New Member - seek advice on CKD/Diabetes/Pancreatitis condition

[Hanao]

Hi! I am new here (referred by the member of Feline Diabetes Support Group).

Quick Intro about my cat: Hana is 17yrs old this Sep and was diagnosed with diabetes on April 5, 2026. She has been on Prozinc and now at 1.25IU.
She was doing well for a couple of month then became ill with acute pancreatitis on June 25, 2026. Since then, she has been on SQ fluid 100ml a day, on and off with Cerenia, mirtazapine, and Buprenex (it was my choice not to hospitarize her given her age and spicy personality. And she was eating - no diarrhea or vomiting except June 25). She was diagnosed with Stage 2 CKD back in Aug 2023 and has been on Aventi Advance Kidney powder. Her Creatinine number was around 150-166mmol in previous bloodwork including June 25, but it went up to 237mmol on July 13. 2026 (Urea at 19.6mmol).

As for her diet, with recommendation from Feline diabetes community, she has been on weruva (Valentine tuna and pumpkin / Soulmate tuna and salmon) and SquarePet salmon and herring.

On July 18th (Sat), she all the sudden refused all food she ate till a day before (even her favourite Churu) and became lethargic. She spent most of her time by water bowl - just lying on the floor. She has been on 100ml SQ fluid, half dose of mirtazapine, and 1.5mml of Burprenex everyday (Cerenia just first few days). Also, her back legs started to show symptoms of neuropathy (this is me guessing) - she loses balance when she stands up, warbles when walking (she could not stand up in litter box a couple of times).

From Thursday Jul 23, she started to eat more, and her energy level has been improved. Her weight is now back to normal that is around 5.1kg (she weighted around 4.7kg at lowest last week). Her back legs also shows improvement slightly, too.

I thought she had pancreatitis flare when she becane lethrgic around July 18, but after reading "Managing Symptoms" tab, I was curious if that is CKD she was having a hard time with. The reason to my perspective due to:
- sniffed Churu but did not eat.
- hooverd herself to water bowl but did not actually drink
- audible stomach gurgling when she ate
- increased urination (8 times aveg. / max 10 times)
- increased water intake (did not drink from water bowl since SQ fluid treatment on Jun 25, but started to drink water 3-4 bowls a day from around Jul 14ish.
- BG level remained high 20s mmol sometime spiked to low 30s mmol(dose increased from 0.75IU to 1.0IU 4 days ago). It has been around high 10s to low 20s since does increased.

I think I want to know:
- what is major sign/key to look for in order to determine what she is having - pancreatitis flare or CKD or diabetes progressed?
- is giving SQ fluid 100ml daily is in fact too much (this home treatment was suggested by IM)? Or is it okay to
- if Purina Hydra care is also given, should amount of SQ fluid be reduced? I am worried if she is given too much fluid, which may be contributing to more urination?
- which medication (mirtazapine or Burprenex) be reduced since she is eating better and her weight is back? She is still lethargic, but her energy level has been improved (asks for brushing, jumps to bed, moves more etc).

Hana is one and only family in Canada, and I want to do the best I can to ensure she spends her time without pain. Please know hospitalization is not option for me. She got very spicy personality and gets stress very easily. My best intention is to provide her home treatment as much as I can.

Thank you for reading this long post!
Look forward to hearing insight / advices!

 

[Si am cat mom]

Hey there and welcome! First off, you are doing a great job managing all the conditions your baby has going on so - well done.
My rule of thumb with meds with my cats was medicated until his symptoms resolved and stabilized. Since cats often masks symptoms and can be quite stoic, I try to treat a few days past the point where symptoms are noticeable to me assuming that he might still be recovering...so maybe hang on to that mirtaz. Buprenex wasn't something I used, my cat had opioid reactions ( dysphoria and vocalizing) , so we used Gabapentin. Whenever I hear stomach gurgling and hovering around food / water , I think increase stomach acids due to the toxins that build up from the kidneys struggling to do their job. This doesn't mean your baby couldn't also have pancreatitis, of course but you essentially just put out fires and treat the symptoms knowing there will likely be some overlap with many of these conditions. I like pepcid/ famotidine and zofran/ ondansetron for those tummy fits that don't involve vomiting but on going loss of interest in food or limited interest ( eating a few bites). Cerenia and Ondansetron are similar meds, but work different in the body; different mechanisms.
The wobbly stance and falling in the box makes me think weakness also.. Be sure to watch that CBC and make sure the Hemoglobin/ Hematocrit , PCV and Red blood cell counts aren't falling. I mistakenly thought my cats wobbling and losing his footing in the litter box was due to his Osteoarthritis, spondylosis and just old man woes but it was non regenerative anemia caused by his kidneys and proteins that stimulate blood cell production. Lots of over lap though. You know your baby so, you can probably rule things out over time.
With subq fluids, my vet always said as long as my guy didn't have blood pressure issues or cardiac / respiratory concerns - on with the fluids regardless of how or what he was eating and drinking...so I did whatever he would tolerate. You want to flush that system so, it likely will increase urination. My guy would go 6 -8 times the next day when I gave fluids (100ml).
Someone else will likey weigh in with more insights.
Again, you are doing great and I hope Hana feels much better !

 

[Wendy&Neko]

Is June 25th the last time your girl had blood work done? Another cause of wobbly legs is low potassium, not uncommon with CKD kitties. But do not supplement until bloods have proven she needs it. What was her potassium level on June 25th? Having said that, it can change fairly quickly in my experience. And also impacts appetite and causes them to pee more.

I second seeing if you can get a prescription for ondansetron. I find it's better than Cerenia for actual nausea. Just be prepared for sticker shock in Canada. You definitely want the generic, not the Zofran brand. Hovering around water is also a sign of nausea.

How are you testing her blood sugar levels? Inflammation or infection can increase blood sugar numbers, so if pancreatitis that could be one cause of higher numbers. Regularly home testing her blood sugars is how you determine if that is the cause of symptoms you are seeing.

Pancreatitis is painful. Cats often assume the meatloaf position or show one of these signs: Feline Pain Scale. Blood work is needed to determine if CKD had progressed.

I echo the above about being very careful with fluids if there is any chance of a cardiac issue. Neko had CHF from fluids, even though she had had a fairly recent echocardiogram. Things just change in her heart. Going off her food was the main symptom I saw. Your vet should be your guide about whether fluids are safe to give, and how much.

 

[Hanao]

Hey there and welcome! First off, you are doing a great job managing all the conditions your baby has going on so - well done.
My rule of thumb with meds with my cats was medicated until his symptoms resolved and stabilized. Since cats often masks symptoms and can be quite stoic, I try to treat a few days past the point where symptoms are noticeable to me assuming that he might still be recovering...so maybe hang on to that mirtaz. Buprenex wasn't something I used, my cat had opioid reactions ( dysphoria and vocalizing) , so we used Gabapentin. Whenever I hear stomach gurgling and hovering around food / water , I think increase stomach acids due to the toxins that build up from the kidneys struggling to do their job. This doesn't mean your baby couldn't also have pancreatitis, of course but you essentially just put out fires and treat the symptoms knowing there will likely be some overlap with many of these conditions. I like pepcid/ famotidine and zofran/ ondansetron for those tummy fits that don't involve vomiting but on going loss of interest in food or limited interest ( eating a few bites). Cerenia and Ondansetron are similar meds, but work different in the body; different mechanisms.
The wobbly stance and falling in the box makes me think weakness also.. Be sure to watch that CBC and make sure the Hemoglobin/ Hematocrit , PCV and Red blood cell counts aren't falling. I mistakenly thought my cats wobbling and losing his footing in the litter box was due to his Osteoarthritis, spondylosis and just old man woes but it was non regenerative anemia caused by his kidneys and proteins that stimulate blood cell production. Lots of over lap though. You know your baby so, you can probably rule things out over time.
With subq fluids, my vet always said as long as my guy didn't have blood pressure issues or cardiac / respiratory concerns - on with the fluids regardless of how or what he was eating and drinking...so I did whatever he would tolerate. You want to flush that system so, it likely will increase urination. My guy would go 6 -8 times the next day when I gave fluids (100ml).
Someone else will likey weigh in with more insights.
Again, you are doing great and I hope Hana feels much better !

Thank you for the welcome!

I want to thank you for your insight in particular concenring weakness of her legs. I was not aware of regenrative anemia and CKD can cause weakness in legs. I knew only about neuropathy, but I did notice this time that her front paw seems to twich time to time and her balance is a bit untable even when she is grooming useing front legs in sitting postion, which are all new signs I see this time when she became lethargic on July 18.

If I may, could I ask you to have a look at her bloodwork done on July 13th? The previous bloodwork was on June 25 (she became ill with pancreatitis) and April 4 (the day before she was diagnosed with diabetes). RBC, Hemoglobin/ Hematocrit did fall as you mentioned, and Phosphorus is on higher end based on this forum given that the range is for healthy cat. What you have noted on your reply makes sense, and I am hoping that you could share your view on her bloodwork.

As for SQ fluid, your vet means it is okay to give SQ fluid even daily as long as a cat does not have blood pressure issues or cardiac / respiratory concerns? 100ml daily was instructed by IM who is on vacation now. It has been 32 days since my cat has been on it, and she seems just fine with it. However, I do read some people say 100ml everyday is not recommended; 2-3 times a week is ideal amount.

And yes, Hana is feeling better slowly but surely She seems to have better mobility, pees less, and her BG level remains around low 20s around dosing time.

Then this leads to me another question - does CKD symptom improve in a week like the improvement Hana is showing? I am trying to rule things out in any way possible.

Last but not least, I am trying to add B12 (Dr's Bset Fully Active B12 1500 mcg) to her meal for her muscle and nerve system with hope that it will improve her backlegs. Have you used this supplement before? I wonder how much to start to with. Her weight is about 5kg/11lb. She is also on probiotic (S. Bouladii) a half capusel a day.

Thanks agian for reading my post! I am so glad I found this forum! Very resourceful

 

[Hanao]

Is June 25th the last time your girl had blood work done? Another cause of wobbly legs is low potassium, not uncommon with CKD kitties. But do not supplement until bloods have proven she needs it. What was her potassium level on June 25th? Having said that, it can change fairly quickly in my experience. And also impacts appetite and causes them to pee more.

I second seeing if you can get a prescription for ondansetron. I find it's better than Cerenia for actual nausea. Just be prepared for sticker shock in Canada. You definitely want the generic, not the Zofran brand. Hovering around water is also a sign of nausea.

How are you testing her blood sugar levels? Inflammation or infection can increase blood sugar numbers, so if pancreatitis that could be one cause of higher numbers. Regularly home testing her blood sugars is how you determine if that is the cause of symptoms you are seeing.

Pancreatitis is painful. Cats often assume the meatloaf position or show one of these signs: Feline Pain Scale. Blood work is needed to determine if CKD had progressed.

I echo the above about being very careful with fluids if there is any chance of a cardiac issue. Neko had CHF from fluids, even though she had had a fairly recent echocardiogram. Things just change in her heart. Going off her food was the main symptom I saw. Your vet should be your guide about whether fluids are safe to give, and how much.

Hi Thank you for your input!

July 13th is the last bloodwork she had done. I do test her BG everyday before insulin and one mid-point if not two.

About SQ fluid, 100ml daily was instructed by IM, and my cat has been on it for 32 days now. I just don't know if I should reduce it or maybe give Purina Hydra care instead?
I do not want to make her liver or heart extra work, but at the same time I want to ensure that she flushes out things from her kidney and pancreas with help of SQ fluid.

Her potassium was 4.5mmol on July 13 bloodwork. How often do you do bloodwork on your kitty?

And thank you for the Feline Paind Scale! I knew only some of it and will make good use of that for sure!

Thanks!

 

[Wendy&Neko]

K (potassium) of 4.5 is a good number so it's shouldn't be that. Frequency of blood work depends on the cat, what conditions are being monitored, and if there are any new issues to be investigated. Your vet should be a good gauge of whether more blood work is needed. At the same time, you can ask about the fluids/Hydra care.

 

[Hanao]

Hey there and welcome! First off, you are doing a great job managing all the conditions your baby has going on so - well done.
My rule of thumb with meds with my cats was medicated until his symptoms resolved and stabilized. Since cats often masks symptoms and can be quite stoic, I try to treat a few days past the point where symptoms are noticeable to me assuming that he might still be recovering...so maybe hang on to that mirtaz. Buprenex wasn't something I used, my cat had opioid reactions ( dysphoria and vocalizing) , so we used Gabapentin. Whenever I hear stomach gurgling and hovering around food / water , I think increase stomach acids due to the toxins that build up from the kidneys struggling to do their job. This doesn't mean your baby couldn't also have pancreatitis, of course but you essentially just put out fires and treat the symptoms knowing there will likely be some overlap with many of these conditions. I like pepcid/ famotidine and zofran/ ondansetron for those tummy fits that don't involve vomiting but on going loss of interest in food or limited interest ( eating a few bites). Cerenia and Ondansetron are similar meds, but work different in the body; different mechanisms.
The wobbly stance and falling in the box makes me think weakness also.. Be sure to watch that CBC and make sure the Hemoglobin/ Hematocrit , PCV and Red blood cell counts aren't falling. I mistakenly thought my cats wobbling and losing his footing in the litter box was due to his Osteoarthritis, spondylosis and just old man woes but it was non regenerative anemia caused by his kidneys and proteins that stimulate blood cell production. Lots of over lap though. You know your baby so, you can probably rule things out over time.
With subq fluids, my vet always said as long as my guy didn't have blood pressure issues or cardiac / respiratory concerns - on with the fluids regardless of how or what he was eating and drinking...so I did whatever he would tolerate. You want to flush that system so, it likely will increase urination. My guy would go 6 -8 times the next day when I gave fluids (100ml).
Someone else will likey weigh in with more insights.
Again, you are doing great and I hope Hana feels much better !

Hi again, I just realized that your kitty passed away just a couple of days ago. I can't imagine how life has been feeling like wihtout him... I hope that you allow yourself time to grief. Please take good care of yourself, too. I am 120% sure that Makoto had wonderful life because you are his forever mom.

 

[Si am cat mom]

Hi again, I just realized that your kitty passed away just a couple of days ago. I can't imagine how life has been feeling like wihtout him... I hope that you allow yourself time to grief. Please take good care of yourself, too. I am 120% sure that Makoto had wonderful life because you are his forever mom.

Thanks !
I gave b12 injections weekly for my guy... he was already on so many oral supplements for Gut care and the Phosphorus binder. I didn't want to add things to gis food. 100 ml can be too much for kitties with CKD - sorry I wasn't clearer. I did his 3x a week be because thats about all he would tolerate and I'm a terrible stick sometimes so....sometimes it would be Maaaaaaybe 50ml. And I was a vet tech so....that's pretty bad I think establishing a routine is the thing- then you feel comfortable doing all the things and they have an idea of what to expect.
Hopefully your vet can help you come up with a good plan. For me, my vet would always ask what I wanted to do and help me shave off what was not necessary or best practices.
Every cat is a little different. Makoto would feel bad for a couple days, but I would only seem obvious symptoms for a day or two. He would go back to eating more normally and perk up as soon as I started shift his care to more aggressively treat his situation. Cats are so stoic it really is tricky to know what's going on. Whether its the Renal disease or the pancreas- its all endocrine system so I just lumped it into that fire pit and focused on treating his symptoms.
Also, with my guy, had a history of elevated liver enzymes and pancreatitis, so I was used to tracing his behavior when that was an issues vs something else like his dementia or something causing changes. You will see patterns and things that " make sense". I watched his Creatinine, Phosphorus, HCT/ PCV, RBC and bilirubin since those were the ones in the past 2 years that seemed to immediately affect how he felt. We did a mini cbc/ min Chem panel every 3-4 months as needed and full labs every 6, with urinalysis.