Re: Hill's T/D carbs - Thanks, Steve and Liz for the interestingdiscussion

[Jean]

I'm certainly no expert and am reading and asking alot of questions.
Seems like the jury is still out on the carb question re: diabetes, as
well as on the protein/phos question, re: kidneys. I've run across an
awful lot of conflicting information - all from some kind of expert or
another.

At this point in time, I'm leaning in the direction of reduced (not
*none*) carbs, moderate, high quality protein and low phosphorous diet
for my older kitty with diabetes. The fact that kidney values don't show
a rise until the disease is well underway seems pretty well documented.
However, there seems to be quite a bit of research that also says that
implementing a "kidney diet" will not *prevent* the disease in otherwise
healthy cats. There's also alot of research that supports the thought
that cats don't really need carbs at all - they're natural carnivores.
However, the proteins used in alot of canned and dry cat foods are
combinations of grains, and cats can't produce the right amino acid
chains from those sources, like vegetarian humans do.

This may be real simplistic, but I'm kind of coming to the conclusion
that shooting for something close to the "in the wild" feline diet, may
be the best way to go. Still need to do "alot" more research!!!

Thanks all-
Jean

[Jean]

I'm certainly no expert and am reading and asking alot of questions.
Seems like the jury is still out on the carb question re: diabetes, as
well as on the protein/phos question, re: kidneys. I've run across an
awful lot of conflicting information - all from some kind of expert or
another.

At this point in time, I'm leaning in the direction of reduced (not
*none*) carbs, moderate, high quality protein and low phosphorous diet
for my older kitty with diabetes. The fact that kidney values don't show
a rise until the disease is well underway seems pretty well documented.
However, there seems to be quite a bit of research that also says that
implementing a "kidney diet" will not *prevent* the disease in otherwise
healthy cats. There's also alot of research that supports the thought
that cats don't really need carbs at all - they're natural carnivores.
However, the proteins used in alot of canned and dry cat foods are
combinations of grains, and cats can't produce the right amino acid
chains from those sources, like vegetarian humans do.

This may be real simplistic, but I'm kind of coming to the conclusion
that shooting for something close to the "in the wild" feline diet, may
be the best way to go. Still need to do "alot" more research!!!

Thanks all-
Jean

[Liz]

Jean, in my opinion you understood it all very well. Wish you luck
with your kitties, I'm sure they have many great years ahead of them
despite the health problems. :)

[Liz]

Jean, in my opinion you understood it all very well. Wish you luck
with your kitties, I'm sure they have many great years ahead of them
despite the health problems. :)

[Phil P.]

"Jean" > wrote in message
...

Sorry for coming in late -- just got back.


> I'm certainly no expert and am reading and asking alot of questions.
> Seems like the jury is still out on the carb question re: diabetes, as
> well as on the protein/phos question, re: kidneys. I've run across an
> awful lot of conflicting information - all from some kind of expert or
> another.

That's precisely why I would err on the side of caution and follow the
thinking of the majority of the mainstream veterinary community regarding
lowing phosphorus intake. Protein, however, shouldn't be reduced until the
BUN reaches 60 mg/dl.


>
> At this point in time, I'm leaning in the direction of reduced (not
> *none*) carbs, moderate, high quality protein and low phosphorous diet
> for my older kitty with diabetes. The fact that kidney values don't show
> a rise until the disease is well underway seems pretty well documented.
> However, there seems to be quite a bit of research that also says that
> implementing a "kidney diet" will not *prevent* the disease in otherwise
> healthy cats.

Here's where there seems to be a bit of confusion. The reason for
implementing a kidney or lower phosphorus diet isn't to "prevent" CRF but to
*delay* the onset of *clinical* CRF and slow the progression of subclinical
CRF.. As you're aware, kidney values usually don't rise until ~75% of renal
function has been lost. IOW, many cats are *already* in *subclinical* CRF
well *before* CRF is detected by routine blood/USG tests.

In fact, based on data submitted to the Veterinary MedÂ*ical Data Base at
Purdue, 37% of cats with CRF were less than 10 years old. The mean age of
diagnosis was 7.4 years for cats. Another survey at VMDB, showed 53% of
affected cats were over 7 years old and 47% were less than 7. That means
CRF can begin at 4 or 5 or even younger in some cats. The cats
ranged in age from 9 months to 22 years. IOW, without highly specialized
tests, we never know when CRF actually begins. Therefore, lowering
phosphorus intake early in life will more than likely delay the onset of
clinical CRF and slow the progression of subclinical CRF in cats with
undetected CRF. There's absolutely no benefit in feeding high phosphorus
diets.

Good luck.

Phil

[Phil P.]

"Jean" > wrote in message
...

Sorry for coming in late -- just got back.


> I'm certainly no expert and am reading and asking alot of questions.
> Seems like the jury is still out on the carb question re: diabetes, as
> well as on the protein/phos question, re: kidneys. I've run across an
> awful lot of conflicting information - all from some kind of expert or
> another.

That's precisely why I would err on the side of caution and follow the
thinking of the majority of the mainstream veterinary community regarding
lowing phosphorus intake. Protein, however, shouldn't be reduced until the
BUN reaches 60 mg/dl.


>
> At this point in time, I'm leaning in the direction of reduced (not
> *none*) carbs, moderate, high quality protein and low phosphorous diet
> for my older kitty with diabetes. The fact that kidney values don't show
> a rise until the disease is well underway seems pretty well documented.
> However, there seems to be quite a bit of research that also says that
> implementing a "kidney diet" will not *prevent* the disease in otherwise
> healthy cats.

Here's where there seems to be a bit of confusion. The reason for
implementing a kidney or lower phosphorus diet isn't to "prevent" CRF but to
*delay* the onset of *clinical* CRF and slow the progression of subclinical
CRF.. As you're aware, kidney values usually don't rise until ~75% of renal
function has been lost. IOW, many cats are *already* in *subclinical* CRF
well *before* CRF is detected by routine blood/USG tests.

In fact, based on data submitted to the Veterinary MedÂ*ical Data Base at
Purdue, 37% of cats with CRF were less than 10 years old. The mean age of
diagnosis was 7.4 years for cats. Another survey at VMDB, showed 53% of
affected cats were over 7 years old and 47% were less than 7. That means
CRF can begin at 4 or 5 or even younger in some cats. The cats
ranged in age from 9 months to 22 years. IOW, without highly specialized
tests, we never know when CRF actually begins. Therefore, lowering
phosphorus intake early in life will more than likely delay the onset of
clinical CRF and slow the progression of subclinical CRF in cats with
undetected CRF. There's absolutely no benefit in feeding high phosphorus
diets.

Good luck.

Phil

[Jean]

Phil P. wrote:
> "Jean" > wrote in message
> ...
>
> Sorry for coming in late -- just got back.

I've been in and out too - spending alot of time on the feline diabetes
message board and forgetting to keep up with other things :-) This is a
great discussion though and *very* relevant to what's going on with my
kitty right now.

>
>
>> I'm certainly no expert and am reading and asking alot of questions.
>> Seems like the jury is still out on the carb question re: diabetes, as
>> well as on the protein/phos question, re: kidneys. I've run across an
>> awful lot of conflicting information - all from some kind of expert or
>> another.
>
> That's precisely why I would err on the side of caution and follow the
> thinking of the majority of the mainstream veterinary community regarding
> lowing phosphorus intake. Protein, however, shouldn't be reduced until the
> BUN reaches 60 mg/dl.

(do you have any references for this? I'm not doubting it - it fits with
what things I've read that don't give numeric guidelines. A professional
reference would be helpful to have when discussing this with my vet)

I completely agree. My problem has been that my kitty's current BUN is
only 32 after a 34 reading in February. Creatinine is only 1.6 after a
2.4 in Feb. Lab upper normal limits were 34 and 2.3. Kitty's been on K/D
since Feb. but was just Dx with diabetes. That's what puts a whole
different spin on the relative value of K/D which is very low protein,
vry low phos and very high carb and fat. My vet wants him to stay on KD
but I'm thinking it would be better to go for something with moderate
protein, low phos and much lower carb in order to treat the diabetes
better. The choices are a little limited, but there are some foods out
there that meet that criteria. The other problem I'm seeing with KD is
how high in fat it is - 50%. My kitty is 16, has a bit of a weight
problem and high cholesterol

>
> Here's where there seems to be a bit of confusion. The reason for
> implementing a kidney or lower phosphorus diet isn't to "prevent" CRF but to
> *delay* the onset of *clinical* CRF and slow the progression of subclinical
> CRF.. As you're aware, kidney values usually don't rise until ~75% of renal
> function has been lost. IOW, many cats are *already* in *subclinical* CRF
> well *before* CRF is detected by routine blood/USG tests.
>
> In fact, based on data submitted to the Veterinary MedÂ*ical Data Base at
> Purdue, 37% of cats with CRF were less than 10 years old. The mean age of
> diagnosis was 7.4 years for cats. Another survey at VMDB, showed 53% of
> affected cats were over 7 years old and 47% were less than 7. That means
> CRF can begin at 4 or 5 or even younger in some cats. The cats
> ranged in age from 9 months to 22 years. IOW, without highly specialized
> tests, we never know when CRF actually begins. Therefore, lowering
> phosphorus intake early in life will more than likely delay the onset of
> clinical CRF and slow the progression of subclinical CRF in cats with
> undetected CRF. There's absolutely no benefit in feeding high phosphorus
> diets.

Good points. I'm seeing another vet tomorrow for a second opinion about
a good diet, considering the diabetes as well as any sub-clinical kidney
disease. Seems like paying the most attention to low carb (better for
the diabetes) and low phos (better for the kidneys) will address both
needs the best - we'll see what he has to say. I really need advice
that's geared to the "whole cat" so that I'm not making one problem
worse or creating a whole new problem while trying to treat only one of
several. Who knows, since the diabetes developed within 3 months of
starting KD, maybe the high carb content even contributed to that.

Thanks for the thoughts -
Jean

[Jean]

Phil P. wrote:
> "Jean" > wrote in message
> ...
>
> Sorry for coming in late -- just got back.

I've been in and out too - spending alot of time on the feline diabetes
message board and forgetting to keep up with other things :-) This is a
great discussion though and *very* relevant to what's going on with my
kitty right now.

>
>
>> I'm certainly no expert and am reading and asking alot of questions.
>> Seems like the jury is still out on the carb question re: diabetes, as
>> well as on the protein/phos question, re: kidneys. I've run across an
>> awful lot of conflicting information - all from some kind of expert or
>> another.
>
> That's precisely why I would err on the side of caution and follow the
> thinking of the majority of the mainstream veterinary community regarding
> lowing phosphorus intake. Protein, however, shouldn't be reduced until the
> BUN reaches 60 mg/dl.

(do you have any references for this? I'm not doubting it - it fits with
what things I've read that don't give numeric guidelines. A professional
reference would be helpful to have when discussing this with my vet)

I completely agree. My problem has been that my kitty's current BUN is
only 32 after a 34 reading in February. Creatinine is only 1.6 after a
2.4 in Feb. Lab upper normal limits were 34 and 2.3. Kitty's been on K/D
since Feb. but was just Dx with diabetes. That's what puts a whole
different spin on the relative value of K/D which is very low protein,
vry low phos and very high carb and fat. My vet wants him to stay on KD
but I'm thinking it would be better to go for something with moderate
protein, low phos and much lower carb in order to treat the diabetes
better. The choices are a little limited, but there are some foods out
there that meet that criteria. The other problem I'm seeing with KD is
how high in fat it is - 50%. My kitty is 16, has a bit of a weight
problem and high cholesterol

>
> Here's where there seems to be a bit of confusion. The reason for
> implementing a kidney or lower phosphorus diet isn't to "prevent" CRF but to
> *delay* the onset of *clinical* CRF and slow the progression of subclinical
> CRF.. As you're aware, kidney values usually don't rise until ~75% of renal
> function has been lost. IOW, many cats are *already* in *subclinical* CRF
> well *before* CRF is detected by routine blood/USG tests.
>
> In fact, based on data submitted to the Veterinary MedÂ*ical Data Base at
> Purdue, 37% of cats with CRF were less than 10 years old. The mean age of
> diagnosis was 7.4 years for cats. Another survey at VMDB, showed 53% of
> affected cats were over 7 years old and 47% were less than 7. That means
> CRF can begin at 4 or 5 or even younger in some cats. The cats
> ranged in age from 9 months to 22 years. IOW, without highly specialized
> tests, we never know when CRF actually begins. Therefore, lowering
> phosphorus intake early in life will more than likely delay the onset of
> clinical CRF and slow the progression of subclinical CRF in cats with
> undetected CRF. There's absolutely no benefit in feeding high phosphorus
> diets.

Good points. I'm seeing another vet tomorrow for a second opinion about
a good diet, considering the diabetes as well as any sub-clinical kidney
disease. Seems like paying the most attention to low carb (better for
the diabetes) and low phos (better for the kidneys) will address both
needs the best - we'll see what he has to say. I really need advice
that's geared to the "whole cat" so that I'm not making one problem
worse or creating a whole new problem while trying to treat only one of
several. Who knows, since the diabetes developed within 3 months of
starting KD, maybe the high carb content even contributed to that.

Thanks for the thoughts -
Jean

[PawsForThought]

>From: Jean

>Phil P. wrote:

>There's absolutely no benefit in feeding high phosphorus
>> diets.

>Seems like paying the most attention to low carb (better for
>the diabetes) and low phos (better for the kidneys) will address both
>needs the best - we'll see what he has to say. I really need advice
>that's geared to the "whole cat" so that I'm not making one problem
>worse or creating a whole new problem while trying to treat only one of
>several. Who knows, since the diabetes developed within 3 months of
>starting KD, maybe the high carb content even contributed to that.

Hi Jean,
I think it's great that you're researching the best diet for your cat. I think
the quality of the protein you feed is very important. While there are many
conflicting opinions on the phosphorous issue, I don't think anyone is
advocating a high phosphorous diet. I do think while phosphorous is important,
it is also very important to look at the entire diet and to feed a high quality
diet that is fit for a carnivore and that isn't grain based. I think you've
got it right, when seeing the cat as a whole being. That's the main philosphy
of holistic vets.
Best of luck with finding the right diet for your kitty :)

Lauren
________
See my cats: http://community.webshots.com/album/56955940rWhxAe
Raw Diet Info: http://www.holisticat.com/drjletter.html
http://www.geocities.com/rawfeeders/ForCatsOnly.html
Declawing Info: http://www.wholecat.com/articles/claws.htm

[PawsForThought]

>From: Jean

>Phil P. wrote:

>There's absolutely no benefit in feeding high phosphorus
>> diets.

>Seems like paying the most attention to low carb (better for
>the diabetes) and low phos (better for the kidneys) will address both
>needs the best - we'll see what he has to say. I really need advice
>that's geared to the "whole cat" so that I'm not making one problem
>worse or creating a whole new problem while trying to treat only one of
>several. Who knows, since the diabetes developed within 3 months of
>starting KD, maybe the high carb content even contributed to that.

Hi Jean,
I think it's great that you're researching the best diet for your cat. I think
the quality of the protein you feed is very important. While there are many
conflicting opinions on the phosphorous issue, I don't think anyone is
advocating a high phosphorous diet. I do think while phosphorous is important,
it is also very important to look at the entire diet and to feed a high quality
diet that is fit for a carnivore and that isn't grain based. I think you've
got it right, when seeing the cat as a whole being. That's the main philosphy
of holistic vets.
Best of luck with finding the right diet for your kitty :)

Lauren
________
See my cats: http://community.webshots.com/album/56955940rWhxAe
Raw Diet Info: http://www.holisticat.com/drjletter.html
http://www.geocities.com/rawfeeders/ForCatsOnly.html
Declawing Info: http://www.wholecat.com/articles/claws.htm

[Jean]

> Hi Jean,
> I think it's great that you're researching the best diet for your cat. I think
> the quality of the protein you feed is very important. While there are many
> conflicting opinions on the phosphorous issue, I don't think anyone is
> advocating a high phosphorous diet. I do think while phosphorous is important,
> it is also very important to look at the entire diet and to feed a high quality
> diet that is fit for a carnivore and that isn't grain based. I think you've
> got it right, when seeing the cat as a whole being. That's the main philosphy
> of holistic vets.
> Best of luck with finding the right diet for your kitty :)
>
> Lauren

Lauren -

Thanks for the encouragement. It'd be nice if things are more black and
white! But at the same time, it's the "standard treatment protocols"
that cause problems when there are multiple issues and conflicting
treatments. The more I've read, the clearer it is that the grain based
combinations that the cat food makers call protein are not usable in
cats the way they are in humans. It becomes even murkier because alot of
animal proteins also provide alot of phosphorous so it's important to
pick and choose carefully. Slowly but surely getting there!

Thanks again-
Jean

[Jean]

> Hi Jean,
> I think it's great that you're researching the best diet for your cat. I think
> the quality of the protein you feed is very important. While there are many
> conflicting opinions on the phosphorous issue, I don't think anyone is
> advocating a high phosphorous diet. I do think while phosphorous is important,
> it is also very important to look at the entire diet and to feed a high quality
> diet that is fit for a carnivore and that isn't grain based. I think you've
> got it right, when seeing the cat as a whole being. That's the main philosphy
> of holistic vets.
> Best of luck with finding the right diet for your kitty :)
>
> Lauren

Lauren -

Thanks for the encouragement. It'd be nice if things are more black and
white! But at the same time, it's the "standard treatment protocols"
that cause problems when there are multiple issues and conflicting
treatments. The more I've read, the clearer it is that the grain based
combinations that the cat food makers call protein are not usable in
cats the way they are in humans. It becomes even murkier because alot of
animal proteins also provide alot of phosphorous so it's important to
pick and choose carefully. Slowly but surely getting there!

Thanks again-
Jean

[Phil P.]

"Jean" > wrote in message
...
> Phil P. wrote:
> > "Jean" > wrote in message
> > ...
> >
> > Sorry for coming in late -- just got back.
>
> I've been in and out too -

I've been in and out of the country for the last few weeks - Two more months
of this.... ;( I think I have perpetual jet lag! At least I don't have
to keep
resetting my watch - I gain 12 hrs going and lose 12 comming back! .

There's nothing like being greeted by 5 cats! ...


spending alot of time on the feline diabetes
> message board and forgetting to keep up with other things :-) This is a
> great discussion though and *very* relevant to what's going on with my
> kitty right now.

You should try the CRF support list - You'll get a lot of good information.
I'm sure someone can get you the URL.

Here's another site you may find helpful:
Chronic Renal Failure and Diabetes
http://www.petdiabetes.org/chronic_renal_failure.htm


>
> >
> >
> >> I'm certainly no expert and am reading and asking alot of questions.
> >> Seems like the jury is still out on the carb question re: diabetes, as
> >> well as on the protein/phos question, re: kidneys. I've run across an
> >> awful lot of conflicting information - all from some kind of expert or
> >> another.
> >
> > That's precisely why I would err on the side of caution and follow the
> > thinking of the majority of the mainstream veterinary community
regarding
> > lowing phosphorus intake. Protein, however, shouldn't be reduced until
the
> > BUN reaches 60 mg/dl.
>
> (do you have any references for this? I'm not doubting it - it fits with
> what things I've read that don't give numeric guidelines. A professional
> reference would be helpful to have when discussing this with my vet)

Here's one:

"Most veterinary nephrologists recommend that dietary protein reduction be
initiated when the animal's blood urea nitrogen concentration is between 60
and 80 mg/dI. Examples of commercially available diets that contain
reduced-quantity, high-quality-protein include Hill's Prescription Diet k/d,
Purina NF-formula diets, and Waltham Veterinarian medium- and low-protein
diets. Homemade reduced-protein diet recipes are also available." Gregory F.
Grauer, DVM, MS, Dipl. ACVIM, Professor and Section Chief, Small Animal
Medicine, Department of Clinical Sciences, Veterinary Teaching Hospital,
Colorado State University Fort Collins, Colorado (Excerpted from SAIM)


There are others, but that should suffice for now.




>
> I completely agree. My problem has been that my kitty's current BUN is
> only 32 after a 34 reading in February. Creatinine is only 1.6 after a
> 2.4 in Feb. Lab upper normal limits were 34 and 2.3.

Was your cat's hydration status determined? The elevated values might have
been due to prerenal uremia secondary to dehydration.


>Kitty's been on K/D > since Feb. but was just Dx with diabetes.

Was you cat's diabetes confirmed with either fructosamine or glycosylatated
hemoglobin tests? Glycosylated Hb shows the average glucose control over
the past couple of months and the fructosamine test reflects average glucose
control for the past 1-3 weeks. These test distinguish true diabetes from
physiologic (stress) hyperglycemia ("white coat effect"). The trip to the
vet is usually enough to cause physiologic hyperglycemia in many cats.
From the time you put the cat in the carrier, the car ride (cats generally
don't like car rides), the vet's office with the scents of many past and
present animals, restrained for blood collection, and getting poked with a
needle ---- which all could take as much as an hour -- is more than enough
time and stress to trigger the cat's
defensive mechanisms and for physiologic hyperglycemia to develop. Many of
our cats tested "diabetic" at the clinic and normal a few hours later back
at the shelter.



That's what puts a whole
> different spin on the relative value of K/D which is very low protein,
> vry low phos and very high carb and fat. My vet wants him to stay on KD >
but I'm thinking it would be better to go for something with moderate
> protein, low phos and much lower carb in order to treat the diabetes
> better. The choices are a little limited, but there are some foods out
> there that meet that criteria.

For awhile I was a proponent of high-protein, low-carb diets for diabetes -
until a few cats became azotemic. I was able to wean several cats off
insulin completely but I don't think it's worth the risk. After a lot
of research and discussions with vets, I'm now back to the conventional
treatment - fiber blend, and insulin when necessary.



The other problem I'm seeing with KD is
> how high in fat it is - 50%.

Actually, the fat content of canned k/d is 7.6% (As fed) and 26.7% (dry
matter basis).and 20.6% (AF) - 22.3% (DM) for the dry. The higher fat
supplies non-protein calories to meet the cat's energy needs while producing
less waste products from protein catabolism


My kitty is 16, has a bit of a weight
> problem and high cholesterol

Obesity can cause a reversible insulin resistance in cats which often
resolves after the cat's ideal weight is reached.


>
> >
> > Here's where there seems to be a bit of confusion. The reason for
> > implementing a kidney or lower phosphorus diet isn't to "prevent" CRF
but to
> > *delay* the onset of *clinical* CRF and slow the progression of
subclinical
> > CRF.. As you're aware, kidney values usually don't rise until ~75% of
renal
> > function has been lost. IOW, many cats are *already* in *subclinical*
CRF
> > well *before* CRF is detected by routine blood/USG tests.
> >
> > In fact, based on data submitted to the Veterinary MedÂ*ical Data Base at
> > Purdue, 37% of cats with CRF were less than 10 years old. The mean age
of
> > diagnosis was 7.4 years for cats. Another survey at VMDB, showed 53% of
> > affected cats were over 7 years old and 47% were less than 7. That
means
> > CRF can begin at 4 or 5 or even younger in some cats. The cats
> > ranged in age from 9 months to 22 years. IOW, without highly
specialized
> > tests, we never know when CRF actually begins. Therefore, lowering
> > phosphorus intake early in life will more than likely delay the onset of
> > clinical CRF and slow the progression of subclinical CRF in cats with
> > undetected CRF. There's absolutely no benefit in feeding high
phosphorus
> > diets.
>
> Good points. I'm seeing another vet tomorrow for a second opinion about
> a good diet, considering the diabetes as well as any sub-clinical kidney
> disease. Seems like paying the most attention to low carb (better for
> the diabetes) and low phos (better for the kidneys) will address both
> needs the best - we'll see what he has to say. I really need advice
> that's geared to the "whole cat" so that I'm not making one problem
> worse or creating a whole new problem while trying to treat only one of
> several. Who knows, since the diabetes developed within 3 months of
> starting KD, maybe the high carb content even contributed to that.

What where you feeding your cat before?

>
> Thanks for the thoughts -

Before you set off on any therapeutic plan, I'd have the diabetes confirmed
with fructosamine or glycosylatated hemoglobin tests.

Best of luck.

Phil


> Jean
>
>

[Phil P.]

"Jean" > wrote in message
...
> Phil P. wrote:
> > "Jean" > wrote in message
> > ...
> >
> > Sorry for coming in late -- just got back.
>
> I've been in and out too -

I've been in and out of the country for the last few weeks - Two more months
of this.... ;( I think I have perpetual jet lag! At least I don't have
to keep
resetting my watch - I gain 12 hrs going and lose 12 comming back! .

There's nothing like being greeted by 5 cats! ...


spending alot of time on the feline diabetes
> message board and forgetting to keep up with other things :-) This is a
> great discussion though and *very* relevant to what's going on with my
> kitty right now.

You should try the CRF support list - You'll get a lot of good information.
I'm sure someone can get you the URL.

Here's another site you may find helpful:
Chronic Renal Failure and Diabetes
http://www.petdiabetes.org/chronic_renal_failure.htm


>
> >
> >
> >> I'm certainly no expert and am reading and asking alot of questions.
> >> Seems like the jury is still out on the carb question re: diabetes, as
> >> well as on the protein/phos question, re: kidneys. I've run across an
> >> awful lot of conflicting information - all from some kind of expert or
> >> another.
> >
> > That's precisely why I would err on the side of caution and follow the
> > thinking of the majority of the mainstream veterinary community
regarding
> > lowing phosphorus intake. Protein, however, shouldn't be reduced until
the
> > BUN reaches 60 mg/dl.
>
> (do you have any references for this? I'm not doubting it - it fits with
> what things I've read that don't give numeric guidelines. A professional
> reference would be helpful to have when discussing this with my vet)

Here's one:

"Most veterinary nephrologists recommend that dietary protein reduction be
initiated when the animal's blood urea nitrogen concentration is between 60
and 80 mg/dI. Examples of commercially available diets that contain
reduced-quantity, high-quality-protein include Hill's Prescription Diet k/d,
Purina NF-formula diets, and Waltham Veterinarian medium- and low-protein
diets. Homemade reduced-protein diet recipes are also available." Gregory F.
Grauer, DVM, MS, Dipl. ACVIM, Professor and Section Chief, Small Animal
Medicine, Department of Clinical Sciences, Veterinary Teaching Hospital,
Colorado State University Fort Collins, Colorado (Excerpted from SAIM)


There are others, but that should suffice for now.




>
> I completely agree. My problem has been that my kitty's current BUN is
> only 32 after a 34 reading in February. Creatinine is only 1.6 after a
> 2.4 in Feb. Lab upper normal limits were 34 and 2.3.

Was your cat's hydration status determined? The elevated values might have
been due to prerenal uremia secondary to dehydration.


>Kitty's been on K/D > since Feb. but was just Dx with diabetes.

Was you cat's diabetes confirmed with either fructosamine or glycosylatated
hemoglobin tests? Glycosylated Hb shows the average glucose control over
the past couple of months and the fructosamine test reflects average glucose
control for the past 1-3 weeks. These test distinguish true diabetes from
physiologic (stress) hyperglycemia ("white coat effect"). The trip to the
vet is usually enough to cause physiologic hyperglycemia in many cats.
From the time you put the cat in the carrier, the car ride (cats generally
don't like car rides), the vet's office with the scents of many past and
present animals, restrained for blood collection, and getting poked with a
needle ---- which all could take as much as an hour -- is more than enough
time and stress to trigger the cat's
defensive mechanisms and for physiologic hyperglycemia to develop. Many of
our cats tested "diabetic" at the clinic and normal a few hours later back
at the shelter.



That's what puts a whole
> different spin on the relative value of K/D which is very low protein,
> vry low phos and very high carb and fat. My vet wants him to stay on KD >
but I'm thinking it would be better to go for something with moderate
> protein, low phos and much lower carb in order to treat the diabetes
> better. The choices are a little limited, but there are some foods out
> there that meet that criteria.

For awhile I was a proponent of high-protein, low-carb diets for diabetes -
until a few cats became azotemic. I was able to wean several cats off
insulin completely but I don't think it's worth the risk. After a lot
of research and discussions with vets, I'm now back to the conventional
treatment - fiber blend, and insulin when necessary.



The other problem I'm seeing with KD is
> how high in fat it is - 50%.

Actually, the fat content of canned k/d is 7.6% (As fed) and 26.7% (dry
matter basis).and 20.6% (AF) - 22.3% (DM) for the dry. The higher fat
supplies non-protein calories to meet the cat's energy needs while producing
less waste products from protein catabolism


My kitty is 16, has a bit of a weight
> problem and high cholesterol

Obesity can cause a reversible insulin resistance in cats which often
resolves after the cat's ideal weight is reached.


>
> >
> > Here's where there seems to be a bit of confusion. The reason for
> > implementing a kidney or lower phosphorus diet isn't to "prevent" CRF
but to
> > *delay* the onset of *clinical* CRF and slow the progression of
subclinical
> > CRF.. As you're aware, kidney values usually don't rise until ~75% of
renal
> > function has been lost. IOW, many cats are *already* in *subclinical*
CRF
> > well *before* CRF is detected by routine blood/USG tests.
> >
> > In fact, based on data submitted to the Veterinary MedÂ*ical Data Base at
> > Purdue, 37% of cats with CRF were less than 10 years old. The mean age
of
> > diagnosis was 7.4 years for cats. Another survey at VMDB, showed 53% of
> > affected cats were over 7 years old and 47% were less than 7. That
means
> > CRF can begin at 4 or 5 or even younger in some cats. The cats
> > ranged in age from 9 months to 22 years. IOW, without highly
specialized
> > tests, we never know when CRF actually begins. Therefore, lowering
> > phosphorus intake early in life will more than likely delay the onset of
> > clinical CRF and slow the progression of subclinical CRF in cats with
> > undetected CRF. There's absolutely no benefit in feeding high
phosphorus
> > diets.
>
> Good points. I'm seeing another vet tomorrow for a second opinion about
> a good diet, considering the diabetes as well as any sub-clinical kidney
> disease. Seems like paying the most attention to low carb (better for
> the diabetes) and low phos (better for the kidneys) will address both
> needs the best - we'll see what he has to say. I really need advice
> that's geared to the "whole cat" so that I'm not making one problem
> worse or creating a whole new problem while trying to treat only one of
> several. Who knows, since the diabetes developed within 3 months of
> starting KD, maybe the high carb content even contributed to that.

What where you feeding your cat before?

>
> Thanks for the thoughts -

Before you set off on any therapeutic plan, I'd have the diabetes confirmed
with fructosamine or glycosylatated hemoglobin tests.

Best of luck.

Phil


> Jean
>
>

[Phil P.]

"Liz" > wrote in message
om...
> > Therefore, lowering
> > phosphorus intake early in life will more than likely delay the onset of
> > clinical CRF and slow the progression of subclinical CRF in cats with
> > undetected CRF. There's absolutely no benefit in feeding high
phosphorus
> > diets.
> >
> > Good luck.
> >
> > Phil
>
> I posted studies showing that phosphurus did not add to kidney damage
> EVEN in cats with CRF


Steve already debunked all your BS - Either you're obtuse or in denial or
both to accept it. I think most people know who to believe... and it ain't
you. I don't intend to go through this all over again with you.

Tell you what... Post your phosphorus epiphany in the CRF support lists...
You should get a real warm welcome! LOL!

[Phil P.]

"Liz" > wrote in message
om...
> > Therefore, lowering
> > phosphorus intake early in life will more than likely delay the onset of
> > clinical CRF and slow the progression of subclinical CRF in cats with
> > undetected CRF. There's absolutely no benefit in feeding high
phosphorus
> > diets.
> >
> > Good luck.
> >
> > Phil
>
> I posted studies showing that phosphurus did not add to kidney damage
> EVEN in cats with CRF


Steve already debunked all your BS - Either you're obtuse or in denial or
both to accept it. I think most people know who to believe... and it ain't
you. I don't intend to go through this all over again with you.

Tell you what... Post your phosphorus epiphany in the CRF support lists...
You should get a real warm welcome! LOL!

[Jean]

Hi Phil -

> There's nothing like being greeted by 5 cats! ...
And I'll bet they were glad to see *you* too!


> You should try the CRF support list - You'll get a lot of good information.
> I'm sure someone can get you the URL.
> ....
> "Most veterinary nephrologists recommend that dietary protein reduction be
> initiated when the animal's blood urea nitrogen concentration is between 60
> and 80 mg/dI. Examples of commercially available diets that contain
> reduced-quantity, high-quality-protein include Hill's Prescription Diet k/d..

Current BUN is only 32 after a 34 reading in February. Creatinine is
only 1.6 after a 2.4 in Feb. Lab upper normal limits were 34 and 2.3

I've posted a couple questions on the CRF board and done quite a bit of
reading. The problem is that Muffin's kidney values right now don't
qualify him for the CRF category. I've gleaned alot of pertinent info
though, which is what has led me to placing the most credence in
following a low phos diet, but one with lower carbs and higher protein
than k/d in order to treat the diabetes better. The felinediabetes.com
message board has been extremely helpful also.

>
> Was your cat's hydration status determined?
Hydration was OK. I don't have the number for specific gravity - the vet
merely said that kitty was concentrating his urine pretty well.
>
> Was you cat's diabetes confirmed with either fructosamine
Yes - 722
or glycosylatated
> hemoglobin tests?
No

> These test distinguish true diabetes from
> physiologic (stress) hyperglycemia ("white coat effect").

No doubt about it, my kitty is stressed at the vet! Another factor is
that he's been on prednisone for about a year, which can either raise BG
and/or precipitate diabetes. I've been doing home BG testing before and
since changing kitty's diet to higher protein, lower carb and low phos.
The "second opinion" vet hinted that given kitty's current BG curves,
and all the other factors (pred & borderline kidney values) he *might*
be a cat who can be regulated through diet alone. His recommendation
(for now) was to
1. continue insulin - 1u PZI Vet BID
2. wean off the pred (for arthritis) and see if the cosequin (he's been
getting for a couple months now) is working well enough - if not, he'll
look into something besides pred for pain control.
3. feed a moderate protein, low carb, low phos diet
4. home test BG to keep a close watch on BG
5. re-check bloodwork frequently (in a month) to closely monitor kidney
values
6. re-evaluate diet if kidney values start to rise

"second opinion" vet now has a new client :-)

>The higher fat
> supplies non-protein calories to meet the cat's energy needs while producing
> less waste products from protein catabolism

That's pretty much what the vet said - not to worry about fat content
since it doesn't cause the same problems in cats that it does in humans

> Obesity can cause a reversible insulin resistance in cats which often
> resolves after the cat's ideal weight is reached.

He was up to 15lbs at one point, but is now down to 12.5

> Before you set off on any therapeutic plan, I'd have the diabetes confirmed
> with fructosamine or glycosylatated hemoglobin tests.

It's definitely been confirmed and I have already seen very positive
results from the insulin. He's *much* perkier/more active, coat is much
better and not peeing so much. From what the new vet has said, I'm just
keeping my fingers crossed that losing the pred and changing diet might
just do the trick without insulin and without sabotaging kidneys. Time
will tell!

Thanks for all your thoughts!
Jean

[Jean]

Hi Phil -

> There's nothing like being greeted by 5 cats! ...
And I'll bet they were glad to see *you* too!


> You should try the CRF support list - You'll get a lot of good information.
> I'm sure someone can get you the URL.
> ....
> "Most veterinary nephrologists recommend that dietary protein reduction be
> initiated when the animal's blood urea nitrogen concentration is between 60
> and 80 mg/dI. Examples of commercially available diets that contain
> reduced-quantity, high-quality-protein include Hill's Prescription Diet k/d..

Current BUN is only 32 after a 34 reading in February. Creatinine is
only 1.6 after a 2.4 in Feb. Lab upper normal limits were 34 and 2.3

I've posted a couple questions on the CRF board and done quite a bit of
reading. The problem is that Muffin's kidney values right now don't
qualify him for the CRF category. I've gleaned alot of pertinent info
though, which is what has led me to placing the most credence in
following a low phos diet, but one with lower carbs and higher protein
than k/d in order to treat the diabetes better. The felinediabetes.com
message board has been extremely helpful also.

>
> Was your cat's hydration status determined?
Hydration was OK. I don't have the number for specific gravity - the vet
merely said that kitty was concentrating his urine pretty well.
>
> Was you cat's diabetes confirmed with either fructosamine
Yes - 722
or glycosylatated
> hemoglobin tests?
No

> These test distinguish true diabetes from
> physiologic (stress) hyperglycemia ("white coat effect").

No doubt about it, my kitty is stressed at the vet! Another factor is
that he's been on prednisone for about a year, which can either raise BG
and/or precipitate diabetes. I've been doing home BG testing before and
since changing kitty's diet to higher protein, lower carb and low phos.
The "second opinion" vet hinted that given kitty's current BG curves,
and all the other factors (pred & borderline kidney values) he *might*
be a cat who can be regulated through diet alone. His recommendation
(for now) was to
1. continue insulin - 1u PZI Vet BID
2. wean off the pred (for arthritis) and see if the cosequin (he's been
getting for a couple months now) is working well enough - if not, he'll
look into something besides pred for pain control.
3. feed a moderate protein, low carb, low phos diet
4. home test BG to keep a close watch on BG
5. re-check bloodwork frequently (in a month) to closely monitor kidney
values
6. re-evaluate diet if kidney values start to rise

"second opinion" vet now has a new client :-)

>The higher fat
> supplies non-protein calories to meet the cat's energy needs while producing
> less waste products from protein catabolism

That's pretty much what the vet said - not to worry about fat content
since it doesn't cause the same problems in cats that it does in humans

> Obesity can cause a reversible insulin resistance in cats which often
> resolves after the cat's ideal weight is reached.

He was up to 15lbs at one point, but is now down to 12.5

> Before you set off on any therapeutic plan, I'd have the diabetes confirmed
> with fructosamine or glycosylatated hemoglobin tests.

It's definitely been confirmed and I have already seen very positive
results from the insulin. He's *much* perkier/more active, coat is much
better and not peeing so much. From what the new vet has said, I'm just
keeping my fingers crossed that losing the pred and changing diet might
just do the trick without insulin and without sabotaging kidneys. Time
will tell!

Thanks for all your thoughts!
Jean