Dealing with a ravenous cat (polyphasia)

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atajev

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My cat, Mona, was in remission and OTJ for about 9 months, and then jumped back on the insulin train last summer after she got ahold of some dry dog food (we have a dog who also needs a specialized diet and his happens to be dry). She's been poorly regulated since, but recently she's been pretty steady with preshot BG #s around 300-350, and nadirs around 100-150 (sorry, my spreadsheet is way out of date, but that's the current state). A year ago (when she was OTJ) she was 11 lbs. Now she is all skin and bones at 6 lbs, though she's been steady at that weight for several months now. I test for ketones regularly and she's never had any more than a trace so far.

I'm feeding her a quarter can of 9Lives pate at breakfast and midday, and a half can at night. That's the same food, quantity, and schedule she was able to regulate and go into remission on originally.

While her BG numbers are settling down a bit into at least a consistent pattern, she is clearly starving and has developed polyphasia. She eats EVERYTHING edible that she can get to and we don't know how to live with this particular symptom at this point. We have small children and she needs to be locked in a room anytime we have any food or even used dishes out. She has learned to open our toaster oven and keeps burning herself to get to things being cooked. She has clawed open sacks of flour and eaten it. She jumps on the table and literally steals food out of our children's mouths. She will eat meat, grains, fruit, vegetables, candy, dairy, leaves, dirt, paper...literally everything to try to satiate her hunger. I feel so terrible keeping her locked up multiple times a day (she hates it), but she absolutely can't be out if even a cup of orange juice is anywhere in the house.

Everything I can find says very simply that polyphasia is a symptom of diabetes and that the underlying medial issue needs to be treated. Well, duh. That's not helpful. Since I'm already treating the underlying diabetes as well as I can, how do I treat this symptom and help her to feel better while she's experiencing this?

Should I try increasing her food (and insulin accordingly as needed)? Or will that not help once they're to this stage? Any other advice?
 
When is the last time Mono had a full workup at the vet?
Seems like something else beside diabetes since Mona is loosing weight.
I would feed more. My MurrFee, who had acromegaly would eat over 2 5.5 oz cans of Friskies together with Evo dry and still loose a little weight.
My MurrFee too ate through both bags of cat and dog food and other things too.
 
Hi Katie,

Should I try increasing her food (and insulin accordingly as needed)?
If Mona were mine, that's what I would do (after consultation with Saoirse's vet) but other members may have different suggestions. Have you discussed the polyphagia and weight loss with your vet? Both can be symptoms of conditions other than diabetes (feline hyperthyroidism, for example).


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Sorry, I should have said that she got a full work-up just this month and everything looked fine, with the one exception of her BG being about 201 at the point when her blood was drawn that morning (which is obviously exactly what we expected). The vet said he didn't see anything at all that would indicate that there was anything other than diabetes at play.

He also just said (as does the internet at large), that he didn't really have any specific advice about the hunger beyond trying to get her regulated a little better.
 
The vet said he didn't see anything at all that would indicate that there was anything other than diabetes at play [...] he didn't really have any specific advice about the hunger beyond trying to get her regulated a little better.
Maybe look for a second opinion?


EDITED TO ADD:

Did they include thyroid markers in the tests? Also, though rare, feline Cushings is yet another endocrine disorder that has polyphagia as a symptom. With so many possibles perhaps a referral to a specialist might be a good plan. If Mona's that hungry and losing weight something's interfering with her cells properly utilising the nutrients she's eating.


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I'll try doubling her food immediately and seeing if it helps, but I also might try getting a second opinion if that doesn't have any noticeable effect pretty quickly. We're all pretty miserable right now. :(

Thanks, folks.
 
:bighug::bighug::bighug:

I feel for you. It's so hard when we can't find something to help our little ones when they're poorly. I hope that you'll be able to solve the puzzle and help Mona back to wellness again.


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Thanks. I'll see if I can get a copy of the labs. I just got a verbal report over the phone of the findings and his interpretation. I know some thyroid stuff was tested, but I don't know what. I don't think it was any kind of specialized testing, just the standard cat full panel that he runs. All I know is that it was expensive!
 
It helps enormously to get copies of all labs. If you key the results into a spreadsheet you'll be able to track changes over time. (Vets won't have as much time to devote to Mona as you have.) Since I started doing it for Saoirse, the lab tests are much more meaningful to me. Also, when there are numbers outside the reference ranges you can learn a lot by doing a bit of online research for things that influence the markers and possibly come up with potential avenues of treatment that you might not otherwise have discovered.


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Hmm, this sounds familiar! Goof has been the same way ever since having the UTI brought him out of remission. He just wants to eat all the time! I got to thinking that most of the canned foods are 75% or more water, so I started adding some plain tuna to it. It seems to fill him up a little more and lasts a little longer. A little.:rolleyes:
 
I would definitely try increasing her food. At 6 lbs she needs approximately 150 calories a day to sustain that weight, but if she is skin and bone (and did well at 11 lbs) she will need more calories daily, at least 50-75, maybe more, to help her start gaining weight. This should also help her hunger. My guys run between 7-14 lbs and they eat considerably more than that, even my tiny girl (they also eat 9 Lives).

Please keep us posted on how Mona is doing!
 
I agree, I would increase the food. Is her ideal weight 11 lbs? If so, she definitely needs to gain some weight. I would also increase the frequency of your feedings--I'm not sure how often you're feeding now but increasing meals to 4-6 times a day could help a bit. Especially since this is abnormal behavior for her.

I sympathize, because I have a (perfectly healthy) cat, about 18 months old, that will snatch the food off your plate while you're trying to eat, regardless of what it is. Last night he attacked my hand to make me drop my forkful of salad. He is a rescue cat that was starving out in the cold last winter, and so he's developed a very aggressive attitude towards all food. I've been trying to keep him at bay with a squirt bottle while I eat (I don't like shutting him in the bedroom at every meal and hope I can eventually teach him not to steal food), but I've only had partial success with that. I still have to put him in his cat carrier when I'm spooning the cat food into their dishes or he'll jump on the counter and try and rip the can out of my hand while I'm portioning the food.
 
I agree, I would increase the food. Is her ideal weight 11 lbs? If so, she definitely needs to gain some weight. I would also increase the frequency of your feedings--I'm not sure how often you're feeding now but increasing meals to 4-6 times a day could help a bit. Especially since this is abnormal behavior for her.

I sympathize, because I have a (perfectly healthy) cat, about 18 months old, that will snatch the food off your plate while you're trying to eat, regardless of what it is. Last night he attacked my hand to make me drop my forkful of salad. He is a rescue cat that was starving out in the cold last winter, and so he's developed a very aggressive attitude towards all food. I've been trying to keep him at bay with a squirt bottle while I eat (I don't like shutting him in the bedroom at every meal and hope I can eventually teach him not to steal food), but I've only had partial success with that. I still have to put him in his cat carrier when I'm spooning the cat food into their dishes or he'll jump on the counter and try and rip the can out of my hand while I'm portioning the food.


Oh God, nothing hurts my heart like hearing about starving animals. I'm so glad you found him in time!
 
Was any imaging (x-rays, ultrasound) performed?
Were any special GI blood tests performed? The being hungry and losing weight while feeding "normal" amount of food shows that something is amiss

No imaging, we were holding off on any further tests pending the results of the bloodwork, but didn't pursue anything else since it was all deemed normal.
 
I agree, I would increase the food. Is her ideal weight 11 lbs? If so, she definitely needs to gain some weight. I would also increase the frequency of your feedings--I'm not sure how often you're feeding now but increasing meals to 4-6 times a day could help a bit. Especially since this is abnormal behavior for her.
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I'm unfortunately not able to feed any more frequently since I work full-time out of the house (we use timed feeders now for the midday meal often, but the feeders can't do feedings any more frequently than 4 hour increments), and that's a definite limitation. 11lbs was a little heavy for her, but she should probably be in the 8-9 lb range.

Our other cat is slightly overweight at 11 lbs, and she's maintaining that with the same amount of food as Mona (1 can a day total). Maybe we have magical air that gives our cans of 9Lives a caloric boost. ;) Or more likely, they're just really lazy indoor cats!
 
... the feeders can't do feedings any more frequently than 4 hour increments ...
If you could find a good deal on Petsafe 5 feeders, they're brilliant: great meal timing flexibility (digital timer), reliabilty, and they're burgle-proof. I tried several timed feeders and the Petsafe 5 is far and away the best one I've used. I've got two for Saoirse. I use one every day for overnight feeds (she needs to eat every 2 hours) and I have the second one in reserve so that if I ever needed to switch back to feeding her hourly I can set the two of them up to run in series. Well worth a look.

With the feeders you have, perhaps you could put out a bit extra food in each compartment for the time being?


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I would feed more. You can also put frozen pucks out so as they melt Mona can eat during the day. There is also a 2 meal auto feeder than can be set at 2 hrs increments.
 
My bet is on her thyroid being out of whack. Before she passed our Patchcat developed thyroid issues and dropped weight so fast. And starving was how I would describe her. She just couldn't get enough to eat.

Definitely consider she might be a borderline case even if her level is looking within normal range . Sometimes thyroid readings can be deceptive
 
I'm unfortunately not able to feed any more frequently since I work full-time out of the house (we use timed feeders now for the midday meal often, but the feeders can't do feedings any more frequently than 4 hour increments), and that's a definite limitation. 11lbs was a little heavy for her, but she should probably be in the 8-9 lb range.

Our other cat is slightly overweight at 11 lbs, and she's maintaining that with the same amount of food as Mona (1 can a day total). Maybe we have magical air that gives our cans of 9Lives a caloric boost. ;) Or more likely, they're just really lazy indoor cats!
Unfortunately, there is a difference between maintaining weight and gaining weight, in terms of caloric intake. If Mona is skin and bones then it sounds like she needs to gain back some of the weight she has lost, which requires a higher intake.

I also agree that it would be a good idea to check her thyroid.
 
Here are her latest labs. Now looking at these I also recall him mentioning the value that indicated an inflamed pancreas, but he said that it was not any higher than he would expect from a cat who was poorly regulated (which she was at the time since our insulin was too old).
 

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Unfortunately, there is a difference between maintaining weight and gaining weight, in terms of caloric intake. If Mona is skin and bones then it sounds like she needs to gain back some of the weight she has lost, which requires a higher intake.

I definitely understand that. I'm going to start with doubling her current food and see how that effects her over the next week or two.
 
Here are her latest labs. Now looking at these I also recall him mentioning the value that indicated an inflamed pancreas, but he said that it was not any higher than he would expect from a cat who was poorly regulated (which she was at the time since our insulin was too old).

@Critter Mom is very knowledgeable about almost anything to do with the pancreas, she may have some ideas for you.
 
Mona's thyroid values are in the low part of the reference range. Lower thyroid activity would be more likely to slow down metabolism and lead to weight gain. The Spec fPL 7.7 is above the high end of the reference range but I have seen worse values on Saoirse. The problem is that sometimes the Spec fPL number bears no connection to how symptomatic a cat may be. Nevertheless there must be pancreatic inflammation given the result. My vets told me that problems in the pancreas can have a knock-on effect on the thyroid. Saoirse's thyroid marker has been just outside the lower end of the reference range since March last year. They consider that it's Euthyroid Sick Syndrome and haven't wanted to treat for low thyroid levels (a common veterinary response to the condition, I believe).

I'd suggest running a full curve this weekend to see how Mona's responding to the Lantus - especially for how long each day she's in the higher numbers; those preshot numbers are above renal threshold. I'd also suggest monitoring urine for glucose levels as well as ketones. If Mona's tipping a lot of glucose into her urine then that's not gonna do her kidneys any favours.

Hopefully Larry and others will weigh in soon with a review of Mona's labs.


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How do the feces look and smell?
'fluffy', lighter colored, odiferous feces may point to a deficiency of pancreatic enzymes and thus impaired ability to absorb nutrition. This may happen with pancreatitis.
Loose stools with reeking can point to other GI problems such as bacterial overgrowth, again impairing absorption.
 
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How do the feces look and smell?
'fluffy', lighter colored, odiferous feces may point to a deficiency of pancreatic enzymes and thus impaired ability to absorb nutrition. This may happen with pancreatitis.
Loose stools with reeking can point to other GI problems such as bacterial overgrowth, again impairing absorption.

The first description matches what her feces look like. They look like the texture of milk chocolate mousse, but smell horrific. They're not much different in color than our other healthy cat's, but the texture and smell are distinctive.
 
Nevertheless there must be pancreatic inflammation given the result. My vets told me that problems in the pancreas can have a knock-on effect on the thyroid.

I'd suggest running a full curve this weekend to see how Mona's responding to the Lantus - especially for how long each day she's in the higher numbers; those preshot numbers are above renal threshold. I'd also suggest monitoring urine for glucose levels as well as ketones. If Mona's tipping a lot of glucose into her urine then that's not gonna do her kidneys any favours.

Thank you for all that info. I trade off between the ketone only and ketone/glucose urine strips and she always has a lot of glucose in her urine (usually the highest level detected).

Today is my son's 2nd birthday party so I won't be able to get to Mona consistently enough for a full curve, but I should be able to get one in tomorrow.
 
The first description matches what her feces look like. They look like the texture of milk chocolate mousse, but smell horrific. They're not much different in color than our other healthy cat's, but the texture and smell are distinctive.
In that case, get a sample to the vet and ask about a trial of Rx pancreatic enzymes. If you can't digest it, you get no value from it. Explains why the cat is losing weight!
 
The first description matches what her feces look like. They look like the texture of milk chocolate mousse, but smell horrific.
The fluffy stool is likely down to steatorrhea (too much fat in the stool). It's a hallmark symptom of exocrine pancreatic insufficiency. As BJ has advised above, if there are not enough pancreatic enzymes going into the digestive tract then it won't be broken down into nutrients that can pass through the gut wall.

Here's a site with some info on feline EPI.

IDEXX do a feline TLI test for EPI. If you're getting blood tests done then ask the vet to check B12 and folate levels. I'd imagine there's a strong possibility that Mona may be B12 deficient. If your vet can give fluids they might help pancreas inflammation. I'd also suggest speaking to your vet about whether it's possible to detect bile duct blockages in a cat with imaging diagnostics (and whether there is a treatment option - don't know as I haven't researched it - just brainstorming here).

FWIW, when Saoirse had the really pancreatitis flare she had steatorrhea briefly but it resolved with treatment. She was (obviously) on insulin, and she got a course of B12 injections (a great system booster in general). She was treated with metronidazole for diarrhoea (Stomorgyl 2, not Flagyl - apparently the Stomorgyl doesn't taste as foul as the Flagyl). I made sure I added a good bit of water to her meals, too. It might be worth getting advice on a suitable, easily digestible food for Mona. I fed Saoirse finely minced, home poached chicken and broth when she was at the height of her flare and then a liquid recovery food called Liquivite. I don't know whether similar products may be available where you are. It did Saoirse a power of good; our vet was gobsmacked at the improvement in her within a few weeks.

Here are the IDEXX treatment guidelines for pancreatitis. Assuming EPI is the issue here, as BJ advises above supplementation with pancreatic enzymes should help Mona to start absorbing nutrients from her food. For general information, your vet may suggest giving probiotics but there has been a study in humans which concluded that probiotics may be contraindicated in cases of pancreatitis. (Saoirse can't tolerate them; they make her nauseated or sore.) There's a link to the study from the following web page (and it's also cited on Tanya's Site):

http://ibdkitties.net/pancreatitis.html

Just looking back at the comment about dog food in your opening post, maybe it would be worth a look at the ingredients in the food to see whether there is something that might be a common cat allergen and letting your vet know in case it's something he can help with?

I hope some of the above may help Mona. Please keep us up to date with developments. I hope she feels much better very soon.


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Again, thank you! I'll try to get a feces sample into the vet as soon as possible. I wasn't able to get a curve yesterday after all, but it also wouldn't have been too useful since she got some birthday cake crumbs, a Cheerio, pasta water (boiling on the stove!!) and ate dog food twice. It's not possible to keep her food intake and therefore BG levels controlled at all when she's so desperate to find food 24/7. We really need to fix the polyphasia before I have a chance of getting her regulated again. It's been feeling like a horrible Catch-22, but obviously if she's not digesting her food, that is going to be a HUGE factor and something that can be addressed separately.

And to Jeanne, sadly that doesn't work. She wolfs down her food in less than a minute and then comes and steals ours. With the little kids, meals involve lots of up and down and running around and throwing food on the floor, so they're an ordeal of their own! Then we need to clean as well as we can to find all of the bits of food since she'll eat literally anything. Licking the boiling pasta water yesterday - that was a new one, and really bad. :(
 
Also, my husband gets B12 injections himself. It would be funny if they both end up needing those for a while.
 
Oh God, nothing hurts my heart like hearing about starving animals. I'm so glad you found him in time!
Yeah, my heart broke for the poor little guy at the SPCA, and I couldn't resist bringing him home. He ran, starving, into a random couple's house on the coldest day of the year (we were having an unusually cold winter last year where temperatures were regularly below zero), and refused to go back outside. So the couple brought him to the SPCA, and they did a great job bringing him up to a healthy weight. Originally, they thought he was older than he was and his growth had been stunted due to malnutrition, but it turned out it wasn't as bad as they thought because he grew a bit more after I adopted him! Even with his food behavior issues, he's an incredibly sweet cat I'm glad we have him. He's the only cat I've ever had who'll beg you to pick him up and cuddle him, and if you don't, he'll jump right into your arms.

Julia, have you tried feeding your meal-jacking cat at the same time you eat? Would a plate of his own keep him from wanting to rob your dish?
Yes, but as soon as he wolfs his food down (which usually takes just a minute or two), he immediately comes after mine. I'm trying to train the behavior out of him with both positive (giving him a treat on the cat tree after I finish my meal) and negative (squirt bottle to fend off physical attacks while I'm eating). I'm hoping that with enough time and repetition, he'll start to grow out of it. This has improved him a little bit, but he still has a long way to go.

I'm unfortunately not able to feed any more frequently since I work full-time out of the house (we use timed feeders now for the midday meal often, but the feeders can't do feedings any more frequently than 4 hour increments), and that's a definite limitation. 11lbs was a little heavy for her, but she should probably be in the 8-9 lb range.
How often are you currently feeding her? Are you already doing 4x a day?
 
Well that settles it. You gotta eat in the closet from now on, Julia:woot:. >>>>>>CLOSET EATER!<<<<<< Park a tablet in there, and watch Netflix while you eat, and turn up the volume so you can't hear him screaming at you through the closet door.;)


I have actually put Goof in the bedroom and shut the door so we could eat in peace.
 
I have actually put Goof in the bedroom and shut the door so we could eat in peace.

We did this for every meal the first 6 months after we adopted Orpheus! I still put him in bedroom when I'm baking or cooking a dinner that involves more than just heating up food (I have to say, the amount of cooking we do at home dramatically went down after adopting Orpheus), or if he's being especially bad, but I'm convinced we're going to eventually beat his bad behavior with food and he has to be out and about for that to happen. Someday....:cat:

The funny thing is, I don't have to worry about him when I have company over for dinner, because he's very skittish around people he doesn't know and won't come downstairs. Even if I have his dinner out and waiting for him, I have to feed him upstairs! If a friend stops by to feed the cats that he doesn't know, they have to leave his food in the bedroom for him because he won't come out to eat until they go back downstairs. o_O
 
Not much of an update from our house yet. After doubling Mona's food, she seems to feel slightly less bony to me, but she hasn't actually gained any weight. I have an appointment for Thursday to discuss her situation and get blood drawn for more tests, with a focus on pancreas functioning.
 
I suggest at least getting a thyroid panel done, too. Problems in one can have a knock-on effect in the other.

WRT which tests to request, it might be a very good idea to post a thread here on Feline Health asking for help. Perhaps entitle the thread: "Which Tests Should I Ask Vet to Run? Symptoms are Polyphagia and Weight Loss."
Put a question mark icon next to the title to get more eyes on the thread.

Fingers and paws crossed you'll find the answer and that Mona will recover very soon.

:bighug::bighug::bighug:


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