? 5/29, Tango, BG continues to spike, time to restart insulin?

From 5/24 https://www.felinediabetes.com/FDMB/posts/3074166/

Hello... I would really appreciate it if you all could see below and let me know what you think.

I'm really thinking we need to restart Tango on insulin. Since May 11th his BG has been increasing. Just tested and it was 402, highest yet. BG was in 80s/90s for 6 months. On May 11 it was 98 (the day before we left on vacation). Day we got back it was 187. Thought it could be from having strangers over, but it's been 10 days.

We took Tango to the his regular vet (Bayside) on Thursday. We explained all that was going on. Did not do blood as it was done in April. Did do a urine test. This is what she said, "urinalysis results are back (culture is pending and results should be back Tuesday). His urine is minimally concentrated, which can be due to his stage 3 kidney disease and/or his diabetes. He has 1+ glucose in his urine, which indicates that his blood glucose level has been elevated (it has been 2+ and 3+ in the past".

Tango does need dental work. She said although they could do dental there, she's not comfortable doing so due to Tango's issues (diabetes, HBP, kidney disease) because they're not equipped to handle if something goes wrong. Wants to send where they have a board certified anesthesiologist (I think). She put in a referral in to UCD (Univ of CA, Davis). My concern with that is it will probably be awhile before we get an initial appt.

I asked about restarting insulin and she deferred question to the specialist that has been handling Tango's care. We didn't take Tango to the specialist (MarQueen Hosp) this time because they do not do dental work at MarQueen.

I emailed vet at MarQueen and am waiting for a response. I asked if there's another option where to go for dental work and about restarting insulin.

I added lab work to spreadsheet.

There is no chance Tango got into any other food as we only have wet, low carb. And, no chance of getting into human food. His behavior is pretty much the same. Does seem to want to eat more, water intake is about the same.

Also, we are not treating kidney disease. Vet says she doesn't feel it's necessary at this time. She gave an explanation, but I can't think of it now. Need to ask again.

Big question... do we restart insulin now or continue to wait? For what, I'm not sure?

Thank you so much. As always, this group is so appreciated.

 

Hi Lori I'm sure an experienced member will respond to you by tomorrow, mean time I see you said Tango had Stage 3 kidney disease.
I would definitely add that to your signature so members are aware of it
Tap in your name up top then tap on signature and add it then tap Save

 

It might be a good idea to start insulin. I think you can start at 0.5U but I will tag a couple of more experienced members for their inputs on starting dose. I presume you can follow TR like you did the last time?

@Bron and Sheba (GA)
@Wendy&Neko
@tiffmaxee

Not sure how vet deduced he CKD Stage 3 without bloodwork!! Is he showing any symptoms - I presume his peeing and drinking must have gone up - but are there any other symptoms like loss of appetite, nausea, vomiting etc? A urinary tract/kidney infection can also elevate kidney values.

 

@Bandit's Mom
Labs are entered on Lori's SS
Also on your previous post Wendy said she noticed Tango
has been barfing frequently, and that should be investigated by the vet.
Have you discussed that with your vet yet?

 

Done. Thanks Wendy.

Bhooma, blood work was done. Pls see spreadsheet. Initial urine test did not indicate UTI - vet did send out for urinalysis culture. Should get results tomorrow. Peeing and drinking water are about the same. Appetite is good. He is meowing for more food as I type. He jumped up on the island and is just staring at me. No other symptoms.

 

Sorry. My mistake. I saw the labs and looked at the left-most column instead of the right-most.

ETA: I've moved the 2023 numbers to a new tab on the SS so that we don't have to scroll all the way down to see them

 

I agree. I would start insulin with 0.5 U, it’s is a good place to start. You can always increase if needed.
I would push for a dental appointment with UCD. Teeth can often be the reason cats fall out of remission,

 

With sugar in the urine I too would start insulin again. We mentioned the vet should check her teeth. Did she look?

 

Thank you for moving 2023 to ne tab

 

Yes, she did look at teeth and definitely recommended getting work done. Just a matter of how soon we can get in to UCD or finding another place. Regular vet not comfortable doing with Tango's condition and at Marqueen they don't do dental at all.

 

We will push for dental appt and start with .5 U twice a day.

Thank you.

 

Needing a dental is one of the most common reasons cats fall out of remission. Hopefully with that taken care of quickly (and insulin on board), it'll be a short stay here. Post here once you've started and we'll see if he needs to be fast tracked up in dose. He may need to go up to his previous breakthrough dose.

There are dental specialist vets - your vet may know of some if you can't get into UCD quickly. Those specialists are used to dealing with complicated kitties. Neko went to one - twice. They also had a board certified anesthesiologist on call if the case needed it.

 

Thank you and will do. Did get a phone call from UCD this morning. Waiting for doc to review case and call back. Also checking around for dental specialist.