? Theodore bouncing? PMS +653

NadineTheodore

NadineTheodore

Active Member
Hi,

Theodore is bouncing I believe?

I switched to Alpha Track 3 because as his numbers were getting lower it was hard to really understand if he was under 150 and I wanted to be more accurate so I don't have any hypo risks. In the meantime he also had a URI. Vet asked me to lower him to 3.5U as she felt antibiotics and new vial could send him too low and she felt that 4.5U was too high. Anyways, his numbers are horrible now. He is done his antibiotics and his lowest numbers are still in 300s. Any suggestions? Should I let him be a little longer at 4.5 or raise to 5 units?

@tiffmaxee
@Wendy&Neko
 
Whe a cat has an infection the last thing you want to do is lower his dose unless it’s earned especially since he has a history of ketones. I’d go back to 4.5. Inge thin coupled with not enough insulin and not eating and drinking enough is a recipe for DKA. I would be checking ketones.
 
You are going to get higher numbers with the AT. You'll notice that's when his numbers tanked. Is is possible for you to put a blank line in the spreadsheet after the last day you used the FS Lite and before the AT? Also look at last year, his numbers got better once you switched to the FS Lite. It's the nature of the meter, the numbers just look worse than with most of the kitties here. Not sure if he's bouncing or on just too low a dose.

I never really understood why you wanted to know if he's under 150. That is no where near hypo. Even SLGS, our most conservative dosing method, does reductions under 90 and most of those cats go no where near hypo.

I'd be tempted to go to 5 units. But with SLGS, you are supposed to wait 7 days on the 4.5 unit dose before increasing. I presume he's over the Clavamox? Does his URI seem gone? By going to a lower dose (mistake), it's probably allowed glucose toxicity to enter the picture too. Hope you are testing regularly for ketones.

New vials don't usually have a dramatic difference, unless the old one was left out of the fridge or damaged somehow. It's usually not the insulin that's the problem - it's usually the cat. :cat:
 
tiffmaxee said:
Whe a cat has an infection the last thing you want to do is lower his dose unless it’s earned especially since he has a history of ketones. I’d go back to 4.5. Inge thin coupled with not enough insulin and not eating and drinking enough is a recipe for DKA. I would be checking ketones.
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Thank you @tiffmaxee , we are back at 4.5 units but I am wondering if I should even go up to 5 units tomorrow? He has a internist appt Feb 1 to do a ultrasound recheck since his his last bloodwork showed anemia :(
 
Wendy&Neko said:
You are going to get higher numbers with the AT. You'll notice that's when his numbers tanked. Is is possible for you to put a blank line in the spreadsheet after the last day you used the FS Lite and before the AT? Also look at last year, his numbers got better once you switched to the FS Lite. It's the nature of the meter, the numbers just look worse than with most of the kitties here. Not sure if he's bouncing or on just too low a dose.

I never really understood why you wanted to know if he's under 150. That is no where near hypo. Even SLGS, our most conservative dosing method, does reductions under 90 and most of those cats go no where near hypo.

I'd be tempted to go to 5 units. But with SLGS, you are supposed to wait 7 days on the 4.5 unit dose before increasing. I presume he's over the Clavamox? Does his URI seem gone? By going to a lower dose (mistake), it's probably allowed glucose toxicity to enter the picture too. Hope you are testing regularly for ketones.

New vials don't usually have a dramatic difference, unless the old one was left out of the fridge or damaged somehow. It's usually not the insulin that's the problem - it's usually the cat. :cat:
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I haven't been able to check for ketones as I just missed his last few pees but I will try to catch one tomorrow.. His URI seems done although he does have the occasional sniff. I feel it's because it's so cold here in Canada and likes to sleep in his bed by the window which is naturally a colder spot. He also was diagnosed with Anemia last time we ran his bloodwork. We have an appointment with the internal feb 1 to do a recheck ultrasound.

Do you think it would be okay to give him 5 units in the AM
 
Yes, you could increase, given how much you test and if he doesn't see anything below 300 by then. What was his HCT value at his last bloodwork?

This part of Canada is seriously warming up. Supposed to see 15C next week!
 
Hi @Wendy&Neko ,

it was .27 the Hematocrit

https://drive.google.com/file/d/1fbQtGwDWQOA91_4mT7iVVot1fJ3NmqRo/view?usp=sharing

Last week was awfully cold, I had barely any motivation to leave the house but this week is getting better...I wish we had 15C...Highest will be around 7 but on the bright side I am so happy it will not be below 0 temperatures for Theodore's appointment as I hate when he travels in the cold. It's almost a sure thing he will get a URI.
 
Wendy&Neko said:
Thought we'd talked about labs before. It's helpful if you have that link to your previous post here: https://felinediabetes.com/FDMB/threads/dose-advice-1-8-theodore-5-238-2-250.285439/ Makes it easier to go back and see what was discussed.

Hooray for no ketones! One less thing to worry about from the dose reduction.

Did you get the urine protein/creatinine test results back yet?

We aren't 15C yet, just wet.
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@Wendy&Neko Apologies and Yes it was 5, it says the following:

Interpretation of Feline UPC Ratio:
Proteinuria may be pre-renal, renal or post-renal. Non-renal causes include
hemolysis, inflammatory disease, hypertension, glucocorticoids, muscle
damage, urogenital tract diseases, hematuria and pyuria.
For renal proteinuria:
UPC <0.2 = non-proteinuric
UPC 0.2-0.4 = borderline proteinuric
UPC >0.4 = proteinuric
Please refer to our on-line directory of services (test code: UPCR) or
www.iris-kidney.com for further information.

We also did not do blood pressure, I didn't want to stress him out with another visit since he's going in Feb 1 anyway
 
I expect the IM vet will want to deal with that. If not done already, a blood pressure test will be in order. Neko had proteinuria. I think today Telimisartan is one option depending on the cause. Back in the day Neko was on benazapril. That's brand Fortekor in Canada. A "chewable" that Neko wouldn't eat. Apparently dogs do. Most self respecting cats do not. Not sure if that's what Theodore would get. I wonder if there is a connection with the anemia.
 
Wendy&Neko said:
I expect the IM vet will want to deal with that. If not done already, a blood pressure test will be in order. Neko had proteinuria. I think today Telimisartan is one option depending on the cause. Back in the day Neko was on benazapril. That's brand Fortekor in Canada. A "chewable" that Neko wouldn't eat. Apparently dogs do. Most self respecting cats do not. Not sure if that's what Theodore would get. I wonder if there is a connection with the anemia.
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Hmm could the proteinuria be a result of his diabetes being out of control? He is such a complicated case. My vet is great but she is also newer, maybe 1-2 years practicing but she's passionate about helping Theodore and every other vet pretty much has advised me to put him down because of all his issues. Megacolon, FIV, no teeth (they were rotten, broken as I found him as a stray), now diabetes....Still he is full of life and although he has a few problems, I refused to give up on him. The challenge is diabetes is tough and while I do think very highly of her, I think having more experience would have helped with Theodore given how complicated of a cat he is. Hoping the internal medicine doctor will be helpful. Theodore does not deal well with pills...I've gotten all his medication in liquid format so I really hope we can get something worked out..fingers and paws crossed
 
NadineTheodore said:
could the proteinuria be a result of his diabetes being out of control?
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I don't think so, Neko's proteinuria showed up when she was regulated. Kidneys is one possibility. The other possibilities are in the list you posted. His red blood cell numbers are down, and hemolysis in on the list. That's why I thought they might be connected.

I was really happy with Neko's IM. Helped me prioritize what to work on first, and was really good at problem solving, with me involved.
 
Wendy&Neko said:
I don't think so, Neko's proteinuria showed up when she was regulated. Kidneys is one possibility. The other possibilities are in the list you posted. His red blood cell numbers are down, and hemolysis in on the list. That's why I thought they might be connected.

I was really happy with Neko's IM. Helped me prioritize what to work on first, and was really good at problem solving, with me involved.
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I'm not sure what's more serious, kidneys or hemolysis but wouldn't hemolysis be a symptom of something else? His kidney values aside from creatatine look all good unless he has something else that's artificially lowering her numbers (hyperthyroid) but his T4 levels were fine... He's definitely complicated that's for sure. :( The doctor said 5 is extremely elevated so I hope it's something that can be treated and not serious.
 
NadineTheodore said:
I noticed Ivy has Anemia as well, what was the cause if you don't mind me asking?
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Not sure I know. I assume it’s kidney related. We’ve been watching it go up and down for several years now. I think the only thing she takes related to it is B12 methyoclbalamin (also for her neuropathy).
Her last level in September was 28. So always watching it closely. :(
 
Staci & Ivy said:
Not sure I know. I assume it’s kidney related. We’ve been watching it go up and down for several years now. I think the only thing she takes related to it is B12 methyoclbalamin (also for her neuropathy).
Her last level in September was 28. So always watching it closely. :(
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Do you mind me asking what dose she takes? Is it injectable, pills or liquid drops?

I do b12 injectables twice a week .25 ML not sure that's exactly enough?

I added something called Pet-tonic too. Theodore isn't a fan but we are trying to help him. He doesn't have neuropathy but his back I could easily count his bones. He's not overly skinny, he's generally a larger frame. He should be 16lbs wish and he's 13 lbs 13 oz today...His heaviest was around 20 which was a little much.

https://www.zoetisus.com/products/petcare/pet-tinic
 
NadineTheodore said:
Do you mind me asking what dose she takes? Is it injectable, pills or liquid drops?

I do b12 injectables twice a week .25 ML not sure that's exactly enough?

I added something called Pet-tonic too. Theodore isn't a fan but we are trying to help him. He doesn't have neuropathy but his back I could easily count his bones. He's not overly skinny, he's generally a larger frame. He should be 16lbs wish and he's 13 lbs 13 oz today...His heaviest was around 20 which was a little much.

https://www.zoetisus.com/products/petcare/pet-tinic
Click to expand...
I’ve been giving her Zobaline since she developed neuropathy. (Hasn’t helped, still walks on hind hocks) but she is able to do stairs and jump on the sofas and walk around.)
(I’m about to run out so I am going to switch over to Vitacost B12 and see how that goes. I may add folic acid (since that’s in the Zobaline product)
https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
Before that I gave Cobalamin:
https://www.chewy.com/nutramax-coba...MIv4jB0Zr-gwMVoF1HAR0fygb4EAQYASABEgIuSfD_BwE

Do you think the injections help him? My vet doesn’t seem to want to add anything right now.
 
Staci & Ivy said:
I’ve been giving her Zobaline since she developed neuropathy. (Hasn’t helped, still walks on hind hocks) but she is able to do stairs and jump on the sofas and walk around.)
(I’m about to run out so I am going to switch over to Vitacost B12 and see how that goes. I may add folic acid (since that’s in the Zobaline product)
https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
Before that I gave Cobalamin:
https://www.chewy.com/nutramax-coba...MIv4jB0Zr-gwMVoF1HAR0fygb4EAQYASABEgIuSfD_BwE

Do you think the injections help him? My vet doesn’t seem to want to add anything right now.
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I do think the injections help. I notice he seems to have more energy with them but I think the dose might be low?

We started at .2M once a week and we are at .25ML/twice a week

The thing is Theodore really only had one fang left and some tiny small teeth so pills are difficult for him. If I can inject I feel better because I know it goes in and if he's eating while I am injecting, he doesn't even notice...I should also mention it was a great help for him when he had DKA
https://www.drugs.com/vet/vitamin-b-12-1000-mcg-injection.html
 
NadineTheodore said:
I do think the injections help. I notice he seems to have more energy with them but I think the dose might be low?

We started at .2M once a week and we are at .25ML/twice a week

The thing is Theodore really only had one fang left and some tiny small teeth so pills are difficult for him. If I can inject I feel better because I know it goes in and if he's eating while I am injecting, he doesn't even notice...I should also mention it was a great help for him when he had DKA
https://www.drugs.com/vet/vitamin-b-12-1000-mcg-injection.html
Click to expand...
I crush all of Ivy’s pills and supplements and feed mixed in with her food. The only thing I pull her with is Denamarin 1x daily. Wash down with syringe of some water.
Ivy only has 1 fang top and bottom on one side and some small teeth left also :(

How long has he been getting the injections? I assume the vet prescribed and you give at home? Do they suggest an increased dose if you don’t think it’s enough?

Ivy pretty much sleeps most of the day. Has for years. She’s very low energy. My little old lady dragon.
 
I believe I started in September because he was little off and that was .20mL/weekly for 5 weeks then once a month to maintain. (1000 mcg/ML or 10,000 mcg/10mL strength). We honestly didn't keep up with I believe after November but restarted in January when his blood results showed anemia. Vet increased to .25mL weekly but then I spoke with someone in a different support group that suggested increasing to twice a week as they will urinate excess b12 and it's not something you can "overdose" on...He's been fine but I haven't had his bloodwork re-checked since. He's had a lot going on with his URI this month and now trying to fight the high numbers.

Theodore was also a lazy cat but will run for food especially if I put the pure bites freeze fried chicken on his food. He used to attack string but since his diabetes diagnosis he hasn't. He will paw at it a little but not chase it the way he used to. It used to sound like a bowling ball flying through my house :D
 
NadineTheodore said:
I believe I started in September because he was little off and that was .20mL/weekly for 5 weeks then once a month to maintain. (1000 mcg/ML or 10,000 mcg/10mL strength). We honestly didn't keep up with I believe after November but restarted in January when his blood results showed anemia. Vet increased to .25mL weekly but then I spoke with someone in a different support group that suggested increasing to twice a week as they will urinate excess b12 and it's not something you can "overdose" on...He's been fine but I haven't had his bloodwork re-checked since. He's had a lot going on with his URI this month and now trying to fight the high numbers.

Theodore was also a lazy cat but will run for food especially if I put the pure bites freeze fried chicken on his food. He used to attack string but since his diabetes diagnosis he hasn't. He will paw at it a little but not chase it the way he used to. It used to sound like a bowling ball flying through my house :D
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Got it. It’s a lot to manage so many conditions and complications. ;)Thanks for sharing the information with me! I hope we can both get a better handle on all of this sooner than later :bighug:
 
Staci & Ivy said:
Got it. It’s a lot to manage so many conditions and complications. ;)Thanks for sharing the information with me! I hope we can both get a better handle on all of this sooner than later :bighug:
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I hope so as well! Has Ivy done the acro test? I haven’t yet which I will ask the internal medicine specialist about again since his internal organs were slightly enlarged last time with ultrasound but regular vet feels it’s unlikely given he goes down with insulin
 
NadineTheodore said:
I hope so as well! Has Ivy done the acro test? I haven’t yet which I will ask the internal medicine specialist about again since his internal organs were slightly enlarged last time with ultrasound but regular vet feels it’s unlikely given he goes down with insulin
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Yes. We tested and it was negative. And Ivy responds to insulin also. Just not the way I’d like her to :(
Hopefully your result will be negative, too.
 
Injections are cyanocobalamin B12, pills/Zobaline is methyl B12.
NadineTheodore said:
but regular vet feels it’s unlikely given he goes down with insulin
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No reason to rule out acromegaly. Neko went down with insulin too. We've seen acros here on smaller doses than Theo. For most of her diabetic life, Neko was an acro on 3 units or less.
 
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