Newly (mis)diagnosed Diabetic?? Advice Please

Hi All!

I'm so happy that I was able to locate a community as my 6 year old cat was recently diagnosed as diabetic. The thing is, I truly don't think he is diabetic, I think it was due to him having an infection, and the stress of the visit. Let's start with the initial symptoms:

My husband and I noticed that Chunk had lost quite a bit of weight over the last month, sneezing, and increased urination. We free fed him, and noticed he wasn't eating as much. So first, we tried switching his food from Hill Science Light to Hill Science Indoor. He started eating a lot more! Bad batch of food? We weren't sure.

His congestion remained the same, so not allergies okay. His appetite went away a bit again, so we figured maybe he didn't like the change or food. We started introducing wet food in addition, which he started to enjoy just fine. My husband went ahead and still brought him to the vet as he was due for vaccines as well anyways.

At the first visit, they diagnosed a UTI and upper respiratory infection. They offered us either an oral antibiotic to be given daily, or a shot that will last 2 weeks. We opted for the shot. They took a blood test to check his kidneys and a urine test, and told us they would call when the results are available. After coming home, and the next day, much of his energy seemed to have returned. He was eating a little more, and congestion cleared a bit.

Wednesday rolls around, we get a call that his tests are back. Kidneys were fine, urine showed his sugar reading at 450. They asked us to come back to get insulin etc. I was heart broken, but also motivated to tackle this and get more information. I did think it was strange to diagnose on one single test. He was also super stressed because he's been in the car and the vet 5 times in his life. What if it was a bad test? What if him being sick and stressed affected it? We go and the doctor was unavailable, but they sent us home with insulin to be given at 1 unit every 12 hours with 1/4 cup serving of food. 2 hours after his first insulin injection at the vet, he throws up. Never has vomiting been an issue, we figured maybe it was stress. We monitor him for the rest of the night before bed.

The next early morning, super energetic again! Then we give him his food and injection, becomes sluggish and throws up again about 2 hours after second injection. Am I crazy, or could my cat have been misdiagnosed? After the antibiotic shot he seemed to be turning a corner. His nose cleared up a bit, and it seemed to help his appetite. I at least think more tests need to be done to confirm, he seems to just drop after his injections. I'm not trying to be in denial, I want nothing more for my cat to feel better. I cancelled our vacation so we can just take the time at home to monitor him. But something tells me this was a little bit of a hasty diagnosis. My husband is currently taking him back to the vet while I am at work. Any advice?

 

I would ask the vet to run a fructosamine test. This is the equivalent of a human hemoglobin A1c -- it tells you if the blood glucose numbers are out of normal range over a period of weeks. (Its a few weeks for the fructosamine.)

Any sort of stress, whether it's from an inflammation or infection or environmental stress can raise blood glucose numbers. Also, urine glucose tests tend to not be terribly reliable. Blood glucose is a much better means of assessing where levels are.

If your cat is congested, I'd also suggest running the tub or shower and getting the bathroom steamy. Put your kitty in the bathroom for a while. The steam will help to break up the congestion. A cat that is congested can't smell his food. It's going to affect his appetite.

What insulin did your vet suggest and at what dose?

 

Chunk is on ProZinc at one unit every 12 hours. Glucose was ran again and it is lower than last time, but still high. They decided to run a ketones test and he is at the halfway point before they start diagnosing DKA. They gave him a shot to help with this, as well as a shot to help his appetite. The doctor said it was good that we brought him in so fast so that we can try to combat this before it gets to this point, but I'm really afraid.

 

I'm glad you managed to get him back into the vet. Some reading on DKA for you to understand what is happening: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

Can you find out the names of the medication in the shots they gave him? They should be giving him fluids to help get rid of the ketones.

We've had many kitties in full DKA who have come through it, but it will mean some extra work for you at home. The formula, as per the link above is not enough insulin + not enough food + infection or systemic inflammation. We are strong believers in home blood testing here, which will help you get to a better insulin dose and also keep him safe.

What food are you feeding him now? A low carb wet food is best for diabetics. With a kitty in DKA (or close), you'd want to add some water to that food to help flush the ketones. You also need to make sure he eats lots. A cat who has been in DKA we suggest 1.5 times their normal calories. Get a prescription for both an anti nausea medication (ondansetron is best) and an appetite stimulant to help make sure he eats lots. The vet might give you Cerenia instead of ondsansetron - which you need to get at a people pharmacy. The appetite stimulant will probably be Mirataz, which is a cream you rub in their ears.

Lastly, the vets need to figure out what infection/inflammation he has. Maybe the antibiotic shot was not the right type of antibiotics.

 

Hi and welcome to the forum.
It’s lucky this was caught early.
Re the food…apart from the 2 main meals before the dose of insulin, give lots of snacks during the day and evening. It’s food, insulin and fluids that will help get rid of the ketones.a snack is a teaspoon or two of low carb food. He may be a bit picky with food so let him eat whatever he will eat at this point as eating anything trumps everything.

I would get a bottle of Ketostix from Walmart or a pharmacy and test the urine daily for ketones at the moment.its important they are monitored and action taken if they increase at all. You will need to get a urime sample from Chunk.

I would also recommend you look at home testing the blood glucose so you can be in control of what the blood glucose is doing, it will save multiple trips to the vet and save on stress and your hip pocket.
Here are a couple of related links
HELPUS HELP YOU if you can set up a spreadsheet and signature that would be most helpful to us. If you have trouble with the spreadsheet @Bandit's Mom will help you.

HOME TESTING HINTS AND LINKS We can help you with home testing. It is not as scary as it sounds., Chunk will not hate you and you will be able to keep him safe.

Please keep us updated on how Chunk is going and ask lots of questions. It will be overwhelming for a couple of weeks but you will all get there and remember we are here to help you.
Bron

 

Thank you so much for all of the information. This most recent visit was done by my husband, so I've been playing catch-up.

I'm trying not to be negative or get ahead of myself, but for the DKA, I'm really hoping it doesn't get to the point of official diagnosis. To my understanding, DKA requires hospitalization and I'm concerned with the potential costs, and the idea of Chunk being terrified in a kennel hooked up to tubes and potentially passing that way is terrifying to me. If anyone reading this would be willing to share how many days for their DKA stay and the costs, that would really help us manage our expectations and plan in advance for tomorrow.

So catching up for the most recent visit: his reading monday was 431, today it was around 275. High, but progress. They gave him fluids, a shot to help with how he's feeling (he is not sure of what kind), and Elura for appetite. My husband gave him the Elura before he had to leave for an appointment, and by time I got home he was meowing excessively near where we keep his food. Yay! For his typical diet, we fed Hill Science dry food freely. We know now that this is not okay, and unfortunately probably contributed to his current state. The vet wants us to keep the same food at a 1/4 cup serving twice a day. After reading some of the posts on here, I opted to purchase some Tiki grainfree wet food. I did a little less than half a can, and mixed 1/8 cup of dry food with it to entice him to try it. He was eating very quickly, and we want him to keep it down and not throw up again, so I removed it every so often to get him to slow down a little. I did my first injection with him just fine, and it's been an hour so far no throw up! He still is so hungry and I feel so bad. I think we'll try giving a little bigger of a serving in the morning.

I'm taking tomorrow off of work to take him back to the vet around noon to see if we've curbed it. Unfortunately I have to go by myself due to our work schedules, and my job might fire me over it but I honestly don't care at this point, this is where I need to be. We took next week off to go to Florida, so we cancelled our trip so that we can have the next 11 days to focus on our boy. My Southwest flights aren't refundable technically, but I'm hoping giving them a call and explaining everything will change their minds, after all this is money that could go to Chunk's care. I'll get more information about medicines that were given tomorrow when I'm there.

 

Do you think it would be safe to give him a snack tonight? My vet said no snacks so I'm a little concerned.

 

Yes, please feed him snacks. It's easier on his pancreas and much better if you are giving a longer lasting insulin - which you are. Human diabetics eat several small meals too.

 

Yes I echo Wendy. Give him lots of snacks. Just feeding twice a day is old thinking. It’s very important he eats lots of food.
Be careful If you are swapping to a low carb diet as the BGs can drop. It’s better if you can monitor the BGs if you can. do you have some honey or karo at home in case of a hypo?

 

I did end up giving him a snack of a few teaspoons of wet food mixed with a little more water before bed. I am trying to feed him his morning meal/shot and he refuses to eat. He isn’t allowed to have the appetite medicine again, it’s only once every 24 hours. I have not been able to purchase any monitors as of yet. He’s awake and alert, just seems sluggish this morning. Should I just take him into the vet early, they open in a couple of hours? I know I shouldn't give him insulin without food.

 

Do you have any antinausea medications?
Also try something else to tempt him

 

You can pick up a ReliOn glucose meter and test strips and lancets(size 26 or 28) from Walmart. Also get some cotton balls to hold behind the ear when you test. I’d try and get them today if you can.
There is no need to get a pet meter. They are expensive to run and the human meters are just as good.
Also pick up some Ketostix so you can test for ketones. You need to know where he’s up to with those so you can change things if needed.
If he doesn’t eat , yes would take him in early as you don’t want to be skipping doses of insulin with ketones in the picture

 

The other shot given to him yesterday was anti nausea. We ended up getting him to eat half as much as we wanted to give him. I am taking him in now, as he has started laying down in a way he never does, almost in a loaf manner but as if he's bracing himself. He won't lift his head up in recognition if I say his name and his breathing is shallow. Please keep us in your thoughts. I really wish I knew about feline diabetes before diagnosis, so that I could have looked for signs. I looked back on pictures of the last few months and how I missed the transition I'll never understand.

 

I’m glad you are taking him back to the vet. Make sure they check for ketones and electrolytes. I’d also get them to do a pancreatitis test which is an fPLsnap or an fPLspec. Neither of these tests are routine blood tests so they would not have been done with any routine tests.
Pancreatitis symptoms can be nausea, vomiting, pain, not wanting to eat, dehydration. It’s treated with antinausea meds, subQFluids and pain meds.
Please let us know how things go. We’ll be thinking of you and Chunk.

 

Thinking of you and Chunk, I hope he will be ok, whatva beautiful boy. Sending prayers

 

Update, after writing my last response he randomly picked up and was acting normal so I waited a few hours before taking him in. The waiting room at the clinic scared the crap out of him unfortunately, there was a very long wait and there were 7 large dogs barking and fighting the entire time. He was shaking, so we found a little nook near the exam rooms to sit at and he seemed to relax. They took him back for his bg and ketone test, and they said they wanted us to be seen by the doctor so we were "put back in line." They did tell us immediately that his ketones were still just as elevated as yesterday. His BG was 270, which I know is still high but we made progress from 431. When we were finally seen, the doctor said he still wanted us to try at home because he definitely seems severely stressed when at the clinic. His levels apparently are still not at the point for DKA, and we are to come back tomorrow for a retest.

I went ahead and asked him to explain the hospitalization process so that we can prepare ourselves if it gets to that point in the next few days, and he explained that their clinic has had pretty good luck in the past with DKA kitties and that the average cost is $3k-5k. We went home and tried feeding him and he refused. We tried his original food, his wet food, both mixed. We were able to get him to eat about 1/2 of his serving, we gave him his injection. We think he's just still coming down from the amount of stress he experienced in the vet. When we came home, he had an accident in his crate.

I plan on trying to feed him a couple of "snacks" this evening to make up for the remaining part of his meal. I'm hoping the new dose of appetite enhancer kicks back in for his morning meal and we can get him to eat a bigger serving than typical. We bought a glucose monitor and keto strips and are going to practice tonight.

We are severely stressed at the idea of admitting him in such a loud and chaotic environment.

 

I am so sorry it was so stressful at the ER with all those dogs barking. That was poorly managed by the ER. Here is Australia a lot of vets and ERs now have designated cat and dog areas which is so good.
Did they give him another antinausea injection?
Did they check his electrolytes?
Did you mention pancreatitis?
It’s really important he eats well so getting the antinausea meds is very important. Lots of small snacks might be easier for him to eat. Remember it is ok for him to eat ANYTHING at this point. It doesn’t have to be diabetic friendly.
here is a link to TEMPTING CATS TO EAT
could you ask the vet for some ondansetron antinausea meds? They can be given every 8 hours if necessary and are often better than the cerenia for nausea. You would need a script from the vet and then get the ondansetron from the human pharmacy.
Test twice a day if you can for the ketones. and good luck with the glucose monitor.
If he gets lethargic, vomits or won’t eat, I would take him back to the vet.

 

HOMETESTING HINTS AND LINKS

if he won’t eat you might have to look at SYRINGE/ASSIST FEEDING until he can eat on his own.

 

I’m sorry Chunk does not feel well. It sounds like he could have pancreatitis and I wonder if they tested for it. With ketones higher today it might just be that though. The nausea shot was cerenia and it only lasts for 24 hours. It comes in pill form too and I would get some if he’s not eating well and especially if vomiting. Ondansetron will work really well for nausea only but needs to be given every 6-8 hours. It’s what I use when my cats are nauseous. Many cats under dose both drugs which I don’t understand because they are effective and have few side effects. Did you find out what antibiotic shot was given? As someone else mentioned you need to know what kind of infection to treat it. Did you find out what the antibiotic was?

Were any vaccines given? I hope not and would not give any until he’s better. He likely has enough immunity to last years already.

 

6/23 Vet visit: Vet said no signs of pancreatitis or dehydration so testing for electrolytes/pancreatitis wasn’t necessary. He actually put some weight back on (yay) and they were pleased with his change in demeanor. BG was 370, so higher, but we think this is mainly due to him switching back to dry food since he was no longer interested in the wet food. In absense of weight loss, vomiting, and signs of dehydration, instructed to bring him back on Saturday for a new check up.
Injections given: cerenia for nausea, subq fluid injection as a precaution.

Currently still taking appetite stimulate once every 24 hours. Drinking and using the litter box no problem, more playful, now likes the new wet food you recommended Fancy Feast Friskies chicken pate (yay!). Currently supplementing with dry food when no longer interested in it. Not finishing entire serving of wet food, but we’re working on it! Giving 2 teaspoons or remaining wet food as a snack every few hours.

We now have Ketostix, and a BG monitor, so we are well on our way to monitor him at home. If anything starts to go astray we plan on bringing him in right away. I asked for medical records in case we want to go to a closer vet, I’ll work on getting those into his spreadsheet. I’m considering asking for the topical anti nausea so we can administer at home.

I saw someone ask about vaccines. Unfortunately, during his Monday appointment (before test results and diabetes diagnosis) he was given his vaccines. Do you think that may have contributed to his initial decline?

 

Also, are supplements worth looking into?

 

As far as supplements, it depends on what supplements you're thinking about. However, until you have a solid baseline for Chunk, I wouldn't want to add anything new or different until he's eating, you have a handle on his blood glucose, etc. If you change too many things at once, you don't know what's helping or causing a problem.

 

As far as vaccines, the body has to work harder when given so my vet never gives to a cat not feeling well. It’s history now so don’t worry about that . It would be helpful if you would add a signature.