My old mancat just diagnosed

[Fiona and Sasha]

Hi there,

My Sasha is a male rescue cat of approx. 17 years of age and we live in Perth, Australia, along with an almost 15 y.o. female cat, Bella, who has been by my side since she was a kitten and is my first ever animal companion. Sasha has been with us for nearly five years (to Bella's dismay), during which time he has been diagnosed with hypertrophic cardiomyopathy, borderline hyperthyroidism and IBS. Yesterday I found that he might be diabetic and this was confirmed today. His BGL was above 20 mmol/l and he is still dehydrated following two subcutaneous saline treatments. Thankfully, the ketone levels came back OK. I don't know how that happened, as he looks so ill and has been having trouble walking. Such a relief that it isn't as bad as it could have been. I took him into the vet tonight for his first insulin injection (Lantus), but he still doesn't want to eat or drink. I hate to see him so miserable. We are going back tomorrow for a BGC test. He has already received injections of Vitamin B and Convenia (antibiotic), and he also had a dose of Cerenia (for nausea) last night.

Thank you to all the people who have provided support and information on this site. I stayed up very late last night reading the discussion board and some other sites, which prepared me well for Sasha's condition today, the vet visit, and comments from a friend. My cat-loving friend was suggesting that Sasha has had enough, but I know he wants to live and he is such a fighter. He has been coming to me for comfort, so I don't think it is his time yet. And, on the plus side, his kidneys are doing great, so that is encouraging. Why not at least try the treatment? I am worried about the financial commitment because I have not had much work over the past year and this year won't be much better, plus I am doing a post-grad degree, but I will just have to figure it out as we go.

I can't believe the number of people on this site. So sad to see it is such a common problem, but so heart warming to see that other people care about furries as much as I do. Plus, I am so grateful for all the useful info I can get. I have read the newbies FAQ once, but no doubt will need to refer to it many times over the coming month.

Kind regards,
Fiona (and Sasha)

 

[Larry and Kitties]

Welcome. The major cost are for BG testing strips. Most of us here test our ca't blood glucose (BG) level using a human meter. We do it before each shot and periodically between shots. This saves in vet visits as well as help prevent the cat's BG from going too low.
The other cos is for insulin. Levemir and Lantus are human insulin that are excellent for cats. Most of us here purchase the 5 pack of disposable pens or cartridges (if available). You do not use the pen needles by draw up the insulin with a syringe. The cost per ml is more for the pens/cartridges than the 10 ml vial but most of use can use up a 3 ml pen.cartridge before it goes bad which is not the case for the 10 ml vials.
Most here also feed commercial, low-carb canned food.

 

[Elizabeth and Bertie]

Hello Fiona and extra-sweet Sasha, and welcome to FDMB

A diagnosis of feline diabetes can really come as a shock at first, but the good news is that it is treatable.

Do you know why Sasha is off his food? It is very important that a cat eats.
I see that the vet gave Cerenia for nausea. Did the vet discuss appetite stimulants?
Can Sasha be tempted by any favourite foods? Some folks here assist-feed their kitties during periods of crisis to ensure they get nourishment. Is that something you might consider trying?

It is good that the ketone test came back OK. You can continue to monitor for ketones at home using Ketodiastix strips (or Australian equivalent) that should be available from most pharmacies. Does Sasha use a litter tray? A piece of crumpled plastic food wrap in the tray can help to catch a sample; you only need a tiny weeny amount.

When you say that Sasha has "trouble walking" do you mean that his back legs are weak?
This could be caused by neuropathy which is quite common in newly diagnosed diabetics. It's caused by nerve damage and can be helped by supplementing the diet with methyl B12. Neuropathy is reversible.
Back leg weakness can also be caused by potassium deficiency; and if the potassium is low this can be corrected with supplementation.

Would you be willing to learn to test Sasha's blood glucose at home? Most of us here hometest and find it to be an invaluable tool in diabetes management.
Most folks here use ordinary glucose meters made for humans.
In essence, the test involves pricking the outer edge of the cat's ear to get a tiny blood droplet, transferring that droplet to a test strip in a glucose meter, and waiting for the meter to count down and give the result. This should not hurt Sasha at all, but, like anything new it can take a few goes to get the hang of it.
If you'd like to try hometesting we can help you to learn that.

Chin up, Fiona. There may be much that can be done to help your boy.

Eliz

 

[Fiona and Sasha]

Hi Larry. Thank you very much for the warm welcome and the info.
I recall now that test strips are quite expensive. Forgot about that, so thanks for the heads up. I already own an Accu-Chek Active meter, so will see how I go with using that. I was charged AU$41 for 3ml of Lantus and $38.20 for 100 syringes today. I will shop around when I get a chance.
Food is going to be a problem, given the IBS issue and Sasha refusing to eat the wet variety of the Hills Z/D. Will discuss with the vet tomorrow. Would also love to hear from others on this site that have to work around the same dietary considerations.

 

[Fiona and Sasha]

Hi Elizabeth. Thank you so much

I am definitely keen to learn to do things at home in order to keep costs down and to control Sasha's wellbeing. Have had issues with these vets (as have others, according to reviews on the internet), so I am very wary. Plus, I don't have a car so can't get him to the vet quickly if he gets very ill. I don't think I will let the vets know that I plan to home test. Will put that off until I have questions or problems arise.

I don't know why Sasha won't eat . He is normally a hungry cat. Appetite stimulants might be the way to go, possibly followed by syringe feeding, which I know he will hate. I gave him some tuna in springwater tonight to see if he would eat his favourite thing, and he did take about a tablespoon of that, but didn't want any more. Will make sure I mention it to the vet when I take him in tomorrow.

The walking problems appear to be due to peripheral neuropathy of some sort. A month ago the vet put it down to a likely back problem, but now I wonder. As such, I asked the vet for B12 and he said that B1 (thiamine) was the way to go. Surprising, as I know that B12 is the best thing for people with similar problems, but the vet gave a B-complex anyway, so that covers both of those and more. I will check the potassium levels with the vet. It would make sense given that he was so dehydrated.

Scars suggest that Sasha got into much trouble in his younger years. One of his ears is tattered and torn, so hoping he can also deal with the pain of testing.

 

[phlika29]

Hi

The vit b complex should actually help with his IBS. With regards the weakness you want the methylcobalamin. Many people use zobaline tablets

http://www.ilifelink.com/zobaline-for_diabetic_cats-3_mg_x_60_tablets.html

From the price you quoted for the lantus it sounds quite reasonable (as in the UK) unlike the US where it is significantly more.

Re the appetite have you changed food recently? What is he on? Before you try the appetite stimulant I would advise you carry on with the anti nausea tablets, or give both at the same time. I would ask the vet for some more cerenia or alternatively I like to give my cat ondansetron. You will probably need to give it for a week or so to get him over this hump.

 

[Elizabeth and Bertie]

With regards the weakness you want the methylcobalamin. Many people use zobaline tablets

Another one that you may be able to get in Oz is Dr's Best 'fully active B12' (methylcobalamin). It's half the dosage of Zobaline so you need 2 capsules to get the equivalent amount. It has no taste and can be added into food.
.

 

[Critter Mom]

Hi Fiona,
Sorry to hear that Sasha is so poorly. FWIW, cats with diabetes can be very lethargic, be quite depressed, have poor coat/body condition, and may look very ill but with the right treatment the way they can rally is nothing short of amazing.

I see that Sarah has already given you some recommendations about anti-nausea meds. Cyproheptadine is a good appetite stimulant and unlike mirtazapine, doesn't carry the risk of inducing serotonin syndrome. Given that Sasha has IBS issues, it might be an idea to ask for a Spec fPL test to check for pancreatitis. It can cause nausea and inappetence.

Feeding little and often can help a lot with nausea. Here's a nausea symptom checker from Tanya's site. It's a useful reference for inappetence problems.

 

[Fiona and Sasha]

Thank you, phlika and Elizabeth. I wonder if IBS cats have trouble absorbing B12 through the gut like people do.

Phlika, Sasha stopped eating whilst on his regular diet of dry Hills D/Z food. I actually took him to the vet becasue I thought he had a problem with his mouth! I swapped him to the wet D/Z once I had a suspected diabetes diagnosis and he ate that the first time and has refused to eat it since, so I then tried him on some Fancy Feast varieties and tuna in springwater (his favourite) to see if he would eat things he finds appetising.

Thank you for the encouragement and info, Critter Mom.

In Australia (or the three vets I have been to in Perth, anyway), vets don't do blood tests for pancreatitis. They use ultrasound to diagnose, and it does not always provide definitive results. The vet also said that it is untreatable, so there is not much to be gained in knowing whether a kitty has it or not. Personally, I like to know what is going on so that considered judgements can be made about all treatments, for peace of mind, and for monitoring.

Today, Sasha was quickly going to his food like he really wanted to eat, but he turned away when he smelled it, no matter what was put in front of him. Many hours later he has eaten a tiny amount twice, 3 hours apart. The vet gave him something for appetite or nausea today when he went in for his curve test, but I have no idea what. We didn't really discuss the treatment and tests he had today. I have been in tears all evening because the vet said he doesn't know why Sasha isn't eating and, if he doesn't eat very soon, he wants to put a feeding tube in (within 48 hours). He asked me to think about whether I wanted to continue treatment or put an end to it all. The lack of communication unsettles me and good vets are hard to find near me (I have been to both, plus one further away). I think the vet I saw today and who did the suspected diagnosis does want to try to get Sasha well. He did a lot today and he only charged me for the BGC. However, I also asked how do I know what Sasha's BSL is — do I need to test – and he abruptly said "no, we do that here". This could either be because he thought it would decrease my stress or that he is very much against home testing. I feel uncomfortable about making a decision regarding Sasha's fate when I can't even get all the info I require from the vet to make that decision.

Not sure what to do about home testing this week. I am due to give Sasha his injection at about 7.30 am, but my test strips are out of date, so I doubt the machine will accept them. Can't recall how the age of the strips affects results, either. Need to look all this stuff up again. I only need to give one unit (twice a day). The vet wants to check the BSL on Friday, but I have to take Sasha back sooner if he doesn't eat more. He had IV fluids today so he is finally properly hydrated at least. I only had him healthy for a year or so, so I definitely want to spend more 'good' time with him.

I am beyond exhausted and am keeping Sasha awake, so think I will take myself off to bed now and try to sleep. Poor Sash keeps falling off the couch while trying to step down (he already uses steps, but these aren't good enough for the condition he suddenly finds himself in). He wants to lie down next to me, so I had better stay off the couch for at least a week. Will start a separate thread if I have a specific question. Thanks so much for reading and for the replies.

 

[Critter Mom]

The vet also said [pancreatitis] is untreatable, so there is not much to be gained in knowing whether a kitty has it or not.

I could not disagree more! Pancreatitis in some cats may be a chronic condition, but it is certainly NOT untreatable! Here are the IDEXX guidelines for pancreatitis treatment should you need them. In addition to info on diagnostics, it covers all manner of therapies to help kitties going through acute episodes and also supportive measures that can help those with the chronic condition feel much, much better. It can be a bit of a roller coaster at times, but as one learns more about how to help the cat it does get easier to manage.

I have a strong suspicion that Saoirse developed pancreatitis as a sequela of undiagnosed IBS (probably caused by a food allergy - she's getting tests done soon). The IDEXX guidelines recommend B12 supplementation and yes, IBS can cause malabsorption issues. Prior to diagnosis, Saoirse's coat was badly rusted, I think partly from malabsorption issues and partly from her body not being able to use nutrients properly because she didn't have enough insulin. When she was tested, she had a marked B12 deficiency. She improved a great deal when she had a course of B12 injections last year. She's having another course at the moment. All her new fur grew back black, too. Well ... maybe not the white bits! She also looks younger and healthier than she has done in years. Our main vet couldn't believe the difference in her after only a couple of months of treatment and diet change (to grain-free, species-appropriate, low carb wet food).

Today, Sasha was quickly going to his food like he really wanted to eat, but he turned away when he smelled it, no matter what was put in front of him.

To my mind, that behaviour sounds more like it's nausea-related rather than due to lack of appetite. If a cat is struggling to eat due to nausea it may be necessary to give BOTH anti-nausea and appetite stimulant meds. It is a positive that your vet is looking to address the inappetence in a hurry, and aggressively if necessary. Some vets don't. (I lost a cat to hepatic lipidosis because a vet didn't intervene in time, even though she had been hospitalised for days. )

Word of warning: I'm not suggesting that Sasha has pancreatitis (I'm not a medical professional) and I hope that he doesn't, but I am a bit worried about your vet's suggestion that there might not be much you can do to help him should he be diagnosed with pancreatitis. Sometimes cats going through pancreatitis flares may become extremely ill until they get the right treatment regime in place, but then they can rally in a way that is nothing short of a-mazing. I was really worried that I might lose Saoirse at one stage last year, but after a number of weeks on the right treatments and food that she could eat OK her recovery was gobsmacking! I've seen other cats here make great recoveries, too. I got a lot of help from the people here when Saoirse was bad. Indeed, the vet ordered in some of the medication recommended here and in the IDEXX guidelines especially for Saoirse because I insisted that she get it. (We're lucky to have excellent, collaborative vets now.)

 

[Fiona and Sasha]

Thanks, Critter Mom. Much appreciated. I will do some research and print out the IDEXX guidelines and take it to the vet tomorrow and ask him to comment. Not sure how I will go with that, as I am taking Sasha at the end of the day. We have been hurried out every day so far this week — except today! Sasha has FINALLY started eating a bit better and I think he has eaten enough, so emergency over, and I kept him home tonight and will take him in tomorrow night.

I bet you are glad that you were so persistent on behalf of Saoirse. I am really glad it worked out so well for you. There is, and will always be, only one Saoirse.

Managed to get some blood from Sasha. Poor thing — I butchered him, but he doesn't seem to be too mad at me. Will do another thread about that.

 

[Critter Mom]

I'm delighted that Sasha's eating! You must be greatly relieved, Fiona.

I learned the hard way about the value of being an advocate for my little ones.