new here - trying to understand treatment options

A

alphadog0228

New Member
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.
 
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