Baby is almost 19 - has CKD + newly dx, please advise

[Deborah A Rodriguez]

Hi, Our Baby almost 19, had copious urine up until about 4-6 weeks ago. Now we are challenged to obtain the 3 samples of urine for the glucose test the vet wants before proscribing insulin because her urine has become scanty.

My partner is retired (thank goodness or I would never be able to watch our cat carefully) but has only been able to get 2 samples, both positive for glucose in urine, the darkest indicator, but no ketones, thankfully.

The vet (newly trained) would have expected more urine unless she is really not diabetic, but we have 2 of the 3 samples positive. I attach her fructosamide test which the clinic may ascribe to 'white coat' syndrome.

I plan to attempt a blood sugar test using the dot of blood on the ear with Baby over the weekend. This seems to be a skill I should master.

We had been using FF (yes, we will need something better).

I have no data yet for a chart. I hope what I have written makes sense for Baby's sake. She seems OK but she sleeps quite a bit and her urine output changed alot. We give her 100 ml/night Lactated Ringers religiously.

Thank you.

 

[Idjit's mom]

Deborah, here you are! Thank you for bringing Baby to meet the rest of the gang and start getting you more much needed support and information.

First, a link to videos and tips for home testing:
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
How to test your cat's bg at home: Video I made showing how to test your cat's blood sugar by JanetNJ

You can condition Baby to the testing process..choose a testing station that is comfortable for both of you, with good lighting.
Rub and stroke her ears, tell her what a wonderful kitty she is, and give her a low carb treat. I use small pieces of cooked plain chicken, others use bonito flakes, Pure Bites freeze dried chicken and Orijen freeze dried meat.

Here are the links to the spreadsheet and how to understand the spreadsheet grid:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

The FAQs forum has an Index with valuable information that you can explore. But please read the following document:

• New? Seeing Low Numbers? How You Can Help Us Help You

When we find out what insulin vet prescribes, we can provide information there also.

The Fancy Feast Classics and/or Friskies pates are fine. All below 10% carbs.

 

[Deborah A Rodriguez]

Deborah, here you are! Thank you for bringing Baby to meet the rest of the gang and start getting you more much needed support and information.

First, a link to videos and tips for home testing:
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
How to test your cat's bg at home: Video I made showing how to test your cat's blood sugar by JanetNJ

You can condition Baby to the testing process..choose a testing station that is comfortable for both of you, with good lighting.
Rub and stroke her ears, tell her what a wonderful kitty she is, and give her a low carb treat. I use small pieces of cooked plain chicken, others use bonito flakes, Pure Bites freeze dried chicken and Orijen freeze dried meat.

Here are the links to the spreadsheet and how to understand the spreadsheet grid:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

The FAQs forum has an Index with valuable information that you can explore. But please read the following document:

• New? Seeing Low Numbers? How You Can Help Us Help You

When we find out what insulin vet prescribes, we can provide information there also.

The Fancy Feast Classics and/or Friskies pates are fine. All below 10% carbs.

 

[Deborah A Rodriguez]

Thank you, I may be able to tackle the spreadsheet tomorrow. We confirmed a third urine glucose reading at the 'high' level per strips our vet requested.
She has not used litter box very often to urinate (as in the past).....so I emailed the vet pronto.

I will not be able to do hands on blood glucose test for first time until tomorrow.

 

[Idjit's mom]

Deb, if you need help with the spreadsheet, @Chris & China (GA) can set it up for you. Just PM (start a conversation) with her and let her know what you need.

I hope vet can help and Baby starts feeling better and getting the waterworks going again. Sweet lovely girl!

 

[Deborah A Rodriguez]

Thanks so much Lou. I will start tomorrow.

 

[Deborah A Rodriguez]

Hi everyone

We are at vets now
They want to start Baby on Glargine 100u/ml once in am

Marine drugs closed today

They put u-100 syringes which seem wrong

They said they will do 2 to 3 curves

I have been stroking Baby’s ears and acquired Wal Mart items

 

[Idjit's mom]

Glargine (Lantus) is a good insulin for cats. You can read about it HERE on the Lantus forum. I think the Rx is for one unit once a day, not 100 units, but cats have a faster metabolism than humans and need insulin 2 X a day, 12 hours apart, so you would give 0.05 (1/2) Unit morning and evening. My vet also told me to inject one unit once a day, and when I started reading here and questioned her, she said because it was easier on the human to do it that way. It might be easier on the human, but not effective for a cat.

Edited to add: when you order from Marks Marine get the pens and you will not waste insulin that might not be used before expiration or loss of effectiveness with the vial.

You can do your own curves, and save money and Baby vet stress which raises blood sugar, sometimes resulting in a higher starting dose than needed, or dose increases based on elevated BG numbers. The one unit, divided into 1/2 unit morning and night is a good starting dose!

In addition, instead of tackling a curve, which is testing every 2 hours for 12 hours, (especially since you are just beginning) ALWAYS test before injecting insulin, just try to withhold food for 2 hours so the test is not food influenced. If Baby is starving to death (and I can identify with that) feed a little, then test a much calmer cat. Then get a couple of tests in the 12 hour cycle, at different times each day. This is actually going to give you better information than a curve that reflects numbers for just one day.

The U100 syringes are the right kind, but you want syringes with 1/2 Unit marks. You can get ReliOn syringes at Walmart with half unit marks.

Be sure to start reading the yellow tagged stickies at the top of the Lantus forum so that you can understand how it works and get the basics down. Ask any questions you have, the Lantus members really help each other out. It's going to be ok and Baby is going to feel so much better, which makes you feel much better.

 

[Deborah A Rodriguez]

Glargine (Lantus) is a good insulin for cats. You can read about it HERE on the Lantus forum. I think the Rx is for one unit once a day, not 100 units, but cats have a faster metabolism than humans and need insulin 2 X a day, 12 hours apart, so you would give 0.05 (1/2) Unit morning and evening. My vet also told me to inject one unit once a day, and when I started reading here and questioned her, she said because it was easier on the human to do it that way. It might be easier on the human, but not effective for a cat.

Edited to add: when you order from Marks Marine get the pens and you will not waste insulin that might not be used before expiration or loss of effectiveness with the vial.

You can do your own curves, and save money and Baby vet stress which raises blood sugar, sometimes resulting in a higher starting dose than needed, or dose increases based on elevated BG numbers. The one unit, divided into 1/2 unit morning and night is a good starting dose!

In addition, instead of tackling a curve, which is testing every 2 hours for 12 hours, (especially since you are just beginning) ALWAYS test before injecting insulin, just try to withhold food for 2 hours so the test is not food influenced. If Baby is starving to death (and I can identify with that) feed a little, then test a much calmer cat. Then get a couple of tests in the 12 hour cycle, at different times each day. This is actually going to give you better information than a curve that reflects numbers for just one day.

The U100 syringes are the right kind, but you want syringes with 1/2 Unit marks. You can get ReliOn syringes at Walmart with half unit marks.

Be sure to start reading the yellow tagged stickies at the top of the Lantus forum so that you can understand how it works and get the basics down. Ask any questions you have, the Lantus members really help each other out. It's going to be ok and Baby is going to feel so much better, which makes you feel much better.

Thank you, Lou. So informative. I will re-read.

 

[Idjit's mom]

Deborah, any updates on Baby? I hope you both are doing well and that we hear from you soon.

 

[Veronica & Babu-chiri]

Hi and welcome!

You mentioned in the header that Baby has CKD, what stage is he ?

FF pates are ok for diabetic but they are high in phosphorus and with CKD you want to give him food that is low in phosphorus, we use a food list made by Dr Lisa Pearson that is great and that can help you find some food that will help with both conditions, look for one that is 10% or less in carbohydrates (carbs) and under 250 ( if you can go under 200 even better) in phosphorus this is the link for the list http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

[Deborah A Rodriguez]

Deborah, any updates on Baby? I hope you both are doing well and that we hear from you soon.

Hi Lou:

Thank you so much for the check in.
Baby had a blood glucose curve at the clinic.
"
Diagnostics: - BG curve 8am - 206 Glargine 0.5U "given at 8.30am 10am - 194 12pm - 164 2pm - 205
Hospitalization Summary: We are very pleased as Baby's curve is ideal today. The 0.5 unit once dialy seems to give her good control. We recommend a recheck appointment in 2-4 weeks for exam and fructosamine level. Owner is to continue monitoring urine glucose daily until then."

 

[Deborah A Rodriguez]

Hi and welcome!

You mentioned in the header that Baby has CKD, what stage is he ?

FF pates are ok for diabetic but they are high in phosphorus and with CKD you want to give him food that is low in phosphorus, we use a food list made by Dr Lisa Pearson that is great and that can help you find some food that will help with both conditions, look for one that is 10% or less in carbohydrates (carbs) and under 250 ( if you can go under 200 even better) in phosphorus this is the link for the list http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Thank you so much Veronica. I will need to educate myself.

 

[Idjit's mom]

Hi Lou:

Thank you so much for the check in.
Baby had a blood glucose curve at the clinic.
"
Diagnostics: - BG curve 8am - 206 Glargine 0.5U "given at 8.30am 10am - 194 12pm - 164 2pm - 205
Hospitalization Summary: We are very pleased as Baby's curve is ideal today. The 0.5 unit once dialy seems to give her good control. We recommend a recheck appointment in 2-4 weeks for exam and fructosamine level. Owner is to continue monitoring urine glucose daily until then."

Deborah, are you home testing her blood sugar so that you have more accurate daily information on Baby's blood sugar levels? I see the instruction to continue monitoring urine glucose daily". I assume that is with the glucose testing strips you dip into the urine.
If you want to look into testing her blood sugar, like we do with our kitties, we can provide information on supplies and the process. It's far more accurate than testing the urine that has been collecting in the bladder for an undetermined period of time. We use a spreadsheet to record insulin dose and testing results.
In addition, I have learned that the type of insulin you are using works best for cats with consistent dosing twice a day, 12 hours apart as a cat's metabolism is faster than a human's and uses the insulin differently. Would you consider dosing Baby with 0.25 unit morning and night? I guess I didn't know or remember that Baby was getting 0.5 U of Lantus (glargine). You can read the stickies at the top of the Lantus forum HERE for more information on this insulin and how it works.

I know you have your plate very full and I don't want to add to your burden, just wanted to bring this additional info to your attention for your consideration, and to help Baby feel as well as possible.

 

[Deborah A Rodriguez]

Deborah, are you home testing her blood sugar so that you have more accurate daily information on Baby's blood sugar levels? I see the instruction to continue monitoring urine glucose daily". I assume that is with the glucose testing strips you dip into the urine.
If you want to look into testing her blood sugar, like we do with our kitties, we can provide information on supplies and the process. It's far more accurate than testing the urine that has been collecting in the bladder for an undetermined period of time. We use a spreadsheet to record insulin dose and testing results.
In addition, I have learned that the type of insulin you are using works best for cats with consistent dosing twice a day, 12 hours apart as a cat's metabolism is faster than a human's and uses the insulin differently. Would you consider dosing Baby with 0.25 unit morning and night? I guess I didn't know or remember that Baby was getting 0.5 U of Lantus (glargine). You can read the stickies at the top of the Lantus forum HERE for more information on this insulin and how it works.

I know you have your plate very full and I don't want to add to your burden, just wanted to bring this additional info to your attention for your consideration, and to help Baby feel as well as possible.

Hi, Lou: My partner does the shots (we share the nightly CKD fluids), and he is a stickler to the clinic's protocol. I will try to convince him as we love Baby.
I will re-read as I skimmed the Lantus forum. You're right next 2 days too busy (audit, etc.) but I will make the spreadsheet for her.
Thanks.

 

[Idjit's mom]

stickler to the clinic's protocol. I will try to convince him as we love Baby.

I hope you can, my vet also recommended 1 X day injection and I learned differently. It's unfortunate that not all vets/clinic are deeply educated in feline diabetes and we see all kinds of things that have proven to be less effectual if not detrimental (starting dose too high or increasing by too much too fast) to these fur kids. I am not saying that the 1 x day shot is detrimental, just not as effective as the 2 shots a day would be. It's worth a shot so that Baby gets the full benefit, and not a dose that works for 12 hours, then no insulin support for the next 12 hours, until the next shot.

 

[Veronica & Babu-chiri]

Diagnostics: - BG curve 8am - 206 Glargine 0.5U "given at 8.30am 10am - 194 12pm - 164 2pm - 205
Hospitalization Summary: We are very pleased as Baby's curve is ideal today. The 0.5 unit once dialy seems to give her good control. We recommend a recheck appointment in 2-4 weeks for exam and fructosamine level. Owner is to continue monitoring urine glucose daily until then."

My vet also recommended shots once a day and they ended messing things up more because they didn't considered how his blood glucose acts during the night going very high again since there's no insulin in his body, even in the curve they did 6 hours after his shoot he was already in his way up .

The fructosamine test is a very good instrument for diagnose since it will give you an average of how his blood glucose acted during a period of time and it allows vets to determine if he needs insulin, but it doesn't tell you how he was at an specific time, he could have gone too low ( which is very dangerous ) and that will not be reflected in the test or very high which is also not desirable, so is not very useful as an every day control mechanism

With a preshot number of 206 I seriously recommend that you test at home, because that is a bit low, ok not normal, but low number to start (specially for a newly diagnosed) and he could go a lot lower into dangerous low levels during the day without you knowing it

Lantus(gragline) is a depot insulin, which means a bit of it stays in the cat's ( or human) system that is part of the reason why in humans it needs to be shoot only once a day (our metabolism runs different from cats metabolism, slower among other things that's part of the reason gargline can be shoot only once a day in humans) and when you do not shoot every 12 hours this depot doesn't form properly causing weird ups and downs which is exactly what you want to avoid

 

[Myrtlesmum]

My cat is similar to yours, diabetic but not bad ( high 100’s - low 200’s) and early CKD. I was dosing twice daily but find that her blood glucose is pretty well controlled with a tiny bit of insulin - 0.25 or less once daily and sometimes she can go even up to 3 days or longer. If you caught the diabetes in early stages it may respond well to the insulin and seeing as the numbers aren’t that high, you don’t want to see that much movement (or risk going too low). Most important thing is to test so you can see how she reacts to the insulin dosage and see for how long it acts for your cat. Every cat is different and trial and error will tell you what is best for your cat.