Diet dilemma - kidney issues and diabetes

My 14 year old cat was diagnosed with diabetes Friday (glucose 480) mild kidney disease (BUN normal so far), inflamed heart that is too small with a grade 1 murmur. I had a diabetic cat who died 17 years ago due to complications of diabetes (vet tech and vet killed him actually - she didn't read my instructions to reduce the amount of insulin he was given, he was then not eating as much and hypoglycemic all week then went into liver failure and I didn't know to force feed him and the vet didn't apparently either so he died of liver failure).

Anyway the vet (different vet) wants me to feed him (for 3 weeks) food for the kidney issues which is high carb and low protein. Of course that is diametrically opposite from the diabetes needs. She did tell me that diabetes could start the kidney issues. I questioned then why not see if controlling the diabetes makes the kidney issues go away rather than aggravate the diabetes via diet. She said that by treating the kidney issues for 3 weeks with that diet she was hoping that would go away.

Has anyone else had this issue (diabetes and kidney issues) and what has your vet told you to do with respect to diet?

We are using Lantis 3 units once a day. Vet is checking him 11 days. Due to my finances (was fired due to cancer and am still not full time employed, have a gofundme for my health insurance - no medicaid expansion in this state) and the nearly $700 I just had to spend on this cat is breaking the bank have not bought a glucose monitor yet.

I had read on pubmed that giving lanis twice a day was slightly more likely to put a cat in remission than once a day in part because their glucose didn't return to baseline, but that overall diabetes control was the same one a day vs twice a day. Have not yet approached the vet about this. She claims he will not go into remission. I didn't argue with her as she can be touchy about some things but is otherwise a decent vet and cuts me financial breaks here and there which I currently need. Thoughts?

 

See the Feline CRF website for tons of good info
The dietary recommendations have altered. At the first stage or two of renal impairment, high quality protein is allowed in the diet because reducing the protein content results in muscle wasting and debilitates the cat.

You'll want a low carb food with low phosphorus, not necessarily a low protein food. Did the vet say what stage of renal disease he had?

 

Stage 2 creatinine 2.4, BUN normal

 

That website appears not to work. Using the way back machine I found

https://web.archive.org/web/20150410192023/http://www.felinecrf.org/canned_food_usa.htm

Once you are on the food page, if you click on other links some of them have also been archived. I am printing to pdf file in case they all go away at some point in time, although theoretically if they are in the archives of the internet they shouldn't...

 

Then I'd be inclined to try the Friskies Special Diet pates which are low carb and low phosphorus. There are others, tool

 

The catinfo website also has a food chart grouped by Phosphorus levels: http://catinfo.org/docs/FoodChartPhosphorus9-22-12.pdf

One thing that gets forgotten sometimes also is that quality of the protein you're feeding also makes a difference in controlling CRF. Foods that contain more muscle meat over byproducts are going to help ease the load on the kidneys. If you can afford one of the higher quality low phosphorus foods, you may see better results than with ones with lower quality protein. Wellness, Weruva, and Instinct are a few brands that have low phos, low carb options, but there are others as well.

 

My Tiger was treated for hyperthyroid, after getting the I-131 Treatment, it was discovered she is early stage CKD (and now hypothyroid as well as diabetic ) The specialist who performed the I-131 as well as my regular vet said she needs high protein, low carb foods, diabetes trumps the proposed CKD diet foods. If you look at @Ann & Tess Spreadsheet, they have a great link to a list of low phosphorus, low carb foods as well.

If you have not done so, I highly recommend you join the Tanya's Website Support Group. Unfortunately, that informational website has been recently hacked, but here is a link to an archived database, hopefully the issue will be resolved soon. If you join the support group(there is a link on their website) there are many great people who are knowledgable and helpful.
https://web.archive.org/web/20150316101607/http://felinecrf.org/

 

Thank you everyone for your advice and links to resources.

 

Rudy has both and we switched him to friskies special diet turkey wich is low carbs and low phos. He is also on lantus- right now we are still trying to get him regulated after switching from prozinc. he is currently at 2 units twice a day. Rudy also gets B12 shots twice a week and went from laying on the floor all day to being able to climb stairs again.

Let me know if you find a better food than what I am currenly using. Personally I found the kidney group to be hard to navigate. When I asked for food advice I was hoping for someone to tell me exactly what they used that worked, but instead I got theories of what ingredients are good or bad and percentages to look for. I was a bit overwhelmed trying to figure it all out and went for the friskies. My vet said it was a good choice for him at this point, but I'm still open to ideas.

 

KarenBlasky Thanks for the information. I am still trying to pick through the mess of information to figure it out. My cat is stage two kidney but BUN is normal. I am thinking since the vet told me that diabetes can cause kidney issues and sometimes they clear up with you regulate the cat's diabetes that the focus should be on the diabetes. The vet said the focus should be on the kidney stuff for 3 weeks. But then since the carbohydrates are high in those foods that would mean that we would be regulating his diabetes for too much carbs. I will post a list of foods that might fit the bill that I find after going through all the different lists out there.

 

Squeaker is in IRIS 4 kidney failure and is still in good health. If your cat is in renal failure (kidney disease) it doesn't go away, it means the kidneys have sustained damage and will continue to deteriorate, they don't "heal". Squeaker was diagnosed with chronic renal failure I'm March 2014.
It is not a good idea to put a cat on the low protein renal diets. There is debate in the veterinary community about whether or not low protein renal diets are beneficial but what is known is they can lead to loss of muscle mass.
We feed Little Friskies Classic Pate and phosphorus binder mixed in. Phosphorus is damaging to the kidneys.
You also mentioned an "inflamed heart with a grade 1 murmur". Has the heart been evaluated by a cardiologist? Are medications being given for the heart? It is very possible that due to the heart issue your cat threw a small clot and that damaged the kidneys.
I encourage you to join the yahoo group for chronic renal failure and please check out the website: felinecrf.org.

 

My cat has diabetes and early stage CRD. I think it is really important to get the diabetes under control and this will help the kidneys.

I agree with Julia and Bandit that you need to be feeding high quality muscle meat and not meat byproducts. I home prepare Sheba's food but I also use Weruva cats in the kitchen brand of canned food for some carbs. They are low phosphorus and low carbs and are high quality protein which is what you need to feed.
With the home prepared food, to lower the phosphorus level, I add cooked egg white as part of the protein and use egg shell powder instead of bone meal(which has phosphorus in it) and these two things lower the phosphorus level of the meal.
I personally would not feed a high carb, low protein diet for three weeks. It will mess up the diabetes and the low protein idea is now thought to be not as good as once thought.
The current thinking is to give high quality protein..muscle meat....but low phosphorus, which is the real villain for CRD.
Lantus insulin should be given twice a day 12 hours apart. Three units is a lot of insulin to commence with.
If I were you, I would buy a blood glucose monitor and home test your cat. I don't know where you live but if in the US Walmart is where I think people get their monitors.
And ask for help here with the correct dose for your cat giving it twice a day. It is not true he can't go into remission ....you will not know unless you try and there is every chance he could go into remission.

 

Just came back from the vet doing the glucose curve (someone is sending me their now, unfortunately, unneeded glucose meter so I can get a better handle on regulating his glucose after I have that) and his glucose is still high. When I asked specifically about the kidney function tests his phosphorus and BUN were normal, creatinine was the only thing high at 2.4. With 3 units one a day his curve only dropped to 313 (pre insulin he was 480) so the dose has been increased to 4 of Lantus. I will switch to two shots a day when the meter arrives and see how that goes. My vet is now saying just use the kidney food for 3 weeks. Not sure why. My personal feeling was if kidney function is affected by diabetes then it would seem to me to make sense to get the diabetes issues under control first too.

 

If you use one of the low phosphorus and low carb canned foods several people have mentioned above, you will be addressing both the kidney issue and the diabetes. Kidney diets are high in carbs and low in protein and you don't want either of these things at his stage of CRD.
If he was my cat I would feed him one of the above mentioned low phosphorus, high protein and low carb canned foods and get him onto twice daily insulin as soon as possible. And monitor his blood sugar. This will be your best way forward to help both his kidneys and his diabetes. Please, though, once you have the meter and are going to give the insulin twice a day, post here for advise as the best dose to give. Don't try and guess the dose yourself..
ETA : I have just seen you have posted on the L and L forum for advice re dosing.......that is great!