Liver Function Blood Work Concern

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Marc&Jenny

Marc&Jenny

Member Since 2012
I have been tracking the blood work for my diabetic for a while now. I'm concerned because over the last two years his liver function tests have gone from really high to really low. I've inserted a tab in LB's spread sheet with the lab work (it's at the top of the sheet and says bloodwork).

The most recent blood work shows that Little Bears ALT and ALKP are less than 10 and his total protein and albumin are low as well at 5.0 and 2.2 respectively. That's down from his blood work on 9/11 of an ALT of33, ALKP of 27, total protein of 6.4 and albumin of 2.9 which were all normal numbers.

I'm just not sure if I should be concerned or what to be concerned about. I know what high liver readings mean but I'm not sure what low ones mean. Any information that anyone can provide would be greatly appreciated. I'm planing on talking to my vet when she calls about his most recent fructosamine levels when they come back from the lab but I need some knowledge so that I can speak intelligently to it and know what questions to ask.

His diabetes seems to be under decent control (though some recent stress events have been causing some hiccups). But the liver levels are a trending that I don't seem to be able to pin down as far as a cause.

Update: he has no sympotms, no jaundice, no alteration in eating habits, no change whatsoever. He has become more active since he was placed on the lantus two months ago.
 
From looking at spreadsheet the liver function is not the most concern right now, getting on a proper dose of Lantus would be.

Please read the Lantus protocol. http://www.tillydiabetes.net/en_6_protocol2.htm Lantus should not be dosed based on preshot readings. After the 22 on the 29th, 1U should probably be the current dose, if not lower. Lantus is dosed based on the peak or lowest BG during a 12 hour cycle, known as nadir. Little Bear was getting mid-cycle BGs that show 1.5U is too much insulin, such as on 4/25. The 1U doses right before the dental were working well and as expected. Lantus establishes steady BGs which are in the normal range if dosed correctly. The 300s you see are responses to the low BG incidents, not a sign that LB is not receiving enough insulin.

I also see several skipped preshot BG readings. With values as low as LB has received on 1.5U and even 1U, please test his BG before every shot to know whether it's safe to give insulin.

Have you visited our Lantus Tight Regulation Insulin Support Group? They would be a tremendous help to get you on the right track with insulin dose for Little Bear.

Sorry my post is not addressing your question, but I have to call attention to what could be potentially dangerous insulin dosing. Vets are learning that Lantus is a great insulin, yet may not be giving owners correct advice on dosing it as it is different from other pet insulins they have used in the past. We want to help you understand how Lantus works.
 
Yup, i'm familiar with that information. We are keeping him on the 1.5 till his sugar levels come back below 150, then he will be back on 1.0 as that seems to be the dose he is responsive to now. The liver levels are an issue as they were a problem prior to all the dips and spikes in blood sugar. I'm looking for the information regarding the liver levels. It may be malnutrition but I wanted to make sure that it wasn't something else I needed to be concerned about.

As far as missing shots... I am the only one in the house that can check his sugar for some reason so he only gets the checks when I'm here to do them. We get what we get. I do them as often as I'm able.
 
Looking at the fructosamine tests, it does look like the diabetes is getting better unless the downward trend is caused by swings instead of overall lower numbers, but from the numbers you do catch it looks like it is more likely to be better regulation.

Have you discussed the lower liver numbers with the vet? Have they done any imaging to see if there are any mass concerns? If the numbers had stayed in the normal range I would think it would be from the better DM regulation causing less stress to the liver, but since they are in the low range now, it seems like some more in-depth testing needs to be done other than blood work.
 
We just got a new set of blood work. Liver enzymes are back to normal. It was a vitamin deficiency. We started supplementing with a daily vitamin does with their morning meal. There was never any change in either cat's response so we knew it couldn't be anything too bad.

Additionally, our diabetic had no sugar in his urine. The vet was very impressed and I was very pleased.
 
Marc&Jenny said:
We are keeping him on the 1.5 till his sugar levels come back below 150, then he will be back on 1.0 as that seems to be the dose he is responsive to now.
Click to expand...

This isn't quite how Lantus works. If 1.5u is too much insulin, you'll see even higher numbers than you would at 1u of insulin. That's why we make dose adjustments based on the lowest number of the cycle, not the highest. Keeping him on too high a dose to get his numbers down isn't going to happen because a high dose will keep his BG just as high as too low a dose. When cats drop too low, their livers release glucose into their blood stream, which can cause high numbers for up to 3 days. That's why finding the right dose without going over is very, very important.

Bandit's liver values were always out of whack when his BG was uncontrolled, and they went back to normal once his BG was normal.
 
Um, the post your responding to is very old. I was posting an update to the liver work from May. We actually have very good control right now at 1 unit, he still swings into the 300s but his nadir is at 60 so it works.
 
Sorry, it's very hard to tell what's going on without an updated spreadsheet--the last dose you have indicated is 1.5u, so I assumed that's where you still were.

With Lantus, getting daily nadirs is very important; otherwise, you don't have a true picture of how the insulin is working. Too much insulin will keep numbers just as high as too little insulin. If you're seeing big swings like you indicate (300s to 60s), then that's not having good control over his blood glucose. Here's a very helpful guide to understanding what the different blood glucose levels mean: http://petdiabetes.wikia.com/wiki/Blood_sugar_guidelines
 
The 300 to 60 is what it is, that's what we have to work with right now. If the dose is bumped to 1.5 then his nadirs start hitting 30, but if i drop to 0.5 then his nadirs are at well over 100 and he tops out over 400. This is a human glucometer. I appreciate the guide you posted, it's not necessary as I'm well versed on what each level means, 10+ years in the medical field has done that for me. The syringes we have won't allow us for any further dosing alternatives. I'd love to find something that would allow us to give him a .25 as I think that his happy dose would be about 1.25. Alas, I will have to content myself with what I've got available.

Because of my work schedule and the fact that I'm in South America right now, sugar checks only happen when I'm home. My husband has only been able to successfully obtain 1. can't give you what I don't have. I'm home every other month, I'll try to do better in the future. Sorry, this is the best I can do right now. The last week of sugars is missing from his chart from the last time I was home in July but he started bottoming out on the 1.5 again so we dropped him to 1u just before I left.

Just wanted to update people on his liver enzymes and the fact that the low ones from May had been because of a vitamin deficiency.
 
J&B,
Sorry, just always feel like i have to explain myself or justify my actions. Hard not to feel like people are telling me I'm a bad mommy for not doing this or that when it comes to what I'm able to do to take care of my boys. I get a little defensive because of it. I'm only home part of the time and so i don't have the ability to keep as stringent a watch on my cat. I'd love to see him come off the insulin but without becoming OCD or obsessive about it (which I don't want to be, and some people already think I am), it isn't realistic for me right now to check his sugar as much as I could/should. I do what I can and the control we have obtained (while not the absolute best) is far better than the 7 units that used to not even touch his sugar level. It's progress, in the right direction. He's been on insulin for 2.5 years at this point and I'll just have to keep doing the best I can as this is the job I've got and coming "home" to work isn't an option for me.
 
It is completely not my intention to make you feel like a bad cat owner! You're treating his diabetes, and if you didn't care about him you wouldn't be doing that. I'm just trying to give you some advice to help you out.

Being in the medical profession, you might already know that humans on insulin who make dose adjustments based on daily testing have far better control over blood sugar than those who test infrequently. It's the same thing for cats; that's why the recommended dosing protocol is written for testing at least three times daily. You're certainly won't be OCD for testing the recommended amount; that would be like saying you're OCD for following your doctor's treatment orders!

What many people don't realize is that testing more frequently actually lessens the work and stress experienced with treating a diabetic cat. When you have enough data to make safe and accurate dosing decisions, then things become more predictable and easier to handle. Given LB's length of time on insulin I would never promise remission is almost certain, but I would at least give the protocol a shot and see what happens. It is possible. Even if he doesn't reach remission, the safety and good control the protocol offers is worth trying it in and of itself.

I followed the TR protocol working two jobs (one of which is full time with a 2 hour commute) while going to grad school, so you certainly don't have to work from home! Testing 3-4 times daily and doing a curve once a week is very possible. It may require a little creative scheduling ( I had to set an alarm to get Bandit's nadir in the evening and then go back to bed), but it's certainly doable, and will lessen your own stress in regards to getting control over LB's diabetes.

Do you have u-100 syringes with half unit markings? This is how we measure .25u of insulin. Cats need fine dosing because they are so small, so dose adjustments should be made in .25u-.5u increments, sometimes even finer than that. Here's a picture of .25u insulin in a U-100 syringe:

025unit-1-2.jpg
 
When i'm home, I usually test 3-6 times a day.

it's fabulous that you did that while working two jobs and if i was working in the state, city or zip code I live in I could probably swing it as well. I work out of the country and i'm gone for 4 weeks at a time, sometimes longer. When I'm home, I don't work so I test more frequently. That's why my spreadsheet shows glucose checks for a month and then none for a month or so.

I have u-100 syringes but they are not half unit marked. Our vet doesn't carry those. Where can we get them? I have been ordering syringes from 800petmeds but the ones they have are marked at 1 unit as well.
 
You can get them in any pharmacy--you don't even need a prescription to get them in most states. I get mine at Walmart and they're only about $13 for a box of 100. Ask for .3cc, 5/16" (8mm), 30-31g syringes with half unit markings. Make sure you double check they have the markings before you leave the store; sometimes they mix up the boxes with the unmarked ones and you can't return them once you leave the store.

Who takes care of LB and gives his shots when you're away? Is it your husband? Would it be possible to convince him to help you with the testing? I used to pay a college student to come in and test Bandit when I had to travel for work or school until my boyfriend finally stopped being such a wimp and started helping me test Bandit (bribing with food helped a lot--both the boyfriend and the cat :-D ). If you get your hands on a a bio or health sciences student they will do it for practically nothing usually...the student I got to help out came and tested and fed Bandit several times a week for free admission to shows at a local music venue.

If your husband is having trouble drawing blood, there's ton of tricks we have to help him out--for example, what size lancets are you guys using? Using 26-28g lancets vs. the 30-33g lancets that come with the glucose meters make a world of difference, as does warming up the ear before poking.

The three important daily tests to get with Lantus are before each shot (to make sure it's safe to give insulin), and then a test about half way through one of the cycles to get the nadir (to see how the insulin is working), but any additional testing helps out. That said, we can only do what we are able, so if having your husband, a friend, a family member, a neighbor, or a high school or college student simply aren't possibilities for you to work out a testing schedule, then you're doing all you can do. Again, I'm certainly not trying to make you feel bad, because I know how hard it is to work things out when you're incredibly busy, but I also know how much less stressed I was when I was not terrified of hypos and was able to better control his BG. I did the testing by myself the first 6 months of Bandit's treatment, but when my brother and my boyfriend started pitching in and helping with the testing, things got even easier. Just some suggestions that I hope help you out. :smile:
 
Yes it's my husband. He is unable to obtain them and unwilling to donate the time, I don't know why as LB is his cat. I think it frustrates him too much and he is a little overwhelmed with other stuff. I'm not worried about hypo's (interestingly enough). But I will look into the syringes as it's an ongoing issue, particularly with the lower dosing.
 
Would he be OK with having someone come by to test the cat?
Maybe a vet tech, or high school student interested in Vet Tech, who wants some experience?
You might need to offer a nominal payment.
 
Arghh. I totally understand that frustration. My boyfriend refused to help test Bandit for the longest time, and he works nights so he was there and awake to get the AM nadir, but he wouldn't because he tried testing once and decided it was too hard.

I was finally able to get him to turn around by explaining to him how him testing would improve Bandit's health and possibly save his life (he loves Bandit to death); and asked him to go over his testing with me step by step so I could help point out where he was having trouble. Of course, him being stubborn and hating to admit he doesn't know how to do something perfectly, this was tough. So I bribed him by making dinner for him every week that he helped me out testing, that was enough motivation to get him testing on a regular basis. After about a week or two of regular testing, it got easy for him and he was fine doing it.

Oh, and I put my foot down and said that if he wasn't willing to put in this little bit of effort to help make my life a bit easier and less stressful, then I wasn't going to do all the wonderful girlfriend things I do to support him anymore, and we would see how well our relationship worked then. So I suppose it was a combination of threats and bribery, but I don't feel bad about either.
 
Marc&Jenny said:
When i'm home, I usually test 3-6 times a day.

it's fabulous that you did that while working two jobs and if i was working in the state, city or zip code I live in I could probably swing it as well. I work out of the country and i'm gone for 4 weeks at a time, sometimes longer. When I'm home, I don't work so I test more frequently. That's why my spreadsheet shows glucose checks for a month and then none for a month or so.

I have u-100 syringes but they are not half unit marked. Our vet doesn't carry those. Where can we get them? I have been ordering syringes from 800petmeds but the ones they have are marked at 1 unit as well.
Click to expand...
No problem that you won't have testing info to post while you are away; plenty of others have petsitters who also just give shots but don't test, so what about if you can make an entry on the day you leave town... put something - out of town, no testing and only shots done until my return - if you know the date you can put it, then when you return, add a comment to say first day back and testing to continue.
hopefully it will let others know to refrain from asking for numbers to be added.... without a little note, many people will say 'hey, it's out of date!'

Best of luck with the liver function numbers improving.
 
Having someone else come into our house is not an option. I swear, I'm not being difficult, there just aren't a lot of people we trust enough to come around when we aren't there (whether they are being paid to or not).

Additionally, I'm working to get my husband to get on this band wagon. He's very supportive as long as he doesn't have to put forth any effort. I'm going to revisit the 'dialogue' with a little more force.

On another note. I found the syringes at the online diabetic warehouse place... plus they have the glucometer strips and the larger gauge lancets so I popped some of those into the cart. Maybe with those, he can have some better success and will be more willing. I'd post the email I just sent to him but i don't think that would be good manners.
 
Blue said:
No problem that you won't have testing info to post while you are away; plenty of others have petsitters who also just give shots but don't test, so what about if you can make an entry on the day you leave town... put something - out of town, no testing and only shots done until my return - if you know the date you can put it, then when you return, add a comment to say first day back and testing to continue.
hopefully it will let others know to refrain from asking for numbers to be added.... without a little note, many people will say 'hey, it's out of date!'
Click to expand...

Done, thanks for the tip... i even colored it bright yellow and if my husband takes a sugar it still pops in appropriate color per formatting so you still see the trends.
 
I wish I could find an example but you could also do something like fill in/color to beige or some color all along maybe 3 lines on the ss and then type in there, no testing while out of town.
Lots of people do that if they are away and have a pet sitter, or even if their cat's at the vet in ER or something for a few days..... so long as people looking know that your ss IS very up-to-date, they will have to work around no data just like you have to do when you return home.

Good luck with yr husband helping more; it could just be that he is just like the rest of us in the beginning, it was hard and we were frustrated, but even you know it gets easier, so maybe in time, he'll feel better about testing.
 
it's not that, he's in concentrated graduate school for his PA and always studying... if he isn't studying, the last thing he wants to do is something he doesn't want to do. He's a medic too so the 'medical aspect' doesn't scare him or anything. I think he just really doesn't want to do it cause he get's frustrated if he has to try more than once. He forgets that it was months before I could get to where I got it on the first or second stick... takes practice.
 
Jenny,
the changes you made to the ss look great! Now people will know when you are not home so no BG tests will be done, only shot given.

There's only one thing you need to add because people will ask. ....
you were out of town and did not test but did the cat get shots?
... can you put something like Jenny out of town, dose stays the same till my return... or something like that.
 
The ss looks terrific, Jenny. Now every will see that you are the tester so when away, only shots are given.
You have now ruled out the posts to update you ss!

There was one thought I had about those dives in numbers you mentioned....going from 300 to 60.
Lots of cats' numbers can be manipulated by food.... just by dividing up the day's worth of food into portions and using an auto feeder, you can guide the numbers. All it may take is a tbsp of food at maybe +3 and +5 to pull up the numbers, or slow any diving. Several small meals through the day may help to get a more balance to numbers. You don't have to feed more food in a day, but rather spread it out into several smaller portions. If you have any questions from others who need to use this food method to mellow out their cats' numbers, just ask.

Have a great day and pats for kitty.
 
We can't do more than the two feedings as my husband is in class most of the days and our diabetic is a bully and will eat whatever is out.
 
Eh, well, the pet sitter idea was a shot. Sorry he's being so difficult.

You might ask him how long it took him to master his skills as a medic and be able to do them easily and confidently. Or note how long it takes to master the new skills he is learning as a PA. Or remind him how long it took for you to get it.

An auto feeder might help with the food situation. And/Or use 4 stacked/overlapped baby gates in a doorway to separate the diabetic from the civvy so they can have their own food.

They make glucotest crystals that you add to the litterbox which will show if glucose is spilling in the urine, ie glucose is too high. Not real precise, but it is something that is easy to check. Thee are some other supplemental monitoring tools in my signature link.

Hang in there!
 
Bandit is very food aggressive and Gabby wasn't, so here was my solution.

I fed them every meal at opposite ends of the kitchen, so that they each had their own food dish and their own "spot" they ran to at meal times. I bought two auto feeders, one for each cat. When I was gone during the day, I put a frozen piece of cat food in each one and set them to go off at the exact same time, 6 hours after the shot. Since the portions are smaller when you feed more frequently, Gabby (the picky one) would get through all or most of her food before Bandit would scarf his down and try to clean up her plate. I also added extra water to Bandit's frozen portions so that it would slow down his eating.

You can also do this for night feedings, or you can feed another meal if you're setting an alarm to get a nadir test.
 
We have to monitor them during feeding. They have separate eating locations but the non-diabetic doesn't eat all his food and the diabetic scarf's his own and then goes after the other one's. We looked at auto feeder options, multiple feed's a day and other options suggested on the message boards. We don't have the ability to be consistent with anything so we stuck with twice a day feedings. The diabetic eats and asks for more consistently even though he is used to getting plenty. One time (a long time ago) we kept putting down food to see if he would stop when he was full. He would puke the food up and then eat it again, then look at us and start crying for more. We tried explaining to him about measured feedings and that he was getting plenty but he will have none of it and cries all the same. He will sit on the edge of the other room (from where we feed his brother) and watch his brother eat. Once his brother walks away, if no one is watching, he creeps in and will sit right near the bowl reaching in for bites until he either gets caught or empties the bowl. He scoffs at barriers from food, he is quite inventive when it comes to edible items. We can't store anything out on the counter or below a certain height. Came in one day and he'd busted into a bag of raw pasta. He's stolen a bag of hot dog buns as well. It's been a challenge but we have some great stories.

Talked to the husband. His comment was that LB is defiant and won't sit still or allow him to check the sugar, becoming aggressive in attempts to get away when it's time for a sugar check. We had a conversation about it and he's going to try again. We will see.
 
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