Diabetes and Chronic Kidney Disease

Discussion in 'Welcome to the Group - Post an Introduction Here' started by Callao, Jan 11, 2016.

  1. Callao

    Callao New Member

    Jan 11, 2016
    Hello world! Two years ago, the furry little love of my life was diagnosed with chronic kidney disease. Despite the vet's initial pessimism (we weren't sure she'd make it through the night), Callao has been living a healthy-ish, happy, normal-ish, kidney-deficient life for nearly two years! During her routine check up last week, her blood tests revealed elevated glucose levels, suggesting that she is diabetic. On Friday, we started her on 1u of Lantus glargine once a day. I spent the weekend reading as much as possible and shopping around for insulin, needles, glucometers, and urine test strips (with an obscene amount of cuddling with Callao).

    I'm wondering if anyone else out there has experience managing both of these diseases simultaneously. Particularly, I have concerns about:

    1) The diets are on opposite ends of the spectrum for these diseases. Should I stick to the low-protein diet that is good for her kidneys? Should I consider transitioning to a higher protein diet that is good for her diabetes, and maybe add a phosphate binder to ease the work for her kidneys? (Any changes would happen slowly and after we have her glucose regulated and with much monitoring.)

    2) Can I administer sub-Q fluids for her kidney disease around the same time as the insulin? Will the sub-Q fluids affect the insulin? Can I do them at the same time, but on different sides of her body?

    3) She is only 6.5 years old. When she was ~3-4, she weighed a hefty 13.5 pounds. She lost ~4 pounds in the 6 months prior to being diagnosed with kidney failure. Throughout the past 2 years of kidney panel blood work, she showed no signs of high glucose. She is now back up around 13.5 pounds and has high glucose. Though there's no way to know, I wonder if she could have had undiagnosed diabetes earlier in life which led to her kidney failure, which was resolved with weight loss and sub-Q fluids, but is now returning due to weight gain. It's all very speculative, I know. What are the chances she might go into diabetes remission if we manage her weight better? We are already on a diet to help her get back to a healthier weight.

    Anything else I should know? Any advice or tips on managing diabetes and kidney disease together would be much appreciated. Thanks in advance!

    ~Meg (and Callao)
  2. Bron and Sheba

    Bron and Sheba Well-Known Member

    Feb 21, 2015
    Hi Meg and Callao and welcome to FDMB.:)
    It sounds like you are getting yourself well organised. That is great, and really good you are going to test the blood sugars.
    I have a diabetic cat who also has early kidney disease and yes both can be managed as far as the diet goes.

    Can I ask a few questions first please?
    Do you know what stage of CRD Callao is at?
    What medications are you giving for the CRD of any?
    Has she had her blood pressure checked and if so what was it.?
    What food are you feeding at the moment.?
    Are you feeding wet or dry food
    What country are you in?

    The CRD prescription food for cats is too high in carbs for a diabetic cat, so you need to find a food that will be OK for both FD and CRD. It would be good to know first what stage of the CRD she is at as that can make a difference as to what you feed. In the earlier stages it is better to feed a high protein, low carb food, wet not dry.

    Re the Sub subcut fluids.....I do not give those yet but from what I have seen others say, they give it in a different place on the body and at a different time. But I will try and find someone who does that to talk to you about that.

    You might be interested to read these threads


    It would be a great idea if you can start a spreadsheet to document the blood sugars it is much easier for people to help you. Here are the instructions

    Testing and tips

    Hope this helps a bit. Keep asking questions and if you can answer the ones I asked we will be able to help you further:)
  3. Bron and Sheba

    Bron and Sheba Well-Known Member

    Feb 21, 2015
    Are you able to help at all with Subcut fluids and when to give them in relation to insulin injections please Amy, or anything else to do with CRD and FD ...thanks
    Mister's Owner likes this.
  4. Callao

    Callao New Member

    Jan 11, 2016
    Hi Bron,

    Thanks for your quick reply! I have some of the answers to your questions, but not all.

    1. When originally diagnosed with kidney failure, her BUN and creatinine levels were so off the chart that they had to dilute her blood to get any reading at all. They estimated she had <15% kidney function left and did not think she would live through the next day or so. I think that places her in Stage 4, according to the reading I've done. However, in her most recent blood work, numbers are more like Stage 3: BUN = 67 mg/dL, Crea = 3.3 mg/dL, though she doesn't have any vomiting.
    2. The only medications we give her for the kidneys is 100 cc's of sub-Q fluids (Plasma-Lyte A) once a day every day. We originally had her on phosphate binders and potassium supplements, but she has had normal phosphorus and potassium values without those for the past year.
    3. I don't believe she normally has her blood pressure checked during routine visits. She had dental work done this summer and they closely monitored her blood pressure during the entire procedure to make sure it was normal. It started, remained, and ended normal. I can ask the vet to check her blood pressure when we re-visit on Friday if it's useful.
    4. I currently feed the Hills K/D renal care dry food. I've tried very hard to get her to eat any wet kidney diet food, but she hates it. I've also used the Royal Canin kidney diet dry food. So its probably a pretty terrible choice for diabetes, but it has given us a pretty manageable two years despite her kidney problems, and she (weirdly) likes it. I occasionally treat her with a nibble or two of chicken breast. I would feed her cooked egg whites because they are low on phosphorous, but she doesn't fancy it for whatever reason.
    5. I'm in the USA.

    I'll check out the other forum links you suggested. I've also already started a full calendar with all of her treatment times, doses, pees and poos, and (as soon as the glucometer gets here tomorrow) glucose levels. Since I'm a scientist by day, no doubt these will be meticulously recorded and plotted in spreadsheets. :)

    Thank you!

    Megan (and Callao!)
  5. Bron and Sheba

    Bron and Sheba Well-Known Member

    Feb 21, 2015
    Hi Megan,
    Have you ever visited Tanya's CRD website
    It has some very knowledgeable people there who might be able to help you with the CRD side of things. They may be able to stage Callao's CRD for you and tell you if you need to feed the prescription food or if other food is OK.
    There are a many of us here on this forum who have cats that also have various stages of CRD.
    Most of us feed over the counter food that is low in phosphorus and carbs and high in protein. The current thinking is that cats do better on high protein diet unless they have advanced CRD. It helps maintain their muscle mass and body weight.

    Here is a link that gives you all the values of foods.. You need to have a food that is 200mg or less of phosphorus /100 calories. The prescription ones are usually under 100 but are high in carbs that makes it very hard to manage diabetes.

    The hills K/d has 27% carbs and we try and keep under 10%.
    Wet food is much better for Callao than dry because of two reasons. It has much more moisture than dry (7% rather than 79%) and dry food are much higher in carbs than wet generally except for the gravy higher carb wet foods.

    I feed home prepared diet for Sheba but there are many foods around that are suitable for CRD and FD.
    Fancy Feast is too high in phosphorus so keep away from that.
    I also keep a supply of some of the Weruva brand cans as they give full nutritional Values of all the our foods. Check out these four types and go to nutritional info. And look for phosphorus under 200mgs/100 calls and carbs less than 10%


    Has Callao had her urine checked for protein? Also specific gravity?
    And it is a good idea to ask for a BP check because if it is high it can damage the kidneys further and there are meds to treat it....same with protein in the urine. Ask to get the BP checked as soon as you go in for the checkup so as to get it taken before she gets too stressed with the visit.

    With the egg white, I think most cats would only eat it mixed in with wet food. It is a good way to lower the overall phos level of the meal.
    Also with the insulin. Lantus is a really good choice, but it works best if given twice a day to cats.
    If you can get the SS up and running and start to take some BSLs .....blood sugar levels.....it will be much easier to see how she is going with the insulin. We recommend you take a BSL before you give the insulin and food and then again about 4 or 5 hours later to see how far it brings her down.
    Do you have some honey in the house just in case she drops too low?
    Hope I haven't loaded you with too much info........it can be scary at first. But it is wonderful you are doing all you can for Callao.:)
    I will also tag @Wendy&Neko as she has Neko who has FD and CRD and she may be able to help too
  6. Anitafrnhamer

    Anitafrnhamer Member

    Jul 9, 2013
    Squeaker has diabetes (diet controlled) and Stage 4 CRF. I would not give fluids within a couple of hours of the insulin. Is there anyway you could give at +6 (half-way between insulin)?

    The "go to" for renal failure is: http://www.felinecrf.org/index.htm

    Also a yahoo support group: https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info

    Great food list: http://www.felinecrf.org/canned_food_usa.htm#canned_usa

    Many of us manage cats with multiple health issues. And with Stage 3-4 monitoring BP is crucial, it can cause blindness, strokes, among other nasty issues.
    Bron and Sheba likes this.
  7. Wendy&Neko

    Wendy&Neko Well-Known Member

    Feb 28, 2012
    Hello and welcome. My Neko has FD (due to acromegaly, benign tumor on the pituitary) and stage 2 CKD. She started with FD over 4 years ago. I am feeding her a low phosphorus, low carb, high quality protein diet. In her case it's raw food, some manufactured and some made with a premix. There are also several brands of canned cat food that are suitable for both diseases. If your kitty won't eat low phosphorus foods, adding binders is an option many use. We'd had a number of people here manage both conditions in their cats for many years.

    Has your vet done more than one blood test that shows elevated glucose? Do you know what the test number was? Some cats show very high vet visit stress numbers. My non diabetic cat once tested over 220 at the vet's office and 53 at home the next day. That's another reason home testing is important, so doses aren't based on temporarily inflated numbers.

    Neko is also taking Azodyl, which I think is helping her BUN. She has high urine protein, also in part due to her acromegaly so she is taking benazapril for that. Regular blood pressure checks are a good idea. If it's high, lowering the BP can help the kidney values.

    I'm not giving fluids yet, but have seen several people do so. It seems to vary by cat, whether it impacts the blood sugar numbers. For some it's quite an impact. I've seen some recommend shooting in different places, shoulders for fluids and flank for insulin.

    Shooting Lantus twice a day is best. Cats metabolize insulin faster than humans so most are on twice a day shots. I am glad you are starting on a low dose and will be home testing her. It's hard to say whether she will be able to go into remission. It's harder with CKD, but I've seen it happen.

    The Lantus and Levemir forum here has a lot of information in Sticky Notes at the top of the forum. Lots of reading to do, but we all remember what it was like to be new and love to help.
    Critter Mom likes this.
  8. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

    Feb 14, 2011
    When Trix was first diagnosed with CKD, she was still on insulin (she is now OTJ). When it came to giving fluids, no matter how much time I put in between doing her fluids and her insulin, her BG numbers would drop like a rock. The only thing that kept her numbers from plummeting was separating where I gave the two different injections on her body. I would do her fluids up around her shoulder region, and I moved her insulin shot to her flank. For Trix, this was the only thing that kept her BG numbers stable.

    I also agree about keeping tabs on BP. For Trix, getting her BP under controlled improved her CKD staging from Stage IV to Stage III.
    Critter Mom likes this.
  9. Callao

    Callao New Member

    Jan 11, 2016
    Thank you all for your responses. We're already very familiar with Tanya's CKD site. It has been a constant resource these past two years. Since Callao's numbers have been quite stable and she is acting normal and happy, we feel we are at a decent place with her kidney issues. (Always room for improvement, but the diabetes might be the biggest issue now.) For now, we are mostly concerned with reaching a treatment plan that works for both diseases, ideally without any drastic changes to the kidney regiment. I will definitely talk to my vet about regular BP monitoring with her routine check-ups.

    Regarding the diabetes diagnosis, her original blood work showed a glucose level of 591 mg/dL. A few days later, but once again at the vet's office, it read > 600 mg/dL (I don't recall the exact number). That was the day we started her on insulin (1 u/day of Lantus glargine). We have been giving 1 u/day insulin since Friday, Jan 8 at the vet's suggestion. She did not suggest home testing blood sugar levels before administering insulin. Today, our home glucometer arrived, so I was able to do a test here. It read 546 mg/dL, and was tested 2.25 hours after giving 1 u of insulin. (Unfortunately it did not arrive in time to test before the insulin.)

    546 mg/dL is quite high, but I understand insulin typically causes a dip in blood glucose ~6 hours after the insulin shot. So I could expect her glucose to be lowest around 1 am. I'm considering waking up at 1 am to do another test at what should be a low point in her curve. (I have not done a full curve yet, but plan to this weekend.)

    Thusfar, I have been giving the insulin in one shoulder, waiting ~2 hours, and then giving the sub-Q fluids in the other shoulder. I will also ask the vet about doing the insulin shots towards her flank. Thanks for the tip!

    I'll keep you posted on the 1 am glucose test... if I can manage to wake up!
  10. Wendy&Neko

    Wendy&Neko Well-Known Member

    Feb 28, 2012
    With numbers those high today, I think you can save yourself the wake up call. She's not likely to be in any danger tonight. It is useful data gathering if you want.

    Just FYI - not all cats read the rule book with Lantus. Although the average low point is 6 hours after insulin, some are as early s 4 hours or as late as 9 or 10 hours. Part of what you'll be doing in the next little while is trying to figure out what Callao likes to do.
    Critter Mom likes this.
  11. Callao

    Callao New Member

    Jan 11, 2016
    I'm not worried about her going too low tonight, but if I know that even her low point is quite high, I could talk to the vet about increasing her dose or the frequency. I've read that response varies a lot from critter to critter, but are there estimates of how much 1 u of insulin typically reduces blood glucose?
  12. Wendy&Neko

    Wendy&Neko Well-Known Member

    Feb 28, 2012
    A saying you'll see a lot here is ECID - each cat is different. It's really true. For some cats 1.0 U is a drop in the bucket (Neko got to a high of 8.75U but she has two high dose conditions) and for some cat 1.0U is too much and would cause them to go into hypo. If a cat is on too much insulin, you can also get really high numbers as their bodies sends out stored sugars to compensate. You job now that you are testing, is to gather data to help get an idea of how she is doing on this dose and we'll be able to help you figure out what to do next with the dose.

    You'll notice that most of us have spreadsheets (SS) in our signatures. We track our test data there and it helps us figure out how are sugar cats are doing on a dose. The instructions for creating a spreadsheet are here.
    Critter Mom likes this.
  13. Callao

    Callao New Member

    Jan 11, 2016
    Spreadsheet-ing has begun! (And is now part of our signature, as suggested.)

    I've also written to the vet today to ask about adding a dose in the a.m. or increasing her p.m. dose based on the numbers from last night. I'll keep you all posted. Thanks!
    Critter Mom likes this.
  14. Critter Mom

    Critter Mom Well-Known Member

    Jun 16, 2014
    I can't remember who posted it, but this week I saw a forum post where the member said that the administration of sub-q fluids did have an impact on insulin treatment. IIRC, I think she said administration of sub-qs could make the BG drop. She also said that she gave insulin in her kitty's flank and that helped with the issues. (Sorry I can't remember who posted this info. Perhaps do a forum search for posts in the last few weeks containing the word 'flank'???)

  15. Wendy&Neko

    Wendy&Neko Well-Known Member

    Feb 28, 2012
    Great job getting that spreadsheet started.:) Good to see her out of the 500's this morning.

    Lantus doesn't last 24 hours in cats. It would be much better to give the same dose morning and evening, 12 hours apart.
    Critter Mom likes this.
  16. paris

    paris New Member

    Nov 15, 2017
    Hi, I've come across this page as my cat has been diagnosed with stage 4 CRD, to be honest we are at a loss with what to do. the vet is saying she doesn't really stand a chance but from all what I've read I feel like she might, and they are not even 100% sure it is CRD unless we pay £370 more for a few lab tests. I feel like they are just telling me its the worst because at the moment I dont have the money to pay for everything they are asking. currently she is at the vet on a drip and antibiotics just incase its only a bad infection. the vet ruled out diabetes even though the symptoms are the same as CRD. I have a feeling it could be that instead of CRD or even possibly both.
    I would really appreciate any advice anyone can give you all sound like you have much more information than my vet is telling me.
    we've already paid £350 for blood test, urine test drip and overnight stay, the further £370 is for further tests at the lab to see if it is kidney failure which we thought the original tests were for
  17. Sharon14

    Sharon14 Well-Known Member

    Aug 16, 2015
  18. paris

    paris New Member

    Nov 15, 2017
    @Sharon14 thank you so much for your help
    Sharon14 likes this.

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