? Missy's Tests results, need help please!

Finally took my 14yrs old Missy to an IM visit and it doesn't look good at all: looks like CKD stage 1, pre-diabetic and confirmed Pancreatitis/IBD.
Below, I'm posting a copy of the post I've also crossposted on Feline Chronic Kidney Diseas and Raw Feeding for IBD Cats on FB groups along with latest bloodwork fron Dec.2022 and GI Panel+ Urinalysis done at IM visit.

In addition: although the IM vet said Missy is "pre-diabetic", I'm actually afraid she's already diabetic....tested her BG earlier while she was just laying down, calm and fasting for at least 4 hours and her numbers were 214!! Is it possible BGs can rise super high in less then 1 minute (time it took me to warm up her ear and test)?
Missy gets very angry/anxious with nothing and won't let me mess around with her with another test, needles or anything else without taking a great chance of being biting and send me to the ER!

Also, I've created a SS for Missy along with her Labs results, please let me know if you can view/access correctly.
THANKS IN ADVANCE FOR ANY HELP. Not sure I should tag anyone in particular but I will if I'm allow to do so.


"I took my Missy to an IM for a visit recently: ultrasound didn’t reveal any mass but definitely increased walls thickness and some kidneys shrinkage. GI panel was also done and tested Positive for Pancreatitis, which could explain some of her weight loss and inappetence (Missy’s behavior drastically changed since we lost Micio 1-1/2 month ago (18+ yrs old male cat) and I have been syringe feeding her since except for the last week when, coincidentally after a slight increased on Budesonide (from 0.1ml once daily to 0.15ml), she suddenly started eating pretty much everything on her own.
Another big concern is her consistent increased Glucose numbers since last year and kidney values as well; Missy suddenly started drinking and peeing a lot last year and lost some weight as well.
IM doctor thinks Pancreatitis/IBD are likely more responsible for Missy’s decreased appetite and weight loss but, while she agreed on raw meat diet being a good choice for those issues, it’s not best for her renal disease and feel like we need to make a decision on the diet as there isn’t one that will work for all the issues.
So here’s my question: if Raw Meat Diet is too high in Protein (as all vets always suggested), what should I feed my cat? Could that have been the cause of CKD?
Am I doing something wrong with the diet?
Missy is on raw meat diet for 11 yrs (last 6 yrs with EZ Complete) along with pro/prebiotics + Kibow Fortis + SEB and S. Boullardi when needed + CBD oil and extra Omega 3 for her Arthritis.
Food batches are usually made with Chicken+Pork, Chicken+Beef, Turkey and I rotate them every day.
IM doctor wants me to monitor Missy’s weight in the next couple of months and suggested she needs about 225 kcal/day: how do I calculate that? Not sure it should be about the calorie but instead about the quantity/quality and how many meals per day. Missy eats about 130-135gr. (around 4.5oz) per day (divided in 4 meals) plus freeze dried treats. She used to weight around lb.12.5 in 2021 then last year started loosing and dropped to lb. 10.68 last December and now back up to lb.11.2.
If raw meat diet is not recommended for CKD, what other option is out there without worsening her pre-diabetic status? Dry/hydrolized protein diet has been suggested before but not an option for me though…"










=AZXbJ7k0L0jnO2Uh7E7puHIkt2NiHLe2eEhSKbEb99j4atEaILhxG5nTk_BA6wSdUXqO_wOXUzbs1_uDlCGTWIFSnQMHM8UcsTyfAk79912pT3YkZ82F3-j3dhmTTKB1WUaGwcadJXKloQFyfMo6re0o&__tn__=*bH-R']

=AZXbJ7k0L0jnO2Uh7E7puHIkt2NiHLe2eEhSKbEb99j4atEaILhxG5nTk_BA6wSdUXqO_wOXUzbs1_uDlCGTWIFSnQMHM8UcsTyfAk79912pT3YkZ82F3-j3dhmTTKB1WUaGwcadJXKloQFyfMo6re0o&__tn__=*bH-R']

 

First of all, big big hugs! There are people who are way more experienced than me and will provide great advice. I just wanted to share that I have a feral, skittish, and highly anxious baby myself. I have never been this sad or upset in my whole life (we were diagnosed about 3 weeks ago). My husband has scratches all over, including his face, from this process. I understand and empathize that we do not have those cats seen in the demonstration videos or in other groups. I was literally one more traumatizing event from starting an antidepressant myself (might still happen- this has been a roller coaster and we are still early on).

If she is pre-diabetic, maybe a diet change (although complicated with the CKD) will make the world of difference and you won’t need injections. But if you do, I never thought I would be able to give my cat injections and the first 2.5 weeks were so traumatizing to her and to me. I tried everyone’s advice- food, treats, pets, brushing, desensitization, sneak attacks, ect. with the shot. I finally had to start her in anxiety medication (gabapentin) and be more matter of fact- I walk over, pet her, inject, leave a treat, and walk away. We have gotten 7 successful shots in a row with this. She comes back around in about 10 minutes. I’m a pharmacist (for humans) and would assume gabapentin may not be recommended because of the CKD, but I would get more opinions from here and your vet.

We haven’t started home testing because we can barely do the insulin- but I plan too. My biggest mistake was pushing my baby past her comfort trying to do so much at once with the insulin and home testing (and felt criticized from other groups for not being able to do both) and she was terrified of my husband and I. I have not felt this way posting on this board. Take your time in working up to the gold standard of insulin and testing and work with your cats allowance. They do adapt and even though it is so heartbreaking to have to force them to.

Thinking of you so much,
Heather and Flora

 

Thanks for your support and suggestions....Just on January 26th I've lost my other 18 yrs old boy Micio after dealing with multiple diseases for many years. From IBD to EPI to Heart murmur and Diabetes + Acromegaly in the last 1-1/2 year. I knew absolutely nothing about diabetes, insulin, testing and shots 'till I joined to this group made out of very knowledgeable people that totally guided me throughout the whole process. At 52 I'm still very adverse to needles, shots and such and I thought I would never be able to do any of it for my cat but, to my biggest surprise, I ended up winning my fears and learn how to test my Micio before give him insulin because I understood it is essential to know glucose numbers before shooting ...either for animals or humans. I've been through some error an trial during the process but I managed to bring down his numbers to a good range, even with Acromegaly and, I still believe, that it was primarily because of TESTING and get to know all about the numbers throughout the whole day. I was fortunate that Micio was the most easy going cat and would allow me to do all this but not quite as lucky with my Missy as she is a completely different cat....she allows me to sirynge feed her, to brush her cheeks for 2 minutes, test her BG's once in awhile but would turn into cat from hell if I'll try to pick her up or touch her near her sides or feet/hands... she won't scratch me, she'll just chew my hands off and send me to the ER again. She's just a very emotional cat, she gets traumatized with nothing and her attitude progressively worsened thoughout time.
I'd have no issues to test and give her insulin but she won't let me and I feel it'll be impossible to treat her for either diabetes and CKD.
By the way, Missy has been on raw meat diet for the last 11+ yrs , probably one of the best options for IBD and Diabetic cats also recommended by many vets now.
Really hope you'll get to test your fur kid more as it is very important to do so, especially before insulin. Hugs

 

Hi Simone

That sounds as if she was in pain. Pancreatitis is a painful condition. She may also need an anti nausea medication such as cerenia or ondansetron.

If you are stage 1 CRD I think a raw diet would be fine. You don't give a low protein diet to CRD cats until they are very advanced with CRD. Lowering the protein levels in the early stages is old thinking and leads to muscle mass loss in the cats. The way to go is low phosphorus. You can substitute the bone in the supplements with egg shell powder or you can buy some supplements that are made for cats with CRD. Both there ways will lower the phosphorus level of the food.
You can also look at the Weruva brand of cat food that has a new range out that is specifically for cats needing low phosphorus foods.

I also wanted to say well done getting some tests in. test when you can and we can see how it is going. From the tests you have got so far, it does look as if a small amount of insulin may be needed.

I'm going to ask @Marje and Gracie to have a look at the lab results for you. I'm not sure she is around much at the moment though.
I might also tag @Suzanne & Darcy.

 

The EZ Complete is made with eggshell for calcium, not bone, so there's no reason you need to change the food you're feeding. It's a lot more important that she likes her food and eats well.

As for the CKD, I only see an elevated BUN, the Creatinine is normal. An increased BUN can be from feeding a high protein diet and/or from being dehydrated. I wouldn't freak out about the possibility of CKD right now.

You could ask them to run their new Renal/Tech test for a better idea of her kidney status but it has to be run twice from 2 - 24 months apart. This is a recent test from ANTECH.

There's also an early CKD test done by a different lab (IDEXX) that's called an SDMA which only has to be done once but you'd have to ask your vet if they're willing to use a different lab.

 

Tnx. I use EZ Complete to add to the meat when making batches and that is already low in phosporus (should be around 8%) as there's no bone.
Today I managed to get her BG's and totally freaked out at the results...214 while fasting and relaxed is way high.
Although the vet doesn't consider her diabetic yet, I agree with you that Missy needs some insulin but that's the problem...she would not let me go near with a syringe without getting furious and bite me. She's such a different cat, I can only caress and brush her cheeks area for a few minutes and have to stop before she'll start getting upset, I cannot touch her anywhere else around her body (don't know if is because of her arthritis or what).
This is truly the worst nightmare as I won't be able to treat her diabetes with insulin, neither I'll be able to give her fluids if she needs it.
The IM doctor mentioned there is a new way of treating diabetes though an oral med called Bexacat; I just checked that out but doesn't sound a great option to me...what do you guys think of it?

 

Tnx. Yes, EZ is a good choice and have been feeding it to my cats for about 6 yrs now. Not sure why a SDMA test wasn't run on the latest blood work at the IM visit, it was from IDEXX though...I'll ask the IM on Wednesday, we're suppost to discuss about Missy's diet and she was going to let me know more about Bexacat medication as an alternative to insulin shots...I told the IM if I have to give her insulin she won't let me

 

We have just recently had some information about Betacat. I think they are doing trials at the moment. For someone like you, it might be great. Not sure it is on the market yet. You could as your vet to contact the RVC in the UK as they are running the trial.

 

I just realized I did not attached a copy of the last bloodwork done at the IM vet on Feb 20th along with urinalysis by IDEXX. For some reason I wasn't able to attach it on main post so here it is

 

Hello Simone. I was just thinking about you this past weekend and wondering if you had posted after that introductory post about Missy.

 

This morning I will look at everything you posted, including labs.

 

Thank you Suzanne! Took me awhile, didn't know how and where to start with Missy...this is such a deja vu, right after Micio passed...I'm so not ready for it

 

This sounds like she needed the increase in Budesonide and it reduced her inflammation and made her feel better. Were you using anti-nausea medication during all this time since Micio passed away? I ask because you said she would not eat since Micio’s death.

 

You know what you are doing! You are one of the most well-informed cat owners that I know!

 

I love your new photo of Missy and Micio! What a gorgeous boy he was. And Missy is beautiful too. I think emotionally this must be very hard on you after losing Micio.

 

Okay, so I believe this is already stuff that you know. 1) USG has dropped since last time. USG can fluctuate so we look at trends; (2) the ALT is just barely out of range. You could try milk thistle if you want to, but vets do not worry about ALT that is just barely out of range -- they start to worry if it gets much higher than that; (3) her BUN isn't that bad either and is just barely out of range. My 15 year old cat's BUN recently improved, along with a lot of other kidney values... so it can happen. Anyway, cat's can stay in stage 1 for a really long time. It may not progress very quickly. The thing to make sure of is that you control phosphorus levels in her food and I think you have that covered with EZ Complete. I suppose you could switch to a more moderate protein if you want to (probably what the FB kidney group will recommend) but I don't know that I would change her diet right now. I would monitor and perhaps move to a more moderate phosphorus diet if she progresses to stage 2.
Regarding Bexacat: It lowers blood sugar by increasing urine excretion of glucose through inhibition of sodium-glucose cotransporter 2 (SGLT2) and results in effective glycemic control. What are the effects on the kidneys for this? Is this making the kidneys work harder? Just a question.

Here's an article by AAHA that will help you to have questions ready for the IM on Wednesday about Bexacat.

https://www.aaha.org/publications/n...ion-for-cats-requires-careful-case-selection/

 

Missy and Micio used to eat together at their table but since he passed she not only doesn't wait at that table anymore but she wants me to feed her somewhere else; she acts hungry but wants me to feed her either by syringe or by licking the food off my finger bit by bit. I tried to leave the food next to her but she'll walk away, anyway I cannot leave raw meat food out for too long. Not trying to encourage her behavior but don't want her to skip her meals neither. I tried Cerenia before with no change, not sure she has nausea though: I never seen her lip smacking or drooling neither she vomits after I feed her. Lately she'll only vomit if she's straining when passing stools (just like yesterday when puked a big hairball with some undigested food) and sometimes she may ended up with looser stools and some bloody mucus.
On 24 February I increased the Budesonide from 0.1ml to 0.15 ml daily and indeed, right after her appetite increased as well! Not sure her high BGs I've got yesterday are from the tiny increase with Budesonide, I wouldn't thinks so though...
My theory was that if Pancreatitis is the cause of increased glucose numbers then, by increasing the Budesonide to help with the inflammation, maybe it'll help bringing down BGs as well...not sure I explained myself well?! It may seem a non sense but even the IM said it could be a possibility. Although Missy's on a low Budesonide dose so the risk for it triggering the diabetes is low but no 0.
This Wednesday I'm going to have a call follow up with the IM and we'll talk about Missy's diet and will ask the doctor more info about the new med Bexacat as a possible insulin alternative

 

What about getting a libre sensor placed so you can get an idea of her glucose numbers? Also, it sounds like maybe the CBD isn't doing the job for her arthritis. She may need some genuine pain medication like Bupe or you may want to consider Adequan of Solensia injections. Solensia are only monthly injections whereas Adequan, at first, requires more frequent injections and then the transition is usually to monthly.

 

It doesn't seem nonsensical to me! This is what I was thinking/hoping as well.

 

I'm already giving her Milk Thistle since after blood work in December 2022 and, not sure it's already working but ALT numbers already lowered a bit on last small blood work a few weeks ago.
Tnx for the Bexacat link, have been reading about it but sounds scary to me though. IM doesn't consider Missy diabetic yet and told me to monitor her urine for Ketones a Glucose for now .

 

We tried Adequan injections many years ago but no way...she'll start screaming like crazy even before we do anything! We were able to shoot only 2 but no more after that...that's why I don't forsee myself starting her on insulin shots without making trips to the ER

 

This is problematic. I'm so sorry. It sound like she needs some gabapentin to relax her - either in food or a compounded flavored liquid mixed in the food you are getting her to lick from a spoon.

This is going to be a very gradual process where you can figure out a way to test her. I hope she won't need insulin!

 

How in the world did you get her to the vet? Did you give her something like Gabapentin? How did you get her into a carrier? How was she acting at the vet, Simone?

 

Okay, I just saw the Fructosamine test. 371. Bad. But you already know that. The only thing I can think that mitigates that is if she were having a pancreatitis flare up during the two weeks prior to the blood being drawn. She was, wasn't she? Or an IBD flare up? So it might not be as bad as the 371 next time you get it checked? But if you get a Libre put on, you may not even need to check Fructosamine again at all as you will be able to have continuous monitoring of her BG.

 

For some reason Missy still let me brush her teeth and even test her but, unless I warm up her ear very well, she won't let me test her more than once if I make a mistake...I'll try to test her more often so hopefully she'll get use to without stressing too much.
I can still pick her up while she's standing (but not when she's laying down) and she knows I'm taking her to the vet so she goes into a scaredy cat mode and freezes up, then I just drop her in the carrier without any issues. Love the carrier I have because is big and I can unzipped it all the way around so it collapses and open up flat, the vet just leave her in there and proceed with the visit. Last couple of visit I did start giving her Gabapentin, 40mg the night before and 60mg 2-3 hours before appointment and it works pretty well. She gets so scared that she will ended up peeing on herself, then I usually have to get her urine at home and bring to vet so they can run the test.
I don't know how she acted at the IM last visit because they took her on the back for the visit and the tests; they said she was good and just hiss a little bit but , I swear, at one point I heard her screeming a few times (probably during ultrasound).

 

I can see my girl”s exactly same behaviour from Missy. My girl hospitalised Monday and vet said she does have pancreatitis ( they don’t do fPL test- ) looking at her lipase . She does pee on her when she visited vet. now her SDMA and Cre numbers going up within last 5 days even though she is in fluids. …. I will keep your girl on my prayers……

 

Sorry to hear that, hope she'll recover soon ...sending you hugs