Desperate for help! Chronic bladder stones & now diabetes

Hi everyone, I am new here but I need help VERY bad for my poor cat.  My vet doesn't seem to have any good advice and I've combed the net for days and can't find much.

Ladybug - 15 year old house cat, 14 pounds, chronic bladder stones.  Mostly ate junk dry food her entire life because I didn't know any better.  Switched her a few years ago to Taste of the Wild dry because I still didn't know any better.  Diagnosed with 6 very large struvite stones, had surgery to remove stones.  Was put on Science Diet c/d by the vet.  She was vomiting the food so badly that I gave up after a month and put her back on Taste of the Wild dry and Before Grain cans, 50/50 mix.  3 months later, more bladder stones.  Placed on the prescription dry food that dissolves the stones, then put back on c/d.  This time a mix of dry and cans.  Been on c/d for about 18 months.

Ok now the next problem:

Took her to the vet for ear inflammation and itching.  He looked and said ears were fine.  Gave her a rabies vaccine and depomedrol shot for the itching. Within hours she was guzzling water and this went on for weeks, drinking up to 1 gallon water per day.  Vet said this is normal - steroids cause increased thirst.

1 week ago she was urinating blood everywhere.  Decided to go to a NEW vet and new vet diagnosed diabetes with blood glucose of 382.  Placed on 2 units insulin per day - 1 unit every 12 hrs. Tresaderm for yeast infection in ears. Baytril for UTI caused by sugar in urine.

OK HERE'S WHERE I NEED HELP, PLEASE!!  What the heck do I feed this cat?! I got rid of ALL dry food, as the c/d dry was 43% carbs!  The c/d cans is 26%.  Vet says there is no way to balance needs of chronic stone formation with diabetes so feed c/d canned and give enough insulin to overcome the carbs.

I have read Fancy Feast classic is a great food for diabetics, but then I read about the risk of feeding fish everyday??

I am home testing her blood glucose 2x per day and she is in the low 200s without insulin, high 100s with insulin.

If I risk it and get her on an all meat diet - raw, or at least high quality canned pure meat foods, I risk the bladder stones coming back, and the dissolution formula only comes in dry form.  Other option would be another surgery to remove stones if she develops them and I can't put her through that again! So then if I feed c/d I have diabetes to worry about.

Please help!  Is there anything out there that is ok for chronic bladder stones, AND diabetes? Vet talked to the Hills people and they had no idea what to say.  Thank you so much, I am really overwhelmed right now.  I've had my Ladybug since the day she was born and I really do not want to lose her.  She is healthy, active, very playful, and totally normal otherwise.

What kind of stones did she have?

As far as Fancy Feast classics, only a few flavors are fish based. I don't know what you mean by a meat diet causing crystal formation, but maybe this site will help www.catinfo.org. Dr. Pierson has a section on urinary troubles and a section on diabetes, and she uses the same raw diet to address both issues. You can also consider home-cooked. Both of these require proper balancing, but it's not really that hard to do. A wet diet of any kind is better than dry.

An all meat diet, especially raw, is a naturally acidifying diet, so it would be good for a struvite prone cat. You can also add methionine (the active ingredient in the Rx urinary foods) separately to her food as needed. The only caution there would be that you would need to monitor her urine pH at home to ensure it doesn't become too acidic as that would put her at higher risk of calcium oxalate stones.

The all meat diet (properly balanced raw or cooked or canned) would be best for the diabetes as well. On the site that peaches08 mentioned, the vet writes about how insulin use has been reduced or eliminated using a high animal protein diet. I would suggest reading that site thoroughly because it really does address both problems in depth.

I was  in a similar situation back in 2006 . 

My cat  Louis had had had had a few episodes of urinary inflammation and then got a urethral blockage that might have killed him,   and was found he had a lot of struvite crystals. 
So the vet recommended the c/d.    That is super high carb . Louis gained quite a lot of weight on it despite us cutting down the amount to where he was never satisfied.   but the vet seemed to think it was the only choice,  though he admitted a lot of cats got fat on it.     (At that time I did not realise that most vets have little or no training in feline nutrition, and what they are taught is usually from reps from this company and a few other big pet food companies. )

Anyway,  my cat  ended up with diabetes after being on Hill's c/d dry for 5 years.   After that,  I met quite a few people whose cats got diabetes after being on that food!  especially the dry.  ( My cat would not eat the canned c/d.)

I  was worried about the crystals coming back.  especially having a male cat ( since they have a narrower urethra that can get blocked more easily).   

Anyway,  in my case    I did some research and found out that the same diet that would be good for his diabetes should also be the best way to naturally help his urinary tract.    a WET food diet  high in animal protein, moderate in fat and very low in carbohydrate.  I avoided fish since it is higher in some minerals.   I also added some warm water to the food .   The wet food helps keep the bladder flushed out so there is less chance for stuff to accumulate in there.   

And this diet helped keep his urinary pH  mildly acidic,  as it is meant to be.  It could also help to keep the amount of phosphorus fairly low. 

 After I switched him to such a diet,  he never again had urinary tract problems   and I had urinalyses done twice a year for the rest of his life.    

Now ..  about your situation which is a bit different since it sounds like your cat has maybe had trouble with both kinds of crystals -- the struvite that can be dissolved and the calcium oxalate that have to be surgically removed.

We have heard other reports on this site from people whose cats got stones after being on a grain free DRY food.  apparently related to the very high mineral content in the food.  In some cases they ate only the dry , in some they ate a combination of dry and canned.     But that may be what happened with your kitty.

 I think you may be OK if you switch to ONLY wet low carb food,  add water to the food,  and choose a food that is not high in minerals.  Feed NO dry at all.

The c/d is so high carb that it might turn out that your cat could have her diabetes controlled only with a diet change to very low carb food,  and might not need insulin shots.

 You might want to start out by cutting out the dry c/d,  since at least that will decrease the carb amount.  The canned c/d is still too high in carbs, though.    So then you could start mixing in some low carb canned,  and gradually transition to that.   ( to attract her to eat a new food, you could get some Fortiflora powder from the vet... it is a probiotic which can't hurt,  but it's in a powder that is very tasty to cats,  so some vets also recommend it as a food attractant.) 

The best prescription diabetes food is the canned Purina DM  ( that's the only one that is really low carb)  but it is a little bit higher in phosphorus than you might want to feed.  (There really is not a need to feed a prescription diabetes food anyway ;  there are other options that are just as good or better. ) 

Here is a link to a list with info on canned food http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

 If this were ME,  I would keep the carbs under 8%  of calories  ( those are the numbers in the columns on the left side)   and  if possible keep the phosphorus under 1.2% of dry matter ( that's the column on  the right side that says "Phos DM")    or under about 250-300 mg per 100 kilocalories ( that's on the right half of the page,  the column labeled "mg Phos/100 kcal"

 Wellness Turkey is an example that might be a good choice to try.

 Actually Louis ate a lot of Nature's Variety Instinct Venison raw frozen (listed on page 27)  That is very low carb and the phos is only 0.72% on a dry matter basis.  For some reason the canned version of that is a lot higher in phosphorus.   but the duck is pretty low phosphorus.

   I had thought c/d was more for struvite crystals.  One of the factors for struvite crystals is the urine being too alkaline,   which happens with food too high in plants.  So it's  counterintuitive to feed a food with a bunch of corn,  but it's cheap to manufacture, and they just add acidifier to the food .   Unfortunately sometimes adding those acidifiers overdoes it,  the urine gets TOO acidic  and they end up with the calcium oxalate crystals that can't be dissolved and have to be removed by surgery.  Yes, that has happened to cats that were on a prescription urinary diet !).

Here is a link to a document with some stuff I had found when I was reading about this , and later put it together in a Google doc and included a comment I had written about my cat .  Urinary Crystals and Feline Diet Research   

 and since then,  Dr. Lisa Pierson has written a lot more on her site about cats urinary tract / bladder health.  Feline Urinary Tract Health

IMPORTANT  ( IF YOUR CAT IS ALREADY ON INSULIN  WHEN YOU CHANGE HER DIET,  YOU WILL NEED TO START TESTING BLOOD GLUCOSE AT HOME , because her insulin needs will decrease if you cut down the carb amount in her diet that much!    ) 

 Dr Pierson's website has another excellent  article on Feline Diabetes that tells about diet,  insulin and blood glucose testing,  which more and more vets are now recommending.   Feline Diabetes    

Believe me  I know all this is scary.   but take a deep breath and  know you can get through it.    Your kitty is lucky to have you.   

 I see  I gave a link to the same site as Peaches.

  and I was very long winded. 

I also wanted to say that while you are transitoning diet,  you can also monitor your cat's urinary pH  using sticks ;   there are various ways to get urine to test.  some cats don't mind if you hold the stick in the stream of urine while they are peeing.  or hold a cup .   For other cats you can put down some plastic wrap over the litter and hope to catch some drops of urine on it to test.

Or they have little plastic beads you can substitute for litter to get a sample.

Thank you everyone, this information is VERY helpful!

She is not getting any more dry at all.  I cut that completely out.

She did have surgery to remove struvite stones because there were 6 of them and they were HUGE.  They said it could take months to dissolve them and in the meantime she would continue to have inflammation, pain, urinating issues, and infections so it was best to do a surgery and wash her bladder out and get them done with immediately.

But since then she has gone on the dissolution formula to dissolve some smaller stones that reformed.

Ok I will stop feeding her the fish formula of the Fancy Feast and try to find a better all meat diet that is not fish.

Even with cutting out ALL dry food, and switching her to only 1/2 can of c/d per day, and the rest low carb, 100% meat canned food, the blood glucose has not come down at all without insulin.  I do check her 2x per day at least, and sometimes 3x per day.

I have checked her glucose, then fed her a can of Fancy Feast all meat, very low carb food and within 2 hours check her glucose again and it is up near 300.  So just switching her to all meat is not really helping.  But I will obviously keep up this diet and try to get her switched to a higher end meat food and just keep testing.  If I have to keep doing the insulin for weeks or months that will be fine.  I'll just do whatever!

And thank you for the info on the phosphorous level!  That is something I worried about but forgot to ask.