New Member Lulu, diabetic 20 year old cat

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Lulu's person

Lulu's person

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Hello, I am Lulu's person. I don't know how to get to the diabetic forum so I am starting here as directed. I have been reading your forum for awhile and finally decided to join.

Lulu is 20 years old and has been doing well on Prozinc insulin for 8 years. She weighed 8.8 lbs when her glucose went haywire in January. She had several low blood sugar emergencies in January and we reduced her Prozinc according to the vet's recommendations. She weighed 8.8 lbs. She had been on 4 units 2x daily for 7+ years. We reduced her insulin to 2 units, then 1 unit then 3/4 unit because she continued to have frightening low episodes and ER visits. We began keeping track of her glucose levels in January and started daily curves in May because she kept losing weight. In March she weighed 7.7 lbs. She now weighs 5.6 lbs. We have been frantically trying to get her to stop losing weight but it seems impossible. She is hungry all of the time and eats a lot but still looses weight. I have read that it is due to unregulated insulin but her charts look good most of the time. I have read that is is because of too much insulin and too little insulin. Our vet is at a loss.

She has been stabilized on 3/4 unit since March but she has lost a lot of weight. She is also more and more dehydrated and we have her on lactated ringers increasing up from 100 units to 300 units a day. Her blood tests have been good since the beginning and the vet can find no other causes. About 3 months ago we had an adrenal test done on her because her Ph/N ratio was slightly off. She was not doing well and we thought it was time to let her go if nothing more could be done. Her test results were not definitive buy slightly suggestive. The vet put her on a small dose of Fludrocortisone for Addison's disease and she improved. It was a shot in the dark because the data shows adrenal issues in cats are said to be uncommon but I suspect that might be because the testing is expensive and not commonly done.

I am looking for any help on trying to get her to gain back some weight. No ketones in her urine. Curves better than the ideal curve on the Prozinc chart. We started high calorie high protein Quail egg treats and she loves them but is still losing weight. Please help if you can.
 
Lulu's person said:
Hello, I am Lulu's person. I don't know how to get to the diabetic forum so I am starting here as directed. I have been reading your forum for awhile and finally decided to join.

Lulu is 20 years old and has been doing well on Prozinc insulin for 8 years. She weighed 8.8 lbs when her glucose went haywire in January. She had several low blood sugar emergencies in January and we reduced her Prozinc according to the vet's recommendations. She weighed 8.8 lbs. She had been on 4 units 2x daily for 7+ years. We reduced her insulin to 2 units, then 1 unit then 3/4 unit because she continued to have frightening low episodes and ER visits. We began keeping track of her glucose levels in January and started daily curves in May because she kept losing weight. In March she weighed 7.7 lbs. She now weighs 5.6 lbs. We have been frantically trying to get her to stop losing weight but it seems impossible. She is hungry all of the time and eats a lot but still looses weight. I have read that it is due to unregulated insulin but her charts look good most of the time. I have read that is is because of too much insulin and too little insulin. Our vet is at a loss.

She has been stabilized on 3/4 unit since March but she has lost a lot of weight. She is also more and more dehydrated and we have her on lactated ringers increasing up from 100 units to 300 units a day. Her blood tests have been good since the beginning and the vet can find no other causes. About 3 months ago we had an adrenal test done on her because her Ph/N ratio was slightly off. She was not doing well and we thought it was time to let her go if nothing more could be done. Her test results were not definitive buy slightly suggestive. The vet put her on a small dose of Fludrocortisone for Addison's disease and she improved. It was a shot in the dark because the data shows adrenal issues in cats are said to be uncommon but I suspect that might be because the testing is expensive and not commonly done.

I am looking for any help on trying to get her to gain back some weight. No ketones in her urine. Curves better than the ideal curve on the Prozinc chart. We started high calorie high protein Quail egg treats and she loves them but is still losing weight. Please help if you can.
Click to expand...
@Suzanne & Darcy
@Wendy&Neko
@JanetNJ
@Sienne and Gabby (GA)
 
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@Lulu's person
Welcome I have tagged a prozinc user for you, can you go to your title and put New Member in front of Lulu
To do this look to the right and tap on Thread Tools , then tap on Edit Title and add New Member and then tap Save.

Let me tag one other member for you
 
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@Lulu's person
Hi . Are you home testing ?

We need you to create your signature, it's information about your kitty , it's at the end of everyone's post in gray letters.
Tap on your name up top then tap on the word signature and add this information
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Bexacat or Senvelgo (if applicable) and dates
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Thank you!

Do you see mine about Tyler


Here is the link on how to create a spreadsheet and it also explains how to use it
https://felinediabetes.com/FDMB/forums/spreadsheets-tech-support-testing-area.6/
 
Lulu/ Age 20 / DX 2018/ Prozinc / CareSens N / LC wet Fancy Feast Pate / SLGS since Jan 2024/ hypoglycemia, dehydration & weight loss since Jan 2024 / fludrocortisone for Addison's since Jul 2024

Added above to Signature page. So sorry about your loss of Tyler, what a beautiful boy!! I know Lulu and the rest of our feline menagerie 4 other geriatrics are all on borrowed time.

Lulu had no problems on 4 units of Prozinc for over 7 years. All of a sudden in January she had to be given Karo and rushed to the ER for BG of 37. It continued all month with more ER visits until we got the dose down to 3/4 unit and never shooting a reading of under 200. She has been on 3/4 -1 unit since with some fat shots, some skinny shots and some skipped shots because she was too low to shoot. Her curves are good except for the occasional too low to shoot, no DKA and she is as spry as ever. We recently went back to 3/4 unit from 1 because she had too many days of too low to shoot and a nadir of 47 last week (non symptomatic but scary).

We found the Prozinc information in January and I am sure it saved her life. Our biggest concern is her continued dehydration and weight loss. We give her Ringers 2x daily now and weigh her before and after. We feed her lunch after checking her nadir because she is starving all day and we check her nadir before lunch.

Do I need to copy this information to the Prozinc page? I am there but it doesn't say anything and only two members are chatting.
 
Thank you. Yes we test 3x daily 8AM 2PM PM Pre-shot AM & PM and midday nadir. We test more if she is not within range. She has a beautiful curve most days.
 
I looked at the spreadsheets and I don't think I could do one or that one is needed since her charts are good with only occasional flat curves or low curves. Her usual range is 250-350AM pre shot, 70-150 nadir and to 230-250 PM pre shot plus or minus, much like the ideal ProZinc curve chart. We have only had two or three readings over 400 ever and more than a few nadirs under 70 when we continue checking until it goes up. We have incorporated the fat shot, skinny shot, delayed shot and no shot criteria pretty well.

I don't understand the charts I looked at anyway. We are mostly concerned with her dehydration and weight loss. I feel like she is starving to death and don't know what to do. All I read says it is too much or too little insulin but her charts do not show unregulated blood glucose. We bought kitten food and Quail egg snacks with cranberry because they are high calorie pure protein. She loves them but she keeps losing weight and needing more subcutaneous fluid. We are careful not to confuse weight loss with dehydration but use dehydration symptoms that we have used with our other cats, past and present, for years.
 
Yes, All of her bloodwork has been great except for her Ph/K ratio which was slightly off. Lulu has has been on ProZinc for 8 years and suddenly began having low glucose issues in January. She possibly has Addison's disease or hypoadrenocorticism, the ACTH stimulation test was not conclusive but because of her Ph/K ratio, sudden low glucose readings, weight loss and dehydration she was put on fludrocortisone. It helped her feel better at first but she is still having the same issues and wasting away. She was stable on 4 units until January when she started having dangerously low glucose issues. She is now on 3/4 unit losing weight hungry all of the time and needing subcutaneous fluids for dehydration. We will probably do blood work again this week if she feels well enough. The vet stresses her out terribly. I thought we were losing her when we had the last blood tests 3 months ago and promised her she would never have to go back to the vet. But she is like the Energizer Bunny, she keeps going and going.
 
Lulu's person said:
Yes, All of her bloodwork has been great except for her Ph/K ratio which was slightly off. Lulu has has been on ProZinc for 8 years and suddenly began having low glucose issues in January. She possibly has Addison's disease or hypoadrenocorticism, the ACTH stimulation test was not conclusive but because of her Ph/K ratio, sudden low glucose readings, weight loss and dehydration she was put on fludrocortisone. It helped her feel better at first but she is still having the same issues and wasting away. She was stable on 4 units until January when she started having dangerously low glucose issues. She is now on 3/4 unit losing weight hungry all of the time and needing subcutaneous fluids for dehydration. We will probably do blood work again this week if she feels well enough. The vet stresses her out terribly. I thought we were losing her when we had the last blood tests 3 months ago and promised her she would never have to go back to the vet. But she is like the Energizer Bunny, she keeps going and going.
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What was off about her Ph/K ratio? Was her potassium normal?

also: great job and yay! Lulu to make it to 20!
 
Ok, with rapid weigh loss the liver is impacted.
L-Carnitine is a supplement that you can give with food. It is used in weight-loss diets because 1) it promotes energy expenditure from adipose tissues and 2) it protects the liver during weight loss. There are numerous studies pointing to its use as a supplement both for humans and cats, it is safe and I really recommend you start giving it to protect Lulu’s liver.
 
Vey importantly regarding vet stress: ask your vet to give you gabapentin. You can try half a dose at home (50mg) to make sure that the 100mg will not nock her out. She doesn’t need to be stressed for vet visits! Ask for the gaba!
 
What do Lulu’s stools look like?

Have you done chest/abdomonal X-rays and ultrasound?

Have you done a GI panel? This is usually a send-out test to Texas A&M University and includes an fPLI, fTLI, folate, and cobalamin levels.

How long ago was the thyroid testing done? Was it only a T4 test or a complete thyroid panel (T3, T4, free T4, TSH)?

Is she indoor only or does she go outside? Any history of having fleas or eating mice or other rodents? Has a fecal sample been performed?

Many, many things can cause ravenous appetite and weight loss other than diabetes. Insulin needs can and do change over time, but in a long term stable diabetic, it can also sometimes be a clue to something more ominous. I know how hard it can be to watch them literally wither away in front of your eyes; I hope you can find some answers.
 
How much sub Q fluids are you giving twice a day. Are you making sure the fluid from earlier has gone? 300 ml a day is too much for a cat.
Have you tried Hills a/d canned food? It is good for cats who need building up or are recovering from illness.
Can you post the lab results? To do that you copy and paste them
 
I’m not a vet and haven’t even treated Addison’s in humans (the species I treat), so take this with a huge grain of salt, but I believe humans are given prednisone in addition to fludrocortisone, the former to replace/augment cortisol, and the latter to replace aldosterone, the two hormones deficient in Addisons—but I bow to the advice and opinion of your vet.

weight loss and weakness can happen as a result of two main issues: the electrolyte imbalance/dehydration/low blood pressure resulting from inadequate aldosterone, and the lack of glucose available to the body resulting from insulin SENSITIVITY (as opposed to the insulin resistance we’re used to seeing in our kitties). So the body takes in protein (since cats don’t use carbs like humans) but is unable to convert the protein to glucose. I THINK because again, my patients walk upright.

good luck with Lulu,

edit: humans take prednisone but I believe cats cannot successfully metabolize prednisone and so IF cats with Addison would get pred I ASSUME it would be prednisolone
 
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Steroid trivia (for anyone trying to keep meds straight while vet is talking)

Mineralcorticoids are steroid hormones that influence the balance of salt and water in the body. Fludrocortisone is an example

Glucocorticoids are steroid hormones that influence the body’s metabolism of glucose and reduce inflammation.
Prenisolone is an example.
 
Wow, thank you all for the great suggestions and information. All of our cats are indoor only except for a deck they cannot get off of. I will ask the vet about the L-Carnitine, prednisolone, and other thyroid tests. She is going in for bloodwork on Friday and I made a list of all of your questions and information to ask the vet. I have gabapentin and prednisolone for Caledonia, Lulu's 18 year old half Norwegian kitten, just diagnosed with spinal spondylosis and cancer. She did not like being drugged so we don't use it for her. We are just keeping her comfortable with Solensia and prednisolone for as long as she is happy and not in pain or distress. I fostered Lulu when she was very pregnant and ended up keeping her and two of the kittens. Her other kitten, Bojo and our newest adoptee, Cody, both have CKD and are on meds and subQ too. Our fifth fur baby, Oscar, is hyperthyroid and doing well on his thyroid meds.

I know 300 units is too much fluid for her but the only other option is to let her be dehydrated and miserable. I suspect her kidneys are just shot but she does not have symptoms of kidney disease. The vet says they are very small. I realize that we are just buying time and would not put her through and heroic tests or treatments at her age. It is just that she is still so happy and healthy except for the DM, dehydration and weight loss. She is still bright eyed and more active and alert than any of our other cats. We just do not want to give up because of her age if there is more that we can do.

The Addison's seems to be her only hope since Fludrocortisone helped for a while. I have tried to read about the treatment for cats with Addison's and all I get is that it is rare and as far as I can find there has only been one other cat in the world diagnosed with both DM and Addison's and no information about that at all. Her Ph and K are both high but close to normal and the ratio is only pushing a little out of range. The I thought steroids were an absolute no for cats with DM but will aske the vet about prednisolone or more meds. I listed her blood work from March but it got deleted. We will wait for the new tests. T4 was 1.3 and no ketones.
 

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Lulu's person said:
Wow, thank you all for the great suggestions and information. All of our cats are indoor only except for a deck they cannot get off of. I will ask the vet about the L-Carnitine, prednisolone, and other thyroid tests. She is going in for bloodwork on Friday and I made a list of all of your questions and information to ask the vet. I have gabapentin and prednisolone for Caledonia, Lulu's 18 year old half Norwegian kitten, just diagnosed with spinal spondylosis and cancer. She did not like being drugged so we don't use it for her. We are just keeping her comfortable with Solensia and prednisolone for as long as she is happy and not in pain or distress. I fostered Lulu when she was very pregnant and ended up keeping her and two of the kittens. Her other kitten, Bojo and our newest adoptee, Cody, both have CKD and are on meds and subQ too. Our fifth fur baby, Oscar, is hyperthyroid and doing well on his thyroid meds.

I know 300 units is too much fluid for her but the only other option is to let her be dehydrated and miserable. I suspect her kidneys are just shot but she does not have symptoms of kidney disease. The vet says they are very small. I realize that we are just buying time and would not put her through and heroic tests or treatments at her age. It is just that she is still so happy and healthy except for the DM, dehydration and weight loss. She is still bright eyed and more active and alert than any of our other cats. We just do not want to give up because of her age if there is more that we can do.

The Addison's seems to be her only hope since Fludrocortisone helped for a while. I have tried to read about the treatment for cats with Addison's and all I get is that it is rare and as far as I can find there has only been one other cat in the world diagnosed with both DM and Addison's and no information about that at all. Her Ph and K are both high but close to normal and the ratio is only pushing a little out of range. The I thought steroids were an absolute no for cats with DM but will aske the vet about prednisolone or more meds. I listed her blood work from March but it got deleted. We will wait for the new tests. T4 was 1.3 and no ketones.
Click to expand...

I hope this is not the case but (again noting I AM NOT A VET, my patients walk upright) but Lulu’s vet may want to consider doing an abdominal ultrasound to look at her adrenal glands. I am assuming Lulu no longer has ovaries.

Addison’s can occur if the pituitary gland is damaged so not stimulating the adrenals. Or it can occur with direct damage to the adrenals (auto immune, infection, trauma, etc). It’s hard for me to put these puzzle pieces together (high progesterone, low aldosterone, low-ish cortisol) with a single cause although they may be inter related. For example an adrenal tumor producing progesterone while damaging other parts of the gland that should be producing cortisol and aldosterone. But this is just speculation on my part—I don’t usually treat endocrine diseases

Adrenal tumors are said to be rare, and those that produce produce progesterone even more rare, but imho (and also not a vet) I suspect they aren’t often found because cats have tiny adrenals and many may have other health issues occur first. You do an amazing job raising so many super-seniors.

in the species I treat Addison’s can cause fluid and electrolyte imbalances outside the range we see in healthy or somewhat healthy patients so I can’t comment on what fluids are right and bow to your judgment and that of your vet.

I think steroids can worsen DM so balancing may be a challenge if she needs them, and maybe it’s why her vet didn’t prescribe them, but what you describe to me (just an MD) sounds like she’s not producing glucose when she eats. Diabetic cats who need steroids for other conditions I think get steroids and then deal with the raised BG levels, but it sounds like Lulu is having more problems with low blood sugar right now

I again hope NOT a tumor. If it is, i hope treating the results (Addisons) lets her continue her joy filled life with you.

edit: I reread and noticed she is really stressed at vet. So im not sure of the value of the ultrasound vs the risk involved in stressing a super senior cat with possible Addisons, especially since at her age I’m sure you wouldn’t do surgery. For similar but opposite reasons (my boys tumor produces too much of the hormones your girl lacks) I weigh every test/visit against “will this upset his adrenals”
 
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I would love to hear from someone with a DM Addison's cat if April ( @@manxcat419 ) does have one. My vet is cautiously taking a shot in the dark and I feel he might be too cautious. My layman's knowledge of salt and hydration make me think she needs more treatment for the Ph\K ratio. It may be futile or even counter productive with her DM but I wish I knew more.
 
.
She was spayed along with all 4 of her kittens.
We would not consider invasive tests or surgery because of her age and disposition

I am just curious if Addison's caused the low glucose events that began suddenly in January. If so, it seems we could try a more aggressive, if possibly dangerous, use of Prednisolone and/or an increase in Fludrocortisone?? I'm not asking your advice just if I am way off base to talk to the vet about it.

I worry about her increasing need for fluids as much as the weight loss. They both scream Addison's to me. Addison's is considered rare in cats but the symptoms can be vague and it is rarely looked for so it would it not be found. The test we had done is new and while suggestive, is still inconclusive and treatment is somewhat contraindicated. I am glad our vet was willing to give it a try.

I appreciate your information on your Addison's specie's knowledge. Do Lulu's tests give you any hints about how "Addison’s can cause fluid and electrolyte imbalances outside the range we see in healthy or somewhat healthy patients".

I have been thinking like you say here, "I think steroids can worsen DM so balancing may be a challenge if she needs them, and maybe it’s why her vet didn’t prescribe them, but what you describe to me (just an MD) sounds like she’s not producing glucose when she eats. Diabetic cats who need steroids for other conditions I think get steroids and then deal with the raised BG levels, but it sounds like Lulu is having more problems with low blood sugar right now".

I wonder what to do. I would rather deal with her back on 4 units if she could gain weight and maintain fluids. It sounds like she is not producing glucose or not utilizing it when she eats...her PSBG can drop 200 to 250 points in 8 hours on one unit now, she eats voraciously and is still losing weight. I keep telling her to use the insulin and food to "make more kitty cat" but she keeps wasting away. I don't know where glucose goes...or the fluid. It all seems to go straight through her without processing. But she does get some energy, she can still jump onto my lap and the bed (with steps) albeit with more difficulty, she can chase treats and check the food bowls when anyone goes near the kitchen. She is the most active cat in the household, which isn't saying a lot because the others are sleeping most of the time. It is a full house of geriatrics, cats and people. I do not like her being so hungry all of the time in spite of eating all of the time. I must admit she is getting finicky about her food and take some blame here for giving her treats too often but we try to do high proteins, low carb treats. I just can't stand to see her so hungry.

Hopefully the blood tests on Friday will give us some ideas but we will not get the results back until next week. Thank you for sharing your expertise even if it is with a different species.
 
Lulu's person said:
.
She was spayed along with all 4 of her kittens.
We would not consider invasive tests or surgery because of her age and disposition

I am just curious if Addison's caused the low glucose events that began suddenly in January. If so, it seems we could try a more aggressive, if possibly dangerous, use of Prednisolone and/or an increase in Fludrocortisone?? I'm not asking your advice just if I am way off base to talk to the vet about it.

I worry about her increasing need for fluids as much as the weight loss. They both scream Addison's to me. Addison's is considered rare in cats but the symptoms can be vague and it is rarely looked for so it would it not be found. The test we had done is new and while suggestive, is still inconclusive and treatment is somewhat contraindicated. I am glad our vet was willing to give it a try.

I appreciate your information on your Addison's specie's knowledge. Do Lulu's tests give you any hints about how "Addison’s can cause fluid and electrolyte imbalances outside the range we see in healthy or somewhat healthy patients".

I have been thinking like you say here, "I think steroids can worsen DM so balancing may be a challenge if she needs them, and maybe it’s why her vet didn’t prescribe them, but what you describe to me (just an MD) sounds like she’s not producing glucose when she eats. Diabetic cats who need steroids for other conditions I think get steroids and then deal with the raised BG levels, but it sounds like Lulu is having more problems with low blood sugar right now".

I wonder what to do. I would rather deal with her back on 4 units if she could gain weight and maintain fluids. It sounds like she is not producing glucose or not utilizing it when she eats...her PSBG can drop 200 to 250 points in 8 hours on one unit now, she eats voraciously and is still losing weight. I keep telling her to use the insulin and food to "make more kitty cat" but she keeps wasting away. I don't know where glucose goes...or the fluid. It all seems to go straight through her without processing. But she does get some energy, she can still jump onto my lap and the bed (with steps) albeit with more difficulty, she can chase treats and check the food bowls when anyone goes near the kitchen. She is the most active cat in the household, which isn't saying a lot because the others are sleeping most of the time. It is a full house of geriatrics, cats and people. I do not like her being so hungry all of the time in spite of eating all of the time. I must admit she is getting finicky about her food and take some blame here for giving her treats too often but we try to do high proteins, low carb treats. I just can't stand to see her so hungry.

Hopefully the blood tests on Friday will give us some ideas but we will not get the results back until next week. Thank you for sharing your expertise even if it is with a different species.
Click to expand...

as I said I’m neither a vet nor have I ever treated Addison’s in a human. About one percent of type I diabetic humans also have Addisons and the theory is both were caused by an autoimmune process (making antibodies against your own pancreas and adrenal gland—and also probably not what’s causing Lulu’s potentially having both but I include it to make clear). This is a rare condition in humans but I believe they treat the Addisons (pred and mineralcorticoid) then deal with the problems that ripples into the DM. Because the addisons is the more immediate and pressing problem. Human diabetics with Addisons go downhill without adequate control of the addisons. It has syndrome name, I’ll look it up later

If Lulu isn’t making cortisol then she can’t get the glucose she needs out of eating. . It’s similar to plain diabetic cats who are hungry and losing weight despite scary high blood sugars: the body isn’t getting the sugar where it needs to go for the diabetic, it can’t make the sugar (or even attack its liver for sugar) in Addison.

I can’t advise you on what is right but it seems she’s not improving in her current course so it may be time to at least consider a need for pred and if indicated more mineralcorticoid—I don’t know the dosing and can’t even pretend what she requires. Ditto for fluids.

I know he’s (she’s?)..the vet..is guessing at Addisons because no clear results. So I get going slow. I do think the high progesterone needs explaining and to me (a simple country doc) I’d have adrenal tumor at the top of my differential.

The treatment for adrenal tumors is surgery. Based on Methos’ age I asked for an alternative so we’re treating the Conns and Cushing’s it causes, and now also the DM the Conns and Cushing’s causes.

Methos’ dex test was borderline the first time. Later it wasn’t. It doesn’t sound to me like there can be a ton of waiting to try again with Lulu. I regret the time lost between Methos’ two tests but he wasn’t losing weight like lulu is.

I’d say when you see the vet ask him the risks vs benefits of trying to fully treat lulu as an Addison’s cat, esp since you can monitor her glucose and give insulin as needed. Best of luck,
Colleen
Who’s had two totally unrelated cats out of five have hormone producing adrenal tumors
 
Schmidt’s syndrome is when humans have addisons and either dm type I or autoimmune thyroid disease (hasimoto’s). This link is a (somewhat recent) anecdotal report on a teenager with diabetes diagnosed with Addison’s after hypoglycemic episodes. They treated her with fludrocortisone (mineral cortisone) AND hydroxycortisone (glucocorticoid like prednisolone) and she stabilized although her insulin requirement doubled.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391923/
 
Also and most importantly, (sorry but I’ve been a bit sleep deprived so not at my best): what do you mean you almost lost lulu at the last vet visit?

if you mean she literally almost died or needed serious resuscitative efforts, I’m concerned about her Friday visit and you may want to discuss with your vet the game plan. If she truly has Addison’s but isn’t on glucocorticoids then stress even emotional stress can trigger a life threatening addisonian crisis (in the species I treat).

if a human has Addisons and undergoes stress their adrenals can’t produce cortisol. Their sugar plummets, which is deadly, their potassium soars, which is deadly, their blood pressure drops precipitously, which is deadly, their sodium drops, you get the picture.

I really hate to be painting such a distressing picture and if she has Addisons hopefully just treating it without running down why will be enough. But I am
Concerned about the “almost lost her” which, if she actually has Addisons, might not be hyperbole.

edit: while I haven’t treated Addison’s i have treated addisonian crisis. This is something to be avoided.
 
So this is probably irrelevant, but I recall a discussion about subQ fluids and whether they were recommended in certain circumstances, as well as the supplements HydraCare and PorusOne supplements to help hydration. The comment was about subQ fluids and the potential for “having a negative effect on the renin angiotensin aldosterone system.” I had an ancient (20ish year old) hyperT kitty at the time who was chronically and excessively dehydrated despite subQ fluids (there were other issues at play as well), and it was the first I’d heard that subQ might not be advised. It was an interesting read.

Here’s the thread in case you want to read the corresponding story and journal links.

https://felinediabetes.com/FDMB/threads/question-about-purina-hydracare.284848
 
By discuss with your vet I mean talk to them Thur on the phone to consider the risks of stressing lulu with her visit to them Friday when she may have Addisons and is not on a glucocorticoid. You and he may want to evaluate the pros and cons of whatever testing is planned va risk if she does have untreated addisons, whether or not they want to just do a trial of treating her as such based on borderline tests previously and her symptoms, (and by treating I mean glucocorticoids and mineral orticoids in the appropriate dose), or if deciding to go ahead with testing do they have on hand what’s needed to treat addisonian crisis (if cats get that which I have to assume they do)
 
JL and Chip said:
So just to double check… her stools are normal color/consistwncy, correct?
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Stools are small and hard I when I see them. No diarrhea. It is hard to tell with 5 cats. She does throw up a small amount of clear liquid occasionally. usually just before feeding and insulin time.
 
SmallestSparrow said:
Also and most importantly, (sorry but I’ve been a bit sleep deprived so not at my best): what do you mean you almost lost lulu at the last vet visit?

if you mean she literally almost died or needed serious resuscitative efforts, I’m concerned about her Friday visit and you may want to discuss with your vet the game plan. If she truly has Addison’s but isn’t on glucocorticoids then stress even emotional stress can trigger a life threatening addisonian crisis (in the species I treat).

if a human has Addisons and undergoes stress their adrenals can’t produce cortisol. Their sugar plummets, which is deadly, their potassium soars, which is deadly, their blood pressure drops precipitously, which is deadly, their sodium drops, you get the picture.

I really hate to be painting such a distressing picture and if she has Addison's hopefully just treating it without running down why will be enough. But I am
Concerned about the “almost lost her” which, if she actually has Addison's, might not be hyperbole.

edit: while I haven’t treated Addison’s i have treated Addisonian crisis. This is something to be avoided.
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I mean she was in such bad overall condition I thought it might be time to help her go if nothing else could be done for her. She did not have any severe reaction or Addison's crisis. I have read about that and it sounds terrible. I don't think she would survive that. She has always been very stressed at the vet. He suspects that it effects her bloodwork and other tests. Our vet has agreed that when the time comes to help her go he will come to the house to do it so she is not stressed at the end.
 
JL and Chip said:
So this is probably irrelevant, but I recall a discussion about subQ fluids and whether they were recommended in certain circumstances, as well as the supplements HydraCare and PorusOne supplements to help hydration. The comment was about subQ fluids and the potential for “having a negative effect on the renin angiotensin aldosterone system.” I had an ancient (20ish year old) hyperT kitty at the time who was chronically and excessively dehydrated despite subQ fluids (there were other issues at play as well), and it was the first I’d heard that subQ might not be advised. It was an interesting read.

Here’s the thread in case you want to read the corresponding story and journal links.

https://felinediabetes.com/FDMB/threads/question-about-purina-hydracare.284848
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Thank you. I printed the article to read later. I'm sure it will help us since we have 3 cats on SubQ now. It would be wonderful if this would work. It seems like the more subQ fluid she gets, the more she needs. That is not the case with my two CKD kitties.
 
SmallestSparrow said:
By discuss with your vet I mean talk to them Thur on the phone to consider the risks of stressing lulu with her visit to them Friday when she may have Addisons and is not on a glucocorticoid. You and he may want to evaluate the pros and cons of whatever testing is planned va risk if she does have untreated addisons, whether or not they want to just do a trial of treating her as such based on borderline tests previously and her symptoms, (and by treating I mean glucocorticoids and mineral orticoids in the appropriate dose), or if deciding to go ahead with testing do they have on hand what’s needed to treat addisonian crisis (if cats get that which I have to assume they do)
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Thank you. I will not do any more than a full blood panel this time. The Adrenal test was too hard on her and I think the Ph/K ratio and other results will be enough to decide to try more steroids. My vet is very cautious about steroids but she is in a position where quality of life is more important than longevity. I think based on my reading that the dehydration might be helped by more steroids. If we can SLGS with more steroids I think it is worth a try. I hope the vet is willing to risk it.
 
Hi @Lulu's person!

SmallestSparrow said:
You may also want to try a PM or DM or whatever this board calls the private conversations with @manxcat419 because on a different thread she mentioned she doesn’t get always get notified if tagged.
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That is exactly what happened - but I did get notified of the PM. Obviously answering in the thread because the board rules don't allow medical advice to be given privately. Thank you for the suggestion.

I do indeed have a cat with both Addison's and DM. Her Addison's is the result of an adrenalectomy for a tumor that was causing Cushing's - her surgery was about 6 years ago now. Her remaining adrenal never recovered sufficient function so she is now reliant on steroids. She did, in fact, have an Addison's crisis which I attribute to the first IM who she saw and who was managing her case pre- and post-surgery. He had seen the warning signs on her weekly blood work, but instead of starting treatment he chose to give it "one more week". When she went into crisis, he then refused to approve starting treatment until he had personally examined her, leaving her hospitalized for 5 days on fluid therapy only and quite obviously actively dying due to lack of any real treatment. We pulled her from there and took her to another ER half a mile away where they saved her life.

According to Roxi's second IM, this combination should not really be possible in cats. His feeling was that because she had already been a long-term diabetic, there was just too much underlying destruction of beta cells in her pancreas for it ever to recover insulin production. With that said, I have not seen the kind of breakdown on an ACTH stim result that you have there so I have no idea if there is high progesterone in her results. According to the information on the results you have, high progesterone could be the cause of raised glucose levels which may not actually be true diabetes. That might at least partially explain the difficulty in finding a dose that adequately manages her glucose at all times.

Roxi started her Addison's journey on both prednisolone and Desoxycorticosterone pivalate (commonly known as DOCP and sold under the brand names of Zycortal and Percorten-V). DOCP is generally preferred over fludrocortisone for dogs and cats and is administered by a sub-q injection every 25-35 days (depending on the pet's individual response). For her, we were gradually able to wean her off the prednisolone - again, her IM specialist was not fully able to explain why she was OK off that one because most cats do need both and atypical Addison's (the condition that only requires one steroid) needs prednisolone but not DOCP. We do keep a small amount of pred on hand for stressful events as we were told she would likely need it if she was under stress. Fortunately, because I work in a clinic, she doesn't suffer huge amounts of stress when she comes to work with me for blood work etc because she can see me the whole time and has got used to the idea that sometimes she will spend the day at work with me.

If Lulu was my cat, given how borderline her glucocorticoid level was post-ACTH and the fact that she was stressed at the time (and therefore likely producing to her maximum capacity), I would ask to try a low dose of pred. Because Addison's tends to cause dehydration due to blood work imbalances, especially in electrolytes, this may be enough to at least partially resolve the dehydration and reduce the amount of fluids you need to give. I would also ask about switching the fludrocortisone for DOCP - it's easier to administer and works better in cats. Fludrocortisone doesn't control sodium levels well in cats, and often leaves the sodium level low compared to DOCP which could very easily be a major cause of her dehydration.

If you have other questions that I haven't answered here, please let me know - when I reply once to a thread, I do then start getting notifications. I had to learn most of what I know as we went along given how rare Addison's is in cats - if what I learned the hard way can be helpful to you, I'm more than happy to share information.
 
Sweet Lulu growled and hissed at the vet and her good friend, the vet tech/cat-sitter, but they got her blood drawn. He prescribed 0.5 mg Prednisolone which is such a small dose it has to be done at the compounding RX so we will not get it until Wednesday. He is very cautious but will also consider increasing Fludrocortisone after we see the results of the Prednisolone. She hit her all time low on weight today at 4 lb. 15 oz. after breakfast and before fluids. We tried reducing fluids yesterday so I guess that did not work. Vet verified dehydration 2 hours after we administered fluid this morning. So we will experiment some more on keeping her well hydrated without overhydrating her. We got syringes to try for SubQ for her instead of the bag because it is faster and we hope less stressful for her. She has plenty of loose skin to take it fast. We only learned about that method at the ER with Cali a couple of weeks ago. I hope it is easier for her. Most of our other older cats have gotten used to SubQs and even purred knowing they would feel better afterwards. Vet tech said it might be harder for us doing the syringe but I don't see how anything could be harder than hearing her extreme distress and vocal objections, it sounds like cat murder and she never even growled or hissed before. I know there is very little or no pain for her in administering the SubQ but she hates to be "held against her will". I know it is not uncommon cat behavior but she and both of her kittens are extremely independent and fanatical about being sure they are not ever being "held against their will" more so than any other cats we ever had (and we have had a lot of sweet cats, or rather, they had us. We do not own cats, we are their servants, thus my name, "Lulu's person". It has always been funny with these girls when they are snuggling then test to be sure they can leave then don't go. Love cats, they are all such unique individuals!! Your advice and knowledge was very helpful in relaying our concerns to the vet today. Thank you all so very much. We will have to wait to see how she does with the changes.
 
manxcat419 said:
Hi @Lulu's person!


That is exactly what happened - but I did get notified of the PM. Obviously answering in the thread because the board rules don't allow medical advice to be given privately. Thank you for the suggestion.

I do indeed have a cat with both Addison's and DM. Her Addison's is the result of an adrenalectomy for a tumor that was causing Cushing's - her surgery was about 6 years ago now. Her remaining adrenal never recovered sufficient function so she is now reliant on steroids. She did, in fact, have an Addison's crisis which I attribute to the first IM who she saw and who was managing her case pre- and post-surgery. He had seen the warning signs on her weekly blood work, but instead of starting treatment he chose to give it "one more week". When she went into crisis, he then refused to approve starting treatment until he had personally examined her, leaving her hospitalized for 5 days on fluid therapy only and quite obviously actively dying due to lack of any real treatment. We pulled her from there and took her to another ER half a mile away where they saved her life.

According to Roxi's second IM, this combination should not really be possible in cats. His feeling was that because she had already been a long-term diabetic, there was just too much underlying destruction of beta cells in her pancreas for it ever to recover insulin production. With that said, I have not seen the kind of breakdown on an ACTH stim result that you have there so I have no idea if there is high progesterone in her results. According to the information on the results you have, high progesterone could be the cause of raised glucose levels which may not actually be true diabetes. That might at least partially explain the difficulty in finding a dose that adequately manages her glucose at all times.

Roxi started her Addison's journey on both prednisolone and Desoxycorticosterone pivalate (commonly known as DOCP and sold under the brand names of Zycortal and Percorten-V). DOCP is generally preferred over fludrocortisone for dogs and cats and is administered by a sub-q injection every 25-35 days (depending on the pet's individual response). For her, we were gradually able to wean her off the prednisolone - again, her IM specialist was not fully able to explain why she was OK off that one because most cats do need both and atypical Addison's (the condition that only requires one steroid) needs prednisolone but not DOCP. We do keep a small amount of pred on hand for stressful events as we were told she would likely need it if she was under stress. Fortunately, because I work in a clinic, she doesn't suffer huge amounts of stress when she comes to work with me for blood work etc because she can see me the whole time and has got used to the idea that sometimes she will spend the day at work with me.

If Lulu was my cat, given how borderline her glucocorticoid level was post-ACTH and the fact that she was stressed at the time (and therefore likely producing to her maximum capacity), I would ask to try a low dose of pred. Because Addison's tends to cause dehydration due to blood work imbalances, especially in electrolytes, this may be enough to at least partially resolve the dehydration and reduce the amount of fluids you need to give. I would also ask about switching the fludrocortisone for DOCP - it's easier to administer and works better in cats. Fludrocortisone doesn't control sodium levels well in cats, and often leaves the sodium level low compared to DOCP which could very easily be a major cause of her dehydration.

If you have other questions that I haven't answered here, please let me know - when I reply once to a thread, I do then start getting notifications. I had to learn most of what I know as we went along given how rare Addison's is in cats - if what I learned the hard way can be helpful to you, I'm more than happy to share information.
Click to expand...

I wonder, and this is just speculation to occupy my mind so I’m not focused on two cats with pancreatitis on my sofa, if at some point Roxi’s remaining adrenal gland woke up enough/bulked up enough to handle day to day steroid needs but needed a hand for the more extreme times, explaining the ability to ween her off prednisone (with some on hand for when needed).

I don’t know the major type of Addisons seen in cats—in humans it’s often a cause that will take out both adrenals before it’s discovered (for example infections or autoimmune). Adrenal tumors in cats are said to be rare, so vets probably don’t see many cats with only one gland. Perhaps for this reason they don’t often see a cat that can manage day to day off pred. I’ll try to find human surgical cases to compare.

And since her DM makes her a bit insulin resistant but the Addisons tips her to insulin sensitive maybe there’s a sweet spot she found. It’s interesting and fortuitous.

edit: in the species that walks upright (in order to serve cats), if the single gland removed was not making excess hormones then the other takes over right away. If it was making excess hormones the remaining gland is inoperative post surgery and steroids are required (but in rare cases may not be needed permanently)
 
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Lulu's person said:
Thank you. I will not do any more than a full blood panel this time. The Adrenal test was too hard on her and I think the Ph/K ratio and other results will be enough to decide to try more steroids. My vet is very cautious about steroids but she is in a position where quality of life is more important than longevity. I think based on my reading that the dehydration might be helped by more steroids. If we can SLGS with more steroids I think it is worth a try. I hope the vet is willing to risk it.
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I’m sorry I didn’t see this…usually I get a notice about replies but not this time and was at the vet yesterday. I’m glad he’s going to try the pred and possibly increase the mineralcorticoid. I hope it helps and I hope you can get it soon enough.
 
Lulu's person said:
Sweet Lulu growled and hissed at the vet and her good friend, the vet tech/cat-sitter, but they got her blood drawn. He prescribed 0.5 mg Prednisolone which is such a small dose it has to be done at the compounding RX so we will not get it until Wednesday. He is very cautious but will also consider increasing Fludrocortisone after we see the results of the Prednisolone. She hit her all time low on weight today at 4 lb. 15 oz. after breakfast and before fluids. We tried reducing fluids yesterday so I guess that did not work. Vet verified dehydration 2 hours after we administered fluid this morning. So we will experiment some more on keeping her well hydrated without overhydrating her. We got syringes to try for SubQ for her instead of the bag because it is faster and we hope less stressful for her. She has plenty of loose skin to take it fast. We only learned about that method at the ER with Cali a couple of weeks ago. I hope it is easier for her. Most of our other older cats have gotten used to SubQs and even purred knowing they would feel better afterwards. Vet tech said it might be harder for us doing the syringe but I don't see how anything could be harder than hearing her extreme distress and vocal objections, it sounds like cat murder and she never even growled or hissed before. I know there is very little or no pain for her in administering the SubQ but she hates to be "held against her will". I know it is not uncommon cat behavior but she and both of her kittens are extremely independent and fanatical about being sure they are not ever being "held against their will" more so than any other cats we ever had (and we have had a lot of sweet cats, or rather, they had us. We do not own cats, we are their servants, thus my name, "Lulu's person". It has always been funny with these girls when they are snuggling then test to be sure they can leave then don't go. Love cats, they are all such unique individuals!! Your advice and knowledge was very helpful in relaying our concerns to the vet today. Thank you all so very much. We will have to wait to see how she does with the changes.
Click to expand...
Knocking on wood:
I’ve never given fluids but since Lulu enjoys eating is it something you can do with her on a sofa with a bowl of treats to keep her anchored in place as opposed to held down?
 
Also in poor Lulu’s defense, her adrenal gland appears to be producing excess progesterone pre-stim and excess androstenedione post stim. Since she doesn’t have ovaries these are coming from her adrenals.

So if she’s not generally been this difficult at the vet before maybe it’s the hormones essentially giving her “roid rage” that’s talked about with body builders. I don’t know if that happens in cats, or at what levels,’other than an article I read about adrenal tumors found in three cats whose presenting problem was aggression. I do know excess cortisol (not lulu’s case) in humans can cause irritability and anger, and Methos went from a cat that loved everyone and slept through a vet visit to a snarling guy whose chart is covered in CAUTION labels. In fact, the last visit before his diagnosis I was shocked because he hissed at the vet he adores. I told her “see, I know there’s something wrong with him we haven’t found yet, he never hisses”. Anyway I give him grace for his mood and I hope Lulu improves.
 
Great news on the syringe fluids! She was great except a little meow with the initial needle stick, calm and cool and quiet and happy throughout. It was much faster and she hardly knew it was happening. So I hope her SubQ woes are over. We just need to fine tune the amount she needs.

I asked the vet about the progesterone, I don't know anything about androstenedione???? I think he didn't know anything about the progesterone and was not very concerned. To be fair, I may have overloaded him with questions by then and I had gotten some action on the Prednisone and a possible increase in the Fludrocortisone. We opted out of the DOCP because it is not available in pill form to use at home. I said all I know is that progesterone caused PMS for me. That could be called "roid rage" LOL I also know that cortisol is a stress hormone and can a Cortisol test can help diagnose depression caused by too much of it. I am sorry Methos has gotten grumpy, it is a sign of underlying issues in most case human or feline. I wish vets knew more about these issues and hopefully they will in the future. Cats have been ignored in this respect for too long with the excuse that it is rare so we don't even need to test...thus too many pets presenting with
 
I also agree with the ultrasound but to check for IBD. My cat Simon was losing weight a couple years ago. All of his bloodwork was normal. My vet referred us to an internal med vet. They did an ultrasound and also a test to see how well he was absorbing nutrients from his food. That turned out to be the issue. We originally started on a prescription hydrolyzed food and it worked. However I eventually switched to a homemade diet using a recipe from a FB group for IBD cats. He has been on that diet for over 2 years and is doing great. Even though he is not diabetic, the recipe is low carb and works for diabetic cats.
 
SmallestSparrow said:
I wonder, and this is just speculation to occupy my mind so I’m not focused on two cats with pancreatitis on my sofa, if at some point Roxi’s remaining adrenal gland woke up enough/bulked up enough to handle day to day steroid needs but needed a hand for the more extreme times, explaining the ability to ween her off prednisone (with some on hand for when needed).

I don’t know the major type of Addisons seen in cats—in humans it’s often a cause that will take out both adrenals before it’s discovered (for example infections or autoimmune). Adrenal tumors in cats are said to be rare, so vets probably don’t see many cats with only one gland. Perhaps for this reason they don’t often see a cat that can manage day to day off pred. I’ll try to find human surgical cases to compare.

And since her DM makes her a bit insulin resistant but the Addisons tips her to insulin sensitive maybe there’s a sweet spot she found. It’s interesting and fortuitous.

edit: in the species that walks upright (in order to serve cats), if the single gland removed was not making excess hormones then the other takes over right away. If it was making excess hormones the remaining gland is inoperative post surgery and steroids are required (but in rare cases may not be needed permanently)
Click to expand...

Well - she is a cat, so anything is possible. But what's weird is that she was only ever on a tiny, tiny dose of pred...and only for a couple of weeks. The dose was so small right from the start that they weren't even sure it was doing anything. So it's possible that she really never did need it...which would be very unusual according to everyone I've talked to about it. But again - since cats are masters of the weird and unexpected, anything is possible. At this point, I just try to take Roxi at face value. None of the problems she's had, and none of her reactions to them, are normal. She's just her own little weird self! If you do find any comparable human studies, I'd still be interested to read about them though.
 
SmallestSparrow said:
Also @manxcat419 im so sorry they missed Roxi’s crisis—how scary that must have been and I’m glad you got her to appropriate care.
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At the time, I remember being more angry than scared if I'm honest. I could see the problem, but for some reason the ER vets either couldn't see it or refused to see it. I yelled at one of them on the phone, then drove straight down there and broke her out AMA. On the way there, I'd called the other ER, explained the situation and got their buy in on taking a chance on starting meds. We'd just put her through a $12000 surgery - there was no way I was going to watch them sit on their hands while she died right in front of them.
 
SmallestSparrow said:
So if she’s not generally been this difficult at the vet before maybe it’s the hormones essentially giving her “roid rage” that’s talked about with body builders. I don’t know if that happens in cats, or at what levels,’other than an article I read about adrenal tumors found in three cats whose presenting problem was aggression. I do know excess cortisol (not lulu’s case) in humans can cause irritability and anger, and Methos went from a cat that loved everyone and slept through a vet visit to a snarling guy whose chart is covered in CAUTION labels. In fact, the last visit before his diagnosis I was shocked because he hissed at the vet he adores. I told her “see, I know there’s something wrong with him we haven’t found yet, he never hisses”. Anyway I give him grace for his mood and I hope Lulu improves.
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I think that's almost certainly the case. Roxi was, frankly, terrifying while she was in the grip of Cushing's. She was a cat who would quite deliberately run after people to attack them. And that was with people she knew. She was an unholy terror, but it really wasn't her fault. She still has what we fondly term "kitty minutes", meaning that time to get anything done with her before she starts lashing out is limited, but that's really quite normal with any cat.
 
manxcat419 said:
I think that's almost certainly the case. Roxi was, frankly, terrifying while she was in the grip of Cushing's. She was a cat who would quite deliberately run after people to attack them. And that was with people she knew. She was an unholy terror, but it really wasn't her fault. She still has what we fondly term "kitty minutes", meaning that time to get anything done with her before she starts lashing out is limited, but that's really quite normal with any cat.
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I will grant the ER found his tumor (somewhat accidentally) so I’m grateful to them. But…I took him bc he’d stopped eating. While normally thin and muscular he’d put on a lot of weight so I was terrified he’d destroy his liver. They admitted him and said if he didn’t eat they’d put a tube down. I got a hotel room down the road. I went constantly to ask how he was doing. They always had an excuse why they hadn’t yet started feeding him. I was in tears as I pleaded with the night vet to please start feeding my tubby cat who’d not eaten in going on four days. They finally let me go back to see him to try to get him to eat. My heart broke when I saw his entire cage covered with a 2x3’ bright pink caution sign.
For his ACTH stim tests it takes a village: our wonderful vet to oversee and calculate doses, his favorite two techs, one to massage him (and stealthily hold him), the other (best at blood draws), and me holding chicken breast in front of his nose. And him on gabapentin. He’s a huge boy with big polydactyl paws and the first time we used this system he wasn’t as groggy. So he reached both paws up to bring my hand closer. His paws cover half of my hand (I have small hands) —everyone else in the room gasped but he never lets his claws out with me. Next time we doubled his gabapentin.
 
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