? Help with Tiger's Lab results

Previous Thread http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-bgs-hi-hi-hi-hi.225863/
This morning I heard a rattle in his chest. No fever..so you know what that means. Took Tiger to the Vet this afternoon. Did a complete blood workup(gave me a discount), ketone test(Neg) and bg(HI). Results from the blood work should be in tomorrow. She did a thorough exam and also heard the rattle and his heart is struggling because of the fluid.
She took him off the Prozinc and he is now on Vetsulin. "The Prozinc should have brought it down by now."
Dose is: 4u's twice a day check bg every 2hrs and to call her on Saturday if still HI. 11pm will be his first dose.

 

Did she give him any medication to remove the fluid from his chest?
Has he had fluid on his chest before?
Not sure that swapping to caninsulin is a good choice.
I am not a user of caninsulin so I will tag @Deb & Wink

 

No meds yet wants to get results back from the blood test. HI has read HI since I started testing him. She wants a faster acting insulin..at least for right now.

 

Vetsulin (Caninsulin) does have a bit faster onset than Prozinc. The downside is that the duration is usually shorter than Prozinc.

Vetsulin can drag the BG's down earlier in the cycle.
Onset is often at +1.
It's why the recommendation is to feed at least 20-30 minutes before giving the dose of Vetsulin.
So the food starts to get digested, dumps some glucose into the blood stream and prevents a really fast, hard crash in BG numbers.
Feeding a small meal 1 to 2 hours after the shot can also help to "stabilize" the BG levels.
The BG's usually shoot up faster around +8 to +10 when the Vetsulin stops working.
But, ECID and Tiger may get longer duration.
You have to give the Vetsulin time to work.
3 cycles on Vetsulin is not enough time to see if it is working well.
It takes time for a cats body to adjust to an insulin.

Please keep using the same SS for Tiger. Simply put a big bold line across one row so we know you switched to Vetsulin. Larger print for that big bold line would be good too. So the insulin change jumps out at us.

Sticky: Beginner's Guide to Caninsulin (Vetsulin)

 

Are you checking daily for ketones.

 

Jacjue, what does your work/life responsibilities look like.

If the Vetsuilin dose not work the next option may be NPH insulins.

Might need to dose 3 times a day, every 8 hours, with the NPH insulin.
That's another possibility.

 

Hopefully the Vetsulin will work better for him....ECID so it's possible but you may also need to be prepared to give it every 8 hours instead of every 12 if it wears off too soon.

 

Ya Doc said at least 3 days, she wants me to call her on Sat. that would be 4 cycles. She just wants to see if I get a reading. It's been awhile since I used the Vetsulin, not sure if you remember seeing one of my 2 previous threads. Jazz was on it until I switched him to Pz. I popped onto the thread when I got home to refresh my brain. Be ready for a 911.

 

Yes, he is always Neg.

 

Yes, Doc mentioned that. This is my life lol. Taking care of the sick and unwanted cats because of their illnesses or behavioral problems. I usually have a steady amount of furbabies..around 20. Oh and 2 unwanted dogs..one has breast cancer and the other behavioral.

 

Sorry forgot to answer your other question. No he's never had fluid before.

 

Someone told me back in the day..30/shot/60

 

@Deb & Wink Ummm how do I do this? "Please keep using the same SS for Tiger. Simply put a big bold line across one row so we know you switched to Vetsulin. Larger print for that big bold line would be good too. So the insulin change jumps out at us."

 

I actually figured it out how to bold it. Where should I add the word Vetsulin?

 

On the AM side of the SS, just put the letters VETSULIN, one to a cell across one row.
Using the +1 to +11 cells would work nicely.

That should show up nicely.

 

So what did Tiger do on the Vetsulin?
Good, better, best?
Same?

 

Just updated ss. Am shoot is going to be 5u. Put him on Prednisolone 5mg once a day for 5 days and vaporizer to help his breathing. If no improvement with his breathing I will take him back in for more blood work.
Lowdown on blood test..red blood cells are low, anemic and dehydrated and of course glucose is high(456)
Here are "flagged" results from his blood test:
ALT (SGPT) 382 (High)
Alk Phosphatase 247 (High)
BUN 53 (High)
RBC 3.0 (Low)
HGB 4.4 (Low)
HCT 14 (Low)
Differencial Absolute
Neutrophils 8,692 (High)

 

Vetsulin hasn't had a chance to make a difference.

Did you get subq fluids (or you probably already have some) for the dehydration?
I'm not one of those people that can interpret blood work.
You might want to change the title of your post, to see if there is someone that can help with that.
(Besides the fact Tiger's kidneys are shot. But you said that already.)

I'll tag @Larry and Kitties I know he can interpret bloodwork. Not sure if he's around this weekend.

 

This is in the deadly low range. This is part of the reason for the breathing difficulty. There is not enough red blood cells to get the needed oxygen.
Typically, when the HTC is low like this the results will include a reticulocyte value. Reticulocytes are immature red blood cells and the level will tell you if there are enough reticulocytes being produced in response to the low HCT

 

I'll scan the results in a little bit and share them here. Doc said he has juvenile blood cells. And yeah unfortunately she said the same thing.

 

Doc is not sure if the diabetes is causing the kidney values. And we don't know how long the old man's glucose has been HI. Dang cats don't tell you that they are sick until it's too late for us to help them.

 

There is a tab on the SS (spreadsheet) where you can enter lab values.
You need to add a column first, for the reference ranges your lab uses. (Idexx, Antech, etc.)
Then you add a column on the labs workbook for the lab values you got for a particular date.

See Julie and Kitty's SS for an example. Kitty’s Spreadsheet

 

lol ya ok

 

Yeah Jacque, we are asking you to do some work here.

Sorry to say, but the cell phone pic attachments are often so blurry, can't read them in the first place. Not even zooming to 200%.

You don't want us guessing "Now is that a 3 or an 8? I think it's an 8. Is that other number a 1 or a 7? Can't tell."

 

Even if I'm using a pc for attaching? I don't use my cell hardly at all. I have a old flip phone lol

 

Yup, even then.
Someone attached a PDF of their cat's spreadsheet SS yesterday. She had not figured out how to get the link into her signature. SS was barely readable. Squinting and trying to see if "that was an 8 or a 3" was realer than real. Just today.

With attachments, there are a limited number of pixels that make up the image. Think of those attachments as being the old analog version of a picture vs newer digital televisions and the HD resolution.

And I use a 17" pc screen to view everything on the message board.

p.s. Old style flip phone here too. Hate smartphones.

 

2/28/20 Tiger's Lab Work..not a complete workup done. If no improvement with the breathing I'll take him back in Monday and get more tests done
https://docs.google.com/spreadsheet...1HOujGcKsAscdui05Ul21PD0pI/edit#gid=730720334

 

https://docs.google.com/spreadsheet...1HOujGcKsAscdui05Ul21PD0pI/edit#gid=730720334

 

How's the lab tab look?

 

Looks good, very good. Now we just have to find someone that knows what it means. And interpret the values.

Could you change the title on your post please Jacque?

Put the question mark prefix on the post, change the title to ask for help looking at some lab results. Hopefully someone will respond. Our best person that does that lab result interpretation is away on vacation for a couple of weeks right now.

 

5U.....FINALLY GOING DOWN 385 +8

 

Finally! 385 isn't scary. <100 is scary at +2. <50 is scary most anytime with Vetsulin, and needs to be propped up with food.

 

He dropped like 300..freaking me out lol. Have only seen 1 reading in the 300s in Feb. I just hope his body isn't like "what the heck is going on?" I'll try not to worry. At least we know that the Vetsulin is working and getting close to a nadir, I think.

 

The very low HCT (14%) really concerns me. There is no listing in the SS for immature red blood cells (reticulocytes) which would indicate if the body is responding (regenerative) to the low HCT by creating more red blood cells.
The high ALT (SGPT) and Alk Phosphatase dents to indicate a liver problem and if not eating much that could be the reason.
The Creatinine is at the upper range and usually indicates the start of kidney insufficiency. No Phosphorus level is included that couopd indicate a kidney problem.. Nor is the urine specific gravity list since that is a good indicator of kidney insufficiency. When kidney function really gets bad that inhibits the creation of red blood cells which results in a low HCT.

 

Thank you sooo much for taking a look see. Doc said according to the lab..the red blood cells are "juvenile". And for sure not eating as much as he used to...but today he is eating better. I'll likely take him back in this week to get more tests done. The rattle in his chest has diminished..but still there.

 

He is much more alert and up and about today. Color looks great still. Medium hydration..he just had his shot so I will subq later. As far as eating? I should mention that Tiger 18 and has only 3 teeth. He hates it when meat from canned pate gets stuck(I have to squirt water in his mouth to unstick the food. Tried blender but it turns it into a smoothie, he hates it. Right now I offer several pate brands to him..basically it's whichever one annoys him the less. And an occasional jar of Gerber baby food. He really loves Blue Wilderness Soft Moist Treats.

 

My civie had almost all her teeth pulled before she came to live with me, at age 1 and a half. Has 5 teeth left, pulled due to stomatitis I believe although the shelter never said so.

She eats all foods just fine, but has a bit of a problem with the shredded pieces, like in her Tiki Cat succulent chicken (Puka Puka Luau) that she gets for snacks.

 

Awww, Tiger's just fell out..I'm always finding teeth laying around and then I'm like "ok, who lost a tooth" they just look at me as if to say "not me"

 

@Deb & Wink, @Chris & China (GA) with your guidance.....I got "yellow" 221 +3

 

Test again at +4.

 

208 +5

 

I was gonna at +4 but I fell asleep sitting up on the couch

 

Basically the same no worries. We all need naps now and then.

 

Totally

 

I just got a pee sample(mid stream). Using One Step Vet 10 strips. Almost all were in the first column except for the SG it was either 1.030 or 1.040. His ph is 6 and of course his glucose is ++500

 

The most important test to pay close attention to is ketones. Make sure to read the results at the exact right time because the longer it sits, the darker the color

 

The bottle says 60secs so I set the microwave to go off

 

Talked to Doc today. She put him on Clavamox to see if it will clear up his congestion..Amoxi might not have been strong enough. If it doesn't show signs of clearing up then it's his heart. She doesn't want me to have to spend more money on more labs. She's been my Vet for over 20yrs and knows about all the cats that I have. Try's to keep the bills down for us. Anywaaayyyy, she also said keep Tiger on the 5u's a little longer.

 

Thread is continued in Vetsulin forum
http://www.felinediabetes.com/FDMB/threads/tigers-bg-readings-are-insane.226588/

 

He's bouncing from those pinks the other day.

 

So we get to wait it out..poor old man. His body is like "Hey, I'm used to 500s..what the heck is going on?" well, I'm gonna dump some sugar