Kidney issues & diabetes long term

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dexter2017

Member Since 2017
Hey everyone. My male cat Dexter has diabetes since October and for a short time the insulin did its job and he was well regulated. About two months ago, he started with leg weakness and when we brought him in the sugars were high again (in 400s) so they increased his dose a little bit but he kept testing high. Our vet reached out to an endocrinologist last week who recommended bringing him for an urine culture and changing his food to low carb and resetting his insulin back down to half what he was on. We did those things and he seemed fine until three or four days later. He's stopped eating slowly and was lethargic and drinking lots of water. We tested and his sugar on the human meter was high 400's or low 500's even after he ate a little and had his insulin five hours later he tested over 500. Last night he took a turn for the worst and urinated all over the place and threw up. He went to the vet first thing this morning and his ketones are through the roof. He is on a fast acting iv of insulin now and they hope to get his blood sugar down today. But his kidneys are failing and she said it will be difficult to treat in the long term due to the conflicting treatments needed. For diabetes, high protein low carb food, for the kidneys usually they'd do a special diet of low protein food. Has anyone dealt with this? She said he would probably yo-yo back and forth with either insulin issues or kidney issues. We are not sure how old he is as he was an adult cat when I adopted him 10+ years ago so maybe 13 on the young side or up. We are having the conversation on whether we should make that tough choice to put him down if he doesn't have much chance of being stabilized one way or the other. I appreciate any thoughts. They had tested him for Ketones last week at the vets but the urine was so diluted and it didn't show any.
 
Welcome Dexter and his dad. I am sorry you have to join us under these conditions:bighug:. Sounds like he is DKA? There are a few kitties here with kidney problems/ CKD, and diabetes. @Djamila has a food list that is friendly for diabetic and kidney health issues. I thought I saved it but I cannot find it :banghead:. I'm sure you are going through a lot with him at the ER right now but he can get the treatment he needs there. I'm going to try to stay positive for you and say if he can stabilize at the Vet, and you are willing to do the follow up care at home, he can be stabilized with both conditions :):bighug:.

Can you give us some additional information on Dexter?
  1. What insulin and dose is he on?
  2. What glucometer are you using?
  3. How often are you home testing?
  4. What is his diet?
  5. Do you have ketone test strips for home?
I'm sure others will chime in :cat:
 
I believe that cats that are dehydrated will show much worse kidney values, but when hydrated and properly treated the kidneys can often improve. @Meya14 has experience with DKA and can maybe add some info.
 
So there's two basic kinds of kidney issues - chronic kidney disease, and acute kidney injury. Both will look like elevated kidney levels on lab, but they in fact are very different diseases.

Chronic kidney disease is a slowly worsening function of the kidneys that often happens in older cats. Cats can live a long time with CKD, and they may die from complications or die from other issues of old age before the kidney disease gets to them. CKD is -TREATABLE-.

Acute kidney injury happens when there is sudden damage to the kidneys and they start to fail. This can be physical trauma, infection, blood loss/low bp, or *severe dehydration. This is -REVERSIBLE- to a large extent once the initiating factors are taken care of.

In DKA, there is often low BP, severe dehydration, and toxic byproducts that cause acute kidney injury. It is impossible to know how bad any chronic kidney issues are until the DKA is gone, as there is no way to test for chronic kidney disease when the cat is very sick. Most cats in DKA will have normal (or only slightly lowered) kidney function once they recover. Vets probably don't encounter acute kidney injury often so they assume all abnormal labs means CKD.

DKA is a severe illness but most cats are fine once they recover.

The best thing that you can do once your cat starts to feel better is home test. Insulin needs can change week by week, day by day, so staying on the same dose and only doing curves at the vet is not the best way to get it under control. Home testing lets you see issues right away and address them before problems become severe and expensive.
 
Thanks for your replies. Unfortunately, he was too sick. He was completely unresponsive to insulin and fading fast. The vet called for us to come worried he wouldn't make it to the end of the day. We made the decision to have her euthanize him as he was getting very anxious and uncomfortable.
 
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