Help! Poor Appetite and Losing Weight Fast Although Diabetes is Well Managed

[Ki Jai's Human]

Hi

I just discovered this forum - wish I'd known about it a long time ago.

TL-DR: Ki Jai has poor appetite and continues to lose weight though tests don’t show anything to explain it. He’s being treated for a triad + diabetes, though his blood tests show all are well-managed. He has probable diabetic neuropathy (back legs can’t support him at all).
I have to find a solution to his loss of appetite fast, or I’m going to lose him.

More Details:

Ki Jai is 13 years old. He has been treated for mild/moderate diabetes for about 18 months now, with Lantus insulin. His dosage has been low, and has varied depending on his blood tests: he started out at 2 units per day (12 hours apart), then 1 unit, then none, then back to 1, then most recently 2 units again.

He also has had a triad disease for about 2 years: cholangiohepatitis, pancreatitis, enteropathy (intestine, pancreas and live disease). These have been treated with Atopica (Cyclosporin), Prednisolone and Fortiflora, though we stopped the Atopica about 6 weeks ago.

During February through March, his appetite decreased and he began slowly losing weight. I wasn’t worried initially, as he was slightly overweight and he was still eating a decent amount. He also seemed slightly unsteady on his feet. I made a vet appointment for early April, and the day before the appointment, his appetite crashed and his back legs became noticeably weakened.

Tests showed his diabetes had reappeared (mild to moderate), and the vet said he probably had diabetic neuropathy. We got his diabetes back under control quickly, and I started giving him Zobaline B12, but his back leg strength continued to deteriorate to the point that they now are completely unable to support him. He also seems to have become incontinent.

His next tests (2.5 weeks ago) showed normal results – i.e. the diabetes and the 3 triad conditions were all well-controlled. However he eating very little, he continues to lose weight and his neuropathy shows no sign of improvement. He’s now down to 10.4 lbs from 14.5 a few months ago (13-14lbs is probably a healthy weight for him).
He's currently on Ondansetron for nausea and a very small dose of Mirtazapine for appetite (.75mg every 2 days), but his appetite remains poor. He's also on daily Ursodiol.

If I can’t get him to eat more, he’s not going to last much longer.

Questions

1. Does anyone have any suggestions as to what would be causing the loss of appetite, as his tests show no problems except the neuropathy? I am compiling the reports I received from the vet, and will post them shortly.
2. Are there any good nutritional products for stimulating appetite?
3. Can people recommend concentrated “emergency” nutrition products that I can give him (if necessary, by squirting into his mouth) to arrest the loss of weight?
4. I gather that cats often recover from diabetic neuropathy in 2 to 6 months, provided the diabetes is properly controlled. Should I be concerned that after a month on Zobaline, his back legs shows no signs of improvement? Or is it possible that it may take a while before I see any progress?

 

[Ki Jai's Human]

Here's a more detailed summary of his history, followed but vet reports from the last 6 months or so.

In July last year, we (the vet and I) restarted his insulin (1 unit per day) after having stopped it for about 6 months.

In November, all his tests showed normal levels, so I continued with 1 unit per day of Lantus.

His appetite decreased and he was slowly losing weight, so in early April, the vet saw him again. The tests showed his fructosamine and blood glucose values were moderately elevated, so we returned to 2 units of Lantus per day. He also had started showing signs of weakness in his back legs, which the vet said might be diabetic neuropathy.

His subsequent tests showed all the diabetes and his other conditions were now all well-managed - however the neuropathy continued to worsen to the point where his back legs can't support him at all - he is unable to lift his butt off the ground.

His weight had been stable at 12.2 lbs for about 3 weeks, but about 2 weeks ago his appetite dropped dramatically, and his weight has now dropped to 10.4 lbs. Since all his conditions are well-managed, I don't know what’s causing him not to eat. The severe drop in appetite began shortly after his back legs became completely unable to support him, so I wonder if it’s related to distress over that.

Next: vet reports ...

 

[Ki Jai's Human]

7/28/2022:
(We believe the anemia mentioned below is probably a side effect of the Atopica medication)

I was pleased to see that Ki Jai looks very good and has gained 12 oz compared to 5/2022.

His lab test results show that his diabetes is out of remission, his anemia is resolved, and his liver enzymes are elevated.

Here are my comments from Ki Jai's medical notes:

Ki Jai’s blood test results show no sign of hyperthyroid.
His kidney values are back in the normal ranges; I do not think that Ki Jai has significant CKD at this time.
His liver values ALT and Alk Phos are mildly to moderately elevated compared to normal and compared to 5/2022. Ki Jai is experiencing a recurrence of his chronic inflammatory hepatopathy, likely as a results of stopping the Atopica.
His fructosamine and blood glucose values are mildly elevated indicating a recurrence of Ki Jai’s diabete mellitus.
His chronic anemia has resolved.
His white blood cell counts are in the normal ranges.

Plan: For Ki Jai I recommend:
1) Continue the prednisolone 5mg orally once daily in PM.
2) Continue the Vitamin B12 once weekly
3) Continue the Proviable Forte 1 capsule daily OR start Fortiflora 1 packet daily
4) Restart Cyclosporin (Atopica) 25mg orally once daily.
5) Restart Lantus insulin 1 unit SQ once daily
6) Continue to feed mainly pate style canned food approx. 6- 9 oz per day.
7) Continue to feed the I/D kibble in addition to canned as needed to maintain Ki Jai’s body weight at 15 pounds.
8) OK to use oral Cerenia or oral Ondansetron as needed to treat nausea.
9) I recommend to monitor Ki Jai’s appetite, attitude, water consumption, urine production, and body weight. If those parameters are stable, schedule an exam + labwork in 4 weeks.
10) If KiJai’s lab tests look favorable, then I recommend to reduce his Atopica from 25mg to 15mg orally once daily. For this dosing I recommend Rx Atopica for Cats 100mg/ml 17ml.
11) For Ki Jai’s exams I recommend to administer gabapentin 100mg orally 3 hours prior to vet appointment and have Ki Jai confined to the bathroom.

Attached are his records.​

 

[Ki Jai's Human]

11/09/22:
From vet:

Good news, his lab test results look excellent. His liver values are back in the normal ranges, he has only a very mild anemia, and his fructosamine indicates good glycemic control.

Here are my comments from Ki Jai's medical notes:

Ki Jai’s blood test results over all look quite good.
His kidney values are back in the normal ranges; I do not think that Ki Jai has significant CKD at this time.
His urinalysis shows a well concentrated urine consistent with adequate renal function with no indication of a UTI.
His liver values are back in the normal ranges, likely as a result of restarting the Atopica.
His red blood cell count is mildly low compared to normal and compared to 7/2022 but not as low as on 5/10/22. It is likely that this mild anemia is related to Atopica and is unrelated to iron deficiency or blood loss.
His fructosamine and blood glucose values are mildly elevated indicating that Ki Jai continues to be diabetic and continues to need insulin. His fructosamine indicates that his diabetes is being well managed on his current, conservative dose of insulin.

His white blood cell counts are in the normal ranges.

Plan: For Ki Jai I recommend:

1) Continue the prednisolone 5mg orally once daily in PM.
2) Continue the Vitamin B12 once weekly
3) Continue the Proviable Forte 1 capsule daily OR start Fortiflora 1 packet daily
4) Continue Cyclosporin (Atopica) at the reduced dose of 15mg orally once daily. This is equivalent to a 5 pound dose orally once daily.
5) Continue Lantus insulin 1 unit SQ once daily
6) Continue to feed mainly pate style canned food approx. 8- 10 oz per day.
7) Continue to feed the I/D kibble in addition to canned as needed to maintain Ki Jai’s body weight at 15 pounds.
8) OK to use oral Cerenia or oral Ondansetron as needed to treat nausea.
9) I recommend to monitor Ki Jai’s appetite, attitude, water consumption, urine production, and body weight. If those parameters are stable, schedule an exam + labwork in 4 months.​

 

[Ki Jai's Human]

About 2 months after the above report, his began to lose weight very slowly, but steadily. At first his appetite seemed the same as always, but it gradually began to decrease, though not by much. Initially, I wasn't concerned, as he'd been a little overweight, and I assumed that he was simply returning to a healthy weight.​

In late March, he was down to about 13.8 lbs, and seemed possibly a little unsteady on his feet, so I made an appointment for the vet to come to examine him on April 7th. I expected this to be just another routine checkup, as 13.8lbs was a pretty normal weight for him.

Email from vet, 4/9/2023:

I hope Ki Jai is doing well after his vet exam Friday evening.
As we discussed, he has lost 2 pounds body weight compared to 11/2022.
His lab test results show that his liver values are slightly elevated, his Spec fPL is mildly to moderately elevated consistent with chronic pancreatitis, and his insulin dose needs to be adjusted upwards.

Here are my comments from Ki Jai's medical notes:
Ki Jai’s lab test results show no sign of chronic kidney disease or hyperthyroid.
His urinalysis shows a well concentrated urine consistent with adequate renal function with no indication of a UTI.
His liver values are mildly elevated (ALT= 174, Alk Phos= 65) compared to normal (ALT < 158, Alk Phos <59) and compared to 11/9/22 (ALT= 140, Alk Phos= 37.)
His red and white blood cell counts are in the normal ranges; there is no indication of chronic inflammation or anemia.
His Spec fPL is mildly elevated (7.5) compared to normal (3.5) which is consistent with chronic pancreatitis
His fructosamine and blood glucose values are moderately elevated indicating that Ki Jai continues to be diabetic and continues to need insulin. His fructosamine indicates that his diabetes not being that well managed on his current, conservative dose of insulin, and that Ki Jai would benefit from an increased dose of insulin.

Plan: For Ki Jai I recommend:
1) Continue the prednisolone 5mg orally once daily in PM.
2) Continue (or resume) the Vitamin B12 once weekly
3) Continue Fortiflora 1- 2 packets daily
4) Increase the Atopica to a 6# dose (18mg) orally once daily.
5) Increase the Lantus insulin to 1 unit SQ every 12 hours.
6) Start Ondansetron 4mg (1 tab) orally once daily Mon- Fri
7) Start Cerenia 16mg ½ tab orally once daily Sat, Sun
8) If Ki Jai is still not eating well, OK to also give mirtazeline 0.75mg orally every other day.
9) Continue to feed mainly pate style canned food approx. 8- 10 oz per day.
10) Continue to feed the I/D or SD Hairball Control kibble in addition to canned as needed to maintain Ki Jai’s body weight at 14- 15 pounds.
11) I recommend to monitor Ki Jai’s appetite, attitude, water consumption, urine production, and body weight. If those parameters are stable, then I recommend an exam + labwork in 4 months​

 

[Ki Jai's Human]

Despite increasing his insulin dose, and giving him occasional doses of Mirtazapine and Ondansetron, his appetite continued to decline, and his back legs started to show signs of weakness.
I made an appointment for April 28 for another vet visit. The day before (April 27), his appetite dropped dramatically and his back legs became significantly weaker, to the point where he was having trouble staying upright in his litter box. He was having trouble peeing and pooping. When the vet came, Ki Jai had not peed for over a day. He became very agitated during the examination, and shortly after we let him out of the bathroom, he peed all over the floor. I think he'd been holding it in, and all the probing and stress of the exam caused him to finally release his bladder.

Email from vet, 4/30/2023:

I hope Ki Jai is feeling better after his stressful vet exam yesterday.

His lab test results are back and they are interesting. His liver values are back in the normal ranges which is somewhat unexpected and positive compared to increased liver values. I'm not sure how to explain that, especially in light of his worsening symptoms.
His Fructosamine indicates that his current dose of insulin is adequately controllinghis diabetes at this time, and that he does not need an increase in insulin.
Somewhat more concerning is that he has an anemia again. His anemia is not severe enough to cause weakness. Unlike the last time that he developed a non regenerative anemia, this is a mildly regenerative anemia which suggests chronic blood loss. The most common cause of mild chronic blood loss is intestinal bleeding.
Also concerning is that his white blood cell counts are elevated, more than every before, indicating significant chronic inflammation. The cause of inflammation is not indicated on blood tests, but the combination of significant inflammation plus blood loss in an older patient with concerning symptoms of weight loss and weakness suggests neoplasia (cancer.)

Here are my comments from Ki Jai's medical notes:

Ki Jai’s lab test results show no sign of chronic kidney disease or hyperthyroid.
His urinalysis shows a well concentrated urine consistent with adequate renal function.
His liver values are back in the normal ranges
His fructosamine is only mildly elevated indicating that Ki Jai’s diabetes is being well controlled on his current dose of insulin.
His red blood cell count is reduced and his reticulocyte count is mildly elevated indicating that Ki Jai has a regenerative anemia such as is seen with intestinal blood loss. His white blood cell count including both the neutrophil and monocyte counts are significantly elevated indicating significant chronic inflammation.

Plan: For Ki Jai I recommend:

1) Continue the prednisolone 2.5mg orally once daily in PM.
2) Continue the Vitamin B12 once weekly
3) Continue Fortiflora 1- 2 packets daily as long as Ki Jai likes the Fortiflora
4) If Ki Jai is eating well, continue the Atopica at 6# dose (18mg) orally once daily.
5) Continue the Lantus insulin 1 unit SQ every 12 hours.
6) Continue Ondansetron 4mg (1 tab) orally once daily Mon- Fri
7) Continue Cerenia 16mg ½ tab orally once daily Sat, Sun
8) Continue mirtazeline 0.75mg orally every other day.
9) OK to start Miralax 1/8tsp mixed in wet food twice daily for constipation
10) Continue to feed mainly pate style canned food approx. 8- 10 oz per day.
11) Continue to feed the I/D or SD Hairball Control kibble in addition to canned as needed to maintain Ki Jai’s body weight at or above 12- 13 pounds.

If you feel so inclined we could try to schedule a repeat abdominal ultrasound for Ki Jai to gain additional information.​

 

[Ki Jai's Human]

We scheduled an ultrasound for May 9th. By the time of the appointment, his back legs had weakened to the point where they could not support him at all.
They also performed another set of his standard blood and urine tests. The results showed that his triad illnesses and diabetes were all well under control.

Email from vet, 5/10/2023:

I hope that Ki Jai is recuperating from his trip to the vet without too much difficulty.
I imagine that his rear limb weakness has been (temporarily) exacerbated by the gabapentin he received yesterday.
His abdominal ultrasound was remarkable by what was not present; that is, there was no discernable tumor or mass affecting any of his intra- abdominal organs. I was more than half expecting to see an intestinal mass based on his regenerative anemia and elevated white blood cell count.
His CBC shows that his anemia has resolved, and his elevated white blood cell count has normalized to a significant degree. Based on his relatively normal ultrasound, I suspect that he was experiencing intestinal bleeding secondary to oral prednisolone which has resolved or improved since cutting his dose in half.
His fructosamine continues to indicate good glycemic control. I don't think that he will benefit from an increase in his insulin. His fructosamine is slightly lower than last time, so if anything you might try reducing the insulin to once daily for 1 week to see if an insulin dose reduction might improve his rear limb strength.
One of the findings on the ultrasound was some debris accumulating in his gall bladder, which is an indication for restarting the ursodiol. I think it is likely that refills for the ursodiol are already authorized, in which case you can reorder directly from the compounding pharmacy.​

Here are my comments from Ki Jai's medical notes:
5/9/23 Abd U/S Notes:
12# 4oz 100.8
Ki Jai has cholangiohepatitis, pancreatitis, enteropathy, and diabetes diagnosed 4/2021
Symptoms managed with Atopica, prednisolone, and Lantus insulin.
Recent weight loss, increasingly finicky appetite, and rear limb weakness.
Recent labwork (4/28/23) showed a regenerative anemia and leukocytosis with mature neutrophilia and monocytosis.​

Abd U/S: Diffusely enlarged liver with homogenous hyperechoic parenchyma consistent with chronic hepatopathy. Moderate amt inspissated bile in gall bladder. Small intestine have increased wall thickness to 3.4 mm. Firm to hard stool in colon.
Asses: Ultrasound changes are consistent with known medical issues.
Ki Jai has lost 4 oz compared to 4/28/23
Submit CBC and Fructosamine to IDEXX​

DRG
5/10/23 Fructosamine= 308 consistent with good glycemic control, possibly relative insulin over dose.
CBC shows a normal red blood cell count with persistenly elevated monocyte count.
The previously noted regenerative anemia and neutrophilia (4/28/23) have resolved, likely as a result of reducing the prednisolone dose.​

These lab test results do not provide an indication for Ki Jai symptoms of weight loss and rear limb weakness.
Possible causes for rear limb weakness include diabetic neuropathy, relative insulin overdose, muscle weakness due to loss of muscle mass, myelopathy such as intervertebral disc disease, inflammatory myelopathy, or spinal tumor.​

I think a temporary insulin dose reduction and preventing further weight loss are the practical steps to take.​

For Ki Jai I recommend:
1) Reduce the prednisolone to 2.5mg orally every other day in PM.
2) Continue the Vitamin B12 once weekly
3) Continue Fortiflora 1- 2 packets daily as long as Ki Jai likes the Fortiflora
4) If Ki Jai is eating well, continue the Atopica at 6# dose (18mg) orally once daily.
5) Reduce the Lantus insulin to 1 unit SQ every 24 hours for 1 week and then reasses.
6) Continue Ondansetron 4mg (1 tab) orally once daily Mon- Fri
7) Continue Cerenia 16mg 1⁄2 tab orally once daily Sat, Sun
8) Continue mirtazeline 0.75mg orally every other day as needed to stimulate appetite.
9) Continue Miralax 1/8tsp mixed in wet food twice daily for constipation
10) Continue to feed mainly pate style canned food approx. 8- 10 oz per day.
11) Continue to feed the I/D or SD Hairball Control kibble in addition to canned as
needed to maintain Ki Jai’s body weight at or above 12- 13 pounds.
12) Resume Ursodiol 60mg flavor tab orally once daily (due to debris in gall bladder.)​

I recommend to monitor Ki Jai's appetite, energy, water consumption, urine production, rear limb strength, and body weight.
If those clinical parameters are stable, then I recommend an exam in 1- 2 months​

 

[Ki Jai's Human]

Sorry for the massive amount of information posted above - I don't know what is relevant and what isn't, so it seemed like the best thing to do was to post everything I received from the vet.

 

[Wendy&Neko]

Hello and welcome. Sounds like you have a complicated kitty.

Did the vet ever test his cobalamin (B12) levels before suggesting supplementation? Just curious if it's needed. The ultrasound results don't tell me much about his small intestines, was it a vet specializing in ultrasounds who did the U/S, or just the regular vet? I'd look for more details than just wall thickening to see if there is a GI issue leading to weight loss. It doesn't have to present as tumours or masses.

Has there been any tests other than fructosamine to see how well Ki Jai's diabetes is being regulated? We are great believers in home testing here. Fructosamine only gives an average and isn't a good basis for understanding how well he's really doing on insulin. If he's not well regulated, his neuropathy won't get better. You can however treat with methyl B-12 (Zobaline for example), more information in this file: Feline Diabetic Neuropathy. Also, cats will continue to lose weight if their diabetes is not well regulated. Lowering the insulin dose will not help, unless the current insulin dose is too high.

Kibble, especially not the "vet" formula kibbles are no good for diabetics. They are way too high in carbs. But I would not change his diet until you are home testing, as cats going onto diabetic appropriate food (under 10% carbs) can have a drastic reduction in insulin dose needed.

What dose of ondansetron is he getting? And how much does he weight? Sounds like he's underdosed on mirtazapine and many vet dose ondanetron too low. You might want to look at Miritaz instead of mirtazamine if you are giving as pills now, and it can be given daily. I'm also not sure why Cerenia is only being given two days a week? It can also be given daily.

Fortiflora's not a good probiotic, it's single strain. Though it can sometimes help entice cats to eat. The Proviable is a better option for probiotic.

And finally, one last post to read for now:
New? How You Can Help Us Help You!

 

[Ale & Bobo & Minnie (GA)]

Pancreatitis can cause loss of apetite and so can unregulated diabetes. I know he’s on ondansetron but have you ever tried Cerenia too?

Also, what do you mean when you say his diabetes is well managed? Typically, a cat only develops neuropathy when the diabetes is not regulated because there’s too much sugar damaging the nerves and that’s what causes the neuropathy. Are you home testing him? That’s the only way to managed and regulate the diabetes. Minnie recovered from severe neuropathy with a generic version of zobaline but only once her diabetes was truly regulated so the fact your cat has been on it for a month and you haven’t seen an improvement again tells me his diabetes is not managed nor regulated.

we can help with home testing if you’re willing to do it. I think it’s the best chance you have help him. Minnie didn’t start getting better until I was home testing her daily and following the guidance from the experts here.

 

[Ki Jai's Human]

Hello and welcome. Sounds like you have a complicated kitty.

Did the vet ever test his cobalamin (B12) levels before suggesting supplementation? Just curious if it's needed. The ultrasound results don't tell me much about his small intestines, was it a vet specializing in ultrasounds who did the U/S, or just the regular vet? I'd look for more details than just wall thickening to see if there is a GI issue leading to weight loss. It doesn't have to present as tumours or masses.

First, thanks for your long and detailed reply. It's so kind of you to take so much time to help out with my little guy.
The Ultrasound was not performed by my regular vet. I believe they were performed by a radiologist who comes to the clinic every 2 weeks. Should I ask for copies of the images (if that's available)?

Has there been any tests other than fructosamine to see how well Ki Jai's diabetes is being regulated? We are great believers in home testing here. Fructosamine only gives an average and isn't a good basis for understanding how well he's really doing on insulin. If he's not well regulated, his neuropathy won't get better. You can however treat with methyl B-12 (Zobaline for example), more information in this file: Feline Diabetic Neuropathy. Also, cats will continue to lose weight if their diabetes is not well regulated. Lowering the insulin dose will not help, unless the current insulin dose is too high.

The only tests I'm know of are the ones described in the attached PDF reports and emails from the vet. What other tests do you suggest? Ki Jai is incontinent right now, so I can't do any urine collection (he doesn't pee in his litter box, he pees on his bed which I keep covered with one of several puppy pads).
I have been giving him Zobaline for about 3 weeks now.

Kibble, especially not the "vet" formula kibbles are no good for diabetics. They are way too high in carbs. But I would not change his diet until you are home testing, as cats going onto diabetic appropriate food (under 10% carbs) can have a drastic reduction in insulin dose needed.

I was only giving him kibble when he wouldn't eat anything else. For the last 7 years, he's had primarily wet food (I would put a little Science Diet in his bowl at night to tide him over, so he wouldn't wake me in the middle of the night to be fed!). For the last month, he's eaten wet food exclusively. I have been trying to stick to food which is high protein, low carb (though at this point the critical thing is to get him to eat at all).
His insulin dose has always been small - only 1 unit, either once a day or every 12 hours.

What dose of ondansetron is he getting? And how much does he weight? Sounds like he's underdosed on mirtazapine and many vet dose ondanetron too low. You might want to look at Miritaz instead of mirtazamine if you are giving as pills now, and it can be given daily. I'm also not sure why Cerenia is only being given two days a week? It can also be given daily.
And finally, one last post to read for now:
New? How You Can Help Us Help You!

He weighs 11 lbs as of 2 hours ago. The day before yesterday he weighed 10.2lbs. That's a big change, so I'm a little unsure if the scale is accurate, though it had good reviews on Amazon.
Ondensatron dose is 4mg per day. I don't know why the vet prescribed Cerenia only 2 days a week - I'll ask. Ki Jai seemed to have a better appetite on the Ondansetron days than on the Cerenia days.
I thought Mirataz was just the transdermal version of mirtazamine? I think the dose is low because of his hepatic disease, though from what I could gather from Google, 1.88mg is usually the lowest suggested dose. Are you saying that if I used the transdermal version, I can give it to him more often? I thought it's recommended to be given at 40 hour intervals, or is that only the pills?

Fortiflora's not a good probiotic, it's single strain. Though it can sometimes help entice cats to eat. The Proviable is a better option for probiotic.

I used to give him Proviable Forte, but once he started having appetite issues, he wouldn't eat food with Proviable on it.

Note: my susbsequent posts may not have been visible when you replied - I made several follow-up posts with copies of the reports emailed by the vet (including all his medication details), and attached PDFs of the test results, for all his last 5 exams.

 

[Ki Jai's Human]

Pancreatitis can cause loss of apetite and so can unregulated diabetes. I know he’s on ondansetron but have you ever tried Cerenia too?

He's been getting Cerenia on weekends, though he has seemed to eat more on the days he gets Ondansetron.

Also, what do you mean when you say his diabetes is well managed? Typically, a cat only develops neuropathy when the diabetes is not regulated because there’s too much sugar damaging the nerves and that’s what causes the neuropathy. Are you home testing him? That’s the only way to managed and regulate the diabetes. Minnie recovered from severe neuropathy with a generic version of zobaline but only once her diabetes was truly regulated so the fact your cat has been on it for a month and you haven’t seen an improvement again tells me his diabetes is not managed nor regulated.

According to the vet, in November, his test results showed the diabetes was controlled. During March his back leg weakness began to appear.In early April, the test showed mild to moderate diabetes. 3 weeks later, the tests again shown normal results - but the back leg weakness continued to get worse.
(I've posted the reports from the vet and attached PDFs of the test results. They may not have been visible when you replied, as they had to go through moderation, so were delayed quite a bit after the first post).

we can help with home testing if you’re willing to do it. I think it’s the best chance you have help him. Minnie didn’t start getting better until I was home testing her daily and following the guidance from the experts here.

I'm very willing to try. The only thing is, he's incontinent and doesn't pee in his litter box, so I don't know how easy it will be to collect samples.

 

[Ale & Bobo & Minnie (GA)]

Home testing is done with blood not urine. if you’re vet is running a fructosamine test at each visit that’s gotta he getting expensive and it doesn’t tell you much. The test is only useful for the initial diagnosis. No need to do it after that. The tests run at the vet cannot tell you if the diabetes is regulated or not. @Hendrick Cuddleclaw has a link to a video that shows him testing on his signature

 

[Chrispooky12]

Hello, I just wanted to add by the vet notes it looks like you are only giving the Zobaline once a week. Zobaline is to be given once daily for neuropathy. It took about a month for my boy to be able to jump up onto everything (counter tops table refrigerator)giving him Zobaline once a day. He is & has been a regulated diabetic kitty for awhile now & I stopped giving him Zobaline about 3 months ago because I was unable to keep up with the cost of it & he is still jumping up on everything. Home testing is the best thing you can do for your boy.

 

[Ki Jai's Human]

Hello, I just wanted to add by the vet notes it looks like you are only giving the Zobaline once a week. Zobaline is to be given once daily for neuropathy. It took about a month for my boy to be able to jump up onto everything (counter tops table refrigerator)giving him Zobaline once a day. He is & has been a regulated diabetic kitty for awhile now & I stopped giving him Zobaline about 3 months ago because I was unable to keep up with the cost of it & he is still jumping up on everything. Home testing is the best thing you can do for your boy.

I was initially giving him Zobaline twice a day, but I've dropped to once per day.

 

[Ale & Bobo & Minnie (GA)]

Unfortunately most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments.

With a diabetic cat you need

• A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
• A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
• We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
• HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after your beloved kitty properly.

We are happy to help you with setting up the spreadsheet, how to learn to home test and much more. This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions!

 

[Ki Jai's Human]

Home testing is done with blood not urine. if you’re vet is running a fructosamine test at each visit that’s gotta he getting expensive and it doesn’t tell you much. The test is only useful for the initial diagnosis. No need to do it after that. The tests run at the vet cannot tell you if the diabetes is regulated or not. @Hendrick Cuddleclaw has a link to a video that shows him testing on his signature

Thanks for the link to the video. Can you recommend a test kit, and some place where I can get detailed instructions?

 

[Ki Jai's Human]

Unfortunately most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments.

With a diabetic cat you need

• A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
• A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
• We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
• HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after your beloved kitty properly.

We are happy to help you with setting up the spreadsheet, how to learn to home test and much more. This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions!

Right now Ki Jai is getting only 1 unit of Lantus insulin every 24 hours (reduced from 1 every 12 hours) at the vet's recommendation as he's eating so little. Do I still need a Hypo kit?

 

[Ki Jai's Human]

Unfortunately most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments.

With a diabetic cat you need

• A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
• A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
• We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
• HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after your beloved kitty properly.

We are happy to help you with setting up the spreadsheet, how to learn to home test and much more. This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions!

One more thing - right now I'm concerned that the most critical thing is stopping the weight loss, and getting him to gain back some weight. He's barely eaten anything today, and his spine has become very prominent.

I got 3 different types of weight gain products:
Amazon.com : Tomlyn High Calorie Nutritional Gel for Cats, (Nutri-Cal) 4.25 oz : Pet Multivitamins : Pet Supplies
Amazon.com: MIRACLE VET High Calorie Weight Gainer for Dogs & Cats 4-in-1 - Mass, Recovery, Appetite Stimulant - Vet-Reviewed - 2,400 kcal - 16 oz : Pet Supplies
Amazon.com : Under the Weather Pet | Ready Cal for Cats 100cc | High Calorie Nutritional Supplement for Weight Gain & Not Eating | 10 Vitamins, 7 Minerals, Omega Fatty Acids : Pet Supplies

They're not exactly the highest quality food, but he's stopped eating almost entirely, and I need to keep him alive in order to be able to give him other treatments. I've started him on the Under the Weather supplement - he licks a little off my hand, but I mostly have to give it to him in a syringe.

Do you guys know of any similar products perhaps more appropriate for diabetes?

For context, I've gotten about 20 - 30 different kinds of cat food (mostly pate), as he seems to eat a food for a while, then won't accept it anymore. I suspect that he eventually comes to associate each food with feeling nauseous or some other unpleasant sensation - which is why he'll eat new foods for a while, then refuse them thereafter.

It's really heartbreaking, because with time and proper control of the diabetes his neuropathy could heal - but if he doesn't eat, he'll never get that time. If only I could explain that to him ....

 

[Diane Tyler's Mom GA]

Can you recommend a test kit, and some place where I can get detailed instructions?

If you live in the US you can get The
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197
You can order them on line also
Our numbers are based on human meters
Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 10 or 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming

Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

Here is a post by another member with some more testing tips:
https://www.felinediabetes.com/FDMB/threads/9-9-bailey-amps-117-5-62.252712/#post-2851043

Tap on this blue link and read post #64 the post numbers are to the right of each post and you can read about the freeze dried treats I listed

https://felinediabetes.com/FDMB/threads/new-to-this-i-need-advice.269452/#post-3007388

You can even give small pieces of plain boiled chicken


Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

Tap in your name up top then tap on the word signature and add all the information you have so far from the Help us to help you blue link and tap Save

 

[Diane Tyler's Mom GA]

One more thing - right now I'm concerned that the most critical thing is stopping the weight loss, and getting him to gain back some weight. He's barely eaten anything today, and his spine has become very prominent.

I got 3 different types of weight gain products:
Amazon.com : Tomlyn High Calorie Nutritional Gel for Cats, (Nutri-Cal) 4.25 oz : Pet Multivitamins : Pet Supplies
Amazon.com: MIRACLE VET High Calorie Weight Gainer for Dogs & Cats 4-in-1 - Mass, Recovery, Appetite Stimulant - Vet-Reviewed - 2,400 kcal - 16 oz : Pet Supplies
Amazon.com : Under the Weather Pet | Ready Cal for Cats 100cc | High Calorie Nutritional Supplement for Weight Gain & Not Eating | 10 Vitamins, 7 Minerals, Omega Fatty Acids : Pet Supplies

They're not exactly the highest quality food, but he's stopped eating almost entirely, and I need to keep him alive in order to be able to give him other treatments. I've started him on the Under the Weather supplement - he licks a little off my hand, but I mostly have to give it to him in a syringe.

Do you guys know of any similar products perhaps more appropriate for diabetes?

For context, I've gotten about 20 - 30 different kinds of cat food (mostly pate), as he seems to eat a food for a while, then won't accept it anymore. I suspect that he eventually comes to associate each food with feeling nauseous or some other unpleasant sensation - which is why he'll eat new foods for a while, then refuse them thereafter.

It's really heartbreaking, because with time and proper control of the diabetes his neuropathy could heal - but if he doesn't eat, he'll never get that time. If only I could explain that to him ....

@Ale & Bobo & Minnie (GA)
@Wendy&Neko
Hi Ladies I know nothing about anything that her kitty is going g through
Do you think she should ask the vet for a feeding tube since he really isn't eating much at all

 

[Ale & Bobo & Minnie (GA)]

He needs insulin twice a day. It would be best to give him .5 unit every 12 hours. No food and not enough insulin can lead to ketones. Are you testing for ketones at home? Yes, a feeding tube would be an option and I’m surprised the vet hasn’t suggested. Are you syringe feeding him?

 

[Ale & Bobo & Minnie (GA)]

You can ask your vet for AD recovery food. It’s not ideal for diabetic cats but he needs to eat so that’s a priority. It’s very palatable and easy to mix with water to syringe feed and I’d get him as much of it as you can daily right now

Hill's Prescription Diet a/d Urgent Care Wet Dog and Cat Food, Veterinary Diet, 5.5 oz. Cans, 24-Pack https://a.co/d/fWu1kIo

 

[Diane Tyler's Mom GA]

He needs insulin twice a day. It would be best to give him .5 unit every 12 hours. No food and not enough insulin can lead to ketones. Are you testing for ketones at home? Yes, a feeding tube would be an option and I’m surprised the vet hasn’t suggested. Are you syringe feeding him?

@Ale & Bobo & Minnie (GA)
Ale I deleted my post about the feeding tube because I didn't copy her entire post so I posted it again, take a look she is syringe feeding. Post #21

Thanks Ale

 

[Wendy&Neko]

Should I ask for copies of the images (if that's available)?

No, I don't read images. But I was expecting a lot more text. The last Ultrasound report I got for a cat covered an entire page. And a full paragraph of that was describing what was found in the small intestines.

He weighs 11 lbs as of 2 hours ago. The day before yesterday he weighed 10.2lbs. That's a big change, so I'm a little unsure if the scale is accurate, though it had good reviews on Amazon.
Ondensatron dose is 4mg per day. I don't know why the vet prescribed Cerenia only 2 days a week - I'll ask. Ki Jai seemed to have a better appetite on the Ondansetron days than on the Cerenia days.
I thought Mirataz was just the transdermal version of mirtazamine? I think the dose is low because of his hepatic disease, though from what I could gather from Google, 1.88mg is usually the lowest suggested dose. Are you saying that if I used the transdermal version, I can give it to him more often? I thought it's recommended to be given at 40 hour intervals, or is that only the pills?

Ondansetron can be given 3-4 times a day, it doesn't last that a full day in the cat. Recommended dose is 0.5-1.0 mg/kg of cat. He's 4.6 kg, so could get 4 mg three times a day. Cats can also get both Cerenia and ondansetron. Cerenia dosing is 2mg/kg, so could get 8 mg every day in addition. The vet got the Cerenia amount right, but not the frequency. I could give both ondansetron 3 times and Cerenia once each day to help with nausea. Back off when he starts eating better. As for Mirataz, it is absorbed more slowly than the pills, and the nice thing is that it's easier to control the amount given. I don't know what the restrictions are with liver kitties, but for kidney cats it's given less often.

Others have given great advice on increasing how often you give insulin and food you can give. I'll add Royal Canin Recovery formula as another option for food. My cat Neko really liked it, it's diabetic friendly too, and easy to syringe. Often if I got a couple syringes in, she'd start eating on her own. Here is some information on assist feeding and other ways to get food in.

• Suggestions on How to Stimulate Kitty's Appetite
• Syringe/Assisted Feeding (Video and Tips)
• THE '~LIVER SHAKE~' FOR SICK CATS

 

[Ale & Bobo & Minnie (GA)]

@Wendy&Neko do you think budesonide would help?

@Ki Jai's Human Minnie had IBD and it got so bad at one point that even with ondansetron and Cerenia she still stopped eating and the vet had to put a feeding tube on her. She started budesonide and with that, she started eating again on her own that’s why I’m asking Wendy if that’s something you should ask your vet about.

In the meantime, I hope you’ll start to give insulin x2 a day. Insulin only lasts for 12 hours so once a day only means he’s unprotected for the other 12 hours. It’s better to split the dose and give it 12 hours apart.

Ketones test strips can be bought at any human pharmacy and I really think you need to start testing him for it daily. Not enough food and not enough insulin can cause ketones and that’s life threatening.

We’ll know more about the diabetes once you start home testing him. If you live near a Walmart, you can buy all the supplies there and you don’t need a prescription for any of it. Call before you go to make sure they have it all in stock. If you can start home testing as soon as possible, we’ll be able to tell if he needs more or less insulin, although I have a feeling he’s not getting enough but we need to confirm it.

 

[Wendy&Neko]

do you think budesonide would help?

No clue, we don't have a diagnosis of a condition that needs treating. In fact, we know very little about what is going on in the small intestines cause there are no ultrasound details. Diagnosis comes first.

 

[Ale & Bobo & Minnie (GA)]

The vet keeps talking about intestinal bleeding he says caused by the pred. He also has CKD and pancreatitis, but the thickening of the intestinal walls indicates IBD or lymphoma I believe.
“Ki Jai has cholangiohepatitis, pancreatitis, enteropathy, and diabetes diagnosed 4/2021
Symptoms managed with Atopica, prednisolone, and Lantus insulin.
Recent weight loss, increasingly finicky appetite, and rear limb weakness.
Recent labwork (4/28/23) showed a regenerative anemia and leukocytosis with mature neutrophilia and monocytosis.“

@Ki Jai's Human can you reach out to the vet who performed the ultrasound and ask what the thickening of the intestinal walls means in their opinion? Was the ultrasound performed by a specialist or a general vet? I also don’t see ketones mentioned anywhere. Did they check for them in the blood work?

 

[Wendy&Neko]

The measurement given for just one spot on the small intestine on the ultrasound was in higher normal range. But one data point doesn’t tell the story. Was there more measurements, what part of the small intestine was tested, how about the other sections, were any of the layers thickened? It is possible to have thickening in just one part of the intestine, but not others.

Ketones would be tested as part of urinalysis, not bloodwork.