That was a lot of fancy words that I wish I understood. I’m betting my money (it’s not much) on this: his diabetes was because he was fat. The kidney failure we’re not sure. But the result of the mix was that he could not eat carbs for his diabetes and proteins was out of the question because of the kidney failure. We do believe (in hindsight) that he had diabetes for a few years before he was medicated.
If it’s one thing I might say kept him going for so long was that he was on science hills organic food from the beginning (real food not leftover proteins from fish industry) and the last 4 he was on diet food and later on medic food, and only wet. He had to pull teeth on one side, and always preferred wet food. He had about two years on insulin.