Newly diabetic cat - can new renal diet be the culprit?
September 26, 2018 8:02 AM   Subscribe

I have a 12-ish year old cat that was declared early stage kidney disease in May, and has been on a renal diet since. When I returned for follow-up tests her kidney results showed great improvement - but her blood sugar was suddenly through the roof. I'm wondering if it's diet-related, though the vet says that's not likely. Much more detail inside, and cat picture.

In May, my cat had routine tests run and her Chloride level returned 112 (reference level 114-126 mmol/L), and Creatinine returned 2.6 (reference levels 0.9-2.5mg/dL). Urine was dilute with a gravity of 1.019. Not losing protein via urine.

Also worth noting, she'd lost about 1lb since previous vet visit six months or more before. (This is the May reading.)

The vet declared she had mild (stage II) renal disease and recommended kidney diet. Tried several kibbles and wet foods (she has had several teeth removed and prefers kibble, can't seem to get her to eat wet food). Finally settled on Royal Canin Feline Renal Support S - which she eats just as happily as ate her previous kibble.

It seems to me that her levels are juuuuust outside tolerance for normal, but I am not a vet so I'm prepared to accept that just outside normal does equal renal disease. I know older cats are prone to kidney problems, I was just hoping she had a few more years before that crept up on her. I keep plentiful amounts of clean & fresh water available for my cats so they always have the opportunity to drink as much as they like/need. (Three cats, four water dispensers/bowls + cat #2 likes to drink from the bathroom faucet many mornings.)

After a few months brought her back in and discovered she'd lost another pound or so, and her blood sugar levels were through the roof. They only thought to check blood sugar after I mentioned that she'd been drinking more and peeing much more than previously. (She will literally lay in front of a water bowl and drink for extended periods.)

Recommended 2 units of Insulin and monitor glucose. I have had no luck with getting a blood draw to test her glucose, so I took her in to the vet last Friday to test. Blood sugar is still very high, but I saw the other vet at the practice and she agreed to look into whether Royal Canin might know about any side effects. Note that Royal Canin also recommends the renal support "for intermittent or supplemental feeding only" - but my vet is basically recommending it permanently.

Currently she's on 3 units of Insulin and getting the renal diet. I don't love giving her the shots, and she doesn't love getting them, but she's pretty good about it and I'm committed to doing whatever I need to so that she's as healthy as possible and around as long as she has a decent quality of life. (Other than being annoyed at the shots and extra trips to the vet, she doesn't seem to be worse for wear.)

Finally, this is the kitty in question: Laney Wookie McScratcherson. I adopted her from a shelter about 5 years ago, and she's about the best cat buddy a person could ever ask for.

The, open-ended, question is - has anyone else seen this, or have any advice? Is it time for a new vet? Is this totally normal?
posted by jzb to Pets & Animals (6 answers total)
So I'm not a vet, but I am an obsessive cat parent who has a girl cat with kidney disease. The renal diets are a trade-off because first of all, cats are obligate carnivores and one of the stressors for kidneys is a high protein diet (also phosphorous). The renal diets will have lower protein usually (you can look at the back of the bag/can and see guaranteed min/max proteins, it'll be a %, then compare to old food. I guarantee it'll be lower) so as not to stress the kidneys as much.

Which means more carbohydrates that cats don't use in the same way we do. Obligate carnivores. This has a few downsides... they'll lose muscle without enough protein potentially, they'll get fat (these foods are calorie dense also or at least Royal bills itself as such), other problems I am not qualified/haven't researched but blood sugar doesn't strike me as out of the realm of possibility.

My point being is that these diets will help with one problem but potentially create/exacerbate other problems. What is for sure though is that kidney disease doesn't get better... kidney function never improves, you only stop the degradation for as long as possible.

Note that Royal Canin also recommends the renal support "for intermittent or supplemental feeding only" - but my vet is basically recommending it permanently.

Yes, I found this very curious as well, recently. I alternate between royal A/D (dry/wet, I think I have the letter right) and some of their old food.
posted by OnTheLastCastle at 9:19 AM on September 26, 2018

It's been a few years since my renal cat passed on, but as I recall the three cat killers work together: kidney disease, diabetes, high blood pressure. If Fluffles gets one, the other two are waiting in the wings.
posted by acorncup at 12:40 PM on September 26, 2018 [2 favorites]

Post your question on this board. Ask if anyone else has a renal cat with diabetes. Some answers should def be taken with a grain of salt. But, there are very knowledgeable folks here. This board was extremely helpful to me with diabetic pets. I don't have experience with renal issues, though.
posted by crw at 1:01 PM on September 26, 2018 [1 favorite]

If you wouldn't mind, these additional details can help fill out the picture:
What was the blood glucose level, in May (it's usually in the panel) and again a few months later?
Was a fructosamine level done and what was the value?
Were there glucose and/or ketones in the urine in May and again a few months later?
Was a urine culture done?
Which brand insulin are you using (Vetsulin, Lantus, etc) ?
posted by dum spiro spero at 7:24 PM on September 26, 2018

Our 10 year old cat was recently diagnosed with diabetes. A year previously, a catsitter overdosed him on pain medication following a bladder block (!!) and his kidneys failed, but he recovered completely. We had him on a bladder diet, not a urinary diet, since the kidney failure was caused by an overdose. Our vet said that cats with kidney failure often go on to develop diabetes, but he wasn't sure why. He didn't mention diet as a major cause for feline diabetes.

We have him on a diabetic diet (Purina Pro Plan DM ST/OX) and 2.5 units of Lantus twice daily and he's doing much better.
posted by nerdfish at 2:41 AM on September 27, 2018 [1 favorite]

@dum spiro spero: I only have the PDF of results from May and got verbal results after.

Glucose in May: 128 mg/dL

I don't think Fructose was done.

Ketones & Glucose negative in May. I don't think they did urine on follow-up.

Urinalysis, in May, but culture? I'm not sure.

It's a Lantus Insulin pen.
posted by jzb at 6:18 AM on September 27, 2018

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