Advice needed: how to feed a cat with both CKD and diabetes

I am fostering a new diabetic kittie named Smittie. I have been told she has CKD and am lost. Although I have joined,fb feline CKD, yahoo group, and Tanya's, they are not familiar with CKD and diabetes. Rescue vet has her in kd canned and dey. 38-42 carbs and testing shows she is always "hi". She is on prozinc 3u. I really am lost here and need,help. Should I switch her to lantus?

Pattie

 

Hi Pattie,

Do you know what IRIS stage of CKD Smittie has because that has an impact on dietary choices: Assuming that you're fostering from a shelter, did they get lab work done to Dx the CKD? If yes, did you ask the experienced members of Tanya's group to review them for you?


Mogs
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That carb ratio is very high, particularly for a diabetic cat. Look for foods that are below 10%, there's a food list on here somewhere. Go to the search bar and type in "food list".

 

I am on Tanya's group,but did not receive much help on the diabetes part. Only one person commented on the labs and that was to say..can't comment much about labs but...

I was disappointed on that. So not getting much help,at all

Pattie

 

I'm sorry to hear that, Pattie. There are some members here who are good at labs stuff. Maybe try uploading a copy and asking for input?

I'm sure you've already seen this but here's the section of Tanya's site that covers tests and results.

As best I can ascertain, in the early stages management of phosphorus levels (preferably with a low phosphorus diet) and monitoring of blood pressure and regular labs are the first things to get in hand. Vitamin B complex supplementation is recommended (due to loss of same due to excess urination) and Saoirse has benefitted from same. (Note: caution is required with B12 supplementation - further details are available on the relevant section of Tanya's Site.)

Saoirse is at early stage II. Because she also has pancreatitis I need to feed her the only low carb food I've found that any way agrees with her. It's too high in phosphorus, but it is a suitable diabetic diet. From what I've managed to glean from the site thus far, protein restriction is more of an issue in later IRIS stages. Our vet has started her on a small amount of phosphorus binder to keep her levels in an acceptable range. It's not ideal but she has to eat. :-/ I've also bought some Astro's nitrogen/creatinine scrub to help bind nitrogenous waste products in the gut but I need to review it with my vet before trialling it. (Saoirse has mild azotaemia.)

Sorry I can't contribute much, Pattie. I'm finding getting my own head round it very tough going. (I have PTSD and I'm really struggling trying to read and understand the new information.) Maybe if you changed the title of this thread to something like "Advice Needed: How to Feed a Cat with Both CKD and Diabetes" and use a question mark icon it might alert members better to the help you need? It would also be helpful if you could find out which IRIS stage Smittie is at so that people will have a better idea of any dietary changes that need to be made due to her status.


Mogs
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I recently made a list of high-protein, lower-phosphorus foods combining info from Tanya's and Lisa Pierson's sites. I can give you the list if that would help, but I don't know if you are at the protein-restriction phase yet. Are the labs posted on this forum somewhere too?

 

Excellent suggestion Mogs. I changed the heading. I really need to figure this out because her big is horrible.

Pattie

 

I really hope you'll find a food that helps, Pattie.

 

The phosphorus levels are listed at Cat Info, too.

 

I'm in a similar boat as Mogs & Saoirse as far as multiple diagnoses... Rudy was really high on prozinc and then became regulated on lantus and has been off that for almost 4 weeks now My vet said that no food is going to be perfect for all the issues. we are currently using wellness turkey and wellness chicken. you can look at the values on the charts that others have already posted and try to find one that you and your vet thinks would do the least amount of harm. it's really hard managing more than one issue, but a lot of us are in that boat and feel your pain. hugs!!!!!

 

Hi Patti,

I agree with others that it would be good if you can establish what stage the kidney disease is currently. If it's fairly early stage then you may have lots of food options available to you. If it's late stage then your options will be much more limited.
It's also important to know the kitty's blood phosphorous level. That information may further affect your food choices; and will let you know whether you need to add a 'phosphorous binder' to the food (to help limit phosphorous absorption).
In my experience, the folks on the Tanya support forum were very helpful at interpreting lab results (with regard to CKD staging).
Edited to add: Here's a link to a page with info on Iris staging (scroll down page to see Iris staging using creatinine values). http://felinecrf.org/how_bad_is_it.htm

It is very helpful to try to get the diabetes under control if possible, because then there will be less work for the kidneys to do.

There is quite some debate about whether to feed prescription kidney food or an 'ordinary' higher protein (non-prescription) food for CKD kitties. And quite a few folks now make the decision to feed ordinary higher protein foods, particularly in the early stages of the disease.
One of the problems CKD kitties face is maintaining muscle mass, and the higher protein foods help maintain body condition. (But in the late stages of the disease it may still be necessary to change the diet to one which is lower in protein.)

Feeding an ordinary food (which is low in carb) could also have the benefit of lowering the blood glucose. However, we suggest that folks only lower the carb content of the diet if they are able to monitor their kitty's blood glucose at home. That's because the insulin dose may become too high, and may need to be reduced in order to prevent hypoglycemia.
Fortunately, 'home testing' is not hard to learn. But, like anything new, it can take a few goes to get the hang of things.

I'm going to tag Bron @Bron and Sheba for you to see if she can help.

Reassuring hug to you,

Eliz

 

Hi Pattie,
Elizabeth tagged me and asked me to if I could help you with the diabetes/CRD problem. I agree with everything she has told you.

First of all let me say YES both can be managed with a bit of fiddling and adjusting! If you can post any results you have of Smitties, it would be very helpful, so we can see where he is up to with the CRD.

By the look of it you have another diabetic cat and are used to testing. Is that correct?
I tried to have a look at Smitties SS but could not access it. Can you have a look at that please? You might not have hit the share button.

One of the main things you can do to help Smitties with the CRD is get the BSL numbers back into normal range if at all possible. That will take some of the pressure off the kidneys.

I would get rid of the high carb food and choose a low carb, low phosphorus, high protein canned food from one of the lists below. I don't know what country you live in, but hopefully the lists will cover your country. If they don't, let me know and I will try and find one for your country.
VERY IMPORTANT.....When you change from the high carb food to the low carb food, Smitties BSLs will probably drop a lot....so you need to be testing frequently to keep him safe, until he has changed over to the low carb food and stabilises. I would do it gradually over a period of days when you can be there to monitor his BSLs.

When you are looking for a food try and get one that has less than 250mgms of phosphorus / 100grams of food, or better still, less than 200mgms of phosphorus/ 100grams of food. When you think you have found some good ones, post them and we can check them out for you, if you like. Phosphorus is the real problem for CRD cats and by feeding a LOW phosphorus food you are taking a lot of pressure off the kidneys.

I feed Sheba home prepared raw and cooked food high protein, low carb, low phosphorus food. If you are interested in going down that track let me know. I also give her a little low carb, low phosphorus, high protein canned food ......the ones I use are from the Weruva range ....'cats in the kitchen' Fowl ball and fric a zee canned for low carb. And Pumpkin Lickin chicken for the medium carb (13)...it is in a pouch. For high carb I use chicken magnet....also a pouch...(16 carb).

Another way to lower the phosphorus is by replacing some of the canned food with cooked egg WHITE. Egg White is very low in phosphorus but is high in very good quality protein. An egg white cooked is about 17 calories or 40 grams. So what you could do is mash up the egg white and give half with the morning food and half with the afternoon food......taking out the 17 calories of canned food that the egg white is replacing......By doing this you are lowering the overall phosphorus level of the meal..........have I explained that OK?
I give Sheba an egg white every day mashed in with her other food. Don't use the egg yoke as it is high in phosphorus.

Another thing which is very helpful is to add warm water to the canned food to make it more soupy (as much as Smittie will tolerate.) extra fluids help flush out the toxins and are a really important thing you can do to help keep Smitties CRD stable.

Pattie....all this probably sounds like a lot of work but once you are sorted, it will just be routine. The hardest part for me was getting it all sorted out in my mind and then implementing it. It is now routine and easy.
I think it is wonderful you are fostering a diabetic kitty. Good luck with it all. Ask lots of questions and if I can help in any way tag me.

Below I have listed some information about food and phosphorus, protein and carb levels.

Bron

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

http://weruva.com/catsitk-cans-nutrition.php

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

http://www.felinediabetes.com/FDMB/threads/food-links.133016/

 

Odd, I am on both Tanya's and yahoo groups and there are a number of cats with multiple health issues.

Without knowing what the Phosphorus, potassium, BUN and Creatinine values are it will be difficult to advise. You can still feed your cat Little Friskies Classic Pate (Fancy Feast is only a last resort for kidney cats) and you can add phosphorus binder to reduce the amount of phosphorus your cat gets from the food. The Rx kidney diets are not ideal, as you know high carbs, but more so than that many cats don't like them, and given they are low protein they can lead to loss of muscle mass.

If you have not already done so please post the latest labs on the yahoo kidney group.

Squeaker is in Stage 3 renal failure and a diet controlled diabetic. There are so many things you can do to help a kidney cat.

Please post those labs with a subject something like "Smittie labs diabetic and CKD" when I see that post I will know to look at that post specifically.

 

I just went to the yahoo group and found your original post and the group gave you solid advice about Smittie being in early stage CKD and also made mention of lower carb food for the diabetes. Having now seen the labs posted this is what I would advise given that I also deal with diabetes, CKD, RCM, and pancreatitis:

1. No more kibble this is probably a big contributing factor to glucose elevation and trouble regulating even with insulin. Canned food only and the lowest in phosphorus that you can find. No more kidney food it is not needed at this time. Kidney diets are used when the cat has reached an advanced level and is progressing toward end stage renal failure.

2. Smittie is in Stage 2 based on the Creatinine level and at this stage you need to work on lowering the phosphorus by adding binder to wet food. Aluminum Hydroxide Gel Powder is the least expensive and very effective product to use. ALOH is a tasteless powder that you mix in with the food. Based on the Stage 2 and latest phosphorus level Smittie should receive a total dose of 14- 28 mg per pound divided between however many meals you feed per day. Tip---1/4 tsp of binder is equal to about 300 mg (that is a level tsp not a heaping tsp). So if Smittie is say 10.5 lbs you would need 294 mg (10.5 * 28) per day of binder so 1/8 tsp in two meals will be how much you use. You can order the binder powder here: https://www.pureformulas.com/phos-bind-200-grams-powder-by-rx-vitamins.html. Just make sure that your other cat or cats do not eat the food with the binder in it. If you can't monitor feeding times then you can give a binder in the form of a treat to Smittie right before putting out (low carb wet) food. Binder chews can be ordered here: http://www.bockvetpharma.com/#!conseal-alh/c1h7d.

So to recap. Get Smittie onto a low carb wet food for the diabetes, add phosphorus binder in the form of loose powder or the chews.

 

wow, just had to weigh in and say how amazing all this advice is.

As some may know (probably not...I'm here sporadically) my Edgar has had 25% kidney functioning for YEARS now, started having seizures a couple years ago, and now the diabetes. Oh! And he absolutely steadfastly refuses to eat anything that's even remotely moist.

What I've been doing is a mixture of:

• Dry EVO cat & kitten
• Freeze-dried Stella & Chewy Tummy Ticklin' Turkey
• Freeze-dried Stella & Chewy Chick, Chick Chicken

With the two freeze-dried, I basically wet my hands and mash up the pellets. If I make them truly wet he won't eat them. Damp is about all I can get him to stomach.

I've also put him on several supplements:

• Zobaline
• DMG Immune Support
• Amino B-Plex
• Trixsyn for joints and movement (he's stiff)

Luckily, I have an incredible holistic pet supply store just a few blocks away. They've been guiding me.

 

How much Zobaline are you giving? Tanya's Site advises caution giving B12 supplementation with CKD.

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he gets one zobaline a day. his neurologist recommended it.

 

The B12 is very good for the nervous system (e.g. treatment for neuropathy) and for many other things. I don't know about you but I'm finding it hard balancing what I can and can't give Saoirse. What is helpful for one thing is harmful for another.

 

B vitamins, especiall B12 are critical for cats with CKD who have reached the point of nonregenerative anemia. The only "caution" is they type of given----methyl vs cyano and formulas of B complex containing A and D. B12 is especially useful when the cat is bordering anemia. http://www.felinecrf.org/vitamin_b.htm

 

There is an additional caveat about dosages further down Tanya's Vitamin B page under the Section 'B12 and Diabetes'. Within that section it cites a study which found that high doses of B vitamins can reduce glomerular filtration rates.


From Tanya's Site:

I've also recently come across another research article which conveys a similar warning:

Vitamin B6, B9 and B12 in Diabetic Nephropathy - Beware.


From the article:

Hence my comment about how frustrating it is when something is helpful in one way (e.g. B12 helps with anaemia and neuropathy) yet harmful in another (e.g. too much B12 [plus certain other B vitamins] may speed progression of diabetic nephropathy).


Mogs
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