K/D Diet & Diabetes

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SabrinaFaire

SabrinaFaire

Member Since 2011
I hope it's OK I'm posting this outside my intro post.

To recap, my cat Hobbs was diagnosed with kidney disease in September and was put on the Hills K/D diet.

Shortly thereafter, he started having diabetic symptoms though I didn't recognize it. He was peeing more (I thought his kidneys were getting better), sometimes mold would grow on the clumps (vet said this was because of the sugar in the urine), his pee was sticky (more pee was harder to keep up with in his box so he'd sometimes go outside of it), and he lost weight (about 4lbs). Took him in for his follow up a couple of weeks ago, vet says he's diabetic.

I'm just wondering because the k/d diet is higher in carbs than regular food. Is it possible that it could mimic diabetes?

I trust my vet, she's the Dr after all, and I'm just wondering this because I'm in denial or anything. It just has me wondering, you know? Has anyone else ever had experience with this? I'm wondering if I should get a second opinion.
 
What are typical blood glucose readings? A frutosimine test also might be in order. Is suspect,;like your vet, that Hoobs might be diabetic.
 
Well, when I first brought him in it was 487, a week later after being on 2u/2x day of Lantus it was down to 151. Last week it was 57 and they lowered his dose to 1u/2x day and I got a meter on Friday. It's been in the mid 300s since then. I haven't been able to do a "curve" because I'm still getting comfortable doing the metering and poking his ears, I figured one thing at a time, maybe this weekend I'll try.
 
If I understand the question correctly, you want to know if the higher carb food can artificially inflate Hobbs' Blood Glucose numbers and cause him to be diabetic, implying that if you switched to a lower carb diet his numbers would drop into a normal range and he would no longer need insulin?

The answer is yes and no. Hobbs is definitely giving you some diabetic numbers, so I would agree with your vet that he is diabetic. The large majority of diabetic cats (including my Bandit) can go into remission after being placed on a low carb diet, and being on slow acting insulin like Lantus for a period of time to allow the pancreas to heal. However, once a cat is diabetic, even once they are off insulin they are still diabetic--they are now just diet controlled. If I were to feed Bandit high carb food today, his blood sugar would in a diabetic range again tonight. If I were to continue to feed him high carb food, he would need insulin again.

Some lucky cats go into remission as soon as the high carb food is removed. However, they are still diabetics and need to stay on a low carb, canned diet to eliminate the need for insulin. Most cats need insulin for a period of time.

Infections (like UTIs or gum inflammation) can also cause temporarily high numbers. Once the source of the infection or inflammation is treated, the cat will likely no longer need insulin again. However, he will still be a diabetic cat.

Have you checked out the sticky's in the Lantus forum yet, particularly the one that explains the Lantus dosing protocol? http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581 It's hard to tell until you have some more numbers, but 2u is a bit high for a starting dose, unless your cat has a very large frame. Most cats do not need much more than 1u once the high carb food is removed. That 57 you got as a preshot is an indication to me that the dose is too high. Too high a dose will keep your cat's blood sugar just as high as too low a dose, because when a cat reaches a very low number glucose is dumped into their blood streams as a survival mechanism.

I would recommend changing the diet and reducing the dose down to .5u or 1u, while continuing to home test. I would also urge you to check out the Lantus Tight Regulation Forum so that you can read a bit more about how Lantus works. Dose adjustments should be made usually in .25u increments, and are based off the nadir (the lowest number of the cycle), which is usually about 6 hours after the shot. Is it possible for you to get a third mid-cycle test every day in addition to the pre-shot tests? It could be in either cycle. Those mid-cycle tests will tell you whether or not the dose is too high or low.


EDIT: I see that you already lowered the dose to 1u--that's great! Do you know how to fill the the number of units on your spreadsheet? They go in the columns labeled "U". Check out Bandit's Spreadsheet in my signature to give you an idea of how the spreadsheet get's filled out and please ask if you have any questions about it!
 
Julia: Yes, that's what I meant! :) Thanks for answering too. I thought that might be the answer but I wanted to know either way.

I just learned this morning that the U on the spreadsheet is number of units, so I need to update that, just haven't had time.

As for a mid-cycle test... maybe. I usually feed him about the time I get home, which is 5:30 +/-. I could try to get one before bed, though that's pushing it for sleep. During the day isn't an option though, I don't work close enough to home to be able to do that.
 
SabrinaFaire said:
Julia: Yes, that's what I meant! :) Thanks for answering too. I thought that might be the answer but I wanted to know either way.

I just learned this morning that the U on the spreadsheet is number of units, so I need to update that, just haven't had time.

As for a mid-cycle test... maybe. I usually feed him about the time I get home, which is 5:30 +/-. I could try to get one before bed, though that's pushing it for sleep. During the day isn't an option though, I don't work close enough to home to be able to do that.
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I work two jobs, one of which includes an hour commute there and back, and I'm in grad school, so I understand tight schedules! What I did was test before each shot (7am and 7pm), and then I got a mid-cycle test at 1am. Usually that meant going to bed at 11pm, and setting an alarm and getting up at 1am to get that test, and then going right back to bed. On the weekends when I was home Sat. and Sundays during the day, I would do curves. I know it seems like a pain, but once it becomes routine it's really not a huge deal. Other options are teaching a family member or roommate how to test and have them help you out once a day, or bribing a friend or neighborhood student to come over a few times a week and get the mid-cycle tests so you only have to set the alarm and get them a couple times a week. You may not have even considered this option yet because you're just learning to test yourself, but in a couple of weeks, you'll be a pro at testing, trust me. Until I convinced my boyfriend to learn to test Bandit, I taught a college student I met through my second job to come over and test Bandit during the day 3 times a week.

It's very hard to regulate your cat well without those mid-cycle numbers. And the sooner you can regulate your cat, the better and sooner are your chances for remission. Lantus has an 80+% remission rate in cats when tight regulation is followed (I've attached an article for you and your vet). As someone who is super, super busy all the time, I am so glad I dealt with the minor inconvenience to get those tests, because it is far easier on my schedule to take care of a cat a in remission than one still on insulin.
 

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I don't have any real advice, but yes, Grey was a diabetic who went OTJ for several years due to being on low carb food. Once the CRF made us switch to the K/D, I had to put her back on insulin. Everyone here has given you great advice, and be sure to utilize Tanya's CRF site as well as Janet&Binky's food chart to watch for phosphorus levels. The K/D is already super low phosphurus, and if I had to pick which way to go again with Grey (GA), I'd have switched back to insulin and K/D much earlier. It sounds like you have a good head's up on your baby's conditions and once you get the BG numbers where they need to be, I think your baby will be just fine!

Oh, and check out the litterbox part of www.catinfo.org, that made a big difference in being able to keep my girl going in her litterbox rather than outside of it. Maybe setting puppy pee pads in the areas he's going outside the box? It's a pain, I know, but it's better than just peeing on carpet/rugs/whatever. Also, is arthritis a factor? I gave my girl Adequan and that helped her a lot; I think she felt like she couldn't get in and out of her box even with the very low step-in fronts I bought.

Best of luck to you!

Suzanne
 
I would definitely discuss with your vet about what stage of kidney disease your kitty is in. It makes a huge difference in what you should be feeding on whether it's early or late stage kidney disease. This is a great page to help you understand what stage it is based on the test results the vet shares with you: http://www.felinecrf.org/how_bad_is_it.htm. If you're still in stage 1 or 2, you don't need the k/d.
 
Suzanne: He's not peeing outside the box now, he was quite frequently for maybe a month or so. I just couldn't keep up with the scooping. He was peeing SO MUCH. I joked and said that the pee-bergs could have sunk the Titanic. They were HUGE. Great tracks of land!!! So he would get over that pretty quickly and pee right in front of the box. Which is in our bathroom so it was pretty noticeable to us.

Julia: The vet said that he was "sub clinical" not even showing symptoms. At dx his Creatinine was 2.34 which is Stage 2 according to that link, on December 14 it was down to 1.34 which would be Stage 1. So, by that, it would seem like he doesn't need it. And to be honest, over the years I've done research on cat food to determine what would be good for him balancing with what I could afford and I never even liked the non-Rx Hills food. :?
 
SabrinaFaire said:
Julia: The vet said that he was "sub clinical" not even showing symptoms. At dx his Creatinine was 2.34 which is Stage 2 according to that link, on December 14 it was down to 1.34 which would be Stage 1. So, by that, it would seem like he doesn't need it. And to be honest, over the years I've done research on cat food to determine what would be good for him balancing with what I could afford and I never even liked the non-Rx Hills food. :?
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Gabby was also a stage 1 at diagnosis--like you, we caught it almost by accident. My vet gave me the same advice as you--that the prescription diet would help halt the progression of the disease. After 3 weeks on NF (that's the Purina version of K/D), she was starting to thin down and look really scraggly, and being me I started doing my own research. That's when I discovered the low phosphorus/quality protein vs. low protein controversy, and based on the muscle wasting I was starting to see in her I figured even if I was making a mistake I'd still rather see Gabby enjoy quality of life rather than a quantity of life. So I switched her to a high quality protein, low phosphorus diet, and in the 2 years I had left with her (she passed away from stomach cancer, completely unrelated to her kidney disease), her kidneys did not worsen in the least. In the year and 3 months I had left with her before her cancer diagnosis, she was thriving on the diet. My vet even made a point of mentioning it, I think as kind of a "you were right" consolation at the time, even though it didn't really matter at that point. She did tell me she was changing her diet recommendations for stage 1 cats though, based off the research I brought her.

Gabby wasn't diabetic, though, so I think switching foods is a much easier choice for you. If the kidney disease is stage 1 then your priority right now should be managing the diabetes, because that is the more serious condition at the moment. And like I said, it's not even like the two things have to be counter productive--there are several foods that are good for both conditions.

Wellness, Merrick's, and EVO all have store finders on their web sites, so definitely plug them in to find a place near you that sells them. I know Petsmart sells Wellness, and PetCo Merrick's and Wellness, but most towns have a locally owned pet food or farm supply store that sells them, too, and they are usually way cheaper there than at the chain stores. I pay $1.16 a can for Merrick's (about the same as what you pay for Fancy Feast), because my local feed store gives me a deal if I get 24 cans at a time, and they have the large 12 oz cans of Wellness and EVO, which are very economical. It was a dollar forty something for Merrick's at PetCo last time I was in there. Definitely check out the pricing around you--you can find some very good deals.
 
Julia, that research was the spreadsheet you posted in the other thread, right? Did you get those numbers by calling the company?

I'm in Omaha so we have a mixture of boutique natural pet food supply stores, feed stores, and chains all within 10 or so miles. Never thought Omaha would have such an advantage! I have to go to PetCo tonight for litter anyway so I was going to see what they have.
 
Well, the food research, yes. Here's that info repeated if you're having trouble finding it:

Here's an updated food list with the values for several premium foods: https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&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.
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Just an FYI, the Protein/Fat values for the Merrick's Before Grain Turkey are reversed on that chart. I called the company to confirm the correct values because it seemed off to me. I didn't personally call the company for all of the values (I'm not 100% sure who gathered all the values for the updated chart), but premium cat food companies are way more forthcoming with their as-fed values than big ones like Purina, so you can easily call any one of the companies on the list to confirm them if they seem off, like I did. I also have some PetGuard values too that aren't on either list, but none of their foods would be ideal for a cat with both diabetes and kidney disease. Their low phosphorus Chicken & Beef flavor is about 13% carbs and contains some grain, so a bit too high for a diabetic. Gabby loved it, though, and it was great for putting and keeping weight on her.

What I was talking about with sharing research with my vet were studies that showed that low protein diets may not be necessary for cats in early stage kidney disease. If you're interested in doing some reading on the subject, here's a great site to get you started: http://www.felinecrf.com/managd.htm
 
a lot of us with renal cats and diabetes feed their cats friskies special diet. seems to do the job and is a lot easier on the pocketbook
 
dian and wheezer said:
a lot of us with renal cats and diabetes feed their cats friskies special diet. seems to do the job and is a lot easier on the pocketbook
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The only problem with Friskies special diet is that ideally you want a higher quality protein source because you want less protein metabolism residue, and Friskies uses lower grade ingredients. If a food without byproducts simply isn't affordable, though, it's the next best thing.

However, I would suggest trying to work a premium food in your budget if you can--there are lots of ways to reduce costs like by buying them in bulk or in 12-13oz cans if they're available. And any premium food is automatically going to be cheaper than the prescription diets.

Another option is making your own raw food, so that you know it's low in phosphorus, sodium, and that you're using a higher grade protein. I don't have experience with homemade diets, but I've heard that after the initial equipment investment, it ends up being cheaper over time. Tany's CRF page discusses them a bit: http://www.felinecrf.org/which_foods.htm
 
Julia, what is the difference between "% as Phosphorous fed" and "Phosphorous per 100 kCal"? I'm noticing that on Binky's list, the values of k/d and k/d with chicken for phos per 100 are 75 & 84 respectively, which is a lot lower than your list, for example the EVO 95% Chicken & Turkey is 155. But of course I want to make sure I'm understanding it right. I know I need to read up more, I don't expect you to do all the research for me, just thought I'd ask if it's a quick answer. :)
 
SabrinaFaire said:
Julia, what is the difference between "% as Phosphorous fed" and "Phosphorous per 100 kCal"? I'm noticing that on Binky's list, the values of k/d and k/d with chicken for phos per 100 are 75 & 84 respectively, which is a lot lower than your list, for example the EVO 95% Chicken & Turkey is 155. But of course I want to make sure I'm understanding it right. I know I need to read up more, I don't expect you to do all the research for me, just thought I'd ask if it's a quick answer. :)
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It's just the difference in how the numbers are figured--if you're looking at "Phosphorus per 100 kCal", the recommendation for early stage renal kitties is to stay under 250 mg/100kcal, or under 1% "as Phosphorus fed". It's the percentage figured into caloric intake vs. the percentage in the food itself.

Here's what you are looking for: A canned food (for moisture), under 250 mg/100kcal (or 1%) for Phosphorus, lower sodium, high quality protein, and under 10% carbs for the diabetes.

To save you time, though, all of the foods I named for you in my earlier post meet those requirements. The Friskie's Special Diet flavors meet some of the requirements--it's low phosphorus and low carb, but the sodium content isn't great and it uses lower grade ingredients.

The prescription renal diets are going to be the lowest in phosphorus because of the low protein, but you don't HAVE to go that low in phosphorus. Like I said, you also have to think of carbs as well, and something under 250 mg/100kcal is going to be just fine. I would urge you to read the articles I provided for further reading a few posts ago. You're not just looking at one thing (low phosphorus content) in choosing a food for your cat. You need to balance protein, fat, carbs, phosphorus, and sodium to find a food that is right for your cat's condition.
 
I'm going to put it this way, and I apologize if I'm being too blunt, but in my opinion what's the point of feeding the prescription diet to help the kidneys if it causes your cat's health to deteriorate from protein malnourishment and uncontrolled diabetes? It's addressing only one problem, which at this point isn't the largest health concern for your cat. It's far easier (and less dangerous) to give phosphorus binders to reduce phosphorus absorption if need be eventually (and he's not even that far gone into the kidney disease yet) than it is to administer high doses of insulin to combat high carb intake.
 
For what it's worth, Grey was stage 4 CRF. That's why I went the direction I went. I agree with Julia, you have to find what fits your cats needs.
 
I'm new here and don't know too much, but my cat was on k/d wet and dry and then diagnosed with diabetes. I switched to the lowest phospherous low carb foods I could find (thanks Julia & Bandit) - canned of course. I feed the Wellness Turkey and EVO Turkey and Chicken 95%. My vet agreed that switching to only canned with a high quality protein would take some stress of his kidneys and would hopefully offset the slight increase in phospherous. He was not in CRF but prone to ammonium urate stones. It seems like just switching to canned food helps with lots of other health issues. I hope it helps your cat as well.

P.S. The Hills nutritionist said to keep him on k/d despite the diabetes and control the diabetes around the k/d. The Royal Canin nutritionaist completely disagreed with that statement and said unless my cat was well into CRF, focus on the diabetes. I'm glad my vet was willing to do some extra research for me. I'm also glad I learned enough hear to ask the right questions.
 
Suzanne&Grey said:
For what it's worth, Grey was stage 4 CRF. That's why I went the direction I went. I agree with Julia, you have to find what fits your cats needs.
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Suzanne, K/D or NF canned is absolutely suitable choice for a stage 4 kitty--I don't want it to sound like it's never good decision to feed prescription renal foods, because studies have shown that lower protein is beneficial in the end stages.

BrodyCat said:
The Hills nutritionist said to keep him on k/d despite the diabetes and control the diabetes around the k/d. The Royal Canin nutritionaist completely disagreed with that statement and said unless my cat was well into CRF, focus on the diabetes. I'm glad my vet was willing to do some extra research for me. I'm also glad I learned enough hear to ask the right questions.
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I learned the very hard way with my cats to do my own research regarding diet, and to not trust the vet where prescription diets are concerned. Back when I could not figure out why Bandit was so obese (THIS is what he looked like at age 6), I decided to seek out an expert to help with his weight loss. That's how I found Bandit's former, former vet, who was actually one of the developers of Hills Prescription and Science Diets. He came highly recommended and cost me an arm and a leg. I thought wow, he must really know what he's talking about when it comes to nutrition, so I can really trust his weight loss treatment plan for Bandit. He had me eliminate all canned food from his diet (he was eating canned Wellness and Purina Indoor dry at the time), and put him on the prescription dry W/D. Bandit lost weight, but he also developed triaditis. After he got down to a reasonable weight, the vet had me switch him the Science diet light, and told me that he must eat a weight control food for the rest of his life. Well, this went on until I happened to notice his increased drinking on the solely dry diet, and I started to do a little research on my own on feline nutrition. I was stunned with what I discovered about obligate carnivores and grain and fiber content. I immediately switched him to a mix of mostly Wellness with some grain-free dry food (I hadn't figured out the frozen food trick yet), but the damage had already been done. A couple months later he was diagnosed with diabetes. I am absolutely convinced that Hills W/D and Science Diet caused Bandit's diabetes.

You always have to remember that there's not only a personal financial motive for the vet to sell you the prescription food, but the prescription food companies inundate vets and vet students with promotional materials constantly. I live in the same town as Cornell Vet School, and Purina dumps so much money into the school it's ridiculous. I think most vets truly believe that they are the best thing for the cat, even when they're not because that's what they're being told.
 
Julia & Bandit said:
Suzanne, K/D or NF canned is absolutely suitable choice for a stage 4 kitty--I don't want it to sound like it's never good decision to feed prescription renal foods, because studies have shown that lower protein is beneficial in the end stages.
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Oh no, I know didn't you mean anything negative about my case! I just figured for SabrinaFaire's sake (and anyone else trying to help their kitties) that I needed to clarify why I chose the route that I did. For the OP's cat, I absolutely agree with you. High blood pressure that can result from out-of-control diabetes will also destroy nephrons. Her cat has a great chance, why monkey around with fluctuating blood glucose and possibly high BP when there are better options out there?

Julia & Bandit said:
I am absolutely convinced that Hills W/D and Science Diet caused Bandit's diabetes.
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My Grey's story is very similar! I fed the Science Diet Indoor Light Formula, only she didn't drop much weight, just became diabetic. I too, firmly believe that "fat cat formula" dry food shortened my cat's life. That's why it was priority #1 to get my new cats on a wet diet. Thankfully, they think wet food is awesome!
 
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