18 Year old Poppy (renal/diabetes)

I've posted on the intro thread here:

http://www.felinediabetes.com/FDMB/threads/18yo-renal-cat-now-has-diabetes.215995/

I've tried lots of renal food with her and most of it she hasn't shown much interest in (which isn't unusual). I do have some mirtazapine, which I could give now and then if needed. I'd normally give some renal food with gravy from normal food on top. I'd then give her a small tube of gravy that had a phosphate binder in. In the last 2-3 months she simply start licking the renal food/normal food combo and refusing the phosphate-laced food.

About 5-6 months ago she weighed 4.2kg. Just under 3 months ago that dropped to 3.8kg and last week it was down to 3.45kg. So the aim now is simply to get her eating good amounts to stabilize the weight and maybe get it back up close to 3.8kg. If I manage that, I would move her onto the Royal Canin wet food I have (using an appetite stimulant from time to time, if needed). She did some interest in the diabetic food when I tried it a couple of days ago. The problem is, she has lost some teeth in her time and with her age she isn't able to chew so well. She much prefers really soft food that requires minimal chewing. The diabetic wet food is chunks, so I may have to mash that up a bit.

I'll get some strips for testing the ketones in her urine. I'm also going to get the proteins in her urine tested tomorrow or Tuesday to see if she has managed to maintain her kidney function throughout this current condition.

I'm in the UK and I'm fortunate enough to live on the same road as my vets (which is a 24hour emergency care hospital). Really lucky on that front.

Her morning numbers have tended to be between 15 and 25 and the evening numbers have been (3 times in a row) around 30-35. I've only tested in the afternoon once and that was yesterday. It was 5.2. I'm going to check her bloods again this afternoon and will post the results.

I bought a vitamin 5 complex that has additional B12. It is a liquid and does have some sorbitol as a sweetener. I asked my vets if it is ok to use and they were non-committal because of the sweetener. From what I've seen and read, sorbitol is ok and doesn't affect glucose (especially if in a meal). Poppy does have some diabetic neuropathy, so I would like to get her on the B12. I've never given her any vitamin B, but I probably should have done considering she also has the renal issues.

Generally, her appetite is good and she is keeping herself hydrated. The vets and the vet nurses did say that it would take a few weeks to really get on top of the glucose and get the diet/dose correct. They also said that the insulin injections would take some time to really have a consistent effect. Today is only day 7 of insulin and she's receiving the basic 1 unit at the moment.

I just read as well that, ideally I should wait 30min-60min after her insulin before giving her food.

EDIT: the afternoon glucose reading today was 13.6

 

Hi I'm sort of new myself but concerning the B12 from what I understand there should be no sugar in it at all . Here is what I use , it's a capsule and I sprinkle it on the food
Vitacost Vitamin B-12 Methylcobalamin -- 5000 mcg - 60 Capsules

• SKU #: 844197016143
• Shipping Weight: 0.08 lb
• Servings: 60

Most use what is called Zobaline , it's the same thing , but is expensive. The one I showed you is 17.00 and some change ,. Today is buy one get 1/2 off on the next one
Go to vitacost.com
Most of us feed our diabetic cats Fancy Feast Classic Chicken Pate, you can also add a little water to it to make it where you cat can lap it up.

 

Welcome to you and Poppy. I know other members are going to start chiming in with additional information and suggestions for you.
If you have the time, would you please create a signature so that Poppy's pertinent information is available whenever you post?
It's that grey text we have beneath our responses to you, and it will save re-reading through all the posts or asking you repeatedly for that information. Please indicate that you are in the UK so that we know there are going to be differences in supplies and food available.

Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished.

We also use a spreadsheet to record the insulin and testing data, so that you can see how the trends and patterns emerge, and members can review her progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

You can review information about Prozinc insulin HERE and recommended protocols for usage. I just scanned quickly regarding your question of waiting after injection to feed and found this: The proper sequence for dosing insulin is: Test/Feed/Shoot. So, I think it would be worth time spent reading the Beginner's Guide and the Protocol for Prozinc to help you become more informed about this insulin.

Diabetic neuropathy is treatable, and here is a link on that subject, as it's Methylcobalamin - aka - methyl B-12 that is the treatment for the condition. You will want to get the right B-12 to help Poppy recover.
http://www.felinediabetes.com/FDMB/...europathy-weak-back-legs.178252/#post-2172382

I am going to tag some of our UK members to help out with some input about low carb food that might be ok for Poppy's renal issues
@Diana&Tom @Elizabeth and Bertie

 

It is a tricky one. I could probably use something that is sprinkled on her food because she is eating quite well at the moment.

The sorbitol is a sweetener and not a sugar. Studies done on sorbitol have shown it to have a negligible effect on glucose consumed without food and not effect on glucose at all when consumed with food (this test was done with glucose used as a control).

That said, I will probably still look for something without a sweetener. I can use this complex I have myself given that I have to supplement my own diet with B12.

 

Hello Poppy's dad (sorry don't know your own name!) - welcome to FDMB. As you've seen, this is an amazing site to be a part of and you will get all the help and support you need.

I echo Lou's points above about creating a "signature" and a spreadsheet for bg data - we're very numbers-orientated here and it will help us to see at at a glance what Poppy's overall health situation is and how she responds to any particular dose of insulin.

Lou has given you some other links that you might like to check out, and meanwhile ref food available in the UK - I'll link the UK food list here for you although I'm not sure if it will tell you a lot about suitability for renal issues specifically. Elizabeth might know more about this - she's our UK food guru and has spent countless hours collecting and logging the data you'll find on the link:


https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

Do keep asking questions, there is always someone who's been through a sinilar experience and we can tag individuals who may be able to add more info. As far as availability of supplies is concerned, mention you're in the UK so you get the right replies (this is a US-based board and the vast majority of members are in the US. There are others all over the world, including a few of us in the UK so we usually know where to point you to get certain things).

Good luck! We're all rooting for you and Poppy!

 

Thanks. My name is Scott by the way.

I'll have a good look at the various food options. The Wainwrights she has been having lately looks to be pretty good for the nutrients she needs. I compared it to the Royal Canin DM wet food and it compared very favourably.

Most cats with diabetes will have glucose problems due to weight/diet issues I assume. In Poppy's case it is down to either her advanced age or possibly pancreatitis. The vets believed it was possibly pancreatitis, but they didn't do the PLI check to get a clear view. A lot of feline diabetes food is part of weight management food group. In Poppy's case, she actually does need to put some weight on. Hopefully she will do this with good management of the diabetes. But I'd like to get her weight up from 3.45kg to closer to 4kg before I focus hard on diet.

 

Per Mamakin's suggestion that you look into Fancy Feast classics, I'm sorry to report that the phosphorus content is too high for a kitty with renal issues. There is a website about feline nutrition by Dr. Lisa Pierson who has also compiled a food chart for US canned foods.
Dr Pierson recommends " start with protein minimum of 40, fat maximum of 50, carb max of 10, and for cats with kidney issues....phos less than 300." All of the FF classics have a phos count above the 300. www.catinfo.org

Another of our members located in the UK is feeding raw with a supplement named Felini. I did some further research just to see what the phos count would be and discovered this, Felini Renal, phosphorus free. Now I didn't know what a BARF diet was, and found that it stands for Biologically Appropriate Raw Food, and this may be something to investigate and explore with your vet.
https://www.zooplus.com/shop/cats/s..._rr&slot=2&exprienceid=7604&strategyid=101663

I made the decision to change Idjit's diet to a raw meat plus complete supplement with egg shell instead of bone to hopefully avoid renal issues in the future. He is a diet controlled diabetic, not currently on insulin so he has to be on the low carb diet for the rest of his life. For us, the raw was a win/win. He is doing very well, licks the plate and I find it doesn't take much preparation.

 

Thanks for letting him know about the FF being too much phosphorous, I have deleted my post

 

You didn't have to delete, all input is valuable. I wasn't really paying attention to that phos issue either, until Idjit went to vet for his dental and his labs came back with some elevated numbers. Those numbers could have been affected because of fasting but I wanted to be proactive. The amount of phos in the FF may not be a problem for kitties with no renal issues.
There are other processed wet foods that are much lower in phos here in the states, I just don't know what they have in the UK for Scott and Poppy.

 

Hi Scott (waving from Surrey!),

Just going through your posts here, and jotting down some thoughts, and some questions...

Which phos binder are you using? Some folks have most success (in terms of palatability) with aluminium hydroxide than with the brand name binders.

Yep, always a good idea to check a newly diagnosed kitty for ketones, especially if the kitty is unwell, off their food, or is known to have an infection. Anything above 'trace' is a reason to talk to the vet ASAP.
Be aware though that the test strips don't register all types of ketones, so if you notice that your kitty's breath smells fruity, like acetone, that may also indicate ketones.

Given those numbers, and the higher PM number in particular, it's 'possible' that Poppy's blood glucose is dropping too fast, or too far, and is triggering some 'bouncing' up in blood glucose levels (rebound).
It would be good to see some more mid-cycle data as well as pre-shot numbers.
Can I persuade you to set up one of our natty blood glucose spreadsheets to record your data on? Here is the link. If you need help do shout out. There are some smart techy people here who can help you. (Sadly, I am not one of them... )
FDMB SPREADSHEET INSTRUCTIONS

For neuropathy a specific form of B12 is needed, methylcobalamin (and not cyanocobalamin). Dr's Best do quite a good version of this. (More details in the 'UK info' link in my signature.)
However.... While B12 is normally a very safe vitamin to give to kitties (any excess being excreted in the urine) care should be taken with kitties who have mid - late stage kidney disease, as the kidneys may be less able to filter out stuff from the blood, including the vit B12. So, a reduced dose in this situation may be wise...

Quick note re sorbitol... While this seems to be often well tolerated in cats, it 'can' raise blood glucose in some. And it can cause digestive issues in some kitties.

Oh, how we wish it only took "a few weeks" to get diet and insulin dose correct... For sure, there are some kitties whose diabetes gets under control quite quickly. But for many cats it takes a lot longer. And insulin requirements can change a lot over time; cats may need more insulin, or less. It can be a constantly shifting picture. This is one of the many reasons why hometesting blood glucose is SO important. It enables us to respond quickly to those changes.

Just on getting "the diet/dose correct", while the balance of food and insulin is very important, it's also worth pointing out that diet itself plays a huge role in feline diabetes.
Some vets see diabetes management as 'just' balancing food intake and insulin requirements. So, a cat can be on a high carb diet (which will raise blood glucose levels) as long as enough insulin is given to balance that out. However, doing this keeps some cats on insulin when they don't need to be. Many vets still don't understand the extent to which diabetic remission is possible for cats. And cats on high carb diets almost never go into remission... With appropriate low carb diet many cats have the potential to go into remission...

It can take a little while, especially initially, to see the effect of an insulin dose. The response to the insulin can be a bit erratic at first. But if the blood glucose drops too low at any point then the dose should be reduced immediately.

With Caninsulin (which often starts acting soon after being injected) it can be a good idea to wait maybe 20 -30 minutes after feeding before giving the shot. That is not 'usually' an issue with Prozinc though; but if Prozinc has an early onset in your kitty then for sure, waiting a while between feeding and giving the shot may be helpful.

Generally speaking if you can get the blood glucose under good control (below the 'renal threshold') this will make less work for the kidneys to do. But dealing with kidney disease and diabetes can sometimes be something of a balancing act.

We all understand that it can feel a bit overwhelming at first when our kitty is diagnosed with diabetes. But you are already doing really, really well. And the fact that you've already learned to hometest blood glucose is brilliant!
Your kitty is very lucky to have you in her corner.

....Sorry about long post!

 

I noticed you were online and new and went and caught up on your two posts. I just wanted to say welcome even though no one really wants to have to be here! It sounds like you are already fairly primed to understand and start the work of getting her diabetes under control.

My cat, Alice, was severely underweight, and she has gained from a low of 1.83kg, to 3.04 today. A lot of that was because I got her on a good insulin, the right dose, and I fed her low carb wet food. Lots of it. Her underlying issues at least in part relate to her mammary tumor. She is almost 13 and has never been overweight. I just want you to know weight gain is possible, and low carb food is extremely important for that. A diabetic cat will feel like they are starving because they really are, on a cellular level. Until they have enough insulin to feed that glucose to the cells.....

You mentioned you have mirtazapine. Is there any sign that Poppy has also been nauseous? Like going up to food, licking mouth, then walking away? Giving an appy stimulant without nausea medicine may be uncomfortable for kitty.

This site is full of wonderful support and information. I wish you and Poppy well on your journey.

 

I've been using Ipakitine for a number of years now. I've tried 2 or 3 others and the Ipakitine is a really good option I think.

One of the vets I spoke to said that, ideally I would check the bloods every 4 hours whilst we get a good idea of the glucose levels throughout the day. I'm probably going to do this because on Saturday they went from 5.6 at 3.30pm to 35.4 at 10.30pm. That's an increase of 30 in the space of 7 hours. There's always been an increase from midcycle to end cycle and it has tended to be around 15 to 35, but Saturday it was 5.6 to 35.4. Mornings (only 3 tested so far) have been 15, 25 and 14 (today). I'm obviously new to this, but that Saturday increase from 5.2 to 35.4 looks like a bounce. I will get the speadsheet sorted asap.

As for the B12. It's always a balancing act when also dealing with renal problems. I have Poppy's proteins checked every month and they've been stable for a long time. I'm going to have them checked again in a day or two and see if they've increased after the diabetes diagnosis/treatment. Two days before she was admitted to hospital, the levels were consistent with all previous readings. They also checked her creatinine and that remained consistent during her hospital stay. At the moment, the Vit B complex she is getting is only 3 small drops, but I may hold off for a week or two until I get the insulin dose sorted out and have checked a few more B12 options.

I mainly saw 2 different vets during Poppy's time in the vet hospital. I usually see the same vet for her renal issues and he's a very experienced senior vet in the practice and he's a very positive vet as well. In my experience, most vets can be a touch pessimistic and a bit too quick to consider euthanasia. My vet hospital has a lot of vets coming and going and you can easily see a different vet everytime you go in. I had a cat with renal problems about 5 years ago and I think I saw 7 different vets in a row. After that, I specifically asked to see the same vet (the vet I was most happy with, who was this senior practice vet) and have done so since. Unfortunately, Poppy's illness happened when this vet was away on holiday. He returns today. All that said, sometimes the younger vets can be a bit more aware of newer treatments and trends. One of the vets I saw last week did talk about how the diet is just a big a part as the insulin and that if we get that right Poppy could very possibly go into remission. I mentioned whether the renal problem could make it more difficult for her to go into remission and he didn't think so. He said that the main factors in going into remission are getting the glucose under control (through diet/insulin) and also about about how soon this is done. Obviously if you get on top of it early, then it is more likely to be reversed.

 

Not really nauseous. She has vomited once or twice, but I'm not concerned about that. The day I took her into the vets and she went on IV's, she drank a lot of water and then vomited it all up. That was one of the main reasons I took her into the vets that day. Since then, there's only been two moments she has vomited. Generally, no issues with vomited or nausea.

I used the mirtazapine once last Thursday about 9pm. She was a bit restless that night (possibly because of the stimulant). I've not used it again since and haven't needed to because she is eating 200g-300g a day and her appetite is pretty good and consistent.

The mirtazapine she has is 2mg and I thought that if I switched her to a diabetic wet food and her appetite for is wasn't great, I would try the stimulant. But maybe I would use a lower dose than 2mg.

 

Statistically, cats have a much higher likelihood of remission if they are regulated within 6 months.

The vet you saw last week that spoke of regulation and diet was not wrong.

Here is an article I found recently discussing this:

“Treatment and monitoring
The aim of therapy in newly diagnosed diabetic cats is to maximize the chance of remission by strict glycemic control (72 to <180 mg/dL; 4 to <10 mmol/L), while avoiding hypoglycemia. Diabetic remission is defined as persistent euglycemia without the requirement for exogenous insulin or oral hypoglycemic therapy in cats previously requiring treatment to control diabetic signs.13,38,44 For long-term diabetic cats that do not achieve remission (≥6 months), the aim is to control clinical signs and avoid clinical hypoglycemia. Remission may occur in a small proportion even after 2 years of insulin treatment, if rigorous glycemic control is maintained.

In newly diabetic cats, early effective glycemic control can resolve glucotoxicity before there is permanent loss of sufficient β cells to maintain euglycemia, which increases the probability of remission. A protocol aimed at strict glycemic control within 6 months of diagnosis showed that 84% of cats achieved diabetic remission compared with 35% (p<0.001) when strict glycemic control was not instituted for ≥6 months after diagnosis.45

Besides early institution of tight glycemic control, factors associated with remission include a low-carbohydrate diet (12% versus 26% of energy from carbohydrate), long-acting insulin (glargine versus PZI or lente), higher age (suggesting possible slower disease progression), lower maximum dose of insulin (mean maximum dose of glargine of 0.4 U/kg versus 0.7 U/kg or <3 U/cat versus >3 U/cat), lower mean blood glucose after treatment with insulin, and lower cholesterol concentrations.13,44–47 Corticosteroid administration in the 6 months before diagnosis of diabetes is associated with significantly higher remission rates.45 Peripheral neuropathy at diagnosis is associated with decreased probability of remission. This is likely because diabetic neuropathy presents later in the course of disease, so these cats have been diabetic for longer period of time and have greater β-cell damage.45

To maximize the probability of remission, blood glucose concentration is the most useful guide for adjustment of insulin dose. Home blood glucose monitoring is recommended to avoid the effects of stress hyperglycemia, and it should be measured prior to insulin injection, to prevent inadvertent overdosing of insulin when blood glucose concentration is around the normal range. Ideally, normal or near-normal blood glucose concentrations (54–180 mg/dL; 3–10 mmol/L) will be achieved over each 24-hour period, and clinical signs will resolve. Clinical signs themselves are relatively insensitive indicators of glycemic control when glucose concentration is below the renal threshold (252–288 mg/dL; 14–16 mmol/L).”

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053045/

 

Hmmm, yes, that is a huge jump in numbers toward the end of the cycle. And it is possible that Poppy's blood glucose is actually dropping lower than the numbers that you've caught so far... (With Alphatrak you really don't want it dropping below about 4mmol, just to be on the safe side. Numbers below 3.6mmol can be considered hypoglycemic on the Alphatrak.)
It may well be that the numbers would even out if you reduced the dose (less/slower dropping in first half of cycle, less/slower rising in second half of cycle.) And it's likely that Poppy would feel better without that blood glucose roller-coaster going on too...

Eliz

 

This was of real interest to me. Poppy is showing signs of neuropathy and was only diagnosed in the last week. She has been having a urine check every month for over 2 years and the Vets always kept a check on the glucose too. One time (early this year or late last year) they said the glucose was a little high but not of huge concern. They would keep an eye on it in case it remained or even increased. The next urine sample showed that the glucose has reduced back to normal.

That said, Poppy did start to show weight loss 2-3 months ago and signs of neuropathy in the same sort of time frame. Given her age and renal issues, I put the weight loss down to the age/renal side of things and I knew nothing about diabetic neuropathy until this past week. But, I would be very, very surprised if Poppy was diabetic for more than 2-3 months. I'm not sure if a diabetic cat would have high levels of glucose in the urine or if would be possible for a diagnosis to go missed because the glucose wasn't high. Given her renal issues, I would assume that if she was diabetic, a urine check would show high enough glucose numbers to lead to a blood test for a definitive diagnosis?

 

It was 13.2 today today (mid-cycle) and I'm going to try and test it again before the nighttime test. It has been jumping up to 30-35 from late afternoon into night, so I will see how it is in the middle of that second 6 hour spell between mid-cycle and nighttime insulin.

EDIT: It was 21.4 at 6.30pm today (up from 13.2 at 3.45pm). An increase of 8.2 in 2 hours and 45 mins. I'll check it once more around 10pm. I fully expect it to be 30+.

I do wonder whether morning insulin is too high or whether it is needed at all. It is only 1 unit. I'm going to check 2-3 hours after the morning insulin tomorrow and see whether the numbers are dropping below 5 before rising again in time for the mid-cycle check and ending up 30+ by 10pm.

 

My sugar baby was diagnosed in February, at 11 years old. Four months before he was diagnosed, he had been sick and had blood work done. His blood glucose was elevated because of stress and they ran a fructosamine test, which was normal. In October they put him on a diuretic because he was holding some extra fluid and looked very blown up. They really couldn't figure out why. In January, only a month before he was diagnosed with diabetes, I stopped the water pill to see if he would blow back up again. He didn't, and in fact he continued losing weight. By February, he had very bad neuropathy and was walking like a bunny on his hocks. His back legs were so bad that his back was hunched over when he walked. He's a large cat, 18 lb when he's healthy. Well, sure enough, they diagnosed very high blood sugar through a fructosamine test in February. Which was odd, because in October it didn't present at all. My point of this post is to tell you this - Jack had extreme neuropathy when diagnosed early February, and by early June he was in remission. His neuropathy is nearly gone and he looks extremely healthy! Every cat is different, and you just don't know.

 

Wow, that's good news. To bounce back as well as that in only 4 months or so is impressive.

I'm wondering whether Poppy had reduced insulin production and was, as they sometimes call it, pre-diabetic. At the stage where a vet would say she needs to be monitored and maybe have a change of diet. At that point she had some sort of pancreas problem (suspected pancreatitis) and that reduced insulin production right down to the point that she presented as diabetic and required insulin injections. Right now, she may be regaining insulin production and the insulin injections are causing a problem (maybe because they are not needed or maybe only half a unit is needed).

Her three afternoon checks have been mid-cycle (5-6 hours after the morning insulin). I'm going to check tomorrow 2 hours after her morning injection and compare it with the morning glucose level. That should give some valuable information.

 

@Daddy Jack's Mommy is quite right that statistics alone just don’t say everything. I also think we are a little more dedicated over here than whomever that study sampled. Haha.

Is it definitely neuropathy? Wasting in the hind area can cause them to walk awkwardly. First I noticed Alice’s gait was off. Then later she started to walk with a wide stance, and stand lower on her back legs, but we all think this was due to the muscle weakness. She stands up pretty well now. I thought neuropathy at first but with vet discussion, came to the conclusion at least in Alice’s case, it was just because she was weak. That issue is improving, too.

I wanted you to have the article info to review but of course every cat is going to be a little different. That article is great though in that it encourages dietary changes and home-testing, something that seems to be pretty novel and strange to many vets!

 

Well, there is a definite possibility that it is weight loss/muscle loss that is causing the issue in the hind legs. For sure she has lost plenty of muscle in the back legs so it might not be neuropathy.

incidentally, Poppy's 10.10pm blood glucose reading was 22.2 (it was 21.4 at 6.30pm). That's her lowest reading at this time of the night. She's not been below 30 at this time until now.

 

All that being said, you know, I did get Alice a regular B12 shot at the vet a few months ago when she was not at all regulated (I knew less then about which kind for neuropathy), and it certainly perked her up a bit. Cats with diabetes may have some issues with absorbing their nutrients properly, so not a bad thing.... Of course I understand you are dealing with renal issues and that can make it more complicated in regards to what supplements, foods, and medicines you can give.
/
It’s backwarda to what I am used to, normally I think cats are likely to be lower at night versus day. I am glad it was lower for her last night.

 

She was up at 30 this morning, which is the highest morning reading for some time.

I will visit the vet today, give him the readings and see what he says.

Poppy also is tended to wet herself a lot also. I know most diabetic cats will tend not to use their trays. She is frequently having a pee where she is sleeping. I'm going to have to give her a bit of a wash today because I'm sure the smell of pee is possibly confusing her into going wherever she happens to be.

 

Oh, poor little Poppy... My cat Bertie also did this when he was newly diagnosed. He liked to sleep on my pillow at that time, so I woke up more than once to find my hair soaked in cat's pee...
....This kind of thing can happen when a cat is in high blood glucose levels. The kidneys are trying to filter that glucose out of the system, and as the glucose is passed through it takes a whole lot of water with it. The need to pee can become so great and so urgent that they can pee anywhere.
It can happen too that the nerve damage caused by chronic high blood glucose levels means the cat is less aware of its need to pee.

Cats in high blood glucose levels are also much more prone to urinary tract infections. And this can exacerbate the problem.

Getting the blood glucose under better control is key to resolving the issue.

Don't be surprised if your vet suggests that you increase the dose based just on the high numbers that you're seeing. This happens a lot (far too much, unfortunately)... But your test data so far shows that Poppy's blood glucose can drop a lot, and that the high numbers are only part of the picture...
Although there's not a lot of data, the tests so far do indicate (to my eyes at least) that there is a strong possibility of bouncing (rebound). And my feeling is that the dose may already be too high.... As I said before, you may well see the numbers even out a bit if you reduce the dose...

'If' the dose is too high, but is increased further, then that will just exacerbate the problem...

Scott, do consider putting your test data on one of our spreadsheets. It's a great way to keep track of the numbers and to spot patterns and trends; really helpful in working out what's going on.
FDMB SPREADSHEET INSTRUCTIONS

Eliz

 

I'll get the spreadsheet sorted asap (really busy at the moment).

She was up at 30 this morning. I gave her the insulin and decided the check again about 2 hours 30 min later so I can see the situation earlier than mid-cycle. The vet told me that prozinc tends to have an effect for between 4 and 6 hours, so I would have expected to see that number come down. Instead, it had risen slightly to 32, which is a concern.

I'm going to check again at mid-cycle and then speak to the vet. She's not comfortable, which is not surprising with those high numbers. She's drinking and not really eating. She also tried to vomit a little earlier.

 

Her mid-cycle check was 21.7.

She's drinking plenty but not really eating today.

I've just been to see the vet. He had a little concern about the 5.6 reading I had mid-cycle on Saturday. Without that he said he would increase to 1 and a half units. Because of that he wants to give it until Thursday and if there are no readings below 10 or 11, then I am to increase to 1 and a half units.

Around 5pm I moved her outside because the sun came out and it was quite pleasant outside. After that she looked a lot more comfortable and has been eating some food. I'll see how her glucose is in a couple of hours.

 

It was up at 36 last night. I'm about to do the morning check, but she will move up to 1 and a half units from today.

How long would a cat be on a slightly increased dose before another increase? I'll speak to the vet before any dose change of course, but if she has 3 more days with some high numbers and nothing lower than 11 or 12, would she then be ready to increase half a unit to 2 units?

 

I've just checked her mid-cycle (the first one since the move up to 1 and a half units). It was 3.7. This surprised me so I checked it again it was 3.3.

She's spent the day lying in the garden (mostly in the shade) and it has been a very warm day. She hasn't eaten anything either (but she has just now eaten something).

 

I've finally got the spreadsheet up and running.

Poppy has had a bit of a rough day today and is quite weak at the moment. She started on 1.5 units (up from 1 unit) this morning after being 36.9 last night. She started the day on 17.4 and then had 1.5 units. She spent the day in garden (mostly in the shade on a warm/hot day and with a bowl of water next to her which she frequently drunk from). She didn't eat anything all day (which isn't unusual for her during a warm day). I checked her bloods 7 hours after her insulin and was shocked to see them at 3.7. I checked them again and they were 3.3. She was weak, dragging her feet and confused. After speaking with the vet, I rubbed some honey on her gums and re-checked her an hour later and the numbers had recovered to 7.2.

It was a bit scary and very disconcerting. I don't know whether sitting out in the very warm weather (although mostly in the shade) is good for her, even if she does want to be outside. The vet said I should reduce the dose to 1.25 and see how she does on that. Currently she still hasn't really eaten, isn't drinking and is still very weak. She vomited 15mins ago and couldn't really stand up and support her own weight. I wonder whether that drop in her numbers hasn't taken its toll on her and she recovering from it.

I have a spare bedroom where she sleeps at night. She has a heat pad there, a litter tray 2 feet away from her and food and water right next to her. She's very comfortable in there and I wonder whether I should just keep her in there during the day when it is very warm? She is due her evening check and then her evening shot. If the numbers haven't risen much from the last check of 7.2, I'm scared about giving her 1.25 units in case her numbers drop again over night.

 

Hi there, just reading your post...

Please start a new thread with a "?" Tag regarding dose tonight before giving insulin... Symptomatic hypos are serious, her dose possibly should not have been increased at all (she may have been bouncing, thus the high numbers) .

Just because the"typical" nadir for an insulin is at certain hours, doesn't mean all cats will nadir there, and if you're not testing earlier, you may we'll miss her nadir and just catch higher numbers...My Willow is on Lantus which has a "typical" mid-cyclle nadir, but her lowest Nadirs have been as early as +1.5 and +2. Also, cats Nadirs change... Willow also has later nadirs occasionally. Spot checking is important.

Also, cats who hypo may be more sensitive to insulin for the next few cycles, so please watch closely...And do get advice on dose before giving, please!

Lastly, I don't know if you've seen these but please print off these links to how to respond to low numbers, and hypo toolkit...You really need to test frequently during a hypo as karo/honey can wear off quickly, and she needs to eat high carb food to get hold her sugar up longer.

With love, Nikki

 

Also, you can use a "911" tag during hypo or other emergency situation to get more attention, more quickly, when you need help fast. From the "basics" sticky:

911 Posts
Periodically you may need help ASAP! We call those 911's. When you are posting, simply click to add the "911" prefix to your post to get extra attention. The prefix is found on the bar where you type in the title. Please, this is for 911 situations ONLY. Do not tag questions as 911 that are not.

If our have already shot her insulin, please post that you'd like guidance, and test at least hourly in the beginning. Also, ensure that she is eating.

I'm not experienced at all with prozinc, and am too new to offer dosing advise but please keep us updated with Poppy's numbers!

With love, Nikki

 

Her numbers about 5-6 hours after the 3.3 reading were 11.2. She hasn't been eating at all really. She ate a little just after the 3.3 reading but nothing since. I don't want to give her the mirtazpine that I have because it makes her a bit agitated and twitchy. The plan is to give her some mirtazipine in the morning if she isn't eating still at that point.

I spoke to the vet before her evening dose. He said that unless she has eaten something, to hold off on the insulin until the morning. I have opted to not give her insulin because I can't keep as good an eye on her during the night as I can in the day. At the moment alert and showing no signs of the hypo.

The issue with the dose and getting the balance right is proving much more of a headache than I'd imagined. I didn't never thought that an increase from 1 unit to 1.5 units could impact like this. The fact that her numbers were up to 36 just 24 hours ago is a concern. I'd have hoped than one unit every 12 hours would prevent such high numbers.

The issue of a bounce was a concern. I did check her 3 hours after her morning shot to get an idea of how she was inbetween that morning shot and the mid-cycle check in case she was dropping and then bouncing back up. But that 3 hour check showed similar numbers to the morning check (30.7 to 32.3, a slight increase after 3 hours) and four hours later (7 hours after the morning shot) it was down to 21.7.

I also checked her numbers inbetween the mid-cycle check and the evening check/shot. That showed an increase from the mid-cycle number of 13.7 to 21.4. By the time of the evening check/shot, that 21.4 and had become 22.2. Of course, I've only checked 2-3 hours after the morning shot once and I've only checked inbetween the mid-cycle check and the evening check/shot once as well. But I've not picked up a sudden drop and bounce on those days. But something is going on.

Perhaps she needs to be on 1 unit for longer than 5-6 days to see if it starts bringing down those higher numbers? Maybe an increase from 1 unit to 1.25 would be better than increasing from 1 unit to 1.5 units? Depending on her numbers in the morning, I'm thinking about going back to 1 unit from 1.5 units rather than 1.25. But I do need to get her eating again because she has lost too much weight and has quite a bit of weakness in her hind legs now. She needs more energy/strength. If she isn't eating by morning, I'll have to start with the appetite stimulant.

 

Hi,

From what I understand it can take 3 cycles, maybe more, for some cats to "break" a bounce.... I wouldn't know personally because Willow has always been incredibly stable (anti-jinx) lol. So definitely need to spot check more than once.

I'm going to tag @Bobbie And Bubba , @Wendy&Neko and @Bron and Sheba because they're far, far more experienced with FD than me, perhaps they have experience with prozinc or can tag others who might, or can offer dosing advise for tomorrow morning

Insulin is a hormone, and cats react differently. Willow can respond to as little as a 0.1U increase, I've used that to nudge her numbers. We don't recommend increasing by higher than 0.25 U unless your cat is at quite a high dose.

She definitely earned a reduction of 0.25u with that hypo today, but like I said, you may want to go back to 1u, or possibly less if people think that that might have been too high a dose.

Many members on this board have lived FD day in and out for years....Not only their own cats, but by helping with countless other cats. Literally hundreds of cats have been helped into remission by this board; and so, so many more that may not have achieved remission, but regulation like my Willow. Please ask questions and take advantage of this amazing resource.

With love, Nikki

 

Hi again! Looked at your SS (thanks for putting it up) but I think you may be entering your numbers in the US tab, because they're showing up lime green... If you enter them in the world SS tab, they will automatically convert on the US tab. The SS color codes the numbers, so it's quite easy to spot trends and patterns with how your cat responds to insulin.
With love, Nikki

 

Sorry, no experience with Prozinc. We do have a separate forum for Prozinc users, and it might help to get experienced eyes on your dose if you post there.

 

Hi Scott, I am going to tag @Djamila as she is familiar with Prozinc.
With a drop to 3.3 on the Alphatrak you need to reduce the dose of the insulin. Do not give 1.5 units again....it is too much.
A bounce can last for up to 6 cycles so don't worry if Poppy stays high for a couple of days. Don't be tempted to give the 1.5 units. Bouncing is completely normal so don't worry about it. She will bounce from the 3.3 which sounded like she was a bit symptomatic with a hypo. Make sure you have some high carb food and honey available for low numbers.
What stage of kidney disease is she in? If she isn't in the late stages, she would benefit from some higher protein food to build up her muscles. Have you thought of feeding a raw or home cooked diet?
Adding cooked egg white will add protein without adding any phosphorus..

 

She's stage 3 kidney disease but has been for quite some time I think. I have the proteins checked in her urine every month and they've been consistent since her last blood test.

I think the crash down to 3.3 yesterday was a combination of her having an increased dose to 1.5 and not eating enough food. For most diabetic cats, I would imagine there is no issue with appetite, but there is with Poppy. In most cases, you are looking to fit the cat into a routine. I think with Poppy, I'm going to have to fit into her routine - for the time being at least.

The problem is, she weighed 4.2kg at the start of the year. That dropped to 3.8kg about 3 months ago and over the last 3 months this has dropped to 3.45kg. Most of that weight loss is muscle mass loss. She's had a couple of dentals in her time and has lost a good proportion of her teeth. This, combined with muscle loss/the ageing process, makes it difficult and tiring to chew. I moved her to a food that is very mushy (almost like baby food) and she was eating good amounts of that. But that was about a week or so before she started to struggle and had to go to the vets for fluids and then had the diabetic diagnosis. So it didn't really have time to stop the weight loss and start to reverse it. I've tried her on a more complete food in the last week which is shredded with lots of small bits in it, but she still struggles to chew that. I'm going to go back to the mushy food (it is a specialist senior food after all and is pretty good for nutrients).

With the weight loss, her stomach will have shrunken and her appetite with it. Add to that the difficultly chewing and she now has unusual eating patterns. This makes it difficult to dose the insulin. After all, how do you give a regular dose of insulin with irregular food intake?

My plan of action is the following:

1. Start her on mirtazapine (she's had a 2mg dose today) with a 2mg tablet every other day. Closely monitor how much she eats and dose the insulin according to how well she is eating.

2. Go back to senior food that takes no chewing and see if she can eat a good amount of that (if she does, it makes regulating the insulin much less awkward).

3. Hopefully the use of the appetite stimulant and more suitable food will lead to her putting on a little weight (hopefully muscle mass), increase her stomach size and get her back to a natural appetite that no longer requires mirtazapine.

I'll see how I do with that. I've yet to check her bloods this morning, but will do shortly. She's started drinking again and after the mirtazapine she has eaten a little (not much but I'm hopeful she will get through the 40g of food I gave her). I'll get to the shops later today and pick up some more of the senior food she was eating before she had to go into hospital.

Does anyone have any experience with using mirtazapine for a longer period of time than a few days? Of the stimulants out there, this is one of the better ones for a cat with renal issues, but I wonder whether it is something I could use for a few weeks whilst trying to recover a healthy appetite?

 

Hmm, I'm not sure what has happened. I clicked on the link for outside the US. Looking at it, maybe I clicked on the link for human meters outside the US rather than Alphatrak monitors outside the US?

 

What is the senior food you mention. Is it high in carbs?
I have a kitty with very few teeth and she eats a raw diet of chopped up (small) meat no problem.
Would she eat chicken mince cooked lightly to supplement her diet?
Lots of FD kitties have poor appetites. Change your subject line to ask about appetite and mirtazapine

 

It is Applaws Senior Cat Food. The protein is 11%.

I used to give her cooked chicken and I'd cut it up into the smallest pieces I could. Even doing that I would notice her twisting her head to the side to chew, making squelching noises as the food was, presumably, chewed between two parts of the gum with no teeth.

I've considered blending meats down or maybe I could, as you suggest, use some mince and add some of that to the senior cat food. I've never tried chicken mince. That could be an idea because she could swallow that whole, with no need for chewing.

 

11% protein is very low. Did you mean carbs? I am concerned about such low carbs. That would be why she is losing muscle mass.
Cats do turn their heads to the side to chew. And it’s fine if she chews with her gums. It’s good mentally for them
Just make sure the chicken has no additives added.
As I said above I have a cat with no back teeth and she still chews her food with her gums.

 

No, that is the protein (11%). My feeling is that if she eats it, then that's a plus. She's has a mirtazapine 2 hours ago and still isn't really eating.

 

You're not wrong. Her reading today was HI (so over 41)!!

Obviously she had no insulin last night because she was only just over 11 last night and not eating (vet's advice was to miss a dose). I'm now going to go back the 1 unit she was on previously rather than the 1.25 the said I could try. I'll test her again in a couple of hours.

 

I think that protein is too low. Do you know what the carb is? I would definitely give some extra protein . What do you think about cooked egg white? Would she eat that mixed in?

 

Hi, 11% protein is extremely low, and probably contributing to muscle wastage. There are other foods available suitable for diabetic CRF cats. I believe you have been given the link for the cat food chart but here is the sortable chart so you can search by numbers.

Please see the site https://www.felinecrf.org for loads of info on kidney disease.

Also, Willow can only eat foods that we have blended with water (we even blend pates), we use an immersion blender. She cannot eat shredded/flaked/chunked without blending.

Please ask your vet about nausea meds; here we frequently use cerenia and/or ondansetron. Your cat does *not* have to be visibly nauseas (vomiting, licking, etc) to be nauseas; they hide it too well. Often the only symptom is seeming disinterested in food, walking or turning away. An antinausea med can make the world of difference.

Appetite stimulants such as mirtz should not be given without having an antinausea med on board, as it is very stressful for the nauseated cat to feel it *must* eat, and in fact doesn't have a choice, while nauseated, and can (often does) create food aversions.

With love, nikki

 

I'll speak to the vet today about nausea meds. That could be a help.

I'm finding it tough, I must say. All the while I am thinking "she is 18 and she is struggling. Am I putting her through discomfort with no likely chance of getting through this?".

I put her in the spare bedroom with food and water. She decided that she wanted to be outside in the sun and so climbed off the bed, down the stairs and out into the garden. She is weak and unsteady on her feet, but she's strong enough to decide that she wants to go outside and strong enough to do it.

She has been drinking and she's picked a little at food. A higher percentage of protein in her food would be good and a high fat content is not a concern in her case. The phos levels are a little of a concern. But, to be honest not a major concern right. I used to give her a phos binder in a gravy treat, but she's not even eating those treats at the moment. To just get her eating a reasonable amount would be enough for me right now.

Her kidney condition is reasonably under control and she's not in any danger of kidney failure. It's just a question of her appetite and trying to control the blood glucose. If I can't get her eating, then she will continue to go down hill and I'll have a much tougher time trying to control the glucose levels. I suspect she needs a higher dose than 1 unit (mainly because she was still getting high numbers with 1 unit), but as I found out yesterday, if she has more than 1 unit and then doesn't eat there will be a possible crash in her glucose levels.

 

Do you have the Weruva brand where you live? They have low phosphorus low carb canned food. Check their website. I think raising the protein level will help and getting some antinausea meds as well.
She may not need higher doses of insulin. The high numbers could be bouncing numbers.

 

I think there's every chance that the high numbers are bouncing numbers. Purely because she has had a urine test every month for the last 2 years and diabetes has never flagged up before. The senior vet I often see mentioned one time that the glucose was a little high and we should keep an eye on it, but if she was diabetic I would assume that the glucose in the urine would be high enough to concern an experienced vet (or any vet for that matter) to go for some blood work. He didn't and the next urine test showed the glucose had reduced to normal. Since then, there has been no concern about glucose in the urine. The last urine sample I gave them showed higher than normal glucose but again, nothing too alarming. They did the fructose test and said the numbers were elevated in the 3-4 weeks prior. But everything was suggesting that issues with glucose have only been very, very recent.

Of course, something could have happened to reduce the pancreas function significantly. But chances are that this is a case of gradual wear and tear in an older cat.

I did do a couple of days where I checked to see if there were big drops and subsequent bounces but found nothing. I know that whilst she was in the hospital she had a moment where she dropped to 4 and had risen up to 40 once or twice. I don't know, but maybe if I can get her eating regularly again it could be an idea to reduce the dose from 1 unit to 0.75?

There is no Weruva in the UK. Somebody mentioned HiLife as an alternative. This is a brand I know and have used in the past.

 

Hi Scott,

I'm glad you're going to speak to your vet about the antinausea meds; they are really worth a try. Following that, I'm not sure if you've seen the page on tricks to stimulate appetite, but here's a link. Also, crumbling freeze-dried meat snacks over food often helps (can't remember if that's mentioned there).

Regarding increasing the dose, I'm not sure if anyone's ever explained what bouncing is? Heres my bad explanation

Essentially, since the cat has not been getting the insulin it needs, over time its body adjusts to the higher glucose levels and recognizes them as the "new normal". Then all of a sudden, we introduce insulin. Insulin drops the numbers. It may drop them too fast or too low, or sometimes just *any* drop below what the body *thinks* is now normal, it doesn't have to be a big or significant drop.

Anyway, the body panics and dumps stored glucose into the bloodstream because it thinks it's in danger of going too low..... So all of a sudden you have high numbers on your blood tests. Bouncing can take 3 days to clear, but then they can also bounce again (because the body still thinks it's in danger and dumps more glucose)...So whenever you test, you get high numbers. Which often leads to increasing the dose, because it *looks* like the dose is too low, but that leads to too much insulin and a vicious cycle.

However, if you wait out the bounce holding the same dose, the numbers will come down as the body adjusts to the lower numbers, resulting in a need for *less* insulin.

From the sticky:

"Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

Anyway, hope this helps, and hope Poppy feels better soon
With love, nikki

 

I spoke to the senior vet who has been treating Poppy for the renal issues over the last few years. He went over her urine tests from the turn of the year. They were all negligible for glucose, even up to the 15th May. By the time of the next urine sample (2 days before I took her into the vets - which then saw her spend 5 days in the hospital on IV fluids) they glucose in the urine and increased significantly. It looks like the issue with glucose only started sometime after the 15th May.

Anyway, he has given me an injection to give to Poppy (I think it is cerenia). I'll see how she after this. He said that medically there is nothing more than can be done if this doesn't work other than more fluids. It's simply a case of hoping the cerenia works and getting her eating again. As he said, we're stuck in a rut at the moment because she has to start eating before any treatment of the diabetes can take effect.

What I will say is, when I try to give her food she licks her lips and turns away like she is trying to get a taste out of her mouth. When I walk it with a plate, she lifts her head up (as she often does, looking for food). But then you try to give her food and she turns away as if nauseous.

By the way, how long would it normally take for the cerenia to take effect? I've just given her the injection. The vet said it would sting her a bit and she certainly was aware of this injection unlike the insulin.

For the record, he numbers were 28 at the mid-cycle point today after a reading of HI (41.7+) this morning.

 

Wonderful that you've gotten the cerenia! It can sting a bit; keeping it refrigerated may help, if you have to use it again.We usually give these meds 30-60 minutes before a meal to give it a chance to kick in.The licking and turning away are typical signs of nausea, so hopefully it will work. Cerenia can be given once daily.

There is also another anti nausea med available and commonly used across the board, Ondansetron; it is given twice daily (I *think* possibly up to 3 times as a maximum dose, but I'm no sure on that) It works along different neural pathways than cerenia: while cerenia is often used to treat vomiting, ondansetron is often used to treat nausea that doesn't cause vomiting. That being said, Willow has never vomited but Cerenia generally helps with her nausea.

And some people find that the two work best together for their cat. So it really is individual to the cat and whatever is going on. Hopefully the cerenia will help Poppy...Fingers crossed for you and her! If not, you can try Ondansetron (hopefully it's available near you)

Side note... Some vets may not be aware that ondansetron can be given to cats, as it's a human med; if yours isn't, ask him/her to look it up in Merck.

Lastly, not sure if anyone's mentioned cyproheptadine... It's another appetite stimulant, if your cat doesn't do well with mirtz.

Thinking of you both with love, please keep us updated! Nikki

 

I gave her the cerenia. She hasn't eaten anything yet, but has been sleeping for last hour or two.

I read that nausea can happen with both renal problems and diabetes and that other appetite problems it can also cause some restlessness, which Poppy has been showing at times.

I'll leave her to sleep and relax and see if she will eat later. If there is no change in appetite, I will speak to the vet about cyproheptadine and ondanestron.

Looking at Willow's spreadsheet, I am impressed by your dedication. 7 to 8 checks of BG a day and 14 different feeds across 24 hours. It really is round the clock care. I'm not sure if I could match that.

 

This is my response from on the other post!

All I really want to say is, increasing the mirtz wouldn’t help if she is nauseous, but Cerenia or ondansetron (Zofran) would be a good help for that.

I personally as a human have taken mirtazapine for sleep actually, but the next 48 hours I am SO hungry, and I don’t even realize sometimes it is from the mirtazapine!!!

Has anyone talked to you about syringe-feeding? Forgive me, I can’t temembwr right now or re-read all the thread. It’s not something which I have a lot of experience with, but perhaps if she is having trouble eating this could be what helps turn things around? Someone else could weigh in on that.

 

I have been told that the appetite stimulant effect of mirtazapine does last for up to 48 hours, so it is possible that I will see more appetite tomorrow.

I haven't tried syringe-feeding. It is something I may look into. But I would only do it if she was reasonably tolerant of it.

I've just given her some food now and she had a little eat. It was shredded chicken in sauce and she was interested in it but when she got to the chicken, she tried to chew it and had some difficulty and started to lose interest. I think the best option is to try the same approach that nikki does with Willow and blend the foods down to something that she can lick and forget all about chewing.

 

Hi, it's a team effort between me and my husband, thanks! There's really no need to worry and about matching lol. Willow is on Lantus and we follow the Tight Regulation protocol, which runs cats at lower numbers so requires more testing, but not necessarily as much as we do. It works for us. Many follow the Start Low, Go Slow guidelines which is what I believe Prozinc users follow. It keeps cats at higher numbers generally, so there is less risk of hypoglycemia (although there is always a risk) and therefore requires less testing (preshots plus hopefully two mid-cycle tests, I believe) and home Blood Glucose curves once a week (which would be I think 6-8 tests on that day).

As for the food, we (and many!) make use of an automated pet feeder such as this one, which we set to feed at certain hours so we don't have to also helps with sleep lol.

Please don't feel overwhelmed! It is possible to keep Poppy safe and you sane. We've all got some tips and tricks to share, just ask!
You're doing great, Poppy is so lucky to have you

With love, nikki

 

It is quite stressful at the moment, no doubt. I almost feel like taking Poppy to the vets and leaving her with them for a day so that I can get a good night's sleep and a little break from it all.

I don't mind the testing but I do feel bad disrupting Poppy if she is resting/sleeping. At the moment I am mostly just doing 3 tests a day (morning, mid-cycle and evening). I may try to move to 4 tests (morning, +3, +6 and evening).

I'm going to start blending her foods tomorrow because I suspect she will eat much more if it is more like a liquid/sauce. Just like Willow, she simply struggles with most solids now. I remember 2 or 3 years ago she would often just eat chunks whole or if I gave her some of those biscuit/pocket treats, she would eat them whole too. I knew that because on the rare occasion she vomited it back up and it was whole and unchewed. Even back then she was struggling to chew. I think that lack of teeth and increased fatigue (through age and this current illness) is possibly presenting as a lack of appetite. It could be a lack of appetite but I am more and more certain now that she has moved beyond chewing most foods.

Of course, the other issue is that because she has obviously had a a decreased appetite for some time she will have adapted to that. Her stomach will have shrunken in conjunction with that and so it is a case of trying to build her appetite up bit by bit.

How much water would you add to one pack/pate?

 

It's great that she's eating some I can't remember if I mentioned, but add water when you puree the food (many/ possibly most of us just add water to all meals anyway, as it's a great way to ensure they're getting plenty of water). Willow's ends up a slurry consistency, and works very well for her. She just can't do shreds either.

Syringe feeding does usually take some practice but is very doable, much is the cat realizing that it's not all bad, and the owner learning not be too stressed (as cats do pick up on that); both learn the routine and it just happens. There are videos, etc if it comes to that, but let's hope the anti nausea meds and Appy stimulants do the trick.

There's a labs tab on your SS if you'd like to enter Poppy's lab results...There are some people quite experienced with reading them, and they sometimes pick up on something our vets might miss, not being nearly as familiar with FD cats as are many here.

Thanks for the update! You can count on the fact that there are many people reading your thread, and are ready to pop in if needed or asked

Also, maybe start a new thread tomorrow, as this one is getting a bit long, probably because of me lol.

With love, nikki

 

Ref the reluctance to eat - your description reminds me of a situation @Elizabeth and Bertie experienced with her kitty Sophie... I think she found a particular food in the end that was quite acceptable, and also fed raw turkey mince which kitty managed. Eliz, have I remembered right and if so can you expand please??

 

You have to do what you need to, because you have to be healthy to care for her. Be sure to take some time for yourself, and by that I don't mean time on the computer reading more on FD!

Waking Willow was hard for us as well (guilt!) I've taken to giving her test strip container a good shake and clicking the lid hard, which usually wakes her, and when she sees I have her monitor she perks up because she knows it means a treat (even when inappetent, she generally loves her treats). So it's a routine we all learn.

Willow used to hork food too. The amount of water to add can vary, since some food is far more gelatinous and needs more water than, say, a fish based saucy food. Also, how watery she'll take it. We're probably usually 50:50 food:water, and it's more runny than paste-like, we call it slop or slurry. The more you can put in, the better (if she'll eat it)

Hth, with love, nikki

 

I was actually planning on picking up some turkey mince tomorrow. I think some people cook it slightly and some use it raw. I might just blend it in with some other food to increase the proteins in the meal.

 

Good point. It's a question of working out what she prefers. I used to giver 15g gravy tubes because I could hide her phosphate binder in there. She used to always lap them up after a meal. About a month or so ago she simply started refusing them. I noticed that she would even have trouble eating them because they are quite thick. I suspect she will prefer it quite watery.

As for syringing food. I could try that with some of the blended stuff, if she doesn't eat the blended stuff. I have syringed 20ml-30ml of fluids in the past and that's possibly a little more awkward because it is more fluid and is easy for her to choke a little. There are plenty of videos. I'll take a look at them if it comes to it.

 

@nslade001

That’s not taking time for oneself??! lol

 

Exactly lol

 

Just one last little night time update. I blended some chicken in sauce (the stuff she struggled with a little earlier). She wasn't interested unfortunately. On the plus side, she had a good drink and then used her litter tray (I don't think she's used her tray for some time). Her BG test was HI again, which is possibly not surprising after her crash yesterday. She's had her 1 unit of insulin and I've settled her down for the night on her bed with her water and the blended food.

I'll see how she is tomorrow and if she has eaten anything overnight and then maybe try a different food in the blender for her to try.

I wonder whether she still has some issues with her pancreas and this is affecting her appetite? Perhaps some more time on IV would help because I suppose it's possible she still has some inflammation in her pancreas?

 

Did Poppy have pancreatitis? I totally missed that, and thought she had just been diagnosed with diabetes on top of her CRF.

Absolutely, she may still have a flare going on. Cats with pancreatitis are usually treated with a combination of antinausea meds, appy stimulants as needed, and painkiller, usually buprenorphine as pancreatitis *is* painful, even if cats don't show signs of pain. Also, they are often given SQ fluids at home along with the other 3.

Please see this primer on pancreatitis as it is quite detailed, and do post for advice or if you have any questions. It would absolutely explain her loss of appetite.

With love, Nikki

PS if you could, it would be great if you could set your alarm to do a spot check a bit later, especially if she hasn't eaten, to ensure she isn't dropping too low again.

Could you entice her to eat anything, even by licking small amounts off your finger or a spoon? Sometimes they'll eat for that when they refuse to eat by themselves, fussy things.

I know it's all exhausting at first and I hope I'm not pushing...

With love, nikki

 

Well, the vet did say Poppy had pancreatitis, but they never did the check (PLI check or something) to say with real certainty. But for various reasons they were confident it was pancreatitis and treated it as such. Now, I should also point out that I brought her home before the vets said that it was time for her to come. This was because she had been in 5 days and on the afternoon of day 5 was very unwell (flat out on a heat pad, not very alert, low temp etc). The vet was quite pessimistic and, although not saying it outright, was hinting towards ending her discomfort. I returned 5 hours later at 10pm and Poppy's temp had recovered and she was up and about. The fact that she had been there 5 days and was looking quite confused. I took her home and she was quite weak even then (this was 11 days ago). Since then she's been up and down a lot.

I assumed that they were giving her antibiotics, but when I took her home there were no meds at all. The vet said that fluids were the best treatment for pancreatitis. He also suggested that they could try an ultrasound to have a look at see if there was anything they were missing.

I'm not starting to come around to the idea of taking her back in to go back on fluids in case she does still have inflammation in the pancreas or something else going on.

I think like Willow, Poppy seems to go for the fish wet foods. I think I will try some of that tomorrow. I always check on her 2-3 hours after I put her to bed. I'll try and do a spot check, but I will probably be back checking on her about 6-7 hours after her insulin. She was up HI (41.7+) this morning and 6 hours after the insulin had come down to 28.1.

I did mention to the vet today about me giving her sub-q's at home and he said that would be fine but we will wait and see of the cerenia has an effect. Given that fluids are the best treatment for pancreatitis, I think this is something I should really do. Maybe 100ml's twice a day and see how she does?

 

I agree that subQ fluids at home is the way to go if the vet is agreeable.
I also think you need to be giving regular cerenia and / or ondansetron to combat the nausea. Cats won’t eat if they are nauseated. Ondansetron needs the vet to write a script and you get it from the pharmacy as it is a human medication. It can be given every 8 hours if needed and can be given at the same time as cerenia. I found ondansetron very effective for Sheba.
If Poppy is not getting enough to eat she will be weak.
I know it is hard if renal issues, FD and pancreatitis are in the picture. You are being a great dad Scott

 

He really is

Scott, cats often do better at home unless the situation is dire, and if the caregiver feels they can do it; at this point it sounds like Poppy may be best treated at homes with antinausea meds and SQ fluids as suggested by @Bron and Sheba; I would strongly suggest starting painkillers as well.

Although Willow was never tested for pancreatitis, she has had a couple of suspected flares and both times seemed much more comfortable when put on bupe, although she never showed signs of pain beforehand such as meatloafing or hiding; she just became lethargic, inappetent and nauseas. We use the bupe you put in her cheek, and is absorbed.

Unfortunately, some vets still feel that if a cat isn't exhibiting obvious signs of pain, there is no need to treat for it your vet seems quite reasonable, with the cerenia injection and agreeing to SQ fluids, so will hopefully respond well to your request.

With love, Nikki

 

I checked on her a couple of times and there's no signs of low glucose. She's drunk some water but not touched any food.

I'm now in a position where something has to change one way or another. That means either me giving her SQ fluids at home (maybe 3 times a day) and syringe feeding her or taking her into the vets to go on IV's there. Obviously in the hospital, they can monitor her much more closely and give her the meds she needs as and when (be that pain relief, stimulant or antinausea). The problem is, I just don't like leaving her in the hospital for days at a time. I'm concerned that she will become withdrawn and depressed. If this is still an issue with pancreatitis and I am thinking that it is, then would giving her SQ fluids at home be enough to get on top of the inflammation in the pancreas? She had 5 days on IV's and it didn't quite get on top of the pancreatitis. She is an older cat and maybe she needed some more days on IV's? I don't know enough about pancreatitis. Is it possible that, in an older cat, they might not be able to bring it under control?

When she was in hospital on IV's, she was eating (not huge amounts, but the day I brought her home she had eaten the 30g-40g that was given to her a few hours earlier). This is why I am now fairly convinced that this is still an issue with the pancreas and maybe she needs good quality fluids and possibly pain relief.

The vet I spoke to yesterday said I could try to SQ fluids if there was no change in her appetite after the cerenia. I'm just concerned whether SQ fluids at home would be enough. She is weak and can sometimes struggle to move around (especially if she has been lying down for some time before). Once she is up and about, she can move around better. My concern is that if I take her into the hospital they will start suggesting that maybe she is too old and weak for treatment and the best thing for her may be euthanasia. I'm well aware of her age and doing what is best for her. I'm just not sure whether it is possible to get on top of the pancreatitis given her age and current condition. One of the vets I saw last week kept talking about "all her other medical problems". But she has this condition and the renal condition and that's it. The renal condition has been managed well and the proteins in her urine have been steady for over 2 years. Although she is possibly just into stage 3 of the kidney disease, it is progressing slowly because her age (low activity, small meals etc) and therefore if we can get this pancreas issue under control, then she could well have another year of good quality life, if not more. There is also the chance that the BG issue could improve.

As I say, I just don't know whether home treatment could be sufficient and I'm sure she probably does need pain relief. Bupe sounds good and can be used in renal cats. The vet I saw last week said they usually give metacam (which is great for inflammation and pain relief) but it isn't great for renal patients. The other pain relief he mentioned was an opiate and that would cause drowsiness.

I wonder whether giving her SQ fluids at home, syringe feeding and using metacam could be an option? The effect of metacam on the kidneys is uncertain. About 10 years ago a warning label had to be added to metacam (meloxicam) about the effects on the kidneys. I've just read an interesting article on PetMD that suggested low doses of metacam actually slow down the CKD (although some dispute the studies that showed metacam to be safe because those behind the studies had a conflict of interest).

 

I had Sheba on metacam for a few years (she was early stage CRD) and it had no effect on her renal numbers. But you can only give it if the cat is eating. It can certainly make a difference. But you need to make sure the dose is suitable for a cat.
I would ask the vet to do a fPL test to see if in fact she has pancreatitis or not.
I would also get some ondansetron tablets to see if they help with the nausea. They can make a difference
Also ask the vet if Poppy is a good candidate for some hills a/d urgent care canned food... it is higher calorie and can be fed in a bowl , spoon or syringe fed.
If possible I would keep her at home if you can manage.
Pancreatitis usually comes in flares then settles if in fact that is what she has. You need to get that fPLtest done to make sure.
Yes the BG should be able to be managed. I think your main issue is getting her to eat and maybe her hydration. I would try and address those issues.
Hugs

 

Hi,

*Many* of the cats here have acute or chronic pancreatitis. One of our members wrote the pancreatitis link I mentioned earlier. It can be managed at home with giving antinausea meds 30-45 min before breakfast, see if the cat will eat, try appy stimulant, see if cat will eat. (There are many tricks.... Willow*can* eat a slurry but usually needs encouragement to start, with finger or spoon feeding, and often adding toppers such as those in the other link I mentioned. Sometimes she'll eat off a saucer but not out of a bowl. Often she wants us to hold the bowl. We play with it. Other meals (sometimes the next) she'll eat by herself. The important thing is for her to eat.)

If cat won't eat on own, syringe feed some food. It's never come to that with Willow.

Other than that, it's just give the painkiller as prescribed (for bupe transmucosal it's usually 3 times daily). The vet can give an injection of bupe that lasts I think 3 days, I don't have experience with that. Or there's metacam; many, many here use bupe, it has less risks than metacam, and it works. The link I sent for the CRF site discusses pain control in CRF cats, including use of metacam.

And SQ fluids. The vet can tell you amounts and frequency.

I would recommend starting another thread with a new topic title, possibly something like need help...Newly diagnosed cat, possible pancreatitis. Many, many experienced board members have dealt with this. You can link back to this thread for continuity.

I hope Poppy feels better today, with love, Nikki

 

I've started a new thread here:

http://www.felinediabetes.com/FDMB/threads/pancreatitis-with-diabetes-and-renal-issues.216209/

She's gone back into the hospital for a minimum of 48 hours on fluids and a few tests. Hopefully that can get her eating again and get on top of the inflammation in the pancreas. Her BG test this morning was 30.3 after being HI last night. The vet said her BG levels and lingering pancreatitis will likely be the reason for her lack of appetite.