Intro to Lucy -- better reg, suspected UTI, leaks urine

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derf

Member Since 2013
Hi,

Newbie here.

Lucy is a 14yr old diabetic cat (since age 5).
We recently moved to the Pittsburgh area and therefore found a new vet.
She switched Lucy from 4 units of ProZinc U-40 to a starting dose of 3 units of U100. Worked her up to 3.5 units based on BG readings.
In the midst of this we found blood in her urine on the floor one morning and assumed UTI although we know it can be caused by other things. Could not get to see vet for three days so proactively prescribed antibiotics.
First 5 days on antibiotics she seemed to be improving.
Upped her insulin up to 4 units based on BG readings

She now consumes 1/5 the water she used to ............but she usually leaks urine on the floor in small puddles wherever she lays. She still uses the litter box and there is a whole lot of pee in there.

But the leakage has us baffled.

Is she just not accustomed to how her bladder feels when it's slightly full?
I don't she knows she is doing it.

I know there is a lot going on at the same time...............

All comments and suggestions welcome

Thx

Derf
 
Welcome to you and Lucy! There is lots of good info on this site and lots of people who like to help.

That is a lot of insulin. Most cats here are under 2 units, lots in the .5 range. First question - what does Lucy eat? We have found dry high carb food raises bg levels substantially. (when we switched Oliver from dry to wet, his levels dropped 100 points overnight). A vet explains why wet low carb is best here: www.catinfo.org. If you are already feeding wet low carb, hurray!

Do you test her levels at home? Stress raises bg levels and most cats are very stressed at the vet. Then doses determined by those numbers may be too high when the cat gets home. This can result in a bouncing effect , going from high numbers to low ones at midcycle and bouncing back up again. The best way to see how the insulin is really working for Lucy to test her levels at home and see how low the insulin actually takes her. We have taught hundreds of people how to do it at home and would be happy to teach you, if you are not already doing this. If you do test at home, can you share some numbers?

The same vet site has some great info on UTI issues. It is a complex problem. It would be helpful to know what the vet finds in her urine sample, hopefully taken at the office. That info would help us help you.
 
Thanks for the quick reply.

Diet: Wet --Purina DM 1/8 can x2 daily
Dry -- 1.5 : 1 mix of Purina DM Dry and Royal Canin Gastro Response High Fiber.
The high fiber food was added several years back after she developed constipation issues.
Didn't seem to change her required insulin. This was back when she was on U 40 and getting BGC's done at the vet to determine insulin dosage. They said they liked to keep her at around 300-- which I thought was high...but she seemed ok.

I also forgot to mention she has chronic pancreatitis and we have to mix pancrezyme with her wet food at each feeding.

Since the move to Pittsburgh and the switch to U 100, (vet started her on 3 units) we have been monitoring her at home using a standard blood glucose meter and test strips. We did a 3hr interval test(12 hr total) on her last weekend and readings were in the mid 200's. Our vet stated she would like to see her in the 100-200 range.

We may never know if it was a uti or not.....

My biggest concern/confusion is over the leaking urine... this never occurred until we increased her dose (see orig post).

Anyone heard of/experienced this?
 
now that the last course of antibiotics is over from the first suspected UTI, that is he next logical step I suppose if it doesn't clear on its own (the leaking)

Just wondering if anyone else had experienced this with U 100 insulin dosage increases.
 
The U100 is BCP ProZinc or some other insulin? I would be surprised if it was the insulin change. It seems more likely connected to the UTI. I found this article with lots of possible ideas:

http://veterinarynews.dvm360.com/dv...-managem/ArticleStandard/Article/detail/43293

You might also change the subject to Leaking Urine? so people who've had that issue can help. The only time I've dealt with that is when my older cat has HCM and he just couldn't get around.

Certainly agree with levels suggested by new vet. We generally consider cats regulated if they are in the 200s at preshot and 100s or below at nadir.
 
leaks urine Re: Intro to Lucy

Wow you folks are great!! I will read up

Insulin says lantus 100 units/ml -- filled at a local drugstore

Thanks for the input.
 
Sue and Oliver (GA) said:
The U100 is BCP ProZinc or some other insulin? I would be surprised if it was the insulin change. It seems more likely connected to the UTI.
Click to expand...


Just to make sure we are on the same page -- I meant increase in U100 dosage change, not change from u40 to u100
 
The leakage could also be caused by diabetic neuropathy. If that's the case, try supplementing methyl-b12 by opening up a capsule and mixing it in with her wet food every day. I use the human version, Vitacost, as it's much cheaper (Zobaline is the cat version). It's perfectly safe to give, even to non-diabetics, as they pee out any excess. If it is neuropathy, depending on the severity, it can take anywhere from 3 to 6 months before seeing a difference, although some report a noticeable difference within a few weeks.
 
Hello and welcome to the board

I like the vets goal of getting her into the 100-200 range - that will help her heal and feel better. It will also help if the leaking issue is neuropathy. You would find that goal easier if you got rid of the dry - the dry is too high carb for a diabetic cat and is likely keeping her higher than she should be. The wet is fine but you could change her to a non prescription wet if you want to save some money - many of us here feed Fancy feast classic pates, friskies pates or wellness grain free as they are low carb too - but cheaper. We have a whole list of foods if you are interested.
Once you get rid of dry she will likely need less insulin too - so home testing is critical.

Did the vet check her for cystitis or bladder stones or anything like that?

Do you want to set up a spreadsheet? It would help us see whats going on as well as you and your vet track trends if you share it. Heres how (but let us know if you need help with it): http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207


Wendy
 
Yes I am now beginning to realize the amount of damage (eyesight, possible neuropathy in hind quarters, reduced sense of smell) that come with 9 yrs of keeping your cat at a BG of 300....pisses me off that I did not question the vet or do more research on the subject back then. It's like realizing all at once the suffering you've put your baby through -- and it's your fault for being ignorant. And you can't go back and change it.

But you can move forward. And that's why I'm here.

I'm surprised at the suggestion that the DM dry is too high carb (and possibly the high fiber food). I guess the high fiber food makes sense to me as it is not formulated for diabetics. Could you please supply more info on this subject?

As for the need for high fiber food -- trust me, without it it's like an ever changing minefield of BM as she goes when she can, wherever that may be.

They have done numerous xrays and ultrasounds on her in the past year and there is no evidence of stones or cysts, as she had developed a pattern of recurring UTIs.
____________
Somewhat aside:
There had been a small urine spot outside the litterbox back in Jersey (July).
Lucy is a VERY vocal cat and she was in by the litter box going in and out about 5 times in 3 min, then looking at me and meowing. She then stared me right in the eye and let out 2 guttural yowls which still curdle my skin to this day. I got her carrier and whisked her off to the vet.
The urinalysis came back negative.
It was explained to me that a cat's bladder and urinary tract can get inflamed to the point that it results in blood in the urine in the absence of a UTI. They also indicated that stress can be a trigger. They gave her some pain meds to deal with the pain of the inflammation. Can't remember what it was and if it acted as an anti-inflammatory as well.

Thoughts?
 
I don't how your finances are, but lots of people with complex cats have done a telephone consult with Dr. Lisa Peterson. (http://www.catinfo.org). You probably read her website page on UTI issues. She has done a lot of study in the field and might be able to inform and guide you. I haven't ever done it, but others say it is more than worth the cost.
 
Dr lisas site also explains very well about cats dietary needs , fibre etc and the fact that the DM dry isn't good enough for diabetics.

The diabetic dry is useful for vets to give to cat owners who can't/won't home test and/or who don't realize about remission. High carb dry is easy for many owners because it means the owner can feed the cat the food and give some insulin and the cat probably won't have a hypo - because it won't be well regulated. The cat eventually likely will fail. It also won't go into remission. Higher blood glucose means higher urine glucose and so a nice breeding ground for bacteria.. and so UTIS. Plus dry food is easier for many owners to handle and feed. And a little cheaper than wet.

However you are one of the different ones like us who want to get your cat regulated.. and possibly maybe even into remission! (although it has been a long time so less likely). You are willing to home test and that makes all the difference.

Wendy

PS is that pain killer Metacam?
 
So what do I do in place of the dry? She is downright addicted to it!
We actually have an automated feeder set up to give her an afternoon snack and 3am snack. Between AM and PM feeding of wet. Otherwise we get yelled at or woken up or both, or she acts like she is going to puke but what comes up is foamy saliva.

And Lucy NEVER goes upstairs unless it is to wake us up (stairs are getting harder for at this point but she can do it slowly).

As for the painkiller, I believe it sounded like it had morph in the name (related to the opiate family in some way).
 
You can start weaning her off the dry by crumbling it up and adding a "dressing" to the wet. Then add less dry and more wet every day. There is also a probiotic called FortiFlora that has the same enzyme that makes dry food "additive". You can buy it online and dress her wet food.
 
OK. Getting a bit confused here. (big surprise)

I'm looking at Binky's spreadsheet for dry food and see that the Purina DM dry has only 13% of its calories coming from carbs. This is one of the lowest on the dry food list. The RC Hi Fiber is not listed, unless it is the one listed "Hi Factor" (I know that RC refers to it as HF) but anyway they average out at 35% of cal from carbs --not good for Lucy.

Then I'm looking at Binky's wet food list and seeing everything from 0 to mid 20's and 30% of cals coming from carbs.

So then the strategy is to convert her over to a bevy of different wet foods with low % of cals coming from carbs? But making sure she is getting enough overall calories.

I wish I Purina DM wet info was there so I could see how it stacks up -- she already devours it so if anyone has numbers for it that'd be cool -- or I could get off my ass and do the calculations and contribute them.....

Remembering the chronic pancreatitis issue and continuous tylan treatment, I am wide open to guidance.
I'm not asking you to pick what my cat should eat, just for some steerage in the right direction.

What baffles me the more I think about it is why so many vets don't ever approach treatment this way. I can only assume that they don't trust clueless people not to kill their diabetic cats.
 
Janet and Binky's list is fairly old. Dr. Lisa Pierson updated Janet and Binky's list with more foods and more nutritional information and is the one most of us go by. You want anything in Column C to be below 8-10% calories from carbs, the lower the better.

As to dry foods, there is only a small handful that are considered even remotely appropriate for any cat, much less a diabetic:
Young Again Zero Carb (online only) - around 5%
Nature's Variety Raw Instinct - 7%
Innova Evo Cat and Kitten - 8%
Wellness Core Original - 11%
 
For the fiber issues, try adding some psyllium husks instead. It's a lot better and a lot more pure than whatever "fiber" the pet food companies are putting into their "high fiber" foods.
 
You mentioned constipation and were given 1 option, psyllium (comes as an unflavored powder). To understand more about it, plus have more options, pop over to Feline Constipation

You mentioned Lantus; we have 2 subforums for those using Lantus. One is the Tight Regulation forum which follows a protocol that often results in obtaining a diet controlled state. Descriptions of the protocol and handling and storing Lantus are posted in the stickie notes at the top of the 2nd section.

If you can manage to ditch the high carb dry, and home test the glucose at all pre-shots and a fair numer of mid-cycle tests, you'd be able to do the Tight Regulation protocol. If life is a bit chaotic and you can't manage the Tight Regulation protocol, there is a Relaxed Lantus subforum. Changes are made more slowly using the Start Low, Go Slow method.
 
Thanks for the info on the DM wet -- she loves it so no problem there.

The DM dry is, while not optimal, kinda low in % cal from carbs.

The RC hi fiber is a killer; problem is, it took ALOT of poop land mines just to get the mix of DM to RC right so she always makes it to the litter box. We just moved into a new house and I am hesitant to try to tackle the fiber issue from scratch again. Not saying I won't -- just hesitant.

Home testing with her is a two person job and testing every time pre shot is not feasible so we will never be tight regulators; I'll check out the Relaxed Lantus user group.

She seems to have stopped leaking urine. AFTER the course of antibiotics was over. It was very gradual. I really wonder if she needed to get accustomed to how her bladder, etc felt on the new insulin does we had upped her to prior to the suspected UTI and antibiotics. Hey, one cat, three variables leads to no unique solution.

Right now we are doing the "take it slow" method with insulin dosage changes. She's at 4.0 units x 2 of lantus. We usually do a 0-3-6-9-12 home BG curve on her on Sundays but missed it this week. Her numbers have been in the 190 to 305 range over the last month -- but some readings have been with a UTI while on antibiotics and therefore POSSIBLY not representative of her true BG. They seemed high when she was on the antibiotics but who knows....

One of he biggest challenges to date has been getting her to bleed for a reading. Our vet suggested paw pad testing. Lucy's paw pads just don't want to bleed -- at least not with a 31 lancet -- which we purchased long before I found this message board. From what I've read I should be testing the ear with a 28-29 for starters, yes?

Thanks for the links, folks!

Will keep you informed of Lucy's progress -- prob under a new thread which more accurately reflects her current status.
 
Dm dry is 13% carbs. Not the highest as you said but from experience and research diabetic cats need under 10 and preferably lower the better. The cats I see on here are not well regulated and certainly no remission with that %carbs and it also explains why she is on such a high dose of lantus compared to the other cats on here that are usually around 1-2units.

From personal experience I find dm dry spikes my cats blood sugar taking them up by over 200 points for over 24 hours.

Just saying that if your goal is remission or good regulation you might want to ditch the dry. Remission would also mean no more testing;)

Yes you want a thicker lancet 28g or 29g is better for newbirs
 
derf said:
...The RC hi fiber is a killer; problem is, it took A LOT of poop land mines just to get the mix of DM to RC right so she always makes it to the litter box. We just moved into a new house and I am hesitant to try to tackle the fiber issue from scratch again. Not saying I won't -- just hesitant.
Click to expand...

I completely understand. Spitzer wound up with IBD, so I'd get diarrhea every where! Make any food switch slowly and cautiously. Start by adding just a pinch of plain psyllium powder (a fiber) to the canned food. Reduce the high carb dry by 5-10 kibbles. Each day that is successful in terms of no land mine poops, take another out another 5-10 kibbles. You may increase the psyllium up to 1/4 teaspoon per meal.
 
Maybe there are some ideas in this Ear Testing Psychology article, by member Kpassa that would help make the testing process easier.

Are you warming the ear before hand, to get the blood flowing better? Applying a tiny bit of triple antibiotic ointment with pain relief first, to numb the ear and help the blood drop bead up? Giving lots of low carb treats to make your kitty Lucy want to come for the testing? Treats can be food or rewards like brushing, or ear scritchies, something she loves.

Yes, I understand what it's like to try to transition a dry food addict to low carb canned food. Took me weeks to do that transition for my dry food addict Wink, but once I did, he very soon went OTJ (off-the-juice, insulin being the juice) and has not needed insulin for 8 months now. It took a lot of persistent, failed efforts, backtracking, tempting him to get him to switch.

I think the thing that worked best for me, was to cut back on the dry food gradually, give him the wet food first, and crumble some Halo Liv-a-little freeze dried chicken treats over his canned food. He'll do just about anything for those chicken treats. They were my secret weapon. Some people have luck with bonito flakes, but Wink hates fishy flavors. ohmygod_smile
 
Thanks for the info. I need to track down some low carb treats..........
Sorry for the slow response.

I need to consult with her vet re the chronic pacnreatitis as I don't know how to address this for her midday feeding if no one's around.

By the way, do you give your pets a midday snack? We have a dry food autofeeder programmed to do so. Even with the high %carb diet the lantus seems to keep her BG pretty even (as determined during a 0 3 6 9 12 hour home testing curve.

I'm perplexed as to how to do so with wet food. Sorta. I know you can buy pet feeders with refrigerated sections that you program to open at specific times. The issue with Lucy and the pancreatitis is that we need to mix her wet food with pancrezyme at all wet food feedings for her to digest her food. If I left the food+enzyme combo sit for hours it would be a yucky pile of mush even I wouldn't eat.

Thoughts?
 
Sorry, no thoughts on the food from Wink and me.

I did want to alert you to this writeup A Primer on Pancreatitisby long term member Marje & Gracie. Maybe there is information here that would be useful to you. It's from over in the Health Links forum, in case you want to bookmark it for yourself for future reference.
 
My Bailey is on pancreatic enzymes. And he gets a can at bedtime mixed with enzymes and he munches the sloppiness all night. Doesn't seem to bother him so I think Lucy would be ok to eat it from a feeder. However I discovered if you mix in a little low carb dry when you make it, it doesn't go as runny - but not too much or it ends up as cement. I also add the dry after the original 20 minute sitting time.
 
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