Relation between BG's and Low Magnesium, low pH, etc

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carolynandlatte

carolynandlatte

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I was doing a search to see if if a low pH would cause fluctuations to BG that might not be controlled by insulin. didnt find anything. If anyone knows anything about that possibility I would love to hear more. I did find information on Low Magnesium and high calcium (in people). I dont know anything much about the source or if there is any truth behind it.

Insulin Resistance: Vicious Cycle
Hypoglycemia can have different causes. Both causes lead to a vicious cycle.

Cause 1: High carbohydrate consumption, which causes intracellular magnesium deficiency
High carbohydrate consumption (doesn't matter if it's starches or sugars) results in high insulin levels throughout the day. High insulin levels make the intracellular Magnesium decrease and the Calcium increase. Studies [Barbagallo, Renick 1994] show that high blood glucose levels causes the flushing of different minerals, among which magnesium. Calcium, on the other hand, is not affected. This poses a problem, because calcium is the antagonist of magnesium. A mineral antagonist "fights" some other mineral, meaning that high calcium levels will cause lower magensium levels. Check all mineral interrelationships. After eating a high-carbohydrate diet for several years, a magnesium deficiency will be inevitable. This won't show up on the blood magnesium tests, because most magnesium is stored inside the cells, intracellular.

The reduced intracllular magnesium alters the way the cell opens the door for glucose. The low-Mg and high-Ca causes the insulin-key to not fit on the door. Besides that, also the intracellular Mg and Ca of the pancreas cells change. This makes the pancreas overshoot insulin. The next time you eat carbohydrates, the same events occur and it gets worse and worse.
Click to expand...
http://www.newtreatments.org/hypo.php


The way I am understanding this is a high carb diet (kibble) will eventually decrease magnesium and increase calcium. Decreased magnesium *may* make it difficult for insulin to work properly. Also the pancreas may fire more randomly and sometimes at inappropriate times?

I ask for clarification and/or knowledge on this because Latte had eaten kibble for nearly 14yrs. It is still about 50% of her diet almost 4 yrs later (please leave that be...old, and many disease processes going on....she NEEDS to eat!...thanks :roll: ). Ive recently discovered in lab work that she has low magnesium - 2.1 (3.3-7.8). She has a history of high calcium - 11.1 (8.3-10.9). She IS on a prednisolone and has a zillion factors that could be reason for her random good and worse BG numbers. Im just wondering if the mag/cal , and or if low pH could cause further issues with her BG that are completely out of my control no matter how much or little I shoot.

Thanks for any insight!
 
dang.... that's gonna take some investigation..... ~O)
I hope some of the knowledgeable folks here will give you some feedback :smile:
Deb, angel Evie, and the boys
 
Hi Carolyn -
You could try including the keywords "acid-base" along with the minerals, in your search;
could also try going to this 2009 paper, "Potassium and Acid-Base Balance: Myths and Facts"
and searching for related topics. I posted the link and some excerpts, to your Metabolic Acidosis Help post a few weeks ago
http://felinediabetes.com/FDMB/viewtopi ... 306#p15306

I think it'd be a good idea to also post this question to the folks over at Helen's CRF list. They may well have some info to share, since pH and mineral balances are common issues w/ CRF.

While doing some random reading on GI complications of diabetes awhile ago, I came across another aspect of the relationship between carbs and BG fluctuation - the possible influence of gastroparesis (delayed gastric emptying). Haven't had time to actually search the literature, and this paper is old and re: humans... that said, if the general relationships hold true for cats, it might be worth exploring. Latte's longstanding GI symptoms may be *part* of the reason why regulating her has been such a challenge. If she's experiencing any diabetes-related enteric neuropathy, it might be causing some gastroparesis and exacerbating her GI issues.

The bottom line is that, despite a poor correlation between *symptoms* and delayed gastric emptying (in humans), BG responses to carbs and gastric emptying are related *and* if you can reduce fluctuations in the rate of gastric emptying, it might help reduce fluctuations in BG. I'm sure the knowledgeable folks here can give a readout...

Some ***key points*** are excerpted below, with [my comments/questions in brackets] -

http://www.ncbi.nlm.nih.gov/pubmed/8894465
Gastric emptying in diabetes: an overview. 1996. [told you it was old!]

"...Gastric emptying is delayed in 30%-50% of patients with longstanding diabetes mellitus. ...in patients with "early" Type 2 diabetes... suggested that gastric emptying is often accelerated. ...***acute changes in the blood glucose concentration have a major effect on gastric motor function and gastric emptying.*** There is an inverse relationship between the rate of gastric emptying and the blood glucose concentration, so that ***emptying is slower during hyperglycaemia and faster during hypoglycaemia*** [might explain why Latte gets active and hungry when dropping?] ... there is a high prevalence of upper gastrointestinal symptoms in diabetes. However, the correlation between symptoms and delay in gastric emptying is poor. Recent studies ...blood glucose concentration modulates the perception of some sensations arising from the gastrointestinal tract. ...the blood glucose response to oral carbohydrate and gastric emptying are related and ***there is evidence that modulation of the rate of gastric emptying, by dietary or pharmacological means, could be used to optimise glycaemic control.*** The use of prokinetic drugs, particularly cisapride, is currently the most effective approach to the treatment of symptomatic patients with gastroparesis. ..."

Two members of the CRF list have used cisapride for their IBD and megacolon cats:
http://pets.groups.yahoo.com/group/feli ... sage/33524
...Cisapride if sure the colon is haing motility issues. We used it starting this time last year for Mystery and it did help.

http://pets.groups.yahoo.com/group/feli ... sage/33529
Cisapride is a motility drug - it must be started [according to our vet] while the colon nerves are still working. Evidently our vet feels that the nerves in (Killian's) colon aren't working properly and that is why he/she has prescribed Cisapride.
We have to give Killian Cisapride with food because it is very very difficult to medicate her - we have Cisapride compounded into a liquid with no flavor added and mix it and Miralax into a/d food and add a little bit of water and she eats it up, there is no flavor to either so she can't tell it is there.
--------------------

Another variable would be the type of carb in the kibble - corn is about 54% digestible; wheat is about 60% digestible, and rice is about 72% digestible - might influence how much and how fast it enters her system.

I may be off-base with all of this... just figured I'd put it out there for the knowledgeable ones here, to comment on. :smile:
Deb, angel Evie, and the boys
 
Hi Carolyn

You always ask interesting questions. As far as the carb thing goes, for cats in particular I think we have to be very careful about applying human studies. FOr that reason, I'd look at the problem at a more basic level. Your kitty has low magnesium. This is not terribly uncommon in diabetics or cats with CKD as magnesium gets washed out in the urine (as do many electrolytes). Also, because of old FLUTD theories, many cat foods still have restricted magnesium levels so the availability is perhaps less than what a polyuric cat needs. (I have it in my head that it's dry foods that tend toward such Mg restriction, but would have to google for evidence.) Mg is tricky to supplement, however (hypermagnesemia can cause renal issues!) so I would confer with her internist on if and exactly how to supplement. I would also check her current foods to see if they advertise low Mg; you can even call them and try to get their nutritionist DVM on the phone to discuss this.

As far as hypomagnesemia goes, I have not seen and cannot find any evidence of its being affected purely by insulin administration. It is associated with polyuria, as I said, and also with ketoacidosis.

As far as the BG stuff goes ... I was only able to find a study on horses which said that elevated calcium levels did not affect insulin production. THis doesn't help us much :-) as cats are not teeny horses! Hypercalcemia can be a real puzzle in cats as some cats have it for no good reason and with no apparent result.

I'm not sure I've got all your questions spot-on. If I haven't answered any, or answered the wrong ones, let me know :-)
 
Deb

Hi Deb

deb and the boys said:
Another variable would be the type of carb in the kibble - corn is about 54% digestible; wheat is about 60% digestible, and rice is about 72% digestible - might influence how much and how fast it enters her system.
Click to expand...

Do you have a source for these numbers?
 
Hi Jess,
Thanks for replying. I had no clue if a similar process could happen in cats, so I thought I would throw it out there. After I did this, however I became incredibly overwhelmed! And realized that none of it may even matter at this point. There are soo many variables with Latte, that I will probably die before her, trying to figure it out. :roll: I just need to let it be and accept her high numbers, along with the low....and be grateful when we have flat cycles.

I meant to ask about the magnesium in our follow up this week...but so many questions...limited time. *sigh* You did a good job explaining how the low mag could come about. The high calcium...always been an issue for her. Its never been high enough to cause great concern. Does the calcification in her one functioning kidney have anything to do with that? I think she may also have some in her ureter (?!?!?) right term? Making sense? Its been a while since that was found, so I would have to look back at old reports.

I should post an update on her MA this weekend over on the other health board....
In summary, nothing has really changed ...pH is low, though bicarb did go up. Creatinine has also gone up a little in the last few weeks. We are stopping the potassium citrate because she foams at the mouth and makes her miserable. He does not feel its worth giving it (quality of life) if its not going to change much. We will recheck and assess again in a month. There was also brief discussion of her breathing/choking/gagging issues. The written report states she had elevated heart and resp rate (could be stress). Lung sounds were increased in all fields, along with consistent, mildly increased respiratory effort. He felt it was possible the string of days she vomited, stopped eating, etc. shortly after her last labs was due to a pancreas flare, considering her unusually high amylase.

On the positive side - she has been acting as if she feels pretty darn good the last week or so.

Thanks again for taking the time to research and answer my questions!!!
 
Hi Jess!
geezzz can't believe its been nearly a week since logging in here... just came up for air... my apologies for not replying to you sooner :mrgreen:

(not sure how to do the fancy quotes)....
"deb and the boys wrote:
Another variable would be the type of carb in the kibble - corn is about 54% digestible; wheat is about 60% digestible, and rice is about 72% digestible - might influence how much and how fast it enters her system.
....
Do you have a source for these numbers?"
....

These were general numbers I picked up on the website of a veterinarian who's doing some research on interferon. I didn't intend to use them in a precise context... just meant to show a general comparison between wheat, corn and rice... as a topic to look into. I should've included the link and done a better job of getting my thoughts across! Here's the link:
http://www.flowertownanimalhospital.com ... ition.html

My diabetes learning curve is *really* steep..... does enteric neuropathy (sp?) or gastroparesis (sp?) play a role in any GI issues associated with feline diabetes? I haven't really found much re: cats, in my limited searching - most of it was re: humans.... probably about as useful as the horse stuff ;)

Deb
 
Hi Deb

I was curious because I couldn't find similar numbers. Really the question is much more complex because corn, etc. contains protein and starch, so what percent of what component is digestible, etc. The truth is that no one cares much about cats in terms of this research and the research would very likely involve cruel experiments so we might never know.

deb and the boys said:
My diabetes learning curve is *really* steep..... does enteric neuropathy (sp?) or gastroparesis (sp?) play a role in any GI issues associated with feline diabetes?
Click to expand...

I've seen gastroparesis in some sick cats but not generally for diabetics. Basically the food just sits in the stomach and doesn't move on into the intestine. The cats frequently regurgitate and will refuse to eat. A lot of the stuff that comes from human DM studies has to be taken with a few caveats because 1- humans have diabetes for much, much longer (ergo we dont' see many of the kidney side effects that they do since they occur over 20-30 year span) and 2- Type II diabetes often occurs as a whole complex of issues involving the heart, arteries, and other issues related to poor diet and obesity. We dont' have the same concerns about our pudgy diabetics, and indeed a lot of these cats are pushed into diabetes through steroid use.

Hope this helps :-)
Jess
 
Thanks Jess, for your great explanation... it totally makes sense and of course, there are no simple or predictable answers when it comes to myriad interactions among a complex of diseases, organ functions, diet, meds, chemistry... on and on til it makes my head spin! My background is in wildlife ecology, and it seems to me that we could find many parallels between the principles of ecosystem function and the way systems function in an individual's body... multivariate and utterly amazing! Anyway, I am new here, seeking to learn as much as I can, and hopefully can contribute occasionally, if I have knowledge to offer. I appreciate your expertise and the generosity of your time... you and others here, are making a difference in the lives of so many!
Deb, angel Evie, and the boys
 
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