Newly Diagnosed - Puka the Bengal

[Elisabeth T.]

Hi Everyone,

I didn't think I'd have to be joining another kitty chronic illness forum (I'm had been and still am a member of Tanya's CKD page - but not for this kitty).

I'm sorry I have to be here but glad there is such great resources!

The story:

Our dear Puka started losing weight a couple months ago. We thought most likely cause would be hyperthyroidism. Simple enough ..right? But nothing in the in office exam suggested it. The vet eluded to the next likely cause...diabetes...

Her weight on February 11th, 8lbs.

She had surgery late in Oct. 2016 to remove a mass off her toe that turned out to be a benign basal cell tumor. At that time she was 10.7 lbs.

That means she is down 2.7lbs in just 4months?!?!?!

So when the labs come back and her thyroid was beautiful, the vet was right...she has diabetes....and liver damage ... and man I'm concerned about some of these other labs but we'llnsee if they improve with the treatment we're doing..


Labs:

Urine - via cystocentesis
Urine Glucose: 3+ (1000 mg/dL)
Urine Clarity: Cloudy
Specific Gravity: 1.045
Bilirubin: Negative
Ketones: Negative
Protein: Negative
Blood: 3+
PH: 6.5
All other urine attributed normal

Blood-
ALP: 110 (12-59 U/L)
ALT: 668 (27-158 U/L)
AST: 319 (16-67 U/L)
Creatine Kinase: 153 (64-440 U/L)
GGT: 2 (0-6 U/L)
Amylase: 807 (623-2239 U/L)
Lipase: 186 (11-242 U/L)
Albumin: 3.7 (2.6-3.9 g/dL)
Total Protein: 8.3 (6.3-8.8 g/dL)
Globulin: 4.6 (3-5.9g/dL)
Total Bilirubin: 0.1 (0.0-0.3 mg/dL)
Bilirubin Conjugated: 0.1 (0.0-0.2mg/dL)
Bilirubin unconjugated: 0.0 (0.0-0.2 mg/dL)
Bun: 32 (16-37 mg/dL)
Creatinine: 0.9 (0.9-2.5mg/dL)
Glucose: 353 (72-175 mg/dL)
Calcium: 9.8 (8.2-11.2mg/dL)
Phosphorus: 3.9 (2.9-6.3 mg/dL)
TCO2 (Bicaebonate): 19 (12-22 mmol/L)
Chloride: 106 (114-126 mmol/L)
Potassium: 5.8 (3.7-5.2 mmol/L)
Sodium: 153 (147-157 mmol/L)
ALB/GLOB Ratio: 0.8 (0.5-1.2)
Bun/Creatinine Ratio: 35.6
NA/K Ratio: 26 (29-42)
Hemolysis Index 4+
Lipemia Index 4+
Anion Gap: 34 (12-25 mmol/L)
SDMA: 4 (0-14 ug/dL)
WBC: 18.6 (3.9-19.0 K/uL)
RBC: 7.6 (7.12-11.46 M/uL)
HGB: 12.2 (10.3-16.2 g/dL)
MCV: 53 (39-56 fL)
MCH: 16.1 (12.6-16.5 pg)
MCHC: 30.0 (28.5-37.8 g/dL)
%Retic: 1.1
Abs0lute Retic: 84 (3-50 K/uL)
Nuculated Red Blood Cells: 9 (0-2 per 100wbc)
Platelets: 382 (155-641 K/uL)
Neutrophils: 11532 (2620-15170/uL)
Slide reviewed microscopically. Neutrophils appear slightly toxic.
Band: 186 (0-300 /uL)
Lymphocyte: 5952 (850-5850/uL)
Monocyte: 186 (40-530/uL)
Eosinophil: 744 (90-2180/uL)
Basophils: 0 (0-100 u/L)
Neutrophils: 62%
Band: 1%
Lymphocyte: 32%
Monocyte: 1%
Eosinophil: 4%
Basophils: 0%


The vet wasn't quite sure what to think with the liver. Maybe fatty liver, maybe overflow of inflammation of the pancreas from the diabetes.. maybe an infection, maybe even worse.. the big C..?!?!

She gave the option for antibiotics, an ultrasound, or even a biopsy with a culture. She said if we did the antibiotics it would ruin chances of a culture down the line though. We have gone with the antibiotics ...30 days of clavamox (augmentin). It's been 4 days and her digestive track is already a wreck. I need to get her some probiotics if she's to survive 30 days of that!!!!!!

In addition, we got a liver supplement, Denamarin, that has to be given on an empty stomach. Seriously, insulin twice a day with food and then I have to find an empty stomach for this pill?!?! And I have to work to afford this all! LOL

Then there's the insulin. We were prescribed Lantus. 1U every 12 hours with food. 300 bucks and still will waste half a bottle?!?! I did the Google and wanted to do the thing with the pens, but the pharmacy needed the script re-written. I didn't want to delay treatment so..I went ahead and bought a vial. Anything for Ms. Puka. Heck, it's only money, can't take it with you when you die.

Now, my mother is diabetic and currently I'm using her meter (just a CVS Advanced Glucose Meter) and strips to try and torture this poor animal to get the hang of poking her ear for a drop of blood. I was successful once last night...out of an embarrassing number of failed attempts. Poor cat..I felt awful for poking her over and over...
I don't know if my measurement holds much weight but it was 274 2hrs after her insulin injection. I think I need more practice and time to do a proper curve that would have any true meaning.

Anyway, just hello..that's how we got here. Thanks for reading my rant lol

 

[Red & Rover (GA)]

Hello and welcome. Sorry you have to be here, but this is the best place for a diabetic cat to be.
Please re-post in the Health forum where there are more eyes. Also, please list what you are feeding. In the meantime, I'll tag @Marje and Gracie for you. She is good at interpreting labs.

Like Tanya's site, there is an overload of information at the beginning, but it becomes second nature quite quickly.

Here is a link to help with testing: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

And this is a good starting place to begin to understand Lantus and feline diabetes: http://www.felinediabetes.com/FDMB/...the-basics-new-to-the-group-start-here.18139/

 

[Elisabeth T.]

Thank you!! I have posted in the Heath forum with the food info.

Lots to learn and I'm hopeful that we can sort out this liver mess and then maybe managing the diabetes may be a little easier and a lot less anxiety provoking.

 

[Marje and Gracie]

Is there a hematocrit (HCT) or PCV on her labs that you missed including? I'm asking because her reticulocyte count is high which can be seen in cats who have been anemic although her hemoglobin is good.

The liver enzymes, especially the ALT, has more than a mild elevation. I think it is very helpful to have a full abdominal ultrasound done, if possible. Denamarin might help but it is restrictive on when to give it. I would get up two hours before AMPS and give it but you can't crush it or pulverize it. I finally went to milk thistle which was easier to give.

Yes, she should have a probiotic and I like Renew Life Ultimate Flora Critical Care 50b cfu dosed at 1/3 capsule twice a day given away from the same time as the antibiotic.

Many people use their vials a very long time. As long as it doesn't have floaties or look cloudy, you might be able to use it almost six months.

I hope the vets will find the source of the liver issue.

 

[Elisabeth T.]

Hi!!

Whoops, I sure did glance right over the hematocrit - 40.6 (28.2-52.7%)!!

Ultrasound is the next step once we get her labs redone after these antibiotics.

Sorry for the dumb question, but what does AMPS stand for?

Thanks for all your knowledge!!

 

[Larry and Kitties]

what does AMPS stand for?

The BG (blood sugar reading) before the morning (AM) shot of insulin

 

[Elisabeth T.]

Thanks @Larry and Kitties

Look! I learned I could tag people!! Smh...lol

 

[Marje and Gracie]

Hi!!

Whoops, I sure did glance right over the hematocrit - 40.6 (28.2-52.7%)!!

Ultrasound is the next step once we get her labs redone after these antibiotics.

Sorry for the dumb question, but what does AMPS stand for?

Thanks for all your knowledge!!

Great...so she is not at all anemic. Thanks for adding that.