? IBS/CKD/Newly Diagnosed Diabetes

[PicklePop's Mom]

Hey All,

I would love some input on thoughts around diet. Pickles was just recently diagnosed and started on Lantus. My vet recommended to switch her to a twice a day schedule before giving the shot. We don't have a meter yet and so are going on food intake until her Libre 3 is installed next week.

Normally she has been a grazer ever since she was diagnosed with IBS and put on pred every other day. She's on a low dose of 4.5mg and a 2x a day gabapentin dose of 30mg for arthritis. We switched her to the Hill's k/d prescription diet when her kidney disease started progressing and it seems to agree with her. However now I'm wondering about the carb content in that diet and if we should try something else.

Does anyone have suggestions for a diet that would help with all three? Limited ingredients for the IBS, but good for the CKD/Diabetes? I've been to Tanya's website before and looked at brands. I'm thinking the Weruva but not sure.

I was also hoping to know if anyone else has transitioned a grazing cat into a 2x a day feeding cat and any tips on that. Pickles ate good yesterday but this morning she only ate like 1/4 of her food at breakfast so we skipped the dose. I'm hoping going without all day she will be hungrier for the evening meal. Should I be feeding right before the dose or more like 30-60 mins before the dose?


Sorry if I'm a bit all over the place - it's been a whole lot of into coming at us at once and I'm trying to get a handle on it all. Thanks so much.

 

[CORKY]

Hey All,

I would love some input on thoughts around diet. Pickles was just recently diagnosed and started on Lantus. My vet recommended to switch her to a twice a day schedule before giving the shot. We don't have a meter yet and so are going on food intake until her Libre 3 is installed next week.

Normally she has been a grazer ever since she was diagnosed with IBS and put on pred every other day. She's on a low dose of 4.5mg and a 2x a day gabapentin dose of 30mg for arthritis. We switched her to the Hill's k/d prescription diet when her kidney disease started progressing and it seems to agree with her. However now I'm wondering about the carb content in that diet and if we should try something else.

Does anyone have suggestions for a diet that would help with all three? Limited ingredients for the IBS, but good for the CKD/Diabetes? I've been to Tanya's website before and looked at brands. I'm thinking the Weruva but not sure.

I was also hoping to know if anyone else has transitioned a grazing cat into a 2x a day feeding cat and any tips on that. Pickles ate good yesterday but this morning she only ate like 1/4 of her food at breakfast so we skipped the dose. I'm hoping going without all day she will be hungrier for the evening meal. Should I be feeding right before the dose or more like 30-60 mins before the dose?


Sorry if I'm a bit all over the place - it's been a whole lot of into coming at us at once and I'm trying to get a handle on it all. Thanks so much.

Welcome to FDF, Pickles and Mom, Vent, Vent, that's what we are here for and to answer any concerns you may have, I know it is overwhelming what you are going thru, we all have there, when we hear that our precious Fur ball has diabetes, but it is manageable, Referring to diet, diabetic cats need a diet of wet can wet can foods between 0-10%, most of the kibbles like the prescribed you feed , contains a large amount of carbs, with the daily grazing is very hard to keep the Glucose in check, The Libre you say you are waiting for your Vet to place, you yourself can do it the instruction in the box are very simple, and you will save on Vet bills, however please know that by my experience and other members the Libre has its problems, cats tend to remove it, or they can fall off, they are to last 14 days, but on most cases that is not the case, and on low reading it reads much lower that reality, so it's good to have a back up, Most of us members use the ReliOn Premier human monitor and strips, it is very reliable and inexpensive, I will tag several members that use Lantus and the procedure on diet and dosing for this insulin and have years of knowledge on dosing and the other conditions Pickle has
@Sienne and Gabby (GA)
@Bron and Sheba (GA)

 

[PicklePop's Mom]

Thank you so much Maria!! I've been reading a bunch about the foods but I'm now a little overwhelmed. Some recommendations are to prioritize the carbs but some say to prioritize the phosphorus and adjust insulin accordingly and with her IBD it's been a struggle to get something that won't cause a flare up and allow for the low pred dose. I should be able to get the keto-diastix strips today so we can spot check urine which will definitely make me feel better. I want to figure out how to do the BG meter but if I'm honest I'm really nervous about it so I'm procrastinating. I'm worried about switching the food causing something else GI or kidney related to go out of whack. I have a good stock of her prescription diet since we just got the refill order and I don't want to waste it . I know I will have to transition her super slow - in the past we've done a 2 week transition period for a new food.

I'm not sure if I can handle her to get the libre on myself especially having to shave her so for the first application I want to go in and let them do it. Re-applications might be possible but I'm hoping after the 10-14 days we have enough continuous data from that monitor that I can go to meter strips at home instead and test at feeding/dosing times.

One of the biggest questions I have is about the scheduling of it all. I can't seem to find helpful info on how long after feeding I should dose and once I do start monitoring with a meter when I should fit that into the pred/gaba/food then insulin routine.

 

[CORKY]

Thank you so much Maria!! I've been reading a bunch about the foods but I'm now a little overwhelmed. Some recommendations are to prioritize the carbs but some say to prioritize the phosphorus and adjust insulin accordingly and with her IBD it's been a struggle to get something that won't cause a flare up and allow for the low pred dose. I should be able to get the keto-diastix strips today so we can spot check urine which will definitely make me feel better. I want to figure out how to do the BG meter but if I'm honest I'm really nervous about it so I'm procrastinating. I'm worried about switching the food causing something else GI or kidney related to go out of whack. I have a good stock of her prescription diet since we just got the refill order and I don't want to waste it . I know I will have to transition her super slow - in the past we've done a 2 week transition period for a new food.

I'm not sure if I can handle her to get the libre on myself especially having to shave her so for the first application I want to go in and let them do it. Re-applications might be possible but I'm hoping after the 10-14 days we have enough continuous data from that monitor that I can go to meter strips at home instead and test at feeding/dosing times.

One of the biggest questions I have is about the scheduling of it all. I can't seem to find helpful info on how long after feeding I should dose and once I do start monitoring with a meter when I should fit that into the pred/gaba/food then insulin routine.

That is exactly the reason why I tag a couple of members that can help you with Lantau, Corky uses ProZinc so the procedure is different in the meantime you can go to the Main Forum and the sticky notes there it contains a lot valuable information and there is also a Lantus Forum , am sure that you will get a response before the afternoon is over

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

Have you tried a novel protein diet for your cat? IBD is somewhat like an allergy and certain proteins cause the inflammation to flare. A steroid, like prednisolone or budesonide help to reduce the inflammation. If you can eliminate the protein, it will help with the IBD. One of my kitties has IBD. It was easy to figure out the offending protein since all she'd been fed was poultry. Look at sources like rabbit, venison, pork, or anything that is not part of her usual rotation of food. There are a few IBD group around. The one I've used is Raw Feeding for IBD Cats. They have lots of good information and they have a Facebook page if you have questions. The website is also a great resource for information about supplements and medication.

Raw feeding is diabetes friendly. It's protein only so the only source of carbohydrates would be from the supplements that need to be added to make the raw food nutritionally complete. I use a pre-mix -- FoodFurLife. This is a powder that's mixed with water and added to the ground meat. This is a link to their chart that includes the phosphorus content based on what protein you're using. They note that the pre-mix should be fine unless Pickles has late stage CKD.

Not everyone wants to go the raw food route. Weruva is a good brand of food. It's a bit of a juggling act when it comes to managing diabetes, CKD, and IBS. This is a link to a list of sites for CKD diets. There's one list on the page that includes low carb, kidney friendly options. Just make sure that whatever food you choose contains taurine. There's a note about a few of the foods that they do not contain taurine and this is important for a cat's health.

Unfortunately, K/D, even the canned food, is very high in carbohydrates. The canned foods are around 27% carbs. The dry food is higher. You would need to be dosing whopping amounts of insulin to offset the carbs in K/D. One good thing about the food is that you can return it if you're so inclined. You also don't want to make an abrupt change in Pickles diet. Any change should be a slow transition otherwise, you risk a GI upset.

It's fine for Pickles' diabetes for her to graze. In fact, we encourage several small meals during the first half of the 12-hour insulin cycle. The only restriction is that you don't want to have food available during the 2-hours prior to shot time. You don't want the pre-shot numbers to be elevated as a result of food. Many vets still encourage feeding your cat twice a day. That made a great deal of sense with older types of insulin that onset almost immediately and dropped blood glucose numbers like a ton of bricks. That doesn't happen with Lantus.

With Lantus, insulin doesn't start working in most cats for about 2 hours. Unless your cat is in low numbers, it's usually OK to give a shot but we encourage new members to post and ask for help if they are unsure what to do. We also encourage members to leave food available (e.g., a timed feeder) if you're out of the house during the day or you don't want to be waking up during the night. With Lantus, the routine is to test, feed, and shoot all within a few minutes. I used to give my cat her shot while her head was in her food bowl. (She was very food motivated.)

I would encourage you to get a hand held glucometer. Some cats have a marked response to insulin. You need to know if it's safe to give a shot especially if you are transitioning Pickles to a lower carb food. Some cats are also quite good at removing the sensor from the Libre or the sensor stops working (always at a bad time). It's important to have a back up.

This is a link to the Lantus page. There are yellow sticky notes at the top of the page that you may find helpful. There's information about how Lantus works, dosing methods, and a great deal more.

Please let us know if you have questions. We're here to help.

 

[PicklePop's Mom]

She was on the Merrick limited ingredient duck and doing well on that. We switched to the k/d chicken to help the kidneys and has been okay while on pred. It seems like the Merrick wasn't much better in the carb department so I don't think going back would be helpful for either illness. Unfortunately she was on every variety pack under the sun growing up (I was a teenager at home when I got her so wasn't in charge of it) so finding a novel protein that was also affordable was difficult. I'm looking at all of the Weruva brands since they seem to have chicken only which she'll eat. Really happy to hear we can let her graze. Between my and co-cg work schedules we can remove food for the two hours AMPS/PMPS.

When we started the novel duck only protein in 2020 I considered a raw diet but at the time it seemed very complicated and I was concerned about not making a balanced diet. The powder sounds intriguing and I'll look into that. Thank you so much for the in depth reply.

I've been pouring over the sticky threads all day and am going to grab a meter on my way home to learn how tk pick her ear tonight. I started up the spreadsheet today too. So much helpful info here. So happy to have found it. Weve been managing a lot with her having ibs and hyperthyroidism before radiation treatment and thought we would have some calmer senior years but of course she's thrown us for yet another loop. Oh well. Nothing we can't learn how to handle.

 

[Sienne and Gabby (GA)]

If you're picking up a meter, this link on home testing will be helpful. There's general information as well as links to videos. You may want to consider getting some treats. There are freeze dried protein treats around or if Pickles like human food, that works, too. Providing a reward for your poking your cat's ear goes a long way to make the testing process easier.

If she eats chicken, you can get ground chicken at any grocery store or you can purchase chicken and grind it yourself. I've done both although that was prior to my having a cat with IBD.

The beginning of this process is completely overwhelming. We've all been there. The good news is that it becomes a routine and much, much easier. There are members' cats who literally let them know it's shot time. Ultimately, what you're doing is going to help Pickles feel better.

And when you get done with all of the sticky notes, you may want to take a look at the FAQ page. Just be warned, it's a deep rabbit hole.

 

[squeem3]

Independent pet stores often sell chubs of frozen raw meat for pet food use. Some are just ground meat, others may contain organs and / or bone as well. Plain ground meat is what you want if you plan to add a pre-mix or other supplementation. Hare-Today.com is a reputable online source for all sorts of novel raw meat for pet food use. This is an option if you don't want to grind meat yourself. I've heard of people warning not to use ground meat from a store because of the potential for bacteria from dirty grinders being mixed throughout the meat. Cooking kills the bacteria and you could cook the meat plain (no oil or anything) and then add supplementation. Some cats like cooked meat better than raw meat.

My IBD/diabetic/early kidney issue cat eats a commercial freeze dried raw food in rabbit. It's the only raw food his IBD and food allergies can handle.

The Weruva company also makes the lesser expensive and more widely available Soulistic brand. The Soulistic varieties are nearly identical to Weruva, just a few ingredient changes. Compare the ingredients of both brands to see what your cat's IBS tummy can handle.

 

[PicklePop's Mom]

If you're picking up a meter, this link on home testing will be helpful. There's general information as well as links to videos. You may want to consider getting some treats. There are freeze dried protein treats around or if Pickles like human food, that works, too. Providing a reward for your poking your cat's ear goes a long way to make the testing process easier.

If she eats chicken, you can get ground chicken at any grocery store or you can purchase chicken and grind it yourself. I've done both although that was prior to my having a cat with IBD.

The beginning of this process is completely overwhelming. We've all been there. The good news is that it becomes a routine and much, much easier. There are members' cats who literally let them know it's shot time. Ultimately, what you're doing is going to help Pickles feel better.

And when you get done with all of the sticky notes, you may want to take a look at the FAQ page. Just be warned, it's a deep rabbit hole.

Oh man yup that is a deep rabbit hole.

On the plus side I stopped at Walmart and got supplies and have been able to do two tests with PMPS and +1! She did great with co-cg holding her for the first and she almost slept through the second. Levels went up from 277 to 344 though so idk what that was about. Not sure if the reading was wrong PMPS or if she spiked from eating - we gave her some treats that I'm sure weren't helpful for levels but good for rewarding.

It definitely is way more reassuring to have the ability to check. I have a message into my vet to have them weigh in on the food options. I'm ditching the dry version of the k/d regardless.

 

[Sienne and Gabby (GA)]

Congrats on getting successful tests!

It's likely that the numbers are going up because you fed Pickles. Also, Lantus doesn't kick in immediately. Onset is around 2 hours after you give a shot. You're also not necessarily going to see much of a response to Lantus for 5 - 7 days. It takes that long for the depot to stabilize. You want to always get a test prior to giving a shot to make sure your cat is in safe numbers. You also want to get a minimum of one test during both the AM and PM cycles.

Did you download our spreadsheet? I ask because the numbers in the 200s are color coded yellow on our templates. Yours are a khaki sort of color.

Don't be surprised if your vet is clueless about the carbohydrate content of the food. I doubt the vet even knows what the carbs are in the prescription dry diabetic food or even some of the canned foods. They get most of their information on the prescription foods from the pet food manufacturer sales reps.

 

[PicklePop's Mom]

Congrats on getting successful tests!

It's likely that the numbers are going up because you fed Pickles. Also, Lantus doesn't kick in immediately. Onset is around 2 hours after you give a shot. You're also not necessarily going to see much of a response to Lantus for 5 - 7 days. It takes that long for the depot to stabilize. You want to always get a test prior to giving a shot to make sure your cat is in safe numbers. You also want to get a minimum of one test during both the AM and PM cycles.

Did you download our spreadsheet? I ask because the numbers in the 200s are color coded yellow on our templates. Yours are a khaki sort of color.

Don't be surprised if your vet is clueless about the carbohydrate content of the food. I doubt the vet even knows what the carbs are in the prescription dry diabetic food or even some of the canned foods. They get most of their information on the prescription foods from the pet food manufacturer sales reps.

Oh yeah I changed it because the bright yellow makes the text invisible on my phone. It's the same color rules in the Google sheet just a different highlight fill color. I'll try and find a color closer to the original that still works in dark mode. I also added a column to track food intake when given.

I've already forgotten that Lantus takes 2 hours so yeah that makes sense. I'm planning on doing another test before bed at +3.

My vet has been really good with most everything and we only switched on the reccomendation of the internal Med specialist we've gone to for both the ibs and when the ckd was dx'd. She was okay with me doing research when we were looking for a novel protein so I have high hopes that she'll be open to the conversation.

 

[Sienne and Gabby (GA)]

The alternative is to change the color of the font for those cells with numbers in the 200s. If you look at Gabby's spreadsheet, that's what I did for the same reason.

 

[Diane Tyler's Mom GA]

Just a suggestion. Weruva.com
You might want to try Weruva Pates
low carb/ low phosphorus
I don't know if it's good for IBD though
if you tap on this link and look at post #32 I listed some Weruva pates for another member that's low carb/ low phosphorus with kitties with CKD
https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3124085

You want the metabolizable energy profile percentage of carbs to be less than 10%, and the phosphorus which Weruva lists in Minerals to be less than 250 mg per 100 cals. So you have to look at two different places in the Weruva charts. This is where I was told where to look by a member. On the Weruva on the left are 3 lines click that and then click on cat foods , when you pick one to look at click on it then click on click on click to view Detailed Nutrition Information


You can even check out the soulistic pates
https://www.soulisticpet.com/pate
When you click on one of the flavors then click on
COMPLETE NUTRITIONAL INFORMATION (link to page)
and look at the same two places like on the weruva

 

[PicklePop's Mom]

Raw feeding is diabetes friendly. It's protein only so the only source of carbohydrates would be from the supplements that need to be added to make the raw food nutritionally complete. I use a pre-mix -- FoodFurLife. This is a powder that's mixed with water and added to the ground meat. This is a link to their chart that includes the phosphorus content based on what protein you're using. They note that the pre-mix should be fine unless Pickles has late stage CKD.

Not everyone wants to go the raw food route. Weruva is a good brand of food. It's a bit of a juggling act when it comes to managing diabetes, CKD, and IBS. This is a link to a list of sites for CKD diets. There's one list on the page that includes low carb, kidney friendly options. Just make sure that whatever food you choose contains taurine. There's a note about a few of the foods that they do not contain taurine and this is important for a cat's health.

So I have some really dumb questions. I've been reading about making the raw food with the pre-mix and it says you can batch it and freeze. Is that in like ziplocks or tupperware portioned out? Or do you use the silcone cubes (I do this for homemade bone broth a lot in 1/2 cup portions)? What do you do at mealtime - do you defrost the day before in the fridge? I imagine you can't microwave it or something.

 

[Sienne and Gabby (GA)]

I freeze in ice cube trays. At one point, I figured out the amount in a cube and I defrost a day’s meals over night. I have microwaved if I forgot to defrost but I didn’t completely cook the cubes. I think @Wendy&Neko portions a bit differently.

 

[Wendy&Neko]

My Neko got the Merrick Limited Ingredient duck as one of the foods in her rotation for her diabetes/kidney/GI issues. She most likely had small cell lymphoma instead of IBD (cats usually get Inflammatory Bowel Disease, not IBS) but couldn't be tested as her heart didn't allow anaesthesia. She was originally on raw, but at some point it became harder to eat because of mouth issues, so watered down can food was what she got. I got some Ziploc small plastic cube freezer containers, which held about the right amount for a day's worth of raw food. I used my kitchen scale to put the right amount of grams into each container. I was feeding two cats raw at the time. The containers stacked nicely in the freezer and I'd just take them out the night before to thaw.

The advantage to putting raw in plastic bags and flattening it out, is that if you forget to thaw it out, you can put it in a cool water bath for about 20 minutes to thaw. You could do the same with the plastic tubs, but it might take longer as it's a thicker package.

As Sienne said, find for kitty to graze, and it's easier on both the GI system and the diabetes to do so.

Have you talked to your vet about the possibility of using budesonide instead of prednisolone? Budesonide works mostly locally in the GI so for the majority of cats, not the same blood sugar spikes. Neko was regulated when she had to go on budesonide and it made no difference to her blood sugar.

Out of curiosity, how was Pickles diagnosed with IBD? My current IBD kitty it was very obvious, fish and beef cause vomiting. But she did have an ultrasound and endoscopy too.

 

[PicklePop's Mom]

My Neko got the Merrick Limited Ingredient duck as one of the foods in her rotation for her diabetes/kidney/GI issues. She most likely had small cell lymphoma instead of IBD (cats usually get Inflammatory Bowel Disease, not IBS) but couldn't be tested as her heart didn't allow anaesthesia. She was originally on raw, but at some point it became harder to eat because of mouth issues, so watered down can food was what she got. I got some Ziploc small plastic cube freezer containers, which held about the right amount for a day's worth of raw food. I used my kitchen scale to put the right amount of grams into each container. I was feeding two cats raw at the time. The containers stacked nicely in the freezer and I'd just take them out the night before to thaw.

The advantage to putting raw in plastic bags and flattening it out, is that if you forget to thaw it out, you can put it in a cool water bath for about 20 minutes to thaw. You could do the same with the plastic tubs, but it might take longer as it's a thicker package.

As Sienne said, find for kitty to graze, and it's easier on both the GI system and the diabetes to do so.

Have you talked to your vet about the possibility of using budesonide instead of prednisolone? Budesonide works mostly locally in the GI so for the majority of cats, not the same blood sugar spikes. Neko was regulated when she had to go on budesonide and it made no difference to her blood sugar.

Out of curiosity, how was Pickles diagnosed with IBD? My current IBD kitty it was very obvious, fish and beef cause vomiting. But she did have an ultrasound and endoscopy too.

She basically stopped eating during the summer of Covid. Showed signs of hunger and went to eat but then licked it and sat down and looked at me. If she did eat she would vomit it back up. We got a dx of hyperthyroidism from the primary vet and put on methimazole. She still didn't gain weight or eat so she was hospitalized with internal med dept at a pet hospital near us. There she had an ultrasound which was clear so they did an endoscopy. It was fine until they got to her intestine which was inflamed almost completely. I can't remember if they did a biopsy but I think they did - no cancer. So she got put on pred and switched to the Merrick since it was duck only but not prescription price and it worked. (I researched the crap out of every ingredient in every alternative protein canned food easily available at the time. I wasn't ready to consider a raw diet back then) She started eating again and gaining weight. We've since had the hyperthyroidism cured with radiation and tapered her down to 4.5mg pred every other day and the internal med dr isn't incredibly concerned about it since it's such a low dose. She did mention budesonide but said it's not always as effective so I didn't want to switch yet - though it's a possibility in the future. Or we could lower to 2.5 or 3mg pred every other day. I just don't want to muck with it yet - especially if we're considering yet another diet change. I'm very cautious to change too many things at once but I want to get her off the high carb k/d diet ASAP. We switched to every 3rd day and she wasn't really eating by the third day and laying about - that's one of her GI signs is she doesn't curl up in a ball to sleep. We think it's cause her GI is inflamed and painful so she stretches out on the floor instead. She did that a lot before getting dx'd.

FWIW I just ordered one of the Weruva WX sample/variety pack of the two chicken only flavors to see if she'll be interested in either of them and keep it down. When we switched from the merrick I had a sample pack and did like a tsp of a food for 2-3 days to see if she would 1. eat it or 2. tolerate it and she threw up some of them but not the k/d chicken so that's what we switched to. We take at minimum 14 days to switch food fully.

EDIT: If I think about it I think it's the fish varieties that she doesn't get along with.

 

[Wendy&Neko]

Fish is a common allergy, and unfortunately a lot of brands put it in.

My IBD girl is on 3 mg every day. I've tried lowering it, and her GI system complains. Unfortunately am now seeing some side effects of the steroid, but she's been on it for over 6 years. Good plan to try changes slowly. The pred will mean she'll likely need a higher insulin dose, but we dose around necessary meds.

The WX foods are not complete meals, but rather intended as supplemental or intermittent. When you are looking at foods, most of us feed in the 4-6% carbs range. Lower is not necessarily better. Some cats actually do better on higher, like 8% carbs. You could even add back the Merrick if it's something that agrees with her.

 

[PicklePop's Mom]

Fish is a common allergy, and unfortunately a lot of brands put it in.

My IBD girl is on 3 mg every day. I've tried lowering it, and her GI system complains. Unfortunately am now seeing some side effects of the steroid, but she's been on it for over 6 years. Good plan to try changes slowly. The pred will mean she'll likely need a higher insulin dose, but we dose around necessary meds.

The WX foods are not complete meals, but rather intended as supplemental or intermittent. When you are looking at foods, most of us feed in the 4-6% carbs range. Lower is not necessarily better. Some cats actually do better on higher, like 8% carbs. You could even add back the Merrick if it's something that agrees with her.

Oh interesting. I thought it was labeled that for the same reason a lot of the ckd diets are - low phosphorus. The k/d is technically labeled that since the phosphorus is too low for the accredited standards but I've heard it's okay for senior and ckd kitties. So I should shoot for a low but not zero carb and as low phosphorus as I can get. I think there was another weruva that I found like that.
.. Yeah, it was the BFF play pate chicken checkmate. Idk. It all feels so crazy complicated and nothing feels like a right choice.

 

[Wendy&Neko]

The WX would be good to keep in the rotation if she likes it. The hallmark of IBD cats is they get bored of a particular food easily and get fussy. I find having a rotation of options helps keep things interesting.