Newly Diagnosed - Advice Please?

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mintealette

Member Since 2024
Hello everyone,

My little girl, Zoey (8 y/o) was just diagnosed last month on January 30, after a blood test in December showed an abnormally high glucose.

The vet attributed it to stress/anxiety at first & prescribed her an anxiety medication. She was due back for another glucose check in March to see if the meds helped bring it back down, but around mid-January she started drinking & peeing in excessive amounts. Her old vet was completely booked & the wait time would've been well over 2 weeks out, so I took her to a different vet closer to where I live.

They came back immediately with the results. Her glucose was sitting at just below 500 (it had nearly doubled since December), & they wanted to start her on Bexacat immediately. They'd also put her on an antibiotic called AmoxiClav, which was supposed to help with the burns she'd gotten from peeing so much.

Everything was fine at first. The first couple days were a bit rocky - the Bexacat was causing her to have liquid diarrhea & she didn't have much of an appetite. But once we got into a routine, she did really well & was starting to act more like herself. She went in for a spot check a week after starting on the Bexacat & both her glucose & ketone levels were completely normal. The staff at the vet were all so happy for her, & it was a huge relief for me as well. But it's like her behavior changed completely overnight - The very next day, she started experiencing nausea, vomiting, diarrhea, lethargy, & her appetite was practically non-existent. I'd also noticed that she seemed to be biting at her bottom a lot more & scooting across the floor after having a BM (she was still experiencing liquid diarrhea at the time). When I looked, it appeared as though she'd rubbed the skin raw, & she was experiencing a bit of leakage as well.

I took her back to the vet on February 13, & they did another spot check. Her BG & ketones were still normal, her weight hadn't changed, & while a rectal exam showed some inflammation, her doctor said it wasn't anything too serious & that we'd just need to get the diarrhea back under control to give that area a chance to heal itself. They also put a lot of emphasis on making sure I was giving her the Bexacat with food (which I told them I had been doing), as not doing so could cause diarrhea & vomiting.

After giving her some SQ fluids to ensure she wasn't dehydrated & instructing me to skip the Bexacat for a day & resume treatment the next, they sent us home with:
  • Cerenia - 2 tablets, to be cut in half & taken once every 24 hours, over 4 days. This was supposed to help with the nausea.
  • Purina FortiFlora - A probiotic supplement they said was supposed to help with the diarrhea.
  • 2 cans of Purina Pro Plan E/N canned wet food - Feed 1/4 can with the Bexacat
It's been 4 days & there's been little to no improvement. All attempts to give Zoey her medications have been proving to be quite difficult because she's highly suspicious of anything I feed her. Sometimes I wish she wasn't so smart.

The Cerenia has done nothing to help with the nausea - she's still gagging but not actually throwing anything up, & instead just swallows it back down. The FortiFlora helped a little at first? She still had diarrhea, but it went from being completely liquid to having almost a soft serve ice cream sort of consistency. However, it's been 2 days since her last BM & it's starting to concern me.

She's shown some interest in wet food & I've been slowly transitioning her from a dry to wet diet. But as I said before, she's so suspicious of anything I give her. She won't eat wet food from the bowl, but (& this is a bit gross) she'll eat it out of my hand.
I leave out a tiny bit of dry food in her bowl in case she wants to nibble a little between meals, but she doesn't touch it - even though the other cats eat the same food, she only wants it from their bowl & not her own.

I talked to the vet & now they want to prescribe her even MORE medicine. I'm starting to wonder - if she needs all of these new medications just to manage the side effects from the Bexacat, is it really the best thing for her? Sure, all the testing they've done so far shows that she's doing well physically, but at home she just seems so miserable. I don't know what to do for her. She never wants to spend time with me anymore & prefers to spend the day hiding in other rooms away from me. If she's in my room, she's under the bed. I miss her lots.

At this point, would insulin or some other alternative be better for her? Am I doing something wrong? I'm at a complete loss & could use some advice from those with more experience.
 
FortiFlora just isn't a good probiotic. There are much better ones out there. Some people here use Visibiome. There's additional info on using probiotics for general health and for diarrhea here:

https://www.foodfurlife.com/my-cat-has-diarrhea---what-do-i-do.html#/
https://www.rawfeedingforibdcats.org/probiotics-for-cats---why-and-which-ones.html

Info on how to pill cats: https://www.felinediabetes.com/FDMB/posts/3150838/

Ask the vet about using insulin instead of Bexacat. Lantus and any of the generics is the preferred insulin of choice.
 
During the Bexacat trials 38% of participants experienced diarrhea. Maybe time to go to insulin.
https://www.elancolabels.com/us/bexacat
I think you may be right.

Bexacat is such a new treatment option too, that I originally had some reservations about putting her on it. She's not a very good pill taker even with a popper & often notices immediately if I've crushed something into her food. But since I didn't like the idea of having to poke her every 12/24 hours, I figured it'd be worth a try at least. It does what it's supposed to, but all of these side effects that she has to take additional medications to manage just isn't worth it. She's clearly not happy.

We're going to be moving next week, so I'll be scheduling her an appointment with a new vet as soon as we're settled in. Until then, I've got a glucometer coming in the mail tomorrow & I'll be keeping a close eye on both her BG & her behavior. I'm not looking forward to the car ride downstate though - Zoey doesn't travel well AT ALL.
 
FortiFlora just isn't a good probiotic. There are much better ones out there. Some people here use Visibiome. There's additional info on using probiotics for general health and for diarrhea here:

https://www.foodfurlife.com/my-cat-has-diarrhea---what-do-i-do.html#/
https://www.rawfeedingforibdcats.org/probiotics-for-cats---why-and-which-ones.html

Info on how to pill cats: https://www.felinediabetes.com/FDMB/posts/3150838/

Ask the vet about using insulin instead of Bexacat. Lantus and any of the generics is the preferred insulin of choice.
Thanks so much for the tip! We're moving soon, so she's going to be seeing a new vet. I'll talk to them about switching her to insulin.

Some good news though: Zoey finally went poop not long after posting this. Huge relief & it seems like her diarrhea is starting to get better at least
 
What is the carb content of the Purina plus and what were you feeding her before? You want to make sure she’s in a low carb diet from here on out.

FOOD CHART have a look on this chart and choose foods that are under 10%. Most of us feed our sugar kitties foods that are around 5-6%

With a diabetic cat you need
  • A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
  • A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
  • We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions.
 
There is a post at the top of this board that discusses the newer oral treatments including Bexacat. The two things that stand out is that while diarrhea is a common side effect, if it persists, it's time to discontinue Bexacat. Likewise, if there's an infection present, I would be reticent to keep my cat on Bexacat.

My favorite probiotic for treating diarrhea is S. boulardii. Jarrow is a reliable brand although, there are now quite a few options on Amazon. Just make sure there's no sugar or sugar substitute in the ingredients. The Raw Feeding website that Squeem3 linked has excellent information on managing GI issues. If you made a fast switch in your cat's food with the diabetes diagnosis, it's possible that the food switch contributed to the diarrhea.

If you're thinking that a switch to insulin is indicated, you'll need to make a shopping trip. It sounds like you've ordered a glucometer. Many/most members here use the Walmart brand, Relion, meter. The strips are the least expensive around. We have great information on home testing. You'll also want to get lancets in order to draw blood. You will likely need a 28 gauge lancet to start out. It takes a couple of weeks for the capillary bed to build up so your cat's ear bleeds more easily. Once that happens a 30 or 31 gauge lancet (higher numbers are a thinner needle) will be fine.

If Zoey is not happy with car rides, I'd think about getting some Feliway spray for her carrier. My diabetic kitty was terrible in the car and like you, I had a 6 hour drive when I moved. Someone else was driving. What helped enormously was that the carrier had an opening at the top. I was able to sit with my arm around Gabby for the entire trip. I'd also suggest getting Feliway diffusers set up at your new place as soon as you can.
 
There is a post at the top of this board that discusses the newer oral treatments including Bexacat. The two things that stand out is that while diarrhea is a common side effect, if it persists, it's time to discontinue Bexacat. Likewise, if there's an infection present, I would be reticent to keep my cat on Bexacat.

My favorite probiotic for treating diarrhea is S. boulardii. Jarrow is a reliable brand although, there are now quite a few options on Amazon. Just make sure there's no sugar or sugar substitute in the ingredients. The Raw Feeding website that Squeem3 linked has excellent information on managing GI issues. If you made a fast switch in your cat's food with the diabetes diagnosis, it's possible that the food switch contributed to the diarrhea.

If you're thinking that a switch to insulin is indicated, you'll need to make a shopping trip. It sounds like you've ordered a glucometer. Many/most members here use the Walmart brand, Relion, meter. The strips are the least expensive around. We have great information on home testing. You'll also want to get lancets in order to draw blood. You will likely need a 28 gauge lancet to start out. It takes a couple of weeks for the capillary bed to build up so your cat's ear bleeds more easily. Once that happens a 30 or 31 gauge lancet (higher numbers are a thinner needle) will be fine.

If Zoey is not happy with car rides, I'd think about getting some Feliway spray for her carrier. My diabetic kitty was terrible in the car and like you, I had a 6 hour drive when I moved. Someone else was driving. What helped enormously was that the carrier had an opening at the top. I was able to sit with my arm around Gabby for the entire trip. I'd also suggest getting Feliway diffusers set up at your new place as soon as you can.
Thank you so much for the information! I'll be sure to look into it! After a week using FortiFlora, there hasn't really been much change at all. I do also plan on changing her food out for something healthier, but I haven't made any fast switches. She used to get a mix of both dry & wet food, but since her diagnosis, I've been slowly transitioning her to a mostly wet food diet. She has a timed feeder that I have set to go off at 2PM that provides just enough dry food so that she has a little something to nibble on between mealtimes (Breakfast at 8AM & dinner at 8PM). Any food left over after 10PM is pulled before bedtime.

Right now, she eats about a 1/4 can of 9Lives Meaty Pate for breakfast & dinner, & she gets the Bexacat with her dinner. I know that's probably not the best option for her, but unfortunately, I live in the middle of nowhere & there are only two stores in town that sell cat food. My anxiety prevents me from driving & I live so far out that I can't DoorDash anything, so most of my shopping for her has been done online. But since we're moving to a bigger city anyway, it'll be much easier to find what I need locally, & the food chart provided earlier will be a HUGE help choosing a diet that best suits her needs.

I ended up going with the PetTest Advocate glucometer. A friend of mine who also has a cat with diabetes recommended it to me. She claims it's never given her any issues, but I plan on taking it with me to Zoey's next vet appointment to test it against theirs, just to be sure. The kit comes with 50 test strips & 50 of the 21 gauge lancets. If a higher number means a thicker needle, would the 21G be too big if I'm just taking a sample from her ear?

As for the travel situation, I do have a bottle of Nature's Miracle cat calming spray that I picked up from PetSmart a while back. I spray her carrier with it before taking her to the vet & the carrier itself has an opening for me to reach in to pet her during long car rides. It helps some, but 3 hours downstate is much different from the 20 minutes it takes to get to the vet. She hasn't had any accidents in her carrier since I started using it, but still cries her little heart out the entire time.
 
As already mentioned, fortiflora is more of a flavor enhancer than a probiotic. S Boulardii is the best one for healthy bowel movements.

If you still want her to have access to dry food, there are 2 that are low carb enough for a diabetic cat. Dr Elseys and Young Again Zero Carb. Bobo is a picky eater but he really loves Dr Elseys chicken and turkey dry. I get it from Amazon or Chewy

you may want to ask your vet for a med to give her for the drive. I give my cats Xanax on 4th of July so they can survive the fireworks. Something like that may be a good idea. Some folks also use gabapentin
 
If your vehicle is large enough you may want to use a dog crate instead for the trip. That will be big enough to put a litter box in it.

Also before you start your trip put a harness on her to wear and microchip her with your current info registered.
 
You're already doing a lot that's in line with what we would suggest! The 9 Lives food is low carb. Most of us feed our cats more often than twice a day. It's fine to let your cat graze or to set the timed feeder so there are multiple meals available. The only time you don't want to have food available is 2 hours prior to "shot" time. Just a note... The newer oral insulins may make this recommendation irrelevant. You don't feed 2 hours prior to shot time so the pre-shot numbers aren't influenced by food and you don't want to give insulin based on an artificially inflated number. Since Bexacat is pharmacologically different than injectable insulin, it's unclear if this is applicable. However, if you switch to either Lantus (glargine) or Prozinc, it will apply. Feeding multiple smaller meals is easier on your cat's pancreas. It also means you can leave food in the automatic feeder while you're out of the house.

The PetAdvocate meter may be just fine. If money is no object, I suspect the strips are pricey. It looks like the strips are about 80 cents each. The minimum number of tests you will need is 4 per day or $3.20/day or approximately $22.50/week. The Relion strips are about 17 cents each (or 68 cents/day or $4.75/week). If you multiply this out for a month, the costs rapidly become quite different. This is particularly true since there are times when you will need to test a great deal more. The other issue is that you will only be able to purchase the pet meter strips online. 50 strips seems like a lot. It's not a month's worth of strips. Inevitably, you run low on strips at a time when you least expect it to happen. It's another reason we suggest having a human meter as a back-up.

Just to clarify, the lower gauge lancets are thicker and makes it easier to get a drop of blood. The size lancets you have are fine.
 
You're already doing a lot that's in line with what we would suggest! The 9 Lives food is low carb. Most of us feed our cats more often than twice a day. It's fine to let your cat graze or to set the timed feeder so there are multiple meals available. The only time you don't want to have food available is 2 hours prior to "shot" time. Just a note... The newer oral insulins may make this recommendation irrelevant. You don't feed 2 hours prior to shot time so the pre-shot numbers aren't influenced by food and you don't want to give insulin based on an artificially inflated number. Since Bexacat is pharmacologically different than injectable insulin, it's unclear if this is applicable. However, if you switch to either Lantus (glargine) or Prozinc, it will apply. Feeding multiple smaller meals is easier on your cat's pancreas. It also means you can leave food in the automatic feeder while you're out of the house.

The PetAdvocate meter may be just fine. If money is no object, I suspect the strips are pricey. It looks like the strips are about 80 cents each. The minimum number of tests you will need is 4 per day or $3.20/day or approximately $22.50/week. The Relion strips are about 17 cents each (or 68 cents/day or $4.75/week). If you multiply this out for a month, the costs rapidly become quite different. This is particularly true since there are times when you will need to test a great deal more. The other issue is that you will only be able to purchase the pet meter strips online. 50 strips seems like a lot. It's not a month's worth of strips. Inevitably, you run low on strips at a time when you least expect it to happen. It's another reason we suggest having a human meter as a back-up.

Just to clarify, the lower gauge lancets are thicker and makes it easier to get a drop of blood. The size lancets you have are fine.
Good to know! She loves the 9Lives wet food, so I'll stick with it! The only reason I've got her eating only twice a day was because for a while after starting treatment, she wouldn't eat much at all. I space out her feeding times to ensure that she's hungry when I put food out for her. There's dry food in her bowl just in case she gets the munchies before dinner, but since starting her on wet food, she's lost interest in the dry. And despite the fact that she usually LOVES wet food, it takes a bit of coaxing & often sometimes spoon feeding just to get her to eat it (I've tried the "tough love" approach & tried to wait it out to see if she'd eat on her own; She wouldn't). She doesn't trust that I haven't mixed medicine into it - honestly, I can't say I blame her. I'd be suspicious too.

She does appear to be doing a little bit better today & her appetite is slowly starting to come back. Once she's eating without needing to be spoon fed, I'd be happy to let her graze a bit more. In response to someone else's suggestion, I've already looked into the Young Again Zero dry food for her. I requested a sample a little while back, which they were happy to send, & she seems to like it. I haven't switched her over yet, but I'm hoping she doesn't eventually lose interest in it like her regular dry food. She's pickier than any other cat I've ever lived with.

The new glucometer arrived earlier. I haven't tested it yet, but I did manage to get through the setup fairly easily. I'm going to take it with me to Zoey's next appointment before attempting to use it on her myself. If it works, great. I'll keep it as a backup. But if there's an equally (or more) reliable, cheaper option out there, I won't say no. These vet bills aren't cheap, especially since they keep trying to push more medications on her.

I really appreciate all of you so much! These past couple weeks have been very stressful for both of us, but it's helped me a lot to have gotten the chance to talk to people going through the same thing & to learn from your shared experiences. I know a lot more now than I did when this started. Thank you so much!
 
But if there's an equally (or more) reliable, cheaper option out there, I won't say no. These vet bills aren't cheap, especially since they keep trying to push more medications on her.
As other members have mentioned most of us use the Relion Human meter
Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197
 
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