New member - Cat recently diagnosed with CKD and diabetes

[Kili]

Hello to everyone out there...

Recently, my dear cat Ottie (16.5 years old) has been diagnosed with CKD early stage 3.
To add to this, we have also received news that Ottie has also got diabetes. Ottie is special in the way that he is my first ever cat/pet that I have had since he was 7 weeks old. Unfortunately, that makes me inexperienced.

This has been a lot to take in recent days... and I'm hoping this is the place to get some support and help.
Ottie has been put on Royal Canin renal diet (wet pouch) since the CKD diagnosis few weeks ago.

It is quite amazing how many questions that rushes around in my head... but I will try and make them concise.

QUESTION 1
Ottie has always been the type of cat that has multiple small meals throughout the day... and has never managed to have 2 big meals per day. He often pukes when faced with too much food at once, so we adapted throughout his life to give him multiple times a day (6-7 times per day spread out). The vet since the diabetes diagnosis has advised us that it is preferable for Ottie to consume 2 big meals in a day to ease the administration of the insulin shots. But is this really the only way? I have read somewhere that cats do not have huge glucose spikes after meals, and hence it doesn't really matter. Is this the case?
The thing I'm most scared of is that Ottie could have insulin shock.

QUESTION 2
The renal diet appears to have low protein, and additional carbs added. Would this be a problem to diabetic cats?

QUESTION 3
Ottie has always done a poo like clockwork once daily... but since the change to renal diet, he seems to be constipated, producing less poo. As a consequence, I have given him Lactulose 3ml daily (if possible) mixed with his food to help his constipation. Ottie is a 5.6kg cat.
Considering Lactulose has sugary taste for consumption... Would this affect his diabetes? My vet tells me no, but the internet seems to say the opposite.

I'm sure I have ever more questions... but to keep things short, I will stop here for now.

Thanks in advance for any help.

 

[Ale & Bobo & Minnie (GA)]

Hi and welcome!

feeding twice a day only is very old fashioned advice that works for dogs who have a much lower metabolism than cats. Feeding smaller meals throughout the day is actually easier on their pancreas and helps avoid big sugar spikes. Most of us feed the 2 largest meals around shot times then 2-3 smaller meals or snacks in between. It’s also good to have a few snacks out for him overnight.

Bobo has CKD but he wasn’t diabetic when he was diagnosed so I’m not sure about the prescribed food. He also never ate any of it so I had no choice but to keep feeding him FF and I’ll have to add a binder as the CKD progresses. Let me see if I can find the info for you if no one else chimes in about it.

I believe it’s better to try something like pumpkin or Miralax as lactulose does have sugar added.

can you tell us what insulin was prescribed and what’s the dose?

With a diabetic cat you need:

• A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
• A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
• We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
• HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after Ottie properly

We are happy to help you with setting up the spreadsheet, sorting out what food to buy, how to transition safely to a low carb diet, how to learn to home test and much more.

keep asking questions!

 

[Elizabeth and Bertie]

Hi, my diabetic kitty, Bonbon, also has CKD. And it's not uncommon for diabetic kitties to have other concurrent health issues. I know it's a lot to take in at first. But you will manage just fine, honestly!

QUESTION 1
Ottie has always been the type of cat that has multiple small meals throughout the day... and has never managed to have 2 big meals per day. He often pukes when faced with too much food at once, so we adapted throughout his life to give him multiple times a day (6-7 times per day spread out). The vet since the diabetes diagnosis has advised us that it is preferable for Ottie to consume 2 big meals in a day to ease the administration of the insulin shots. But is this really the only way? I have read somewhere that cats do not have huge glucose spikes after meals, and hence it doesn't really matter. Is this the case?
The thing I'm most scared of is that Ottie could have insulin shock.

As said in the comment above, the 'feed twice a day' thing is a bit old fashioned now. And the Royal Veterinary College in London advise smaller more frequent meals, or allowing cats to continue to 'graze' if they are used to that.
It 'is' often important that the cat eats a decent meal before being given insulin though. And this is especially the case if using a faster acting insulin such as Caninsulin/Vetsulin.
Having food available can also be safer for the cat, because some cats will sense if their blood glucose is dropping too fast or too low and will seek out food.

We recommend low carb wet foods for diabetics. However - for cats already on insulin it's important to be testing blood glucose at home before reducing the carb content of the diet. Reducing the carb content of the diet can reduce blood glucose significantly in some cats, and the insulin dose may need to be reduced so as to avoid hypo.

The renal diet appears to have low protein, and additional carbs added. Would this be a problem to diabetic cats?

There are different approaches to managing diabetes and kidney disease together, and it is a topic that divides opinion. Some people prioritise the CKD, some the diabetes. But often it can be about finding a balance that works for the individual cat.
These days more people seem to feed ordinary cat foods to their CKD kitties. CKD kitties can be prone to losing muscle mass. So there can be benefit in continuing to feed a diet that has a decent protein content 'if possible'. CKD foods are also often higher in carbohydrate than is ideal for diabetic kitties. Renal foods are low phosphorus though, and it is important to try to limit phosphorus intake.
The best advice I received was to 'feed the cat the lowest phosphorus ordinary food that they will eat'. And it's also possible to add 'phosphorus binder' to the food if necessary, to reduce the absorption of phosphorus.

There is a great website devoted to all things CKD. Here's the link:
https://www.felinecrf.org/

Eliz

 

[Ale & Bobo & Minnie (GA)]

Hi, my diabetic kitty, Bonbon, also has CKD. And it's not uncommon for diabetic kitties to have other concurrent health issues. I know it's a lot to take in at first. But you will manage just fine, honestly!



As said in the comment above, the 'feed twice a day' thing is a bit old fashioned now. And the Royal Veterinary College in London advise smaller more frequent meals, or allowing cats to continue to 'graze' if they are used to that.
It 'is' often important that the cat eats a decent meal before being given insulin though. And this is especially the case if using a faster acting insulin such as Caninsulin/Vetsulin.
Having food available can also be safer for the cat, because some cats will sense if their blood glucose is dropping too fast or too low and will seek out food.

We recommend low carb wet foods for diabetics. However - for cats already on insulin it's important to be testing blood glucose at home before reducing the carb content of the diet. Reducing the carb content of the diet can reduce blood glucose significantly in some cats, and the insulin dose may need to be reduced so as to avoid hypo.


There are different approaches to managing diabetes and kidney disease together, and it is a topic that divides opinion. Some people prioritise the CKD, some the diabetes. But often it can be about finding a balance that works for the individual cat.
These days more people seem to feed ordinary cat foods to their CKD kitties. CKD kitties can be prone to losing muscle mass. So there can be benefit in continuing to feed a diet that has a decent protein content 'if possible'. CKD foods are also often higher in carbohydrate than is ideal for diabetic kitties. Renal foods are low phosphorus though, and it is important to try to limit phosphorus intake.
The best advice I received was to 'feed the cat the lowest phosphorus ordinary food that they will eat'. And it's also possible to add 'phosphorus binder' to the food if necessary, to reduce the absorption of phosphorus.

There is a great website devoted to all things CKD. Here's the link:
https://www.felinecrf.org/

Eliz

Thoughts about Miralax with CKD? I know Miralax pulls water and with CKD not sure if thats ideal? Pumpkin would be a good option and/or fiber

 

[Ale & Bobo & Minnie (GA)]

Found the food info posted by @Diane Tyler's Mom :
Foods for Diabetes and Kidney Issues
BFF play chicken Checkmate
Protein 31%
Carbs 5%
Phosphorus 133%

BFF play chicken & turkey topsy turvy
Protein 32%
Carbs 5.20%
Phosphorus 134%

BFF play chicken cherish
Protein 31%
Carbs 4.90%
Phosphorus 132%

BFF chicken & turkey tiptoe
Protein 31%
Carbs 5.10%
Phosphorus 133%

BFF chicken duck & turkey take a chance
Protein 32%
Carbs 5.20%
Phosphorus 152%

BFF play chicken & lamb laugh out loud
Protein 31%
Carbs 5%
Phosphorus 152%

BFF play chicken & duck destiny
Protein 32%
Carbs 5.10%
Phosphorus 163%

BFF play chicken & beef best buds
Protein 33%
Carbs 5.30%
Phosphorus 175%

Don't know if your kitty likes pate but here is the list of the BFF line.
YOU WANT CARBS UNDER 10% AND PHOSPHORUS IDEALLY LOW 200's OR LESS

Also

https://www.amazon.com/Weruva-Focus...cphy=9003521&hvtargid=pla-1796056536677&psc=1

I know you can buy single cans of the BFF I listed at Petco, Petco, to see which ones your kitty likes , the Focused one not to sure

 

[Kili]

It seems from the past 2 replies that there is no need to "feed twice a day".

HOWEVER... it seems like you have to still have 2 relatively larger meals to plan your insulin shots. Considering one pouch of wet food comes in at 89g... How much is enough food to be considered big enough prior to insulin injection?
Also, my cat is temperamental and doesn't always eat when you require him to in order to plan the insulin shots. I feel this is the biggest hurdle for me. My biggest fear is if my cat has hypo.
Considering insulin shots have to be around the same time daily, twice a day... What if Ottie doesn't eat enough at the required time?

The other issue with my cat Ottie is that he is very sensitive to changes in his food. So giving him laxative is already a challenge, and requires great effort to trick him to eat it when mixed with his food.
That's why phosphorus binder could be a major challenge. I'm already very grateful that he seems to like the renal food wet.

BTW, we are in United Kingdom... so some products can be a challenge to get hold of, such as Miralax

 

[Ale & Bobo & Minnie (GA)]

Can you please tell us what insulin he’s on? We need to know that to answer your question about feeding since some are more forgiving than others.

 

[Ale & Bobo & Minnie (GA)]

I understand about pick eaters since Bobo is one and I’m also worried about how he’s going to do with the binder so it sounds like you’re going to prioritize the CKD over the diabetes as Eliz mentioned. That’s find if you want to keep him on the food he’s now. I don’t know if it’s right carb or not but you can see if you find it on this
FOOD CHART

 

[Elizabeth and Bertie]

BTW, we are in United Kingdom...

Waving to you from sunny Surrey!

 

[Kili]

Can you please tell us what insulin he’s on? We need to know that to answer your question about feeding since some are more forgiving than others.

At the moment, we do not know since we only got the diagnosis yesterday. We are due for an appointment with the vet on Monday, to go over how to inject, etc etc.

Feeling overwhelmed, I am frantically searching the internet for any further info since our vet seems very "textbook", and not imaginative so far.
Apparently in UK... only 2 types of insulin are administered (according to the internet). I believe they are the newer slower releasing one. So it's most likely Prozinc, but still not sure until appointment.

My vet so far has given me no indication that the Royal Canin renal food may cause problems with diabetes, and has dismissed my concerns over the laxative lactulose that may hamper his diabetes. I have even laid my views of whether Ottie may need more protein added to his renal food diet, but the vet dismissed that as not being necessary.

It almost seem like you have to be a vet to look after Ottie, but I'm sure I will learn. My concern as always is whether Ottie will cooperate and follow the necessary treatment. Going to the vet has always been a stressful event for both of us. Ottie always flips out once injected at the vet for his vaccination... But I'm hoping it's because it's at the vet. I really hope that Ottie doesn't freak out every time he has to have an injection... let alone his ears being pricked for blood glucose analysis.

 

[Elizabeth and Bertie]

At the moment, we do not know since we only got the diagnosis yesterday. We are due for an appointment with the vet on Monday, to go over how to inject, etc etc.

Feeling overwhelmed, I am frantically searching the internet for any further info since our vet seems very "textbook", and not imaginative so far.
Apparently in UK... only 2 types of insulin are administered (according to the internet). I believe they are the newer slower releasing one. So it's most likely Prozinc, but still not sure until appointment.

Oh, love... I hear you... And I totally understand how overwhelming this can feel at first... When my first diabetic was diagnosed I didn't even know cats could 'be' diabetic. And the diagnosing vet suggested I just have him PTS, just because he was diabetic...
But, I got online, and I found that there were people managing their kitties' diabetes just fine.... And you will be fine too....

Yes, regarding insulin in the UK, a vet is expected to prescribe a veterinary insulin first (other insulins can be prescribed later if necessary). And that means either Caninsulin or Prozinc.
Statistically it's 'slightly' more likely that your vet will prescribe Caninsulin. Caninsulin is an older insulin, and it was around for a long time when there was not much else available. So, many UK vets are used to using this, and will have it in stock because it's also routinely prescribed for diabetic dogs. ...Prozinc is newer. And slightly less than half of UK vets seems to be prescribing it as a first insulin. However, Prozinc is the preferred option for new cases (according to the RVC).
If the insulin that's prescribed first doesn't work well for your kitty then you should be able to switch to another insulin.

My concern as always is whether Ottie will cooperate and follow the necessary treatment. Going to the vet has always been a stressful event for both of us. Ottie always flips out once injected at the vet for his vaccination... But I'm hoping it's because it's at the vet. I really hope that Ottie doesn't freak out every time he has to have an injection... let alone his ears being pricked for blood glucose analysis.

Vet visits can be stressful for some kitties, for sure (I have three ex-ferals that are a complete nightmare!). But most day to day diabetes management can be done in the home environment.
Most cats will be just fine with insulin shots. These are just injected under the skin (often the scruff of the neck). And it's often the case that cats don't even feel it, especially if they're munching on a bit of food or eating a couple of cat treats.
And regarding testing blood glucose at home, 'most' cats can be tested, and 'most' people who try can learn to do it. Honestly! But, don't jump too far ahead too soon. Baby steps are fine... ...And remember to breathe...

Since your kitty isn't yet on insulin this is the perfect window of opportunity to switch to a lower carb diet - if you can...
The CKD food that you're feeding should have data on the pack (percentages for protein, fat, ash, fibre, and moisture). Here's a link to a carb calculator so that you can work out the 'percentage of calories from carbs' for that food:
https://balance.it/convert?fbclid=IwAR2xNMkabwGDL_b5pQqyD4Nrb19b4pJO0nWLg0bPjjWit_C3sJDgz9d4ACQ

 

[Kili]

We recommend low carb wet foods for diabetics. However - for cats already on insulin it's important to be testing blood glucose at home before reducing the carb content of the diet. Reducing the carb content of the diet can reduce blood glucose significantly in some cats, and the insulin dose may need to be reduced so as to avoid hypo.

I am puzzled as to what I can give Ottie since nearly all commercial cat food seems to be high on glucose. He is currently on Royal Canin Renal cat food (wet) at the recommendation by the vet. But that seems to have high glucose content (not sure though).
My vet doesn't seem fazed by this at all.

 

[Elizabeth and Bertie]

I am puzzled as to what I can give Ottie since nearly all commercial cat food seems to be high on glucose. He is currently on Royal Canin Renal cat food (wet) at the recommendation by the vet. But that seems to have high glucose content.
My vet doesn't seem fazed by this at all.

We have lots of low carb food options in the UK. See the link to the low carb food list in my signature for some ideas. If you're willing to buy online that will greatly increase your options.

 

[Ale & Bobo & Minnie (GA)]

What you’re feeling is completely normal and we’ve all been in your shoes not so long ago.

you want to look at carb content. Some carb is fine, you just want to stay under 10%, it doesn’t have to be 0%.

I echo what Eliz is saying. Prozinc is the better choice always. Caninsulin is called that because it was made for canines. It’s harsh and short acting, plus it does not last a full 12 hours and Ottie won’t be protected the entire day. Since you haven’t been given a prescription yet, I’d strongly encourage you to fight for prozinc and push back as much as you can. Some vets are flexible, some are not. I know you’re in the UK but maybe you may want to share the guidelines from the American Animal Hospital Assn for the treatment of diabetes in both dogs and cats. the AAHA no longer recommends Caninsulin/Vetsulin for treating feline diabetes. It doesn’t hurt to try.

you also don’t need to have curves done at the vet. Most cats are super stressed there so home testing really does help minimize that. Cats learn fast and by alway giving a low carb treat immediately after testing, both my cats became super cooperative and would actually look forward to all the attention and extra treats around test time.

This is what this place is amazing. Folks here have been doing this for 25+ years. Unfortunately most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments. Vets also get their information about nutrition from the big cat food manufacturers.

take a deep breath and keep in mind that feline diabetes is a marathon not a sprint. If we can handle it, you can too!

 

[Kili]

We have lots of low carb food options in the UK. See the link to the low carb food list in my signature for some ideas. If you're willing to buy online that will greatly increase your options.

Thank you for the list. I presume they are all low carb food options.
Now in relation to CKD... How would we manage that too. Are the list also low in Phosphorous? Is phophorous the only thing to look out for in CKD cats?

The vet has prescribed our cat with Royal Canin Renal diet... but it seems like it's inappropriate?

 

[Kili]

you also don’t need to have curves done at the vet. Most cats are super stressed there so home testing really does help minimize that. Cats learn fast and by alway giving a low carb treat immediately after testing, both my cats became super cooperative and would actually look forward to all the attention and extra treats around test time.

What kind of treats can Ottie have since he is a CKD cat with diabetes? Can he have any treats available at the local supermarket? Or is it doing more harm than good.

 

[Ale & Bobo & Minnie (GA)]

I give Bobo freeze dried treats but I’ll let Eliz talk about that’s available in the UK.

 

[Veronica & Babu-chiri]

What kind of treats can Ottie have since he is a CKD cat with diabetes? Can he have any treats available at the local supermarket? Or is it doing more harm than good.

Most of the treats are made with flour which makes them high in carbs and pretty high in phosphorus (which is bad for his kidneys) , but if you can find some freeze dried those are probably ok, or you could just give him some cooked or boiled ( or even microwaved) chicken or turkey pieces those would be low carb and most ( if not all ) cats like them to be honest Babu gets comercial human turkey breast that is sold in the delicatessen area of the supermarket, it is a bit high in salt but he only gets a few pieces ( 3 or 4 very small ones) so it really doesn't affect much and he just loooves it, I just made sure it was a brand that did not had added sugars or artificial flavors or something like that

 

[Veronica & Babu-chiri]

The vet has prescribed our cat with Royal Canin Renal diet... but it seems like it's inappropriate?

Most if not all of the renal diets are very high in carbs which makes them not diabetic friendly, royal cannin is especially high in carbs because they fill it with carbs to supply the calories (calories is not the same as carbs )they take out from the protein they take out to make it low phosphorus, It is recomended to use it only if the cat's CKD is really in the last stages which doesn't seem to be your cat's case even if the cat is not diabetic

 

[Veronica & Babu-chiri]

Now in relation to CKD... How would we manage that too. Are the list also low in Phosphorous? Is phophorous the only thing to look out for in CKD cats?

Regarding the food yes that is pretty much the most important thing to control for food for CKD cats, you want it as low in phophorus as possible to help his kidneys work as little as possible. Calcium and sodium contents (and maybe potassium) can become a problem as CKD progresses but are not usually something you would need to address at least not now (and maybe never )

 

[Veronica & Babu-chiri]

I have given him Lactulose 3ml daily (if possible) mixed with his food to help his constipation. Ottie is a 5.6kg cat.

Lactulose is made from the milk sugar lactose and it being a sugar it may have some effect in his glucose levels, not all cats (or people ) are affected by it but there's always a risk, I would use pumpkin as suggested if possible but if the problem continues I think Miralax would be a bit better to use, it is not the best thing after all the best would be not to have to use anything but sometimes you have to compromise a bit and Miralax works fine for cats with diabetes and CKD

 

[Kili]

Regarding the food yes that is pretty much the most important thing to control for food for CKD cats, you want it as low in phophorus as possible to help his kidneys work as little as possible. Calcium and sodium contents (and maybe potassium) can become a problem as CKD progresses but are not usually something you would need to address at least not now (and maybe never )

I'm so lost. Initially I thought I just had to psych myself to be able to give Ottie his daily insulin injections... But it seems as though even his renal diet that the vet has prescribed is no good either.
My biggest worry in the upcoming future is that my cat Ottie is not the most cooperative type as it is... I sincerely hope he can handle the treatment of his daily injections.

His renal diet that he is currently on (Royal Canin renal diet)... One day he doesn't mind it, and another day he just doesn't eat it. On top of that, I feel that it is causing him constipation, which makes him grouchy.
If he is not even eating his renal diet, how is he going to cope?

From the list that one of the members posted about widely available food in UK... there isn't too much information about Phosphrous levels, which would seem that the binders must be used...
BUT Ottie most likely will refuse to eat anything with something sprinkled on it.

The frustration that I have is that the vet seems totally amiss about renal diet even being a problem. As far as the vet is concerned, CKD is sorted out by renal diet, and the insulin injections will sort out his diabetes.
BUT from my time on this forum, it seems like that is not the case.

 

[Veronica & Babu-chiri]

My vet so far has given me no indication that the Royal Canin renal food may cause problems with diabetes, and has dismissed my concerns over the laxative lactulose that may hamper his diabetes. I have even laid my views of whether Ottie may need more protein added to his renal food diet, but the vet dismissed that as not being necessary.

Unfortunately a lot of vets seem to be more scared of CKD than diabetes which in my opinion is not quite the right approach since an uncontrolled diabetes can actually do more harm to the kidneys on the long run that what a diet that is a bit higher in phosphorus may do ( you could even control the phosphorus with a phosphorus binder if needed), neither of them is good I'm not saying you should disregard his CKD problem is more of dealing with both of them at the same time with the same importance and it can be done since there are foods that can address both issues, being low carb and low phosphrus you don't have to choose to treat one or the other

 

[Kili]

Lactulose is made from the milk sugar lactose and it being a sugar it may have some effect in his glucose levels, not all cats (or people ) are affected by it but there's always a risk, I would use pumpkin as suggested if possible but if the problem continues I think Miralax would be a bit better to use, it is not the best thing after all the best would be not to have to use anything but sometimes you have to compromise a bit and Miralax works fine for cats with diabetes and CKD

At the moment, it seems like even the lactulose is not helping enormously with this poo situation. Would pumpkin provide enough of fibre to do the trick.
I have even tried giving him psyllium husk, but so far it's a real battle to get him to eat that with his food. Lactulose worked for a few days, but now it's very difficult to get him to have it with his food.

We live in the UK, and Miralax is not something that is easily obtainable.

 

[Veronica & Babu-chiri]

His renal diet that he is currently on (Royal Canin renal diet)... One day he doesn't mind it, and another day he just doesn't eat it. On top of that, I feel that it is causing him constipation, which makes him grouchy.
If he is not even eating his renal diet, how is he going to cope?

One very important thing for any cat is that they eat so the most important thing on a diet is that they actually eat it the perfect food is no good if the cat doesn't like it and doesn't eat it

 

[Veronica & Babu-chiri]

At the moment, it seems like even the lactulose is not helping enormously with this poo situation. Would pumpkin provide enough of fibre to do the trick.

Yes pumpkin would probably do the trick

We live in the UK, and Miralax is not something that is easily obtainable.

I live in Mexico and Miralax is not really available either, but you could probably look for the generic polyethylene glycol under another brand and I actually dissolve it with a little bit of water ( about 2ml) and give it to my cats with a syringe twice daily so that I do not have to mess with their food which they do not like much like Ottie

 

[Veronica & Babu-chiri]

From the list that one of the members posted about widely available food in UK... there isn't too much information about Phosphrous levels, which would seem that the binders must be used...
BUT Ottie most likely will refuse to eat anything with something sprinkled on it.

Most phosphorus binders are totally tasteless so he won't even notice you added it but if you can get him to eat a low phosphorus diet, the phosphorus binder will be a problem to address down the row not now.

The frustration that I have is that the vet seems totally amiss about renal diet even being a problem. As far as the vet is concerned, CKD is sorted out by renal diet, and the insulin injections will sort out his diabetes.
BUT from my time on this forum, it seems like that is not the case.

I could only wish both issues were as simple as that, and I wish I could tell you that is true but no it is not that easy, but that doesn't mean it can not be done and it gets easier once you have sorted out things starting is the hardest part.

You will need to change his diet and for that take into consideration that he has to like his new food, you will need to start testing his blood glucose at home as well as give insulin to control his diabetes and you will probably need some blood tests done periodically to monitor his kidneys and eventually make some adjustments and give some extras like phosphorus binders, azodil and maybe some omegas and vitamins for example but that will be latter on first you just need to start with the basic changing his food and giving insulin

 

[Ale & Bobo & Minnie (GA)]

I was just going to say that the binders are tasteless but Veronica beat me to it. And also about the food, I struggled with Bobo because he wouldn’t eat any of the CKD friendly foods. He literally would starve and not touch it and so after trying them all I gave up exactly because eating is more important than not eating for any cat. A diabetic cat that is not eating and not getting enough insulin is at high risk for ketones and no one wants that!

I know how wretched I felt until I came to terms that I had to put a pin on the CKD and treat the diabetes. My honest advice for you having been where you are now is to feed him what he’ll eat. I would consider going back to what you were feeding him before if that was low carb. What was he eating before the royal Canin? It would stop the constipation and the not wanting to eat on and off

 

[Kili]

Most phosphorus binders are totally tasteless so he won't even notice you added it but if you can get him to eat a low phosphorus diet, the phosphorus binder will be a problem to address down the row not now.

Most foods don't give any indication of phosphorous levels. One of the members sent a list of food available in UK that are low carb, but not sure about the how to find low phosphorous as well. Any suggestions?

It seems that often to do the right thing for your cat, you have to go against the advice of your own vet. It's almost as if you have to be the vet for your cat.

Like I mentioned previously, the vet suggested my cat to be put on the Royal Canin renal diet. But for whatever reason, since this diet... Ottie is constipated. A cat that poo like clockwork, has since stopped. Tried using laxative to help, but giving that to Ottie is increasingly a challenge. I'm so confused of what the right thing is.

 

[Kili]

Prior to Ottie's CKD diagnosis... Ottie used to eat canned food from Encore.
Does anyone know if this cat food is high in phosphorous?

 

[Ale & Bobo & Minnie (GA)]

What a lot of us do is either go on the food manufactures website and search for the nutrition info or if it’s not listed, reach out to, as in call or email, the food manufacturer and ask about carb and phosphorus content. The food chart does list phosphorus but I’m not sure about the UK list. Here in the US, I also look them up on Chewy because under questions, most of the time someone has already asked that and Chewy will reach out to the manufacturer, get the answer, and post it. Sorry, you do have to be a bit of a detective to figure it out.

 

[Nimi S]

Prior to Ottie's CKD diagnosis... Ottie used to eat canned food from Encore.
Does anyone know if this cat food is high in phosphorous?

Hi, for Encore you can try searching for older posts by typing Encore in the search bar here. I tried doing it and a lot of the posts mentioned that while Encore is a good food/brand, it is not nutritionally complete and may be given as a complementary food/treat.

Ale has also offered a good suggestion of writing/calling the food manufacturer for more details. Some are kind enough to reply back.

My cat Shen does not have CKD but during his early days of diabetes diagnosis I had been worrying and reading up about CKD too.
Had come across this link to a list of feline CKD food compiled by a member of the Feline CKD Facebook Group. Page 29 has Europe/UK Cat Foods. I've attached the pdf too. It doesn't have recommendations per se but does list various brands and flavors along with the % details (carb, fat, phos etc). Hope it helps!

 

[Kili]

WHICH OPTION WOULD YOU CHOOSE?

As you already know... our beloved Ottie has CKD and has diabetes.
The biggest issue appears that the solutions to both these conditions tends to oppose each other.

OPTION 1
To feed Ottie with a manufacturer that produces food with high protein, and low carbs.
Then combine the diet with phosphorous binders.

OPTION 2
My vet proposes to put Ottie on Royal Canin renal diet
Carb controlled by insulin injections.

OPTION 3
Half the diet will be Royal Canin renal diet
The other half will be food with high protein, low carbs + phophorous binders.
(essentially combination of option2 + option3)

Some say that it is more important to control the diabetes first, then CKD...
I do not know what to do...

Is the only benefit of renal food from manufacturers simply food that is low in phosphorous?

 

[Ale & Bobo & Minnie (GA)]

Only you know your cat and what decision would be best for him.

I personally went with option #1 because as I already shared, Bobo wouldn’t eat any of the other foods and it’s more important he eats than anything else. A diabetic cat that is not eating is at high risk for ketones which are life threatening. So that’s the choice I made for him since CKD takes years to progress and I can add a binder once we get to a later stage

Interestingly enough, his numbers had improved at his last checkup which was puzzling for me since I thought CKD only got worse not better.

 

[Kili]

Only you know your cat and what decision would be best for him.

I personally went with option #1 because as I already shared, Bobo wouldn’t eat any of the other foods and it’s more important he eats than anything else. A diabetic cat that is not eating is at high risk for ketones which are life threatening. So that’s the choice I made for him since CKD takes years to progress and I can add a binder once we get to a later stage

Interestingly enough, his numbers had improved at his last checkup which was puzzling for me since I thought CKD only got worse not better.

This is getting even more confusing. On the website about CKD https://www.felinecrf.org/which_foods.htm#therapeutic_diets
It seems to imply it's best to keep your cat on therapeutic renal diet (like Royal Canin renal diet), but then does this indirectly create problems for his diabetes?
This is the real kicker... the solution to CKD seems to directly conflict with the solution for diabetes. It's like you're stuck between a rock and a hard place.

What is more important to control? CKD or diabetes?
And even then... is it no good to depend on insulin to control his diabetes?

The issue I have now is that Ottie started off great on renal diet. Seem to come back to life for a bit... but now it's going to other way. Ottie is not as keen as he used to be on the renal diet... and he doesn't seem that lively, and now constipated.

 

[Ale & Bobo & Minnie (GA)]

I feel like you’re asking the same question over and over again expecting a different answer? I told you what I opted for Bobo, beyond that, I’m not sure what I can or anyone else can tell you. Not sure what else you’re asking us? It’s one thing to have a CKD cat and it’s another to have one that also has diabetes. Bobo wasn’t diabetic when he was diagnosed so I tried all the prescription foods and all the other ones as well. Once he became diabetic, I decided to prioritize that and give him low carb foods. What I said to his vet and she 100% agreed with me is that the most important thing above all else is that he eats. He’ll continue to eat his regular food and when the need comes to add a binder, I’ll do that.

Is it not good to use insulin to control diabetes? Is that your question? The only way to control diabetes is with insulin. That’s how I got Bobo into remission. Food and insulin. Not treating the diabetes can lead to many other horrible health issues, like neuropathy, blindness, starvation and ketosis, to name a few, a regulated diabetic cat can live a perfectly healthy life.

 

[Nimi S]

This is getting even more confusing. On the website about CKD https://www.felinecrf.org/which_foods.htm#therapeutic_diets
It seems to imply it's best to keep your cat on therapeutic renal diet (like Royal Canin renal diet), but then does this indirectly create problems for his diabetes?
This is the real kicker... the solution to CKD seems to directly conflict with the solution for diabetes. It's like you're stuck between a rock and a hard place.

What is more important to control? CKD or diabetes?
And even then... is it no good to depend on insulin to control his diabetes?

Here’s a link to another page on the felinecrf.org website which explains how to manage the diet of a cat who has both conditions - diabetes as well as CKD. The overview at the beginning mentions

• “It is not uncommon for a CKD cat to also have or develop diabetes.

• The dietary needs of a diabetic cat may seem incompatible with the needs of a CKD cat but the diabetes must take precedence.”

Scroll down to the bottom of the page on that link and you’ll come to a section called “Diet for Cats with Diabetes and CKD” which gives some guidance on that topic.


ETA: A small part from the above mentioned section says “Understandably, many people find it confusing trying to decide if a food is suitable for a cat with both CKD and diabetes. The simplest thing is to aim to feed a food with less than 10% carbs (ME) and as low a protein and phosphorus level (DMA) as your cat will eat. If necessary, add phosphorus binders.”

The guidance seems pretty straightforward.

 

[Ale & Bobo & Minnie (GA)]

@Elizabeth and Bertie @Veronica & Babu-chiri maybe you can shed additional light here?

 

[Kili]

I feel like you’re asking the same question over and over again expecting a different answer? I told you what I opted for Bobo, beyond that, I’m not sure what I can or anyone else can tell you. Not sure what else you’re asking us? It’s one thing to have a CKD cat and it’s another to have one that also has diabetes. Bobo wasn’t diabetic when he was diagnosed so I tried all the prescription foods and all the other ones as well. Once he became diabetic, I decided to prioritize that and give him low carb foods. What I said to his vet and she 100% agreed with me is that the most important thing above all else is that he eats. He’ll continue to eat his regular food and when the need comes to add a binder, I’ll do that.

Is it not good to use insulin to control diabetes? Is that your question? The only way to control diabetes is with insulin. That’s how I got Bobo into remission. Food and insulin. Not treating the diabetes can lead to many other horrible health issues, like neuropathy, blindness, starvation and ketosis, to name a few, a regulated diabetic cat can live a perfectly healthy life.

Maybe I have not read your prior message properly, but this message that included a bit of your history with Bobo made things much clearer.
I understand that everyone has to make the right decision for their cat... but being inexperienced, it often feels like stabbing in the dark, with not many clear, definitive answers.
I feel like if I make the wrong decision, my cat will get worse and might even expire. All these decisions are quite overwhelming.

In a way, I wish my vet gave me similar clear indications. Like I indicated previously... my vet seems to think that renal diet should be followed to cater for CKD, and seems unfazed by the additional carbs that it contains.
My vet seems to think that the carbs in renal food doesn't matter because you're taking insulin shots.

I'm not sure whether you can understand my confusion... but to have contradicting advice from your own vet that insists on renal diet to treat CKD...
When logically it doesn't seem to make much sense of a diabetic cat eating more carbs. The vet seems to indicate renal food as the best choice for CKD, which to someone inexperienced, sounds scary.
When you have no idea what's best for your cat... choices are always hard to make.

 

[Ale & Bobo & Minnie (GA)]

I get that. I had to start ignoring my vet’s advice and only when I did that, I got Minnie regulated. Unfortunately most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments. Vets also get their information about nutrition from the big cat food manufacturers so they are biased in what they recommend. A high carb diet is not good for any cat, especially a diabetic cat. That’s like feeding your diabetic child pasta, ice cream and sweets. To me, it was a matter of deciding what was here and now that I needed to get a handle on quickly and that was the diabetes since the CKD takes years to progress. If you can find that your cat likes foods that are both CKD and diabetic friendly, that’s obviously the best case scenario. I couldn’t. I wrote to a dozen companies and asked for samples and Bobo turned all of them down. I tried every brand at the pet store, same.

You’re at the beginning of this journey so it’s completely natural to feel overwhelmed. You want someone, aka your vet, to just give you the right advice and tell you what to do so you can just do it. But the reality is you’re going to have to do a lot of research so you can become an expert at what the health issues your cat has because that’s the only way you’ll feel sure about what you decide to do. You’ll likely have to try different things till you can safely decide the best course of action. We can only tell you what worked for our cats, but every cat is different. My advice to you would be to find the UK foods that are good for both CKD and diabetes and try it out to see if he’ll eat any or some of them. This is a journey and you don’t have to know everything and decide everything right this minute. I went through plans A, B, C, D, till I got it all down.

 

[Ale & Bobo & Minnie (GA)]

Been meaning to say Ottie is a cutie. Please give him a few squeezes for me

 

[Kili]

Been meaning to say Ottie is a cutie. Please give him a few squeezes for me

Thank you for your support. Your comment almost made me cry.
Fortunately, Ottie is less picky compared to Bobo, but still picky nonetheless.

I will have to find the courage to make the decisions eventhough it goes against the vet's advice. At the moment, everything sounds like a death setence, but I will have to find strength to believe that I can fix this.
It is certainly a lot to learn, and hopefully nothing I do will cause lasting harm to my Ottie, and in fact actually make him better.

Do you have any preference of phosphorous binders? I hope that these binders will help with the CKD. Why do some say that phosphorous binders aren't entirely necessary until later stages? Ottie is early stage 3, so I presume he definitely requires it.
I was looking at Ipakitine... but it seems like it's not ideal if your cat has elevated calcium levels. Ottie's calicum levels were 2.7 mmol/l in a range of 1.6-3.0

What I find hard to understand is that Ottie's Phosphate levels came in at 1.7 mmol/l in a range of 0.7 - 2.1... So he doesn't seem high... but yet he has CKD with Creatinine levels of 302 and Urea of 20.8 which are both very high.

Did you by any chance also have to deal with constant constipation?
Ottie has always done a poo like clockwork, until his diet was changed to renal food. On the renal food, he is constantly constipated. I wonder if this will remain the same with phosphorous binders.

 

[Ale & Bobo & Minnie (GA)]

Bobo is still in stage 2 so I haven’t needed it just yet. I think someone on this thread said Ottie isn’t either? Not sure, I’d have to look back. That is something I’d hope your vet would be able to advise you on. I’ll defer to the other CKD pros on this thread.

Minnie had severe neuropathy to where she couldn’t jump anymore or even go in and out of the litter box. This place saved her life because once I got her regulated, she recovered almost completely. The vet just kept saying at the most she’d get 30% of her mobility back. So, I trust the advice I get here always over the vet’s. I’ll actually get all my second opinions here. The vet said to do this what do you guys think? I made all the mistakes with her but then with Bobo I got it all right. You’re already way ahead of the game so just try to take it one day at time and know you don’t have to make all the decisions today now.

as fas as housekeeping, do you think you could create your signature? It really helps us to have all the info there instead of having to scroll all the way up and search through all the comments. We also try to keep the threads to 50 comments max so it may be a good idea to start a new one tomorrow. You can link this one at the top so folks can read all the pervious posts. Thanks!

 

[Bron and Sheba (GA)]

I will have to find the courage to make the decisions eventhough it goes against the vet's advice. At the moment, everything sounds like a death setence, but I will have to find strength to believe that I can fix this.

Hi and welcome to the forum.
You have been getting a lot of great support.
I just want to add a couple of things.
Many vets don’t know a lot about feline diabetes and are not up to date with the latest treatments. They have a lot of animals and diseases to get their heads around. Vets get their nutritional training from the big food manufacturers and always seem to promote their products over much more suitable foods.
You are paying the vet for advice…you pay the bills…you don’t have to take their advice. Remember you are Ottie’s advocate as he can’t speak for himself. Don’t just go along with what the vet says if you think it is not right, just because you don’t want to hurt the vets feelings. Your priority is Ollie and what is best for him

 

[Ale & Bobo & Minnie (GA)]

Sorry meant to answer before. No constipation for Bobo. Minnie had constipation and diarrhea occasionally but she had IBD not CKD. I gave her Miralax and fiber for constipation.

 

[Chrispooky12]

Hi & welcome. My boy hasn't been diagnosed with CKD but his last bloodwork is pointing towards it, but he was sick at the time of his bloodwork so that could have been why his numbers were high. I've been trying to feed him 100% Weruva BFF line that is in the comments above but he won't always eat it so he's also eating fancy feast. I wanted to address your baby's constipation. I started my boy on Mirilax (I know you said that's not available where you live) it helped him but he was still having a hard time going, I would cry for my boy because he was having such a hard time & I didn't know what to do. A member here suggested slippery elm with bark( not sure if it's available where you live) once I started giving it to him a couple of days later he was no longer constipated it was a game changer for him. I mix a little under 1/4 of a tsp of beechnut beef baby food with it than mix in a tablespoon of water & him my other boy not diabetic eat it right up. I give a little under 1/4 of a tsp so I can give a little to my other boy because it also helps with stomach upset & digestion. They have it once every other day & Mirilax once during the am cycle the same day as the slippery elm, then the other day they have Mirilax 2xs a day on both the am & pm cycle. If you look on my spreadsheet in the comments it makes more sense. I hope you get everything figured out & get your baby on the right track. We are all here for you lots of hugs Christina Panzer & Spook

 

[Kili]

Hi & welcome. My boy hasn't been diagnosed with CKD but his last bloodwork is pointing towards it, but he was sick at the time of his bloodwork so that could have been why his numbers were high. I've been trying to feed him 100% Weruva BFF line that is in the comments above but he won't always eat it so he's also eating fancy feast. I wanted to address your baby's constipation. I started my boy on Mirilax (I know you said that's not available where you live) it helped him but he was still having a hard time going, I would cry for my boy because he was having such a hard time & I didn't know what to do. A member here suggested slippery elm with bark( not sure if it's available where you live) once I started giving it to him a couple of days later he was no longer constipated it was a game changer for him. I mix a little under 1/4 of a tsp of beechnut beef baby food with it than mix in a tablespoon of water & him my other boy not diabetic eat it right up. I give a little under 1/4 of a tsp so I can give a little to my other boy because it also helps with stomach upset & digestion. They have it once every other day & Mirilax once during the am cycle the same day as the slippery elm, then the other day they have Mirilax 2xs a day on both the am & pm cycle. If you look on my spreadsheet in the comments it makes more sense. I hope you get everything figured out & get your baby on the right track. We are all here for you lots of hugs Christina Panzer & Spook

I'm quite concerned with my boy Ottie and his constipation. He seems to struggle, and for a cat that never had problems prior to renal diet, it's hard to watch.
To help him so far, I give him 3.5ml of Lactulose and 1/8 of a teaspoon of psyllium husk daily. In the past 3 days, he has only managed to have one pebble.
Previous week, the lactulose helped, and he managed to produce a single sausage 3 times and a few pebbles inbetween. This week, it's not helping.

I am going to give the pumpkin a try... but this is very much dependent on whether Ottie will cooperate. I think his bunged upness is making him grouchy. But at least his appetite is unchanged.

 

[Ale & Bobo & Minnie (GA)]

I think you can also try to increase the fiber to x2 a day. No miralax in the UK huh?

 

[Veronica & Babu-chiri]

Ok sorry I did not answer right away but weekend was a bit of a caos at home, I'm going to try and answer as best as I can and comment on what you have been discussing

I will have to find the courage to make the decisions even though it goes against the vet's advice. At the moment, everything sounds like a death setence

Hang in there I know that at the moment everything seems like a lot and very complicated but seriously it gets better once you start dealing with it and very importantly both diabetes and CKD are treatable they do NOT mean a death sentence,

Cats can leave long happy lives with both illness, you just have to treat both not one or the other. Babu is 20 years old and has been living with both of them for many years now (over 6 years) and I have a 17 years old girl that has been living with kidney desease for almost 16 years now so don't lose hope yet.

WHICH OPTION WOULD YOU CHOOSE?

As you already know... our beloved Ottie has CKD and has diabetes.
The biggest issue appears that the solutions to both these conditions tends to oppose each other.

OPTION 1
To feed Ottie with a manufacturer that produces food with high protein, and low carbs.
Then combine the diet with phosphorous binders.

OPTION 2
My vet proposes to put Ottie on Royal Canin renal diet
Carb controlled by insulin injections.

OPTION 3
Half the diet will be Royal Canin renal diet
The other half will be food with high protein, low carbs + phophorous binders.
(essentially combination of option2 + option3)

I would have to say that ideally I would not choose any of them I would go for the option where you give a low carb low phosphorus diet, that's what I actually did even though there were no comercial options where I live so I started home cooking the food to meet both criteria, but luckily for you for what I've heard there are some options in the UK , you probably just have to do some research to find them

But if forced to choose I would go with option 1 Why? Because that option will actually help you deal with the diabetes and that will be a good start, as I mentioned you can deal with the phosphorus issue later on considering that his phosphorus levels are still with in range which makes the issue not terribly urgent, not that you won't have to, considering his creatinine levels, but not right away in an urgent matter

Well Option 2 will get his diabetes out of control and make it really really hard to regulate, and quite frankly uncontrolled diabetes will affect Ottie much more in the short term than CKD could, uncontrolled diabetes can go really fast into ketones and those are really life threatening and even if that didn't happened Ottie will keep on losing weight, feeling really bad and that will end in you more complications a lot sooner than CKD, CKD is bad there is no other way to put it but, it usually evolves more slowly than untreated diabetes.

Regarding Option 3 with that you will actually be as you are right now, not really addressing either one of Ottie's problems which will get you into more complications and with food he doesn't like and does not eat

I'm quite concerned with my boy Ottie and his constipation.

If he was not having constipation problems before the diet change, I would consider going back to his previous diet that he likes and does not give him any problems until he gets regular again, and in the mean time research what options you have available over there maybe even buy a can of what ever options you find and slowly start to changing his diet to a more appropriate one.

Do you have any preference of phosphorous binders? I hope that these binders will help with the CKD. Why do some say that phosphorous binders aren't entirely necessary until later stages? Ottie is early stage 3, so I presume he definitely requires it.

Actually phosphorus binders depend more on the phosphorus levels than on the creatinine and Ottie's phosphorus levels are not ideal but not critical yet so that gives you a bit of time to settle into a new diet and after the diet change is complete think about starting with the phosphorus binder, who knows maybe if his new diet is low in phosphorus you may not even need the phosphorus binder ( although with high levels of creatinine is best to keep phosphorus levels low so in very critical cases you may need it but I don't think that is Ottie's case)

I was looking at Ipakitine... but it seems like it's not ideal if your cat has elevated calcium levels. Ottie's calicum levels were 2.7 mmol/l in a range of 1.6-3.0

It's true since Ipakitine is calcium based so not good for calcium levels it has a sort of a seafood smell that many cats and dogs do not like and quite frankly in my experience ( with my dog ) it is not really very effective, most people use aluminium hydroxide but it is not available in Mexico so I use Renvela and it has worked really well in both my CKD cats (actually in my 3 CKD cats but that's another story) and some people are using Vitamin B3 and seems to work ok too


I hope all this suggestions help, in the end it is you who has to decide what to do, I'm not really sure how open your vet is to discussing all of it even if is not his usual approach some vets are open to listen to new ideas so maybe you could try and discuss it with him with all this new information but more importantly don't loose hope there are many options of what you can do to help Ottie

 

[Kili]

UPDATE

Ottie finally managed to poo an ok amount on Sunday 09-JUL. Watching my boy struggle, I was filled tears of joy when he finally pooped. It sounds silly how a good poo can bring tears.

Went to the vet today to discuss further the diabetes issue... and the vet prescribed Prozinc (1 unit). We discussed that we will be putting Ottie on a low carb diet (below 5%) from now on, and hence starting low on insulin dosage. My biggest fear about injection was Ottie going hypo... but according to the vet, it seems it happens gradually rather than suddenly... giving plenty of time to react to the situation. By gradually I mean across 2 hours. Is this true?

It was quite overwhelming to learn the injection procedure... and I'm still yet to do my first injection on Ottie, but I hope Ottie will not feel it. I am hoping that I can beat the diabetes on diet alone eventually... but that's my hope only for now.

I still think that monitoring Ottie's blood glucose level by pricking his ears will be a challenge and most likely Ottie will hate me for it and run whenever he sees me. With so much of the pricking of the ears... Doesn't their ears get swollen and painful?

Battle still continues with his diet where Ottie is constantly suspicious of his food, because of the things I put in it to help him... such as the phosphorous binder (Ipakitine) as well as Lactulose to help him with constipation.
Sometimes it would be helpful if Ottie was a little dumb... but unfortunately he is far too clever for his own good. I'm not sure if Ipakitine is a good choice, but one that was recommended by the vet. The vet is not really knowledgeable when it comes to the different Phosphorous binders... but in my keeness to get Ottie going... I have opted for Ipakitine for now. Has anyone in UK got good suggestion on aluminium hydroxide equivalent?

I know that money is the last thing you think about when it's your beloved... but it is amazing how much they rip you off for the simplest of things at the vet. Ipakitine was charged at £37 for 60g bottle, when on Amazon it's £14.56.