3/12 Sasha AMPS 504 L+1/R+1 498 +6 343

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=65974&p=717289#p717289

Good morning everyone, back to work and off to some start... Had to give him the .5 R, he just ate all LC food. I have to leave for work @ 7, will test him then. Going to try to run home during lunch...ughhhh but he is ketone negative still

Hope I did the right thing by giving him R. Left him out a lot of food, and some frozen food so he can nibble on it thru out the day.

Ok everyone have a good day, I will check back later on!

 

Re: 3/12 Sasha AMPS 504

I think giving the R was a good idea. I don't thing you have to worry about him going too low. I think he'll be okay.
Yay for negative ketones!!

Have a good day.

 

Re: 3/12 Sasha AMPS 504

I'm glad he is negative for ketones. I hope the R brings him down enough for comfort, his and yours.

 

Re: 3/12 Sasha AMPS 504

Yay for negative ketones but yuck on those black numbers :sad:

 

Re: 3/12 Sasha AMPS 504

Hi Tara, great for negative ketones. Have a good, calm day at work and sending vines for Sasha to have a nice surf. Take care.

 

Re: 3/12 Sasha AMPS 504

Hey Tara!! I didnt see this new condo LOL I just put a post for you in your condo from yesterday Ill copy it here for you :smile:

 

Re: 3/12 Sasha AMPS 504

Hi! Thanks for the encouragement and support, I was like a lunatic driving to work today Wondering if I did the right thing with the .5 R! I was able to get home for lunch for about 10 minutes to check on him. He came down nicely, still does not want to come out of the pinks!

While at work I called the vet, because I forgot to ask what his weight was and when I tried to weigh him myself I couldnt believe my eyes... he put on almost a whole pound in a week! He's 10 pounds 10 oz. Dont know if it was all that high carb FF he was eating, or if he had fluids in him.

Any way, this is the vet who was kind enough to let me post date checks, I asked him to look over the paper work from the ER vets, and they did take Sasha's blood there and do a full analysis on it. Something about billireubenanemia (I dont know if that is how you spell it) and they did diagnose him with Pancreatitis.

The vet also asked about his BG tests and when I said they were still high, he told me to do 4 units AM and 3 units PM... but this is also the vet that tells me I should let him free feed on dry DM food. I am sticking with you guys and not making any changes to his dosages... you all know a lot more than these vets!!!

Violet thank you for letting me know about the meter!!! How often does Garland get the ketones and how much fluids do you give him when you see they are present? Hugs to you and Garland!

Ok back to the grind, I'll check in later..Hope every one is having a great day!

 

Hi there

That's great news - I was wondering if he got weighed the other day.

I'm not familiar with "billireubenanemia" I'm sure there must be someone around FDMB who is.

A few questions -
How's the transition back to LC coming along? How many oz did he consume yesterday?
So far today?
Does he look/feel like he has put on some real weight?
What's the latest ketone reading?
How is he behaving?

If his PMPS is still pink, go ahead and give Sasha 0.5uR following the 3.25u Lantus. I don't think it will be necessary for you to stay up all night testing, however a +1 and +2 is important and will give you a better idea of when you may want to get a sleep test tonight.

If he is still pink in the morning, I'm thinking an increase to 3.5u Lantus BID may be in order.
Something is going on with Sasha. It could be that he needs dental attention, particularly since he has never had a dental.
Does he have bad breath?

 

Tara:

Do you have his bloodwork results? If so, can you please post them so we can look at them?

Elevated bilirubin can occur as a result of autoimmune hemolytic anemia. Bilirubin is a "breakdown product" of red blood cell hemolysis. Excessive bilirubin would cause the gums and whites of the eye to look yellow and urine would be dark yellow. The skin under the fur could also look yellow.

Here is an article I found about AIHA: AutoImmune Hemolytic Anemia

I also found this written by Andrea Jensen of Ohio State University:

I'd really like to see his bloodwork results...and urine if you have it. I would be amazed at a vet that would make that diagnosis and not mention it to you :shock: :shock: Do you see anywhere that they did an fPLI or SpecFPL test for pancreatitis? An U/S is only one piece of the puzzle....the pancreas may look inflamed but my vets use both tools...the U/S and the bloodwork to confirm a diagnosis of pancreatitis. While his symptoms don't seem to fit, I will also say
that the literature indicates that a high number of cats may experience a very mild, chronic pancreatitis with very diffuse symptoms....occasional vomiting, occasional nausea, sometimes don't want to eat, etc.

 

We have some experience with it, but I doubt it will be any help. When Garland had that neck infection, her bloodwork showed high levels of bilirubin. When we took her back after the infection cleared and her ketones were back to normal the bilirubin was gone. Not exactly sure what that all meant though. (?)

Tara, to answer your earlier question, I give 100ml a day for a couple days when her ketones get above 1.6, along with an insulin increase. So far she seems to get them every 6 weeks or so. Im hopeful our last round of it was our last (crossing fingers)

 

Violet, wasn't there some question when Garland was ill that there was a possibilty that bilirubin in the urine (which is not a normal finding in a healthy cat) was possibly staining the ketostix and causing a false positive for ketones? I can't find any references for this, but I believe that Venita mentioned it. That it is another good reason for testing blood ketones in addition to urine ketones in a cat with questions about bilirubin issues.

Tara, I wonder if Sasha was verging on Hepatic Lipidosis while he was hospitalized, and if that caused some abnormalities in his blood bilirubin levels. I am not anywhere near an expert on this issue, so take this as speculation on my part.

 

Wow - it is rare for a diabetic cat to gain weight quickly -- most diabetics lose weight when their blood sugar is high.

Have you looked into Acromegaly? This condition causes insulin resistance requiring higher than normal doses of insulin and the excess growth hormone causes weight gain.

viewtopic.php?f=12&t=375

 

Hi There,
Another vote for the acromegaly test. It's very rare for .5u R to do nothing for a cat's blood glucose. I also would recommend stiffer and faster dose increases to prevent a return of the DKA. I utilize 1/2u increments for Oscar, my current foster (likely an acro) and you can see it's cut my time on increases in 1/2. It's also cut his risk level. https://docs.google.com/spreadsheet/pub ... utput=html

 

The dose increase of .25u and the small doses of R are getting run over by a truck it seems.

That weight gain is large in so short a time, and you can't blame the insulin as the dose is so low.

I vote for acro as well.

 

I think that Tara is dealing with enough right now and we don't need to throw one more thing at her. Sasha needs time to recover; he is getting a lot of fluids and if he got those in relation to his vet visit, he will weigh more.

However, Carolyn and Phoebe, if it is something that is really worrying you, I think it would be lovely if one or both of you would be so kind as to pay for the acro and IAA tests for Sasha.

 

Its always good to start your own folder with all the blood work results. I'd get a copy - ask reception for it. They are normally great about printing copies. Marjorie and others can give feedback too. Maverick who recovered from FHL had high bilirubin and jaundice, but he also had other elevated liver numbers.

 

Acromegaly and any insulin resistance issue is no joking manner. I would hope that you would want to help in a more positive manner. The testing is VERY expensive for us - I have two confirmed acromegalic cats - but the testing does not need to be done to treat. Why? Because acromegalic cats have tumors and perfectly functional pancreas which requires some cautions to be taken, regardless of the tests being done or not.

I would like to suggest that you take the time to read a bit about acromegaly in the high dose forum so that you are aware of the conditions.

And yes, it is worrisome to see the signs and have no one mention the condition. Suggesting the possible reason for some of current numbers and issues is being helpful

 

For those of you who are stopping by to ostensibly offer Tara some support, perhaps going back and reading Sasha's history will be enlightening. This has been a VERY sick cat. Tara has put every last bit of both physical and emotional energy into around the clock care of a cat who, only because of her diligence, has survived very high ketone levels. Again, for those who don't spend a great deal of their time here, you know that this was an extraordinary situation because we strongly encourage a cat/bean in this situation to go to the ER. Tara spent pretty much every dollar she has on caring for Sasha. It would seem far more prudent to make sure that Sasha has cleared any possible medical condition before racing to the conclusion, and expense, of acro/IAA testing when other, more frequently occurring conditions need to be ruled out first. In medicine, when you hear hooves, you think horses before you think zebras.

As for weight gain, when Gabby survived DKA, she re-gained weight fairly quickly. Taking the time to read Sasha's history rather than making an assumption will provide you with the information that we coached Tara to feed Sasha whatever he would eat and to allow him to eat as much as he would like in order to keep the ketones at bay. It's no surprise he's gained weight.

 

I'm sorry, Gayle, if you thought I was joking....I was not. The tests are expensive and regardless of whether you can treat it with or without the test, caregivers want to know exactly what they are dealing with.

I have read extensively on acromegaly because a few of my close friends have acro cats. And I have helped Tara in a positive manner from day one. So let's just keep it positive and look at all the possible reasons for the high numbers including infection. Let's not jump to conclusions...we are all here to help in a cooperative manner. Thanks, Gayle.

 

I don't feel that it's wrong to care and offer any input we have.

I believe posts were offered in a well meaning fashion, with no flippant remarks about tests or payment needed.

The tests for insulin resistance are not needed, as some people have what can be referred to as undiagnosed acros, but there are issues that come along with acro which are not a harm to mention.

If one has a very sick cat, I would hope that ALL thoughts and suggestions be allowed on board.

 

Hi there Tara

Having a (former) high dose boy myself, I know that high dose conditions are something one should always consider.
Based on the information (above) that you provided in your 911 post on Health (03/06) I kinda doubt it.

What you do have here is a very sick kitty, a bean who needs to work for a living and very few, if any vet visit $$$.

I recommend you stay focused on the task at hand - making sure he consumes enough calories, is well hydrated, and gets enough insulin to keep the ketones at bay, which apparently he has been since 03/09.

You also have to figure out if there is an infection somewhere, fueling the whole episode.

I believe you will get on the other side of this crisis one day in the near future and when it's over I hope Sasha's insulin need will return to his "pre-crisis" levels.
If not, then you may want to put aside some $$$ for the testing.

Everything in it's time.

 

All I was trying to do was help.
In addition to poor Sasha being so ill, I see resistance and mention it but it is not allowed until other health issues are cleared?

I don't wish multiple health issues on ANY cat, but if I see something, I say it. I thought that it was allowed to offer what I hope will help to add to the full picture for Sasha.

I did not think I had to read back through the entire history before replying; for that I am sorry if my jumping the gun was premature.

 

perhaps it's time to repost Janet's Suggestions for Advice Givers as a gentle reminder for all:

One of the great things about the FDMB is the way people learn everything they can and then "pay it forward" by teaching other people. However, it's easy to cross the line between offering information and "playing vet". Here are some suggestions to help you to be helpful without unduly risking the health of someone else's cat.

• Above all, do no harm. Be sure you are familiar with the particular cat's circumstances before giving food and dosing advice. Wrong advice on food and dose can have dire consequences for a cat's health. Don't give generic advice on these issues. Even something as beneficial-sounding as "Put your cat on a low-carbohydrate diet" can result in death if the cat is already getting insulin (yes, it has happened). If you do decide to suggest something risky, outline the potential risks and benefits for the recipient.

• Explain your reasoning. If people understand why you're suggesting something, they are not only more likely to be successful with their own cat, they are also much more likely to be able to help someone else's cat down the line. (This applies to the person asking the question as well as all the members and lurkers who are reading the answers, hoping to learn something new.)

• Know the subject. Read the Health articles here at felinediabetes.com and the FDMB FAQ, as well as the articles at Pets with Diabetes and Gorbzilla, know what's in them, and know where they are. Browse PubMed, and have a look at old posts in the FDMB Think Tank. Have a library of links handy that will help back up your points, and include them so that others can learn what you know. If you like to cite Steve and Venita's Wiki, contribute to it and help keep it up-to-date and correct. If you have time, read up on topics that don't apply to your personal situation; you never know when you'll have need of the knowledge.

• Be willing to admit you don’t know. If you're not sure of the truth of what you're saying, or if you don't know whether your personal experience applies to the current situation, say so, and solicit clarification or advice. Some of the best discussions have occurred that way! Suggestion: start the discussion on Think Tank, or include the words "Tagged for Think Tank" somewhere in the conversation so that the Webmaster can archive it later.

• Do outside research. Don't get all of your information from the FDMB; that just turns it into an echo chamber (or worse, a massive game of "telephone"). Learn new things and bring them into the discussion. Learn from others when they bring in new things, too; that's part of the fun.

• Know the principles; know the exceptions. "Every cat is different" is not just a slogan. There are general guidelines that work for most cats, and then there are the cats that didn't read the manual. You need to know about both in order to help with the complicated cases.

• Follow up! If you give someone advice, and they take it, follow up to see how they're doing, and to see whether the cat is responding in the way that you expected. This especially applies if you advised doing something unusual or risky.

• Keep your advice public. Helping cats is a team effort, and it's undermined when people are receiving offline advice, unknown to the rest of the group. Many sets of eyes are better than one.

• Don't act as if you're entitled to tell people what to do. You can offer help and advice, but it's up to the other person to decide what advice to take for their cat. They won't always agree with you -- that's life. If it makes you crazy, move on to someone who is interested in what you have to say.

• Don't attempt to diagnose over the Internet, or make blanket assertions about a cat's health status. There's always a possibility that there's something that you don't know about the cat. Be aware that the cat may have other diagnosed or undiagnosed health conditions (such as renal impairment, pancreatitis, hyperthyroid or acromegaly) which may be complicating the situation or causing symptoms which look like diabetes. (Obvious exception: an immediate hypoglycemic episode with symptoms.)

Yes, it sounds like a lot of work, but it's worth it! You and your cat will benefit, you won't have to live with any ghastly consequences of your well-meaning but incomplete advice, you'll contribute to the FDMB's reputation for being a top-notch source of information and support, and generations of diabetic cats to come will rise up and call you blessed.



tara, i apologize for this discourse taking place in your thread. it happens from time to time. unfortunately, it's often the one who is being helped who is upset from these kinds of discussions. please take sandy's words to heart... "everything in it's time."
it's a good idea to simply start a new thread for the evening. thank you.

i'm closing this thread.