Hi Janet,
When her blood glucose levels drop to “ normal” levels her appetite goes away and she seems “ off”.
If a cat is in high BG levels it can sometimes become extremely hungry (polyphagia) because without enough insulin the cells in the body don't receive enough glucose to properly utilise the food consumed by the cat. The cat may also lose consumed calories if BG is so high that glucose starts spilling over into the urine.
However, I've seen umpteen cases here of kitties developing appetite problems after starting insulin treatment (and to this day I've yet to see a hypothesis/explanation of why this seems to happen). Because Bella's a little bit ketone-prone it's especially important that she gets enough food and enough insulin. Is she eating sufficient to maintain her weight (or gain weight if she needs to) during the periods when her appetite is stronger? Very importantly, is Bella showing any signs of nausea? Here's a symptom checker:
Nausea symptoms and treatments
Nausea is frequently a cause of poor appetite in cats (and we do see a lot of it here). Cerenia and ondansetron are usually very effective treatments but obviously it's important to work with your vet to identify the underlying cause of any nausea/inappetence. Note that if the nausea is due to gut motility/constipation problems then treatment to resolve the constipation and a short course of metoclopramide (Reglan) may be more appropriate; Cerenia and ondansetron are highly likely to be ineffective.
If Bella's not showing any signs of nausea but is still reluctant to eat I'd suggest asking your vet about whether a mild appetite stimulant might help her to eat better (e.g. cyproheptadine - much milder effect than mirtazapine and can be dosed more frequently. (Safety note: cyproheptadine is contraindicated in cats who have high blood pressure/glaucoma/liver issues.)
I'd suggest contacting your vet tomorrow so that, should Bella need any supportive treatments to help her eat enough, then you'd be able to get the Rx before the weekend. (Cats do seem to have this really annoying knack of throwing wobblers when the vets are closed!
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On seeming 'off', it's not uncommon for newly-diagnosed cats to jWhen BG levels start to move back into a healthier range upon commencement of insulin treatment, the cat's body is better able to utilise food and appetite starts going back to a normal, healthy level. Also, some cats may initially experience lower energy levels when first their bodies start seeing lower BG levels than their bodies have become accustomed to, but usually this initial dip in energy will reduce after the first few days of insulin treatment. (Note: Lethargy is tricky because it can also be a hypo symptom so always check BG if in any doubt.) As treatment continues, one may see energy levels dip at the lower points in the cycle but to then pick up when the cat's BG is higher. Again, this should improve with time as the kitty's body again becomes accustomed to running at healthier BG levels. If the lethargy persists then the situation needs to be reassessed (might be that the insulin in use/dose is producing very fast/steep drops and these can make some cats feel quite icky).
Needless to say, it's important to let your vet know about any changes in Bella's clinical signs.
Mogs
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