07/20 Mouse AMPS 374, +3 425, +7 464 Vet Says dose too high

[Sam Q]

If this is too long to read here is the meat:

The vet thinks the dose is too high because there was no glucose in his urine sample and the numbers are typically high. She says ALL Diabetic cats have glucose in their urine.


Ok long story:
Mouse's Vet is my boyfriend's co-worker. She works the day shift and he is a vet tech on the night shift for a different practice. It is a weird dynamic that he is the one that speaks with her but it worked in the past.
Today they finally spoke on Mouse's new lab results. I will not rant about not getting the SPEC I asked for but he was DXed Chronic Pancreatitis and started having a flare up that day after them both telling me I was overthinking it when I suggested Chronic Pancreatitis. I digress. So Mouse was DXed Diabetes in Nov 2020. Her dosing advice was too fast too much and he had checkmark curves. Switch to Levemir in March 2021 and I meet you all and start following along I think in May 2021 and stopped asking for advice from them. Today she suggested that the dose was too high because there is no glucose in his urine. What ....the ....hell....

I don't think my sweetheart wants to tell her that because of this group I officially have more information about this stuff than her.


What are your thoughts?

https://felinediabetes.com/FDMB/threads/07-18-mouse-amps-204-4-135-not-eating.250030/#post-2820374

 

[Librarianista]

I have no advice for you, but you are not alone. Today my vet was *also* surprised that there was no glucose in the urine. She also wants her BG in the 100-200 range rather than being too at risk for hypoglycemia. Seems like maybe we are her only patients who do TR glucose testing so she doesn't know how to advise us. She normally prescribes Vetsulin and gave us Lantus only after we asked, so what we are doing seemed totally outside her wheelhouse.

I didn't push it too much. In the end, it's my cat and I'll take care of her.

 

[tiffmaxee]

No glucose in the urine is a good thing. It means the kidneys are protected and the cat is controlled. Once Max was controlled he never had glucose in his urine yet he never went otj probably due to chronic pancreatitis fur a few years before diabetes. My vet was thrilled with how regulated Max was. He showed my spreadsheet to all his 3rd year students that spent a week with him.

Now I will look at your ss and be right back.

 

[tiffmaxee]

I’m back. He’s bouncing. He is not getting too much insulin in my opinion.

 

[Christie & Maverick]

Just curious, was this the visit on July 13th when they ran the urinalysis? If yes, then it is conceivable that he was under renal threshold, especially if you fasted the night before, that means less sugars entering the blood stream since less carbs were metabolized, and overnight into next morning, voilà no sugar in the urine. Look at the low yellows then green/blues the next day. I suspect that's why. I personally would be following the BG tests when making dose decisions, not whether you caught him on one day where he wasn't dumping sugars in the urine. The rest of the time he most certainly is.

ETA: if you are following TR I'm going to suggest you consider an increase. I apologize, I haven't looked back to see why you went to 1.25u, other than a reference to a dose reset in your notes, which is terrible advice from whomever gave it to you. Those rarely work, and as you see, you are now encountering high numbers as a result, and you'll need to work your way back up, even past the dose you were at when you "reset". With the numbers I'm seeing, who cares if he is bouncing. I'd bump him back up to 1.75u. You've seen what this dose can do, and the best was mid 130s. Otherwise, you've been seeing consistent nadirs quite well above 300.

 

[Marje and Gracie]

@Sam Q

I’ve read back through some of your posts. I’m sorry Mouse, who is extremely adorable, is not feeling well.

I’d like to address a few things from his SS and posts.

First…his dose. I agree with Christie that taking the dose back up to 1.75u is best. When you drop the dose back as you did, we call it a rebound check and for cats whose dose has been increased slowly as Mouse’s has, rebound checks never work. Second, there is no evidence that Somogyi actually exists in humans much less cats. He’s just bouncing and that is different. Here is a post from a other moderator, Sienne, but if you want more detailed info, I can go back and find a very detailed post she did:

I also want to caution you about Somogyi. This is a concept that was introduced in 1938 by an MD based on a small number of human observations. The original study data could never be replicated. In other words, it is at best, very dated and likely poor research. Further, it's not been replicated in cats and certainly not been replicated in cats that have been prescribed Lantus or any other long acting insulin. Roomp & Rand published a study not all that long ago that disputed the presence of Somogyi in cats using Lantus. Despite the research literature, and frankly, much to my amazement, there are vets who seem to be wed to a concept that is more urban legend than backed up by science.

Now to address GI Issues for your poor boy:
Unless a cat has exocrine pancreatic insufficiency (EPI) as diagnosed through the Texas A&M GI which you had done and was normal, they should never, ever, ever have pancreatic enzymes. Digestive enzymes are fine and I use Dr. Mercola’s daily but pancreatic enzymes are extremely caustic. If you were giving them, it could be partially why he’s not been feeling well.

Have you ever tried egg yolk powder for constipation and motility? It is so much better than giving them Reglan, Miralax, and enemas. I, like Elise, also find that ondansetron works well in combo with cerenia.

Pepcid. Ugh. I feel vets throw Pepcid at cats like candy. Yes, for a cat with CKD, it might eventually need to be given. Here are a couple resources on nausea, nausea 2, and using Pepcid. The woman who wrote these is a friend of mine and the absolute most knowledgeable person I know about the feline GI system. She runs the Raw Feeding for IBD Cats FB group. I’ve shared many of her articles, etc with my vet who has implemented them with other patients with great success. If your baby is. It getting probiotics, there are so many wonderful ones to use but I really like Visbiome and NOW Probiotic Defense.

Word of caution…..if he has thickening of the intestines, and I saw what your vet said on his lab tab, I would treat as for IBD meaning digestive enzymes, probiotics, and if you really want to address it, slowly switching to a balanced raw diet. I use the premix made by FoodfurLife which also makes the egg yolk powder. All the things your vet said that are listed on the lab tabs are not likely what is causing that and I learned the hard way that it shouldn’t be dismissed or ignored. BTW, cats that have had worms, giardia, coccidia, etc are more prone to developing IBD if not given lots of good intestinal support. My boy had giardia as a kitten and that’s why I’ve always had him on good probiotics, digestive enzymes, and a balanced raw diet.

Nutriscan can help identify food sensitivities…not allergies. I used it on both my healthy cats and dropped chicken from my boy’s diet.

I hope some of this will help. Let me know if you have questions.

 

[tiffmaxee]

Oops. I got this one wrong.