New, Liam. Overwhelmed, struggling to regulate CKD kitty

[Teanuhb]

Hello,

My Liam is 12 years old. He was diagnosed with FD back in late March. I have been working with an internist to help regulate him but every time we give him a new dose he seems to bounce back for a few days and then get worse again. He has CKD and the vet has recommended he continue to eat the kidney diet. However, I'm concerned about the carbohydrate content counteracting the efficacy of the insulin. He's up to 3u of Glargine (Semglee) and this morning I gave him 3.5 because his BG was over 300. Throughout the day his numbers have been all over the place (I'm now home testing) with AlphaTrak

His polyuria and polydipsia have improved but he's hungry all the time. He has gained some weight, which is encouraging but it's so frustrating to see his numbers spike today.

I have tried feeding him small meals 4 times a day, which means he will often wake me up at 4am asking for food. I've also tried giving two meals, twice a day with an active treat session or two where he runs up and down the stairs to get freeze dried chicken treats.

I feel like I'm failing him, I feel awful that he likely feels ill and I don't really know where to go from here.

My questions are:

How many days should I wait before I increase insulin if his numbers remain high?

How much will the freeze dried treats spike his blood glucose?

Would it be worthwhile to try to feed a low-carb, low phosphorous food (I have some Weruva Steak Frites) to see if that might help his blood sugar? I'm worried that if his diabetes remains this far out of control it's going to quickly hurt his kidneys, if it hasn't already.

Would it be preferable to continue feeding 4 meals a day or 2? I have seen some people on here give glargine 2 hours after food and some give with food. The vet told me one hour which is what I've been doing. Should I try giving with food since his numbers spike so quickly after he eats?

I realize this is a lot and probably quite scattered. It's been a rough day of poking him to get BG readings only to find out his condition has worsened.

Thanks in advance for your kindness and help.

https://docs.google.com/spreadsheets/d/1AdS1BfJZ-gMgu8lF8ZrHdSF694rk2Wkb8atpAdLNVjE/edit?usp=sharing

Christina

 

[Chris & China (GA)]

How many days should I wait before I increase insulin if his numbers remain high?

It would depend on the dosing method you choose. There are 2 different methods, Tight Regulation and Start Low, Go Slow. TR gives the best chance at remission because you can increase the dose as often as every 3 days if the current dose isn't getting him where you want him but it does require more testing on the caretaker's part (and sometimes balls of steel). SLGS has you hold the dose for at least 7 days and then running a curve before deciding on an increase.

How much will the freeze dried treats spike his blood glucose?

Very little....that's why most of us use them.

Would it be worthwhile to try to feed a low-carb, low phosphorous food (I have some Weruva Steak Frites) to see if that might help his blood sugar? I'm worried that if his diabetes remains this far out of control it's going to quickly hurt his kidneys, if it hasn't already.

Absolutely!! The kidney diet is not only very high in carbs, it's very low in protein. It used to be that vets suggested restricting protein but newer research says that you want them eating a good quality protein and that restricting it just leads to muscle wasting. The Weruva foods are MUCH higher quality protein as well as being low carb/low phos.

Would it be preferable to continue feeding 4 meals a day or 2? I have seen some people on here give glargine 2 hours after food and some give with food. The vet told me one hour which is what I've been doing. Should I try giving with food since his numbers spike so quickly after he eats?

Most of us feed our cats multiple small meals several times a day. It's easier on the pancreas to deal with smaller meals as well as keeping kitty a lot happier too! The "2 meals a day" rule is old school and more meant for the harsher insulin's like Vetsulin, Novolin, Humulin. In those cases, it was important that there was a big meal on board when the insulin kicked in. With Glargine, we don't have to worry about that.

You do want to take food up for 2 hours before shot times so that when you test, you get a number that's not influenced by food. For the rest of the cycle, feed as you normally would (or plan to) and don't worry about the time between the food and the test. It only matters for those 2 tests...the AMPS and PMPS.

Since Glargine is a gentler insulin, it doesn't usually start to kick in for 2-3 hours after the shot, so most of us Test/Feed/Shoot, all within about 5-10 minutes. We test to make sure they're high enough for insulin, Feed to make sure they're at least willing to eat and Shoot, usually with their head still in the food bowl. Because you do have some time before the shot kicks in, it's OK if kitty wants to take his time eating his meal.

You might want to consider getting an auto-feeder like the PetSafe 5 or CatMate 5. You can program it to open and offer a fresh meal ...which is really nice at 4am!....and you can program it to open to an empty slot 2 hours before shot times so that you know he hasn't eaten for those 2 hours.

Great job getting the spreadsheet going, but now you're going to have to get busy testing! You should always test before each shot, and get at least 1 mid-cycle test on the AM cycle and at least a "before bed" test on the PM cycle.

Once you get several days worth of data on your spreadsheet, we'll be able to help you more.

 

[Teanuhb]

Wow, this is so incredibly helpful. More information than I have gotten from the two internists we've seen. Thank you so much! I will try the Test/Feed/Shoot and Feed/Shoot going forward since he happily eats all of his food at mealtime. We have been doing SLGS but will do another curve tomorrow since I increased to 3.5 and see how he does, reevaluate whether we should start TR.

Do you typically feed based on the quantity (per weight) on the can? This is what I've been doing but he just seems so hungry lately that I'm wondering if I should give him more of if it's a symptom of his diabetes.

Thank you again.

Edited to add: I did get a petsafe feeder for him in hopes that he wouldn't wake me at 4am but of course now he paws at it aggressively and very loudly at bedtime to try to get into it.

 

[Diane Tyler's Mom GA]

Hi Christina, I have to say Liam is such a cutie
Might be a good idea to set up your signature, it's at the end of everyone's post in gray

Click on your name upper right hand corner , a drop down will appear , tap in signature , fill out info

• On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback. There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

 

[Diane Tyler's Mom GA]

Do you typically feed based on the quantity (per weight) on the can? This is what I've been doing but he just seems so hungry lately that I'm wondering if I should give him more of if it's a symptom of his diabetes.

How much does Liam weigh?
The general rule of thumb is about 20 calories per pound of ideal weightweight
So what would be his ideal weight?
Example

If he should weight 16 pounds
20x16=320 calories

If he should weigh 14 lbs
20X14=280 calories

 

[Chris & China (GA)]

Do you typically feed based on the quantity (per weight) on the can? This is what I've been doing but he just seems so hungry lately that I'm wondering if I should give him more of if it's a symptom of his diabetes.

Until his glucose is under better control, he'll probably be hungrier than normal because no matter how much he eats, the glucose that each cell in the body needs is hanging out in the bloodstream instead of moving into the cells to feed them. Think of insulin like a key and on every cell there's a lock. Without the keys, the glucose just stays in the blood and no matter how much food he eats, he's still basically starving to death.

A good starting point is usually 20 calories per pound of ideal weight, then weigh once a week and adjust as needed. You can use a plain bathroom scale or a lot of us buy baby scales so we can get more accurate numbers.

I did get a petsafe feeder for him in hopes that he wouldn't wake me at 4am but of course now he paws at it aggressively and very loudly at bedtime to try to get into it.

Cat's....gotta love 'em!! Hopefully once his diabetes is better controlled, he'll let you sleep a little later.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!!

Great jog with getting Liam's spreadsheet set up and with testing. In addition to what you're already doing, you'll also want to get at least a "before bed" test every night during the PM cycle. Many cats experience lower numbers during the PM cycle. If that's the case with Liam, you might end up missing a dose reduction. In addition, without PM numbers, you're missing half of your data.

One other suggestion -- If the 2 days of data were from April, you may want to put a blank line or two between them and your June data. I wasn't looking carefully and assumed they were from this month.

Depending on what stage your cat's CKD is, you may want to discuss a phosphorus binder with your vet. You can feed Liam any low carb food since the binder prevents the phosphorus from effecting Liam's kidneys. If he's early in his CDK, a low carb/low phos food should be fine.

 

[Teanuhb]

Thanks all! I will work on my signature and on calculating how much he should eat.

he was diagnosed with CKD a couple years ago and his numbers have remained stable with the kidney diet and low phosphorous food. I’m very hopeful it hasn’t worsened after so much time with uncontrolled diabetes. Fingers crossed. He has a follow up next month.

I just came to the realization that our vet recommended we give him Metamucil (1/8) tsp twice a day and it has sugar as the first ingredient. Could this be the reason his BG is so high? I just tested him tonight before his dinner and shot and his BG was over 400. I cant imagine any other reason why it would be this high when his numbers were beginning to stabilize back in April and not much has changed in terms of his food. I just got a pure psyllium husk supplement from our local co-op and it has no additives, just the fiber. Should I give the same amount as the Metamucil? I have been trying to find posts with more information on this but there’s not much in terms of dosing.

my partner and I plan to do another curve tomorrow, no Metamucil and see if there is a difference at all. Probably won’t change overnight but I’m really hoping this is the cause and we can begin to get him back on track.

 

[Chris & China (GA)]

Yes, if there's sugar in it, then the Metamucil could cause his BG to be higher (which is why no matter who tells you to try something, read the label first before you buy it!)

A lot of people have a lot of success with Miralax. It's a tasteless powder you can mix into food. Most start at 1/8th teaspoon twice a day and titrate as needed. It works by pulling water out of the intestinal tract into the stool so it's easier to pass.

The psyllium husk is OK too if he'll eat enough to help.

 

[Katherine&Ruby]

Hi there and welcome! Regarding psyllium, I would start with a really small amount, like 1/16th of a teaspoon in his food to see how he does on it. Is it for constipation? Sometimes these fibers work well to move things along and then other times it can bulk the stool and make things worse. Just monitor the litter box and his behavior around it once you start.

 

[Teanuhb]

Yes, if there's sugar in it, then the Metamucil could cause his BG to be higher (which is why no matter who tells you to try something, read the label first before you buy it!)

A lot of people have a lot of success with Miralax. It's a tasteless powder you can mix into food. Most start at 1/8th teaspoon twice a day and titrate as needed. It works by pulling water out of the intestinal tract into the stool so it's easier to pass.

The psyllium husk is OK too if he'll eat enough to help.

Yes, I'm so disappointed that I wasn't more careful.

Hi there and welcome! Regarding psyllium, I would start with a really small amount, like 1/16th of a teaspoon in his food to see how he does on it. Is it for constipation? Sometimes these fibers work well to move things along and then other times it can bulk the stool and make things worse. Just monitor the litter box and his behavior around it once you start.

Thank you! I will do that. It is not for constipation. The vet said to add it because it would help him feel fuller and help with diabetes management. I'll be monitoring his stools closely now.

 

[Katherine&Ruby]

The vet said to add it because it would help him feel fuller and help with diabetes management.

I've given psyllium to Ruby and I haven't found it to lower glucose levels, but it will probably make him feel fuller. I add a lot of water to my Ruby's meals, in a 2:1 ratio of food to water. That will also fills her up and adds some good hydration!

 

[Teanuhb]

I've given psyllium to Ruby and I haven't found it to lower glucose levels, but it will probably make him feel fuller. I add a lot of water to my Ruby's meals, in a 2:1 ratio of food to water. That will also fills her up and adds some good hydration!

Ah, yes. I always give lots and lots of water with his food also. He seems to prefer it that way. Fingers crossed that the change in fiber supplement will at least help bring his numbers down a little.

 

[Katherine&Ruby]

Getting rid of the Metamucil should help, as will transitioning him off KD if you can, but I know kitties really like the renal food. My Ruby also has CKD and she liked the Weruvas a lot.

 

[Teanuhb]

Getting rid of the Metamucil should help, as will transitioning him off KD if you can, but I know kitties really like the renal food. My Ruby also has CKD and she liked the Weruvas a lot.

Doing a curve today and his BG is already beginning to decrease +2 hrs post shot/meal. A bit of encouragement to start the day!

Which Weruvas does Ruby eat? I've tried the Steak Frites although it has such a high protein content that it does concern me to feed him that too much. I've also been feeding Goody Stew Shoes and he looooooves that. Laps it right up.

 

[Katherine&Ruby]

I would not worry about protein content. Recent studies have shown that reducing protein does not help with CKD, and in fact in senior cats low protein diets can make things works because of muscle wastage. You want Liam to be eating low carb and high protein and fat. Phosphorus is the thing you need to watch for, as it tends to be present in the animal proteins our cats need, and causes the most damage to the kidneys. This is why the addition of a binder might be necessary if your kitty's phosphorus levels go above 6 in bloodwork.

Ruby likes lapping up the pates, so Jeopurrdy Delicious and Family Food were among her favorite LC, and I gave her Meowiss Bueller for a higher carb LC (7%) early in the cycle to prevent steep drops. She also really likes Lamburgini, another slightly higher carb LC. For the last four months though she has been on a raw diet (very low/zero carb, high protein and fat) and it's lowered her kidney values substantially.

 

[Teanuhb]

I would not worry about protein content. Recent studies have shown that reducing protein does not help with CKD, and in fact in senior cats low protein diets can make things works because of muscle wastage. You want Liam to be eating low carb and high protein and fat. Phosphorus is the thing you need to watch for, as it tends to be present in the animal proteins our cats need, and causes the most damage to the kidneys. This is why the addition of a binder might be necessary if your kitty's phosphorus levels go above 6 in bloodwork.

Ruby likes lapping up the pates, so Jeopurrdy Delicious and Family Food were among her favorite LC, and I gave her Meowiss Bueller for a higher carb LC (7%) early in the cycle to prevent steep drops. She also really likes Lamburgini, another slightly higher carb LC. For the last four months though she has been on a raw diet (very low/zero carb, high protein and fat) and it's lowered her kidney values substantially.

Thanks for sharing this information. Our vets have all recommended that we don't feed raw + feed the KD strictly and I think it's just taking me a little bit to deviate from their advice because I've always felt they know best and wanted to trust them completely. I have been seriously considering beginning the journey of transitioning back to a raw diet and have looked at the recipe on Dr. Pierson's site but she does not recommend using this recipe for CKD cats. Would you mind sharing which resources did you use for guidance to formulate Ruby's diet?

 

[Katherine&Ruby]

Thanks for sharing this information. Our vets have all recommended that we don't feed raw + feed the KD strictly and I think it's just taking me a little bit to deviate from their advice because I've always felt they know best and wanted to trust them completely. I have been seriously considering beginning the journey of transitioning back to a raw diet and have looked at the recipe on Dr. Pierson's site but she does not recommend using this recipe for CKD cats. Would you mind sharing which resources did you use for guidance to formulate Ruby's diet?

Yeah, definitely. Raw feeding is one of my favorite topics right now.

The reason why Dr. Pierson's recipe doesn't work for CKD kitties is it contains bones, and that means high phosphorus. I buy boneless ground meats from raw pet food purveyors (though you can buy from the supermarket too--stick to vacuum sealed packages rather than the ones in trays with cling film) and mix it with either EZ Complete (https://www.foodfurlife.com/cats.html#/) or Alnutrin with Egg Shell Calcium (https://www.knowwhatyoufeed.com/store/index.php?route=product/product&product_id=51). The two products are meal completers, as raw meat alone is not balanced and does not provide all of the nutrients that a cat needs, and they contain egg shell calcium instead of ground bone meal like other meal completers do. EZ Complete is not shipping at the moment because of a pandemic related shortage of one of their ingredients but they are supposed to resume by the end of this week/early next week. The Food Fur Life website has a lot of information about raw feeding in general like how to source the meats and food safety. The difference between the two mixes is you have to add liver and a source of Omega 3s like fish oil to Alnutrin. EZ Complete contains chicken liver and Omega 3s in the form of powdered green lipped mussels, so you don't have to add, but if your kitty has a sensitivity to poultry, Alnutrin is more flexible because you can choose your own organ meat like beef or lamb.

Let me know if you have any other questions.

 

[Teanuhb]

Thank you! We did a curve yesterday and saw a little improvement but when I checked his BG today before his dinner/shot it was 677. I had not given him any food 2 hours prior to this test. I'm so confused and disheartened. Is it normal for BG to spike this much in spite of no changes to his diet?

 

[Chris & China (GA)]

Is it normal for BG to spike this much in spite of no changes to his diet?

It's important to keep your spreadsheet updated. We're very data driven here and can't offer much in the way of helpful advice without knowing the stats.

One thing you do need to do is start getting at least 1 other test on the PM cycle. At least a "before bed". Most cats go lower at night so it's important as well as the fact that without PM tests, you're only seeing half the picture. That's like trying to figure out what the puzzle picture is with only pieces filled in on one side.

I'd also like to invite you over to the Lantus, Basaglar and Levemir forum (Semglee too since it's like Lantus and Basaglar). You'll get the most experienced eyes there since everybody uses the same type of insulin.

We do things a little differently there in regards to posting but here's How to make the most of your Lantus, Basaglar and Levemir Land experience to help you.