Diabetic cat with diarrhea - part 2

Friends, thanks to your guidance (see thread 1), Maya and I are already seeing a drop in her BG levels. Hope is creeping in...

Nevertheless, diarrhea is still a problem.

 

Can you link the previous thread here? I’m not sure what you’ve tried. Metronidazole?

 

@Aleluia Grugru & Minnie - is this the post you were referring to?

I generally recommend a probiotic, S. Boulardii for diarrhea. You start with about 1/4 of a capsule twice a day mixed into canned food and gradually increase. Your signature says you're feeling Royal Canin dry food. If so, it's likely contributing to Maya's higher numbers. If you are feeding dry, you can mix the probiotic with water and syringe it into your cat.

 

I have linked the first thread above.
I was told that the food I've been giving her is not the best, but I was advised to keep it up for a while until her BG numbers get stable.

Any recommendations for wet food?

 

Hi Sienne,

I asked Marisofi to hang fire on a diet change for a little while because:

1. Marisofi has only just started home testing and consequently we don't yet know how the Caninsulin is working. With a few days' more data there should be a clearer picture of how low the Caninsulin is taking Maya at nadir and that will set Marisofi up to carry out a food transition more safely.

2. Maya has had diarrhoea for a while and her eating can be iffy, plus she's currently underweight. I considered that a cautious approach to diet change is needed right now in order to reduce the risk of exacerbating the current GI/eating issues, something which could also complicate administration of insulin. (Marisofi is waiting for blood test results (fTLI, B12/folate) because her vet is concerned that Maya might have EPI.)


Mogs
.

 

Maya is currently getting Metrobactin (metronidazole) and FortiFlora.


Mogs
.

 

Thank you! I had suggested S Boulardii as well as Visbiome probiotics. I don’t think Fortiflora does anything to control the stool more than any regular probiotic would

 

B12 shots will help if she’s b12 deficient. If that’s the case, no probiotic will help much

 

Very good point.

Helpful info, Marisofi:

Texas A&M B12 Treatment Protocol

The Importance of B12


Mogs
.

 

Thank you all! Hanging in there, waiting for the test results. In the meantime, I love seeing these yellow boxes on the spreadsheet!

 

You're girl's doing a nice bit of sunbathing there! You're doing great with the testing, Marisofi.

(((Maya)))


Mogs
.

 

Do you know if I can give her S Boulardii without having seen her B12/fTLI results? Or is there a chance she might have a reaction?

 

Hi Marisofi,

While S. boulardii works well for many cats, it doesn't agree with some cats (those with yeast sensitivities). Here are helpful links:

ibdkitties.net - Probiotics

ibdkitties.net - Importance of B12

On the probiotics page, it gives info on S. boulardii dosing and also signs to watch for which indicate that it might not agree with the cat.

When are the test results due? It might be an idea to ask the vet whether a course of B12 supplementation might be beneficial in any case (definitely helps pancreatitis kitties).


Mogs
.

 

Thanks Mogs. It's been 10 days now and still no test results. I've asked the doctor about this and she said that they had to send the sample abroad to get feedback because these tests are not run in Greece. Not sure if she's being honest but I guess I'm going with it.
By the way, she's not eating the Hill's food at all. Today I let her have Wellness Core, which I checked that has low carbs, and she gobbled it all down!

 

Ten days sounds excessive. The samples would need to have been transported quickly to the external lab and also processed in a timely fashion. That said, IIRC when Saoirse had a TLI test it did take a little longer than usual to get the result back, but surely the vets should be able to get the results via email from the lab?

Some links on TLI testing for you:

TAMU - TLI Assay

TLI, Folate and B12


Mogs
.

 

Hi Marisofi
I am so glad you joined FDMB! Although I have no personal experience with a diabetic kitty, I have found the forum really helpful, there’s a lot of wonderful people here with a lot of experience and knowledge.

I am sorry Maya is also experiencing diarrhea since October, on top of diabetes, and that she has lost 2 kilos since summer, it is a long time and a lot of weight to lose for a cat. How is her appetite and how much does she eat now? Also, I don’t know about fTLI, but I am sure B12/folic acid are run in Greece too, (I am in Greece myself and my cat has had a B12 test here before), and I agree 10 days is too long for the clinic to send the results anyway.

That said, I feel you should use all the advice you can while you wait for the results of these lab tests. I will repeat I have no experience with a diabetic cat myself, so please @Critter Mom , @Sienne and Gabby (GA) , @Aleluia Grugru & Minnie and everyone correct me, but I think you should consider switching Maya to a high quality low carb wet food, regulate insulin accordingly, and try better probiotics than fortiflora. I also don’t understand exactly when you feed dry and wet during the day, and if and how this can have effect on the measurements on Maya’s spreadsheet, as dry can have a big impact on glucose levels. So, here are my thoughts on food, insulin, and supplements:

FOOD:
As far as food change is concerned, I understand it should be done while monitoring glucose with the help of the members here at the same time. There are wet foods with lower carbs and better quality than diabetic prescription food. A good quality wet food (avoid fish though) will also be of benefit even if Maya turns out to also have EPI (or IBS, or IBD, or anything basically). Royal canin diabetic dry can have more than 25% Kcals from carbs, hills m/d wet is just over 10%, whereas with wellness core, some flavors do have lower carbs, but I see it contains a lot of ingredients and I assume you can find better quality. You can check out %Kcals from carbs from the excel: https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml# and also calculate them yourself using this one: https://docs.google.com/spreadsheets/d/1NOyUfaKxNa580Wnz-0c0_kRQgvlMJgnu/edit#gid=984948269, it is wise to verify content yourself because sometimes they change the recipes and the first excel may not be updated yet. You can check out some good quality wet food, verify carb content, and compare ingredients with wellness core to see the difference for yourself. If you want info on can ingredients, also search for “If you opt to feed canned food” in this link: https://www.ibdkitties.net/feline-nutrition/. I would check out: thrive complete, granatapet, mac’s, grau, wild freedom, available on zooplus.com and zooplus.gr. Some of these brands also offer single protein cans, which are great for an elimination diet. Remember to change foods gradually, so first eliminate dry and prescription and stick to low carb wellness core, and then slowly introduce new food while home testing and seeking advice here in the forum. I will please the older members to commend and correct me!

INSULIN:
I am not experienced at understanding readings, I understand Maya will need constant monitoring and a lower dose after you eliminate high carb food from her diet, but I am leaving dosing and optimal levels to experienced members of the forum.

SUPPLEMENTS:
Please consider a better probiotic than fortiflora, if knowledgeable members of the forum can verify it won’t harm even before you know b12 levels. Also, be sure to space out with any antibiotic. I don’t see visbiome available in Greece, however I do see Lamberts s. boulardii 300mg.
Also, I don’t know if Maya can benefit from b12 supplementation even before Marisofi receives the lab results?

Please everyone commend on the above, correct me and help Maya and Marisofi!

 

καλημέρα, Σοφία.

Because Marisofi has only just started home testing and because Maya has a GI disturbance plus GI test results pending, I've suggested that Marisofi hang fire on a diet change for a short while. Covered on previous thread in this post:

https://www.felinediabetes.com/FDMB/threads/diabetic-cat-with-diarrhea.239127/#post-2689063

Already covered in post #13 of this thread. (The ibdkitties Probiotics page contains comprehensive info on benefits/risks of S. boulardii supplementation.)


Mogs
.

 

Thank you so much for the comprehensive email Kalypso!

Actually, I have news: the test results for B12 and folic acid have come back. The vet told me over the phone that there is no deficiency. She now believes that the diarrhea has to be caused by an issue with pancreatic enzymes, but she cannot be sure until we receive the fTLI results. As Kalypso noted, these are not run in Greece, so samples were sent to the UK on 18 November. In the meantime, the vet suggests that I take her over to the clinic for weekly shots of B12, even though she is not deficient. What are your thoughts on this? She also insists that I need to increase the insulin, so that she stabilizes around 200s.

Today there was a very weird incident. I measured her BG four hours after her morning shot, and at first it showed 82!!! I thought that perhaps there was a problem with the device, so I measured again immediately and it was 187.

Also, these past two days I've been feeding her Wellness Core (same as her sisters) because she frankly wouldn't eat anything else, and she's been eating *a lot*!

The diarrhea still worries me... I think I may order S Bourladii to give it a shot...

 

Glad you've got some of the results back, and that B12/folate levels are good. Hopefully you won't have to wait much longer for the TLI result.

Good suggestion, particularly with the diarrhoea ongoing since that sometimes depletes B12 reserves. B vitamins are water soluble and excess is excreted in urine.

The target there is to be under the renal threshold (highly desirable). Trouble is with Caninsulin is that dose increases may not lower the overall curve very much (bucket-shaped, so there's typically a significant difference between preshot and nadir BG levels, especially in the early days of treatment and where higher carb food is being offered). Even if it turns out that Maya were to eventually need a dose of 5IU 2x per day it's safer to get to there through gradual increases so that one can monitor how low each dose increase drives the down the nadir to make sure that Maya doesn't get dropped too low at any stage. Gradual increases also reduce the risk of skipping over the 'goldilocks' dose for the cat's needs at a given time.

If a handle can be got on the diarrhoea then subsequent transition to a lower carb food should help improve the overall BG range, including the preshot levels. Also, there is the possibility of switching to a longer-acting insulin at some stage.


Mogs
.

 

It's always recommended to discuss addition of supplements to the diet with the vet.


Mogs
.

 

T

Ευχαριστώ, I'll go for the B12 shot and ask about the probiotic.

 

Παρακαλώ!


Mogs
.