New member - FIV+ Diabetic with Potential IBD? Looking for Sugguestions

[GreyJax]

Hi everyone! I have been lurking here every now and again. My grey boy was diagnosed with diabetes about a year ago and since then we have been having multiple issues with him and a few ER visits.


The main reason I am posting here is because he has been having chronic diarrhea/loose stool that is yellowish in color and it's causing discomfort for him. Another thing that is odd is after he has diarrhea his privates are exposed, and he is biting it.


We have been keeping logs on him ever since he was diagnosed with diabetes and the diarrhea seemed to show up about two months after diagnosis and diet change. In the beginning it wasn't happening enough for us to be too concerned. Prior to him being diabetic I had him on Purina indoor dry formula about 95% of his life. We switched in the beginning to a mix of Royal Canin Glycobalance and Purina DM to see which he would like best. At first he was all about the Glycobalance, then he stopped being interested in that so we switch him to DM and he has been now eating a mix of wet Purina DM and dry Royal Canin Glycobalance because it has been a chore trying to fully convert him to an all wet diet (I am going to be reading the post on how to convert once we get him feeling better again and have researched the feeders people have been talking about on here and the idea of freezing the food).


Before the privates biting, we had another emergency visit (same hospital) when he wasn't eating at all. At that time, he was treated for a GI upset. They gave him an abdominal ultrasound which showed thickening of the intestinal walls. The GI panel came back okay, no issues. They sent him home with Cerenia for nausea and Mirataz to help his appetite and he was okay after that. They chalked it up to a flare up and probable IBD.


When the privates biting first happened about two months ago, we took him to the ER thinking maybe there were crystals or a blockage, but nothing was found after an ultrasound. The diarrhea back then wasn't even mentioned because we didn't think it was related. After observing him a bit longer we noticed that the privates biting was only happening after the diarrhea and ended up taking him back in to get his anal glands extracted. The doctor (an internal med doctor at the hospital we took him) at that time told us that she got it all out and it was a chalky substance. He was sent home with gabapentin for discomfort and we figured the privates biting would stop once it healed and now that his glands we're extracted. We were then told to follow up with our primary vet.


Let’s get down to recently. Starting two months ago is when the privates biting and the diarrhea started to get worse. He has some good days and some bad days. I have since been working on the issue with my primary vet. We did another ultrasound last week which showed thickening of the intestinal walls, a small section on the small intestinal bowel was corrugated looking (about 4cm in size). He has an enlarged lymph node in his belly and his spleen she mentioned was a different texture (no real details on that). She said all of this could be IBD but also could be lymphoma. Because he is diabetic, she is a bit hesitant to go the steroid route because it is counteractive with insulin. There is also the option of a biopsy to rule out lymphoma, but she stated that it could be hard for him to recover from surgery due to his condition of being diabetic and FIV+. The first thing she mentioned we could try is Atopica however I have her getting a second opinion on that because it states not to give Atopica to FIV+ cats due to it being an immunosuppressant.


I guess what I'm looking for is to see if anyone has had any success with any of these options? Should I be as concerned as I am about trying Atopica? Are there other options maybe we are not aware of? Diet change? At one point during all of this pumpkin was suggested for added fiber. We did try it for about a week, but it seemed like he was avoiding the pumpkin in his wet food regardless of how mixed in I could get it. He also doesn’t fully finish his wet food, so it is hard to make sure he is getting the full amount that was suggested by the doctor. In hindsight a week is also not a lot if time and I’d be willing to try the pumpkin again if anyone has any good experiences with it. And the one thing completely stumping both me and my vet is the privates biting, is it just an innocent bystander?


Other than the diarrhea, the privates biting and the discomfort after diarrhea (scooting, half squatting around) he seems okay, he has a normal appetite, when he isn't feeling bothered by his bum, he is active and likes to play. Thank you for reading any for any input anyone can provide.

 

[Wendy&Neko]

Hello and welcome. Sorry you've had to deal with a complicated kitty. My girl also had a few secondary conditions to deal with, one of which was either small cell lymphoma or severe IBD. We couldn't biopsy because her heart couldn't take the anaesthesia. So her IM vet put her on budesonide, which is a locally acting steroid that works on the GI system. For a lot of kitties, including Neko, the budesonide does not impact the blood sugar numbers. Depending where the thickening is on the bowels, an endoscopy might be an option to differentiate between IBD and SCL. It still requires anaesthesia, but is less invasive. I have yet to see a cat have much success with Atopica.

If your kitty (name?) does have IBD, a diet change would indeed help. This website has a lot of info: https://www.ibdkitties.net/ Probiotics can also help, I like Visbiome which is specially designed for IBD. Neither the Glycobalance (higher carb) or DM do anything special for diabetes. However, if you aren't home testing his blood sugars, don't change the diet to a better lower carb food until you are. Side note, low carb/low phosphorus food with plenty of water added can help crystals if present. More reading here: https://catinfo.org/feline-urinary-tract-diseases/ Possible he has idiopathic cystitis? I had a non diabetic cat who did the privates during a flare. Have you tried putting in Feliway diffusers to calm him?

Did the GI panel done also test for EPI? There is the Texas A&M panel that also includes the TL1 test.

 

[GreyJax]

Hello and welcome. Sorry you've had to deal with a complicated kitty. My girl also had a few secondary conditions to deal with, one of which was either small cell lymphoma or severe IBD. We couldn't biopsy because her heart couldn't take the anaesthesia. So her IM vet put her on budesonide, which is a locally acting steroid that works on the GI system. For a lot of kitties, including Neko, the budesonide does not impact the blood sugar numbers. Depending where the thickening is on the bowels, an endoscopy might be an option to differentiate between IBD and SCL. It still requires anaesthesia, but is less invasive. I have yet to see a cat have much success with Atopica.

If your kitty (name?) does have IBD, a diet change would indeed help. This website has a lot of info: https://www.ibdkitties.net/ Probiotics can also help, I like Visbiome which is specially designed for IBD. Neither the Glycobalance (higher carb) or DM do anything special for diabetes. However, if you aren't home testing his blood sugars, don't change the diet to a better lower carb food until you are. Side note, low carb/low phosphorus food with plenty of water added can help crystals if present. More reading here: https://catinfo.org/feline-urinary-tract-diseases/ Possible he has idiopathic cystitis? I had a non diabetic cat who did the privates during a flare. Have you tried putting in Feliway diffusers to calm him?

Did the GI panel done also test for EPI? There is the Texas A&M panel that also includes the TL1 test.

Thanks so much for your response! I'm going to be speaking with our primary vet Monday after she gets a second opinion on the Atopica. If she still feels strongly about it I'll give it a shot. The next step she wanted to take was the biopsy but if it comes down to that I will ask if an endoscopy could be done instead, I'm not sure where the thickening was on the bowels, she didn't provide that much detail during our previous call last week. The next step after ruling out SCL would be the steroids in which she suggested prednisone but I will ask her to also look into budesonide, it sounds like a better option if that is the route we have to take.

I will take a look and read through the two links you sent me, thank you for those and run using probiotics past my vet as well. If neither the Glycobalance (higher carb) or DM do anything special for diabetes how come it is a prescribed food for diabetics? Is there information out there on better foods and what to look for in canned for for a diabetic cat with IBD?

Also we do not home test. We attempted to before but weren't having luck with the lancets. Do you recommend any home tests? Or maybe some tips and tricks for beginners? I would LOVE to home test him for some piece of mind and if we want to diet change I agree it would be a good idea to keep an eye on his BG.

I never heard of idiopathic cystitis but this does sound like a possible cause that I will also run by my vet. Is it possible though that the IBD is causing this? Our mindset so far has been lets treat the issue of the diarrhea and then we're hoping it will resolve the biting as well since it seems related.

 

[Wendy&Neko]

f neither the Glycobalance (higher carb) or DM do anything special for diabetes how come it is a prescribed food for diabetics?

You will note the DM is called "dietetic management", not diabetic management. The "prescription" food companies do a lot of the vet training on nutrition, hence that's what vet's prescribe. Read more on that catinfo website I linked, the website is written by a vet specializing in feline nutrition. Many vets get something like 4-5 hours training on nutrition, and that's for cats and dogs. Basically you want low carb wet or raw food, for IBD go with a novel protein they haven't had before, such as rabbit, venison, lamb, duck etc. There are plenty of commercially available options. The catinfo site also has a food list with many of the foods available in US and some in Canada. You want a food with under 10% carbs. Food list is here.

Idiopathic cystitic and IBD would not be related, I don't think. Cystitis is related to the bladder and can be painful.

Another link full of tips for you: Hometesting Links and Tips Starting out with larger lancets can help, personal preference if you free hand or use a lancing device. Warming the ear before hand is key to a good blood flow, plus a meter than needs a small drop of blood.

 

[Ale & Bobo & Minnie (GA)]

Most vets prescribe those foods because most vets are not well versed in nutrition. Hell even human doctors aren’t. Minnie has been diagnosed with IBD via endoscopy and biopsy. Btw, the biopsy is collected during the endoscopy so one procedure only. Wendy was super helpful in guiding me through it so I’d listen to everything she says, she’s a pro and likely knows more than most vets. Minnie is on budesonide and it’s helped tremendously. She’s also on visbiome probiotics and again, if you ask most vets will say they don’t need it and most won’t even have heard about it at all. I took Minnie to a nutritionist who prescribed it as well as a novel protein diet. Ziwipeak is a brand that has great options but I also found that eliminating beef from her diet had done wonders. Another probiotic that is helpful in regulating the stool is S Boulardii which Minnie is on as well. Cats with IBD also need vitamin b12 injection and a b12 deficiency can mess with their stool. A blood test should confirm if that’s the issue. Minnie gets a b12 injection twice a month and it’s as easy as giving insulin.

 

[GreyJax]

You will note the DM is called "dietetic management", not diabetic management. The "prescription" food companies do a lot of the vet training on nutrition, hence that's what vet's prescribe. Read more on that catinfo website I linked, the website is written by a vet specializing in feline nutrition. Many vets get something like 4-5 hours training on nutrition, and that's for cats and dogs. Basically you want low carb wet or raw food, for IBD go with a novel protein they haven't had before, such as rabbit, venison, lamb, duck etc. There are plenty of commercially available options. The catinfo site also has a food list with many of the foods available in US and some in Canada. You want a food with under 10% carbs. Food list is here.

Idiopathic cystitic and IBD would not be related, I don't think. Cystitis is related to the bladder and can be painful.

Another link full of tips for you: Hometesting Links and Tips Starting out with larger lancets can help, personal preference if you free hand or use a lancing device. Warming the ear before hand is key to a good blood flow, plus a meter than needs a small drop of blood.

Thank you again for all of this information. I will thoroughly read through the site and check out the tips for home testing. Once I get comfy with that I’ll see a ill trying a new diet. I’m also going to mention idiopathic cyctitic to my primary vet tomorrow to see if that is the cause for the biting. I also bought a few diffusers for around my place. I’ve bought them before but never really noticed a difference but will try again! All of this gives me a good place a start. I really hope I can get my little buddy feeling himself again!

 

[GreyJax]

Most vets prescribe those foods because most vets are not well versed in nutrition. Hell even human doctors aren’t. Minnie has been diagnosed with IBD via endoscopy and biopsy. Btw, the biopsy is collected during the endoscopy so one procedure only. Wendy was super helpful in guiding me through it so I’d listen to everything she says, she’s a pro and likely knows more than most vets. Minnie is on budesonide and it’s helped tremendously. She’s also on visbiome probiotics and again, if you ask most vets will say they don’t need it and most won’t even have heard about it at all. I took Minnie to a nutritionist who prescribed it as well as a novel protein diet. Ziwipeak is a brand that has great options but I also found that eliminating beef from her diet had done wonders. Another probiotic that is helpful in regulating the stool is S Boulardii which Minnie is on as well. Cats with IBD also need vitamin b12 injection and a b12 deficiency can mess with their stool. A blood test should confirm if that’s the issue. Minnie gets a b12 injection twice a month and it’s as easy as giving insulin.

Thank you for sharing your experience with me! In your opinion would it be better for me to seek out a specialist in nutrition rather then trying to supplement and change his diet on my own? Or is it something simple enough? I don’t want to mess up his nutrition completely. I’m going to read through all the information provided here and by Wendy.

 

[Wendy&Neko]

You can start here for help with food/diet, there are a number of us who've had to go through the same issues. Most of the commercially available foods are complete diets, you just need to find one with proteins that agree with him and is low carb.

 

[GreyJax]

Awe

You can start here for help with food/diet, there are a number of us who've had to go through the same issues. Most of the commercially available foods are complete diets, you just need to find one with proteins that agree with him and is low carb.

Awesome! Thank you again. First I need to get better/more comfortable checking his BG and I’ll keep going through the motions with my vet. I have already started to read a lot of the info here and I’m glad I stumbled upon this place! The food spreadsheet is awesome! I’ll be sure to keep updating this thread on our progress.

 

[Wendy&Neko]

Good luck with the testing. Post if you have problems - we've all been through it. Remember to try to remain calm - cats pick up our emotions. Start with picking a spot to test, rub his ears and give him a treat. Associate good things with the ear rub, eventually you can work up to testing.

 

[Ale & Bobo & Minnie (GA)]

Thank you for sharing your experience with me! In your opinion would it be better for me to seek out a specialist in nutrition rather then trying to supplement and change his diet on my own? Or is it something simple enough? I don’t want to mess up his nutrition completely. I’m going to read through all the information provided here and by Wendy.

I agree with Wendy. The only reason I took Minnie to a nutritionist is because I was at the end of my rope and in between vets since I couldn’t find one who knew enough about feline diabetes and IBD. The probiotics are something you can add now no need to consult a specialist for it and we can help with dosage. The b12 you need a prescription for, but it’s water soluble so any excess gets peed out. If you’re adding a new protein, do one at a time so you know what works. Any change in food can also affect his stool, so I’d look into getting started on the probiotics soon and testing the b12 level so you can rule that out

 

[GreyJax]

I agree with Wendy. The only reason I took Minnie to a nutritionist is because I was at the end of my rope and in between vets since I couldn’t find one who knew enough about feline diabetes and IBD. The probiotics are something you can add now no need to consult a specialist for it and we can help with dosage. The b12 you need a prescription for, but it’s water soluble so any excess gets peed out. If you’re adding a new protein, do one at a time so you know what works. Any change in food can also affect his stool, so I’d look into getting started on the probiotics soon and testing the b12 level so you can rule that out

What would type of info would I need to provide to get assistance on dosing the Probiotics?

 

[Ale & Bobo & Minnie (GA)]

What would type of info would I need to provide to get assistance on dosing the Probiotics?

Which probiotics and your cat’s weight. Minnie gets 1/3 of a capsule of visbiome once a day mixed with food. S Boulardii is about 1/4 of a capsule once or twice a day. Probiotics are natural which is why you don’t need a prescription for it

 

[GreyJax]

He is 10lbs. Which probiotic do you recommend? We don’t have a ton of success with pills so I’d prefer maybe liquid medication maybe a dropper to give him. I’d also maybe say something to mix in his food but I’m not sure how well it would help if he is not eating all of his meals. Right now, until I get confident I can test his BG with no issues we have been feeding him canned mixed with the dry glycobalance and he seems to sometime prefer the dry which I want to change but I’m just happy he is eating. Or if it’s possible to maybe give it to him as a treat mixed with tuna water or something. Thank you for all of your help!

 

[Ale & Bobo & Minnie (GA)]

Have you read through all the info Wendi and I gave you above? Visbiome is for the IBD and S Boulardii is for stool maintenance. Minnie is on both as they work differently. All probiotics I know of come in capsules you can open up and divide it up

 

[GreyJax]

Have you read through all the info Wendi and I gave you above? Visbiome is for the IBD and S Boulardii is for stool maintenance. Minnie is on both as they work differently. All probiotics I know of come in capsules you can open up and divide it up

Yes I have been reading through everything this site has to offer as well as catinfo site. It’s a ton of info to take on so I’m sorry if I forget or miss something. Thank you for the suggestions!