12/7/24 WATSON AMPS 369 Libre/328 Meter; +1-386; +2-341

Rosie Lass

Rosie Lass

Active Member
Yesterday Watson had his Ultrasound along with some blood tests. Since they had him fast from 8:45am-8:45pm he, of course, had a hypo event at 2:45am which I attempted to treat without feeding him an actual meal. He got some maple syrup a couple times, a few treats 3 times, and 2 tsp of gravy from food 2 times. He was still only in the 110 range when we hit the vet hospital but stress shot him up to 286 within 15 minutes. I'm going to try to attach the vet's synopsis of what was done (cystocentesis, TAMU-TLI, PLI, Cobalamin, Folate, Urinalysis, Fructosamine), what they found (wall thickening in intestine and colon and dark prominant lymph nodes around investines, previous imflammation of pancreas) and the next steps (endoscopy with biopsies) and what their treatment plan would be for either suspected outcome (IBD or Small Intestinal Lymphoma)

Wendy, I would appreciate it (if you can actually see the treatment plan) if you would tell me if these plans look appropriate. I did increase his dose to 3.0 today. Fingers crossed he doesn't bottom out today since I'm gone +7 thru +11 today.

It's going to be a while before I can afford the colonoscopy since yesterday's bill was $1508!
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Pictures will be in a reply to post.
https://www.felinediabetes.com/FDMB...mps-285l-271m-1-334-2-391-3-333-4-379.296225/
 
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First comment, the spreadsheet doesn't show a hypo event the night of the 5th. Was he showing hypo symptoms? Numbers in the 50's are normal BG numbers on a human meter. However, it does look like you had to work to keep him up in safe numbers. Since he went that low, I would not have increased his insulin dose. Even if he went lower due to not eating.

As far as the ultrasound goes, did they give you a detailed report? What you've shown is not enough detail to proceed to next steps. I expected to see measurements of the various sections of the bowels and thickness in mm of those segments. Based on where there is thickening above normal, and endoscopy may or may not be appropriate. The endoscope cannot get to the middle section of the bowels, though it could reach the top or bottom end which is thickened (a colonoscopy). The other concern is thickened muscularis layers, which cannot be sampled by endoscopy. Did they talk about the option of a surgical biopsy? If they don't find signs of small cell lymphoma, they will assume IBD. The treatments are different so you do want to know what you are dealing with.

Sorry they charged you for the fructosamine - that was an unnecessary add on and cost.
 
Hi Rosie, I’m sorry you had a very tough night before the ultrasound. You did a great job keeping Watson safe. It’s so tricky when we are not supposed to give food and of course that’s when they go low.
(It’s why I have started to give Ivy 1/2 dose the night I fast her before I take her to the vet for fasting bloodwork.) I’m always concerned about “not feeding” when she has one of those nights which she is known to have where she dips low and I have to do exactly what you did, feed her frequently to get her through the night.

Sending you both lots of hugs and support :bighug::bighug::bighug:
 
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Wendy&Neko said:
First comment, the spreadsheet doesn't show a hypo event the night of the 5th. Was he showing hypo symptoms? Numbers in the 50's are normal BG numbers on a human meter. However, it does look like you had to work to keep him up in safe numbers. Since he went that low, I would not have increased his insulin dose. Even if he went lower due to not eating.

As far as the ultrasound goes, did they give you a detailed report? What you've shown is not enough detail to proceed to next steps. I expected to see measurements of the various sections of the bowels and thickness in mm of those segments. Based on where there is thickening above normal, and endoscopy may or may not be appropriate. The endoscope cannot get to the middle section of the bowels, though it could reach the top or bottom end which is thickened (a colonoscopy). The other concern is thickened muscularis layers, which cannot be sampled by endoscopy. Did they talk about the option of a surgical biopsy? If they don't find signs of small cell lymphoma, they will assume IBD. The treatments are different so you do want to know what you are dealing with.

Sorry they charged you for the fructosamine - that was an unnecessary add on and cost.
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@Wendy&Neko. I haven’t shot Watson yet tonight so I can drop back to 2.75 again.

I guess I’m confused on what is considered too low/hypo. My alarm goes off when it hits 60 and I was under the assumption that we don’t really want to drop below 90 so I am trying to get his number back up to the 90s or above, When Exactly do I start trying to get his blood sugar back up, at what number? He was showing no symptoms.
I posted the information that I got from the IM Vet. There was nothing with actual measurements in the paperwork she sent me. She seemed to think we should avoid surgery and do biopsy via colonoscopy.
 
Staci & Ivy said:
Hi Rosie, I’m sorry you had a very tough night before the ultrasound. You did a great job keeping Watson safe. It’s so tricky when we are not supposed to give food and of course that’s when they go low.
(It’s who I have started to give Ivy 1/2 dose the night I fast her before I take her to the vet for fasting bloodwork.) I’m always concerned about “not feeding” when she has one of those nights which she is known to have where she dips low and I have to do exactly what you did, feed her frequently to get her through the night.

Sending you both lots of hugs and support :bighug::bighug::bighug:
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@Staci & Ivy Thanks Staci! I definitely will never fast him again with a full dose the night before. I thought it was a ridiculous idea anyway, but I figured the vet should know what she was talking about I guess I’m really confused about what numbers I should even be looking at because I always thought the 50s were considered too low and I should be shooting for at least 90 so hopefully I can get some guidance on that. I thought I knew what I was doing, but apparently not
 
If the IM vet thinks thickness can be reached via colonoscopy, that will be easier on Watson. The anaesthesia is for a shorter time and he should be able to go home that night. Perhaps the IM vet saw more details that are in the report you got.

My concern with telling you when to give carbs is the Libre numbers. If the BG meter says he is under 50, then you definitely need to give higher carb food. With SLGS, you give a reduction if they go below 90, but if he spends part of the time above 50 then you can feed him regular LC as long as he stays above 50. That is good time in healing numbers.
 
I think, as Wendy said above, if Watson is in the 50s on a handheld meter, that’s too low if you are following SLGS.
You would take a reduction if under 90 on a handheld meter.

But if he is under 90, (but above 50) she’s saying it’s really ok since those are healing numbers. (But you would still take a reduction, if under 90 on a handheld) with SLGS.
Of course Wendy can correct me if I’m wrong here.
 
Wendy&Neko said:
If the IM vet thinks thickness can be reached via colonoscopy, that will be easier on Watson. The anaesthesia is for a shorter time and he should be able to go home that night. Perhaps the IM vet saw more details that are in the report you got.

My concern with telling you when to give carbs is the Libre numbers. If the BG meter says he is under 50, then you definitely need to give higher carb food. With SLGS, you give a reduction if they go below 90, but if he spends part of the time above 50 then you can feed him regular LC as long as he stays above 50. That is good time in healing numbers.
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@Wendy&Neko @Staci & Ivy I don't think Watson will be getting that colonoscopy after all - I just got the estimate in the mail today for $4581.00 and I just can't afford that. I'll just have to see what they suggest for treatment for either situation and try to follow that suggestion.
 
Ouch! I got an endoscopy done by a vet specializing in endoscopies, who travelled to my vet's clinic, and it was around $800. The other option is a surgical biopsy, maybe get a quote on that.
 
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