? Senior cat just diagnosed - Concerns!

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Bobbi & Angel

Bobbi & Angel

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Hello, my name is Bobbi and my cat, Angel, is 16 years old. We went to the vet on Tuesday afternoon because Angel had not been eating well (completely stopped eating dry food, so switched to wet food to get her to eat), lost some weight, and was drinking excessively. There is a lot of info here, I'm sorry if it is too much or too confusing, I am just very concerned.

The results at the vet were not entirely clear and indicated high blood sugar as well as some issue with her kidneys. The vet wanted to do a urine sample, I think for a specific gravity test?, but we couldn't get a urine sample at the time. He decided that we should treat for diabetes to get her blood sugar down. She was given an insulin shot in the office (around 1:30pm), I am not sure how much, as well as sub-q fluids. She really perked up for a couple hours when we got home, but I'm not sure what the cause was.

We were prescribed Humulin 2 units every 12 hours to be started the next day. The vet also said we should switch to a low carb food, so we bought Wellness wet food and have been feeding her that. She is not eating as much as she should be, but seems to be eating slightly more than before the trip to the vet (she seems to like this food a lot). Her drinking was much less yesterday (probably due to the sub-q fluids?) and seems to be a little bit excessive today. I can try to measure how much, but we have another cat, so it would only be an estimate.

I did Angel's first shot this morning at 7am after she had eaten something. She seemed pretty lethargic most of the day and would pick at her food every so often, then around 1pm she followed me in the living room, laid down, and when I started petting her, she kind of grumbled at me a little bit. She went to use the litter box, then vomited right afterwards. :( This is the first time through any of this that she has vomited, I'm wondering if it was due to switching her food so abruptly.

I was very concerned about giving her more insulin after this without knowing her blood sugar levels and I read some info on this site about meters. I took a reading at 6pm (+11 hours from her last shot) and it was only 80. I have been reading some of the forums on here and saw that I should wait and test again, which I did, at 9pm (+14) and it was 78. So I decided to skip her dose for tonight, I hope this was the right decision!

I am worried that the diagnosis might not be correct, since the vet only had the one blood test to go off of and seemed to think it could be a problem with her kidneys instead. I am supposed to try to get a urine sample tomorrow (will be hard because we have 2 cats, so I'm not sure the best way to do this) and have it at the vet by Friday. My plan is to test her blood sugar again in the morning around 6am to see if they are elevated, and then proceed from there, but I am hoping to get some advice here........thank you.
 
Yes you were right to skip tonight! 78 is a normal number. Do you have a copy of the bloodwork? If you do, you can post it we have several members that can read labs and give you some info.
 
Hello and welcome to FDMB. We are very glad you found us. :)Good job on the home testing. I find that the testing I do helps me so much as I'm trying to tell how the insulin is working in my cat. Interpreting the results of those tests takes a little time, but don't worry we will be right there to help you as much as you'd like. I'm not familiar with the insulin you are using and since it's almost a big holiday weekend there may not be as many people on here as usual... but I see that there are much more experienced eyes than mine online right now so I'll tag one of them and ask for assistance. @Tricia Cinco(GA) & Harvey

For what it's worth I do think you were wise to skip tonights dose... I think I would have done the same in your shoes. In the early days when one doesn't have much data from testing, it seems wise to err on the side of caution. ...
 
Sharon14 said:
Yes you were right to skip tonight! 78 is a normal number. Do you have a copy of the bloodwork? If you do, you can post it we have several members that can read labs and give you some info.
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No, I don't have a copy of the bloodwork. At the time, I was so overwhelmed with everything they were giving to me for treatment, I didn't even think to ask. I should be able to drop by the vet in the morning and ask for a copy, right?
 
I just did a reading at 6:15am and got 316. I'm hoping that her eating a few bites of food while I was trying to get a reading didn't mess this up? It was probably no more 5 minutes between her eating and me finally getting some blood to test.

I am not sure how to proceed. Should I give her only 1 unit instead of 2 units?
 
Good, better to be safe! Will you be able to get a few tests in during the cycle? And do try to get those labs from your vet.
 
Try to get a test @+2(2 hours after shot) then a few more if possible before the usual nadir of +6. Then depending on what that number is, a few more after that. You won't have to test so much everyday, we're just trying to establish a base for how well the insulin is working, so the more tests the better. Always get that preshot(PS) test. I'll try to find someone that knows about Humulin. After we check your labs, you may want to consider changing to a different insulin. ProZinc or Lantus are the best for cats and have longer duration and gentler curves.
 
Snickers started on Humulin and it dropped her fast and low. Thanks to the advice here, I switched her to BCP PZI, although nowadays you can go with Lantus or Levemir as well. Great job testing--that's key!
 
Here is a copy of the lab results from Tuesday.
 

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Sharon14 said:
I'll tag @Marje and Gracie to help you interpret the labs. She lives out west, so it may be awhile before you hear from her.
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Thanks a lot!

I just did a test at +2 and got 285. Does that seem right? I have to go to training for my new job in about 45 minutes and I could be there for 2-4 hours. I will get another reading as soon as I get home.
 
Yes, from what understand Humulin drops them early, so if you could get an out the door test right before you leave, that would be great. Also, do you leave food out?
Good luck with the new job training!
 
The blood test results creatinine, phosphorous and bun indicate quite advanced kidney insufficiency. A high phosphorous can make a cat feel bad and such a high level mean that a low phosphorus food or phosphorous binder is necessary. Administering of subQ fluids is also likely called for.
For info on kidney insufficiency see:
http://www.felinecrf.org/index.htm
 
Larry and Kitties said:
The blood test results creatinine, phosphorous and bun indicate quite advanced kidney insufficiency. A high phosphorous can make a cat feel bad and such a high level mean that a low phosphorus food or phosphorous binder is necessary. Administering of subQ fluids is also likely called for.
For info on kidney insufficiency see:
http://www.felinecrf.org/index.htm
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Ok, thanks. I'm not sure how I should proceed from here. The plan was to get a urine sample in by tomorrow, but it's been difficult because we have 2 cats. I'm just worried about all this time that we aren't treating her for the right issues...
 
I just called to make a quick appointment for Angel to have a urine sample done at the vet an hour from now, since I'm having no luck getting one myself. While I'm there, would it be inappropriate for me to ask for sub-q fluids to be done, or to be sent home with stuff to do the fluids myself? I am assuming this appointment will only be with a technician since they slotted me in so easily.... It really seemed to make her perk up the first day and I feel awful not treating her for the kidney problems.
 
Just got back from the vet. They couldn't find her bladder again, just like the first time, but did sub-q fluids. A different vet looked over her bloodwork and we are going in tomorrow morning to do IV fluids (keeping her there for the day, I think?) and to talk about what to do from here on out. Needless to say, I am super worried now because they didn't really tell me anything today and going in for the IV seems serious. I just wish we had some answers!

But on the plus side, she seems to respond pretty well to the fluids. She's much more energetic and alert, just like last time.
 
Check out the link Larry gave you for feline CRF. Learn as much as you can so you'll know what questions to ask.
 
Sharon14 said:
Check out the link Larry gave you for feline CRF. Learn as much as you can so you'll know what questions to ask.
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Thanks, I looked over a lot of the information on that page and will do so again before our appointment tomorrow.

I just did a test at +11 (it's about 1 hour and 20 minutes before her next dose is due) and I got 89.... Do I skip the dose? I don't understand why this keeps happening...
 
Have you fed her? If not, don't and test again at shot time. I'll try to find someone familiar with your insulin. Often if the AM preshot number is high and the next Preshot number too low to shoot, the dose is too high and you need to reduce.
@Sue and Oliver (GA) do you know about Humulin?
@BJM
 
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Sharon14 said:
Have you fed her? If not, don't and test again at shot time. I'll try to find someone familiar with your insulin. Often if the AM preshot number is high and the next Preshot number too low to shoot, the dose is too high and you need to reduce.
@Sue and Oliver (GA) do you know about Humulin?
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Ok, thanks a lot. I really appreciate all your help, it has been keeping me sane throughout this process...

She has been grazing on and off, I haven't taken up her food since she isn't really eating much at once and I'm afraid to stop her from eating when she wants to. She just ate a few bites right before I did the test and had a couple of freeze dried chicken treats afterwards. I will try the test again in an hour, when I'm supposed to do her PM shot.
 
Sue and Oliver (GA) said:
I would not shoot under 200. If she is 200+ test, feed and then shoot. I would give one unit, not two until you can get some more data and see how the insulin is working. Humulin tends to have a fast onset so you want some food on board. This link is rather old but has good info:

http://www.felinediabetes.com/FDMB/threads/humulin-n-primer.303/

I wonder if she is lower because the initial dose is too high.
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Thank you. I have looked through that post but will do so again.

For her AM shot today, I did 1 unit instead of 2 units because this same thing happened yesterday, where her PM preshot test was too low for a shot (80). Tomorrow morning, she has a vet appointment 1.5 hours after her AM shot and I'm under the impression that they plan to keep her for most of the day, so I'm assuming they will be doing bloodwork again at some point and will be able to see how her blood sugar is.
 
It doesn't look like she will be high enough for a pm shot so one unit from this am may be too much also. If she is above 200 in the tomorrow morning, you might try 0.5 units. She may be high because it will have been 24 hours without insulin, but I'd suggest reducing anyway. You want to get away from this pattern of preshots too low to shoot.

One caution: cats' levels are very likely to be higher at the vet than at home (noise, other animals, people who are not the mommy :D) Some people report levels 100+ or more. If the kitty is higher at the vet because of the stress of being there, doses based on those inflated levels can be too much insulin once the cat gets home.
 
Hey Sharon! for some reason I didn't get the notification on this post until now. I don't really know much about Humulin though. I think Sue has some knowledge of it, so I'm glad she is here!
 
Sue and Oliver (GA) said:
It doesn't look like she will be high enough for a pm shot so one unit from this am may be too much also. If she is above 200 in the tomorrow morning, you might try 0.5 units. She may be high because it will have been 24 hours without insulin, but I'd suggest reducing anyway. You want to get away from this pattern of preshots too low to shoot.

One caution: cats' levels are very likely to be higher at the vet than at home (noise, other animals, people who are not the mommy :D) Some people report levels 100+ or more. If the kitty is higher at the vet because of the stress of being there, doses based on those inflated levels can be too much insulin once the cat gets home.
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Ok, good to know, thanks so much!! I will bring all of this up to the vet once we figure out what is going on with her kidney issues. If we can get that sorted out, maybe with at home sub-q fluids or something, we can focus on how to deal with her insulin shots. I am just hoping we are able to deal with the kidney issues, like I read about on the link Larry provided. I'm not sure if my hopes are too high and unrealistic when it comes to the kidney issues.

My vet, who I just switched to, does not seem to care much about this at-home testing and monitoring. He only told me to do the 2 units twice a day and watch for signs of hypoglycemia....if I hadn't done my reading on this forum, I am sure we would have had serious issues with too high doses!!! I am hoping the vet I see tomorrow (same office, different vet) will be of a different opinion and will be willing to discuss a plan for safe at-home treatment. I did not discuss the dosing changes with a vet yet since I haven't seen the same vet again. I will make sure tomorrow to tell them was dose I did when I drop her off. I hope they won't be upset that I didn't follow their instructions, but I'm glad I didn't...
 
I just did another test: 106 at +12
It took a couple tries, I'm not very good at this yet and she doesn't like me touching her ears. Poor thing!! She does like her dried chicken treats though lol

Tomorrow I will try 0.5 units. I wish I had gotten some more measurements today to see how low she dropped.
 
If you'll be around one day over the weekend, you can run a curve-testing her PS, +2,4,6,8,10 then PS. That will give you info on when the insulin kicks in and how long it lasts. Can you set up the spreadsheet? It's a great way to see how well things are going.
 
Ok, I can try that, assuming she is only kept at the vet for the day tomorrow. I have been using the spreadsheet and put in all the numbers I have gotten so far.

I was just looking at my syringes and they are not in increments of 0.5. Is it ok for me to estimate tomorrow or do I need to go buy new syringes somewhere?
 
For now you can eyeball half of one unit

The vet can't tell you that you can't test at home. She is your cat and it's your job to keep her safe. Seems like it would be hard to argue with your recent testing - if you had given 2 units last night or tonight, you'd likely have been dealing with deadly hypos
 
Angel's preshot test was 331. I am going to do 0.5 units.

I have a question. Will blood sugar levels that are too low or high cause a cat to be lethargic/less alert? I mean like any of the numbers I have been getting for Angel, so 80s or 300s. I am jsut trying to understand why her behavior keeps changing throughout the day.
 
Good morning Bobbi. Yes blood sugar levels can cause lethargy. Even though 80 is a normal number if Angel isn't used to being in those numbers it may be causing her to feel tired. Good luck at the vet today, keep us posted.
 
At the vet. They are planning to do a glucose curve today along with the IV.

I am glad I did my research with the links you all provided because this new vet is not explaining anything to me like it has been explained in the sources provided on here.
 
They finally got a urine sample and confirmed that her urine is dilute, indicating kidney failure as expected. Her urine specific gravity test result was 1.015 (I think that's how it works? He said "ten fifteen")

They decided to keep her for today and tomorrow to do IV fluids and are giving her something that's supposed to settle the acid in her stomach and hopefully bring her appetite back. I think the word he used was gastritis or something similar.

They will also be checking her glucose every so often. I told the technician that I only gave 0.5 units, so I dont know what they will do later. When they call to update me I will ask for her glucose numbers and make sure they know the dose I did this morning.

I hope this helps her enough that we can do an at home treatment plan to manage the diabetes and the kidney failure. I'm not sure how optimistic to be. :/
 
Always ask questions, like Why they are doing anything they're doing, what numbers mean, etc. lots of folks here have kitties with kidney failure and will be able to give you some tips. Get copies of any tests they do today.
 
Pancreatitis is a condition that can affect appetite. But let's let them do their thing today and see what answers they have for you later. Just be aware they may get much higher levels than you get at home as Angel may be stressed, and they may prescribe a higher dose that you'd want to give based on her levels at home.

Many diabetic have elevated kidney values - it goes along with diabetes. It could be that she has kidney disease and you'll need to treat that. The site Larry gave you is material you can read and reread.
http://www.felinecrf.org/index.htm

Meanwhile, remember to breathe. Sounds silly but deep breaths relax and restore you. Regardless of what they do and find, clearly Angel has a life filled with love with you and is a lucky kitty.
 
I'm picking Angel up this afternoon. She has been on IV fluids at the vet since yesterday morning.

They're sending her home with Science Diet k/d canned food. If anyone has other recommendations for food, please let me know. I think there was a link posted above, but I'm not sure if it was recommended specifically for kidney disease? My other problem is that we have 2 cats and the other one will not keep his nose out of Angel's food, so I need to make sure it's ok to feed him the same food she eats.

The plan is to have Angel home for a week, then to bring her in to test her kidney values again. It seems wrong not to have her receive fluids for a whole week, form what I read about kidney disease. They're giving a medicine as well, but in my rush to decide between tablets or liquid, I can't even remember if she said it was for lol, so I will have to ask. We will be doing 0.5 units of insulin twice a day. Thank you to everyone here who helped me find the right dose. They recommended that, once she begins to eat full meals, I give her 1 unit, so I'll keep that in mind.

I'm getting copies of all the tests they did. If there's anything else I should ask or do before I take her home today, please let me know.
 
Yes, try the food chart on that CRF site.

http://www.felinecrf.org/diet_and_nutrition.htm

Science Diet wet certainly has nothing over the pet store brands except that it costs more. Also here is a thread for kidney cats and diet.

http://www.felinediabetes.com/FDMB/threads/kidney-disease-in-cats.158451/#post-1687509

You can read a lot more threads by searching (upper right hand corner of this page search box). Try CRF diet or kidney disease +diet

If you want, you can give fluids at home. Lots of people here have done it and think, once you get used to it, it is very doable. Then she wouldn't need to wait a week and wouldn't need the stress of another lengthy vet visit. Here is a site with pictures and info:

http://www.felinecrf.com/managb.htm
 
Sue and Oliver (GA) said:
Yes, try the food chart on that CRF site.

http://www.felinecrf.org/diet_and_nutrition.htm

Science Diet wet certainly has nothing over the pet store brands except that it costs more. Also here is a thread for kidney cats and diet.

http://www.felinediabetes.com/FDMB/threads/kidney-disease-in-cats.158451/#post-1687509

You can read a lot more threads by searching (upper right hand corner of this page search box). Try CRF diet or kidney disease +diet

If you want, you can give fluids at home. Lots of people here have done it and think, once you get used to it, it is very doable. Then she wouldn't need to wait a week and wouldn't need the stress of another lengthy vet visit. Here is a site with pictures and info:

http://www.felinecrf.com/managb.htm
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Ok, thank you so much! I will look through these threads and search for others.

I have done fluids at home before, when she was sick a couple years ago and stopped eating/drinking completely, so I would be comfortable doing it again. The worst part is that no matter what, she seems to know I'm trying to stick her with a needle and gets scared.
 
Ok, I have Angel home now and we weren't given anything to do fluids. When I asked about it, the technician said that was something the vet wanted to discuss after we bring her back next Saturday for another blood test. Should I have been more insistent?

Also, I'm supposed to give her Famotidine 10mg every morning to help with stomach acidity, not sure if this is standard or not?

Angel is not really very interested in eating right now, at least not any more than she was before her stay at the vet. She will not touch the k/d wet food they gave me (for what it counts, my healthy cat won't touch it either lol), but grazed on the k/d dry food when we got home. I haven't been able to get to the store yet to buy her any of the food on the low carb, low phosphorus list. I just did her preshot test and got 350 (+11). She's just drinking a lot of water right now and didn't eat more than a few bites of her food. Is this because of her sugar level or should I be more concerned about her kidneys? I really am not sure what to do because she doesn't seem any better after her stay at the vet and I don't want to make her worse by reacting too slowly.

I'm going to give her 0.5 units of insulin again tonight since that seemed to be the correct dose, especially given that she's not eating much.
 
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