Kitty 4/11 pmps and vet visit

[kse]

Kitty's pmps was 357 tonight. So, the amps was 416--a 59 point drop. So maybe the 3.75 helped.

Okay--let me tell you about the meet and greet!

The vet was nice and most impressed with Kitty's care. She indicated that we could have a secondary problem and she suggested a complete blood panel along with the T4 testing. She said if we did have additional problems, she did not think they were severe, but there could be something effecting the insulin. She mentioned Kidneys and Thyroid.

So, I agreed to let her do the blood work--she sent it out and will have the results tomorrow. I had a small panel done during DKA and her kidneys were not terribly bad for an old cat--1.9 cr and 49 bun. In fact her kidney numbers have stayed consistent for a year, so unless something as changed in the last 3 weeks, I am hoping the kidneys are at least okay.

The thyroid--who knows, I am suspicious, but not convinced there is a major problem there.

She also did a uninalysis. It is done manually. The ph was 6, ketones were negative, BUT her glucose was >1000. I went back and looked at old urinalysis test (last couple of months) and this is not consistent with any test she has had performed at the other vet. It normally is in the 250 range--they use machine test. The vet told me not to check her bg tonight, that she was high and we would just see what the bloodwork showed tomorrow. I smiled and said okay!

So, when we got home I let her rest and then tested for her pmps about an hour later---I was expecting higher than 357, with the excitement of the car ride and vet visit.

I've read that glucose in the urine is not a true indicator of bg---that it has a lot to do with urination times and frequency. Is this correct? I find it hard to believe her glucose in the urine was >1000 and she tested 367 at pmps.

This vet said she would call me with the results tomorrow and also fax the results to the other vet. It will be interesting to compare their comments.

This vet never mentioned resistance--she just said PZI might not be the best insulin for Kitty. I was kind of buying in until she told me she mainly uses lantus and NPH. Does anyone use NPH any more?

The vet also said that we needed to treat the whole cat not the numbers, and that Kitty looked good!

So, it has been a busy day!

Oh yea--I shot 3.75 again tonight.

 

[Sue and Oliver (GA)]

I think that all sounds encouraging except the NPH. That is another name for Humulin which is just not used anymore. It is harsher than the 2 Ls or PZI with a sharp drop about the 3-4 hour mark with most cats and does not usually last 10-12 hours. Here is some info on it: http://www.felinediabetes.com/pet-insulin.htm But if she is willing to use one of the other lantus, you could use go with those, if you change.

Otherwise she sounds great!

 

[judy and squamee(GA)]

Sounds good. Do you think you will stick with the new vet?

 

[kse]

I'm not sure which vet I will choose.

I am anxious to get the blood results back and compare the two vet's approaches.

The vet today was a great listener and I like that.

I sure hope the test doesn't reveal anything too bad.

One more positive today-- she weighed 8.9 lbs.-- highest weight since dx.

 

[Kelly & Oscar]

Glad to hear it went well, but still sounds like this vet is someone that isn't *completely* up to snuff on feline diabetes. BUT... it is a big thing that she will listen to you and take note.

The previous BUN value was a little high, but that also could be due to the dehydration that diabetes causes. The >1000 glucose value in the urine has no direct correlation to blood numbers. Meaning it doesn't correlate to a 1000+ blood glucose reading. It just means that her blood glucose is high enough that the kidneys are filtering it out in significant quantities. What was her urine specific gravity #? (it is usually like 1.030 or similar value)

Did they do more than a simple T4 check? There is a free T4 equilibrium test and TSH test that can be done as well. When there are concurrent diseases going on (like diabetes) you can't rely on the simple T4 check that goes with the CBC since it can be lower than actual due to euthyroid sick syndrome.

Do post the bloodwork values once you have them!

 

[Joanna & Bix (GA)]

Is that N? Do you think maybe she meant she uses it in conjunction w/Lantus when they have high #s? Some do that (or maybe that's R?), and I think vets use shorter-acting insulins in the office for things like DKA, so maybe that's the context she meant, rather than as something she would send someone home with for BID dosing. It's kind-o hard to imagine someone putting Lantus & N in the same sentence really....? Trying to go with giving her the benefit of the doubt here. You could always ask an innocent "gosh, do you think the Humulin might be a better insulin for her than PZI or Lantus?" and she what she says ... hehe sneaky sneaky

 

[Kelly & Oscar]

R is the fast acting insulin that some use as a bolster with high numbers. I think that is what you are thinking of.

The only reason I can think of her saying Lantus and NPH in the same sentence is if she was lumping dogs and cats together and giving examples of the insulins she uses. I believe NPH is stil the 'go to' insulin for dogs since they metabolize it differently than cats.

 

[kse]

I requested the complete panel of thyroid test. She did indicate there was more than one test, but said they would just test the T4 first and if that gave no definite answer she would request the additional test.

She said there would be enough serem left to break it out if we needed additional confirmation for hyper T. Does that sound correct?

I am not sure what the specific gravity was; I will get the lab results and post tomorrow.

 

[kse]

The conversation concerning insulin went lIke this....,

Vet: PZI might not be the best insulin for Kitty. There are other options.

Me: do you use Levemir?

Vet: no

Me: Lantus

Vet: yes, I use Lantus and NPH

Me: Gulp!

 

[Kelly & Oscar]

I requested the complete panel of thyroid test. She did indicate there was more than one test, but said they would just test the T4 first and if that gave no definite answer she would request the additional test.

She said there would be enough serem left to break it out if we needed additional confirmation for hyper T. Does that sound correct?

I am not sure what the specific gravity was; I will get the lab results and post tomorrow.

Well if that initial T4 test comes back normal, definitely request the other tests still. There have been a couple of kitties here on the board that have had regular initial T4 values but were in fact hyperT based on the subsequent tests.

http://www.felinecrf.org/related_diseases.htm#HyperT1

Occasionally a cat may have low levels of the thyroid hormones and appear to be hypothyroid. True hypothyroidism is extremely rare in cats, and in the case of a CRF cat, this is more likely to indicate that the cat has "euthyroid sick syndrome". This occurs when the T4 levels appear lower than they actually are because of another concomitant disease such as CRF.

Blood tests are also used for definite diagnosis - these measure a hormone produced by the thyroid gland, thyroxine (T4). However, as the Winn Feline Foundation mentions, a small number of cats with hyperthyroidism may have normal T4 levels because levels may fluctuate throughout the day, and you may just happen to test when the level looks normal.

 

[donnahc]

Well if that initial T4 test comes back normal, definitely request the other tests still. There have been a couple of kitties here on the board that have had regular initial T4 values but were in fact hyperT based on the subsequent tests.

I know that to be true in humans Kelly, since I have T issues myself. I would assume it would be the same in kitties.