out of remission :(

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kalypso

Member Since 2019
Hello all!
This was my latest thread:
https://www.felinediabetes.com/FDMB/threads/too-low-glucose-almost-hypo-sos.234110/#post-2619216

My name is Sophia and I am writing on behalf of my friend Dionysia and her diabetic cat Lisa! Lisa first got diabetes due to cortisone injections to control her asthma, got some help with glimepiride pill (Dionysia was too afraid to give insulin) and went into remission 10 months ago. In the meantime, she only had some high glucose values after she got cortisone injection to treat a severe asthma attack but it only lasted for a couple of days or so after the injection and then it was back to normal values. Also, her renal values have risen during this time and she has been trying to help with supplements and food.
Currently Lisa is on a wet renal (animonda and purina) diet of around 7% Kcals. She gets renalvet supplement every day, flixotide 125 oral spray once every 4 days and lysinviral plus supplement also every 4 days. She had been peeing and drinking more lately, and Dionysia measured her bg which was 325! :( Her vet told Dionysia to start Lisa on the glimperide pill again! Dionysia wanted me to ask you why you think her glucose rose, if you think something is to blame and if it happens often! Any insights will be helpful!
 
kalypso said:
Hello all!
This was my latest thread:
https://www.felinediabetes.com/FDMB/threads/too-low-glucose-almost-hypo-sos.234110/#post-2619216

My name is Sophia and I am writing on behalf of my friend Dionysia and her diabetic cat Lisa! Lisa first got diabetes due to cortisone injections to control her asthma, got some help with glimepiride pill (Dionysia was too afraid to give insulin) and went into remission 10 months ago. In the meantime, she only had some high glucose values after she got cortisone injection to treat a severe asthma attack but it only lasted for a couple of days or so after the injection and then it was back to normal values. Also, her renal values have risen during this time and she has been trying to help with supplements and food.
Currently Lisa is on a wet renal (animonda and purina) diet of around 7% Kcals. She gets renalvet supplement every day, flixotide 125 oral spray once every 4 days and lysinviral plus supplement also every 4 days. She had been peeing and drinking more lately, and Dionysia measured her bg which was 325! :( Her vet told Dionysia to start Lisa on the glimperide pill again! Dionysia wanted me to ask you why you think her glucose rose, if you think something is to blame and if it happens often! Any insights will be helpful!
Click to expand...
Sorry she’s out of remission. Did she get any bloodwork done at the vet that you could post? Renal food is usually very high in carbs, and really only necessary if the cat is in stage 4 renal failure. Otherwise what she needs is a low carb food that is also low in phosphorous. It’sposible the food is keeping the numbers high. If there’s any infections or dental problems that can contribute to high numbers too.
 
Hi Janet, thanks for your reply!
Lisa currently eats these two:
Do you think they are too high on carbs? or can be causing high bg anyways?

Here are her latest blood work of a month ago:

γ-GT 4.0 (1.8 - 12) U/l
creatinine 1.80 (0.8 - 1.9) mg/dL
urea 82 (10 - 30) mg/dl
ALT (SGPT) 53.2 (8 - 52) U/l
potassium 5.9 (3.4 - 5.4) mmol/l
sodium 154 (142 - 158) mmol/l
magnesium 2.7 (1.8 - 2.5) mg/dl
phosphorus 6.2 (3.9 - 6.3) mg/dl

WBC 14.2 (5.5 - 19.0) k/μl
LYMPH 3.3 (1.1 - 7.0) k/μl
MXD 0.7 (0.0 - 1.1) k/μl
GRA 10.22 (2.50 - 12.50) k/μl
LYMPH % 23 (20.0 - 55.0) %
MXD % 5.0 (1.0 - 15.0) %
GRA % 72 (35.0 - 75.0) %

RBC 9.2 (5.2 - 10.0) M/μl
HGB 13.6 (9.0 - 15.6) g/dl
HCT 40.5 (29.0 - 51.7) %
MCV 44.0 (41.9 - 56.2) fl
MCH 14.8 (13.0 - 18.0) pg
MCHC 33.6 (28.1 - 32.0) g/dl
RDW 31.8 (14.2 - 17.6) %

PLT 316 (170 - 600) k/μl

How can you tell if she has any infection?
 
The pro plan wet food is 32% carb. way too high. I'd go back to the zooplus over the renal food.

Your cat is VERY early CKD. Barely stage 2. Most don't even realize there's a problem at that level. At this point renal food could do more harm than good... Besides being super high in carbs, renal food is low protein which can lead to muscle wasting. Definitely just go with a low prosperous, low carb wet food. The WBC is creeping up, so I would guess an infection is starting to brew. It looks like he is very dehydrated. Did they give him fluids? He could use them for sure! Add lots of extra water in his food.

This is a good website with pretty much anything you need to know about ckd. http://felinecrf.org/how_bad_is_it.htm
 
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Thanks again Janet!
I calculated the %Kcals from carbs of the purina from the link I listed and I get 7,26%. Mabe it's a different variety than the one in the US? Also, Integra and Smilla are 6,98%. Could the food still be to blame?
Also, I guess she needs to redo the bloodwork and take some antibiotic if WBC are high?
Finally, how do you tell she was dehydrated? I mean from which value?
I have let her know about CKD level and renal food!
 
kalypso said:
Thanks again Janet!
I calculated the %Kcals from carbs of the purina from the link I listed and I get 7,26%. Mabe it's a different variety than the one in the US? Also, Integra and Smilla are 6,98%. Could the food still be to blame?
Also, I guess she needs to redo the bloodwork and take some antibiotic if WBC are high?
Finally, how do you tell she was dehydrated? I mean from which value?
I have let her know about CKD level and renal food!
Click to expand...
I am going to tag @Marje and Gracie who is good at reading labs and may have more insight. If there’s an infection antibiotics could help. Are the teeth ok? The urea is very high disproportionately to the creatinine which is only slightly high which suggests dehydration. You can feel the cats gums and see if they are nice and wet or if they feel tacky/sticky. Also you can see how fast the scruff snaps back when pulled
 
Hi.
I haven’t heard of glimperide being given to cats, but I have heard of gliperzide which makes the pancreas work harder and doesn’t support the pancreas as insulin does as it heals. I would not use it.

You can also check for hydration by feeling the gums. If they are slippery, that is good. If they are tacky, the cat is most likely a bit dehydrated.
To check the teeth you would have to open the mouth if you can. Otherwise the vet would need to check.
 
Can she give the dose while the cat is eating food?
I would not use that pill and it makes the pancreas work hard and can spoil it for another remission.
I would get her teeth checked and also has she been eating only low carb food?
 
I will let her know about the pill and to get the teeth checked!
Lately she eats renal wet food with 7% Kcals from carbs, do you think it could be to blame?
 
kalypso said:
I will let her know about the pill and to get the teeth checked!
Lately she eats renal wet food with 7% Kcals from carbs, do you think it could be to blame?
Click to expand...
Most renal food that I know if is much higher in carbs.
can you find out the actual food she is feeding?
Janet commented earlier in this thread that the cat is very early CRD. They do not need a renal diet. They need to have a low carb, higher protein and a low phosphorus diet.
Have a look at the Weruva cat food site. It will give you all the nutritional information there.
Look for food that is 200 mg phosphorus/100kcals or less.
 
Yes I have posted the actual food links above, can you doublecheck carbs for me?
I know about Lisa not needing renal food, I have let Dionysia know, unfortunately all vets here recommend her renal. Weruva is not available in Greece but there are other low phos alternatives.
 
kalypso said:
Yes I have posted the actual food links above, can you doublecheck carbs for me?
I know about Lisa not needing renal food, I have let Dionysia know, unfortunately all vets here recommend her renal. Weruva is not available in Greece but there are other low phos alternatives.
Click to expand...

These are the carb%
I've calculated them based on the Typical Values listed on the websites you sent. Might make sense to verify that with the values printed on the can/pouch.

Here's a carb calculator:
http://scheyderweb.com/cats/catfood.html

Here's a list of low carb food available in the UK and most of Europe:
https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml
 
Thank you!
Is it possible that these food could trigger the cat to get out of remission? She started them recently
 
Hello again all!
Lisa has been out of remission and on glimperide pill for 3 weeks now. She eats low carb low phos wet food. My friend Dionysia says her symptoms have improved, but not her bg values which are in 300s. Here are her latest lab results:
blood tests (8/4/2021):
WBC 12.63 x10E9/L (6.30 - 19.60)
RBC 8.39 x10E12/L (6.00 - 10.10)
hemoglobin 12.2 g/l (8.1 - 14.2)
hematocrit 36.8 % (22.7 - 46.8)
MCV 43.9 fl (41.3 - 52.6)
MCH 14.6 pg (12.0 - 16.0)
MCHC 33.3 g/dL (27.0 - 32.8)
CHCM 33.90 g/dL (26.90 - 33.00)
CH 14.9 pg (12.0 - 16.0)
RDW 17.9 %CV (14.4 - 19.4)
HDW 3.18 % (1.60 - 2.90)
% neutrophil 59.7 (29.5 - 74.5)
% lymphocyte 31.7 (20.0 - 61.2)
% monocyte 2.4 (0.2 - 5.0)
% eosinophil 5.8 (3.4 - 11.4)
% basophil 0.2 (0.0 - 1.0)
Neutrophils 7.54 (3.00 - 13.40)
Lympocytes 4.01 (2.00 - 7.20)
Monocytes 0.31 (0.00 - 1.00)
Eosinophils 0.74 (0.30 - 1.70)
Basophils 0.03 (0.00 - 0.10)
platelets 343 x10E9L (156 - 626)
MPV 19.2 fl (8.6 - 18.9)

BUN 26 mg/dL (18.0 - 41.0)
creatinine 1.22 mg/dL (0.70 - 2.20)
potassium 4.3 mmol/L (3.9 - 5.3)
albumin 3.9 g/L (3.0 - 4.6)
glucose 363 mg/dL (64.00 - 144.00)
fructozamine 442 μmol/L (174 - 294)
ALT (SGPT) 59 IU/L (6.0 - 83.0)
phosphorus 5.4 mg/dL (2.9 - 8.1)
gamma GT 1.26 IU/L (< 2.00)
T4 1.66 μg/dL (1.45 - 4.70)
blood pressure 11

urine tests (16/4/2021):
USG 1010
creatinine 24.07 mg/dL
protein 3.7 mg/dL
color yellow
looks clear
ph 7
white blood cells +
red blood cells ++
glucose 500 mg/dL
urine culture negative

Please give us your insights on the above. Dionysia is particularly wondering why bg values are not getting lower although she sees improvement in symptoms.
 
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