OTJ but numbers trending higher, also would love thoughts on lab work

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Riyah

Riyah

Member Since 2023
Hey everyone!

Here's my previous post: https://www.felinediabetes.com/FDMB...sulin-for-11-days-so-far.284124/#post-3129538

Lily hasn't had insulin since 11/19 but I've noticed her numbers have stayed in the 900-100s. I know OTJ instructions say I could've stopped testing as frequently and our vet also suggested stopping with home testing until we see symptoms. However, with the higher numbers, I'm feeling awfully anxious and tonight she surprised me with a 137 reading, way higher than any of her readings over the last 1.5 months.

She did have a new flavor of food for dinner, "Tiki Cat Luau Ahi Tuna & Mackerel in Tuna Consomme," but it's supposedly very low in carbs so I'm not sure if that was the reason. Someone on my previous post did mention that foods with very very low carbs could cause higher BG levels, but I haven't really looked into that. We have been trying some different foods recently to see what she can eat long term (early in her diagnosis we fed mostly FF but wanted to find something a little healthier), so that could also be contributing, however I make sure they're under 7 carbs. I did feed her a midnight snack of one of her usuals and tested 1 hour later and she was at 101.

A bit of a part two, we did have a check up on 12/20 with our vet for updated blood/urine tests and I'll try and attach the results. All tests suggest that she's in remission but one of her kidney values did increase quite a lot, which has me worried.

Creatinine: 2.2 (1.3 on 11/2)
BUN: 36 (26 on 11/2)
USG: 1.028 (1.036 on 11/2)

I've been doing some light research because I'm wondering if any of her diet changes have affected the kidney values and USG. Our vet said "The most benign cause for the decrease in the urine concentration could be due to the change to a higher water-content food (canned) or it could indicate a recent decline in kidney function." We also ran another kidney test called Cystatin B, which also came back normal. Someone here also had an interesting take on kidney values here that might be relevant but I haven't been able to read through all of the links.

Are there any suggestions on what to do here? The normal range I'm seeing should be 80-120, so 137 does not look ideal for remission. Would drop dosing be appropriate at some point?

And for her lab work and kidney values, has anyone seen something similar when switching to an all wet diet? It's just such a big increase in a short amount of time, so I'm trying to figure out what the cause could be.

Thank you!
 
Lily's creatinine is just over the high end of the range. The other values are at the high end of the normal range. I'd be curious if you have an SDMA value as it's predictive of kidney problems.

A couple of thoughts for your consideration. There's about 6 weeks between test data. I'd get another set of tests in a few months. Another factor is the size of your cat. I have big breed cats. Some of their lab values tend to run a bit higher due to their being big (and I don't mean overweight).

You might want to look for foods that are lower in phosphorus. Lower phos foods may help to prevent any further problems.

I'd encourage you to take a look at Tanya's site. It's a great resource for cats with kidney issues. They also have a support group where you can ask questions.
 
Riyah said:
Hey everyone!

Here's my previous post: https://www.felinediabetes.com/FDMB...sulin-for-11-days-so-far.284124/#post-3129538

Lily hasn't had insulin since 11/19 but I've noticed her numbers have stayed in the 900-100s. I know OTJ instructions say I could've stopped testing as frequently and our vet also suggested stopping with home testing until we see symptoms. However, with the higher numbers, I'm feeling awfully anxious and tonight she surprised me with a 137 reading, way higher than any of her readings over the last 1.5 months.

She did have a new flavor of food for dinner, "Tiki Cat Luau Ahi Tuna & Mackerel in Tuna Consomme," but it's supposedly very low in carbs so I'm not sure if that was the reason. Someone on my previous post did mention that foods with very very low carbs could cause higher BG levels, but I haven't really looked into that. We have been trying some different foods recently to see what she can eat long term (early in her diagnosis we fed mostly FF but wanted to find something a little healthier), so that could also be contributing, however I make sure they're under 7 carbs. I did feed her a midnight snack of one of her usuals and tested 1 hour later and she was at 101.

A bit of a part two, we did have a check up on 12/20 with our vet for updated blood/urine tests and I'll try and attach the results. All tests suggest that she's in remission but one of her kidney values did increase quite a lot, which has me worried.

Creatinine: 2.2 (1.3 on 11/2)
BUN: 36 (26 on 11/2)
USG: 1.028 (1.036 on 11/2)

I've been doing some light research because I'm wondering if any of her diet changes have affected the kidney values and USG. Our vet said "The most benign cause for the decrease in the urine concentration could be due to the change to a higher water-content food (canned) or it could indicate a recent decline in kidney function." We also ran another kidney test called Cystatin B, which also came back normal. Someone here also had an interesting take on kidney values here that might be relevant but I haven't been able to read through all of the links.

Are there any suggestions on what to do here? The normal range I'm seeing should be 80-120, so 137 does not look ideal for remission. Would drop dosing be appropriate at some point?

And for her lab work and kidney values, has anyone seen something similar when switching to an all wet diet? It's just such a big increase in a short amount of time, so I'm trying to figure out what the cause could be.

Thank you!
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I don't know much about kidney problems (knock on wood) but I can tell you that when my Snickers was falling out of remission in November, her numbers were not initially super high. In fact, she was getting normal range numbers mixed with some slightly higher numbers--like a 145--and then normal numbers again. So initially I wasn't worried because I didn't quite see what was happening.

When I was spot checking her I might pull an 80, and everything would seem fine. But then I started to realize that if I spot checked her a few hours later, it might be a 165. Initially, I did not record all her spot pulls because I didn't really think anything was wrong. But then as I realized her numbers were trending up I started to record them. Also, my old Relion meter was broken. Snickers was in remission for over three years, so when I spot checked her I just used the AlphaTrak I already had. I did go buy a new Relion when I realized she was falling out of remission. I only mention this in case you want to look at Snicker's spreadsheet.

If you look at November, you can see where she had a 111 but then a 141, a 131 but then suddenly a 336! Anyway, the fructosamine test you'd normally get (and we did get one) didn't really help because her normal numbers were sort of evening out the higher numbers, if that makes sense. So the test just read normal. But my vet and I discussed it and after monitoring her for a while we both agreed that she was falling out of remission. We did run other tests to eliminate other problems, by the way.

So I guess my advice would be to do a curve. See what Lily's numbers are throughout the day, not just one or two hours in a day. We caught Snickers's fall pretty early, and if you can do the same then it'll help you get her regulated faster and maybe even back into remission.

On the other hand, maybe it is just the changes in her food that you mentioned causing the issue. I've heard of some people's cats getting higher BGs from certain types of protein, even if they were low carb, just because they had a negative reaction to them. Like an allergy, I guess. I've never encountered that myself, but it's worth mentioning if you're trying out new stuff. Either way, I hope you get some answers soon.
 
Here are her labs: https://imgur.com/a/iPfBbPo The left side of values is from 12/20 while the right side is from when she was diagnosed on 11/2.

I'll definitely need to do some more research on the CKD websites. I did ask our vet about whether we should switch to lower phos foods and he said "current recommendation is to not start a significantly phosphorus-deficient diet in the early stages of chronic kidney disease." In addition, the FGF-23 test we had done apparently checks for phosphorus overload and her levels came back as below detectable.

For the BG numbers, a curve is a great suggestion. I think I'll do one tomorrow. I did purchase some Weruva and FF food recently that has beef in it, which she's never really eaten before, maybe it doesn't sit well with her? That might just be me being overly hopeful that it's an easy solution like that.

We did also have a fructosamine test run and it came back as 250, however this was of course prior to the higher number I got two days ago. Snickers numbers look so good though! I see you still shoot on green numbers, do you think she's headed towards remission again? While we were on insulin, I didn't shoot below 200 as per my vet's advice, and I'm kicking myself thinking about whether low doses on those numbers would've helped with a strong remission. However, she did go down to low low greens, like 55-63, soon after, so I'm not sure what was going on there.
 
Riyah said:
Snickers numbers look so good though! I see you still shoot on green numbers, do you think she's headed towards remission again? While we were on insulin, I didn't shoot below 200 as per my vet's advice, and I'm kicking myself thinking about whether low doses on those numbers would've helped with a strong remission. However, she did go down to low low greens, like 55-63, soon after, so I'm not sure what was going on there.
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Glad you got your test results back. I'm not good reading stuff like that but other members are great at it! Like @Sienne and Gabby (GA)

As for Snickers, yes, I absolutely shoot on green numbers. 200 is way too high not to shoot, imo. I think vets say stuff like that because a lot of people don't like to home test, so vets have to say things like that to try and keep cats safe so they don't go hypo. If that makes sense.

My vet knows I shoot low numbers and has no problem with it because she knows that I home test, and trusts that I know what I'm doing. I think microdosing with smaller doses like the 0.5, 0.1, or just one drop are integral to ensuring a long and lasting remission. I learned that here actually! :) That's what I did with Snickers the first time she went into remission and she was in it for 3.5 years.

I admit that I am hopeful she is headed toward another remission this time around as well. I think it helps that we caught her falling out of her mission so early. But even if she doesn't go back into remission this time, I am happy and grateful that her numbers look so good.

I don't remember if I said, but I test mostly with a human meter, the Relion Premier. But I still have my Alpha Track 3 just in case. In fact, I used it today because I got a 106 with the Relion, which isn't high exactly but is high for Snickers. Just to see, I tested her with the Alpha track and it was only 118 by comparison, which made me feel a lot better since 118 on the AT3 is totally within normal range for a non-diabetic cat, and especially great for a diabetic cat so...yay!
 
That's great! For us, if you look at her SS, I think the point we started getting <200 numbers was so early on that I was still overwhelmed with the diagnosis itself and learning as much as I could. She was also bouncing from high numbers at AMPS to low at PMPS, so I was confused with that as well. If she goes back on insulin I'd definitely shoot lower since I'm seeing so many people on here do so.

Our vet was actually quite helpful but definitely erring on the side of caution, which is why he said not to shoot under 200. I think he also maybe didn't know I was testing so frequently so I would've been able to safely do so :( On 11/16, he did give the go ahead to shoot if the number was 150 or higher, but the day after is when we got he 80 reading! And we did shoot a few more times after that, but then we started getting the light green numbers. So many things I would've done differently in hindsight.

She's also due for a dental so I'm wondering if that is having any affect. I've seen it posted here constantly that teeth problems get cats out of remission. The vet didn't say it was urgent but something on my mind for scheduling. But also, now that her kidney values are up, that makes me a little uneasy for anesthesia.
 
Riyah said:
That's great! For us, if you look at her SS, I think the point we started getting <200 numbers was so early on that I was still overwhelmed with the diagnosis itself and learning as much as I could. She was also bouncing from high numbers at AMPS to low at PMPS, so I was confused with that as well. If she goes back on insulin I'd definitely shoot lower since I'm seeing so many people on here do so.

Our vet was actually quite helpful but definitely erring on the side of caution, which is why he said not to shoot under 200. I think he also maybe didn't know I was testing so frequently so I would've been able to safely do so :( On 11/16, he did give the go ahead to shoot if the number was 150 or higher, but the day after is when we got he 80 reading! And we did shoot a few more times after that, but then we started getting the light green numbers. So many things I would've done differently in hindsight.

She's also due for a dental so I'm wondering if that is having any affect. I've seen it posted here constantly that teeth problems get cats out of remission. The vet didn't say it was urgent but something on my mind for scheduling. But also, now that her kidney values are up, that makes me a little uneasy for anesthesia.
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I think you're doing a great job with everything, so don't be hard on yourself about "hindsight" and all that. We can only do the best we can with the information we have at the time :) But it's great that you're learning to much now!

Let's see...I think @Wendy&Neko is also good with the kidney values. Maybe she can chime in. :)
 
What time of day was the urine/blood taken for testing compared to the previous tests? Urine specific gravity is usually higher first thing in the morning. Do you know if she was a little dehydrated? That can cause kidney numbers to look worse.

As for her current BG numbers, what does your Alphatrak 3 says is normal BG range?
 
Hmm, our first appointment was at 9:30am, the most recent one was 10am, so not too different. I don't know if she was dehydrated but at the second test, she'd been fully switched over to an all wet diet, while at her first one she'd been drinking water like crazy while eating majority dry food since she was undiagnosed/untreated. Our vet's comment about the USG maybe being affected by the higher water intake from her diet switch is definitely new info to me, and of course would be the preferred reason over CKD.

I don't see anything about a set range but on some other threads here, I see people have said 68-150. On the user guide, the default low and high reading settings are apparently preset to 65 and 250.
 
My vet always suggested a blood/urine rework a couple weeks later if a number or two seemed off. A one off is acceptable, it's the trend/pattern you are looking for.

I like that +11 tonight. :D
 
Riyah said:
I don't see anything about a set range but on some other threads here, I see people have said 68-150. On the user guide, the default low and high reading settings are apparently preset to 65 and 250.
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When I asked, my vet initially told me that normal range for healthy cats in the Alpha Trak is roughly 70-120. She has since said that up to 150 is acceptable. If you Google it, you'll find similar answers ranging from 80-120 or 68-150, but it's always somewhere around there. If that helps :)
 
@Sienne and Gabby (GA) The SDMA was done and is 12. I’d do as Sienne and Wendy suggested and check again. My vet usually suggests a recheck in 1-3 months depending on how off the labs are.
 
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I'll try and do that. It'd either give me peace of mind or confirm that CKD is happening. I was thinking, after someone asked about dehydration, that maybe she could've been? Since going on insulin and regulating, I almost never see her drink water. However, I usually add some extra water into her dinner, but not every single day.
 
It’s a good idea to add water to every meal. They do drink less or not at all in my case if eating an all wet diet.
 
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