Advice? After 7 years the universe gave me another sugar cat.

[B. & Juniper "Babbu"]

Hi all.

After much, much less time than I anticipated before I might be back here, I have returned to the feline diabetes management trenches.

Here's Juniper! Born 5/2015

AKA Grey Baby, Babbu

Adopted as a foster fail in July 2019 after a little over a year of fostering with a goal of weight gain. For most of her time with us she's had a vacillating but mostly weak interest in food, and she's never weighed more than 7.5lbs.

At the end of August this year, after a scary bout of inappetance, constipation, and lethargy (lasting ~3+ days), I took her for a vet exam at our regular spot and she was given sub-Q fluids and a B-12 shot, plus a blood panel which later revealed slight anemia but no other significant findings. Took her back for more sub-Q the following day, and even went home with the Ringer's bag and kit to attempt at home (but she's so wriggly, I haven't managed it yet.)

I made an appointment for a specialty internal vet consultation - soonest was a month out - with the expectation that we might be looking at IBD or stomach lymphoma particularly due to the anemia and the speed at which she bounced back with the sub-Q and B-12. In the meantime, while waiting weeks for the appointment, I watched her appetite soar (so much wet food! where she had previously preferred mostly dry!) and the pee in her litter box multiply. Hoping this was just some kind of re-adjustment after the massive dehydration she had been through, I then watched her re-interest herself in dry food and resume frequent water bowl visits, on top of the still primarily wet food diet.

October 1st, at the internal specialist appointment, her blood glucose was 399. Even though I was told this was higher than even the highest end of stress induced hyperglycemia the vet had seen, I was hoping against hope the fructosamine analysis & urine test would let us off scot-free.

Today I got the results and her fructosamine (466 umol/L) plus glucose in the urine means I've got another sugar cat.

The Positives!
- No ketones in the urinalysis
- No UTI indicated in ""
- everything else we looked at (abdominal ultrasound to suss out possible IBD etc.) and the pancreatic function look normal

My regular vet is closed Sundays but I've already left a message to try to get on their books ASAP to figure out how we're going to treat her.

I'm interested in the oral medications as a possibility, but even though I'm no stranger to DM management in cats I'm not optimistic about Juniper's tolerance for glucose testing at home and I have no idea where to start with monitoring ketones or glucose in the urine. (My previous sugar cat was not tightly regulated on the level of e.g. hourly spreadsheets).

I still have a ReliOn Confirm (battery's dead though!) from my last go-round but I don't know if I should get an updated model.
Any insights or updates on the world of feline diabetes since fall of 2017 are welcome.

 

[Wendy&Neko]

Hello and welcome (back). Sorry to hear that history is repeating itself for you, but at least you don't have to go through the learning curve again.

First, something to read about the oral medications, and most important when they are a good idea or bad idea: New Treatments for Feline Diabetes

Ketones are an elevated risk with the new meds but good to hear that's not in play now. You will want to get a fresh container of Ketostix and keep testing to make sure they don't show up. Tips to catch and test a urine sample If it's difficult to catch a urine sample from her, there are also blood ketone meters available. Ketodiastix (a variation on Ketostix) can also test for urine glucose.

Relion Confirm - I had one of those too, loved it. But the test strips aren't made for it anymore. The Relion Premier is (I think) one of the more common ones used now from Walmart. You will need a new meter and test strips, regardless of going forward with the new medications or insulin. Might want to start the "rub ear, give treat" routine now to get her used to it.

FYI, having had a diabetic cat and now 3 cats with small cell lymphoma, one with IBD, I'd much rather treat diabetes any day. The most recent one is also a wriggly squirmer, but I have managed to test her to get a baseline.

Regarding food, you might want to work on lowering the number of carbs she'll eat. See if you can reduce or get rid of the dry food altogether. Even on the newer meds, lower carb diet makes a difference.

Finally, a post with a bit more information:
New? How You Can Help Us Help You!

 

[Sienne and Gabby (GA)]

I agree with everything Wendy said. The other advantage of ditching the dry food -- or using a dry food that is low in carbs -- is that it might have the advantage of dropping your cat's overall blood glucose levels. Dr. Elsey's Clean Protein and Young Again Zero Carb are the only two dry foods that are lower in carbs. There are also freeze or air dried raw foods that may be an option for Juniper.

 

[Lisa and Witn (GA)]

I agree with everything said above. I have had 6 diabetic cats over the last 22 years and found it has been easy to fall back into the routine for caring for one.

One thing that may be new to you is there are several biosimular insulins to Lantus that are less expensive. I have used them and saw no difference between them and Lantus. If you decide to use one of these ask your vet to write the prescription for pens instead of the vial. You will use each pen as a miniature vial. By doing this one package of pens will provide almost a year's worth on insulin, depending on your dose. You don't waste any insulin by throwing it away because it is no longer working.

 

[B. & Juniper "Babbu"]

Thank you so much for your replies y'all, I deeply appreciate it. <3

Some backstory/context:

Although Juniper is now my second sugar cat, she's the first one I've been able to fully monitor & support & manage care for from the very start of symptoms and diagnosis.

My Cat Guy (born ~2003, DX 2015, GA 2017) was diagnosed while I was living overseas with my partner on a fellowship grant, and Cat Guy was in the care of a friend (from fall 2014 to early summer 2016) who took the best care he could of my soft son - but I couldn't ask for tight regulation, or be involved as I desperately wanted to. And when we were finally reunited, I didn't have the energy or mental fortitude or fervor to switch up the routine he had been on with my friend and move more towards tight regulation. Cat Guy had DKA and been hospitalized for a week in fall of 2015, and my friend had brought him back to better health & stabilization in the following months on the routine they established, so I was taking kind of an 'ain't broke, don't fix it' mindset.​

This time around I'm better prepared and already much more informed, but it's still scary being at the start of things (not to mention, reactivating the old incredible anxiety and grief). I don't know how much I should be worried about ketone development while we're figuring out treatment, for example.

Last night I slept a few hours on our guest room couch with her (she's got her own separate mini-suite in our house, essentially, because she won't tolerate our other cat) and then moved back to my actual bed for the rest. When I came to check up and feed her after I woke up, I saw she'd had a Category 4 puke event on the rugs, and diarrhea in her litterbox. Puke had no notable foreign objects or hairball or any other remarkable features, just partially digested wet food slurry. The diarrhea was kind of soft pudding texture. Her demeanor was pretty normal - BAR as they say - if a little extra vocal (presumably due to hunger, but also we just had a HEAVY thunderstorm last night and our other cat seems a little weird about the atmospheric conditions as well, honestly).

The reasonable part of my brain that's NOT overtaken by semi-post-traumatic panic over cat health says this was probably because I switched her too abruptly to different wet food than what she has primarily been eating since her weird crash in late August. She was eating mostly [Fancy Feast Chicken & Cheddar Cheese in Gravy] and the [Temptations Chicken Pate in Gravy] because those two were the only wet options out of like 20-30 canned and pouch options I tried her on leading up to & immediately after her crash. I had been occasionally mixing in some [Fancy Feast Classic Chicken Pate] and [Weruva Slide n' Serve Chicken Breast Dinner with Chicken Liver] because I figured any gravy-branded cat food is likely to be higher in carbs than I would ideally want her to be eating.

Yesterday I removed her available dry kibble (a mix of [I and Love and You Naked Essentials Chicken & Duck] and [Blue Buffalo Basics Skin & Stomach Care Duck & Potato] and switched her wet food to a 50/50 split of just the FF Chicken Classic and the Weruva pouch, which she was eating enthusiastically. Then the puke this morning.

I've since offered her a mostly even mix of the FF Chicken-Cheddar, FF Chicken Classic, and Temptations, and made her dry kibble available again. I'm very much still in the mindset of MAKE SURE SHE'S STILL GETTING CALORIES!! but of course am also apprehensive about the higher carb content involved. (Haven't been able to find protein/fat/carb breakdown info on the Temptations pate - it's not on the 2017 spreadsheet presumably because it's newer. But my assumption is high carb.)
She's already eaten about half of the wet portion, so I'm climbing down from the panic ledge for now.

Sorry for the long post and thank you to any of you who read it all. I'm constantly fighting myself on wanting to provide ALL relevant context vs. wanting to be concise. ¯\_( ͡° ͜ʖ ͡°)_/¯