Newly diagnosed diabetic cat, not feeling great

[Samsmommy]

My 8 year old cat Sam was diagnosed at the beginning of July. The vet has had him on 2.5 mg glyburide, and I've switched him to a canned food diet. I've been feeding him Wellness grain-free canned varieties which he likes. The vet did a fructosamine test at the end of July, which showed good control of the diabetes. I was told to continue with the glyburide and canned food, and Sam will go back for a 3 month follow-up and bloodwork in October.

However, this weekend, he has not been feeling very good. He's had a poor appetite and some diarrhea, and is more lethargic than usual. He did not eat any of his supper last night. He's had a few nibbles of his breakfast today and looks slightly better than he did last night. Wondering if I should be taking him to the weekend emergency vet today, or if I can wait to get him into his regular vet tomorrow? Not sure how serious of a problem this could be...any advice would be appreciated.

 

[BJM]

Are you home testing the blood glucose?

Are you testing the urine for ketones/glucose? There are tips in my signature link Secondary Monitoring Tools on how to do that. I strongly recommend testing for ketones NOW. Only 2 of 3 ketone types can be smelled and they smell fruity or like nail polish remover (acetone).

When the glucose is not being matched up to enough insulin in the body, the cat cannot use it. The body begins to break down fat for calories. A by-product of fat breakdown is ketones. Too many ketones may become diabetic ketoacidosis, a potentially fatal, expensive to treat complication of diabetes. Also, the fat being released goes to the liver which may cause it to swell, resulting in hepatic lipidosis, another potentially fatal, expensive to treat condition.

 

[Samsmommy]

I did end up taking him to the emergency vet. No ketones in the urine but he does have an infection. His blood sugar was high. The oral glyburide is not effectively controlling his diabetes. They are starting him tonight on IV fluids and antibiotics for the infection. Tomorrow morning I'll be transferring him to his regular vet to get the insulin started. I'm glad I took him in today and didn't wait until tomorrow.

 

[BJM]

I'm glad you took him in. Much better safe than sorry. We generally don't recommend the pills for the diabetes as they may push the pancreas to produce more insulin which can just tax it further.

For insulin, preferred insulins for cats are ProZinc, Lantus, BCP PZI, and Levemir. Caninsulin/Vetsulin, Humulin/Novolin do not last a full 12 hours in most cats. If you get Lantus or Levemir, ask for an Rx for the pens. A pen contains 300 mL and it is often possible to use all of it before it becomes ineffective. A vial is 10 mL and even if you store it in the refrigerator, you seldom get more than 6 months worth out of it. Disregard the 1 month and pitch info on the insert or from the pharmacist; that is true only for humans who don't refrigerate it and use it up within a month. Also, start with a low dose for safety and ease into any increases. By treating the infection, the glucose is going to come down some anyway, and you don't want to deal with hypoglycemia (too low glucose) if you can avoid it.

We strongly advocate home blood glucose testing to help keep your cat safe and to evaluate how well the dose is working. An inexpensive human glucometer, such as the WalMart ReliOn Confirm, Confirm Micro, or Prime, are inexpensive, have inexpensive test strips, and 26-28 gauge lancets are the basic tools you need to check and the won't break the bank the way the AlphaTrak. If your vet insists on the AlphaTrak, politely decline unless the vet will provide it for free, and provide free test strips. Strips are often $1, sometimes more per strip!

For diet, check out Cat Info for information by veterinarian Dr Lisa Pierson. There are many over the counter food choices with under 10% calories (not weight) from carbohydrates.

 

[Samsmommy]

Thank you! That's helpful information on the types of insulin and cost-effective glucometers! I have a human client on Lantus pens, and it's so simple to use- I hope that's what my vet will prescribe. I have Sam on Wellness Grain Free, which he seems to like and looks to be good on the low carb spectrum. Hopefully my boy will be feeling better soon. I'm very relieved no ketoacidosis at the moment.

 

[BJM]

Actually, you treat the pen as a mini-vial and use a syringe to draw out the insulin. Cat doses can be measured in quarter and half unit increments that way, which is better for their much smaller bodies. Just take the needle and cap off, then insert the syringe in the little stopper.