? We’re back.. questions on meds and request for any advice.

Here is my first “introduction” post:

http://www.felinediabetes.com/FDMB/...titis-ckd-newly-diag-and-now-diabetes.161957/


Sorry this go long – just wanted to give as much info as I could.

I need some advice from those that have been doing this longer than me. Since my first post Gizmo has been put on insulin (Lantus). I am fighting multiple issues/problems and want to make sure I am on the right track with what I am doing.

Current weight (09/02/16) 9.6#’s (he had lost a lot of weight and is slowly putting some back on). He is a big kitty (but not fat).

I don’t have exact dates so these are approximate:

2 months ago 1u 2x/day 12 hours apart.

1 ½ month ago upped to 2u 2x/day 12 hours apart.

I am not home testing (yet?). on 09/02/16 took him in for a glucose curve and vet couldn’t get test below 500(?) and determined UTI. He was put on antibiotic (Clavamox) and just finished his last does this morning.


I am concerned that UTI is not completely gone and really want to give another round of antibiotic – am I being too overly cautious? Is it necessary? This is the 3rd UTI in the past 30 months or so.

Feeding prior to injection and injection within 5-8 min after eating (he will eat 1 can in one setting).

Meds and feeding info:
4:30-4:45 am

1 sm can Hills k/d
mixed with food:
1/8 teaspoon PancrePlus,
1 teaspoon RenaPlus (low potassium).
1ml Joint Purr-Fection Liquid Health 2.3 oz Liquid (new, started this morning for arthritis)

4:45-5:00 am
2u Lantus
1ml Clavamox for the past 7 days – completed.

1/4-1/3 cup Purina Gentle dry kibble

4:30-5:00 pm
1 sm can Hills k/d
mixed with food:
1/8 teaspoon PancrePlus,
1 teaspoon RenaPlus (low potassium).
1ml Joint Purr-Fection Liquid Health 2.3 oz Liquid (new, started this morning for arthritis)

4:45-5:00 pm
2u Lantus
1ml Clavamox for the past 7 days – completed.

1/4-1/3 cup Purina Gentle dry kibble

Other meds/supplements:

Slippery Elm Powder (1/8 teaspooon as needed, only give twice)
Tobugesic Oral (RX for 0.58 ml) as needed for pain. I only give 0.2-0.3 ml and not very often as it zones him out pretty bad). Last dose was last weekend for arthritis pain.


Other concerns:

Generally, not energetic though better this week after AB. Drinks and eats insatiably, so much so that he never seems content or relaxed.


Appetite is NOT an issue so don’t suspect nausea. No pain from pancreatitis as near as I can tell.


Hind leg weakness seems to be better since RenaPlus (potassium). Levels have come up but still has a limp going up/down stairs.


Started Purr-Fection liquid due to vet voicing concerns of arthritis.


Retest curve currently scheduled for 09/23/16.


I introduce new meds/supplements one at a time so I can tell if there is an adverse reaction. The SEB caused loose bowel (mushy) but not diarrhea. It could have been the small amount of baby food that it was mixed with or the SEB – not sure. I was afraid to mix with his regular food because I am afraid of turning him off eating (though that is not currently an issue, it has been in the past with panc. flares).


Urinary output it large. Issues with pooping outside box but this has always been an issue with him (since he was a kitten). No constipation and goes regularly.


Also, vet said to start Omega3 for arthritis but have not yet. Looked at them last week and got confused. She said to just squirt the contents of the pill in the food. Anyone use Omega3? If so, which do you use?


Any advice? Anything more I should be doing? I need to call and talk with vet today for labs from last week. She was supposed to call me with them but hasn’t yet.

 

First, Omega-3, I use Nordic Naturals Pet. You should be able to source this locally; I get mine at the local health food store. Dosage I use is 1.25 mL twice a day.

It would be beneficial for Gizmo and you to start hometesting (will not only give you peace of mind but will save quite a bit of money). I used an inexpensive human meter, Walmart Relion Micro. It served us well. Just read your first post and it is possible to test from the paw pad. Wrap Gizmo up in a towel like a burrito then he will lie completely still for the test. I had to do that with Squeaker. Be sure to wrap the towel around the chest to catch the front legs, then lie him on his back and test from a back foot.

Food------change the food. The Hill's k/d has 35.40% carbs. Way too high for a sugar cat. Not to mention it is low protein which is not good for any cat. Low protein foods will cause weight loss. No dry kibble, use wet food only. Dry food is too high in carbs and given that it is a water depleted diet it is not good for a cat in renal failure. The food list here will help you to find a lower carb, low phosphorus food that is suitable for his health issues: http://felinecrf.org/canned_food_usa.htm.

I would suggest that a urine culture be done in regards to the UTI. With renal cats, sometimes it can take quite a while to overcome an infection and they can be an ongoing issue. Also, antibiotics can cause diarrhea; they also tend to wipe out gut bacteria. It is wise to use probiotics whenever an antibiotic is used. Probiotics will help with diarrhea and ensure the gut bacteria stays in balance. Again, you should be able to source these locally at any pet food or health food store that has a pet department.

 

Do NOT eliminate the dry food unless you are home testing. It could cause serious hypo episode.

It would be best to change to all wet food but you MUST home test while making the transition. Take it from one who didn't test or knew about FDMB. It was a long night learning during a crisis but Smokey survived it without long term damage thanks to the good peeps here.

For the UTI's. Where cultures done? If not is it just suspected he has one? Could be the AB isn't the correct one.

 

Thank you!

Food - he has crf. Stage 2. Was told that k/d food was best. To tell you the truth I have tried all kinds of food. With the panc flares I hate to mess with something that may cause another. I think the last one almost killed him and brought the diabetes to a head. The small amount of dry is approved by the vet (I know they don't know everything) but we were trying to get the weight loss stopped (reversed). Before the last panc flare and resulting bad labs I had him on raw diet and he was doing relatively well. Previously he was on FF classic and did well for 3-4 years (until the first panc flare). I am fortunate that he is NOT a picky eater and will eat any food (cat) if there is no panc flare going on.

I just seems like I cannot get control of all that is going wrong and he just seems so depressed or at least unhappy. He used to be such an active, playful cat.

No diarrhea at all.

 

Yes. Those are the results I am needing to get from the vet. He had finished a different AB about 1 week before the curve test (09/02) so vet gave different AB (Clavamox) on that date.

For clarification - vet sends labs to outside lab unless it is an emergency (which are run in-house). It is less expensive and it gives a better, broader picture. Full labs were taken last Friday along with urinalysis and frutosamine (?) test.

 

Happy to report that Gizmo is doing better. Alert, attentive, loving. Still ravenously hungry but maybe a bit less so?

The Joint Purr-FectionLiquid Health is a wonderful thing. Remarkable that in just three days he is jumping and walking with more confidence and less pain.

I removed the dry kibbles slowly over the past few days (he really wasn't getting much to begin with) and added an extra can of the k/d.

So if k/d (Hills chicken stew) is not good what am I to feed him for kindneys and pancreatitis management?

I am so happy he is feeling better. He is relaxed and content. He is currently asleep beside me on the couch and has been sleeping with me again.

I think I am going to take him in Tuesday for the curve and test to make sure the uti is completely gone.

Thank you for any input and advise.

 

Many feed raw who have cod at least until stage 4--there is lots of new research available and many doctors are too busy to read it all....
there is a "sticky" in the home page on a primer for pancreatitis-it is very informative
Has your vet talked to you about SQ fluids? (for kidneys and/or pancreatitis )
Below is a link to a article that may interest you on pancreatitis....


You will want to try to feed a low phos. food or get a phos binder -you just add it to the food-it may cause constipation and many of us use miralax to avoid that issue (I give every other day to avoid the problem)
most cats do best with a single protein and if you can find a novel protien it is usually helpful-

there is also a mix called foodfurlife that you add your meat to and it has all the good stuff you need.
@Wendy&Neko has lots of experience with many of the things you are working with....
Home testing is critical ..... it has saved many cats lives..... we also suggest increasing by .25 as a drop or 2 can make a huge difference and it can take up to 6 cycles (12 hours a cycle) to know if you should increase-decrease or hold the dose-
Stress at the vet will make the bg go higher-
I cannot stress enough how important it is to home test.....
good luck

 

My Neko has stage 3 CKD, really bad arthritis (due to her acromegaly), and has had at least one pancreatitis flare, probably due to her IBD/lymphoma. If you've read Tanya's website on CRF, you'll find that KD is not recommended until later in the progression of kidney disease. Muscle wasting is a concern if you do the low protein foods too early. Ideally, once you are home testing, for diabetes and kidneys you want a low carb (less than 10% carbs), low phosphorus (less than 1% dry matter) wet food or raw food. I have used the FoodFurLife premix as well as the TC Feline Special premix that are formulated to meet those requirements when added to raw. I find it's actually better to have a few proteins that I feed in rotation so they that if they go off one protein (or become allergic), you have other proteins to fall back on. If you'd rather feed canned food, then either use the food list Anita pointed you to or the food list at catinfo.org. Note that manufacturers are always coming out with new flavors or formulations, so it's hard to have any one list stay up to date. However, between the two you do have the majority of foods that are on the shelves.

Home testing is s life saver for your cat and a wallet saver for you. We cannot stress how important home testing is. With larger dose increases and the stress of a vet visit, it's very easy for your cat to be overdosed. A curve of an overdosed cat can look like that of a cat that is underdose. Add vet stress and I bet the vet suggests another large increase. My non diabetic cat once tested over 220 at the vet, and 53 at home the next day. If I hadn't home tested, the vet might have suggested starting insulin for a kitty that was just stressed. At the time, they did suggest a fructosamine, which I declined and saved my pocketbook. And I've lost track of the number of people who have come here (usually late at night or on weekends), finally got their first home test done, and found kitty in low numbers due to overdose and the vet clinic closed.

I am glad the Joint Purr-fection is working for you. I usually found that those types of ingredients took a few weeks before you really started to see improvements. In the US, Adequan shots are also really good for arthritis. You might want to ask the vet about that.

As for the UTI - the urine has to be sent out for a urine culture and sensitivity, not just a urinalysis. The culture is where the lab tries to grow the bacteria so they can determine exactly what is causing the UTI so the appropriate antibiotic is used. Different bugs require different drugs. I'm not a fan of doing antibiotics unless they are really indicated.

 

Keno has stage 2 kidney disease and I was feeding k/d wet and I feel it was a huge mistake because of the high carbs. When we got up to 5 u of Lantus twice a day, I gave up on the k/d and have started her on Hill's m/d. It is medium high in carbs (17%) but her BG's are coming down. It is also not bad for phos - only 71%.

I found it next to impossible to find low carb/low phos foods. I tried Weruva Paw Lickin' Chicken because it is 3.3% carbs and 82% phos, but it made her BG's go up - possibly because it has potato starch. I don't want to use a phos binder if I can avoid it - they bring their own set of issues such as constipation.

I'm staying with the Hill's m/d to see if we can get her regulated feeding just that. She is very sensitive to food changes and they give her diarrhea, so I am also giving Florastor a s. boulardi probiotic and it s helping a lot.

 

Last year some one put together this list of low carb/low phosphorus foods. Since then, the Weruva line has expanded. I sometimes feed Glam N Punk. Nutritional breakdowns are on their web site. Another option is to make your own food, which I was doing until recently, now I just do some of her food that way. She's gotten fussy. There are some kidney friendly cat food premixes like FoodFurLife.

We consider anything over 15% to be high carb foods, that includes Hills M/D.

 

Thank you for this list. It is a tough balancing act with CKD and diabetes. I don't consider anything over 80% to be low phos so I try to stay under that, which is not easy. My recent experience with Weruva's Paw Lickin' Chicken has made me wary of anything with potato starch as an ingredient.

I ordered some FoodFurLife and I am going to start making my own food.