Coughing/Asthma as a symptom of Diabetes?

[Courtney and Kismet]

My cat's diabetes diagnosis was accidental. I took him to the vet for what I thought was Asthma, and what the vet confirmed to be Asthma. Curiously, Kismet's chest x-ray didn't look like asthma, and furthermore, he exhibited no other symptoms of asthma. At any rate, we were prescribed oral prednisolone, a nebulizer, flovent, and theophylline to treat him. These medications didn't seem to work at all, and in fact, his asthma got progressively worse.

About a week later when his blood results came in, we had the DM diagnosis. We stopped the prednisolone immediately, and all other meds, and started insulin. His asthma disappeared! This was a cat who was having these attacks on average of 3-4 times a day (some days as many as 7) for about a month.

My vet (soon to be ex-vet) told me there was no connection between coughing and diabetes. I disagree 100%. Does anyone else have any experience with a cat coughing due to elevated BG levels? In a way, I am kind of happy that he does cough when his BG is too high. It's an alarm to us.

This is a video of Kismet I took September 6th, a week before he was diagnosed with Diabetes. We have been asthma free since then, with the exception of one minor episode the second day after insulin.

Kismet's Asthma Attack

 

[hmjohnston]

I've wondered if Sneakers had asthma b/c she wheezed all the time since DX (instead of purring) but she never did that. So I feel i can rest easy now after watching that. She still has the wheezing but it might be more related to her being acro than FD.

I don't know if the two are connected, though. I hope you find out.

 

[BJM]

Perhaps there is another condition besides the diabetes. I'd want to rule out heart problems; impaired cirulation may back up fluids into the lungs.

 

[Traci and Boomer]

Hi,

I have a cat (Merlin - avitar) with asthma-he had a chest x-ray and they found "donuts" in his lungs which is a tell-tale sign of feline asthma. He used to cough like Kismet on your video. He gets flovent 2x a day and he doesn't cough anymore. I've also had 2 cats with diabetes, neither of which ever coughed.
Was Kismet's chest x-ray clear? Is there any other reason a cat would cough-did the vet give you ideas? I've never heard of diabetes causing coughing. I've seen hundreds of diabetic cats (on this board) for a couple years and this is the first time anyone has ever had this question (that I know of)
So - the vet is now saying Kismet doesn't have asthma after-all? This is so confusing!

 

[Courtney and Kismet]

I'm glad Sneakers doesn't have these attacks, they're scary! There are many symptoms of asthma, though, and wheezing is one of them. Every cat is different, it may be a good idea to check him out.

We have an appt with specialist today; hoping she can figure it out! I think I may just have isolate the problem though. Kismet's history is complex as so many variables changed at the same time. Read his bio for the full story, but I thought that perhaps he was allergic to the food I was feeding him. His asthma totally disappeared when I started giving him insulin, though, which is why I suspect there must have been a connection between coughing and DM. When he was diagnosed, we also switched his food, though. Yesterday, we started feeding him Fancy Feast Classics. Last night he had chicken. Today he had ocean whitefish. 5 minutes after eating the fish, he had his first asthma attack in days.

I will update you all when we get back from the specialist.

Wish us luck!

Courtney and Kismet

 

[Squeaky and KT (GA)]

A 'heart' cough looks the same as asthma - they're both caused by not being able to get a full breath. Has you vet ruled out something like HCM instead? I thought Scruffy had asthma for quite some time...until the fluid began overflowing into his abdomen instead. Now that he takes Enalapril daily and lasix as needed for his HCM, the only time he coughs like that is when the fluid in his lungs starts building up. When he coughs, I increase his lasix for a couple of days until it quits. Asthma in cats is very hard to actually diagnose...it's diagnosis is usually ruling out everything else. X-rays WILL usually show the 'circles' after damage is done...

I know this coughing thing is terrible. Snowshoe DOES have asthma but I'm beginning to suspect heart problems also....

BIG HUG!!!

 

[Courtney and Kismet]

So we saw the specialist today and got some good news, but still don't know about what might be causing the asthma.

His BG levels were normal today, and we are reducing his insulin to 2 units, and will continue to reduce his dose based on the keto-diastix readings. For every two days he tests negative for Glucose, we reduce his insulin dose by 25%. She thinks he may be a transient diabetic *fingers and paws crossed* and hopefully we can get him into remission. She remarked that is very unusual for cats so young to be diabetic and said most diagnoses are between 8-12.

We did an ultrasound and findings were unremarkable. There is some evidence of diabetic lipidosis though that was to be expected. Pancreas and Kidneys look great. She ordered a urinalysis and fructosamine level test, results pending. We are still not sure what is causing the asthma attacks, but she thinks it might be a food allergy and has advised no/little fish. She also ordered a change in diet to canned food, she recommended Purina DM but said Fancy Feast was also OK. So happy with her and the prognosis! Feeling very relieved and optimistic about the future.

She told us to stop home testing unless we felt it was necessary before he ate. We were instructed to test using the keto-diastix strips every day and keep a log. If his glucose goes up, she said we could test then if we felt compelled, but doesn't think it is necessary and also cautioned that glucose levels may go up if we adjust the dosage as it takes time for him to equilibriate.

I brought my ReliOn Prime to have her test it against the AlphaTRAK. AlphaTrack gave a reading of 118 and the Prime was at 96. She said this was OK, but usually likes to see results within 20 points. She emphasized, as so many here do, to be consistent and only use one meter.

She also told us not to use the Flovent because it is a steroid, though it is better than an oral medication for asthma. As an alternative, she prescribed albuterol, a rescue inhaler to give 2 puffs only in event of an attack.

Here's hoping our new treatment plan yields good results!

 

[Traci and Boomer]

"She told us to stop home testing unless we felt it was necessary before he ate. We were instructed to test using the keto-diastix strips every day and keep a log. If his glucose goes up, she said we could test then if we felt compelled, but doesn't think it is necessary and also cautioned that glucose levels may go up if we adjust the dosage as it takes time for him to equilibriate."

????? I don't understand this reasoning at all.

Please resume home testing your cat before each injection - especially since you've changed his food to wet food which is lower carb. You need to make sure his blood sugar warrents a shot EACH time. 2 units of Lantus is higher than most cats start on; I realize your guy was on 3 units which is (obviously even higher)....I would post my story on the Lantus board. Those guys are experts on Lantus and helped me get two cats OTJ quickly. I don't understand what a ketostick has to do with a blood sugar reading??? Reducing a dose by 25%? This is odd. I don't think this vet knows the Lantus protocol.

I know you are happy to have a new vet who seems to know more than your last one about FD-but a lot of the things you are reporting don't make sense. PLEASE - post on Lantus to get some advice from people who do this day in and day out.

Regarding the asthma- flovent is a steroid, but it's not the same as getting prednisone or a shot of dex. It's much much less likely to cause diabetes. But if Kismet doesn't have signs of asthma then he doesn't need it. The albuterol is for the coughing (or panting) and can help him get over the emergency.

Best of luck to you! I really liked your story of how you all met. He sounds like a great cat and you are a good bean.

 

[Sienne and Gabby (GA)]

Traci asked that I stop by.

There is a good deal of confusing information in your post. To the best of my knowledge, there is no such diagnosis as "diabetic lipidosis." However, a cat that is not eating can have hepatic lipidosis -- "fatty liver" disease. The ultrasound may show some indication of irregularity but you would also need a blood test (ALP) to determine whether there is any continuing problem with liver function. Was Kismet not eating for several days (more than 3)?

There is no convincing epidemiology to support a relationship between asthma and diabetes. While inflammation from allergy (and there can be respiratory involvement with an allergic reaction) may be involved in raising BG levels, coughing is not a symptom of diabetes. What I suspect is that Kismet has a fish allergy. Fish is a common allergen in cats, as is beef. I would also strongly urge you to fastidiously read the labels of what you're feeding. Many varieties of Fancy Feast contain fish. For example, FF Classic Chicken contains (first few ingredients): Chicken, chicken broth, liver, meat by-products, fish, poultry by-products, artificial and natural flavors... The dry DM you were feeding contains fish oil.

FWIW, testing urinary glucose is unreliable. The position statement by the International Diabetes Foundation notes:

The limitations and proper interpretation of urine glucose test results need to be understood. These include that urine testing gives the results since the last time urine was voided. If the urine is free of glucose, it is an indication that the blood glucose level is below the renal threshold, which can vary, but is usually accepted as corresponding to a blood glucose level of 10 mmol/l (180 mg/dl). Results also do not distinguish between moderately raised and grossly elevated blood glucose levels. A particular concern is that a negative test does not distinguish between normoglycaemia and hypoglycaemia.

The danger is that you have no means of assessing if your cat is hypoglycemic. You will get the same reading with urinary glucose if Kismet's BG is 150 or if it's 20. You cannot keep your cat safe using Ketodiastix. The same is true for high numbers -- you don't know how high. Urinary glucose also dose not tell you what Kismet's glucose levels are at the moment. Rather, the reading reflects what the level is over the several hours that it takes for waste to be processed, the bladder filled, and the urine excreted.

In the early days of the Tight Regulation protocol, cats were started on much higher doses of Lantus than is currently recommended. For some cats who are started on higher doses or cats we've seen here who have had a hypoglycemic event early after their diagnosis, it can "jump start" their pancreas. Given your starting dose, this may have been the case with Kismet.

Your vet is not familiar with the difference in calibration between the Alpha Track and a human meter. There is typically a 30 point difference in the test results between the two meters with the Alpha Track reading higher.

 

[hmjohnston]

I agree- it does sound like Kismet does have a fish allergy- and that can be watched out for.

As for the difference in meters- pet meters do read higher than human meters in many cases.

Glad you got a few things cleared up- maybe not from the vet but at least from here :lol: .

At least you have a track to follow in your investigation. Good about the asthma and the fact that the levels seems to be dropping. I would continue to test so you know what is going on.

 

[Courtney and Kismet]

Thank you Traci, Sienne and hm.

To answer your question re: diabetic lipidosis -- the vet described this as fatty liver associated with diabetes? I imagine she means the same thing as hepatic lipidosis. Kismet has never gone a day without eating in his life LOL! He starts campaigning for food about an hour before feeding times. He is very vocal about his hunger and is a good eater.

I've resumed blood testing as per your advice. I've been having a hard time catching urine samples as he has been urinating far, far, less, and usually in the wee hours (no pun intended!) of the night.

BG levels were low tonight. I'm holding his insulin for the evening and will continue to test. Hoping we will be OTJ tomorrow morning as well.

Also, it would seem that it is a fish allergy. Vet said this probably wasn't likely as most asthma attacks are associated with inhaled irritants. He seems to be doing better with the DM than with the FF, though, so we have been offering it exclusively. We got an albuterol rescue inhaler today and will use that as needed.

Thank you all for your really wonderful advice, support and encouragement. Keep your paws crossed for us.