New dx and overwhelmed! Advice, please!

Hi -- I'm new here and I'm hoping someone can offer advice and encouragement. Our 5-year-old male Mookie, a domestic shorthair, was diagnosed with FD last Friday, 11/25. We were shocked -- he's so young! How could that happen?!

Until three weeks ago Mookie was a healthy, playful kitty. Around that time I noticed a decline in his appetite, which is very unusual! We brought him to the vet for a checkup on Friday, 11/11. She suspected an upset tummy and gave him a famotidine injection, prescribed 2.5mg of a human acid reducer daily, and 3.75mg mirtazapine every three days to stimulate his appetite. His diet at that time consisted of grain-free dry kibble and a variety of premium wet food, fed 3x/day. A week went by with a little improvement in his appetite and activity level, but he was clearly not feeling well.

By Wed 11/23 he was lethargic, anorexic and slightly dehydrated. We brought him to the vet immediately. She gave him subq fluids, took xrays, and took blood and urine for analysis, which had to be sent out to a lab. The only thing unusual on the xrays was a large intestine full of poop! He was constipated, and she recommended an enema. We were ecstatic that it was a relatively simple issue.

Unfortunately, his condition didn't improve, and we started syringe feeding baby food on Thursday (Thanksgiving). Because of the holiday we had to wait until Friday for the lab results. We brought him back on Friday, and she told us he had FD. His blood panel showed glucose at 300; fructosamine at 662. The vet prescribed 1.5U of Lantas twice daily and instructed us on how to give him his shots, which we started on Friday night. She said to continue the syringe feeding so that he gets 300 cal/day, or 3 jars of baby food. We're giving him plain chicken and turkey.

That brings us up to today. I'm slightly less panicky, I've found this forum, and I have about a zillion concerns and questions. Much of my confusion is with the diet/insulin interaction. In Mookie's case, his diabetes is secondary to his anorexia. We've been syringe feeding him every 3 hours and offering dry and wet food. Yesterday he showed interest in food for the first time, but the only kibble he'll eat is Fancy Feast with Chicken & Turkey -- which we offered out of desperation, knowing it was junk food. However, the first three ingredients are brewers rice, poultry by-product meal, and corn gluten meal, and I'm worried about how the low-quality carbs are interacting with the insulin. He's eating some low-carb FF wet food, too. At this point is it more important that he eat, rather than what he eats? Does the timing of shots and meals make a difference with an anorexic cat? Do we need to start home-monitoring his glucose ASAP? (which I didn't know I could do until I found this web site) The vet was supposed to give us a follow-up call yesterday, but we haven't heard from her. Please advise on how to go forward.

Thanks so much!
Zoe and Mookie

 

Welcome Zoe and Mookie!

I hope it will help to know we were all overwhelmed when we first arrived here. The more you learn, the more confident you will become.

Yes, you want him to eat. So for now, whatever he will eat is good. Some ideas to try on wet food are parmesan cheese, tuna juice, heating it up till nice and sticky. Also Fortiflora is magic for some cats. It contains the animal digest that makes dry food so irresistable. You can usually get it from your vet or on line - sometimes from the vets at PetSmart.

We figure we would never dose our 2 legged children blind so we don't give insulin for our 4 legged ones without testing first. Here's a video that shows how we do it: Video for hometesting We have taught hundreds of people how to do it over the internet and would be happy to teach you

Continue reading. Ask questions. We would love to help you help your Mookie.

 

Welcome Zoe and sweet Mookie! You are in the right place. Each of us came here with the same fears and concerns you are now experiencing. You will never be alone in this journey through the world of feline diabetes. There is always someone here to give advice, talk you through a crisis, or just hold your hand. I'm relatively new here myself, so I won't have any advice for you, but I'll always have my hand out to you.

As Sue said, eating is the most important thing right now. As Mookie starts to feel better, he will start eating again. I was so excited when my Weezer started to eat again I took a video to send to my husband's phone!

Again, welcome! I look forward to seeing your posts and progress.

 

If he is eating fancy feast wet food, then you have no problem.... get rid of the dry food as it's contributing to his crappy high BG numbers. He will put the weight back on once he's on the insulin and you work towards getting him regulated. Tons of cats are taken to the vet because of weight loss and it's found they have DM. So just let him eat as much of the wet fancy feast pate flavors, no gravy.

About the 'slow stool', that's easy enough to fix as well! My Oliver has the same issue, the vet's comment when looking at his Xray was 'that's alotta poops in there!' So, all you do is mix in 1/2 tsp of Restoralax or Miralax into his wet food. You just have to add water to the food as the powder draws water from the body to soften the stool and get things 'moving' again. I add it to both my cat's food daily in their first meal of the day, just for maint.

I am not sure about that starting dose of 1.5units twice a day; it may turn out to be too much, so you may want to consider starting lower at 1u.

Home testing is pretty important; you can't possibly know if you are giving too little or too much insulin, so just pick up a meter at the store - Relion is quite affordable at $9 and the strips are the most inexpensive. For sure start testing now, and if you have not started insulin yet, you can see how the change in food is affecting his BG numbers. Often the stress at the vet office results in a high number, but that fructosamine result of 662 pretty much lets you know that his numbers have been lousy for the last little while and will need to start the insulin.

Lantus is a great insulin and be sure to read the stickys that will let you know all about using this insulin, handling it, and explains the shed / depot.

You and Mookie are going to be just fine. Welcome.

 

Thank you all for your comments and suggestions. I already feel a bit more calm knowing there are so many experienced members of this forum who are willing to help. I haven't had any experience with a feline disease that required regulation. At home we also have Henry, a 7-year-old Siamese who's healthy. Our Siamese Bubba passed 2 years ago at 23, and our Siamese Booger passed 5 years ago at 19. That they had healthy, long lives makes it harder to understand why Mookie is sick at only 5 years. His annual checkup and blood panel done in September were normal.

I'm feeling as though I may have caused his FD somehow by gradually changing his diet from a high-carb to a low carb/high protein diet which made him pretty unhappy -- even though I know the new diet is better for him. I'm glad to know the FF is a good choice because both my boys like it. I'll try the stool softener, too, and get a monitor asap. I've watched the video several times, and I think I can do it!

Thanks again, everyone. I'll keep you updated.

 

You should not be blaming yourself for his having diabetes, and you did not cause it by changing to a better diet. If anything, he may have been affected by his dry food before. It could be anything that caused it, and most of it would have been out of your control.

I was feeding two cats the same dry foods, no diff in how they were fed, but one is still super healthy, 2yrs older, and Shadoe needs insulin.

I am sure you are going to catch on quickly and home testing plus insulin shots are very easy.
Keep asking all the questions you like; someone will have an answer for you.

 

Wanted to say welcome welcome welcome!

The vet told me that Bean was probably onset of diabetes by stress..... and of course her dry food only that all 3 of them were eating for all of their lives. Now that there is a sugar girl in the home at age 8, my Civvie Slappy at age 15 (almost 16) does not get dry food. Then of course we had wonderful Civvie Gumpy (GA) that switched to wet Friskies Special Diet which she loved. Now, we have Ittle Sista, just a small alien of only 6 months and she eats what Sugar Bean eats... F. Feast classics, Friskies and SophistiCat from petsmart... all low carb from binkys list of low carb foods.

I also found that the 100% meat frez dried treats ground up and put on the wet food are a hit... we use the Grandma Lucys, Pure Bites (dog treat as they are cheaper), and petco brand tuna flakes. Perhaps you could try some of these to intice him to eat.

As far as the testing, all I can say is PLEASE PLEASE PLEASE TEST. I have a spreadsheet that will show you what NOT testing can do as my Bean girl was only 27bg when I got the first successful test. We tried several times and being a newbie, I could not get a reading. But with that said, practice won and so did those treats mentioned above and she/we finally got into a routine and testing was not a big issue and I am soooo glad I found this place. My vet did not recommend it. Without testing I just know that I would not have my wonderful Bean with me today, and of course it is because I FOUND THIS PLACE :razz:

Where do you live? lots of times, folks are close enough to lend a hand if need be.... I needed, was offered and took them up on it... the best thing I could have done for my Civvie Slappy, and she is still with me today....thank gosh!

Hang in there, this will get easier.... Listen, learn and ask any question you want....someone here will always offer advice, support and just a cyber hug....

SOOOOO furry hugs to you and Mookie :YMHUG:

 

You're right, Gayle, about not blaming myself. I just feel bad that my little guy is suffering. And thanks, Ohbell, for your kind words and suggestions.

 

...and Mookie and I live in Denver, Colorado.

 

To echo what Gayle said. I've had probably two dozen cats in 30 years. Every single one of them ate the same stuff. Cheap canned food that wasn't low carb, and I always left dry food out for them to graze 24 hours a day. It was always just whatever was cheap at the grocery store. I'd buy "quality" dry, and they'd refuse to eat it.
Anyway, Bob was the first one ever to get diabetes. I didn't even know FD existed before the vet told me he had it. You, on the other hand, switched over to a better diet, and then found out Mookie was a sugarcat.
Neither Bob nor Mookie was anyone's "fault". It just happened.
I think I read that 1 in 400 cats gets diabetes? If it was caused merely by poor diet, when you look at how much dry or high carb gravy food moves off the grocery store shelves every day, it seems that number would be closer to 50% or more.

I wonder what the average life span of a cat would be if everyone fed nothing but "good food" from the time they were kittens? They'd probably outlive us!

Important thing is now you have found this place. And that's a great thing!
Oh, if you go into the "control panel", you can add "Denver, CO" to your "avatar" and it'll show up every time you post. I know we have other members in Colorado, so you aren't alone!
Welcome to you and Mookie,
Carl

 

Welcome Zoe and Mookie,

I'm going to third Gayle about not blaming yourself for Mookie getting diabetes! I personally have 13 cats, only 2 of which are diabetics and those two I adopted as diabetics, currently. But when I first arrived here I had 10 cats all of which ate what they all ate, cheap dry food with a little canned (in gravy) food in the morning and evening...but then one cat Muse started going downhill, it was shortly after she escaped so at first I thought parasites or infection...when in reality it turned out to be diabetes. Why Muse and not the others? I'll never know, but it was what it was. Unfortunately I didn't catch it in time for Muse, I lost her just a few days after finally finding out what was wrong with her, but I had a new tool to fight this condition, so 4 months later I adopted Maxwell from this very board, and then in June of this year I adopted Musette, both were already diabetic, right now Maxwell has been in remission for over a year, and Musette however is still insulin dependent and probably always will be, again the difference is?....They are different cats what worked for one, isn't going to work for the other. Both eat the same food, both are close to the same age, but how their bodies handle being diabetic are different. What they both have in common though is that they are both healthy, happy and well-loved kitties who have become cherished members of my family...Musette just needs a couple of itty bitty shots everyday, other than that they are just cats.

If you need any help with testing just let us know I happen to know a wonder couple, who are members of this board, that are right in your neck of the woods. In fact they are so great that they took 4 hours out of their day back in June to meet the plane carrying my Musette and drive her to met up with my husband and I to hand Musette off so that we could get her home after our local airport flooded. So I can just about bet they would be willing to pop over and give you a little hands on help.

Mel, Maxwell, Musette & The Fur Gang

 

Hey Zoe,

I live in Colorado Springs. If you are in South Denver, we might be able to meet if you need help with home testing. We also had a few people in Denver but I haven't seen them post lately. Let me go looking.

Sue

 

Until you are testing, keep the diet consistent! Why? Because glucose levels may drop as much as 100 points from diet change alone and you run the risk of your cat having a hypoglycemic episode (glucose drops too low), which could be fatal.

Also, Lantus takes a 3-5 days to build up in the body, injecting every 12 hours exactly. Usually, we suggest folks start with 1/2 to 1 unit, twice a day - a low dose, to see how the kitty handles it. Giving 1.5 units could be a little high for your cat and cause a hypoglycemic episode - you won't know until you start testing - you may want to back off to 1 unit until you can test, to reduce the chances of that.

To be prepared in the event of a hypoglycemic episode, please read this

 

Sue,

Marcy & Klinger are in Aurora CO so they should be fairly close let me drop her a pm too

Mel, Maxwell, Musette & The Fur Gang

 

Oh shoot. Marcy is leaving on vacation today.

 

Scott and Squeak are old-timers from Denver. He's also willing to help - I will PM you his info. Do you know how to check your PMs? (Private messages)

 

Hi Zoe.

I am in Denver. Let me know if you need help, need a new vet, places to purchase syringes, etc :smile: I will do what I can to help! There is another member here too, but I'll have to look up her screen name to get in touch with her.

 

It's a great relief to know I have people willing to help living nearby. Thanks so so much everyone.

Mookie is eating on his own, and this is the second day we haven't had to syringe feed him. It seems as though he went from being anorexic to ravenous overnight. We have a pre-shot vet visit tomorrow morning for a blood test, and I'm planning to talk to the vet about our intention to begin monitoring him at home.

 

Hi,
I'm concerned there is something else going on for Mookie. Although the fructosamine test came back a little high, an actual BG of 300 is not given other issues.

Here's the frustosamine ranges:
Normal non-diabetic cats
190−365
Newly diagnosed diabetic cats
350−730

The frustosamine test covers about the same amount of time as his feeling ill. The constipation would also cause stress and be caused by dehydration and those stresses on the body would raise blood glucose.

It is also unusual for a cat who may not have had high blood glucose for very long to be "anorexic." To me anorexic means you can feel spine and rib bones easily. If a cat doesn't eat for a few days they are going to lose weight, but the bigger threat is hepatic lipodosis "fatty liver." Uncontrolled diabetes will cause anorexia if left untreated or poorly treated over a period of time, but more than 2 weeks.

I recently lost my dear diabetic Gandalf because of an intestinal tumor. I don't want to alarm you, but from my experience I am concerned about the cause of the constipation. Had you noticed if he was peeing an unusually large amount? Uncontrolled diabetes causes that, so it can drain the body of water needed to process stool properly. But if you were not seeing that, there is a possibility something else is going on and more diagnostic tests would be in order.

It could also be that he has been diabetic for a while, which would cause the anorexia and possibly the constipation. But from the way you describe events it seems he went from a healthy weight to "anorexic" within less than 3 weeks, as well as from active and eating normally to lethargic and inappetent.

However it is sometimes easy to see high blood glucose, even higher than usual frustosamine, and determine the main problem is diabetes, when there could be something else going on and these are symptoms of that disease process. Mookie is young at 5 and has been on what sounds like a decent diet, those 2 aspects are not typical of the diabetic cats we see here, so that's why I am calling it to your attention.

As for other diagnostic tests, a belly ultrasound by a licensed radiologist would be top on my list. The Xray was good to do, but we had that in Gandalf's case also and it was not until the vet compared Xrays taken weeks apart that they could see he had some type of blockage and even then they told me a soft tissue tumor may not be visible on Xray.

Good luck. The help you've received concerning diabetes is excellent, but please consider the possibility something else is causing Mookie to be so ill.

 

Hi, Vicky,
I'm very sorry for your loss. Thank you for your willingness to share your experiences of Galdalf's illness even though it must be painful for you.

Perhaps I'm using the term anorexic when I should be using inappetance. I'll try to clarify.

09/26/11: annual exam; weight 14lbs 5oz; lab panel normal.

11/14/11: recheck due to weight loss and inappetance; weight 12lbs 9oz. Vet gave him a famotidine injection, a script for mirtazapine, and recommended an OTC acid reducer.

11/23/11: recheck because his appetite had not improved although he was still eating small amounts; weight 12lbs 2oz. No diarrhea or vomiting. Recommended blood panel, urinalysis, subq fluids, xrays, enema.

11/24/11: Mookie stopped eating and was lethargic. Started syringe feeding chicken and turkey baby food every 3 hours.

11/25/11: vet visit. Blood panel abnormalities include glucose 300; fructosamine 662; ALT 259; cholesterol 270; triglyceride 249; T4 0.5; differential neutrophils 8928; eosinophils 1240; trace ketones in urine. Dx diabetis mellitus secondary to anorexia; vet suspects pancreatitis but no liver damage. Subq fluids administered; received script and instructions for Lantas 1.5U every 12 hours. Vet will call on Monday.

11/26-28/11: continued syringe feeding 300 cal/day = 3 jars of baby food

11/29/11: Mookie started eating on his own; very hungry and thirsty; seeking affection and purrs; not playing yet; restless

11/30/11: same; vet called to check in; she can't explain restlessness

12/01/11: same; researched the restlessness and found it's a side effect of mirtazapine; will discontinue it.

One of many things I've learned on this forum is that we should have started monitoring Mookie's glucose as soon as we started the Lantas (if not before), which was on 11/25 -- especially for the first 3 days. Also, as BJ suggested, the dose should have been lower to start. But like others, I followed the vet's instructions instead of the advice of the good folks on this forum who have more experience with FD. We won't get our first glucose numbers until tomorrow when we bring Mookie in again. That's 8 days after the first injection.

Vicky, I too, think something else is wrong. The apparent health decline occurred in the 6 weeks of Oct to mid Nov. I didn't notice changes in his drinking or peeing, but that doesn't mean it wasn't happening. I did notice a change in the amount of food he was eating, but initially I thought he was being a picky eater.

I want to have more tests done, but I haven't wanted to stress him even more right now until we get the diet and glucose regulated. I'm thrilled he's eating again, and he's even gained a few oz. I think having an ultrasound done is a good idea. Are there any other tests you'd (or anyone else) recommend? Your concern and feedback are appreciated.

P.S. Being new to this board, I'm not certain of when I'm supposed to start a new thread? or do I just keep going with this one?

 

Hi,
I'm still trying to sort thru all those lab results to see if I can figure out what they indicate....but as to your question about another thread? Staying with this one is fine. If the subject matter changes, you can start a new thread at any time, but this thread is still ok to use since people are "here" in the conversation.
It's when they start to get 50+ posts long that people get lost trying to follow!
Carl

 

Thank you, Carl. I welcome your comments, opinions, guesses, and encouragement. In truth, this is a nightmare, but I'm trying to maintain a positive outlook and learn as much as I can.

 

Hi Zoe,
Thank you for all the info!

The possibility of pancreatitis is certainly there because of the inappetence. I'm curious to know what brand of "premium wet food" Mookie's been eating. There is some thought that higher fat content aggravates pancreatitis and some of the premium brands such as Wellness and EVO are higher in fat than other foods. I'm not saying to change Mookie's diet, just making you aware. Not everyone believes that about higher fat foods, I don't think it's been proven in cats. Those of us who have treated pancreatitis know that diet can make a difference however.

There is a list of things you can do to ease symptoms of and treat pancreatitis. They are sub-Q fluids, pain meds such as Buprenorphine, Pepcid AC (famotidine), appetite stimulant (mirtazipine is one, cyproheptidine is the other, the latter is given daily and may be less agitating) also B-12 shots and only if absolutely necessary, a steroid such as prednisolone.

I don't quite understand how they can claim no liver damage when ALT is a value showing liver involvement and it is significantly elevated at 259 (although the ranges for problems can vary between testing equipment). Normal ranges I show on paperwork from Idexx lab equipment is 12-130 for ALT. I'm not sure if there might be an elevation in that value if some hepatic lipidosis was starting or not. Also the pancreas and liver can be involved in a condition known as triaditis, which also involves the intestines, hence the name. All the duct work between the organs is connected and if the pancreas becomes inflamed from pancreatitis that inflammation can spread between them. You can read more about the condition here http://www.marvistavet.com/html/body_feline_cholangiohepatitis.html

I'm also kind of surprised that with trace ketones showing nothing more was indicated, as far as further monitoring of that or further treatment such as daily fluid administration. Ketones can develop quickly and occur when a diabetic cat loses body fat. You can get ketone test strips to test his urine at home, BTW.

It sounds like Mookie is getting some better. It is never too late to start testing blood glucose at home. And as far as waiting with more diagnostic tests, regulating diabetes does not happen within days, it can take weeks or months. I don't think you should wait that long.

And thank you for the kind words about my experiences with Gandalf. He lived for over 6 years as diabetic because of the kind and knowledgeable people on this board. I consider it an honor to pay it forward for all the love he gave me.

 

Well, I for sure am not a Vet, and they have the distinct advantage of being to look at ALL the numbers and how each may affect the other. Like if "A" is high, that may explain why "B" is low and "C" is high....

I looked at Bob's original dx lab results just to see what "normal" ranges are, and then found a couple of websites that explain what each thing "is", and what may or not be normal.

Obviously the numbers you listed were the ones that were "out of normal" on your lab results.

A couple that stuck out to me were the ALT (normal range 20-100) but what's confusing is that this says that if it above normal, it can indicate or be due to liver damage, but in your case, the results say that there is no liver damage.

Cholesterol 270 (normal 82-218)

which seems conflicting to me.... High ALT indicates a lists of things that would be not indicated by high cholesterol, but by low cholesterol instead..... but then when I look at Bob's test results, he had diabetes, but his cholesterol was at the high end of the "normal" range....?
triglyceride 249 - above normal, but

T4 .5 (normal.8 - 4.7), so that goes along with "HypoT".

I think the real problem is that I really don't "get" how they all tie in, which is why I'm not a vet or a lab tech!

These are 3 sites I found that might help you out:
http://www.assistfeed.com/BloodTestValues.htm
http://www.petplace.com/cats/understanding-blood-work-the-biochemical-profile-for-cats-2/page1.aspx
http://www.vetmed.wsu.edu/cliented/lab.aspx

 

I agree with Carl, tying all those results together in to an X,Y & Z diagnosis is the key and it is what vets do. We are just pointing out what we know of based on those few results which are unusual. I hope the website links give you some more information to help learn what's up with Mookie.

 

Vicky, until recently my cats' diet has been about 75% kibble and 25% canned. For at least the last 6 months (when I upgraded from Purina One), the kibble has been Evo, Orijen, Wellness, Nature's Variety Instinct, or California Natural, rotated periodically. Canned food has consisted of about 1.5oz/day, also rotated, of Merrick, Weruva, Halo, Evo, or Nutro. Getting Mookie to eat canned or wet food has always been a challenge because he prefers kibble. He will usually just lick the juice in the canned food. Since finding Binky's list I'm slowly changing the ratio to more canned and less dry.

Thanks again, Carl, for all your input and the links. I'm planning to print out your and Vicky's comments to take with me to the vet tomorrow -- armed and ready -- so that I can ask some specific questions about the numbers and possible concurrent conditions. I'm thinking a second opinion from another vet might provide more answers, in addition to an ultrasound. I'll give an update tomorrow.

 

You might also see if your vet can get you FortiFlora, Zoe. It is a probiotic but you can use it as a flavor enhancer for the wet lo carb. It has the animal digest that makes dry food so irresistible. Some cats love it and will devour lo carb with a sprinkle on top. Some don't get into it at all. Just try a little - it can cause diarrhea in large quantities.

 

Hi, Sue,
I just ordered Fortiflora from Amazon.com a couple of days ago! Also, following Dr. Lisa's web site on diet, fish oil and milk thistle as supplements. I tried the tuna flakes when I was trying to get Mookie to eat, but he wouldn't have anything to do with them.

 

LOL Zoe,
My Civvie Slappy smelled the tuna flakes and looked at me like I had 3 heads and immediately said "helllll no", of course in kitty lang. And the other 2, Sugar Bean and Civvie Ittle Sista, fight each other to see who can get their silly heads in the bottle first.

I know it can be exausting trying to figure out what they are going to like and not like, but keep trying. Civvie Slappy LOVES Grandma Lucys 100% lamb tho and the other 2 are ok with it, but dont tear mamma up trying to get to it. All my girls like the foraflora depending on what day it is. When I have used it, I just sprinkle lightly on the top like I would be salting something as I dont want other end problems. Adding a bit of tuna water also helped with the wet food.

I had to literlly put the dry food in a tidy cat container and hide it in the garage to make my girls not think about it. The smells alone from under the sink was driving them crazy and they would not show any interest in the wet food.

I was totally loosing patience with Slappy to transition to wet. She is 15/16 and very very picky. It took her to get sick and have to be dropper fed script a/d to transition, but now my problem is ALL she will eat is a/d!!!! GRRRRRRR. And she definately WILL NOT EAT RAW. lol

Hang in there and furry Friday hugs