Back on the juice, but this time with CRF

[MindyC]

So...Max was first diagnosed with diabetes back in 2010. We had him OTJ in 6 weeks (yay!). We've been great since then, even got to the point where when he was sick, checking his sugar never crossed my mind.

3 years ago he was diagnosed with chronic renal failure. The vet said then that Max has been one of the most gracefully declining cats he'd ever seen. He was 14 then. He's 17 now. And then he got sick last week.

Vomiting and diarrhea triggered a trip to the vet. Honestly, I thought it would be the "this is the beginning of the end" conversation. We finally decided on a blood draw to see where his kidneys were before deciding on medications, and lo and behold, one kidney value went back to normal (what the heck?!?) and his sugar was sky high. So we're back on insulin (Novalin-N this time, we don't expect he'll go back into remission), and he's been on antibiotics this past week for whatever GI bug he had. He's doing much better now, and seems to have settled into the test/feed/shoot pattern again better than I have.

We haven't done anything different for him with the kidney issues other than getting a timed feeder so he can eat 4-5 times a day instead of only twice. We're still feeding the same Friskies we've been feeding for the last 9 years. Occasionally when he seems to have a bit more vomiting than usual (it happens with the kidney issues), we give him a small dose of pepcid to help calm his stomach...but those doses are few and far between because it can also damage his kidneys.

So here's my question: what do I need to know about the kidney issues with diabetes? Keep in mind he's 17--we're not expecting him to be around another 8 years. He's no longer sleeping in bed with us because he can't jump up there. I've had stairs built for him to get up to the table we keep the cat feeder on (to keep the dogs out of it), and we've installed a litter box on the main floor in the house (they've always only been in the basement). We want to keep him comfortable, but we aren't looking for heroic measures here.

 

[Veronica & Babu-chiri]

Hi, sorry to hear about Max's problems.

I think you do want to address his kidney problem because the thing with kidneys if you do not do something about it, it may not be an emergency but it can make him feel very lousy for a long time before it actually becomes an emergency and you do not want that and it will affect his BG

Did the vet mentioned how bad is it ? What are his creatinine and phosphorus levels?

On general terms you will need to address both issues, so first thing would be change his food to a low carb(for diabetes) and low phosphorus (for his kidneys) diet in doctor Lisa's list that would be under 250 in phosphorus or if you can find under 200 is even better, and keep in mind that most kidney prescription diets are not appropriate for diabetics because they are very high in carbs and Friskies is very high in phosphorus (having high phosphorus levels can make a cat feel bad and generate a lot of other problems)

If he's getting stomach acid it would be good to consider giving him something to help with that, that something can go from raising his food, and water bowls, giving him SEB (slippery elm bark) to giving him meds this alone will help him feel a lot better.

There are other issues you may want to address but it would be good if you could post his lab results to get an idea of how bad his kidney issues is

Here's a link to Tanya's web page where there is a lot of very good information regarding CKD or CRF

http://www.felinecrf.org/what_is_ckd.htm

 

[MindyC]

Here is what his test results were:

GLU 531 mg/dL (high)
CREA 1.3 mg/dL (normal)
BUN 70m g/dL (high)
BUN/CREA 55
TP 8.9 g/dL (borderline high)
ALB 3.6 g/dL (high end of normal)
GLOB 5.3 g/dL (high)
ALB/GLOB 0.7
ALT 109 U/L (normal)
ALKP <10 U/L (low)

I don't really know what any of this means, other than that his sugar is very high, his creatinine has gone solidly back to normal (that was high a few years ago when we got the CRF dx), and that his BUN is high. The vet said it is usually a combination of the BUN/CREA numbers that diagnose kidney failure. So...? I don't know if any of the numbers given are phosphorus. We stopped all regular vet visits shortly after the CRF dx--it stresses him out beyond belief, usually triggering vomiting, diarrhea, and urination in the crate, and the diarrhea could last a few days. He does that now when he gets mad, so he only goes to the vet when really absolutely necessary (as it was last week).

I'll sift through the food charts and see what we can do about his food. We have another cat, and they both eat the same thing, from the same dish. The Friskies we feed is canned, low carb (4-5% carbs) pate, and we add water. Plus there are currently two water bowls out (one for the dogs, one for him), and he drinks from both.

 

[Veronica & Babu-chiri]

Actually his creatinine is not really very high , with 1.3 IRIS (International Renal Interest Society) would consider him just at risk of CKD (chronic kidney desease) especially given his age, BUN is a bit high but BUN can be high for a lot of reasons other than his kidneys like dehydration (which he probably was a little bit given the vomit and diarrhea he had ) and getting high protein food can also raise it a bit.

None of the results they gave you is phosphorus which I found strange since they were concerned with his kidneys it would be good to have that result just to be sure he doesn't need a phosphorus binder although I think is very unlikely given his CRE an BUN

With those numbers I think diabetes should be your main concern so that you can get him regulated again (that will also help his kidneys) and trying to help his kidneys so that the problem doesn't progress, probably a good approach would be to find a low carb food (less than 10% ) that is also low phosphorus (less than 250 or even less than 200 if you can in Dr. Lisa's list) to help his kidneys and probably consider giving him some omegas and B vitamin complex ( here's some information about them from Tanya's page: omegas and B complex) and the good thing is that a normal (not prescription ) low carb low phos diet can be eaten by both your cats without any problem and keep adding water to their food that is also good for both of them.

If he keeps having stomach acid you can consider SEB ( slippery elm bark) it has worked very well with one of my cyvies that has a bit of a gastritis problem (from both stress because she's very nervous and CKD)