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Hi, and welcome to JustAnswer. I'm Dr. Barbara, and I hope to help you out today with your kitty.
First a glucose of 400 shows that your kitty is not controlled at all, and that she has a need to be on insulin. Indeed, most cats need to be on insulin to control diabetes, and they usually benefit from a special high protein, high fat diet.
The last blood work that was done didn't show she had an elevated glucose? Am I correct? Have they had her on insulin that you know of?
I realize that I haven't answered your specific questions, so while you're answering mine, I'll start addressing yours.
Actually, 200 is too high also, or let's say not ideal by any means. Do you feel you can't give her insulin?
It's not unusual for an older cat to be on IV fluids for 40 hours, but what is unusual is that she would continue to be dehydrated even tho' her blood work didn't show and elevated glucose, kidney disease or liver disease. I do find it hard to believe that her blood work didn't show any of these things.
Dehydration definitely shows up as a small heart of X-ray. A large liver is highly likely, not from dehydration directly, but from anorexia in a cat for 2 or more days. They develop a disease called hepatic libidosis and the main treatment for this is eating or force feeding if necessary.
Totally understand your reluctance to give her insulin. . .most people honestly feel that way at first. We could talk about that if you like, but your little girl has maybe more urgent problems right now.
Do you remember the values in her latest blood test for glucose, creatinine, BUN, phosphorous and liver enzymes? Do you know if a urinalysis was done? Did it show any ketones in her urine? Or was her blood ketone level measured?
At a level of 200+ for her glucose, this would exceed a healthy kidneys ability to reabsorb the glucose from her urine, causing her to make excessive urine and be rather chronically dehydrated....or sure could do this.
Just received your last post. Wonderful that she did not have ketones in her urine, which means she is not ketotic and does not therefore have what we call complicated diabetes. But still,*****too high and means that her kidneys can't reabsorb enough fluid to sustain her and her cells are not getting the glucose in them that they need to survive healthfully.
The length of time for IV fluid treatment depends upon a cats response to that plus other therapies. If she has remained dehydrated, then it is not too long for her. If her kidneys tested as normal in her blood work and look normal on her X-rays, and she doesn't show any fluid accumulation in her body cavities (chest and abdomen), then she is dehydrated because she is diabetic still as determined by her blood glucose.
I'll go up and continue to address your specific questions now while you write
Also, hepatic libidosis is likely here. How long since she has eaten?
Oh, I just read your third question. The only other thing to do for a diabetic cat is to change her to a special diabetes diet. . .which they usually love. This can work to put some cats in remission for awhile, but usually they become diabetic again, just not as seriously diabetic.
She really does need insulin.
Can't say that insulin will definitely help her, but with what you have shared so far, I think that it will. Insulin is really very easy to give, once you are instructed and have just a little experience. What has been your reluctance?
So, also, how long since your kitty has eaten, and do you know if she had a special thyroid test called a free T4?
I only brought that up, because she is of the age where hyperthyroidism is quite common, and her weight loss and frailty would at least be greatly conributed by this. In the usual blood test a total T4 is run, and this can be erroneously suppressed by other diseases. . .like diabetes. A free T4 would give an accurate measure of the T4 level even in the face of disease.
It really is quite good that she has eaten even a little for you at home and for the doctors and veterinary technicians at the hospital. She may not have hepatic lipidosis then, especially if her liver enzymes weren't elevated. Do you remember if they were?
Is she a calico kitty?
The easiest way I've found to give insulin is to put a cat in a top loading carrier or in a nest in a laundry basket. This keeps her from moving and exposes the back of neck and shoulder area.
Tabby. . .hmmmmm. Usually it's calicoes that are very independent and not lap kitties except on their limited terms. But of course, other colors can have these traits too.
Any elevation in liver enzymes means something is going on. Hyperthyroidism will cause liver enzyme elevation as well as hepatic lipidosis.
Yes, should be very easy to treat hyperthyroidism.
She of course would need blood tests to regulate her on insulin, but your vet would start her on a rather low dose and then test her about 5-7 days later. What I usually do is at first run one test at the suspected nadir (when blood glucose would be the lowest). This is usually at about 8 hours after the morning dose. If this level is still too high, I increase the dose slightly and run the same test one week later. Only when her glucose is at the correct level for the nadir, do I run a (preferably 24 hour) glucose curve, checking the blood every 4 hours. This allows me to know the amount of insulin my patient needs and how often. Almost always, twice daily is needed, but sometimes once daily suffices.
You could bring her back every 4 hours, but most cats don't like being forced into a carrier and going in the car. Also, the stress of these trips can cause a cat's blood glucose to be elevated.
I would have her come in one week later only for one test run at her probable nadir time (usually about 8 hours after her morning insulin). This will probably still be high, but lower than when you started. With this info, I'd formulate her new insulin dose, and then repeat one week later. If she still was too high, I'd repeat this process until her nadir was at a good level (around 80). Only then would I suggest a glucose curve.
12-14 is not really extremely old for a cat, but she definitely has one disease that could cause her frailty. . .diabetes. She may also now be hyperthyroid too. Also, because her kidney function is good, I do really think that insulin is going to make a big difference for her!
It is actually ideal to use a glucose meter at home. . .some people can do this and some can't.
As I mentioned before, stress really increases the blood glucose level in cats so it can make regulating them a little more difficult, but not impossible. This is why I do recommend that the glucose curve be done in hospital, and preferable a 24 hour hospital. Cats do settle into their cages very well. . .they adopt their space and relax there.
Home glucose checking can be done from ear veins which require very little to no restraint to use.
She wouldn't have to be tested twice daily at all. Usually, the glucose meter is for times when she isn't acting right and you want to know where her glucose level is right then. To test her you would clean her ear with alcohol and nick an ear vein with the very small needle to get just enough blood to measure her glucose.
Please excuse me for a few minutes. . .my dog seems to be in great need of a walk. Be back in a few minutes. . .hope you understand. :-).
You're welcome, and thanks so much for your service! Emma just needed to pee. . .but it was very urgent!
I have worked with myriads of people new to insulin, so please contact me again as you are initiating insulin treatment if you need.
Also, if you still have questions or concerns right now, don't hesitate to ask or state.
Happy New Year to you and your family!