? 7/11 Bear AMPS 133, +3 50, +3.5 86, +4 131, +6 66, +7 88 - Vet said to skip shot tonight?

Meredith Bear’s Mom

Meredith Bear’s Mom

Member Since 2022
Hi everyone,

Bear is doing okay after his recent diagnosis of CKD and pancreatitis. The bupe seems to be helping but the vet doesn't want to keep him on it long term. She also wants to switch him to kidney-support food. I mentioned my concern about it spiking his BG and messing up his regulation but she really thinks it's important to switch him, especially with his pancreas issues. She said we can always switch back if he seems to be spiking too high with it. The IM specialist and ER doc agreed. So we are going to try it. I know it really isn't ideal for his diabetes but he has SO much going on right now that I want to trust them and see what happens. If he can stomach the wet food (fingers crossed) then at least that one is lower carb. He's also going for a GI biome on Thursday since he has some brightening of his stomach lining also.

I'm sad right now. Bear seems to be a little lethargic. Maybe it's just the bupe. I just can't help but worry. He still has a good quality of life - he loves to sit in my lap while I work and purrs. He purrs for chin scratches and he loves food. He is using the potty box. He loves to spend time outside on our patio. I've still only had him for less than a year and I'm heartbroken over the thought of losing him.

Previous post: https://felinediabetes.com/FDMB/thr...ney-failure-pancreatitis.279302/#post-3086474
 
Update: ended up taking him to the ER. He was unable to stand for a few hours and very sleepy. They couldn’t find anything wrong but suggested again reducing his dose to 1U and skipping tonight’s dose. They really think he’s dropping too low.
 
Meredith Bear’s Mom said:
Adding @Wendy&Neko just in case since we are getting close to shot time
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I’ll have to look at the labs later but I don’t see a need to skip the dose since he has come up to 127 by +10. I’m assuming you can get some food into him? If you can get him to eat, I’d shoot the full dose on time. If a cat has infection of any kind and does not get enough food, water, and insulin, ketones can quickly develop which means DKA can be a potential issue especially with a cat who has had DKA before.

If you cannot get him to eat, a token dose (1u) is better than no dose but if you are able to get food into him, I’d go for the full dose.

Have you ever seen this post on shooting insulin if kitty isn’t eating? It’s helpful.

I am right in the middle of cooking dinner right now but will pop back in shortly regarding his labs and also some other thoughts on the kidney diet.
 
Marje and Gracie said:
I’ll have to look at the labs later but I don’t see a need to skip the dose since he has come up to 127 by +10. I’m assuming you can get some food into him? If you can get him to eat, I’d shoot the full dose on time. If a cat has infection of any kind and does not get enough food, water, and insulin, ketones can quickly develop which means DKA can be a potential issue especially with a cat who has had DKA before.

If you cannot get him to eat, a token dose (1u) is better than no dose but if you are able to get food into him, I’d go for the full dose.

Have you ever seen this post on shooting insulin if kitty isn’t eating? It’s helpful.

I am right in the middle of cooking dinner right now but will pop back in shortly regarding his labs and also some other thoughts on the kidney diet.
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You are all good. Thank you! He eats no problem.
I’ve never seen that post before but it’s very interesting and put it into an interesting perspective.

look forward to hearing more from you. Enjoy your dinner :)
 
Meredith Bear’s Mom said:
You are all good. Thank you! He eats no problem.
I’ve never seen that post before but it’s very interesting and put it into an interesting perspective.

look forward to hearing more from you. Enjoy your dinner :)
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You’re welcome.

Your little Bear has a lot going on. Poor baby boy.

I noticed the UPC was a touch high. Did the vet mention retesting 2 more times 2 weeks apart? It’s important to determine if he has proteinuria and the early, the better.

Did the check his blood pressure? That is really very important for them to do every time you take him in.

I’m concerned his ALT and AST are high. Possibly due to pancreatitis as the liver and pancreas are so close together that inflammation of the pancreas can cause the liver values to rise. It sounds like they are doing an ultrasound this week? They also need to look at those kidneys because the only definitive way to diagnose pyelonephritis is by u/s. I had a CKD cat who had a kidney infection on two separate occasions a few years apart and it was treated with a six week course of Baytril but there are other drugs now.

I’m also concerned his phosphorus is at 6. I’ve found that the lower you can keep the P and the higher the HCT for CKD cats, the better for longevity and QOL. Usually phosphate binders, like aluminum hydroxide powder, are started at 6. I believe there are some other options mentioned on Tanya’s.

I’m not a fan of prescription diets. The renal diets are great for being low in P but they don’t have enough protein in them. Of course, you can try and supplement the protein by feeding a cooked egg whites with it which is a great way to add protein and have it be low P is cooked egg whites. The only caveat is the ingredients in most prescription diets are substandard.

Those are some initial thoughts but I want to run through the reports again. It’s in a very different format than I get from my vet so I want to be sure I haven’t missed anything.
 
Two other things:

1. Fluids for CKD are usually not started until the creatinine is above 3.5 and with his heart issues, I would hold off it was my kitty. You can add water to his food. One tsp = 5 ml so if the vet said to give 50 mls subq fluids, that’s ten tsp of water.

2. I’m concerned about the liberal use of gabapentin by many vets. If he’s stressed, maybe try Rescue Remedy for pets (no alcohol) or, even better, one of the excellent flower remedies from Green Hope Farms. I love the purity of these. Gabapentin can cause respiratory distress at the incorrect dose. You can also try Feliway.
 
Marje and Gracie said:
You’re welcome.

Your little Bear has a lot going on. Poor baby boy.

I noticed the UPC was a touch high. Did the vet mention retesting 2 more times 2 weeks apart? It’s important to determine if he has proteinuria and the early, the better.

Did the check his blood pressure? That is really very important for them to do every time you take him in.

I’m concerned his ALT and AST are high. Possibly due to pancreatitis as the liver and pancreas are so close together that inflammation of the pancreas can cause the liver values to rise. It sounds like they are doing an ultrasound this week? They also need to look at those kidneys because the only definitive way to diagnose pyelonephritis is by u/s. I had a CKD cat who had a kidney infection on two separate occasions a few years apart and it was treated with a six week course of Baytril but there are other drugs now.

I’m also concerned his phosphorus is at 6. I’ve found that the lower you can keep the P and the higher the HCT for CKD cats, the better for longevity and QOL. Usually phosphate binders, like aluminum hydroxide powder, are started at 6. I believe there are some other options mentioned on Tanya’s.

I’m not a fan of prescription diets. The renal diets are great for being low in P but they don’t have enough protein in them. Of course, you can try and supplement the protein by feeding a cooked egg whites with it which is a great way to add protein and have it be low P is cooked egg whites. The only caveat is the ingredients in most prescription diets are substandard.

Those are some initial thoughts but I want to run through the reports again. It’s in a very different format than I get from my vet so I want to be sure I haven’t missed anything.
Click to expand...
Thank you so much for this, Marje. I'll respond in order below. I also wanted to mention that I forgot to add in his labs from the most recent ER visit to the folder, so those were only the ones from the original doctor visit. I added them in and they're in there now if you are able to/willing to look at them also. His ultrasound report and images are also added.

The vet did not talk about retesting UPC, I can certainly ask her to do so though. He goes in tomorrow for GI testing so could ask them to do it then?

They said his BP was fine both times (ER visits).

According to the ultrasound he does not have a kidney infection. He had a nasty one when we first had him so that was one of my thoughts too.

I was reading about the binders on Tanya's. I think I will definitely get him some.

I'm assuming then you believe that the low-protein thing is a myth? I definitely worry about the ingredients in the Rx food, but it seems from reading Tanya's that there is more to the diet than just the protein. It seems like maybe the other foods are lacking vitamins and minerals that are helpful for renal support? Sorry I just feel totally overwhelmed by all information that seems to contradict itself.

Again, thank you so much. This is so helpful. And if you are willing the additional reports are in his folder :)
 
Marje and Gracie said:
Two other things:

1. Fluids for CKD are usually not started until the creatinine is above 3.5 and with his heart issues, I would hold off it was my kitty. You can add water to his food. One tsp = 5 ml so if the vet said to give 50 mls subq fluids, that’s ten tsp of water.

2. I’m concerned about the liberal use of gabapentin by many vets. If he’s stressed, maybe try Rescue Remedy for pets (no alcohol) or, even better, one of the excellent flower remedies from Green Hope Farms. I love the purity of these. Gabapentin can cause respiratory distress at the incorrect dose. You can also try Feliway.
Click to expand...
Yeah, I think we will stay away from fluids. He is great about getting water in his food.

Interesting, I've never heard of this. Especially with his heart and asthma issues this makes me nervous. Thanks for the heads up!
 
Meredith Bear’s Mom said:
Thank you so much for this, Marje. I'll respond in order below. I also wanted to mention that I forgot to add in his labs from the most recent ER visit to the folder, so those were only the ones from the original doctor visit. I added them in and they're in there now if you are able to/willing to look at them also. His ultrasound report and images are also added.

The vet did not talk about retesting UPC, I can certainly ask her to do so though. He goes in tomorrow for GI testing so could ask them to do it then?

They said his BP was fine both times (ER visits).

According to the ultrasound he does not have a kidney infection. He had a nasty one when we first had him so that was one of my thoughts too.

I was reading about the binders on Tanya's. I think I will definitely get him some.

I'm assuming then you believe that the low-protein thing is a myth? I definitely worry about the ingredients in the Rx food, but it seems from reading Tanya's that there is more to the diet than just the protein. It seems like maybe the other foods are lacking vitamins and minerals that are helpful for renal support? Sorry I just feel totally overwhelmed by all information that seems to contradict itself.

Again, thank you so much. This is so helpful. And if you are willing the additional reports are in his folder :)
Click to expand...
I firmly believe the low-protein thing is a myth. High quality protein is expensive for commercial pet food companies to add to food. It makes no sense, and there is a lot of info about this now, to feed a cat leaking protein a low protein diet. It might make sense if you have a very sick cat in stage 4 CKD but at that point, it’s time to start looking at QOL. I’ve never fed any of my CKD cats a low protein diet and they’ve all done really well, eventually passing from a non-CKD issue.

They absolutely should be rechecking that UPC and make sure he doesn’t have proteinuria. You’ll have to look at the dates he’s had the UPC tested but it’s three tests over a minimum of two weeks to determine proteinuria.

I’ll look at his additional tests and BRB.
 
Interesting how the other test his ALT was normal. Different labs, yes, but that’s a big difference. I don’t really have any other comments to add.
 
Marje and Gracie said:
Interesting how the other test his ALT was normal. Different labs, yes, but that’s a big difference. I don’t really have any other comments to add.
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Hi Marje. Sorry for my delay in getting back to you. Thank you so much for all of this information. I’m going to request the test when I chat with my vet this week. I spoke to another vet at the clinic in passing (she handles our 3 dogs but does cats as well) and she agreed with me that the diabetes should be treated first. She agreed that the Weruva Wx food is a great option to help with both kidneys and diabetes. I haven’t talked to my vet about that yet but was really relieved to hear the other vet say that.
Thank you again for your help! I’m actually at the AVMA Convention today where I’ll learn more about pancreatitis and CKD at some talks. Hopefully will learn something that can help Bear :)
 
Meredith Bear’s Mom said:
Hi Marje. Sorry for my delay in getting back to you. Thank you so much for all of this information. I’m going to request the test when I chat with my vet this week. I spoke to another vet at the clinic in passing (she handles our 3 dogs but does cats as well) and she agreed with me that the diabetes should be treated first. She agreed that the Weruva Wx food is a great option to help with both kidneys and diabetes. I haven’t talked to my vet about that yet but was really relieved to hear the other vet say that.
Thank you again for your help! I’m actually at the AVMA Convention today where I’ll learn more about pancreatitis and CKD at some talks. Hopefully will learn something that can help Bear :)
Click to expand...
You’re welcome! I hope you get some great info.
 
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