9/7 Ruby AMPS 225/+3 153/+6 141/+9 83/PMPS 89/+2 96 vet discussion

[Katherine&Ruby]

Yesterday.

Ruby is responding to the dose increase. She pooped last night! It was a big one. She was sitting in the litterbox last night and seemed uncomfortable for hours, so I'm going to keep increasing her Lactulose until I find the right dose. Her oncologist gave me the ok to do so as apparently Lactulose does not get absorbed in the body.

I expressed my concerns about Ruby's high numbers to the oncologist, referring to my fear of ketoacidosis and kidney damage, and here is what she said that I thought was interesting, but am unsure about it and would love to hear any take on it:

You need very little insulin to block ketone production, You need much more to control hyperglycemia. So it is unlike Ruby will become ketotic when you are giving insulin, unless she becomes sick ( urinary tract infection, pancreatitis, etc) Cats do not develop kidney damage from diabetes like people do, thus veterinarians do not work hard to keep cats blood sugar in a narrow range. Human diabetic patients also get eye problems, vascular problems and skin ulcers that we don’t recognize in cat diabetic patients. Disease is similar but not identical in the two species.

Hope everyone had a great day!

 

[Tina Marie (GA) and Jan]

Hi Katherine,
I'm sorry I don't have a source, but I have also read that cats don't live long enough as diabetics (when older at diagnosis), to develop the same kidney decline, and eye damage, for example, as diabetic people. I could be an example I suppose - I've had type 1 D for 42 yrs. Very slight eye damage which is very recent, and no kidney decline the first 30 yrs. And DKA - only had it at diagnosis (BG around 1000, BMI 16-17), and with pneumonia once, and with the flu once. BUT, I still have to be careful comparing cats to people! In Type 2 people, which is a type more similar to most cats with D, they can have vascular damage, liver damage, or even kidney damage, prior to Type 2 diagnosis, especially if they have gone undiagnosed for a long time. So for THAT reason, it's a little hard to believe high BG can't affect the kidneys (a little sooner) in a cat.

So I cannot really disagree with your oncologist. About the lactulose - best of luck finding Ruby's perfect dose . . . AND THEN I wish you strong intuition going forward. Ruby does thank you!! She knows you don't have it easy keeping up with her needs

 

[carfurby (GA)]

Nice slide today. I hope you can find a good dose of lactulose for Ruby. I'm not sure about what the vet said.

 

[Katherine&Ruby]

Hi Katherine,
I'm sorry I don't have a source, but I have also read that cats don't live long enough as diabetics (when older at diagnosis), to develop the same kidney decline, and eye damage, for example, as diabetic people. I could be an example I suppose - I've had type 1 D for 42 yrs. Very slight eye damage which is very recent, and no kidney decline the first 30 yrs. And DKA - only had it at diagnosis (BG around 1000, BMI 16-17), and with pneumonia once, and with the flu once. BUT, I still have to be careful comparing cats to people! In Type 2 people, which is a type more similar to most cats with D, they can have vascular damage, liver damage, or even kidney damage, prior to Type 2 diagnosis, especially if they have gone undiagnosed for a long time. So for THAT reason, it's a little hard to believe high BG can't affect the kidneys (a little sooner) in a cat.

So I cannot really disagree with your oncologist. About the lactulose - best of luck finding Ruby's perfect dose . . . AND THEN I wish you strong intuition going forward. Ruby does thank you!! She knows you don't have it easy keeping up with her needs

Jan, I love the perspective you bring to this! Thank you for relaying your experience and first hand knowledge, though I am really sorry you've had to go through all of that as a Type 1 diabetic. The only reason I question the oncologist's perspective is I see so many kitties here with both diabetes and kidney damage that it can't be a coincidence.

 

[FrostD]

Hmm. My two cents, without googling - I think some cats just tend to be more prone to it than others, Minnie comes to mind. I do wonder if it works differently when the diabetes is compounded/made worse by other things - like in Ruby's case the pred, in Mr Kitty's case the acro

Now Mr Kitty...sheesh. The guy was unregulated forever, had few bouts of pancreatitis, the chylothorax, and ketones never went above 0.6 or 0.8.

Now we do see a lot of cats here with both CKD and diabetes but I'm not sure the relationship, or how many cats in the general population have CKD.

 

[tiffmaxee]

I think ckd is too common in cats if they live long enough. All my cats had it to some degree. If a cat stays above renal threshold I would suspect it more likely to occur but I don’t think they need to be tightly controlled to avoid it if not genetically prone. That being said my cats passed from lung cancer at about 17, , lymphoma at 12 and heart failure at 19 1/2.

 

[Katherine&Ruby]

Hmm. My two cents, without googling - I think some cats just tend to be more prone to it than others, Minnie comes to mind. I do wonder if it works differently when the diabetes is compounded/made worse by other things - like in Ruby's case the pred, in Mr Kitty's case the acro

Now Mr Kitty...sheesh. The guy was unregulated forever, had few bouts of pancreatitis, the chylothorax, and ketones never went above 0.6 or 0.8.

Now we do see a lot of cats here with both CKD and diabetes but I'm not sure the relationship, or how many cats in the general population have CKD.

Minnie has IAA, so I guess that explains why she is prone to ketones. Ruby's ketones have not gone above .4 in the few tests I have done in the past weeks. As for CKD, maybe it's something that strikes older kitties, just like diabetes, and so there might not be a strong correlation between the two aside from age of diagnosis.

 

[FrostD]

Minnie has IAA, so I guess that explains why she is prone to ketones. Ruby's ketones have not gone above .4 in the few tests I have done in the past weeks. As for CKD, maybe it's something that strikes older kitties, just like diabetes, and so there might not be a strong correlation between the two aside from age of diagnosis.

Mr Kitty also has/had IAA. "Many" cats here do but I can't say I've seen a pattern of IAA and ketones...that said, some people don't stick around long enough or can't/don't do the test, so who knows!

I'm a bit of a...naturalist?...when it comes to health-related things. I believe in hard core science and medicine, but I also believe that once the body starts to deviate from the way it's intended to work/excessive intervention it causes issues (so in humans things like taking excess vitamins/supplements, inducing labor, things like that). So, kidneys aren't intended to process that much glucose, I do believe that wears things down over time. Now, the question is will that become a problem before any of the other old cat problems? Nobody knows, unless perhaps the kidneys are already in trouble.

Long winded way to say...I'm not too worried about ketones for Ruby, she's been through a lot and seems to be holding ok. I dont exactly like the higher numbers/big swings she sees and the effects that may have on kidneys and other things, but I think all things considered your priorities in regards to treatment are right. It's just unfortunate it means picking and choosing what to "let slide" for the time being.

Oh! Did they do the ultrasound?

Edit: nevermind, I think you said actual appointment was 22nd if I remember correctly. It's late and I'm tired

 

[Wendy&Neko]

Minnie has IAA, so I guess that explains why she is prone to ketones.

Nope, IAA has nothing to do with it. Neko had IAA too, always "ketones neg" on her spreadsheet. The formula for DKA is not enough insulin + inappetance + infection/inflammation. If you want a really good explanation of what's going on inside, this is a good read: What is Feline Diabetes? In this case, I do agree with the vet on ketones, to a certain point. You can't always know in time if there is infection/system inflammation, so keep testing for ketones when she's high.

 

[Kathy and tiger]

Hugs to you girls

 

[Suzanne & Darcy]

Darcy went into DKA when he was in the mid-yellows. It did turn out that he must have had an infection though since when I took him in he had a temperature over 105. It came on so suddenly though (from my perspective that is). However, even after his DKA he had high ketones on the blood meter for a long time even though he was getting quite a high dose of insulin- so I am not sure that I buy the theory that it takes only a small amount of insulin to prevent ketones. It wasn’t until his numbers got a little better that his ketones went (and stayed) down. Also, how can it be okay to be spilling glucose into the urine all the time?

Ruby doesn’t spend that much time above the kidney threshold, does she? Good day yesterday, by the way, after a yellow start.
There are so many theories out there about what causes kidney disease in cats - including vaccines and the media used in them - and commercial food, etc. that we couldn’t even scratch the surface there. We all just know that a lot of cats are prone to it. My cat Julius, who was 15 when he died in January, had perfect bloodwork showing excellent kidney function. He was felled by a mass in his lungs. My Maverick (SCL) died at 16 and was on chlorambucil for several years. His kidney function was excellent until the very end and that was only after we tried the rescue drug Lomustine. His SCL stopped being controlled by the chlorambucil at some point. I still blame myself for not having more frequent ultrasounds done just because he seemed to be doing so well. But I digress… I’ve lost several kitties to kidney disease (and some to a combination of kidney disease and cancer). Ruby is so well cared for by you and gets a great raw diet … I think she has the best chance of living a long and healthy life!