Need Advice - Diabetes, Kidney Issues, Hard to Regulate

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JenCarpenter

JenCarpenter

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Hello all! I'm new to the Feline Diabetes boards (I posted an introduction as well). I'm hoping to get some advice on my current situation - specifically from anyone who has experience working with cats who have diabetes and kidney issues and cats that are hard to regulate.

My 13-year-old cat, Peppin, was diagnosed with diabetes just over a month ago (around 5/20). He had blood work done and the vet found he had pancreatitis as well. He was prescribed Lantus insulin twice per day (6 a.m. and 6 p.m.) with the dosage depending on his blood sugar (for example, if his blood sugar was above 200 and he ate more than 50% of his food, he was given 2 units. If his blood sugar was below 200 or he ate less than 50% of his food, he was given 1 unit. If his blood sugar was below 100 he was not given any insulin). In addition, I have been doing home glucose monitoring with the AlphaTrak2 four times per day (at 6 a.m., 1 p.m., 6 p.m., and 9 p.m.).

About his food: he had always been given a diet of one Fancy Feast can per day and free-fed on dry Purina food. He used to love his canned food, so we tried to get him eating the EVO 95% turkey and chicken canned food. He ate that for a few days and then stopped eating, so I ordered the dry EVO turkey & chicken food, which he loved.

His progress seemed promising for the first couple of weeks. There were a couple of times where his blood sugar dropped too low (below 60), so we briefly tried to administer 1.5 units twice per day - this caused his blood sugar to remain too high so we went back to the previous method. Then his blood sugar started creeping up so we started giving 2 units twice per day - this worked for a week or so and then all of a sudden his blood sugar shot up (500+ at most readings).

At this point I took Peppin back into the vet and he had more blood work done. The vet found that his kidney (BUN?) was high now as well. I started doing sub-q fluids every other day, along with an antibiotic and Pepcid AC (the vet also prescribed a sub-q anti-inflammatory that stings, the name escapes me now, which he absolutely hated getting). He's not a big fan of the fluids, but I'm making it work. She also transitioned him to Hill's Prescription K/D dry food.

I've been giving the fluids, the medication, and the kidney diet for about a week now and his blood sugar readings are still consistently high. My vet's newest theory (she consulted with an internal medicine specialist as well as a human MD with specialty in diabetes patients with kidney problems) is that his liver is not able to process the larger amounts of insulin, so we've been giving him only 1 unit twice per day.

Other weird behaviors I've noticed lately: he's had some balance issues (which I know can come along with the diabetes and high blood sugar), not being able to jump all the way on the couch and falling off when he walks across it. He's also been laying in his litter box the last couple of days, just lounging there a couple times throughout the day. And he hasn't been grooming himself as well either.

I've trusted the vet up until now ... I feel like we've done test after test and all different types of insulin dosage with no positive outcomes. His blood sugar is worse now than it was in the beginning. I've taken him to the vet a handful of times, spent a significant amount of money for all the tests, and am wondering what else I can do to help him out. I'm tempted to give him more insulin (2-3) units this weekend when I can monitor how it will effect him, but I wanted to see if anyone else has experience with cats that have both diabetes and kidney issues? I don't want to give him more insulin if it's going to stress his kidneys, but I'd also like to see his blood sugar numbers come down.

Any advice is truly appreciated - thanks in advance!
 
Jen, I can't advise you, but there are plenty on here that deal with all kinds of health issues in addition to diabetes. I'm sure someone will be along soon. Welcome!
 
First issue, the food-----Peppin needs to be on a canned only diet. One with low carbs and lower phosphorus. Squeakers excursion into diabetes was short lived so I'm not well versed on whether or not you are experiencing insulin related issues or not. That said, we are dealing with chronic renal failure and pancreatitis about every six months. I am including a link to a list of low carb/low phosphorus foods that will be much better than dry food which is too high in carbs and can be a contributing factor in the difficulties you are having in regulating the glucose levels. http://www.felinecrf.org/canned_food_usa.htm

The balance issues you spoke of could be due to low potassium, or anemia, or both. It could also be due to an ear infection or any given number of things, without seeing the blood work it would be hard to help isolate a cause. Maybe you could send the full blood panel. Also was a CBC done?

Here is a website with all the information about kidney disease: http://www.felinecrf.org/index.htm. The high kidney values could be nothing more than a consequence of the increased kidney function due to the unregulated diabetes. When you get the diabetes regulated you may find the BUN and Creatinine levels return to normal. It isn't the insulin that is stressing the kidneys it is the increased urination that occurs with diabetes.

I'm not sure that I would increase the insulin that much. It could kick in unexpectedly and cause a hypo. For dosage advice, I would post in the Lantus group.
 
The K/D is too high in carbs for a diabetic cat, so it's no surprise that Peppin's numbers are crazy high. Dry food is also the absolute worse thing you can feed a cat with compromised kidneys. There's all kinds of great info on Feeding Your Cat: Know the Basics of Feline Nutrition . Low carb canned food is the best thing you can feed your cat. Water is the key to healthy kidneys, so canned food is always going to be better! Fancy Feast classics are low carb and a lot of us feed them. Friskies pate's are also low carb (under 10%) but there are lots of other foods available too. The Food Chart can help you find foods that are low carb. Kidney patients also do better with low phosphorus (unfortunately, the Fancy Feasts aren't low phos) but with only a BUN test, it's possible your cat's kidney's aren't as bad as you think. Getting his diabetes under better control may very well improve his kidney values too

Lantus is also best dosed consistently...Not on a sliding scale. It's actually better to give the same dose every 12 hours while testing at home to see how low the dose takes him and making adjustments from there. Lantus dosing is based on how low it takes them, not the pre-shot test results.

The people here have years of experience with this disease and with using Lantus effectively and safely. It sounds like your vet doesn't understand how to use it.

It's great that you're home testing, and if you'll use our spreadsheet to record your results, it'll really help us to help you! Here's instructions on How to create our spreadsheet
 
@Larry and Kitties - That's a good fact to know! I don't have the exact levels, but I do remember the vet saying his urine specific gravity looked normal.

@Anitafrnhamer - Thank you! I will pick up one of the foods on the list soon and see if he will eat it as opposed to the dry food. I can try to get a copy of the blood panel from my vet - I do know a blood count was done, as his white blood cells were slightly elevated (which is why he was placed on the antibiotic). I will post over on the Lantus group to ask about increasing his dosage.

Thanks guys!
 
@Chris & China - I had originally read that canned food was better, but for whatever reason Peppin didn't like the EVO brand. I think if I get something different he may have a better appetite for it, as he always loved his Fancy Feast before. As far as the dosage - the vet had cited a study done by someone she knew (I have the paperwork somewhere) but I don't know how recent that information is, which is why I wanted to ask around for advice from others who had more/recent experience with Lantus. I am currently doing home testing 4x per day using the AlphaTrak2 meter. Thanks!
 
Well the most current literature is in the "Tight Regulation Protocol" thread. If I remember, the last time it was updated was 2013 and it's the one the AAHA recommends

Try to get our spreadsheet up and let us see what kind of numbers you're getting and I'm sure the people in the Lantus Forum will be able to help you get him under better control!

If you have trouble with the spreadsheet, let us know and we can help you get it started!

Also, if you want to continue using the AlphaTrak, that's fine, but the vast majority of us here use human meters (and the numbers on the protocol graph are mostly from human meters too) The cost of the strips for the AT are just too outrageous for most of us that test 4-8 times a day.

The Relion Confirm and Micro are both good meters with strips that are only $35.88 for 100 (available at WalMart)
 
@JenCarpenter is this the article you are talking about? It talks about tight regulation, but not in the same way we practice it here. I read that yesterday, and questioned it because it says, and this is a quote: "As long as you are feeding your cat ONLY low-carbohydrate foods, you do not need to be fearful of clinical hypoglycemia. In fact, those blood glucose numbers in the 60-120 range are the objective of the protocol. Even if the blood glucose drops to 30-50, do not feed sugar syrup or dry food. A small, high protein wet food meal is all you need for a cat at these numbers and that is more for the owner than the cat."

@Chris & China , would you look at this too? I started to post it last night.
 
@Shiloh & Rhonda ...that protocol is from another message board and we REALLY don't agree with it....they dose lantus on a sliding scale and feel that cats can't go hypo on low carb food, which is a very dangerous idea. They started with a protocol that used ProZinc (which CAN be dosed with a sliding scale) and then just decided to use the same idea with Lantus.

Shiloh's looking pretty good, but since you skipped last night, the "cycle clock" starts over, so you need to hold the .25 for at least 6 cycles unless Shiloh's nadirs don't come back down into greens soon. With reductions (which you recently took) you go back to the last "good dose" if it looks like the reduction is failing....you don't necessarily have to hold it for 6 cycles
 
Thanks Chris. I didn't agree with it either. Was just trying to find things to convince DH that Shiloh wasn't ready for OTJ....as much as we both want it. I saw that and I was shocked!

Was just telling Julie in my condo that I am very seriously considering going back up to .5, but this week really sucks for mid-cycle testing, so thinking of waiting until Friday, so I can be here to test and watch her.
 
@Chris & China - I responded to you as well over in the Lantus forum. The AlphaTrak2 supplies are very expensive, so I wouldn't mind switching to a cheaper meter if that has been found to be successful.

@Shiloh & Rhonda - The dosage chart was similar, but only had doses of 0, 1, or 2 and also took into account how much food the cat ate. It seems like it is not the way to go from what everyone here has experienced.
 
HI, MY CAT ALMOST WENT INTO RENAL FAILURE. I DON'T LIKE KD BECAUSE OF HI CARB COUNT. I CANNOT ACCESS THE ABOVE WEBSITE FOR PROPER FOOD. CAN SOMEONE HELP ME, PLEASE?
 
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