Newly diagnosed boy won't eat

[Burmese Mumma]

Hi All, I'm Vicki along with my 16 year old Burmese boy, Winston, who was diagnosed with diabetes a few days ago. Winston has just been hospitalised for 4 days - wouldn't eat, respiratory issues inc. sneezing (suspected cat flu), excessive drinking / urinating and wobbly hind legs - reason of testing for diabetes. Only in April was he a healthy 5kg boy with fairly normal blood results. He is a CKD kitty but he has been fairly stable since being diagnosed 3 years ago.

Winston is now down to 3.5kg and his glucose levels have been through the roof over the past week, ranging from 31 to 26 (that's 500's if my conversion is right). I'm not yet testing glucose at home as I'm waiting for his Freestyle Libre kit to arrive. He's currently on Glargine insulin - 2 units twice a day. Since bringing him home on Friday evening I have no idea whether the insulin amount is helping - I have an appointment with his vet early Monday morning to run tests again.

I've been trying to feed him every 12 hours on Hills M/D but he's not at all interested. After an unpleasant attempt at assisted feeding (by hand) I went out and purchased Royal Canin Diabetes pouches and gave it a go tonight - that was even worse! I had no choice but to revert to the Hills again given it's pate like consistency is easier to assist feed, but that was still an enormous effort to get him to swallow it.

Before all of this he used to eat raw food twice a day, breakfast and dinner. A brand we have in Oz called "BARF" (biologically appropriate raw food) which is low in phosphorous. During the day and late night he would free choice feed on Royal Canin Renal Dry food, which I've since found out has 41% carbohydrates (eek!). Winston has always been a grazer, and loves crunching on dry food. He was never an over-eater, and never excessively overweight.

Now we're on TR with no dry food and prescription wet food he hates, and will not even lick without assistance. I am beside myself with worry. This is one of the most confronting things I've had to deal with and I desperately want him to eat. I can barely get him to eat 50gm per sitting - apparently this is half of what I'm supposed to feed.

If anyone can provide any advice on how I can get my boy to eat I would be so grateful. I really want to give him his raw food again but there's so many conflicting opinions. And is free choice feeding so terrible? I don't want to compromise TR and any chance of remission. He's so unwell and I'm so sad for him. I feel completely helpless.

 

[Callie & Patches]

My vet said Callie could have 2 snacks a day. I give her 3 ounces for breakfast and dinner and 1 ounce for lunch and bedtime. I don't understand why he can't have his raw food as long as it's low in carbs and agrees with his CK condition. We have found that most prescription foods are too high in carbs.

 

[Myrtlesmum]

Hi from Melbourne as well. Sorry you have to be here. Your boy looks beautiful - I used to have a brown Burmese girl and I know they are very special cats - mine had CKD for 5 years before she passed and was just the sweetest thing. Now to your question: great that you have stopped feeding the dry food but there was no reason to stop feeding the raw - raw is great for diabetics and at this point it is more important that he eats - so if all he wants to eat is raw then feed it to him. The other foods I find my cat will eat that are low carb fine for diabetics is Fancy Feast Classic Chicken and Giblets Pate and also the fishy flavours of the Gourmet Delights brand from Woolworths. You can free feed if that is what your cat prefers. I don’t know that much about TR but my cat went into remission the first time on a more go slow (different insulin) type protocol. Cats on go slow seem to also go into remission and it also seems that there are cats who have been on TR for a long time without going into remission. If you’re not home testing 2 units twice a day may be high and your cat may possibly not be hungry if blood sugars are too low - especially if you have switched him to an all wet food diet and his higher numbers where when he was still eating dry food.

 

[Karen&Rocket]

Hello I'm sorry you're having such a hard time with Winston. I'd highly recommend posting in the Feline Health (the Main Forum) section of this message board. It's the one just below this one. This section is really just for introductions and I'm sure you'll get a lot more help over there. Best of luck to you and Winston!

 

[Burmese Mumma]

My vet said Callie could have 2 snacks a day. I give her 3 ounces for breakfast and dinner and 1 ounce for lunch and bedtime. I don't understand why he can't have his raw food as long as it's low in carbs and agrees with his CK condition. We have found that most prescription foods are too high in carbs.

Hi donnalea - your routine with little Callie seems far more appropriate for my boy too. I'm going to check with the vet tomorrow if I can do something similar, as the portion sizes for twice a day feeds only is just too overwhelming for Winston. After reading some other cases, I suspect once I'm able to monitor his glucose at home it'll be much easier. I tried to feed him his raw food this morning but he's not interested. There's definitely something else underlying so we need to get to the bottom of it. Hope your little girl is doing ok.

 

[Burmese Mumma]

Hi from Melbourne as well. Sorry you have to be here. Your boy looks beautiful - I used to have a brown Burmese girl and I know they are very special cats - mine had CKD for 5 years before she passed and was just the sweetest thing. Now to your question: great that you have stopped feeding the dry food but there was no reason to stop feeding the raw - raw is great for diabetics and at this point it is more important that he eats - so if all he wants to eat is raw then feed it to him. The other foods I find my cat will eat that are low carb fine for diabetics is Fancy Feast Classic Chicken and Giblets Pate and also the fishy flavours of the Gourmet Delights brand from Woolworths. You can free feed if that is what your cat prefers. I don’t know that much about TR but my cat went into remission the first time on a more go slow (different insulin) type protocol. Cats on go slow seem to also go into remission and it also seems that there are cats who have been on TR for a long time without going into remission. If you’re not home testing 2 units twice a day may be high and your cat may possibly not be hungry if blood sugars are too low - especially if you have switched him to an all wet food diet and his higher numbers where when he was still eating dry food.

Hi Myrtlesmum, so great to have a fellow Melburnian and Burmese friend here with me. I tried to feed Winston his raw food this morning but like in my reply to donnalea he just doesn't want to eat all. He's on antibiotics (3rd round) so let's hope that sorts out any underlying infection like flu or even pancreatitis(?). Thanks so much for recommending the other brands, that is so helpful. I'll give them a try - I think I just need to offer him some other options, and at a time that suits him until I see the vet tomorrow. On his blood sugar possibly being too low now, that's something I wondered also. It's impossible running blind, but the vet was so worried about his extremely high glucose (range between 31-26) she suggested the 2 units twice a day over the weekend just to get it down. Can't help but think the crazy high levels were induced by serious stress of being hospitalised for 4 days (he was sooooo bad) and also the infection he seems to have. It's been a really hard run for him the past few weeks. Also good news about your success with go slow insulin. I'll check with the vet on that approach also.
On a more positive front, he's looking a lot more alert and has been able to go for little walk, still with a wobble but it's promising. He also came to bed last night and cuddled under the blanket - he was even purring. A first since he's been home. So amongst all of the grey clouds there's been a touch of sunlight

 

[Burmese Mumma]

Hello I'm sorry you're having such a hard time with Winston. I'd highly recommend posting in the Feline Health (the Main Forum) section of this message board. It's the one just below this one. This section is really just for introductions and I'm sure you'll get a lot more help over there. Best of luck to you and Winston!

Thanks for the tip, Kes (and Rocket!). I realised I may have been on the wrong message board after posting (whoops). I'll jump onto that one instead.

 

[Myrtlesmum]

Hi Myrtlesmum, so great to have a fellow Melburnian and Burmese friend here with me. I tried to feed Winston his raw food this morning but like in my reply to donnalea he just doesn't want to eat all. He's on antibiotics (3rd round) so let's hope that sorts out any underlying infection like flu or even pancreatitis(?). Thanks so much for recommending the other brands, that is so helpful. I'll give them a try - I think I just need to offer him some other options, and at a time that suits him until I see the vet tomorrow. On his blood sugar possibly being too low now, that's something I wondered also. It's impossible running blind, but the vet was so worried about his extremely high glucose (range between 31-26) she suggested the 2 units twice a day over the weekend just to get it down. Can't help but think the crazy high levels were induced by serious stress of being hospitalised for 4 days (he was sooooo bad) and also the infection he seems to have. It's been a really hard run for him the past few weeks. Also good news about your success with go slow insulin. I'll check with the vet on that approach also.
On a more positive front, he's looking a lot more alert and has been able to go for little walk, still with a wobble but it's promising. He also came to bed last night and cuddled under the blanket - he was even purring. A first since he's been home. So amongst all of the grey clouds there's been a touch of sunlight

If he is on antibiotics - is it Amoxyclav by chance? Myrtle stops eating entirely when she takes that and I have had cats vomit on it as well - it can be very hard on the stomach and should be taken with food. If it is Amoxyclav see if the vet can change to something else or better yet maybe a shot.

 

[Burmese Mumma]

If he is on antibiotics - is it Amoxyclav by chance? Myrtle stops eating entirely when she takes that and I have had cats vomit on it as well - it can be very hard on the stomach and should be taken with food. If it is Amoxyclav see if the vet can change to something else or better yet maybe a shot.

Yes, he is! Prior to that he was on Doxycycline, and prior to that an antibiotic paste but I can't recall what that was. I am so glad you mentioned this because this whole debacle of not eating, and then diabetic symptoms came about when he started his antibiotics. I don't want to be paranoid but I can't help but think something is a bit on the nose with all of this. He was definitely unwell, that is true - sneezing, signs of respiratory issues, inability to swallow food properly (likely sore throat) which is why he first went on antibiotics. His health continued to decline BUT when he finished the first round (the paste) he actually had is appetite back and seemed significantly better. Unfortunately he was struggling to swallow food, so that's when the second round started and that's also when everything went wrong. While he was hospitalised he was on IV fluids, and I believe he was getting an antibiotic injection/s. Honestly, I want to stop the antibiotics but I'm scared if he does have an infection I'm doing him harm. Keen to hear your thoughts. Thanks so much for your interest - I am beyond grateful!
P.S. Love that pic of your Myrtle, what a pose!

 

[Myrtlesmum]

I’m not a vet, but if it was me, I would stop the antibiotics - he has been on so many for so long that surely they must have done their job by now. It will probably take a couple of days though for his appetite to come back. It may have been an infection that raised his blood sugar to start with though and that may take time to settle. I know you are waiting for the Libre kit to arrive but would you try testing the traditional way? Some pharmacies will give you the machine if you buy the strips - may be useful as a backup if the other way doesn’t work. That way you could even test his bg today to see how he’s tracking.

 

[Burmese Mumma]

I’m not a vet, but if it was me, I would stop the antibiotics - he has been on so many for so long that surely they must have done their job by now. It will probably take a couple of days though for his appetite to come back. It may have been an infection that raised his blood sugar to start with though and that may take time to settle. I know you are waiting for the Libre kit to arrive but would you try testing the traditional way? Some pharmacies will give you the machine if you buy the strips - may be useful as a backup if the other way doesn’t work. That way you could even test his bg today to see how he’s tracking.

Clearly I'm not a vet either but I feel like it's been long enough too. When he got better it was also a couple of days after the antibiotics stopped, so that's also in line with what you're saying. I'll talk to the vet tomorrow about giving him a break, and I'll also try to hunt down the AlphaTRAK today. Back up is always good. Will keep you posted. Thanks again!

 

[Myrtlesmum]

Regarding th alpha track - obviously completely up to you - but most people here use a human meter. Easier and cheaper to get supplies..... I have both the Accucheck Performa and the Freestyle Optimum - I prefer the Accucheck as it works with a smaller drop of blood and absorbs the blood faster (before kitty can run away!)

 

[Burmese Mumma]

Regarding th alpha track - obviously completely up to you - but most people here use a human meter. Easier and cheaper to get supplies..... I have both the Accucheck Performa and the Freestyle Optimum - I prefer the Accucheck as it works with a smaller drop of blood and absorbs the blood faster (before kitty can run away!)

On my way to pick up the Accucheck Performa now - thanks so much for the good advice.
One more question, and apologies in advance for my ignorance but I haven't yet discussed home BG testing with my vet. When would you suggest to do the test? Would it be before or after dinner? I'm too nervous to mess with increasing the amount of insulin but I can at least get some data for the vet tomorrow morning. The test today might also alert me to his levels being too low, like you suggested earlier. I've just watched a tonne of YouTube videos on home testing, so I'm feeling (somewhat) ready to give it a go.

 

[Myrtlesmum]

Well done. Test before dinner and at least 2 hours after he last ate - you don't want his result to be food influenced. It's OK to feed him during the day, just pick up his dish 2 hours before you intend to test. Sometime (like just now) I feed Myrtle a snack about 3 hours before I want to test - that way I know she won't be hungry and looking for food just before I'm due to test. Generally I test, feed and then give insulin.

 

[Myrtlesmum]

Also don't be surprised if your vet doesn't know how to home test or thinks it's unneccessary. The practice I go to has excellent vets, but each one I see is like "What? How do you do it?". When she was first diagnosed the vet said no need to test. When Myrtle went into remission quite quickly he said how great it was that I was testing as otherwise I probably would have overdosed her. Also, this time around I completely ignored the vet's instruction on dose - again he had suggested way too high a dose. To be honest, I trust my instincts and the people on this board more than my vet when it comes to diabetes and often finding the right dose is just a matter of trial and error.

 

[Karen&Rocket]

@Burmese Mumma Hi, I noticed you hadn’t posted since Saturday - any update on Winston? I hope he’s ok.

 

[Burmese Mumma]

@Burmese Mumma Hi, I noticed you hadn’t posted since Saturday - any update on Winston? I hope he’s ok.

Hi Kes, thanks so much for checking in. So many things going on at the moment including some initially promising news with Winston's glucose levels on Monday morning... he was 11 mmol/L when we took him to the vet at 8am. My hubby and I were so happy for him! Even though he still needed "assisted feeding" (nightmare) I was really hopeful.

The vet decided not to give him insulin that morning, and then recommence the insulin routine in the evening, reducing 2 units of Glargine down to 1 unit.

Sadly since then his blood glucose has been on the rise - we can measure ourselves now thanks to the great advice on Accucheck from @Myrtlesmum We haven't been able to get him under 28. He was so high last night (prior to dinner) the Accucheck couldn't even give us a reading. So, and exactly to what @Myrtlesmum suggested, my feeling on the vet's advice was not giving me much comfort, so we increased the insulin back to 2 units as of last night.

He was still 31 this morning and 28 tonight. We couldn't measure during the day as both my hubby and I had to be in our respective offices today, but I'm working from home the next two days, and have decided to take next week off also. So at least I can check regularly and collect enough data to draw some insight.

By the way, and in case some of your members are not already onto it, I'm using the RVC Pet Diabetes app to capture all of the data - it is excellent! I've also been reading a lot of their studies as well as watching videos on their FB page and its been really valuable.

On the eating front, we stopped his antibiotics on Tuesday morning he's actually gained an interest in food back... hooray! He can only eat a touch at a time ~30g but the fact he can eat by himself is an absolute achievement! I've also taken the advice on allowing him to eat a couple of times during the day... which he has responded really positively to. Honestly, the guidance has been a God send.

We have an appointment with a well regarded feline diabetes specialist on Friday afternoon, so I'm really keen to hear what she to say. I'll also ask her to check his mouth and about pancreatitis. I'll definitely keep you posted.

Thanks again for reaching out and for being such amazing support. This community has given such invaluable advice but most of all, it's given me confidence where I've felt so confused. Big hugs to you all.

 

[Myrtlesmum]

Great to hear Winston is starting to eat again but sad to hear his bg levels are so high. Well done on starting home testing. I’ll be really interested to hear what the specialist says - may I ask what suburb the specialist is in? I just googled “feline diabetes specialist Melbourne” and got a few results- to be honest I didn’t think that we would have feline diabetes specialists in Melbourne - being the sceptic that I am, I would love to hear how they claim to have achieved that specialty. Good luck with your appointment- I really hope you can get Winston sorted out and on the road to recovery!

 

[Karen&Rocket]

Great to hear Winston is starting to eat again but sad to hear his bg levels are so high. Well done on starting home testing.

My thoughts exactly. Thank you for updating. Today is a really busy day or I would write more, but I'm glad things are looking up a little bit. Best of luck with your appointment Friday. Looking forward to good updates.

Edit: almost forgot - huggle Winston for me!!!

 

[Bron and Sheba (GA)]

Hi Vicki and Winston and welcome to the forum. Years ago I had a beautiful Burmese girl called Ming. One of my current kitties is an Australian Mist and he is 1/2 Burmese....such beautiful natures.
I live in Sydney.
Well done learning to test the blood glucose levels!
I'm sorry your boy had been so unwell. But it sounds as if he is improving...that is good.
If Winston has CRD I would not feed him Famcy Feast as it is high in phosphorus. If you are wanting some canned food options have a look at the Weruva 'cats in the kitchen' website. They will give you the number of carbs and the amount of phosphorus in each food. Look for foods 250mg phosphorus/100 kcal or under. A raw diet that uses egg shell powder for the calcium content is a good low phosphorus option too.
With regards to taking up food before testing the blood glucose levels.......we suggest taking the food up for the 2 hours before preshot so the blood glucose level is not food influenced but when you are testing during the cycle (from +1 to +10) you do not take up the food beforehand. Just feed as normal and take the tests when you need to.

We recommend giving several smaller meals during the day and the night instead of just before shots. It is better for the pancreas. A lot of us feed at preshot then around +2 or +3 and again at + 4 or 5.. what ever you think suits Winston.

Always test before every shot of insulin to make sure it is safe to give it and then if you test between +4 and +7 you will be able to see how low the insulin is taking Winston.

When did you get the 28 and 31? Was that before the insulin was given?
If you haven't been testing in between the shots you won't know how low he may have been dropping. ( I know it is hard if you are working)
Many cats can be high at preshot, then drop lower, then shoot back up at the next preshot. This is called bouncing.....and bouncing occurs when kitty drops fast, drops lower than he is used to or drops very low. His body then panics and dumps glucose and regulatory hormones into his system which shoots up the blood glucose high. Bouncing can last for up to 6 cycles before it comes down again.

In regards to increasing the dose of insulin, the fdmb recommends going up and down in 1/4 unit increments as going up in 1 unit increments is a lot for a little cat and you could well go past the best dose.

Here is a link to information you may find useful
http://www.felinediabetes.com/FDMB/threads/information-for-aussie-feline-diabetic-caregivers.217781/

You may like to start posting on the main forum page where there are a lot more people to help you.
Here is the link
http://www.felinediabetes.com/FDMB/forums/feline-health-the-main-forum.28/
Bron