Question about lactulose use

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Patience's Mom

Member Since 2016
Hi, my name is Deb and I am new to this forum. My sweet little Patience has had a really though road with chronic constipation for several years which eventually turned into turned into Megacolon with bi-lateral anal hernias. She had gone through many, many visits to the vet to have her cleaned out with enemas. In August of 2015, she was also diagnosed with diabetes and since then we have tried, Novolin, ProZinc and finally Lantus which she is still on at 9-units (as of April 3, 2016), twice a day. She only weighs 10 lbs. and her diabetes is still not controlled. After Patience's constipation got to a point that I was bringing her to my "old school" vet almost every week. I was at my wits end, the cost each time was financially draining, and most importantly, she wasn't getting any better! To make a long and heart wrenching story short, in December 2015, I made the decision to have her get an operation to have her colon removed. I felt that although the cost was high, at least this was finally a remedy to her problem.

She came through the operation like a little trooper, the doctor advised, knowing she is diabetic, that I give her Lactulose when her stools start to become "formed". I worried that this is very sweet, but the doc told me that this sugar is not digestible and would not be an issue. Her diabetes was not under control prior to the operation (I was giving her 14-ml of Lactulose daily), and to this day, it is still is not under control. Keep in mind that I continue to give her Lactulose when her stools indicated it's needed. I need advice where to go from here. My vet does not think that the lactulose is the reason for her uncontrolled diabetes, he has ruled out hyperthyroidism and since hyperadrenocorticism (Cushing's disease) is so rare in cats, it was not tested for. As far as acromegaly, she is a petite cat and shows no physical signs (enlarged head, paws or mandible), so it was also ruled out.

I need your advice as to where to go from here. Can I substitute something else for lactulose? I have heard that MiraLax may be an option, but I don't know the dosage to be given. My vet does not believe the lactulose is the issue and seems to be at a loss as to why she seems to be insulin resistant. I have tried adding Purina Pro Paln DM to her diet (1-can) along with the other 3-cans she devours per day, but it also does not appear to have any effect. She continues to drink like a fish, eat like a piggy and pee like a race horse....and poo a lot too! I just don't know what to do. Please help me, help her...your advice would be most appreciated.
 
Hello and welcome.
Are you home testing blood glucose with your cat? Is the vet basing the dosing off a number he gets when doing a blood test? 9 units is awfully high. Are you giving lantus twice a day? how long has she been on lantus?
 
Are you using the powder form of lactulose or the syrup form. Some studies have shown that the syrup form may not be good for diabetics.

"
Abstract
Lactulose is a poorly absorbed synthetic disaccharide frequently used in the treatment of portasystemic encephalopathy. Because lactulose syrup contains small amounts of absorbable sugars, it may cause hyperglycemia in diabetic individuals, but is usually well tolerated. We report the case of a patient with diet-controlled diabetes and cirrhosis who experienced a marked deterioration in glycemic control, requiring insulin use, when he began using a different brand of lactulose syrup. The hyperglycemia resolved and insulin was discontinued after use of the original brand of lactulose syrup was resumed."

http://www.ncbi.nlm.nih.gov/pubmed/7716610



Also it would be very helpful if you started a spreadsheet and entered all data you have on glucose testing. Link for starting a spreadsheet:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/


If you are not already home testing I would suggest trying to get that started. Link for home testing:

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/


Patience's Mom said:
since hyperadrenocorticism (Cushing's disease) is so rare in cats, it was not tested for.
Click to expand...


Cushing's may not be as rare as previously thought. There have been 6 kitties on this forum in the last 1 1/2 years that were diagnosed as Cushing's. The easiest and least invasive test is the UCCR test (urine cortisol:creatinine ratio) which is done from a sample of urine collected at home ( in order to not have the stress of a vet visit) and taken to the vets office. They would send it to an outside lab who does this testing.
 
Patience's Mom said:
As far as acromegaly, she is a petite cat and shows no physical signs (enlarged head, paws or mandible), so it was also ruled out.
Click to expand...


Early stage Acromegaly cats do not always have the physical signs. There are a number of kitties on this forum that have acro and many of them did not have any of the visible signs until later in the progression. To test for this you would need the IGF1 test.
Also you can have your kitty tested for Insulin Auto Antibodies (IAA)


These tests have to be sent out usually to Michigan State University Animal Health.
 
Tuxedo Mom said:
Early stage Acromegaly cats do not always have the physical signs. There are a number of kitties on this forum that have acro and many of them did not have any of the visible signs until later in the progression. To test for this you would need the IGF1 test.
Also you can have your kitty tested for Insulin Auto Antibodies (IAA)


These tests have to be sent out usually to Michigan State University Animal Health.
Click to expand...


I second this. My vet told me the same thing because my boy also didn't have the tell tale features. The IGF-1 proved otherwise. Lactulose didn't affect my cats bg, but in time I found it was less effective so I switched to Miralax (generic Walgreens brand is fine). Miralax proved much better...I started off 1/8 tsp twice daily, and worked as high as 1/2 tsp twice a day. Constipation was a chronic problem for my cat also.

Dawn
 
On Tanya's website I believe is states that Lactulose can affect serum calcium levels. It is not the best option for managing chronic constipation. Miralax is actually just as effective, has no flavor, and fewer risks. 1/8 teaspoon per day is the standard dose for cats.
 
Hi Deb, and welcome to you and Patience.

I'm sorry to hear about all of Patience's trials and tribulations, but I'm glad she blessed to have such a loving mom. :bighug:

I'm not sure whether you've come across the following site before, but it's very helpful for all manner of issues relating to feline constipation:

www.felineconstipation.org


Mogs
.
 
:bighug:Deb my heart goes out to you and Patience. Its terrible seeing our furbabies go through so much and not get better.

We have used miralax per vet instructions at 1/8 tsp bid as needed, up to 1/4 tsp bid. Its effective and from what i understand good for long term use.

I will mention there is powdered pumpkin which is also very effective and natural. Some people can get their cat to eat canned plain pumpkin (not to be confused with pie filling) in their cat food but my cat wouldnt have it. The powdered pumpkin works.

I am wondering what other food does patience eat besides the purina dm? That could have a bearing. Is she off dry food completely?

I'm with the others here in suggesting learning how to use a glucometer at home. I know it may seem too much to think about, and i was resistent too when it was suggested, but i started using it recently and it has proved critical in my cats treatment plan.

That is quite a lot of insulin especially for such a little lady. Please consider testing for acro/cushings.
 
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