New Member - 19 yo cat use back legs

Hello, sorry for the long story, but my soul cat, Miko, has had a lot of medical problems and recently had a glucose reading of 471. I'll try to make this as short as possible while hitting the important notes.

We adopted Miko in 2008 when he was three years old. I bought what I thought was good food (expensive kibble) and he gained a ton of weight. He ended up weighing 29.5 lbs and the vet said he was diabetic. Rather than give him insulin, I switched him to wet food to see if his values would come down. It took almost two years to get him only on wet food but we did it. I tested his glucose at home during this time, and his numbers were normal pretty much the whole time.

He also has FLUTD. He's blocked several times (even on the prescription diet) and has need to be hospitalized. We found that Prednisolone worked to calm his bladder. Initially we only gave him the Pred when he was showing signs of blocking, but eventually it became 5 mg of Pred everyday for the last 10 years.

Since March of this year he has had a recurrent UTI. We were prescribed Orbax the first two times. They also diagnosed him with CKD based on his SDMA levels and later BUN levels. Phosphorus has always been in range. Glucose was slightly elevated (around 200), but that is normal for him at the vet so they weren't concerned.

Each time he tested negative for a UTI at the end of the meds, but a week later the infection was back. The third time we had a sterile collection at the vet. He is fractious at the vet so they told us to give him 100 mg of gabapentin the night before and the morning of the appointment. He suffered severe ataxia and couldn't stand on his own. We switched his to Royal Canin Renal E wet food for the CKD diagnosis. They cultured his urine, found ecoli, and switched his antibiotic to Clavacillian. He did not do well on the Clavacillian and quit eating entirely. The only food I could get him to eat was dry renal food. We took him off Clavacillian, back on Orbax, and he started eating wet food again. His back legs would work, but he was extremely wobbly and stopped doing stairs/jumping/etc.

Miko collapsed and we took him to an emergency vet where they diagnosed him with IVDD based on xrays. For two weeks we had another vet do home visits for laser treatment for his back. That seemed to make a slight improvement is his mobility and he seemed to be doing a little better.

We went out of town for one week and the person who fed him said that he was wobbly, but he was still moving on his own. They also said neither cat was eating very much and only pooped twice whil we were gone.

We got home on Saturday and noticed he was having a hard time moving. We gave him Miralax to see if he would poop (he did!). We also made the mistake of giving him 0.1 ml of gabapentin to see if it would help his mobility. He has been moving less over the last couple of days after the gabapentin, and now he can't stand or walk without me holding his hips straight.

I collected a urine sample yesterday, and there was a lot of blood protein, and glucose. The mobile vet did a laser treatment yesterday too, and I asked about diabetic neuropathy. They checked his glucose and it was 471. We had blood tests earlier today and the glucose was lower (320?). and have another appointment with the regular vet in a couple of hours.

Last night I rubbed a small amount of Mirataz on Miko's ear to help with his appetite. Today we bought low carb, low phosphorus wet food that he actually ate. We will continue feeding that food and discontinue the renal food. The vet advised us to start tapering off the steroid because steroids can cause diabetes. The rate they suggested is 2.5 mg per day for one week, then 2.5 mg every other day for two weeks, then nothing.

Some of my question are:

Is this the correct rate for tapering off long-term steroid use?

Is there anything else I can do right now? I ordered zobaline, but it won't be here until next week.

Can we expect Miko to regain the use of his back legs if we get the glucose under control? He did not have keytones in his urine.

I feel like a failure and I should have prevented this if I was a better pet parent. Any other words of wisdom/support/etc. are appreciated.

 

More questions:

Do I use insulin now to try and get his numbers down immediately or try the diet change and weening off steroids first?

Does the successful recovery from neuropathy factor into this decision?

 

The vet gave me ProZinc and advised to give 1 unit if Miko's glucose was over 200. Recheck at the vet on Friday. His glucose measure 324 at 7:30am after a small meal. I gave him 1 unit of ProZinc at 7:45am. Hopefully I did it correctly.

 

We use 50 - 120 as normal range for blood glucose levels. Miko's numbers are considerably higher and it sounds like they've been high for some time. If the vet has run a fructosamine test at any time, the result will give you information as to whether Miko's blood glucose has been elevated for about 3 weeks. Also, insulin isn't really meant to be given on an "as needed" basis. This is a link to our page that contains Prozinc information. There's information about Prozinc as well as regarding dosing in the sticky notes at the top of the board.

It sounds like you're doing a great job with getting started home testing as well as with getting Miko on a low carb, canned food diet. If what you're seeing is diabetic neuropathy, once Miko's numbers are in a better range on a consistent basis, there's a good chance the neuropathy will resolve. However, it takes time. Don't expect this to happen in a couple of weeks. It can take months. Have you ruled out arthritis?

From what you're describing with the recurrent UTIs, I'm wondering if your cat has a kidney infection. This is a link to information on UTIs and it provides information on kidney infections. You may already be familiar with all of this but I thought I'd provide the link just in case.

While steroids aren't great for a diabetic, some cats need to be taking a steroid. You can always adjust your insulin dose to accommodate the pred. To my mind, that seems like a quick taper given how long your cat has been prescribed a steroid. My cat is prescribed pred for inflammatory bowel. He was taking as much as 1 mg and the tablets were scored. I began tapering at the rate of 0.5mg per week.

The other item that will help you to get started is to set up your signature and a spreadsheet. The information is in this post on helping us to help. you. The signature will give us many of the important details so we don't keep asking you for the information repeatedly. The spreadsheet will allow you to track Miko's progress and allow us to follow along and respond to questions based on your data.

To be honest, I don't think there's a person here who hasn't thought, "If I'd only known...." For me, I would have like to have been more cognizant of Gabby's symptoms. By the time the lightbulb went on, she was critically ill with diabetic ketoacidosis, hepatic lipidosis, and pancreatitis. It was a several day admission to the kitty ICU with my vet and the critical care vet warning me that not all cats survive. She did and she thrived for 6.5 more years. You've found the best place you never wanted to be. The members here are generous with their knowledge, time, and support.

 

Thanks for the reply. I've set up my signature, started a spreadsheet, and I'm trying to wade through the enormous amont of information

Sorry I didn't mention it in my original post, but the reason he is on the daily Pred is for arthritis. He has walked like a little old man for quite some time, but this is different. He holds his left leg out at an angle, has no balance, and wiggles his whole back end from side-to-side when he walks. He stumbles for a couple of steps and falls over. It's heartbreaking. We were considering Adequan and Solensia, in addition to the laser treatment, after the emergency vet blamed the trouble using his back legs on IVDD. We were ready to try Adequan (Solensia is a last resort for us based on his bad reactions to other meds recently) when we got hit with the diabetes diagnosis. I see similar back end weakness described in CKD cats and diabetic cats. I just wish I knew what was causing it (CKD, IVDD, diabetes) so I could treat it appropriately.

I've asked multiple vets about the possibility of having a kidney infection and not just recurrent UTIs, but they think his blood tests would look different if that was the case. I forgot to get a print out of his latest blood results, but I'll pick it up on Friday and add it to the spreadsheet. I wonder if treating him as if he has a kidney infection is something I should push for harder.

Miko's PM pre-shot reading was 163. The vet told me to not give him a shot if it was under 200. This is the first day of insulin and he's only had the AM shot. We did immediately switch back to low carb food with added water like he was getting before the switch to kidney food earlier this year and halved the steroid to 2.5mg. I'll keep testing to monitor his levels. We have a followup appointment at the vet on Friday to see how the insulin is working. 163 is still high but he was at 324 for the AM pre-shot

 

Hi and welcome to the forum.
Sounds as if Miko has diabetic neuropathy. With care it will come back to normal once the BGs come back to normal but it can take several months for it to back to normal. My kitty took at least 6 months, and then she was fine
You can also give zobaline which you can get from lifelink.com
It can be sprinkles on the food and seems tasteless as Sheba never seemed to notice it.
Keep asking questions!

 

Your situation may be more complicated, but 2.5 years ago, after stopping prednisolone for my cat (he had reoccurring pancreatitis), we were able to get his BG numbers under control and in remission fairly soon.

Unfortunately we just started back with cause unknown at the current time. Good Luck! This group is fantastic support and helps better than the vets can do.