Newly diagnosed unregulated diabetic with CKD - HELP!

Hey all,

I've recently taken in a foster/rescue from a situation where the family was not able to properly monitor his diabetes despite a lot of guidance from their veterinarian. He is 4 year old newly diagnosed diabetic (April of this year) and has been through 3 DKA episodes with the previous family when proper insulin doses were not given, insulin was still being given despite concerning behaviours at home which were later revealed (was hospitalized and re-stabilized on IV fluids each time). His story is long one but basically through my veterinary clinic he has landed in my home as a foster as the veterinarian did not feel this poor boy should be euthanized given the family could no longer cope - I have no experience with a diabetic cat but I felt his best chance at getting back to a normal life in a home as opposed to in a busy animal hospital. I have done a lot of reading and am quickly learning that this is not an easy fix but I'm willing to give him the love and patience he needs right now.

His kidney values had been normal up until 1 week ago, although his BG levels have never seem to normalize even on the Hills canned M/D diet. He was feeling much more himself despite the bounces between 100's to 400's until 1 week ago when he had an accident on the carpet and was not himself that night (drinking and peeing like a racehorse and quieter then usual - BG values had been in 300's and 400's all day despite no change in regime and more consistent lower values the previous few days). Given his history his renal threshold seems to be when levels are above 300-400 for longer then 24 hours as it is clear there is some remaining damage to his kidneys from the DKA episodes. I had blood work done the next morning following the accident on the carpet as I knew this was out of character for him. UREA 25.7, SDMA 17, Phos 2.2, Creatinine - Normal. Given these values he is considered to be Stage 2. Was started on Azodyl to lower UREA, Phos binder, switched to Hills Prescription K/D Early Support canned (slighter higher protein then regular k/d). However it is clear the higher carbs are not agreeing with him as his numbers are higher then ever despite being on 4 units of Prozinc twice daily (12 hours apart).

This evening I decided to try him back onto a lower carb, moderate high quality protein, low phos canned food as it is clear the unregulated diabetes is causing episodes where he is not feeling himself - Organix Chicken and Chicken Liver pate is what I chose and added in 25% new diet to 75% k/d renal diet.

Here are his values the past few days:

Friday June 8th - eating only renal k/d 4x day
Pre-shot am: 446
+7 : 270
Pre-shot pm: 464

Saturday June 9th - eating only renal k/d 4x day
Pre-shot am: 259
+9 : 243
Pre-shot pm: 374

Sunday June 10th- eating only renal k/d 4x day
Pre-shot am: 217
+6 : 151
Pre-shot pm: HI

Monday June 11th TODAY:
Pre-shot am: 442
+6 : 270
Pre-shot pm: HI (had accident in the basement which I noticed shortly after giving insulin) - I had made the decision earlier in the day to go out to get the Organix canned so this is when I added in the new food at 25% to 75% renal

I just took a reading now +3 and he is at 390, will try to get another one at +7 as well.

What I'm stuck on is how much to reduce Prozinc dose when transitioning onto a lower carb, higher protein, low phos diet. I don't want to miss the ideal dosing and accidentally overdo it with his insulin and drop his numbers too low causing a bounce back up. Given my work schedule I can only get readings pre-shot both am and pm and around +6 or +7 during the day (3 readings total).

Help would be much appreciated as I know many of the users in this forum have experience with Prozinc, this is a first time using this insulin given our veterinarians had been using Caninsulin with success with the other diabetic cases however it was what he was started on and caused too many bounces (was up and down throughout the day), he is certainly doing better on the longer lasting Prozinc insulin.

 

Hi Elaine, and welcome! And blessings upon you for taking on this kitty and rescuing it from what sounds like an awful situation!

So just to make sure I read that right, he's only four years old?

As far as the CKD, have you seen this site: http://felinecrf.org/index.htm It's a great resource for all things CKD. There are a number of cats around here who have both CKD and diabetes and it's always a trick to figure out the best food. The only food I know is good for both is Primal Turkey. It might not work in later stages, but is okay in early stages like this. If you do a search for this, or post on the Main Health forum, some of the folks who have experience with both can help you figure out what direction to go with the food so you can get him off of the k/d, but still be supportive of both his kidneys and his diabetes. Although my hunch is that he may not actually be CKD, but rather throwing some odd values since he's so unregulated and has had three bouts of DKA in two months.

You're doing a great job of getting tests in, which is super helpful. How long has he been on 4u BID?

We all use these handy spreadsheets (you can see them if you click on the blue links in our signatures). You'll need a Google account (gmail) and then you can follow the directions on this link: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ Once it's set up, you just enter the numbers and the color coding happens automatically. It's a huge help in figuring out next steps for the dosing.

Right now I would suggest you keep the dose you're at and just monitor as much as you can during the food change. Since he's prone to ketones, you really don't want to give him less insulin until you have to.

Are you using a human meter or an AlphaTrak?

Please ask any questions you have, and if you need help getting the spreadsheet set up let us know and there are a couple people around here who can help.