Zobaline and CKD

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Tony’s person

Tony’s person

Member Since 2020
I have read conflicting info on the use of more than 3mg/day of Zobaline for Diabetic kitties who also have CKD. Sometimes I read that any excess is eliminated via urination, and other places I’ve read that when dealing with CKD co-morbidity, that it should be limited to 3mg or even less.
Does anyone have an explanation of the conflicting info/advice? thanks.
 
  • It would be helpful if you can set up your signature
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    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
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    • Diet: "LC wet" or "dry food" or "combo"
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tap on your avatar where it says your name ,then hit profile page ,tap on that ,then go up to the very top, upper right hand side and tap on your name ,it will bring down a drop box, tap on signature, the signature will be under settings, tap on the signature then and you can start to add what I posted above, make sure you hit save ,
Welcome to the best place you could ever be and an awesome group of people
 
https://www.felinediabetes.com/FDMB/threads/new-member-tony-the-tiger.237475/

Tony's Person first post, his cat does have CKD also.
I asked him to set up his signature so we are aware of this.
I took a look at his SS and it looks like he might be dosing
going by pre- shots.
His numbers were a lot of reds and blacks in the beginning
Giving different does at PMPS at times.
Can you please take a look at his SS
@Wendy&Neko

@Sienne and Gabby (GA)

I went back to all of his posts and saw that you have helped him.
If I am wrong about anything I told him please correct me
Thanks ladies :bighug::cat:
 
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Tony’s person said:
I have read conflicting info on the use of more than 3mg/day of Zobaline for Diabetic kitties who also have CKD. Sometimes I read that any excess is eliminated via urination, and other places I’ve read that when dealing with CKD co-morbidity, that it should be limited to 3mg or even less.
Does anyone have an explanation of the conflicting info/advice? thanks.
Click to expand...
What food are you feeding Tony?
Wet food if so what is it?
Is there any dry food you are feeding such as the Hills K/D Dry Chicken, it's too high in carbs
for diabetics. This is why I am asking you to do your signature. Thank you



What stage is his CKD?
Is is prosperous level high, is he still anemic, as you mentioned in your first post?
Is his creatinine high?
 
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Tony’s person said:
I have read conflicting info on the use of more than 3mg/day of Zobaline for Diabetic kitties who also have CKD. Sometimes I read that any excess is eliminated via urination, and other places I’ve read that when dealing with CKD co-morbidity, that it should be limited to 3mg or even less.
Does anyone have an explanation of the conflicting info/advice? thanks.
Click to expand...
All I can tell you can s that I had a kitty with CKD and I joined Tanya's Site for Kidney Disease. All of the members advised me to give 250 MCG twice a day,
but my cat and the was not diabetic.

I would buy the Vitacost brand 500 MCG and empty the capsule and give half in the
morning and the other half at night mixed in his wet food
 
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Which dosing method are you following, it does matter to list it on your signature
because of it would tell you when to increase or decrease the dose.

For example if you are following SLGS it says
Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!


I see Tony dropped below 90 four times so
shouldn't he have reduced by 0.25 units if he was as following SLGS?
@Wendy&Neko

@Sienne and Gabby (GA)
 
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Tony's person, looking at your SS you are shooting different doses a lot of the time.
We want to help you and Tony so you will be able to shoot the same units both
AM and PM , I'm no expert but I think that is the reason you can't get him better
regulated

On 11-14 his AMPS was 96 and 11-16 it was 86 shooting those 2 pre shots
got me worried, since there were no tests done after that and you don't know how low the insulin took him. The units you shot were pretty high.
And on 11-14 his PMPS was 98 with no tests afterwards.
Just want to keep Tony safe :cat:
 
Last edited:
Diane Tyler's Mom said:
https://www.felinediabetes.com/FDMB/threads/new-member-tony-the-tiger.237475/

Tony's Person first post, his cat does have CKD also.
I asked him to set up his signature so we are aware of this.
I took a look at his SS and it looks like he might be dosing
going by pre- shots.
His numbers were a lot of reds and blacks in the beginning
Giving different does at PMPS at times.
Can you please take a look at his SS
@Wendy&Neko

@Sienne and Gabby (GA)

I went back to all of his posts and saw that you have helped him.
If I am wrong about anything I told him please correct me
Thanks ladies :bighug::cat:
Click to expand...

Apologies - I did link to my sheet in my signature. I did it twice, in fact. I don’t know why it’s not sticking.

Regardless, Tony was hospitalized for a week at a Veterinary Specialist hospital at start of his journey, and I’m also working with a geriatric specialist ongoing. So while I do find this forum helpful, please understand that most of what I’ve been doing is under constant advice and supervision of the vet specialists. During his stay in the hospital they did whatever they thought was needed to stabilize him. I’d say whatever he did seemed to make him much worse in some ways...he went in sick and with high BG but he came out extremely sick. He couldn’t stand or walk, he was anemic, and he was extremely thin. Since I’ve had him home he has been getting steadily better in many ways - walking, jumping, gaining weight, BG lower, etc.

They had him on 4-5 units when he came home and I’ve been instructed to give varying doses depending on his BG. However, I’ve been reading this forum and have mostly moving him downward and trying to hold the dose for as long as it seems safe. He’s now down to 3 units...but I go to 2.5 if he has been particularly low. I think his geriatric specialist is wonderful and we speak almost daily.

She just started him on some herbs and she said that one of the herbs could lower his BG so I am not surprised to see his numbers dropping.

The weird thing is that his nadir seems to be just before his shot. (At around +10-11). At +6 he is oftentimes higher?

I’d like to go to 2.5 units but it seems like when I do that he suddenly starts having crazy high numbers again.

Also, FYI - he has been on Hills KD for about 2-3 years. His kidney values are good. Cretan one is in high-normal range and BUN is just slightly above normal. He gets subQ fluids once a week too.

Given that his kidneys are doing so well (relatively speaking), the geriatric vet advised I start mixing a diabetes food with his KD. So I’ve been mixing up both FF pate amd Hills DM along with his K/D. It’s about 50/50. He has gained weight and his anemia has been steadily improving - he’s almost past that now. His neuropathy is also much improved. All his food is wet.

So, overall, I think he’s doing well. The only thing is that I’d like his BG to be more steady amd not so bouncy.

Based on this forum, I’m leaning towards reducing to 2.5 amd holding steady for a week even if I see spikes. The thing is that, as mentioned, he seems to dip most just before next shot.

Oh, and although it looks like I didnt retest when numbers are low, I always retest before shot to ensure BG is going up. My vets told me to feed him, wait 45 mins, then retest - and if it’s going up to give “usual” dose. He is on Lantus and they said that since it isn’t quick acting, so long as he has a full belly and rising BG, he’ll be ok.

I hope that fuller story helps.

Again, back to my original question - any thoughts on Zobaline twice a day for a cat with CKD? I’ve read Tanyas page, and others, and there seems to be conflicting info.
 
I'd like to suggest that you take a look at the information (aka "sticky notes") at the top of the Lantus board. There's a wealth of information about the way that Lantus works contained in those notes.

Lantus is a. depot-type of insulin. What that means is that if you make frequent changes in the dose (i.e., dosing based on the pre-shot number vs the nadir), the results will not be what you expect. Due to the overlap between doses and it's long action, back-to-back dose changes ofter results in wonky numbers. Lantus dosing is meant to be based on the lowest number of the cycle. It is not a good insulin for "shooting down" high numbers.

I would also strongly recommend you get a before bed test every night. You are missing half of your data without PM tests and you have no way to know if your cat is in safe numbers at night. A 98 as a pre-shot number and a 104 as an AMPS could mean that Tony was in very low numbers during the PM cycle.
 
Sienne and Gabby (GA) said:
I'd like to suggest that you take a look at the information (aka "sticky notes") at the top of the Lantus board. There's a wealth of information about the way that Lantus works contained in those notes.

Lantus is a. depot-type of insulin. What that means is that if you make frequent changes in the dose (i.e., dosing based on the pre-shot number vs the nadir), the results will not be what you expect. Due to the overlap between doses and it's long action, back-to-back dose changes ofter results in wonky numbers. Lantus dosing is meant to be based on the lowest number of the cycle. It is not a good insulin for "shooting down" high numbers.

I would also strongly recommend you get a before bed test every night. You are missing half of your data without PM tests and you have no way to know if your cat is in safe numbers at night. A 98 as a pre-shot number and a 104 as an AMPS could mean that Tony was in very low numbers during the PM cycle.
Click to expand...
Thank you @Sienne and Gabby (GA) for replying to my tag .:cat:
Have a good day
 
Tony’s person said:
The weird thing is that his nadir seems to be just before his shot. (At around +10-11). At +6 he is oftentimes higher?
Click to expand...
That's a sign of bouncing and a bounce breaking. Likely from going lower at night as others have suggested. Given that you are seeing 60's on the AT during the day, it's fair to say 3 units is too much insulin for Tony. The 2.5 units sounds like a good start. Since you have been mixing in lower carb diabetic food with his K/D, chances are he just needs less insulin.

I would follow Tanya's site recommendation on B12.
 
Ok, I’ll be brave and do 2.5 units for a week or so. I know his numbers will go up initially. I gave 2.5 this morning and this eve BSPM was 234.
Part of the issue is that I can’t figure out what I’m aiming for. Is the bright green on that sheet supposed to be the ideal?? Maybe I’m being daft, but I tend to think of green as good and red as bad?? My vets told me they’d be pleased with steady 200-300 range. But that doesn’t really make sense to me if normal is 80-120??
 
You want to avoid the bright green (below 68) and aim for the darker green (68-99). Anything bright green means his dose need to be reduced.
Tony’s person said:
My vets told me they’d be pleased with steady 200-300 range.
Click to expand...
That's probably because most of their clients don't home test, so they don't have the margin of error to have lower nadirs. Steady 200-300 could be above renal threshold, and harder on kidneys.
 
Green good
Red not do much

Your vets are happy with higher numbers because they know he wont hypo that way. They figure their clients dont want to be vigilant or cant. Its a good practice to let them know, right off the bat, that you intend to be a hands on catmom. ;):cat::bighug:
 
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