? 1/25 Is kidney issue causing high blood glucose?

[Really Riley (GA)]

@Wendy&Neko @Marje and Gracie Riley's been on Clavamox for the last two weeks for an infection. The vet doesn't know what kind of infection, only that his blood test shows high WBC. The blood test also showed a BUN of 81. Because of that the vet wants me to do daily subcutaneous fluids. This isn't working all that well because I usually get the needle in the wrong place or Riley decides he's had enough. Could the stress and/or infection be causing a climb instead of drop in blood glucose? Or have I increased the dose too quickly? Any advice you can give would be greatly appreciated! Thank you.

 

[tiffmaxee]

I can’t access your ss. Infection can definitely adversely effect BG. Was a urinalysis done with culture and sensitivity?

 

[Wendy&Neko]

Like Elise, I can't see your spreadsheet right now. Could you update fix that link? Any type of infection or inflammation can increase the insulin resistance. Have you seen Marje's fabulous video on Giving Subq Fluids?

 

[Marje and Gracie]

I can’t see his SS either and if you need help with the link, please let me know (send me a PM). When we can see the SS, we can help on the dose and give you some thoughts.

Giving fluids is usually based on the creatinine and not the BUN. So I’d need to see what his creatinine is. Fluids are usually not started until the creatinine is above 3.5.

 

[Really Riley (GA)]

Like Elise, I can't see your spreadsheet right now. Could you update fix that link? Any type of infection or inflammation can increase the insulin resistance. Have you seen Marje's fabulous video on Giving Subq Fluids?

I have no idea what I might have done to the spreadsheet. I can't access it from this site, but can through my Google account. Can you point me in the right direction? I just finished entering all the information I got from the vet in regard to blood and urine.

 

[Really Riley (GA)]

Like Elise, I can't see your spreadsheet right now. Could you update fix that link? Any type of infection or inflammation can increase the insulin resistance. Have you seen Marje's fabulous video on Giving Subq Fluids?

@Marje and Gracie This is a great video! I saw it on YouTube today. I was looking for some more info than the vet's office had given and this was exactly what I needed. After some rough sessions with the stabbing and forcing the fluids I was about to give up. When I saw how relaxed Gus was and how smoothly everything went, I figured if I just followed the instructions on the video and forgot about what the vet tech did, we could get it done. And we did!

 

[Really Riley (GA)]

I can’t access your ss. Infection can definitely adversely effect BG. Was a urinalysis done with culture and sensitivity?

The spreadsheet should be back. There was a urinalysis done, but I'm not sure if it included everything it should have.

 

[tiffmaxee]

I just looked at the labs. Was he dehydrated at the time? His creatinine is not at the point that my vet would suggest daily fluids and definitely not based on one test. He is also still concentrating his urine which makes me wonder with that high white count there is a UTI like your vet is thinking. Was a culture and sensitivity run? If there is a UTI and you don’t see improvement he might not be on the right antibiotic for the bacteria he has. See what Marje has to say.

 

[tiffmaxee]

We cross posted, lol.

 

[Marje and Gracie]

I just looked at the labs. Was he dehydrated at the time? His creatinine is not at the point that my vet would suggest daily fluids and definitely not based on one test. He is also still concentrating his urine which makes me wonder with that high white count there is a UTI like your vet is thinking. Was a culture and sensitivity run? If there is a UTI and you don’t see improvement he might not be on the right antibiotic for the bacteria he has. See what Marje has to say.

I agree 100%. I think your vet has started subq fluids way too soon. At this point, you want to get as much fluid in him orally as possible by adding extra water to his food. It’s always best for them to get their fluids that way until the point where they can’t keep up. BUN can be affected by many things: temporary dehydration, high protein diet to name two. If you start giving subq fluids too soon and he’s stable with CKD for a long time, there is the chance that he will build up scar tissue. Even waiting until Gussie was over 3.5 on his creatinine, we still gave him fluids daily for three years. Thankfully, using tiny needles (because he was so good at laying still for however long it took), and moving the needle around prevented him from getting scar tissue. But....why do it any longer than you have to? Some kitties are absolutely fine with it but some get really tired of it.

@Marje and Gracie This is a great video! I saw it on YouTube today. I was looking for some more info than the vet's office had given and this was exactly what I needed. After some rough sessions with the stabbing and forcing the fluids I was about to give up. When I saw how relaxed Gus was and how smoothly everything went, I figured if I just followed the instructions on the video and forgot about what the vet tech did, we could get it done. And we did!

That is awesome news!!!!! We love it when the video helps someone. Gus was a great teacher and that video is his legacy.

One other thing.....his phosphorus is way too high and needs to come down a lot.....like around 4.5 or so. The phosphorus x calcium should stay well below 70 to prevent tissue calcification and he’s getting too close to 70 especially to be so early in his CKD. It’s too early to do P binders so I’d suggest a few things:

• start feeding him foods that are under 1.00% P on a DMB or less than 200 mg P/100 kcal. These aren’t “low P” like the renal diets but they are lower than many foods. The closer you can actually get to feeding a food that is around 0.5%-0.8% P on a DMB, the better.
• add cooked egg whites to his food; that will give him more protein and offset the total P he gets. IT won’t bind the P in the foods that he gets but it can help lower the P. But I’d still get a lower P food. There is a list in the “New to the Group” sticky with lower P, low carb foods.

I would also take in another urine sample and have his urine protein:creatinine ratio done. That is way too much protein in his urine and CKD cats can be prone to proteinuria.

The interesting thing about his labs is that he is still doing a pretty good job of concentrating his urine. Normally, we see a significant drop in the urine specific gravity even before we see the creatinine going up. Is Riley a really large cat and/or do you have any historic labs to show what his creatinine has been?

The next time you check his bloodwork (and I wouldn’t go longer than three months), I’d see if your vet can send the labs to IDEXX where you can also get an SDMA (it is included if you do a senior blood panel or a superchem.....I’d ask for a senior blood panel) and see what his SDMA is.

 

[Really Riley (GA)]

I agree 100%. I think your vet has started subq fluids way too soon. At this point, you want to get as much fluid in him orally as possible by adding extra water to his food. It’s always best for them to get their fluids that way until the point where they can’t keep up. BUN can be affected by many things: temporary dehydration, high protein diet to name two. If you start giving subq fluids too soon and he’s stable with CKD for a long time, there is the chance that he will build up scar tissue. Even waiting until Gussie was over 3.5 on his creatinine, we still gave him fluids daily for three years. Thankfully, using tiny needles (because he was so good at laying still for however long it took), and moving the needle around prevented him from getting scar tiss aue. But....why do it any longer than you have to? Some kitties are absolutely fine with it but some get really tired of it.


That is awesome news!!!!! We love it when the video helps someone. Gus was a great teacher and that video is his legacy.

One other thing.....his phosphorus is way too high and needs to come down a lot.....like around 4.5 or so. The phosphorus x calcium should stay well below 70 to prevent tissue calcification and he’s getting too close to 70 especially to be so early in his CKD. It’s too early to do P binders so I’d suggest a few things:

• start feeding him foods that are under 1.00% P on a DMB or less than 200 mg P/100 kcal. These aren’t “low P” like the renal diets but they are lower than many foods. The closer you can actually get to feeding a food that is around 0.5%-0.8% P on a DMB, the better.
• add cooked egg whites to his food; that will give him more protein and offset the total P he gets. IT won’t bind the P in the foods that he gets but it can help lower the P. But I’d still get a lower P food. There is a list in the “New to the Group” sticky with lower P, low carb foods.

I would also take in another urine sample and have his urine protein:creatinine ratio done. That is way too much protein in his urine and CKD cats can be prone to proteinuria.

The interesting thing about his labs is that he is still doing a pretty good job of concentrating his urine. Normally, we see a significant drop in the urine specific gravity even before we see the creatinine going up. Is Riley a really large cat and/or do you have any historic labs to show what his creatinine has been?

The next time you check his bloodwork (and I wouldn’t go longer than three months), I’d see if your vet can send the labs to IDEXX where you can also get an SDMA (it is included if you do a senior blood panel or a superchem.....I’d ask for a senior blood panel) and see what his SDMA is.

Thanks very much for the info. I can definitely add some cooked egg whites to his food and I will look for the list of food in the sticky. I could ask for his labs from last April, but that would be the earliest. I'm going to have to get another vet in order to accomplish the rest - it might be a good idea - but there are too many vets in my section of the country that don't know very much about feline health so it's kind of a problem. This vet doesn't "like" IDEXX - prefers to use her own in-house methods. She told me an SDMA wouldn't provide info that would be of any value. I questioned the specific gravity value because she had mentioned his urine was extremely watery. The lab report I was given did not provide a value for SG - the vet tech told me that she thought it was 1.035 because that was hand-written on the paper. The vet did tell me that she thought his phosphorus was high and I asked her if she could recommend what I should do about that. She mentioned a phosphorus binder but said she wasn't certain if it would work so not to worry about the phosphorus! And I am very worried about scar tissue with him. He has lost so much muscle. His weight has been stable at approx. 10 pounds but this is now all in his belly. So I don't have a lot of places to inject the insulin beyond his scruff and adding sub-q fluids needles to the scruff is a lot, I think. We are going to see the vet tomorrow to have another round of blood work and urinalysis. Hopefully the antibiotic has helped. The vet mentioned switching to Baytril but said it was "hard to get". Not sure why.

Thank you again for your help. The vet is not being as helpful as I'd like and I feel kind of alone in this. Except for you guys - you're the greatest! I will not have access to internet starting tomorrow, possible through Sunday. How could I find out if there are any other comments when I check in again on Monday?

 

[Stacy & Asia]

Thanks very much for the info. I can definitely add some cooked egg whites to his food and I will look for the list of food in the sticky. I could ask for his labs from last April, but that would be the earliest. I'm going to have to get another vet in order to accomplish the rest - it might be a good idea - but there are too many vets in my section of the country that don't know very much about feline health so it's kind of a problem. This vet doesn't "like" IDEXX - prefers to use her own in-house methods. She told me an SDMA wouldn't provide info that would be of any value. I questioned the specific gravity value because she had mentioned his urine was extremely watery. The lab report I was given did not provide a value for SG - the vet tech told me that she thought it was 1.035 because that was hand-written on the paper. The vet did tell me that she thought his phosphorus was high and I asked her if she could recommend what I should do about that. She mentioned a phosphorus binder but said she wasn't certain if it would work so not to worry about the phosphorus! And I am very worried about scar tissue with him. He has lost so much muscle. His weight has been stable at approx. 10 pounds but this is now all in his belly. So I don't have a lot of places to inject the insulin beyond his scruff and adding sub-q fluids needles to the scruff is a lot, I think. We are going to see the vet tomorrow to have another round of blood work and urinalysis. Hopefully the antibiotic has helped. The vet mentioned switching to Baytril but said it was "hard to get". Not sure why.

Thank you again for your help. The vet is not being as helpful as I'd like and I feel kind of alone in this. Except for you guys - you're the greatest! I will not have access to internet starting tomorrow, possible through Sunday. How could I find out if there are any other comments when I check in again on Monday?

I know it's a pain, but please consider finding a different vet. Maybe call a few on the phone and ask if you can have a quick chat or email them some questions and ask things like how would they handle high phos or when would they start daily fluids, what lab do they use, things like that and try to get a feel for one that is informed, current and proactive.

I just went through a whole lot of similar CKD drama, and finding a vet that is on top of this stuff is immensely helpful and will make such a difference in Riley's health and the progression of his disease. You can read some of my recent condos to get an idea of what we've been dealing with, I switched vets almost on accident, but if I could go back in time and vet shop like crazy, I would have and maybe wouldn't be dealing with what we are dealing with right now.

 

[Marje and Gracie]

Thanks very much for the info. I can definitely add some cooked egg whites to his food and I will look for the list of food in the sticky. I could ask for his labs from last April, but that would be the earliest. I'm going to have to get another vet in order to accomplish the rest - it might be a good idea - but there are too many vets in my section of the country that don't know very much about feline health so it's kind of a problem. This vet doesn't "like" IDEXX - prefers to use her own in-house methods. She told me an SDMA wouldn't provide info that would be of any value. I questioned the specific gravity value because she had mentioned his urine was extremely watery. The lab report I was given did not provide a value for SG - the vet tech told me that she thought it was 1.035 because that was hand-written on the paper. The vet did tell me that she thought his phosphorus was high and I asked her if she could recommend what I should do about that. She mentioned a phosphorus binder but said she wasn't certain if it would work so not to worry about the phosphorus! And I am very worried about scar tissue with him. He has lost so much muscle. His weight has been stable at approx. 10 pounds but this is now all in his belly. So I don't have a lot of places to inject the insulin beyond his scruff and adding sub-q fluids needles to the scruff is a lot, I think. We are going to see the vet tomorrow to have another round of blood work and urinalysis. Hopefully the antibiotic has helped. The vet mentioned switching to Baytril but said it was "hard to get". Not sure why.

Thank you again for your help. The vet is not being as helpful as I'd like and I feel kind of alone in this. Except for you guys - you're the greatest! I will not have access to internet starting tomorrow, possible through Sunday. How could I find out if there are any other comments when I check in again on Monday?

I would find another vet. There’s not one single thing she told you that I would agree with. IDEXX is one of the premier labs and the SDMA test has proved to be exceptionally helpful in diagnosing CKD. Is it perfect? No but it’s a whole lot better than before we had it. While we like to see the urine specific gravity about 1.040 or higher, a lot of cats whose labs I see and the creatinine is, say 1.9, have a USG of about 1.020. Now that is really dilute urine. It also depends upon what time of day the sample is collected. Just as in people, the more fluid taken in, the more dilute the urine. Have you ever heard the doctors say you are hydrated if your urine is very very pale yellow? What we need to know is if Riley has the capability of concentrating his urine. To find that out, you want to test the very first urine sample of the day before he’s had a chance to get a lot of fluid in by drinking, by what’s in his food, by what he got via subq fluids (it’s worthless to check the USG if the cat has been given fluids the day before or the day of the urine specimen). Does that make sense?

I have seen so many vets overlook phosphorus and proteinuria, the control of both of which are predictors of longevity with CKD. I cannot imagine that baytril is hard to get in Pittsburgh.

 

[Really Riley (GA)]

I know it's a pain, but please consider finding a different vet. Maybe call a few on the phone and ask if you can have a quick chat or email them some questions and ask things like how would they handle high phos or when would they start daily fluids, what lab do they use, things like that and try to get a feel for one that is informed, current and proactive.

I just went through a whole lot of similar CKD drama, and finding a vet that is on top of this stuff is immensely helpful and will make such a difference in Riley's health and the progression of his disease. You can read some of my recent condos to get an idea of what we've been dealing with, I switched vets almost on accident, but if I could go back in time and vet shop like crazy, I would have and maybe wouldn't be dealing with what we are dealing with right now.

That makes sense. I've always been reluctant to make changes, but I don't want to make Riley a learning experience. He deserves better!