Help for 13 yr old Flash, urinates everywhere:

[Flash's human]

Hi, my male cat, Flash, of 13 years had diabetes for 4 months, no ketones, and he was put on insulin w/a low carb, high protein diet eating mostly Purina DM diabetic food. Then, it went into remission, but it came back 5 months later which my vet said is possible so back to giving him insulin. During this time, he has drank lots of water and urinates on counters, couches, beds, etc. Even though he can reach the litter box and fills that as well, he seems to fall asleep and simply doesn't view his bladder being full as an issue. Does having a 2nd litter box, so 1 on each floor of a house possibly help w/this issue? Also, he has early signs of kidney failure(renal disease) as well, so I'm not sure if anything can really be done as you can't put a catheter on a cat.

Please advise if anyone has dealt w/something similar, thanks.

 

[Veronica & Babu-chiri]

Hi and welcome!

Dealing with an unregulated diabetic cat can be challenging, but once they are regulated they usually go back to their old selves.

Also for what you mention there may be some other issues at play here, what are his blood glucose levels? Are you testing at home? Do you have any blood glucose levels test results? What stage of chronic kidney desease CKD ( or kidney failure is he)? What are his creatinine and phosphorus levels ? If you could also post his lab results that would also help

Has an urine culture been made to rule out any urinary infection (UTI) ? This one is important since some of the behavior you are describing does point to an UTI which is common in diabetic and CKD cats

He could also have a neuropathy even if is a mild one since que still appears to be walking normally, this neuropathy is also common in diabetic cats but it usually gets better once the blood glucose is regulated and it helps a lot to give them zovaline (a B12 and folic acid supplement)

 

[Idjit's mom]

Hi and welcome to FDMB. It would be very helpful if you would make a signature so kitty's pertinent info is available when you post.
(light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished.
Another thing that will help us help you if you are/when you begin BG testing at home is to set up a spreadsheet like the one we use here. You will see how the trends and patterns emerge, and members can review his/her progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
We can help you check on the carb % of the food he's on right now and perhaps there would be other food that would be a better low carb choice.
We have 3 litter boxes indoors, because it's a bigger house. One upstairs, one on the main floor on the back end of the house and one in the front bedroom. I'm sure that's overkill, but Idjit kept returning to the previous pee spots and would wet there in revenge for not being let outside in the early AM hours. We did use the enzyme cleaners and put sheets of cheap foil on the "pee places" which worked remarkably well. We got rid of the clay clumping litter and now use Okocat clumping litter. Lighter weight, no odors/dust and he likes it better. He's been extremely compliant since the change in litter.
Poor little Flash, I bet he doesn't like wetting on himself anymore than you like cleaning up.

 

[MindyC]

I could probably write a book about litter box issues between my two cats. Max, the diabetic, likes to pee in the bathtub when he's boycotting the litter box. I'm not entirely sure why, tho it is certainly easier to clean up there. Anyway, we have kidney issues along with the diabetes at this point, and we've recently had improper urination behavior too. What you're describing sounds an awful lot like how he was before the first diabetes diagnosis 9 years ago--like he suddenly had to go and couldn't get to the box. Or like he didn't know he wasn't IN the box when he went. Getting him regulated fixed that back then. This go round, we don't have him well regulated, though he's showing all sorts of signs of improvement. I suspect his litter box issues were/are neuropathy-related. I started him on Zobaline about a week ago, and we haven't had any issues of peeing in the tub since (he's also started traveling through more of the house, going down to the basement again, and jumping into our bed--hasn't done that in months!). The prevailing wisdom from this board indicated he probably had trouble balancing in the litter box since he was peeing on hard surfaces. Sounds like this might be your kitty's issue too.

It could also be a urinary tract infection and he's peeing outside the box to get your attention.

A second litter box could help. We have two cats, and for their entire lives had 2 boxes in the basement. About 6 months ago we moved one up to the main floor of the house for Max--he's just getting old and slowing down. He stays on the main floor because it is warmer, the boxes in the basement were too far to get to.

And last, but not least, my Truman (non-diabetic) is on a daily dose of Prozac due to inappropriate urination. 7-ish years ago we brought home a puppy he did not get along with, and I tried to change from non-clumping clay litter to wood pellet litter (more environmentally friendly). He hated the dog, and hated the litter, and started peeing all over the basement, ruining several pieces of furniture. The basement was unfinished and basically storage, so we didn't know what was going on or where the smell was coming from for a long time. Needless to say, we'll use the red-bag Tidy Cats non-clumping litter until he leaves this earth, and we rehomed that puppy after a year (there were other issues, but don't worry, she made out well with the change and has a lovely life with people we know). Prozac was and continues to be the only reason that cat continues to use the box appropriately. If his box goes too long without being changed, tho, he'll stop using it.

 

[Flash's human]

Hi, I know it's been awhile, but I wanted to make sure I had something to report before posting and get my signature done. So, the okocat litter is amazing! Thanks for that suggestion and the 2nd litter box as clumping litter stays on his paws for a long time and is SO much heavier compared to the wood pellets that I would never go back to fresh step clay littter after this. I'm not sure what I can do about him living in the kitchen, his life has truly become staying close to his water and food dish which is so sad to me since he used to be constantly moving around and especially in the spring time he would be at the windows looking outside. Also, I do walk him on a leash at times which he still enjoys of course. However, he urinates all around and vomits every few days, usually clear liquid due to draining the water dish so often and drinking from the faucet. Also, he has trouble jumping on the counter at times, believe his arthritis is getting worse in back legs though realize that could be tied to kidney AND diabetes issues. His urine was checked, no UTI. Honestly, he just seems like an older, slower version of himself. I know the vet has somewhat of a conflict of interest in advising further tests and determining quality of life, but I have to really consider he may just never get better. This may be his new normal which is sad and gives me pause if I could ever go through this w/another animal, just watch them slowly degrade. My wife and I agree he's not the same, and I want to be hopeful if the vet says move him to 6 UI twice daily, that will be the panacea here, just not sure how likely that is. Prozac would be great, but I really think he falls asleep w/a full bladder on a counter and wakes up w/o even realizing he peed on it the counter since he's just so tired from fighting off the diabetes and renal failure symptoms, so not convinced drugs will help the situation. Cleaning up messes has definitely put a strain on the family though I try to remind them it's part of the deal when you accept an animal, the good w/the difficult times. And, on vet advice, we have been slowing moving him up in insulin dosage from 2 - 5 UI over a month since he has gained some weight as he stopped being ravenous. Since he's only been at 5 UI for a week, I'm not sure if that's the enough time to get him regulated though I think he'll top out at 6 UI since he did that the first time he had diabetes back in 2018.

 

[MindyC]

Hi, I know it's been awhile, but I wanted to make sure I had something to report before posting and get my signature done. So, the okocat litter is amazing! Thanks for that suggestion and the 2nd litter box as clumping litter stays on his paws for a long time and is SO much heavier compared to the wood pellets that I would never go back to fresh step clay littter after this. I'm not sure what I can do about him living in the kitchen, his life has truly become staying close to his water and food dish which is so sad to me since he used to be constantly moving around and especially in the spring time he would be at the windows looking outside. Also, I do walk him on a leash at times which he still enjoys of course. However, he urinates all around and vomits every few days, usually clear liquid due to draining the water dish so often and drinking from the faucet. Also, he has trouble jumping on the counter at times, believe his arthritis is getting worse in back legs though realize that could be tied to kidney AND diabetes issues. His urine was checked, no UTI. Honestly, he just seems like an older, slower version of himself. I know the vet has somewhat of a conflict of interest in advising further tests and determining quality of life, but I have to really consider he may just never get better. This may be his new normal which is sad and gives me pause if I could ever go through this w/another animal, just watch them slowly degrade. My wife and I agree he's not the same, and I want to be hopeful if the vet says move him to 6 UI twice daily, that will be the panacea here, just not sure how likely that is. Prozac would be great, but I really think he falls asleep w/a full bladder on a counter and wakes up w/o even realizing he peed on it the counter since he's just so tired from fighting off the diabetes and renal failure symptoms, so not convinced drugs will help the situation. Cleaning up messes has definitely put a strain on the family though I try to remind them it's part of the deal when you accept an animal, the good w/the difficult times. And, on vet advice, we have been slowing moving him up in insulin dosage from 2 - 5 UI over a month since he has gained some weight as he stopped being ravenous. Since he's only been at 5 UI for a week, I'm not sure if that's the enough time to get him regulated though I think he'll top out at 6 UI since he did that the first time he had diabetes back in 2018.

I noticed in your signature that the vet is recommending not testing. Why is that? I ask because 5U is a high dose, from what I understand. It may be overdosing him, especially since his symptoms have not lessened. Have you posted in the Lantus forum? There is a lot of experience and wisdom there.

We're still dealing with Max not always using the box, and have started leaving puppy training pads in the now 2 places he pees in the bathroom...but his failure to use the box has been a combination of a urinary tract infection (that was diagnosed/treated 3 weeks ago) and not having his sugar regulated yet, so the litter box gets too wet (we cannot use clumping or pine litter due to the other cat's preferences ). We have an appt with the vet this afternoon to hopefully get his insulin switched to Lantus--this vet is being kind of a pain about it. If I have to, I'll make the change without the vet, but we're going to try to place nice first.

 

[MindyC]

Also...have you checked the food charts? I don't know what the Purina DM runs, but if it is high carb (is it dry?) food, it could also be the root of not getting your kitty regulated.

 

[Dusty Bones]

Hello, until you get him on a low carb food like Fancy Feast or Friskies Pate style foods you're just spinning your wheels. I would have him checked for a UTI and then switch his food. Be careful though because once you get on a low carb food his insulin needs will drop dramatically, that's why you need to do some home testing.

 

[Flash's human]

Hi, purina dm is low carb wet food. Reason for vet not testing at home, im guessing is he was on 6 UI last yr since he is 14 lbs. I will get him tested in a few days. My basic question is, does insulin in ANY way reduce the amount of water he drinks or is renal(kidney) issue to blame for that? At times, he simply falls asleep and pees wherever he is which is putting a strain on the family.

 

[SpotsMom]

If he’s falling asleep and peeing I would be strongly suspicious that he’s getting way too much insulin. The only way to know that is to home test.

 

[SpotsMom]

I realize that you are resistant to home testing because your vet said no, but many of us faced that same dilemma when we came here and many realized only by having bad things happen how wrong the vets are to not encourage it. Curves at the vet are simply not enough to bring a cat to regulation. I truly hope you reconsider in order to give your cat the best chance.

And to answer your question, a regulated cat will not generally pee as much.

 

[MindyC]

I have to agree—the only way to know what is happening is to home test. The vets at our office have told me doses twice that were too high. Lantus doesn’t dose by weight either, I don’t think. A typical dose for any cat is somewhere around 2U twice/day. I did get our vet to switch us to lantus this afternoon, and we’re starting with a 1U dose. Max is 8.5lbs at the moment. 9 years ago when he was first diagnosed he was 11-12lbs healthy, and still was only on 2U. A dose higher than 5U would be concern that there is more than just diabetes going on.

Max also has chronic kidney failure, which is why we initially missed the diabetes relapse. He drinks more than average because of the kidneys, he’s drinking a lot more now with the diabetes. The peeing in the bathroom instead of the litter box for him at this point seems to be related to his litter box being too wet. He is not having problems peeing in his sleep or because he’s failing to make it to the box in time.

Ask over on the Lantus board, because I’m still very new at this (again), but I’d be tempted to go back to a 1U dose if it was my kitty and test, test, test. Read the dosing protocols over there and try to sort your kitty’s dose based on his home test results. The people on that board will help you (and they know a LOT). It’s difficult to go against what the vet is telling you, but they routinely fail to dose insulin correctly because they aren’t testing and observing them regularly the way we do at home. It sounds like he’s miserable and so are you—you have the power to change that.