Needing advice about diabetes + CKD management

Hi everyone, right now have two fur babies: Donovan (10 y.o.) and Sierra Nevada (almost 10 months old). My Misty died October 7th after a very gallant fight with CKD, anemia, high blood pressure, and CHF at 18.5. When Misty got her wings she left not only me behind but my Donovan. He will be 10 in April and has had diabetes for about 2 1/2 years. We have had lots of ups and downs with his insulin dosage during the 2 1/2 years and he is now stable at 4 units of Prozinc twice a day. I've been steadily working on a diet change for him since Misty died away from M/D to more wet (he's been eating Nutro and Fancy Feast Savory Centers after unsuccessful tries with many, many foods), a different dry with fewer carbs (he is now on Dr. Elsey's Clean Protein Chicken), and only freeze dried chicken for treats. My goal is certainly all wet he is just stubborn about food changes. Donovan was very depressed when Misty died and so I got a 7 month old kitten, Sierra Nevada, on December 9, and he instantly stopped crying, pacing, and looking for Misty. Well the three of us have finally settled in and all was well until last week. Donovan's appetite was lessening, he seemed lethargic at times, and he couldn't physically meow (he'd open his mouth and nothing would come out). I took him because I though he'd swallowed something, turns out he was constipated and dehydrated. My vet took x-rays to make sure he hadn't swallowed anything and we discovered that one of his kidneys is about half the size of the other, we have no idea for how long or why because he'e never had a problem before. We ran blood work (which I have sent) and he's got some early stage CKD concerns: a very slightly elevated BUN at 37 and a slightly elevated UPC at .7 (he has some protein in his urine). So, question...for those who have managed CKD and diabetes how have you navigated diet? My vet has a call in to a vet/nutritionist for recommendations as well. My goal the last few months was to get him off of dry it has just been very slow going. Are there things you would recommend I look out for or monitor since it seems so early. From my reading, should I have another blood test run in a couple of weeks to see if the UPC number stays high? Are there specific questions I need to ask my vet? I did get insurance for Donovan and Sierra after Misty died so although I didn't spare getting Misty any treatment that she needed, I do feel financially able to do absolutely anything for Donovan as things progress since it will no longer be completely out of pocket. Am I missing something? Thanks so much for your help. I really appreciate it. I am desperate to prolong Donovan's life. Sometimes I wonder if I shortchanged him because Misty was my soul mate and I want to make sure he gets the best of me.

 

My girl was diabetic, then got kidney disease, and later other things too. Throughout all of this, I stuck with low carb and low phosphorus food. In my case, mostly raw food, but there is also canned that fits the bill. For kidney cats (and diabetes), getting rid of dry food is ideal. Are you home testing Donovan’s blood sugars? I would not change the diet until you are doing so, as the change can make a huge change in dose required.

Dehydration can raise kidney values, so I wouldn’t worry about higher BUN just yet. His urine specific gravity is good. I would be more concerned about the high Urine protein creatinine ratio test, and a follow up test, followed by blood pressure check if still high is a good idea.

 

Thanks for responding! Yes, I test twice a day, once before each shot. He is scheduled for a blood pressure heck on Friday. He was supposed to go this morning, but I gave off the "I'm taking you to the vet vibe" and he successfully hid from me for 2 hours. When should I schedule the follow-up tests? Do you mean only if BP is high and if so do you mean bloodwork and/or urinalysis?

 

Do the follow on UPCR test first, a couple weeks later, and if still high, then you should check BP. Checking BP earlier is not a problem. Always good info to have, but required if UPCR is high so the vet can figure out the cause of the urine protein and how best to treat it.

Are you doing any curves of spot checks between the shots? Always good to know how low the dose is taking the cat. That 77 was getting down there, though still safe.

 

Yes, I do spot checks and curves. The vet thinks the 77 wasn't his actual reading. The sample sat a couple of hours before being sent in. He also had a pretty decreased appetite so had eaten very little (no food since before 7:30 am that day and the blood was taken about 11:30am).

 

My sweet boy have both diabetes and ckd - I had luck with Whole Earth Farms duck pate and whole earth farms chicken pate, Organix turkey pate and chicken pate and wellness complete health turkey pate. Also occasionally young again dry, mostly as treat. If there was a food I fed with higher levels of phosphorus I would supplement with phos- bind.

 

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Thank you for the food suggestions. I have been cycling through to figure out what would be good options and what he will actually eat. I will add those into the rotation. I'm happy to see that Wellness is okay, he has previously liked that brand. I can't remember if it was turkey specifically but I will try it out. I do have phos-bind form my cat Misty who died in October from CKD and a host of other illnesses.

 

I did get Donovan's blood pressure checked on 2/29 and they checked his blood pressure three times. Th first time it was low and the second and third times were exactly the same reading and both normal so no worries there. We are going to redo the twice to see if his numbers were impacted by him being sick. I have an appointment for urinalysis in two weeks and I'll take him again a few weeks after that. His numbers have been amazing the past few weeks. He is more regulated than he has been in a really long time. He still eats more dry than I'd like but he is eating more wet. He is eating the Dr. Elsey's Clean Protein Chicken Dry and having better results than he did with Young Again. Plus the Young Again didn't agree with my new kitten.

 

Would you be willing to set up a spreadsheet and start documenting the BG numbers in it? The last few weeks BG numbers would be very helpful as well.
We are very data driven here. If you have any trouble setting it up we can help you. Here is the link
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

I would try and move both your kitties over to an all wet diet if you can as it is so much better for them. Apart from the carb content, there is so much more moisture in the canned food that is so much better for their kidneys.

Here is a link to a discussion on preparing a home made diet for CD-R cats you may find interesting.
http://www.felinediabetes.com/FDMB/threads/home-prepared-diet-of-crd-cats.150441/

 

Yes, I will try the spreadsheet. I have tried before and found it very intimidating. I keep a journal of Donovan's twice a day readings and food intake so that I have some record. I have been working on transitioning him to wet only but it is a slow process. Donovan will choose to just not eat when given only wet. Thus, I have moved him from the M/D to YA and now Dr. Elsey's with less dry and more wet. It will take time with him. He is quite rigid. Even when he first got diagnosed and I changed him to M/D he went almost three days without eating anything because it wasn't what he was used to eating.

 

If someone did the initial spreadsheet setup for you, do you think you would be able to update it yourself?

We have people that do the spreadsheet setup for people that have a problem doing the initial setup. Takes them a couple of minutes or so, once they have some information from you.

You do need a google email account, as that is where you will need to sign in and keep the spreadsheet updated.

We also have wonderful document link right here, >>>>>> Transitioning Dry Food Addicts to Canned Food. There may be some ideas in this document that will help you with getting Donovan to eat more wet food.

I tell people my cat Wink was a founder and charter member of DFAA (Dry Food Addicts Anonymous). I used every single tip in that document to help me get Wink off the dry food and eating canned food. Once I did, his BG levels just kept falling and he became diet controlled.

 

If you are finding the SS too hard just private message @Chris & China (GA), she is a whiz at setting them up in no time at all.
Have you tries the feeeze dried foods that are available now in place of the dry food. Such as ZiwiPeak.
They are crunchy and may help with the transition to wet. They are complete foods.

 

I'd be happy to set it up for you! Just send me a private message by clicking my name and choosing "start a conversation" so I can get some information

It looks a lot harder to use than it really is!

 

Thanks for sending the link. I will go through the document. I am hopeful. Although slow going, he is definitely eating more wet food than he has in the past and I am finding a few low carb wet foods that he is willing to eat. I do have a Google account so that will work for me.

 

Thank you so much! I will send you the message, I really appreciate it.

 

I give him freeze dried chicken and turkey as a treat after I check his BG. I used to give different treats and I have replaced him with these. I am using Whole Life Turkey and Cat-Man-Doo Freeze Dried Chicken. How much can be used as a replacement for dry food?

 

If you mean the treats, they aren't a complete food so shouldn't be used for anything other than treats.

There are lots of freeze dried foods that are complete though like Stella & Chewy's and ZiwiPeak

 

As treats only, those freeze dried treats you are feeding are ok. But a cat needs a nutritionally balanced diet, with the correct vitamin and mineral supplements in the food, to stay healthy.

I see you are in the midwest of the US. This food chart has plenty of foods for a diabetic cat. Look for foods that are <= 10% carbs and have a good amount of protein. Unless your cat has late stage kidney disease. Then a lower protein and phosphorus food may be required.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

These tips on transitioning a dry food addict to canned/wet food may be helpful to you also.
https://catinfo.org/docs/TipsForTransitioning1-14-11.pdf

 

Isn't that chart too old? Over at https://www.felinecrf.org/canned_food_usa.htm there's an updated list. It's kind of confusing because it's done differently than Dr. Lisa Pierson's, but it looks like there's some big changes with some brands. Look at the info for Wellness and Organix. The phosphorus for most of the Wellness food is too high. Also, that site lists sodium which is important if a cat has heart disease.

I'm not sure why people on this forum keep linking to an outdated food chart. It seems dangerous. No offense to anyone. I just don't want to see an animal suffer because of outdated information. Dr. Pierson should either remove that chart from her website or update it. And really, the pet food companies are to blame because they should be forced to put this info on the food label.

 

Yes, they should. But until governments or consumers force them to, most will not. Companies don't even have to do "as fed food trials." They simply can do laboratory analysis of some of the food to prove it has the required minimum food ingredients stated on the packaging and the included vitamins and minerals in the stated amounts.

Different food lists have different focuses. Originally, Tanya's CRF website was not going to do ANY updating to the Kidney disease specific food lists anymore, starting in 2020. She said it was too much work. Even on her USA food list, some of that food data is old, back from 2016, 2017, 2019. In fact, the person that maintains Tanya's CRF website deleted all the UK data in 2020 since it was so old. I find it astounding that someone that maintains a website for cats with kidney disease would have a list of dry foods. The one thing a CKD cat needs is a diet with plenty of water, and you will never have that with a dry food diet.

Yes, Dr. Lisa Pierson's list is 3 years old, and pet food manufacturers certainly have changed the ingredients and introduced more food options. As they have offered more food options to meet some bizarre marketing schemes to appeal to the human consumer, to wit "grain free" but have simply substituted other cheap ingredients like potatoes or peas and beans for the grains, food lists have not been able to keep up with the changes. Or companies that cater to a large pet supply store such as Petco, that decided they were not going to carry any pet foods that contained artificial colors or flavors, so pet food manufacturers put out new options. Are they better for diabetic or any cats? Well, not all diabetic cats do well on the lowest carb options. Some cats actually do better on higher carbs, 8-9%. ECID.

Then there are all the people in various feline diabetes facebook groups that insist Dr. Elsey's Clean Protein dry foods are good for diabetics. Or that say Young Again cat foods are the greatest, and yet we find that when members here eliminate those 2 dry foods from their diabetic's cat diet, they get better glucose control. Or people that tell other people they are feeding something like Friskies Shreds to their cat and we say to ourselves "no wonder that cat is still unregulated" on food higher in carbs than is good for a feline diabetic. Or testimonials on websites like amazon that praise a particular food, paid advertising basically.

It's a balancing act.

There is no perfect world, where there is an utterly complete and up to date food list. There never will be. We work with and recommend the best that we have.

@Casey Warner have you ever personally tried to contact the pet food companies and get the data from them? Have you ever invested any time in creating your own chart of information about cat food? Well, in the last couple of months, I recently helped get the Mexico and Argentina food list updated and linked to our list of food charts. The focus on that list was from one of our members that lives in Mexico City and was trying to help other people that live in Mexico with their cats that have kidney disease. I only had 4 foods that I was contributing to the list. It took considerable time, weeks, to get that information to the person maintaining the list, get the list updated, reviewed, make additional changes, get the list approved by the moderators, get the list approved by the board administrator. Only to have the 1 company that made a certain low carb cat food available in Argentina STOP making the food. Less than a month after the list was updated.

We have a wonderful member @Elizabeth and Bertie that maintains a list for the UK and that list has foods that are available in many parts of Europe. She devotes a lot of time to maintaining that list. She is working on updating the list for 2020.

Perhaps you would like to take over from Dr. Lisa Pierson, and contact all the pet food companies and get the catinfo.org food list updated? How about it? Do you have the time, perseverance and energy to do that? It's a lot of work. But it would benefit a great many cat owners.

Sounds like you think it would be better if we did not give diabetic cat owners any ideas about foods or provide links to various food charts. Never gonna happen. We work with what we have. Perhaps you prefer that people pay 2 or 3 times as much for those "Veterinary diets"? Which again is pure unadulterated marketing hype.

I'm helping a member that lives in France. Her French vet keeps pushing, and pushing, and pushing the "vet prescription" diets all the time. So she tried a food her vet insisted was going to help her cat William with his pancreatitis. Vet believed the cat food sales person and insisted a high carb (32% +) diet would be good for a diabetic cat. It wasn't. Poor cat's BG levels skyrocketed with only a few pieces of that food. And did not help the pancreatitis.

We give people, choices, options, opportunities, suggestions. It's up to each individual member to make up their own mind as to what they will feed their cat.