Please Help! - Lethargy and Yellow Stools

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Princethecat

Princethecat

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Hi this is kind of a frantic post as I’m not sure what to do. My cat Prince is suddenly extremely lethargic and has been pooping outside of the litter box for the past couple of days and has been struggling with appetite. He has been diagnosed with diabetes for the last 2 years. I had initially posted on this board back then but it has been somewhat manageable thanks to great advice.

But this is the last couple of days:

Friday - 10/11: threw up but eating and pooping regularly
Saturday 10/12: poops outside the litter box a greenish/yellow color
Sunday 10/13: noticeable decrease in appetite
Monday 10/14: pooped outside of the litter box again this time tan-ish stool that is slimly.

All this + the lethargy so I tested his levels constantly yesterday. Here’s an overview:

6:30am -eats half a meal, less then us usual
9:40am - tests at 131 mg/dl
Does not eat unless force fed
11am - finally eats
12:40pm - tests at 242mg/dl and I administer 2.5 units of Prozinc insulin

I decided to take him to the vet due to the lethargy and I could tell he was not feeling good. Vet recommends me to go to the emergency vet so I do.

Emergency vet tests blood and ketones and text for DKA. Blood test comes back normal (no liver issues etc.) and Ketones test comes back normal as well - they do not find any ketones.


They test his blood sugar and it is lower @ 107mg/dl despite eating a little prior to coming to the vet.

The vet recommends I do not give him insulin due to the low blood sugar and keep monitoring him and tells me to give him Mirtazapan to help with the appetite. And Karo syrup on gums so I do. It helps some what as when I got back from the vet he ate.

Now I can’t tell if I’m going insane or not I don’t expect him to bounce back right away but he is still lethargic. Not sure when I should be seeing slight improvement or worry. Also I tested his sugar levels at 12:40am on 10/15 (tech 10/14) and they were at 299mg/dl! Which is higher but doc says don’t give meds until 350+ mg/dl

Should I be concerned that this may be something else? An infection maybe? What tests do the vet have to run to determine that? Is this because of his unregulated blood sugar levels at the moment? His lethargy is most concerning to me.

Apologies for the questions but I am seeking advice anything is helpful.

While my signature has a chart - i have monitored his levels on a separate one i can add them in the morning when its not almost 2am here.

Thank you
 
I am also concerned about the lethargy. Did the vet give Prince an antinausea medication? An appetite stimulant is no good if there is nausea present.
I would ask for a test for pancreatitis. For that you need either a fPL snap or an fPL spec test. They are not done with the routine tests.
Even if he is not eating a lot you can give a half dose of insulin. A diabetic cat needs food and insulin.
I can’t see the point in giving karo unless it is fir low blood sugar.
Is he eating yet?
 
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@Bron and Sheba (GA) Hi thanks for the response.

Yes they gave him Cerenia 10mg/ml as an anti-nausea medication. Fed him today and thankfully he ate. Then tested his levels and it is 268 mg/dl about an hour after eating. Not sure if this is high enough to give him is usual dose of insulin (2.5 u Prozinc)? I may give him half to help.

Yes the Karo was for the low level they got at the emergency vet (107 mg/dl despite him eating 1hr prior). Once I took him home he managed to eat a little and I was pretty unsuccessful ln giving him any karo at all so refrained from giving him any more.

He is still lethargic and wants to go hide in corners which is my concern. But this morning he was purring and receptive to my pets which he hadn't been yesterday
 
Sorry I called him Huhu .. it must have been an autocorrect on my iPad.
I would ask about getting the pancreas checked. He may be in pain. Pancreatitis is painful. The treatment for pancreatitis is pain meds, antinausea, sub Q fluids until symptoms subside. My Sheba used to get pancreatitis.
268 is high enough to give a dose but I will ask @Suzanne & Darcy to pop in and have a look as she uses Prozinc
 
Hw is his weight doing? The feces color/consistency could just be due to not eating much. An abdominal ultrasound US) may be in order since may a problem like small cell lymphoma (SCL). One problem is that an US would only show thickened intestinal wall thickness and could be due to IBD as well as SCL. Also are any lymph nodes found to be enlarged? Some of the nodes are accessible to hand/finger palpation and other via US.
 
Hi @Bron and Sheba (GA) and @Larry and Kitties Thanks for responding.

As an update I gave Prince 1 unit of insulin (1hr after first meal in the early morning) and that did initially seem to help. However about 30-45 min after his 2nd meal in the afternoon - I tested his blood sugar again and it was 140 mg/dl which for him is low right after eating.

His weight had been fluctuating for the last couple days from 17.1 - 17.6 lbs (he is a bigger cat) so hard to tell if his weight has dropped very recently as he is in that range.

Felt for lymphnodes and didn't feel anything glaring right off the bat but I'm not 100% sure in my skills to test that.

He started to move away from sleeping in corners and is back to purring / willingly came up to me. It seems like his hunger sort of came back.

However he is still very lethargic so I'm still concerned - the vet called to review his blood work for yesterday and suggested I bring him in for an ultrasound tomorrow like you have suggested @Larry and Kitties .
They didn't seem concerned that it was an infection though since his white blood cells count was normal. I will have to ask about Pancreatitis.

Ill continue to monitor his blood sugar levels - I can't tell right now if he is more irritable when in the higher ranges or lower. It is hard to tell with his general demeanor being off today.

Thanks
 
Hello sorry for my delay in update it’s been a busy couple of days.

Originally I was suppose to take Prince to the vet for an ultrasound on Wednesday afternoon. But from Tuesday afternoon - Wednesday he did a complete 180 in terms of energy/eating etc. He was particularly back to his normal self and even eating normally without the help of any medication.

The vet we were going to was over an hour away and he does not do well in cars or the vet so I thought if he’s doing okay why upset him further right now. I deeply regret however not taking him as this morning he threw up this Friday morning and in the last day or so has been sniffling a little.

He had thrown up before but the sniffling is new. It comes and goes but is still concerning. So today I rushed him to the vet again and they are doing an ultrasound on him currently.
The vet as @Bron and Sheba (GA) you had suggested thought it is pancreatitis.

Well just got the results back and turns out it is not pancreatitis but she did notice some thickening of the GI Tract and his lymph nodes enlarged so it could be either IBD or lymphoma as you have mentioned @Larry and Kitties .

This is all so scary I don’t really know what to think. They have sent him home with Cerenia for nausea and probiotics and I have scheduled a vet appointment with his family vet on Monday.

Will update when I know more but info on IBD or lymphoma would be great.


Thanks
 
IBD is typically controlled with a novel protein diet and probiotics, also psyllium husk powder can help. Here is one website with more information: https://www.ibdkitties.net/ I use Visbiome on my IBD girl, it is a probiotic made specially for IBD. Some IBD kitties need a steroid.

SCL is treated initially with a steroid (typically prednisolone) and a mild chemo called chlorambucil. The protocol for dosing it that easiest on you and the cat is a dose every two weeks. You do need to give an antinausea medication around dosing the chlorambucil. SCL kitties on this protocol have a good chance of going into remission from the small cell lymphoma. Food makes no difference to SCL cats.

Steroids can increase blood sugar. Budesonide is an alternative steroid to prednisolone that doesn't impact blood sugar as much. It didn't impact my Neko's BG at all.

To really tell if you are dealing with SCL or IBD, you need to do a biopsy, either via endoscopy or surgical and it depends what part of the bowels are thickened as to what procedure you need to do. You might want to talk to your vet about getting a consult with an internal medicine vet, as they tend to have more experience with these conditions.

You might also ask to get a GI blood panel done. Some of these kitties with GI conditions have low B12 and can benefit from supplementation.
 
Hi @Wendy&Neko Thanks so much for the info. It was terrifying hearing the news of hearing “potentially” lymphoma. But after reading more it has helped ease those nerves some what. Hopefully, it is manageable ?

I’m meeting with the family vet first on Monday, as in addition to that his blood sugar levels have been different this past week from the previous - I’ve updated the spreadsheet to the best of my abilities but essentially he’s been showing lower numbers (mid 100s mg/dl) even after eating. Usually, he is at around the 300s 1-1.5hr after a meal, to which then I dose 2.5u usually twice a day. So now I have been finding myself only dosing him 1.5u and usually only at night. Since the emergency vet similarly mentioned that the medication for IBD could effect levels.

Ideally, I would like to get a biopsy sooner than later. But not sure how I should go about things till then. Thankfully his appetite is back and the doctor gave him probiotics as well to use with meals. As well as Cerenia to give at home for nausea. He still has a bit of sniffling going on but otherwise energy wise is pretty much back to normal.
 
Regarding the spreadsheet, if you skip some cycles, either put "skip" or "0" in the units cell, so we know you didn't just miss entering the data. I wonder if lowering his dose would allow you to shoot more often with less skipping of shots. Those skips are still sending him high.

Princethecat said:
It was terrifying hearing the news of hearing “potentially” lymphoma. But after reading more it has helped ease those nerves some what. Hopefully, it is manageable ?
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Small cell lymphoma is slow growing, if that is what Prince has. But the sooner the diagnosis the sooner you can start treatment. My current cat has both IBD and small cell lymphoma, which is in remission. She was first diagnosed with it back in 2018. She just had an ultrasound and the vet said "beautiful bowels". :). She hasn't been on chlorambucil for a year and a half. Not all cats are so lucky, but a proper diagnosis so you can treat properly definitely helps.
 
Wendy&Neko said:
SCL is treated initially with a steroid (typically prednisolone) and a mild chemo called chlorambucil.
Click to expand...
Not all oncologists will initially start prednisolone but only use, at least initially, chlorambucil. In ~2005 My Marios was only started w/ and only added prednisolone at the end. Currenlty my Nala, who is in remission, is only on chlorambucil and doing good.
 
And I've even heard of a "specialist" vet who only gave prednisolone and not chlorambucil. Prednisolone (or budesonide) in the short term can help kitty in the short term until the chlorambucil starts working, which takes a while. Steroid can be tapered and stopped after that, if that works for your cat. It didn't for mine.
 
@Wendy&Neko Thanks for the tip I put 0s where I did not administer any insulin. On my personal tracker, I mark when he is being fed as well especially since I’m dosing less so I was having a bit of trouble converting. Is there an updated link on how to use the spreadsheet? The link I found seems to be a dead end. https://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

By shooting more frequently - do you mean when his levels are raised to 300+ ? Regardless of what time it is? Right now I am shooting him at 9am/9pm.
 
@Wendy&Neko @Larry and Kitties

Also thank you for your personal input on your cats - I am glad that they are doing well! It gives me reassurance that Prince will be okay. Thanks for the info on the meds - will keep that in mind going into Monday’s appointment.

May I ask what food you are feeding them? In reading about IBD I have red that lower fat foods are better? Right now I am feeding Fancy Feast Pates - and I don’t want to make any drastic changes, since they are low in carbs and he has the appetite for them.
 
Princethecat said:
By shooting more frequently - do you mean when his levels are raised to 300+ ?
Click to expand...
I mean being able to shoot twice a day consistently, instead of having to skip.
Princethecat said:
May I ask what food you are feeding them? In reading about IBD I have red that lower fat foods are better? Right now I am feeding Fancy Feast Pates - and I don’t want to make any drastic changes, since they are low in carbs and he has the appetite for them.
Click to expand...
Fat amount isn't important. You want to feed protein types they aren't allergic too. My girl does best on turkey or rabbit and is definitely allergic to fish and beef. A lot of the FF have fish in them now. You will get good at reading the labels if you manage to figure out what proteins work, and which don't. The website I linked talks about a protein elimination diet where you start with exclusively one protein and try it for a while to see if it works. Sometimes the allergy is not the protein, but the additives, like gums.
 
Hi @Diane Tyler's Mom GA thanks for the link! I’ve hopefully the sheet correctly now.
For now I am going to be rigorously monitoring his blood sugar level. His ranges are definitely a little scattered. Right now I am giving him 1-1.5 units every time, but he seems to be dropping considerably low, so not sure what to do

As an update from today’s meeting with the family vet. Went and discussed options for biopsy/internal medicine vet. The two that they have suggested (one being the emergency clinic I took Prince to) only have appointments available in Nov so it will be a while.

The vet did suggest two different kinds of food - Royal Canine Rabbit and Peas food and a hydrolyzed one (that is dry food so I don’t think I will consider that due to Prince’s blood sugar levels). Will look into it. @Wendy&Neko Thanks for the insight on the allergies. Right now he is thankfully eating Fancy Feast happily so I will keep that up right now.

Thank you for such helpful advice this last week! Deeply appreciate it.
 
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