7/25, Susie, 117 PMPS, 118 @+1, 97 @+2, 79 @+3, 87 @+4

https://felinediabetes.com/FDMB/threads/7-24-susie-124-amps-155-1-163-2.250297/#post-2823892

Happy to say "bye, bye" to this week. I'm going to have to think about going back to 2.25. Susie just isn't making any progress on this dose.

Can someone explain to me why her cholesterol and triglycerides would be high on her fairly restrictive diet? It that because her glucose was high (217) on the blood test. Are they all tied together?

Also, if someone with great lab test knowledge (@Suzanne & Darcy) could possibly tell me what I need to worry about with her urinalysis results?:
PH: 8 (range 5.5-7.0)
Protein: 2+ (range: negative)
Glucose: 2+ (range: negative) - probably due to her bouncing ?????
Looking back at past labs her PH, Protein and Glucose (urinalysis) have been high since December 2020.

Am I looking at a potential new medical problem and, if so, what does it look like it might be. I have a call in to my vet for assistance as well. Thanks!

 

Hi Summer, I can't help you with the labs, but from looking at her SS, I'm leaning with you on increasing that dose back up to 2.25. She gave you one little greenie the other night - you could tell her she's going to get an increase if she doesn't hit the lagoon today...I usually try to wait 3 days since the last greenie to increase - but you're experienced with her...do you think she'll get back to the lagoon if you increase her tonight or tomorrow morning?

 

Yes, I do think she will get back down with the increase. In fact, I think she will go lower than I want and that is why I reduced to 2 units. It usually takes her several cycles to reflect an increase or decrease but that is not always the case. This cat is always surprising me. It is frustrating. Too low on 2.25 and too high on 2. It is not recommended that I try the fats and skinnys so I just don't know what to do. Every time I get serious about an increase she comes down so I'm going to have a little talk with her today. Hope your husband is recovering well. Boy, be glad you are not here on the west coast of Florida. Red Tide is very bad this year.

 

Congrats on the much improved ALT and AST.
Creatinine is rising, even though not above threshold. It might be a good idea to search for lower phosphorus foods to help protect her kidneys - would like input on that.
I know some of the FF foods have 3-4 x more phosphorus than I would feed a cat with chronic kidney disease. I just wonder if Susie isn't headed that way.
Tina always has higher cholesterol - doc isn't concerned but, it would be great to hear more on that.
If you want to tag Marje, she is a great labs interpreter. Also need to learn about that high urine PH.
Happy Sunday; God loves you!

 

You are very sweet and very supportive, Jan. Good idea to tag @Marje and Gracie to see what she thinks of her labs.
I have also heard that FF is high in phosphorus. Any suggestions for a lower phosphorus food? Thanks for picking up on the Creatinine. I had no idea it was tied to phosphorus. Bless you for being another set of eyes for me.

 

I have also read advice, that it is not necessary to treat for CKD unless creatinine is actually high. But I like to think "prevention". (I could be wrong).
Tina's creatinine got up to 4+ in October 2019. With subQ Lactated Ringers Solution given from that point on, she has maintained a creatinine level of 3.2-3.4, I believe. It can vary based on when I gave LRS last.
Susie has a great BUN level -

Weruva Truluxe is what Tina eats - on the Cat Wok, Steak Frites, and Weruva - Glam n Punk.
Weruva lists ALL ingredients online!! But you can look on my SS tab food and supplements. I have to run for now or I'd be more complete!

 

It was also suggested I try out Weruva for low phosphorous foods for Chloe. Some of the stuff is higher in carbs, but still under the 10% threshold. So far we’ve tried Lamb Burgini (lamb), Funk in the Trunk (chicken and pumpkin), and Chicken Frick A Zee (chicken) and both she and my civvie have liked them. Also have a few others we haven’t tried yet: Fowl Ball (chicken/turkey), Meow Luau (mackerel), and Mideast Feast (tilapia).

 

Tina started on Paw Lickin Chicken - less than 4 carbs DMB. Some cats don’t like the meaty shreds - it smells good enough to eat for humans!
Caution on Lamburgini - shot Tina way up with its 9 to 10% DMB carbs. She loved it though - for her it was medium carb.
Yes they have some high carb food too, but it’s the best brand I know of for lower phosphorus finds.
I wish Tina liked Frick A Zee or Fowl Ball. She doesn’t like darker fowl meat. Cats! Nutrition labels mean nothing to them!

 

I don't know anything about the labs, but it does look like Susie needs an increase. I hope your Mom is doing better this morning. Sending prayers.

 

Thanks for your time today. I will take all this information in and consider a food switch.

 

Thanks, Alex. There are certain foods I just can't feed Susie for strictly moral reasons. Lamb, deer, rabbit, horse meat, bison and duck. Call me a "bleeding heart" regarding those species. I've looked at Weruva before. It is expensive and you have to buy a huge quantity. I'm afraid she won't like it and I'll be stuck. Next time I am in Pet Supermarket I'll see if there are individual cans they sell.

 

Thanks, Carla. I have to give one more day on the 2 unit dose. She is seeing some pretty good blues but they are high. I'll make a decision tomorrow evening.

 

Great job Mama Bean with Susie and your Mom. As caregivers we tend to neglect ourselves sooo please take care of yourself!!!!

 

I found mine at Petco. If you don’t have them near you, you can order individual cans online of some flavors. At least I was able to add individual cans to a cart. Haven’t purchased yet since I’m still shopping around.

 

Interesting things going on in her urine. But....insofar as her bloodwork, it’s quite common for diabetic cats to have elevated cholesterol and triglycerides I wouldn’t worry about that. I didn’t see anything in her bloodwork that concerned me although her potassium is a bit low. Most labs use 4 as the lower end; I see yours uses lower so that might explain it. Her creatinine has come up quite a bit and it’s hard to tell the significance of that without an SDMA. Usually, the first sign of pending CKD is a urine specific gravity (USG) below 1.040 but hers is not (more on that later and it could be throwing everything else off).

Urine:

• her USG is fairly high and this might be attributable to the glucose in her urine and the protein
• the 2+ protein could be a concern and I’d call the vet and find out if they still have urine; if they do, I’d want a urine protein:creatinine ratio to be sure she is not proteinuric which is a concern for any cat. Just be advised it’s not an inexpensive test but if she is proteinuric, it needs to be addressed
• her pH is really high; it should be 6-6.5 but no more than 7. Anything higher can make her more prone to crystals. You can google about how to get the pH down

I’m not judging as I probably am a bleeding heart liberal and I am against hunting; I, personally, would never eat any of those meats but our cats get lamb, elk, venison, bison, pork, turkey, chicken because they do best with a variety of meats and, for me, it has to be more about them than it is about my values for me. I have fed them duck and rabbit but they didn’t like it. I liken it to my sister who is a vegetarian for animal cruelty reasons but once her son was old enough to decide, he wanted to eat meat so she makes it for him. I don’t know....just my perspective right or wrong. We can choose for ourselves but that’s where I draw the line.

 

Thank you for the information, Marje. What do you think about the "double dipping"? Susie was at 180 at +10 and now she is at 117 at PMPS. Should I be prepared for a very active night?

 

You’re welcome.

The 117 is definitely a second dip but Susie doesn’t get overlap or carryover, yet, so you have to look at each cycle separately right now. It’s common that Lantus will give a second dip at the end of a cycle but that’s the end of that one. You won’t really know where she is headed until +2 because she has had second dips before and then gone up. Only Susie knows!!! Sorry for the copout but there’s nothing that really tells me what her upcoming cycle might be. If she was clearing a bounce, she’d be lower at PMPS and it would be a dropping number vs a second dip.

Does that make sense?

You are doing a great job of testing!!!! And Susie is doing so much better than when you first came here. Pat on the back.

 

Let me look at her labs. I agree that it is not uncommon to have diabetics with triglycerides and cholesterol outside of the reference range. I hope the labs are on your SS. I will look now.

 

Nothing really makes sense to me anymore. I am always so surprised by what this cat does. I do understand the clearing a bounce but not the overlap or carryover unless you are referring to the depot and that she has little of at this point. She has been on the 2 units for 13 cycles. All I know is that this cat takes her sweet time to reflect an increase or a decrease so I become more and more hesitant to make changes earlier than most would. Thank you, as always, for the vote of confidence. I will certainly get a +2, like I always do, and take it from there. Just seemed like a really big dip tonight.

 

Thank you, Suzanne. The labs are all on my SS.

 

Okay. Looking at those labs, there is a LOT to be happy about. I am really pleased with the improved liver enzyme values! Super excited, because those had me worried before.

Regarding kidney values, I would not worry at this time. Your BUN and Creatinine are still okay and, as you can see from past labs, they will vary a bit. You don't have an uninterrupted trend of increases. Those values can go up and down and Susie's have a bit. I would not be AT ALL opposed to you finding foods that are lower in phosphorus for Susie, as a precautionary measure to protect the kidneys. Higher phosphorus foods make the kidneys work harder. If you can find lower ones, that would help her kidneys no matter what. Weruva foods, by the way, tend to be a lot lower in phosphorus because they have a "no bones" philosophy, which eliminates a lot of phosphorus.

Now, as to urine... and this is one reason that I say not to worry too much about her kidneys at this time... she has VERY GOOD Urine Specific Gravity, which means that her kidneys are doing a good job of concentrating urine at this time! Hooray. So, when you consider kidneys, you can't just look at the BUN/CREATININE, etc. alone... you need to look at the urinalysis also. So if you put it all together, I think her kidneys are doing well right now. You can re-check in 3 months if you are able.

I feel very optimistic about these labs for Susie, but I will be interested to hear your vet's interpretation of the labs. That's what they are there for

 

A great place to find low carb/low phosphorus foods is on the FB page for feline chronic kidney disease. Andrew Hall on that group is really nice and is so knowledgeable about foods. They have food charts that Andrew has put together. One of the lists is specific to low carb/low phosphorus foods for diabetic cats with kidney disease. Susie does not have kidney disease yet, so you can have a little more leeway on what you feed, but you can lower phosphorus some to make the load easier on her kidneys.

I hope you are doing okay Summer... and that your mother is feeling better. I took care of my mother here at my home for several years before she had to go into a skilled nursing facility and then later passed away. It was difficult at times and stretched me very thin, but I would never change it.

 

You are a dear. Thank you for all of that information. My vet doesn't seem concerned about anything. In fact, after all these months of providing Susie's SS to him, he just asked me, two days ago, what the "@ +number" meant. I tried to explain that it was the glucose reading after a certain amount of hours after the insulin injection. He didn't seem to take any of it in. He is not the best vet for a diabetic cat and that is why I count on all you folks. Thank you so much for looking at her labs and advising me. I feel so much better especially since her ALT and AST came down. I can only attribute that to the milk thistle because she is still up and down with the glucose. I'm so glad you are staying on this site. You have knowledge that will help all of us. I hope you are okay. I think about you often. Have you fallen deeply in love with one of your kittens yet? Or all of them? Thanks, again, my friend.

 

I will look for the FB page for feline chronic kidney disease. If you get the chance, tomorrow, can you send me the link? Sometimes there are several sites with the same name.

I am doing okay but I am worried about Mom. She is mentally not herself anymore. She keeps hearing music in the house. She has these vivid dreams which tie into reality when she is awake. I think the episode last week might have truly screwed up her brain. Only time will tell. Bless you for taking care of your Mom for those years. I know it is not easy. I took care of my husband, for five years, but he never had any dementia. It is truly a different game.

 

I was going to ask you if you'd still been giving the milk thistle. I definitely attribute the improved liver values to that. It is so healing for the liver, even for humans. I'm proud of you for getting that in her.

Oh yes, I'm totally in love with all of my kittens! But I can't keep all of them. They get to go to really good homes and the people who adopt them mostly keep in touch with me and send updates and photos, which I really appreciate.

Your mother may have an infection of some kind affecting her. A urinary tract infection, for example, can really mess up cognition (as well as cause back pain, which I don't know if your mother has). A B-12 deficiency can cause real cognition problems as well. There are so many things. She hasn't had anesthesia recently, has she? Does she have a geriatric physician who keeps a good look out for her and takes care of her? Do you know?

 

Yes, Susie has been getting the milk thistle for about four months now. But, only in her dinnertime meal. I am supposed to be doing it twice a day but didn't want to push her away from wanting to eat so I only put it in her food at night.

Wish I knew more about your cat rescue. I think what you are doing is terrific.

My Mom told me yesterday that she needed to call about a urinary infection. She said she had been up 20 times to go to the bathroom. I mentioned to her that it was Saturday and she wouldn't be able to reach her doctor. I l looked at her lab work from Thursday and she had a urinalysis. I would think that if she had a UTI that the ER would have mentioned it but God only knows how bad medical care is these days. I think you could be right. They did not state a UTI. No anesthesia recently. I don't know about the B-12 but I'm pretty sure she doesn't take it. We will call her doctor first thing in the morning to get a UTI antibiotic.

 

I disagree here. For those tests run in a lab, she does have a string of increases: 1.1 to 1.6 to 2.1. Each time she’s had a lab test done since March, 21, the creatinine has increased. Creatinine does change but not like that without some taking notice. BUN, I agree. Many things can influence it but, after having four CKD cats, I would say it’s not usual to see it drop back down from 2.1 to 1.6 or lower.

Again, I really disagree. A cat can over-concentrate its urine and that’s not always a good thing. I know because I have two who do it. There is a reason behind it. If you read what I wrote in post 16, glycosuria and proteinuria can cause an “artificial” elevation in USG. Does that mean Susie would not be concentrating her urine that well? Hard to say as USG varies during the day and is likely very influenced by the sugar. But certainly, glycosuria is going to result in a higher USG; it’s the chemistry of it all. But the 2+ urine concerns me more. Could it be no issue? Possibly but she had 3+ before. My vet would not leave those kinds of numbers untested for ensuring there isn’t proteinuria in the picture. And....not all proteinuria is tied to CKD. There are other reasons why cats can be proteinuric and it can be idiopathic. We had a civvie cat here of one of the FDMB members who had idiopathic proteinuria. In addition, a pH of 8 is not ok in a cat. A cat’s urine should be acidic, not alkaline as Susie’s is. She is at risk for urinary crystals.

Optimism is great but my vet errs on the side of caution especially when there are trends.

These refer more to duration not depot. Some cats get great carryover and overlap but others do not. Gracie could also be a slow responder. What’s the hurry? Susie is also getting green and each dose of lantus you give her is cumulative; thus why you see some cats being slower responders to a dose. They just have to let the dose “layer upon” itself over time and the depot build.

Deep breath

 

So what are you saying Marje? Should I be getting another test for Susie's urine? She has had high PH since December. I really don't have a lot of money to continue to do test, especially since I have two dogs that are due for annuals in September. Your words concern me though. The pH of 8 being one. I really don't have a lot of confidence in my vet. Their office is always "swamped" with dogs, cats, etc. and my vet seems to be lacking in diabetes expertise. Tell me what you think I should be doing at this point. I need to go test Susie again now to make sure she is not going to continue to drop tonight. You have no idea how much I appreciate your advise. Just as I do for everyone on this site.

 

Right now, I'm just going to check my girl. She surprised me with a 79 at +3 tonight. Will feed and monitor but I am departing the website for tonight. Thanks to ALL for the support and advice. Probably will not be increasing after all. My girl always takes her sweet time to reflect an increase/decrease and maybe that is what she is doing tonight.

 

https://m.facebook.com/groups/703846239667023?view=info&sfd=1

This is the link for Feline Chronic Kidney Disease group. My only warning is that the group can be very sad. It can be overwhelming and there are lots of cats dying all the time because there are so many members. So you may want to get info on foods from them but not follow all the posts. The best group to join for CKD help is tanyackd list on groups io.

 

Yes. The protein in the urine is definitely something that you should ask your vet about. The alkaline urine is not good. I wonder if she is working on a UTI as alkaline urine may be a sign of infection. Also, cats with alkaline urine run the risk of developing struvite crystals in their urine. A lot of things can influence creatinine (and yes, Susie's has been trending upward as Marje said, -- I stand corrected on that.) However, Susie's creatinine is still within normal limits (aka the reference range). I understand about the USG being influenced by a lot of factors, but again, Susie's USG is just barely out of the normal range by 1/1000th of a point. Summer, if you ask your vet to re-test the blood work right now he/she's probably going to say that it won't do any good to re-test this soon. It takes time to show changes.

Regarding protein in the urine.... Urine can be checked more frequently. Tanya's site felinecrf.org states:


The usual way to determine if a cat has proteinuria is via the urine protein:creatinine ratio (UPC). Three urine samples should be collected over a minimum period of two weeks before a conclusion is drawn.



Urine Protein: Creatinine Ratio

Proteinuria Status

Below 0.2

Non Proteinuric (NP)

Between 0.2 and 0.4

Borderline Proteinuric (BP)

Over 0.4

Proteinuric (P)


There is a correlation between the severity of proteinuria and the prognosis. Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria(2006) Syme HM, Markwell PJ, Pfeiffer D & Elliott J Journal of Veterinary Internal Medicine 20 pp528–535 found that cats with a urine protein:creatinine ratio below 0.5 survived almost three times as long as cats with a urine protein:creatinine ratio of over 0.5.

Hope any of this helps.
Good night... well... good morning since you already went to bed.

 

IMHO, you can google ways to bring the pH down and you can buy urine pH strips to check her urine pH at home. I would be more concerned about the protein in her urine.

The least expensive thing to do is have a conversation with your vet about the protein in Susie’s urine. Of course, if you don’t have faith in your vet and your vet didn’t mention it, that might not get you anywhere. I note her albumin is high and that is one protein that can leak into the urine.

Here is some info about proteinuria. Again, just because she has protein in her urine does not mean there is an issue and the high USG might make it less of an issue.

 

Thank you, Suzanne.

 

Hi Summer checking in late just wanted to say I hope they can figure out what's going on with your mom. Nice greens for Susie tonight, I hope you won't have to be up too late testing her ♥

 

I keep thinking about Susie. I can’t remember now if I previously mentioned that a sudden increase in creatinine can be an indicator of an infection - often a UTI. Combine that with other infection indicators. Also can be caused by dehydration, uncontrolled blood sugar and hypertension.
Oh, that brings me to another thing I wanted to say but forgot to mention. Get the vet to test Susie’s blood pressure. It’s important with the things we’re talking about (possible CKD, possible infection) and just age. Why is it we can’t get inside a docs office without a BP check, but vets won’t check our pets without is requesting it.

 

Doesn't stress of going to the vet increase BP? How do you know it's high on a normal basis?

 

I replied to this on today’s condo.