1/3 Quintus still 117 this morning 85 tonight (no juice)

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Stephanie & Quintus, Jan 3, 2018.

  1. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    Yesterday's condo sparked some discussion, good! http://www.felinediabetes.com/FDMB/threads/1-2-quintus-no-juice-today-musings-on-treating-fd.188968/

    I'll get back into it when I have a moment.

    Sticking to no juice this morning. I dug through Quintus's records and plotted his GLU labs on a new sheet in his SS for easy visualisation.

    In other news, I learned from the vet's office this morning that DM cans are being discontinued. While some may cry victory for the demise of another variety of prescription food, I am left to rush to another practice to see if they have some stock left, to give me some breathing space (and shipping time) while I go through @Gill & George 's alternative food suggestions for ordering here (thanks again), and figure out a viable food solution for the old boy.
     
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  2. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    I hope you manage to get some cans of the DM to allow you to transition him at a pace that will not upset his tummy.
     
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  3. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    I think what your are remembering reading is reductions for a long term diabetic cat/ or a cat that has shown he doesn't hold reductions.

    There is a guideline on TR for long term diabetic cats taking a reduction when they drop below 40, not 50 (human meter)

    A strategy for cats that don't hold their reductions can be to wait for three drops below 50 but above 40(human meter) before taking a reduction. A single drop under 40 earns a reduction immediately.
    The CG needs to be using a human meter, we haven't got a number that's equivalent to that 40 for the AT.

    With SLGS there is no provision for long term diabetics or for bouncy cats. Reduction point is always 90, though you will see that some CG's that know there cats will sometimes adjust this numbers down, but that should only be done with caution, and only when CG knows where onset, nadir and duration lies with their cat, as well as understanding how their cat responds to food, that takes time and data.
     
  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    I believe you are recalling the information on Tilly's (German Lantus forum) page. The instructions state:
    (The bold and italics are mine.) A cat doesn't need to be a long term diabetic to use this as an option. It may be worth considering this for Quintus since it may be of use with a bouncier cat. However, if you're not around to monitor, it can be a drawback since it is a bit more aggressive. One point to underscore -- if a cat drops below 40 (on a human meter -- all BG numbers are on a human meter in the quote) then a dose reduction is automatic.

    I'd also consider if you want to use TR since the German Lantus forum is where TR was developed and it's the protocol they use. We typically discourage mixing and matching between dosing strategies. It can make it hard to be consistent if you do so and one thing that works best with Lantus is consistency. Secondarily, it makes it difficult for us to offer any assistance if we haven't a clue how you're approaching dosing.
     
  5. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    You might have read this from Tilly's Page

    Phase 4: Reducing the dose
    When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose. Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. If the cat drops below 40 mg/dl once, reduce the dose immediately! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further.

    If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose. Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet. Try to go from 0.25 IU to a drop before stopping the insulin completely. Reducing the dose too quickly generally does not work: most cats do not go into remission with fast reductions.

    It is the TR protocol that we also follow on this site, the one difference is that in newly diagnosed cats we take reductions below 50(human meter), unless the cat proves that it is not able to hold reductions, for the most part I have seen this work, it is what I did with George, but there are some kitties that just don't seem to hold, they go down, they come up they go down, they bounce all over the place and in those I have seen how holding for 3 drops between 40-50 (human meter) can make a possitive difference, one such cat I remember I Ivanah, Tara adopted that approach for a little while and it helped Ivanah start to hold on to reductions and she eventually bounced all the way OTJ.
     
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  6. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    Thankfully the other vet clinic still has quite some stock! Bought 24 cans, should buy me enough time for the next food plan.

    Exactly, that's it! Thanks. And that's why I couldn't find it, I'd left out the "cat who can't hold reductions" bit.

    Quintus is at 122 right now. So, it's a little high. But if I look at his numbers overall for the last 24 hours, he hasn't been higher 125 -- not something I'd achieved on the previous days with insulin. He's really pretty flat. Now, would it be better to have him as flat, and lower, and could I work at that with micro-doses of insulin? I'm sure it's possible.

    But I went back and looked at Quintus's labs since I've had him. I have quite a few, because I follow my cats quite closely. As I mentioned in my opening post, I put the numbers in a dedicated sheet for convenience. They were not all fasting glucose -- but I'm not measuring fasting glucose here. Over the years, he's varied between 93 and 157. So, maybe he's just a "slighly sweet" cat in his normal, "healthy mode" numbers? If he hadn't soared sky-high, and I'd bought a glucometer to test him, and got those numbers, they'd look "normal". Now, I agree that "after FD requiring insulin" and "before" are not exactly the same situation. But I'm trying to put these numbers into perspective. If he was taking insulin right now and getting wonderfully flat and stable numbers like this, I think overall it would be considered a good situation. It's not as low as what TR aims for, but it's still pretty good. (I'm assuming it is not a prerequisite for participating in discussions here to be aiming for "tight regulation".)

    Which brings me to Glycemic Status and Predictors of Relapse for Diabetic Cats in Remission, an interesting study that was pointed out to me yesterday (thanks, @Wendy&Neko).

    Here are my take-aways from the study, run on 21 diabetic cats in remission (against a control group of 28 healthy cats). It shows that higher fasting glucose levels and impaired glucose tolerance (measured a few hours after administering glucose) are associated with relapse. 30% of the post-diabetic cats relapsed in under 9 months. Compared to the control group, the fasting glucose levels and glucose tolerance of the post-diabetic group is worse. This indeed tells us that a cat in remission with high fasting glucose (or impaired glucose tolerance) is at higher risk for relapse.

    Now, what I'm more interested in is what is not in the study (or if I've missed it, I think you in advance for pointing it out):

    Of the healthy control cats, did any develop diabetes within the 9 months after the study? [ETA not very likely with a sample of 28, given a prevalence of FD that might be around 1%] and if so, was there a link between their fasting glucose levels, glucose tolerance, and the onset of diabetes? this would be interesting as it would tell us if it is just those levels per se which are a problem, or if they are just a problem in post-diabetic cats. This is what I would have liked to find, as it seems given his lab history that Quintus, had he been included in the study pre-diabetes, would probably have a higher-than-most fasting glucose.

    So, is it that if you have high fasting glucose you are pre-diabetic anyway and at higher risk of developing FD? -- whether you've had it before or not?

    Another interesting thing to know would be what the fasting glucose of the post-diabetic cats was before they developed diabetes. Was it high? Does looking at a bunch of post-diabetic cats mean we are looking at cats who already had high fasting glucose before the onset of FD? This would be consistent with the findings of the study, ie that high fasting glucose puts the cat at higher risk of relapse.

    Which brings me to something else, that I thought about this morning, regarding TR, and the idea of "strong remission". Where I would definitely see a benefit on insisting on low numbers before tapering off insulin is if those low numbers "stick".

    Say Quintus has been a 120 kitty pretty much all his life rather than 80. If we keep him on Lantus until we get nice flat readings between 60 and 80, say, are we resetting his "normal, healthy" BG in a way? If that is the case, then I would say that argument makes a strong case for insisting on the "strong remission" with low numbers. But if it's not, then it just means that a "120 kitty" will just fail and fail to stay with those lower numbers, and either never go off the juice, or go back up to his "normal" when we stop it.

    So this is really something I'd be interested in knowing. If we have a cat who lives happily all his life at 100 or 120 rather than 60 or 80, and we put him on Lantus and bring his numbers down, and keep them there, and taper off, will those numbers stay down? What if we try that on a non-diabetic (well, maybe pre-diabetic) cat? If it worked, it could be worth it -- extrapolating (this would need checking of course) from the above study that being pre-diabetic puts you at increased risk of becoming diabetic (d'oh).
     
    Last edited: Jan 3, 2018
    Reason for edit: typo + comment on prevalence of FD and control sample size
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  7. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Oct 2, 2017
    I just don't think there are enough studies done with FD to satisfy what you are asking, and likely there won't be. But you can get some information about what cats numbers were pre-diabetes, at least around here, if people have kept good vet records and are willing to share, perhaps even on some civvie non diabetic cats. Wanna write a research paper? ;)

    Before I elaborate on that however, it must be stated that nobody really knows how accurate these glucose blood tests are in cats pre-diabetes. Many cats are known to have a BG spike just because they are at the vet "white-coat effect". That's why a cat's glucose can be over 200 and most vets won't blink at that because it's assumed, without other signs, it's just an artificial being at the vet number. You could probably get some idea with Quintus if you test him at home (with an AT) and then test him when you are at the vet (with your AT monitor, the same one you used at home) to see how/if his numbers are different with vet stress.

    I guess this is one instance where a fructosamine test would come in handy. If you have a non diabetic cat with a higher number at the vet, and you run a fructosamine, you might have a better idea of what that cat's real number average is, however the vet stress number would still be included in that to slightly skew it upwards. The problem is, who wants to spend the money on a fructosamine test for a non diabetic cat? There's really no point in doing one, other than from a data standpoint, and they are relatively expensive.

    So back to the first thing, I have several recent-ish labs from Asia going back pre-diabetes. How I know it's pre-diabetes is because many of them had a cystocentesis run concurrently and there was no glucose in her urine. Granted, she could have had diabetes, in theory, and her numbers weren't over the renal threshold, thus we missed the urine test confirmation, but I doubt it.

    Asia's BGs:
    9.20.17 diagnosis: 467 mg/dL, urine glucose 3+
    1.13.17 at vet: 215 mg/dL, urine glucose negative
    12.25.16 at ER: 165 mg/dL, urine glucose negative
    5.4.16 with vet that came to my home: 95 mg/dL, no urine test

    At a glance you could say these are trending upwards, and they are, but there are other considerations. The 5/4 test was done at home, by a vet she had for many years, it is still stressful, and that 95 could be inflated, but not as stressful as being at the vet or ER and smelling/hearing other animals, etc. 12/25 was at an ER, she was in a lot of pain and was somewhat lethargic, 1.13 was at a new vet she had never seen before, she was still exhibiting some symptoms of the UTI they treated her for on Christmas at the ER, but she was alert and probably more stressed than at the ER for that reason. Also, these were taken at different times and various amounts of food may/may not have been in her system at the time.

    Lastly, and I don't have any science to back this up, it's just my hunch, your cat will show you what their normal is on insulin once you get somewhere that starts to look like regulation. In the beginning, Asia fought like crazy to get away from any number that wasn't pink, she thought pink was normal and it seemed her body was trying very hard to stay there. Now she has better numbers but it seems like she wants to be in the 50s (or slightly below) a lot, I fight her on this, but I feel like that's where she wants to be. Again, just a feeling I have and I think others know what numbers their cat enjoys to be in.
     
  8. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    Ooh! Might not get as far as writing a research paper, but indeed :banghead: I hadn't thought of it, we probably have many people here who have pre-FD GLU values for their kitties. It would be interesting to have a preliminary look at them if people are willing to contribute (or if I go spreadsheet-hunting for lab values after I've cleaned the disaster that is my kitchen).

    Indeed, the stress-related glucose increase. Quintus is a very relaxed cat. The kind of cat that used to be purring on the examination table as the vet felt all around his belly with his big fingers. And his numbers certainly include some white-coat effect.

    Indeed! Hadn't thought of that. I'll include that in the study design ;)

    Thanks for contributing Asia's numbers! Valuable commentary too.

    Yeah, this is in line with my "gut feeling" that one's metabolism has a "norm" it tends to head towards. However, the fact that we can make an FD kitty stop thinking pink is "normal" (and also that paper on hypo desensitisation through repeated exposure to low numbers) is making me wonder how "hard" that norm is, and if it is possible to manipulate it. And if we can, how long the effect lasts.
     
  9. Mandy & Rex

    Mandy & Rex Well-Known Member

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    Mar 22, 2017
    To add to Stacy's post above, if you have other cats at home, you can also test them. I have done it a couple times on my civvies. I don't remember who, but she said she tests her civvies and her friend's civvies on a monthly basis.
     
  10. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    Yes, I have a civvie, though she's way less complacent than Quintus. I tweaked her ear this morning to see if she'd let me (she did). Once I have more strips (I'm down to 9!) I'm definitely going to have a look at her BG! Might even manage to get my neighbour to let me go and poke her two cats.
     
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  11. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014
    Just to throw some data out there for your study:

    My Maxie was a civie kitty. Her litter mate brother Tuxie (GA) was diabetic. I started testing Maxie about once a month once I got the testing down to a fine art with her brother.... just to keep an eye on her numbers. For 1 1/2 years she ran 4-6.5 (72-117 US) using an AT2 meter . These numbers would be random and at no particular time as far as food went. Then in March 2016 her numbers started going up and I did more tests and they remained high. Her lab work was all good except for the high glucose. Both kitties were on home-made food for about 10 years and neither were overweight. Tuxie ended up being a Cushing's kitty with chronic pancreatitis, but Maxie had no other factors that could have "caused" FD. She remains unregulated after just shy of 2 years now. This is her first spreadsheet after she was officially diagnosed as FD:

    https://docs.google.com/spreadsheets/d/1Fdks4sQSXCO4L40JrWUnYznvxCerej0foef-xWuwc_M/edit#gid=5
     
  12. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    I have all of Gracie’s labs from day one (13 week old kitten) and while none of them were fasting, they were all done at the vet. Prior to her becoming diabetic, they were all in the low 90s except one which was 108. She was typically stressed about going to the vet just in that she would shake a bit.

    Checking my civvies’ (none of these were fasting):
    Tobey 7 years old, eight lab checks, range from 76 (most recent) to 95 except once at 129 when he had URI as a kitten.
    Livia 18 months old, 89 and 107 (that’s all she’s had)

    The issue with a lot of these studies is small sample size.

    I would also suspect that the fasting glucose concentration and glucose intolerance are only a factor in diabetic cats in remission and are not a predictor in nondiabetic cats.

    A good focus for your research might be humans. Of humans that develop Type 2 diabetes, were their pre diabetes dx fasting glucose concentrations or their A1C higher than humans not developing diabetes? I know Type 2 diabetes, or the predisposition to it, appears to have a genetic connection in my family; however my fasting BG is always in the mid 70s to mid 80s. I’ve never had an A1C.
     
  13. Stephanie & Quintus

    Stephanie & Quintus Member

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  14. Stacy & Asia

    Stacy & Asia Well-Known Member

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  15. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    As Quintus's numbers seem to be still steadily climbing, here's where I'm at:

    - he had a painful bowel movement -- could he have had tummy ache? how much can that make BG head up? (cf. @Lesliejm 's question in Mango's condo)
    - his convenia injection was wednesday. I've noticed they seem to "wear off" after 7-8 days. so, could whatever infection he's got going on that does not like the convenia be making his BG rise? => convenia debate aside, how much can an infection make BG rise?
    - or is it "just" he still needs insulin, depot being depleted?

    I'd be tempted to see if I can give him the convenia injection tomorrow and see if it has an impact on his BG. That would clearly be a way of getting an answer to my second question. And if the answer is positive, maybe we need to look a bit more closely at whatever infectious process is going on.

    What is making me lean towards that hypothesis is that Quintus has been "less improved" these last two days. His numbers have been overall better (more stable and overall low) though he hasn't been spending time in green and lime green like the days before. That could be an explanation. But I would not want to "miss" another cause by jumping immediately on that explanation.

    I'm a bit stuck right now because I have 9 strips left and really not sure if I'll manage to score any tomorrow (junkie mode). I will be calling my vet though to see if they can make magic happen (they're out of stock because of me).
     
  16. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    Interesting article. Of course, there are many other approaches to regulation than what we practice here. However, in this article, it states:

    If I had followed that with Gracie, or you with Quintus, they likely would have died from a hypo as even in the 20s (human meters), Gracie showed absolutely no symptoms. We have learned here, many times over, that observation alone does not tell you when the kitty is low.
     
  17. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    Feb 14, 2011
    For the painful bowel movement and infection...this is an ECID (every cat is different) kind of thing. Some have BGS that go up with constipation, infections, pain, stress, etc, and some don't.

    My thought is that he most likely still needs some insulin. We have other kitties (past and present) who simply need a teeny tiny bit of juice. Ella's Rusty is an example of that.

    Without getting into a Convenia debate, I know others mentioned that this may not be the right antibiotic if Quintus does have an underlying infection, and if you're seeing it lose "effectiveness" after 7-8 days and Convenia is supposed to last 14 days, to me that further supports the thought that if he has an infection, Convenia isn't the right medication for it. If there is anything indicating an infection of some sort really is going on, rather than repeatedly hitting him with a medication that probably isn't working, I would be inclined to try something different if you try anything. At the very least, I wouldn't retry Convenia after only 7 days since it stays in the system for at least 14 days. FWIW, my Trixie did have her pancreatitis treated with an antibiotic - we used Zeniquin for it, and it was very quick and effective.
     
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  18. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    So, actually, the half-life of convenia is 6.9 days in cats. That's how you get marketing people to say it lasts 14 days. My vet tells me his clinical observation is that it's much closer to 10 days effectiveness than 14.

    Well, thing is, the boosts in improvement I see after the injections tell me something is working. A pancreatitis takes a long time to get over FWIW in my vet's practice they will suggest two months of convenia coverage for a pancreatitis, right off the bat -- at least that is what they have done with Quintus, both in 2016 and now. It's actually been just two months the day before yesterday.

    But I agree with you, it is really worth stopping and assessing if the current situation requires us to continue insisting with more of the same (ie, it's working and we just need to keep at it), or change strategies.

    I'd like to state again -- because the info is buried somewhere in a past condo -- that although Quintus was not vomiting or showing pain due to his pancreatitis, the ultrasound showed it was really ugly, so did the labs, and the hesitation was about whether it was necrotising pancreatitis or a tumour. Probably not a tumour given he's still here.

    So, that could warrant sticking with the "usual treatment" for longer than usual, given that it seems to be working (week to week Quintus has done nothing but improve, despite sliding back a few days here and there, like he's doing now).
     
  19. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    Trixie actually had chronic pancreatitis for well over a year, and then she had a second really bad flare - that's when my vet decided to try the Zeniquin, since they are finding that about 50% or so of p-titis cases actually are bacterial in origin. Trix only needed the one 10-day course of Zeniquin and it pretty much knocked the p-titis out of her - no more small flares after vetty visits (I could predict that several days after even the most minor visit she would start feeling like crap), her weird OTJ bounciness came to and end, etc. Of course once again ECID, so I'm just offering something else to explore based on my own experience.

    If possible, I would also consider follow-up testing to see how Quintus' pancreas is looking now as well, since the current course of treatment doesn't seem to be sticking all that well.
     
  20. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    Wow that is super interesting, thanks!
     
  21. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    Ah, just looked it up, here it's under the name Marbocyl. Quintus had a three-week course of it and it definitely helped!

    Just to put things in perspective, Quintus doesn't seem ill. He's just a little quieter than these last days. But the weather has also been crap, so who knows. You know, those little signs cat owners spot that make them say something is "not quite right", but when asked what is wrong, it's hard to say what.
     
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  22. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    Wow, just used one of my precious strips to test Quintus and he's back down to 95!
     
  23. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    Stephanie, it's interesting that the manufacturers recommendation for dosing in cats is a single one time only dose....
    (in dogs it can be used a second time)

    I wonder if some of the 'off' behaviour you are seeing might be attributed to known side effects/ adverse reactions??

    https://www.zoetisus.com/products/dogs/convenia/documents/convenia_pi.pdf

    After a little more searching I decided to look on Zoetis spanish site as I wasn't getting any joy from the UK site.

    https://www.zoetis.es/_locale-assets/spc/convenia.pdf this one is in spanish ( I would imagine that it's the same throughout the eu, and CH often adopts similar practices to eu, in my experience. with humans at least, thatthe UK can be more conservative than the eu with drug/antibiotic use), but basically it is saying the same, in dogs it should be used a max of three times, and it does differ from the other document in that it allows for a second dose to be given for skin infections not clearing up. It's use for treating UTI's in both dogs and cats (with UTI's caused by Escherichia coli) is a single dose treatment only.
    I have found no mention of it being used to treat pancreatitis, and it does seem that repeated dosing with convenia, is less recomendable in cats.

    All this makes me wonder if repeated dosing increases the risk of side effects/ adverse reactions????
     
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  24. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    I also wanted to add Dr. Lisa’s discussion on convenia.

    It has also been found that using antibiotics when they are not warranted (i.e. no infection is present) can cause a dramatic change in gut flora which can be a contributing factor to inflammatory bowel disease. I know you like your vet; mine is also excellent and she will absolutely not give antibiotics unless there is infection present. And we never, ever use convenia. Some use it because it’s easier than a pill and it doesn’t have the nausea side effects, in general. However, since I don’t like my relationship with my cats to be about poking stuff down their throat, in the rare instance they have needed an a/b, I have it compounded into a tasty liquid as they think everything that comes from a syringe is a treat.

    If you do use antibiotics, I hope you are also using a probiotic.
     
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  25. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    I’ve read Dr Pierson’s discussion on Convenia again and again. And I wonder, why is it given so much weight? Is it a peer-reviewed study? It’s more a position paper (?) by one practitioner. Because it’s written and out there, am I supposed to give it more weight than my vet and other’s clinical experience with the product?

    I’m certain there are cases of adverse effects. Nothing is without risk. But this whole thing around Convenia is for me clearly a case of throwing the baby out with the bath water.
     
  26. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Oct 2, 2017
    Convenia has its place and can be a lifesaver for some cats with certain bacterial issues when there are no alternatives, given they don’t have a bad reaction to it, of course. That’s not the argument. All antibiotics, medications, even vitamins and supplements can have side effects. The takeaway is this, and no additional study is needed because it is a known fact: Convenia carries risks that some other antibiotics do not have because it is long lasting and you cannot cease giving it if something were to go wrong, it’s not because it’s evil or ineffective, it’s because you can’t take it back, that’s it. If you have a choice and can use something else, why wouldn’t you?

    What I’ve read about it, long before coming here because Asia needed it, was that it was not a first choice antibiotic for the reason listed above and that it should not be chosen for convenience sake if there are other options. I’m so thankful Asia didn’t have any serious adverse events with it, but just because it hasn’t happened yet, doesn’t mean it can’t happen.
     
  27. Marje and Gracie

    Marje and Gracie Well-Known Member

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    It’s just information from another vet’s perspective. Not everything has to be a peer reviewed study. Give it weight, don’t give it weight....your choice.

    I am sure I’ve mentioned this to you before but a substitute vet for our former vet gave Gracie a Convenia shot without my permission and she went into anaphylaxis. If your cat is one that it happens to, you would always treat it with caution esp as Stacy said....there are so many other viable options that I know if my cat had a reaction to, they would be out of his/her system in 24 hours...not weeks.
     
    Last edited: Jan 4, 2018
  28. Stephanie & Quintus

    Stephanie & Quintus Member

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    Dec 9, 2017
    Yes, you summarise the argument very well, and I'm on board with it -- though the amount of negative reactions around convenia would give the impression it's more in the "evil/ineffective" category.

    I definitely agree that all meds come with a risk. In medicine you are always weighing risks and benefits. Injecting insulin comes with a risk. Yet we do it.

    People and cats can have adverse reactions to antibiotics and other meds. And indeed, if that happens, you stop treatment, and if you're using a med like convenia or our Lantus which is long-lasting, you're stuck with it inside the body, and that is problematic, because you can't "stop treatment". I get that.

    On another note, I see many people putting Neosporin (three different antibiotics!!) on their cat's ears although it's not even approved for use on pets and can be toxic. But I don't see anybody get up in arms about it like every single time I mention convenia.

    I have the feeling that Dr Pierson's opinion on convenia (and I'm not inventing anything, she calls it that in her piece) is extremely influential here (and elsewhere) because she has done an incredible job publishing all sorts of useful information about cats. As with everyone and everything, we use our critical reasoning to determine what we accept and what we don't, what convinces us and what doesn't.

    We also decide if we want to throw out the baby with the bathwater or not. I can disagree with Dr Pierson's stance on convenia without rejecting all the rest of her work and positions.

    I'm not convinced that the risks of convenia outweigh its benefits in general. Is there a risk in giving convenia? sure. Is there a risk in giving antibiotics orally to a cat with a pancreatitis and an already upset digestive system, who is already on 5 or 6 other different meds? sure. Is there a risk in not giving antibiotics to a cat with pancreatitis? sure too.

    So I'm ready to take the risk of a bunch of convenia injections, also (and this is where my personal bias comes in) because I've seen Quintus come back from what seemed like the brink of death following that treatment (in early 2016, his first and acute pancreatitis).

    Is there a risk in giving insulin to a cat who seems to manage to stick to decent numbers all by itself? sure again -- and for the moment that's a risk I have not been convinced to take, because the benefits seem to unclear to me. As the discussion these last days may indicate, I'm still in the process of gathering information and arguments and making up my mind on that one.

    Quintus gets sick on combiclav (amoxycillin and clavulanic acid). He gets sick on metacam. He's doing great after years on onsior, which is only approved for use 6 days at a stretch, and supposed to not be ideal for kidneys. His renal numbers have barely budged in years. And he's doing great on convenia.

    I think the crusade against convenia is unfair and inciting people to shy away from treatment which may be useful to their pet.

    And on a personal level I find it extremely annoying that I don't seem to be able to mention the drug without somebody showing up to tell me it's useless or outright dangerous or shouldn't be used (not what you have done here, clearly, Stacy).
     
  29. Stephanie & Quintus

    Stephanie & Quintus Member

    Joined:
    Dec 9, 2017
    Indeed, I understand that. And I'm really sorry about what happened to Gracie. As I mention above I've seen Quintus have adverse reactions to two meds already, and it was miserable.

    But he's been on convenia before. He tolerates it extremely well. I'm happy to continue using it with him. My other (deceased) cat Tounsi also got convenia often and tolerated it well (he got convenia because he was impossible to pill -- really impossible). My civvie Erica is actually on convenia this very minute, following an abscess drainage, and has been before, because she's difficult to pill and her relationship to humans is still a bit fragile after 7 years homeless, and she's also doing great on it.

    But I get the "once bitten, twice shy" mechanism. I keep telling people how great Onsior is for long-term management of arthritis, because Quintus has thrived on it, and was only sick on Metacam, which is usually the first choice. We all have our biases.
     
  30. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    I am putting this out here for anyone reading this thread.

    From the manufacturer's product insert:

    "Cats CONVENIA is indicated for the treatment of skin infections (wounds and abscesses) in cats caused by susceptible strains of Pasteurella multocida."

    "Cats CONVENIA should be administered as a single, one-time subcutaneous injection at a dose of 3.6 mg/lb (8 mg/kg) body weight. After an injection of CONVENIA, therapeutic concentrations are maintained for approximately 7 days for Pasteurella multocida infections."

    https://www.zoetisus.com/products/dogs/convenia/documents/convenia_pi.pdf

    The drug was initially developed for skin infections and its use for treating other types of infections is off label. One of the main reasons it has become "popular" as an antibiotic choice is because it is convenient. Petparents do not have to pill their kitties and that choice is very appealing to many owners. There are many anecdotal reports of convenia causing kidney issues and even in the study zoetisus did almost 10% of the kitties ended up with kidney issues:

    "Twenty-four CONVENIA cases had normal pre-study BUN values and elevated poststudy BUN values (37 – 39 mg/dL post-study)."

    Decisions on the use of this medication for off label use should be made on the basis of whether this is the correct medication or whether it is merely convenient. also taking into account the general kidney health of your own kitty.
     
  31. Stephanie & Quintus

    Stephanie & Quintus Member

    Joined:
    Dec 9, 2017
    Isn’t using Lantus in cats off-label use?
     
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  32. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    In the other document I linked, it's in Spanish, I've highlighted the section below, from Zoetisus eu site, it allows for a second dose, after 14 days, in cats if skin infection is persistent (3 times in dogs), go figure:rolleyes:. It also seems to contraindicate its use in animals using NSAIDS and some other drugs , I can't see that mentioned on the US insert.:confused:


    Worrying.

    Additionally it is contraindicated in animals who have had adverse reactions to B-lactam, just wanted to point that out Stephanie worth discussing with your vet, as you say he got sick after amoxicillin and clavulanic acid.
    these are in the B-lactam class of AB's

    From the product insert
    CONTRAINDICATIONS: CONVENIA is contraindicated in dogs and cats with known allergy to cefovecin or to β-lactam (penicillins and cephalosporins) group antimicrobials. Anaphylaxis has been reported with the use of this product in foreign market experience. If an allergic reaction or anaphylaxis occurs, CONVENIA should not be administered again and appropriate therapy should be instituted. Anaphylaxis may require treatment with epinephrine and other emergency measures, including oxygen, intravenous fluids, intravenous antihistamine, corticosteroids, and airway management, as clinically indicated. Adverse reactions may require prolonged treatment due to the prolonged systemic drug clearance (65 days).

    On the spanish document I linked it also warns of adverse interactions with NSAID, seeing as he is on Onisor, you may want to discuss that with your vet if you haven't already. There are other drugs mentioned below that are also mentioned in the interactions.
    From the Spanish info
    4.8 Interacción con otros medicamentos y otras formas de interacción El uso conjunto con otras sustancias que tienen un alto grado de unión a proteínas (por ejemplo, furosemida, ketoconazol o antiinflamatorios no esteroideos (AINEs)) puede competir con la unión de la cefovecina y, por lo tanto, puede producir efectos adversos.
    4.9 Posología y vía de administración
    Abscesos y heridas en la piel y tejidos blandos en gatos: Una sola inyección subcutánea de 8 mg/kg de peso (1 ml por 10 kg de peso). Si es necesario, puede administrarse una dosis adicional 14 días después de la primera inyección. Infecciones del tracto urinario en perros y gatos: Una sola inyección subcutánea de 8 mg/kg de peso (1 ml por 10 kg de peso).


    I have no axe to grind here, I've never used convenia, nor been in a situation where I might have to consider it. I am the person that reads the product inserts with any drug I / or my family (two legged and four legged) take, it's been my experience with humans (personally and professionally) that docs are not always 100% aware of all complications/contraindications/interactions and sometimes overlook potential problems when prescribing, sometimes its worth raising those questions and highlighting potential risks with them and how they may be applied to an individual patient. I can imagine that the same is true for Vets, in fact it must be even harder, as we well know one drug can be fine for one species but deadly for another. If you haven't already, it may be worth exploring it further with your Vet, especially (this has already been said) , as it will remain in the system for 65 days, granted not at a therapeutic concentration, but as it says above, at a level which may mean having prolonged side effects which in themselves would need treating. I think it is this point that concerns a lot of folk, and why, if there is another choice often that is taken.
    There are numerous folk here who have used convenia, with no problems, but I haven't seen it being used repeatedly, for me that is the worrying dosing scenario with Quintus, repeating shots before you have systemic drug clearance, in my way of thinking, is increasing the drug levels in his body, effectively it's like giving him a larger dose each time, in general, the higher a dose of any given drug, the more likely you are to suffer adverse reactions to it. Again, why not put that to your vet???

     
  33. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I've learned pharmacists are often much better informed about these issues in the human sphere. Unfortunately, vet meds aren't dispensed by veterinary pharmacists.
     
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  34. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    That has been my experience too.
     
  35. Stephanie & Quintus

    Stephanie & Quintus Member

    Joined:
    Dec 9, 2017
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  36. Stephanie & Quintus

    Stephanie & Quintus Member

    Joined:
    Dec 9, 2017
    Ah, interesting! Did a bit of digging online with a vet friend and came up with this: https://www.revmed.ch/RMS/2007/RMS-129/32618 (in French) on the link between allergy to penicillin and cephalosporins. Estimate 1-2% of crossed reactions (was considered much higher in the 80s).

    So, maybe this wasn't clear in my previous discussions, but giving Quintus an extra convenia injection would of course be something I'd discuss with my vet. The possibility of an underlying infection to investigate, too.

    I'm looking at things a little differently following his lower numbers today though, as they indicate we are not in the situation of a slow steady increase, which is what I thought I was looking at yesterday when I was fishing for explanations.

    If his number stay lowish (or go back down like this) and his general state remains good, there is IMHO less of a case for thinking about lengthening his antibiotic coverage.
     
  37. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    My French is rusty, but I'll give it a go, probably better with a fresh head in the morning though.
     
  38. Kathy and TiTi

    Kathy and TiTi Well-Known Member

    Joined:
    Feb 12, 2016
     
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  39. PussCatPrince

    PussCatPrince Member

    Joined:
    Nov 25, 2017
    That's been my extensive experience also.I'm another one that reads up.
     
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  40. PussCatPrince

    PussCatPrince Member

    Joined:
    Nov 25, 2017
    So what does this vet friend have to say then? Seems you have a vet for Quintus plus a pal that is a vet. That's double vets.
    Are they not able to advise and prescribe the best for Quintus between themselves and you?

    Let's us know what they advise you to do.
     
  41. Stephanie & Quintus

    Stephanie & Quintus Member

    Joined:
    Dec 9, 2017
    Neither of them (nor I) are worried about convenia... (And fwiw I didn't ask anybody here about convenia... just mentioned it and shared my reflexions about whether to continue antibiotic coverage given what I was observing.)

    PM BG of hungry cat upon reaching home tonight: 113
     
  42. PussCatPrince

    PussCatPrince Member

    Joined:
    Nov 25, 2017
    I wasn't meaning this convenia thing. I meant about Quintus , the whole cat .

    What do they, your vet and vet friend, state is the best overall, inclusive treatments & meds for Quintus with all his issues?
    To be clear, by that I mean
    1 - the adminstering of insulin.
    2 - The suggested diet.
    3 - Protecting his CKD.
    4 - Obvs his BP and thyroid will be getting the usual meds ?
    5 - Other issues

    Would be interesting to hear what was actually advised from the two vet professionals that you know.

    Edit . I thought of a better phrase.

    What care package do they suggest for Quintus.
     
    Last edited: Jan 4, 2018
    Reason for edit: Thought of a better phrase to explain what I am asking.
    Stephanie & Quintus likes this.
  43. Stephanie & Quintus

    Stephanie & Quintus Member

    Joined:
    Dec 9, 2017
    Ah, gotcha!

    My "regular vet" is the one who put Quintus on Lantus, twice a day, initially on doses that were a bit high imho, and got me hometesting. He didn't know I'd messed with his food during the first weeks and so was a bit concerned about the early numbers -- concern which seemed to lift when I briefed him on the food issues. He encouraged me to transition to LC, and when I seemed to hit a wall, he told me that if I had a food mix he tolerated and his numbers were pretty, outside glucose toxicity and renal threshold, that was fine.

    CKD: I asked my vet last week if we should be concerned about Quintus's phosphorus soon because of the food change (DM is way richer in phosphorus than NF). Quintus's numbers upon last blood panel (upon FD diagnosis) were actually still in the norm (CREA 19.3 mg/l -- upper limit 24; UREA 0.561 mg/l -- upper limit 0.758) which is not very surprising given the "home dialysis" he'd been giving himself by drinking half a litre of water each day. Labs before that, end September, CREA 17.0 mg/l and UREA 0.478 mg/l. Last Jan: CREA 21.7 mg/l & UREA 0.515 g/l (ok ok I'll got put all those in the spreadsheet :p) His position was that this was definitely not something to worry about in the coming weeks given the numbers, but that we would keep an eye on it on the occasion of the next blood panel.

    He's been getting his usual meds for the thyroid, BP, and CKD.

    I haven't had a chance to touch base with my vet this week, I suspect he may be on holiday. I'll know more later today when I go and pick up food for my civvie.

    As for my vet friend, she's somebody I discuss issues with and I can pester with all manner of questions. She doesn't have direct access to Quintus, though, so she mostly gets out of the way when it comes to treatment, though she will make suggestions and is a great sounding board for me when trying to figure out what course of action to take or what questions to ask. She had no previous experience with Lantus and large-scale remissions in FD cat populations and has been extremely interested to follow what I've been doing with Quintus and discovering this forum's existence. She thinks he's doing pretty well now and is, like me, cautiously optimistic. She doesn't think it's worth the risk to keep him on a micro-dose of Lantus, given his "no juice" numbers.

    Things that remain open and I want to discuss with my vet:

    - continuing antibiotic coverage, or not (convenia). I'm leaning towards "no" now because Q's BG these last days seems to go up and down around the "pretty" range, it's not steadily rising, and I think he'll say no too, but if he things it's more prudent to give another shot, I'll go with it
    - whether it makes sense to micro-dose Quintus in the hope his body will "learn" that lower BG is where he needs to stay (I think the answer will be no)
    - if he has any suggestions diet-wise given that the DM cans are being discontinued and that I'm sick of hand-mixing food n times a day
    - if we should do a blood panel, fPLi, (or an ultrasound check?) shortly to confirm that the improvement I am noting regarding his clinical symptoms does indeed reflect that he's getting/gotten over his pancreatitis. I suspect we might do a blood panel, but not the ultrasound, though I'm sure the ultrasound vet would be super curious to go and have a look inside now! Maybe we'll wait a couple of weeks to do a fructosamine test, but if I've been taking spot checks like I'm doing now I'm not sure it will give us a lot of extra info?
    - how we go forward regarding monitoring of his FD
    - if Quintus's numbers start going up again: if it makes sense to move to another insulin that is more compatible with my long days away from home (PZ or why not, degludec if this is something the Zurich Tierspital is already working with).

    @PussCatPrince thanks for giving me the opportunity to sort through all this in my head to write it down -- I hope I have answered you!
     

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