"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 diabetes, as
well as on the protein/phos question, 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