What's messing up with Bella's kidney values, Prozinc or Fancy Feast?

[Alicia2022]

Hi everyone,

Bella had her bloodwork done and it looks worrisome to me but not to our vet, so I decide I ask here if I indeed should be worried and what to do.

Pictures of labs are in Bella’s SS (labs tab) but here are the ones that are elevated + comparison to her June results for reference:

Hematology: EOS 1.54 now / was 0.51 in June;

Chemistry: AMYL 1739 now / was 1156

BUN/UREA 75 now / was 54

CREA 2.9 now / was 1.2

[BUN:CREA ratio is now 26 / was 45 back in June]

Potassium 6.1 now / was 4.9

TP 8.9 now / was 9.6

Her glucose reading at the vet (+7, no fasting) was 299, and fructosamine was 394. Before getting the fructosamine result, the vet was rather supportive of my idea of switching from Prozinc to Lantus because Bella’s BG readings has been all over the place recently and we’ve been doing a sliding scale for a while now. However, now she thinks that everything is fine, Bella’s diabetes is under control, and kidney values are not utterly concerning.

And I am afraid that either ProZinc with its highs and lows or Fancy Feast food are messing up with Bella’s kidneys and this may become more dangerous than diabetes itself. She’s still eating small amounts of dry RC gastrointestinal food (she needs it and it’s given early in the cycle only) but since she had discovered the pleasures of Fancy Feast pate, she’s plainly refusing her RC renal wet food.

 

[Bron and Sheba (GA)]

Fancy feast is higher in phosphorus than some other canned foods so you might want to have a look at some others
Food chart look for foods that are below 250 mg phosphorus/100kcals

Looking at Bella’s SS I would not say that her diabetes in under control. She has had 6 months on Prozinc. I would be asking to swap to Lantus.

 

[Sienne and Gabby (GA)]

I would look for foods that are lower in phosphorus and add as much water as Bella will tolerate to her food.

I agree with Bron. Bella's numbers are not regulated. It looks like she may not be getting sufficient duration on Prozinc. Switching to Lantus may help

 

[Alicia2022]

Fancy feast is higher in phosphorus than some other canned foods so you might want to have a look at some others
Food chart look for foods that are below 250 mg phosphorus/100kcals
Looking at Bella’s SS I would not say that her diabetes in under control. She has had 6 months on Prozinc. I would be asking to swap to Lantus.

I would look for foods that are lower in phosphorus and add as much water as Bella will tolerate to her food.
I agree with Bron. Bella's numbers are not regulated. It looks like she may not be getting sufficient duration on Prozinc. Switching to Lantus may help

Thank you. I will look into Weruva foods because Bella is only eating pates and likes them with added water (so I think she's getting plenty of water, she also likes drinking from the faucet).
So the fructosamine test isn't actually correct? In Bella's case, its result means "excellent control" and of course this is not what her spreadsheet shows. Btw, our vet says that Bella is her only patient who gets home testing, noone else here does this, so our vet thinks we're on top of things.
The vet is concerned that if we switch to Lantus we have once again to start from 0.5 units. Is that correct? Isn't this dangerous? How long does it usually take to figure out the correct dose?
My main concern with Lantus is timing. My understanding is that it has to be given stricktly 12 hours apart. Mine work schedule does not always allow this and the same is true for my husband, so we sometimes give Prozinc shots 10 or 14 hours apart although we always try to keep that 12 hrs rule.
Moreover, approximately once per month we both have to travel for work, sometimes at the same dates, so we have a catsitter for Bella who can give shots but cannot test her. With Prozinc, we asked the sitter to give Bella a dose that was a bit lower her usual dose at that time. My understanding is that this trick would not work with Lantus because it builds that "depot" (something that I really do not understand). I would appreciate your suggestions on how to deal with this issue.
I don't know how to tag people but if Melissa FrostID could take a look at this topic that would be great, too.

 

[Virginie & Chewie (GA)]

Tagging Melissa for you (you just need to type @ then username): @FrostD

 

[FrostD]

What are.your current sliding scale guidelines?

Most vets - since a lot of caregivers do not home test - are satisfied to keep BG under 300-350 most of the time. She spends a lot of time in the 200s, so I suspect that's why the fructosamine looks good.

You do not have to restart at a lower dose on Lantus. Most of the time, it is a one-to-one switch based on BG. With her current BGs, you'd likely be starting Lantus very close to 2.5U.

You are correct on the timing. Lantus likes consistency, in both dose and time. That said, I think you would still would have better results with Lantus...with a kidney cat, any improvement in the FD is better than nothing. We can help you learn how to handle the earlier or later than usual shooting.

The depot is just some insulin that gets stored subcutaneously. It seems a lot more confusing than it is, especially when switching. It really only matters when seeing low numbers and possible reductions - but we would also help you with that. Sometimes partial doses are given (or even doses skipped) to help drain the depot if it seems kitty is really hanging in low numbers - because doing that forces the body to use that stored insulin.

The concept of a "vacation dose" still applies for Lantus, just with a little more forethought. If you know you'll be out of town, you'd just ask for vacation dose advice on the Lantus forum a few days in advance.

 

[Alicia2022]

Thank you, Melissa, for your detailed reply.

What are.your current sliding scale guidelines?

We're kinda playing it by ear.
In general, 2.75U closer to 500 and over 500 (did 3U yesterday PM and got 261 AMPS today, so I think 2.75 should be our max dose).
2.5 over 400
1.5-1.75 200 closer to 300.
To decide on each dose, we look at her previous numbers and also take into account how much she eats on a given day.

You do not have to restart at a lower dose on Lantus. Most of the time, it is a one-to-one switch based on BG. With her current BGs, you'd likely be starting Lantus very close to 2.5U.

That's great. I don't know if I should educate our vet or just tell her we're starting Lantus at 0.5U and then follow this forum's guidlines instead.
Since we're going to be out of town for a few days just before Thanksgiving, we'll plan switching to Lantus after that.