Peripheral neuropathy

[balou1]

My cat was recently diagnosed with diabetes. He's a bengal, Balou, and a very large-boned BIG BOY, almost 10 years old. He was 28 lbs, but is down to 21 lbs. It seems unlikely that he will lose more. Balou was obviously obese, and his brother is 17 lbs and not obese, just also a BIG BOY too. His initial BG level was 456, and is now 350 - 3 weeks later. We are hoping to regulate his glucose by a prescription metabolic diet. He has severe neuropathy in his hind legs and has difficulty supporting himself, which makes him have "accidents" trying to get to the litter box quickly enough. He walks on his hocks and will only take a few steps at a time. I am very concerned with his neuropathy and have many questions.
Is the nerve damage permanent? Will he ever be able to walk normally again?
He has been taking the suggested B12 vitamin pill, which has had no obvious change. Is there something else?
Will a decline in BG to a normal range decrease the effects of the neuropathy?
Is neuropathy a continuing decline in muscles and nerve damage regardless of pathology? Can it be cured?
Are there exercises or other tricks I can do with him to help with the neuropathy?
Does neuropathy cause pain? He appears to have become emotionally depressed, probably due to acceptin that he can no longer do much of anything.

Sorry for the long-winded conversation, but new to cat diabetes.

Pat

 

[Elizabeth and Bertie]

Hi Pat, and welcome to FDMB!

Let me try to answer some of your questions; first briefly, and then in more detail...

I am very concerned with his neuropathy and have many questions.
Is the nerve damage permanent? Will he ever be able to walk normally again?

Neuropathy can usually be completely reversed (with appropriate treatment).

He has been taking the suggested B12 vitamin pill, which has had no obvious change. Is there something else?

The B12 you need to give is methyl B12, AKA methylcobalamin. Other forms of B12 don't do the job.

Will a decline in BG to a normal range decrease the effects of the neuropathy?

Usually, yes.

Is neuropathy a continuing decline in muscles and nerve damage regardless of pathology? Can it be cured?

Neuropathy is, as I understand it, caused by nerve damage due to vitamin B deficiency. It can usually be cured with appropriate treatment.

Are there exercises or other tricks I can do with him to help with the neuropathy?

Yes, getting a cat to exercise (ie. employing games that get a cat to run, jump and play) does seem to help.

Does neuropathy cause pain?

It seems so. And humans with neuropathy do report pain; also numbness and 'pins and needles'.

Quite a few of us have cats that had neuropathy when they were first diagnosed.
My own cat had very bad neuropathy which completely resolved once his blood glucose got under better control, and he was given a methyl B12 supplement to aid the healing of the nerve damage. (A popular methyl B12 supplement here is 'Zobaline', but there are other supplements that work similarly.)

We are hoping to regulate his glucose by a prescription metabolic diet.

I do not know what a 'prescription metabolic diet' means...
I've been on this forum for over 9 years and have not yet seen a cat's diabetes regulate soley through a 'prescription' diet of any kind...

The vast majority of cats need insulin.
Diet is also important for good control of the diabetes. We recommend a low carb wet diet which has less than 10% calories from carbohydrates. There are many 'ordinary' wet foods out there that meet this requirement.
A significant proportion of cats will go into remission (ie. be able to have their diabetes controlled by diet alone) after a period on insulin and a switch to a low carb wet diet.
(Note: A cat on insulin should only be switched to a lower carb diet if the caregiver is able to monitor the blood glucose at home (much easier than it sounds! ). That's because lowering the carb content of the diet can reduce the blood glucose levels considerably; and the insulin dose may need to be reduced accordingly so as to prevent hypoglycemia.)

If your cat has neuropathy to the degree that you describe then it sounds like he has been hyperglycemic for a long time. The litter box 'accidents' also point to very high blood glucose. Balou almost certainly needs insulin, and may be at risk of further deterioration if he doesn't receive it....
Do you have any idea what his blood glucose levels are at the moment..?

Please know that diabetes is very treatable! And with good care (and a little bit of luck) a diabetic cat can recover well, and can live as long and as happily as a non-diabetic cat.

Eliz

 

[Tuxedo Mom]

Elizabeth has given you some very good information. and advice.

I just want to echo the fact that if a kitty has higher numbers such as yours, waiting to start insulin will just make getting your kitty regulated harder to do. Also as long as a kitty is in high numbers they can continue losing weight since the body is not able to process and utilize the food properly without adequate insulin. A diet change is fine but if you do not see any good positive results after a week of diet change then starting insulin would be the next step.

 

[balou1]

Hi Eliz, thank you soooo much for responding quickly. Your responses were very helpful and appreciated. My comments are:
1. I suspect Balou has been hypoglycemic for some time. His blood glucose level 3 weeks ago was 456. On this diet for 3 weeks, lowered it to 350 a few days ago (difficult for me to get blood from his ear without help so I don't do it frequently).
2. I do give Balou the methyl B12, AKA methylcobalamin. Couldn't think of correct name when typing this! I give him a pill of Zobaline (costly here in US)
3. The prescription diet is "Hills Prescription Diet MC," feline metabolic advanced weight solution.
http://www.hillspet.com/en/us/products/pd-feline-metabolic-prescription-diet-dry
It can only be purchased in the US by Vet prescription. Their web site (above) shows the caloric content. Says "low carbs" but how would I know without comparing it to other cat foods. Can you tell if it's really low carbs? What is the product you use? what is it's carb content? what would you consider a low carb content in the food?
4. Here's the dilemma: I have 2 vets; one is very prone to use diet and little medicines to regulate diseases such as diabetes. She believes diet and weight loss should work. I really doubt he'll lose more weight. He's STARVING for food all the time (imagined or not by him!); he was a free eater. He gets 1 cup a day VERY REGULATED by me. The other vet thinks insulin is the way to go, but readily admits he's never seen a cat in 15 years that could be taken off the insulin once they've started. But he is willing to submit to the diet and lowering glucose first. But he doesn't know how long we should wait on diet alone.

How long might this 'weight management' plan (diet alone) take to lower Balou's glucose to a reasonable level? It's been 3 weeks going from 456 to 350. Or are his levels so high that I should just go with the insulin now?
How long before there might be signs of improvement from the methylcobalamin? is it really effective or just an improvement of the glucose levels that "appears" to affect the neuropathy?
Are you aware of any research showing a cat may go into remission (ie. be able to have their diabetes controlled by diet alone) after a period on insulin and a switch to a low carb wet diet? I'd like to read for myself and reference this to my vets.
My vets are also of diverse opinion as to which is better, a wet or dry food diet. Any opinion yourself?
Have you noticed or heard of diabetic cats showing signs of depression? Balou is definitely sad.

Thank you again for your help and information. It really is beneficial to "my" state of mind to know that this disease is treatable! I appreciate your time and effort to answer all my questions!

Pat

 

[Critter Mom]

Hi Pat,

It's been 3 weeks going from 456 to 350. Or are his levels so high that I should just go with the insulin now?

Go with the insulin now. At those numbers without insulin treatment your kitty is more at risk of developing diabetic ketoacidosis (DKA), plus hyperglycaemia is not good for the internal organs nor the nervous system.

A wet, low carb diet is best for diabetic cats (e.g. Fancy Feast classic patés). The percentage of calories from carbs needs to be under 10%. If you start insulin before the diet change you MUST be home testing blood glucose levels before starting the transition since it is often the case that the dose of insulin will need to be reduced because BG levels can drop a lot when a cat is switched to a suitably low-carb food.

YOU NEED TO TEST URINE FOR KETONES DAILY (e.g. with Keto-Diastix). Even a trace of ketones is enough for you to contact your vet for advice. Anything higher than trace ketones and you need to get your cat to a vet immediately for emergency treatment.

Are you aware of any research showing a cat may go into remission (ie. be able to have their diabetes controlled by diet alone) after a period on insulin and a switch to a low carb wet diet? I'd like to read for myself and reference this to my vets.

Check out the file attached to this post. It's the published, peer-reviewed study on treatment with long-acting insulins using the Tight Regulation Protocol. It's a good document for discussion with your vet. It covers insulin choice, diet recommendations and remission rates.

Have you noticed or heard of diabetic cats showing signs of depression? Balou is definitely sad.

Depression is a hallmark symptom of unregulated diabetes. (So is lethargy.)

How long before there might be signs of improvement from the methylcobalamin? is it really effective or just an improvement of the glucose levels that "appears" to affect the neuropathy?

With numbers that high, Balou would need support from insulin as well as the methyl B12. Here's a video showing the story of Tootsie so that you can see just how effective methyl B12 treatment can be.

Mogs
.

 

[Melanie and Smokey]

How long might this 'weight management' plan (diet alone) take to lower Balou's glucose to a reasonable level? It's been 3 weeks going from 456 to 350. Or are his levels so high that I should just go with the insulin now?​

I don't think this diet has a chance of lowering Balou's glucose levels. It appears to be a high carb dry food? Neither the carb content nor being dry is beneficial to diabetic remission. Most "diet" cat foods are not diabetic friendly. The old Hill's Science Diet Lite was a very common fed food prior to a diabetic diagnosis when I started on the board.

How long before there might be signs of improvement from the methylcobalamin? is it really effective or just an improvement of the glucose levels that "appears" to affect the neuropathy?​

Every cat is different. As long as the BGs are still high, Balou's body is still fighting what caused the neuropathy. Getting the diabetes regulated + the methylcobalamin = improvement. With Lucky, our newest foster who had pretty severe neuropathy when he can to us is showing quite a bit of improvement already, 3 weeks into insulin treatment,2 weeks into the Zobaline. Lucky's BGs also came down really fast, within the first week on insulin so he is getting the benefit of regulation/remission paired with the methylcobalamin. He definitely shows he is feeling better and is happier despite having just been rehomed at 14.

Are you aware of any research showing a cat may go into remission (ie. be able to have their diabetes controlled by diet alone) after a period on insulin and a switch to a low carb wet diet?I'd like to read for myself and reference this to my vets.​

I believe the research is linked above. 7 out of the 9 cats we have treated achieved remission after a short course of insulin (6 on Lantus, 1 on Prozinc). All but one is still in remission or maintained until they passed away. Lucky is our 7th and is just testing out being off insulin yet. There are many cats on the board that were able to be diet controlled after a short course of quality insulin.

My vets are also of diverse opinion as to which is better, a wet or dry food diet. Any opinion yourself?​

I won't feed a diabetic dry food unless the cat would starve without it. Anikan, one of mine still on insulin always has increased BGs when he steals dry food. It is one of the low carb dry foods out there so it is simply the dry food, not the carb content affecting him. Diabetes is hard on the kidneys. Dry food is hard on the kidneys. No reason to give the kidneys more stress than necessary.

Have you noticed or heard of diabetic cats showing signs of depression? Balou is definitely sad.​

They feel crappy. Especially with neuropathy going on too. When you see the changes in your cat when they start getting regulated it makes your heart cry happy tears.

 

[Critter Mom]

When you see the changes in your cat when they start getting regulated it makes your heart cry happy tears.

^^ This. ^^


Mogs
.

 

[Critter Mom]

Link to thread with shortcut shopping list for diabetic-friendly cat foods:

http://www.felinediabetes.com/FDMB/threads/shortcut-shopping-list-all-8-or-less-updated.117688/


Mogs
.

 

[balou1]

Thank you EVERYONE for the responses, suggestions, help, etc. You all are so sweet and caring, I am touched to feel your concern for me and am convinced you are all right - I am going to vet tomorrow with MY suggestions re starting insulin and wet food and methylocobalium.

I have 3 further questions (so far) LOL; I guess it's obvious that I need answers!
1. How much food should I give Balou once he's on a wet food with low carbs? He was getting 1 cup of the Hills Metabolic diet food (about 4 weeks to date). I cannot figure out how to read the their (Hills) food analysis and determine how many carbs he was getting on 1 cup of food. His weight from Aug 1 (start of the MD dry food) to today has basically not changed - still varies around 21 lbs. And I have been VERY precise on that amount and no other food or treats.

2. I need help how to check his BG levels. He was diagnosed Aug. 1 through blood work and BG at 456. Within 1 week of strict diet it was 356, but still not changed substantially since then (4 weeks) . I was shown how to get blood from his ear with a needle prick and glucose monitor. I have one since I have diabetes too. Such irony! I simply need 3 hands: one to hold a flashlight and him and the other two hands so I can hold his ear, do the prick and collect the blood on the monitor. I can't seem to prick in a vein in his ear unless someone holds a flashlight behind his ear so I can see the vein. I have tried repeatedly - up to 5 pricks by which time he insists he's leaving! What do I do? It's WAY to expensive to go to the vet every other day and have them do it. Would never be able to prick his paws: he is very sensitive about anyone touching his paws.

3. Is a spreadsheet really necessary? If so, I don't understand what each column item means.

I checked his urine for ketones - negative results.
Been on Zobaline for 3 weeks now (2 pills daily) and no change in neropathy

Again thanks everyone. I LOVED Tootsie's video of neuropathy. Balou's is much worse than shown on the video.

Pat

 

[Sharon14]

Hi Pat. You dont really try to prick the vein, but the 'sweet spot' between the vein and the edge of the ear. Here's a thread with a pic.
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
While the spreadsheet isn't necessary, it is extremely helpful for you and your vet to see trends. My vet was very impressed with it! If you need help setting it up, just ask and someone will do it for you. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
As for how much to feed, there is a calculation that helps determine how many calories a cat needs, @Bobbie And Bubba can explain it to you. Start with that and then weigh him and adjust up or down.

 

[Bobbie And Bubba]

Hi Pat. Here's the formula I like to use to determine calories a cat needs. Use the cats ideal weight in the formula. It's pounds X 13.5 +70. As an example I will use 10 lbs.
10 X 13 .5 =135 + 70 =205. So 205 would be the amount of calories a day. Break down those calories into several feedings as it is better for Sugar cat's pancreas to have several small meals a day rather than 2 big ones. I feed my cat 6 times a day every 4 hours and I use an auto feeder ( mine is PetSafe 5 ) in order to do that when I am not home.

If you kitties needs to gain weight use that weight in the formula and the same for if he is overweight use the ideal weight you want get him to in the formula.

The Spread Sheet is very helpful for you and for those here that might be trying to help you with dosing. If you can't get it going, just post and someone here will help you. (I needed someone to help me get mine going)

Here is an explanation on how the SS works which helped me when I got started.

AMPS is the AM Pre-shot test (always test before shooting to make sure they're high enough to give insulin)...then the U column is for "Units" (how much you gave)

The +1, +2, +3, etc are for how many hours since shooting...so +2 is 2 hours after the AM shot, +9 is 9 hour after, etc.....Since we're all over the world here, saying "he was at 148 at 8pm" doesn't tell us anything...we need to know how long since his last shot

At the end of a 12 hour cycle, it's PMPS time! (PM Pre-shot) and the whole thing starts over

Hope that helps.

 

[Larry and Kitties]

Just note that any calories per body weight is just a guess and widely varies between cats.
My Badger weighs about 11 pounds and eats a lot more than my 14 pound BunBun yet BunBun tends to gain weight if am am not careful about portion control

 

[Melanie and Smokey]

Balou's is much worse than shown on the video.

Lucky's was too. He just drug his back end around most of the time. I just about cry when I see him proudly sit up straight and walking across the room, even with some wobble yet it looks like he is saying "Look what I can do!!!". Getting Balou's diabetes under control in addition to the melthyl-B12 is key. The neuropathy can't start to improve if you don't fix the underlying problem causing it.

Feeding an overweight diabetic can be tricky. Diabetics need extra calories, fat cats don't. I found that restricting ChrisFarley's calories made his BGs go up. Start with the basic calculations and see how things go and adjust from there. Split the calories up in multiple meals a day to keep Balou from getting too hungry and to ease the load on the pancreas.