Remission? Misdiagnosis? Still having litter box issues

[BeeboTheBeanMachine]

Hey friends!

Beebo is still maintaining greens and blues after 12 days of no insulin. It looks to me like she may be heading into official remission.... OR perhaps she was misdiagnosed? Unfortunately we did not start home testing immediately and have no actual evidence of high BG apart from multiple blood draws done by the vet (some at the office, some at home, all seemingly with minimal/no stress) over the past year. I posted an intro to describe the situation here and then an update last week here. We've switched her to 90% wet food (only giving a small scoop of dry if she is crying non-stop at 2am and waking us up in the middle of the night), so it's very possible the food alone has helped regulate her sugar.

Here's the problem... the vet did not push heavily to start insulin because of her numbers. He frequently remarked that although they were higher than ideal, a switch in food might bring them down. Our biggest motivation to try the insulin was because we assumed her stomach/hunger issues were a symptom of the diabetes. For months, she has been experiencing diarrhea almost immediately after every meal. Sometimes the stools are more firm, but they shoot out of her really fast followed by a lot of straining, followed by a couple really liquid drops. The straining is what really concerns me. She pushes really hard for a long time, and each time her legs and lower back shake from the effort. Every now and then, we wake up/get home to find she has gone outside of the litter box. We didn't see much improvement between her being on and off insulin or during any of her previous food transitions. She also acts like she is starving pretty much all the time. She will wake us up three or four times a night yowling outside of our bedroom door for food. I'm guessing this is because the food is going right through her and she is not getting enough nourishment from it. I feel so awful for her and I also really miss getting a full night's sleep. I'm so afraid that something more serious is going on and that we're going to catch it too late to be able to help her.

The vet has done blood tests, stool samples, urinalysis and found nothing of concern that would be causing digestion issues. This is why we started the insulin, because her BG numbers were the only thing that seemed slightly off to him. I've link our recent lab work at the bottom of this post in case you guys notice anything he's missing. Are there different types of tests I should request?

Also, yes, food allergies are something we're considering. Before the insulin, she was on dry food (Blue Buffalo Wilderness Chicken), then the vet put her on Glycobalance which seemed to make the stomach problems even worse, then we moved her to Friskies Pate in chicken varieties right around when we started insulin. For the past week, we've been transitioning her to non-chicken wet foods and haven't seen any improvement so far, but she's been eating about half-and-half between chicken and beef or rabbit or lamb varieties. A couple times the vet prescribed a compounded medication for nausea/diarrhea. She HATED taking it, but when we could get her to take it consistently it did seem to improve, but then as soon as she finished the medication it would resume again. We did this for two rounds. I don't remember what the medicine was right now, but I can call the pharmacy tomorrow if it would really help to learn more about it.

Previous labs and vet records, pre-2019
Most recent lab, June 2019

 

[Dusty Bones]

Regarding the poop part, she may be constipated. When they're constipated they strain and some liquid will come out making you think she has diarrhea but it's just from them straining and forcing some liquid out past the hard poop. I would try some MiraLax in her food, just a little sprinkling in her wet food and mix it in. It's tasteless and then just adjust the amount if the poop gets too soft or still too hard. Dusty would do the same thing but in his case he would strain so much he would also throw up. He was on MirLax for years until I switched his food from Fancy Feast to Weruva and he stopped needing it. So unless you literally just see lots of soft poop it might be constipation.

 

[Bron and Sheba (GA)]

Mycat Sheba had chronic diarrhoea (no cause could be found) until I swapped her to a homemade diet and the diarrhoea stopped.
It would be worth while swapping to a novel protein in the diet to see if that helps.

You could also try plain mashed pumpkin added to the food a couple of times a day...that is really good for both constipation and diarrhoea..you can either buy the plain canned pumpkin with nothing added to it, or you can boil up some pumpkin, drain the water off and mash it. Again nothing added except pumpkin and water. You can give a teaspoon twice a day. I found that made a big difference to my cat. I used to make up a big batch and freeze it in ice trays then put in baggies and use when needed.

Also have you tried slippery elm bark powder. It is soothing to the alimentary tract and might help.

I would also ditch the dry food completely as it willbe higher in carbs than is safe for diabetic cats, especially if they are in remission. If your kitty is not overweight I would feed her more.
A lot of us use a timed feeder which will open when you program it to. You could use it for during the night a couple of times so she is getting some canned food during the night while you sleep..
Feeding several smaller meals during the day and night is better for the cat than just two meals a day.

 

[Bella & Liz]

Have you ever looked into if she might have IBD? I know its really difficult to get a solid diagnosis of the condition, but when my cat was losing weight for no real reason (even though she was begging for food constantly and eating a ton) we did tons of blood work tests to no avail, ended up doing an ultrasound and her intestines were thickened, so she either had IBD or lymphoma, we never did the biopsy to decipher which of the two it was. However after being diagnosed she was put on predisone for a few months, which resulted in her getting diabetes, but she gained a nice amount of weight and had less tummy troubles while on the medication. I know alot of people use probiotics to help with IBD symptoms and general stomach upsetness as well with some success.

 

[BeeboTheBeanMachine]

Regarding the poop part, she may be constipated. When they're constipated they strain and some liquid will come out making you think she has diarrhea but it's just from them straining and forcing some liquid out past the hard poop. I would try some MiraLax in her food, just a little sprinkling in her wet food and mix it in. It's tasteless and then just adjust the amount if the poop gets too soft or still too hard. Dusty would do the same thing but in his case he would strain so much he would also throw up. He was on MirLax for years until I switched his food from Fancy Feast to Weruva and he stopped needing it. So unless you literally just see lots of soft poop it might be constipation.

I feel doubtful that it’s constipation because she does poop a LOT. The straining and few drops of liquid usually come at the end of a full bowel movement (which is very soft but more solid than it was when she ate Glycobalance).

Mycat Sheba had chronic diarrhoea (no cause could be found) until I swapped her to a homemade diet and the diarrhoea stopped.
It would be worth while swapping to a novel protein in the diet to see if that helps.

You could also try plain mashed pumpkin added to the food a couple of times a day...that is really good for both constipation and diarrhoea..you can either buy the plain canned pumpkin with nothing added to it, or you can boil up some pumpkin, drain the water off and mash it. Again nothing added except pumpkin and water. You can give a teaspoon twice a day. I found that made a big difference to my cat. I used to make up a big batch and freeze it in ice trays then put in baggies and use when needed.

Also have you tried slippery elm bark powder. It is soothing to the alimentary tract and might help.

I would also ditch the dry food completely as it willbe higher in carbs than is safe for diabetic cats, especially if they are in remission. If your kitty is not overweight I would feed her more.
A lot of us use a timed feeder which will open when you program it to. You could use it for during the night a couple of times so she is getting some canned food during the night while you sleep..
Feeding several smaller meals during the day and night is better for the cat than just two meals a day.

Sheba is actually Beebo’s “legal” name! That was her name at the rescue (and on all her vet records) but we’ve been calling her Beebo or Little Bee for years. It came from calling her Sheebo when she was acting silly

Thanks for the pumpkin suggestion. We will give that a try. A timed feeder would also be great for our terrible sleep habits. She’s not overweight now, but she used to be. She dropped from 16lbs to ~12lbs in the last year which is one of the reasons were so concerned. She’s a BIG cat so she wasn’t obese at 16lbs.

Have you ever looked into if she might have IBD? I know its really difficult to get a solid diagnosis of the condition, but when my cat was losing weight for no real reason (even though she was begging for food constantly and eating a ton) we did tons of blood work tests to no avail, ended up doing an ultrasound and her intestines were thickened, so she either had IBD or lymphoma, we never did the biopsy to decipher which of the two it was. However after being diagnosed she was put on predisone for a few months, which resulted in her getting diabetes, but she gained a nice amount of weight and had less tummy troubles while on the medication. I know alot of people use probiotics to help with IBD symptoms and general stomach upsetness as well with some success.

This is something I considered but had no clue how testing went about for it. Maybe an ultrasound would be helpful. She was on prednisolone for a long time for her asthma which is what caused her diabetes, so I’d be extremely hesitant to try steroids again. I’ll ask the vet if we can look into possible solutions for IBD.