Newbie here - some advice needed please

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J

jkbank

Active Member
Hi there!
I will try and summarize my situation as briefly as possible:
Gem is my 13yo female domestic short hair. At the end of last summer, she started peeing outside the litter box. We brought her to the vet who diagnosed her with diabetes, put her on 1u lantus/glargine twice a day along with prescription diabetes diet. As we had an already planned vacation, we opted to board Gem for the week and let the vet try and regulate her. When we came home, vet felt that 1u was a good dosage so we would stick with that. Until then, we had been free feeding dry Science Diet (didn't know any better :). I promptly went online and starting researching. I decided that my main goal would be to switch to a low-carb canned food, not the prescription food. We settled on fancy feast classic. However, a day or so after we got home, Gem stopped eating and we stopped the insulin. Brought her to the vet, she had a UTI which they treated. However, they said her BG levels were normal at the time, so hold off on the insulin. Went back after about 10 days, BG still normal, they pronounced her transient.

Fast forward 6 months, she's still peeing all over the place. We tried prozac to no avail. I decided to go to a new vet. What do you know, she's diabetic again! We start the same insulin again. Gem starts breathing heavily. Bring her back, BG still high and she had a respiratory infection. Up the insulin to 2u twice a day, treat with antibiotics. Go back for a recheck, still high, increase to 3u twice a day. Once again, we are going on vacation so we board her again. her breathing was still labored so they scheduled an ultrasound while she was there. We came home, they said she has restrictive cardiomyopathy and some kidney failure, and her BG is still high. She is now on vetmedin, furosamide and benazepril.

I decided that I would try and do some home testing, and that is what brings me here, if you're still reading! I only have one day of data but I'm hoping someone can give me some insight into the readings.

7:00 AM - 409 (meal given)
8:00 AM - 3u given
11:00 AM - 373
noon - meal given, didn't eat much
1:00 PM - 373
2:00 PM - 335
6:00 PM - 319 (meal given, didn't eat much)
7:40 PM - 431 (gave insulin at this point as she had eaten enough)

I know this isn't the most regular testing, but the best I could do with my schedule! To my largely uneducated eye, these don't look great - they are way high, and never really seem to drop (though I don't know how much they should drop over the course of the day). Gem will be going back to the vet this Tuesday to see how she is responding to all the meds, so I will share these numbers with her, but I thought all you experienced folks might have some thoughts.

Thanks so much!
 
Illness frequently changes how the body handles glucose.

The home testing is great; good for doing it. It gets better. It would indicate she is not controlled. This isn't surprising, as you are managing kidney disease and heart disease in addition to diabetes.

What are you feeding? Did you switch to a prescription renal diet?

From a post by Julie and Bandit:
"The good news is that there are commercial foods that are good to feed for both conditions. You simply need a low carb, low phosphorus canned food, preferably without byproducts (higher quality protein sources are easier on the kidneys). Keeping your cat as hydrated as possible is key to managing the disease, along with low phosphorus foods, so definitely no dry food at all (if you're feeding any). Mixing water in with the canned food is one good way to help with hydration. Many people also find that cat drinking fountains also encourage cats to drink more. Anything you can do to get moisture in your cat is important. .... The low-protein kidney diets have only been shown to be beneficial in end stage renal failure. Here's a great page that give you a guideline: http://www.felinecrf.org/how_bad_is_it.htm.

Here's an updated food list with the values for several premium foods: Pet Food Nutrtional Comparisons. You're looking for something with less than 10% carbs and less than 250 mg/kcal of phosphorus. The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, and Blue Wilderness Duck.

If those are out of your price range (although I would strongly urge a food without byproducts, keep in mind that it's still cheaper than the prescription food), the next best thing to feed are the low carb Friskie's Special Diet flavors. These are Turkey & Giblets and Salmon Dinner--make sure they are the ones that say "special diet" on the can, though. PetSmart carries them, and some grocery stores. Here is an updated list of just the phosphorus values for many commercial foods. They can be cross referenced with Binky's chart for carb values if there's something on there that you want to feed. On this chart, you're looking for something that is less than 1% phosphorus (these values are on a dry matter basis, not mg/kcal): http://www.felinecrf.org/canned_food_usa.htm"


Feline CRF web site
http://www.felinecrf.org/
 
Thanks for your reply. I do know that it will be harder to regulate her with the other medical issues, especially since the meds run counter to each other.

As for her diet, I'd say she's getting 90% Purina DM, as originally prescribed by the vet. Knowing what I know from all my research, I realize there are better foods out there, so the other 10% is a variety of canned….the ones you listed above (Merrick, Wellness etc). When the vet informed me of the heart and kidney issues, she made no mention of any necessary diet changes. She thinks I am feeding 100% DM as I haven't discussed rotating the others in. I have done some reading on the felinecrf site, which confused me even further :) I can't quite keep track what food is appropriate for both diagnoses. On top of that, I don't remember how bad/advanced the kidney issues are. At the time, it was so hard to take in all that info from the vet, kwim?! As such, I'm not sure which condition takes precedence. SOmething tells me it's the diabetes, as her BG is still so high, which further taxes the kidneys, but what do I know!

In terms of the curve, what kind of drop is expected over the course of the day? I realize her numbers are high across the board, but wondering if the amount of the drop is expected. Oh, and just did another test, about 2hrs post shot and it was 409. Don't know if that's good or bad, coming from 431 pre-shot.
 
PS ~ 431 <- pre shot of 431
+2 ~ 409 <- possibly not decreased much due to a meal-related increase

should continue going down a bit until about +5 to +7 hours from the insulin shot
Shoud start coming up again until next pre-shot.

It will help you and help us help you if you would start a spreadsheet; instructions here.

Lantus builds up in the body, so each successive dose builds a bit on the previous dose. This means any dose changes generally are done in small amounts after 5-7 days of the same dose.

Also, per FDA, glucometers only have to read within 20% of the 'true' value. What this means is
200 -> 160 - 240
300 -> 240 - 360
400 -> 320 - 480
etc

If the difference between a low number plus 20% is greater than a higher number minus 20%, the numbers are basically the same
Low +20% > hi - 20%
 
Thanks BJM, I had started a spreadsheet template I found, not sure if it's the same one. I tried to grab a screenshot and put it here but that's not working. I will try and convert what I have to that format.

As to the things you mentioned, we haven't had a dose change in quite a while so that should be stable, and meals are fairly stable as well. Sometimes she eats a little more, sometimes less, but it's pretty scheduled.

Actually the lowest number I got yesterday was 11 hours post shot! Which makes no sense as this morning, right before AM shot it was back up to 430 or so.

I will do as much testing as my time at home permits today and put a spreadsheet together to post. I'm thinking she will need a dosage increase but will wait til Tuesday and see what the vet says. Of course any feedback from here in the meantime is most appreciated!
 
I don't use Lantus so no help there but my one diabetic has Restrictive Cardiomyopathy and has been dealing with it for 5 years. She went into remission after 4 1/2 years and there is no knowledge out there if that remission came about because of her RCM. She was dx'd with an echocardiogram and ekg by a board certified cardiologist. Is Gem being seen by a Cardiologist? If not, I would strongly suggest that she be seen by one and not be treated by a regular vet. There are so many different meds for heart trouble and a cardiologist is the top one to know which ones are the best. In the beginning Hope was seeing her every 3 weeks, then we went to every 6 weeks, and now it is usually a max of 4 months before I get nervous and want her heart checked again. There are different forms of cardiomyopathy and each form will require specific meds. Hope's cardio vet works hand in hand with her IM vet also.
 
Some diabetic cats will show elevated kidney values that don't necessarily mean CRF. Gandalf was like that. He had just above normal values practically his whole "diabetic cat" life. I believe I kept them from getting worse by feeding canned food and supplementing his system with sub-Q fluids to prevent dehydration from not well regulated diabetes.

With the BGs you are seeing, Gem is experiencing dehydration because the kidneys are trying to get rid of all that excess sugar in the bloodstream. That extra work is hard on them. So at this point it would be better to concentrate on regulating the diabetes and doing what's best in terms of diet for the diabetes, not the kidney values, although what is good for the diabetes, is probably also good for the kidneys. :-D

If you received a bloodwork analysis from the vet, can you post the kidney values "CREA" and "BUN" here? It depends a little on what type machine used to record them as to what the ranges are, but those ranges should also be on the print out. If you did not receive that paperwork, request it, the vet has to give it to you if you ask. If Gem is like Gandalf's case I would expect the BUN to be higher than normal and the CREA to be just above normal.

Actually the lowest number I got yesterday was 11 hours post shot! Which makes no sense as this morning, right before AM shot it was back up to 430 or so.
Click to expand...

A nadir close to the next shot time actually is something we see with the longer acting insulins, Lantus & Levemir, so it's not that unusual. 3U is a fairly high dose of Lantus, however, and if your vet arrived at that dose by you taking Gem in for curves it could be inaccurate. The best way to determine dose is by home-testing, which you are now doing. The fact that Gem did well on 1U during the first go-around really leads me to believe the problems you're seeing now are because 3U is too much.

If Gem is not experiencing any infection right now, you should be able to safely lower her dose to 1U and essentially start over. Has anyone explained ketone testing to you?

If you have not already done so, I highly recommend that you visit the Lantus ISG's, there are 2, one for Tight Regulation which closely studies the BGs (meaning a little more frequent testing) and Relaxed Lantus which may not be as strict, but home-testing is needed in either case. I think you would learn and understand a lot if you join the TR group, even if you can't home-test frequently.
 
Hope + (((Baby)))GA said:
I don't use Lantus so no help there but my one diabetic has Restrictive Cardiomyopathy and has been dealing with it for 5 years. She went into remission after 4 1/2 years and there is no knowledge out there if that remission came about because of her RCM. She was dx'd with an echocardiogram and ekg by a board certified cardiologist. Is Gem being seen by a Cardiologist? If not, I would strongly suggest that she be seen by one and not be treated by a regular vet. There are so many different meds for heart trouble and a cardiologist is the top one to know which ones are the best. In the beginning Hope was seeing her every 3 weeks, then we went to every 6 weeks, and now it is usually a max of 4 months before I get nervous and want her heart checked again. There are different forms of cardiomyopathy and each form will require specific meds. Hope's cardio vet works hand in hand with her IM vet also.
Click to expand...

I know they did an ultrasound - can't remember if that's an echo or ekg, or whether both were done. The practice has someone board certified come in to run these tests. Not sure if I can swing another doctor at this point, and from what I've read online, the meds she is taking are pretty standard protocol. I will ask further when I go in on Tuesday.
 
Vicky & Gandalf (GA) said:
Some diabetic cats will show elevated kidney values that don't necessarily mean CRF. Gandalf was like that. He had just above normal values practically his whole "diabetic cat" life. I believe I kept them from getting worse by feeding canned food and supplementing his system with sub-Q fluids to prevent dehydration from not well regulated diabetes.

With the BGs you are seeing, Gem is experiencing dehydration because the kidneys are trying to get rid of all that excess sugar in the bloodstream. That extra work is hard on them. So at this point it would be better to concentrate on regulating the diabetes and doing what's best in terms of diet for the diabetes, not the kidney values, although what is good for the diabetes, is probably also good for the kidneys. :-D

If you received a bloodwork analysis from the vet, can you post the kidney values "CREA" and "BUN" here? It depends a little on what type machine used to record them as to what the ranges are, but those ranges should also be on the print out. If you did not receive that paperwork, request it, the vet has to give it to you if you ask. If Gem is like Gandalf's case I would expect the BUN to be higher than normal and the CREA to be just above normal.

Actually the lowest number I got yesterday was 11 hours post shot! Which makes no sense as this morning, right before AM shot it was back up to 430 or so.
Click to expand...

A nadir close to the next shot time actually is something we see with the longer acting insulins, Lantus & Levemir, so it's not that unusual. 3U is a fairly high dose of Lantus, however, and if your vet arrived at that dose by you taking Gem in for curves it could be inaccurate. The best way to determine dose is by home-testing, which you are now doing. The fact that Gem did well on 1U during the first go-around really leads me to believe the problems you're seeing now are because 3U is too much.

If Gem is not experiencing any infection right now, you should be able to safely lower her dose to 1U and essentially start over. Has anyone explained ketone testing to you?

If you have not already done so, I highly recommend that you visit the Lantus ISG's, there are 2, one for Tight Regulation which closely studies the BGs (meaning a little more frequent testing) and Relaxed Lantus which may not be as strict, but home-testing is needed in either case. I think you would learn and understand a lot if you join the TR group, even if you can't home-test frequently.
Click to expand...

I don't remember if they said she had CFR or just impaired function. Again, I will ask when we go back, it was so hard to digest all the info coming at me. I do know that it was not just from the bloodwork but what they saw on ulstrasound. Unfortunately I don't have a copy of that bloodwork but I will try and get it.

I do agree that getting the diabetes under control is probably the main focus, as that will only help with kidney function.

Interesting, I thought the nadir was generally expected midway between the shots. I will re-examine the dosing with the vet after showing her my home-testing results. I don't really understand how she could need a lower dose if her BG levels are so high. I do try and test with the ketone sticks when I can (not so easy, I have 2 cats and am just not home all the time!)

Thanks for all the info. I will look around on the Lantus forums, I just don't know how long I can regularly do the home testing. I am going to fill in the data I have so far into the spreadsheet so people can have a look at it.
Thanks again!
 
Hope + (((Baby)))GA said:
I just don't know how long I can regularly do the home testing.
Click to expand...

The main thing is to ALWAYS test before shooting and do a curve when you have the time to do one.
Click to expand...

OK, thanks, will try my best!

My sheet is up to date now.
 
I don't remember if they said she had CFR or just impaired function. Again, I will ask when we go back, it was so hard to digest all the info coming at me. I do know that it was not just from the bloodwork but what they saw on ulstrasound. Unfortunately I don't have a copy of that bloodwork but I will try and get it.

I do agree that getting the diabetes under control is probably the main focus, as that will only help with kidney function.

Interesting, I thought the nadir was generally expected midway between the shots. I will re-examine the dosing with the vet after showing her my home-testing results. I don't really understand how she could need a lower dose if her BG levels are so high. I do try and test with the ketone sticks when I can (not so easy, I have 2 cats and am just not home all the time!)

Thanks for all the info. I will look around on the Lantus forums, I just don't know how long I can regularly do the home testing. I am going to fill in the data I have so far into the spreadsheet so people can have a look at it.
Click to expand...

I keep a binder of all the tests and any results/reports for each of my cats. There is no way I can remember everything I get told, nevermind understand it all. I come home with the papers and I can do my own research and have some questions I can ask the vet later. It's also very good to compare the old results with the new ones at home.

Nadir's can be anywhere along a 12hr period / cycle. One of my cat's had nadir close to maybe +5 (5hrs after shots) but the other was closer to around +10 or +11, and they were on the same insulin, Levemir.
That's what makes the testing in the beginning very important. Up front, testing often can help you pinpoint where YOUR cat's nadir is to be found... keep in mind that it won't usually stay put, so you may see low points anywhere from +4 to +8, and over time, it can change. Once you know, you can decide where you need to test.

There are 3 tests that are critical: Before am shot before pm shot, just before you go to bed.
Testing before shots is important because your cat may be too low to give a shot, so you may skip that shot or give just a partial shot, so testing at least 15min before shot time needs to be done.
The third one is important because many cats have a tendency to go low overnite. By testing just before you retire, you can know if your cat is likely safe or if you need to stay up a bit and feed some higher carb food to bring up the numbers a bit.

Most people are not able to test all the time; they work or go to school and are away most days during a week. They are usually able to do the 3 tests mentioned above, and then on the weekends or some days off, they can do curves, testing every 2-3 hrs. So, maybe 3 or 4 tests on the week days, and then pick a couple cycles, or test scattered, to learn more about how YOUR cat is reacting to the insulin.
 
The unfortunate thing is the use of Lantus in veterinary medicine is fairly new. From what we have seen here, a majority of vets do not understand that it works differently from other insulins they have used for cats in the past. The tendency is to raise the dose when all they see is high numbers. There is perhaps an idiosyncrasy with the longer acting insulins, Lantus & Levemir, that causes high, flat BGs when the dose is too high. It is a bit of illogic which causes those not familiar with their use in cats to prescribe doses which are too high. Very recently an owner detailed on the board how their cat died from hypoglycemia on just 5U of Lantus. Overdosing is not to be taken lightly. The only way you're going to know and understand how Lantus works for your cat is home-testing and the help of this board. We understand these insulins from our own experiences and from helping others.

Here are a couple of links to read and reread and perhaps print out and take to your vet.

Guide to determining dose with Lantus or Levemirhttp://www.tillydiabetes.net/en_6_protocol2.htm

http://petdiabetes.wikia.com/wiki/Rebound
 
I know it is a hard idea to wrap your head around when their BGs are so high, but sometimes adding more insulin is like throwing gasoline on a fire. Since insulin isn't a drug persay but a hormone the body reacts to too much insulin by releasing stored sugars to counteract what it preceives as too much insulin and thus causing the BGs to skyrocket. The goal is to find a balance point between the best description I have seen here of it is if you are walking up an esculator and you want to only go up so high and stay at that point, you have to adjust your steps so you don't walk too fast and end up at the top or walk too slowly because you will end up right back down at the bottom where you started, but when you find the right rate of speed you can keep walking and not move either up or down.

Mel, Maxwell, Musette & The Fur Gang
 
In my opinion, the diet requirements for diabetes need to be priority before the CKD, unless it's end stage CRF and then you may need to do a balancing act. It does not seem to be end stage in your case, though--you would be giving fluids and the vet would have made a much bigger deal of it.


In the first post from BJM, there are some food recommendations that are good for managing BOTH Diabetes and CKD. I would re-read that section. You need a food under 10% carbs for the diabetes, and less then 250 mg/100kcal of phosphorus, with a high quality protein source.

If you take a look at the Pet Food Nutritional Values above, you'll see that Purina DM is good for the diabetes (3% carbs), but so/so for the CKD (260 mg/100kcal of phosphorus). Also, check out the ingredients:

Ingredients (Canned)

Liver, poultry by-products, meat by-products, water sufficient for processing, chicken, salmon, oat fiber, salmon meal, guar gum, potassium chloride, carrageenan, salt, Vitamin E supplement, calcium phosphate, taurine, thiamine mononitrate, zinc sulfate, ferrous sulfate, niacin, calcium pantothenate, copper sulfate, Vitamin A supplement, manganese sulfate, menadione sodium bisulfite complex (source of Vitamin K activity), pyridoxine hydrochloride, riboflavin supplement, Vitamin B-12 supplement, biotin, folic acid, Vitamin D-3 supplement, potassium iodide.
Click to expand...

It contains a lot of by-products (low quality protein), which are not good for CKD kitties. It also contains a lot of liver, which cats should not have in large amounts. Higher quality protein sources are easier on the kidneys than lower sources of protein. Compare it to a grocery store food like Fancy Feast Liver and chicken:

Liver, meat broth, meat by-products, chicken, poultry by-products, artificial and natural flavors, calcium phosphate, guar gum, potassium chloride, taurine, salt, magnesium sulfate, zinc sulfate, thiamine mononitrate, Vitamin E supplement, ferrous sulfate, niacin, manganese sulfate, calcium pantothenate, Vitamin A supplement, copper sulfate, menadione sodium bisulfite complex (source of Vitamin K activity), pyridoxine hydrochloride, riboflavin supplement, Vitamin B-12 supplement, biotin, folic acid, Vitamin D-3 supplement, potassium iodide.
Click to expand...

Now check out the ingredientsfor one of the foods I recommended, Merrick's Before Grain Turkey, which is 1 % carbs and and 90 mg/100kcal of phosphorus:
Ingredients:
Turkey, Turkey Broth, Dried Egg, Yeast Extract, Glycine,
Glycine, Calcium Carbonate, Sodium Phosphate, Potassium Chloride,
Salt, Guar, Choline Chloride, Taurine, Carageenan,
Mixed Tocopherols, Vitamin E Supplement, Zinc Amino Acid Complex, Iron Amino Acid Complex,
Manganese Amino Acid Complex, Vitamin B12 Supplement, Copper Amino Acid Complex, d-Calcium Pantothenate,
Vitamin A Acetate, Niacin, Lecithin, Vitamin D3 Supplement, Riboflavin Supplement, Folic Acid,
Ethylenediamine Dihydriodide, Cobalt Glucoheptanate, Pyridoxine Hydrochloride, Biotin, Thiamine Mononitrate,
Sodium Selenite
Click to expand...

Do you see the difference in quality? You'll actually be switching to a higher quality food that is better for BOTH conditions and it costs less than what you're paying for the DM.
 
Gayle Shadoe & Oliver said:
I keep a binder of all the tests and any results/reports for each of my cats. There is no way I can remember everything I get told, nevermind understand it all. I come home with the papers and I can do my own research and have some questions I can ask the vet later. It's also very good to compare the old results with the new ones at home.

Nadir's can be anywhere along a 12hr period / cycle. One of my cat's had nadir close to maybe +5 (5hrs after shots) but the other was closer to around +10 or +11, and they were on the same insulin, Levemir.
That's what makes the testing in the beginning very important. Up front, testing often can help you pinpoint where YOUR cat's nadir is to be found... keep in mind that it won't usually stay put, so you may see low points anywhere from +4 to +8, and over time, it can change. Once you know, you can decide where you need to test.

There are 3 tests that are critical: Before am shot before pm shot, just before you go to bed.
Testing before shots is important because your cat may be too low to give a shot, so you may skip that shot or give just a partial shot, so testing at least 15min before shot time needs to be done.
The third one is important because many cats have a tendency to go low overnite. By testing just before you retire, you can know if your cat is likely safe or if you need to stay up a bit and feed some higher carb food to bring up the numbers a bit.

Most people are not able to test all the time; they work or go to school and are away most days during a week. They are usually able to do the 3 tests mentioned above, and then on the weekends or some days off, they can do curves, testing every 2-3 hrs. So, maybe 3 or 4 tests on the week days, and then pick a couple cycles, or test scattered, to learn more about how YOUR cat is reacting to the insulin.
Click to expand...

I have been keeping a folder with all the papers I have gotten, but I will have to make a point of asking for copies of test results when I go in for visits.

I definitely can manage those 3 shots a day on a regular basis, and on some days more often. Hopefully that will be enough data to help make good decisions.
 
Vicky & Gandalf (GA) said:
The unfortunate thing is the use of Lantus in veterinary medicine is fairly new. From what we have seen here, a majority of vets do not understand that it works differently from other insulins they have used for cats in the past. The tendency is to raise the dose when all they see is high numbers. There is perhaps an idiosyncrasy with the longer acting insulins, Lantus & Levemir, that causes high, flat BGs when the dose is too high. It is a bit of illogic which causes those not familiar with their use in cats to prescribe doses which are too high. Very recently an owner detailed on the board how their cat died from hypoglycemia on just 5U of Lantus. Overdosing is not to be taken lightly. The only way you're going to know and understand how Lantus works for your cat is home-testing and the help of this board. We understand these insulins from our own experiences and from helping others.

Here are a couple of links to read and reread and perhaps print out and take to your vet.

Guide to determining dose with Lantus or Levemirhttp://www.tillydiabetes.net/en_6_protocol2.htm

http://petdiabetes.wikia.com/wiki/Rebound
Click to expand...

OK, thanks, I am trying to read and learn as much as I can so that I am not only relying on the vets limited knowledge. I do have a tendency to take medical professionals at their word, but am working on educating myself as well!
 
Julia & Bandit said:
In my opinion, the diet requirements for diabetes need to be priority before the CKD, unless it's end stage CRF and then you may need to do a balancing act. It does not seem to be end stage in your case, though--you would be giving fluids and the vet would have made a much bigger deal of it.


In the first post from BJM, there are some food recommendations that are good for managing BOTH Diabetes and CKD. I would re-read that section. You need a food under 10% carbs for the diabetes, and less then 250 mg/100kcal of phosphorus, with a high quality protein source.

If you take a look at the Pet Food Nutritional Values above, you'll see that Purina DM is good for the diabetes (3% carbs), but so/so for the CKD (260 mg/100kcal of phosphorus). Also, check out the ingredients:

Ingredients (Canned)

Liver, poultry by-products, meat by-products, water sufficient for processing, chicken, salmon, oat fiber, salmon meal, guar gum, potassium chloride, carrageenan, salt, Vitamin E supplement, calcium phosphate, taurine, thiamine mononitrate, zinc sulfate, ferrous sulfate, niacin, calcium pantothenate, copper sulfate, Vitamin A supplement, manganese sulfate, menadione sodium bisulfite complex (source of Vitamin K activity), pyridoxine hydrochloride, riboflavin supplement, Vitamin B-12 supplement, biotin, folic acid, Vitamin D-3 supplement, potassium iodide.
Click to expand...

It contains a lot of by-products (low quality protein), which are not good for CKD kitties. It also contains a lot of liver, which cats should not have in large amounts. Higher quality protein sources are easier on the kidneys than lower sources of protein. Compare it to a grocery store food like Fancy Feast Liver and chicken:

Liver, meat broth, meat by-products, chicken, poultry by-products, artificial and natural flavors, calcium phosphate, guar gum, potassium chloride, taurine, salt, magnesium sulfate, zinc sulfate, thiamine mononitrate, Vitamin E supplement, ferrous sulfate, niacin, manganese sulfate, calcium pantothenate, Vitamin A supplement, copper sulfate, menadione sodium bisulfite complex (source of Vitamin K activity), pyridoxine hydrochloride, riboflavin supplement, Vitamin B-12 supplement, biotin, folic acid, Vitamin D-3 supplement, potassium iodide.
Click to expand...

Now check out the ingredientsfor one of the foods I recommended, Merrick's Before Grain Turkey, which is 1 % carbs and and 90 mg/100kcal of phosphorus:
Ingredients:
Turkey, Turkey Broth, Dried Egg, Yeast Extract, Glycine,
Glycine, Calcium Carbonate, Sodium Phosphate, Potassium Chloride,
Salt, Guar, Choline Chloride, Taurine, Carageenan,
Mixed Tocopherols, Vitamin E Supplement, Zinc Amino Acid Complex, Iron Amino Acid Complex,
Manganese Amino Acid Complex, Vitamin B12 Supplement, Copper Amino Acid Complex, d-Calcium Pantothenate,
Vitamin A Acetate, Niacin, Lecithin, Vitamin D3 Supplement, Riboflavin Supplement, Folic Acid,
Ethylenediamine Dihydriodide, Cobalt Glucoheptanate, Pyridoxine Hydrochloride, Biotin, Thiamine Mononitrate,
Sodium Selenite
Click to expand...

Do you see the difference in quality? You'll actually be switching to a higher quality food that is better for BOTH conditions and it costs less than what you're paying for the DM.
Click to expand...

Like I said, after lots of research I realize that there are lots of better choices than the DM. I am working on rotating them in, finding the ones Gem will eat and then switching fully to those. Thanks so much!
 
Vets are expected to know so much, but when it comes to feline diabetes, many know very little, so members here have had to become the expert, and share infos with their vets.
So long as you have a vet who is willing to work and learn with you, you should be fine.

I have found on the test results, my vet may say all looks fine, but what if one or two of the values have kept rising and are just about at the max of the range? I have pointed it to the vet and asked what's going on here, and what if the number keeps rising? Do I need to change anything I am doing? Get your vet to explain what those values mean and when would it be an issue for concern.

About foods, I don't think much at all of the vet food, but I have to say that when my Oliver was very ill and was not eating, we did get him to eat a bit of the vets A/D food. I would not feed any of the other vet foods, but the A/D has something in it that got my cat to eat a bit, so it can't be all bad.
 
jkbank said:
Thanks BJM, I had started a spreadsheet template I found, not sure if it's the same one. I tried to grab a screenshot and put it here but that's not working. I will try and convert what I have to that format.
Click to expand...

Just put the link to the spreadsheet - no screenshot needed.

Or write it as
AMPS ~ value for morning pre-shot
+number ~value for hours after shot when you tested
+2 ~ value
+4 ~ value
...
PMPS ~ value
 
MommaOfMuse said:
I know it is a hard idea to wrap your head around when their BGs are so high, but sometimes adding more insulin is like throwing gasoline on a fire. Since insulin isn't a drug persay but a hormone the body reacts to too much insulin by releasing stored sugars to counteract what it preceives as too much insulin and thus causing the BGs to skyrocket. The goal is to find a balance point between the best description I have seen here of it is if you are walking up an esculator and you want to only go up so high and stay at that point, you have to adjust your steps so you don't walk too fast and end up at the top or walk too slowly because you will end up right back down at the bottom where you started, but when you find the right rate of speed you can keep walking and not move either up or down.

Mel, Maxwell, Musette & The Fur Gang
Click to expand...

Thanks, that does make sense. I guess I am in the information-gathering stage at this point!
 
BJM said:
jkbank said:
Thanks BJM, I had started a spreadsheet template I found, not sure if it's the same one. I tried to grab a screenshot and put it here but that's not working. I will try and convert what I have to that format.
Click to expand...

Just put the link to the spreadsheet - no screenshot needed.

Or write it as
AMPS ~ value for morning pre-shot
+number ~value for hours after shot when you tested
+2 ~ value
+4 ~ value
...
PMPS ~ value
Click to expand...

I got the template you linked to and it is now part of my signature, thanks so much!
 
dian and wheezer said:
how old is your lantus?? is this a vial or the solostar pens
Click to expand...

It's a vial, and I got it in March when Gem was diagnosed. I had had almost a full vial left over from her first diagnosis but I wanted to start fresh.
 
OK. JUST CHECKING. be aware that you get more mileage out of the 5 solostar pens. you pay more initially but they last longer than a vial. you can use these to the very last frop and can last up tyo 6 months. the vial lasts 28 days maybe a little longer and you are throwing away most of it.. you will know if it is bad if it get floaties in it or you have to keep increasing dosage for same results as when new.
also if getting to high doses and insulin is good, there are other tests to do to check if cat is insulin resistant or acro cat. someone else will have to comment on that as I forget the tests
 
dian and wheezer said:
OK. JUST CHECKING. be aware that you get more mileage out of the 5 solostar pens. you pay more initially but they last longer than a vial. you can use these to the very last frop and can last up tyo 6 months. the vial lasts 28 days maybe a little longer and you are throwing away most of it.. you will know if it is bad if it get floaties in it or you have to keep increasing dosage for same results as when new.
also if getting to high doses and insulin is good, there are other tests to do to check if cat is insulin resistant or acro cat. someone else will have to comment on that as I forget the tests
Click to expand...

Thanks for the heads up on the pens…will keep it mind going forward.

I am in a holding pattern til we go to the vet on Tuesday and then I will discuss all the great info I've gotten here.
 
jkbank said:
I am in a holding pattern til we go to the vet on Tuesday and then I will discuss all the great info I've gotten here.
Click to expand...
Please note that many vets are NOT up to date on contemporary feline diabetes management, so your vet may be very resistant to some of the info we have shared. They have so much to keep up on, this isn't really surprising. It may help if you print out some of the vet journal articles we have available, like this one about using Lantus: Lantus/Levemir testing & dosing protocol Roomp & Rand
 
BJM said:
jkbank said:
I am in a holding pattern til we go to the vet on Tuesday and then I will discuss all the great info I've gotten here.
Click to expand...
Please note that many vets are NOT up to date on contemporary feline diabetes management, so your vet may be very resistant to some of the info we have shared. They have so much to keep up on, this isn't really surprising. It may help if you print out some of the vet journal articles we have available, like this one about using Lantus:
Click to expand...

Thanks BJM, I've certainly read enough on here to know that :-D I will go there armed with information!
 
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