12/15 Chronos New

[Dan and Marc]

Hello,

Back in April Chronos started showing signs of diabetes, drinking/peeing/weight loss etc. His spreadsheet has those values on it.

More background info further below but to giving the more relevant info here(his original thread from back there is then: https://felinediabetes.com/FDMB/threads/new-with-questions.261669/#post-293459

• We changed his food back then (CKD cat) and he was able to go into remission with that alone though did take a little bit as the spreadsheet shows. Since October we have checked his blood each morning and generally his range was 80-190, the few times it was on the higher end we would check again in the afternoon and it would be in the 90-110 range. On 12/04/22 is when we started seeing 150 to the now 300s in the am but also seeing the afternoon or evening numbers going up as well until he is at what his current spreadsheet shows. We just got back from the vet, their meter had him in the 500s but he gets very stressed. They got blood and urine so will have those results tomorrow but she agreed that based on his other issues (listed below) that it was time to start insulin. I chose Lantus and she agreed, she wants us to start him at 0.5 of a unit and go from there since we are still seeing 200 numbers. His current weight is 18lbs.
  
• My main question was the 0.5 starting dose. Is that normal to start with?

Some background:

• Chronos is also a CKD cat but was diagnosed fairly young (he is 12 now and I believe was showing a 2.4 CREA when he was only 3 or 4, as was his brother (same litter). They were put on Hills K/D (knowing more now we wouldn't of done that food) but it kept him stable and his CREA had dropped to 1.9 up until June 2022. Sadly his brother passed away at 6 years of age due to kidney issues, we aren't sure exactly what, but twice he was hospitalized for a CREA at 14 then one at 9, the first time it came down pretty quickly with fluids and antibiotics, he was hospitalized for around 5 days that time. Sadly the second time it didn't come down and he stopped producing urine. So with what his brother went through the Internal Medicine specialist we were seeing didn't want us to change anything since Chronos seemed to be stable and kept that way until we changed his diet.
  
• We switched from Hillls K/D to Royal Canin D (we consulted with a vet Nutritionist), as well as adding 2 TBSP of boiled chicken and eventually doing half Weruva Chicken Pate with the Kidney food. He then went into the normal range and stayed there for awhile.
  
• Unfortunately when we took him in for a check up on his kidneys it showed his normally stable CREA of 1.9 now at 2.5 and his urine concentration also lower. He had been in the 1.9-2.1 range for several years up until that point. The thought is that the higher protein diet he was receiving was causing the increase. We removed the boiled chicken and reduced the Weruva while increasing the Royal Canin D and his numbers improved to 2.3. Which is what he has been on since. However now it seems to not be enough to control his diabetes with food alone and we are unable to find a food that is both low protein and low carb, with phosphorus also taken into consideration. I am part of Tanya's CKD group and have gone over the food charts extensively.
  
• Ultimately his kidneys are the main priority since you can't really stop the progression once it begins. Unlike Diabetes or other issues that can be managed.
  
• So at this time we are planning to keep him on his current food even though its not the best carb wise but with his situation is the best we can do and start insulin.
  
• One other thing to note since it started this year is he developed allergies in the form of itchy and creating scabs/sores. We have seen a dermatologist and did his skin allergen test last Friday on the 9th. So he will also be starting the vaccine in drop form sometime soon. I talked to her and she said they should have no affect on his BG.

Sorry for the overload of info and thank you so much for this community.

 

[Dan and Marc]

Figured out that 0.5 is generally the starting dose, didn't know what BID meant, thought it might be a reference to their weight. So least have that answered.

We will be starting insulin tomorrow AM, currently Chronos eats at 4am, between 10-10:30 am, 4PM, 7:30PM and 10:45-11PM, so five smaller meals, generally the same calories at each meal. We've been testing at around 10:15am and 10:30pm, so also planning to do the insulin after each test and probably move AM to 10:30 so we at the 12/12 mark. Main question is if it is ok if he eats right after getting the insulin?

 

[Bandit's Mom]

Hi @Dan and Marc, welcome to the Lantus forum.

It would help us if you would set-up your Signature with his basic info. That way we don't ask the same questions every time you post.

Here's how you can set-up your Signature:

• In the Menu, under your user name, click on Signature.
• 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.
• There is a limit of two lines. You may separate info with commas, dashes, | etc.
• Be sure to click the 'Save Changes' button at the bottom.

So Chronos is now eating Royal Canin Renal Support - D? Wet or dry? The wet is 16% carbs which is high carbs. The dry would be much higher. I guess you already know this, since you are part of Tanya's CKD group, but you don't need renal food at early stages of CKD. It's much more important to restrict phosphorus and restricting protein at low levels of CKD just leads to muscle wasting. Have you looked at other foods by Weruva? They have a large variety that are both low carb and low phosphorus and they put their nutritional information on their website for every single one.

BID - stands for twice a day. Have you looked at our dosing protocols and figured out which one you'd like to go with? SLGS or TR?

Lantus is dosed twice a day, 12 hours apart. You want to test before you give insulin, feed and then shoot. You do not want to feed 2 hours before giving insulin because you don't want the preshot test (which determines whether it is safe to shoot) to be food-influenced. Most people feed small meals every hour or two in the first part of the cycle. You want to feed less after the nadir because the insulin action is reducing then.

I will tag @Bron and Sheba (GA) and @tiffmaxee for inputs on starting dose, but it would help if you would get back on what food Chronos is eating (wet or dry) and which dosing protocol (TR or SLGS) you'd like to follow.

 

[Dan and Marc]

Thanks for the reply, I have some of that information in his spreadsheet which was in my signature, but I've updated it now to include everything.

Yes we are aware of the carb % of the Royal Canin (he eats wet only and has since he was 5), I explained in my first post after various diet changes that initially got him into remission back in April we determined that high protein foods were affecting his kidney values, we adjusted his food to remove some of the proteins and his kidney values went down though not back to where he was prior to changing his food form the Hill's K/D. The current diet is what we got him to and he stayed on with stable BG numbers until now. Since we cannot find a food that has both lower carbs and is generally low protein and reasonable phosphorus we plan to keep him on his current diet and starting insulin which our vet agrees with. We've met with a nutritionist who also could not find a better combination, I've also scoured the food charts here and on the CKD site and asked there as well. Chronos is not a typical CKD cat, if you're interested you can read my very first thread that I linked in my first post today above, so things that apply to most CKD cats don't seem to apply to him.

Yes we plan to test, shoot then feed. I just wanted to make sure that feeding after shooting was ok, which you've confirmed so thank you. Based on Chronos' feeding schedule which I mentioned above his AM shot will be 5-6 hours after he was last fed and his PM shot will be at least 3 hours since feeding. Our vet wants him to start at a 0.5 dose.

 

[Bron and Sheba (GA)]

What stage CRD is he? Low protein is not necessary until they are very u well around stage 4. Wereva have some new canned foods out now that are very low in phosphorus which is really what you need. High protein saves them from losing muscle mass which is what happens to CRD cats that go onto the prescription diets that are low on protein.

Re the starting dose. If you are doing SLGS are feeding a wet diet exclusively which is what your signature says (I can see you now have it up for us to see thanks) , then 0.5 units is the starting dose.

from the yellow stickie on dosing SLGS:
Starting Dose:

• 1u BID if kitty is not on a wet/canned low carb diet
• 0.5u BID if kitty has been switched to a wet/canned low carb diet
• If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
• Generally, shots are to be given 12 hours apart.

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

 

[Dan and Marc]

Thanks for the reply. I know most people will focus on the diet/CKD aspect of Chronos and understandably, but he is not a typical CKD cat, I've posted most of his history above and in this thread explaining what I could: https://felinediabetes.com/FDMB/threads/new-with-questions.261669/#post-293459

But for a quick summary: At 3 years of age he had a 2.4 creatinine, as did his brother (same liter) we were referred to the specialist we see now who is an Internal Medicine vet who specializes in kidneys and has several studies quoted on Tanya's CKD site. Back then the specialist said they both had CKD even though they were as young as they were (not just from the creatinine levels, but after other labs, ultrasounds etc that he did). Unfortunately his brother ended up having two kidney episodes and passed away at the age of 6, the specialist still isn't certain why his brothers kidneys did what they did but is leaning towards both him and Chronos having something going on genetically. Chronos was left on the Hills K/D diet because we were seeing improvements and the specialists didn't want to change anything, our normal vet was the one who had us put him on it before we saw the specialist, in hindsight we would not have chosen that food (nor would the specialists), however Chronos ate it for 8 years and his kidney values and tests only improved, ultimately bringing his creatinine down to 1.8 where it stayed for the last 5 years. The specialists specifically said this was not normal and Chronos was relabeled as having non-progressive kidney disease which the specialist said is not common and generally not seen. He also said we could continue his care with our normal vet just doing rechecks every six months, which is what we have been doing.

When Chronos first started showing symptoms of diabetes and had a high BG we brought him to our current vet, she did full blood and urine panels and everything was normal aside from his BG levels, he was still at his 1.8 creatinine. We decided to change his diet since we knew how much carbs the Hillls K/D had and consulted with a nutritionist who ultimately recommended the Royal Canin D/Weruva and 2 tbsp of boiled chicken breast (at that time there was a shortage of the D so we had to substitute the E version for a little bit). All of this is recorded on his spreadsheet. As you can see from his spreadsheet he eventually went down to normal BG levels from the diet change. We did a recheck with our vet at that time and found that his kidney values had all risen fairly dramatically, he had a creatinine of 2.5, higher BUN, SDMA and lower urine concentration. The only thing that was changed was his diet, after some consultations we cut back on the proteins, removing the boiled chicken breast and reducing the Weruva while increasing the Royal Canin gradually and checking his BG. His BG stayed consistent and 2 months after we rechecked and his kidney values showed some improvement, creatinine of 2.3, BUN back to what it was and SDMA in normal range again, his urine concentration was slightly improved as well. We did blood work today so will see tomorrow where he is at, but he has had blood work done between now and that test and his kidney values were still the same. So it is believed higher protein for whatever reason negatively affects his kidney values.

As of right now our vet doesn't feel comfortable changing his diet anymore and affecting his kidneys in consultation with his specialist and insulin is now the route we are taking, understanding that it is not the ideal lowest carb diet.