the blood is wicked up toward. This is a vent and the reason the instructions say “don’t put blood on top of strip” is because covering that vent can make readings high. So if you accidentally got blood on that vent retest. Also don’t touch the strip to skin, touch it to the top of the drop of blood —this prevents contamination of the strip.
All that said, her reading is probably high and Suzanne can tell you what to do. One thing I’ve seen them advise others is if you have your ketone test strips test for ketones. If you don’t have them yet that’s ok. I’ve seen many people here have high readings all day for several days. I would be a wreck. I’m a wreck with one high reading. Don’t be me.
You’re doing great and hopefully help is on the way soon. Again to get more attention (bc people who read this may not look at it again) start a new thread. Use the ? prefix, date, kitty’s name, and the problem

edit: maybe put AMPS >750 in the title

edit: I’d also consider asking your vet. Many here don’t and I think that’s a reflection of how accessible and knowledgeable the vet is—but I keep mine in the loop because if things go south and you need to take her in urgently they already have a heads up.
Click to expand...

The ketone strips should be arriving any time now as should the ReliOn meter. I have contacted my vet and I'm now just waiting to get her bloodwork back from yesterday.

At the moment I am living and breathing animal care from the moment I wake til the moment I sleep. It is A LOT, so I am often a wreck but it's like I'm a wreck so often at this point that I'm almost numb to it I'm just trying to keep my girl alive and as happy and comfortable as I possibly can. It feels like the odds keep getting stacked up against us at every turn. I won't stop trying, though.

Unless it's necessary to start another thread I may avoid doing so and just wait for @Suzanne & Darcy to avoid getting too overwhelmed with multiple posts.

Morning shoot went well!
 
It’s going to be okay. I know how upsetting the black numbers can be. I am sorry. Just keep testing for ketones (when the strips arrive) and keep her happy and fed when she’s hungry. Beyond that, we need to wait out this bounce. Did you say they gave her fluids yesterday? I am sorry if you mentioned it yesterday, but I haven’t had time to go all the way through this thread again yet.
 
No test last night? please write HI in the AMPS cell for this morning and go ahead and test her a little today. At least get a +6.
 
Suzanne & Darcy said:
No test last night? please write HI in the AMPS cell for this morning and go ahead and test her a little today. At least get a +6.
Click to expand...

I feel terrible but I haven't been sleeping well (imagine that! ) and slept through the alarm to test her at 11pm. I tested her as soon as I woke up (just before 7am) which is when I got the first HI. I then tested again before her 9am shot and it was still HI. I am going to test her as much as I can today and will absolutely be getting her 6+. I'm lavishing her in food and snuggles and kissing her as apologies for poking her wee ears so much. She seems in decent spirits. She did receive sub q fluids at the vet yesterday.

Going to test her now at +2 and see. What we get...

And still HI. I didn't think there was a worse feeling than seeing her at 691 but HERE WE ARE.
 
Jade_Leah said:
I feel terrible but I haven't been sleeping well (imagine that! ) and slept through the alarm to test her at 11pm. I tested her as soon as I woke up (just before 7am) which is when I got the first HI. I then tested again before her 9am shot and it was still HI. I am going to test her as much as I can today and will absolutely be getting her 6+. I'm lavishing her in food and snuggles and kissing her as apologies for poking her wee ears so much. She seems in decent spirits. She did receive sub q fluids at the vet yesterday.

Going to test her now at +2 and see. What we get...

And still HI. I didn't think there was a worse feeling than seeing her at 691 but HERE WE ARE.
Click to expand...
Oh, I wish I could make her BG come down right away! It is a horrible feeling, isn’t it? You want to help so much and you feel like nothing you do is helping at all. You feel helpless. Do you give her a treat after each test? I recommend Pure Bites Freeze Dried chicken pieces. My cats all love them (and you said she likes crunch) and if I grind them up in the blender there’s not a cat here that won’t eat the wet food that’s below this magic chicken dust food topper (although they are smart and they like to eat it off the top and some of the food and get more.)

Try to get her to eat the lowest carb food that you have today as long as she will eat, that is. I am hoping the high BG will at least make her willing to eat just about anything.
 
Suzanne & Darcy said:
How long do you think she may have been diabetic?
Click to expand...

I just immediately went and purchased the Pure Bites I have had sitting in my Amazon cart for days and also refilled my Churu stores. I don't know why she isn't very interested in wet food but inhales dry food like her life depends on it. She is obsessed with the Hills dry kidney food. I know it's high carb, though, so I am trying to tempt her into wet food.

Speaking of food, I know we are supposed to get into that as well. I wanted to list off what I have in the house at the moment:
-hills dry w/d (will eat)
-hills dry k/d (her favorite at the moment)
-hills dry gut biome (what fixed her bowel movements after Bexacat destroyed it and I've really stopped offering it exceot to the other cat in the house who is really enjoying all of the food I'm trying to give her sister )
-wet hills k/d (she doesn't like it much)
-wet hills w/d (she doesn't like it much)
-Weruva BFF play pates in: takeba chance, check mate, laugh out loud & topsy turvy (I've been told these are good for kitties who are diabetic AND have CKD)(she will somewhat lick at these)
-Sheba pate in chicken, beef & salmon (she seems to like these best)
-greenies treats in various shapes and forms
-Churus

I definitely need guidance on how to get her to eat wet food and just a feeding schedule/what to feed in general. At the moment I feel like im throwing spaghetti at a wall to see what sticks and there are noodles everywhere! (Figuratively speaking)

Lola was diagnosed with diabetes in November of 2023. I don't think she actually had it for more than a couple of weeks before I caught it. She had gotten bloodwork done a few months prior and wasn't showing any signs of it. We were planning on moving to Australia to be with my partner, so she was given vaccines (including rabies) for the first time since she was a kitten. As she was strictly indoor, the vet saw no issue with opting out. I wonder now if all the vaccines were such a shock to her system that this happened. I don't know if thats even possiblem She was also off and on prednisone for most of her life due to asthma sometimes popping up when the weather changes. I've read steroids can be trigger as well. I do know I caught it early. Thankfully I work from home (which I have been neglecting terrible this week, oops) so I noticed right away how much water she was drinking and that she was urinating excessively.
 
Young Again Makes a dry food that is low carb and lower phosphorus as well.

I will send you a bunch of food charts and info.

So she has been on insulin for over a year? Or she was on Senvelgo or Bexacat for a year? I see that in your signature mow, but I don’t think I fully appreciated that she started in 2023. And was anyone testing her BG at that time?

Okay, I just read your introductory post on the other forum. I think I understand better now.

I definitely would recommend the aluminum hydroxide powder that is odorless and tasteless if you are still using it to lower phosphorus. I buy mine from Thriving Pets in Colorado. With AlOH, it works best by being given with every bit of food and not just in the morning or evening.
 
Yikes! The Hill’s Prescription Diet k/d Kidney Care with chicken is over 40 percent carbs. This will make it extremely difficult to get her BG down and stable. I hope you can find something else she will eat.
 
The Young Again foods are at the bottom of the list I sent. Even Dr. Elsey’s would be better than what she’s eating now (at about 2 percent carbs). Dry food can be put into a ziploc bag with Aluminum Hydroxide powder and shaken around. The powder sticks to it.
 
Suzanne & Darcy said:
Young Again Makes a dry food that is low carb and lower phosphorus as well.

I will send you a bunch of food charts and info.

So she has been on insulin for over a year? Or she was on Senvelgo or Bexacat for a year? I see that in your signature mow, but I don’t think I fully appreciated that she started in 2023. And was anyone testing her BG at that time?

Okay, I just read your introductory post on the other forum. I think I understand better now.

I definitely would recommend the aluminum hydroxide powder that is odorless and tasteless if you are still using it to lower phosphorus. I buy mine from Thriving Pets in Colorado. With AlOH, it works best by being given with every bit of food and not just in the morning or evening.
Click to expand...

When she was diagnosed she was immediately placed on Senvelgo. It made her gag and she would spit it out and it became a routine of torture. We really wanted it to work out because her BG was beautiful when tested at the vet but she hated it too much. Then we tried the Bexacat and that seemed to be the answer to my prayers, but over time I noticed that she was having loose stool and her excessive thirst a urinating never truly improved (which isn't uncommon given hiw the drug works). She has only been on insulin since September. Her BG was being spot checked about once a month after the initial stage of frequent checks to ensure her body was adjusting well to the Bexacat. I had been told that bringing her in for spot testing was fine and that at home testing was very difficult. While I researched Senvelgo and Bexacat extensively, I didn't look into the insulin options and the testing until crap hit the fan. I feel so much regret, but I trusted that the vets were pointing me in the right direction and would've told me to test at home. They seemed to think it wasn't necessary.

The Hills k/d food is what her specialist wanted her to be on solely and now I am more convinced than ever (especially after he told me to stop spot testing yesterday morning) is a fool. I wasn't given powder as an option for the aluninum hydroxide. Will I need a prescription for it? I am so upset that everything I've tried to do to help her and keep her well is the opposite of what she needs.
 
Suzanne & Darcy said:
The Young Again foods are at the bottom of the list I sent. Even Dr. Elsey’s would be better than what she’s eating now (at about 2 percent carbs). Dry food can be put into a ziploc bag with Aluminum Hydroxide powder and shaken around. The powder sticks to it.
Click to expand...

I am ordering some of the Young Again food but since it will take longer to get here, I'm also having Dr. Elsey's overnighted from Amazon. Looking into the other options listed as well. Thank you so much! I badly want to do right by my girl.
 
Jade_Leah said:
I am ordering some of the Young Again food but since it will take longer to get here, I'm also having Dr. Elsey's overnighted from Amazon. Looking into the other options listed as well. Thank you so much! I badly want to do right by my girl.
Click to expand...
I think Chewy is having a 25 percent off Dr. Elsey’s right now. Let me check.
 
Suzanne & Darcy said:
I think Chewy is having a 25 percent off Dr. Elsey’s right now. Let me check.
Click to expand...

I truly cannot thank you enough for your help. I wish I had found this forum a year ago. Or even a month ago. You are giving me hope and a chance to actually DO something and try new things.

I've ordered Dr Elseys, Young Again & the powder (which I will need help dosing). We have the Pure Bites coming as well.

Lola has always been a grazes. Do you suggest that I tightly restrict her mealtime?
 
Right now, I would not restrict her eating times — except to say that you should not feed her for two hours prior to the a.m. and p.m. tests — in order to get accurate preshot tests that are not inflated by food. On the one hand, she is so high right now that I do not know if it will make a tremendous amount of difference, but on the other hand, her food is so high in carbohydrates that it definitely will raise her blood sugar. When she’s in better numbers, it will be very important to have an accurate preshot test to see if she can receive her full dose or would need a reduced dose for that cycle.

When she gets into better numbers, I would recommend scheduled feeding times if she will adapt to that. If not, then I would recommend not feeding much at all after nadir because it can shorten the duration of the insulin and cause a premature rise in numbers. Very small snacks of LC or, of course, the “testing treats” are fine.
 
Does she still have asthma? I saw you mention that she was on prednisolone for asthma. I have an asthma cat. The vet prescribed Prednisolone for her (because it would be the “easiest” thing for me) and we did it for a while, but I have switched her over to inhaled steroid medication now, which is actually controlling her wheezing and noisy breathing much better — and she won’t have the body-wide side effects of the Pred.
 
Suzanne & Darcy said:
Does she still have asthma? I saw you mention that she was on prednisolone for asthma. I have an asthma cat. The vet prescribed Prednisolone for her (because it would be the “easiest” thing for me) and we did it for a while, but I have switched her over to inhaled steroid medication now, which is actually controlling her wheezing and noisy breathing much better — and she won’t have the body-wide side effects of the Pred.
Click to expand...

I just got the Lola's bloodwork back. Her kidney values have worsened again. On 11/11 the values were creatinine 2.1, BUN 62 & phosphorus 6.9. As of yesterday 11/18 the values are creatinine 2.9, BUN 86 & phosphorus 10. They also showed up ticks in eosinophils and basophils which are markers for inflammatory conditions such as Inflammatory Bowel Disease according to my vet. He said there was a elevation in pancreas enzymes but not dramatic.

I am trying not to fly into a full blown panic and not knowing what any of this means for for and her future.

The full lab report has been uploaded to the Google drive I shared with you.
 
Suzanne & Darcy said:
Does she still have asthma? I saw you mention that she was on prednisolone for asthma. I have an asthma cat. The vet prescribed Prednisolone for her (because it would be the “easiest” thing for me) and we did it for a while, but I have switched her over to inhaled steroid medication now, which is actually controlling her wheezing and noisy breathing much better — and she won’t have the body-wide side effects of the Pred.
Click to expand...

Lola hasn't had any asthma symptoms in st least a year. I mentioned it only because I know that steroid usage can be a catalyst for diabetes.

Her +6 was 642. So still very high but relieved there's an actual number.
 
Does the vet think she should be on sub-q fluids at home. A daily fluid treatment could help her to feel better and reduce BUN.
 
Suzanne & Darcy said:
Does the vet think she should be on sub-q fluids at home. A daily fluid treatment could help her to feel better and reduce BUN.
Click to expand...

That is actually something that he and I are emailing back and forth about as I type this. I am not opposed at all the doing them at home as long as I'm taught how and feel confident I'm doing it properly. I feel like it truly can't hurt to try it out. Seeing what he has to say.

I know he is in communication with the specialist about what could be happening and if it's possible that she is experiencing insulin resistance due to the CKD/pancreas issues.

For now I am going to continue to keep her eating and drinking and giving her 4.5 units of ProZinc for her shots. If this is indeed simply a bounce that must be waited out, I'm hoping that we can see some lower numbers as the days go on. Is that how bouncing usually works?

Her Dr. Elsey’s arrives tomorrow and hopefully we can get her to eat that and then even more so hoping she will eat the Young Again. I was notified that the aluminum hydroxide powder you suggested has also shipped.

Let me know what you glean from her labs whenever you have a chance to take a look.
 
Her white count is still way too high — and the neutrophils. The inflammatory markers your vet is referring to can also indicate infection/inflammation. I think she needs a longer course an antibiotic that is appropriate to treat a kidney infection.
 
You must log in or register to reply here.
Back
Top