New Member: Newly diagnosed...ish 02/09

Hi everyone! I've been lurking for the past week whilst waiting for Bo's fructosamine to come back absorbing as much info as possible.

A bit of background on Bo. She's been a pretty healthy cat with a bit of anxiety for most of her life. Last July she became very poorly with triaditis and was hospitalised for a week maxing her insurance! Since then we have regular check ups at the vet to check her liver enzymes and adjust anything as needed. She has been on destolit and steroids ever since.

We tried to get her off steroids at one point but her liver enzymes went up so she went back up to her full dose.

She has had raised glucose levels on several occasions at the vet but they put it down to her stress levels. At one point they needed to use full on gauntlet gloves she gets that feisty, even with gabapentin on board! She did have a fructosamine at one point which was fine.

Last week she had a day of not feeling well. She was off her food, lethargic and nauseous. I gave her a little sardine because I knew she'd eat it and I wanted to get her meds in her. You can't pill this girl, it has to be crushed and in her food. She ate it but about 20 minutes later rushed to the tray and had diarrhoea. She was drooling too and as soon as she left the tray she vomited. So I made an appointment with the vet for the next day and as I was on the phone she came out of hiding and perked up. Blooming typical!

Now, when Bo is particularly stressed she can get a bit of idiopathic cystitis and avoids the tray. We then work on getting her back in the tray until the next stressful event. It's our dance that we've done since she was a kitten. The week before this unwell episode I had some flooring replaced so miss Bo was stressed, even with gabapentin (starting to think it doesn't actually do anything for her). So at the moment we're peeing on the bathroom floor.

This day of feeling unwell I went to clean up a puddle (forgot to replace the puppy pad) and it smelt sweet which was new. So I grabbed a testing strip from a neighbour and glucose lit up like a Christmas tree.

So the next day she had more bloods and today I found out her liver enzymes are normal after 2 weeks on half steroid dose (and for the 1st time since her liver kicked off) but her fructosamine is 377.

My vet's plan is this:

Test her liver again in 2 weeks after a month on half dose.
Reduce to half every other day if enzymes remain OK
Start low carb diet
Aim to get her off steroids and reassess fructosamine etc.
Start insulin if fructosamine is still up once off steroids or if liver dictates we have to stay on them
Straight in if I have any concerns

Does this sound reasonable? I have ordered a glucometer as she has glucose in her urine so I want to keep a closer eye so more than happy to test at home to get an idea of what her BG does. I've also started her on a low carb diet of Hi-Life and have KatKin on the way.

When are good times to check BG when not on insulin to get an idea of what it does?

 

Welcome to the group!!

I’ll throw out a caveat that I’m not an expert, but to me it sounds like your vet has a good plan. It is common for steroids to throw our kitties into high BGs, sometimes it will even instigate diabetes. So it makes sense to wait to start insulin and see if Bo’s BGs are still high after the steroids clear his system.

it sounds like you’re comfortable testing BG levels. I think it would be a good idea to get a couple readings or even one reading a day to make sure that Bo isn’t consistently in high numbers. Monitor Bo and make sure he’s eating normally and isn’t behaving lethargically. Consider picking up some ketostix (cheap at Walmart) and taking daily ketone measurements from Bo’s pee.

I mention these ideas because long term high BG can increase the potential for cats to develop Diabetic ketoacidosis which can be fatal. This occurs when your kitties body builds up ketones which can happen when kitty has high BG, has an infection and or isn’t eating(amongst other ways). I have linked the forum info on this topic but I think it would be a good idea to look around the forum for some information on ketoacidosis so you are familiar with the symptoms.

Im not saying that Bo will develop ketoacidosis at all, but I think it might be the biggest potential risk of not starting insulin right away if Bo actually is diabetic. I think keeping track of BG and ketone levels will give you a great set of data to indicate if Bo becomes at risk for DKA or not.

Again, not an expert, just my 2 cents.

Fingers crossed that Bo is just spending a little extra time in high BG Town! Keep us updated!

 

Thanks Amanda

I'm really hoping this is just steroid induced and can be sorted with diet and coming off them. We'll see if her liver plays ball.

I already have wee sticks. There were trace ketones on her poorly day when I first tested her pee, I'm thinking her not feeling well was BG related perhaps.

I forgot to mention she's lost weight without trying, eats me out of house and home and pees (quantity and frequency) for England. She also sleeps a lot at the moment but still purrs with the slightest touch bless her.

I used to be a midwife so have a clinical mind and tested baby BG a lot. I know it's not the same as a cat but I'm happy with the equipment which is a start.

 

Oh awesome, that’s great that you’re comfortable with testing BG. It can be a really big hurdle when starting out. The drop in weight and increase of appetite is definitely a symptom of diabetes (amongst other conditions), has he been drinking and Peeing excessively as well? That is another typical symptom. Before Mowgli was diagnosed he would drink even my toilet dry and the litter box was FILLED daily!!

I really hope it’s just the steroids but it sounds like if it isn’t that Bo is lucky to have such a qualified mom to take the reigns!

 

Aww thank you! Qualified mum lol. Just a bit neurotic I think haha. It also helps that I'm medically retired so I'm all hers.

Her thirst hasn't gone up but she's eating a lot of wet food so I'm wondering if she's getting the extra her body wants from the extra food? Maybe a mix up of thirst and hunger signals, thirsty but thinks she's hungry so eats?

Definitely peeing excessively. Part of getting her back to using a tray is escorting her when I see her heading to the bathroom and encouraging tray use. I did that twice in two hours the other day and both times big pees.

 

Hi there,

Wet food is usually a minimum 70% water, so it goes toward the cat's daily fluid requirements. Often non-diabetic and well-regulated diabetic cats on an all-wet diet get all their fluids for the day from the food they eat, and barely touch their water bowls. Obviously you still need to put it out for them.


Mogs
.

 

Hi Mogs, yes she access to water but she and her brother from another mother generally don't drink, only when it's stupidly hot.

 

Welcome "Lurker" Would you mind sharing your name? Completely ok if you'd rather not. Welcome you you and Little Bo

Theres a ton of info here at your fingertips with good folks that live this disease everyday. We strive to help any and all who find these pages.
I have no expertise to share just wanted to extend a warm welcome with hopes of Bo's recovery and your sanity restored.
WELCOME TO FDMB welcome to our family.
jeanne

 

If ever there's a need to encourage additional water consumption you could try mixing a little extra water into the food.

I see that Amanda has already given you some information about the importance of testing for ketones. Here's another resource with some helpful tips:

Tips for Collecting Urine Samples

How they're going to work with the inappropriate urination issues you've been contending with of late I do not know, but they might give you some ideas you could adapt to your situation.

For general information, cats can develop diabetic neuropathy if they've been experiencing high BG levels for some time. Signs of the condition's presence can be subtle, for example a cat may not be able to jump to higher surfaces, or they may start walking on their 'wrists' and their hocks if the condition is more severe. Some cats with neuropathy may have problems with urinary incontinence. Treatment for diabetic neuropathy involves bringing BG levels back into regulation and supplementation with B12 methylcobalamin (water soluble and tasteless so easy to mix into food). I wonder whether a methylcobalamin supplement might be worth a try to see whether it'd help with the inappropriate toileting? Perhaps you could ask your vet about it. (Note: The normal B12 injections you get at the vets are cyanocobalamin, a different form of the vitamin.)

If Bo's urine has glucose in it then her BG levels are high (renal threshold is c. 14-16mmol/L, exact point varies between cats). With BG running in that range while she's not receiving insulin it's a very important safety precaution to do a daily test for ketones in the urine. Anything higher than a trace result and a call to the vet is needed as ketone levels can rise quickly. Catching any build-up early enables the prompt treatment needed to avoid DKA.

Fingers and paws crossed that Bo won't have any issues with ketones, but if they start appearing you might need to consider starting insulin treatment earlier than currently planned. The BG test data you're planning to gather will help you and your vet to monitor things 'in real time'.

You can do spot checks at any time. If you test about an hour after Bo has eaten, it may reveal food spikes over and above the fasting BG level.

A question for you: is Bo eating low carb wet food? Here's a list of low carb foods available in the UK for you to check.


Mogs
.

 

Thanks JT, I'm Siana (pronounced sharna).

She seems a bit more alert on her low carb food already!

Thanks for the info Mogs. I have urine sticks so can definitely test once a day. Any particular time better? Before/after food or is random ok?

Now you mention it she can't jump up onto my coffee table anymore, she has to jump on the sofa and step over to it. Honestly thought that could just be an age thing but maybe it is related. I'll look into getting the B12, anything to help her get back to the tray and keep her as healthy as possible.

I've just switched her to Hi-Life as it's easy to get if we're in a bind and also going to add in Kat-Kin for a bit of variety and nutrition.

 

Random's fine for the ketone tests, Siana (lovely name!). Grab 'em as the opportunities arise.

Can't really tell when only subtle issues are present, Siana. I didn't think Saoirse had any neuropathy problems when she was first diagnosed. There was one occasion before her Dx when I found a puddle in front of her litter box. She had started to drink more water by that stage (not as excessive as it later became) so I thought maybe she might have just mistimed her visit to the box, especially as there were no prior or subsequent accidents. Saoirse had had so little energy prior to Dx that she would spend most of her time asleep. Her energy levels picked up after she started insulin treatment, and it was only when she tried to jump to a 2' high wide windowsill and missed ( ) that I could see she had a mobility issue, and it also explained the litter box accident.

At the following link you'll find recommendations for where to source diabetic-friendly B12 methylcobalamin, and also all manner of other useful UK information:

UK Food Info and Where to Get Supplies

The lower carb wet foods will go some way towards keeping Bo's BG levels a bit lower. I'm glad to hear she's already a bit perkier.


Mogs
.

 

WELCOME Siana

Beautiful name ...awesome Bo!

 

Thanks Mogs. B12 and folic acid purchased so we'll see if that helps her.

How do you pronounce Saoirse?

 

That was Methyl B12 you purchased right?

 

Yes it was x

 

Seer-shuh. It's Irish for 'freedom'. Saoirse's brother was called Amadán (rough pron. Ommadawn), Irish for 'fool'. (They were born on April 1st.)

Fingers 'n' paws crossed the methylcobalamin might help a bit with the mishaps. (((Bo)))


Mogs
.

 

Mogs I swear I thought I replied but turns out I didn't! Great names!

Glucometer just turned up so did a random BG...wow she didn't want to bleed, definitely need to try warming first. She didn't seem to mind at all but she was being bribed with a bit of cooked chicken at the time. This girl is very food led lol.

So random/post meal is 13.1 on the CodeFree.

 

Afternoon, Siana.

Hovering around the renal threshold (the point where glucose spills over into the urine). I've seen worse, but definitely check ketones. You might also find some helpful tips in the following:

Secondary Monitoring Tools


Mogs
.

 

Yeah she already has glucose in her urine. I'm going to see what her pre meal is in the morning, I think it'll be interesting to know.

 

Just did an evening read, 16.6.
She really wasn't impressed with the stick this time.

Should I start a spreadsheet even though we're not on insulin...yet? Should I just give her food as and when she wants it? Steroid munchies are strong with this one!

 

Try to keep the food low carb . Never hurts to get ahead of the game and have a spreadsheet ready.

 

We are all over the low carb food and chicken for test treats.

OK I'll have a play around tomorrow and start a spreadsheet. Knowing the number is actually increasing my anxiety a bit but it'll be worth it.

Thanks jt

 

We did a before breakfast read this morning which was 14.3. No ketones in her pee but still lots of glucose.

I'll end this thread here. I'll do some random tests here and there and if I have any concerns with her. Next liver check in 2 weeks so we'll see if her steroids can come down again then.

Thank you for the warm welcome and advice, it's very much appreciated and I know that Bo and I are in safe hands here x

 

Great news about the ketones. You know where to find us when you need anything.


Mogs
.

 

Loving Little Bo's puffs.