Introducing my cat and a question re: causes of spike after remissison

Hi all,
I've been reading this forum to gather real life advice and help my recently diagnosed cat, but now I need some more specific advice, and ask if anyone has seen this situation before.
Quick background: Arancino has been diagnosed in July; I brought him in because he looked a bit off. It turned out that he had a UTI and elevated glucose at the vet - not extraordinary in itself, because he's so stressed out when I bring him in (even on gabapentin) that he pukes, pees and poops in his carrier.
He's done very well on Lantus, and regulated very quickly to the point I was able to withdrew it 6 weeks ago, and while his glucose has been very slowly creeping up, yesterday it has spiked to 13 mmol/L (alphatrak).
From his general behaviour, I suspect he has an UTI again, so I will call the vet tomorrow to see what can be done. I am in Ontario and there is a new lockdown in effect, so I am not sure what availability the vet has. Also, I'd rather not to take him in the vet's office unless absolutely necessary, as he becomes very agitated (the vet has problems restraining him) - his blood tests are so messed up they are borderline useless (I am considering in- house visits, but you know, covid).
At last check, he also had very slightly elevated Spec fPL, but that may be related to his pancreas not functioning normally.
My question is: both the vet and I assumed that the UTI was secondary to the diabetes; but given how quickly his glucose levels shot up yesterday, I am starting to wonder if it is not the other way round, that is, his UTI triggers the raise in BG, because his immune system is compromised and can't fight infections effectively? He's eating normally, drinking a bit more than usual, and no issues peeing; he was up for playing last night. He's had most of his teeth removed a year ago (due to FIV), so he only has his fangs left.
I initially thought that the spike was caused by eating his sibling's HC food on Christmas day (my bad, I forgot to remove the bowl), but the levels are persisting after 48h - I would expect a glucose load to be cleared in 12-24h tops. Right?

Any other general advice, especially for a cat that won't cooperate at the vet's? I can see the terror in her eyes... I mean, the vet's eyes!
Anything else I might be missing?

I will upload a SS as soon as I figure out how (DONE)

The plot shows all the records in one figure (insulin and readings).

 

Welcome to FDMB!

The text file won't help us!! We're pretty well wed to the spreadsheet we use. There is a world version that will convert the mmol/L to the numbers we use in the US. In order for us to give you any degree of feedback, we'd need to multiply everything you listed by 18. I'm tagging one of our members who can give you a hand getting your spreadsheet (SS) set up. @Bandit's Mom In the meantime, you may want to look at this post on helping us to help you. It has information on setting up your spreadsheet as well as what information you can include in your signature.

There are a few considerations. Without seeing what your cat's numbers looked like at the time you stopped Lantus, it's hard to know whether it was a good time to stop insulin. We typically like to see a cat in numbers below 100 (5.6 mmol/L) on a human meter for two weeks. Also, the dose is tapered down to about a drop before discontinuing. If you were following your vet's advice, chances are the dose was not that small and the numbers may have been higher.

How old is your Lantus? If it's been open for a few months, it may be losing potency.

Any form of infection or inflammation will cause a rise in blood glucose. It may be that a UTI is involved. Many cats fall out of remission due to dental issues. The problem with UTIs and diabetes is a bit circular. If your cat has glucose in his urine, the glucose is a good medium for bacteria to grow. Thus, a diabetic can can be more prone to UTIs. However, I am among the many people here who's diabetic cat never had a UTI. It's like with humans -- some people are prone to UTIs and some are not. One thing to consider is whether it's a UTI or a kidney infection. The latter take a much longer course of antibiotics to treat. Also, how was the urine collected? You want to have a cystocentesis (a needle into the bladder) so you have a sterile urine collection and the vet should run a culture and sensitivity (C & S) to make sure you are prescribed an antibiotic that's appropriate to the bacteria.

As for Arancino's numbers, Lantus dosing is based on the nadir (lowest point in the cycle) not on the pre-shot numbers. If the only data you have is from shot time, you have no idea how low your cat's numbers may have dropped. Can. you get more tests? This is a link to the Lantus board. You may want to review the sticky notes at the top of the board. There's a huge amount of information in the notes about Lantus, dosing, etc.

 

Thanks so much for your warm welcome!

The spreadsheet should be available from my signature, and the US (mg/mL tab) is automatically filled in when filling the tab with mmol/L tab. I hope I set the sharing permissions correctly - people should be able to open it - let me know if otherwise (I like the plot form better, but it uses a program that reads text files, hence my choice of format).

I achieved consistently less than 8 mmol/L on a cat meter, which should correspond to roughly 5.6 mmol/L on a human meter, for two weeks before stopping insulin. I did not taper the dose down (the smallest I could reasonably measure was 0.5 U; I did not trust myself to measure smaller doses), but injected only once a day instead. I have several points at nadir (3 to 6 hours after injections) in the spreadsheet, but I wanted to cover the time further away from injection to make sure the insulin was not waning down too quickly. The numbers I gave above are Arancino's latest numbers (all without insulin). I know people would love to see more points, but Arancino is a former stray and not easy to handle, as his vet will tell (he must take gabapentin before his visits or he'll shred them to pieces).

The urine was indeed collected through a cystocentesis, and a urine culture was used to establish sensitivity to antibiotics. There was only a handful of possible antibiotics to choose from; unfortunately bacterial resistance is a real problem. I hope it is not a UTI again because we are running out of options :-(

Because Arancino is essentially toothless, dental issues (very common in FIV cats) are unlikely, but not impossible. I will check his BG again tonight. I still keep my fingers crossed that he just had a big helping of high carb food when I was not looking...

This is the link for the SS: https://docs.google.com/spreadsheet...HCLEsNbqxtJt98EbPOTe2YfHpXRzYMdpgO9JJ/pubhtml

 

Welcome. Waving from the Kawarthas.

Hopefully it is just the carbs wearing off.

Some people find that a pair of magnifying reading glasses from the dollar store help with small doses.
If needed, here is a link to how to measure small doses (scroll down):
Sticky Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

 

Thanks for the info!
Unfortunately, after a promising evening yesterday (downward trend), this morning Arancino's BG was 15.3 mmol/L (~257 mg/mL) on his alphatrak, so I gave him 1 unit of Lantus from a fresh pen. I am at home all day, so I can monitor him and take another reading at nadir. There is no HC food around, so I know at least that this reading is not related to that; his behaviour looks normal to me (playing, eating, and drinking back to normal), so I am not too worried. Setbacks happen.

Oh well, it was nice to give him a break from shots for a few weeks...

 

Thanks
I am in the GTA.

 

Tagging a couple of neighbours for you in case you need specific information in the 6ix.
@Colio
@Butters & Lyla

 

Welcome. Arancino is adorable! Glad to hear his behaviour seems to be back to normal.

I'm in the GTA as well. The lockdown has made it a little more challenging with vet visits. Butters' vet does curbside drop off only; I'm not allowed to come in with her. The vet calls me on the phone while he is examining her.

Happy to be of assistance if you need anything locally!

 

Thanks so much! I already have experience of visiting vets during lockdown: Arancino with his diabetes, Toki (civ) with acute pancreatitis, and Ponyo (civ) with a bite wound. August was not a fun month :-(
My vet calls me after the visit, which is a bit pointless, I think.

 

Sorry about your August. Not good.
Your vet doesn't call until after the visit? That one I haven't heard of before. Butters has seen three different vets since May, not including two hospital stays. One vet let me in with her, two vets and the two hospitals called during the examinations. You've probably already done this, but could you ask them to call you when Arancino is in the room with them.