Update on Bear; PZI; High numbers

Status
Not open for further replies.
D

Diabetic Cats in Need (DCIN)

Active Member
Before Christmas, I brought Bear to the Board. The post is here. Here is the text of the email I sent to Bear's Beans on 12/26/10 to discuss what the Board's responses had been and a possible plan of action.

I heard back from Dad late last Sunday. He provided me with an Excel document of Bear's BG readings, including a full curve done on 1/8/11. I have put that document, with some comments from me and a first column to indicate the timing of the tests, here.

In his email, he wrote to me:
His numbers are still high and it doesn't appear they are dropping too low, so we may increase his dosage 1 unit to 4 units 2x daily. He is still urinating inappropriately, so that might be another issue all together. Any input is appreciated.
Click to expand...

Some observations I have:

* Bear's numbers continue to be high, including the mid-cycle tests the Beans have gotten. The lowest reading observed was a 183 at PM +4.5 on 12/24/10. During the curve on 1/8/11, Bear's lowest observed point was 265 at +4, but his nadir may have gotten into the high 100s during the unobserved period between +4 and +7.

* Bears does not always receive shots close to every 12 hours. However, because he is on ProZinc and his BG levels are so high, I would not list that as a top barrier to regulation.

* Bear's beans dropped his dose from 4U to 3U on the PM cycle of 12/25/10 (before they would have received my email). I do not know why this dose reduction was made. That drop does not appear to me to have significantly changed Bear's numbers. The does appear to be a few days right after he came back from Boarding on 12/29/10 that his PS numbers seem to have lowered. I do not know whether or how much insulin he might have received while boarding. I would expect that he received his normal doses. If he received no insulin, this would surely be some sort of confirmation for a rebound test.


I am just seeing no good pattern in these numbers. I continue to stand by the recommendations that I wrote to the Beans in my 12/25/10 email, including for a rebound check, but I was hoping for additional eyes that might be able to see some pattern here that I am not seeing.

My goodness, this has to be so frustrating for these Beans.

Thanks to all!!
 
Re: Update on Bear; Need eyes again please

I just got this follow-up email from the Dad:
The vet skipped one of his shots while he was boarded because he wasn't eating, so just skip those numbers. I took Bear to the vet last Tuesday and they gave him an antibiotic shot since he had a UTI. The vet also said to increase his insulin shot by one unit twice a day. So we are now at 4 units and he is still peeing on the floor. I'd like to get another blood curve tomorrow with him on 4 units.
Click to expand...

I am guessing that was a Covenia shot.

So Kristen, yes, they have had him treated for a UTI, although Dad didn't mention being tested for it.

It is interesting that one of the shots was skipped during boarding. That may point to rebound being the issue, as the numbers during the few days after boarding were the lowest in the series. But maybe I'm just seeing it because I want to see it.
 
Bear's Beans here. Finally signed up so we can post info ourselves. We were able to get a curve last Sunday, his lowest number was 238, probably dropped slightly lower between 5.5+ and 7.5+ See the below readings from his curve. On 1/11 we took him to a local vet to get another opinion on his urination issue. She found Bear had a slight UTI and gave him an antibiotic shot, also suggested moving to 4 units BID. By 1/18 he was still urinating throughout the kitchen all the time. Headed back to vet on 1/18, they checked urine sample and UTI had cleared up. They suggested taking an x-ray to rule out stones, no stones found. Then vet recommended valium to calm him and if that had an impact, switch to prozac for long term treatment. After 3 days on valium, no reduction in inappropriate urination. We stopped valium since he was very unstable on his feet after taking even the minimum dosage. Also came to the conclusion that his inappropriate urination is not due to stress or anxiety since it happens when nobody is home (we have 2 young kids). On the evening of 1/23, after BG curve was complete, we put Bear in a gated area with puppy pads all over the floor. Of course he has everything he needs in the gated area (food, water, litter, bed) but we don't feel right keeping him this way for an extended time. Here are our next courses of action:
1. Try switching to Lantus.
2. Insulin detox for 24~48 hours (need bloodwork done first to check his liver values).
3. Try dropping to 1U dose on PZI and do more BG curves.
**We are starting to run low on PZI, so now is a good time to try any of the above options**

1/23/2011 8:05AM 381 4 units
1/23/2011 10:04AM 329 2 hours after 4 unit shot
1/23/2011 11:46AM 249 4 hours after 4 unit shot
1/23/2011 1:35PM 238 5.5 hours after 4 unit shot
1/23/2011 3:35PM 238 7.5 hours after 4 unit shot
1/23/2011 5:15PM 295 8.5 hours after 4 unit shot
1/23/2011 7:05PM 386 11 hours after 4 unit shot
1/23/2011 8:00PM 435 12 hours after 4 unit shot INCREASING TO 5 UNITS

Forgot to add, he is still urinating while in the gated area. At least now we don't have any "surprises" throughout the kitchen. We have seen him pee in the litter box a few times, but 90% of the time is on the floor/puppy pad.
 
I would vote for #3 before changing insulin. If you started with 3 units, you may have been over his ideal dose to start with and he may indeed be rebounding. Rebound If you do decide to try one unit for a few cycles, test a lot and check for ketones.

Let's see what other votes you get.
 
Hello...glad you were able to sign and chat with us yourself.
You guys are trying so hard, it must be terribly frustrating.

Firstly I must say strongly....Please DO NOT stop insulin and "detox".
I have not ever seen stopping insulin at these high levels sanctioned on the board other than here, and in light of the infection and the ongoing high numbers, that is a horrible recipe for your kitty to end up with diabetic keto-acidosis.

I hear how concerned you must be.
I have been going through recurring UTIs with one of my cats and it took a full 21 days of antibiotics to properly rid it once and for all. The inappropriate peeing has all but cleared up as well. Perhaps discussing this with your vet if you don't see a marked difference?

If you want to do a rebound check ( and I would hesitate on this ) rather than starting all over at 1 unit, a reduction to 50% of the current dose should give you the info you need in about 2-3 days is often the recommended approach. All the while testing vigilantly, daily for ketones.
You should see a lowering of numbers at preshot and a general lowering of curve,over a couple of days and then you know you are on the right path.

If you do not see a lowering trend, then you have not lost as much ground dose wise and can return to where you were, and push through the higher levels, increasing gently until you see the lower nadirs and preshots you would hope for.

Does that all make sense?
 
Hi,

I posted on the first thread made for you and Bear. I hope you are able to turn things around soon. I have a few questions for you to consider.

How old is your insulin?

Is it out of date?

If it is not out of date, are you gently rolling the insulin? Not shaking the insulin? Are you keeping it in the refrigerator on a shelf or in the door?

Did you have these high numbers with Bear from the very beginning of the diabetes diagnosis or is this a new development?

Do you have two litter-boxes? If you don't have two boxes already, consider adding a second box. This might alleviate some of the elimination issues but this really might be tied to the higher glucose numbers. Try this and see if it helps in the interim.

If he's never had good numbers since initial diagnosis, I would urge you to start on another insulin as soon as possible. It is obvious the insulin is not working and I don't think you want to continue to experiment with the same insulin. Try another insulin - so, I like your Lantus suggestion.

At no time should you withhold insulin for 24-48 hours. Your cat has infection issues so this will contribute to high glucose readings, but if you take away what insulin is in the mix, you will have the ideal recipe for serious complications such as diabetic ketoacidosis.

For future reference, the convenia antibiotic (shot) is really geared for skin infections, so might not be the best choice when the next UTI pops up - and it might happen again because there is so much glucose in the urine. Many vets like to give the shot so you won't have to pill kitty. If you search the board for covenia you will see many discussions on this topic.

I read through all the posts but can't remember right not if Bear is eating canned food only. If he's eating any dry food that is a contributing factor to high numbers.

Those are just some questions/thoughts I had reading all the posts/spreadsheet.

Best,
Pam & Layla
 
Thanks for all the input. We are trying to get this sorted out so Bear can have a better quality of life.
To answer Pam & Layla's questions:
The insulin is approximately 1 1/2 to two months since we bought it from a vet. The expiration date is 4/2012. Yes I gently roll the insulin before each shot and it is kept on the refrigerator door. We did not regularly check his BG numbers until Venita, from Diabetic Cats in Need, showed us how some tips to get a reading and provided a better BG tester. Previous attempts to get his BG readings were met with hissing, struggling (21LB cat), urination, and frustration on all parties involved. Simply put, we can't say his BG numbers have always been high. We have mostly had at least 2 litter pans with no impact on his urination issue. Bear has been on a wet food only diet for at least six months.

We tried adjusting Bear's insulin dosage to 1U BID since his evening shot on 1/27. Below are the BG numbers from his curve Saturday on 1U. No drastic changes in his readings. We did notice a few small vomit spots while cleaning him up tonight. We've been from 1U to 5U BID with PZI in the last month and a half without any improvement of his BG numbers or urination issues. We realize the only other option at this point is to try switching to Lantus. Any pointers on switching insulin types would be appreciated.

1/29/2011 8:30AM 314 Still on 1 unit - started on evening of 1/27
1/29/2011 10:25AM 375 2 hours after 1 unit shot
1/29/2011 2:10PM 251 6 hours after 1 unit shot
1/29/2011 4:00PM 234 7.5 hours after 1 unit shot
1/29/2011 8:35PM 352 12 hours after 1 unit shot
1/29/2011 11:45PM 318 saw vomiting spots in cage
 
We are feeding him Friskies. We have not been checking his ketone level, we didn't have any strips. We just did and it was in the moderate range. We will increase his dosage to 2U bid and continue to check his ketone level.
 
Moderate ketones need immediate treatment from your vet or a 24-hour ER hospital.

Check again as soon as you can, and if Bear is still showing positive for ketones call your vet and take him in. The condition can escalate quickly to diabetic ketoacidosis. The numbers are not going to go down if he is showing ketones at this level without professional intervention.

It sounds like the insulin is okay - and you are doing everything right, so once the ketones are cleared you should consider another insulin. Lantus or Levemir - either might be a good choice for your Bear.

Just guessing (and based on my experience with DKA) here, but it is possible that the infection hasn't cleared completely.

Please post again with the next ketone reading - and let us know you are calling your vet - taking him in.

Best,
Pam & Layla
 
Bear's Beans are taking him to an ER vet. They also have asked DCIN for Lantus, which their regular vet agrees to put him on. I hopefully will be able to get the Lantus to the Beans this afternoon.
 
We took Bear to the ER vet this morning. The prognosis was not good. He had ketones in his urine and would need 3~5 days in the hospital to possibly get back to his previous condition, which wasn't good either. Bear also has vision problems, most likely caused by diabetes, and the Vet said his vision wouldn't improve even if we got his insulin regulated. After discussing the worst/best possible outcomes we decided to have him "put to sleep". This decision weighed heavily on us and he will be missed greatly. In the last few weeks we consulted with 3 Vets about Bear's situation and feel this was the proper and humane decision. We want to thank everyone for their input on this thread.
 
To Bear's Mom,
I am sorry for your loss.
Its a hard decision to make that I also had to do a few months ago for the same reasons.
 
Please accept my condolences to your family. You did so much for sweet Bear - he will always be with you in spirit.

Hugs,
Pam & Layla
 
To Bear's parents

I am so sorry for your loss. I'm sorry that you had to make that decision under circumstances we all dread.

May Bear's spirit surround you forever with his love. And may you feel his spirit hugging you when you are missing him.
 
I am so sorry that you were forced into making this decision for your sweet Bear. What a handsome boy. I'm sure you have wonderful memories of the love you shared in the short time he was your companion and I'm sending hopes that those memories and that love will comfort you as you grieve his leaving.

Emmy & Dude (& Mittsi too)
 
Status
Not open for further replies.
Back
Top