Diabetic cat - how bad is he

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Toddycat

Member Since 2015
Hi
Bit of advice needed by people in the same situation as me as I'm not sure whether my cat is suffering too much
Todd is 9 years old and was diagnosed with diabetes just after Xmas. 6 months down the line, he lost lots of body weight, but has recently but a tiny bit back on. However his insulin has been upped to 6 units twice a day and his glucose levels are still sky high and don't really come down much with insulin (40mmol/l for example)
He constantly now wees all over the house, I have 6 litter trays and training pads everywhere but he wees wherever he is, and is always soaking wet with his own urine as he lies in it. He also poos wherever he is without going to a litter tray. He is constantly thirsty, throwing his water bowl round the floor.
All he does now is lie on the floor, apart from a very occasional time he'll jump on the bed and purr, but that's mainly to get me up for food.
He also has kidney disease.
He's been checked for any urine infections etc so that's not making problem worse.
I'm not sure how much longer I can cope with this, insulin keeps getting upped and he is getting no more stable (if not worse)
It's breaking my heart to think about putting him to sleep but I'm at my lowest point, any suggestions?
Thank you x
 
Hi and Welcome to the FDMB! This is the best place you never wanted to be!!

Diabetes is not a death sentence, and many of the cats here are also diagnosed with some stage of kidney disease, so you're in good company!

Can you give us a little more information? What are you feeding Todd? What kind of insulin are you using? Are you home testing or just taking him into the vet now and then for tests?

There's a lot you can do for your "extra sweet" kitty and I hope you'll give us all a chance to help you!
 
He is on caninsulin, 6 units twice a day
day. I home test him. He is fed purina dm food at the moment with a little extra normal shop bought low carb no sugar cat food, and that's stopped the weight loss, but he's so lethargic, urinating all over the carpets and floors, lying in his own urine, I just don't know what to do for the best for him.
 
I'm going to make a guess - you're in the UK? They are required to start with Caninsulin. However, we find that it tends not to last a full 12 hours in most cats, and doesn't get good glucose control. If you can demonstrate, via home testing, that the insulin isn't working well for your cat, your vet may switch to a different insulin.

Home testing will help you determine how the insulin is working in your cat - when it is working strongest (nadir, lowest glucose), when it wearing off, how deep of a swing in glucose is created. You'll need a human glucometer that uses inexpensive test strips and a small sample - Abbot is one company I think you'll find which has good meters. Also, you'll want to pick up lancets for alternate site testing (25-28 gauge).

Testing is done by making a small prick on the outer edge of the ear, just outside the red vein along the edge. It can help to practice testing on a piece of fruit and on yourself, to get a feel for the timing.
ear veins.jpg
 
Hi,
Sorry you are having all this worry with Todd, but I am sure the people on this forum will be able to help you get it all sorted out so hang on in there.:bighug: It is great you are home testing !

Caninsulin Is not a good insulin for cats. Glargine or levemir are long acting insulins and are much better for cats. So ask your vet if you can change to one of those. 6 units is a lot of insulin. How did you get to that dose? It is possible Todd is getting too much insulin. There are some very knowledgeable people here on the forum who will be able to help you sort it all out.
First of all, if you could set up a spreadsheet with Todds blood sugar readings, that will allow people to see how he is going. Here is the link to do it. If you run into trouble setting it up....just post and someone will help you

http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

With the lethargy ....do you think Todd might be dehydrated? Check to see if his gums are moist...if they are tacky, then he could be dehydrated. Also pull up the skin on the scruff of his neck...if goes back quickly he is probably ok it if it is slow to go back, he is probably dehydrated and might need to go to the vet to get some subcutaneous fluids. You could also try adding some extra fluids to his food. I do that with my cat who has both diabetes and early kidney disease.

He is probably not using the litter box because he is feeling unwell or is dehydrated. He will also be hungry while he is unregulated so he will need extra food until the blood sugars get under control. The litter box problem can be sorted out....I know it is upsetting ...just know he is not doing it on purpose ......,
Are his legs weak? He might be associating the litter box with discomfort of pain...that is common

Is he having any special treatment/food/medications for the kidney disease?
Would you like to tell us your name?
So the things you need to do are
Check for dehydration and give extra fluids
Ask the vet to change the insulin to glargine(lantus) or levemir
Set up the SS
Give him extra food if he wants it
Know that Todd can be helped ......lots of people come here just like you at their wits end and are helped:)
Keep asking questions..we love to help and keep posting.:bighug::bighug:
 
Sorry, my name is Laura. Yes I'm in the UK, I will phone my vet about changing insulin tomorrow. He's definitely not on too much insulin yet, we've gradually increased it by half units over the last 6 months and it's really making no difference yet.
Yes his back legs are weak, but I've bought special low cat litter trays for him, he still won't use them. I know he's not doing it on purpose, but it's just so hard. He does seem slightly dehydrated but he drinks constantly. The vet said there was nothing he could do for his kidneys and it.would.make the urination problem worse. I just don't know if he has any quality of life anymore, but he has been my best friend for 9 years. All my family are telling me I need to make a decision. He was actually booked into the vets 2 weeks ago to be put down but perked up on the day and neither myself or the vet could do it. He's gone downhill more since.
 

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There are 2 things which cause difficulty standing and walking:
Low potassium due to excessive urination
Diabetic neuropathy due to the high glucose damaging nerves​
The first requires blood work to check; giving potassium when it isn't needed can cause problems.
The second, you can give methylcobalamin, a specific form of Vitamin B12. Along with good glucose control, it helps improve the nerve function over time. It is water soluble, available over the counter, and the dose is 300 mcg daily. If you get one with no added sweeteners, you can mix it into the food.

There is a research trial going on in the UK where they are studying Lantus.
@Elizabeth and Bertie can tell you more about it, as well as helpful info on over the counter, low carb foods available in the UK.
 
BJ, a question about the B12. Shiloh seems to have a little trouble with her back legs, but I think it is the tile floor rather than anything neurological. Would the B12 hurt her if no neuropathy?
 
No. It is exceptionally difficult to overdose on B vitamins, as any excess is excreted via the renal system.
 
That's one brand, it includes some folic acid, another B vitamin, too. You may find the individual incredients separately and combine them yourself for lower cost.
 
Hello Laura and Toddycat, and welcome to FDMB :bighug:
(Waving 'Hi' from Surrey!)

So, Toddycat is on 6 units Caninsulin twice a day, and you are hometesting?

Laura are you testing before each insulin shot? And also testing during the insulin cycle? (Caninsulin often 'peaks' (has lowest blood glucose level) at around 4.5 to 5 hours after the insulin shot (but 'every cat is different'). I'm just wondering if you've seen any effect at all from those 6 units?
And are you testing Toddycat's pee for ketones? You can do this with Ketostix/Ketodiastix or similar available from most pharmacies. Crumpling cling film in the litter tray is a good way to catch a sample, and you only need a tiny amount for the test.

It may be that Toddycat would respond better to another insulin. If it is shown that Caninsulin isn't being sufficiently effective then your vet can prescribe a longer lasting (non-veterinary) insulin under the 'cascade system'. Longer lasting insulins in the UK include Lantus/glargine, Levemir, and Hypurin PZI. UK vets vary enormously in their willingness (or otherwise) to prescribe alternative insulins. Some vets actively encourage the use of alternative insulins; some can be persuaded; and some doggedly refuse...

As BJ said above the RVC is currently running a research trial into diabetic remission; and they have been using Lantus and another insulin (one that is not generally available in the UK yet, 'Prozinc').
I think cats have to have been diagnosed less than 4 months and have no other complicating health issues in order to get onto the trial. But one of our members here (whose cat couldn't get onto the trial) did get some help from one of the vets involved in the trial. The RVC vet contacted the member's own vet and encouraged him/her to prescribe an alternative insulin...
FYI: The link to the Remission Clinic FB page is here: https://www.facebook.com/RVC.Diabetic.Remission.Clinic/timeline

Do you know the stage of Toddycat's kidney disease?
And are you monitoring his phosphorous intake? There is a link in my signature to low carb cat foods in the UK, and some of those also have the phosphorous level listed (in the blue column).
FYI: Here's the link to the hugely informative feline CRF forum. There is also a wonderful support group you can join. The folks are very kind and helpful: http://www.felinecrf.org/

Chin up, Laura. There may well be things that can be done to help Toddycat feel better.

Reassuring hug to you,

Eliz
 
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Hi Eliz
Thanks for the encouragement, I'm just waiting for the vet to call me back now and I'm going to suggest an alternative insulin.
I test before insulin and after, depending on when I'm home. This is a previous reading (in mmol/l)
18:00 41.3
Insulin 18:15
19:10 35.2
20:10 34.1
21:10 28.4
22.05 26.4
(bed time)

A morning example :
07.25 25.6
(insulin then given)
08:40 30.5
10:00 26.0
11:00 21.8
12:00 16.8
13:00 22.2
14:00 17.3
16:00 22.7

It kind of jumps around at 4-5 hours after giving before starting to increase

I'm not sure what stage his kidneys are at, he said not final stages? There are no ketones in urine, I test for that

Thanks for any advice, just was toddy better! x
 
Hi Laura,

That second list of numbers ("morning example") does show that there is some response to the Caninsulin. Are these numbers 'typical' for Toddycat?

Have you ever got a number that is significantly lower than those you've written above? (Sometimes it happens that a cat's blood glucose drops lower than it's body is comfortable with, and the body responds by releasing stored glucose into the system to push the blood glucose up. When that happens the level can stay high and 'flat' for up to a few days afterwards.)

Are you using Alphatrak or a human meter?

What foods are you feeding him apart from the Purina DM?

(Sorry for the questions!)

Eliz
 
16.8 is the lowest I've ever seen him go, he's usually in the high 20s, 30s. I use the alphatrak meter.
He's fed purina dm and also sheba tender terrain beef and salmon as I read they were low carb no sugar off the shelf cat foods x
 
You have to watch the phosphorus levels in food since he also has kidney disease. Ideally that should be .5 and below but using commercial food generally there are only a few that are 1 and below (don't know if you use different units for measuring this in the UK - point is that it needs to be very low). The other thing is the kidney diet is high carbs low protein and the diabetes one is the other way around. There is some controversy for stage 1 and 2 kidney disease about the low protein. Since my cat is stage 2 I am going to switch him to a high protein, low carb, low phosphorus diet. If he were stage 3 I'd leave him on the kidney diet and just give him more insulin. If you have to feed him a food that is higher in phosphorus then you can give him a phosphorus binder to help with that if his labs indicate he is having difficulties with too much phosphorus.

Go to this link and scroll down to find the UK lists (dry food list and canned food list) of foods and what percent of what is in them, including the phosphorus.

http://www.felinecrf.org/diet_and_nutrition.htm

I am finding I am getting conflicting advice whether I ask the same questions in a diabetes forum or a kidney disease forum.

Also make sure you have your cat tested for hyperthyroid since there is weight loss just to be sure that is ruled out (T3 and T4 tests) even though out of control diabetes and kidney issues both can result in weight loss. My last diabetic cat had that and hyperthyroid (he died 17 years ago). This one has diabetes and kidney disease. I have another cat who is hyperthyroid and nothing else - at least so far.
 
Hi, sorry for late response. He's not doing too well, and I'm not sure I can cope after just cleaning up the 13th wee of the day off the carpets
 
Toddycat said:
He's not doing too well, and I'm not sure I can cope after just cleaning up the 13th wee of the day off the carpets
Click to expand...
Sounds like it's been a tough day, Laura...

Cats in high blood glucose numbers can be incontinent. It may be that there is a sudden urgency to pee and they can't make it to the litter tray. (Or it may be that nerve damage from diabetic neuropathy makes it harder for them to 'recognise' that they need to pee, or to control the muscles (am not sure which....))
When my Bertie was newly diagnosed he used to pee everywhere, he just couldn't help it. And he often sleeps on my pillow, which means that I've woken up more than once with my hair soaked in cat's pee (he had peed in his sleep).
All that stopped though when his blood glucose levels got under better control. And that should be the same for Toddycat too.

What did the vet say when you asked about trying a different insulin?

I know it's hard, but try not to give up hope.

Hugs,

Eliz
 
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