Help! Cat w/IBD and losing control of diabetes.

Jenni

Jenni

Member Since 2015
I'm back again....

Smudges is now being treated for IBD. I've had to change his diet to help IBD but now his diabetes is getting out of control. His BG numbers are rarely below 400 since the switch--mostly in the 500-600 range. He is also on Budesonide to help with IBD symptoms. The medicine and diet change are improving the IBD but I need to get a handle on his diabetes again.

I've recently increased his Lantus to 2.5 units twice daily and his BG barely changes throughout the day! The vet says I can increase to 3 units but I'm increasing it slowly. I don't want him to go into hypo again.

I can't believe his diet change makes this much of a difference. He has also lost some weight recently so I was told to let him eat as much as he wants to get his weight back up.

I'm freaking out! He has never received this much insulin before or had BG so high. Does anyone have experience treating both IBD and diabetes at the same time? I need some help!
 
What food are you feeding Smudges now? I dealt with IBD plus diabetes, plus CKD and a side helping of heart issues in Neko. She was also on budesonide. There are low carb novel protein canned foods out there. There is also a vast selection of raw foods with novel proteins.

Your spreadsheet seems to be different format now. I am having difficulty figuring it out. Are you still following SLGS? I see no recent curves, or even much mid cycle data and none from the night cycle. Without that data, i am not sure you needed the increases you have done. IBD and budesonide did not impact Neko’s numbers.
 
I agree with Wendy regarding your spreadsheet. It looks like you were using our spreadsheet back in 2015. If you started a new sheet, you likely didn't copy the formatting.

I have an IBD cat. Gizmo isn't diabetic but there are appropriate foods out there and, frankly, I feed him like he's diabetic -- all low carb. I found this website, Raw Feeding for IBD Cats, to be incredibly helpful. Even if you opt to not put your cat on a raw food diet, there is a great deal of information on the website and they have a Facebook page, as well, where people are likewise helpful.
 
Jones was IBD and diabetic - there are options out there for LC and high protein. Novel proteins. Jones was on Nature's Variety Rabbit (contains pork) and Rawz Turkey.
 
Diet can make a huge different in BGs because the carbs really vary, 2 of our FDs that were diagnosed with IBD actually did well on DM and m/d (MANY trials and errors to find foods that worked for them!). Manny can only eat DM or he gets terrible poop, Tinkerbell did well on the m/d for quite a while, if we fed her anything else for more than a meal or two her IBD would flare. DM is good in carbs, m/d not as good but still not crazy high, I think it is like 13. I my reading, raw and novel protein are the some of the best diets for IBD.
My guess is the Budesonide is a contributing factor. It can be better for diabetics, but it is still a steroid. Our foster Percy was in remission and that threw him out quick, now he is almost to 3U and getting higher numbers again.
 
Wendy&Neko said:
What food are you feeding Smudges now? I dealt with IBD plus diabetes, plus CKD and a side helping of heart issues in Neko. She was also on budesonide. There are low carb novel protein canned foods out there. There is also a vast selection of raw foods with novel proteins.

Your spreadsheet seems to be different format now. I am having difficulty figuring it out. Are you still following SLGS? I see no recent curves, or even much mid cycle data and none from the night cycle. Without that data, i am not sure you needed the increases you have done. IBD and budesonide did not impact Neko’s numbers.
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I took the conditional formatting off for color highlights and tweaked it for easier reading but the spreadsheet is pretty much the same. I also keep separate worksheets (tabs) for diet/notes and lab results with lots of information. I don't do as many curves as you guys do but I do follow vet instructions. Just yesterday I checked his numbers 3 extra times but they are so high right now and barely change that doing a full curve just doesn't seem helpful at this point.

He is eating Hills Z/D wet and Royal Canin HP dry as suggested by vet to control IBD. He was vomiting and had diarrhea episodes regularly before switching to these foods. Unfortunately, they are not great for diabetes. However, the vet recommends diet for the IBD to get it under control and increasing insulin to control the higher diabetes. He is also a very fussy eater when it comes to wet food. I'm just thankful he is eating any at all. He has always preferred kibble.

I just don't understand why his numbers are so much higher and stay that way. We also had to switch to Relion Premier Compact glucometer because they discontinued strips for the Relion micro. That may account for some of the change but it shouldn't be that much different.
 
Tracey&Jones- GA said:
Jones was IBD and diabetic - there are options out there for LC and high protein. Novel proteins. Jones was on Nature's Variety Rabbit (contains pork) and Rawz Turkey.
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Thank you for the suggestions. I will look into it and speak with the vet tomorrow.
 
Sienne and Gabby (GA) said:
I agree with Wendy regarding your spreadsheet. It looks like you were using our spreadsheet back in 2015. If you started a new sheet, you likely didn't copy the formatting.

I have an IBD cat. Gizmo isn't diabetic but there are appropriate foods out there and, frankly, I feed him like he's diabetic -- all low carb. I found this website, Raw Feeding for IBD Cats, to be incredibly helpful. Even if you opt to not put your cat on a raw food diet, there is a great deal of information on the website and they have a Facebook page, as well, where people are likewise helpful.
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Thanks, I'll check out the website.
 
I took the conditional formatting off for color highlights and tweaked it for easier reading but the spreadsheet is pretty much the same.
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For those of us who always open spreadsheets, we look more for the color coding than the actual numbers. It allows us to see the trends in numbers. You can't easily see the trends without the color coding.
 
ZD is also a poor choice food. It is 35% carbs. :eek: Rawz also makes a pure rabbit pate, and Koha does now too, if rabbit is a food he can eat. If he likes the crunch, you can get some freeze dried raw novel proteins that are low carb. Several companies make a pure lamb canned food product, venison might be another option that is readily available, as is duck. Do read the labels carefully as man6 will sneak some chicken in. Rawz, Ziwipeak, Nature’s Variety, Koha have some unique protein canned foods. Have you determined through an elimination diet which proteins trigger the IBD flairs? Sometimes wheat/gluten or other products can be triggers.

Another good thing to add to his food is a probiotic. I use Visbiome, designed specifically for IBD and they have pet products, though I just use the human powder sachets.

One last question, how was the IBD diagnosed? What tests were done?
 
Wendy&Neko said:
ZD is also a poor choice food. It is 35% carbs. :eek: Rawz also makes a pure rabbit pate, and Koha does now too, if rabbit is a food he can eat. If he likes the crunch, you can get some freeze dried raw novel proteins that are low carb. Several companies make a pure lamb canned food product, venison might be another option that is readily available, as is duck. Do read the labels carefully as man6 will sneak some chicken in. Rawz, Ziwipeak, Nature’s Variety, Koha have some unique protein canned foods. Have you determined through an elimination diet which proteins trigger the IBD flairs? Sometimes wheat/gluten or other products can be triggers.

Another good thing to add to his food is a probiotic. I use Visbiome, designed specifically for IBD and they have pet products, though I just use the human powder sachets.

One last question, how was the IBD diagnosed? What tests were done?
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He was a number of foods prior to getting really sick with regular diarrhea and vomiting last November. His BG numbers were pretty good then. He has a long history of vomiting (usually after eating wet food, but not always). He was getting Wellness Chicken & Herring wet and Evo dry. Because EVO doesn't exist anymore we had to switch. He was getting Dr. Elsey's Clean Protein dry and loved it but like I said he was vomiting more frequently and had prolonged diarrhea. He had an ultrasound which showed thickened intestines but it was not conclusive that he has IBD. I also had to rush him to emergency multiple times because he was going into hypo. His insulin dose was too high.

The vet felt it was likely that he has IBD and recommended treating him as if he does to see if that would control his symptoms. In that respect, the change in diet is definitely helping. He threw up a very small amount and had a little diarrhea two days ago but other than that, nothing remarkable. Prior to the diet change, vomiting/diarrhea frequency had increased. Last summer, multiple blood tests showed signs of kidney disease but he just had another blood test a couple of weeks ago and kidney levels were back to normal.

He was really sick several weeks ago for about a week and his weight has been fluctuating so I don't want to mess around with his diet too much but need to get his diabetes manageable again. I keep meticulous notes in his spreadsheet on the diet/notes tab.

I sprinkle Fortiflora on the wet food primarily to get him to eat it. He is just not a fan of wet. We have changed vets to someone I trust. She believes (based on his symptoms and how sick he got recently) that is was more important to get the IBD under control and increase the insulin as needed. That totally made sense to me. But now, I need to get his BG back on track while ALSO keeping him on a diet that does not aggravate probably IBD.

Content from ultrasound on 11/28/18:
Markedly thickened small intestines with maintenance of normal wall layering. Right kidney looks consistent with chronic kidney disease. Could not follow ureter out on ultrasound--no stones identified in ureter. No evidence to support deterioration of kidney function due to obstruction.
 
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Just received the following response from my vet:

It is not abnormal for a cat of Smudges size to need 4-5 units of Insulin twice daily (sometimes more). I recommend 3.5 units of Insulin twice daily (you do not need to increase in .25 increments you can just go to 3.5 units).

This doesn't sound right to me. I'd rather make an adjustment to his diet that will be good for both IBD and diabetes. I'm not comfortable giving him such high doses of insulin, especially all at once. This just doesn't seem like the best solution.

Last night, I gave him mostly Clean Protein dry with a little of the Royal Canin HP and his AMPS BG was 401. That is a considerable decrease from what it has been lately.
 
I would not do an increase in dose and change diet at the same time. I would stick to your current dose. Though we do need some mid-cycle tests to ensure what he is doing when making that change in diet. You may see he needs less insulin not more.

I forgot to ask if he was on any medication for the IBD.
 
You might want to keep a log of what proteins you are feeding each day, and any resulting vomits/diarrhea. That helped me figure out what proteins were no longer any good. Chicken, fish, and beef can be common allergens. Another way to decide what works is to feed just one protein for a couple weeks, then gradually add in a second one, etc.

It can take a few days to see the full effects of removing the higher carbs. Like the progress so far. However, removing higher carb food can have a drastic change on insulin needs. I strongly getting a few mid cycle tests in the next several days. I once sat up with a member who went fro 5.5 units to zero over the space of a couple days when she removed dry food from the house. Testing kept her cat alive.
 
Okay so I just got off the phone with my vet. I am going to wean him off the HP dry and transition back to Clean Protein for a bit. I am not going to increase insulin at this point. If he starts vomiting/diarrhea after a few days then I know he needs something else. She recommended trying Young Again LID Zero for Mature Cats Dry because it is limited ingredient with hydrolized protein. Does anyone know if that is low carb? I've heard good things about Young Again but welcome any thoughts about this. Still need to find a good wet food too.

She said his weight loss may be due to not getting enough insulin while his BG is so high because the body is eating it's own muscle basically. So I need to either increase insulin and maintain the IBD diet or keep insulin dose the same and monitor while switching diet to lower carb.

This whole situation is scaring the daylights out of me! I just want to do what is best for my cat and I feel like I'm failing miserably...
 
Tracey&Jones- GA said:
I would not do an increase in dose and change diet at the same time. I would stick to your current dose. Though we do need some mid-cycle tests to ensure what he is doing when making that change in diet. You may see he needs less insulin not more.

I forgot to ask if he was on any medication for the IBD.
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He is getting Budesonide oil for IBD
 
I'm not sure I understand the rationale for not increasing the insulin while you are changing food -- other than if the carb content is different. If the FD is not under control, your cat is likely to keep losing weight. Smudge will be hungry since the end product of what he's eating isn't getting into his cells. (All food is metabolized into glucose. Insulin helps the glucose get into the cells versus floating around in the blood. If the insulin isn't getting into the cells, your cat is literally starving to death no matter how much he's eating.)

Young Again LID is low carb. It is also primarily pork which may be a novel protein for Smudge. My kitty (Gizmo) has IBD. I give him a raw diet and alternate between pork and lamb. (I just ordered rabbit.) The other thing that will help with the diarrhea is a better probiotic than what you're using. ReNew Ultimate makes a very good probiotic. It's available on Amazon or at Whole Foods. You may also want to specifically get saccromyces boulardi (S. boulardi) which is a specific probiotic that is helpful in getting diarrhea under control. There's information on probiotics/supplements in the links I posted above on the Raw Feeding for IBD Cats site.

 
Sienne and Gabby (GA) said:
I'm not sure I understand the rationale for not increasing the insulin while you are changing food -- other than if the carb content is different. If the FD is not under control, your cat is likely to keep losing weight. Smudge will be hungry since the end product of what he's eating isn't getting into his cells. (All food is metabolized into glucose. Insulin helps the glucose get into the cells versus floating around in the blood. If the insulin isn't getting into the cells, your cat is literally starving to death no matter how much he's eating.)

Young Again LID is low carb. It is also primarily pork which may be a novel protein for Smudge. My kitty (Gizmo) has IBD. I give him a raw diet and alternate between pork and lamb. (I just ordered rabbit.) The other thing that will help with the diarrhea is a better probiotic than what you're using. ReNew Ultimate makes a very good probiotic. It's available on Amazon or at Whole Foods. You may also want to specifically get saccromyces boulardi (S. boulardi) which is a specific probiotic that is helpful in getting diarrhea under control. There's information on probiotics/supplements in the links I posted above on the Raw Feeding for IBD Cats site.
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Why would I increase insulin if I'm switching back to a lower carb food? That would send him straight to hypo.
 
She indicated that Smudge was on Hills Z/D wet and Royal Canin HP dry if she is switching to a LC options for wet and going back to Dr. Elsey's - there will be a carb% drop in there.

Plus the suggestion was to increase to 3.5 from 2.5u...that is too huge an increase while converting to LC.
 
I think there is a lot of confusion about data provided. He is currently receiving 2.5 units twice daily. I am NOT going to increase it. I started giving him the Clean Protein dry last night and will continue with that and Z/D wet until I receive the Young Again Zero LID Mature (order just placed).

I am monitoring his BG more closely today--his numbers are already lower and more reasonable. I'm more than a little scared about what insulin doses will be like once he receives YA Zero since it has zero carbs....

I still need to find a suitable wet food. He really doesn't like wet but I'm hoping that I can find something low carb that his IBD will tolerate to make up a majority of his diet.
 
Jones loved the YA - it just seemed a little concentrated for him and he ended up with diarrhea again. :(

If raw is not an option (which it wasn't for Jones as he would eat wet but not raw) then try to find a wet with limited ingredients (single source protein) and doesn't have all the gums in it. That is why I liked the Rawz.

Have you tried any freeze dried raw? Maybe the texture would be more to his liking?

Jones liked it and he did well on it but he was a grazer so you can't leave it out that long.
 
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YA is not zero carbs, more like 5%. It’s a marketing term. Still LC though.

As Tracey mentioned, the various gums in wet food for preservatives can also be a trigger for IBD. As can carrageenan. You have to really look at the ingredient lists.
 
Tracey&Jones- GA said:
Jones loved the YA - it just seemed a little concentrated for him and he ended up with diarrhea again. :(

If raw is not an option (which it wasn't for Jones as he would eat wet but not raw) then try to find a wet with limited ingredients (single source protein) and doesn't have all the gums in it. That is why I liked the Rawz.

Have you tried any freeze dried raw? Maybe the texture would be more to his liking?

Jones liked it and he did well on it but he was a grazer so you can't leave it out that long.
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I have never tried freeze dried food. Smudges is definitely a grazer. It's been impossible to get him down to eating set meals. He likes to eat a little then come back and eat a little more, then come back and eat a little more....

I like to give him wet food in the a.m. and p.m. and just leave a little kibble for overnight but this has been impossible with all that is going on. Right now, I need to increase his weight by 1 lb and find foods that he likes and are good for both diseases. Finding the right diet has been quite a journey of ups and downs since he was diagnosed diabetic. It is so frustrating and heartbreaking! I will never give up on him. He turns 18 this month!
 
I've been researching some of the wet food suggestions. But for various reasons, I'm not finding an option that I'm thrilled about (availability, quality, limited ingredients, cost, etc.) I want to stick with a canned novel protein wet food option that is low carb, high protein and limited ingredients. It has to be something that is not going to irritate IBD but is appetizing to a fussy eater. It would be great to find something locally so if he doesn't like it, I'm not stuck with a case of it. It would also be great to find something reasonably priced but I'd sacrifice that for quality.

Was thinking about Natural Balance LID but they recently switched their formula to include pea protein. Not thrilled about that but it's a lot easier to buy than some of the other choices.

I did order the Young Again Zero dry for mature kitties today. Gotta wait for that to arrive. I want to find a good wet food to try right away. I feel stuck...
 
I got four paws down on pea protein at home. The Nature’s Variety LID recently added pea protein and is apparently inedible now. :rolleyes: I too am a fan of the Rawz.
 
It can be extremely frustrating to get the right food....which is the one they will eat and not set off an IBD flare. Jones did not do well with the pea protein.

Where are you located? Maybe see if someone would be ok with bringing something in.
 
Thankfully, his BG is at a more "reasonable" level. Stayed below 400 all day. I just did his PMPS at 320. i only gave 1 unit of insulin and hope that is okay. Will stay up very, very late and test again in about 4 hours or so....

I'm in Madison, WI so there should be a great deal of pet food store options but there really isn't when it comes to this. Choices are limited. I did look up Rawz. From what I could tell they only sell to a limited number of retailers (vet clinics). The food is not available online either. And why are dandelion greens in cat food? Some foods include turmeric and ginger. WTH?!
 
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ZiwiPeak has some novel protein varieties (e.g., venison) and has no gums, carrageenan, etc. I'm not sure if they discontinued their rabbit variety. It also has more texture than some of the other pate style foods.

For a grazer, several of the automatic feeders have space for an ice pack in the bottom.That would allow for Smudge's food to stay cool.

(I was asking about if your goal was to drop the carb count. I wasn't clear if you were doing one thing at a time or not regarding food vs insulin.)

 
Jenni said:
I'm in Madison, WI so there should be a great deal of pet food store options but there really isn't when it comes to this. Choices are limited. I did look up Rawz. From what I could tell they only sell to a limited number of retailers (vet clinics).
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Their store finder shows lots of stores in Madison. At least one of them will deliver to your door. Generally you have to go to smaller or independent stores to buy the product. I have never seen it in a vet clinic here.
 
Wendy&Neko said:
Their store finder shows lots of stores in Madison. At least one of them will deliver to your door. Generally you have to go to smaller or independent stores to buy the product. I have never seen it in a vet clinic here.
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I will have to look again. When I put in my zip code it said the closest store was Indiana.
 
Okay, starting new diet today! Exciting and scary. I do have questions.

The Young Again directions say to cease all previous food completely. This is contradictory to every instruction I've ever heard of to mix in small of amounts of new with previous food to introduce it slowly to avoid stomach upset. What would be the reason for going cold turkey? I'm still going to mix in a little Clean Protein to be safe (plus I don't want it to go to waste).

I also bought some Rawz Rabbit and Duck pates. He seems to love the rabbit so far. But if should only eat a total of 1/4 cup of YA per day, how do I adjust that if he is also eating Rawz? He is not going to be happy about this. He loves to graze and is an absolute HORROR to live with if he doesn't have access to food upon command. Right now, he needs to gain about 1 lb so I'm not too worried about overeating but I need to get an idea of how much of each I should be feeding him normally. I hate this.... :-(
 
How much does Smudges weigh? Dr. Lisa has a formula for number of calories per weight of cat. Of course that varies based on activity level of the cat too. Though Neko was 13-14 lbs, she maintained her weight on about 200 calories per day. Look at the number of calories in a 1/4 cup of YA, and see if it makes sense for what he needs. Combine the calories for the wet and dry you are feeding to make sure it’s what you need to give.

I can’t think of a reason to immediately stop feeding other food besides YA, other than helping the bottom line of YA. I think those that feed it here do it as a supplement. I would make small changes to avoid tummy upset, especially in an IBD cat.
 
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