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Re: [FH] Diabetes/anemia/heart failure/kidney failure: Please help!

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  • savionna@aol.com
    Hi Lesa, In a message dated 8/3/04 3:52:52 AM, tiger6387@yahoo.com writes:
    Message 1 of 3 , Aug 4, 2004
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      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

      weight. >>

      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:

      1. www.petdiabetes.org/insulin.html

      2. www.lillydiabetes.com/Products/TimeActivityProfiles.cfm

      << 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:

      1. www.petdiabetes.org/home_bg_testing.htm
      2. www.sugarcats.net/sites/harry/bgtest.htm
      3. http://tlb.best.vwh.net/bg_punkin/test_bg.html

      << 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
      digestive system).

      << 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,

      1. http://rocquoone.com/diet_and_health.htm
      2. www.avma.org/convention/recap/news/tuesday16.asp
      3. http://home.earthlink.net/~jacm2/id1.html
      4. www.catinfo.org
      5. www.homevet.com/petcare/feedingyourcat.html
      6. www.maxshouse.com/feline_nutrition.htm

      For info on diet and renal issues, see:

      1. www.southpaws.com/news/99-2-nutrition-CF.htm
      2. www.vetshow.com/download/purina/finco.pdf
      3. www.vetshow.com/download/purina/bovee.pdf
      4. www.cm-d.com/buckeye/tech_manual/8_28.html
      5. www.bowchow.com/kidney.html

      For general info on renal issues in cats, see:

      1. www.felinecrf.com
      2. www.felinecrf.org
      3. www.mindspring.com/~kerspin

      For charts with nutrient information (incl carbohydrate and phosphorus) of
      common cat foods, see:

      1. www.sugarcats.net/sites/jmpeerson
      2. webpages.charter.net/katkarma

      << 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

      HGB 5.6

      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
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