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Sheila & Beau GA & Jeddie GA
Member Since 2009
Re: BUD's vet visit
That does sound like a good vet. Not sure on the slight renal insufficiency diagnosis. Does he think she might be slightly dehydrated? How is her drinking and peeing, btw? If she does have beginning renal issues, giving sub-q fluids would be very helpful for both her kidney health and her BGs. Just a small amount and maybe every other day to start. Something to keep in mind.
Also, lowering the dose of insulin does not cause ketones. Some cats are more prone to them and some seem very non-prone to them, but in general you need several factors to create a situation where they can develop. Key factors are high BGs, not eating enough, infection, not enough insulin, dehydration and probably stress. Doesn't have to be all of those things, maybe just 2-3 of them.
You have to remember that high BGS can be caused by too little insulin and too MUCH insulin. Which brings me to answer your last question: why the 500s? As I posted yesterday, it could be rebound as you don't have data over night or during the day to show how low she went. I don't think she went very low, but possibly lower than she is used to - or she dropped faster than her body was comfortable. Without more data it is hard to say.
That does sound like a good vet. Not sure on the slight renal insufficiency diagnosis. Does he think she might be slightly dehydrated? How is her drinking and peeing, btw? If she does have beginning renal issues, giving sub-q fluids would be very helpful for both her kidney health and her BGs. Just a small amount and maybe every other day to start. Something to keep in mind.
Also, lowering the dose of insulin does not cause ketones. Some cats are more prone to them and some seem very non-prone to them, but in general you need several factors to create a situation where they can develop. Key factors are high BGs, not eating enough, infection, not enough insulin, dehydration and probably stress. Doesn't have to be all of those things, maybe just 2-3 of them.
You have to remember that high BGS can be caused by too little insulin and too MUCH insulin. Which brings me to answer your last question: why the 500s? As I posted yesterday, it could be rebound as you don't have data over night or during the day to show how low she went. I don't think she went very low, but possibly lower than she is used to - or she dropped faster than her body was comfortable. Without more data it is hard to say.
Vicky & Gandalf (GA) & Murrlin
Member Since 2009
Re: BUD's vet visit
Don't really have anything to add other than to say Sheila is right on both points - the ketones and the 500s. Oh and that your vet sounds like he has a brain and doesn't just repeat verbatim what he was told in vet school by the pet food sponsors.
Don't really have anything to add other than to say Sheila is right on both points - the ketones and the 500s. Oh and that your vet sounds like he has a brain and doesn't just repeat verbatim what he was told in vet school by the pet food sponsors.
Sheila & Beau GA & Jeddie GA
Member Since 2009
Re: BUD's vet visit
I meant to add that I tested Beau 2-3 times a week for ketones for about a year. then I stopped because he never had even a trace even when he had high numbers. When he was on vetsulin 400s were common and 500s were an occasional finding. With Jeddie, I tested for ketones a few times a week when I first got him because I basically gave one dose (of vetsulin) and then stopped because I could not test him (BGs) without getting bitten and he had given two lowish numbers in the first 4 days off insulin. He was eating well and not drinking excess water so I didn't worry.
I think all my ketone strips are expired now, even the ones that are individually wrapped in foil, but if I was worried at all about a lowered appetite, infection, etc., I would go out and buy new ones. They are a good thing to have in your arsenal with a diabetic. It wouldn't hurt for you to pick up some and test a few times a week, especially after a day she has had higher numbers. I think it will give you some peace of mind.
Sub-Q fluids will also help to prevent ketones, as I think that dehydration contributes more than is mentioned and fluids help to flush them from the body. I have seen some posts here were people with susceptible cats keeps fluids on hand for when they see trace ketones so they can start right away in fighting them off.
I meant to add that I tested Beau 2-3 times a week for ketones for about a year. then I stopped because he never had even a trace even when he had high numbers. When he was on vetsulin 400s were common and 500s were an occasional finding. With Jeddie, I tested for ketones a few times a week when I first got him because I basically gave one dose (of vetsulin) and then stopped because I could not test him (BGs) without getting bitten and he had given two lowish numbers in the first 4 days off insulin. He was eating well and not drinking excess water so I didn't worry.
I think all my ketone strips are expired now, even the ones that are individually wrapped in foil, but if I was worried at all about a lowered appetite, infection, etc., I would go out and buy new ones. They are a good thing to have in your arsenal with a diabetic. It wouldn't hurt for you to pick up some and test a few times a week, especially after a day she has had higher numbers. I think it will give you some peace of mind.
Sub-Q fluids will also help to prevent ketones, as I think that dehydration contributes more than is mentioned and fluids help to flush them from the body. I have seen some posts here were people with susceptible cats keeps fluids on hand for when they see trace ketones so they can start right away in fighting them off.
MommaOfMuse
Member Since 2010
Re: BUD's vet visit
Musette was a DKA survivor before I adopted her, so I tested her in the beginning about 3 times a week. Thankfully she has only shown a trace once since I have had her, and then since she wasn't showing any other signs I simply upped the amount of water I added to her food, and that trace disappeared. But I do have fluids on hand just in case she ever tests for them again so I can start her on fluids immediately.
Now I don't worry about her as much because even in the higher numbers she hasn't thrown anymore keytones, but when she does start hanging in those higher numbers I start testing her more often for them...She makes it very easy on me as she likes to go do her business first thing in the morning while I'm doing mine. :lol:
Mel, Maxwell, Musette & The Fur Gang
Musette was a DKA survivor before I adopted her, so I tested her in the beginning about 3 times a week. Thankfully she has only shown a trace once since I have had her, and then since she wasn't showing any other signs I simply upped the amount of water I added to her food, and that trace disappeared. But I do have fluids on hand just in case she ever tests for them again so I can start her on fluids immediately.
Now I don't worry about her as much because even in the higher numbers she hasn't thrown anymore keytones, but when she does start hanging in those higher numbers I start testing her more often for them...She makes it very easy on me as she likes to go do her business first thing in the morning while I'm doing mine. :lol:
Mel, Maxwell, Musette & The Fur Gang
Vicky & Gandalf (GA) & Murrlin
Member Since 2009
Re: BUD's vet visit
Epakitin is a phosphorus binder. From what reading I've done, using a phosphorus binder is recommended in chronic kidney disease when phosphorus levels increase as a result of the disease's progression.
What was Bud's Creatinine level? A BUN of 36 suggests typical diabetes caused dehydration to me. Creatinine is the more important kidney function value in addition to a urine specific gravity test to see how well the kidneys are concentrating urine.
Unless her phosphorus and creatinine were high, I don't understand the need for Epakitin at the stage of "renal insufficiency." Gandalf had renal insufficiency for the last 3 years and he maintained his values on sub-Q fluids, he did not have kidney disease, just overworked kidneys from the diabetes. This is my opinion, but without the high values to support the need for a medication, I don't understand why the vet would want to use it.
Epakitin is a phosphorus binder. From what reading I've done, using a phosphorus binder is recommended in chronic kidney disease when phosphorus levels increase as a result of the disease's progression.
What was Bud's Creatinine level? A BUN of 36 suggests typical diabetes caused dehydration to me. Creatinine is the more important kidney function value in addition to a urine specific gravity test to see how well the kidneys are concentrating urine.
Unless her phosphorus and creatinine were high, I don't understand the need for Epakitin at the stage of "renal insufficiency." Gandalf had renal insufficiency for the last 3 years and he maintained his values on sub-Q fluids, he did not have kidney disease, just overworked kidneys from the diabetes. This is my opinion, but without the high values to support the need for a medication, I don't understand why the vet would want to use it.
pamela and tigger
Member Since 2009
Re: BUD's vet visit
Exactly Vicky.
Ditto too on the urine specific gravity. On your test copies of the urine tests Beth, it should show what these are. Dr. Lisa always says to check these as well for early kidney problems.
As far as the raw diet, it seems that your vet is coming from an old notion that restricting protein is the way to go. Not so, especially since it is not a contributing factor to promoting kidney disease. Dr. Lisa talks about it a lot.
Please read up on kidney issues. There are a lot of things to consider before coming to this diagnosis. Bud may or may not be in early kidney failure. You just need to read and educate yourself. ETA, I will try and get you some links to help too. It was just so late last night.
BTW you can use the Search button on the Health board and see what others have said about using Epakitin and other kidney issues.
Vicky & Gandalf (GA) said:
Exactly Vicky.
Ditto too on the urine specific gravity. On your test copies of the urine tests Beth, it should show what these are. Dr. Lisa always says to check these as well for early kidney problems.
As far as the raw diet, it seems that your vet is coming from an old notion that restricting protein is the way to go. Not so, especially since it is not a contributing factor to promoting kidney disease. Dr. Lisa talks about it a lot.
Please read up on kidney issues. There are a lot of things to consider before coming to this diagnosis. Bud may or may not be in early kidney failure. You just need to read and educate yourself. ETA, I will try and get you some links to help too. It was just so late last night.
BTW you can use the Search button on the Health board and see what others have said about using Epakitin and other kidney issues.
Vicky & Gandalf (GA) & Murrlin
Member Since 2009
Re: BUD's vet visit
Yeah, those values don't even suggest kidney insufficiency to me. Gandalf ran just above the upper range for Creatinine about 3.0 to 3.4 at the highest. USG would be 1.01 if the kidneys weren't concentrating at all, so 1.02 is a little low, that may be why the vet thinks insufficiency, not the Creatinine.
I suggest doing some research on CRF websites, there are several good ones. Google "Feline kidney disease" and you will get most of them, especially felinecrf.org and felinecrf.com. They are 2 different sites.
Editing to add, the values seem typical of an uncontrolled diabetic, with the BUN indicating some dehydration and the lower USG because there's so much going through the kidneys trying to wash away the excess sugar causing them to not concentrate well.
Yeah, those values don't even suggest kidney insufficiency to me. Gandalf ran just above the upper range for Creatinine about 3.0 to 3.4 at the highest. USG would be 1.01 if the kidneys weren't concentrating at all, so 1.02 is a little low, that may be why the vet thinks insufficiency, not the Creatinine.
I suggest doing some research on CRF websites, there are several good ones. Google "Feline kidney disease" and you will get most of them, especially felinecrf.org and felinecrf.com. They are 2 different sites.
Editing to add, the values seem typical of an uncontrolled diabetic, with the BUN indicating some dehydration and the lower USG because there's so much going through the kidneys trying to wash away the excess sugar causing them to not concentrate well.
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