Decreased appetite

Hi all, some 5 weeks into the world of cat diabetes and since I live in the UK only in the last few days persuaded vet to change my kitty to prozinc insulin.

Kiska is 12 and has diabetes, suspected related to long term steroid use for allergies. She’s had a time of it on the Caninsulin with significantly upset tummy and diarrhoea on and off for a week or two.

We starts the Prozinc 5 days ago, we are only 2 units currently twice a days which is too low judging from readings but vet said wait a week so that’s what we are doing. Readings 8 hours plus after feeding ranging from 15mmol to 26mmol at the worst one just before feeding and insulin.

My problem is she’s got a severely decreased appetite. She’s on raw meat diet and recommendation is 120-150g per day for her weight 4.75kg. She’s currently eating about half that with encouragement. Doesn’t seem at all lethargic, poop finally normal and generally feels like she’s improving otherwise.

Is this being off food normal with the change to prozinc insulin and does anyone know what the issue might be? It’s clearly not hypo issue which is all I’m finding on Google searches.

Any advice happily received! And thanks for reading.

Rachel

Hello and welcome! I am sorry you have been having such a difficult time with your sweet Kiska. I don’t usually hear our members say that their cats who have transitioned to ProZinc have a decreased appetite — unless there were other issues. In fact, with the numbers you have mentioned (270 to 468) she should be quite hungry. Have you had bloodwork done recently that you can share? I am sure you had some done at diagnosis. Is Kiska still taking a steroid? My cat who has significant skin allergies does very well on Atopica (cyclosporine) which is not a steroid and won’t raise BG (blood glucose.)

I am glad you convinced your vet to switch to ProZinc. Caninsulin is not a good insulin for cats and it drops their BG hard and fast and doesn’t last long before it starts to rise again.

With ProZinc, you will not need to feed and wait 30 minutes before shooting the insulin. Unlike Caninsulin, ProZinc typically onsets at about +2 (two hours post shot) so you have plenty of time. As a result, with ProZinc you can test the BG, feed kitty, and shoot the insulin all within a few minutes. You can even give the insulin while she’s eating if that works for her. Even if she doesn’t eat a large amount at breakfast, you have about two hours to get more food into her before onset. I usually recommend that my ProZinc kitties get their first snack at +2 and a second snack at +4. This helps prevent steep drops and generally smooths the cycle. You don’t want steep drops of over 100 points (5.5) in an hour if you can help it because that potentially sets her up for a bounce where she will have high BG for several cycles afterwards.

You will find that her nadir (lowest BG in the cycle) will be around +6, so you probably should try testing BG at that time. It’s not unusual for new ProZinc users to have an early nadir at around +4 so you should try and vary your testing times and record them.

I am glad that your vet said to hold the dose for a week. That is what we would also recommend. It’s best to take it slowly. If you record nadirs in the 200s, I would recommend an increase of .25 units. If nadirs are in the 300s then I would recommend a .5 unit increase. You already have mentioned what we would call a yellow nadir (from the spreadsheet color of numbers in the 200s) so you should increase only by .25 units to be safe and to more gradually accustom her to lower numbers. Also, if I am understanding correctly, the 270 (15) was a reading taken at +8 so it’s quite likely she was lower than that earlier in the cycle. Moving too quickly often results in a lot of BG swings. Many vets recommend increasing only by whole units and that can be too much.

I would be happy to help you if you need it.

She is beautiful

Hi! Thankyou for the advice, some really useful information for new user.

Spoke to the vet and they’ve raised her dose to 2.5 units twice per day.

She didn’t eat last night (only a few biscuit treats (high protein ones)) but gave her prozinc dose anyway as blood reading was 410.

This morning her blood was 30.3 (545) and she wouldn’t eat. I’ve given her the prozinc dose anyway on the basis her insulin levels are so high. Tried to feed 2 hours post and she’s not interested still.

A bit frustrating as on caninsulin she was I think under control at highest she had at 2 units was 270 to 370, I know changing prozinc is probably in her best interests but it’s frustrating to see her blood sugars sky high and her not wanting to eat. I know it’s early days with dose change and she’s only been on Prozinc just over a week. It’s probably not helping the nerve damage in her front leg too.

Advice happily received, just frustrated worried kitty mom.

Update she finally ate breakfast 2.5 hours after her injection.

I’m glad she finally ate something. Are you testing her for ketones? I worry about her having a DKA with this lack of appetite and the higher numbers.

Rachels Kiska said:

. It’s probably not helping the nerve damage in her front leg too.

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What nerve damage in her front leg? When/how did this happen?

Last ketone check was a few days ago on Mon and zero ketones, will try and catch pee sample.
Last glucose check a few minutes ago was 313 which is at least a step in the right direction!

The nerve damage we think was brought on by undiagnosed diabetes and steroid long term use for allergies, back legs were wobbly and front right lost a lot of use of, has been slowly recovering. Blood test some 6 months before diagnosis showed no real signs of diabetes.

Hi,

Just an update, happily pee tests come back negative for ketones.

I think it’s the high blood glucose putting her off eating,

Hi,

Just an update, happily pee tests come back negative for ketones last night although very high for glucose.

I thought it was the high blood glucose putting her off eating, 475 just before dinner yesterday and she didn’t want to eat anything all night.
This morning 151, she would only eat treats (high protein cat meal biscuits) so I gave her extra and still gave her the insulin shot. I’m going to try and stuff more in her during the day. The food offered for breakfast was canned meat which is usually highly desirable treat but wouldn’t touch it.

I guess at some point the insulin levels will work and her glucose levels will stabilise and her appetite will improve.

Rachels Kiska said:

Last ketone check was a few days ago on Mon and zero ketones, will try and catch pee sample.
Last glucose check a few minutes ago was 313 which is at least a step in the right direction!

The nerve damage we think was brought on by undiagnosed diabetes and steroid long term use for allergies, back legs were wobbly and front right lost a lot of use of, has been slowly recovering. Blood test some 6 months before diagnosis showed no real signs of diabetes.

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For nerve damage, it’s important to give methylcobalamin. Are you familiar with that?

Rachels Kiska said:

Hi,

Just an update, happily pee tests come back negative for ketones last night although very high for glucose.

I thought it was the high blood glucose putting her off eating, 475 just before dinner yesterday and she didn’t want to eat anything all night.
This morning 151, she would only eat treats (high protein cat meal biscuits) so I gave her extra and still gave her the insulin shot. I’m going to try and stuff more in her during the day. The food offered for breakfast was canned meat which is usually highly desirable treat but wouldn’t touch it.

I guess at some point the insulin levels will work and her glucose levels will stabilise and her appetite will improve.

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Has she been seen by a vet recently and did they do bloodwork? I just don’t want anything to be missed that could put her in danger. I am very happy about the negative ketone tests. Well done!

Hi, yes in close contact with the vets and the blood work 5-6 weeks ago was what identified the diabetes. She’s had 4 doses of methylcobalamin and due the last this week.

I think I’m taking her back on the Caninsulin, the dose she was on was on consistently between 144 and 360 max. We’ve almost been on Prozinc for 2 weeks and her blood is all over the place and consistently very high except once where was about 110. It’s not consistent in any way. The 110 was when she hadn’t eaten any dinner and it was time for breakfast but two other morning under same conditions it’s 384 and 475. She’s not eating well and her back legs are getting shaky again and the improvement in her front paw is starting to get worse again with increased knuckling and constant holding up.

I just don’t think Prozinc is working for her at all.

Hi, yes in close contact with the vets and the blood work 5-6 weeks ago was what identified the diabetes. She’s had 4 doses of methylcobalamin and due the last this week.

I think I’m taking her back on the Caninsulin, the dose she was on was on consistently between 144 and 360 max. We’ve almost been on Prozinc for 2 weeks and her blood is all over the place and consistently very high except once where was about 110. It’s not consistent in any way. The 110 was when she hadn’t eaten any dinner and it was time for breakfast but two other morning under same conditions it’s 384 and 475. She’s not eating well and her back legs are getting shaky again and the improvement in her front paw is starting to get worse again with increased knuckling and constant holding up

I just don’t think Prozinc is working for her at all.

Rachels Kiska said:

Hi, yes in close contact with the vets and the blood work 5-6 weeks ago was what identified the diabetes. She’s had 4 doses of methylcobalamin and due the last this week.

I think I’m taking her back on the Caninsulin, the dose she was on was on consistently between 144 and 360 max. We’ve almost been on Prozinc for 2 weeks and her blood is all over the place and consistently very high except once where was about 110. It’s not consistent in any way. The 110 was when she hadn’t eaten any dinner and it was time for breakfast but two other morning under same conditions it’s 384 and 475. She’s not eating well and her back legs are getting shaky again and the improvement in her front paw is starting to get worse again with increased knuckling and constant holding up.

I just don’t think Prozinc is working for her at all.

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I would consider switching to a long acting insulin like Lantus (glargine) which would give her better control of BG. Even in the UK vets are allowed to prescribe this insulin if a pet specific medication is not working. At least that is what other members who are in the UK have told me. Going back to Caninsulin is taking a step backwards.

Many of our members use Zobaline with success for diabetic neuropathy. That is what I used. It is given daily.
Zobaline for Cats 3 mg x 60 tablets – LifeLink

Rachels Kiska said:

yes in close contact with the vets and the blood work 5-6 weeks ago was what identified the diabetes.

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I believe something else is going on besides just diabetes that the vets are not considering, not mentioning or are overlooking completely — that is why I asked. It’s not normal to have no appetite in the higher BG numbers. Most cats are ravenous in high numbers, as their bodies cannot make use of the calories they are taking in. Many of our members are alarmed when their cats start getting into normal BG numbers and they notice a decrease in appetite at that time. Of course, the cat doesn’t have to eat as much at that point because the calories taken in are able to be converted to energy.

I am just concerned. You have all my best wishes for your sweet Kiska.

Thankyou, vets referring her to a specialist, no news yet. Thanks for the advice.

please let me know how she is when you have news. I care.

Hi, sad news, i’m afraid.

Kiska has lymphoma cancer. This with her diabetes means we can’t use the steroids well to support the chemotherapy.

The prognosis is poor and the cost too high for us to proceed so we are going down the palliative care route and saying goodbye when the time is right. Thanks for trying to help. Xxx

Rachels Kiska said:

Hi, sad news, i’m afraid.

Kiska has lymphoma cancer. This with her diabetes means we can’t use the steroids well to support the chemotherapy.

The prognosis is poor and the cost too high for us to proceed so we are going down the palliative care route and saying goodbye when the time is right. Thanks for trying to help. Xxx

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I’m so sorry. What kind of lymphoma? Small cell lymphoma can be treated with prednisolone and chlorambucil. Many diabetic cats have other conditions that require steroids and the insulin dose must be adjusted to accommodate that. It doesn’t mean that the cat cannot take the steroid. I have worked with many cats who just need a larger dose of insulin because of prednisolone.

How was the lymphoma diagnosed? Biopsy? It can’t be definitively diagnosed without a biopsy. Did they do pathology? How about an endoscopic biopsy? Ultrasound can point to lymphoma due to intestinal thickening but it alone is not definitive.

Here is the spreadsheet of a cat that is on ProZinc. He takes a pretty high dose of steroid (prednisolone) 10 mg twice a day due to triaditis. He has a lot going on besides that, but he still gets fairly good numbers with ProZinc. Yes, it’s a higher dose than most cats due to the steroid, but he has a decent quality of life with the steroid and the higher insulin dose. I would not hesitate to give a cat a steroid and however much insulin was warranted if it was a QOL issue. The steroids can make them feel so much better. I have had two cats with small cell lymphoma who did very well on steroids and the chemo drug chlorambucil. I have also had several others who had inflammatory bowel disease whose life was so much better on prednisolone.

Anyway, I really feel for you. I have been managing several cats simultaneously with serious illnesses now for a long time. It’s very draining, but I love them so much. I have lost three cats in the last six months. Now I am down to one chronically ill cat who os doing okay so far. I have been down the road of small cell lymphoma several times though. If it happens to be large cell lymphoma, I have some valuable information I can share as well (studies I recently became aware of.).

Thanks for updating me. I really feel for your situation with sweet Kiska.

Here is Biddy’s spreadsheet

Biddy's SS