New Member: new diagnosis and management in difficult case

[Rocky1710]

Hi everyone! I'm new here as my cat is newly diagnosed and I am learning all there is to know about diabetes. I appreciate all the insight and posts I've read so far. I am located in the US and am working closely with my vet.

Long story on my cat so here it goes: 8 year old male, I've had him since he was 4 weeks old. Currently 15 pounds although lost 3 pounds in the past 2 months. This past September cat developed chronic diarrhea and lack of hygiene. He obviously didn't feel well and neglected himself. At first vet he was negative for parasites, dewormed anyway with profender. CBC showed elevated WBC and was treated with metronidazole. Glucose level was 85 so completely normal. Fast forward 1 month to a different vet (we relocated to a new area and I went back to my old vet, traveling). We ran a senior wellness panel and it showed very low B12 and high folate. Sent blood to Texas to rule out a pancreatic issue (TLI, PLI, Cobalamin) and it was negative. Ultrasound did not show anything of significance. He is also FelV and FIV negative. So his diagnosis was IBD. He was prescribed the Royal Canin hydrolyzed protein dry food and weekly B12 injections. Stools hardened up somewhat but after a few weeks he had full blown diarrhea again. Vet prescribed him prednisolone and this is where the nightmare really started. He was on the steroid for only a few weeks when he developed the staggering walk and the further weakness. Brought him back to the vet (january 21) and she immediately suspected diabetes. Blood sugar was over 500. Did not have the ketoacidosis. Potassium levels were ok. WBC elevated and was treated with convenia. Was started on ProZinc 1 unit twice/day. He is now weaned completely off the prednisolone. The worst part of all of this is his severe neuropathy. He can manage only 4 or 5 steps before he collapses. It's heartbreaking to watch. He is weak and lays around all day. I am very consistent with his care. He gets fed at 7am, gets his insulin around 7:30 and this is repeated in the evening at 7 pm. He is still on the royal canin food which I know needs to be switched (his vet didnt want to make too many changes all at once given his IBD, and that he was weaning off the steroid). He does NOT like wet food, but I just read the article posted on this forum about making the switch so will discuss this with my vet tomorrow. He is still eating and drinking so I know he hasn't given up yet. I've been monitoring his sugars at home and am comfortable using the monitor and giving injections. I did a glucose curve today and here are the results while he is on now 2 units of insulin twice/day:

7:30 am- 396 mg/dl
9:40-469 mg/dl
11:45-436 mg/dl
4:00-447 mg/dl
6:30 PM-454 mg/dl.

I texted my vet these results tonight and she said to increase his insulin to 3 units twice/day.

I am about a week away from euthanasia to be honest. The neuropathy is very hard to watch and i question his quality of life. I am in the mindset that it is better to do this one minute too soon rather than 1 minute too late. I do not mind the routine of insulin injections or the money involved with the insulin. I am 100%concerned with his quality of life. I realize I need to change his food and maybe this will help but what can I do about the painful neuropathy? Any suggestions are greatly appreciated!!! Thank you for reading if you made it this far!! I will appreciate any advice for my dear cat!

 

[Sienne and Gabby (GA)]

There are a couple of things to consider.

First, getting your kitty into better blood glucose (BG) numbers will help with the neuropathy. Please consider adding methylcobalamin (methyl-B12) to his diet. The B12 shots are cyanocobalamin which isn't quite the same. Zobaline is available on Amazon and is formulated for diabetic cats.

Based on the very limited numbers you included in your post, I'm guessing your cat needs more insulin. Normal BG is 50 - 120. The numbers you're seeing are way high. This is likely due at least in part to the RC food. Their dry foods, even the diabetic foods, are notoriously high in carbs

For an IBD kitty, you really need to consider novel proteins. (The only definitive way to know if this is IBD is via biopsy.) Foods such as rabbit, lamb, venison, and likely several others may help to calm down your cat's gut. Many IBD cats do exceptionally well on a raw food diet -- even cats that reject canned food. There are also freeze dried raw foods or air dried raw that have more of the texture of dry food. (ZiwiPeak makes an air dried raw and Stella & Chewy's has freeze dried.) I'd encourage you to take a look at this site on Raw Feeding for IBD Cats. There is also a section on the page about Meds & Supplements that has great information about treating diarrhea. (I swear by S. boulardii which is a probiotic and works like magic.)

With weaning your cat off of the steroids and if you change foods, you may see a marked change in BG numbers. Please monitor your cat's numbers.

The good news here is that it sounds like the diabetes is steroid induced. It may take a little while for the numbers to re-regulate and for the neuropathy to resolve as the numbers come down. Please don't give up on your kitty.

 

[Rocky1710]

Thank you for your reply. I will definitely look into your suggestions and discuss these with my vet tomorrow . Tonight she asked me to increase his insulin from 2 to 3 units twice/day If we wind up changing his food I will keep an eye on his sugars. I really appreciate your input!

 

[Chris & China (GA)]

what can I do about the painful neuropathy?

Neuropathy in cats isn't painful like it can be in humans. It's mostly just heartbreaking for us to watch....but with the right treatment and some time, they can come a long way back! Here's a video of a cat that had severe neuropathy and how well they healed with getting the BG under control and using Zobaline for cats B-12

I texted my vet these results tonight and she said to increase his insulin to 3 units twice/day.

Your vet is raising the dose too much, too quickly. We recommend doing dose increases in .25 to .5 unit increments. If you've been testing, it will really help if you'll put at least the last few weeks of numbers into our spreadsheet. We're very data driven here and depend on it to give you the best advice possible.

Here are the Instructions on getting the FDMB spreadsheet. Holler if you need help!

 

[Wendy&Neko]

So his diagnosis was IBD

I second Sienne's comment that you need to have either a biopsy or endoscopy to diagnose IBD and differentiate it from small cell lymphoma. Don't get too upset by the latter - a large percentage of cats with small cell go into remission on the right treatment protocol. Currently on my third such. Sigh! You can try the novel protein and see if it helps, which is one way to differentiate, as small cell lymphoma it doesn't matter what food you feed. BTW, Primal also makes freeze dried raw food. We had one kitty here who refused all wet, but did eat the freeze dried, and eventually went into diabetic remission.

Another thing to consider if your cat needs steroids, is that there is an alternative to prednisolone. My Neko could not have pred due to her heart, so she was put on budesonide, which is more locally acting on her GI system. It did not impact her blood sugar numbers.

 

[Rocky1710]

Thank you for the responses . Yes my vet definitely considered lymphoma for my cat and said a biopsy was the way to determine that diagnosis. Unfortunately, he would need to be sent out to a specialist for that procedure and with a price tag of over $600 we just can't do that right now. Plus in my cat's current condition I can't see putting him through anesthesia right now.

I will be chatting with my vet today and will bring up the issues all of you mentioned so far.

Also, has anyone experienced their cat having constantly dilated pupils? I mentioned this to my vet last week and she said it could be due to high blood pressure or pain. They do react to a bright flashlight but even in the day light they are dilated. Thanks again for any insight!

 

[Deb & Wink]

Dilated pupils can be a sign of hypoglycemia also.

 

[jt and trouble (GA)]

A little a story about dry food ... Trouble was dumped on us... that is, I took him to save him from that final needle. His owner dumped dry food into a bowl 3 times a day and surprise Trouble comes up diabetic. Dry kibble was all Trouble knew. I came here and learned that his numbers were probably high because kibble was all he would eat. Well when neuropathy set in I knew I HAD to make a change. Started him on FF Turkey and Giblets and he took to it right away...to a degree. Poor Trouble would sit for an hour staring where his old bowl of kibble sat. It tore me up but in the back of my mind I kept hearing everyone here saying "it for his own good"
AND IT WAS. After a LOOONG time Trouble finally, was able to eat without the sit n stare. Not only that but he was off insulin in a matter of weeks. Now, Trouble didnt have any other issues he was just too fat and with a poor diet. I know its MUCH harder when kitty has other issues and I PRAY you find just the right combination for Rocky. You've already made a good start as you are here. Listen to these folks. Theres a wealth of information in others stories. and WELCOME TO FDMB your new family.

 

[Diane Tyler's Mom GA]

@Rocky1710 hi is there any news in your kitty

 

[Rocky1710]

Update: thank you everyone who has responded. I chatted with my vet last night and we agreed that if his case became to the point where he is suffering, I would let him go with the dignity he deserves. HOWEVER we have not given up on him yet and I don't think he has either. I am going to begin the very slow transition to wet food as long as his bowels aren't too agitated. I purchased some of the wellness wet food tonight (I looked it up on the cat food nutritional chart in this forum) and to my surprise he ate some of it! I am starting with the smallest portion, just a small spoon full and will gradually switch him over. Again, I need to make sure his colon agrees with this. My vet was on board with this decision. I will also keep a close eye on his blood sugars and am comfortable testing at home. He seems a bit more lively the last two nights although his weakness from the neuropathy is still present. I realize this can take weeks to months to heal. Hopefully I will see an improvement sooner rather than later. I've learned soooo much from this forum already! Thank you all for being so welcoming and for the info!

 

[Sienne and Gabby (GA)]

Keep in mind that if the IBD is a factor, Wellness doesn't come in novel protein varieties (or at least not the last time I looked). It's also high in fat. You may need to try a few foods to see if one agrees more than another.

If you run into tummy troubles, please take a look at the Medication and Supplements section on the IBD link I provided above. The website has great information on probiotics, natural products like slippery elm bark, etc. that are helpful for IBD kitties.

And this is great news from you and your vet!

 

[Rocky1710]

Keep in mind that if the IBD is a factor, Wellness doesn't come in novel protein varieties (or at least not the last time I looked). It's also high in fat. You may need to try a few foods to see if one agrees more than another.

If you run into tummy troubles, please take a look at the Medication and Supplements section on the IBD link I provided above. The website has great information on probiotics, natural products like slippery elm bark, etc. that are helpful for IBD kitties.

And this is great news from you and your vet!

Thank you! I will definitely check that out. He ate the wet food again this morning which is a total surprise as he normally won't touch wet food! One day at a time!