New: Update for Chronos

[Dan and Marc]

Original Post: https://felinediabetes.com/FDMB/threads/new-with-questions.261669/#post-2934595

We met with our vet on April 8th, they got blood and urine. His labs should sugar in the urine, no proteins and no ketones. His BG from the lab was 296. Everything else was stable for him except having elevated basophilis (he has been having skin allergy issues this year so vet said thats usually the main reason those elevate). One thing to note we had been using Mozotic for the skin scabs he was getting from allergies for the past four months. After talking with the vet she said if he had been licking the ointment, since it contains corticosteroids that it could of impacted his BG. We can confirm he was licking it in general.

Plan was to swap him from the Hills K/D he was on since it is quite high carb and change him to Royal Canin D (we met with a vet nutritionist who said this was the lowest carb based kidney diet, more info in original post)

Unfortunately we only got one case of Royal Canin D before it become out of stock everywhere. We began changing him over to the Royal Canin and checking his blood each day, the first few days we were seeing decreases (originally we saw him on our Contour Next meter at 338) but the first few checks were 280 then 240. I believe Tuesday of last week I noticed a new skin scab so I put some of ht Mozotic on it because I thought it was in a location he couldn't lick but was wrong as I saw him licking that area later that night without issue. The next day his BG was back to 300. It dropped a little each day after. I am guessing it was just random fluctuations but did seem like an odd coincidence.

We had to order the Royal Canin E until the D comes back in stock (the Nutritionist said this could be used as a back up since it is the next lowest carb count one). He is currently on half the D and half the E plus two tablespoons of boiled chicken (she suggested this as well to lower the carb count). Today he was at 266 on our meter.

I called the vet to see what our next steps should be and she said she wanted us to wait a couple of weeks and keep testing every day and to report if he goes higher but since generally it seems to be lowering she wants more time to see where the diet changes ends up. He is acting like his normal self with the exception of some mild drinking. Our hope is to get the Royal Canin D and have him be on that fully but will depend on supply. (I am aware there are other food options but as everyone has their own opinions on food and other variable with him specifically this is what we are currently comfortable with).

My main concern is it ok to wait to see if the diet change does anything? Generally how long would you wait before it became clear diet alone was not enough an insulin is needed?

 

[Bron and Sheba (GA)]

Are you able to add some more earlier data into the spreadsheet?
If the BG are in the 200s that indicates to me that your kitty needs insulin.
I know you are waiting to see if the food will make a difference. But if you are doing that you really need to be testing for ketones every day to see that are not starting to appear. I know he had non at diagnosis but that does not mean he won’t get them now, especially insulin is being withheld while you see if the food makes a difference. Usually you will see a difference in the BGs within a week if the food is going to make the difference.
Do you have any lab results to share with us? Your kitty may just need a lower phosphorus food not a prescription food.
What stage if CRD has your kitty been staged?
How many carbs in the new food that is replacing the one you can’t get?

 

[Dan and Marc]

He is a unique kidney cat, I explained it somewhat in my original thread but sorry for a long story:

Basically when he was 4 him and his brother both had 2.3 and 2.4 creatinine which is pretty high for that age. We started them on the Hills CKD diet (would of chosen differently at the time had I known about food as I do now). His brother had an acute kidney incident a year later, he had a 14 creatinine (miraculously came down the next day to 4 and then when we brought him home a few days later was 2.1) and was admitted to our local VCA who to our benefit has a well known Internal Medicine doctor who specializes in kidneys. The IM Vet has done or was part of the group of vets who did some of the studies quoted on Tanyas CKD site for instance. His brother survived that incident and we also decided to have the IM vet see Chronos as a patient. Unfortunately a year later his brother had another episode, we got him in asap and his creatinine was already at a 9 and unfortunately did not respond like before but only worsened. His kidneys stopped producing urine and he was retaining all the fluid they were giving him, the specialist still doesn't know what happened but thinks it may have been something genetic because there were no signs of blockages or any other reason that the specialist could find. So we sadly lost Phanes at that time.

So we were obviously very diligent about watching Chronos and the specialist diagnosed him with progressive kidney disease and he was treated as such for 3-4 years. However during all that time his creatinine, BUN and Phosophorus never changed and actually improved, he is currently at 1.9CREA, BUN usually 20-28 range and Phosphorus between 4-6 and has been there consistently for the last 2 years now, so the specialist said he is now considered to have non-progressive kidney disease and that it would take an acute kidney episode or other factors to potentially trigger him into progressive. From what he said it's pretty rare for cats to be labeled as non-progressive since you can't regenerate the filters within the kidneys, but for whatever reason Chronos' situation is unique and with all that he didn't want us to change anything unless something occurred, so we kept the same diet and have been checking him every 6 months since. Never mentioned his age but he will be 12 this June so 8 years of kidney values that originally were what you would expect of a CKD cat (though not at that young of an age), have only improved for whatever reason and now his values being what they are and his age he basically wouldn't be considered a CKD cat.

Sorry for all that but just wanted to explain why he was on that food and that he isn't really a standard CKD cat.

Anyways back to diabetes:

I did talk to our vet and she said for now she just wants us to check his blood every day and if it keeps trending down to keep monitoring but if not then yes we would start insulin. We did just get the Nova Plus monitor since it can check ketones using blood (recommended by another member from this forum) so we will be checking the ketones every day as well. We have the urine strips but I've only been able to catch him in the litter box once so far to check using those.

For your quetion abot the carb count difference, based on Tanyas CKD food chart: https://felinecrf.org/canned_food_usa.htm the food (Hills Chicken K/D) he was on was 38.90 carbs and the Royal Canin D is 22.24 and the Royal Canin E is 27.32. Currently he is getting half of both the Royal Canins plus 2 tablespoons of boiled chicken breast until we can get the Royal Canin D again and have him fully on that.

As for labs I just have what the vet told me over the phone, I have pretty bad anxiety and in the past when they would send me the labs I would over think everything so unless really needed, I stopped having her send them to me and just have her tell me the kidney values and anything that is off or she thinks is relevant.

 

[Bron and Sheba (GA)]

I did talk to our vet and she said for now she just wants us to check his blood every day and if it keeps trending down to keep monitoring but if not then yes we would start insulin. We did just get the Nova Plus monitor since it can check ketones using blood (recommended by another member from this forum) so we will be checking the ketones every day as well. We have the urine strips but I've only been able to catch him in the litter box once so far to check using those.

I’m glad you are going tho check for ketones daily at the moment.

For your quetion abot the carb count difference, based on Tanyas CKD food chart: https://felinecrf.org/canned_food_usa.htm the food (Hills Chicken K/D) he was on was 38.90 carbs and the Royal Canin D is 22.24 and the Royal Canin E is 27.32. Currently he is getting half of both the Royal Canins plus 2 tablespoons of boiled chicken breast until we can get the Royal Canin D again and have him fully on that.

Wow that are very high carbs. Definitely not suitable for diabetic cats.
I know you have complex issues with your kitty but I can’t believe that he has to have a prescription diet. Is it the dry food you are feeding? That has very little moisture in it (around7%) whereas most wet foods have 78% and kidneys need lots of moisture.
I am sorry to be so sceptical but I would really like to know what the prescription food has in it that is so much better than other cat food. Most of the ingredients do not look very good in prescription diets and I can never see anything special in those diets.
How many carbs in the Royal Canin D?
If your kitty was put on a low carb diet I’m sure his BGs would drop dramatically. At the moment he is being fed a high carb diet which is like letting a human diabetic live on Macdonalds and desserts and just stresses the pancreas more.
I appreciate you are in a difficult position but I would seriously question the diet he is on. Especially now that his kidney values are normal.

 

[Dan and Marc]

We only feed our cats wet food. We had a consultation with a vet nutritionist out of a VCA in Maine who recommended the Royal Canin D since it has the lowest carbs and phosphorus of the kidney foods she recommends. You're saying the Royal Canin D is very high too? The food chart from Dr. Pierson has the Royal Canin D at 16% and the phosphorous at 80. What carb % is ideal? We still want to keep his phosphorus low, CKD is still a concern for us given what the specialist said and being on the low phosphorous food for all these years has played a part in that.

 

[Bron and Sheba (GA)]

We only feed our cats wet food.

That’s good!

You're saying the Royal Canin D is very high too? T

I was talking about the dry food when I was saying the food is very high carbs.
However if the canned food is 16% carbs, that is still considered high carb. That carb content is what we give our kitties if they drop too low and need to be brought back into safer BG numbers.
There is really nothing magical or special about prescription diets. To get a low phosphorus, they add carbs and reduce the protein content, and that is why they are higher carb foods.
I had a diabetic kitty who started to have some higher kidney numbers and I fed her a home made diet where I controlled what went into the diet. I also added cooked egg white each day which is high protein and low phosphorus and that lowers the amount of phosphorus in the diet. Until the cat is late stage CRD they don’t need a low protein diet…that is old thinking. Low protein makes them lose muscle mass.
I don’t want to cause you more anxiety but I would really look more into the diet as there are other low carb low phosphorus options out there. For example Weruva website publishes all the nutritional values of their foods. I used to used some of the cats in the kitchen ones.
If you look for foods that have less than 200mg phosphorus/100kcals that is acceptable for cats wanting a low phosphorus diet.
If the cats phosphorus levels are normal then you don’t need an extremely low phosphorus level food.
look at this FOOD CHART

also HERE is a thread discussing home made CRD diet.