Diabetes/anemia/heart failure/kidney failure: Please help!
We are new to the group. I have read hundreds of your posts and I
found a lot of useful information. Thank you so much for sharing! I
will now post the recent story of our cat, Sodapop, who has gone
downhill after a visit with supposed critical care specialists.
Please offer advice if you have any, as I am very worried for our
15-year old cat! Thank you very much!
On Friday, on the suggestion of our normal vet, we brought Soda to
specialists at "Gulf Coast Veterinary Internists" in Houston. Before
this visit, we already knew that Soda had diabetes, chronic renal
failure, and anemia. He was stable, though, for several months. But
in the past two weeks his appetite had diminished and he was losing
weight. Also, his blood glucose was not being controlled by his
insulin, but we found that if we bumped the dose up (from 2 units
Humilin to 3 units, twice a day) that Soda would have a seizure.
Still, he was not in terrible shape.
The specialist ran a battery of tests, took Xrays and ultrasound. She
diagnosed a new problem: "Restrictive Cardiomyopathy and Congestive
Heart Failure." They kept Soda in the hospital for four days to
"treat" this condition. This treatment ($2600 worth) involved: 2-3
furosemide injections daily; 2-3 famotidine injections daily; 2-3
enalapril maleate injections daily; 2-3 metocloropramide injections
daily, two glucose curves, and some other things.
On Monday the specialist pronounced Soda's heart problems controlled
and released him to us. But he is MUCH MUCH WORSE than he was before
we took him to these people! He can no longer walk; his muscles are
weak, and when he tries to stand he loses his balance. He is not
eating. He is unbelievably thirsty. He vomits. I fear that he is
dying. My wife is beside herself, crying and despondent.
This is the specialist's prescriptive regimin:
1. 100cc plasmalyte A twice a day
(Before, we were giving him 150cc Ringers once a day)
2. Hill's K/D food
(Before, we were giving him Hill's W/D)
3. 3 units PZI insulin once a day
(Before, we were giving him 2 units humulin twice a day)
4. Enalapril 1mg tablet twice a day
5. Furosemide 12.5mg, 1/2 tablet twice a day
6. Famotidine, 1/4 tablet every 12-24 hours
We are taking Soda to his regular vet in the morning. Please--we will
listen to any advice! Thank you so much. --Mike and Lesa
Here are some test results for Soda from the specialist taken on
Friday when we broght him there:
Osmolality, calculated 372
T4 (RIA) .26
BPc (blood pressure?) 154-164 over 4 days
While in the care of the "specialists," Soda's weight fell from 9.4 to
Thank you again for any help or suggestions. All the best from Lesa,
me, our cats Soda, Sammy, and Tiger, to you and your family and pets!
- --- tiger6387 <tiger6387@...> wrote:
>Mike and Lisa,
> The specialist ran a battery of tests, took Xrays
> and ultrasound. She
> diagnosed a new problem: "Restrictive Cardiomyopathy
> and Congestive Heart Failure> problems controlled
> and released him to us. But he is MUCH MUCH WORSE
> than he was before
> we took him to these people! He can no longer walk;
> his muscles are
> weak, and when he tries to stand he loses his
> balance. He is not
> eating. He is unbelievably thirsty. He vomits.
I am sorry to hear about Soda. When Soda was released
he was stable but the problem that caused him to have
RCM is not something that is cured, rather it is
something that we attempt to modulate via various
medicines. There are many links in the links section
specifically about CHF that are very good. It is
important that Soda eats because of the med he is on
that enables him to breathe. Ask your vet for a couple
cans of Hills A/D a critical care prescription food.
You can either finger or syringe feed it to him.
DIAGNOSTIC AND THERAPEUTIC APPROACH TO THE
RCM is not as common as HCM but a few members have
dealt with it. Look for posts about a cat named Morag.
Here is a link to get you started:
Advances in Treatment of Heart Failure
Soda's weight fell because an animal in a critical
care situation catabolizes lean muscle mass. This is
Nutritional Therapy of Heart Disease
>The most serious issue Soda is facing is his heart.
> This is the specialist's prescriptive regimin:
> 1. 100cc plasmalyte A twice a day
> (Before, we were giving him 150cc Ringers once a
> 2. Hill's K/D food
> (Before, we were giving him Hill's W/D)
Hill's A/D is ideal for a cat who is not eating enough
to maintain his lean muscle mass.
>This is an ACE-inhibitor
> 3. 3 units PZI insulin once a day
> (Before, we were giving him 2 units humulin twice a
> 4. Enalapril 1mg tablet twice a day
>This is the diuretic that enables Soda's breathing
> 5. Furosemide 12.5mg, 1/2 tablet twice a day
> 6. Famotidine, 1/4 tablet every 12-24 hours
> We are taking Soda to his regular vet in the
> morning. Please--we will
> listen to any advice! Thank you so much. --Mike
> and Lesa
> Here are some test results for Soda from the
> specialist taken on
> Friday when we broght him there:
> BUN 107
> Creatine 2.6
> Phosphorus 7.1
> Glucose 684
> Potassium 4.8
> Osmolality, calculated 372
> Magnesium 2.6
> WBC 8.3
> RBC 3.4
> HGB 5.6
> HCT 15
> Lymphosytes 996
> Monocytes 913
> T4 (RIA) .26
> BPc (blood pressure?) 154-164 over 4 days
> While in the care of the "specialists," Soda's
> weight fell from 9.4 to
> 8.2 pounds.
> Thank you again for any help or suggestions. All
> the best from Lesa,
> me, our cats Soda, Sammy, and Tiger, to you and your
> family and pets!
> ------------------------ Yahoo! Groups Sponsor
> Yahoo! Domains - Claim yours for only $14.70
> Your reply will go to the author of this message. If
> you feel your reply will benefit the entire group,
> please change the "To:" line to
> Yahoo! Groups Links
Do you Yahoo!?
Yahoo! Mail - You care about security. So do we.
- Hi Lesa,
In a message dated 8/3/04 3:52:52 AM, tiger6387@... writes:
<< But in the past two weeks his appetite had diminished and he was losing
A leading contributing factor to weight loss in diabetics is poor glucose
control. The cells can't use the "fuel" from food without the "right" amt of
insulin. And while uncontrolled diabetics are usually ravenously hungry, they can
also be inappetant. Renal issues will also affect appetite.
<< Also, his blood glucose was not being controlled by his
insulin, but we found that if we bumped the dose up (from 2 units
Humilin to 3 units, twice a day) >>
Which Humulin? Ultralente? Lente? N? "Humulin" is the *brand name* of
genetically engineered insulin from Eli Lilly. U, L, and N are diff. *formulations*
of insulin with very diff. activity profiles (onset, peak, and duration). For
info on this, see:
<< that Soda would have a seizure. >>
That "seizure" is more than an indicator of lack of control...it signals the
potential for significant neurological damage and death when too much insulin
is given. Did the vets instruct how to care for the cat in a hypoglycemic
episode? If not, some info is here:
Did the vets mention that it's possible to test the cat's blood at home using
a portable monitor just like humans rely on? Hometesting is an easy,
inexpensive, reliable way to effectively manage blood sugar...to achieve good control
and avoid the significant dangers of hypoglycemia. Some sites on this incl:
<< 2-3 famotidine injections daily >>
Famotodine (Pepcid Rx) is simply an acid blocker for the stomach that can
help with nausea.
<< 2-3 metocloropramide injections >>
Metoclopramide (Reglan Rx) is used to reduce gastric uspet and improve
gastric outflow (diabetics can have gastroparesis, from nerve damage to the
<< two glucose curves >>
What did the curves indicate?
<< But he is MUCH MUCH WORSE than he was before
we took him to these people! >>
Part of the reason *may* be that they changed the insulin formulation...and
it's going to take a while for the cat's body to adjust.
<< He can no longer walk >>
There can be various contributing factors to this. A possible one is diabetic
neuropathy, which is related to the same type of nerve damage that affects
the digestive system. It is caused by excess glucose, which damages the nerve
sheaths. For some information, see www.laurieulrich.com/jasper.
<< 2. Hill's K/D food
(Before, we were giving him Hill's W/D) >>
It may be worthwhile considering the role of diet in diabetes. Hill's w/d is
high in carbohydrate (38% calories from carbs in the dry; 23% in canned),
which is exactly the *opposite* of what any cat needs, more so a diabetic, who has
no ability to control glucose naturally. Cats are *obligate carnivores* who
have *no* dietary requirement for carbohydrate and limited ability to process
it. A possible result of feeding an obligate carnivore a high-carbohdyrate diet
is *diabetes*. The recommended diet for nearly all cats, but esp diabetics,
is a high-quality, low-carbohydrate (at least less than 10% cal from carb),
well-balanced, moisture-rich, meat-based diet.
K/d is low in protein, which is now thought to be the inappropriate approach
for animals with renal issues. The recommended diet is the highest amt of
high-quality protein that the individual cat can tolerate with the lowest amt of
*phosphorus*. K/s is also high in carbohydrate (35% cal from carbs in the dry;
28% in canned).
Further, both of these products are poor in the type of high-quality
nutrients that cats need to survive.
That said, it is important for the cat to eat, esp when receiving insulin (to
avoid not only malnutrition but also hypoglycemia and liver
complications)...so whatever food is palatable and acceptable can be offered. It is also
important to keep in mind that the amt and type of food will affect insulin
response. In general, the lower the carbohdyrate level, the less the amt of insulin
For information on diet and diabetes...and general info on feline nutrition,
For info on diet and renal issues, see:
For general info on renal issues in cats, see:
For charts with nutrient information (incl carbohydrate and phosphorus) of
common cat foods, see:
<< 3 units PZI insulin once a day >>
The *starting dose* was 3 units of PZI SID...after 4 days of hospitalization?
The recommended safe starting dose of all insulins is 1 unit BID, except for
those in danger from ketoacidosis or other life-threatening complications. The
protocol for raising the dose thereafter is to let each dose "settle" (which
generally takes at least 7-10 days), perform a full curve (12 hrs), then
adjust as needed by no more than 0.5 units. Almost no cats get 24 hr duration from
any insulin, even the long-duration types like PZI, which makes it all the
more important to perform curves to see the full effect before adjustment.
<< BUN 107 >>
Since you didn't give the ref range, I'll go by the Antech range. For BUN,
it's 14-36, so this is high. BUN can be elevated for various reasons besides
renal issues (acute or chronic), such as dehydration, infection, and poor glucose
<< Creatine 2.6 >>
This is slightly elevated (ref 0.6-2.4)...and can also indicate dehydration
and poor glucose control.
<< Phosphorus 7.1 >>
While this is in range (2.4-8.2), it's desirable for the phos to be around 4.
Did the vet discuss the possibility of using a phos binder?
<< Glucose 684 >>
This is quite elevated (ref is 50-150 mg/dL and the desirable range for cats
on insulin is 100-300 mg/dL) However, glucose values are meaningful only in
relation to each other and to the insulin cycle.
<< Potassium 4.8 >>
Ref is 3.4-5.6, so this is not too bad.
<< RBC 3.4
HCT 15 >>
These are quite low.
<< T4 (RIA) .26 >>
This is a thyroid indicator. Did you mean 2.6 (micro)g/dL...or is it a diff.
Did the vets perform a urinalysis? If not, you may want to bring a clean
sample or have a cystocentesis. It would be important to see the urine specific
gravity for information on renal status...and also to check for infection, since
diabetics are prone to urinary (and other) infections, incl in the kidneys.
Indicators to look for incl bacteria, WBC, RBC, and blood. // Rosemary