Food for diabetic kitty with crf

I have a beloved old kitty who has just been diagnosed with diabetes. She already has CRF and is on kidney diet food. The research I have done so far clearly indicates that low carbohydrate food is important for a diabetic cat but the kidney diet seems to be high in carbohydrates. Does anyone have any experience dealing with this and/or suggestions as to what I should do? I am desperately worried that given my poor kitty's age and pre-existing conditions that this may be the end.

 

I haven't had a diabetic kitty with crf but i've had a diabetic kitty and a crf kitty living in the same household at the same time so to accomodate both we fed 4 of the Friskies Special Diet flavors as they are both low carb and low phosphorous which is what a crf kitty needs. we feed the special diet flavors turkey & giblets, beef & liver, beef & chicken, and salmon

have you seen this page regarding crf?
http://www.felinecrf.org/

 

My Sab has had kidney "irregularities" most of his life; he's 12 now. For years he's done well with Hill's k/d. After his sugar diagnosis in February, I put him on Wellness Grain Free canned food. Subsequent blood work since diagnosis shows no changes in his kidney values. Maybe this is helpful?

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Re: Food for diabetic kitty with crf/newbie to site

thanks so much for your input. I'm kind of freaking out here because poor old Lucy is so old and has so many health problems that it is very hard to decide if or when it would be the kindest thing to let her go. She will be 20 at the end of this month and I've been treating her for CRF with fluids and diet for about 2 years now. She also has low potassium and needs potassium pills every day to combat that. She has such bad arthritis that it is difficult at this point to figure out how much of her mobility problems can be attributed to the arthritis and how much may stem from the very recently diagnosed diabetes (only diagnosed 2 days ago). She was put on steroids last summer--minimal dosage possible--when she stopped eating as a last resort in an attempt to get her to eat again. That may or may not have contributed to her diabetes. Part of the routine for her medications was to hand feed her some dry cat food every morning before she got her potasssium pill because she had to have food in her stomache for that medication. Our vet prescribed insulin (1 unit Lantus once daily) for first 3 days and tomorrow I'm supposed to test her urine (by putting glucotest in her litterbox) and go to twice daily if she has elevated sugar in her urine. He has not suggested home testing of her blood with glucometer--probably because he feels that we are walking a fine line between trying to keep her going and giving her some quality of life in her remaining days. She is presently getting potassium pill every morning, steroid drops every other day, sub-Q fluids every 3-4 days, and Baytril pills every day for another week (UTI) plus the insulin injections. She is not very mobile but still makes it to the litterbox and the food bowl. She does still enjoy being flea combed and purrs away when I sit her in my lap and comb her. I suspect that it is time for me to say goodbye but as long as she is still able to sit in my lap and purr it's very hard to make that decision. Although sometimes I suspect she is purring to make ME feel better!! She is the most wonderful cat in the world and I'm lucky to have had her for as long as I have.

 

Steroids will most likely worsen her diabetes. And from what I know, but I can be mistaken, all existing alternatives to steroids are known to be risky for the kidney.

I cried when I read your last post. Cuz I can imagine how difficult it can be to have your kitty sitting on your lap, purring, and at the same time, know that she is struggling on a daily basis just to keep surviving. Understand that this is breaking my heart... but personally, if my kitty was struggling like your kitty is, and if I knew that even with all that medicine, her life on a daily basis would be painful because of something like arthritis, I would want to put her to sleep... Geez I'm crying like a baby again... Only you know when it's time to say goodbye.

 

The good news is that there are commercial foods that are good to feed for both conditions. You simply need a low carb, low phosphorus canned food, preferably without byproducts (higher quality protein sources are easier on the kidneys). Keeping your cat as hydrated as possible is key to managing the disease, along with low phosphorus foods, so definitely no dry food at all (if you're feeding any). Mixing water in with the canned food is one good way to help with hydration. Many people also find that cat drinking fountains also encourage cats to drink more. Anything you can do to get moisture in your cat is important. You said you're giving fluids, which makes me think she might be further along than a lot of cats. The low-protein kidney diets have only been shown to be beneficial in end stage renal failure. Here's a great page that give you a guideline: http://www.felinecrf.org/how_bad_is_it.htm.

Here's an updated food list with the values for several premium foods: https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50. You're looking for something with less than 10% carbs and less than 250 mg/kcal of phosphorus. The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, and Blue Wilderness Duck.

If those are out of your price range (although I would strongly urge a food without byproducts, keep in mind that it's still cheaper than the prescription food), the next best thing to feed are the low carb Friskie's Special Diet flavors. These are Turkey & Giblets and Salmon Dinner--make sure they are the ones that say "special diet" on the can, though. PetSmart carries them, and some grocery stores. Here is an updated list of just the phosphorus values for many commercial foods. They can be cross referenced with Binky's chart for carb values if there's something on there that you want to feed. On this chart, you're looking for something that is less than 1% phosphorus (these values are on a dry matter basis, not mg/kcal): http://www.felinecrf.org/canned_food_usa.htm

Do NOT use Binky's list for phosphorus values--the carb values are still ok to use but the phosphorus values are really out of date, and some things that were low on that list are now ridiculously high in phosphorus. You can cross reference the carb content from foods on Binky's list with the phosphorus values on Tanya's canned food list, however.

Now for the larger question...my Gabby never progressed beyond stage 1 with her CKD, but she ended up with stomach cancer and it was really hard trying to figure out how far to go with treatment, and when it was time to say goodbye. This chart really helped me: http://www.pawspice.com/Feline Quality of Life Scale.pdf. Gabby lasted 7 months with the cancer before it was her time. Towards the end, I was feeding her a variety of foods every 4 hours (usually giving her the food every 15 minutes for the hour until she ate all of the portion at each feeding), but she still seemed happy and not in pain so we went on with it. Once she stopped eating despite being on the max dose of appetite stimulants, I knew it was time.

 

Thank you so much for your helpful advice--both the food suggestions and especially the chart on quality of life. Lucy seems to be feeling a good deal better today--she had a good night and was purring loudly when she came for cuddles. Hopefully if I can get the diabetes stablized she can chug on for a while longer. Until the diabetes developed her main challenge was the arthritis. Her kidneys aren't great but the potassium supplement and sub-q fluids seem to have been keeping her from rapid deterioration in that department. They have not changed dramatically in the 2 years or so that I've been giving her fluids. We put off the steroids until it was literally a life/death situation and have kept them at a minimal dose because we were so afraid she would develop diabetes. My vet said if we had to find a bright side to the recent diabetes diagnosis it is that IF we can get her stabilized on insulin we may be able to increase the steroids to help her arthritis. Talk about a delicate balancing act!!
I am supposed to be testing her urine for glucose to determine whether to move to 2 injections of insulin/day. Hmm--would have been very simple when she was still feeling awful and drinking--thus peeing--constantly. Now that she isn't doing that so frequently it may be more challenging. I bought some of the suggested foods to try her on so that I can move away from using dry food to ensure she has food in her belly before her potassium pill and insulin injection. All of my cats have been on Wellness canned (with additional water mixed in) for years but sadly they all seem to prefer dry food (California Natural)--even Mouse who now has no teeth due to stomatitis. Since Mouse is allergic to fish and all kidney diets that I could find included fish I always had a bit of Wellness chicken out during the day and would separate Lucy from the other 3 trouble-makers at night so that I could put kidney diet down for her (mixture of Wellness and Iams Multi-stage renal wet plus mainly dry Iams multi-stage renal with some California Natural mixed in). I had been handfeeding her dry food in the morning before her potassium pill but will try to find a good quality wet food that she will eat in lieu of the dry food. If she continues to feel better I will just have to work out a new routine for myself and the kitty crew.
This message board is incredibly helpful--far more information than I got from my vet. I can't tell you how much I appreciate all the good advice out there!!

 

Another thing that will help you get her blood glucose under control is to home test blood sugar levels with a human glucometer--that's what we all do here. Urine testing only gives you a picture of what blood sugar has been for the past few hours, and it does not detect what your cat's blood sugar is if it drops below the 240 (the renal threshold, where the kidneys spill glucose into the urine). It also cannot detect hypoglycemia, which is when blood sugar drops too low. Home testing will allow you to have much more control over her blood sugar.

Hometesting seems hard at first, but it doesn't hurt the cat and after a week or two they really don't mind as long as you give a treat with every test (low carb, of course). Check out the links in this thread: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287. We recommend testing before each shot to make sure it's safe to give insulin (just like a human diabetic), and a mid-cycle test to show you how much the insulin is dropping her blood sugar. Dose adjustments are made based on the mid-cycle tests.

Many people here use the Relion meters (the confirm or the micro) from Walmart because they are very inexpensive and easy to get.

A lot of vets don't recommend home testing because they think the owners will be unwilling to do it because it seems difficult--but it's REALLY not hard at all! Bandit fought me the first couple weeks, but once he realized treat=test, he not only allows me to do it, he comes running to get tested whenever he hears the glucose meter beep on. :smile:

 

If Lucy continues to do well I will definitely look into the glucometers. Browsing through this website and the message board showed me that that was clearly the preferred way of testing insulin levels. I have to admit I hate the thought of sticking her but then I hated the thought of giving sub-q fluids, adequan injections, insulin shots and all of the other things that I have learned to do. If Lucy was not such a sweet and patient cat we probably would not have made it this far. If everything continues to go well I will be talking with my vet next week and will ask him about the blood testing. If everything doesn't go well I will be talking to him much sooner. Thanks so much for this suggestion--if I attempt this route I'll be all over this message board trying to figure out how to draw blood with the minimum amount is stress for Lucy (and me). Thanks again!!

 

People always think home testing their cat is going to be way harder than it is--but if she has a sweet disposition I guarantee it will be a piece of cake for you! I think the biggest aversion that scares people is pricking their ears. However, cats have very few nerve endings in their ears, so the pricks don't hurt them at all. If she handles the insulin injections fine (where there actually are nerve endings), then she will be fine with the pokes. Some cats get upset the first week or so because they don't like being restrained (if they won't sit still), or because it startles them, but once they get used to it even fractious cats are perfectly fine with it.

 

That is very encouraging and it's likely Lucy will not even flinch. She doesn't even seem to notice the insulin injections (although I had been giving them to her in the scruff and read on this message board that it was better to use a different area due to lack of blood supply in the scruff--she did flinch when I gave it to her in her rear this morning, but no big deal). She doesn't love the sub-q fluid poke (and that is a much bigger needle) but that is only a couple times a week. It sounds as if the blood testing for sugar levels needs to be done multiple times a day--I'm a bit worried that may end up just being too much. I guess she'll tell me if it is. She is still doing pretty well today so I am encouraged. I'll aske her vet on Tuesday (he gets back in town then) about the glucometer. I'll no doubt be hounding you with questions after that discussion. Meanwhile, fingers crossed, my sweet baby seems to be feeling much better. This is about the 3rd time when she has looked as if it was time to say goodbye but she keeps surprising us. My family finds it absolutely astonishing that I am willing to do all of this for my cats--I'm infamous in my needle-phobia and they remember me as a child screaming and holding on to chairs in the waiting room every time Mom took us in for vaccinations. When I started taking in foster kittens 4 years ago I rapidly learned that it is amazing what you can just take in stride when you are trying to keep your loved ones happy and healthy. Foster kittens = germ bags!! Thanks s much for your support and advice!!

 

This is where the low carb TREATS come in. Because the poking doesn't actually hurt the cat, if you give a treat after test they actually learn to expect and want it. When I click on my blood glucose meter, Bandit comes running, jumps in his testing basket, and starts purring. Granted, it took us a few months of testing to get to that point, and the first couple weeks he fought me tooth and claw, but that's also his personality when I try to do anything against his will (nail clipping, baths, grooming...). From how you describe her I really think you won't have a problem.

 

Any suggestions for good low carb treats? I used that strategy when I trained Lucy and her sister Ethel to let me trim their nails. They both got to the point that when I sat down and picked up the nail clipper they would fight over who went first. Your kitty picture actually looks like Lucy--she's a seal-point Siamese. Mesers rule!!