kxk34
Member Since 2022
Hi! My name is Kaitlyn and my cat Fuzzy was diagnosed with steroid-induced diabetes last Thursday (January 6, 2022). Fuzzy started taking prednisolone (8mg daily) to treat severe IBD on December 9, 2021.
Fuzzy is estimated to be about 13-14 years old, but at least one vet has speculated that she may be older. Because of her IBD she is currently extremely underweight, with her weight fluctuating between 3.7 and 4.0 lbs during this past week and trending downward overall. She has always been a very petite cat, weighing between 6-7 lbs consistently throughout the years, so the sustained weight loss since summer has had a dramatic impact.
After browsing through some of the posts here Fuzzy seems to be a rather atypical case so I'm going to first get into some background information about her health the past 9 months to give the full context of her diagnosis and our concerns and reservations about how we should proceed.
Background:
Fuzzy has had a rough time the past several months. The last vet appointment before she started losing weight was May 11, 2021 and at that time she weighed 5.9 lbs which was consistent with her recorded weights over the 7-8 months prior. Over the summer, we noticed she had been more withdrawn so we brought her in to the vet and learned that she had lost some weight and that she had an ear infection. Unfortunately, the antibiotic she was prescribed made her very nauseous so her eating became pickier and eventually got to the point where we could barely get her to eat as we were trying to figure out what was going on with her in the early fall. During that period, our vet had us giving her mirataz nearly daily.
We finally got a diagnosis of IBD in November after several sets of special tests. She began treatment for IBD in mid-November. At that time, she switched to a fully hydrolyzed protein diet of both canned wet food and dry food. At first the abrupt diet change upset her stomach, but she quickly regained her appetite and now happily eats throughout the day. She also began receiving metronidazole daily as well as weekly B12 injections.
Towards the end of this pre-IBD diagnosis period, things got very scary because her mobility started worsening out of nowhere to the point where she could barely walk due to incredibly poor balance, in addition to having clear neurological symptoms (e.g., pronounced head tilt, leaning, circling, etc.). We believe that these symptoms were due to a thiamine deficiency caused by the prolonged period of recurring hyporexia/anorexia and issues with absorption from food due to GI inflammation. Based on this belief, she started getting a Vitamin B complex supplemental injection intramuscularly (daily for 10 days, then reduced to 2-3x weekly) and this helped noticeably within the first 24 hours. Since starting the injections she has regained the ability to walk and stand on her own (though she still wobbles) and no longer has the neurological symptoms.
Unfortunately, she has continued to lose weight. In light of this, she started taking prednisolone (8mg daily) on December 9, 2021 to treat GI inflammation with the hope that it would help her put on weight. Her weight stabilized somewhat around 4.3 lbs for a week or so but then began to decline again the past week. This has been very hard on us emotionally because other than her worsening body condition her quality of life has improved dramatically since starting treatment for IBD and receiving her vitamin B complex supplement injections. Her appetite has been great, she’s been eating and drinking readily, and since regaining her mobility she has been in great spirits overall. She’s been spending a lot of time with us and is as bright and sweet as ever after which has been really special to see after witnessing her become more withdrawn during the time period where she was having issues walking (October/November 2021).
She had started to have a good appetite prior to receiving the steroid, but definitely started eating and drinking more afterwards. We were told this is normal so we aren't sure whether there were any changes in these behaviors that may indicate when exactly the diabetes came into the picture. The only other (presumed) side effect we've noticed is hair loss on her ears and on the side of her nose near her eyes. The vet said this can happen with steroids.
Diabetes Diagnosis:
Last week, we wanted to do a urinalysis just to be safe after we noticed some odd behavior going to the litter box one day. We collected a free-catch urine sample on January 4, 2022 and the results showed that she had glucose in her urine. On January 6, 2022 the vet diagnosed her with steroid-induced diabetes based on the previous urinalysis results coupled with a value of 452 on the glucometer during her visit that day. Given these results, we reduced her prednisolone amount to 5mg daily. Today she went back to the vet for her injections and they checked her blood sugar with the glucometer again and got a value of 310.
We ordered a glucometer starter kit (that has not arrived yet), but have not started her on any insulin yet.
The vet mentioned starting her on insulin today, but I didn’t know how much she had eaten this morning and did not feel comfortable because the vet had previously said a value above 400 would tell us she had diabetes, but below that it might be more ambiguous given that for years her lab results have shown glucose values between 200 and 279 due to stress while visiting the vet.
The hydrolyzed protein diet she is on does not appear to be a good fit for a diabetic cat given the amount of carbohydrates in the dry food especially. Unfortunately, we are unable to adjust her diet at this time due to her very low body condition and ongoing issues with IBD, weight loss, and inability to gain or maintain weight. We also are unable to stop giving her the prednisolone without tapering the dose down first, but the vet does not recommend taking her off of it entirely due to the potential for her IBD to become even more uncontrolled unless we switched to a stronger drug typically used for GI lymphoma that I'm a little concerned she's not strong enough to handle right now given her condition.
Complicating (non-health) factors:
This has been a very difficult couple of months for us because our vet went on maternity leave right before Fuzzy’s IBD diagnosis was confirmed. This means that throughout all of this our vet office has been short staffed and, most significantly, that we’ve been working with another vet at the office who is not as good a fit for us and who we are not particularly comfortable with. I mention the circumstances with our vet just because it's a unique situation in that we have a vet who knows Fuzzy and who we trust and fit well with, but are temporarily unable to see her and unfortunately this coincides with such a critical time for Fuzzy.
Unfortunately, there have been experiences during this period that make it harder to feel confident in the advice that we’re getting. Most notably, when Fuzzy’s mobility kept worsening, the vet didn’t offer much on that front at all other than to suggest that it was a sign that we should consider euthanasia. We identified thiamine deficiency as a potential cause of Fuzzy’s mobility/neuro issues based on a note that our regular vet had made in an earlier email right when the balance issues started and additional research and we were the ones who suggested the treatment that ended up giving Fuzzy her mobility back. We also felt very pressured to start her on the prednisolone when we had wanted to hold off to give her a chance to see if she might gain weight with the hydrolyzed diet and metronidazole first so to have this happen only a few weeks after she began taking it is pretty demoralizing. Again, I say this not to complain but just to explain why we have so many doubts about how to proceed given that this is happening during a time when we do not have access to our normal vet. I appreciate everything this vet has done for us. I just wanted to explain why it's hard to know how to navigate at times.
Our comfort level has also declined during this period because we’ve frequently felt like we are on our own trying to figure out what is wrong with her due to issues with communication since the vet we have to see is not great about answering our questions, as well as difficulties scheduling regular appointments for exams (other than receiving her injections from a tech) due to being short staffed, etc. These past two weeks there have also been issues because a COVID outbreak at the office last week exacerbated existing difficulties with being short-staffed, etc. and there were a few instances of miscommunication and things falling through the cracks with respect to the blood work done last week so we’re not even sure we have all the information from the bloodwork taken the day of her diagnosis yet and the one page of bloodwork results we received today had additional elevated values besides glucose (ALT, and calcium) that were not mentioned and did not have CBC results despite us requesting it— this is not to complain given the understandably difficult situation, but just to note that this is not a great week to get such a big diagnosis and feel good making big decisions given that things have seemed more disorganized and distracted than usual (again, understandable).
All of this is just to say, it is exceedingly hard for us to feel super confident about any course of action or diagnosis given this unfortunate set of circumstances... This dynamic has been highly stressful to navigate, but ultimately felt manageable until this most recent news. I’m scared of making the wrong move because of how frail and small Fuzzy is already. Even after reading about everything I don’t fully understand the diagnosis to be honest and given her frail state I am very scared of doing too much too soon and possibly harming her. I recognize that everything is a risk right now given that she is already in very bad condition due to her inability to put on weight because of her severe IBD which makes it harder not to be scared of making one wrong decision that could lead to us losing her and we've already made one decision under pressure (putting her on the prenisolone) that has made her situation worse (by apparently giving her diabetes).
Questions:
Our main concerns right now relate to how we should proceed with respect to the insulin and whether there is anything we should be doing in the meantime to minimize risks to Fuzzy. Ideally, I’d hoped that we could get a glucometer soon so that we could test her throughout the day at home to get a clearer picture of what her levels look like before starting her on anything, but we will not have that for another 2-3 days and the vet indicated that we should act sooner rather than later.
One thing we were wondering is whether there is any way that it is possible that she could not actually be diabetic but could occasionally reach those levels due to stress/prednisolone (given that she previously would get values as high as 279 without the steroid).
We were also wondering whether there is anything we can do to confirm the diabetes diagnosis beyond what has been done already so that we know that we are taking the correct course of action in starting her on insulin right now. We requested that a fructosamine test to be done the day of the diagnosis but we were warned that a more encouraging result on this test would not be informative because she only started taking the prednisolone about a month ago.
Finally, if anyone has any advice or insight on managing a diagnosis like this in a cat who has IBD and/or is very underweight like Fuzzy we would very much appreciate it.
I apologize for the lengthy background, etc. but I just wanted to give the full context of our unusual situation so that you were better positioned to give us advice if possible. Thanks in advance for your help!
Fuzzy is estimated to be about 13-14 years old, but at least one vet has speculated that she may be older. Because of her IBD she is currently extremely underweight, with her weight fluctuating between 3.7 and 4.0 lbs during this past week and trending downward overall. She has always been a very petite cat, weighing between 6-7 lbs consistently throughout the years, so the sustained weight loss since summer has had a dramatic impact.
After browsing through some of the posts here Fuzzy seems to be a rather atypical case so I'm going to first get into some background information about her health the past 9 months to give the full context of her diagnosis and our concerns and reservations about how we should proceed.
Background:
Fuzzy has had a rough time the past several months. The last vet appointment before she started losing weight was May 11, 2021 and at that time she weighed 5.9 lbs which was consistent with her recorded weights over the 7-8 months prior. Over the summer, we noticed she had been more withdrawn so we brought her in to the vet and learned that she had lost some weight and that she had an ear infection. Unfortunately, the antibiotic she was prescribed made her very nauseous so her eating became pickier and eventually got to the point where we could barely get her to eat as we were trying to figure out what was going on with her in the early fall. During that period, our vet had us giving her mirataz nearly daily.
We finally got a diagnosis of IBD in November after several sets of special tests. She began treatment for IBD in mid-November. At that time, she switched to a fully hydrolyzed protein diet of both canned wet food and dry food. At first the abrupt diet change upset her stomach, but she quickly regained her appetite and now happily eats throughout the day. She also began receiving metronidazole daily as well as weekly B12 injections.
Towards the end of this pre-IBD diagnosis period, things got very scary because her mobility started worsening out of nowhere to the point where she could barely walk due to incredibly poor balance, in addition to having clear neurological symptoms (e.g., pronounced head tilt, leaning, circling, etc.). We believe that these symptoms were due to a thiamine deficiency caused by the prolonged period of recurring hyporexia/anorexia and issues with absorption from food due to GI inflammation. Based on this belief, she started getting a Vitamin B complex supplemental injection intramuscularly (daily for 10 days, then reduced to 2-3x weekly) and this helped noticeably within the first 24 hours. Since starting the injections she has regained the ability to walk and stand on her own (though she still wobbles) and no longer has the neurological symptoms.
Unfortunately, she has continued to lose weight. In light of this, she started taking prednisolone (8mg daily) on December 9, 2021 to treat GI inflammation with the hope that it would help her put on weight. Her weight stabilized somewhat around 4.3 lbs for a week or so but then began to decline again the past week. This has been very hard on us emotionally because other than her worsening body condition her quality of life has improved dramatically since starting treatment for IBD and receiving her vitamin B complex supplement injections. Her appetite has been great, she’s been eating and drinking readily, and since regaining her mobility she has been in great spirits overall. She’s been spending a lot of time with us and is as bright and sweet as ever after which has been really special to see after witnessing her become more withdrawn during the time period where she was having issues walking (October/November 2021).
She had started to have a good appetite prior to receiving the steroid, but definitely started eating and drinking more afterwards. We were told this is normal so we aren't sure whether there were any changes in these behaviors that may indicate when exactly the diabetes came into the picture. The only other (presumed) side effect we've noticed is hair loss on her ears and on the side of her nose near her eyes. The vet said this can happen with steroids.
Diabetes Diagnosis:
Last week, we wanted to do a urinalysis just to be safe after we noticed some odd behavior going to the litter box one day. We collected a free-catch urine sample on January 4, 2022 and the results showed that she had glucose in her urine. On January 6, 2022 the vet diagnosed her with steroid-induced diabetes based on the previous urinalysis results coupled with a value of 452 on the glucometer during her visit that day. Given these results, we reduced her prednisolone amount to 5mg daily. Today she went back to the vet for her injections and they checked her blood sugar with the glucometer again and got a value of 310.
We ordered a glucometer starter kit (that has not arrived yet), but have not started her on any insulin yet.
The vet mentioned starting her on insulin today, but I didn’t know how much she had eaten this morning and did not feel comfortable because the vet had previously said a value above 400 would tell us she had diabetes, but below that it might be more ambiguous given that for years her lab results have shown glucose values between 200 and 279 due to stress while visiting the vet.
The hydrolyzed protein diet she is on does not appear to be a good fit for a diabetic cat given the amount of carbohydrates in the dry food especially. Unfortunately, we are unable to adjust her diet at this time due to her very low body condition and ongoing issues with IBD, weight loss, and inability to gain or maintain weight. We also are unable to stop giving her the prednisolone without tapering the dose down first, but the vet does not recommend taking her off of it entirely due to the potential for her IBD to become even more uncontrolled unless we switched to a stronger drug typically used for GI lymphoma that I'm a little concerned she's not strong enough to handle right now given her condition.
Complicating (non-health) factors:
This has been a very difficult couple of months for us because our vet went on maternity leave right before Fuzzy’s IBD diagnosis was confirmed. This means that throughout all of this our vet office has been short staffed and, most significantly, that we’ve been working with another vet at the office who is not as good a fit for us and who we are not particularly comfortable with. I mention the circumstances with our vet just because it's a unique situation in that we have a vet who knows Fuzzy and who we trust and fit well with, but are temporarily unable to see her and unfortunately this coincides with such a critical time for Fuzzy.
Unfortunately, there have been experiences during this period that make it harder to feel confident in the advice that we’re getting. Most notably, when Fuzzy’s mobility kept worsening, the vet didn’t offer much on that front at all other than to suggest that it was a sign that we should consider euthanasia. We identified thiamine deficiency as a potential cause of Fuzzy’s mobility/neuro issues based on a note that our regular vet had made in an earlier email right when the balance issues started and additional research and we were the ones who suggested the treatment that ended up giving Fuzzy her mobility back. We also felt very pressured to start her on the prednisolone when we had wanted to hold off to give her a chance to see if she might gain weight with the hydrolyzed diet and metronidazole first so to have this happen only a few weeks after she began taking it is pretty demoralizing. Again, I say this not to complain but just to explain why we have so many doubts about how to proceed given that this is happening during a time when we do not have access to our normal vet. I appreciate everything this vet has done for us. I just wanted to explain why it's hard to know how to navigate at times.
Our comfort level has also declined during this period because we’ve frequently felt like we are on our own trying to figure out what is wrong with her due to issues with communication since the vet we have to see is not great about answering our questions, as well as difficulties scheduling regular appointments for exams (other than receiving her injections from a tech) due to being short staffed, etc. These past two weeks there have also been issues because a COVID outbreak at the office last week exacerbated existing difficulties with being short-staffed, etc. and there were a few instances of miscommunication and things falling through the cracks with respect to the blood work done last week so we’re not even sure we have all the information from the bloodwork taken the day of her diagnosis yet and the one page of bloodwork results we received today had additional elevated values besides glucose (ALT, and calcium) that were not mentioned and did not have CBC results despite us requesting it— this is not to complain given the understandably difficult situation, but just to note that this is not a great week to get such a big diagnosis and feel good making big decisions given that things have seemed more disorganized and distracted than usual (again, understandable).
All of this is just to say, it is exceedingly hard for us to feel super confident about any course of action or diagnosis given this unfortunate set of circumstances... This dynamic has been highly stressful to navigate, but ultimately felt manageable until this most recent news. I’m scared of making the wrong move because of how frail and small Fuzzy is already. Even after reading about everything I don’t fully understand the diagnosis to be honest and given her frail state I am very scared of doing too much too soon and possibly harming her. I recognize that everything is a risk right now given that she is already in very bad condition due to her inability to put on weight because of her severe IBD which makes it harder not to be scared of making one wrong decision that could lead to us losing her and we've already made one decision under pressure (putting her on the prenisolone) that has made her situation worse (by apparently giving her diabetes).
Questions:
Our main concerns right now relate to how we should proceed with respect to the insulin and whether there is anything we should be doing in the meantime to minimize risks to Fuzzy. Ideally, I’d hoped that we could get a glucometer soon so that we could test her throughout the day at home to get a clearer picture of what her levels look like before starting her on anything, but we will not have that for another 2-3 days and the vet indicated that we should act sooner rather than later.
One thing we were wondering is whether there is any way that it is possible that she could not actually be diabetic but could occasionally reach those levels due to stress/prednisolone (given that she previously would get values as high as 279 without the steroid).
We were also wondering whether there is anything we can do to confirm the diabetes diagnosis beyond what has been done already so that we know that we are taking the correct course of action in starting her on insulin right now. We requested that a fructosamine test to be done the day of the diagnosis but we were warned that a more encouraging result on this test would not be informative because she only started taking the prednisolone about a month ago.
Finally, if anyone has any advice or insight on managing a diagnosis like this in a cat who has IBD and/or is very underweight like Fuzzy we would very much appreciate it.
I apologize for the lengthy background, etc. but I just wanted to give the full context of our unusual situation so that you were better positioned to give us advice if possible. Thanks in advance for your help!
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