New Member - advice on fluid timing?

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Klynn

Klynn

Member Since 2023
Hello,

We are at a possible last ditch attempt to keep Nutmeg with us, she's 16. A month ago she was diagnosed with diabetes, kidney failure, and a UTI. Besides drinking more water and some accidents (which we thought were age/behavioral) I had no idea she was sick, her energy and appetite were great, I brought her in initially for constipation. We had her on Lantus (0.5u gradually moved up to 3u), switched to kd dry food with some wet friskies mixed in to help appetite. She's been getting fluids at least 2x week at the vets and did the glucose checks there, last week I started the fluids at home, but she was still going downhill. She has no appetite, very lethargic, and acting like the end is near, sleeping in nooks and under things she never has before.

Yesterday the vet admitted the lantus wasnt working, she hadnt gotten below 600 all day, so I got a Novolin (n) prescription starting last night. Her 4 hr read just now was 346 so at least its working. I just started home glucose tests, the vet recommended before I just watch and see to not over obsess and stress. He also says daily sub-q fluids now, 100 ml. She's on wet kd and eating ok but not great.

My main question is, does it matter what time of day I give the fluids? I dont want to interfere with the insulin or her appetite. I could splt it into 2 doses 50/50 also.

She is the sweetest cat, she purrs even now when I walk into a room, I just cant hear it from 10 ft away like I used to. She purrs through her shots and even my repeated pokes on her dehydrated little toes trying to get a big enough drop for the meter. She loves all people, shes always been super friendly to our kids and all their friends, she just thinks every human exists to love on her. We had her and her buddy since they were kittens together, we lost him a year ago to cancer and I still miss him so much, I'm having a really hard time worrying, accepting that this might be her time too.
 
Fluid timing does depend a bit on the cat. If you give fluids in the scruff, try to give the insulin in another location. I found fluids would lower Neko's numbers a bit (not true for all cats), so I tended to give fluids in the last half of the cycle when her numbers were going up anyway.

I'm surprised the Lantus wasn't working. It's almost always a better insulin than Novolin, that doesn't last nearly as long. Where did you get the Lantus from? The KD dry food is very high in carbs, so it's not surprising you'd need a higher insulin dose. It's also possible that her body was reacting to lower numbers (we call it bouncing), when she was being tested at the vet. It's very common in cats, and can make it harder initially to see how low they are going.
Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

I'm glad you are testing at home now. You'll get a much better idea how she's doing on the insulin. Have you tried testing on her ears? Hometesting Links and Tips - includes numerous links, instructions, pictures, & videos

I hope you can improve her quality of life and have some more time with her.
 
Hi and welcome to the forum Nutmeg and Klynn.
Are you able to post the results of the blood tests Nutmeg has had? If you don’t have them, ask the vet to email them to you. They are yours and you are entitled to have them.
Im wondering if the blood tests were taken when she was dehydrated. Kidney results can improve a lot once the cat is hydrated again.
The kd dry food you are feeding is very high in carbs…38% carbs. Diabetic cats need foods that are 10% or under carbs.
Cats with kidney failure do not need to eat the special “prescription kidney food” until they are very late stage. To feed it earlier is old thinking. The current idea is to feed low phosphorus foods and low carb and keep the protein higher than the prescription kidney foods. This prevents the muscle wastage that happens when a low protein food is fed.
There are plenty of lower phosphorus, low carb wet foods you could feed Nutmeg. We can help you there.
I am also very surprised that the lantus doesn’t work, but I would say it is most likely because you are feeding the very high carb dry food.
Novolin N is not a suitable insulin for cats. It is a fast acting harsh insulin that does not last 12 hours.
With Novolin you need to be feeding Nutmeg an hour before giving the dose of insulin. So you test, feed, wait one hour then give the dose.
With Lantus you can test, feed and shoot one after the other.
Please keep asking questions as we are very happy to answer them.
 
Thank you Wendy! I'll do the fluids now (7:30 ish), she ate her 1st dinner pretty well. I've been feeding her around 6:30 am/pm (her auto feeder would go off) because she was always hungry then, but I do the insulin at 9 am/pm because I'm always home then, so I give her a little 2nd dinner at 8. The goal was meals timed with insulin but then it became get her to eat anytime I could. I don't have the numbers from the vet, the lantus did work for about 2 weeks I think, but physically she never came back all the way. The vet is very much a "look at the cat, not the numbers" type, it could be the kidneys that are really the threat here and causing her shut down, which cant be fixed with some shots (though the bouncing or high BG from the insulin hasnt helped).

The first time I did the ears I got nothing even with warming and multipe pokes, but she didnt like me handling them. Shes so low energy she didnt care about me messing with her feet, I had to warm them too. The last one I got from her ear because I didnt want to drag her out of her hiding spot, still took me 3 pokes and 2 test strips!
 
Bron and Sheba (GA) said:
Hi and welcome to the forum Nutmeg and Klynn.
Are you able to post the results of the blood tests Nutmeg has had? If you don’t have them, ask the vet to email them to you. They are yours and you are entitled to have them.
Im wondering if the blood tests were taken when she was dehydrated. Kidney results can improve a lot once the cat is hydrated again.
The kd dry food you are feeding is very high in carbs…38% carbs. Diabetic cats need foods that are 10% or under carbs.
Cats with kidney failure do not need to eat the special “prescription kidney food” until they are very late stage. To feed it earlier is old thinking. The current idea is to feed low phosphorus foods and low carb and keep the protein higher than the prescription kidney foods. This prevents the muscle wastage that happens when a low protein food is fed.
There are plenty of lower phosphorus, low carb wet foods you could feed Nutmeg. We can help you there.
I am also very surprised that the lantus doesn’t work, but I would say it is most likely because you are feeding the very high carb dry food.
Novolin N is not a suitable insulin for cats. It is a fast acting harsh insulin that does not last 12 hours.
With Novolin you need to be feeding Nutmeg an hour before giving the dose of insulin. So you test, feed, wait one hour then give the dose.
With Lantus you can test, feed and shoot one after the other.
Please keep asking questions as we are very happy to answer them.
Click to expand...

Thank you, I could see going back to the lantus if she pulls through and stabilizes. Last week (5/2) she was on 2u Lantus and was over 600 the morning I brought her in, he thought I'd been skipping doses because he believes in it too! So we went another week on 3u. I dont know the details but I believe her kidneys are in advance stage (also the daily fluids suggest that). The first week she went in every day, and by Friday he said with the k/d she'd live as long as I gave her 2 insulin shots a day. In the clinic she gobbled down the dry but at home would barely touch it, this weekend she barely ate so I went to the sample can they gave me, which she gobbled then threw up (on the rug of course, those instincts are strong). But she never really got 'better' with all these weeks of trying and upping the dose and bi-weekly fluids. I think the vet is fine managing those extra carbs with insulin, docs do like to control what they can so I understand why they use rx foods even with other options out there. I trust his experience, if she stabilizes I'd definitely like to explore other options down the line. I'll ask next week about the test results.

Her hunger doesnt exactly correlate with the hour before shots but I'll do my best. She's getting lots of special treatment :) Eating 2nd dinner now so thats good!

Thank you for the support, Ive gotten so much information from this site and members!
 
Klynn said:
Thank you, I could see going back to the lantus if she pulls through and stabilizes. Last week (5/2) she was on 2u Lantus and was over 600 the morning I brought her in, he thought I'd been skipping doses because he believes in it too! So we went another week on 3u. I dont know the details but I believe her kidneys are in advance stage (also the daily fluids suggest that). The first week she went in every day, and by Friday he said with the k/d she'd live as long as I gave her 2 insulin shots a day. In the clinic she gobbled down the dry but at home would barely touch it, this weekend she barely ate so I went to the sample can they gave me, which she gobbled then threw up (on the rug of course, those instincts are strong). But she never really got 'better' with all these weeks of trying and upping the dose and bi-weekly fluids. I think the vet is fine managing those extra carbs with insulin, docs do like to control what they can so I understand why they use rx foods even with other options out there. I trust his experience, if she stabilizes I'd definitely like to explore other options down the line. I'll ask next week about the test results.

Her hunger doesnt exactly correlate with the hour before shots but I'll do my best. She's getting lots of special treatment :) Eating 2nd dinner now so thats good!

Thank you for the support, Ive gotten so much information from this site and members!
Click to expand...
I would ask to have the kidney values retested to see if they have improved with the subQ fluids.
 
I wouldn’t switch the insulin until she stabilizes like you say. Lantus is a much better insulin and you won’t have to worry about the feeding time. Dry food is not great for the diabetes or CKD since it’s high in carbs and has no added water in it. I understand you thinking he wants to control what he can but it’s more like this is all he knows, but at the same time, he can’t say Lantus is not working when he’s recommending dry food, which makes it nearly impossible to regulate a diabetic cat.

I hope she pulls through because we can def help you get her diabetes regulated. Another evidence your vet is not up to speed with what’s best for diabetic cats is saying she needs to eat only twice a day at shot times. That’s very old fashioned thinking and it works for dogs not cats. Cats have a much higher metabolism and benefit from eating smaller meals throughout the day. It’s also easier on their pancreas. Don’t think that it’s wrong to let her eat anytime she wants, even when her apetite comes back. Is she in an apetite stimulant?
 
Ale & Bobo & Minnie (GA) said:
I wouldn’t switch the insulin until she stabilizes like you say. Lantus is a much better insulin and you won’t have to worry about the feeding time. Dry food is not great for the diabetes or CKD since it’s high in carbs and has no added water in it. I understand you thinking he wants to control what he can but it’s more like this is all he knows, but at the same time, he can’t say Lantus is not working when he’s recommending dry food, which makes it nearly impossible to regulate a diabetic cat.

I hope she pulls through because we can def help you get her diabetes regulated. Another evidence your vet is not up to speed with what’s best for diabetic cats is saying she needs to eat only twice a day at shot times. That’s very old fashioned thinking and it works for dogs not cats. Cats have a much higher metabolism and benefit from eating smaller meals throughout the day. It’s also easier on their pancreas. Don’t think that it’s wrong to let her eat anytime she wants, even when her apetite comes back. Is she in an apetite stimulant?
Click to expand...

She is not on an appetite stimulant, shes more just inconsistent with sometimes eating and sometimes not. He did not advise me on the feeding times, I'd picked that up from reading on the board but generally was trying to get her to eat whenever she showed interest. When she was eating the dry I had the auto-feeder going off 4 times a day, the sound would often remind her to eat and our dog would eat it if I just left a full bowl. Prior to diagnosis and switch to k/d she would eat ANYTHING in sight - all her food, the dogs food, any and all people food she could get into - dinner leftovers in the sink, pizza boxes on the stove, cheezits inside a kids backpack, she would undo zippers and chew through plastic bags. I'm now giving her only canned 4-6 times a day, I add water to it to make it easier and get that extra in her. I have read and read and googled and the information on food treatment of CKD is very conflicting, and very biased. There is no proven treatment, its a vet or company or pet owner developed something that they think worked in some number of the animals they tried it on.

If she only had diabetes, no she would not be on k/d. But since she has kidney failure, and I'm not working with a homeopathic vet, we are treating with prescription kidney diet and sub-q fluids. She went a week barely eating any dry food, on 3u lantus, had sub-q fluids 3x, and her glucose was still over 600, that had probably been going on for several days putting more stress on the kidneys. He has treated hundreds of cats in this situation including one of his own who lived several years on dry k/d and lantus. Over the month since she got sick, her diet has gone from dry (non prescription she'd been on for years, then k/d) to mixed dry/wet to wet, the insulin dose has gone up, and both the diabetes and kidneys have spiralled downward.

Last night she ate at 5 pm, I gave fluids at 7, she barely ate at 8 pm, I gave her the insulin at 9, and she threw up at 11 - basically 6 hrs after her last real meal. at 12/1 am I got her to drink water and eat a little again. I'm carrying her to the water and bringing the food to her, she's not moving around much. I gave her a little litter pan close by but she figured my clothes on the floor were a better option. At least I know she peed once last night :rolleyes: Still purring and cuddling! And she woke me up crying at 6 am for breakfast, from her spot under the bed, where I bought her food and she ate just fine as long as I was holding the bowl. She ate at 8 too, shes just better in the mornings.

I'm going to try giving the fuids earlier today instead of evening, maybe that upset her stomach.
 
Not to add on to everything, but she may need an anti vomit med like Cerenia. If she’s eating, she’s probably not nauseated, if not I’d suggest ondansetron for that.

Are there cats that are managed on dry and on super high doses of insulin? Yes, but I take the Lantus is not working assumption with a big grain of salt when there’s dry in the mix. One week off of it, is not long enough to know for sure. But you’re dealing with other issues right now that are more of a priority. Also, it’s normal for unregulated cats to be ravenous since they can’t process the nutrients in food well and eat but are always hungry and still lose weight.
 
She's made it through the weekend but seems hanging on by a thread. She cant walk at all, that slowly went down over the weekend, so I'm carrying her to food, water, and the litter. She is still eating, purrs and cuddles, and sometimes has these looks in her eyes like she's still with us and happy living and plans to keep it up. So I'm just keeping up with the novolin, fluids, and feeding her anything anytime she wants. She is barely sleeping, im used to her sleeping all day without any notice of me walking in a room or the noise from the kids, but everytime I'd leave her for a bit and come to check, she'd be up.

She hasnt vomitted since Thurs night, so I think the earlier fluids are helping. She had one good solid BM on Saturday.

I'm going to petco/petsmart to pick up some more food she might like better than the kd, I switched in some fancy feast and friskies which made her happier, if these are her last days she should be eating for taste not treatment. She is drinking a lot of water too, but cant without assistance.

Thank you all. I think her kidneys and organs have probably been deteriorating this whole time.
 
You might also want to try some recovery food which is hills prescription AD. It’s HC but as you said, it’s more important she eats now. I’m sorry for what you’re both going through. She is a cutie and I hope she does turn a corner :(
 
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