13 Year Old Male Cat with Diabetes and Renal Failure

I have a male cat and for 1o years he was fine. Last year he was diagnosed with diabetes. We put him on Lantus insulin and fed him the Purina Pro Plan DM diet. That kicked into remission and we were continuing along great for about six months then I brought him in for his check up. The doctor as part of his regular check-up did a urine check and found out that he was in Stage 2 Renal failure due to the DM food that we were feeding him.

So we stopped the DM and tried to find a food that would support both conditions. They came up with Royal Canin Senior Consult. My cat will not touch it. Taking him off the DM threw him back into diabetes after a couple of weeks.

I did a curve which remained high. Now my glucometer is not reading properly. I bought a One Touch Verio and it was working fine now it keeps asking for the Control Solution. I've used that twice but it won't read properly. Yesterday I had him into the vet and they did a comparison between my meter and their "pet" glucometer. There's was about 4-5 points higher.

He won't eat, I haven't given him insulin today and I'm worried sick. The strips are probably older than six months so it might be the strips. I really don't know what to do. Yesterday my vet was not in and the vet I saw was useless when it came to diabetes. She said she was unfamiliar at what their breath should smell like if they go into ketosis. What kind of vet would say that? The vet assistant didn't even know how to get my meter to work. He brought it out into the waiting room. All you have to do is stick the strip in and it reads.

I am so worried. He won't eat, I can't get a good reading and my vet is AWOL and I'm waiting to see if they can come up with another food that he will like that will support both diseases. I'm wondering if it might be better to put my buddy down. Please help if you can!

 

I'm not familiar with the Verio meter. There should be an expiry date on the bottle of strips.
It's always good to have a back-up meter just for situations like this.

Can you ask your vet for the lab results? There are people here who are very good at interpreting the results.

I've never heard of the DM causing renal failure. (In all honesty, most prescription cat food is a waste of money.) The current thinking for kidney cats is to get them on a high protein diet. it doesn't have to be a prescription diet. Fancy Feast pates or Friskie pates will do just fine.
Both are low carb. You need to stay as low carb as possible for the diabetes. Depending on the phosphorus levels (that's why it is necessary to get a copy of the lab results), you may need to add a phosphorus binder to the food. The stuff from the vet is designed for dogs and has a sweetener. For diabetic cats, it is best to add aluminum hydroxide powder directly to the food. We can help you with that.

 

High protein is what causes the renal failure so I don't think a high protein diet is the way to go. Although I wish it was. If it keeps him non-diabetic and I could given him medicine for the renal failure that would be great. But my vet seems to know what he's doing.

 

A low protein diet for kidney cats is no longer the way to go.

You can find a well-researched article here: http://www.felinecrf.org/nutritional_requirements.htm#protein

 

I'm sorry to hear about your boy having kidney disease. Did your vet also do full bloodwork to diagnose the kidney disease? It cannot be diagnosed based on a urinalysis alone. Cats with CKD (Chronic Kidney Disease - its no longer called Chronic Renal Failure because they are not literally in kidney failure until a much later stage) need a good quality, normal to high protein diet but lower phosphorus (lower phosphorus is the key). It's tricky with Diabetes because you want high protein, low carb and most of those foods are higher in Phosphorus but you can still find something that will work for both. There's an amazing group on Facebook for CKD which can also help you out a lot called Feline Chronic Kidney Disease: https://www.facebook.com/groups/felinecrf/ Many members also have Diabetes. At this point feed your kitty what he will eat, even go back to the DM since he liked it so much, because it's more important that he actually eats than what he eats. The best diet in the world won't help if they don't eat it. Once he's eating again you can get him onto a lower phosphorus food that he will like.

 

Ahh bless you. I'm so sorry this happened. I have the same issue. I know it's worrying and I'm new to this too but I've been doing a lot of research so here's my plan of action.

I won't be changing Tempests (my kitty's) food. It's low carb and she eats it. It's more important the diabetes is controlled (unfortunately) and we do what we can about the ckd.

I'm currently feeding low carb sheba fine flakes in jelly, Whiskas +7 in jelly and felix as good as it looks in jelly. They aren't high protein but it's what she eats. Check out Dr Lisa's food chart she lists the carbs and phosphorus- it's the phosphorus that you need to keep as low as possible. I also don't feed lots of fish flavours - once a week as a treat.

She also gets plain chicken as a treat too.

I add extra water to the pouches and turn it into a jelly soup. This helps flush the kidneys. She pees more but that's ok. I also put extra bowls of water around to encourage her.

When her phos levels get too high we will begin a phos binder and when she needs it I will give subq fluids at home and anything else she needs.

It's more important kitty eats right now, so try some plain chicken maybe? No additives. Or some tuna in spring water (even the water bit) or some deli ham. Or offer some of the DM if that's what he will eat.

Tempest is maintaining her weight so far, so I'm not too concerned about muscle loss or weight which is why the high protein diets are recommended.

Hope that helps a bit. Sending prayers!

 

Thank you. Yes we've done blood and urine work. Thanks for your recommendations.

 

Yeah he likes any food I'm eating, chicken, fish, bacon. He loves people food. Just not his food. Thanks for your advice. I just got a treatment plan from my vet which is almost $1,000 after which I'm spent almost $500 in the last week weeks with a check-up and testing. I told them no. If I have to put him down, I guess I'll have to but I'm not going to financially bankrupt myself. I love him and it's breaking my heart but I can't drop $1,000. I just can't. I could put it on my CC but why when I don't know if they can stabilize him?

 

I'm sorry but how is what I suggested going to financially bankrupt you?

There's absolutely no reason why you cannot continue to feed your original food and use a phos binder IF and when the time comes that he needs it.

My kitty is at stage 2 ckd, she's fine in herself. I don't need to financially bank rupt myself to continue down the road I'm going. She happy, ckd isn't something that can be stabilised it's just something you deal with until kitty progresses to the end stage and you support them as you go along.

I don't know what 1000 treatment plan your vets gave you, but my vets allow me to make my decisions on how I treat my kitty. If I don't know something I ask or I research it, ckd is just one of those things that happens to some cats as they get older. To date I've spent £80 with vets on her CKD. The only one change I've made is adding water bowls and water to her food. That doesn't cost 1000s

 

I wasn't saying that what you suggested would bankrupt me. I was saying the treatment plan that the doctor suggested is going to bankrupt me. They haven't recommended a phos binder. They are wanting to check his blood pressure because they are talking about hypertension, they want do an in-house blood curve for the diabetes, an ultrasound, and a whole list of other things that will cost $1,000.

 

He's your cat, you get the final say.
Maybe he doesn't need a phos binder yet. Mine doesn't.
Bp can be an issue as a lot of ckd kitties can have heart issues.

Do your own curve at home? Likely if you change the food to low carb he may go back into remission. Worth a try?
I don't always take every test the vet wants - I take the necessary ones. If your vet has an issue with you championing your kitty then get a new vet. Youre the customer and you pay the bills.

 

I just did a curve this past weekend. It was mostly high. The information from this vet practice gets confusing. I had the vet (not mine), the vet tech and the receptionist all writing me today and the information gets confusing. I would just like to deal with one person. I just tested him with the new strips and changed the batteries. That seemed to fix the problem I was having with the glucometer. I got a reading of 23.9 which is probably accurate so I gave him one more unit of insulin for a total of 3. I figured one more unit wouldn't be bad.

 

I have never heard of that. Good kidneys can handle high protein and high phosphorous.
Degraded kidneys can remove enough phosphorous and high phosphorous levels make a cat feel bad and decreases appetite. Typically high protein foods also have high phosphorous levels.
I would use a phosphorous binder if you need to lower phosphorous levels. My civi Snowball is a aluminium hydroxide to lower phosphorous level.

 

I don't know what to say. This is what my vet is saying that the high protein DM made his kidneys start to fail and he diagnosed Stage 2 Renal Failure. He hasn't mentioned a phosphorus binder. He is a vet and I'm sure he must know what he's talking about. At least I hope he does.

 

I've had 2 CKD cats back-to-back. The first one was not a diabetic but had all sorts of other things going on. The goal was to manage the CKD the best we could. The second one was a diabetic. The goal was to find a balance and treat both. By choosing what to do and get at the vet and what I could do and buy elsewhere at a cheaper price, it did not break the bank.

Testing at home means you don't have to do curves at the vet. There are some things you need a vet for and some things you don't. You need a vet for the blood tests and the blood pressure tests, and for certain meds. You may not need blood pressure medication at this time, but you do need the vet for the test. A number of things that your cat might need can be bought cheaper than at the vet clinic. Working with a vet is a two way street. They have to work with you too.

Phosphorus binder if/when needed is inexpensive. A 200 gram jar will last a very, very long time. http://www.thrivingpets.com/index.php/aluminum-hydroxide.html But do not give until the phosphorus lab results reach a certain stage.

Lantus can be bought from Canada for roughly $150 for a 5 pack of pen vials. "Insulin from Canadian Pharmacies" post A 5 pack of pens should last you a year, depending on the dose. Also you can check out the Supply Closet on the forum. A number of people buy from Alan who is very reliable.

If you could obtain and post the lab results, we could give you a better idea of exactly where your cat stands before you commit big bucks for an ultrasound or smaller bucks for a phosphorus binder.

The more knowledge and support you have, the better the decisions that need to be made.

 

Thanks for your advice and compassion. I'm glad the phosphorus is inexpensive. I get my Lantus at the vet. He's only on 2 units twice a day so it lasts awhile. I will try to get the lab results.
Thank you.

 

All three of my cats had CKD and only Max was diabetic. Please get the labs and post them here. If you start a spreadsheet, which I strongly encourage you to do, there is a tab for labs. Depending on the labs there are lots of things you can do to make your cat feel better. Was a urinalysis done to rule out a UTI? Lantus is much cheaper from Canada. Did you buy a vial? It will last 5-6 months if stored in the fridge and treated carefully.

Another site I highly recommend to learn about kidney disease is:

http://www.felinecrf.org/

 

Hi, I live in Canada so I will always get the Lantus from Canada, so no issue there. Yes they did a full urinalysis. I've asked for the results and they should send them to me tomorrow. I will post them once I get them. Thanks for the website information.

 

Welcome from Ontario.

 

Lucky you! Lantus is so expensive in the U.S.

 

Here are Mr. Pink's labs.

 

It's interesting that the SDMA is so elevated yet creatinine not. I know the SDMA is supposed to detect kidney disease earlier though. Do you have the urinalysis results? What was the USG? If stage 2 which us what it sounds like, the current thinking is as mentioned that a low protein diet is not needed. Your cat has to eat enough or he can get fatty liver disease. How is his weight? A regular lower phosphorus canned food or raw would be the best. Have a look at the food lists and try some. Finding a good food that works for both conditions is hard. I know first hand. The potassium is low and the calcium a little high so I would recheck those in a month or two to see if it's a one time thing. Potassium is easy to supplement but too much can be a problem so you want to be sure.

 

I thought that was all the results. Sorry I have no idea what the USG is. This morning he seemed fine but he's not drinking or eating much. There was urine in the litter box though. My building is undergoing some construction on the balconies and it's very loud so he's probably all confused and scared. I have nowhere to put them. If he's not taking in fluids I may have to get the subcutaneous fluids done..

 

You did post it all I was told. I can't bring up the second page. USG is urine specific gravity. It seems the urinalysis is on page two. Any protein in the urine?

 

The USG is 1.024 is on the low side and does indicate some kidney degradation.
However, the phosphorous value does not indicate that.
The potassium being at the lower limit does indicate excessive urination which can be due to kidney degradation or diabetes.
The creatitine value is NOT indicative of kidney degradation.
The calcium value being borderline low could indicate other problems like cancer
A high protein diet tend to raise the BUN value.

My civi Snowball has kidney degradation as demonstrated by high phosphorous, high creatitine, high SDMA and USG of 1.022 ( it is now 1.018)

 

I agree with Larry. Not all cats have elevated phosphorus at early stages of kidney disease though. My last two didn't. The protein in tge urine could be a sign too but that could be gone on the next test.

 

The protein is Positive 1+ whatever that means.

 

http://www.pethealthnetwork.com/cat-health/cat-diseases-conditions-a-z/proteinuria-cats

 

I saw that. There's an add on test that shows if it means anything or not. I wouldn't run it with a +1 just once. Max had it but he would come and go and never was above +1. Just make a mental note to see if it's higher the next time you run a urinalysis. If higher it can mean there's proteinuria. Highly unlikely at this time.

Max also had a slightly elevated calcium at times but never had cancer.

 

Thank you.

 

Thank you.

 

Has anyone heard of a food called Holistic Select http://www.holisticselect.com/recipes.aspx?pet=cat. I've tried it before when I couldn't get to the vet. Mr. Pink really seems to like it. It's grain free and he has eaten some and even started drinking water again. His sugar was down to 10 this am.

 

Hi I'm very sorry to hear about your kitty's diagnose, CKD in older cats is unfortunately quite common, please forgive me if I'm repeating what others have said, I just caught your post, his condition is manageable and I've known of many kitties that have lived for many years with stages 1-3 and ended up dying of something else.

It's important that you keep his diabetes under control since high glucose levels will damage his kiddneys even more, that being said, keeping him with low carb food is important (none of the prescription kidney foods that I've heard of is low carb on the contrary) controlling the phosphorus intake is also important ( even though his phosphorus levels are not too bad yet) there are a number of comercial food that are low carb, low phosphorus this is the link to the low carb-low phos list, if they are available where you leave, this will help you handle both conditions

At this point restricting his protein intake is not longer the recommended way to go, you need better quality protein not less, resticting protein is used at very advance stages.

Giving him more water is also very important at this stage and if taken naturally is much better, so wet food is a must ( not only for his diabetes but to help his kidneys) and you could add water to all his food, usually subq's are not recommended unless his creatinine levels are consistently over 300-350 or for some other reason he is dehidrated

There's a site with tons of valuable information about CKD this is the link

Did they do a culture as part of the urianalisis,?

Was an ultrasound done to discard stones or other problems?

Turbid appearance,Blood and protein in the urine are signs of UTI (Urinary tract infection ) but the way to confirm it is with a culture, UTI would cause him to feel really bad and probably lose his appetite, if bacteria is present he would need antibiotics.

 

Hi, thank you for your reply. I'm hoping to get more information from my vet when he is back in on Monday. I want to have a talk with him. Because this new vet did not know my cat or his case. His glucose seems to be coming down as it was 10 this morning and I am feeding him this Holistic Select food which is grain free. http://www.holisticselect.com/recipes.aspx?pet=cat#anchor He really likes it. I've upped is insulin doseage on my own to one unit because the vet was not being responsive. Upping it to 3 has seemed to bring his sugar down a good bit. I hope I'm doing the right thing.

 

I may have missed it but what insulin is he on?

There are lots of very experienced people here that can help you manage his diabetes they just need a little bit more information.

Grain free does not automatically mean low carb

 

He's on Lantus.

 

Were you able to fix or get a new meter, are you home testing?

How long has he been on Lantus? You are injecting 1 unit every 12 hours?

We usually change doses in 0.25 increments,

I suggest you take some time to read the information on the Lantus forum (This is the link to the Lantus forum ) also we use an spreadsheet to keep the information and help everyone understand it this are the instructions (link to spreadsheet) it would help a lot if you could fill it in so that the very experienced people on the forum can help you

 

Were you able to fix or get a new meter, are you home testing?

How long has he been on Lantus? You are injecting 1 unit every 12 hours?


I suggest you take some time to read the information on the Lantus forum (This is the link to the Lantus forum ) also we use an spreadsheet to keep the information and help everyone understand it this are the instructions (link to spreadsheet) it would help a lot if you could fill it in so that the very experienced people on the forum can help you

 

Sorry missed the link to the spreadsheet here it is

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

 

You can go to Costco and get the pen cartridges without a prescription. Even cheaper than the vets. Or even check at any human pharmacy. My local one will not do it without a prescription but Costco doesn't have an issue.

 

I'm in Ontario and have bought a 5 pack of Lantus cartridges and recently a 5 pack of Levemir cartridges without a prescription at Shoppers Drug Mart. I collect Optimum points there and the insulin purchase gives you points. I use those points to buy test strips.

 

Well here in Alberta - we are no longer able to collect points or airmiles on our pharmacy purchases effective immediately.

 

Well that's a big drag! I'll enjoy it here as long as it's available.

 

I got new strips for my One Touch Verio and changed the batteries. I also calibrated the low/high levels to what the vet recommended. I think it's working fine although his sugar is all over the place.

 

That's great it will help you and your kitty that you can test him

I would be very good if we could see his numbers, that way some of the very experienced ones here can help you better, and it would be even easier for them if you could set up the spreasheet http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/