Confused by vet's diagnoses - CKD / diabetes - vet says prioritise CKD

[Deric Smith]

Hello everyone.

We took Boo to the vet on Saturday for another checkup.

Vet seems adamant that we must prioritise CKD instead of the diabetes "because we can treat diabetes with insulin" but according to them if I continue feeding Boo LC wet food that will in all likelihood exacerbate the kidney problem. Vet says I am causing much more damage than good by feeding him LC wet food. Scaring me into choosing a renal diet for him, which is guaranteed to keep him on insulin forever because it is all high carb. I tried explaining to the vet I want to give this cat the best chance of going into remission so that he doesn't need these blasted insulin injections everyday, but the vet stated it is highly unlikely that Boo will ever not need daily insulin. Boo is, what the vet termed, an "insulin dependent" diabetic. Is there such a thing? Surely, if I feed this cat LC wet food, his blood sugar *should* decrease to a point where he will no longer need insulin?

I am so suspicious of the vet's diagnosis re CKD vs diabetes. All the vets at this clinic seem aligned in their advice re CKD vs diabetes so this isn't just the opinion of one vet. My partner is raging against me because he thinks I should just listen to the "experts" and stop causing more possible damage to Boo. I am terrified that my LC wet food preference *is* causing Boo harm. Yet the food these vets are advising we feed Boo (Royal Canin) is expensive, very HC and of course there is a massive display of it in the vet's reception area - so (conspiracy theorist in me!) of course they want to sell as much of this junk as they can to unsuspecting well meaning pet owners.

You will know Boo also has a nasty gum infection and requires the removal of several teeth. Vet initially refused to perform any surgery on him to remove the teeth. After some cajoling, vet then stated she could administer an antibiotic. Then on Saturday, to our surprise, she said that they would administer a 5 day course of Zodon for cats, thereafter we must take him back so that the vet can assess whether it is safe to do the surgery to remove the teeth. I'm not sure what's changed between now and two months ago when they said they said they couldn't administer anything for the teeth, but it is a relief that Boo is finally receiving some treatment for it because it was clear, from him vigorous face rubbing, that his mouth was hurting him.

I have started performing BG tests more frequently (although I do not live with the cat so I can only do them when I am there on the weekends to see him). First tests though, were not encouraging.

Sun morning after food but before AM ProZinc jab - 32.7.
Sun evening after long nap but before PM ProZinc jab - 30.6.

I did ask the vet whether we could ascertain the stage of CKD. She has taken blood and will test for this.

I am so worn down by this already. Any advice or insights or encouragement would be much appreciated. Vet says in her 15 years she's never known a cat with CKD and DM to go into remission and therefore not require insulin.

 

[Wendy&Neko]

Hello there, and welcome. We've had lots of cats with CKD and diabetes go into remission. My girl wasn't one of those, due to other conditions, but she was well regulated on low carb food (wet and raw) that was low phosphorus and diabetic friendly.

If you can post the blood work results here, we have people who can help interpret them. Knowing the CKD level is key and tells you whether you need to have kidney food. As an example, even though my Neko had stage 3/4 kidney disease, her internal medicine specialist vet was OK with what I was feeding her. Another good website, albeit a LOT of information, is http://www.felinecrf.org/

Level of CKD will also determine whether anaesthesia for a dental is possible. If concerned, you can always ask for a reference to a dental specialist vet. They general deal with a lot of complicated cases and much more used to CKD and diabetes considerations.

Zodon seems to be Clindamycin, which is a good antibiotic for the mouth. One caution, it can be hard on tummy flora (I speak from personal experience!). If you give him a probiotic, at least two hours apart from the Zodon, that may help any upset tummy.

 

[Bron and Sheba (GA)]

Hi Paul,
I don’t agree with your vet in several things.
First of all ….all diabetic cats are dependent on insulin until they go into remission and then they are diet dependent diabetics. So that statement is just stating the obvious!

Feeding a diabetic cat a low carb diet will not damage Boo. But a very HC prescription diet is guaranteed to keep him on insulin most likely forever. Vets get their nutritional education from the big pet food producers so it is biased. It used to be thought that feeding a CKD cat a low protein diet was the way to go but time has shown that the cats loose a lot of muscle mass if they go on a low protein diet. So that is old thinking now. The current treatment is to feed a high protein but low phosphorus diet until they are very advanced in the CKD disease.
You need to look for low carb, low phosphorus canned food …FOOD CHART
Look for food that has 250 mg phosphorus (or less) / 100kcals

Are you able to bring Boo to live with you so you can test more often. Just seeing a BG test here and there doesn’t tell us much. We need to see tests taken during the cycles as well so we can see how well the insulin is working. We can’t see if he is staying up high all the time or dropping low during the cycles and then bouncing back up at the end of the cycle.
Diabetes puts a strain on the kidneys so if you can improve the diabetes, that can only help the CKD.
Posting Boo’s blood results will help.

 

[FarmKitty]

Hey, just wanted to chirp in with some support and my experience with a CKD + Diabetic cat. Dixie started off at 22 mmol/L, and when I got her on insulin she dropped to the yellow range (ranging up to 16 mmol/L). Her fangs fell out years ago, but her back teeth were really bad (calcified? I can't remember). She had a dental procedure to remove all teeth except her lil front ones. After her dental, her blood sugar kept to under 9 mmol/L. It definitely seemed to have a positive effect on her diabetes.

It has been 2 years since then, and her numbers have continued to trend downward. Just wanted to demonstrate that this can be a long process, and that the numbers can trend down (you can even see from the chart that mine started trending up in the beginning... that wasn't fun). I switched her from ProZinc to Lantus in 2021 and that allowed me to further control her blood sugar curves.

During this time, Dixie was diagnosed with CKD. I also heard the same sentiment from my vet's nutritionist, that "since diabetes can be handled with insulin, then the CKD will be prioritized with food". They offered me Royal Canin Urinary Aging Care (14% carbs ME) or Royal Canin Senior Consult (30% carbs ME). I looked for an alternative food and found Wervua's Steak Frites which was pretty comparable:

On a dry matter basis (we don't really use Dry Matter Basis, but it just demonstrates the comparison of the foods)
Weruva : 61.9% protein, 27.8% fat, 7.5% carbs, 0.57% phos, 0.04% mag, 0.56% potass, 0.22% sodium, 0.68% fiber
vs
Royal Canin: 48.7% protein, 21.5% fat, 16.4% carbs, 0.6% phos, 0.1% mag, 1.9% potass, 0.5% sodium

The Weruva one has even less phosphorus levels than the prescription one they were trying to sell me! I let the nutritionist know I had found that alternative and they just said it was also a good option and that some of their clients have used it to successfully manage their cats.

The Steak Frites ended up raising her blood sugar levels (maybe allergic to beef?) so I have landed on Weruva's Goody Stew Shoes (chicken) and I also added in a Phosphorus binder from the vet's recommendation. Her CKD progression from stages 1-3 was very quick, but now it has slowed to halt (fingers crossed), and her phosphorus levels have decreased to a level that my vet is very happy with.

Unfortunately, it is a super frustrating process dealing with vets and diabetic cats... Something to keep in mind is that caring for a diabetic cat is a lot to ask of an owner, and it is common for the owners to just not treat the diabetes, or even put their cat down. The vets and vet assistants obviously want to see the cats taken care of, so they might give you very simple/easy advice, such as feeding dry food if you cat likes it. Or only feeding twice a day.

You have to take it into your own hands and be proactive about sourcing a glucometer, testing daily, increasing/decreasing the insulin dose, etc. What I do is go to the vet whenever I need blood tests (always ask for them to send them to you!), or when I want a professional opinion on something I want to do. For example, I wanted to switch Dixie from Prozinc to Lantus after finding info about it on this forum. So I did all the research and then I asked my vet about it. They gave me the go-ahead, but they never would have actually suggested to me. So you really gotta take the reins on this stuff.

Also, if you can afford it, get lots of blood tests and let your vet know your blood test schedule. Lots of people don't do yearly blood tests (or any tests). I have noticed that my vets are more interested in treatments I bring up if I am also committed to getting blood tests so that they can make sure that things are going well. Especially with the CKD diagnosis early on.

I know that people here like to poop on vets all the time... but just thought I would share my perspective/opinion on why the vets give weird advice. When Dixie was first diagnosed, the vet assistant was so enthusiastic that I had researched diabetes before coming in for the appointment. She expressed that lots of people weren't interested in caring for their diabetic cats. I just think that this makes a little more sense as to why the vets do what they do. The average joe sees their cat drinking a lot and thinks "wow, must be a hot summer!". Then they start losing weight and stop eating and they go "wow, what a picky cat!". And then when their cat has no energy, perhaps they finally go to the vet. Do you think that person wants to hear "Oh yeah! Your cat has diabetes, so now instead of $20/month, the food will be $180/month, and oh yeah you need to test your cat's blood 3 times a day, and get over your fear of needles to give injections! Oh and don't worry, you will have plenty of time to research diabetes as you stay up all night monitoring your cat's blood sugar hoping that they won't suddenly die! Hurray!". Yeah.... I can see why they just offer the dry food and fructosamine tests .

If (big if) you can, go to a different vet clinic. Shop around a bit (you can always bring your blood tests with you). I know that this is very location dependent, but if it is an option then try and find a vet that is more willing to work with you. I changed vets and I am so happy that I did!

Also remember that you can change a diet at anytime... maybe you start the prescription diet for a few weeks at your vet's request and they do the dental. Then you have some time to research CKD and what types of food can be given, then you just switch to the new food. Nothing permanent I started off with the diabetic Rx cat food initially, and then switched after a month when I had done more research. I know you are worn down, so don't try to fight too many battles at once in the beginning. Just keep gathering more info to build your confidence.

Boo is, what the vet termed, an "insulin dependent" diabetic. Is there such a thing? Surely, if I feed this cat LC wet food, his blood sugar *should* decrease to a point where he will no longer need insulin?

It's hard to say... I have noticed from this forum that cats who go into remission typically do it after a few weeks. Dixie has been on insulin for 2 years now, and she is inching towards remission but she also might be on insulin for the rest of her life. So it isn't a guarantee.

My partner is raging against me because he thinks I should just listen to the "experts" and stop causing more possible damage to Boo.

It is definitely weird going against professional advice, so I understand where your partner is coming from. Try to treat it like an experiment. You will do the work in finding a food right for Boo (check out Tanya's CKD site for food info if you haven't yet), then keep tracking Boo's blood sugar and decide on getting a blood test in a few months. When you get the blood test, you can your partner can see the results and then make a decision on how to go from there.

 

[Deric Smith]

Thank you so much to all for your invaluable responses.

Boo has picked up 400g since his diabetes diagnosis two months ago. At the time he was 3.3kg, down from his normal weight of 4.5 - 5 kg. He is now 3.7kg and still eating like a horse.

He is going in for his teeth extraction tomorrow although we are going to say to the vet to not do it unless they are confident he has a fighting chance of waking up. One of the positives of the dental, I'm hoping, will be that we will be able to eliminate that infection as a possible cause of the stubbornly high BG.

Re food, I am feeding him LC wet food, all of which is high animal protein and well below 0.3% phosphorous. I apologise I cannot tell if this is a "good" level of phosphorous? I've searched for the lowest I could find. Am thinking of asking the vet to suggest a phosphorous binder to include in the food as well. Is this advisable and if yes, which are best out there (aluminium based, calcium carbonate based, something else?)

I totally agree with the perspectives on here - it's all a learning curve.

Thanks too for the links to Tanya's site and the food chart - wealth of info there!

 

[FarmKitty]

Re food, I am feeding him LC wet food, all of which is high animal protein and well below 0.3% phosphorous. I apologise I cannot tell if this is a "good" level of phosphorous? I've searched for the lowest I could find

What food are you currently feeding him? I think phosphorus levels are usually looked at using Dry Matter Basis (or Dry Matter Analysis), and any "complete" cat food must have at least 0.50% (DMA) phosphorus. Check out post #4 here for some more info on why using DMA is good for looking at phosphorus levels. Tanya's CKD site also uses DMA when listing the phosphorus levels for foods.

Am thinking of asking the vet to suggest a phosphorous binder to include in the food as well. Is this advisable and if yes, which are best out there (aluminium based, calcium carbonate based, something else?)

This will all depend on Boo's blood test results. You need to know what stage of CKD he is in and what his current phosphorus levels are. With my cat, her phosphorus levels were 2.12 (where 1-2.1 mmol/L is the good range). Using low-phosphorus food brought her down to 1.8, and using the phosphorus binder brought her further down to 1.6. So you can see it will really depend on where Boo is currently at! Same thing for the protein levels in the food. If Boo is peeing out protein then your vet may need you to add in more medications or switch foods.

He is going in for his teeth extraction tomorrow although we are going to say to the vet to not do it unless they are confident he has a fighting chance of waking up. One of the positives of the dental, I'm hoping, will be that we will be able to eliminate that infection as a possible cause of the stubbornly high BG.

I really hope the dental goes through and well! My vet said that diabetic cats are super prone to infections... Dixie had so many ear infections when her diabetes was unregulated, and they have completely stopped now. I also noticed that her BG levels would rise when she had ear infections. Diabetes causes so much stuff to go wrong in their bodies... she is a totally different cat now that her diabetes has been regulated. The dental will be the first step! Fingers crossed for you.