What do you do when your big, lovable diabetic cat suddenly develops renal disease? You call in the nutritionist cavalry! In this episode, Dr. Andy Roark is joined by boarded veterinary nutritionist Dr. Caitlyn Getty to tackle a real-world “hot mess express” case: Claudia, an obese diabetic cat who’s now showing signs of kidney issues. Together, they dig into the complexities of nutritional management for cats with multiple chronic conditions. Dr. Getty breaks down why common diets can conflict with one another in cases like this, and how Hill’s Prescription Diet Multi-Organ Feline can help bridge the gap. They cover protein and phosphorus challenges, insulin dosing concerns, fiber benefits, and the power of a slow and steady transition when switching foods. Whether you’ve got cats with combo problems like diabetes and kidney disease or just love nerding out over nutrition, this episode is full of practical takeaways and clinical insight. Let’s get into this episode.
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LINKS
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ABOUT OUR GUEST
Caitlyn is a Board Certified Veterinary Nutritionist® and Scientific Communications Senior Specialist on the US Professional Veterinary Affairs Team at Hill’s Pet Nutrition. She spent 13 years at the University of Illinois completing her BS, DVM, and PhD in Nutritional Sciences. During veterinary school and her PhD, she became very interested in nutrition education of veterinary students and the power of nutrition in health and disease. She completed a rotating small animal medicine and surgery internship on the north side of Chicago and then moved to Raleigh, NC to complete her Small Animal Clinical Nutrition residency at North Carolina State University. She currently lives outside Indianapolis with 4 cats, 2 dogs, and her fiancé!
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. I am back with my friend Dr. Caitlyn Getty. Caitlyn is a boarded nutritionist and I have a case for her today. Guys, I am looking at Claudia, a 11-year-old female spayed, domestic short hair who is a diabetic cat, and I thought we had her managed and maintained, and then she starts to get PUPD again.
She’s drinking more, she’s peeing more. I thought, oh, no. We’re slipping away. Our insulin is not working, we’re not being regulated. But no, unfortunately, when I check her blood work, she’s developing renal disease on top of diabetes and obesity. How am I gonna manage this cat? I talk to Caitlyn about the nutrition aspect of this.
How do I manage this cat for the long term? She’s got comorbidities, she’s got a lot of things going on. Talk to me about how you look at this. Talk to me about what tools you reach for. And we get into it guys. She starts to talk to me about Hill’s Prescription Diet Multi-Organ Feline and why it’s useful in this case and what she’s looking for.
And we break down that diet and when we should be reaching for it. And she talks a lot about when we’ve got what she calls, the Hot Mess express cases, where they’ve got a lot of things going on. I get Caitlyn in to take a look at this case with me, break it down from a nutritional standpoint and start to talk to me about what’s important and how we are gonna maintain this cat, in the best way possible.
This episode is made possible ad free by Hills Pet Nutrition. Let’s get into it.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Andy Roark: Ooh, welcome to the podcast, Dr. Caitlyn Getty. How are you my friend?
Caitlyn Getty: I am doing awesome. How are you?
Andy Roark: I’m great. Thanks for being here today. For those who don’t know you, you are a veterinarian. You’re a boarded nutritionist, and you have a PhD in nutritional sciences. You are a nutritionist with Hills Pet Nutrition, correct?
Caitlyn Getty: I am, it’s awesome.
Andy Roark: Outstanding.
Caitlyn Getty: It’s fun. It’s a lot of fun.
Andy Roark: yeah. Well, you every time I talk to you, you seem to be having a great time. Like you, you like two things from what I can tell, school and fixing nutrition problems.
Caitlyn Getty: Mm-hmm.
Andy Roark: It’s school, food, and nutrition problems.
Andy Roark: That’s it.
Caitlyn Getty: They all go together.
Dr. Andy Roark: All three. I’ve got a case today that I wanted to bounce off of you, if that’s okay. It’s a nutrition case that I’m sort of wrestling around with.
So I have got an 11-year-old female spade, domestic short hair named Claudia and Claudia is a diabetes cat and has been for a long time. Claudia is also a big girl. She is definitely a big obese diabetic cat like you would expect. And I’ve had Claudia on Hill’s Prescription Diet Metabolic and that has helped her quite a bit and it seems to be helping maintain along with insulin.
So she’s got an insulin routine that works. She’s on a metabolic diet. The owners are feeling good. They feel like things are going in the right direction. And we’ve been making steady progress here and everybody was feeling good until recently. Claudia has started drinking more water and urinating more frequently, and the owners are back and they’re like, “Hey, we’re seeing the signs again.”
And I’m looking at this cat that I thought was well maintained, but is now PUPD, and I kind of thought, eh, I’m afraid that our, our diabetes is kind of getting outta whack and, and we’ll have to dig into that. But when I checked blood work on Claudia, she’s actually showing signs of renal disease. And so her renal values are spiking up.
I don’t think this is necessarily related to her diabetes at all, but. I’ve got a new problem that I’m dealing with and so I go and I look at the bag of metabolic, which again has been great for her. It’s a great diet. Metabolic is kind of high in protein and it’s kind of high-ish in phosphorus and those are things that I definitely am not a big fan of in my renal cases.
And so I’m kind of feeling a bit stuck as far as having a diet that’s been working for her and then this new sort of condition coming in. And so. Let me ask you for advice here. Where do I kind of go with this case?
Caitlyn Getty: And that’s a tricky one because diabetes is one of those things that once you have it controlled, I don’t wanna touch
Andy Roark: I don’t wanna touch it. Yeah, I don’t want, I don’t wanna touch it anymore.
Caitlyn Getty: Don’t wanna touch it anymore, you wanna go with what you’ve got. And now we’ve got this renal disease that is kind of in direct conflict with our diabetes.
So like you mentioned, when we’re thinking about. You know, our diabetic patients usually we’re reaching for, for one of two dietary strategies. So she’s on the higher protein, high fiber kind of strategy, which is gonna help maintain her blood glucose, you know, by helping blunt that glycemic index.
We’re trying to get that weight off of her, which we’ve been pretty successful at, which is really gonna help that insulin sensitivity. The high protein is gonna help maintain that lean muscle mass, but also cats or carnivores are always using that for energy. It’s gonna help. Again, with that glycemic response. The other kind of strategy that we can use is , the lower carb, the high protein kind of really fixating on how the cat metabolism works in that way as well. Which is also another great option. Usually maybe not. For the really large, large friends. But both of those options being super high in protein usually also come with, like you mentioned a lot of phosphorus, right?
Yeah. Because if we think of protein, we’ve got the ATP, it’s got that phosphorus right on the end there. And so now we’ve got a cat who has renal disease and we’re like, huh. Now we’re looking at, we want something that’s lower in phosphorus, which isn’t in conflict with diabetes, but it’s in conflict with the diabetic diet.
Andy Roark: Hmm.
Caitlyn Getty: got, know, we don’t want a high protein per se because we don’t wanna put a lot of work on those kidneys. Maybe we don’t need to restrict the protein down super low. But we also don’t wanna provide additional work. And then we look at the renal diets. We’re like, okay, so these are lower protein, they’re lower phosphorus. They do have more fat than maybe we’d want for a cat that has a little bit of trouble maintaining her weight. But then calories can only come from one of three places, right? They can only come from carbs, fat, or protein. And if we’re dropping down the protein and the, the fat might be pretty similar to one of the low carb, high protein, probably a little bit higher than the metabolic, but the rest of the, the calories need to come from carbohydrates,
Andy Roark: Yeah.
Caitlyn Getty: And so now we’ve got this diabetic cat and we’re like. But now we don’t wanna increase your carbohydrates too much because your diabetes is
Andy Roark: Right,
Caitlyn Getty: So what do we do?
Andy Roark: Right.
Caitlyn Getty: And so that’s where you start digging through the books. You’re looking at all the different diets. You’re like this diet doesn’t have enough fiber ’cause also renal diets usually don’t have a ton of fiber. She’s been doing well on a fiber type diet. Those diets are super highly digestible, super calorie dense. So we’re looking for something that’s gonna be higher fiber, higher protein for the diabetes. We want lower phosphorus, lower ish protein for the renal disease. Nothing seems to match. And so we’re flipping through, you know, the Hill’s Product Guide. And we find the feline Multi-Organ, and we find that it’s. You know, maybe not as high of a protein as the metabolic was, but it’s in that moderate range. It’s higher than a renal food. It’s a little bit lower than metabolic, but it’s still in that high to moderate range. It has a phosphorus that’s kind of at the beginning of our renal threshold , for cats. got a lower sodium, which can help the kidneys. It also has a pretty nice fiber profile. It’s got a really nice blend of soluble and insoluble fibers. The carbs might be. a little higher than the low protein, low carbohydrate, but you know, pretty similar to the fiber method.
You’re like, huh, this might be something that we can try for this cat. ’cause it’s, it’s maybe not hitting each thing perfectly, but it’s, bringing them together in a way that doesn’t cause a conflict with either disease
Andy Roark: Okay.
Caitlyn Getty: really meets up nicely with her current diabetic strategy management strategy.
Andy Roark: Talk to me a little bit about sort of making a diet shift in a diabetic cat. Right. So I, I feel like , the diet that she’s been on is working well with her current insulin dose and I’m gonna start changing her diet and, you know, obviously I’m, I’m worried about that sort of changing the way I’m gonna need to manage her diabetes overall.
Can you speak a little bit to best practices in making a shift like this when I’m also trying to juggle in insulin.
Caitlyn Getty: Absolutely. . Super scary on the surface, right? ’cause we don’t wanna rock any boats, but this is a case of slower and steady is gonna help us win with this case. And I think starting with, you know, looking at how many calories she’s getting from her metabolic each day. And making sure that we are mimicking that with her new multi-organ, but also doing a slow transition over a couple of weeks so that we can really monitor her clinical signs.
Are we seeing any issues where maybe her glucose is gonna be spiking or she might be having signs that she’s not very well controlled. And so this is a case where. Normally a transition, we’re gonna think of about a week, but she’s a pretty sensitive little flower. We don’t want her diabetes to get outta control.
We don’t wanna see her in the hospital for a DKA. So let’s do it over two or three weeks. Let’s, you know, start really slow with maybe instead of 25, 75, we do 10 and 90, and then we walk it up until at the end of the three weeks we’ve transitioned over to multi-organ. We’re checking her, her glycemic response.
Maybe she needs to come in for a Libre or a curve or something like that to see where we’re at and see how well she tolerates it and taking it slow and that’s gonna be our best bet. We might have to do a little bit of insulin tweaking because medicine is medicine. But as we go slow and we make the change, then we can make those changes kind of as we go.
Andy Roark: Sort of what are the other sort of conditions at the top of your lists for the multi-organ diet? So, you know, we’re talking about sort of a renal cat with diabetes. I’m thinking about the cats that I see that have, you know, sterile cystitis or, or I get a lot of stones and things like that.
What are the other sort of umbrella conditions that tend to fit nicely under sort of a multi-organ diet?
Caitlyn Getty: Sure. So that’s a great question. And. There’s a whole host of things, but it’s, it’s gonna be those cats that have more than one problem that you look at, like this cat like Claudia. You look at her or him and you’re like, I don’t know. One of these diets works, but this other one doesn’t. I need both.
What are we gonna do? So, the cystitis is a good lead into those cats that maybe have struvite or calcium oxalate, right? This is gonna be a diet that has that SOX shield. It has the minerals that are gonna be controlled. It’s going to be a little bit lower sodium, it’s gonna have the Omega-3 fatty acids.
So that’s gonna be nice for those kinds of cats. It’s a moderate protein but not restricted protein. So our liver cats, right now, the only recommendation for a liver cat really is to go to something like a, a KD because we don’t have
Andy Roark: Mm-hmm.
Caitlyn Getty: feline L/D in this country. And a lot of those cats don’t necessarily need protein restrictions.
So Multi-Organ can be a great option, even if it’s liver disease on its own. That’s one of those things where that’s a, it may be a single nutritional issue that I’d reach for Multi-Organ, but if they have liver disease and. Then Multi-Organ becomes even more attractive. heart disease. So these cats with heart disease often need a lower sodium. They need omega threes to help support their heart and the inflammation carnitine, they need that protein. And so, you know, heart disease and diabetes, heart disease and renal disease. Although k/d works pretty well for that too, depending. Then also maybe your, like your chronic burning pancreatitis type cats this could be another option for them as well.
Andy Roark: Where do you see vets reaching for feline multi-organ, where they should maybe be a little bit careful? Like what are the scenarios where you see people grabbing it and say, oh yeah, I got this, and, and they should, they should maybe take a beat.
Caitlyn Getty: Sure. ’cause every diet, like every disease, , it’s hard to find, you know, one specific
Andy Roark: Mm-hmm.
Caitlyn Getty: Though we try to make a diet that covers as much, it might not cover everything. So, like I was saying, that liver example, let’s say you have a cat that has hepatic encephalopathy.
Okay. That’s a case where you do wanna reach for something like a k/d, you do wanna do protein restriction. And where this kind of diet is great for those chronic hepatitis or hepatopathy kind of cats that really affected, maybe it’s a shunty kind of
Andy Roark: Mm-hmm.
Caitlyn Getty: issues with this protein. This wouldn’t necessarily be the diet that I’m reaching for. I think that’s probably one of the biggest ones that I’m looking at.
and also, you know, things like it’s, it’s not gonna be for growth. It’s not gonna be for cats that maybe have a super, super high protein requirement, but, but really that protein, if they need a, a big restriction, then I’d be looking for something like k/d.
Andy Roark: That definitely makes sense. Is there anything with the feline multi-organ that you feel like I should know or haven’t asked about? Because I’m, I’m sort of thinking about this. It’s, I’ll be honest, I’ve got the diet, I have, you know, I haven’t reached for it that often. It’s sort of new coming in and so, yeah.
Is there, is there anything that you get questions about or anything that vets. Typically I want to kind of know about this diet.
Caitlyn Getty: I think the biggest thing is, How’s it stand up against something like a low carbohydrate, high protein type of diabetic diet.
Andy Roark: Mm-hmm.
Caitlyn Getty: And, and with that is, you know, we talked about before the two different strategies and it’s a different strategy, but it is still trying to keep the carbohydrates as low as possible.
And I think it’s a cat dependent and you might have to just do a slower transition. So I think that’s probably the biggest question that I can think of.
Andy Roark: I appreciate it. I think I’ve got a good plan with Claudia here. And so anyway, this, this makes sense to me. a slow transition, paying attention to glucose as we go ahead and make the transition. That makes sense to me. This is gonna be super helpful if people want to know more about feline Multi-Organ.
If they are just nutrition fans in general, and you’re like, this is an area where I want to keep growing my clinical knowledge. Where, where do you send them? What are your favorite resources?
Caitlyn Getty: Thank you. Everyone should be nutrition fans, but my favorite resources would be to visit our Hills Vet Academy on hills vet.com. There’s all kinds of learning opportunities and also on the website, if you are interested in all of the diets, you wanna look up the nutritional profile of this food or the other foods, you can go on the product guide and look up that information as well. And there’s just all kinds of resources there so
Andy Roark: Caitlyn, thank you so much for being here, my friend. I really appreciate your time gang. Thanks for tuning in. Everybody. Take care of yourselves, gang.
Caitlyn Getty: Thank you.
Andy Roark: And that’s what we got guys. Thanks for being here. Thanks to Caitlyn for being here. Thanks to Hill’s Pet Nutrition for making this episode possible. Guys, if you wanna learn more about Feline Multi-Organ, definitely check out the links in the show note. I hope that it makes your life better.
I hope it makes your cases go more smoothly. I hope that it helps pets everywhere, gang, take care. I’ll talk to you guys later on.
