UPDATE: Grey crossed the rainbow bridge

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Suzanne&Grey

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Hello all,

I'm Suzanne, and a proud owner of a 16 YO domestic shorthair (spittin' image of a Chartreaux). I've had her since she was 4 months old, she is my dearest and only furbaby. I joined this site a few years ago (2008 I think?) when I first found out that she was diabetic, and thanks to this site I was able to change my then vet's mind about diet controlling her successfully. My new vet (who is awesome!!!) also likes the idea of diet controlled diabetics and loved the results I had, but in October 2011 we ran into what appears to be a common roadblock: CRF. I guess I should also mention we found a thymoma that takes up almost half of her chest cavity in March of 2010. Call us cowards, but the vet and I decided with her age and diabetes that turning a blind eye was best. Oh, I watch how she breathes and things like that, the multiple places her biopsied all came back benign...just that I am not going to put her through chemo and such. I'm afraid that in itself will kill her.

So, due to the CRF we started fluid therapy every other day. The BUN, creatinine, and phosphorus all continued to climb, so we changed Grey's diet to Hill's K/D. I have to syringe feed her, and that's fine. She's actually a pretty good patient. Since I started syringe feeding her, I give her fluids daily. Then her BG jumped to 262...but her renal values improved. I decided at that point that I needed to put her back on insulin since it is so hard to find low carb and low phosphorus foods. until the insulin got here (this afternoon), I've been giving her low carb foods with Epakatin for the phosphorus. I'm putting her back on the K/D but with Prozinc starting tomorrow morning. I only have one class to go to tomorrow, so I should be pretty safe as far as being able to check her numbers. I purchased a new Relion Micro today, since I've had good experiences with that in the past.

So here's where I'm stuck and welcome any and all advice:
1) How soon after eating to I check her BG?
2) How often can I get away with checking her BG throughout the day to check for hypo- or hyperglycemia?
3) Experiences with Prozinc, vs. NPF? NPF is what I had her on initially, before I decided to try the diet control route. That stuff wreaked havoc on my cat's BG...anything from 25 to almost 200.
4) She's underweight right now, from the extended hyperglycemia (I thought it was the renal failure giving trouble :roll: ), and I've recently tried Friskies Salmon pate which she'll nibble at on her own (maybe a few tsp)...can she have that as a low carb lunch? Maybe add some phosphorus binder to it? The vet says sure, but I'd like to hear any and all stories!
5) Experiences with binder? I'm using the Ipakatin one at the moment, but I'm wondering if there are better ones...experiences with aluminum ones? Pricing?
6) Ideas for her a healthy low carb lunch? By the way, she loathes Fancy Feast. Ever since they changed the formula... :-x

That's all I can think of at the moment, after I hit "Submit" I'm sure I'll think of something else. Sorry if I've rambled, it's getting toward the end of the semester and I'm wiped out. If I've left something out or need to clarify something, please ask. I feel so lost, and the more I research Diabetes with CRF, the less options I feel I have. After the horrible experience with NPF, I was reluctant to try her on insulin again. But considering the fact that her BG was climbing on K/D and fluids every other day, I knew I had to reconsider going back to carbs but with insulin. The vet said he has had great success with Prozinc, plus what I've read here, I want to give it a try. But to say I'm scared to death is an understatement. Giving myself a hug now, I don't want to hug the cat in this state of mind. I'll worry her! :lol:

Thank in advance for any and all experiences/advice/hugs... ;-)

Suzanne
 
Re: Diabetes and CRF, experiences please?

Suzanne&Grey said:
How soon after eating to I check her BG?
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If you have used insulin before, you know to check before every shot. With PZI, the next most important time is the nadir - somewhere around +5 or +6 in most cats. But you can check numbers anytime. The more data you get, the better you can see how it works in Grey.

Suzanne&Grey said:
Experiences with Prozinc, vs. NPF? NPF is what I had her on initially, before I decided to try the diet control route. That stuff wreaked havoc on my cat's BG...anything from 25 to almost 200.
Click to expand...
I am thinking you mean NPH or Humulin? Prozinc is a milder longer lasting insulin in most cats. Usually you get a gentle smile type curve that lasts 12 hours with the nadir about half way through the cycle.

No experience with CRF but we have lots of members who do. Keep checking back in. Here are some good informational sites: http://www.felinediabetes.com/phorum5/r ... ?8,1931923
 
Re: Diabetes and CRF, experiences please?

Hi Suzanne,
I'm sorry that Grey now has CRF. I can't answer all of your questions, but I can tell you what we did and how it worked. We fed my Blackie Wellness Chicken and Turkey. Both are low carb and relatively low phosphorus. Also, the cat food is easily mixed with water to syringe feed. Merrick also makes some lower phosphorus/low carb foods. You can check out Janet & Binky's charts - they include the phosphorus. When Blackie's CRF progressed, I added a phosphorus binder, Aluminum Hydroxide, which is tasteless and mixes easily with wet food. I still have quite a bit of it - if you would like to have it, pm me your address and I can send it. We tried KD wet, but it had glucose in it and Blackie didn't like it very well.

The other thing to watch for is a BG drop after giving fluids. ECID, but with Blackie his BG's would drop every time after the fluids.

Have you checked out Tanya's site? www.felinecrf.org Some very helpful info there. Good luck!
 
Re: Diabetes and CRF, experiences please?

If you have used insulin before, you know to check before every shot. With PZI, the next most important time is the nadir - somewhere around +5 or +6 in most cats. But you can check numbers anytime. The more data you get, the better you can see how it works in Grey.
Click to expand...

Thanks! So far it seems to be about +5 for the nadir with her, but as you mentioned I'm trying to get numbers during the day so I can better inform the vet if the dosage needs to change. I printed off the conversion chart for him as well, so that he knows we have some options with U-100 syringes. Right now we are using U-40 syringes with the Prozinc (U-40).

I am thinking you mean NPH or Humulin? Prozinc is a milder longer lasting insulin in most cats. Usually you get a gentle smile type curve that lasts 12 hours with the nadir about half way through the cycle.

No experience with CRF but we have lots of members who do. Keep checking back in. Here are some good informational sites: http://www.felinediabetes.com/phorum5/r ... ?8,1931923
Click to expand...

Yes, NPH. Sorry about that. Again, many thanks! Been reading and reading and reading...

I'm sorry that Grey now has CRF. I can't answer all of your questions, but I can tell you what we did and how it worked. We fed my Blackie Wellness Chicken and Turkey. Both are low carb and relatively low phosphorus. Also, the cat food is easily mixed with water to syringe feed. Merrick also makes some lower phosphorus/low carb foods. You can check out Janet & Binky's charts - they include the phosphorus. When Blackie's CRF progressed, I added a phosphorus binder, Aluminum Hydroxide, which is tasteless and mixes easily with wet food. I still have quite a bit of it - if you would like to have it, pm me your address and I can send it. We tried KD wet, but it had glucose in it and Blackie didn't like it very well.
Click to expand...

Many many thanks to you as well! Janet & Binky's charts have been a Godsend for me! I will PM you about the binder.

FWIW, I use a Baby Bullet blender to make wet cat food easier to syringe. Maybe that info will help someone else. The little bullet is perfect for a regular sized can of cat food (5.5 oz?).

The other thing to watch for is a BG drop after giving fluids. ECID, but with Blackie his BG's would drop every time after the fluids.
Click to expand...

I wondered about this! How long after giving the shot were you able to give fluids so that you didn't interfere with the insulin? I didn't do it last night, she's overdue but I waited until now (+6.5) to give them and her BG is about 150 right now. I may be completely off base here, but I figured that waiting until after her nadir would be a good time to give fluids.


So sorry about everyone's GA's...I dread that day...
 
Re: Diabetes and CRF, experiences please?

Hi Suzanne,
I would give Blackie his fluids up to an hour after his shot. This worked with my schedule and and was close to his highest point. After a while I decided on what bg number I would not give fluids. For example if he had a low preshot that morning (under 150), I would skip his fluids. You may not have to deal with that since you're on Prozinc. I hope you can keep Gray happy and healthy for a long time to come.
 
UPDATE: Re: Diabetes and CRF, experiences please?

UPDATE:

I'm getting concerned, she was lethargic the first day and since, but today she has been crying and while laying down she holds her head to the side. While her BG has stayed under 250, I'm fearing ketoacidosis. I'm waiting for her to urinate so I can check her with ketostix...any advice? Should I just call the vet for a callback anyway?
 
Re: UPDATE: Diabetes and CRF, experiences please?

It sounds like your gut is telling you she is ill and she sounds like she is definitely not feeling well. I know the ER is expensive, but I would take her in. I am so sorry you and your sweet kitty are going through this.
 
Re: UPDATE: Diabetes and CRF, experiences please?

Just got back from the vet, saw one of the vets on call. Here she was 84, there she was 75 for BG. No keytones in the plasma, just trace glucose. No urine, and she has a tiny bladder. He said to feed her and no shot tonight, so that's all I know to do. She only went as high as 262 at the vet's when we were feeding K/D with no insulin, so she should be fairly ok...I hope.

Thank you so much for taking the time to respond and send prayers!

Suzanne
 
Re: UPDATE: Diabetes and CRF, experiences please?

Yay, I just caught some fresh urine from her...Ketodiastix said no keytones, no glucose either...I fed her almost an hour ago? Weird.
 
Re: UPDATE: Diabetes and CRF, experiences please?

I'm glad no ketones and not a terribly low bg level. I wonder if a vet visit this week for a general check up/ blood work might be a good idea. Seems like something else might be happening?

Keeping you both in my thoughts.
 
Re: UPDATE: Diabetes and CRF, experiences please?

I'm calling the vet's office on the way to class tomorrow for an appointment with her regular vet. I knew she was slightly anemic from her severe CRF, and it may have worsened. I haven't given her any insulin since yesterday morning, this morning she was 134, 233 has been the highest today and before feeding her tonight she was 232. She hasn't felt good at any BG, she's very weak and wobbly, she seems to have dropped more weight, and right now I feel like she doesn't have much quality of life. I'm trying to hope for the best, but frankly I'm really just preparing for the worst. It's just going to depend on what the tests reveal, what the vet says, and what I'm willing to put my furbaby through as far as additional treatments.

Suzanne
 
Re: UPDATE: Diabetes and CRF, experiences please?

I would ask the vet to not only check her potassium level but also ask if he/she has done a reticulocyte count to see if she has non-regenerative anemia. Sending prayers for both of you.
 
Re: UPDATE: Diabetes and CRF, experiences please?

Thanks! Her renal panel last week said her potassium had risen to normal values, her BUN had dropped to 88 and her creatinine dropped to 5.7 (both are still very high), her phosphorus dropped but still high, but her calcium went up and her bicarbonate dropped when both were previously normal. Her sodium increased as well. I can't find much on Tanya's CRF site about hypercalcemia, so I don't know if that's what's going on, but the several of the anemic symptoms sure seem to fit. I don't remember if we tested her for reticulocyte count or not, I think we just went by her BUN, creatinine, and phosphorus levels to determine CRF. It's something I'll be sure to mention! I've looked over Tanya's anemia treatment page, I'll mention it as well.

Thanks for your reply, all advice and prayers are truly appreciated!

Suzanne
 
Re: UPDATE: Diabetes and CRF, experiences please?

Grey crossed the rainbow bridge today. There was just no more hope.

Thanks to all of you that sent prayers...she's at peace now.

Suzanne
 
Aw, Suzanne, was so hoping Grey would improve and be back home with you. You have my heartfelt sympathy on the loss of your special and beloved Grey. Being the only furbaby it just makes the loss that much harder.......many of us know and understand and feel your pain. You did what was needed to be done for her....as painful as that decision is you let her go and that is love. My heart goes out to you and may alll those years of wonderful memories help you through the "moments".
 
Suzanne

I am so sorry to hear of your loss and all that you have been through. My prayers are with you and may you be comforted.

Terri
 
Suzanne,
Big loooong hug. I'm so sorry Grey has crossed the bridge. Thank you for sharing her with us even for such a short time. She's not gone, you just have to hug her differently.

Fly free sweet baby.....and land softly back in Mama's heart....
 
I am so sorry to hear about your sweet Grey, Susanne. It seemed like she had multiple problems that you did your best to deal with. I hope knowing how blessed she was to live a love-filled life with you will help ease your pain.
 
Suzanne, I'm so sorry that you had to let Grey go. I was hoping there would be a better outcome. I too have had CRF and diabetic kitties and know how hard it is to know when to give up the fight. Thank you for posting an update. My thoughts are with you.
 
Suzanne,
Sooo sorry to hear about Grey.
Please fly free Grey and stop to play w/ my Gumpy girl
wings_cat
 
Suzanne, I am so sorry that you lost Grey. I know how hard you tried to help her. I hope in time your loving memories will ease your pain. Fly Free Grey! wings_cat
 
I'm so very sorry for your loss. I know that hopeless feeling... My sincere condolences.
Fly free little Grey, land ever so softly...

jeanne
 
Thank you everyone, this has been incredibly difficult. I've never been without a pet before, and I had Grey over 16 years. I feel very lost right now. When I had to put my dear black cat to sleep, I had Grey to snuggle and comfort me. When I lost my "horse of a lifetime" Grey was there as well. When I had a bad day at school, break up with a boyfriend, whatever...even when I had the other two pets...Grey was my little rock to lean against. Everyone used to laugh about my "little shadow", she was with me in whatever room I was in. Even the bathroom. If I got up to get water from the kitchen, she followed. When I would sit in my recliner, if she hadn't already jumped into my lap I would see a pair of ears and hear her meow wanting to jump up. When I would lay down on the couch or in my bed, she'd jump up to snuggle. Every day when I would leave the house, she'd be in the window watching me leave. Every day when I returned home, she'd start meowing from that same window and once I opened the door I get the screaming meows, "Where have you been?!" I really miss that.

To explain Monday's vet visit, mostly to help me but to possibly help anyone else, Grey had gotten so weak, she was unable to make it to either litter box within feet of her water, heated bed, toys, and fireplace. She urinated very little at a time, and the total amount was far less than normal. She had also dropped more weight (one pound in a week). I asked the vet to run some tests so that I could make a decision. She was severely anemic, but the vet did not have much hope for her. It really did appear that her little body was simply shutting down. He was willing to go further with treatment if I wanted to, but I truly wondered how much more I could put her through, her being a good patient or not. Her cries sounded like "mommy help me!" while I struggled to make a decision, but oddly enough when I finally said to euthanize she stopped crying. Maybe she really said "mommy help me go." As I sat there second guessing myself silently as the final injection was being adminstered, her vein blew. I knew then that I made the only decision I could, and that was to let her go. She couldn't have withstood a transfusion. He went to the next foreleg, and that vein blew. He went higher and got was finally able to get this done. Her passing, while peaceful, she fought with all her might and continued breathing longer than we expected. That was my Greybaby, tough as nails until the very end. I felt a strange sort of pride and dignity for her that despite how far she had gone, she had that much fight left. I can't explain it. I've been fearing finding her dead in my house for days, yet her fighting death at the time of euthanasia had a strange comfort for me. I guess I didn't want to feel like I had waited too long, and that served as proof that I hadn't done so? Same with the testing, maybe I just wanted numbers to tell me what to do.

Having had a "special needs" pet before, I'm very familiar with rearranging your life to tailor to their needs. It didn't bother me to give her any of her treatments, she really was a great patient. And until recently, despite giving her the various treatments, she still had so much quality of life. Now I just need to accept the quantity. As selfish as this sounds, I just didn't expect to put her down before finals. I truly thought I had more time. Thankfully, I've done very well all semester and my finals aren't going to change the nursing department's decision on my starting nursing school in January. I just wish I could hug Grey one more time.

Thanks again everyone,

Suzanne
 
I am so very sorry ... and, if it's any consolation, I really believe you did the right thing - starting back with deciding not to put her through chemo for the thymoma. It sounds like the CRF advanced and any treatment at this point would have been for you, not for her. Thank you for granting her the loving gift of a peaceful passing. She was dearly loved, and will be deeply missed.

She was a very, very lucky kitty to have chosen you as her mom. You got to walk together on this great journey for many years, and although she has gone ahead, you will walk together again someday.

Wishing you peace and comfort. My deepest sympathies.
 
I am so sorry about the loss of your baby Grey. Tears are running down my face as I type this. She sounds like a wonderful kitty and I am hoping you are finding some peace in the good memories of your time with her.
 
So terribly sorry for your grief, Suzanne.

Land softly, Little Grey

celi & binks

200px-Candleburning.jpg
 
Suzanne, so sorry for your loss. You gave her a great gift - taking her pain away! Now our wishes for your heart to mend.

Peace!

Claudai
 
I am so very sorry that the first time we visit your condo is to offer our sorrow and support for the loss of your beloved Grey. We are so very sorry and know how tough this time is. What a wonderful life Grey had with you and now Grey is free, happy and feeling good and waiting at the rainbow bridge with all our much loved kitties who have gone ahead.
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