High dose condition?

[Lkldcatlady]

Hi - I posted this to the Acromegaly board as well, but I'm not sure if that was the right thing to do. Just wanted to check and see if anyone else has ever encountered anything like this.

I read something about Acromegaly someone else posted and I tend to get a little paranoid so I wanted to find out if this is something I should pursue at the point. Bob was diagnosed on 4/27/2013 as diabetic. We are at 4 and 5 units and it just doesn't seem to make his numbers go down (My vet does seem to have increased on the ProZinc very quickly.) What concerned me was some of the other symptoms. I had Bob at the vet last week and she talked about his "big head". I'm almost positive Bob always had a big head, but now that I think about it, he has a pot belly, large head and big paws. he's a big cat anyway, so I'm just not sure. Also, the whole reason I took Bob to the vet initially was that he seemed to be wheezing a little. Also, I noticed him opening his mouth like he was going to sneeze (like a human does when they sneeze) a few times. I haven't really noticed those symptoms lately, but I also work full-time. It's been 1 month - do you think I should be concerned about these symptoms or is it too early to tell? It just seems like alot of other people's cats were effected more quickly by smaller doses of insulin and I'm becoming frustrated that nothing has changed much....

 

[Blue]

Hi - I posted this to the Acromegaly board as well, but I'm not sure if that was the right thing to do. Just wanted to check and see if anyone else has ever encountered anything like this.

I read something about Acromegaly someone else posted and I tend to get a little paranoid so I wanted to find out if this is something I should pursue at the point. Bob was diagnosed on 4/27/2013 as diabetic. We are at 4 and 5 units and it just doesn't seem to make his numbers go down (My vet does seem to have increased on the ProZinc very quickly.) What concerned me was some of the other symptoms. I had Bob at the vet last week and she talked about his "big head". I'm almost positive Bob always had a big head, but now that I think about it, he has a pot belly, large head and big paws. he's a big cat anyway, so I'm just not sure. Also, the whole reason I took Bob to the vet initially was that he seemed to be wheezing a little. Also, I noticed him opening his mouth like he was going to sneeze (like a human does when they sneeze) a few times. I haven't really noticed those symptoms lately, but I also work full-time. It's been 1 month - do you think I should be concerned about these symptoms or is it too early to tell? It just seems like alot of other people's cats were effected more quickly by smaller doses of insulin and I'm becoming frustrated that nothing has changed much....

Hi there....
I will tell you to switch insulin first because no acro cat can manage on the insulin you are using.
Switch to Levemir and try to drop down a bit in dose because your increases do seem too large.

Also, what are you feeding Bob? Are you going with the low carb wet food that's under 10% and from Dr. Lisa's list? If yes, then we can rule out Bob's diet as a cause.
If your signature is correct about feeding some dry food, stop ALL dry now and drop the dose to maybe 2 units am and pm. Dry can cause some cats to need large doses of insulin.

Are there any other health issues that Bob has? Heart or asthma or any other problem?
I see that you did get a 194 on the 13th but then back up to the high numbers.... another sign with acros fighting back with resistance, but I would prefer to see what kind of numbers Bob can get on Levemir.

All acros owners have switched to Levemir from Prozinc/PZI or else they had to go with dosing every 8 hours, and who had time for that frequency?

You are using the AT meter but you can go back to a human meter and save yourself some money because if Bob's acro, you will be needing the extra cash for more insulin. The AT is a waste of money because there's nothing special about it at all.

Tell your vet you want to switch to Levemir, and you can ask in the Levemir forum for the rate at which others switched. I don't think it's a 1:1 switch.

If you are wanting your vet to have Bob tested now, here are the two links to the sheets about the IGF-1 and IAA tests you should have done.
IAA Test
IGF-1 (Acro) Test

If you have any questions about acromegaly, you can message me anytime.
There is an open group on Facebook where anyone can join and ask questions.
https://www.facebook.com/groups/68039236605/
Called Feline Acromegaly-open group

there is also the other site of Rebecca's http://www.catacromegaly.com which you can join; I can watch for your registering if you like.

Gayle

 

[Lkldcatlady]

Bob is still on dry because he's being VERY difficult switching to the canned, so I definitely have ruled out the diet issue yet. I have found the Young Again dry zero carb cat food, which some people REALLy love and I've found a couple who really hate it. I would like to at least try that - it should be here Friday. I'm very nervous about just forcing him to eat the canned - I don't want him not to eat. I think I'll try the young again and continue to give him some wet food as a treat (he will ONLY eat the fish and I know he shouldn't have that all the time).

i think I will have the vet test for the growth hormone this friday. I'll take the info from the website and have them draw his blood and mail it. My vet seems to think Bob is just being a little resistant and thinks it's too early for me to worry. She says if his numbers don't go down in the next 3-4 weeks, we will give the Lantus a try. But if he turns out to be positive for the growth hormone, we will have to rethink our strategy altogether...

Thanks for the info - I will check out the other groups, but I'll wait for test results before I join. I really hope it's not the case, but we will see.

 

[Sue and Oliver (GA)]

I like your idea of confirming the diagnosis before making any changes, Dara.

 

[Libby and Lucy]

Your guy sounds a little like my new guy, KK. I just adopted him a couple of weeks ago. He was up to 5 units BID on PZI, eating some lower carb dry food. He does have a pot belly even though he is underweight (has a belly, but I can easily feel his spine and hips). He wheezes a bit too sometimes too. His previous vet when he was in foster care mentioned the possibility of insulin resistance. I switched him to Levemir last week, reduced the dose, and have mostly removed the dry food. He has done GREAT on 1 to 1.5 units of Levemir until he started a (sugary based) antibiotic this week. I am hopeful that once the antibiotic is finished that his numbers will drop again too.

I have had an acro cat and physically KK does remind me of her. I guess my point is that it's hard to know for sure without testing, but those physical characteristics could be additional clues if his dose continues to increase. It can't hurt to have those things on your radar.

I'm not as familiar with Prozinc, I'm more used to Lantus and Levemir, but with those insulins we do see cats on 4-5 units fairly often, especially if they are eating dry food.

 

[Blue]

I have to stress that some cats are super carb sensitive so the dry has to go.
One of my cats would be in the 400s all the time if she got dry food.... her number would soar if she got just a mouthful of a few pieces!

That's why I say if you can cut the dry.... you say the fancy feast is being eaten so there should not be a problem... pull the dry and leave more ff wet.

You WILL have to cut that dose way down before pulling the dry to be safe.

 

[Deb & Wink]

You need to switch to the lowest carb food you can find. Dry or wet, whatever he will eat.

After about 1 week on this diet, if his BG's have not dropped, then something else will need to be tried.

 

[Wendy&Neko]

Hello and welcome from someone with an acromegalic cat - we call them acrocats. Good luck with your food transition plan. Have you tried your cat on raw food? Some will like that better than canned. Neko loves hers and it's very low carb. You can often get sample packs to try it out.

Testing is a good idea to help you figure things out. My Neko is a large cat, but I think she has some Maine Coon in her and they always have larger paws. At least I didn't notice them changing in size in the last couple of years. She didn't show any physical signs of acromegaly, it was the higher doses that was the clue for us.

We are one of several cats with acromegaly here who are on Lantus, so it is an option for you if your vet is more comfortable with that and you want to go that way.

 

[Lkldcatlady]

Thanks everyone for the great information. I think my plan is to finish off the bottle of pro zinc (there is less than half) and transition bob slowly to the young again and whatever FF he will eat. If i dont see any results, I'm def switching to Lantus. I also think ill go ahead with the two tests for the acrogemaly. And attempt to relax!

 

[Grayson & Lu]

Hi Dara -

I'm Lu-Ann and my boy Grayson was dx in January 2012 with FD. I was fortunate to have a [local] friend who had a diabetic kitty, so she helped me when we were first dealing with everything that is associated with FD. G was on ProZinc initially, but we waited to start the insulin for a week while I did the food change. Now Grayson was CARB-STARVED! He would sneak the other kitties' Kitt-N-Kaboodle, as well as the dogs' food. He even figured out how to open 2 different types of Tupperware cannisters!

We started at 1u BID. If you open my SS (link in my signature), and click on the tab for ProZinc, you can see how we gradually increased, and even decreased down to .2u, then went up to to 6u TID (3x/day). It was a bit of a roller coaster, and it was interesting to see him go from cycling 24 hours to not responding - we lived in the pinks for months. Fortunately, people here saw my numbers, dose and suggested I do the testing.

I think your kitty is probably getting used to insulin. It hasn't been very long, and as you see on my SS, it was a while before he settled into it. It was April when I had the tests run for IGF-1 (Acro) and IAA (Insulin Resistance). Given his huge dose and very little response, the IAA result was not a surprise. But since Grayson had gone from 22 to 12 pounds, I had a much more difficult time accepting the IGF-1. I was often reminded, by my vet, as well as the vets at Colorado State Univ and NC State Univ, that the test results and even the ultrasound at NCSU showing enlarged organs WERE NOT A SLAMDUNK DX. Now, I would say that both are REALLY good indicators. I met with Dr. Lunn at NCSU. She was the lead Acro person at CSU, and had her hands on more Acros than anyone else - ANYWHERE. She told me that the unregulate-able diabetes, even at high doses was a bigger indicator to her. Unless/until you get the CT of the brain, showing the tumor, it's not a definitive diagnosis.

All that being said, you can look at their teeth (canines) and see if there's a gap. I posted a picture of G's gap recently. Will attach shortly. The gap (and yes, I compared his teeth to those of my other kitties) is an indicator of the jaw growth - one of the characteristics of many Acros.

Personally, I think I'd try to get a little more data on my cat before I did the testing. ProZinc is a good insulin for many cats. Some, however, like Grayson, did not respond to it (after the first month). That's why I'd postpone testing for now.

It's hard to have accurate numbers when the kitty is still eating dry. I have a multi-cat household, and everyone (except one) were eating dry. I know there are some people here that have seen a 100 point drop just from the food change. That's why everyone is suggesting you change food. I know every time G got into dry or dog food, he'd zoom. I think I noted that on his SS. The c-1 or t-2, etc are the number of cans of Fancy Feast G ate- chicken or turkey. At high numbers, he was ravenous. I used the expression "he'd rip my arm off & beat me with it if I wasn't opening the can fast enough" to describe his ravenous appetite.

I would encourage you to read as much as possible from the linked info in the Acro group here. You can also go to Catacromegaly.com. And look at the physical characteristics of your kitty. If you can, post a picture (larger than your avatar) of his face here. Does he have "saddlebags" - like pregnant bellies, but on his sides?

 

[Grayson & Lu]

...and when you're ready to have the tests run, have your vet call MSU and ask them to send the mailers. It's MUCH less expensive and is exactly what you need to keep the frozen blood frozen. It also helps to schedule the blood draw & overnight shipping for Monday. One of the tests IS ONLY run on Wednesdays. This is what I did, and we had both results by Friday.

I know it's a crazy time for you right now, and it's really hard to be patient, as well as making food changes... but you can do it, and it does get easier. Breathe!

WHEN you have more questions - ask away. Most of the Acro's hang out in a Facebook group, but several of us are here as well (although sometimes not as frequently).

One other thing - if you end up with a positive IGF-1 - then you'll want to consider changing to Lantus or Levemir. Most of the high dose kitties are on Levemir. Apparently there's a difference in the pH levels. I'm no chemist, but I get that Lev is pH neutral, so for higher dose kitties, the Lev tends not to sting (some kitties are sensitive to the higher pH.


Good luck!

Lu-Ann

 

[Blue]

Thanks everyone for the great information. I think my plan is to finish off the bottle of pro zinc (there is less than half) and transition bob slowly to the young again and whatever FF he will eat. If i dont see any results, I'm def switching to Lantus. I also think ill go ahead with the two tests for the acrogemaly. And attempt to relax!

When you switch insulin, I would suggest that you go with Levemir as if your cat does test positive, Lev is the insulin that most acros use.

My two acros were on Lantus, but one did not do well on Lantus, so I switched her to Lev and she visibly improved within days. My other acro was fine on either one. Humans have stated that there is a sting from Lantus shots at larger doses, and some cats have seemed to react better to lev shots.

If your cat is eating wet food now, fancy feast, remove ALL dry, and cut your dose down because your high numbers and dose may be due to the dry food. It does not take much because one of my cats would get numbers in the 400s after stealing just a mouthful of dry food from a civie. She was very carb sensitive and Bob could be as well.

You can test now if you like, but it's a big waste of money if it turns out to be the diet as the culprit.
If you remove the dry today and drop the dose for a couple days, see how it goes by Monday. If your cat is on all wet low carb on Monday and a dose of 2u is giving you continued high numbers, then you could consider testing for acromegaly and IAA.

Gayle

 

[Carl & Polly & Bob (GA)]

Thanks everyone for the great information. I think my plan is to finish off the bottle of pro zinc (there is less than half) and transition bob slowly to the young again and whatever FF he will eat. If i dont see any results, I'm def switching to Lantus. I also think ill go ahead with the two tests for the acrogemaly. And attempt to relax!

I think this sounds like a reasonable plan. I think it might be a good thing if people stopped trying to tell you what you NEED to do and instead offer suggestions.

I think you said earlier that the Young Again dry should be arriving by the end of the week? You've already spent the money on it, and giving it a try seems to make sense to me. If Bob is a super-sensitive to carbs kitty like Blue mentioned, then the YA zero carb would be a good way to find out. I'm definitely not a proponent of long-term diets that include dry food (because of other health problems that dry food can cause over time), but some cats just don't conform to a perfect world, and insist on staying with the "kitty krack". If carbs from his current dry food are the reason behind the high numbers on his spreadsheet, the YA dry should prove or disprove that.

My cat, also named Bob, was on PZI a couple of years ago. He was started on 1u BID, and over the next month, my vet raised his dose agressively up to 4u BID, so your Bob's current dose isn't scary high (yet) to me. And my Bob was only eating low-carb FF and Friskees can with numbers that ranged in the 400s at shot times. For reasons known only to Bob, 4u seemed to be the "breakthrough dose" and over the next six weeks, his doses gradually were lowered and he went into remission after 10 weeks on PZI. The big difference between his numbers and your numbers is that my Bob tended to go lower in the middle of the cycles which is what is "normal". I'm not seeing big drops on your spreadsheet (yet), and again, the reason behind that could be the old dry food he's been eating - especially if he free feeds and snacks on it all day.

Personally, I like your plan. Once you get the YA in the mail, switch him to that along with whatever canned he'll eat. Maybe try to ration the dry. I seem to recall reading somewhere that YA is pretty "calorie dense" and that portion control is recommended (but not 100% sure about that). When you switch, it'd be a good idea to do so on a weekend (assuming you don't have to work) so that you can see if there's a significant mid-cycle drop in the numbers due to the lower carbs in the food. If you see that, then a dose reduction is probably a great idea. See how he does for a few days with the new food, adjust the dose down if the numbers indicate you need to, and try to get at least one or two tests in the middle of his cycles.

I think 4-5 units might still be too early to get Acro tests done, and that you can try to exhaust other possibilities before resorting to the expense of the those tests.

Just my opinion...

 

[hmjohnston]

I posted over in the acro forum and came here to read.

I didn't even mention anything about the dry- I know some cats prefer dry to anything else. Switching the the YA will be a good move. Is it the zero carb YA? What Carl says makes sense- if Bob is a kitty krack addict do the YA and see how it effects the middle of the cycle tests.

You have a good plan. The tests you can either do or wait. Sneakers got up to 6u BID on ProZinc before we switched to Levemir.

 

[Blue]

If you are feeding a good low carb wet food diet and your insulin dose is at 5u BID with your BG all in the 300s and higher, it's a good time to test for acro.

Encouraging dry food for cats who are also eating wet food is not contributing to the health of the cats.
Dr. Lisa's site must be mentioned so that owners can see what dry food does to the cats' body aside from the carbs and BG numbers. Mention of the dental and urinary problems that are more likely to occur when dry food is consumed is very important.
http://catinfo.org/?link=urinarytracthealth

There have been a couple cats who were tested at that dose, were positive for acromegaly then at 6u, went off insulin.
The cats are acro but were on insulin for only a few months at a low dose.
Stating that 4-5u dose is too early to test for acromegaly is incorrect. Well before reaching that dose, the diet and other issues should have been sorted out already. A cat with regular DM is not going to be getting high BG with an appropriate diet and a dose of 5u.

Gayle

 

[Carl & Polly & Bob (GA)]

A cat with regular DM is not going to be getting high BG with an appropriate diet and a dose of 5u.

My cat had regular DM, on an appropriate diet and a dose of 4u bid. He wasn't acro. I've "met" a couple other Prozinc kitties on 5+u doses that can say the same thing.
And yes, Dr. Lisa is a tremendous source of information as to why dry food is the worst thing in the world for cats.
But the simple reality is that some cats refuse to agree, and on a short term basis, some people need to continue to feed it. And if that is the case, then the intelligent thing to do is make it the lowest possible carb dry food you can find.

Do you realize the number of new members that we "chase away" on a regular basis because they come here for help and are handed a pile of "absolutes", "you must" and "you need to" advice?

If anyone hasn't seen it yet, there's a recent discussion about "advice giving" in the think tank. Dry food is mentioned a number of times. I disagree with some of it, but that doesn't make me right. I'm not an expert. But neither is anyone else that posts here.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=22&t=92465

It's worth reading.

 

[Lkldcatlady]

Thanks again everyone! I really appreciate all the advice as I am pretty stressed out about all this. Poor Bob, I keep checking his canine teeth for spaces and comparing him to old pics to see if his head is bigger. Think ill take a Xanax tonight @-) and keep on with my plan. I have decided to wait for the acro tests tho-I think I have several things to to try first -diet and possibly different insulin. If he continues to stay high after those changes, then ill go for the tests.

 

[Lkldcatlady]

My cat, also named Bob, was on PZI a couple of years ago. He was started on 1u BID, and over the next month, my vet raised his dose agressively up to 4u BID, so your Bob's current dose isn't scary high (yet) to me. And my Bob was only eating low-carb FF and Friskees can with numbers that ranged in the 400s at shot times. For reasons known only to Bob, 4u seemed to be the "breakthrough dose" and over the next six weeks, his doses gradually were lowered and he went into remission after 10 weeks on PZI. The big difference between his numbers and your numbers is that my Bob tended to go lower in the middle of the cycles which is what is "normal". I'm not seeing big drops on your spreadsheet (yet), and again, the reason behind that could be the old dry food he's been eating - especially if he free feeds and snacks on it all day.

Carl - I put out a little more than 1/3 cup of dry food each of my 3 cats right after Bob's shot at 7a and 7p. Please don't let that scare you - after all I've learned about dry food, I plan to get them all switched over. Anyway, Bob eats maybe 1/3 to 1/2 of the food right away and then grazes on it. Usually, all food is gone within 3-4 hours. If you could explain how you should feed a cat with diabetes I would appreciate it. Multiple vets (I have some clients that are vets so I have, of course, received some 2nd, 3rd and 4th opinions) have told me it's a good idea for Bob to have access to food in the middle of his cycle in case he goes too low. If I feed him a can of wet food, how does that keep his blood sugar level throughout the day? One vet actually told me that Purina DM is a miracle food and has worked in his office to get several cats into remission (my vet says the same thing). He says cats need a certain percentage of carbs. I'm smart enough to know that's not really true, but what can one think when you have multiple "experts" telling you the same thing?

 

[Carl & Polly & Bob (GA)]

f I feed him a can of wet food, how does that keep his blood sugar level throughout the day? One vet actually told me that Purina DM is a miracle food and has worked in his office to get several cats into remission (my vet says the same thing). He says cats need a certain percentage of carbs. I'm smart enough to know that's not really true, but what can one think when you have multiple "experts" telling you the same thing?

Whenever someone tells me their vet says that cats need "a certain percentage of carbs", I suggest that they share this link with the vets...
http://maxshouse.com/feline_nutrition.htm

It is full of great info about the digestive system of a cat, and what they need and don't need from their food. This is the most important part though:

All animals have a metabolic requirement for glucose. Carnivores, such as the cat, convert glucogenic amino acids and glycerol to glucose for the maintenance of blood glucose, and therefore, have no established dietary requirement for carbohydrates.

Because cats have adapted to diets high in protein and low in carbohydrate, continuous activity of amino acid catabolic enzymes provides a continuous source of carbon skeletons for glucose or energy production and nitrogen for synthesis of dispensable amino acids and other nitrogenous compounds. This continuous metabolic state causes the cat to catabolize a substantial amount of protein after each meal, regardless of its protein content. The cat does not have the capability to conserve nitrogen from the body's general nitrogen pool leading to an obligate nitrogen loss and a higher dietary protein requiremerit than omnivores.

In general, an absence of dietary carbohydrate in the feline diet will not affect blood glucose levels or cause an energy deficiency; this is because the body can use protein and the glycerol portion of fat for glucose production, and fat and protein for energy.

Glucose supplies the body with energy. But cats turn fats and proteins into glucose to supply their bodies with all the energy they need. So, ANY carbs whatsoever are "useless". They don't need them, and they can't use them. So yeah, there is a "certain percentage" that they need. Zero percent. ;-)

What is sad to me is that so many vets don't seem to be aware of that basic nutritional fact. It's got nothing to do with being an expert on feline diabetes. It sounds like just "Feline Nutrition 101" to me.

One vet actually told me that Purina DM is a miracle food and has worked in his office to get several cats into remission (my vet says the same thing).

There's nothing wrong with Purina DM canned food. It is low-carb, and it's appropriate for diabetic cats. But a miracle food? That's a bit of an exaggeration. Given the quality of the ingredients that go into the formula, it's no more of a miracle than Fancy Feast classics or Friskees are. Quality wise, it's no better than cheaper store brands of food. But it seems most vets are "victim" to what seems to be a very good sales staff that works for Purina, and they buy into the sales pitch.
There are 2 big drawbacks to DM. One is the cost and that you can only get it from the vet. The other is that it only comes in one flavor, I believe? Cats either like it or they don't. They might eat if for a week or two, and suddenly decide they don't like the taste anymore. But from a carb standpoint, the canned food is fine.
There's no doubt that cats can and have gone into remission while on Purina DM. But more cats have gone OTJ from eating walmart's brand of low carb pate flavors or any of a dozen other less expensive brands that you can find in a grocery store or pet store like Petco or Petsmart.
Every time my vet sees a new diabetic cat, she tells the caregivers "A diet of Fancy Feast classic flavors is a fantastic choice, and some of my clients have had their cat go into remission on that diet". My cat Bob is the reason she tells them that. He was the first cat she saw go into remission on Fancy Feast. Prior to me and Bob, all her patients got "Hill's Prescription Diet m/d" (which she prescribed for Bob) because it was "made just for diabetes control in cats". Her patients no longer are prescribed Hill's m/d. :mrgreen: Because I found the FDMB board, and "Binky's List", several diabetic cats have been given a better chance of remission than they ever had with the Hill's food. And their daily cost of treating the illness are lower too!

 

[Carl & Polly & Bob (GA)]

I forgot to respond to your question...

Multiple vets (I have some clients that are vets so I have, of course, received some 2nd, 3rd and 4th opinions) have told me it's a good idea for Bob to have access to food in the middle of his cycle in case he goes too low. If I feed him a can of wet food, how does that keep his blood sugar level throughout the day?

Yes, i agree it is a great idea to have food available in the middle of the cycle. Not only in case he goes low, but also because multiple small meals throughout the day are better than just two main feedings. I think human diabetics are advised to do that also. It helps spread out the BG boost from eating more evenly. What you are doing, supplementing the two cans with small amounts of dry would do that. And if you were doing it with the zero carb dry, that would be even better.
If you are able to eventually ditch the dry, you can still do that with canned food. Some people use timed feeders to space out the mid cycle snacks. That's more difficult with multiple cats because you won't know how much each cat is eating if they're all waiting for the timer to dish out the next snack. Some people freeze canned food mixed with water, and leave a couple of cubes out when the leave the house. The hope is that the cats will eat them as they thaw out.

 

[Lkldcatlady]

Thanks Carl-that was helpful. Actually, the vet I was speaking about was referring to the dry DM. That's why this is so frustrating! Everything on this board is common sense so why does my vet not suggest the same things? It would just be nice to have her support. Anyway...just a couple of other questions-I found a high quality canned food in only 4 flavors-I don't recall the name now. The third or fourth ingredient for all varieties is "ocean fish". Should I avoid feeding that food because of the fish? I know that the FF works, I'm just trying different varieties to see what bob likes...

 

[Carl & Polly & Bob (GA)]

Good question about the "fish". I've read here that you don't want to feed fish too often, I think because of mercury concerns? That said, if it's listed third or forth on the ingredients list, it might not be a big issue. I buy the fancy feast in the 24 can boxes. I'll buy three boxes, one of them is the seafood flavors. The other two are the poultry flavors. Bob and Mullet get the seafood once every three meals. I've been doing that for the past year and it doesn't seem to have caused any problems.
On the food you're asking about, the top three other ingredients would most likely be the bulk of what is in the cans. If he likes it, you could work it into the menu.

I get your frustration with "why doesn't the vet know these things?" I don't know what to tell you. Maybe in a casual conversation, ask them how many courses they needed to take in feline nutrition or diabetes when they went to school? I'm guessing "not many" which makes sense if you consider how many different animals and diseases they have to study in order to become a general practitioner vet.

Of the dry foods out there, I believe DM is one of the lower carb foods available. I think it's less than ten percent? When you consider many dry foods are in the 20's and 30's, that's relatively lower.