@wade sent me a PM with these concerns which I want to move here so we all have the same information. I asked him to post a condo so we could comment and because I can’t give dosing advice in a PM.
My first concern, Wade, is that she isn’t eating as much as she was. I don’t know if you are aware of fatty liver disease (aka hepatic lipidosis) in cats but it can be caused not only by anorexia for a few days but also a decrease in calories. Is she on an antibiotic for the UTI? Antibiotics can make cats inappetent so that makes me suspicious with this sudden onset of not wanting to eat. How did they diagnose the UTI....did they do a sterile culture and sensitivity? Also be aware if they did not do a C&S, cats can have sterile interstitial cystitis which means they have the signs of a UTI (and passing blood clots is a sign of sterile interstitial cystitis). It is often brought on by stress and my Gracie had it as a young cat. Most cats who exhibit the symptoms of a UTI actually just have sterile interstitial cystitis which is not treated by antibiotics but by supplements like D-Mannose. Of course, with diabetics, it often is a UTI because of the sugar in the urine which promotes bacterial growth so it’s always best to have a diabetic cat checked for a UTI via C&S if they are showing symptoms.
She is on antibiotics for the previously diagnosed uti; because of her back-end paralysis she can’t posture properly for her bowel movements so she is particularly susceptible to uti’s. She has had two dozen since her accident in November ‘21. On this most recent (before current) uti the vet put her on a 90 day course of a long term antibiotic (name escapes me right now but it’s nitrofourintin or something similar) because she has developed a resistance to so many of the antibiotics. So she has been on that and it has seemed to be working.
which makes me feel like this most recent potential uti May well actually not be a uti at all but the interstitial cystitis you mention. There are days like today where her urine is clear, then days like yesterday where she passes clots.
I do have a bag of d-mannose but was concerned about giving it to her because it’s sugar-based and I thought that may not be a great idea for a diabetic cat. But if it is safe for diabetic cats and will help her i can start that in the am. To confirm, no issues giving d-mannose to a diabetic cat ?
Re dka: I have the strips and have been checking it weekly. Catching her urine is actually quite easy. She has a ticklish spot on her tummy that if I rub makes her tinkle and since she’s fairly immobile it’s just a matter of holding the strip in the right place. Ten out of ten times if I tickle her ticklish spot she’ll tinkle for me. I can start checking it more frequently since she has been eating less. Can do it daily.
Re spreadsheet: I have been updating most nights for previous day but will increase the frequency there. I will add a morning spreadsheet update each morning as well.
And re dose: I had already as of this am moved the am dose up to 1.25 and the pm to 2.25 but given that both should be the same I can move both to 2 and just keep it there, then measure for drops below 90 to see if she earns a reduction.
my question re this then is this: should I move these doses all at once (so 1.25 to 2 in the am and 2.25 to 2 for pm) or should I do it gradually (1.25 to 2 in .25 increments and holding each dose for 7 days)? If don’t want to mess this up.
I’m also concerned if she’s had/has a UTI because infection + less calories + less water is a recipe for
diabetic ketoacidosis (DKA). Are you testing her urine ketones because I would be doing that every single day if you can catch her urine. I know you have her on pee pads so she might just urinate on those when she has to go meaning it’s hard to catch her urine. There are also blood ketone meters similar to handheld glucose meters but you would have to poke her ears....and the strips are pricey. BUT, either way, you need to be checking her ketones.
Sometimes they decide to slow down on the eating if you are transitioning from dry to wet and, if you think that is the case, it’s better to have her eating like she was and then start transitioning her again slowly. Also, we don’t cut the dose in half if kitty is sick or not eating.
Here is an interesting discussion on “no food, no insulin”. And while you are just shooting
less insulin (which is ok short-term), it’s just something to keep in mind. But you want to shoot the same dose every time. It’s a fine line to walk in getting her insulin she needs to ward off DKA but will also keep her from dropping too low if she’s not eating.
If going back to feeding her the old proportions of dry/wet doesn’t work and restarting the transition, you might want to talk to your vet about getting some MiraTaz (MT) from him/her. It is a transdermal appetite stimulant that you put in the bare part of the inside of the ear. It works really well and I have found with my own cat that I use it in that a 1” dose instead of 1.5” every fourth day works great for him but every cat is different (ECID) which is a phrase you will see here often. With any appetite stimulant, you have to be sure there is no nausea. MT transdermal does have a bit of anti-nausea effects as well and if Oregano is not showing any signs of nausea, then what is in the MT might be enough for her; it seems to be for my cat.
So...for dosing, we need to find a dose that you can shoot consistently without having to worry about her dropping too low, especially if she doesn’t want to eat. The 1u is not going to be enough for her. By the way, it’s
super important you keep the SS up-to-date. I can’t see what happened overnight but I know you were checking it. If we can’t see the full picture, we can’t give you the best advice. You mentioned in the PM she had dropped to 112 which is a perfectly safe BG (actually it’s quite good).
when it gets that low I panic. I’m terrified of a crash. I am going to have to learn to let 112 sit snd not intervene unless she gets below 90.
As
@Staci & Ivy mentioned, you should be dosing primarily on the BG you expect to get a nadir (lowest point in the cycle) and not the preshot (PS)
unless the PS is too low too shoot which is below 90 for SLGS and below 50 for TR. While, based on her SS, 2.5u would likely be a good place to start, I want to be sure and suggest a dose that makes you comfortable about her eating less. For that reason, 2u might be a good dose you can shoot twice a day. If you get a PS below 150, please post here for help but don’t feed her as feeding raises the BG especially at the end of a cycle and we don’t want to shoot a food-elevated BG. Typically, we do not feed two hours before shot time unless the BG is below 50. There is usually someone on here 24/7 because we have members around the world. We have a lot of east coast members who are up really early (like Staci) who can help you with shooting a low BG.
What do you think? I’m going to be gone all day today (have to take one of our kitties to Phoenix to see the cardiologist) but I can check back in while we are traveling. We should be back by 9 pm your time but there are lots of experienced members here who can also help.
