chronic kidney disease kitty newly diagnosed diabetic

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Pennie & Chloe

I had posted this in introduction and it was suggested I post here also:

Hello, feeling overwhelmed with this new diagnosis. I have so many questions and concerns, including the best glucose meter to get, as I'd like to run out to Walgreens or Walmart this afternnon and pick one up, along with whatever else I need, test strips...what kind, etc.

Chole had her curve done yesterday with one unit of Lantus Glargine checked every 2 hours..results:
9am-625
11am-593
1pm-549
3pm-531
5pm-462

They sent her home with instructions to give 2 units every 12 hours and repeat curve on 9/8. She weighs 12.15 pounds.

We have a challenge here because Chloe does not eat a lot at once, she has always been a grazer and she is a kibble addict. I have tried to switch her and my 3 other cats over to wet following cat info.org advise and help from many others. I was successful in this transition to Merrick grain free limited ingredient for all cats except Chloe. I have tried forti flora, toppers, raw, and have spent hundreds of dollars I think..lol..buying all kinds of wet and raw food for her to try. So please dont think I am a bad cat mom for feeding her kibble. She is being fed Hills KD right now because that is what she is drawn too. I also have some Orijen kibble which is higher protein and she does eat some of that also. For treats she gets wellness with cranberry crunchies and pure bites dehydrated chicken or turkey. I have tried multiple times to feed her and the others boiled and raw chicken breast organic, no antibiotics that I have prepared...none of them will eat it..no onions, garlic, etc.

She gets subq fluids every other day between 75-100ml. We are very carful with her because she had issues with fluid around her heart when we first started. At this point she seems to do very well with this fluid schedule which she also gets 0.50 Vitamin B12 injectable with her fluids once per week. She takes azodyl and 1/2 pepcid at the same time once per day which also seems to work very well for her. Her creatinine at last blood draw on 8/27 was 2.5, bun 39. this is when her glucose was 605. I took her in because her water intake had increased dramatically.

I work 3-11 shift Monday through Friday and this is a feeding/insulin schedule I came up with for now:
Feed at 8:30 am
Insulin at 9:30 am

Leave food down until around 6 pm(ish)

Feed at 11:15 pm
Insulin 11:45-midnight

Pick up before bedtime so I know she eats some in the morning.

On the weekends I can do 12 hours apart, no problem.

Thanks for taking the time to read this. :)

Update: I went to Walgreens tonight and got a One Touch Ultra Mini. When I tested it was 398.
 
Hi Chloe's mom!! (could we know what to call you other than Chloe's mom?) Welcome to the FDMB!! The best place you never wanted to be!!

It sounds like you have a tough kitty on your hands when it comes to food, but if you can get her eating a lower carb kibble, it'll help with the diabetes. There are only 2 dry foods that are low carb...Evo Cat & Kitten and Young Again Zero Carb....but keep trying to get her transitioned to canned because the more water you can get into her, the better it'll be for her kidneys!!

Have you checked into Tanya's Comprehensive Guide to CKD? It's kind of the Bible of kidney disease sites.

As far as the diabetes goes, you've got a great insulin .....Lantus is one of the best! You have been started on a pretty high dose though....we usually start at somewhere between .5 and 1U every 12 hours and then through home testing make increases in .25 unit increments.

Since you're still feeding dry, the protocol we would have you use is called Start Low, Go Slow. I've given you the link so you can read about it!

It takes 5-7 days of the same dose (unless they drop below 90) to build up the depot that Lantus has, so you'd be holding the starting dose for at least that long. You ALWAYS test before shooting to make sure they're high enough to shoot at all, and then IF YOU CAN, get mid-cycle tests on the AM cycle (like around 5-7 hours after the shot) and then it's always very important to get a "before bed" shot on the PM cycle (most cats go lower at night, so it's really important!)

You don't want them to eat for the 2 hours before those "Pre-shot" tests, so that you know their numbers aren't influenced by food.

It's also important to give the shots as close to every 12 hours as possible. With your schedule, I might suggest waiting and giving Chloe her shot at around 11:30 in the morning so when you get home at night, you'd be able to shoot again at 11:30PM....You could still feed her early in the morning if that's her usual routine too as long as you take up the food by 9:30am!

We have a spreadsheet we use around here that will be a very valuable tool for you to have. Here are Instructions on getting the FDMB spreadsheet

I don't want to overwhelm you (if I haven't already!) so ask any questions you may have and we'll be happy to help answer them! The people here are very good with their time and experience!
 
Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning, pre-shot, test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening, pre-shot, test)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

It is merely a grid for storing the info; no math required.
 
Chris & China said:
Hi Chloe's mom!! (could we know what to call you other than Chloe's mom?) Welcome to the FDMB!! The best place you never wanted to be!!

It sounds like you have a tough kitty on your hands when it comes to food, but if you can get her eating a lower carb kibble, it'll help with the diabetes. There are only 2 dry foods that are low carb...Evo Cat & Kitten and Young Again Zero Carb....but keep trying to get her transitioned to canned because the more water you can get into her, the better it'll be for her kidneys!!

Have you checked into Tanya's Comprehensive Guide to CKD? It's kind of the Bible of kidney disease sites.

As far as the diabetes goes, you've got a great insulin .....Lantus is one of the best! You have been started on a pretty high dose though....we usually start at somewhere between .5 and 1U every 12 hours and then through home testing make increases in .25 unit increments.

Since you're still feeding dry, the protocol we would have you use is called Start Low, Go Slow. I've given you the link so you can read about it!

It takes 5-7 days of the same dose (unless they drop below 90) to build up the depot that Lantus has, so you'd be holding the starting dose for at least that long. You ALWAYS test before shooting to make sure they're high enough to shoot at all, and then IF YOU CAN, get mid-cycle tests on the AM cycle (like around 5-7 hours after the shot) and then it's always very important to get a "before bed" shot on the PM cycle (most cats go lower at night, so it's really important!)

You don't want them to eat for the 2 hours before those "Pre-shot" tests, so that you know their numbers aren't influenced by food.

It's also important to give the shots as close to every 12 hours as possible. With your schedule, I might suggest waiting and giving Chloe her shot at around 11:30 in the morning so when you get home at night, you'd be able to shoot again at 11:30PM....You could still feed her early in the morning if that's her usual routine too as long as you take up the food by 9:30am!

We have a spreadsheet we use around here that will be a very valuable tool for you to have. Here are Instructions on getting the FDMB spreadsheet

I don't want to overwhelm you (if I haven't already!) so ask any questions you may have and we'll be happy to help answer them! The people here are very good with their time and experience!
Click to expand...
Chris & China said:
Hi Chloe's mom!! (could we know what to call you other than Chloe's mom?) Welcome to the FDMB!! The best place you never wanted to be!!

It sounds like you have a tough kitty on your hands when it comes to food, but if you can get her eating a lower carb kibble, it'll help with the diabetes. There are only 2 dry foods that are low carb...Evo Cat & Kitten and Young Again Zero Carb....but keep trying to get her transitioned to canned because the more water you can get into her, the better it'll be for her kidneys!!

Have you checked into Tanya's Comprehensive Guide to CKD? It's kind of the Bible of kidney disease sites.

As far as the diabetes goes, you've got a great insulin .....Lantus is one of the best! You have been started on a pretty high dose though....we usually start at somewhere between .5 and 1U every 12 hours and then through home testing make increases in .25 unit increments.

Since you're still feeding dry, the protocol we would have you use is called Start Low, Go Slow. I've given you the link so you can read about it!

It takes 5-7 days of the same dose (unless they drop below 90) to build up the depot that Lantus has, so you'd be holding the starting dose for at least that long. You ALWAYS test before shooting to make sure they're high enough to shoot at all, and then IF YOU CAN, get mid-cycle tests on the AM cycle (like around 5-7 hours after the shot) and then it's always very important to get a "before bed" shot on the PM cycle (most cats go lower at night, so it's really important!)

You don't want them to eat for the 2 hours before those "Pre-shot" tests, so that you know their numbers aren't influenced by food.

It's also important to give the shots as close to every 12 hours as possible. With your schedule, I might suggest waiting and giving Chloe her shot at around 11:30 in the morning so when you get home at night, you'd be able to shoot again at 11:30PM....You could still feed her early in the morning if that's her usual routine too as long as you take up the food by 9:30am!

We have a spreadsheet we use around here that will be a very valuable tool for you to have. Here are Instructions on getting the FDMB spreadsheet

I don't want to overwhelm you (if I haven't already!) so ask any questions you may have and we'll be happy to help answer them! The people here are very good with their time and experience!
Click to expand...

Hi Rhonda. My name is Pennie...added to my signature this morning. Very familiar with Tanya's site. In fact that is where this is from: Although canned foods are generally a better choice for CKD cats than dry foods, since phosphorus control is so important, if I had a cat who was prepared to eat a dry prescription diet, I would feed that rather than feed a non-prescription commercial canned diet with added binders. She is eating the Hils kidney diet for the most part at this time. She was at stage 3, but with this food and fluid increase her values dropped nicely. I still always offer her wet and will look into those other foods you mentioned. As a mater of fact I had those links saved from yesterday as I was doing all this reearching.

She had 1U insulin at her curve on Friday. Since then I gave her 2U Frinday night, Saturday AM and PM. This was prescribed by her vet with a return curve visit on 9/8. My questions are, should I start her on 1U this morning at 11:30 and should I cancel her next curve appointment and do myself at home, which would have to be done on a weekend. I understand to pick her food up 2 hours before testing and shooting-how soon do I put the food back down?

Now I'm going to look into the spreasheet. Thank you so much for all your help!
 
Chloe's Mom said:
Hi Rhonda. My name is Pennie...added to my signature this morning. Very familiar with Tanya's site. In fact that is where this is from: Although canned foods are generally a better choice for CKD cats than dry foods, since phosphorus control is so important, if I had a cat who was prepared to eat a dry prescription diet, I would feed that rather than feed a non-prescription commercial canned diet with added binders. She is eating the Hils kidney diet for the most part at this time. She was at stage 3, but with this food and fluid increase her values dropped nicely. I still always offer her wet and will look into those other foods you mentioned. As a mater of fact I had those links saved from yesterday as I was doing all this reearching.

She had 1U insulin at her curve on Friday. Since then I gave her 2U Frinday night, Saturday AM and PM. This was prescribed by her vet with a return curve visit on 9/8. My questions are, should I start her on 1U this morning at 11:30 and should I cancel her next curve appointment and do myself at home, which would have to be done on a weekend. I understand to pick her food up 2 hours before testing and shooting-how soon do I put the food back down?

Now I'm going to look into the spreasheet. Thank you so much for all your help!
Click to expand...
@Chloe's Mom , I think most of that response should have been directed @Chris & China

Regarding the curve, if you can test every two hours for 12 hours, or every three hours for 18 hours, I would cancel. The numbers will be normal at home without vet stress, and save you a lot of money.

Regarding putting the food back down, our normal routine is test, feed and shoot, so as soon as you get the pre-test shot, you can put the food back down.
 
The only comment I have is that kitties with CKD really shouldn't get anything with cranberries. This from crf.org:

"You should avoid giving cranberry or food containing cranberry to CKD cats - it is too acidic for CKD cats, who tend towards acidosis anyway. Cranberries also contain benzoic acid, which cats lack the pathways to metabolise. The active ingredient in cranberries is D-Mannose, so you could consider giving D-Mannose to a cat who is prone to urinary tract infections"
 
Oh shoot, you are right. Will take care of that right away.
 
Chris & China said:
Hi Chloe's mom!! (could we know what to call you other than Chloe's mom?) Welcome to the FDMB!! The best place you never wanted to be!!

It sounds like you have a tough kitty on your hands when it comes to food, but if you can get her eating a lower carb kibble, it'll help with the diabetes. There are only 2 dry foods that are low carb...Evo Cat & Kitten and Young Again Zero Carb....but keep trying to get her transitioned to canned because the more water you can get into her, the better it'll be for her kidneys!!

Have you checked into Tanya's Comprehensive Guide to CKD? It's kind of the Bible of kidney disease sites.

As far as the diabetes goes, you've got a great insulin .....Lantus is one of the best! You have been started on a pretty high dose though....we usually start at somewhere between .5 and 1U every 12 hours and then through home testing make increases in .25 unit increments.

Since you're still feeding dry, the protocol we would have you use is called Start Low, Go Slow. I've given you the link so you can read about it!

It takes 5-7 days of the same dose (unless they drop below 90) to build up the depot that Lantus has, so you'd be holding the starting dose for at least that long. You ALWAYS test before shooting to make sure they're high enough to shoot at all, and then IF YOU CAN, get mid-cycle tests on the AM cycle (like around 5-7 hours after the shot) and then it's always very important to get a "before bed" shot on the PM cycle (most cats go lower at night, so it's really important!)

You don't want them to eat for the 2 hours before those "Pre-shot" tests, so that you know their numbers aren't influenced by food.

It's also important to give the shots as close to every 12 hours as possible. With your schedule, I might suggest waiting and giving Chloe her shot at around 11:30 in the morning so when you get home at night, you'd be able to shoot again at 11:30PM....You could still feed her early in the morning if that's her usual routine too as long as you take up the food by 9:30am!

We have a spreadsheet we use around here that will be a very valuable tool for you to have. Here are Instructions on getting the FDMB spreadsheet

I don't want to overwhelm you (if I haven't already!) so ask any questions you may have and we'll be happy to help answer them! The people here are very good with their time and experience!
Click to expand...

Hi Chris and China. I hope I am doing this right, I posted this to the wrong place a bit ago. My name is Pennie...added to my signature this morning. Very familiar with Tanya's site. In fact that is where this is from: Although canned foods are generally a better choice for CKD cats than dry foods, since phosphorus control is so important, if I had a cat who was prepared to eat a dry prescription diet, I would feed that rather than feed a non-prescription commercial canned diet with added binders. She is eating the Hils kidney diet for the most part at this time. She was at stage 3, but with this food and fluid increase her values dropped nicely. I still always offer her wet and will look into those other foods you mentioned. As a mater of fact I had those links saved from yesterday as I was doing all this reearching.

She had 1U insulin at her curve on Friday. Since then I gave her 2U Frinday night, Saturday AM and PM. This was prescribed by her vet with a return curve visit on 9/8. My questions are, should I start her on 1U this morning at 11:30 and should I cancel her next curve appointment and do myself at home, which would have to be done on a weekend. I understand to pick her food up 2 hours before testing and shooting-how soon do I put the food back down?

Now I'm going to look into the spreasheet. Thank you so much for all your help!
 
BJM said:
Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning, pre-shot, test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening, pre-shot, test)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

It is merely a grid for storing the info; no math required.
Click to expand...

Thank you very much for this info, very helpful!
 
:bighug:

I've just recently started down the CKD path myself. Saoirse was diagnosed early stage II at the end of March this year. :(


Mogs
.
 
Critter Mom said:
:bighug:

I've just recently started down the CKD path myself. Saoirse was diagnosed early stage II at the end of March this year. :(


Mogs
.
Click to expand...
There are a couple of very good Facebook groups that have really helped me manage Chole's ckd. Maybe you already are aware of them. If you'd like any info about them or if I can help in any way, please let me know. I'm still learning, but if I can help I will :)
 
Hi Pennie!

Sorry not to get back to you sooner...had to take my mom to church this morning!

Since Chloe is a new diabetic, I'd suggest starting at 1 unit and holding that dose for the next 5-7 days while you get tests any time you can. If you decide to change your shooting schedule to 11:30/11:30, if you can get a +2 or +3 every day on the AM cycle (so around 1:30-2:30pm) that can really help. It can also let you get an idea if you should leave some extra or higher carb food down in case Chloe looks like she might be dropping quickly when you have to leave for work!

If you can't get a curve in until next weekend, then plan on doing it at home (cancel the vet) and do it when you can and then (depending on what we see then) you may need to increase, but only in .25 unit increments, so it's important to have syringes that have half unit markings. .25 doses have to be "eyeballed" or measured with calipers since nobody makes syringes with .25 unit markings :(

Since she is eating the K/D, she is probably going to need a higher dose of insulin, but it's better that we raise slowly and make sure it's done safely. Tiny amounts of insulin can make huge differences so we don't ever do increases in whole units

Are you testing for ketones too? That's another important thing to do when you can because anything more than a trace is a medical emergency that will require her to get to the vet
 
No problem. Wasn't sure so gave her 1.5 this morning. I will definitely go with the 1130a and 1130p schedule. I was basing the other schedule on info I received from vet tech. This group has been our saving grace.

They gave me a box of 100 needles but they do not have the half amounts just full units. Where could I get the ones you are describing..online?

How do I test for ketones?

Rhonda has started a spreadsheet for me. I think I need to set up a Google accout. Once I figure it out she also gave me instructions to add to my signature. Will have that all in place soon.

This has been a lot to take in but everyone here has helped me so much already..very thankful.

I plan to do her curve at home one week from today as next Saturday I won't be home the full 12 hours to do properly.

Will test her before work as you suggested.
 
If you want to get the syringes online, American Diabetes Wholesale is a great company and a lot of people here use them. The UtiCare syringes (60 in a box) come with half unit markings as do the BD U100 syringes (100 in a box)

You can also get them from WalMart...their Relion 3/10mL, 30 or 31 gauge, 8mm syringes come with half unit markings for $12.58 per box of 100 (a lot of times even if you ask, they'll tell you they don't, but trust me, they DO!)
relion syringes.png (click on pic to expand)

To test for ketones, you'll need to get some ketone test strips. They're about $7 at WalMart (I'm sure ADW has them too) and here are some Urine Testing Tips to help you with the "how" part
 
Ok, will get those this week. What higher carb foods should I have on hand? All I was told to get from vet was karo syrup.
 
Fancy Feast Gravy Lovers, or any food with gravy is likely to do the trick.
You can make gravy at home, too. Pick the protein, make a stock, slowly add flour to thicken while stirring frequently.
 
When I do Chloe's curve on Sunday, does that mean she cannot eat anything at all for 12-14 hours?
 
No...you Test/Feed/Shoot....all within about 5-10 minutes.....Test (to make sure they're high enough for any insulin), Feed (to make sure they're eating "normally") and Shoot

It's fine to break up the total amount they eat into "mini-meals"...it's easier on the pancreas to deal with smaller meals anyway instead of 2 huge meals. Most of us feed mini-meals but try to get most of the food in the first half of the cycle so that when the insulin is starting to wear off anyway, we're not adding carbs too, but some of us can feed right up until +10 without problems.

It's one of those things that you just have to see how YOUR cat does! ECID! (Every Cat Is Different)

By keeping track of when you feed on the spreadsheet, you can sometimes start to see a pattern too
 
Right I understand that for a normal day. Was just inquiring about when I do the 12 hour curve on Sunday...can she eat during it except for the first 2 hours before the injection ?
 
Yes, if that's what she'd normally do, you want your curve days to be as close to every other day as possible so you know what's going on most of the time when you're not there
 
Oh I did not realize that curves were so often. I need to read up on this more.
 
If she'd normally have access to food during the day when you're not at home to test, you want "curve days" to be as much like any other day as possible
 
Yes, that is the case. Cut off for food is at 930p so I can test at 1130p. Then food goes back down until 9:30a.
 
Last edited by a moderator:
Chris & China said:
Yes, if that's what she'd normally do, you want your curve days to be as close to every other day as possible so you know what's going on most of the time when you're not there
Click to expand...
Pennie, what Chris was saying was that you want your curve days to be as normal as possible. Not that you want to do a curve every other day. If you would do it regularly, do it on your curve day as well.
 
I'm seeing replies in email. Have been so busy trying to fit in all I need to do before work each day. I'll get used to it."lol. I also have to go to the gym now 3 times a week for bone loss in my lumbar area, osteoporosis. My time before work is jam packed. I have been testing and writing everything down. I'm trying to get the spreadsheet set up on my iPad using apps.

Thanks for clarification on the curves Rhonda. I was thinking every other day and thinking how am I going to pull that off. As I read the post from Chirs again, it is very clear. I know it's because this is so new and I am so tired and not thinking clearly.

Chloe's numbers are still high but she is drinking less, peeing less, her stools are not as soft and I notice quite a difference with the one insulin unit verses two. She's doesn't act as doped up, is the only way I can think to put it. I'll have the SS up by tomorrow or tonight if I'm lucky.

Thanks so much!
 
Have the spreadsheet set u,p all numbers are in thus far. The ones that done have the numbers after her curve at the vet were the injections given before I had the meter to do the testing. Doing her curve at home Sunday.
 
I can see your spreadsheet just fine.

When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2 hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name | cat's name | date of Dx (diagnosis) | insulin | meter
general location (city and state/province)
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.
 
Thank you, I'll add her ckd diagnosis date later tonight when I get home.
 
I've ordered syringes with the half marks, more test strips which I got twice as much for the same price at Amazon, ketone test strips and a white board so I can keep track of our busy schedules. I'm off tomorrow so am trying to stay up until 1:30 to test my sweet girl again before bed.
 
Made it till 130a to test again. Can update SS from my phone too now, very convenient.
 
Yeah Pennie!!! You're doing good!!

Now that you have your spreadsheet up, I'd like to invite you over to the Lantus Forum to start posting. You'll get the most experienced eyes over there and everyone understands how to use Lantus/Levemir

Here's some info on "Making the most of your ISG experience" to help guide you on how we post over there too....You'll also learn a lot just by looking at how others post

Sure would like to see Chloe out of those icky blacks....I think you're testing just enough that you could try going with the Tight Regulation Protocol too.

Here's some reading for you on "IS TIGHT REGULATION POSSIBLE WITH A FULL TIME JOB? YES!"

Also, as you start to read about other Lantus cats over there, you'll think of questions you hadn't even considered yet!

Hope to see you posting in the Lantus/Levemir forum soon!!
 
Have read the tight regulation post and was browsing the Lantus area last night. Thanks for pointing me in the right direction.
 
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