Very experienced eyes needed to take a look at Rocky's SS

I would love to get some of you very experienced members to cast your eyes over last 7 days of Rocky's SS as I don't really understand these numbers.
At some point I reduced or not gave insulin thinking that he is bouncing although I had no evidence of low numbers and Rocky is on a very low dose of insulin so he shouldn't bounce? It did not help.
Another strange thing is that a dose on a small number AM would produce much higher reading in the evening and the same dose given on that higher number PM would still produce low number next morning. I've never seen that with Rocky before. If his numbers were higher AM rather than PM one would have to consider a Dawn Phenomenon but I'm observing "Sunset Phenomenon"!
Any thoughts on this?

 

Hi Marlena,
Is Rocky still on Caninsulin?

 

No darling, he is on PZI Hypurin.

 

Hi Marlena! A couple of quick questions: how old is your current vial? And it looks from your notes like you're having some health concerns and giving bupe occasionally. Can you share a little about the history there? It does look like his numbers are creeping up a smidge right now, so I understand your concern. I suppose bounces could happen at any level, but with my low dose/low BG kitty, I think rather than bounces, we just get cycles where for whatever reason he just doesn't respond much.

 

Hi Djamila,
many thanks.
Would like to give you more details but I'm chasing my tail at the moment so will do that tomorrow if it is ok with you.
Best regards,
Marlena

 

Hi Marlena! Nice to see you again!

I do see that Rocky's numbers are coming back up...I think the questions Djamila asked will help us (when you have time! No rush to do it today). I'll check in tomorrow and we'll see what we can figure out.

Hope you're doing well otherwise!

 

Oh ok, my apologies. I've not seen it referred to as Hypurin

 

I see a note from 7 May about new insulin.

 

Dear Rachel!
I'm doing ok, thank you but I have to admit that I'm totally consumed by this sugar dance. Rocky is not too bad but I know something is not quite right with him but the vet is saying he is all right. Well, the only thing which shows in his recent tests is that his urine is not concentrated well enough but everything else seems good in terms of kidney function. I suspect that he is in early stages of CKD but there is no treatment, we can only monitor him to see how it is progressing. He is also prone to UTI so recent diagnosis is FLUTD. His urine pH indicates that there is a problem (pH is 7.5 - too alkaline) but the vet insists that it is within the normal range. I disagree. There are few reason for alkaline urine and I think we have to wait and see whether Rocky would show other symptoms pointing us in some direction and we have to repeat the tests, something my show up. I'm sure that my vet thinks I'm a neurotic cat mum but I do rely a lot on my intuition and most of the time I'm right. Vets often ignore symptoms, they just concentrate on lab results which is wrong.
So going back to Rocky's BG control - it looks like he needs a higher dose for some reason.
My insulin is good, stored and handled properly (that's the first thing which comes to mind when BGs go up). I've given Rocky higher dose last night and tested him after 4 hours and he went down as expected. My injection technique is good as well. I've been doing this sugar dance for 3 years now so I consider myself well experienced. But when it comes to interpretation of the results it is so important to have opinions of other experienced members and together we might be able to come to some sort of idea what could be wrong.
I do appreciate your opinion, thank you so much.
I hope that you and your kitties are doing great Rachel!
Rocky sends his love
Marlena

 

Dear Djamila,
I have replied to Rachel with some information.
I give Rocky bupre sometimes when I think he might be in pain and when his BG goes up suddenly. He is probably suffering with arthritis or urinary tract pain as he often suffers with UTI. Next week we are starting injections of Cartrophen (same as Adequan in US) which is used for urinary problems and arthritis as well.
I'm happy to give you more info, just let me know if you need any specific questions answered.
Oh, one more thing: Rocky's symptoms for sometime now are:
meowing a lot
polydipsia (he eats raw diet with added water but still drinks after his "soup" meal), interestingly does not have polyurea only when full blown UTI
vomiting (not too often, maybe once or twice a month)
licking his undertail, inner thighs and lower abdomen which is now bold.
Thank you so much for your help Djamila,
sending best regards
Marlena xxx

 

Hmmm...does sounds like he might be in the very beginning stages of CKD. Something to just keep an eye on for now probably.

As for the pH, 7.5 is too alkaline as you know. You may want to look into what you can do to bring that back down some. Do you do any urine testing at home? It might be helpful if you can keep an eye on that at home and get an idea of if it stays in that range or changes...it could contribute to the bladder problems he's having.

It sounds to me like what's going on is that he isn't feeling well and that could bring his numbers up. I know you said the vet doesn't see any problems...have you considered getting a second opinion? It might help to see if someone else could take a look at him and see if they can offer some more information.

HUGS!

 

Hi Marlena,

I see you've received good input from Rachel and Djamila. I don't really have anything else to contribute because you're doing all the right things diet-wise to optimize urine pH. I like Rachel's idea of seeking a second opinion on Rocky's health.

 

Kitty mamas know! I'm sorry your vet doesn't seem to be sharing your concern and agree with Rachel that a second opinion might be a good idea. Are you making your own raw, or is it commercially made? If you make it, you might consider adding blueberry or cranberry to help with the pH, and if it's commercial check and see if those are already there or not as some of the raw options here include one or both in their recipes, but some don't. If you don't already have them, you can get urine test strips off of Amazon that may help you keep an eye on the pH at home and help determine if this is on ongoing issue or just transient, and also measure if different foods are impacting it for good or ill.

As you know, any kind of infection or inflammation can impact BG, so hopefully getting him some relief from the arthritis will have a positive impact as well.

It sounds like you're doing everything right as far as the FD treatment itself, so it may just be an issue of needing to dose around his other health issues until they reach the point where the vet can recognize whatever is going on, or until they resolve on their own.

 

Very true .

So with everyone else, from what your doing, everything sounds good. I think I had read in the past Bupe can effect BG a little for some kitties. Kris can clarify if this makes any difference but if you are adding a little water to his meals, is it warm water? I always see her mention warm water, over room temperature, and it has helped her Teasel with cystitis . I've also heard adding the blueberry or cranberry, as Djamila mentioned, is helpful. I have a link where to get some blueberry powder but it's in the states. I could try and ask some other UK'ers if you're interested?

 

I don't think the water temperature matters but the extra water is key. I'm think I read in Marlena's post that she adds water to Rocky's raw food.

 

Yes she is. I just wasn't sure if the temperature was important

 

Marlena, I have a question for you now: I was just searching for some information about what proteins are okay for cats, and ran cross a comment you made recently. So it sounds like you do make your own raw and know a fair amount about food allergies. My cat seems to have some mild IBD that flares on occasion (not diagnosed, just by my observation) and since the most recent round he has stopped eating anything with chicken in it. He's loving venison and rabbit right now, and I just gave him a small sample of pork which he seemed to like, but I don't know if pork is okay? Are there proteins you recommend or that you would suggest avoiding?

 

No pork for your kitty darling.
Chicken, beef and maybe lamb are most allergy causing or you might want to avoid these if you think allergy is present.
Best is probably rabbit, duck, goose, venison, turkey or some really exotic proteins like ostrich or bison. No fish. With IBD it might be a good idea to introduce a novel protein (one he never had before).
I make my own raw diet and I add a lot of hot water so the temperature is right and its very soupy.

 

Yay I was right!

 

Girls,
I think I solved the mystery with Rocky's unpredictable numbers.
I have tested him today (had to wait the whole day for a urine sample!) and have some results: pH is 6.5 (done 2 tests with two different test strips) and there are leucocytes present so Rocky might have an infection. I will keep doing these tests and will report finding to the vet whom we are seeing on Tuesday. This evening BG is very good so insulin is working, looks like Rocky has UTI again. I started giving him potassium and Vit C, need to buy some cranberry and blueberry extract and d-mannose.

 

Alrighty, no more pork! Thank you so much! He seems to like the venison, rabbit, and duck, and I'll try the pheasant as soon as it arrives. So that should give him enough choice to keep him busy for awhile. He gets bored with food easily, so I try to keep a bit of a rotation.

We have an excellent butcher nearby, so one of these days I'll get brave and try making my own. I just haven't been quite up for getting a meat grinder to take up more space in my tiny little kitchen.

So glad to hear you may have found the source of the trouble for Rocky! Hope he'll be on the mend soon! Please keep us posted.

 

Dear Djamila,
You really don't need a meat grinder! Ask your butcher to mince the meat for you, take it home quickly and prepare a larger portion by mixing everything up and put little portions in the freezer (I use larger ice cub trays). In the UK where I live we are lucky that we have very good quality minced meat and I use that. Never had any problems with bacteria. Today I managed to buy a packet of tiny chicken hearts from France so I froze little portions for my animals, they absolutely love them and chicken hearts are good source of taurine which is an essential amino acid for cats (you guessed it - for heart health!). Taurine supplement comes in a powder form and you have to add it to your homemade raw food or just give fresh hearts but chicken hearts are the best source of this amino acid.

 

Let's hope that is the culprit! Since you know how to deal with it and get Rocky feeling better!

 

The leucocytes reading on the multistrips is not accurate for kitties. Every single test I got for both kitties I had a reading of 2-3 and lab testing an microscopic viewing showed no problem


ETA Earlier discussion on leucocytes



http://www.felinediabetes.com/FDMB/...6-3-81-bw-results-are-in.154075/#post-1623981

 

Thank you Mary Ann

 

Now Rocky has HYPO!!!
I really am a nervous wreck now!

No, we are OK, I'm dealing with it, Rocky got honey and lots of lovely food he enjoys so he is happy but I'm not going to bed!

 

Hang in there, Marlena - you've been through this before and have the experience/knowledge to deal with it.

 

He heard you talking about his numbers staying so high!

 

Any new tests? Kitties can be so dramatic

 

Yes, piece of cake now ha ha ha!
At least I know what to do and don't panic anymore.

 

Rocky quickly goes up, he really enjoyed all this lovely food I gave him!

 

So I still don't know what's going on with Rocky.
First he seemed to be resistant to insulin and then suddenly crushed. Maybe his higher BG was due to him feeling unwell with a possibility of kidney/urinary trouble. Before he crushed in the evening I gave him a dose of bupre (painkiller) as he was meowing and clearly uncomfortable, then he did a massive wee so maybe whatever was bothering him went away and the insulin dose I gave was too much in this situation, also morning insulin dose was quite high for him although it did not move his BG during the day but might have being still active in his system in the evening (late nadir?).
Now, the test I've done is not telling us much as it is not reliable for leukocytes (Mary Ann has brought my attention to this) but I'm wondering why when I did this test before it never showed leukocytes but this time I got ++. Nitrite, protein, blood, ketone and glucose were all negative. pH was 6.5 which is good.
I'll keep you informed about further developments.
Love to you all,
Marlena and Rocky

 

More on leukocytes:

"l Dipstick analysis allows assessment for the following: n Presence of blood in the urine. However haemoglobinuria and myoglobinuria cannot be distinguished from haematuria on dipstick. n Protein. However a protein:creatinine ratio is recommended for more accuracy to determine if significant proteinuria is present, as the protein value on dipstick is not always reliable and false negative results can occur (positive dipstick for protein with protein:creatinine ratio in the normal range). Protein would increase in the urine with inflammation. n Glucose. Glucosuria may be present with stress in cats, however in cases of persistent glucosuria and/or if ketones are present, further tests should be performed to assess for possible diabetes mellitus, as mentioned above. n Urine dipstick is frequently positive for leukocytes in cats; this is unreliable and does not indicate the presence of inflammation or infection. n Specific gravity on dipstick is unreliable in dogs and cats."

http://www.langfordvets.co.uk/sites/default/files/Feline Update Autumn 2011 revised 030713.pdf

A long read but good information overall on FLUTD

 

It looks like Rocky usually runs higher at night, so I'm thinking you're right that the higher dose yesterday morning was still active at PMPS last night and contributed to the drop. He isn't often lower at night, so that was probably an indication. And with lower number/lower dose cats, an increase in insulin can sometimes result in a longer cycle instead of a lower nadir for the cycle in which it was given. And as you said, couple that with him feeling better (the pH getting back to normal range), probably conspired to bring about that low BG.

Hopefully the improvement in overall health will also start to bring those pre-shots down in general (once he's recovered from last night at least).