How to deal with Diabetes and CRF diet

[Mouse]

I have three CRF kitties and one of them diabetic. Maus was in remission on Fancy Feast Classics until I switched him to Natures Organics and then to Wellness Adult Turkey for his CKD. He was on that for March and February. I thought those would be ok for his diabetes but his bg is SUDDENLY in the high 400s and 500s when before it was always below 100. I'm just starting ProZinc insulin yesterday evening and so haven't had a chance to gauge his blood glucose levels on that, yet. I've changed Maus to Royal Canin DS44 but have just found out that it is contraindicated for Kidney Disease and now I'm considering Purina DM Dietetic Management. (A great feline crf site, http://www.felinecrf.org/diabetes.htm#diet, mentions that for diabetic/CRF cats.)

All of my cats are taking all day and all night to finish eating now (they just don't like their food) and so have to remain separated from me, diabetic Maus and my leukemic dog Scout. My other three cats (2 are CKD) are eating Wellness Adult Turkey but they don't like it, (but they like it better than Natures Organics and Evo 95%).

Does anybody have any idea how we can ever be all together? I'm disabled and mostly bedridden so I hardly get to be with any of them but Maus. Is Merricks an alternative for all of them, CKD and diabetic and one who is neither? Is Friskies Special Diet? Anything else? How much do your cats like those foods?

I'm afraid there isn't an easy answer for me either.

I got the following fantastic reply when I posted to a thread from March. does anybody have anything else to add?

Welcome! I would recommend you start your own thread and give a little background like what type of insulin you're using, etc. Wellness Turkey canned is a low carb food, and so are the Nature's Organics, so I don't the food is what's raising his BG. However, it doesn't hurt to start with something else if those are the only ones giving you higher numbers.

The good news is that there are commercial foods that are good to feed for both conditions. You simply need a low carb, low phosphorus canned food, preferably without byproducts (higher quality protein sources are easier on the kidneys). Keeping your cat as hydrated as possible is key to managing the disease, along with low phosphorus foods, so you'll definitely no dry food at all (if you're feeding any). Mixing water in with the canned food is one good way to help with hydration. Many people also find that cat drinking fountains also encourage cats to drink more. Anything you can do to get moisture in your cat is important.

Here's an updated food list with the values for several premium foods: https://docs.google.com/leaf?id=0B8Uu8g ... ist&num=50. You're looking for something with less than 10% carbs and less than 250 mg/kcal of phosphorus. The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, and Blue Wilderness Duck. The Merrick's was a huge hit with both my cats (including my CKD kitty), and it's what Bandit (my diabetic) eats now.

If those are out of your price range (although I would strongly urge a food without byproducts, keep in mind that it's still cheaper than the prescription food), the next best thing to feed are the low carb Friskie's Special Diet flavors. These are Turkey & Giblets and Salmon Dinner--make sure they are the ones that say "special diet" on the can, though. PetSmart carries them, and some grocery stores. Here is an updated list of just the phosphorus values for many commercial foods. They can be cross referenced with Binky's chart for carb values if there's something on there that you want to feed. On this chart, you're looking for something that is less than 1% phosphorus (these values are on a dry matter basis, not mg/kcal): http://www.felinecrf.org/canned_food_usa.htm

Do NOT use Binky's list for phosphorus values--the carb values are still ok to use but the phosphorus values are really out of date, and some things that were low on that list are now ridiculously high in phosphorus. You can cross reference the carb content from foods on Binky's list with the phosphorus values on Tanya's canned food list, however.

 

[Mouse]

I immediately got a call from my vet just after I posted. He says Maus does not have kidney disease! I swear he told me that he did. I'm posting his lab values for your opinion. His BUN is high and in my opinion his phosphorus level is high, too, but my vet says since his creatinine is normal that he's ok. I'll repost these values on the CRF group, too:


Alk Phosphatase: 106 (6-102)
Urea Nitrogen: 56 (14-36)
Creatinine 1.6 (.6-2.4))
Phosphorus 4.9 (2.4-8.2)
Glucose: 176 (64-170)
Sodium: 159 (145-158)
Amylase: 2489 (100-1200)
T4 4.3 (0.8-4.0)
Platelet Count: 519 (200-500)

He also has hyperthyroid which is being controlled with medication.

This still leaves me with the problem of keeping all my pets with me on their separate foods.

 

[carolynandlatte]

Alk Phosphatase: 106 (6-102)
Urea Nitrogen: 56 (14-36)
Creatinine 1.6 (.6-2.4))
Phosphorus 4.9 (2.4-8.2)
Glucose: 176 (64-170)
Sodium: 159 (145-158)
Amylase: 2489 (100-1200)
T4 4.3 (0.8-4.0)
Platelet Count: 519 (200-500)

He also has hyperthyroid which is being controlled with medication.

Hi Mouse! Glad you found your way here. What a great response (Julia, I assume) gave you!!!

Here is my response to you on the crf list (so others can see the info you have been given):

Hi Chandra!
No, it does not cost anything to join. I am glad you registered and started
posting.

Are you giving insulin? Can I ask, do you home test Maus on a daily basis? Not
only do I highly recommend it for safety, but I also wonder if that 500 BG you
caught was related to something else. If you were feeding higher carb or dry
food and switched to the lower carb wellness (wet), it is possible he(? or she?)
did not need as much insulin and went too low. His liver could have freaked
out, dumping a bunch of sugar in the body and Wham! Is it possible Maus has an
infection going on? Dental issues? Both of those would also affect BG's in a
BIG way!

Which wellness were you feeding? The chicken and turkey are some of the lowest
carb contents you are going to get in any food. If Maus' numbers soared at a 4%
carb content, feeding Purina DM wet (7%) is only going to make it worse. I
would be even more concerned if you offered dry, as those contents will be 13%
and up range.

Here are some thoughts from Dr. Lisa on Purina DM, and prescription foods:
"Please understand that there is nothing 'magical' about the prescription
diabetes-management diets. Several of them, such as Hill's m/d and w/d (dry and
canned), Purina DM dry, and Royal Canin DS (dry) are all too high in
carbohydrates. Purina DM canned is sufficiently low in carbohydrates (~7%) but
it is expensive and it is predominantly liver which should not make up the bulk
of a cat's diet. The prescription diets also contain species-inappropriate,
hyperallergenic ingredients such as corn, wheat, and soy."
http://www.catinfo.org/?link=felinediabetes

If you were going to use any dry I would aim for Evo, Core, or Instinct (all
still higher carb content than wellness wet, but better ingredients).

Why does feeding our cats have to be so complicated?!?!! *sigh*
FWIW, my foster cat started refusing FF about 4 months ago. UGH! A lot of other
folks on FDMB have noticed their cats turning noses up at FF as well. They must
have made some change to their 'formula'. It's really too bad.

Carolyn (and Latte, in spirit)

Hyperthyroidism, from what I understand can mask kidney disease. It is one issue I never had to deal with, so I am not sure how that works. I am assuming you have looked at Tanyas website for that information:
http://www.felinecrf.org/hyperthyroidism.htm
I think it also may be related or interwined with FD for some cats. Again, I have no experience with that. Hopefully someone else will know, or you could start a separate thread?

The phosphorus looks fine. Even in a cat with kidney issues you typically do not start treating to reduce it until it is around 6.

The BUN is elevated, but not drastically. It could be as simple as your cat being dehydrated, or eating a high protein diet.

The Amylase is quite elevated. Is that something which can be elevated with hyperthyroidism? Sometimes it can be an indication of pancreatitis, but more specific tests would need to be done in order to determine that.

 

[Mouse]

Are you giving insulin? Can I ask, do you home test Maus on a daily basis? Not
only do I highly recommend it for safety, but I also wonder if that 500 BG you
caught was related to something else. If you were feeding higher carb or dry
food and switched to the lower carb wellness (wet), it is possible he(? or she?)
did not need as much insulin and went too low. His liver could have freaked
out, dumping a bunch of sugar in the body and Wham! Is it possible Maus has an
infection going on? Dental issues? Both of those would also affect BG's in a
BIG way!

Which wellness were you feeding? The chicken and turkey are some of the lowest
carb contents you are going to get in any food. If Maus' numbers soared at a 4%
carb content, feeding Purina DM wet (7%) is only going to make it worse. I
would be even more concerned if you offered dry, as those contents will be 13%
and up range.

Here are some thoughts from Dr. Lisa on Purina DM, and prescription foods:
"Please understand that there is nothing 'magical' about the prescription
diabetes-management diets. Several of them, such as Hill's m/d and w/d (dry and
canned), Purina DM dry, and Royal Canin DS (dry) are all too high in
carbohydrates. Purina DM canned is sufficiently low in carbohydrates (~7%) but
it is expensive and it is predominantly liver which should not make up the bulk
of a cat's diet. The prescription diets also contain species-inappropriate,
hyperallergenic ingredients such as corn, wheat, and soy."
http://www.catinfo.org/?link=felinediabetes

If you were going to use any dry I would aim for Evo, Core, or Instinct (all
still higher carb content than wellness wet, but better ingredients).

Why does feeding our cats have to be so complicated?!?!! *sigh*
FWIW, my foster cat started refusing FF about 4 months ago. UGH! A lot of other
folks on FDMB have noticed their cats turning noses up at FF as well. They must
have made some change to their 'formula'. It's really too bad.

Carolyn (and Latte, in spirit)

I do home test Maus daily and the values went up so rapidly that the vet and I tried to see if his new diet of Royal Canin DS would help lower them. They were in the high 200s and 300s since March 11th. After March 27th they were in the high 300s and they've just been 489 and 578 the days before today. I was only testing him sporadically in December/ February when his numbers were about 93, 75, etc.

He's been given several exams by the vet since February when he had his teeth cleaned so I don't think it's other health or dental issues either.

I was feeding him Wellness Adult Turkey back then so that should have been ok but still his numbers soared. Before that I fed my cats canned Natures Organic Turkey and before that Evo 95% Chicken and Turkey and I also tried Evo 95% Beef. (My cats hated both though I tried that for quite a while.)

I started trying the Royal Canin DS hoping it would be an easy and specific answer. I knew prescription diets weren't the best foods but someone on the Diabetic Cats DM group was absolutely adamant that it was now regarded as the only food that I should consider. She said it would be great for all the cats but now I know that she was wrong and I shouldn't have listened to her. She was the only person that answered me so I didn't get any opposing advice there. Her's was the only voice. Besides the excellent information you've offered I've found out it's contraindicated for kidney disease. (Remember I have 2 other CKD kitties.)

I'll look for Evo, Core and Instinct.

Feeding has indeed become incredibly complicated! Fancy Feast to satisfy everything but my cats changed and so did the food evidently.