Yemala out of remission; 3 PM bg 498; 10 PM bg 396

Hroswitha

Hroswitha

Member Since 2011
Hi all.

Yemala was first diagnosed in 2006, in remission a month later. She fell off the wagon in 2011 when she got steroids for an ear infection. Back into remission a month later.

She was diagnosed with kidney disease in June of this year, and moved onto prescription food. She's been eating Science Diet k/d since then. We had her blood levels done again today, and while her phosphate and Creatine are both down dramatically, her bg was off the chart.

We will be starting her on insulin again tomorrow night. I'm working on procuring a Lantus pen in the area for as little as I can. With the current bg levels, the vet recommends 2 units bid.

Is this an appropriate level?

She will be moving entirely onto a food that is both low in phosphates and carbs. We're done with the Science Diet.

Advice?
 
I posted this on your other condo:

“How did they diagnose CKD? Was an SDMA done? Do you have a urine specific gravity?

I agree with Chris....Mala’s BUN could be elevated due to a little dehydration and raw diet. I will say her hematocrit is a bit lower than I would expect.

My very healthy 8 yr old cat has a creatinine of 1.7 so you can’t base it in that alone.

Sorry you have to be back here!”
 
Hroswitha said:
We will be starting her on insulin again tomorrow night. I'm working on procuring a Lantus pen in the area for as little as I can. With the current bg levels, the vet recommends 2 units bid.

Is this an appropriate level?
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How much does she weigh? and are you going to be doing TR?
Hroswitha said:
She will be moving entirely onto a food that is both low in phosphates and carbs. We're done with the Science Diet.
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As I am sure you realize, once you get her of the Science Diet and onto a wet LC, Low P diet this may in itself lower BG, so you will need to be watchful as the dry HC works its way out of her system.
I hope someone can offer you some advice on low carb low P foods, we do feed low P food as George is early ckd, but being in Europe the foods I use are not available stateside, so can't help with that.
 
TR - is that home testing? I've forgotten all the lingo.

Yes, we test at home. BG this morning was 360. She's off the Science Diet and eating a low carb/low phosphate food with a rather high protein.

Her weight is down since June. She was 8.35 lbs in June at her CKD diagnosis; she is 7.75 now. I believe she's lost some muscle mass.
 
TR is tight regulation, one of the Lantus protocols. Read about the TR and the SLGS (start low go slow) in the stickies at the top of the Lantus forum. When you decided which protocol you are going to use, please put either TR or SLGS in your signature.
 
From Startingthe TRvsticky.
dose for glargine or detemir when following the Tight Regulation Protocol:
  • the formula is 0.25 unit per kg of the cat's ideal weight
  • if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
  • if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
7.75pounds= 3.44kg

So starting dose on TR
3.44*0.25=0.86u

Given that you are changing to a wet low carb diet I would round it down to 0.75u if you were doing TR

On SLGS you would start at 0.5u as you are switching to an all wet LC diet. 1.00u if there is still dry in the picture.

So based on both dosing methods the 2u is high for your cat, you might end up working your way they, bit as a starting dose you run the risk of it being to high of a dose, I'm sure you know the implications of that as this is not your first time round.

When you were first here did they use the two dosing methods? I know this is something that came about later.
 
I am familiar with the SLGS method, as I believe that's what we were doing with her in '11. She started at appx. 1u 2X daily, with bgs read beforehand. I think you're recommending .5 units 2X daily, yes?

Mala has not had dry food since '06. She has been on low carb food for years, but with the CKD diagnosis, we moved her onto a food with an unknown carb count. I think that's what triggered this flare up. She's back on low carb food, this time with low phosphates.

We can do that. I will be posting her bgs daily using the standard protocol as I go. I'll look up the TR guidelines for Lantus and see what I can do.

Thank you, for this and for advice in advance.
 
Yes 0.5u bid on slgs

Or o.75u bid on TR

Have you come across tatas CKD site? Lots of rxceexcel info there, great resource

https://www.felinecrf.org/canned_food_usa.htm

Above is a link to low p foods available the chart also gives you carbs, if it was hills science diet, looks like that was around 28% carbs. As it's wet it should get out of her system quickly, I misunderstood, thought that the low p food the doc had swapped you onto was dry, my bad.
 
It's all good. I will not feed kibble to indoor cats. I have 2 ferals in the yard who eat it, though I don't like it, because the logistics of feeding them wet got to be too hard. Freezes in the winter, attracts bugs in the warm seasons, and they just don't care for it.

28% carbs. No wonder she's back in sugar land. The charts I'm reading indicate that the food she's eating now is around 6% carb, and around 194 on phosphates with 60% protein. My vet says that high of a protein percentage would make the phosphates claim dubious, but the chart was compiled by Lisa Pierson, so I trust that a bit more than this vet. Many vets have told me that putting a diabetic cat into remission was impossible, and that CKD is a death sentence sooner rather than later.

Mala will start insulin tonight. We're do the SLGS method, and I'll put that in the signature line. .5units to start, monitor bgs, and no increase or decrease for 3 days.

I'm hopeful we can at least find a balance point for her, even if she won't go into remission right away. Thank you again.
 
Hroswitha said:
I will not feed kibble to indoor cats. I have 2 ferals in the yard who eat it, though I don't like it, because the logistics of feeding them wet got to be too hard. Freezes in the winter, attracts bugs in the warm seasons, and they just don't care for it.
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We've 4 indoor cats that are on all wet, and two outdoor cats, the outdoors get a mixture of both, mostly wet which they prefer, but I have to keep them eating kibble because that's what they get when we are on vacation not feasible to get them to a cattery, and my friend comes and tops their kibble up regularly. In an ideal world they'd all just have wet, really don't like dry.


Since unregulated diabetes is so hard on the kidneys getting that regulated has to be a priority which will be easier with lc, I know that others here have used phosphorus binders if the phosphorus becomes problematic. We've not had to yet, georges P was within normal limits and trended down with the food changes we made.

Good luck with the shot tonight I hope it doesn't take to long before you see progress. If you find you want to move things along quicker you can always swap to TR when you're back into the swing of things. Looking at how much you've tested in the past if you're planning on following a similar routine then there should be no issue.
 
Phosphorus is currently in normal limits. The CRE has come down into range as well. BUN was high, but that could be a symptom of dehydration. Hard to say.

Little girl will start with her insulin tonight, we'll go on SLGS protocols and post our results as we go. And to all who will help us walk this line, you have our enduring gratitude.
 
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