New Member - Six Dinner Sid gets diabetes

Hi everyone,

My cat is a real Six Dinner Sid who lives with multiple families, eats several dinners and does whatever he wants. I probably should not say "my" cat, but I just can't do otherwise. I love him very much and I worry a lot about his health.


A little story about how I got to know him (which you can skip, as it's not related to diabetes):
TL;DR: He's outdoor/indoor visiting multiple people, but I believe we are his favourite humans

We live in a gated apartment complex in the suburbs of Dublin, Ireland. Three years ago, a big tabby cat showed up at my door insisting I had to let him in. In fact, he was so dedicated that he then broke into the apartment through the window (which we found hilarious, because it involved quite some jumping and balancing on the railing). After that, he started coming here regularly (although we did not feed him initially), he'd just sleep on the couch and sometimes try to jump on our bed and sleep there (which I also did not allow initially). I posted his photo on a local Facebook page, and managed to get in contact with his owners. Turned out they had recently moved to the area. Their new house had only a small garden with no mice, so the cat possibly decided to "look for a better life" elsewhere. He used to come back to them to sleep and eat, but had eventually stopped doing this. The woman actually said they used to have two cats that'd go for a walk together, but the other one was run over by a car when crossing the street going back home. So she believed it was safer for that cat to stay with us or someone else in the same complex.

On most days he was usually spending 10-15 hours in our apartment. He became like a family member to us, and I believe he liked us too, as he brought us many presents over these years: dozens of mice, some of which were still alive, and even a couple of birds. I could see he started trusting us, as he'd allow us to pick him up and would even purr when I would carry him around. He also often slept on his back with his belly totally unprotected.

About the cat
He's a neutered male tabby who must be around 8-9 years old.

Symptoms
He started gaining weight about two years ago and was ~6.5kg this July. Then he suddenly lost a lot of weight, stopped hunting, started sleeping on the floor instead of the bed/sofa, started drinking a lot (I rarely saw him drinking water before). He also stopped visiting us very often, and would go to the neighbours on the ground floor instead. I was heartbroken, but now I think that was because it was hard for him to climb the stairs and/or window.
He also got a lot of hair mats on his lower back/hip area.
I could hear him make "chewing" sounds when he'd lie on the floor trying to sleep. I think that was because he was nauseous. I actually saw him vomiting a few times, and sometimes intense "chewing" would happen just before.


Diagnosis and Treatment

We took him to the vet a few weeks ago, and his blood tests showed 21mmol/l blood glucose, and also glucose in his urine (which was a challenge to collect, as he pees outside). His fructosamine was high but close to the borderline (not sure what the number was, that's what the vet said). The vet initially prescribed him 1IU of Caninsulin twice a day, which they told us to increase to 2IU after a few days as that did not have much effect. They also prescribed him dry Diabetic Royal Canin.

He's been on Caninsulin for more than a week now. His blood glucose still stays around 20mmol/l. I'm home testing it using a OneTouch Verio human glucometer. I've noticed it sometimes goes to 14-16mmol/l a few hours after the injection but it is back to 20 or more at the time of injection. I've read on Caninsulin web that cats should not get more than 2IU per injection in the first 2-3 weeks of treatment, so I don't think we can increase the dose just yet.

I believe he is probably feeling slightly better than before, as I could see him jump on the couch a few times, and even entering through the window which requires quite some exercise. He's still mostly lying on the floor though, and obviously not feeling very well.

This is how his BG numbers (in mmol/l) look like:
link to the graphic.


Regulating his diet is a real challenge, as he goes everywhere. I talked to many neighbours and also put a collar on him saying "Diabetic, DO NOT FEED", but there is always a chance he'll eat something not so appropriate. Also, keeping his feeding on schedule is close to impossible so we let him graze.

I wanted to contact my vet soon with the recent BG measurements, and would like to gather a bit of information before that. I'm seeing that many people use a different type of insulin, maybe I could suggest that to my vet.

I would appreciate any advice!


Have a nice day everyone!

 

Just created the spreadsheet. Will work on the signature now!

 

Hello and welcome!

Wow, that is quite a story on Kabosu/Six Dinner Sid! Such a character!

Great job getting him the FD care he needs, starting home testing, and getting the spreadsheet up and running!

It's a bit of a quick increase up to 2U-- we usually recommend gradual increases (0.25U at a time) so that you don't miss the perfect dose. Not sure the 1U was given enough time to settle in after one day.

One thing to keep an eye out for is any hint that he might be briefly dipping lower and then "bouncing"-- zooming up in an (over-) reaction by his body. If you can get some more nighttime tests, that would be helpful in trying to catch any hint of a low (many cats go lower at night than during the day).

You mention having trouble regulating his diet given his, um, lifestyle, but didn't mention what he's supposed to be eating now, unless I missed it?

And finally, yes, Caninsulin works for some cats, but in general doesn't seem to be the best fit with their fast metabolism. The "gentler" insulins such as Prozinc or Lantus (human insulin) are preferable, if you can get your vet to agree.

Welcome again! Looking forward to following along with Kabosu's adventures!

 

Thank you for replying!

We actually started 1IU on December 25, and then switched to 2IU the evening of December 31, so it was almost a week before increasing the dose. I just updated the spreadsheet with the injections we made before we bought a glucose meter.

As for the food, the vet suggested we switched to Royal Canin Satiety (Weight Management it used to be called) about 1.5 ago, before the diagnosis.
He used to eat it but then stopped several month ago. After that, I was mixing that with Purina Senior, which he ate occasionally, not even every other day. So it is hard to say what he ate in the meanwhile. Probably something widely available.
A few months ago I also started giving him Applaws Tuna pouches, or their Tuna/Salmon/Chicken/Mackerel in jelly. He loves these.
Since the diagnosis, we've been feeding him dry Royal Canine Diabetic, and some Applaws Tuna as a treat for injections/ear pricking. The last couple of days I've been giving him Naturo Turkey Mousse instead which he adores, and wet Royal Canin Diabetic pouches. He actually does not want the dry Royal Canin anymore (and I just received a new package from zooplus :'()
I will probably go buy some Sheba pouches from the recommended UK foods (we're not in UK but the available foods must be very similar).

 

Any way to return the Royal Canin dry (some of the "prescription" foods in the US come with a guarantee, not sure about Royal Canin)? Not only doesn't he like it, but it's actually not good for his diabetes (despite the name!). The ideal diet for a diabetic cat is low-carb, and that dry food (most dry foods) have tons of carbs.

The pouches and other wet foods are probably better, although I'm not certain of the varieties. Tagging a couple of UK folks, @Elizabeth and Bertie and @Critter Mom, who might be able to make some specific recommendations.

And be prepared: if he was eating carb-y dry food for the first several weeks and now is switching to low-carb wet, that can have a dramatic effect on blood glucose. It's excellent that you are doing the testing, it will help you catch any changes and keep him safe. Make sure you keep some high carb gravy food/honey on hand, to bring him up quickly if needed, and be prepared to have to reduce the dose (wouldn't that be nice!).

 

Thank you so much. I just contacted Zooplus customer support, and I will try to return the dry diabetic Royal Canine. I will keep the wet one, as I already opened it. That one is weirdly in gravy, despite the "diabetic" name.
I checked the UK food list, but I am not sure what to pick from there, as I've never heard of most of those (except for Whiskas and Sheba).
Would appreciate any suggestions. I can probably order a few cans of multiple brands and see how they work.

 

I've not bought them for a while but Sheba Fine Flakes in Jelly Poultry Selection would be worth a look. The formulation was low carb when I was feeding them to Saoirse. I doubt they'd have changed it much.


Mogs
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So I've ordered a lot of different foods from zooplus: Bozinga, Lilly's Kitchen, Catessy. In the meanwhile I'm feeding Kabosu-san with Whiskas in Jelly and Naturo's Pate, both of which are below 10% carbs.
I still believe someone else feeds him here, but I may be just paranoid. I have to work today but I'll try to follow him a bit more during the weekend and discover where else he goes.

I also just talked to our vet, and she thinks he may have insulin resistance and wants to do an ultrasound on him next week. She'll also test his urine for infections. If both are clear, we'll switch him to Prozinc.

 

Hmmm... might be a little early to suspect insulin resistance, but I approve the switch to Prozinc anyway ! Really, it's just a much better insulin for cats, hopefully Kabosu-san does well on it.

Is she looking for something specific with the ultrasound?

 

She said she suspects pancreatitis, although he eats a lot, and with pancreatitis he would have lost appetite. She also says diabetes can sometimes be secondary, because of a tumour, for instance, she wants to rule that out as well.

 

OK, it's good to rule out things like tumors, for sure. There are blood tests for pancreatitis that (in my view) give a more reliable diagnosis than an ultrasound interpretation, but again, an ultrasound is very helpful to rule out other things being amiss.

More info on pancreatitis (tests and treatment) here: A Primer On Pancreatitis

 

I agree with Nan: while the ultrasound will pick up on pancreatic abnormalities, the Spec fPL test will give you information on presence and degree of severity of any pancreatitis. Also, there are specific tests for some 'high dose' conditions such as IAA (where the body has a negative reaction to injected insulin), acromegaly or Cushing's syndrome, though usually those aren't tested for till a cat's dose has gradually been adjusted up to about 6IU BID and it still hasn't reached a point of better regulation.


Mogs
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Thank you! I will ask our vet about that test.

I now think the real problem is that someone still gives him some inappropriate food. This morning a few hours post injection he had 17mmol/l, and I was feeding him small portions of wet low-carb food mixed with quite some water. He ate three times, each time about 1/3 of a pouch which I thought was good. Then I went to the vet to get a new bottle of Caninsulin, and while I was out, he left through the window. When he came back an hour ago he looked like he was pregnant! And also weighted almost 200 grams more than this morning! Who on Earth would give a cat with "Diabetic: DO NOT FEED" on his collar 200 grams of food?? I want to cry now. Now we'll see 22+ mmol/l in the evening...

THIS is how his belly looked like

 

Any chance he's snacking on the local wildlife? That'd be better, anyway.

 

I mean, better in terms of carbs. Not so great for the wildlife, on the other hand...

 

This is unlikely: he was normally bringing the wildlife to us, even if he ate part of it already . He's such a nice guy who loves sharing with his humans haha. Honestly, I think he is too weak right now to hunt... He won't play as he used to.

 

Awwww....

Wonder if it's a neighbor leaving a bowl of kibble out for "strays"? Like you, I can't imagine feeding a cat with a big note saying "do not feed!" but maybe they've never even seen the note?

I think you're going to have to make him an indoor cat for a little while as you sort this out. Not only is there the food issue, but once you start getting his readings down below the stratosphere, it's going to be dangerous to let him go outside after shooting insulin. Sigh.

 

Many diabetic kitties will have some degree of 'insulin resistance' at first, just because of cell damage due to high blood glucose. That pretty much goes with the territory when a cat is diabetic. And once cats get onto insulin and a good diet they can begin to heal from this damage. This is nothing out of the ordinary at all, and isn't something that needs to be tested for. ...But that isn't the same thing at all as having a specific 'insulin resistant' condition, such as acromegaly for example. But specific insulin resistant conditions aren't usually suspected until a cat gets up to about 6 units of insulin.

Ultrasound is very expensive... Why exactly does your vet think that's necessary at this point...? Blood tests can give a lot of useful info...

 

I agree. I wouod pay maye $700 now for an ultrasound.

 

If it's only for suspected pancreatitis then the blood test would make more sense, especially since Kabosu-san doesn't appear to be showing any clinical signs of same at the moment.


Mogs
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There are no strays in the area. He's the King of the area, so it's likely the bowl would be for him. There are many elderly people who live here and let him in, I think they may have missed the note, because they didn't have their reading glasses on, for example... Or they just don't get how serious it is. One man I got to know recently thought that milk was not food, so he was giving the cat milk BECAUSE he saw "no food" on his collar... I actually wrote "no food or milk" now, maybe I'm missing something else I should have listed? but there is only that much space on the collar...

I am definitely thinking about this, the problem is that he is not litter trained.. And 9yo is a bit old for that... I kept him inside the whole afternoon and just took him out for his toilet a couple of times.. but it's really hard at night especially. Also he LOVES his freedom and really believes all those apartments he visits are his home (I saw him inside other apartments, and I felt like he really believed that's all his!)

She told me the ultrasound, plus the urine test will be 290 euros.. It's quite expensive, but the blood test was 180 initially + 60 when they also decided to check fructosamine, so it's quite comparable actually.

 

My understanding is that they can only prescribe Prozinc (and even B12) after the ultrasound. I'm actually going to call them on Monday and ask whether we can try Prozinc first, and only do the ultrasound if that doesn't help either...

 

That's not bad for Dublin.


Mogs
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That's not bad at all. My kitty's cost a lot more!
What exactly is the purpose of the ultrasound? ...Sorry if I'm being a bit thick... It's just that this isn't usually done with just an ordinary diabetes diagnosis....

Does she mean acromegaly? This is caused by a tumour on the pituitary, and can present as insulin resistant diabetes. Is this what your vet means? If so, there is nothing about your kitty's situation currently to suggest acromegaly... And there is a blood test for this anyway....

No, that's not the case. A vet can prescribe Prozinc following a diagnosis of diabetes, just the same way that you got your Caninsulin. And in fact the current prescribing guidelines recommend that Prozinc should be prescribed for new cases, not Caninsulin.

 

9yrs old is not too old to learn to use a cat litter tray.
My current girl, adopted as a 12 year old diabetic, had never used a litter tray, and took to it like a duck to water, bless her.
And I've fostered quite a few cats who have never used litter trays, including some very elderly ones and some ferals, and they all used trays too.

Even my indoor/outdoor cats who usually love going outside in the day time are choosing to use litter trays at the moment, because it's winter and they don't want to freeze their fuzzy little butts, haha!

It can be worth trying different types of litter. And it's also possible to put some garden soil over cat litter in a tray so that the smell is familiar. And if you know of places where your kitty usually pees or poops outside then you can bag some of the soil from that place and put that in a litter tray too, so that it has his scent... Once they try a litter tray they can very soon get to like it....

Is your kitty neutered..? Just wondering if peeing/pooping outside is also a territorial thing...? If he's not neutered then he may settle down more if he has his pom-poms removed...

Eliz

 

Wow, this is indeed encouraging, I am going to try!

He is neutered, so no pom-poms anymore

 

Sigh, I am not exactly sure. I believe this bad response to Caninsulin, and the fact that he had diarrea and bloating, made her think there may be something wrong with his pancreas.

Nice! She told they always start with Caninsulin, because it is cheap, and it also lets the owner understand whether they are comfortable doing insulin injections. Prozinc will be more than 100 euros per bottle (Caninsulin costed me only 8 euros!), so I guess that's why they may think it's cheaper to do the ultrasound first, then switch to the expensive insulin?.. I'm just guessing here, but I will see if we can start Prozinc before the ultrasound.

 

I tried to keep him inside since yesterday, and it was a real challenge. He needed to go outside a few times in the evening, and then he woke us up four times at night because he was hungry. We also spent most of the morning following him outside and bringing him back whenever he was trying to enter someone's balcony. He just wouldn't stop meowing, and was very stressed. Around 3pm we gave up and let him go to the neighbours (and then I took a much needed nap). He was very stressed here, and wouldn't rest at all. Funnily enough, he is back in two hours, and is now quite calm. I feel like he NEEDS to check all his other apartments. At some point we thought he does that morning routine visiting everyone and checking that no new cat appeared in either of his homes. After that, he can sleep calmly.

 

Hell's bells, that is some price difference!
Do you have online pet pharmacies in Ireland where you can buy Prozinc cheaper with a prescription from your vet? In the UK it is often a lot cheaper to buy insulin that way. But I have no idea if that is an option for you in Ireland...?

 

Maybe also ask about some of the human insulins that work well in cats, such as Lantus, if those are cheaper. I'm not sure whether they can be prescribed by a vet directly in Ireland, or if they can but only if you go through all the "pet insulins" such as Caninsulin and Prozinc first (I believe that's the case in the UK?).

 

I believe they can only prescribe animal insulins at the vet. Getting human one without a prescription from a human doctor would be close to impossible here..

I've started getting worried about his swollen belly (from the picture above). He often looks like a piñata after eating, and now I've started thinking he may have something else going on in his belly... I don't remember seeing him like this a year ago.
Googling it made me very scared this forum has some stories of kitties not reacting to insulin with swollen bellies that turned out to be incurable tumours. So I am thinking it will be better to do the ultrasound.

 

Could also be a food sensitivity or IBD... Since he does his business outside, you aren't going to see some of the other symptoms of that.

Since the ultrasound is pretty affordable (comparatively!), I'd go for it. It will either give you peace of mind, or if something does turn up, perhaps it will be something that can be addressed when caught early. But fingers crossed for the first possible outcome!

 

Hi Dasha,

While they may not stock human insulins they should be able to prescribe a human insulin under EU drug cascade rules. From the Irish Health Products Regulatory Authority:

Supply and use of human medicines in veterinary practice
Veterinary practitioners are entitled to use human medicines under the terms of Article 10 of the Directive 2001/82/EC (the ‘cascade’ principle) and under Regulation 18 (2) of the European Communities (Animal Remedies)(No2) Regulations, 2007 (S.I. No. 786 of 2007).​

Unless some major change to EU licensing and prescribing rules has been made in the last 11 days, there are currently only two insulins licensed in the EU for use in cats: Caninsulin and Prozinc. These insulins must be tried first and shown to not be fully effective before a vet can legally prescribe Lantus under drug cascade rules. Thereafter there's not a problem, the vet can issue an Rx for Lantus or Levemir which can be filled at a human pharmacy.

It might be an idea to ring around a few pharmacies to find out how much they charge for Lantus. If you can get 3ml cartridges there is likely to be less waste than with a 10ml vial because cats typically need small doses of insulin and you'd be less likely to use the entire contents of the vial before it became unusable. I can't find any Irish prices on the web so here are some UK prices by way of a guide to how the costs of the various insulins compare. I had a look at prices from an online UK pharmacy just now and found 5 cartridges of Lantus for about £55 / €61 (15ml total). A few years ago I used to pay c. £50 for a 10ml vial of Lantus at a local pharmacy. I don't imagine it would have been much more at the end of December. One of the cheapest online UK vet Rx sites has a 10ml vial of Caninsulin for £22, and a 10ml vial of Prozinc for £51.68.


Mogs
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Thank you so much for this super useful information. I did not know it was possible!

In the meanwhile, I called the vet clinic. Our vet is on holidays, but the on duty vet said she talked to two other vets, and they all agreed they should not start ProZinc before the ultrasound. Now I think there may be something really bad they are suspecting but not telling me about. I don't have the full results of his blood tests to try to guess, they just told me all but blood glucose was okay.

 

Fingers still crossed for a good report from the US. And there can be all kinds of reasons why they came to that decision (although I personally prefer it when my vets share their reasoning with me, so I don't have to guess!). You should also be able to request copies of the bloodwork anytime, although probably by the time you get it the ultrasound answers would be in anyway, so no help on the guessing games.

Please keep us posted on the results!

 

This confused me completely. I read it and thought to myself, "Why is Dasha getting a report from America?"

I'm not safe to be let out on my own.


Mogs
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Hi Dasha,

It's always good to get copies of any test results/reports for your own records. In addition to providing info needed in the here and now, sticking them in a spreadsheet so that they can easily be compared is a great aid to gauging the success of treatments and also tracking a cat's health over a longer timescale.

Also, vets and lab technicians deal with the results for many, many animals and might miss things that we, focused as we are just on our own little ones, might pick up more quickly. For example, my civvie, Lúnasa, has renal insufficiency so that's what my vet focuses on when he gives me headline results over the phone. It was only when I got a hard copy of the labs that I discovered that her glucose levels were higher than normal - even after allowing for vet stress - since she had been switched to a renal therapeutic diet. I now know to keep a closer eye on her blood sugar levels, even though she isn't currently diabetic (and will hopefully stay that way).


Mogs
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Our ultrasound appointment is still two days away, but I got his blood test results!

 

I'm not good at reading labs, but I'm not seeing any major red flags here? Anyone else?

There are a couple of readings out of range, of course, but they're all marginal and if there's a theme tying them together I don't know what it is.

 

So the ultrasound showed inflammation in his pancreas, intestines and bile duct. His blood test also showed pancreatitis. They decided to keep him hospitalized for a while to get his pancreatitis under control... :'(
They will also check his stool for parasites, and his bloods for FIV and feline leukaemia viruses. They think this may also be a lymphoma but they won't know until we do biopsy. We decided to treat his pancreatitis first, and only then do the biopsy if the inflammation does not settle.

 

Hi Dasha,

Sorry to hear that Kabosu-san is in hospital but hopefully the fluids and other treatments he gets will help him to feel better very soon. Here are some helpful links:

IDEXX Feline Pancreatitis Treatment Guidelines (Check out the sections on anti-nausea, pain control and appetite stimulant meds - strongly recommend asking your vet for a supply for home administration when Kabosu-san comes home, since first and foremost cats can't go long without food plus steady, reliable food intake is needed in order to ensure consistent dosing of insulin.)

ibdkitties.net (All manner of useful information for kitties with intestinal issues.)

Nausea and appetite problems - symptoms and treatments (A great aid to spotting foods that may cause pancreatic discomfort, and also supportive treatments to help manage a cat with digestive system issues to eat more comfortably and reliably.)

In addition to the above mentioned treatments, a course of B12 injections can be a great help for both IBD and pancreatitis.


Mogs
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