? High BG help: Diabetes, CKD, new foods, and calcitriol. Ugh.

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stacia

stacia

Member Since 2014
Yes, we know how to have a good time! Also, today is Tasha's 16th birthday so congrats to my sweet evil mess for making it this far!

At the end of February, we went to a new vet (due to relocating). The vet is great - thrilled with our testing and hands-on approach. Tasha's labs showed stage 3 CKD with creatine of 2.7. The recommendation was to switch to an rx food (although the vet wasn't too convinced of that herself considering the diabetes) and to try calcitriol. I did a bunch of research and opted for the calcitriol and switched her food from Friskies pates to
Nutro Max Cat With Savory Duck and Venison varieties (both 8 carbs but lower in phosphorous).

Prior to this, her AMPS/PMPS had been mostly in the low 200s, occasionally too low to shoot, on 0.10u (yes, 1/10th of a unit) of Prozinc.

Her BG numbers stayed fairly consistent as we switched foods and she had her teeth cleaned (no extractions). We added the oral calcitriol (it's compounded with some kind of chicken) and her numbers sky-rocketed. We increased her dose to 0.20u and got little response. We stopped the calcitriol almost a week ago and after 5 days, no response in her BG. Yesterday morning, we switched her back to Friskies (still off calcitriol) and her numbers have started to come down a little.

The vet suggested putting her back on the calcitriol and switching her to Lantus. We are probably about a month from either ordering new insulin, regardless of type, but I'm not sure if switching her right now is what we should do. It feels like introducing another variable.

Thoughts? She acts pretty darned great. No changes to attitude, appetite, or behavior. She handled the dental like a rockstar. Her BG numbers are just a disaster.

Spreadsheet in my signature. Scroll down a ways - I'll be starting a new tab in her sheet soon.

Thanks for any feedback. Let me know if I've missed something or if there's a question. I tried to keep this brief while getting in the important parts.
 
I would agree with your vet. Except for the prescription food idea :)

I am a strong believer in Calcitriol. We've had 3 CKD girls now. The one that could tolerate Calcitriol made it over 3 years (was at the top of stage 4, almost normal numbers when she passed away though I think it was her kidneys that failed in the end due to new meds). Just tell your compounding pharmacy that it is a diabetic cat and to make sure there are no sugars in it. Our compounding pharmacy has gotten so used to our diabetics I think they might default to that now just in case :)

If your current insulin doesn't seem to be working, you have 3 choices - switch, keep doing what you are doing with the same insulin and keep getting the same results, or come up with a different plan with your current insulin that might produce a different result. I don't use Prozinc so I can't help with that, but with only a 0.2U dose right now, I think you'd have room to test a bit more and work the juice a bit more to see what Prozinc can do for you.
 
She was over 400 this morning, realizing I got her a little late and she may have been angry because she was in her cage.

I agree that I'd like to have her on the calcitriol and it may be that I need to speak with the compounding pharmacy. I thought we may have been on to something when we switched her back to the Friskies and her numbers started dropping the last few days (not that one high number this morning means we aren't). And it may mean she just needs an increased dose.

To be clear, the vet wasn't really feeling much love for the prescription food either. She said it was what they'd usually recommend but with the diabetes, it's not as simple as that. I'm glad she at least isn't pushy about it and wants to work with us on things, unlike previous vets.

I'm going to see what tonight's number is, try to get a mid-day read in the meantime, and make a decision then about increasing her dose.

Thanks for the input. I'm uncomfy with these numbers for my girl and want to do my best for her.
 
Anita -Thanks for the link. I've been reading over there and have posted a time or two. But their thought is - feed and treat the diabetes first. So while they've been helpful in other things, including convincing me that the calcitriol is a good idea, this bg game isn't one they seem to know. :(

Thanks, Mogs. Better number from her this morning. And happy as a clam.

I emailed the vet that we're holding off on an insulin switch for now. I don't want to introduce another variable until we have her steady back on her food and calcitriol. The pharmacy suggested I call to speak directly to one of the pharmacists for better info about the compounding agent so I'll do that this afternoon.
 
Update: I reached the pharmacy and they confirmed there's nothing in the calcitriol compounding formula that should raise her BG. So it's food or some other factor. Her numbers continue to be in the 200s since pulling her off the Max Cat and back to Friskies. I don't get it, but maybe she's sensitive to something in that "better" food. I know my wallet is sensitive to it.
 
It all balances out, Mogs - we need to switch Ripley to an LID to rule out allergies now so if it's not one of them costing us a fortune, it's the other. Meanwhile, her numbers continue to be under 300 at lest with the Friskies. 0.2u, and no calcitriol. Time to mix things up again. Every day's a party.
 
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