UTI Diagnosis

[Melissa and Celle]

Celle was just diagnosed with a UTI. Of course I don't know exactly when it started, but she went outside of the litter box on Wednesday at the same time that her BG seemed higher than usual on a dose of 0.85.

We've been trying to get her settled on a dose, so my question is how this diagnosis changes what we were doing. My plan was to do a curve on Sunday to see if it's OK to increase the dose yet again from 1 unit to 1.2 units. But now it seems like we need to wait until we can get readings on 1 unit without infection.

Does anyone have experience with how infection changes the numbers? Does it make them more erratic, just higher, or is there not really much of an effect? Is it OK to just stick with the current dose of 1 unit once we start antibiotics or do we need to decrease the dose (which I'd hate to do -- I thought we were making progress)? Is it even worth testing her now knowing that any readings are going to be off due to the infection?

 

[Hope + (((Baby)))GA]

Is it even worth testing her now knowing that any readings are going to be off due to the infection?

Yes, no matter what is going on as long as you are shooting insulin you need to test before every shot. Each cat is different on how an infection affects their numbers.

 

[pamela and tigger]

Celle was just diagnosed with a UTI. Of course I don't know exactly when it started, but she went outside of the litter box on Wednesday at the same time that her BG seemed higher than usual on a dose of 0.85.

Just curious, how was the UTI diagnosed? What did they say when you took her in?

We've been trying to get her settled on a dose, so my question is how this diagnosis changes what we were doing. My plan was to do a curve on Sunday to see if it's OK to increase the dose yet again from 1 unit to 1.2 units. But now it seems like we need to wait until we can get readings on 1 unit without infection.

I would not do a curve if there is an infection. It doesn't do much good and it pretty much interferes with the results.

Does anyone have experience with how infection changes the numbers? Does it make them more erratic, just higher, or is there not really much of an effect? Is it OK to just stick with the current dose of 1 unit once we start antibiotics or do we need to decrease the dose (which I'd hate to do -- I thought we were making progress)? Is it even worth testing her now knowing that any readings are going to be off due to the infection?

Infection does 'usually' raise bg numbers. I would stay with the same dose but test, of course, and check for ketones in her urine. An infection changes what you would normally do. You don't want to have to deal with a ketoacidosis situation. When will you be starting the ab's and what kind are they recommending?

Dealing with a cat that is diabetic and who also has an infection is hard. You don't want to let your cat go into DKA which can be a cause of one, or a combination of, three things....too little insulin - not enough food - and an infection.

How is Celle's appetite? If she is eating then that is half the battle and a good sign.

 

[Sheila & Beau GA & Jeddie GA]

Yes, infection changes the BG, usually higher, but can be erratically higher especially once ABs are started and the infection begins to clear up.

I feel that diabetes is secondary to any other disease/situation the cat is going through - meaning, you treat the other situation and work the diabetes around it. If the dose needs to be higher because of the other situation, or in some cases lower, you adjust the dose as needed until the other thing resolves.

You should not risk high BGs while an infection is going on, nor should you risk a hypo if something is causing lower BGs (pancreatitis, inappetance for any reason, lymphoma). Even a healthy cat will have dose fluctuations over time. The numbers should be the guide - so, yes, ALWAYS test before shots.

 

[Melissa and Celle]

Just curious, how was the UTI diagnosed? What did they say when you took her in?

I took in a urine sample. When she goes outside the box, it collects itself in the litter tray. It's not 100%, but usually outside the box means she has another UTI.

How is Celle's appetite? If she is eating then that is half the battle and a good sign.

Her appetite seems normal, but she's a little off, clearly not feeling well.

 

[pamela and tigger]

Just curious, how was the UTI diagnosed? What did they say when you took her in?

I took in a urine sample. When she goes outside the box, it collects itself in the litter tray. It's not 100%, but usually outside the box means she has another UTI.

How is Celle's appetite? If she is eating then that is half the battle and a good sign.

Her appetite seems normal, but she's a little off, clearly not feeling well.

Melissa, I didn't have a chance to check your ss last night since we were in the middle of a major thunderstorm and I had to post in a hurry. Kept losing power.

In looking at your spreadsheet now, I am wondering in lieu of the UTI if you shouldn't raise the dose up slightly - I think you have plenty of room to do this. Take into account what Sheila said in her post too. You might have to back off the dose as the infection clears so keep an eye out for that as well.

If she does indeed have a UTI we don't want a DKA situation here, but since she is eating that is a good sign.

Are you able to check for ketones?

 

[Melissa and Celle]

If she does indeed have a UTI we don't want a DKA situation here, but since she is eating that is a good sign.

Does the infection increase the risk of ketones? I asked the vet to check her urine sample that I took in for the UTI test, but then I forgot to ask about the results. Would it be standard for them to test, or might they not have done that? I don't have a way to test at home.

 

[pamela and tigger]

If she does indeed have a UTI we don't want a DKA situation here, but since she is eating that is a good sign.

Does the infection increase the risk of ketones? I asked the vet to check her urine sample that I took in for the UTI test, but then I forgot to ask about the results. Would it be standard for them to test, or might they not have done that? I don't have a way to test at home.

It can, but not having an appetite and high bg numbers (not enough insulin) can also contribute. That is why I suggested you increase the dose you are giving. Just checked your spreadsheet and I see no reason not to increase to 1.5 units for now and monitor. But you said she was eating so that is a good sign.

I am not trying to alarm you here really...checking for ketones is always suggested as a precaution. Just so you know, it doesn't matter if your vet checked for ketones in the urine or not since ketone buildup can happen over a short period of time if all the right scenarios are in place = not enough insulin, inappetance, infection.

You can buy Keto-diastix (which measure urine ketone levels and blood glucose values) or just Ketostix which would be fine too, to monitor the ketone level. You can get these at your pharmacy.

How is she doing now? Is she still eating? So it looks like from your spreadsheet you just started the antibiotics tonight?

 

[Vicky & Gandalf (GA) & Murrlin]

If she does indeed have a UTI we don't want a DKA situation here, but since she is eating that is a good sign.

Does the infection increase the risk of ketones? I asked the vet to check her urine sample that I took in for the UTI test, but then I forgot to ask about the results. Would it be standard for them to test, or might they not have done that? I don't have a way to test at home.

Hi Melissa,

Yes, infection does increase risk of ketones - development of ketones can happen because of infection, lack of food and lack of insulin. They do not have to have high blood glucose numbers to develop ketones either. So if you have not ever tested for ketones, now is the time to learn how and begin doing it regularly. We have quite a few tips for that, so just ask.

I'm concerned about the way the UTI was diagnosed however. A free catch sample can be contaminated, no matter how well it's taken care of. There is only 1 way to get a reliable UTI diagnosis - a sterile urine draw where urine is drawn directly from the bladder (does not hurt the cat) then the sample is sent out for a culture & sensitivity test to determine what type of bacteria is present, which will also help in treatment as the sensitivity part lists which antibiotics are best to treat that type of bacteria. Just throwing an AB at a supposed UTI is sometimes not helpful because if it's not the right AB, the infection can come back.

A culture & sensitivity can take several days, so please don't stop giving the AB you were prescribed for her. At this point, the best thing to do is treat her with the AB you were given (it would throw off the results of a C&S at this point) for the period indicated then have a C&S done if symptoms return. It sounds like she may have had UTI's before, so an accurate diagnosis in the future will help.

Dr. Lisa Pierson has written several times about proper diagnosis and treatment of UTIs. Her website page about urinary problems in cats is here: http://www.catinfo.org/?link=urinarytracthealth#Urinary_Tract_Infection__

Just want to make sure you get the best treatment for Celle. And it would be fine to raise her insulin dose, especially now. She may be higher because of the infection, but her BG numbers definitely indicate an increase by at least .25U is warranted, even .5U according to the Tilly protocol for BGs this high.

You are getting a good enough range of tests in to show that, without doing a full cycle curve.

I hope she feels better soon!

 

[Melissa and Celle]

Update: I emailed my vet and heard back that Celle's urine sample from Wednesday was negative for ketones.

I'm concerned about the way the UTI was diagnosed however.

Agreed. The vet did want to get a sterile sample to culture, but Celle has been emptying her bladder on the way to the vet. I didn't have an opportunity that I could take her in and pick her up before closing until Monday (and I hate to leave her there all day anyway). So we decided to just start the antibiotic that was a best guess and get a sterile sample in two weeks to make sure the infection is gone.

 

[eeraby]

I'm not so sure that, despite the probable UTI, that Gandalf isn't ready for an increase. Hate to see those reds.

 

[Vicky & Gandalf (GA) & Murrlin]

I'm not so sure that, despite the probable UTI, that Gandalf isn't ready for an increase. Hate to see those reds.

:lol:

Wrong kitty, Beth.

We agree though, Celle is ready for an increase.

 

[Vicky & Gandalf (GA) & Murrlin]

Update: I emailed my vet and heard back that Celle's urine sample from Wednesday was negative for ketones.

I'm concerned about the way the UTI was diagnosed however.

Agreed. The vet did want to get a sterile sample to culture, but Celle has been emptying her bladder on the way to the vet. I didn't have an opportunity that I could take her in and pick her up before closing until Monday (and I hate to leave her there all day anyway). So we decided to just start the antibiotic that was a best guess and get a sterile sample in two weeks to make sure the infection is gone.

You did the right thing, Melissa. I don't want you to feel that you didn't from what I explained about urine cultures in my previous post. Better to at least start antibiotics than not and if that's the best way for vet to see the urine, you did great!

 

[Melissa and Celle]

Thanks Vicky. I did up the dose to 1.25 units this evening, so I hope that and the antibiotics will keep her under 400.

 

[eeraby]

:lol:

Wrong kitty, Beth.

We agree though, Celle is ready for an increase.

I read that as wrong, Kitty Beth. :?

And I'm wondering if I was wrong, how could we agree. And it took me several rereads to figure it out.

Poor Bud. Brain dead mom.