Help with food - diabetic/CKD/ possible IBD

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WilburCat

WilburCat

Member Since 2022
Hi! I’m hoping you all can help us with food choices.

Wilbur is a 13.5 year old ball of love with a long medical history: idiopathic hypercalcemia (on alendronate, prior to 11/2019 also on prednisolone), post ablative hypothyroidism (on levothyroxine, s/p 3 mCi 3/2017), steroid induced diabetes (on insulin 11/2019-2/2020, restarting 1/2022), pancreatitis (1st known episode 12/2021), diabetic neuropathy (right plantargrade, resolved with improved glycemic control and Zobaline), one prolonged episode of apparent osteomyelitis due to dental infection (surgery 5/2020 for extraction and 12/2020 to drain, on antibiotics from 12/2020 to 6/2021, path benign both times, no growth on cell culture, CT x2 c/w osteomyelitis), thickened ileum (new on US 12/2021, not seen on whole body CT 4/2021), new onset significant constipation (started cisapride and miralax, 1/2022), CKD (most recent Cr 2.3 and SDMA 19, tends to run 2-3 and 12-19 respectively over last 6 months).

Despite all of that he had been feeling pretty good in terms of quality of life until recent episodes of pancreatitis and the constipation. He is now almost totally back to his usual self. He had been scheduled for a biopsy tomorrow to sort out the thickened ileum - IBD vs lymphoma - but his glucose has been back up over the last week and we are going back on insulin (semglee, on basaglar prior).

Up until the diagnosis of CKD, he had been on a very low carb diet and off insulin for almost 2 years. We switched him at diagnosis to a renal diet per our internal medicine vet’s recommendations knowing it was a gamble in terms of the carbs. He is a total kibble junkie and multiple attempts to get him to wet food all the time have failed. He gets aggressive towards his siblings who have kibble in their Meowspaces and walks around howling and refuses to eat.

Given the recent GI events and US findings, she is wondering about IBD and recommended a Royal canin renal support diet + HP but said she didn’t think we would be able to find it. She was right. She said we should stick with just the HP.

I’ve read Dr Lisa’s cat info food website and extensive Google searches on our part have not left us with a ton of options that we can find.

Right now we are doing Royal canin renal support soft to get the cisapride and miralax down with the HP kibble.

Does anyone have an IBD/CKD friendly dry diet they can recommend? Or maybe a better question is does protein restriction really matter in cats? We found a type/brand called Young Again which is limited ingredient and they claim it’s good for cats with kidney disease but the protein content us much higher than the prescription diets are.

many thanks for any diet tips!!
 
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Hi and welcome to the forum.
Unless your kitty has very advanced CRD, you do not feed a low protein diet. That is old thinking. Low phosphorus is what you need to be looking for.
Do you have any path results you can share with us?
What is HP?
Cats with CRD and FD can eat a high protein, low carb diet?
What were you feeding during the 2 years Wilbur was in remission?
Royal canine renal support D is 16 carbs and the Renal support renal food T is 23 carbs…..both wet foods. The dry foods would be much higher in carbs.

Young again is used by quite a few people here.
Is there no way Wilbur will eat a wet food? Have you looked at a raw diet?

Here are two lists from Dr Lisa…the top two on the list ..FOOD CHART
I’m going to tag @Wendy&Neko as she may be able to help.
Also @Katherine&Ruby , @FrostD
 
thanks for the reply!

1) What defines low phosphorus? The Young Again cat food is 0.52% which seems to be fairly in line with the prescription cat diets. Is less than 100 mg/100 kcal accurate as a target for phos content? the young again mature LID zero is 132 mg/100 kcal.
2) No path reports - we cancelled his biopsy (in the last 3 weeks he has had 2 day admissions for pancreatitis and then severe constipation with now return of his diabetes) to allow his glucoses to get better so he'd be healthier going into surgery. We also did not want to have a cat recovering from abdominal surgery and simultaneously starting back on insulin.
3) HP = hydrolyzed protein (type of prescription diet from royal canin)
4) Our vet who we really trust seems to feel strongly about the limited protein which is why we switched over this past summer from his very low carb diet to the renal dry. That said, our admittedly somewhat biased lit review agrees with what you said above with respect to questionable benefit of protein restriction.
5) He was actually on a different variety of the Young Again (mature zero) which is why we very much are leaning towards their limited ingredient diet even though its not hydrolyzed protein like the vet has recommended but the manufacturer advertise as good for GI issues. I didn't want to bias any responses in my initial post by adding that he had been on the Young Again for almost 2 years but now consider yourselves biased.
6) He will eat a limited amount of wet food but pretty much refuses all very low carb wet food (ie the tiki tiki). He seems to like the renal D wet food and it is our current delivery method for cisapride and miralax. In the past each time we have tried to transition off kibble, he howls incessantly, gets aggressive with the other cats, and refuses to eat. Honestly we just gave in when we found the Young Again a few years ago. He does also seem to like the Wellness Gravies (was willing to eat when he had pancreatitis) but the phos content of that seems high at 204 mg/100 kcal (or am I wrong about definitions of low phos?)
7) We have started to consider raw diets but are not sure how to find a good recipe that will meet his needs and ensure he has all his nutrients.
 
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WilburCat said:
1) What defines low phosphorus
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Low phosphorus is around 200mg/100kcals or lower.
There is no need to use the low phosphorus food unless the phosphorus is higher than normal in the path results.

WilburCat said:
No path reports
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I would ask your vet to email you Wilbur’s path results from the last several months. You have paid for them and are entitled to have them.
If you could then post them here, we have people who can look at them and will be able to advise you moving forward.


WilburCat said:
We have started to consider raw diets but are not sure how to find a good recipe that will meet his needs and ensure he has all his nutrients.
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There are supplements available that can be added to raw meat to make the meal complete nutritionally. I don’t live in the US so I will let one of the others I tagged give you some names of the supplements and answer your other questions.
 
Thanks for your answers! Sorry for confusion - to me path means pathology like from biopsies rather than lab results! Lab results we have - I just need to sort through my electronic records to find them!
 
Hi and welcome!

Bron already addressed most of the food stuff.


As for raw feeding - Katherine wrote a pretty comprehensive post over in Think Tank - https://www.felinediabetes.com/FDMB/threads/raw-feeding-senior-kitties.248460/

The biopsy truly is the only way to distinguish IBD vs lymphoma. A handful of diabetic cats here have had it done, so I personally wouldn't delay just because of BG and insulin.

The treatment for IBD is usually prednisolone, which usually does affect BG. Budesonide is another option that doesn't seem to affect BG for most cats BUT it often doesn't work as well and is harder on the liver.

Treatment for SCL also starts with prednisolone usually. I believe budesonide is another option Chemo like chlorambucil is added if the pred isn't working.

My cat currently has the ol' mystery IBD/SCL diagnosis. He is a poor candidate for anesthesia and has elevated liver values, so my plan is to wait until he's showing more significant GI issues then I will start the pred. He's in remission, so if the pred knocks him out of it I will simply start insulin again. He needs what he needs to be comfortable. If after enough time the pred doesn't seem to be helping, I will do the chlorambucil
 
Getting a biopsy done will tell you if you are dealing with IBD or SCL, or small cell lymphoma. Diet makes no difference with an SCL cat, except that cancer seems to like carbs, so I stick with lower carbs. Colonoscopy may be an option to surgical biopsy.

FoodFurLife website sells EZComplete which is a low carb, low phosphorus premix for raw (or cooked) food if you want to try making your own. Freeze dried raw might be a low carb novel protein option with crunch, if you need that. Not sure which ones are low phosphorus though. Dry food by itself is not good for kidney cats. But maybe with freeze dried you can gradually add more and more water.
 
First, thank you so much for all your replies!

Second, he is rescheduled for a lab recheck and biopsy in 3 weeks assuming his kidney labs don’t markedly worsen. Our vet mentioned budesonide as a steroid option and chlorambucil as well.

Third, thanks for the raw food information! We are going with young again LID zero for the time being since he did so well on that brand in the past.

Finally, random non diet related question, I’ve noticed the tresiba forum is very quiet. Does tresiba in cats tend to be dosed once daily and with more flexibility than glargine/detemir? Or is it also bid with tight window? Does it work better in terms of less hypo events?

again a million thanks!!
 
Sorry I am so late to this conversation, I didn't see Bron's tag. Wishing you all the best for the biopsy when it happens. You've gotten some pretty good information already. There is a caregiver here who gives her cat hydrolyzed food, but she waters it down so that the cat can get adequate moisture and she doses insulin around that as it is high carb. Don't know if your picky eater will go for soupy kibble though but it is worth a try as more moisture is better for the kidneys.

One thing that someone said once that stuck to me about breaking die hard kibble eaters--you have to put all of the cats on wet food and eradicate all dry food from the house. If they even smell it, and they do, they will hold out for it. I know it's an expensive proposition to suggest that everyone go on canned food (I don't know how many cats you have), but the way I see it, you either pay for better food for them now or vet bills later.

I feed my cats ground boneless meat with EZ Complete and it really could not get any easier. Ruby's kidney values have improved and her coat is shiny and she does well on it. She also gets very constipated but that's managed with a good daily dose of lactulose. She also has SCL and is on pred only for now, and we dose her insulin around the increased glucose levels.
 
@Sue and Luci went from Levemir to Tresiba to try to get some more duration and get rid of the yellow preshots, and I think she was the last person to post regularly there. I believe she, like most people shot twice a day. Anyway, Sue went back to Levemir. Luci just her yellow preshots. We don't have any dosing methods for Tresiba, so I'd recommend that only very experienced people give it a try.
 
Thanks everyone for responses on tresiba and food! It might be the kibble smell because the other cats do have kibble. Again thanks!!!
 
The other website that can be helpful is Raw Feeding for IBD Cats. Many of the people who are feeding their cats a raw diet use the EZComplete pre-mix so there is considerable overlap. The Raw Feeding group also has a Facebook page that is fairly active and they are great about answering questions. The website has wonderful information about supplements and medications that you may find helpful.
 
So, we are going to try to convert everyone over to canned/soft food. We have read Dr Lisa’s information and used several calculators to pick the best food. I think we have looked at food tables so much that we have confused ourselves.

With respect to carb math, should we be targeting based on As Fed Basis or Dry Matter Basis? It seems we want less than 7% from carbs but As Fed vs DMB changes the math significantly. So what do we calculate and base decisions on - as fed vs DMB? Or better formed question what number should we be looking at?

Is it worth trying for 4% vs 1% carbs or is the absolute difference so negligible that it isn’t worth it?

Thank you!!!
 
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Hi there,

We use ME (metabolizable energy) instead of as fed or DMB. We aim for less than 10% of calories from carbs, and because the moisture content can vary, as fed and DMB don't give us that precise information. You can calculate ME from as fed and DMB numbers, though I am math challenged and never quite figured it out but maybe you'd have better luck! Here's a thread on calculating carb percentages: https://www.felinediabetes.com/FDMB/threads/calculating-calories-from-carbohydrates.205128/
 
Thanks for the reply. I’m honestly even more confused than I was earlier but maybe i just need to take a break from the math!!
 
Yes, we’ve been using it too but foods have changed/been discontinued and we’re trying to double check all the math on our own. I’m going to try to get a spreadsheet calculator to do it for me once I’m confident I have a handle on each step!
 
As an update - we ended up going with Young Again as a kibble but using Weruva as our wet food because they are so transparent on their website about the nutrition. No math and second guessing ourselves (honestly a BA, a BS, a MS, a PhD, and an MD between me and my husband but we didn’t trust ourselves to be 100% certain in our math - I don’t get why all companies cannot be transparent). Just looking at their webpage - easy peasy!!
 
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WilburCat said:
As an update - we ended up going with Young Again as a kibble but using Weruva as our wet food because they are so transparent on their website about the nutrition. No math and second guessing ourselves (honestly a BA, a BS, a MS, a PhD, and an MD between me and my husband but we didn’t trust ourselves to be 100% certain in our math - I don’t get why all companies cannot be transparent). Just looking at their webpage.
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I love Weruva for the same reason! Though I did have an occasion to correct their percentages. I think it was on their Jeopurrdy Delicious pate their protein/fat/carbs added up to 101%, but that was pretty minor and they've corrected it since I wrote to them. I use feed homemade raw but use Weruva for medium and high carb food because I trust their nutritional values.
 
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