Sugar control and ckd diet

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Faith was originally diagnosed January 2022, went into remission August same year, put back on insulin at the beginning this year in October. When restarted on insulin they mentioned she is in the early stages of kidney failure (stage 2, which I found out today from a new clinic- was told stage 1 by my original clinic w/the same labs). I’m having a terrible time getting her sugars regulated and I know that’s hurting her kidneys. She only gets 0.5 units bid; for her weight she should supposedly get 1.15 units, but her nadir drops to the low 50’s on one unit. Problem is, her peaks are around 330- not good for her kidneys. Add into this she is 23. I’m desperate to find some way to help her but I’m not sure there is a way. Cats only get regular insulin if they have acromegaly and dosing for her isn’t possible if you follow the 2:1 (L:R)- no way to accurately give 0.25 units. Do I just have to accept that this is the best I can do? Is there a list of foods for ckd sugar cats? I’ve had her 20 years, the idea of having to accept that I can’t help her is killing me.

also, the vet mentioned starting sub q fluids- she drinks really well, I got her a fountain years ago and even when her sugar is controlled she drinks a lot (I’ve monitored it since starting the fountain because it was her first and only uti). Should I start fluids anyway? I thought fluids were for cats with worse damage. I know nothing about ckd- help?
 
Faith was originally diagnosed January 2022, went into remission August same year, put back on insulin at the beginning this year in October. When restarted on insulin they mentioned she is in the early stages of kidney failure (stage 2, which I found out today from a new clinic- was told stage 1 by my original clinic w/the same labs). I’m having a terrible time getting her sugars regulated and I know that’s hurting her kidneys. She only gets 0.5 units bid; for her weight she should supposedly get 1.15 units, but her nadir drops to the low 50’s on one unit. Problem is, her peaks are around 330- not good for her kidneys. Add into this she is 23. I’m desperate to find some way to help her but I’m not sure there is a way. Cats only get regular insulin if they have acromegaly and dosing for her isn’t possible if you follow the 2:1 (L:R)- no way to accurately give 0.25 units. Do I just have to accept that this is the best I can do? Is there a list of foods for ckd sugar cats? I’ve had her 20 years, the idea of having to accept that I can’t help her is killing me.

also, the vet mentioned starting sub q fluids- she drinks really well, I got her a fountain years ago and even when her sugar is controlled she drinks a lot (I’ve monitored it since starting the fountain because it was her first and only uti). Should I start fluids anyway? I thought fluids were for cats with worse damage. I know nothing about ckd- help?

When you talk about the food to give, diabetic cats need to consume wet cat foods between 0-10% carbs, if you are feeding kibbles (hard food) or treats, these contain between 25-45% carbs, cats cannot digest carbs, so that could be a reason why the BG is high, I do not know if you are in the Us but below is a link with a Drs Food chart, the third column will have the amount of carbs for each food, since his Bg went to 50, it is important that you keep handy what is called a HYPO KIT, this contains Karo syrup or honey, some medium carb foods between 11-15% and some high carb foods between 16-24% carbs, this will help you regulate the BG gradually to higher numbers, we can guide you with that if that is the case, in order to help you we need you to create your signature, you are home testing which is great, so you can also create a spreadsheet to collect the daily reading, links below, and guide you with dosing, you can give us the labs, and all possible information, it is overwhelming, but manageable, we are here for you, no concern is a small concern, I will tag another expert that can help you as well
@Bron and Sheba (GA):bighug::cat::cat:


https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
https://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
 
The CKD diabetes food list link , contains a list of foods good for both diabetes and CKD. A great website for CKD is https://www.felinecrf.org/. The food list I linked actually came from that group. That website also helps you look at her blood work, and figure out when is a good time to start fluids.
She only gets 0.5 units bid; for her weight she should supposedly get 1.15 units, but her nadir drops to the low 50’s on one unit.
That means you should reduce the dose to 0.75 units as the 1 unit is taking her too low, given that you are feeding kibbles, which are not best for CKD cats. And yes, you can reliably measure 0.75 units. Either with 1/2 unit marked syringes or using digital calipers. We do not dose insulin by weight, but rather by nadir, or how low the dose takes the cat.
 
The CKD diabetes food list link , contains a list of foods good for both diabetes and CKD. A great website for CKD is https://www.felinecrf.org/. The food list I linked actually came from that group. That website also helps you look at her blood work, and figure out when is a good time to start fluids.

That means you should reduce the dose to 0.75 units as the 1 unit is taking her too low, given that you are feeding kibbles, which are not best for CKD cats. And yes, you can reliably measure 0.75 units. Either with 1/2 unit marked syringes or using digital calipers. We do not dose insulin by weight, but rather by nadir, or how low the dose takes the cat.
I didn’t tell the entire story. The new vet from my previous clinic started her on 2 units- it almost killed her the first dose and I was giving maple syrup and low carb food to keep her alive. I changed her to one unit- that vet told me to keep giving it. I refused and searched out my vet from her original insulin dependent time. When she bottomed out on 1 unit I did drop her to 75; she still went to the 50’s at her nadir. I dropped her to .5 bid 3 days after changing to .75 and at first she still dropped to the 50’s. My current vet told me to hold it if it’s too low but wait, because she was still getting over the higher doses. Then she started disappearing at the time for her am shot and rather than not be on a schedule I skipped it. She has been on .5 units bid for about the last week. At her lowest she is in the 70’s, but her peaks are around 330. Today was hard because she only went to 176 before going back up to the 300’s only 4 hours after reaching 176. I’m just getting a little frantic because she had such an easy time the first go round. I just want to do right by her.. but I don’t know what to do.
 
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When you talk about the food to give, diabetic cats need to consume wet cat foods between 0-10% carbs, if you are feeding kibbles (hard food) or treats, these contain between 25-45% carbs, cats cannot digest carbs, so that could be a reason why the BG is high, I do not know if you are in the Us but below is a link with a Drs Food chart, the third column will have the amount of carbs for each food, since his Bg went to 50, it is important that you keep handy what is called a HYPO KIT, this contains Karo syrup or honey, some medium carb foods between 11-15% and some high carb foods between 16-24% carbs, this will help you regulate the BG gradually to higher numbers, we can guide you with that if that is the case, in order to help you we need you to create your signature, you are home testing which is great, so you can also create a spreadsheet to collect the daily reading, links below, and guide you with dosing, you can give us the labs, and all possible information, it is overwhelming, but manageable, we are here for you, no concern is a small concern, I will tag another expert that can help you as well
@Bron and Sheba (GA):bighug::cat::cat:


https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
https://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

She is super duper picky.. it took a long time the first time around to find foods that she would eat consistently. So of course the Tiki Cat varieties she will eat are not the right ones and her Young Again zero Mature isn’t Health. And the Ziwi Prime and Fancy Feast aren’t even on the list. Now I’m anxious as all get out, because getting her to eat wet food at all is hard- she either eats the entire can in half a day, or she licks off the moisture on top and ignores the rest. The local shelter loves me- she will love a food for a week, I’ll buy a case- she turns up her nose. I keep a few cans just in case, but so far once it’s a no, it stays a no, so they get the rest. And unfortunately some of the weruva were no from last time. I wish she was as easy as the first 20 years- she wanted Sheba perfect portions salmon. She would only eat that for years. When she got sick I bought a can of everything on the list.. looks like I’m back to that. And I have a boo koo of savory centers and regular low carb Tiki Cat.. and Young Again Zero Mature.. and Ziwi Prime..
guess I’m starting again on the food game.
 
Being really picky about food is a sign of nausea. Not uncommon for CKD kitties. You might want to talk to your vet about an anti nausea medication like ondansetron, or possibly Cerenia. I prefer ondansetron for nausea, though it has to be given more often than once a day like Cerenia.
 
Oh- and how do I set up a spreadsheet when I use a Libre? I have a monitor but only use it to double check lows..
Hi Liane and Faith, I see Wendy asked me to jump in here. I use a Libre 3 (and will be moving to a Libre 3 + soon as supplies of 3 dwindle). How do you like the 3 Plus??

Take a look at my spreadsheet as I use my Libre data on all the cells. If my Ivy gets tested for the lows with a handheld meter I notate that in the cell as well. (I have a Contour Plus meter)
A great resource for all things Libre for cats is the “Freestyle Libre for Dogs and Cats” Facebook page. Lots of great information if you’re not yet familiar with it.
I hope this helps you and lots of good luck with your beautiful Faith!! :bighug:
 
Being really picky about food is a sign of nausea. Not uncommon for CKD kitties. You might want to talk to your vet about an anti nausea medication like ondansetron, or possibly Cerenia. I prefer ondansetron for nausea, though it has to be given more often than once a day like Cerenia.
Oh dear. She has been picky her entire life. Even before the ckd. Her labs were perfect in June this year.
 
Hi Liane and Faith, I see Wendy asked me to jump in here. I use a Libre 3 (and will be moving to a Libre 3 + soon as supplies of 3 dwindle). How do you like the 3 Plus??

Take a look at my spreadsheet as I use my Libre data on all the cells. If my Ivy gets tested for the lows with a handheld meter I notate that in the cell as well. (I have a Contour Plus meter)
A great resource for all things Libre for cats is the “Freestyle Libre for Dogs and Cats” Facebook page. Lots of great information if you’re not yet familiar with it.
I hope this helps you and lots of good luck with your beautiful Faith!! :bighug:
I’m not real sure about the 3+ so far. First one went on and counted down just like all my 3’s. Failed 20 hours early. Applied #2, went on fine, counted down.. 7 hours later it said, “signal unavailable, recheck in 5 hours.” I check the help section, it said to turn my Bluetooth on and off. No change. Then it said turn the phone on and off. Still no change. Called Abbott- they told me to replace it and they would send replacements for both (they think Faith is my daughter). Got home from picking up #3, #2 had started working again. I gave it another chance, it went awol again at bedtime. Replaced it- so far, so good. I’m hoping this one does better.
 
I’m not real sure about the 3+ so far. First one went on and counted down just like all my 3’s. Failed 20 hours early. Applied #2, went on fine, counted down.. 7 hours later it said, “signal unavailable, recheck in 5 hours.” I check the help section, it said to turn my Bluetooth on and off. No change. Then it said turn the phone on and off. Still no change. Called Abbott- they told me to replace it and they would send replacements for both (they think Faith is my daughter). Got home from picking up #3, #2 had started working again. I gave it another chance, it went awol again at bedtime. Replaced it- so far, so good. I’m hoping this one does better.
Ugh. Sounds not so great.
Good job getting them replaced for your daughter :cat:
And great you can install them yourself!! :bighug:
 
Ugh. Sounds not so great.
Good job getting them replaced for your daughter :cat:
And great you can install them yourself!! :bighug:
Placing them isn’t hard- a good set of clippers, then an electric razor, clean w/alcohol, skin tac, and pop it on. The biggest part is making sure it’s located where she can’t scratch too well- and her good preemie shirts!
 
Placing them isn’t hard- a good set of clippers, then an electric razor, clean w/alcohol, skin tac, and pop it on. The biggest part is making sure it’s located where she can’t scratch too well- and her good preemie shirts!
Sounds like you have a perfect setup going.
My Ivy wears a “tube top “ because she hated a tee shirt. She was very stressed and chewing through them but doesn’t mind her top now.
Whatever works is what’s best!
 
I used to get onesies and cut the bottom off and hem them, but I found some preemie onesies that fit perfectly and have a thin knit band at the hem that keeps them from riding up- Amazon is hit and miss w/sizing for pet shirts and these are sturdier.
 
Hi Liane and Faith, I see Wendy asked me to jump in here. I use a Libre 3 (and will be moving to a Libre 3 + soon as supplies of 3 dwindle). How do you like the 3 Plus??

Take a look at my spreadsheet as I use my Libre data on all the cells. If my Ivy gets tested for the lows with a handheld meter I notate that in the cell as well. (I have a Contour Plus meter)
A great resource for all things Libre for cats is the “Freestyle Libre for Dogs and Cats” Facebook page. Lots of great information if you’re not yet familiar with it.
I hope this helps you and lots of good luck with your beautiful Faith!! :bighug:
I was just looking at Ivy’s spreadsheet.. do you check the reading hourly round the clock or am I missing how to review hourly readings? I’m using the app, not a reader, so that may be my issue..
 
I was just looking at Ivy’s spreadsheet.. do you check the reading hourly round the clock or am I missing how to review hourly readings? I’m using the app, not a reader, so that may be my issue..
I use the app on MY phone, not hers to get the readings.
You can move the bar to see any exact moment in past 12 hours. Then I just record it so I can see her trends with precision.
 
I use the app on MY phone, not hers to get the readings.
You can move the bar to see any exact moment in past 12 hours. Then I just record it so I can see her trends with precision.
What phone are you using? I can’t get the bar to move. I’m on an iPhone 14 Pro.. and is this in the main screen or a different one? I’m playing now, trying to see if I can figure it out!
 
What phone are you using? I can’t get the bar to move. I’m on an iPhone 14 Pro.. and is this in the main screen or a different one? I’m playing now, trying to see if I can figure it out!
I have a 13 pro but it’s the Libre Linkup App on my phone which lets you move the bar (not the Libre 3 app)
 
OOHH! So I could put that app on my tablet (no desktop or laptop except work- owned) where I was planning to put my spreadsheet to work on it!

I feel better. I thought it was an ITCE error and I couldn’t figure it out. THANK YOU!!
 
OOHH! So I could put that app on my tablet (no desktop or laptop except work- owned) where I was planning to put my spreadsheet to work on it!

I feel better. I thought it was an ITCE error and I couldn’t figure it out. THANK YOU!!
Yep. you can put the app on your tablet and your phone. I have it on both of mine so I can look at it from either place.
And my son also has the app on his phone so he can keep an eye on it when I go out as well.
 
Do you need help setting up the spreadsheet? I can ask @Bandit's Mom to help you.
I very likely will, but I just learned something that answered a lot of my questions. I’ll definitely be reaching out once I start setting it up after work today or tomorrow.

Today might take a while.. my medical foster needs to go back to the rescue.. I’ve been delaying it because I don’t want to send her back to boarding.. but aside from reinforcing her confidence and reassuring her that hands really don’t mean pain even if she makes a mistake, she has gotten all she can from me. (Took her from a super fearful bitey little dog to just anxious and biting isn’t her first response when she is afraid, plus she had medical issues and needed to heal from a mast tumor removal and spay. She is going to make someone a wonderful pet. If anyone wants a chi-dachshund mix, housebroken, crate trained, very eager to please who desperately wants to be owned, message me. She’s under 10 lbs, so a good choice for an apartment or condo. Oh- probably good with younger/not grumpy cats- she tried to befriend Faith and got swatted for her efforts.
 
Thank you. I’m about to start comparing the list to what I can get locally.. she is hit or miss w/chicken, so I’m going to just buy 1-2 of each and keep track of what she likes. She is so picky. I hope I find something..
 
I’m still working on getting the reader set up. It’s not compatible with iPads and I don’t have an old phone that I can find yet I’ll work on the spreadsheet tomorrow.
Hi Liane, just checking back. What reader are you trying to sync with an iPad or something?
You will want to install Libre Linkup app on an iPad to see current readings. (The iPad won’t read the Libre directly).
I bought an in older iPhone 8 on eBay to use for Ivy (it’s her phone and acts as her “reader”) and it sends the data through Libre Link Up app and I have that app on my personal phone. That’s how I see her data 24/7.
Does this make sense?
 
Hi Liane, just checking back. What reader are you trying to sync with an iPad or something?
You will want to install Libre Linkup app on an iPad to see current readings. (The iPad won’t read the Libre directly).
I bought an in older iPhone 8 on eBay to use for Ivy (it’s her phone and acts as her “reader”) and it sends the data through Libre Link Up app and I have that app on my personal phone. That’s how I see her data 24/7.
Does this make sense?
It makes perfect sense. I wanted to put the linkup app on my iPad. It’s not compatible according to the App Store. I don’t have another phone and I can’t put the linkup and reader app on the same phone
 
low carb/ low phosphorus
if you tap on this link and look at post #32 I listed some Weruva pates for another member that's low carb/ low phosphorus with kitties with CKD
https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3124085


@Liane Jacobson
I’m pretty frustrated looking for the low phosphorus wet foods.. but on the semi- bright side, her Ziwi peak steam and air dried kibble is, if I’m reading correctly, acceptable. She loves it, so yay. It’s got 41% protein, 32% usable protein, 8.4% carbs, 1.5% phosphorus. Is my math right? Here is the website link with nutrition info: https://us.ziwipets.com/pages/typic...ss-fed-beef-with-southern-blue-whiting-recipe
 
Once I know what she will eat I probably will- but I don’t want to buy a case until I know she will eat it… I’ve donated cases of food she loved until I bought a case…. I went back and did some creative searches on petco and found enough to start off with. If I get desperate I can hopefully figure more out.. but I have a start, so yay.

I appreciate all the help I’ve gotten from you all- I was feeling completely frantic at learning I was told not to worry about her CKD then finding out she is worse off than I thought. She has appropriate kibble and in an hour she’ll have appropriate wet foods. I feel so much better. Next challenge, get another phone to better set up her spreadsheet (and get that started tonight).
 
They let you buy individual cans..…??? Now I feel dumb. Oh well- live and learn. She has food for now and I’ll go order more!
 
I’m pretty frustrated looking for the low phosphorus wet foods.. but on the semi- bright side, her Ziwi peak steam and air dried kibble is, if I’m reading correctly, acceptable. She loves it, so yay. It’s got 41% protein, 32% usable protein, 8.4% carbs, 1.5% phosphorus. Is my math right? Here is the website link with nutrition info: https://us.ziwipets.com/pages/typical-analysis?q=typical-analysis-cat/ziwi-peak-cat-steam-dried-grass-fed-beef-with-southern-blue-whiting-recipe
Ziwi peak lists on their website the DMB of their food:
https://us.ziwipets.com/pages/typic...-southern-blue-whiting-recipe&tabbedContent=2
From what I see, that phosphorus is too high for a CKD cat… unfortunately…
 
Calcium 1.8%
Phosphorus 1.5%
Ca:P ratio 1.20
Potassium 0.8%
Sodium 1.0%
Choline (mg/kg) 6690
Magnesium 0.14%
Iron (mg/kg) 190
Copper (mg/kg) 38
Manganese (mg/kg) 14
Zinc (mg/kg) 152
Iodine (mg/kg) 3.1
Selenium (mg/kg) 0.6

Ok how do you figure it then? I was thinking 1.5% was within the limits.
 
I’m just frustrated still. She does not like chicken based food, she prefers beef and fish. I’ve tried 2 flavors of what I found yesterday and she is less than enthused and it shows on her readings today. I’m going to keep trying but I’m starting to think maybe get the weruva wx varieties and figure out the least amount of fishy food that she likes to get her to eat it. It’s so frustrating finding food she will eat..
 
Calcium 1.8%
Phosphorus 1.5%
Ca:p ratio 1.20
Potassium 0.8%
Sodium 1.0%
Choline (mg/kg) 6690
Magnesium 0.14%
Iron (mg/kg) 190
Copper (mg/kg) 38
Manganese (mg/kg) 14
Zinc (mg/kg) 152
Iodine (mg/kg) 3.1
Selenium (mg/kg) 0.6

Ok how do you figure it then? I was thinking 1.5% was within the limits.
Unfortunately no, 1.5% is way over the recommended 0.4 to 0.7% DMB for CKD cats.

I know it is frustrating, she#s hooked on fish right? It can be difficult to convince them to get over it, it's super addictive to them!
Anyway, any change you do, go slow.
Do you have any phosphorus binder that you could use in the meantime? Aluminum hydroxide is typically used, it has no taste, can constipate though.
 
Hi Liane, just checking back. What reader are you trying to sync with an iPad or something?
You will want to install Libre Linkup app on an iPad to see current readings. (The iPad won’t read the Libre directly).
I bought an in older iPhone 8 on eBay to use for Ivy (it’s her phone and acts as her “reader”) and it sends the data through Libre Link Up app and I have that app on my personal phone. That’s how I see her data 24/7.
Does this make sense?
Ok, I’m getting a phone to use as a reader. I was so frustrated, I just don’t understand why I can’t install the libre official apps on my iPad. I did find a couple that I can use, so I’m working on learning them.

On the bright side, she has stabilized- in a strange way. Her lantus is lasting 24 hours most days… she rarely goes over 200 except in the evenings. She tends to hang at 80-130 most of the day. So that is something.
 
Ok, I’m getting a phone to use as a reader. I was so frustrated, I just don’t understand why I can’t install the libre official apps on my iPad. I did find a couple that I can use, so I’m working on learning them.

On the bright side, she has stabilized- in a strange way. Her lantus is lasting 24 hours most days… she rarely goes over 200 except in the evenings. She tends to hang at 80-130 most of the day. So that is something.
Good luck with the phone.
I have the Libre Linkup app on my iPad (so I can receive the data in live time on the ipad, same as on my phone).

Those bg readings are great! :bighug:
 
Things had been going well for us, but I think I may be losing her. She dropped from 88 to 53 this morning; I fed her some treats that I keep in a container on the bed to use while I’m fixing canned food during early AM lows.. then I fixed her usual tiki cat and he ate a half a can. And dropped into the 40’s. Gave her a tsp of maple syrup which usually keeps her up until the protein kicks in. She got to 112 but won’t eat anything else (has churn, tiki cat, and her Shameless pets treats that she will usually ALWAYS eat. She isn’t acting uncomfortable (and not even too unusual, mostly irritated that I stuffed the syrup down her throat) and of course I can’t find the dang relion to double check the Libre results… but she is a super elder.. and if it’s her time all of this would be expected. I don’t want to cause her anxiety and stress if she is just trying to leave me… but I want to be sure she is comfortable and has what she needs. What do I do?? She had gone to hide after the syrup but now is back on the bed napping in her usual spot… I hate this..
 
And I was in the ER all day yesterday (kidney stones, yay) so missed charting her results from the previous day so it’s not as informative with a big gap in her spreadsheet..
 
Things had been going well for us, but I think I may be losing her. She dropped from 88 to 53 this morning; I fed her some treats that I keep in a container on the bed to use while I’m fixing canned food during early AM lows.. then I fixed her usual tiki cat and he ate a half a can. And dropped into the 40’s. Gave her a tsp of maple syrup which usually keeps her up until the protein kicks in. She got to 112 but won’t eat anything else (has churn, tiki cat, and her Shameless pets treats that she will usually ALWAYS eat. She isn’t acting uncomfortable (and not even too unusual, mostly irritated that I stuffed the syrup down her throat) and of course I can’t find the dang relion to double check the Libre results… but she is a super elder.. and if it’s her time all of this would be expected. I don’t want to cause her anxiety and stress if she is just trying to leave me… but I want to be sure she is comfortable and has what she needs. What do I do?? She had gone to hide after the syrup but now is back on the bed napping in her usual spot… I hate this..
I hope she’s doing better.
it’s probably best to start a new thread with a question in the headline to get some help and advice. (please link your last post so people will know what’s going on.)

Sending you positive energy :bighug::bighug::bighug:
 
I hope she’s doing better.
it’s probably best to start a new thread with a question in the headline to get some help and advice. (please link your last post so people will know what’s going on.)

Sending you positive energy :bighug::bighug::bighug:
She was in the 50’s for 5 hours.. now she is in the 300’s. I’m so confused.. I don’t know if this was a strange bounce or what. she was stable for days then did this 5 hours in 40-50’s… She had stayed out of the 300’s for 4 days, now this.

but at least she is ok.. I’m not going to do well if she leaves me.
 
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