New here, trying to find the right dose

[Kurt]

Hello! First time post...I do want to start off by saying thank you for all of your contributions to this forum. It's been very helpful over the last several months.

Lila is a 15 year old Siamese who has CKD, Diabetes, Neuropathy and IBD. She eats Hills K/D wet food along with Royal Canin Renal Support S ( when I'm not home I leave this out if I'm going to be gone a while ) Although it's been a rough road, I have managed so far to keep her in fairly good health on my own. ( that is, being single ) However, as these issues progress, I have a few main concerns.

First off, I'm unemployed right now, so it's very easy to care of Lila regarding glucose testing, feeding wet food consistently each day, etc. So my two concerns:
1 Regulating her blood glucose levels 'quickly' before her neuropathy gets too bad. I'm having a difficult time as you will read below an see from the spreadsheet.
2 And doing so after finding work. That is, because of her eating habits or being a grazer, it will be difficult to feed her wet food only in the morning and then again in the evening. I will have to leave her dry food out. ( Right now I feed her wet food about 4 to 5 times a day ) Overall she eats 1 to 2 small cans of wet food daily ( hills k/d -2.9oz)

So a quick synopsis or history:
Her CKD has been pretty stable the last 2 years at around Stage 2 ( low end ). After being diagnosed with diabetes about a 1.5 years ago, she started with .5 units of PZI and is now up to 1.5 units 2x a day. I'll be totally honest, I never really monitored her glucose levels regularly until her neuropathy came about. Yes, another conversation. The few curves that have been ran at the vet this past year looked normal and dosage was adjusted accordingly. The curve ran about a month ago showed the 1.5 dose seemed to be the sweet spot. She now has had neuropathy, well noticeable, for the last couple months. I had a second vet look at Lila and he wanted to rule out arthritis by trying a couple of doses of Gabepentin. The thought process was that if this was something other than neuropathy, we might see some improvements in mobility. We did not. No xrays have been performed as I don't want to put her under at this age. But I can play with her, brush her out, etc and she doesn't show any sign of pain at all.

Her glucose values, lately, have been very difficult to regulate. There is no pattern historically speaking or now that I can see. (I did roughs checks for about two weeks before finding the spreadsheet used here. ) I was going to input those values, but again, they were spot checks so I'm not sure that data is very useful other than generalizations. Thus I started the official spreadsheet in my signature with more control or rather strict 2 hour fast times before testing. However, there isn't much difference between my rough checks over a couple of weeks and what is posted in the spreadsheet. My vet, as of today, says we should increase her insulin to 2 units.

Because of her IBD and 2 months into neuropathy, Lila takes .5ml of B12 ( methyl ) injections 2x a week and has been on B12 for about 4 weeks now. ( I use the inject able form as the pill form isn't absorbed easily into a cat with IBD from what I have read ) There has been a slight improvement overall but she still has to lay down every 10 or 15 steps, wobbly going up stairs, and gait is off more often than not. And periodically, still lays down by the litter box after using it. ( she did this a lot before the B12 ) I tried an injectable B complex for a week before moving to the B12 Methyl, but Lila did not improve and both her appetite and bathroom movements ( pee/poo ) slowed down. As soon as we took her off the B complex, those two went back to normal. ( also in trying to regulate her BG levels, we decided to take her off Budisinide and try Fortiflora for her IBD but the lack of the steroid didn't seem to make much difference with her BG levels, and Lila was getting constipated and throwing up again) The Budisinde seems to help her with her tummy and overall digestion. She is now back on .25ml 2x a week for the last several weeks.

sidenote: I have also tried Miralax for her motility issues, but this actually seemed to constipate her more. She is a unique cat in that she doesn't respond to anything the way other cats do! I do add plenty of water into her wet food as well as pumpkin ( about 3 to 4 teaspoons daily ). Every other cat out there seems to respond well to extra hydration and canned pumpkin. Not Lila She poops small to medium semi hard 'pellets' and every few days, normal stool. She has also had several enemas over the course of a year when she gets really backed up. But still struggles more often than not with pooping.

In the last year, her blood work has been stable as far as the CKD, normal levels for Potassium, Phosphorus, etc. You can see her most recent labs attached. She has also been tested several times for a UI, comes back negative. Ketones, negative. She is generally a happy cat and eats/drinks fine. Of course she had good days and bad days so sometimes thing vary. Seems no amount of testing including ultra sounds, show anything abnormal.

I hope all this makes sense, lately I have been pretty stressed out and not sleeping well with this over my head. Should I leave it at 1.5 units for now, decrease or increase it? As you will see, I did try increasing it a couple of times but not much effect.

Thank you very much,

 

[JanetNJ]

Sorry your kitty is struggling. I'm glad your getting her the b12... That should help but key will be getting her regulated. I don't use that particular insulin but I'm sure someone will be by to advise on dosing.

You were concerned about how to feed her once you are back at work since she's a grazer. What many do is use a timed feeder and either freeze a portion of food so it's fresh or place an ice cube in it.


2.9 creatnine is actually stage 3 ckd, not 2. Keep an eye on it. Since she's got issues with constipation you could ask about doing sub q's at home a few times a week. When my cat was 2.9 I started sub q's a few times a week and it lowered him down significantly and he seemed to feel much better. Your other option is to add extra water to the food and I would recommend adding extra water bowls or fountains in any room your cat hangs out in.


A big issue is the food you are feeding.
Hills k/d is 26% carb. The TV is also over 20%. Basically you are feeding donuts.

What you want is a low carb wet food under 10% carb. Once you change the diet you will see the numbers cone down significantly!! Most of us feed fancy feast classic or Friskies pate. If you want low phosphorus for the ckd, weruva bff are low in both. http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

[Djamila]

Another food that is low phosphorous and low carb is Primal Turkey. You can get it in freeze dried or frozen. I have one cat who prefers the frozen, and the other prefers the re-hydrated freeze dried. Which just shows that cats are kind of weird, since the recipe is identical for both versions!

When you're ready to go back to work, we can definitely help with lots of tricks for feeding wet food during the day. I work all day and my cats free feed with no dry food. It can be done!

Janet has given you some good advice about the carb level of the current food. Having CKD and FD at the same time is tricky, but lots of people around here deal with both issues. Here is a list of foods that meet the needs of both diets. It's not up to date though, so cross reference it with the list Janet gave you to see the more current values.
https://docs.google.com/spreadsheets/d/112NvvzgxEBOtkb42rA0XR8GeShw9xXs9kccf9-olK7I/pubhtml

As far as the IBD, I would recommend s. boulardii instead of fortiflora. Fortiflora tastes great to cats, and you can certainly keep sprinkling it on the food to entice her to try some lower carb foods, but folks around here have found that the s. boulardii is more effective at stabilizing the IBD issues which will hopefully help with the constipation. If not, there are a million other tricks around here as constipation is very very common and talked about on the board all the time!

The other factor is the steroid. That may make it difficult to keep her in lower numbers, but if it's the only thing that helps, you just have to dose around it, and we can certainly help with that. You may just have to remind us occasionally that she's taking a steroid so we remember why her numbers might act a little differently than normal.

It sounds like you have a lot you're dealing with, and you're doing a great job! I think working on changing the food would probably be the first step. Does that seem like something you can try at this point? Once you find a lower carb food that she likes, you will likely see some improvement in her numbers and her symptoms.

 

[Kurt]

Sorry your kitty is struggling. I'm glad your getting her the b12... That should help but key will be getting her regulated. I don't use that particular insulin but I'm sure someone will be by to advise on dosing.

You were concerned about how to feed her once you are back at work since she's a grazer. What many do is use a timed feeder and either freeze a portion of food so it's fresh or place an ice cube in it.


2.9 creatnine is actually stage 3 ckd, not 2. Keep an eye on it. Since she's got issues with constipation you could ask about doing sub q's at home a few times a week. When my cat was 2.9 I started sub q's a few times a week and it lowered him down significantly and he seemed to feel much better. Your other option is to add extra water to the food and I would recommend adding extra water bowls or fountains in any room your cat hangs out in.


A big issue is the food you are feeding.
Hills k/d is 26% carb. The TV is also over 20%. Basically you are feeding donuts.

What you want is a low carb wet food under 10% carb. Once you change the diet you will see the numbers cone down significantly!! Most of us feed fancy feast classic or Friskies pate. If you want low phosphorus for the ckd, weruva bff are low in both. http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Thanks for the reply.
Yes, you are correct about Stage 3. Will keep my eye on it.

As far as hydration, I do keep multiple water bowls around the house and a fountain for decoration as she never drinks from it I always add water to her wet food and will keep adding as she eats it! ( keeping it a certain soupy consistency ) I will look into the Sub Q today as she hasn't been drinking as much in the last week. good idea

As far as the food, I understand. I was focusing more on the kidneys, and the fact that Lila is finicky and turned down a lot of canned food until the Hills she eats now. I am on the fence about the amount of protein but for now, want to keep her on the lower side since it seems to keep her kidney values 'stable'. I will look to see about a food change or rather finding the right balance between Protein, Carbs, Phosphorus, and what she will eat. It's not easy trying to sort out which foods have the right balance while trying to sort out all the conversions and calculations as well.

Thank you!

 

[Kurt]

Another food that is low phosphorous and low carb is Primal Turkey. You can get it in freeze dried or frozen. I have one cat who prefers the frozen, and the other prefers the re-hydrated freeze dried. Which just shows that cats are kind of weird, since the recipe is identical for both versions!

When you're ready to go back to work, we can definitely help with lots of tricks for feeding wet food during the day. I work all day and my cats free feed with no dry food. It can be done!

Janet has given you some good advice about the carb level of the current food. Having CKD and FD at the same time is tricky, but lots of people around here deal with both issues. Here is a list of foods that meet the needs of both diets. It's not up to date though, so cross reference it with the list Janet gave you to see the more current values.
https://docs.google.com/spreadsheets/d/112NvvzgxEBOtkb42rA0XR8GeShw9xXs9kccf9-olK7I/pubhtml

As far as the IBD, I would recommend s. boulardii instead of fortiflora. Fortiflora tastes great to cats, and you can certainly keep sprinkling it on the food to entice her to try some lower carb foods, but folks around here have found that the s. boulardii is more effective at stabilizing the IBD issues which will hopefully help with the constipation. If not, there are a million other tricks around here as constipation is very very common and talked about on the board all the time!

The other factor is the steroid. That may make it difficult to keep her in lower numbers, but if it's the only thing that helps, you just have to dose around it, and we can certainly help with that. You may just have to remind us occasionally that she's taking a steroid so we remember why her numbers might act a little differently than normal.

It sounds like you have a lot you're dealing with, and you're doing a great job! I think working on changing the food would probably be the first step. Does that seem like something you can try at this point? Once you find a lower carb food that she likes, you will likely see some improvement in her numbers and her symptoms.

Thanks for your reply,

As I was telling Janet, I will have to look into a food change. Again, it's not easy with the conversions, calculations as well as personal preferences for protein content, etc. I want to keep Lila on a low protein diet as it seems to have kept her CKD stable for now. I have looked at the charts posted as well as the one from Tanya's site and honestly, it's confusing. I wish someone could point me to some food that is low in protein, phosphorus, and carbs. But from what I can see and understand, there is no one solution or perfect food?

I will also look into your suggestions for her IBD. What I don't understand is when Lila was drinking a lot of water up until last week and eating wet food containing extra water and pumpkin...it didn't seem to make a big difference? Perhaps it goes back to her glucose levels as part of the equation. Anyhow, will look into Sub Q and continue adding water to wet food w/ pumpkin.

As of today, since it will take me time to find the right food, I will take the vets suggestion and try 2 units for the next several days. I don't know what else to do in the short term to get her levels down. If Lila is eating a lot of carbs, I guess I'll have to counteract that with a higher dose short term? I do know that when the carbs are eventually lowered, I will have to keep an eye on BG levels and possibly adjust the dose.

Thanks for understanding or rather making the comment about having a lot on my plate. That was a relief. My friends and family have no idea how much time I have spent and why on the amount of research and catering to Lila. It's time consuming and stressful for sure.

I am hoping someone can chime in on a dosage level. I only chose 2 this morning since the vet suggested it, and both you and Janet suggest lower carbs for lower numbers...She does have a lot of black and red on her chart. 1.5 seems to be the right dose when her pre shot is in the 300's. Of course I'm just guessing but getting desperate to stabilize her BG while looking into the changes.
Thank you!

 

[Djamila]

I think the increase to 2u should be okay. It looks like you're starting to spread around the mid-cycle tests which is great. It will help you to figure out at what point she is more likely to be at her lowest point (nadir), and also help to keep her safe as you do the increase. One of the things about feeding higher carb foods is that it does increase the chance of having bigger dives in the numbers/hypos, so the extra monitoring will help keep her safe. Please know that I understand how complicated the food can be, and how picky cats are about what they eat, so I'm not saying that to add pressure to your food decision. I just want you to keep an eye on her as you increase because you might start to see some drops and bounces. You can learn to manage it though since you're home and can monitor and steer if she needs a boost.

 

[Kurt]

I think the increase to 2u should be okay. It looks like you're starting to spread around the mid-cycle tests which is great. It will help you to figure out at what point she is more likely to be at her lowest point (nadir), and also help to keep her safe as you do the increase. One of the things about feeding higher carb foods is that it does increase the chance of having bigger dives in the numbers/hypos, so the extra monitoring will help keep her safe. Please know that I understand how complicated the food can be, and how picky cats are about what they eat, so I'm not saying that to add pressure to your food decision. I just want you to keep an eye on her as you increase because you might start to see some drops and bounces. You can learn to manage it though since you're home and can monitor and steer if she needs a boost.

Thank you!

I think for now, I may try and switch to Royal Canin Renal Support D. It's similar to the Hills but rather than 38 percent carbs, it's 22. Not perfect, but better for her while I research other foods. And yes, will pay attention to the insulin increase and carbs with respect to up's and down's...

It's a relief after all this time lurking, to have some other opinions...it took me several days just to come up with my first post. lol
Much appreciated.

 

[Djamila]

I think it took me a couple of weeks of lurking before I posted the first time too. It took me forever to just figure out where I was supposed to post since there is the Intro form, the Main forum, and the Prozinc forum. So confusing!!! I'm glad you made it here!