Weight loss in regulated cat part 5

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Waheeda

Member Since 2017
Hi @Yong
At BG 214, I gave him 1.2u his +4 reading is mid 171. But this morning at BG 209, I gave him 1.4u, he went low. Doesn't it mean for this BG range, I should give him 1.3u? Lol! I don't know how to do that cos my u-100 syringe has no half point mark so I'm already eyeballing every 0.2. If I were to reduce to 1u as your suggestion, won't he be going high? Is my reasoning logical?
 
209 and 214 are kind of the same number...
The idea behind lowering is we don't want him to go as low as 47 and have to be steered. I think I made another suggested scale on end of part 4.
170 - 220: 1.0U
>220: 1.2U
 
209 and 214 are kind of the same number...
The idea behind lowering is we don't want him to go as low as 47 and have to be steered. I think I made another suggested scale on end of part 4.
170 - 220: 1.0U
>220: 1.2U
Yup the 2 numbers are close, so I thought if 1 makes him go low while the other makes him a bit high, I thought we meet halfway. So that's not how it works :banghead:
But u are lowering to avoid the lime green numbers. Ok got it! Will try. Thanks!
 
Hi @Kris & Teasel @Yong @JanetNJ
Can help take a look at my SS?
I thought we were doing well with the dosage, staying mostly in the blues. But this morning he bounced but dropped down in the blues and had a low pmps. No shot was given which I really don't like to do cos he'll be high tmr. Where did I go wrong? How do I adjust the dose?
 
Here's my take on it: you've used a sliding scale and it's helped. However, my thinking when things go wonky is to revert to consistent dosing for a bit to see if that will help to calm him down. I suggest you try 1 u both AM and PM for a few days to see if that approach helps.
 
Here's my take on it: you've used a sliding scale and it's helped. However, my thinking when things go wonky is to revert to consistent dosing for a bit to see if that will help to calm him down. I suggest you try 1 u both AM and PM for a few days to see if that approach helps.
1u regardless of his pre shot values? Even below 200?
 
1u regardless of his pre shot values? Even below 200?
Sorry - I should have been clearer. When he gives you at least your lowest to shoot number (170?) give 1 u. If he's above that at PS, give 1u. I see that that you've alternated higher with very small doses or NSs. This suggests to me that a middling dose that can be given both AM and PM is worth trying. The goal is to even out the PSs somewhat to get away from such different AM/PM doses or NS at one dose time.
 
Sorry - I should have been clearer. When he gives you at least your lowest to shoot number (170?) give 1 u. If he's above that at PS, give 1u. I see that that you've alternated higher with very small doses or NSs. This suggests to me that a middling dose that can be given both AM and PM is worth trying. The goal is to even out the PSs somewhat to get away from such different AM/PM doses or NS at one dose time.
We were having similar amps and pmps few days ago. It's only 2 days back it gets wonky!
What do you mean by middling dose? Sorry if I'm asking dumb questions.
My boy's weight is also worrying me. Weighed him at the vet and he gained like 0.01kg since April! I'm trying to figure out what to do.
 
We were having similar amps and pmps few days ago. It's only 2 days back it gets wonky!
What do you mean by middling dose? Sorry if I'm asking dumb questions.
My boy's weight is also worrying me. Weighed him at the vet and he gained like 0.01kg since April! I'm trying to figure out what to do.
I'm calling 1 u a middling dose. If he's gaining weight and is getting too heavy, you'll have to cut back on food, especially the dry YA (if you still feed that) - it's very calorie dense.
 
I'm calling 1 u a middling dose. If he's gaining weight and is getting too heavy, you'll have to cut back on food, especially the dry YA (if you still feed that) - it's very calorie dense.
I see. So it's 1u for 170 onwards. I do shoot at 140-170 too. 1u will be too much for that values. What do you suggest I shoot?
His weight is stagnant! Not gaining since last weighed at the vet in April. But then again I suspect he probably would have lost some more in April to May cos his BG was in 300's.
 
I see. So it's 1u for 170 onwards. I do shoot at 140-170 too. 1u will be too much for that values. What do you suggest I shoot?
His weight is stagnant! Not gaining since last weighed at the vet in April. But then again I suspect he probably would have lost some more in April to May cos his BG was in 300's.
OK. Don't shoot if BG is between 140 and 170. Only shoot if it's 170 or higher and then give 1 u. This is a standard way of giving insulin. Sliding scale is a more advanced technique. Problem is, the higher doses are driving his BG down low enough that it's either a NS or much smaller dose next cycle. Then the opposite happens - small dose or NS causes BG to rise, along with any bouncing caused by the low BG. When a problem arises it's sometimes best to go back to basics for a bit. That's why I suggested a consistent 1 u assuming PS is above 170. The goal is to try to even out some of the ups and downs.
I see. So it's 1u for 170 onwards. I do shoot at 140-170 too. 1u will be too much for that values. What do you suggest I shoot?
His weight is stagnant! Not gaining since last weighed at the vet in April. But then again I suspect he probably would have lost some more in April to May cos his BG was in 300's.
Sorry, misunderstood the weight issue. If he needs to gain, feed him more. More FF, more small meals, etc. You're right though, getting better control of BG is key.
 
ok so it's back to 1u twice a day. Any other views @Yong @JanetNJ ?
I dread to think how high he'll go tmr amps. On top of no shot, double stress at the vet.
 
ok so it's back to 1u twice a day. Any other views @Yong @JanetNJ ?
I dread to think how high he'll go tmr amps. On top of no shot, double stress at the vet.
You can try it. I've always been a pretty aggressive dose. If it were my cat I would have done a Skinny 0.5 on that 128 (equivalent to about a 160 on my alphatrak)provided I could test... But I would be hesitant to suggest it to someone else because I would feel aweful if they had to deal with a hypo because of my advice.
 
Hi @Kris & Teasel @Yong @JanetNJ
Can help take a look at my SS?
I thought we were doing well with the dosage, staying mostly in the blues. But this morning he bounced but dropped down in the blues and had a low pmps. No shot was given which I really don't like to do cos he'll be high tmr. Where did I go wrong? How do I adjust the dose?
Hi Waheeda!
I like the suggestion of trying 1.0U BID. We have another Vetsulin kitty that we're trying to switch to consistent dosing instead of sliding scale as well. So things may still look a little wonky when starting it out but be patient. Jebat definitely seems to be saying he doesn't need as much insulin :cat:. Let's try giving 1.0U as long as PS is over 200 and when if he gives 170 - 200 while starting this new consistent dosing, skip the first time, get a before bed test to see how he's doing on his own. If he does go up, then next time we'll try 0.25U between 170-200 if you'll be there to monitor him for a bit :). He's looking good!
 
You can try it. I've always been a pretty aggressive dose. If it were my cat I would have done a Skinny 0.5 on that 128 (equivalent to about a 160 on my alphatrak)provided I could test... But I would be hesitant to suggest it to someone else because I would feel aweful if they had to deal with a hypo because of my advice.
I was thinking of just a 0.1 or 0.2 cos he usually runs slightly higher at night. But couldn't try as I had a funeral to attend. Won't be able to test him at critical +3 onwards. I'll be so worried if he's not monitored.
 
Well, without any insulin last night he's 205 at amps! What a surprise! I was expecting a high 300.
So I'll experiment the 1u for the next few cycles. I'm confident 1u is gd enuf in the morning but he tends to run higher at night. We'll see.
Thanks @Kris & Teasel @Yong @JanetNJ

The vet was trying to push the prescriptive wet food to help him put on some weight. Have any of you tried it? I know it's pricey but I won't mind trying if it's good. I can mix it with FF cos he loses interest in FF if I give him that whole day.
 
Honestly, the YA should help him gain weight. :) Maybe you could do FF for meals and the Burp for during the cycle foods?
The naughty boy doesn't consistently eat YA. Some days he eats quite a bit and some days he doesn't. But surprisingly he has finished a whole bag in 2 months. Ya will giv him FF twice daily and see how it goes.
 
Morning!
Jebat is doing well last few days. Yesterday pmps he was hovering around 120. I know I'm not supposed to shoot but I did. A tiny dose I could hardly see in the syringe. I was nervous the next few hours hoping he won't go low. Thankfully he stayed flat. Do you know why he's always flat at night. No curve. Based on last night, do u think it's safe for me to shoot a bit more at 120? Mayb a skinny 0.2? I definitely won't shoot at amps cos he tends to drop more in the morning but I think he can handle it at night. Your thoughts ?
 
Hi @Kris & Teasel @JanetNJ @Yong
Not a good day today. Just came back from the vet. Jebat is having kidney failure too. And he's anaemic and high amylase which is an indicator for his pancreas. I have attached his blood test. We are going for ultrascan on Thursday as his abdomen is a bit bloated and vet wanted to check his pancreas. He'll have sub q of 100ml daily and is on iron tablet. I feel like crying now. My poor boy!
Any tips on his diet? Cos diabetes and kidney failure food is opposite of one another. What do I do?
 

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I'm so sorry for double bad news now, Waheeda! :bighug::bighug::bighug:
I'm going to tag @Marje and Gracie to have a look at your labs that you posted too. She'll be able to help know which stage CKD which can help determine phosphorus levels. Good news, you're not the first to have a sugar kitty with kidney issues :bighug:
 
I'm so sorry for double bad news now, Waheeda! :bighug::bighug::bighug:
I'm going to tag @Marje and Gracie to have a look at your labs that you posted too. She'll be able to help know which stage CKD which can help determine phosphorus levels. Good news, you're not the first to have a sugar kitty with kidney issues :bighug:
Thanks Yong! I'm feeling so depressed now. Hopefully no more bad news after the scan. Is the anaemia due to the kidney disease?
 
I feel like I've read something linked with anemia before :bookworm::bookworm::bookworm:. I'll have to dig around again, unless Marje knows :)
Just when I've managed to regulate his BG, this happens. He's doing so well lately and I was hoping to see the old jebat again.
 
Hi @Kris & Teasel @JanetNJ @Yong
Not a good day today. Just came back from the vet. Jebat is having kidney failure too. And he's anaemic and high amylase which is an indicator for his pancreas. I have attached his blood test. We are going for ultrascan on Thursday as his abdomen is a bit bloated and vet wanted to check his pancreas. He'll have sub q of 100ml daily and is on iron tablet. I feel like crying now. My poor boy!
Any tips on his diet? Cos diabetes and kidney failure food is opposite of one another. What do I do?
Sorry to hear that bad news. I see from the labs he's stage 2. This is about where my Zimmy was when we started sub q's. You may only have to do the sub q's daily until the pancreas settles, then a few times a week. Very anemic. In addition to the iron please give him Vitamin B12 Meth... My cat was boarderline at 29% HCT. I gave b12 for four weeks and the next time he tested he was at 42% and it had completely resolved itself. The other thing I noticed was the phosphorous is high. You want to try to keep that down under 5... so that means either finding a food low in phosphorous, OR adding a phosphorous binder to his current food. the best phosphourous binder is aluminium http://www.thrivingpets.com/index.php/aluminum-hydroxide.html.

The good thing is you caught this relatively early. Sub q's help a LOT. There's a great group on facebook called Cats with Chronic Renal Failure that can really help.
 
Sorry to hear that bad news. I see from the labs he's stage 2. This is about where my Zimmy was when we started sub q's. You may only have to do the sub q's daily until the pancreas settles, then a few times a week. Very anemic. In addition to the iron please give him Vitamin B12 Meth... My cat was boarderline at 29% HCT. I gave b12 for four weeks and the next time he tested he was at 42% and it had completely resolved itself. The other thing I noticed was the phosphorous is high. You want to try to keep that down under 5... so that means either finding a food low in phosphorous, OR adding a phosphorous binder to his current food. the best phosphourous binder is aluminium http://www.thrivingpets.com/index.php/aluminum-hydroxide.html.

The good thing is you caught this relatively early. Sub q's help a LOT. There's a great group on facebook called Cats with Chronic Renal Failure that can really help.
The vet did mention phosphorus binder in passing but didn't press for me to get it. I'll Chk with her on Thursday. What about the amylase level? His is out of the scale.
 
Thanks Janet. I'll ask the vet for vit b. Is YA low in phosphorus? He's only eating YA, FF classic and burp. I still can't get the info for burp but FF and YA should b ok? Cos I read that kidney disease can't take high protein. So diet wise do I take care of his diabetes or his kidney?
Actually protein is ok in these early stages. It does more harm then good to lower the protein at this point. That's an outdated idea. The YA zero mature is low in phosphorous at .5 (YOu want to keep it under 1) Fancy feast tends to be a little high in phosphorous BUT that doesn't mean you have to stop feeding it... it just means you sprinkle a little of the phosphorous binder in it. (no idea on the burp food). The phos binder the vet usually gives is mint flavor... not a favorite with cats. the one that I linked you is flavorless. a vitamin b shot at the vet won't help.. you need to get the oral one. I just bought it on amazon. I'm sure you can use Zobaline if you have it. I bought vitacost capsules and just opened them up and sprinkled on the powder.
 
Tanya who does that awesome CKD site also has a book out now... available on amazon. I was going to buy it when I lost Zimmy (not because of his kidney's... he acutally stayed in stage 2 for 2 years without much progression because of the fluid treatments.)
 
Actually protein is ok in these early stages. It does more harm then good to lower the protein at this point. That's an outdated idea. The YA zero mature is low in phosphorous at .5 (YOu want to keep it under 1) Fancy feast tends to be a little high in phosphorous BUT that doesn't mean you have to stop feeding it... it just means you sprinkle a little of the phosphorous binder in it. (no idea on the burp food). The phos binder the vet usually gives is mint flavor... not a favorite with cats. the one that I linked you is flavorless. a vitamin b shot at the vet won't help.. you need to get the oral one. I just bought it on amazon. I'm sure you can use Zobaline if you have it. I bought vitacost capsules and just opened them up and sprinkled on the powder.
Ok I'll get the phosphorus binder online. He's been taking zobaline for 2 mths for his neuropathy. Do I need to give him double dose?
 
Tanya who does that awesome CKD site also has a book out now... available on amazon. I was going to buy it when I lost Zimmy (not because of his kidney's... he acutally stayed in stage 2 for 2 years without much progression because of the fluid treatments.)
I've just joined the cdk group on Fb. Dey hv diabetic cats with cdk too?
 
There are low carb/low phos. foods. When I started feeding Zimmy BFF food his phos level went form 4.7 down to 3.9 in a month. So it might be worth a food change if you want to try that before trying the binder. If he is picky though, then keep feeding the ff and just give him the binder.
 
There are low carb/low phos. foods. When I started feeding Zimmy BFF food his phos level went form 4.7 down to 3.9 in a month. So it might be worth a food change if you want to try that before trying the binder. If he is picky though, then keep feeding the ff and just give him the binder.
We have very limited low carbs food over here. From the list, I can only find wellness core and one other brand. And he doesn't like them. I think the best would be the binder with burp. What's BFF food?
 
We have very limited low carbs food over here. From the list, I can only find wellness core and one other brand. And he doesn't like them. I think the best would be the binder with burp. What's BFF food?
best feline friends made by weruva
 
Waheeda, Zobaline is good for neuropathy and does have Methyl B12 but it doesn't have a lot in it. You could see if your Vet is ok with giving some additional Methyl B12 with Zobaline since that does have folic acid to help absorb it better. Not like you can really overdose him on B12 anyways, they pee out excess.
Bronx's Dad uses these: https://www.amazon.com/dp/B008NIHCZC/?tag=felinediabetesfdmb-20
If you can order them, you could add 1 of those with his Zobaline :)
 
Waheeda, Zobaline is good for neuropathy and does have Methyl B12 but it doesn't have a lot in it. You could see if your Vet is ok with giving some additional Methyl B12 with Zobaline since that does have folic acid to help absorb it better. Not like you can really overdose him on B12 anyways, they pee out excess.
Bronx's Dad uses these: https://www.amazon.com/dp/B008NIHCZC/?tag=felinediabetesfdmb-20
If you can order them, you could add 1 of those with his Zobaline :)
Thanks Yong! I'll order this online today. The vet didn't even talk about vit b. She was also quite clueless about food for diabetic ckd cat.
 
There are low carb/low phos. foods. When I started feeding Zimmy BFF food his phos level went form 4.7 down to 3.9 in a month. So it might be worth a food change if you want to try that before trying the binder. If he is picky though, then keep feeding the ff and just give him the binder.
The BFF food is so expensive if I order online! 1 can is like $20! I thk I will continue with his normal food n add in phosphate binder.
 
@Yong tagged me about the labs and I have a few different thoughts for you. I've had four CKD cats, three who were stable for several years and passed from something else.

First, elevated amylase in cats is insignificant; it's an indicator of pancreatitis in dogs, but not cats. The half Life of amylase is very short so levels can change frequently during the day. The ultrasound will help but the lab test for pancreatitis is the snapfPL if done right there in the vet's office or the specfPL if the labs are sent out. You might want to read my Primer on Pancreatitis for more info.

It's too soon for him to be on daily subq fluids if it's for the CKD. Until the creatinine is above 3.5, he should get as much fluid as possible from drinking water or from you adding extra water to food which will be tough with YA. If you can get the BFF or another canned food, you can add lots of water to it. Subq fluids are a treatment for pancreatitis but I'd want to be sure he has it before I started giving fluids esp daily fluids.

The reason I am cautious about fluids is because if there are any unknown heart issues, subq fluids can quickly overwhelm the heart. I always think it's best to have an echo done before giving longterm daily fluids.

Phosphorus control is critical in how the kitty will feel with CKD. I think it is one of the biggest priorities to longevity. Elevated P can really make kitty feel bad and if you multiply the P level by Ca (calcium), a result between 60 and 70 increases the risk of tissue calcification. He is there so that means you can't just get the P down by feeding a lower P food.

I would not feed a food that is higher in P and hope the binder will work if he will eat one that is lower in P because you have some work to do to get his P down and I think you will have to be aggressive. If he absolutely won't eat a lower P food, then your options are more limited.

While the most important thing is for him to eat, the lower P food you can get, the better but you will also need the binder because his target for P level is 4.5. I believe you are outside the US but I'm not sure where or what you have access to. The food tables (there are US and outside of US) from Tanya's will help you but also remember you need to keep an eye on sodium as well but, for right now, getting the P down is the priority. The renal prescription diets as the lowest P and are quite effective in getting it down but they are way too high in carbs.

You also can't just dump binder on food. I, personally, think aluminum hydroxide powder is the best one...it's tasteless and inexpensive. I used to buy mine at Thriving Pets which Janet also linked. Here is the discussion on Phosphorus control, binders, and dosing. If you need help on the dosing, pls let me know. The binder needs to be mixed into the food, allowed to sit a bit, and then fed. The binder binds the P in the food, not the cat.

Your vet should check his blood pressure. Many CKD cats have high BP and it can usually be controlled easily with a a drug like amlodipine although some cats require a combination of drugs.

And finally, because of his anemia, he does need B vitamins but not just oral methylB12. To properly address anemia, he also needs a multi B. The discussion on B Vitamins on Tanya's can guide you in what to buy based on your location.
It's also critical to address that anemia and get the drop to stop and hopefully increase the HCT. Once the HCT gets below 20%, more significant measures have to be taken.

Please tag me if you have questions.
 
T
@Yong tagged me about the labs and I have a few different thoughts for you. I've had four CKD cats, three who were stable for several years and passed from something else.

First, elevated amylase in cats is insignificant; it's an indicator of pancreatitis in dogs, but not cats. The half Life of amylase is very short so levels can change frequently during the day. The ultrasound will help but the lab test for pancreatitis is the snapfPL if done right there in the vet's office or the specfPL if the labs are sent out. You might want to read my Primer on Pancreatitis for more info.

It's too soon for him to be on daily subq fluids if it's for the CKD. Until the creatinine is above 3.5, he should get as much fluid as possible from drinking water or from you adding extra water to food which will be tough with YA. If you can get the BFF or another canned food, you can add lots of water to it. Subq fluids are a treatment for pancreatitis but I'd want to be sure he has it before I started giving fluids esp daily fluids.

The reason I am cautious about fluids is because if there are any unknown heart issues, subq fluids can quickly overwhelm the heart. I always think it's best to have an echo done before giving longterm daily fluids.

Phosphorus control is critical in how the kitty will feel with CKD. I think it is one of the biggest priorities to longevity. Elevated P can really make kitty feel bad and if you multiply the P level by Ca (calcium), a result between 60 and 70 increases the risk of tissue calcification. He is there so that means you can't just get the P down by feeding a lower P food.

I would not feed a food that is higher in P and hope the binder will work if he will eat one that is lower in P because you have some work to do to get his P down and I think you will have to be aggressive. If he absolutely won't eat a lower P food, then your options are more limited.

While the most important thing is for him to eat, the lower P food you can get, the better but you will also need the binder because his target for P level is 4.5. I believe you are outside the US but I'm not sure where or what you have access to. The food tables (there are US and outside of US) from Tanya's will help you but also remember you need to keep an eye on sodium as well but, for right now, getting the P down is the priority. The renal prescription diets as the lowest P and are quite effective in getting it down but they are way too high in carbs.

You also can't just dump binder on food. I, personally, think aluminum hydroxide powder is the best one...it's tasteless and inexpensive. I used to buy mine at Thriving Pets which Janet also linked. Here is the discussion on Phosphorus control, binders, and dosing. If you need help on the dosing, pls let me know. The binder needs to be mixed into the food, allowed to sit a bit, and then fed. The binder binds the P in the food, not the cat.

Your vet should check his blood pressure. Many CKD cats have high BP and it can usually be controlled easily with a a drug like amlodipine although some cats require a combination of drugs.

And finally, because of his anemia, he does need B vitamins but not just oral methylB12. To properly address anemia, he also needs a multi B. The discussion on B Vitamins on Tanya's can guide you in what to buy based on your location.
It's also critical to address that anemia and get the drop to stop and hopefully increase the HCT. Once the HCT gets below 20%, more significant measures have to be taken.

Please tag me if you have questions.
Thanks @Marje and Gracie for your reply!
Wow that's quite lots of info to absorb.
His abdomen is a bit bloated so the vet thinks an ultrasound can detect if there's any liquid there which is also harmful cos it can push the diaphragm and affect the heart. I think for my peace of mind, I should go ahead and just check on the organs. It's not easy to arrange for a sonographer to come down.
So first thing to do is to push the phosphorus down. But I don't have BFF here. I'm in Singapore. I can buy online but it's gonna be so costly and I have to wait. Where do I get Tanya's food table?
I've got the phosphate binder from the vet. I've attached the photo. Is that good enough? It's flavourless and I read some reviews online and it's all positive. He's also on iron tablet now, 1 pill a day. The vet said if the red blood doesn't improve then mayb a transfusion is needed.
So u think I shouldn't do the sub q now? But he's so much more alert today after last night's sub q. He does drink about 2 cups full a day.
 

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@Yong tagged me about the labs and I have a few different thoughts for you. I've had four CKD cats, three who were stable for several years and passed from something else.

First, elevated amylase in cats is insignificant; it's an indicator of pancreatitis in dogs, but not cats. The half Life of amylase is very short so levels can change frequently during the day. The ultrasound will help but the lab test for pancreatitis is the snapfPL if done right there in the vet's office or the specfPL if the labs are sent out. You might want to read my Primer on Pancreatitis for more info.

It's too soon for him to be on daily subq fluids if it's for the CKD. Until the creatinine is above 3.5, he should get as much fluid as possible from drinking water or from you adding extra water to food which will be tough with YA. If you can get the BFF or another canned food, you can add lots of water to it. Subq fluids are a treatment for pancreatitis but I'd want to be sure he has it before I started giving fluids esp daily fluids.

The reason I am cautious about fluids is because if there are any unknown heart issues, subq fluids can quickly overwhelm the heart. I always think it's best to have an echo done before giving longterm daily fluids.

Phosphorus control is critical in how the kitty will feel with CKD. I think it is one of the biggest priorities to longevity. Elevated P can really make kitty feel bad and if you multiply the P level by Ca (calcium), a result between 60 and 70 increases the risk of tissue calcification. He is there so that means you can't just get the P down by feeding a lower P food.

I would not feed a food that is higher in P and hope the binder will work if he will eat one that is lower in P because you have some work to do to get his P down and I think you will have to be aggressive. If he absolutely won't eat a lower P food, then your options are more limited.

While the most important thing is for him to eat, the lower P food you can get, the better but you will also need the binder because his target for P level is 4.5. I believe you are outside the US but I'm not sure where or what you have access to. The food tables (there are US and outside of US) from Tanya's will help you but also remember you need to keep an eye on sodium as well but, for right now, getting the P down is the priority. The renal prescription diets as the lowest P and are quite effective in getting it down but they are way too high in carbs.

You also can't just dump binder on food. I, personally, think aluminum hydroxide powder is the best one...it's tasteless and inexpensive. I used to buy mine at Thriving Pets which Janet also linked. Here is the discussion on Phosphorus control, binders, and dosing. If you need help on the dosing, pls let me know. The binder needs to be mixed into the food, allowed to sit a bit, and then fed. The binder binds the P in the food, not the cat.

Your vet should check his blood pressure. Many CKD cats have high BP and it can usually be controlled easily with a a drug like amlodipine although some cats require a combination of drugs.

And finally, because of his anemia, he does need B vitamins but not just oral methylB12. To properly address anemia, he also needs a multi B. The discussion on B Vitamins on Tanya's can guide you in what to buy based on your location.
It's also critical to address that anemia and get the drop to stop and hopefully increase the HCT. Once the HCT gets below 20%, more significant measures have to be taken.

Please tag me if you have questions.
I went to Tanya's website for the food table but the link doesn't work.
Since I don't Hv BFF here, can I feed him Applaws?
 
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