DIABETIC CAT W/ KIDNEY DISEASE & PANCREAITIS

[mona's mom]

Sally is a 15 yr. old Humane Society angel I brought home @ 12 yrs. old, after owner died. She has been diabetic over 2 yrs. and though her pancraes and kidney values were high in June, they have since doubled and an ultrasound showed a very damaged right kidney. It is impossible to regulate proper insulin dosage w/o daily blood glucose testing, which I have been doing now almost 3 weeks. I had been using urine test strips prior which my vet had suggested along with careful observation of her urination, water intake, etc. She had been vomiting, but no longer does. Instead her urine is more watery and massive, but less frequent. Her hind legs are very weak and I give her 1/2 potassium tablet crushed in water in syringe which i administer orally. I was told to give 1/2 tab 2X daily, but read on this message boardor a link that potassium is not good for kidney disease. I give one unit sub q's daily and if monitor reading is above 200 but less than 300 give 1cc of insulin. above 300-500, I give 2. She has crashed twice in past and I know pancreaitis interferes w/ correct dosage. Please help, she is very sick and has developed a low noise when she breathes, which she never exhibited before.

 

[Carl & Polly & Bob (GA)]

Wow, welcome to the board!

You are juggling three things at once, rather than "just" diabetes. The bright side is that there are people here who have to deal with one, two or all three of them too.

Give it a few minutes, but I'm sure you are about to get lots of advice and help....

You mention insulin doses, but not what type of insulin. Which kind are you using?

Others will be by shortly,

Carl

 

[Sue and Oliver (GA)]

We do have a number of people dealing with both pancreatitis and diabetes and kidney issues. No expert here but do have a link to 2 good pancreatitis sites: http://www.idexx.com/pubwebresources/pd ... itions.pdf and http://www.marvistavet.com/html/body_pa ... line_.html

Also Methyl B12 seems to work well for neuropathy and is not supposed to cause any other issues: Neuropathy


Be patient and check back in. Board is slow this pm but you should get more replies about your kitty's specific issues.

 

[mona's mom]

Thank you Carl for your response, the only one so far. Originally my vet had her on Vetsulin. After she crashed the first time in Dec. of '09, the emergency all nite clinic suggested I change insulins. My vet put her on Humilin N. A short time ago when my vet had her for a few days because I felt she was going downhill, she had an A.M. reading of 225. He gave her 2 units and several hours later she went into hypo. His assistant told me she was scared. After extensive reading of this site, I determined that this might have occured due to the fact that no insulin had been administered for more than 48 hours. It was approx. an hour after that episode that I went to pick her up as had been previoult planned. I didn't know about the crash until I went to get her. The next day I took her to a previously set up appt. w/ a specialits from Sarasota. She did ultasound which revealed shriveled right kidney. She's the one who said regulation would be immpossible w/o daily testing (blood). Sallie seems much worse now, however- weak, lethargic, etc. I attribute this to kidneys, which I am fastidious about fluid therapy. What range is the typical desired or accepted level for diabetic kitties? Thank you so much for your care and concern.

 

[Sue and Oliver (GA)]

Check out the links in my response to see if they will help.

Generally we say a normal cat off insulin runs from 40-120 with the majority of the time spent in double digits. A well regulated cat, on insulin, would generally have preshot numbers in the mid to low 200s with a nadir 100 or under, but no lower than 40.

 

[BJM]

...Sallie seems much worse now, however- weak, lethargic, etc. I attribute this to kidneys, which I am fastidious about fluid therapy. .....quote]

Weak & lethargic can be diabetes, too high OR too low.

What was her last blood glucose reading today?

Do you have ketone urine testing strips? If not, pop out to a pharmacy and get some; if her glucose level is high, she may be breaking down fat for energy and generating ketones. These can trigger ketoacidosis, a fatal diabetic condition.

 

[BJM]

..... if monitor reading is above 200 but less than 300 give 1cc of insulin. above 300-500, I give 2. ...

when you say 1cc do you mean 1 mL, or 1 UNIT.
Humulin N is usually a U-100 concentration; thus 1 Unit of Humulin N is 1/100 of an mL or CC (1 cc = 1 mL)

 

[Barn Cats R Us]

I give one unit sub q's daily and if monitor reading is above 200 but less than 300 give 1cc of insulin.

What is 1 unit SubQ's daily...her fluid therapy? If so, does "1 unit" mean 100 mL's?

I attribute this to kidneys, which I am fastidious about fluid therapy.

The folks here have previously recommended to give SQ fluids, and SQ insulin, on opposite sides of kitty's body. I believe this was to make sure the fluids don't interfere with the insulin absorption rate.

Can someone please confirm the reasoning behind "the opposite side of the body" method?

Deb

 

[mona's mom]

Sallie's most recent reading was today at noon, it was 160. I gave no insulin. When I said 1cc I meant one unit.

Thank you for your interest and help. Sallie is not not doing well at all.

 

[Sue and Oliver (GA)]

You are using Humulin, right? Do you have any mid cycle numbers? Wonder if there is a chance she is crashing low at mid cycle?

 

[mona's mom]

I have done mid cycle testing, but she has been so critical past couple of days or so, I only do to, immediately prior to injection. If it is below 200, I do nothing. This is what vet suggested, since that time, in his care, when she crashed several hours after 2 units for a 225 reading. Again, he had not given her any for a good 48 hours or so. For a kitty w/ pancraeitis and kidney failure her numbers may be regarded differently.

 

[Carl & Polly & Bob (GA)]

As you know, the problem is that you are having to treat muliple issues at the same time....

Low Potassium - muscular weakness, myalgia, and muscle cramps (owing to disturbed function of the skeletal muscles), and constipation (from disturbed function of smooth muscles).

Kidney problems - you said one kidney is damaged, and her numbers are high? But you also mentioned reading that "but read on this message boardor a link that potassium is not good for kidney disease"
I just found this on a website about CRF -

4. Potassium supplementation - cats in renal failure tend to lose too much potassium in the urine. This leads to muscle weakness, stiffness and poor hair quality. Low potassium levels may also contribute to the worsening of the kidney failure.

which seems to say that low potassium is bad for kidneys, while supplements can help.
I am hoping one of the folks that has dealt with kidney troubles of CRF can clear this up.

He gave her 2 units and several hours later she went into hypo. His assistant told me she was scared. After extensive reading of this site, I determined that this might have occured due to the fact that no insulin had been administered for more than 48 hours.

Not necessarily due to the fact that she hadn't had any insulin for 48 hours, but more likely just because the dose was too high based on her BG when it was given.

She's the one who said regulation would be immpossible w/o daily testing (blood).

Maybe not "impossible" but I would think very unlikely. And not safe. Daily testing at home is the safest way to manage feline diabetes, and gives you the best chance that BG can become controlled.

Sallie seems much worse now, however- weak, lethargic, etc. I attribute this to kidneys, which I am fastidious about fluid therapy.

Are you administering sub-q fluids? If so, how much and how often? Are they lactated ringers, and have any supplements been added to them by the vet?

she is very sick and has developed a low noise when she breathes, which she never exhibited before.

I don't know if other people noticed this. I didn't the first time I read it. This is very concerning.... I think a vet visit is in order if this continues for any length of time. Odd breathing noises are something that needs to be looked at by the vet soon, I think.

Carl

 

[BJM]

The folks here have previously recommended to give SQ fluids, and SQ insulin, on opposite sides of kitty's body. I believe this was to make sure the fluids don't interfere with the insulin absorption rate.
Can someone please confirm the reasoning behind "the opposite side of the body" method?
Deb

That is it exactly - Lantus and Levemir cannot be diluted.

 

[mona's mom]

Sallie seemed to improve for a few days,but has drastically worsened w/i past 36 hours. She is listless and appetite is off. She has remained in the 120-190 range @ night with blood glucose testing and in the 215-240 range in morning prior to shot. I have been giving 1CC just in morning. I am going to get her to vet at noon. The odd noise she is making is not constant, but continues. It might otherwise be construed as purring, but I know better. Coupled along w/ other matters- very weak hind legs, diminished appetite, etc , it is most disturbing. Thanks to all of you who responded. I really don't want to put her down, as she is still responsive and loves attention. She tries to get around but has to rest frequently. She urinates in different places which is probably due to her weakness of mobility. I don't mind that, but she has trouble squatting. I pick her up whenever possible to help her, but she still gets it on her fur, which I feel bad about.