Please help, my cat is diabetes and has CKD!

Hello, I'm Ruth and I have a rag doll named Fatso. He is the sweetest and the most beautiful pet He is 14 years old and had diabetes on and off for a couple of years. I managed to have him off insulin or with very little insulin by eating the Purely Fancy Feast all protein diet ( instead of the Royal Canin prescription diet that the vet wanted him on). That worked great until a couple of months ago when he stopped eating and was dehydrated and was hospitalized for a couple of days. He was diagnosed with kidney disease level 4. The vet wanted him on the Royal Canin renal support D food which I did and that helped him with the kidney disease, which is great, but his diabetes has spiked and is now a big problem again. He lost his regulation and now I will have to pump up the insulin again. I'm not a fan of the Royal Canin prescription food but I don't know what else to feed him to manage both conditions. I would appreciate if anybody on this forum can help me and my beloved Fatso. Thanks a lot!

 

Hi Ruth, thank you for posting here on the Main Health forum so that you can get more eyes on your questions about a better diet for Fatso.
As I told you, I feed a raw diet to Idjit. I use FoodFurLife EZ Complete Supplement and he has transitioned well. You can read about this diet on their website if you are interested. For Idjit the low carb and lower phosphorus is a win/win, in my opinion.
I asked the FFL staff for more information and received this reply:
Regarding your question about phosphorus, the typical guidance for phosphorus in earlier stages of CKD is to feed a food that is less than 1% phosphorus on a dry matter basis, or less than 250mg phosphorus per 1,000kcal. EZComplete is both.

The Veterinary / Rx renal diets typically have phosphorus at lower than AAFCO (which minimum is 0.5% on a dry matter basis). But they achieve this by trading protein for carbohydrates.

If you want to feed a low carb diet, then yes, raw is your best option. In a traditional raw diet with bone, the phosphorus is over 2% on a dry matter basis. This is because bone is used as the source of calcium - but it is also the largest repository of phosphorus in the body. By removing the bone and replacing it with an alternate source of calcium like eggshell (which is what EZComplete premix powder uses), this alone reduces the food to less than 1% phosphorus on a dry matter basis, typically to 0.8% - 0.9% DMB if using very lean meats. You can lower the phosphorus further by using fattier cuts of meat.

That said, Laurie has had 5 CKD cats since she transitioned her cats to raw 7 years ago (half of her crew were seniors when they transitioned), and she now has 2 and Carolina has 1. We've both tried feeding low protein in order to lower phosphorus further (because outside of bone, the organs and meat are the source of phosphorus, which is why the Veterinary / Rx renal diets replace meat with carbs). Lowering phosphorus further in a homemade diet is actually quite easy to do with food made with EZComplete by adding fattier cuts of meat, as mentioned above. If you target 15% fat as fed, the food will have about has much phosphorus as the Rx diets (below the AAFCO minimum), and protein will be around 40% on a dry matter basis - not quite as low as the Rx foods, which are around 30%. At about 10% fat as fed (with food made with EZComplete), the protein will be just about 50% on a dry matter basis. BUT. But it turns out that - in our experience - phosphorus really isn't the only consideration in an ideal CKD food, unless your kitty is late stage 4 or in kidney failure. Again, based on our experience.

We went back to feeding mostly lean meats. Doing extensive research, we learned why our cats do better on the higher protein diet: senior cats need MORE protein, not less. Over time, on the higher fat diet, our cats got weaker in the back end. That's muscle wasting. In a referenced piece by Dr. Mark Peterson, one of the most widely recognized small animal endocrine specialists in the world, he walks through the known needs of senior cats from published studies. It turns out, based on that info, senior cats need a minimum of 53% protein (dry matter basis) to prevent muscle wasting. So we weren't imagining it when our observation was our cats did better on a high protein diet. https://endocrinevet.blogspot.com/2011/11/optimal-protein-requirements-for-older.html

Dr. Becker has a referenced article on a study conducted in cats, designed to determine if low protein made a difference in CKD. It turns out, protein control does not impact CKD, where phosphorus control does: https://healthypets.mercola.com/sites/healthypets/archive/2018/02/13/feeding-senior-cats.aspx

So we both feed food made with EZComplete to our cats, using a rotation of chicken breast (lean), chicken thigh (fattier than breast), pork loin (lean), pork shoulder (very fatty), turkey breast (lean) or thigh (fattier), and Laurie uses fatty cuts of beef (chuck beef) and very lean cuts of beef (like top round), and each of us typically feed 2 of 3 meals a day to our cats that are lean, and one that is made with fattier meat.

What we do is control phosphorus by using a specific form of vitamin B3, niacinamide. Laurie lost her 3 prior CKD cats to problems unrelated to the CKD, and the current two have been completely stable for 1.5 years since diagnosis with this approach. Carolina's CKD cat also has hyper-T, IBD, megacolon and a hiatal hernia, and he's been completely stable for two years. Totally stable! Some of it luck-of-the-draw genetically. But this approach has been serving our kitties well.

We hope this helps, please let us know if you have any further questions.

Best Regards,

Laurie & Carolina
@Daddy Jack's Mommy has been researching using a raw diet for a non-diabetic cat, there are other members who use the supplement for their diabetic cats.
I am hopeful that members with more experience using phosphorus binders as well as canned food will chime in to offer suggestions and help you make choices, since Fatso is beyond the first stages of CKD.
I will do some further research and see if I can get some links to the threads on this subject.

 

My cat has uncontrolled diabetes and early ckd. Have you looked on Tanya's site for her food chart? The key is finding low phosphorus food that is also low carb. I'm feeding bff and Tiki cat to cc... But she's only very early stage 2, so at stage 4 you may need an even stricter diet. Weruva makes some good choices but cc isn't too into them. Can you post her labs? Are you doing sub q fluids at home?

There's a great group on Facebook called Cats with Chronic Renal Failure. They may be able to help

 

wow! that is so much valuable info! Thanks a lot! I'll look into that, and will post some more info of Fatso. As I told you, he is really HIGH on BG and that is my priority right now, I talked to the vet today and I'm increasing his insulin right now, I need to check it before I'm going to sleep today but I think that he will be ok since he is so high. I'm kind of in a bind right now, since I will take off soon to travel, I had that planned from before and Fatso is going to be with my boyfriend, who he adores. He managed to give him the insulin the last 2 summers. I was planning to teach him how to do the fluids this time ( the supplements and the prescription food are easy to handle), but, it would be a bad time for me to try a new diet. I'm having so much anxiety over this already. I hope that I could regulate Fatso before and keep the prescription food until I come back. I'll definitely look into all this info, maybe I'll take the step into raw food...he is a hunter anyway, he just went outside and came with a frog in his mouth, dear Lord...Thanks again for all this info, I'll keep in touch

 

Fatso is a mighty hunter! Please do keep us updated, he's so darned cute and we want all to be well at your house. (What did you do with the frog? )

 

Thanks Janet! I didn't look into Tanya's chart, I'm new on this and already feeling better about finding solutions. By the way, what is bff and Tiki cat ( beef?). Fatso supposedly is on level 2 now, but, I'll have him tested again next week. He doesn't have vomiting and his poops are masterpieces, so, no problem there. My biggest problem today is his diabetes spiking up with the prescription food, which has all kind of undesirable stuff on it, he loves it, especially the gravy, but, they use all kind of gross ingredient to get them hooked.

 

Yes, he is, he went to the yard and was so proud with the frog on his mouth, but grossed me out! When he finally released him ( it was a chase in my living room for a while) I scoop him with the dust pan and dropped him back outside....I hope that he is still alive but I don't know. Thanks! He is so cute!

 

I mean Fatso is so cute, regarding the frog, I hope that he survived

 

That is a photo of Fatso of when he was really a Fatso ( pre diabetes) he loves to eat!

 

Just wanna snuggle with him, he just looks fuzzy and furry to me, and being a bit round myself I would never say a thing about his "fluffiness".

 

Fatso doesn't seem to understand that it's GIRLS who are supposed to kiss frogs --

bff is made by Weruva -- I know this only since I saw it at the farm-and-pet store and looked it up (best feline friend??)
Tiki Cat is another catfood manufacturer, clever variety names, zero carbs according to Dr Lisa's chart

 

Yes, he is so fluffy, I snuggle with him all day long, he is so adorable ...took after me lol

 

Yes, he doesn't understand that...lol
As for me, I prefer that he brings a frog that a mouse as he is used to
Thanks again for all this valuable info! I'll be looking into it asap

 

He loves to cuddle

 

Hello Ruth and Fatso. Welcome to FDMB. I have an 11 year old diabetic boy, and a 14 year old girl who was recently diagnosed with stage 2 CKD. I also have 3 other cats ages 6, 12, & 13. Because they find eating to be quite social and they play musical bowls while they eat, I needed to find a food that is low in both carbs and phosphorus. I completely understand that your first concern, at this time, is Fatso's high BG. But keeping him on low phosphorus food will help to prevent his kidney disease from progressing (which I know you know). At this point, I think keeping all of my feline critters on lower pho food is to their benefit, as none of them are young. I'm transitioning to EZ Complete raw (and I appreciate @Idjit's mom for telling me about this stuff). I have yet to be successful because I didn't have a grinder, and my diabetic was totally turned off by the texture (with my vitamix). However, my CKD kitty LOVED it! I now have the grinder (a cheap one from amazon), and plan on using it tomorrow for the first time. My intention is to get all of them eating EZ Complete, as I have been losing my mind trying to find appropriate food that I can afford and that all of them will actually eat. This has been quite challenging. I have found one food that all of them love more than any other canned food that they've ever had, and it's low in both carbs and phosphorus. It's called Whole Earth Farms Duck Pate. It's a bit costly for me, but not as expensive as some others that I can't even afford to try. (Money is an issue for me. ) The problem with the duck pate is that it is very difficult to get. Most places are out of stock, and I continually checked chewy.com until I found that they had it. But it went quick! I just ordered some from another online store the other day, at Healtypets.com. They were also out of stock, but they allowed me to put it on back order. I called the company and was told that they should receive a shipment soon. (I'm hoping!) @JanetNJ also suggested some great foods. In addition to the FB group that Janet mentioned, there is also another wonderful support group--for CKD--that I've learned a lot from: Feline Chronic Kidney Disease.

I'm so sorry to hear of the problems that you're having with Fatso's BG levels. It has to be so frustrating to see his diabetes return with a vengeance, and to also be dealing with another dx of CKD. However, it is good news that his CKD has gone from stage 4 to stage 2. That's wonderful! Celie's has gone from stage 2 to having normal urea nitrogen (BUN) and creatinine levels. I'm not sure why, except to say that I'm giving her only low pho food now. She is unable to take phosphorus binder because it instantly made her sick. I need to get her onto B3 (niacinimide). When and if the time comes when you're making a decision to get Fatso on something to lower his phosphorus, here is an article that was provided by Laurie and Caroline at Food Fur Life: http://www.rawfeedingforibdcats.org/feline-ckd-niacinamide-in-phosphorus-control.html

We're all hoping that Fatso gets his BG levels down soon!

Edited to add: I just received an email from Healthy pets to inform me that Whole Earth Farms Duck Pate has been discontinued.

 

Hi and welcome!!

Sorry about your diagnose, but dealing with both issues is manageable so hang on.

One question did he had some other issue at the time of the diagnose like an infection, UTI or something? I'm asking this because if it was a sudden rise in his kidney numbers usually is related to something else and once the other problem gets resolved they may go to a lower CKD stage.

Did the vet told you what was his actual phosphorus level?

 

I just found this list on another thread. Low pho and low carb :

https://docs.google.com/spreadsheets/d/112NvvzgxEBOtkb42rA0XR8GeShw9xXs9kccf9-olK7I/pubhtml

 

My Ravan has diabetes & Kidney disease also. You can keep the Phosphorus low by adding Aluminum Hydroxide powder to his food that is over 200 phos. I put a 1/4 teaspoon of binder in 1/2 teaspoon of water & mix till it dissolves. Add it to a teaspoon of food & mix well.There's no taste to it.

I also give Ravan a nano dose of Calcitriol 2 times a week.( it's supposed to help slow the progression of the disease) You can read about it all on Tanyas' https://www.felinecrf.org/phosphorus.htm

No one wants to talk about it but just like with Humans, being overweight is what often causes Diabetes. I have family members that are grossly overweight & both have diabetes. ( joint problem & a host of other health issues due to their weight)

I am very careful not to give Ravan treats & to keep his weight down. It's not cute it's dangerous!

"If your cat is overweight, he's at high risk of many health problems. ...
For example, if your cat's ideal weight is 8 pounds but he's actually 10 pounds, then he's carrying around an extra 25% of his body weight.
In human terms, that would be the equivalent of a 180 lb adult man putting on an extra 45 pounds."

Obesity in animals can cause complications in almost every system in the body, with conditions ranging from diabetes to osteoarthritis. https://www.npr.org/sections/thesal...food-may-be-making-our-pets-obese-and-unhappy
Overweight pets have worse scores in vitality, quality of life, pain and emotional disturbance. However, the good news is those values can improve with weight loss.

Good Luck

 

Bff is a brand... best feline friends. Tiki cat too, is a brand of cat food. Many of the soultastic brand is low phosphorus and carb as well but cc doesn’t cate for them.

 

Thanks a lot for all that info Daddy Jack's Mommy! what a bummer about the Whole Earth Farm Duck Pate, that sounded really good...Fatso eats pretty much anything, which is great. As I posted before, I don't want to make a big change to his diet at the moment, maybe I'll look into the EZ complete raw when I come back, since I won't be around in the summer and don't want to scare my boyfriend away ( he will be with Fatso) Anyway, I agree with you that he needs a low phosphorus diet, as much as I don't like the RC renal support diet, that lowered him from stage 4 to stage 2 of CKD in a couple of month, which is remarkable, I also give him Epakitin ( a phosphorus binder type) and renal K, a potassium supplement. I mix them with the food and he loves them, he licks his plate clean I swear! and also I give him the lactated ringer's injection fluid...that seemed to work great for CKD. I understand how money can be an issue with that many cats in your household!!! I spend lots of money for just one in between the RC's very expensive prescription food, the supplements, the fluids, the insulin, needles and the blood works...You are definitely a very special, cat loving person, and I'm sure that your cats love you for that! thanks again! I'll keep posting about Fatso's BG, I need that you be regulated before I leave for sure, more insulin is hopefully the short term solution, and I'll look into a diet overhaul when I come back.

 

Thanks a lot Veronica and Babu-chiri ( cool name!), yes the vet told me, but I don't remember his phosphorus level, but it was very high. But he is much better now on that. At the time of the diagnosis, a couple of month ago they performed all kind of tests to rule out an infection, UTI, but they came negative. It wasn't suddenly, I guess that his numbers kind of fluctuated up and down in every blood work check up, unfortunately, I wasn't aware of the problem until it was too late. Part of the problem is that the vets have too many patients, and don't have much time to explain the potential problems until is too late. I'm learning more from this message board that I ever did from the vet's office.

 

Cool! thank you so much! that is exactly what I need! Low carb, low phosphorus diet...by the way, what the F stands for?

 

Thanks a lot JoyBee and Ravan for all this info! I totally agree with you, overweight animals are like overweight people, they have many issues, and diabetes is an ugly one.
Fatso has that name because he used to be a fatty...I should change his name now to Skinny-so...he isn't fat anymore. But he is paying the price for my ignorance, I fed him comercial dry food before, is cheap and convenient. I used to go out of town, for example, and, it would never be a problem to ask a neighbor to come to feed him. I learned my lesson. At the end, what you save in money and convenience, you end up paying in veterinarian bills, insulin, etc. .....and frustration His weight now is optimal and he looks really good. He is so handsome fat or skinny, even with less pounds to cuddle

 

F probably is Fat, thanks again Daddy Jack's Mommy...this is exactly what I need

 

I think you need to change his name! Fatso is so derogatory! ( Maybe Don Juan. captivating male known as a great seducer of women.)

 

He didn't care that I called him Fatso, lol... it made more sense when he was fat, he weighted 24 pounds at one point in his life pre diabetes. I also call him other names, like po po po pon, it doesn't mean anything but I like the sound. Thanks JoyBee and Ravan!

 

Catcat suggests you call him Ah-So Catso ...

 

Yep. F is for "fat." And You're welcome!

 

Thanks to all for the help I just ordered some bff varieties and Dave's restricted phosphorus diet pork flavor....they have less carbs for sure ( but more phosphorus) than the RC renal support cans. They are also better on protein, which is good...Hopefully they will help my cat with the CKD and the diabetes...

 

Good is a matter of balancing things and to keep his diabetes controlled because something else the vets don't mention or don't take into consideration sometimes is that uncontrolled diabetes can actually harm the kidneys more than a non renal diet will ever do, so if you focus only on de kidney problem and start using renal diets things get a lot more complicated.

Still it would be good to know his current level of phosphorus so that you can start monitoring that part and see if you have to add a phosphorus binder to his diet, he may not need it if the low phosphorus diet does the trick so you need to monitor him and take another blood test around two to three weeks after you change his diet

 

Thanks Veronica! He is currently on a phosphorus binder called Epakitin and also on Renal K potassium supplement. I have scheduled a blood check this Friday, I could try to see if they have something later before I go out of town because I didn't receive the new food from Chewy's yet. The last blood test he did well, he went from level 4 to 2 of CKD

 

Actually, I did receive the new food today...I was thinking that the package was of the lactated ringers fluid. I love Chewy's! Great service! I'm planning of doing a diabetic curve this Wednesday or Thursday, and then switch him for the new food after that, he is already excited, when he sees me opening a box of cans of food for him! I hope that I could switch the vet's appt for blood work too, but...that is harder, they have way too many patients, because they charge an inexpensive monthly fee that includes free visitations but they make their money with lab tests, surgeries, etc....( some of them totally unnecessary)