new here - trying to understand treatment options

A

alphadog0228

Member Since 2025
Hello,
My cat, Mickey, is a 17 yo tuxedo kitty. He weighs now approximately 9 lbs and has lost weight over the last few months. Athe vet has been treating him for a sinus/respiratory infection over multiple months. He has had 4-5 rounds of different antibiotics during this time without probiotics. He finished his last round of Veraflox a few weeks ago. This antibiotic was chosen after the vet cultured his nose and ruled out FIV or other problems. He had about 2 rounds of the Veraflox. After finishing the last one, he slowly redeveloped the sinus infection again.

After another vet visit, we discussed treating it again with another antibiotic and starting him on a probiotic which he has now been on for 7 days now. I decided to hold on the antibiotic again because it seems like he had been on so many of them, and I wanted to see if the probiotic could help restore his gut health. Since I’ve been concerned about his weight, I started weighing him again. He had been at 9 1/4 pounds the 1 week following this October vet visit. I weighed him once a week after that visit. The first week he was 9.1 but this past Sunday he was 8.7 which really concerned me. I contacted the vet again and told her about the weight change. She looked through the data and I asked her if he could be a diabetic. He’s had a lot of tests over the last few months, but they did not take a glucose reading since September 2024, so she told me to come in which we did this morning.

His ear prick test came back at 347 which I know is extremely high. His urine did not show ketones. My regular vet that sees Mickey and who I spoke with was not in today. The vet that was in the office today originally talked about oral medications, but when she remembered he has IBD, she then changed her mind and said that it really wouldn’t be appropriate and could not in good conscience prescribe it. She put in a call to my regular vet who was out of town today to ask for her opinion. My regular vet said she would not recommend the oral meds and that he should go on insulin because of his IBD.

My concern is this seemed like it was hitting him very aggressively with treatment when we only had one data point for a glucose test this morning. This test was not even one that was done with fasting. He has been extremely hungry and eating but his weight has been slowly declining since about the September. Before going in today, I fed him at 5 AM and then again at 8 AM just prior to our 9:30 AM appointment.

The vet suggested I use a libre 3 monitor which we have running today and they are sending blood for a Fructosamine test to see the levels over multiple periods. This will come back early next week. So far, the libre 3 system is reporting readings around 300. I did feed him at noon when he came home so I would think this would be expected.

I am really opposed to starting insulin when there are these oral medications that could be considered. It seems like insulin is a very big step and once in the started, it is for life. Also, with his biome so disturbed after the multiple rounds of antibiotics, it seems very drastic since the biome being off would seem like it would throw off everything in his system.

Has anyone ever been in a situation like this? I am really at a loss of how to proceed, but it is so painful to watch him be hungry and eating and not getting the nourishment he needs. I feel helpless on what to do for my buddy.

Thanks for any thoughts you could share.


JJ
 
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Hello and welcome.

300's is pretty high numbers. The fructosamine will tell you if his blood sugars have been high the last couple weeks and it was a good idea to get it done. There are three main reasons for a kitty to lose weight if still eating what they should, and diabetes is one of them.

You might want to read this post, which talks about Bexacat and Senvelgo - the new drugs, and when they are contraindicated.
New Treatments for Feline Diabetes. There is increased risk of DKA (diabetic ketoacidosis) when a cat gets either of those new drugs. Having an infection and weight loss also increases the risk of DKA and contraindications for the oral drugs.

Insulin is not always a forever for life drug. With proper diet (what are you feeding Mickey?), a good insulin for cats (Lantus/glargine or Prozinc) quite a few cats go into diabetic remission.

I agree that getting his biome in shape is a good idea. What brand of probiotic are you giving?
 
Wendy&Neko said:
Hello and welcome.

300's is pretty high numbers. The fructosamine will tell you if his blood sugars have been high the last couple weeks and it was a good idea to get it done. There are three main reasons for a kitty to lose weight if still eating what they should, and diabetes is one of them.

You might want to read this post, which talks about Bexacat and Senvelgo - the new drugs, and when they are contraindicated.
New Treatments for Feline Diabetes. There is increased risk of DKA (diabetic ketoacidosis) when a cat gets either of those new drugs. Having an infection and weight loss also increases the risk of DKA and contraindications for the oral drugs.

Insulin is not always a forever for life drug. With proper diet (what are you feeding Mickey?), a good insulin for cats (Lantus/glargine or Prozinc) quite a few cats go into diabetic remission.

I agree that getting his biome in shape is a good idea. What brand of probiotic are you giving?
Click to expand...


Thank you for the reply.

He is getting Proviable Forte capsules. I also give him 1 Cobalequin tablet a day that I grind and sprinkle on his food. He gets Methimazole pencream gel 5 mg/0.1 ml on his ear tip twice a day for his hyperthyroidism.

His food is Royal Canin prescription PD and PR. I give him both wet for the PR and PD. I give him about 1/4 cup of the dry PR which he open feeds on. There is always a bowl of that available.

We just had it his blood tested to see if the hypothyroidism medication needed to be adjusted. I had originally thought that was the cause of his weight loss but those numbers came back that he was on the correct dosage so they did not change it.
 
Proviable Forte is a good choice. The food, not so much. Is there a reason is on on the PD and PR? They are rather higher in carbs than is appropriate for a diabetic cat. Quite a few cats have their blood sugar numbers improve when the go on low carb wet or raw food. There are lots of commercially available novel protein cat foods that are low carb. Some of us feed raw food too. How long has he had IBD? Was it diagnosed with a biopsy?
 
The PR and PD were the novel protein food that was recommended when he was diagnosed with IBD in approximately September of 2024. There was no biopsy. They did an ultrasound and saw a thickening and enlargement of the GI tract and also bloodwork. He was vomiting and the vet felt it may be the chicken in the food he was eating. We tried conservative changes to the diet with the PR as a novel protein and the vomiting stopped and his coat and weight were stable.

His glucose in 2024 was good. It was 170 in October 2024 after he had been on the PR and PD for a while. He was on the PR initially. The PD duck came when the rabbit was in short supply as a substitute. In June of 2025, this is when we started treating his respiratory/sinus infection with multiple rounds of different antibiotics through September with no probiotics. This is why I feel his biome is so disturbed and GI so inflamed from the antibiotics that everything in his system could be off and needs to settle down. The doc had also mentioned maybe a fecal transplant to restore the biome more quickly but she did not have a donor program now.

What are the other novel protein foods you mentioned?
 
There are several brands that have novel proteins in them and are low carb. If you know rabbit and duck work, there are some by Rawz, Hounds & Gatos, and Identity. Freeze dried raw options by Stella & Chewy's and Primal, and possibly others.

Natures Variety Instinct LID diets have options that are what we consider medium carb (11-15% carbs).

The source I'm using for some of these is this food list.

Visbiome is another probiotic that works great with IBD kitties - I have one at home. I give it regularly, not just with antibiotics o board. Animalbiome is one company that sells fecal transplant pills. They like to get a poo sample first to analyze it. I tried it with my IBD girl and "meh" was the result. But I do know of someone who did have success.
 
Thank you for these.

I gave him food at about 10pm and his glucose shot up to 350. Way too high. Is there an ideal time to feed them such that you can try to keep the levels constant? Because of the IBD, I have been feeding him several times a day with smaller portions but from what I understand, with insulin, I will be feeding only twice a day. How can I get all the needed calories in him (vet said about 200 per day) if I only feed him twice a day and he is used to eating smaller portions?

I am worried now that I should have put him on insulin today but I thought we only had one level and not enough data to really understand his situation. It is the weekend now and I am not sure what to do.
 
Feeding him several small meals a day is also ideal for diabetics. Human diabetics do the same. That way you don't overwhelm their pancreas. With old school insulins, they used to feed just two meals because the insulin hit hard. Newer insulins are much more gentle.

First, see if you can slowly switch out some of the higher carb food for the lower carb ones. Find one he likes. Make the transition slowly as it could upset his GI. He's already eating some wet, so you are ahead of things. Some tips in here may help:
Keep on the Proviable, it's a good option.

Second, pickup some Ketostix (or equivalent), that you can use to test urine for ketones. Tips to catch and test a urine sample
As long as it stays low to trace, you are OK to wait until next week. Many of our cats were diabetic for a while before we got them to the vet for a diagnosis.
 
Here are two web sites with info on IBD in cats:

IBDKitties – Helping Save Lives…One Paw at a Time
Feline IBD - Healing can happen!

My diabetic also has IBD (and other issues:facepalm:). I have always fed a commercial raw diet so I didn't have to do a food change with the IBD diagnosis. I just had to change the protein from the common ones (chicken, beef, etc) to a novel protein (rabbit) and feed only a brand that didn't have useless fillers like fruits and veggies and various oils and ingredients. My cat's IBD tummy is sensitive to a lot of ingredients in food but not all IBD cats do.

There are commercial canned foods that are suitable for both IBD and diabetes. Rawz and Koha LID are two brands. Novel proteins to try are rabbit, duck, lamb, venison, kangaroo.
 
I have been monitoring his glucose now for about 24 hours using the Libre 3 Plus system that sends the readings to my phone. He has been in the range of 261 to 331 for the last 24 hours on about 1 large TBSP of the RC wet RB and then the RC wet PD at each feeding. Today, I started feeding him at 6am and then every 3 hours at 12, 3 and I will feed at 6pm and 9pm. I stopped the dry RC PR dry food yesterday to try to limit the carbs.

Interesting to me, when I included the probiotic in the 6 and 9 AM feedings it seems his glucose did not change that much and the same happened with the Cobalequin at 12 noon. In other words, there is no wide swing between that range.

Can you share your insight on how they will determine which insulin and how much to start him on? Based on the data, I know he needs insulin. How do they know where to start with the dosage?

Do you think they will give him one injection at the vet and then send me home to check it and give the dosage twice a day? I know I can do this, but I don’t have any skill with giving insulin or using a device to check the levels other than this Libre 3 I have been using for 24 hours.

I am terribly afraid once they give him the first shot of insulin, I may have to be very careful of it dropping severely below 50. That’s why I’m curious about how do they know where to begin the dosage.
 
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Insulin choices vary by vet. I think a lot of it is what they are familiar with - it was with my vet. The AAHA recommended Lantus or Prozinc. (2018) AAHA Diabetes Management Guidelines for Dogs and Cats

Starting dose also varies by vet and their experience. AAHA recommends 1-2 units twice a day. Our dosing methods have recommended starting doses, which wouldn't be anything more than 1 unit, regardless of insulin. We find it's best to start low, get used to testing and shooting and work your way up. The exemption is if there are ketones or DKA on diagnosis.

Experience at the vet will also differ. With Prozinc and Lantus, you shoot twice a day with a 12 hours apart schedule. Depending when the vet appointment is, it might not make sense for you to have shot time then. My vet had me and hubby practice with a syringe filled with water, then we went home and did the first shot ourselves.

It's a good idea to have a hypo kit on hand, just in case. Mostly that means some high carb food.
 
The American Animal Hospital Association guidelines for the treatment of diabetes recommends either Prozinc or Lantus (glargine) for the treatment of feline diabetes. Both are excellent insulins. They are gentler and longer acting than the other insulins that are available. If your vet suggests a different insulin, I'd share the pdf I linked.

We typically suggest a conservative starting dose. The amount may depend on which insulin you're using, the dosing method you opt to use, and if your cat is still eating any dry or high carb food. We have individual forums for Prozinc and Lantus. There is information in the sticky notes at the top of the forums about each insulin, dosing, etc. Once you know what insulin you're using we can be more specific. Wendy also linked information on managing low numbers. You want to have some high carb food or syrup (e.g., corn syrup, honey) that you can use to bring low numbers up.

The headache with having the insulin dose at the vet is that it may not be at a good time for your schedule. Insulin is dosed every 12 hours. If you have a vet appointment at 2:00 PM, I doubt you'll want to get up at 2:00 AM to give a shot. You need to give a shot at a time that will work for you versus what's convenient for the vet.

Most of us were clueless about giving shots or home testing. Frankly, when my cat was diagnosed, no one even showed me how to give a shot. I watched videos on YouTube to learn how to test and give an injection. We have lots of information, including videos, to help you learn. It seems overwhelming at first but it's really not that hard. You cat will also begin to realize that what you're doing helps him feel better. Well, that and treats will also help.
 
Has anyone had experience with the Libre 3 Plus monitor with strange readings on day 14 and 15?

My cat started on 1/2 unit PZ a week ago. We were at the vet on Wednesday for a check up and she wants to increase the dosage but did not want to do so until the Monday after Thanksgiving holiday. She has been monitoring the data via the Libreview app. She told me to continue with the 1/2 unit until then. I had the replacement sensor with me and had intended to have them replace it with a new one at the appointment on Wednesday, but she preferred to wait until after the holiday and she said we did not need the data until then.

Today, the Libre recorded a fast drop from about 320 at 7am to 88 at 1130am (and ‘decreasing’ the app said) which made me fearful and I gave food and syrup because I thought he was going hypo. By 12, his number had gone back up to 120 and stayed constant. All of the previous days (over a week of data) have never had a curve be this low like this which is why the doc wants to increase the dosage to 1 unit in the morning after the Thanksgiving holiday when the office will be open.

There are 22 hours left on the Libre sensor. The doc warned me that sometimes it gives ‘wonky’ numbers when they need to be changed. I am concerned about continuing with the 1/2 unit for the remainder of the weekend(Sunday I will have no data).

I’m trying to determine if the sensor is failing or if I indeed have a curve that has dropped this much since Wednesday. Has anyone experienced this?. I’m feeling confused and don’t want to give a shot without knowing the level first.
 
Welcome to FDMB
Well, let's start with this link on the Libre :PSA: Notice from Abbott - certain Freestyle Libre 3 devices giving false low readings , you can purchase the ReliOn Premier and strips at Walmart, you have one of the best insulins for cats ProZinc and starting on a low dose is great, also, you can do a curve at home without stressing your cat by taking him to the vet, as well as your pocket, a curve is simply testing every 2 hours for a cycle (12 hours), with ProZinc is important to feed the 2 main meals before shot and 2-4 small meals during the day, the protocol for ProZinc is Test, Feed Shoot. As well as diabetic cats need to eat a diet of wet can or raw foods between 0-10% carbs, kibbles and grazing are out of the question, a schedule is important; if you are feeding dry the transition has to be a slow one, so not to upset the stomach and cause a drastic low BG reading. most member enjoy the Fancy Feast Pates between 0-10% most feed 5%, (dry matter carb) please keep posting we are here to help you in all your concerns, I w
ill tag a member that can assist you with dosing or any other concern you may have , in our Main Forum are many stick notes with valuable information 🤗@Suzanne & Darcy
 
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alphadog0228 said:
Has anyone had experience with the Libre 3 Plus monitor with strange readings on day 14 and 15?

My cat started on 1/2 unit PZ a week ago. We were at the vet on Wednesday for a check up and she wants to increase the dosage but did not want to do so until the Monday after Thanksgiving holiday. She has been monitoring the data via the Libreview app. She told me to continue with the 1/2 unit until then. I had the replacement sensor with me and had intended to have them replace it with a new one at the appointment on Wednesday, but she preferred to wait until after the holiday and she said we did not need the data until then.

Today, the Libre recorded a fast drop from about 320 at 7am to 88 at 1130am (and ‘decreasing’ the app said) which made me fearful and I gave food and syrup because I thought he was going hypo. By 12, his number had gone back up to 120 and stayed constant. All of the previous days (over a week of data) have never had a curve be this low like this which is why the doc wants to increase the dosage to 1 unit in the morning after the Thanksgiving holiday when the office will be open.

There are 22 hours left on the Libre sensor. The doc warned me that sometimes it gives ‘wonky’ numbers when they need to be changed. I am concerned about continuing with the 1/2 unit for the remainder of the weekend(Sunday I will have no data).

I’m trying to determine if the sensor is failing or if I indeed have a curve that has dropped this much since Wednesday. Has anyone experienced this?. I’m feeling confused and don’t want to give a shot without knowing the level first.
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Hi and welcome. I’m a longtime Libre 3 user of almost 3 years for my cat.
Sometimes the sensor can give you only readings if there is a problem with the sensor or it’s coming off or something (like the cat has tried to pull it off).
Usually, though it may be a rapid drop in glucose and you may get an error message (10 minute warning).
The Libre graph will then show a drop and a rise again.

I have not yet used a Libre 3 Plus so I am not familiar with day 15 (I have to use up my Libre 3 stash first before buying the newest sensors).

The Libre should stay on for the full life of the sensor. I have never actually had a sensor just randomly fall off in three years.
Perhaps if it was applied incorrectly or the cat tried to pull it off then yes it could come off. If you think your cat will pull it off you should keep something to cover the sensor like a T-shirt or something like that if possible.
I will link the document we have prepared, which gives you lots of tips about using a Libre sensor.
Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats

I do find a Libre to be incredibly helpful, as my cat will not allow poking all the time, but I am able to poke her ear if she goes very low, and I need to find out exactly how she has gone.
For me, when she is in the LO range (which is below 40 on the Libre) that is when I pay very close attention and will poke her ear to see where she is.
Typically she is under 100 on a handheld meter if she is in the Libre LO range.
But, other Libre users have found the spread between their handheld meter and the Libre to be smaller (by 10 to 15 points). Each user seems to have different experiences.
It’s very important, not to use any glue when applying the sensor to your cat as it can kill the sensor as it floods it with glue and it can also damage your cat’s fragile skin.
Please let me know if you have any further questions. I’m happy to help.
 
Hello everyone.
On Tuesday, the vet started Mickey on one full unit of PZ in the AM and keeping him on 1/2 unit in the pm. I was excited about the libre data the first day because it actually increased and then went down into the green zone for a couple of hours and then climbed back up again and then went down with the evening dosage. I was encouraged until I saw the data for Wednesday being recorded by the Libre. On this day, Mickey did not have any movement similar to what we saw on the first day with one unit in the a.m. Instead, he bounced in somewhat curved manner between 350 and 300. There was no real movement below into the green zone. A couple times he went below 300 but for the most part it was in that range. Today on Thursday, it was much of the same. I have not heard anything from the vet who is reviewing the data they receive from the Libre. I am concerned that he is insulin resistant, and perhaps one of his other comorbidities might be influencing his glucose not changing. Please correct me if I’m wrong, but wouldn’t you expect to see some variation in glucose levels when starting PZ even if the 1 unit dosage started just 3 days earlier?

He had a similar pattern to this for the first week when he was only on 1/2 a unit two times a day also. I have a spreadsheet. I am updating on the Facebook group if anyone would like to review it. It’s called Mickey’s spreadsheet.

At this point, I don’t know what to do. He actually does seem better and more active. He was urinating less and drinking less water, but it has gotten very cold here this week so the heat is running quite a bit. It’s hard to tell if he’s just dry because of the heat or if it’s a sign of the diabetes because he is drinking water (not as much as I recall before the insulin - he has a fountain). I’ve been doing a lot of reading, which is taking me in circles. He has a chronic sinusitis and has been on multiple rounds of antibiotics during the summer which I think completely messed up his gut flora. He is taking a probiotic now to try to help get his gut rebalanced. I don’t know what I should tell the vet. I’m wondering if they have ruled out other things that could have been causing the resistance. Things like a bacterial infection of some type. At this point, I’m not sure where to go, I appreciate any comments or thoughts you would be willing to share. It’s only Thursday and it’s been a very long week already.
 
ProZinc is a 12 hour insulin and the same dose must be given every 12 hours, Corky uses ProZinc, never have I ever given a different dose unless He was to have an increase or decrease due to a limeBG (under 50) I will tag Suzanne to give you some Input, Honestly I’m not sure if your vet has much schooling on FD, he’s instructions only lets me think that you will be seeing him every other day, too much inconsistency
@Suzanne & Darcy
 
If you can share the spreadsheet here by linking it in your signature, we'll be able to help you on dosing.
 
Thanks, now I can see the spreadsheet. It's not our format, but will do. I just mention it because the format that FB group has sometimes blows up on tablets and phones. I'm currently on my laptop so it works.

The way we do dosing with Prozinc here, we do give the same dose AM and PM. And since he still is eating some high carb dry food, 1.0 units would also be the starting dose.
alphadog0228 said:
I am concerned that he is insulin resistant, and perhaps one of his other comorbidities might be influencing his glucose not changing
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He's on very small doses of insulin, I wouldn't worry about insulin resistance now. His spreadsheet just shows that it's early days and his PM dose is too low. A cat's body takes a while to get used to the new hormone (insulin), you very seldom see a very quick response when just starting off. Typically people keep the same dose for a week (if dry food in the picture), then see how the cat is doing and if he needs a dose increase.
 
Wendy&Neko said:
Thanks, now I can see the spreadsheet. It's not our format, but will do. I just mention it because the format that FB group has sometimes blows up on tablets and phones. I'm currently on my laptop so it works.

The way we do dosing with Prozinc here, we do give the same dose AM and PM. And since he still is eating some high carb dry food, 1.0 units would also be the starting dose.

He's on very small doses of insulin, I wouldn't worry about insulin resistance now. His spreadsheet just shows that it's early days and his PM dose is too low. A cat's body takes a while to get used to the new hormone (insulin), you very seldom see a very quick response when just starting off. Typically people keep the same dose for a week (if dry food in the picture), then see how the cat is doing and if he needs a dose increase.
Click to expand...
Wendy&Neko said:
Thanks, now I can see the spreadsheet. It's not our format, but will do. I just mention it because the format that FB group has sometimes blows up on tablets and phones. I'm currently on my laptop so it works.

The way we do dosing with Prozinc here, we do give the same dose AM and PM. And since he still is eating some high carb dry food, 1.0 units would also be the starting dose.

He's on very small doses of insulin, I wouldn't worry about insulin resistance now. His spreadsheet just shows that it's early days and his PM dose is too low. A cat's body takes a while to get used to the new hormone (insulin), you very seldom see a very quick response when just starting off. Typically people keep the same dose for a week (if dry food in the picture), then see how the cat is doing and if he needs a dose increase.
Click to expand...

Thank you very much for this feedback. It was very disappointing to see the numbers not moving much. I am trying very hard to stay on track with him.

Non-quantitatively, he seems to have improved. He’s more alert and active but he has some trouble with the neuropathy in his legs due to the diabetes. He also seems to be drinking less water and peeing less. On this, we hit a cold spell so that the heat is running all the time and the house is dry and I feel it as well. He just looks better to me overall since starting the insulin even those his numbers aren’t moving much.

He has this ongoing sneezing and respiratory problem and has been on multiple rounds of antibiotics during the summer which help during the time he is on them, but it comes back after he stops. They just finally put him on a probiotic and we’re finishing the first month of it so it will hopefully help rebalance his gut after all the antibiotics. I can’t help but feel 1that multiple rounds of the antibiotics has also set off his IBD caused a lot of inflammation which is related to the diabetes.

He is on the royal Canin PR/PD wet food, and that has worked well with no vomiting for several months. They just let me start adding 1/8 of a cup of the dry back in this week because his weight was falling a few tenths of a pound every 10 days or so because we are worried about his weight loss. He hasn’t eaten much of it during each of the two major feedings when he gets his shot. 1/2 a can all at once is a lot more than he would eat at one time. He has always been a grazer.

His thyroid was normal the last time they checked it a month or so ago. He gets his medication for that on his ear tip 2x a day. Thank you again for your feedback. It means a lot.
 
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