Feb 3rd/24- New Member - Maurice

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Katie Read

Katie Read

Member Since 2024
Hello Everyone!

The light of my life Maurice (we call him Moedy) is turning 16 this month and he was just diagnosed with diabetes. My family has had him since I was 14. In 2018 I took over his vet care and we got his IBD managed over 2 years. He now lives with my husband and I living his best life. He has had feline herpes virus and presumably IBD/food allergies his whole life. In 2018 they diagnosed him with transient heart murmur. Upgraded to level 1/2 at some point and 3 ecgs over the years and he has been diagnosed with HCM. Two months ago his blood test and UA came back mostly perfect. No indication of diabetes (BG was 8.34mmol/L - but looking back at his symptoms and food + steroid use he was probably prediabetic for a while). We decided to take him off the low dose (0.5mg) transdermal prednisolone that he was on every other day (has been on that dose since 2020, on prednisolone since 2018). Figured if he no longer needed to be on a steroid that would be best. He did not have any GI symptoms during the taper, but three weeks after his last dose he started pooping outside of the box. That became more frequent until it was every poop and then we saw him actually struggling to poop even though it would still come out firm. At the same time he started Clopidogrel to prevent blood clots due to his HCM, and Amlodipine for the BP that we discovered was quite high. He ended up going to the vet about a week later because he was not feeling well and seemed constipated. The xrays showed gas filled small intestine and poop filled lower intestine. They gave him an enema and started him on cerenia, omeprazole, tylosin, and restarted the prednisolone. He has been on forti flora and pumpkin once a day since 2018. He would not let them get blood that day so I took him back two days later on gabapentin for the blood test. It came back with high BG (20.2mmol/L). Fructosamine came back high and glucose was in the urine. No ketones.

Plan is to taper him off Prednisolone, start Atopica (cyclosporin) and parallel the two until he's soley on Atopica. It takes about 3 weeks for it to be effective so once the transition is complete, depending on his BG we would start insulin. I immediately switched him to FF Turkey and Giblets pate. Normally I would do a slow transition but I don't think its appropriate to give him any of his old high carb kibbles. He was eating Royal Canin hypoallergenic kibbles and 1/5 a can Kasiks turkey wetfood. That wetfood is too high in carbs but he has tolerated the turkey for years. I do worry that he only tolerated it because the majority of his protein from the kibbles was hydrolyzed, but so far his is doing really well on the FF (it has only been 36 hours since switching and he has not shown any sign of GI issuses). When we got home from the vet yesterday he had a nice normal big poop which was a relief because he was still pooping less than normal since feeling unwell. About two hours later he had another softer but still formed poop. But both of these in the box. No poop since which is a good thing (his IBD flares usually involve him struggling to poop small amounts of liquid poop outside of the box).

So that is where we are at right now. He seems to be feeling back to 100% these last couple of days! But of course since his diagnosis I have a million questions. Lots have been answered via this wonderful forum and the facebook pages but I have a few lingering that I will ask here.

Food Transitioning -
I am terrified that I switched him cold turkey and that I switched him to a non hydrolyzed protein. It is all going well so far but it has not been long and I don't want him to suddenly end up in the hospital. How long without symptoms means that he is tolerating this food? I also imagine that some mild GI upset might be okay as long as it does not last. I was worried to switch because he has not been the most stable IBD wise at the moment but at the same time he is already on all the medications that we use to support GI issues. So maybe those will help. And perhaps the diabetes was the only reason for the gas and constipation and his IBD will settle as we treat his diabetes. (As long as FF doesn't cause inflammation for him).

I am home for the weekend so I am currently feeding him half a can every 4 hours (total will be 2.5 cans which is the amount of calories his vet said to feed him). However, when we are both out of the house working we would be able to feed him at 6am, 6pm, and 9pm. He usually eats all of the food at once. We did used to leave out kibbles for him to graze on, but really he would just eat them in the morning and then wait until dinner time. He is currently 7kg down from 7.6kg. His appetite is not an issue lol. I did read that we could freeze some wetfood to leave out? So if I give him a can at 6am, leave out a frozen half a can to thaw for him to have for lunch, and then split the next can in half to feed at 6pm then 9pm? But would not having any food overnight be an issue? I could perhaps give 1/2 can at 6am and then leave another frozen 1/2 for overnight eating. He never used to leave himself any food to really graze on overnight but I know he would definitely eat it if it was there. Currently we are not planning on giving him insulin at least for another month but from what I have read this feeding schedule could also work with 6am and 6pm insulin shots? Another possible option for feeding is getting a bag of Young Again LID mature and giving him 2 cans of FF pate 6am/6pm and leave out a TBSP of kibble for lunch and again overnight but he would more than likely just eat the kibbles as soon as they were put down. And it is hydrolyzed protein but still a new food so should probably not introduce it until he is for sure okay on FF. The vet recommended the Prescription Diabetic kibble but I politely declined.

BG testing-
I am (perhaps naively) hopeful that switching him over to a low carb diet and getting him off prednisolone will lower his BG enough that we do not have to ever start him on insulin but I am prepared and ready to do so if it does become necessary. Over the month that we transition him off prednisolone and onto Atopica I do plan on monitoring his BG (and urine ketones if needed). I will add these values to his spreadsheet. I ordered a Bayer Contour Next One, test trips, 28G lancets, and ketostix. Do I just follow the guidelines for testing before 6am/pm meal as if I was testing to see if he could handle insulin? And on days I am available I could also do curves. Since he in on Clopidogrel I am a bit worried about pricking his ear but I imagine it wont let too much blood out and will hold pressure on it after. His blood pressure is back down after a couple weeks on Amlodipine.

Insulin-
If we do get to the point of having to give insulin, should I go with the vet's preference of ProZinc or should I push to use Lantus right away? He said that ProZinc works better in cats but he could prescribe Lantus if I want. From my research I read that ProZinc didn't work as effectively for cats so I am not sure what to do.

I am extremely grateful for this community already and the resources provided have been invaluable. I already feel much more capable of going on this journey with Maurice. Thank you so much in advance for any insight you may be able to provide to my questions.
 
Welcome to FDMB!

One immediate thought regarding diet is that most IBD cats do well on a novel protein. There are a number of cat foods that are both novel proteins and low in carbs such as ZiwiPeak (venison, rabbit and lamb) or Stella & Chewy's (rabbit) as well as other brands that include bison, kangaroo, or anything that has not been a part of your cat's routine diet. Alternatively, you can use a raw diet that is also novel protein. There is a great website for IBD information -- Raw Feeding for IBD Cats. They also have a Facebook page. This will give you more options than a hydrolyzed protein diet. Aside from advocating for a raw diet, they also have tons of information on managing IBD and the Facebook page can offer answers if you have questions. Several of us use a raw diet and buy a pre-mix -- it's a dry product that's mixed with water and added to your cat's ground food. It supplies all of the additional nutrients to make what you're feeding nutritionally complete.

As for feeding times, freezing cat food is an option. I'd also suggest a timed feeder. A feeder will allow you to have food available based on how you set up the time. If I left a frozen cube of food out for my cat, she would immediately stand there and lick it into nothingness thereby defeating the entire purpose! There are also feeders that have room for an ice pack to ensure the food is kept fresh. Most of the members here feed their cats in frequent, smaller amounts rather than feeding just 2 large meals a day.

Many cats will have GI symptoms if you are transitioning too quickly. If Maurice isn't having any symptoms, you're doing things right!

PLEASE test your cat. And please test both for blood glucose and ketones. If you are delaying giving insulin, it's important to ensure that Maurice is responding to the diet change and that he doesn't develop ketones. If his numbers stay in a diabetic range it's one thing. If he develops ketones, it's a medical emergency. Testing your cat at the times you would be planning on giving insulin is fine. Just remember to test before you feed Maurice.

Both Prozinc and Lantus (glargine) are very good insulins for cats. They are both endorsed by the American Animal Hospital Assn for the treatment of feline diabetes. Either is fine. The biggest difference is that Prozinc is likely to be available only through your vet or online. Lantus (glargine) is a human insulin and is available at any pharmacy. Thus, it's not a problem if you run out at an inopportune time.

Just a word from my cat's experience. Gabby did not do well on amlodipine. It threw off her appetite. My vet switched her to telmisartan which she tolerated. It sounds like your kitty is doing well on the amlodipine though.
 
Sienne and Gabby (GA) said:
Welcome to FDMB!

One immediate thought regarding diet is that most IBD cats do well on a novel protein. There are a number of cat foods that are both novel proteins and low in carbs such as ZiwiPeak (venison, rabbit and lamb) or Stella & Chewy's (rabbit) as well as other brands that include bison, kangaroo, or anything that has not been a part of your cat's routine diet. Alternatively, you can use a raw diet that is also novel protein. There is a great website for IBD information -- Raw Feeding for IBD Cats. They also have a Facebook page. This will give you more options than a hydrolyzed protein diet. Aside from advocating for a raw diet, they also have tons of information on managing IBD and the Facebook page can offer answers if you have questions. Several of us use a raw diet and buy a pre-mix -- it's a dry product that's mixed with water and added to your cat's ground food. It supplies all of the additional nutrients to make what you're feeding nutritionally complete.

As for feeding times, freezing cat food is an option. I'd also suggest a timed feeder. A feeder will allow you to have food available based on how you set up the time. If I left a frozen cube of food out for my cat, she would immediately stand there and lick it into nothingness thereby defeating the entire purpose! There are also feeders that have room for an ice pack to ensure the food is kept fresh. Most of the members here feed their cats in frequent, smaller amounts rather than feeding just 2 large meals a day.

Many cats will have GI symptoms if you are transitioning too quickly. If Maurice isn't having any symptoms, you're doing things right!

PLEASE test your cat. And please test both for blood glucose and ketones. If you are delaying giving insulin, it's important to ensure that Maurice is responding to the diet change and that he doesn't develop ketones. If his numbers stay in a diabetic range it's one thing. If he develops ketones, it's a medical emergency. Testing your cat at the times you would be planning on giving insulin is fine. Just remember to test before you feed Maurice.

Both Prozinc and Lantus (glargine) are very good insulins for cats. They are both endorsed by the American Animal Hospital Assn for the treatment of feline diabetes. Either is fine. The biggest difference is that Prozinc is likely to be available only through your vet or online. Lantus (glargine) is a human insulin and is available at any pharmacy. Thus, it's not a problem if you run out at an inopportune time.

Just a word from my cat's experience. Gabby did not do well on amlodipine. It threw off her appetite. My vet switched her to telmisartan which she tolerated. It sounds like your kitty is doing well on the amlodipine though.
Click to expand...

Thank you! I think that’s why Turkey as worked for him the past few years, I suspect he cannot handle chicken as the main meat (seems to tolerate chicken byproducts). But if he doesn’t continue to do well on FF I will definitely get him a novel protein or look into our other options.

Sounds like a feeder like that is exactly what we need for the meal times that we aren’t home/ are sleeping for. I thought they would only work with kibbles but I’ll look into the ice pack ones!! I thought too that Maurice would just sit by/lick the frozen wetfood until he could devour it.

We will start testing as soon as his monitor arrives, hopefully won’t take more than 2-5 days. Can I use the Bayer Contour Next One to test for blood ketones or do I need to get a specific meter for that?

That is very helpful information about ProZinc and Lantus.

I was worried about how he would do on Amlodipine. Seems to be doing well so far but that’s helpful to know there’s another option if needed!
 
You have two options for testing ketones. There are urine dip sticks that you can get at a pharmacy. There is a fiber strip at the end that will change color if ketones are present. There should be a color code guide on the container to tell you what the level of ketones are. This is the least expensive option providing Maurice will allow you to stalk him to the litter box. Just follow the directions on the container regarding timing and storing the strips. You can either dip the strip in your cat's urine flow or use a spoon or ladle to get a fresh sample.

There are also blood ketone meters. They are just like a glucometer except that it's a ketone meter and you need different strips to test for ketones vs glucose. The strips are pricey. However, you are testing only a couple of times per day. The ketone meters are helpful if your cat is "shy" about your getting a urine sample. They also give you a number regarding the ketone levels.
 
Hello and waving at you across the Salish Sea.

You have a complicated kitty so I'm not sure where to start but I'll do the easy ones first. My Neko was on clopidogrel and I blood tested her with no problems. You aren't aiming for the vein in the ears. Also make sure to hold the poke spot for a while after, which will reduce bruising too. Did you see our post on Hometesting Links and Tips

I too would vote for Lantus. Oddly enough, on the mainland I've found Safeway pharmacy to be the cheapest place to buy. Do ask around, prices vary, even more so for testing equipment. Some people buy test strips on eBay.

OK - onto the more complicated one. How was the IBD diagnosed? Did he have a biopsy? Fortiflora is a lousy probiotic, great for flavour enhancing but won't do a lot for the IBD. I strongly recommend you look at either Visbiome or Proviable. Psyllium husk powder is another option for fiber.

I have and IBD kitty at home now, also small cell lymphoma too but she's been in remission from that for over 5 years. Now it's "just" IBD. I too tried the prednisolone taper and she told me, with an ileus diagnosis, that it was a no-go. One thing I haven't tried with her, but did with Neko, was budesonide. Budesonide is also a steroid, but locally acting so primarily just in the gut. It worked great to reduce Neko's bowel walls, and did not impact her blood sugar at all. We've seen quite a few kitties make the transition to budesonide from prednisolone here and it's made a big difference in how much insulin they need. Note, there have been a few kitties react to budesonide with higher blood sugar, but most not.

I haven't seen a lot of great things about Atopica, nor tylosin. Tylan (tylosin) is an antibiotic that targets anaerobic bacteria, which includes the good bacteria in the gut. It can actually further disrupt the gut biome. Has your kitty been seen by an internal medicine vet? He's starting to get into the complicated category and might benefit from a visit to an IM vet with up to date knowledge on GI issues.

Feeding with an autofeeder gives you freedom. The Petsafe 5 or Catmate are good options, and come with little compartments below them that can hold a freezer back or gelpack to help keep things cool.

Also, did you know that Fancy Feast Turkey and Giblets that is made in Canada is now made with fish in it? Just in case that's an allergy too. There are quite a few other turkey or turkey and duck low carb options that I've offered my current IBD girl. You probably need a good couple weeks on a food to know it's OK for IBD. And definitely read the fine print in the ingredients.
 
Canned food is a cooked product so it's fine to leave in a timed feeder all day. There are timed feeders that use ice packs to keep food fresh and / or you can freeze canned food into portions and pop the froze chunk into the feeder compartments to slowly defrost.

My diabetic also has IBD. I suspect the pred he was on since diagnosis was what caused the diabetes. The vet has since switched my cat to budesonide. I feed a commercial freeze dried raw food in rabbit. My cat also has intolerance to certain proteins and filler ingredients.
 
Both Minnie and Bobo had/have IBD.

I second Visbiome as the best probiotic for it. It’s a human probiotic so if you use the capsules, you’d give them 1/4 mixed with food.

sorry if I missed it, but how is his apetite? For the IBD, budesonide is a better choice when it progresses and you need it so he’ll eat. Bobo is also on ondansetron for nausea daily. Bobo is one of the rare cats that became diabetic because of the budesonide, but if your cat is already, it’s not a concern.
 
Wendy&Neko said:
Hello and waving at you across the Salish Sea.

You have a complicated kitty so I'm not sure where to start but I'll do the easy ones first. My Neko was on clopidogrel and I blood tested her with no problems. You aren't aiming for the vein in the ears. Also make sure to hold the poke spot for a while after, which will reduce bruising too. Did you see our post on Hometesting Links and Tips

I too would vote for Lantus. Oddly enough, on the mainland I've found Safeway pharmacy to be the cheapest place to buy. Do ask around, prices vary, even more so for testing equipment. Some people buy test strips on eBay.

OK - onto the more complicated one. How was the IBD diagnosed? Did he have a biopsy? Fortiflora is a lousy probiotic, great for flavour enhancing but won't do a lot for the IBD. I strongly recommend you look at either Visbiome or Proviable. Psyllium husk powder is another option for fiber.

I have and IBD kitty at home now, also small cell lymphoma too but she's been in remission from that for over 5 years. Now it's "just" IBD. I too tried the prednisolone taper and she told me, with an ileus diagnosis, that it was a no-go. One thing I haven't tried with her, but did with Neko, was budesonide. Budesonide is also a steroid, but locally acting so primarily just in the gut. It worked great to reduce Neko's bowel walls, and did not impact her blood sugar at all. We've seen quite a few kitties make the transition to budesonide from prednisolone here and it's made a big difference in how much insulin they need. Note, there have been a few kitties react to budesonide with higher blood sugar, but most not.

I haven't seen a lot of great things about Atopica, nor tylosin. Tylan (tylosin) is an antibiotic that targets anaerobic bacteria, which includes the good bacteria in the gut. It can actually further disrupt the gut biome. Has your kitty been seen by an internal medicine vet? He's starting to get into the complicated category and might benefit from a visit to an IM vet with up to date knowledge on GI issues.

Feeding with an autofeeder gives you freedom. The Petsafe 5 or Catmate are good options, and come with little compartments below them that can hold a freezer back or gelpack to help keep things cool.

Also, did you know that Fancy Feast Turkey and Giblets that is made in Canada is now made with fish in it? Just in case that's an allergy too. There are quite a few other turkey or turkey and duck low carb options that I've offered my current IBD girl. You probably need a good couple weeks on a food to know it's OK for IBD. And definitely read the fine print in the ingredients.
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Hi Wendy!

Thanks so much for your insight. I don't believe we have any Safeways on the island but I will ask around at our pharmacies.

His IBD was diagnosed in 2018 in the unofficial way - he had soft poops for years until I was able to take over his vet care and bring him in. After Xrays -we decided to treat as IBD and see what happens. Now I understand that was not the right way to do it but he had been completely stable for years until we took him off the prednisolone in December. I will definitely get him some Visbiome or Proviable. I just got Psyllium husk for him to replace the pumpkin.

Ileus diagnoses is exactly what we suspected was going on with Maurice until his diabetes diagnoses - vet said it can cause constipation so it was likely that plus stopping the prednisolone. After joining this page I asked his vet if we could switch to Budesonide instead of Atopica. We both did our research before the appointment and we said discussed that Budesonide targets upper GI issues (IBD symptoms showing up as vomitting) but Maurice struggles with diarrhea (before he was stable he would struggle to get little liquid poops out) indicating he has lower GI issues. He also said Budesonide was still a steroid so would affect his heart and inhibit insulin, but Atopica does not inhibit insulin. I said that I read that Atopica does inhibit insulin and isn't proven to be effective for IBD. He said he would do more research but with the time crunch of needing to get him off prednisolone ASAP so we can give insulin if needed I agreed to start Atopica and see how it goes.

This is the first time I have heard that about Tylosin so that worries me. The vet had originally offered Metronidazole which Maurice had been on at the beginning of treating his IBD but at somepoint was switched to Tylosin. So I did research this time to choose which one to give him and everything said Tylosin was the better option. Sounds like we do need to seek out an internal medicine vet to help us.

I was able to order him an autofeeder that I can control on my phone and can place up to 6 meals in and put the ice packs in so that will work for feeding him while we are at work and for an over night snack.

I did read that about Fancy Feast. I am not sure what his allergies are, he was on fully hydrolyzed protein kibble and wetfood for about 1.5 years. Then we introduced Kasik's turkey wetfood to his siblings (he lives alone with us now) and he refused his hydrolyzed protein wetfood after smelling that. After stealing enough bites and licks and no IBD consequences we slowly switched him to that wetfood and he was on that for 2 years with no issues. He did have gabapentin in salmon juice two months ago with no issues but other than the turkey we did not experiment much. I will give it another week or so on FF to see how he tolerates and if he doesnt I will look into limited ingredient wetfoods.

Again thank you so much for your time and insight!
 
Ale & Bobo & Minnie (GA) said:
Both Minnie and Bobo had/have IBD.

I second Visbiome as the best probiotic for it. It’s a human probiotic so if you use the capsules, you’d give them 1/4 mixed with food.

sorry if I missed it, but how is his apetite? For the IBD, budesonide is a better choice when it progresses and you need it so he’ll eat. Bobo is also on ondansetron for nausea daily. Bobo is one of the rare cats that became diabetic because of the budesonide, but if your cat is already, it’s not a concern.
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Great I will look for Visbiome for him!

His appetite is consistently very good. He has to be feeling really unwell to not eat anything at all.
 
Katie Read said:
He also said Budesonide was still a steroid so would affect his heart and inhibit insulin
Click to expand...
Not true. Neko, who had multiple heart issues, was given budesonide instead of prednisolone, and it was fine for her. This is after a consult with both an internal medicine vet and a vet cardiologist. She was fairly well regulated before starting budesonide, and it made no difference to how she used the insulin. I did not have to change her insulin dose as a result. Budesonide works more locally, so on the GI system. It reduced Neko's bowel wall thickness, made her poops easier too.

I've heard of people saying that Visbiome has helped diarrhea. In Canada you can only buy the Visbiome unflavoured pouches for humans. Dose is quite small. Depending on cat size it's like 1/8tsp a day. A pouch lasts a long time. Ileus can also cause diarrhea.

Tylosin also is awful tasting. You will probably have to give in in gel caps if you go ahead with it.

Katie Read said:
he refused his hydrolyzed protein wetfood after smelling that.
Click to expand...
Was that z/d? My vet calls it hydrolyzed chicken feathers. :p
 
Wendy&Neko said:
Not true. Neko, who had multiple heart issues, was given budesonide instead of prednisolone, and it was fine for her. This is after a consult with both an internal medicine vet and a vet cardiologist. She was fairly well regulated before starting budesonide, and it made no difference to how she used the insulin. I did not have to change her insulin dose as a result. Budesonide works more locally, so on the GI system. It reduced Neko's bowel wall thickness, made her poops easier too.

I've heard of people saying that Visbiome has helped diarrhea. In Canada you can only buy the Visbiome unflavoured pouches for humans. Dose is quite small. Depending on cat size it's like 1/8tsp a day. A pouch lasts a long time. Ileus can also cause diarrhea.

Tylosin also is awful tasting. You will probably have to give in in gel caps if you go ahead with it.


Was that z/d? My vet calls it hydrolyzed chicken feathers. :p
Click to expand...

Okay that is great to know! I have found an internist and hopefully when I call tomorrow they can get him in ASAP.

Do you get Visbiome through their website? That is the only place I am finding it after a quick search.

Yep it was z/d lol. He used to eat those kibbles and wetfood no problem.
Then he got a whiff of regular wetfood about a year or so later and never touched the z/d again.
 
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