1/15 Asia PMPS 180, +2 150, +3 120, +4 87

http://www.felinediabetes.com/FDMB/threads/1-14-asia-amps-280-2-320-5-222.189596/

AMPS 258. Not sure what's going on with Miss Asia. I did change her every 12 hour .075 bupe dose to every 8 hours .05, so that's one possibility. I increased back to .075 on the third dose last night. I've read studies show that bupe can be inconsistent with pain relief as well. Her consistently good numbers started coming after bupe was first introduced, and I think that's no coincidence, so it's a large consideration to me.

Maybe her insulin needs have suddenly changed and we are just no longer at a working dose. Whatever it is, I hope I can figure it out soon and get her back below renal threshold, those kidneys don't need any more help in the failing department.

 

Hope you can find a solution that gets Asia back in the blues and greens soon. The lack of control that we have can be so frustrating at times, can't it?

 

Absolutely, for me I can accept it better if I just know why because then there is either something I can attempt to address or something I have zero control of and I just have to deal. When I don't understand, that's were I get frustrated, because I don't like the throwing spaghetti at a wall and see what sticks approach, I want at least a general direction educated guess.

 

I have seen some pretty strange reactions to Bupe as well. Walter walked around like a zombie when he was on Bupe after his first dental - and he was on exactly the same dose as Mandarin who did great on it and seemed to have no adverse reaction. I just wish there were more good options for pain control in cats... and some clear answers for WHY these things happen in some cats. Sorry, not very helpful... I hope you can figure out a better solution for Asia.

 

Sending sliding down vines for miss Asia
But I gotta say looking around it seems like there's a lot of bg wackiness going on. So hopefully this will pass quickly and not be related to her pain mgmt (want her comfortable!).

 

I hope the increased dose of bupe helps Asia feel better and brings her numbers down. Dosing for bupe is such a guessing game.

 

Hope those yellows go away. But you did have blues last night. Not too bad.
Hope you get good lab results.

I was reviewing your December 22 condo for tips on kidney disease.
Asia and Yum are both on Radcat, and they both have BUN numbers that are very high for their creatinine (according to @Marje and Gracie) .
Yum's is more exaggerated than yours (creatinine 2.2 and BUN 98, creatinine 2.4 and BUN 96 for her two most recent labs), but I think the correlation is very interesting.
I'm trying to convince my vet it's due to the blood in the raw food. I haven't seen this in the charts of other cats on radcat, but I haven't seen many.

Also, you went for the oral methyl cobalamin (B12)? Did you call Diamondback re injectable?

 

You’re right, not too bad at all, it’s relative, she was doing great and this suddenly happened, so I’m concerned to figure out what’s going on and address it before it gets too far ahead of me.

Asia’s last BUN was 106 creatinine was 3.2. What is your theory that it’s due to the blood in the raw food? I’m not sure I follow.

Asia’s values were elevated long before this and she was on raw food for all of them, but this most recent is the first since switching to radcat, but also she was dx with diabetes and spent a good time in pretty bad numbers.

I got the oral methyl to get started on something in the meantime, you need an rx for the injectable, I brought it up to my vet, but he didn’t think it would really help much for what I’m using it for. I could push him on it, but I didn’t expect I could get Asia to eat it in her food. It’s not such a big deal to me now because, surprisingly, she is eating it.

I read through all of Yum’s condos since all this started back in November. I hope you don’t mind me asking some questions and pointing out some observations, but I know you must be very upset with Yum’s numbers and I’m concerned for her and you as well. I think adjusting the insulin is probably what you feel you can do to fix this, but my hunch says something else is probably going on and if you address that, the bg’s may follow suit. If you decide to do a new condo for Yum, maybe c&p/respond to this over there so you can keep track of her info for later.

Yum’s sister with the suspected Cushings, that was her actual sister/littermate, yes? And the Cushings was undiagnosed, right? Was the vet that didn’t check the bg before surgery with her the same vet you are currently going to? The place you boarded Yum in November when everything started to go wacky, is that your vets office and is it the same place you boarded her in December as well? Have you considered Yum may have caught something from one of the sick animals at the hospital when being boarded? Given Yum’s sister’s suspected Cushings, it seems like a no brainer to test Yum for that as well as acro & IAA if something similar was diagnosed or suspected in a litter mate, if your vet doesn’t see it that way, or doesn’t know how to get the testing done, can you find a new vet that can? Have you considered going to a new vet for a second opinion? I don’t understand why they are suggesting playing around with Yum’s insulin doses as opposed to trying to get to the root of the issue why she is so high in the first place.

Just some thoughts I had, sometimes you don’t see certain things when it’s your own cat, you know? I know you must be sick with worry and I hope you can find some answers really soon.

 

It really is, all I know for sure is saucer eyes = too much! I can’t tell if it’s just shy of that and effective or not enough most of the time, although when I was over an hour late to give her dose once, she refused to walk down the cat stairs to eat her food.

 

WHOA! Asia jumped on the couch by herself today, for the first time since October!!! Now that is a cause for celebration! I would also note that last night was her first bupe dose of .075 followed 8 hours by that same dose, I don’t know if it’s that, but just putting here for my reference.

 

Thank you, my thoughts exactly!!!

 

I hope the NDW is out of the way now, and Asia will start working the extra juice.

Awesome news on the jumping!

 

Well, a substitute vet who treated (possibly racing) greyhounds being fed raw meat said that to me. BUN can be elevated by stomach bleeding. So this theory has something to do with blood in the stomach.

The junior vet prescribed the injectable cyanocobalamin for anemia. I thought it helped increase Yum's hematocrit a bit, but the cyan can be bad for her kidneys and probably the methyl cobalamin would be more effective.

Ok.

 

Best news of the day!!! Love-love-love!

From yesterday's thread:

Random thoughts... not presented in any particular order:

Shooting low to stay low - Newbies are told they must check kitty's BGs prior to giving a shot "to know if it's safe to give a shot". That's fine for a newbie. Unfortunately, once a caregiver begins to accumulate data and begins to "know thy cat", the emphasis rarely shifts to learning when onset occurs. If a caregiver isn't paying attention to the info in the yellow tagged stickys at the top of the forum, there's a real good chance they'll continue asking about shooting preshot numbers of let's say, 140 or 150 (sometimes anything under 200). It's a shame because when administering Lantus or Levemir, you're not shooting the preshot number. You're shooting for where the cat will be when onset occurs. Big difference!

• Typically Lantus onsets at around +2
• Typically Levemir onsets at around +4

Psychologically, it's easier to shoot Lev on a low number when you know it will usually take around 4 hours for that shot to "kick in" versus only 2 hours prior to the onset of Lantus. Shooting low to stay low is how one attains the long, low curves Lantus and Lev are known for. Levemir's later onset simply makes the decision making easier. Getting back to Alex: Rarely, if ever, did I find it necessary to stall shooting at shot time because of a low preshot number when using Lev... just because I knew her BG numbers would be higher in 4 hours.

Shooting a cat who won't eat/isn't eating well - Let's take this right back to when Lantus and Lev typically onset. Knowing I had 4 hours to get food on board with Lev versus only 2 hours with Lantus made me feel a whole lot better shooting when Alex was sick and not eating well or at all. I figured I could do anything with 4 hours time! Getting enough food into her before Lev's onset wasn't a problem.

For those occasions when I wanted to use a bolus insulin in addition to the basal insulin - For me, Lev wins hands down simply because the action of Lev makes it conducive to administering a bolus twice during a cycle if need be... and one gets the timing right. This can also be done with Lantus, but in my opinion, it's a little trickier using Lantus when you're looking carefully at not wanting to overlap onsets, nadirs, and durations of the two insulins.

Smoother ride - Levemir provided a smoother ride for Alex. Lantus was rather bumpy.

Flexible and forgiving - In my opinion, Lev tolerated me having a life better than Lantus ever did. In other words, with Lev I never felt like there was a huge urgency to administering those shots every 12 hours on the dot. Although, while I do think Lev is forgiving, sometimes I wonder if maybe I was able to relax because there came a point when Alex's diabetes simply became part of life... no more or less than brushing my teeth or hair.

I'm sure I'll think of more reasons why I preferred Lev to Lantus. Those are just some that stand out.

Have a good day!

 

That’s interesting, I’ll have to look into that further. There is more blood in the radcat than in the other raw I was feeding for sure.

 

I forgot...
You mentioned Asia has some bad teeth. Are they infected?
I only ask because Alex had recurring gingivitis. Most vets have a hard time believing pulse therapy can make a difference, but it did help with Alex. Depending on how she was doing, I'd give her clavamox (pills) for the first 5 - 7 days of every month. We weren't too concerned about her developing resistance to clavamox because of her other conditions.
Maybe something to think about ...

 

Yay for this!! Definitely awesome news! Sending vines on over for Asia's numbers to come down slowly to nicer levels...

 

Thanks, Jill, I was happy dancing all over this place when she jumped on the couch, it’s a huge deal!

Those are compelling reasons and I see why it worked better for Alex. A couple of those haven’t and hopefully (touch wood) won’t apply to me. But this! This is so appealing:

That is true, and I think it’s very important to know your cat, it takes a lot of the guesswork out of what number is safe to shoot and if you should stall, skip, or give a token dose. I learned real quick that skipping and giving BCS were not useful to Asia and only served to put her in (really) high numbers for the former, and mess with the depot but the cycle played out just the same if I had given the full dose for the latter.

In my particular situation, that motto has often been “shoot low to go a lot lower”

Many times the preshot number I was faced with was scary because a) I knew it was a falling number (from a double dip) b) I knew onset was often earlier than +2 so I didn’t have much time to get the numbers up c) stalling without food typically made numbers go lower and d) when she has that kind of momentum (before I started using karo and was using HC gravy and honey) I was quite unsure if I could get her numbers up enough in time before onset. I have carb loaded her right after giving a shot on more than one occasion! It would be life changing to have a little more breathing room between shot time and onset!

 

I doubt they are infected to any large degree because I would think it would manifest in her bloodwork and it hasn’t yet, touch wood. She had tooth resorption at 13, we almost lost her because she got so sick with systemic infection and we and our vet didn’t know what was happening. Thankfully, she drooled some blood the very day my vet came to put her to sleep and then she knew it was probably the teeth. She had a bunch of extractions but she has 2 premolars left and they often have big caps of tartar on them. She’s particular and very sensitive about her mouth, understandably. She rubs her face/mouth hard on book corners and box edges, that’s how I know they bother her and I think she’s trying to knock the tartar caps off.

We’ve moved twice in 2 years and the vet I had a year ago said she was too old for surgery and suggested pulse abx in the future should they bother her. The vet I have now thinks surgery could go either way and there’s no right/wrong call on it. He doesn’t like the pulse abx approach and thinks, especially at her age, the side effects cause a cascade of other issues. There’s also the issue of how to get the abx in her to begin with. She’s had abx (convenia, and yes, I’m aware of the risks, she’s impossible to pill safely) in Dec/Jan of last year for a UTI and she did have many problems as a result of the abx and then the additional meds to treat the symptoms caused new symptoms, the whole list being: vomiting, inappetence, staring at her water bowl, diarrhea, lethargy and generally wasn’t acting herself.

It’s such a tricky decision to me, I know if she survives the surgery without complication, having those teeth out is a huge QoL improvement. I almost went for it, but her last labs came back so concerning that I’m at least holding off until I can hopefully improve some numbers there (and her bg), and then I will revisit it.

 

Awesome!!

 

I loved it when Silver did that. He used to have a little step ladder to get up onto my bed.

 

That’s really interesting. I didn’t know this. But it makes sense. Silver is always so much higher at +2 than at preshot. Even his +4 often higher than preshot.

 

She still has her cat stairs to get on my bed, she just gave up trying to get on the couch all together. She thought about jumping up a week or so ago, but didn't, I was proud of the attempt, but today was just awesome!

 

I saw in another condo you use temptations treats at test times. I don't know how carb responsive Silver is, but those are high carb and they say dry food keeps the BGs up longer, so you could have been unknowingly spiking his number before onset. Might be worth experimenting a bit and see if you give LC treats if it makes any difference in his +2 and +4. Freeze dried chicken and boiled chicken are popular choices, I'm sure there are others if you search about, Asia's not a treat cat, so I don't have much experience with it.

 

He only gets two or three at test time. I don’t measure carbs by % and calories. I’m not that obsessive. I have no time or energy for that. He is off dry food and that’s all I plan to do re his diet. Like I could afford the expensive treats like freeze dried chicken anyway.

 

I just want to be clear that while their BUNs are high for where their creatinine levels are, I don’t think it is totally attributable to raw diets. As Stacy remarked, Asia has been on a raw diet a long time and she has the lab tests to show her BUN has trended up with the increase in CKD.

It’s important to remember the old adage, “when you hear hoofbeats, think horses, not zebras”.

 

I found a study that is often referenced regarding this. In dogs on raw diets (2003), while these numbers were elevated over dogs fed other food, they were still within normal range. The conclusion was there should be a different baseline for dogs that are raw fed because of this finding, makes sense. But yes, the very elevated BUN and creatinine couldn't be explained by raw food alone.