April 25, 2024 NEW MEMBER Senvelgo/ insulin question

My cat is 11 years old. He’s always been healthy apart from losing an eye a few years ago due to an abscess. In December 2023 I noticed that he was losing weight. He was never overweight initially my vet suggested I treat him and his siblings for parasites which I did.
he continued losing weight ( I also notice that he was drinking a LOT of water) and by the beginning of February I asked my vet to run full diagnostic tests . Thats when he was diagnosed with diabetes.
I was referred to a vet that specialises in diabetes and Squawkey started insulin injections mid February.
Started with 1 unit every 12 hours and increased to 2 units after 3 days as his glucose reading was not coming down. it improved slightly but still not at an acceptable level and the vet increased the dose to 3 units every 12 hours.
glucose count stabilised at between 120-150
Squawkey seemed happy and his appetite returned to normal
I noticed that he was a bit “wobbly “ sometimes and not as agile.
At our follow up visit the vet mentioned Senvelgo. I’d already been doing some reading about it and told him that my own research didn’t find a lot of li g term reliable data for Senvelgo and o prefer insulin for now.at the next visit the vet insisted we change to Senvelgo because he believes it will improve the neuropathy causing the wobbly gait.
I trusted his judgment
Unfortunately Squawkey 1. Hates the taste of the Senvelgo and it’s a real struggle getting it into him
2. He immediately started losing weight again ( after gaining 400 grams when he started the insulin)
3. His gait for even more unsteady.

finally I told the vet I want to go back to insulin and he agreed
Todays is the 3rd day back on insulin.
His glucose reading is going up instead of down
In the meantime I found an article published by the FDA which quite clearly states that cats already on insulin treatment should not be take off and put onto Senvelgo
I understand the risks etc the main one being DKA
he was being tested regularly ( Ketostix) and was always within normal range but I am still concerned that he might need specialist intervention to stabilise his glucose levels before the normal insulin injections will become effective again. mis love to heat from experts and owners alike who may have had similar experience

 

Oh forgot to mention I am in the Canary Islands, Spain.

 

I don't have experience, I just came here to say, that to my knowledge too, once a cat is insulin dependent, it shouldn't be moved to oral treatment [Bexacat/Senvelgo], HOWEVER, funnily enough, my vet suggested the same to me on our last visit in March Mind that my boy has been insulin dependent for a year already by then. I refused of course, but based on my -otherwise awesome- vet's attitude, to me it came across that she was just enthusiastic about a semi-new treatment discovered, hence why she offered. [Without doing much research prior to doing so.]

I know I'm not adding much value to the topic, if anything, I just wanted to say that it's great that you're doing your own research. I've been down the rabbit hole daily since our diagnosis [now various diagnoses] and it came handy numerous times, as vets can sometimes be a bit... well... 'surface level' in certain topics.

Edit: for hind leg neuropathy [the "wobbliness" you describe] it is usually suggested here to supplement the kitties with B12 methylcobalamin alongside their insulin therapy. With that said though, once the cat is a controlled diabetic and/or their BG is not ridiculously high, the neuropathy usually goes away. [My cat's did, anyway.]

 

@Wendy&Neko might be able to answer your questions. I’m just heading out for the day and can’t stop to answer I’m sorry

 

Welcome to FDMB!

You did the right thing. The SGLT2 inhibitors are not recommended if your cat has been on insulin. There's also a lot more involved that it sounds like your vet was suggesting. We have a post at the top of the this board on the newer treatment options.

We're going to need more information in order to provide help. First, what insulin are you using? What are you feeding Squawkey? It sounds like you're home testing. We ask new members to set up a spreadsheet to track their cat's progress and so we can follow along. We also ask that you put information in your signature so that we don't keep asking you the same questions repeatedly. The information on how to do this is in this post on helping us to help you.

 

Thank you Sienne and Gabby - I am still figuring out how to properly navigate your very helpful site. l'll work on the signature etc ( Cant find the settings button you mention)

Squawkey is on ProZinc 40Ul/ml
We feed him high protien low carb cat food at least twice a day ( Applawse , Gimcat) and Royal Canin kibble for diabetic cats
We are home testing , using the Accucheck Guide me glucose meter. ( Working on getting spreadsheet going)

He stabilised at 3 units every 12 hours until the vet changed to senvelgo
When we told our vet that we feel Squawkey was doing much better on insulin treatment,we were told to reintroduce insulin at 2 units every 12 hours

This morning after breakfast and after his shot, glucose level was 363 (20.16). slightly lower than last night but still far from satisfactory.

We have sent our vet an email setting out our concerns in light of the information we found re switching from insulin to senvelgo but he has not replied yet.
I am not here to complain about our vet but while we do not have an answer from him, we are worried that Squawkey may have suffered a setback that needs to be addressed in more ways than just returning to subcutaneous insulin as if nothing has changed

Is there anything we should and can be alert to, or do, to minimise possible effects of this setback?

 

Thanks Don - you are validating the trepidation i felt when the vet introduced Senvelgo.
Appreciate the tip about B12 for the neuropathy. Going to ask my vet about that too.

 

Just an FYI --

Royal Canin dry food is very high in carbohydrates. In fact, it is inappropriate for a diabetic cat. In the US, the pet food manufacturers lost a class action suit for calling their food "prescription." There is nothing that would require approval by the Federal Drug Administration in the food nor should it need a vet's prescription. If you look at the ingredients, they are not that different than any non-prescription dry food. As long as you're testing Squawkey's blood glucose, you can transition him to a lower carbohydrate food.

There is a particular form of B12 that helps with neuropathy -- methycobalamin (or sometimes referred to as methyl-B12). Diabetic neuropathy is typical if a cat is walking on his hocks. There is not necessarily "wobbling" involved. I'd also check your cat's blood glucose level if you see him wobbling. I'd want to make sure his numbers aren't too low.

 

You're welcome!

As both Sienne and I said, go for methylcobalamin B12 if you find it necessary. Wonder what your vet will/would advise when you bring it up - hopefully they're slightly more aware on that front than on the Senvelgo topic Even if they'd disagree on it, as far as I'm aware [someone more knowledgeable feel free to correct me if I'm wrong] supplementing with that will not do any harm - unless you overdo it and/or he has kidney issues already, as the excess although not toxic, excreted via the urine so it *could* potentially be heavy on the kidneys. But I believe it's very rare. [Again, I may be wrong.]

I do believe once Squawkey's BG is better controlled you may not even need the B12. My Don boy never walked on his hocks, but he did have neuropathic gait - could hardly jump up to 15-20cm at his worst [the video I have him struggling still makes me cry to this day] but nowadays with better glucose control he's acting like a bunny
I *think* supplementing him would only be necessary if it wasn't only hind leg weakness.
I never ended up supplementing mine, I just focused on taming his BG, because -as I'm sure you already know this too- glucose higher than the renal threshold excreted through the urine too, and that IS incredibly damaging to the kidneys.

I say one step at a time. Try to bring his BG down with insulin, and assess the rest after. And for what it's worth [again, no expert here], in my opinion unless he shows signs of DKA, I doubt he'd need a specialist at the moment - only insulin, close monitoring [e.g. regular BG checks, urine dipsticks to see if ketones are present] and perhaps try to ditch the dry food, or limit it as much as possible.