Just joined for my kitty Henry

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stacyeb

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I just found out yesterday morning that my 14 y/o cat Henry has diabetes. I knew something was wrong with him when he began projectile vomiting. We first tried changing his food to a low grain dry one (PetSmart's Simply Nourish), which helped the vomiting, but he continued to linger over the water bowl and act like he was starving. He's never had any health problems before and is strictly indoors. I knew that something was serious was going on, so we got bloodwork done last Wednesday, and his results are terrible. His glucose is 780 and his kidney and liver values are high, too.

I've been reading the articles and posts on this website every chance I've had since I found out, and I'm so grateful that this help is here! This morning, I picked up his lantus, syringes, and also got the CVS brand glucose monitor. I then took him to my vet who showed me how to inject him (my first time to give a shot!!). He's supposed to have 1 unit, two times a day. She told me not to bother home testing, but I don't plan on following that advice. :)

I'm overwhelmed, to say the least! I've dealt with feline leukemia, liver disease, sub-q fluids too many times, but never diabetes! And since his kidney values are high, I'm very worried about what I should feed my guy to help his kidneys as well. I guess I could sure use some guidance about getting started, when I should start testing his glucose levels, and how to feed him. I was thinking of making his food and have gotten the powdered lysine, flaxseed oil, and vit. e, but I still have to get him some chicken. I found a recipe on catinfo.org I thought I would try.

Thank you in advance for your help! Stacy and Henry (one of 7 in an aging cat population) in Texas

High results:

ALT (SGPT) 248 range 28-100
Lipase 200 10-195
Total protein 9.7 5.9-8.5
Globulin 6.4 3.0-5.6
BUN 96 15-34
Creatinine 3.1 .8-2.3
Glucose 780 70-150
Phosphorus 9.9 3.0-7.0
Sodium 157 3.9-5.3
B/C Ratio 31.0 0-0.3

anion gap 32 13-27
WBC 27.6 4.2-15.6
RBC (Low) 5.96 60-10.0
MCH 19.6 11.0-17.5
MCHC 38.9 29-36
Neturophil seg 94 35-75
Lymphocytes 2 (low) 20-55
Eosinphil 0 Low 2-12
Auto platelet 131 low 170-600

negative FIV
 
Hey kitty Henry and Stacy

That was a lot off the charts in the bloodwork


I can't advice you on food, but with a glucose number as high as 780, I don't think 1 U twice a day is enough, but good to start with
 
hi Stacy and welcome to FDMB
Glad you have all the info on food
For dosage I am going to advise you to go to the lantus forum and
they will help you with that
The 780 is really high and Shakes was on lantus a while back,
but I dont want to give a newbie advice
Good luck and we are all here for you
 
Hi Stacy
I've posted a request in the Lantus forum for someone to come take a look and maybe offer some advice.

Welcome to the board,
 
hello, Stacy & Henry, and welcome!

Carl was kind enough to put out a call for more folks to come by and help out with Henry's situation...so hang in there...
help is on the way!

celi & binks
 
Hi Stacy and Henry (I'm very partial to the name Henry; it's the name of my horse!). I can't offer much advice on dosing, as I'm still figuring out my own cat, but this is a great place! Good for you for deciding to home test; it can make a huge difference for both Henry and for your stress level just to know how the insulin affects him personally! I do not get vets not advocating home testing; a doctor would never dream of telling a human diabetic not to test! It's also nice not to have to stress the cat out by dragging him back and forth to the vet all the time (and way easier on your pocketbook, too!) For me, it's worth it just for the peace of mind!

Kidney issues are a common problem among older kitties, and several members have experience with dealing with them and diabetes at the same time, so I'm sure you can get great advice from them on managing Henry.

Welcome to the board-it's a fantastic place to be and you will never feel more accepted and understood than you will here...because while our boats may be different colors and sizes, we're really all in the same boat!
 
I can't help with the dosing or kidney/liver stuff, since I have no experience, but did want to welcome you to the FDMB family! cat_pet_icon
 
Hobbs was diagnosed with kidney disease in September and then with diabetes in December. At first he was on Hills K/D for his kidneys, but it's not really good for his diabetes. The last vet visit the vet put him on Purina DM, but that's bad for his kidneys! Oy!! Because Hobbs is Stage 1, he doesn't need to be on the K/D diet. So I switched him off of either of those to a low phosphorous, low carb canned food. (EVO 95% Chicken & Turkey) However, I'm not sure about Henry, he might be a later stage. I don't know if that's reversible or not.
 
Welcome Stacey and Henry!

One of the first things I was taught was to make the switch over to low carb (LC) wet food, under 10% carbs. It is amazing what a difference the change in diet can make. I'm sure someone will come along with a recommendation that also takes into consideration the kidney issues. I personally don't have experience with that.
Will Henry eat wet food? A guide can be found here.

How much does Henry weigh? Any idea how long he has been diabetic?

Sounds like you have experienced several conditions requiring "special handling" already. Now you are adding 1 more - Feline Diabetes. You will be fine. Plenty of experienced folks around here to guide you.

Glad you got the glucose meter. You'll want to get into the habit if testing prior to each shot, and at least one time during a cycle, which is what we call the hours between shots. Have you attempted to test him yet? If you need tips, just ask. Every Cat is Different (ECID) in how they take to testing and just about everything else :smile: .

We chart our kitties BG info on spreadsheets - instructions on setting one up are here
It helps you as well as those who can help you see patterns and make recommendations based on the numbers and patterns.

I'm not one to understand/interpret blood work but I'm sure others with experience will be along.

Glad you found us!
 
Stacy:

Have you or the vet tested for ketones? I'm surprised that there's no note re. ketones on the lab results given how high Henry's test value was. You can do this easily at home. You need Ketostix which you can get at any pharmacy. The hard part is stalking your cat to the litter box. You need to put the paper end of the test stick in the urine stream or find a way to get a bit of urine. You wait 15 sec. and then match the color on the end of the stick to the guide on the package. More than trace ketones is a trip to the vet or ER. Ketones are serious business which is why we encourage people to check if their cat is in high numbers or if they notice signs of lethargy or if their cat's breath begins to smell like nail polish remover (acetone) or alcohol. Catching the warning signs can prevent a very costly hospital stay so spending a few dollars for the Ketostix is an inexpensive means of prevention.

I'm hoping that your vet has scheduled a return visit to repeat the lab tests once Henry has been on insulin for a week or so. It will take about a week for Henry to begin to start adjusting to Lantus. It is a gentle, long-acting insulin. What that means is that it may not jerk numbers down. It should gradually lower numbers so don't be upset if you don't see huge amounts of activity overnight. I'm hoping that the lab values will start to come down once Henry's diabetes starts to respond to insulin.

One thing you can do which will help to immediately lower Henry's BG (blood glucose) numbers is to start feeding low carb, canned food. Low carb is anything below 10%, although most of us feed about half that amount of carb or less. There are two food lists a listing of nutritional values and Janet & Binky's list. There is a great site, written by a vet, on feline nutrition. It will help you to understand why we stress a low carb, canned food diet.

There is a great deal of information about Lantus in the starred sticky notes at the top of the Lantus board. Below is a description of what's there and links to the information.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
Please let us know if you have questions. We've all stood in your shoes and felt completely overwhelmed by the diagnosis and the size of the learning curve. It will become routine and you will be able to handle it. Just let us know how we can help.
 
Hi Stacy! I've dealt with both kidney disease and diabetes and there are a few foods that are good for both conditions. I'm at work right now on my kindle, but tomorrow I will post that info for you with an explanation of what you're looking for. Basically, you want a food with high quality protein, low phosphorus, low sodium, and low carbs. Some foods that meet these requirements are merricks before grain turkey and beef flavors, evo 95% chicken and turkey, merricks cowboy cookout, merricks surf and turf, and wellness turkey, all canned.
 
Stacy:

I'm glad Sandy and Sienne popped in to discuss the diabetes issue and provided you with some info. Just so you know, the usual starting dose of lantus is .25u/kg of kitty's ideal weight. If kitty is underweight, the usual starting dose is .25u/kg.

I'm very concerned about his renal values. In particular, his phosphorus is really too high and I am surprised that he is not feeling very sick and not eating. High phosphorus levels can cause acid tummies, vomiting, inappetance, and generally feeling pretty poorly. Usually with a number that high, vets like to put them in the hospital with IV fluids to try and bring those numbers down. Some of the renal and liver numbers may be elevated due to the diabetes.

I would call and talk to my vet first thing Monday about those renal values and especially the phosphorus. He is definitely hyperphosphatemic at this point. Are you giving him subq fluids at home? That will help his kidneys and will also help his BG. We don't recommend using subq fluids to bring down BG but he looks like he could use some hydration and the subqs will help support the kidneys. I would also ask my vet about a phosphate binder like aluminum hydroxide.

Here is some information regarding hyperphosphatemia: Phosphorus levels

The main website is Tanya's CKD (chronic kidney disease) website at: CKD

We hope to see you Henry around more and letting us know if his BG is coming down. And just to be sure....that was his actual glucose level and not a fructosamine, right?
 
Thank you for the warm, welcoming, and helpful replies! Henry would thank you too. He's a miserable guy right now. He never leaves the water bowl, unless I'm giving him food. I'm so glad he has a good appetite.

I'll have to weigh him again--I took him in with his 16 year old brother who's also not feeling well, and his younger sister who mysteriously quit being able to walk about a month ago(but can now walk after pred), so I was distracted. And I realized after reading the great question about ketones, that I had the chance to get a urine sample today when he had an accident in his carrier at the vets. I didn't get the test strips today, but I'll put that on my list.

I'm also glad to learn about some other foods that are good for his kidneys and diabetes. He's actually been eating cowboy cookout the past two days! I'm really glad for Merrick foods. My vet doesn't seem to think I should give him fluid, but I think he needs something.

You have all made me feel so much better and less alone! All my thanks, Stacy
 
I do have a phosphorus binder that I was using for my elderly dog, and I'm just trying to figure out his dosage. I think sub-qs are needed too! I probably already have everything I need to do that too, fortunately and unfortunately.

I just weighed him with my home scale and he is exactly 11 pounds. I'm not sure how long he's had diabetes, but I wonder if it's been since the fall sometime?

thanks again! Stacy
 
11lbs = 5kg, so at .25u/kg, that's 1.25u for a starting dose. so starting at 1 is probably fine. we can help you figure out the dose changes after we see what Henry's BG's look like after 5-7 days on the Lantus.

i can't speak to the other health issues, but you can send a personal message to marjorie who posted just above about the phosphorus binder (or anyone else you want more info from) and she could answer your question on that. we have a strong prohibition on FDMB about giving dosing advice through personal messages, because we want advice to be peer reviewed, but you can ask her about it and she'll come and comment.

glad you found us, stacey! we'll do our best to help you get Henry back on his feet again and away from his waterbowl. punkin just laid against his bowl at diagnosis too and it broke my heart. i don't remember now how long it took for him to stop, but at least a couple of weeks. once he got more regulated, though, it did stop and he's turned back into the kitty he was before. you'll see progress too - so be encouraged!
 
Hi Stacy--here's the information I promised but it looks like you're well on your way. One thing I you may want to discuss with your vet is whether or not they believe a low protein diet would be beneficial at this stage in the CRF. Early stage kidney disease/diabetes is a no brainer in terms of diet, but late stage is a different story. Keep in mind that the prescription ultra low phosphorus diets are high in carbs (making the diabetes harder to control), and a lot of cats refuse to eat them after a little while anyway. I'm not trying to influence you decision with that one way or the other--I only have experience with early stage kidney disease and I'm not sure which is the priority condition to treat with your cat right now. The most important thing with kidney disease is making sure Henry eats, no matter what the food.

A diet that is good for both conditions (again, I'm speaking from early stage CRF experience) is a low carb, low sodium, low phosphorus canned food, preferably without byproducts (higher quality protein sources are easier on the kidneys). Keeping your cat as hydrated as possible is key to managing the disease, along with low phosphorus foods. Mixing water in with the canned food is one good way to help with hydration. Here's an updated food list with the values for several premium foods: https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50. You're looking for something with less than 10% carbs and less than 250 mg/kcal of phosphorus.

Here is an updated list of just the phosphorus values for many commercial foods. They can be cross referenced with Binky's chart for carb values if there's something on there that you want to feed. (DO NOT use Binky's list for phosphorus values--they are out of date and while the carb values stay pretty much the same, the phosphorus values can change dramatically over the years). On this chart, you're looking for something that is less than 1% phosphorus (these values are on a dry matter basis, not mg/kcal): http://www.felinecrf.org/canned_food_usa.htm
 
Stacy & Henry:
Welcome to the forum! the best place to be.

I am feeding my 2 of 3 raw foods from the same site that you were viewing; however I am not fighting the kidney disease. I will say that feeding this recipe has been the best thing for them. My sugar Bean has finally gained from her dx 8lbs to well over 10 and Civvie Ittle Sista is only 7 months old and weighs in at almost 7lb already. Both have the best muscle tone ever and great coats. I strongly believe it was with the help of the raw foods that I have been feeding. I do serve both raw and canned right now and have for a while. I am slowly giving less and less of the canned and more of the raw...

HOWEVER:
I did notice while reviewing dr. lisa recipe site that this was listed:


"Note: I do not recommend this recipe for CKD (Chronic Kidney Disease) cats.

(CKD is also known as CRF - Chronic Renal Failure - but we are trying to move away from the word "failure" because it is such a negative term.)

There are other recipes that are more suited to feeding cats with this condition. However, the nutritional needs of these cats must be discussed on an individual patient basis. The reader can reach me via email to request a phone consultation if they wish to discuss an appropriate diet for a CKD patient.

All consultations are conducted via the phone (or Skype) only after the patient's medical records, including lab work, have been provided for my review. General CKD medical management to prolong the length and quality of life, in addition to appropriate dietary issues, is discussed during the consultation. My CKD consultations take up approximately 2 hours of phone time since there is a lot to discuss if optimal CKD management is desired."

I figured you have already seen this on that page, but did want to bring it to your attention. I will probably be worring about that soon enough as Bean is pushing 9 yrs old and has been eating dry for 8+ of those years (until dx on 4/11).

Good luck with mr. Henry and hopes you will be able to do a raw adjusted diet.....
 
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