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? Tucker AMPS 327

Tucker

Tucker

Member since 2018
I’ve strayed from the group because Tucker had been very predictable with his glucose and insulin needs and very regulated. His average pre test has been in the 230-250 range this year and his nadir being in the 130-147 range. He was diagnosed with early stage CKD Jan 2024 and his bloods and urine had been quite stable. Last week he threw me for a loop and yesterday his vet suggest we increase his Lantus from 1 unit to 1.5 units… all at once. I know that’s dangerous so I logged in and was looking for answers in other posts and topics to see if anyone else has experienced similar. Tucker has had diabetes for over 6 years so I thought I knew the ropes! If anyone reads this and can suggest a direction or link any info, I would sure appreciate it! I don’t have a current spreadsheet to share.
The situation:
Last Monday week I found a large puddle of pink liquid by Tucker’s bowl. It had zero odour and it was so clear I wasn’t sure if it was vomit or urine, but I got him to the vet quickly. (He looked great, was eating and drinking, no weight loss.) Vet ran a urine test and he came up as having a really bad UTI, his first ever. His BG was 92.5 at home. He’s a high stress cat and his BG shot up to 432.7 at the clinic. He came home with antibiotics and except for his BG not coming back to normal range, he seemed to be recovering and happy.
He crashed at his recheck yesterday. They did a full blood panel and he freaked out at the test. His BG was 247 at home and 495 at the appointment after the blood test. Super strange thing- at the vet his back toes spread way out! Vet examined his feet and legs and said they moved fine without sign of pain. I got him home and his toes are still spread apart, and his back legs seem weaker than ever before. The vet rang this morning with results and says the infection was completely gone and his SDMA had gone down from his July tests but his Creatinine and BUN were higher. He thinks the rise is due to the very high glucose and prior infection so told me to give him 1.5 Lantus instead of the normal 1 unit… and if I don’t his legs may have permanent nerve damage. Raising insulin doses quickly is against everything I’ve ever done to regulate his diabetes. If anyone has some info about back toes/legs or what to do when a very regulated diabetic goes off the rails, I would sure appreciate it.
 
Do you have a copy of his recent labs you can post? What was his potassium value? Low potassium can cause leg problems. Any chance you could put the last couple weeks worth of data in a spreadsheet? Did the vet check his teeth? Dental problems are one of the main causes of numbers going out.
 
Potassium is fine, so not that. It would have been good to get a urinalysis, to see his urine specific gravity to tell if he's concentrating his urine. He definitely otherwise looks like CKD.
Tucker said:
His BG was 92.5 at home
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No way I'd go up by 0.5 units with nadirs like that. I can't comment any more on dose without a couple weeks of recent data.
 
I’ve requested the urinalysis that was done 10 days ago and then repeated 2 days ago, but they only sent the blood work. I’ll ring when they open up in 5 hours. I can tell you that the vet said the machine maxed out on the infection so he looked at the sample under a microscope and it was rampant. The first sample was almost clear, with a lot of blood in it. 8 days later he rang to say the infection was clear and the urine was beautifully concentrated. (It was dark yellow and stinky, so this wasn’t a surprise.) He told me the specific gravity was normal and the urine was good.

His concern with the blood work is that the creatine and bun took a big jump but his SDMA went down since his July bloodwork - which is unusual. He thinks this might be a temporary rise due to the infection, or a week of very high blood glucose/stress or dehydration or somehow related to the weakness in his back legs/toes spread wide apart??
We were scared to jump his insulin from 1 to 1.5 in one hit so yesterday we went up to a “fat” 1 unit. I tested and he’s still high- but it can take him a week to go back to normal after the trauma of a vet visit. The vet wanted the big increase in insulin to get his glucose down asap- because he thinks the unusual week in the 400’s put stress on his kidneys that resulted in this bun/creatine jump, which he hopes is a temporary thing. (We were more worried about killing him with a hypo if we did that big of a jump.)
 
Did they culture the urine sample the second time? Just going through a situation with a cat that had a UTI (first time ever), went on antibiotics for two weeks and clinical signs all improved. However, the second urine culture showed the infection was still there. Apparently the particular type of bacteria she had doesn't always respond to the first antibiotic type we used.
 
@Wendy&Neko GOOD THING we didn’t do as the vet suggested and jump from 1 to 1.5 Lantus! I’ve been checking him after we jumped up to a “fat 1” and he was just 2.4 (43.2). I’m still asking for the 2 urinalysis paperwork to be sent to me. He just gobbled up some Fancy Feast Classic. I’ve found when we hit him with sugar or gravy he bounces back up to 400 and feels really sick for days after a hypo. Over the last 6 years I’ve learned if I give him low to medium carb food every half hour I can nudge him back into a safe range and avoid the crash.
 
Great catch on that 43! I see Tucker is being a trouble maker again.

His urine specific gravity is fine. I wouldn't worry about the kidney disease progressing a lot.
 
Thanks so much, Wendy. I just realized he’s had diabetes for 7.5 years! I don’t panic at hypos anymore, and can usually ease him back to a safe level. I’m mostly concerned with his weak back feet. His vet thinks it’s neuropathy from long term diabetes and wants to treat it with CBD oil. I’m just worried it could be something more. His creatine and bun are also both up, but the ratio isn’t terrible according to the blood test. If you have any leg suggestions, I’m all ears!
 
Tucker said:
His vet thinks it’s neuropathy from long term diabetes and wants to treat it with CBD oil.
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I've seen other long term diabetics on this forum and this is the first time I've seen weak back legs be due to that. Or CBD oil as a treatment. Any chance he has arthritis now? That is common in older cats in general.
 
The first time his legs got weak it was because he was low on potassium but this time he says it’s because the sudden high glucose during the UTI. He says that he’s seen it in “end stage” diabetics and unregulated diabetics who have too high BG. He called it, “diabetic neuropathy”. He says it’s also common with CKD cats. The CBD oil is only an anti inflammatory and more gentle on the kidneys than a prescription and can be used long term. It’s also what they use for arthritis in his practice. CBD is super regulated in Australia so he has to get it from interstate and prove he’s tried everything else first. (There’s a new arthritis shot here but he says cats either respond great or get much worse with it- so he doesn’t want to risk it on a cat with other issues besides potentially arthritis.)
 
I haven’t heard of this, thank you! I found some capsules near me that are 1000 mcg. May I ask how much I should give him??
 
Search on the Feline Health forum, it's a common question. I never had to deal with neuropathy. You could also go by the amount in the Zobaline capsules.
 
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