6/23 Charlie AMPS 321, +2 305, +3 310, +6.5 358 Lab results | Feline Diabetes Management Board

6/23 Charlie AMPS 321, +2 305, +3 310, +6.5 358 Lab results

CharliesMom22

CharliesMom22

Active member
Yesterday

No yellows today but that's okay. We're increasing to 5.5 tomorrow (right?) so we'll see where that takes us. I will of course be bracing myself for another nasty bounce/NDW before the depot adjusts.

The emailed his lab results to me and let me tell you I was SHAKING opening the email. I could barely hold the phone.

His liver is back to normal!! Which means that we were RIGHT about his crazy high ALT number being from the pancreatitis. Here's what they said:

"Charlie’s liver values look much improved and are back in the normal range and his specfPL, while not completely normal, is much lower than it had been. This is consistent with his pancreatitis resolving.

He does have a mild elevation in his kidney values – his BUN and SDMA are elevated and his Creatinine is at the high end of the normal range. The BUN is higher than it had been a month ago, while the SDMA and Creatinine are slightly lower. His urine concentration was normal, but given his history of intermittent constipation which I suspect is secondary to low-grade dehydration, I would still strongly recommend an abdominal ultrasound with a specialist to look at his kidneys. If he has a primary issue with the kidneys, then that could affect his ability to absorb insulin effectively and may contribute to the difficulties getting him regulated.

His urine did not show any sign of infection and was negative for ketones, which is good. There was glucose present in the urine, which is to be expected."


Ultrasound is not an option right now. I've told them this several times. Curious what everyone's thoughts are on me handling this the same way I did the liver enzymes: give him some more time to recover, support him with supplements, and recheck labs in several weeks. I wonder if this elevation could be a result of the pancreatitis, just as the liver was. @Marje and Gracie I think I heard somewhere that you're good with labs? And @Wendy&Neko curious what you think about the kidney stuff. I added the labs to his spreadsheet.

I'm going to stop the milk thistle for now and add in kidney support--has anyone heard of Renal Essentials by VetriScience or RX Vitamins Renal Support?
 
That sounds like a relatively good report, Jess! I almost wish, though, that there were something decidedly specific pointing to the reason for his elevated numbers. I understand they are thinking there is a possible kidney issue, but that the ultrasound is necessary to know more. I just wish they had said "Charlie has some bad teeth," or a UTI, something relatively fixable like that. The low-grade dehydration is interesting. Is that also related to the kidneys? Or is this an issue of not taking in enough fluids?

I know you'll get some great feedback from Wendy and/or Marje. Looking forward to hearing what they have to say. Good luck with that increase (if it's suggested).
 
CharliesMom22 said:
Yesterday

No yellows today but that's okay. We're increasing to 5.5 tomorrow (right?) so we'll see where that takes us. I will of course be bracing myself for another nasty bounce/NDW before the depot adjusts.

The emailed his lab results to me and let me tell you I was SHAKING opening the email. I could barely hold the phone.

His liver is back to normal!! Which means that we were RIGHT about his crazy high ALT number being from the pancreatitis. Here's what they said:

"Charlie’s liver values look much improved and are back in the normal range and his specfPL, while not completely normal, is much lower than it had been. This is consistent with his pancreatitis resolving.

He does have a mild elevation in his kidney values – his BUN and SDMA are elevated and his Creatinine is at the high end of the normal range. The BUN is higher than it had been a month ago, while the SDMA and Creatinine are slightly lower. His urine concentration was normal, but given his history of intermittent constipation which I suspect is secondary to low-grade dehydration, I would still strongly recommend an abdominal ultrasound with a specialist to look at his kidneys. If he has a primary issue with the kidneys, then that could affect his ability to absorb insulin effectively and may contribute to the difficulties getting him regulated.

His urine did not show any sign of infection and was negative for ketones, which is good. There was glucose present in the urine, which is to be expected."


Ultrasound is not an option right now. I've told them this several times. Curious what everyone's thoughts are on me handling this the same way I did the liver enzymes: give him some more time to recover, support him with supplements, and recheck labs in several weeks. I wonder if this elevation could be a result of the pancreatitis, just as the liver was. @Marje and Gracie I think I heard somewhere that you're good with labs? And @Wendy&Neko curious what you think about the kidney stuff. I added the labs to his spreadsheet.

I'm going to stop the milk thistle for now and add in kidney support--has anyone heard of Renal Essentials by VetriScience or RX Vitamins Renal Support?
Click to expand...
Fantastic news about the liver!!! Did the vet define “primary issue with the kidneys”? I would ask “if” you did an U/S, what treatment would they do for anything they found? I will add we had a non-diabetic cat with Stage 3 CKD (creatinine 3.8) and when his creatinine would go up, we would suspect a kidney infection (UTI). For him, the only way to diagnose that was via U/S so perhaps that is what the vet is alluding to? It was not apparent in Gus’s urine....no bacteria, no blood or RBCs/WBCs. A kidney infection could affect insulin efficacy.

Typically at cat with more than Stage 1/early Stage 2 CKD will have a USG of less than 1.012. Charlie is still concentrating his urine pretty well. Do you have a history for his creatinine? Some cats that are larger or eat a higher protein diet, will have a higher creatinine. For instance, my boy, Tobey, has always had a creatinine around 1.9 which many would say was Stage 1 CKD but it wasn’t until his climbed to 2.8 that we actually are seeing more clinical changes now. If Charlie’s creatinine has always been 2.2/2.3, then I wouldn’t get too worried at this point.

I have heard of but haven’t used used those two supplements for CKD but my vet has Tobey on Herbsmith Kidney Care for Cats. It has Rehmannia in it which is excellent for the kidneys. I believe Tanya’s discusses the two renal support supplements you mention.

Yes...dose increase to 5.5u bid tomorrow. Good luck!
 
Mary & Jude said:
That sounds like a relatively good report, Jess! I almost wish, though, that there were something decidedly specific pointing to the reason for his elevated numbers. I understand they are thinking there is a possible kidney issue, but that the ultrasound is necessary to know more. I just wish they had said "Charlie has some bad teeth," or a UTI, something relatively fixable like that. The low-grade dehydration is interesting. Is that also related to the kidneys? Or is this an issue of not taking in enough fluids?

I know you'll get some great feedback from Wendy and/or Marje. Looking forward to hearing what they have to say. Good luck with that increase (if it's suggested).
Click to expand...
My theory is that the pancreatitis f’d him up really badly and caused severe inflammation in his liver (hence the extremely high but temporary ALT), which in turn caused his kidneys to work overtime. Plus him being in high numbers for so long has to be putting a strain on them.

I agree that the low-grade dehydration is interesting. I’m not sure where they’re getting that from. Every time I’ve brought him in there they’ve said he’s well hydrated. He gets extra water in his food and in between meals. His poops are always well formed and not too hard or soft, just infrequent. So maybe that’s where they’re getting it.
 
CharliesMom22 said:
My theory is that the pancreatitis f’d him up really badly and caused severe inflammation in his liver (hence the extremely high but temporary ALT), which in turn caused his kidneys to work overtime. Plus him being in high numbers for so long has to be putting a strain on them.

I agree that the low-grade dehydration is interesting. I’m not sure where they’re getting that from. Every time I’ve brought him in there they’ve said he’s well hydrated. He gets extra water in his food and in between meals. His poops are always well formed and not too hard or soft, just infrequent. So maybe that’s where they’re getting it.
Click to expand...
I'm glad Marje mentioned Tanya's. Are you familiar with their site, and just in case you aren't: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Tanya's Support Group. They offer excellent information about kidney issues, and they would be a great place to look for supplements. They also have a FB page.
 
Marje and Gracie said:
Fantastic news about the liver!!! Did the vet define “primary issue with the kidneys”? I would ask “if” you did an U/S, what treatment would they do for anything they found? I will add we had a non-diabetic cat with Stage 3 CKD (creatinine 3.8) and when his creatinine would go up, we would suspect a kidney infection (UTI). For him, the only way to diagnose that was via U/S so perhaps that is what the vet is alluding to? It was not apparent in Gus’s urine....no bacteria, no blood or RBCs/WBCs. A kidney infection could affect insulin efficacy.

Typically at cat with more than Stage 1/early Stage 2 CKD will have a USG of less than 1.012. Charlie is still concentrating his urine pretty well. Do you have a history for his creatinine? Some cats that are larger or eat a higher protein diet, will have a higher creatinine. For instance, my boy, Tobey, has always had a creatinine around 1.9 which many would say was Stage 1 CKD but it wasn’t until his climbed to 2.8 that we actually are seeing more clinical changes now. If Charlie’s creatinine has always been 2.2/2.3, then I wouldn’t get too worried at this point.

I have heard of but haven’t used used those two supplements for CKD but my vet has Tobey on Herbsmith Kidney Care for Cats. It has Rehmannia in it which is excellent for the kidneys. I believe Tanya’s discusses the two renal support supplements you mention.

Yes...dose increase to 5.5u bid tomorrow. Good luck!
Click to expand...
I know! I'm so relieved. I was really worried they were going to say his ALT was still through the roof.

Thanks for the tip about the creatinine! I just called his old vet and asked them to send over his bloodwork from 2023 to see if it has always been that level. It looks like it was 2.0 (with a range of 0.3 to 2.1) back in June 2023. I'll add all these values to his spreadsheet now. Also just want to note that he's been on a high protein diet his whole life.

The vet didn't define what the primary issue was. This is actually the first time they've explained anything to me about the bloodwork. Whenever I've asked questions I've been told they're just a general practice and to go see a specialist--which is how I suspect they'd answer the question you suggested about the U/S. I'm going to do some research to try and answer that question myself in the meantime. Thank you for suggesting that btw.

I'll look into the supplements and Tanya's website as well. Thank you for your insights!
 
Wendy&Neko said:
Another happy dance today - for those liver numbers! Being in high numbers and drinking/peeing more can make him dehydrated. Dehydration can raise kidney numbers. I like your idea of waiting and retesting.
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Yes true! I suppose I haven’t had time to properly celebrate my relief and happiness about those numbers yet. I think my initial reaction was “oh my god now they’re telling me to get an ultrasound for some other horrible thing.” It usually takes me a couple days to mentally process vet stuff.

And good point about the dehydration! I read that a high protein diet can also contribute to high BUN, and I did just change to an all chicken-breast diet. Plus I may have been overfeeding him a little because of the trace ketones scare 😬

You used to give Neko chicken thighs with the TCfeline you said, right? I might add some of those in with the breasts just to add a little fat and balance the protein. Might help with the constipation too 🤔
 
Neko got a mix of chicken thighs and breast, but with the premix I also did buffalo, turkey, and elk. Kangaroo and venison she also got, but I used a premanufactured one that had good phosphorus numbers.
 
Seth&Bell said:
That is very good news for the Lil' Chicken Man! How's he feeling?
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Hahaha indeed! He’s doing okay I think. His little Charlie behaviors are slowwwwly coming back online. He’s been hanging out a little bit more, doing tummy traps, and playing with his toys a little bit. The tummy traps get me every time haha. He’s still super tired though. Runs out of energy very easily.
 
They are simply too hard to resist... Even when you know the consequences. Bell has been sluggish as well lately. Most likely due to the heat here
 
CharliesMom22 said:
I know! I'm so relieved. I was really worried they were going to say his ALT was still through the roof.

Thanks for the tip about the creatinine! I just called his old vet and asked them to send over his bloodwork from 2023 to see if it has always been that level. It looks like it was 2.0 (with a range of 0.3 to 2.1) back in June 2023. I'll add all these values to his spreadsheet now. Also just want to note that he's been on a high protein diet his whole life.

The vet didn't define what the primary issue was. This is actually the first time they've explained anything to me about the bloodwork. Whenever I've asked questions I've been told they're just a general practice and to go see a specialist--which is how I suspect they'd answer the question you suggested about the U/S. I'm going to do some research to try and answer that question myself in the meantime. Thank you for suggesting that btw.

I'll look into the supplements and Tanya's website as well. Thank you for your insights!
Click to expand...
You’re welcome. Adding on to Wendy’s comments, if his BG is hog and he’s drinking more water and peeing more, it can affect his USG. To find out if he is able of fully concentrating his urine, you could catch his very first pee of the day and run it to the vet to just do a USG. They should have a refractometer and be able to run it in a few seconds. My charges $15 to do that.
 
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