7/29 New member can't regulate my cat's BG

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Yanna, Jul 29, 2020.

  1. Yanna

    Yanna Member

    Joined:
    May 15, 2020
    Hi! My name is Yanna and one of my cats, Naomi, has been diabetic since 2017. I can't regulate her BG no matter what.
    Her vet at that time prescribed Caninsulin & Royal Canin Diabetic dry which she had for 2 years. We visited the vet twice a month during those 2 years to check her BG (with a meter), she even stayed at the vets a couple of times for a curve, they suggested many dose adjustments, they never did blood tests. Naomi was doing great (even with high BG) Now that I look back, and after joining your forum, I realize that everything we did in those 2 years was WRONG.

    I took her to a second vet in July 2019, she was put on HUMULIN NPH & Purina DM. Her BG numbers were better. BUN & CREA levels were elevated, but this was attributed to BG, dehydration, UTIs, ... She was hospitalized several times to bring those numbers down.
    The term CKD was mentioned in January 2020 when Naomi started Semintra for about a month, then Renal powder and Pronefra for about 2 months, then I was told to stop these and since May 2020 she has been on renal diet. When the vet prescribed an (anti-inflammatory?) pill for Naomi's weak back legs then her BG came down so she had more blood tests and was dx with pancreatitis.
    Since I became a member in your forum I asked my vet to switch to Lantus. So we did this in June. But then Naomi stopped eating (for the first time in her life), she was hospitalized, has lost weight, and has had at least two UTIs. Now she eats a bit better but slowly ( it can take her 6 hours to finish a pouch).

    It's been 3 years now since her diagnosis, and I realize that I have wasted so much time not doing the right things for her. As you'll see in the SS, we have visited the vet at least once a month since July 2019 (need to add more data), yet every attempt to regulate her BG ends in a failure.
    So I am asking for some guidance please cause I feel stuck and left alone. I love Naomi so much and I don't want to give up on her.
     
  2. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    WELCOME TO FDMB! We are so glad you finally found us! Wow you and Naomi have been on one wild roller coaster ride. Well be prepared to abandon that ride. What I see on your spreadsheet is amazing. I believe you have been under served by your vets. sigh
    I am not a dosing expert but there are plenty here who are so hold on for more advice. We'll see if we can right this ship! I believe in my heart we can. Take a deep breath and know we are all here for you and UNDERSTAND
    I'm just glad you've posted. You and Naomi have found a safe place to land.
    We wont give up either!
    jeanne
     
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  3. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Hello and welcome!

    I'm sorry you guys have had such a rough time of it. I'm glad you made the switch to Lantus-- it's a great insulin for cats, hopefully it will be the one that helps to settle Naomi's numbers.

    Looking at your spreadsheet (just the Lantus part), the main thing I see is that you are changing dose very frequently, which isn't recommended with this insulin. Lantus does best with consistent dosing night and day. I'd recommend picking a dose (maybe 2.0 or 2.5U?) and sticking with it for at least a week before re-evaluating. A couple basics to note about this insulin:

    1) Lantus forms what is called a depot; a little bit of each shot "saved for later". This is one reason that most people see more consistent numbers on Lantus, and one reason why consistent dosing is preferred (it helps to keep the depot stable, which helps in interpreting the effect of a particular dose).

    2) We evaluate doses based on the nadir-- how low does the BG get-- rather than pre-shot numbers, which can often be some of the highest during a shot cycle. It's great that you test pre-shots and are getting tests during other times too-- keep it up!

    I should say, even though I made a recommendation above, I'm not sure of the best dose to try going forward-- it's hard to interpret the spreadsheet results with all the changes. I do suspect that 3.0U is too much insulin for Naomi, but with her recent UTIs I don't want to drop it down too much.

    Let's see what others think about this!
     
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  4. Yanna

    Yanna Member

    Joined:
    May 15, 2020
    Thank you both for your replies!

    I'm glad I've found this group, I just hope it's not too late!

    The truth is that I change the dose too often which I shouldn't.
    When I first started Lantus I started with a low dose and stayed there for a few days but her BG kept going up. I think that was the beginning of the UTI even though Naomi had no symptoms at that time.
    The last few days her nadirs are high which makes me think that the bacteria may not have been killed, so possibly we are not done with her infection. We changed three types of antibiotics and after the results of the culture were back she was on Maropenem for about eight days. She will have a culture next week, so we'll see then.
    Opened a new solostar pen this afternoon. I'll add this in the SS.
     
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  5. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Yanna,

    Once you get Naomi's UTI issues resolved you might be interested at some stage in the future in a supplement called d-mannose. It's the active ingredient in cranberry juice that helps to keep the urinary tract healthy but it's not acidifying.

    Here is a link to an old thread with a useful discussion on d-mannose that you might find helpful to refer to at some stage:

    https://www.felinediabetes.com/FDMB/threads/suggestions-on-urinary-health-cat-foods.146240/

    It might provide some information for you to discuss with your vet if the need arises.


    Mogs
    .
     
  6. Yanna

    Yanna Member

    Joined:
    May 15, 2020

    Hi Mogs!

    I started cornsilk & D-mannose last week but after 2 days I had to stop it. I gave Naomi too much and she bloated. I gave her 1/8 D- mannose as suggested, tried to divide the spoon in eight parts. Seemed OK to my eyes. But then I saw in a group that 1/8 tsp should be the powder you get using your thumb, index and middle finger. So what I gave her was 3 - 4 times more compared to this suggestion.

    Yesterday I tried again, gave her a pinch this time. The same today. So far she's doing good.
     
  7. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Yanna,

    I can highly recommend getting hold of a set of mini measuring spoons, e.g. this set available at Amazon UK. (Try eBay too, might be cheaper there.)

    [​IMG]

    The largest spoon in the above set measures ¼ teaspoon. They're invaluable for measuring kitty-sized amounts of things, and help greatly with dose consistency.

    I initially bought a 3-spoon set but even the smallest spoon in the set wasn't small enough for some things. The 5-spoon set is way better.

    Fingers and paws crossed that the d-mannose will be a help to Naomi.


    Mogs
    .
     
  8. Dusty & Roe

    Dusty & Roe Member

    Joined:
    Apr 28, 2020
    Hi Yanna first Naomi is Beautiful and Welcome to the forum . Hang in there Yanna it can all be overwhelming and frustrating to say the least BUT you are now here with the most knowledgeable nicest people . Keep asking questions I’m not as experienced as the other members but can help out with things I know and if you just need to talk or vent .
    Can I ask about Naomi’s diet what is she eating ? Is it just DM ?
     
  9. Yanna

    Yanna Member

    Joined:
    May 15, 2020
    Critter Mom thanks!
    I'll order the 5-spoon set!

    Thank you Roe!
    We started a renal diet in May but her eating habits have changed since her flare in June. She won't demand her food as before, eats slowly. I give her Hill's kd pouches, it's the only renal food she will eat and I mix it with Sheba Classics pate. Some days she is very good ( can eat 2 pouches & 1 tray) but other days she may have 1 pouch and 1/2 tray). I also mix water with her food. She gets 100ml water a day, maybe more some days depending on the meals she is willing to have.
     
  10. Dusty & Roe

    Dusty & Roe Member

    Joined:
    Apr 28, 2020
    Hi Yanna the reason I was asking is because I know that a low carbohydrate diet can make a difference with trying to get BG levels under control but it’s also important Naomi eats too
    I would feel better if the experienced members comment on a renal diet I’m sure there are members that know about this Hang in there Yanna
     
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  11. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Weruva makes several low phosphorus foods. Zoe actually loves a couple of them.:eek: Shes in stage 1 failure and I'm trying to slow that down. She does still eat some Fancy Feast so I dont know if thats counter productive. Mind you, BOTH Weruva and Merrick are considerably higher priced. :rolleyes:
     
  12. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    @Dusty & Roe -

    Hi there,

    Sometimes diet choices can be very tricky when you're managing multiple comorbid illnesses. The trade-offs can be heartbreaking at times. :(

    * Will the kitty eat a prescription diet?

    * Does the kitty like the prescription food but her digestive system doesn't?

    * If treatment/diet for one condition worsens another condition, what do you do?

    The feline Prime Directive is that a kitty must not go without food for any more than a very short space of time (about 24 hours, then steps should be taken to address the inappetence). Without pretty much constant food intake *any* cat is at risk of developing hepatic lipidosis. If a diabetic cat doesn't eat then that screws up insulin treatment and then you're into potential DKA territory as well.

    If, say, a cat has diabetes and early stage CKD then a low phosphorus, low carb food - even though high protein - can be the most beneficial choice (a number of commercial foods fit this profile - see FDMB and Dr. Pierson's food charts). The higher protein content helps the cat to maintain muscle mass (a problem in later stages of CKD), the lower phosphorus content can help slow progression of the disease, and the low carbs help with BG regulation.

    For cats in later stage renal insufficiency it may be necessary to switch to a lower protein, higher carb food to reduce strain on the kidneys. In this instance, you can work the insulin around the CKD treatment requirements by adjusting the dose to accommodate the increased carb intake.

    Similarly, a cat may have digestive system issues and only be able to tolerate a particular food. For the sake of argument, lets say that the food is a bit carby and also a bit too high in phosphorus. In such a case it would be possible to adjust insulin to balance the carb load and add a phosphorus binder to the food to reduce the amount of phosphorus the kitty absorbs from its grub.

    Reduced down, the kitty and its medical needs and tolerances are the ultimate arbiters of dietary and treatment choices. It's agony when one gets to the stage where necessity forces one to make a decision to favour one condition over another. Whichever course offers the best quality of life is a good steer, IMO.

    I am so grateful to the community on FDMB because the knowledge and lived experience that members share here have helped me so much to help my beloved Saoirse, and also my civvie, Lúnasa.


    Mogs
    .
     
    Last edited: Aug 1, 2020
  13. Dusty & Roe

    Dusty & Roe Member

    Joined:
    Apr 28, 2020
    Mogs that is Excellent information
     
  14. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    'Twas hard won, Roe, hard won indeed... Glad you found it useful. It's my little one's legacy to other kitties and their caregivers, a way of paying forward.

    I've learned so much from the other members here about all manner of cat health issues, not just feline diabetes; they have such a wealth of knowledge and wisdom to share. It helps to read all manner of threads here, especially on the Feline Health board, even if it's not something pertinent to one's own situation at the time. One never knows when one might need the information gleaned at some stage, even if it's a long way into the future. Also one might come across a new kitty on the board and some little nugget of information one has come across earlier may be just the thing needed to help them.


    Mogs
    .
     
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  15. Yanna

    Yanna Member

    Joined:
    May 15, 2020
    Dusty & Roe
    jt and trouble
    Critter Mom

    Thank you for your replies! I appreciate it!

    We live in Greece and I can't find Weruva and the other brands available in the USA. We have Friskies but not the pate in the small can. I have noticed that the phosphorus level is only stated in the renal food which makes it difficult for me when I have to choose a low carb, low phosphorus food.

    Naomi eats Hill's kd mixed with Sheba pate. Sheba pate I think is low carb (I've seen other members in this forum buy it), but I'm not sure how high on carbs is the renal food.

    Naomi has lost weight and muscle mass. Perhaps low phosphorus, low carb and high protein, as Mogs stated above, would be the ideal food for her. I'll have a look at the files and see if anything is available here.

    I'll have to order Phosbinder or Ipatikin from amazon.com. though it takes about a month for the products to arrive.

    Do you think I should post on the Lantus forum for dose advice? I'm really stuck.
     
  16. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    You have to be careful with Phos binders. Unless your kitty is in stage 4(i think it is) it shouldnt be given. Guess it wouldnt hurt to have it on hand if you DO need it thought especially if it takes a long time to arrive. I have a bottle of Phos binder. (Given to me by a friend who lost her kitty) But I havent used it . Zoe is in stage 1...probably 2 by now.:rolleyes: I was told not to give it yet.

    I dont think it would hurt to post on Lantus forum. ;)
     
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  17. Yanna

    Yanna Member

    Joined:
    May 15, 2020


    Thank you!

    Yeah, this is what I'll do, I'll order it now.
     
  18. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
  19. Dusty & Roe

    Dusty & Roe Member

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    Apr 28, 2020
    Yanna how are you and Naomi doing just checking in on you
     
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  20. Yanna

    Yanna Member

    Joined:
    May 15, 2020
    Thanks!


    This is interesting! Didn't know about calcitriol.
    I don't think we've ever checked ionised calcium.
    I'll bring this up to my vet and also if Naomi needs any phosphorus binder at the moment.
     
  21. Yanna

    Yanna Member

    Joined:
    May 15, 2020

    Hi Roe!

    Naomi is better, had two pouches renal and one tray of Sheba so far and it's not even bedtime.

    As for me, I'm making one mistake after the other! Managed to get her BG at 140 this morning, and then get it high again!
     
  22. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Jeanne,

    FYI, sometimes necessity takes over and it can be appropriate to administer a phosphorus binder to cats in an earlier stage of renal insufficiency. For example, because of Saoirse's chronic pancreatitis there was only really one food she could tolerate and it was too high in phosphorus for a CKD kitty. Again because of the pancreatitis she could not tolerate Ipakitin (or Pronefra, a similar concoction) and needed something to help with the phosphorus content in her diet. Saoirse also had blood pressure problems and could not tolerate amlodipine or benazepril so the binder was all I could use to help her kidneys. She was only IRIS stage II. Thankfully she was able to take aluminium hydroxide (AlOH) mixed into her grub. I was able to keep her non-proteinuric and non-azotaemic with the help of the binder.


    Mogs
    .
     
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  23. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Really glad you've introduced Yanna to the MarVista Vet website. It's an absolute goldmine of information, especially for meds and their side effects and interactions.

    :cool:


    Mogs
    .
     
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  24. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I remembered seeing it a while back and thought I'd check to see if it was still here and it was! yay me.:p
     
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  25. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
     
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  26. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi @Yanna,

    If you haven't already heard about it, the go-to site on the web for all things feline CKD is Tanya's Site. There's an overwhelming amount of information but its invaluable. From personal experience I would recommend reading it through gradually. Another word of warning: it is a site with much hope but also much candour - it can be quite hard on the emotions at times, another reason not to take on board too much at once. (I ploughed through it too quickly and it knocked me sideways a bit.)

    With a CKD kitty regular blood tests are a necessity. The lab work will tell you and your vet when the time is right to consider binders and other meds. Indeed, when binders etc. are introduced regular blood tests are needed to establish the correct dose of a treatment or supplement. There's no other way of making sure that blood levels stay in the appropriate safe range. A good working partnership with one's vet is so important. With the likes of CKD it really is necessary to work closely together on diet and meds - doesn't preclude a bit of 'healthy exchange of ideas' [*cough*] now and again! ;)

    If memory serves (I haven't been on the board for quite a while) it's possible to order from zooplus where you are. It might be worth looking at the FDMB UK low carb food list for brands that zooplus carry. IIRC Eliz has included the phosphorus levels in the food list. I know that zooplus lists the phosphorus for all the cat foods they offer.

    Welcome to the club! You're far from alone in feeling like that at times. :bighug:

    Glad to hear Naomi's been eating so well today! Long may that continue. :cool:


    Mogs
    .
     
    Last edited: Aug 1, 2020
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  27. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    @jt and trouble (GA) -

    Yep, you need blood work to tell you when blood phosphates are getting too high. Then you decide with your vet about whichever binding agent is to be used, start at a low dose. After that you need to check bloods every couple of weeks to check the effectiveness of the dose and gradually work your way up if necessary (same sort of drill as finding the right dose of thyroid meds). Once the dose is OK then a longer interval between blood tests is the norm.

    One of the difficulties of managing CKD is that there's no way of home testing, has to be done at the vets. In fairness, you need to keep an eye on so many things - anaemia, phosphates, potassium, BUN, etc., etc. - to guide treatment and diet choices and to keep a kitty as safe and well as possible so it makes the need for blood work easier to come to terms with.

    BTW I only needed to put a microscopic amount of AlOH into Saoirse's meals. Even the miniest of my mini spoons was too big. I used Alu-cap for Saoirse. A single capsule's contents were enough for several days.


    Mogs

    ETA:

    Your vet should order a CBC and kidney panel as a matter of course when monitoring CKD status (plus any other appropriate assays as dictated by your kitty's specific needs). I've seen that IRIS are also using SDMA in their staging assessments nowadays. I'm not sure whether it is included in the basic kidney panel; it needs to be added on at our vets, as does B12/folate. It's never any harm to ask the vet about which tests are going to be run.


    .
     
    Last edited: Jul 31, 2020
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  28. Liang & Nathan

    Liang & Nathan Member

    Joined:
    May 15, 2020
    Great information. Thank you.
     
  29. Yanna

    Yanna Member

    Joined:
    May 15, 2020
    The copy I have for the tests performed July 4th says on top "Renal Panel". I don't see SDMA anywhere so I guess this is an extra. I'll ask my vet next time.

    What I notice in this renal panel is that phosphorus [ 3.7 (3.1 - 7.5)] is much lower compared to the previous results in a different panel 10 days ago [5.7 (3.1 - 7.5)]. Different results, 10 days apart, same reference range.

    Which value should be considered when it's time for the binder. Of course, more blood tests will be done and it's not me who is going to make this decision.

    I'm wondering if there is a matter of accuracy.
     
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  30. Yanna

    Yanna Member

    Joined:
    May 15, 2020
    I discovered Tanya's site and FDMB in May, kind of late!
    I really think that things would be better if I had found all this information earlier!

    I have a pack of print outs from both sites and each time I go through them I find something new, something that slipped my mind, or something I thought it didn't apply to Naomi's case but now it makes sense.
     
  31. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Tanya's Site has info on all manner of symptoms and treatments in addition to the CKD stuff. I came to rely on it greatly. Sometimes there can be short outages on the site and I was so petrified that it might be down some time when I really needed it I actually bought the book. Definitely one of the best purchases I've ever made, and there was an occasion when I needed to rely on it while the website was down. It's sometimes quicker and easier to find stuff in the book than on the site.

    Hope Naomi's eating well for you today. :)


    Mogs
    .
     
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  32. Yanna

    Yanna Member

    Joined:
    May 15, 2020
    Thank you Mogs!

    Definitely worth buying it!

    Naomi is doing great today! She's perked up! My worry is her blood BG, I can't help her on my own. There must be something that I do wrong. BG 400+ today
     
  33. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Glad to hear Naomi's feeling more chipper today. :)

    Blood glucose regulation really wrecks your head at times. I feel for you, Yanna. :bighug:


    Mogs
    .
     
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  34. Yanna

    Yanna Member

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    May 15, 2020
    Thank you!!!
     

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