Newbie Roy-E-Tube & Renal Kitty -Thank You & Dosing/Food

[Lauren & Roy]

Thank you All for such quick responses.
Roy's chart now up & updated.

1) It seems the 1.25 Lantus gave him best numbers to date.
Anyone experienced with regular dosing @ 1.25; any risk for hypo with this dosing schedule?

2) Roy has one functional kidney and renal issues, yet was producing near-perfect creatinine after convalescing from a life-threatening kidney stone obstruction in his one kidney. He has a double stent in that kidney thanks to prayer & brilliiant doctors. We add sodium bicarb & aluminum hydroxide to his food.

With recent diabetes diagnosis, the thinking was to stay on kd to protect the one kidney, but we need more stable, better numbers.
Question: Transitioning Food: Roy was on kd with sodium bicarb & aluminum hydroxide. We are transitioning to dm within this past week. Should Roy stay on 50/50 kd and dm to protect his one kidney? Which is harder on the kidney: Protein or diabetes? We are willing to switch to more high quality food but didn't want too many changes at once unless better food brings stronger and more stable results.

Request assistance and experience with 1.25 regular Lantus dosing and best renal/diabetic food balance.
Happy Mother's Day to all you Animal Angels!

Much appreciated,
Lauren & Roy
laurenmeggison@gmail.com

 

[Sienne and Gabby (GA)]

Hi, Lauren.

Just a couple of points so you have some context. The way Lantus works, it's not so much how it works at a particular dose but more, how that dose works right now for your cat. There will be times that you may need to increase the dose or decrease it. We utilize a dosing protocol to provide that information. Cats can go into remission from their diabetes. When this happens, insulin needs decrease due to their pancreas healing. Just because more insulin is needed, doesn't mean the diabetes is getting worse. There can be a number of reasons that the dose changes.

So, FWIW, my cat is on a dose of around 1.25u. There is no guarantee that numbers won't drop at this dose. You can look at Gabby's SS to see that her insulin needs have varied. With respect to Roy, I would let this dose settle a bit. My guess is that you're going to need to increase the dose but with having been shooting different doses at AM and PM, you need to let the insulin level stabilize.

I am hesitant to advise you about food. I would encourage you to consult with your vet. There are several low carb, low phosphorus foods that many of the people here use with their cats that have kidney problems. Using a binder can also be effective. If Roy's kidney values are good, it sounds like you are using preventative measures with the KD. However, it is very high in carbs so it may be worth discussing this with your vet to see if a lower carb food along with phosphorus binders will be more sparing on Roy's kidneys given that it will help to bring his blood glucose levels down. Otherwise, you will need to adjust his insulin dose around the carb levels.

Is there a plan for eventually getting rid of the E-tube? Will Roy eat reliably on his own?

A general housekeeping note: We tend to use a particular format for our subject lines. This allows us to see what your test numbers look like and if we think you may need a hand, it gives us that information. The format is:

• date cat's name AMBG-#, +hour-#
• 5/13 Roy AMBG-441, +1-580, +2-611, +4-499, +6-328

 

[MJ+Donovan]

I have a renal kitty, but she is not diabetic. Her vets have pushed the prescription k/d foods, but I only give it to her occasionally. Instead I give her low-phosphorus foods as listed on the feline CRF site (http://www.felinecrf.org), which I think has already been suggested to you. There is a LOT of information there about diet, supplements, etc. Since you say you are adding phos binder to Roy's food, I would say you can concentrate more on using low-carb foods. Here is one list: http://binkyspage.tripod.com/canfood.html, though there are others whose URL I don't know off the top of my head.

Don't want to scare you, but yes it is possible to hypo on 1.25U Lantus. You're definitely in the right place for people to help you with this. From what I can see on Roy's spreadsheet, the dosage has been all over the place, and I understand he's been in the hospital a few times and much of it was out of your hands. I used Levemir with my diabetic cat, so can't speak from personal experience with Lantus, but I hear again and again that consistent dosing is important. I'm sure someone else will come along and step you through how to help Roy get regulated.

MJ

(edit to add, Ah good, Sienne is here. She can definitely help you with Lantus info)

 

[Sienne and Gabby (GA)]

Here's the link to the other food chart that MJ was referring to: food chart. It contains some of the higher quality foods as well as some of the newer brands.

 

[Marje and Gracie]

Hi Lauren

Welcome to Lantus Land. I also took a look at Roy's spreadsheet and I think Sienne has summed up my thoughts pretty well. I think her suggestion to leave him at this dose right now is a very good one.

I would recommend you read the sticks t the top of this forum. There is a lot of very valuable information there about using these longer duration insulins like lantus and levemir. You will also find the Tight Regulation protocol that we use.

From the protocol regarding increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

So I think it would be good to hold the 1u for a total of six cycles and then reassess unless he comes down below 50. If you get a preshot number below 200, I would not feed him, post, and ask for help on shooting. If, at any time, you get a lower number than you've gotten before and need help dealing with it, please post.

We're happy you are here and hope we can help you and Roy.