advice needed on how to manage diabetes and CRF

Status
Not open for further replies.
nepenthe

nepenthe

Member Since 2010
Adding an update to this post, it looks more like I am dealing with a diabetic cat with the early stages of CRF. He had been having symptoms of pancreatitis and an fPL confirmed it with a 6.4 reading. However an ultrasound yesterday ruled out any underlying causes in terms of anything wrong with pancreas or gall duct. It also ruled out IBD, despite him having had a history of vomiting. This was one of the reasons that he went on, and stayed on, a low dose of 5mg EOD prednisolone since his pancreatitis attack of Jan 2011. he has never vomited, save for a few hairballs since Jan 2011.

We've been seeing insulin resistance, and are now starting to taper him off, 2/5mg EOD for a week to see if the glycemic response improves. He has been diabetic since June 2010. The diabetes pre-dated any pancreatitis.

His U/S yesterday showed, "early bilateral renal disease" and "corticomedullary rim sign" and poorly defined medulla. But, his kidney values (BUN, Creatinine) have always been right in the middle of normal range ever since Jan 2011, having had them tested every 6 mos. The bloodwork from days ago was also right in the middle of normal. The vet said that despite the appearance and echogenicity of the kidneys on ultrasound, he would at the most be at the early state of CRF - like early stage one. The U/S also ruled out CRD and other renal diseases. His white blood counts are all normal too.

The vet now speculates that it is either or a combination of 23 months on the prednisolone that's caused this, or the persistent hyperglycemia as a result of the pred.

At the time in Jan 2011 the vet was speculating that we should consider an ultrasound then, but I opted for an x-ray, which showed him to have normal looking kidneys. I blame myself now for not doing the U/S back then, as it might have shown the kidney irrgularities and thus the vet would have thought twice about the pred (she was surprised to see his kidney abnormalities on the ultrasound yesterday). On the other hand, if we had done one then and they looked normal back then, we would likely be at the same place now, and more likely that we might not have done the U/S this time, assuming his kidneys were still ok. Its really hard to second-guess one's decisions in hindsight.

Does anyone have advice on how to manage diabetes and CRF? (am thinking the dietary demands are inverse)

Is it ever too early in CRF to administer sub-q fluids or phosphorus binders?
 
Low phosphorus, moderate protein. A list of others has been posted fairly recently on the board, if you page through.

Souping up the food provides the extra water weak kidneys need (it takes more water to get things flushed out).
Distilled water has no solute (minerals, etc) and may be helpful to use for both water bowls and souping up food.

Until the renal function is severe, special renal diets may have insufficient protein and result in muscle wasting (per Dr Pierson of Cat Info)
 
That Catfinfo site has lots of useful stuff - esp a listing of foods with their phosphorus content.

This is one of the biggest issues for us with diabetic and renal cats - the diet. In my case, the only foods that he likes which don't have gluten/rice flour or other high glycemic carbs seem to be Fancy Feast's fish-based ones, like Salmon Feast and Cod, Sole and Shrimp. These might be great for his diabetes, but wanting to protect his kidneys, its time I found some other alternatives.

I gave them spring water for the first time today and they really show interest in it. Going to keep that up.

I read lots of good stuff about Epakitin.

Is there a time when its too early to start using sub-q fluids or something like Epakitin?
 
if he only likes fishy foods then definitely look into the phosphorous binders as they may help a lot.
I don't know whether fluids would be indicated yet, especially if his values don't indicate dehydration, but there is no reason why you couldn't do a weekly topup (say 100mL?) plus a b12 injection. things to talk about with your vet :)
 
I add water to the food for some time now, and that helps. Funny thing is when I mentioned B12, she seemed to think that it might make the kidneys work harder. (I know when taking it myself it really increases my appetite).

I'm finding pepcid/famotidine at 2.5 mg really picks up his eating when I pulse it for a few days at a time.
 
My cat has CKD & is diabetic. As for food... like others said, low phosphorous. I tried to go this route with Hobbs with a non Rx food, but his numbers got worse. But he won't eat the Rx food straight. So I mix it with a low phosphorous and low carb food. (Both are wet) He was diagnosed CKD in September 2011 and just a couple of weeks ago was put on sub-q fluids.
 
Witn had both diabetes and CRF. I was able to manage both for several years by feeding her the Friskies Special Diet canned foods. The only flavor I avoided was the Chicken & Gravy since it was high in carbs. During the time she was on this diet, but her glucose levels and kidney values stayed constant.

She also received sub-q fluids a couple times a week.
 
I think that phosphorus is the real enemy here and not as much protein.

There is this phosphorus binder called Epakitin, made from citosan (crustacean shells). I wonder if this is a good thing to add in any case to their food?
 
This is a bit long, but I hope it will help.

You're absolutely correct - the diseases are ery contrary to one another. I find it amazing, though, that your kitty's BUN and Creatinine are the middle of normal. You really lucked out finding it so far ahead of any lab evidence, because by that time, 75% of the kidney function is gone. Wow, great news for both you and your kitty.

We too are dealing with this dilemma, and I have no easy answers (and my kitty’s fPL is 27). I did try to do a homemade quality protein diet for my baby, after 13 months on renal RX food, and that threw Sarah into the brink of metabolic acidosis, so, be very careful. However, your kitty is at such an extreme beginning, you might be able to get away with it. My only suggestionif you try it is that you do labs every week for several weeks to keep a very close watch on your kitty’s response.

Now, and with my vet's approval, I am mixing half RX diabetic diet and half RX renal diet (I also switched from Hills k/d renal over to Royal Canin LP, as k/d actually has glucose as one of its ingredients - go figure). She is doing much better and her TCO2 is back to midline, but I’m supplementing her with potassium for the first time ever to get those numbers back up (she was 3.2 - low end is 3.4 and she was always mid-normal before the short-term protein experiment). Will be doing another lab soon to see if I succeeded and can stop, as her RX food should be taking over by then. The importance of using an RX food is that it contains the right mix of nutrients need by CKD cats (potassium, b vitamins, etc.)

As far as the Epakitin, as long as your kitty is not on the high end of calcium, that will be fine. If, however, you do find the calcium numbers rising, you can switch over to Aluminum Hydroxide. The only problem with that is there are certain medications that will cause kitty to uptake the aluminum instead of excreting it. So, you need to talk that over with your vet also.

I have been using Azodyl for 14 months now, and that has kept my kitty's BUN and creatinine relatively stable. It is a special probiotic that helps "scrub" the toxins to alleviate kidney stress. It also keeps kitty very regular without giving her the runs. Many vets recommend it.

Sarah has also been on sub-q's the entire time. I started at 2x a week. Just in the last couple of months, I've had to go every other day. I think a full year on 2x a week is pretty darn good, so I know the Azodyl does help quite a bit. However, it's probably the pancreatitis and diabetes that has caused the extra dehydration. The only problem is, though, you need to administer Azodyl an hour before meals (preferably by pilling), and it must remain refrigerated. I’m one of those people who sprinkle it on a bite of food, so I know my kitty is not getting the full benefit of it, but it’s still helping.

I am about to try RenaVast in hopes I can replace the Azodyl (or at least just throw it into her full meal and not deal with the hour ahead of time). There are people over in the CKD group that have used it with great results. There are also some people there who are totally afraid of it (they haven't tried it, though). Yet another thing to talk over with your vet.

Finally, you might find it helpful to join the CKD group. By the way, the current P.C. term is CKD (chronic kidney disease in lieu of chronic renal failure). It’s not an instant death sentence if you can catch it in time (which luckily you have).

This is the main information link where you can find all kinds of amazing information: http://www.felinecrf.org/what_is_ckd.htm

This is the group itself: http://pets.groups.yahoo.com/group/tanyas-crf-support/

The group site is set up a bit differently than this one. Also, beware, there are a couple of colorful characters there, and sometimes you have to take others with a grain of salt. However, it has been a great help to me, and I wish I had joined it way back when – I bet my cat would not have diabetes now if I had.

DZ and Sarah
 
thanks a lot for this - Azodyl could have a lot to do with it. Antioxidants can play a huge role. My other cat also has stage 2. He was dx'd in early 09 with numbers in the early stages of 2 and then I switched him to an all canned diet and two years later in early 11, his numbers were still the same (international numbers were BUN: 13, creatinine 239 and USG was 10.36).

This spring I noticed he would come up behind me, after eating, while I was on the couch. I could smell something odd on his breath. A few weeks later it dawned on me that it is ammonia I was smelling.

Around that same time I discovered an OTC supp called n-acetylcysteine. I was looking into it for the purposes of eliminating the radioactive dye I was getting in CT scans. I found research that proved this stuff can bind metals and toxins from the blood, increase glomerular filtration rate in the kidneys and increase blood flow to the kidneys (much like an ACE inhibitor). It also raises glutathione levels (the most powerful antioxidant)

The first time I took 500mg of this, the next morning I noticed my first urine was clear - something unusual in us, despite how much we try to hydrate ourselves. This tells me that the NAC can do some really heavy lifting for the kidneys. There is an Italian study recently done on NAC on cats with CKD.

I gave it to the cat with stage 2 - the one that would sneak up on me with ammonia breath. Two days later, there was no trace of bad breath and not the slightest hint of ammonia. His appetite and energy were up and seemed more bright-eyed ever since.

I am taking him in tmrrw for a work up and am going to put the diabetic one mentioned in the OP on it in a few weeks, after I get him tapered of the prednisolone he is on now - just to get some baselines.

I am thinking of taking them both in every 12 weeks for blood, urine and weighing them, just to get more data points.

Food-wise, i am going to move them off of FF Salmon, with a really high phosphorus count, apparently, (they've been on that for yrs) to something like canned Wellness Chicken. That with some Epakitin should keep extra toxins from food in check.

In your case, I think the biggest plus was the sub-q's for sure. I am going to start the CKD one on them tmrrw and the other one who is "in very early stage one" on them after getting some more baselines in a couple of weeks. Put them both on sub-qs (the one with stage two, or maybe now stage three - I find out tmrrw).

Do you think there are any dangers in giving small amounts sub-q's - say 100-150ml a week - to a diabetic with early stage kidney disease? (my reasoning here is that a diabetic cat's organs might need some extra support in flushing out toxins from the excess glucose)
 
Wow, that's interesting about the n-acetylcysteine - haven't heard of it before. I'll look into that.

Regarding the sub-q's, my only concern is if kitty is not dehydrated, will giving sub-q's start a precent in kitty's system to expect it? Definitely, I think that's a question for your vet.

Goodness. It sounds like you will be doing a lot of care-taking. I can't imagine taking care of more than one special needs kitty right now. Although, I am impressed by those out there who are doing so for multiple cat households (there's someone here who has 7 cats - yikes).

DZ and Sarah
 
Status
Not open for further replies.
Back
Top