Insulin Resistant Boy - Not sure what to do

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orangeclover

Member Since 2023
My cat Finn is about 10 years old - he is a snuggly ball of sunshine.

Over the last year Finn started to pee on everything - couches, outside the litterbox, beds, doorframes - etc. We did some heavy cleaning bought more boxes and had him evaluated and he came back as diabetic - (making all of the drinking and peeing make sense). We had a baby last year, and couldnt have pee everywhere - so we moved him into what was our nursery for our daughter, emptied it of furntiture except cat trees, cat beds, and litter boxes and installed screen door for ventilation and socialization while we tried to get the diabetes under control.

Now months later, Finn is on insulin (up to 7 units) and shows no signs of his blood sugar coming down. It's maxed out on the wearable devices, and hes been on glucose support food and water, with no treats, and 2 doses of insulin a day with no end in sight to the pee and distress.

Emotionally he's as lovey as ever and adores us and the baby when we visit- but physically he's lost weight, is super sick with high blood sugar, and ever thirsty.

I'm frustrated as we have tried 2 vets now, and the outlook doesnt seem realistic or good (they think it might be a pituitary issue which would mean BRAIN SURGERY??!!), but putting him down seems cruel as he's still a happy snuggly boy.

Then again -I know he IS deterorating, AND living everyday somewhat isolated from the family and mostly in pee (despite me cleaning constantly the pee is never ending with 3 litterboxes and pee pads all over the room).

What should we do? I dont want to put him down, but I dont see any way this will improve, and cant let him out in the house with pee and the baby, but also dont want to see him suffer and spend his last days trapped in pee.

I would almost opt to have him be outdoors, but my neighborhood DOES have predators (foxes,hawks, owls) and while he's a big cat, I feel like that would be a hugely stressful change.

To make matters harder - he's also a bonded pair with his littermate, who he cant spend time with. The two sit on either side of Finn's screened door - but when I let his brother in to be with him, its just stressful for them both to be in pee.

Thoughts? Comments? Hope? (cross-posting here from thecatsite.com at a recommendation by commenter)
 
We need a bit more info to try to help you. Can you please tell us what insulin he’s on and what is the diabetes friendly food you’re feeding him? Is he showing any signs of issues with his back legs and mobility like not being able to jump or get in and out of the litter boxes? 7 units is a lot and I wonder if he’s truly insulin resistant, I believe there’s a blood test for that, or if the ideal dose has just been missed. We recommend dose adjustments by 1/4 unit only for precisely that reason. Unregulated diabetic cats do pee a lot but not necessarily all over the place. Going to tag a few more folks here to get more eyes on it @Bron and Sheba (GA) @Sienne and Gabby (GA) @Red & Rover (GA) @Wendy&Neko

btw, diabetic cats can have low carb treats like freeze dried anything pretty much. They do better with smaller meals throughout the day. Are you feeding him only twice a day? That’s not actually good for them. Can you also tell us what tests the vets have ran on him?
 
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Hi and welcome to you and your beautiful boy Finn.
As Ale said if you can tell us the type of insulin he is on, the food you are feeding him and any lab results you can copy and paste, that would be very helpful.
Did the vet test the urine for any UTIs?
How are you monitoring the blood glucose? Are you doing it at home? Or going to the vet periodically?
If the vet is increasing in 1 unit increments, you could have gone past the best dose.
It is also very possible the BGs (blood glucose) is still high, because you are feeding a high carb food. Cats need wet food which is 10% or lower carbohydrates. Most of us feed around 4-7% carbs. All the prescription dry foods at the vet…including the “diabetic” dry are high carb. But don’t swap to any lower carb food yet until the BGs are being monitored closely as the BGs can drop by 100 points or more with the removal of the dry food.
So he is what I would do:
  • Tell us the insulin type and food type
  • If the vet has not tested for a UTI, get that done
  • Think about hometesting the blood glucose. Sounds scary but it’s not and this is far and away, the best way you will be able to manage this and hopefully get it under control. I’ll put the link for hometesting below. Let us know if you are interested and we will tell you the best glucose meter to get.
  • Have a look at the food chart that I will link below for suitable foods. Don’t change yet though.
  • Are you giving snacks during the day and night as well as the 2 main meals? He is losing weight because he can’t absorb all the nutrients in the food at the moment. Once the BGs come back down he will start to put on weight. This happened to my Sheba too.
  • Don’t put him outside.
Before we worry about if it is ACRO, which is a benign tumour on the pituitary gland, let’s see if changing the food, checking the urine for infection, and monitoring the BGs help. And there are treatments for ACRO which don’t include brain surgery.
I can understand why this is so stressful for you, especially with a young baby in the house, but hopefully we can help you solve this :bighug:
 
- He's on glargine, started at 1 unit, and has progressed to 7to see if things help over the course of months. Food is prescription glucose support dry and wet combo. (We tried to give him actual meat, but he turned is nose up to it)
- Yes tested for UTI came back negative
- Yes we have done some home testing via stick and then by a glucose monitor, via stick it was incredibly high, and then on the glucose monitor for a week it stayed maxed out at 400
- No snacks or cookies besides the wet food and dry food (dry food is accessible at all times)
- Dont want to, its just getting to be unsanitary in his room, and people ask if thats an option which I dont think is

Thank you!!! - both vets we saw were surprised there wasnt any other underlying conditions they could find, and that the insulin wasnt having an effect. We are taking him again today to the vet, so I'll bring the food list and talk with his vet about it. If you can think of any options we should bring up let me know.
 
I would completely remove all the dry food for a start and only give him wet. you would be surprised what a difference that can make.
The vet will probably not agree with that because they think the dry food is fine. However we can only tell you what we know to be true.
I would set up a spreadsheet (we can do it for you if you like) @Bandit's Mom wouod be happy to set it up for you. And then if you could start testing before every dose and then during the cycle to see how low the dose is taking your kitty. Lantus dosing is based on how low the dose takes the kitty not the preshot BG.
It is possible you kitty is dropping low at times and then Bouncing back up again. If the lower BGs are not seen, the vet can think that the cat needs more insulin.
I would feed before every dose and then Give 2 or 3 snacks during all the cycles. Low carb snacks are absolutely fine. But not dry food snacks. It is like giving a human diabetic cake and ice cream and expecting their BGs to be OK.
What type of glucose meter are you using?
 
You may have missed my question “is he showing any signs of issues with his back legs and mobility like not being able to jump or get in and out of the litter boxes?”

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. Vets also get their information about nutrition from the big cat food manufacturers so they are biased in what they recommend. A dry high carb diet is not good for any cat, especially a diabetic cat. That’s like feeding your diabetic child a diet of chips, ice cream and sweets. As Bron said, your vet will most likely disagree and we get that here all the time but your cat is not improving following their advice so I hope you’ll try our way now. I can honestly say Minnie only improved once I followed the advice and guidance I found on this site. She had severe neuropathy and would pee wherever she was because she could barely take a few steps without having to stop to rest. I had pee pads on all her favorite spots and on the furniture. I too went through several vets and wasted precious months which led to the neuropathy. She got regulated and recovered almost completely. Had a little residual arthritis but was back to her normal healthy self. Then when Bobo became diabetic earlier this year, I knew what to do and again with guidance from the folks here I got him regulated and into remission last week. Never even consulted a vet this time.

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. Glargine is the generic of Lantus so you’re good there
  • 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.
A word of warning though… once you remove the dry, you’ll need to test his blood glucose before each shot to make sure the super high dose is still safe. A change over can drop the BGs by up to 100 points and we don’t want you to have a hypo on your hands.

We are happy to help you with setting up the spreadsheet, sorting out what food to buy, how to transition safely to a low carb diet, 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!
 
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Just to add a comment or two:

Prescription diabetic food is not necessarily low in carbs. I realize that sounds crazy but it's true. For example, Royal Canin Glycobalance canned food is 14% carbohydrate. (The dry food is even higher.) We consider low carb to be less than 10% and most members feed their cat in the neighborhood of 5% carb. As Ale suggested, I would second getting rid of the dry food. I would also make sure that the canned food your giving your cat is low in carbs. If you switch to a low carb diet, you may need to aggressively monitor Finn's blood glucose levels. His numbers could easily drop as a result of a change to a low carbohydrate diet.

If there's no change in his numbers, I would encourage you to ask your vet to send out a blood sample to the veterinary lab at Michigan State University. It is the one place in the US that can test for acromegaly (IGF-1) and insulin resistance (IAA or Insulin Auto Antibodies). These results will let you know if your cat has a high dose condition. Acromegaly is a pituitary condition. There are sterotactic surgical procedures that are used to treat the tumor as well as medication (Cabergoline) than can be effective.

I'm tagging one of our members who has considerable expertise with acromegaly: @Wendy&Neko
 
Are you by any chance in the UK? Mention of foxes makes me think of that, though I know they are elsewhere too. If in Europe the blood for the IGF-1 test gets send to the Royal Vet Clinic in London. They are absolute experts in acromegaly, which a positive IGF-1 test would indicate. And yes, one of the current forms of treatment for that condition is a surgery to remove the pituitary gland (tumour on it causes the acromegaly/hypersomatotropism) and the pituitary is technically part of the brain. There are other treatment types if going to London doesn't work for you, or other locations for surgery, though they don't have as much of a track record. As I said there are other treatments, but let's figure out a diagnosis first.

My girl Neko also had acromegaly and she had radiation therapy. Cats with this condition can need quite high doses of insulin, as the benign tumour on the pituitary sends out excess growth hormone which in turn causes excess IGF-1 to be produced that blocks the insulin from getting into the cells. Basically you need loads of injected insulin to overcome it. Once I got her numbers down to mostly normal blood sugars, her pee amounts were not much different from that of her cat buddy.

As I see it, you can do a couple things immediately. First, get rid of the dry food, low carb wet or raw is best. How is his appetite in general in general? Second, get the vet to send blood in for IGF-1 testing, either Royal Vet Clinic or Michigan State University. If you are in the US, add IAA (insulin auto antibodies) test onto the IGF-1 one. It goes to the same place and can make some difference in dosing strategies.

Longer term, we can help you get Finn into better numbers more quickly which will greatly help the peeing situation. If you can set up a spreadsheet so we can see his blood sugar data, we can help you get to a better place with his numbers. Details on how to do that here:
New? How You Can Help Us Help You!
 
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