Gallstones, hyperthyroidism, diabetes, blindness and so many tears.

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Thaiger & Katie

Thaiger & Katie

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I feel like I have hit the lottery with finding this forum and reading through the love and support here.

The past two months have been hell. My 16 year old child was in the ICU for two days with a blockage from what was determined to be inoperable gallstones. No sooner did I get her home only to find out she was hyperthyroid. She has been on felimozole for a month now, daily vomiting has stopped, and she has been gaining weight... then the peeing started and the outrageous water intake and yep, we are now borderline diabetes with blood fructose high normal?

The vet left me a voicemail today saying she wanted to change her diet and start insulin. I am so stressed out and overwhelmed. My baby doesn't deserve this, is it cruel to have her live with this many ailments? Would a change in diet possibly send the borderline diabetes into remission without having to start insulin? Is anyone else dealing with both hyperthyroidism and diabetes? My heart breaks for her in having to deal with all of these and the weekly vet visits. Ughhhh. Help me!
 
A change to a low carb, canned diet could help by 100-200 mg/dL if you are currently feeding high carb canned or dry foods. There is a terrific food list at Cat Info. That web site is written by Veterinary Lisa Pierson. I feed all mine Friskies pates - ex. Turkey and Giblet, or Poultry Platter.
 
Hi Katie and extra sweet 16 year old sweetheart! Welcome to the best place you never wanted to be!

Diet change can indeed lower blood glucose and change the need for insulin. If she needs insulin, it's no big deal - we all do it daily. Diabetes isn't a horrible thing - there's lots worse stuff! Sounds like she's got lots happening but I know we have members that can help with all of it. What's been her diet? I'll clue you in tho' - the 'diabetic' foods most vets sell is high in carbs, not what diabetics need.

HUGS! And welcome again!
 
Thank you both so much! Vet is out of the office until Wednesday morning so I plan on reading as much of this forum as I can to go in there armed and ready!

Thaiger (pronounced Tiger) has been on every food imaginable. I adopted her about 4 years ago and she had always been a vomiter so we went through several foods trying to get it right. She stopped eating and drinking which brought her to the emergency vet two months ago and they found the gallstone. In order to get her to eat, they told me to feed her anything she would eat so she went from expensive science diet to the Iams digestive care that they were feeding her at the emergency center (Dry food). Between that food and her felimozole, she has not thrown up in about a month. This is a huge win for us as she was vomiting up to 3x per day prior.

She started hiding from me with the pilling so I've been crushing one pill into half of a mini can of pro-plan wet food daily. She loves the wet food.

So right now, she free range eats the dry Iams digestive care (bright pink bag) and has half a mini can of pro-plan wet food with her pill every day.

Not sure what the vet is going to suggest when I speak to her Wednesday. She didn't give me numbers but said her frutosimine was high normal levels. We've been having basically weekly blood drawn trying to regulate the hyperthyroidism and her glucose has been all over thE place. The vet thought it could be from the stress of traveling to the vets office (she is blind and hates leaving her house) and wanted to run the frutosimine sample for more info.
 
Check out the following low carb dry, too:
Evo Cat and Kitten
Epigen 90
Young Again 0 Carb

Any food changes should be made slowly - 20-25% per day or two - to avoid GI upsets.
 
Hi Katie- Take a deep breath--and another!! :bighug::bighug: My female kitty's name is Tiger too :cat: My Tiger was diagnosed with hyperthyroid and diabetes last year.

Our vet got us on wet food right away, Purina DM canned, but since your Thaiger has gallstones, I would think any food changes would need to be even more carefully and slowly done. I can sure understand and empathasize with how yucky she must feel. I had my gallbladder removed almost 5 years ago- so I know that eating fatty foods, for example, made me feel like vomiting. Even after surgery, my diet had to change dramatically. Has your vet discussed the use of Ursodiol at this point?

You are doing a great job if you can pill your Thaiger, great job! I had no such luck(we were prescribed Tapazole) trying to pill my Tiger and since I knew this would be a lifelong need for medication and it also caused gastrointestinal upsets, at our vet's suggestion, I opted for the Radio-iodine 131 treatment in March of 2014. With any kind of luck, once you can regulate Thaiger's hyperthyroid, her blood glucose numbers will come down as well. Please keep us posted as to how she is doing--:bighug:
 
My cat had gall bladder issues and liver issues and would throw up a few times a day. I found that after he started ursodoil he improved a lot. He also had to have ongoing treatment an anti nausea medication ondansetron. You might like to discuss both of these with your vet.

When remi got diabetes I switched him over to a low fat, low carb high protein food (called thrive). So far it seems to be okay for him (anti jinx). I'm afraid it is a matter of trial and error but hopefully you will get the mix or medication and food right and thaiger will begin to feel better.

Have a look at all the links in the health section especially the one on home testing
http://www.felinediabetes.com/FDMB/threads/nutrition-diet-links.115/
 
By the way - what country are you in? Some foods suggested may not be available in the US (The ones I listed are!)
 
Morning everyone! I'm in the US - Atlanta, GA.

Thai was on ursodoil for a few week but would barely get up and walk - only to run away from me when I came into the room. The liquid administration was very traumatic for both of us. The vet opted to take her off of it since she had become so depressed and lethargic - her mood improved greatly within a week of getting off of it. The vet wanted to get the hyperthyroidism under control before we addressed the gallstones again. But now with diabetes looming - i'm not sure what the game plan is to manage all three.

Thanks for the kudos on pilling my cat - but I don't. :D She hides the pill somewhere and I find it spat out on the floor hours later so now we crush the pill into wet food and there are no problems with her taking it.

I'll be stopping by the store tonight to buy some of the suggested wet food and start weaning her off of the dry and get her on a better diet! I hope this can curb the need for insulin since she is not completely out of the normal range with her sugar levels just yet. I hate putting her on more and more medication!
 
Hello Katie and Thaiger, and welcome to FDMB :)

Have I understood correctly that the fructosamine test showed the blood glucose to be in the higher end of the normal range?
If that's the case then I would guess there is much to be gained by transitioning Thaiger to a lower carb diet. That might be all she needs to keep her in a better blood glucose range...
Keeping fingers and paws crossed for you both....

Hugs,

Eliz
 
Thanks Eliz - you are correct, higher end of normal range with glucose levels all over the place. Talked to the specialist today about possibly only changing her diet but they are insistent that there is more to be gained (possible remission) if we combine that with insulin therapy? I don't know enough about the subject yet I guess. I will be buying a glucose testing machine ASAP to start testing at home and see what is going on with my own eyes.
 
If you have the opportunity it is easier to carefully switch to a low carb wet food before you start the insulin and the base the starting dose on the newer hopefully lower numbers. Obviously this wouldn't be good if he was suffering from diabetic ketoacidosis.

With regards the glucose numbers did they test for pancreatitis? That can raise blood glucose and make them terribly sick. Before remi was diabetic he was throwing glucose into hi shrine when he had a pancreatitis flair.
 
Many of us use the Wal-mart Relion Confirm or Micro human glucometer for testing our kitties BG (blood glucose) levels. We have reference ranges for felines using human meters. The pet specific meters like the Alphatrak are very expensive, the test strips are expensive, and the availability of the test strips are limited.

We have tips for testing if you are interested?
 
Definitely!! I actually just picked up the Relion Micro machine with the micro thin lancets (said 33 gauge - is that too small?). I've been browsing for the glucose conversion scale since the machine I have is for humans. Haven't happened upon it yet so if someone has it handy, that would be great! I read the tips on heating the ear and how to look for the vein and I must admit, I am petrified and freaking out about hurting her or messing something up! I did pick up some Friskies Pate Classic for her as well and will start on that tonight with her nightly felimozole.
 
Guuuuys... I'm the worst.

Practiced using the lancet pen on myself with a 33 gauge needle, it smarts a bit but not bad I guess. Got enough blood with it out of myself for a test.

I then attempted to use it on Thai. She wasn't a huge fan of me holding onto her ear but didn't fight as much as I expected from her. I tried three, yes THREE times and didn't get any blood. Not even the tiniest bit. I feel like such a jerk for stabbing her three times and not even getting what I needed.

I read the page on how to get blood from the ear but I just didn't succeed. I couldn't bring myself to do it to her a 4th time.
 
Don't get discouraged, and take some deep breas-- it takes a bit of time for the ear to learn how to bleed and it is best to quit after 3 pokes or so in one session. It will get better!
Do you have treats, low carb treats such as Pure Bites? Offer a treat, and praise her after every test, regardless if you get blood or not.Thaiger will soon learn to associate test time with treats. Did you warm the ear- many use a baby sock filled with rice heated in the microwave. I use my hands. 33 gauge is pretty small- I use 30 g.lancets but most people here have found 29 works better as it is a larger tip.
 
If you absolutely have to get blood, aim for the vein. Just be prepared to snag a drop on a clean fingernail and blot firmly as it tends to bleed quite freely.
See my signature link Glucometer Notes for information on glucometers, measurement, and feline-specific reference ranges.
See my signature link Secondary Monitoring Tools for additional assessments you may wish to make.
 
The vet is starting us on 1 (dose? Not sure what the correct measurement is) of prozinc insulin 2x a day starting with Friday. She is also insisting that I start switching the diet to the Purina DM wet food at the same time (am I putting any risk on my kitty if I ignore this and do the Friskies pate?).
 
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We express insulin doses in U or units.

No, you are not putting your kitty at risk by using the Friskies pate style foods. Just don't use the other styles of food like the Grilled, Shreds, etc as they are too high carb for your extra sweet kitty.

The Purina DM wet foods is relatively low carb, around 4-5%. It's a good food for a diabetic cat. The reason we suggest other low carb food options are many fold.

1. The Purina DM is expensive. Many commercial foods such as the Friskies pate style and Fancy Feast pate style (USA versions) are also low carb and readily available and much less expensive than the Purina DM.
2. Many flavors available in the commercial foods. Only one flavor of the DM.
3. Purina DM quality of ingredients is no better than the commercial foods. Liver as first ingredient in DM.
4. Many cats seem to get tired of that liver flavor pretty quickly and then refuse to eat. We think it's better to offer your kitty a choice of flavors.
5. Availability of the DM is limited. What if you run out of food and your vet isn't open? Then what are you going to feed?
 
We had our first vomiting episode in 25 days, tonight. Not hairball vomiting, food regurgitation and bile vomiting. This is what led to the hyperthyroidism diagnosis. We're still working on regulating the hyperthyroidism so this diabetes deal is bad timing!

Figured I would share a picture of my sweetpea getting extra lovin' since she isn't feeling great!
 

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As the hyperthyroidism gets under control, you may need less insulin. It will be absolutely critical to home test while you are both adjusting the thyroid medication and the insulin.
 
I hit the vein today with an ear prick more near the top of her ear but didn't get enough blood for a test. Figured i'd leave her alone for another day. :(
 
Hiya Katie,

I'm a wee bit baffled that your vet wants to start Thaiger on insulin at this point. o_O

Are you going to be feeding Thaiger just the Friskies pate, or are you going to keep feeding some dry food also? As BJ mentioned in the first reply to your post; "A change to a low carb, canned diet could help by 100-200 mg/dL."

Folks here have found that, ideally, it's best to switch to a low carb diet before starting insulin. That's because the lower carb diet reduces the amount of insulin that is needed (and some lucky cats find out that they don't need insulin at all).
For cats that are already on insulin we recommend the diet is only changed to lower carb if the caregiver can test the cat's blood glucose at home.

It would be great if you could get the hang of hometesting, and I'm wondering how we can help you with that..?

I saw in one of your posts above that you tested yourself and it smarted somewhat. Please be reassured that it's not like that for kitties. There are very few nerve endings in the cat's ear. It's not at all like us testing one of our sensitive fingers.

The most common mistake I used to make (and still occasionally do) when trying to get blood is not to put sufficient pressure on the underside of the ear (opposite to where you're pricking). The lancet needs something to resist, otherwise it can just push the ear away. Some folks use a little piece of folded tissue or cotton wool against the underside of the ear. I usually use a finger tip (but have occasionally taken a sample of my own blood that way ;))
Massaging immediately below the ear prick can 'milk' out a little more blood.
And two ear pricks close together can produce enough blood for a test where a single ear prick might not.
Here's a link to a page of pics and info on hometesting that you may find helpful (I learned to test from this page when I was new and scared):
http://www.sugarpet.net/bloodtst.html

Whereabouts do you live? I'm just wondering if there is a member who lives near you and could help you with learning to test.

Don't feel discouraged, Katie. Sometimes these things just take a little time to learn. You are a great caregiver and you will do just fine.

Hugs,

Eliz
 
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Thanks for all of the tips! I did it - finally! Yay!

Tested just now and she is at 468... She has food down all day so i'm not sure when she last ate - though she hasn't been eating much in the past couple of days. She gets wet food with her thyroid meds at 8pm. I'm guessing 468 is extremely high? We go to the vet at 10am tomorrow to get her on insulin.

I do have a question that the vet could not answer for me. For the past couple of weeks, Thai has been peeing in the litter box and also outside of the litterbox on anything soft she finds on the ground (clothes, my gym bag, sometimes carpet). She had a urine test last week and there was no indication of a UTI and since she is peeing both in and out of the litterbox (guess it depends on her mood), the vet had no idea why except to question the litterbox cleanliness. I scoop out the litterbox twice every day (she has two litterboxes for one cat) and do a full litter switch once a week so I really don't think it's cleanliness (especially since she still uses it sometimes).

Just now I got home and one litterbox has been peed in and the other one is perfectly clean yet she peed across the room on some clothes that were left on the floor. Is this a diabetic cat thing? I have never had this problem with her before.
 
Thaiger & Katie said:
Thanks for all of the tips! I did it - finally! Yay!
Click to expand...
Congrats on getting that test, Katie! Excellent stuff! :)

Yes, 468 is a high number (and puzzling since the fructosamine test showed borderline diabetes, so there must have been some low numbers in the mix somewhere also).

One of my cats had a phase of peeing on soft things. A number of things were suggested to me, including that the cat may have had some discomfort with peeing and so sought out soft things to pee in.
Have you changed the type of litter recently? Or the position of the litter box? Do you have another cat that may have sprayed on the soft things, and Thaiger is trying to cover the scent maybe?
I'm sure others here will have other ideas.

Good luck with the vet visit tomorrow, Katie.

Eliz
 
Yes, this is a "diabetic cat thing". Excess urination (Polyuria or P/U for short) is one symptom of diabetes. You could think of this as having a very full bladder and not being able to make it to the litter box on time. Think stress incontinence as a parallel condition in humans. That very full bladder is why some diabetic cats go outside the litter box. It's often one of the signs that alerts an owner that something is wrong with their kitty and leads them to the vet in the first place.

When there is excess glucose in the urine, over the renal threshold (180-240 range) than the urine is also pretty sticky and the puddles are extra big.

Just like humans, having diabetes with unregulated, uncontrolled BG (blood glucose) levels makes our kitties thirsty (polydipsia of P/D). What goes in must come out.

I know you said you have 2 boxes. Adding another box in a different location, so your kitty has a shorter distance to go to reach a box when the urge to pee comes, may help out.

I don't think it's your litter. Scooping twice a day is good. I figure cats don't like a soiled toilet anymore than humans do, so when I go, I check and scoop the litter boxes too.
 
I guess I should have mentioned that the area she chose to pee in is further than both boxes from her normal domain (my bedroom). They are in completely seperate rooms as well - no other pets in the home... Nonetheless, I have now put out a 3rd litterbox in the area that she chose to pee today.. Hope that curtails it. I've been using the new Lightweight litter for about 6 months now so no abrupt changes recently.

Oh and @Deb & Wink - you are 100% right. She peed outside the litterbox a week or so ago for the first time and I promptly escorted her to the vet which is when the diabetes was found!
 
See my signature link Glucometer Notes for feline reference ranges using various meters and measurements.
 
Thanks @BJM! I have read the info in your links (SUPER helpful). I'm using the Relion Micro gloucometer so didn't think I needed to do any conversions - and I can see from your info that her levels are definitely high!
 
We have a protocol for using ProZinc here which you might find helpful. Controlling the glucose is your first step. Diabetic neuropathy may reduce the bladder control of your cat.
 
Reduce the control in the sense that she forgets where to go? She purposefully got down off the bed, walked into the room with the litter box and went to the far side of the room (away from the litterbox) to pee on the carpet. I have no idea what is going on with her, this is definitely new behavior that has been worsening over the past couple of weeks.
 
For inappropriate elimination, always go to the vet and rule out any medical problems.

Here is a list I compiled previously. Some of the items may not apply.
***********************************************************************
You might try an integrated approach using multiple options from the list below on a consistent basis:

* start with crating, using a medium large crate (30" long is big enough for cat and a litter box) until progress. She probably won't go where she'd have to lie in it ... but if she does, something is wrong and it may be medical.

* tarps and newspapers may be easier on clean up if you don't crate her

* feeding on a schedule and then placing her in the litterbox (maybe in a crate) within 15-20 minutes after eating, until she goes, then praising and letting her out.

* Feliway/Comfort Zone - friendly facial pheromones which reduce stress and may reduce marking behavior. Cheapest prices are usually on the net (ex http://www.LambertVetSupply.com ) I've used it and it helps.

* Cat Attract litter - supposed to help attract cat to litter box

* rule out arthritis or constipation - pain causes box avoidance

* watch if the other cats ever attack her in the box and if so, you may need to keep her separated from them. I've got one the others attack, completely unprovoked.

* littebox should be 1.5 times length of cat, litter cleaned frequently, but avoid really strong smelling cleaners as cats may avoid them due to the scent.

* you've got to get residual odors out from areas which were 'nailed'. If you don't get those spots thoroughly cleaned, any residual odor may trigger using the spot again. Enzyme based products such as Nature's Miracle, are the most likely to have success. Carpet may need to be rolled back and treated on the back side, plus treating the pad separately (or replacing the pad). It can require repeated applications.

* regular play sessions of about 15 minutes to reduce stress and promote bond with you

* reward desirable behaviors - if you see her use the box, praise and treat her

* put unpleasant textures in places she has peed to encourage avoidance

* read some of this author's books: http://www.catbehaviorassociates.com/ she's pretty good - ex "Starting from Scratch"
 
Put down some doggy pee pads and see if she'll opt to use those instead of the carpet. That might help narrow down where her discomfort might be. She might even be suffering from minor diabetic neuropathy and the litter box rim is too high.

You also want to make sure you use an enzyme cleaner and not a generic pet stain cleaner as cat urine contains uric acid that can only be broken down with enzyme cleaner. If the uric acid remains, the cat will smell that it's a place "okay" to pee in.
 
Went in to the normal vet to get the insulin and am now at the emergency vet getting bloodwork. No ketones in her pee but she has lost .5lbs in 1 week so they want to make sure she doesn't have a bileduct blockage again. Siggghhhh

Glucose was at 474 this morning but no insulin yet.
 
Good news is they didn't find anything so I get to start the first dose of insulin tonight. I have ProZinc and 29 gauge U40 syringes - is that the norm?
 
ProZinc is a decent insulin for cats; in most of them, 1 shot lasts about 12 hours. Pick a time to give the insulin which can be done 12 hours apart.
U-40 means there are 40 units in 1 mL. In comparison, U-100 means there are 100 units in 1 mL.
Starting dose should be 0.5 to 1.0 units.
Please test the blood glucose before you shoot.
If it is less than 200 mg/dL, wait 30 minutes without feeding and retest. If rising and above 150 mg/dL or above 200 mg, it is probably safe to shoot. With the 1st dose, you want to test about +5 hours after the shot to see how low the glucose is going.
If less than 150 mg/dL do not shoot; it is too low without test data to demonstrate it will be safe.

Here is info on handling Hypos. This is when the glucose goes too low. It can be fatal.
 
Thaiger & Katie said:
29 gauge U40 syringes - is that the norm?
Click to expand...
Yes those are noral U40 syringes.
You can use human U100 syringes but you have to convert to get the right dose of a U40 insulin.
filling a U100 syringe to the 2 1/2 unit mark with a U40 insulin equals 1 unit of the U40 insulin. Each 1/2 unit marking on a U100 syringe is 0.2 units of a U40 insulin.
You can get U100 syringes with 1/2 unit marking and yo can get thinner and shorter needle lengths. as thin as 31 gauge nad as short as 6 mm
 
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