Questions about what to expect with long-time diabetic cats

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Hi again! My cat, Cheshire, was diagnosed about 11 years ago, and this forum was an absolute godsend. My vet was uninformed about modern feline diabetes, and the research and info from this forum completely changed the course of treatment for Cheshire and probably greatly extended his life.

He's been on Lantus for 11 years with a low carb diet and has been generally stable. He really dislikes BG testing, so after the first year and he was consistently stable, I stopped putting him through it.

But now it's over a decade later and Cheshire is 17 years old. He's slowing down, had to have some teeth pulled, and his BG is becoming less stable. About once a month I'm noticing he has low BG episodes. All the classic symptoms: stumbling, weak hind legs, bumping into walls. And it's been straightforward to treat (again, thanks to the expert guidance on this forum).

I think his hind legs are generally weaker, but it's hard to tell if it's that or he's just older and slower. He's more likely to snag his claws on things. He's become more likely to poop outside of his litterbox, often I think as a protest on days when I have to go into the office for work.

My question is this: what does old age look like for diabetic cats? Do they slowly become less well regulated? Do their hind legs eventually give out? Are UTIs inevitable (we've avoided them so far). Do they have a slow subtle decline, or do they start having more dramatic issues?

I've read the "average" lifespan of an indoor cat is 18 years, so I'm trying to learn what to watch for as Cheshire ages. I'm in no rush to lose him, but I also want to know as much as I can about what to expect so I can recognize the signs when they approach. I'm very much of the "better a week too early than a day too late," for both myself and him.

Anyone with experience they're willing to share... I'd much appreciate it. Thank you!
 
Hi Chris,
I’m not knowledgable at all regarding diabetes - congrats on keeping him for such a long time so stable!!!

I can give you my two cents regarding a couple of things to expect with any senior cat: they slowly become less able to retract their nails, so yes, they tend to snag things with their claws. And they do slow down, like we do too!

The outside of the box pooping could be related to a reaction to you having to go to work, but it could also indicate arthritis in the hip or leg or back. Has Cheshire been checked for that? Unfortunately there isn’t much to do for arthitis, supplementing with omega 3 helps, many cats are relieved with Solensia (a monthly shot), acupuncture is also helpful, and NSAID pain meds are usually used long term at a very low dose. With arthritis, quality of life is paramount, and pain severely alters it.

Another thing that has me thinking about the hind legs is that it is also a symptom of low potassium levels. In Tanya’s website, I read that “Cats with diabetes may have low potassium levels.” And also that one of the symptoms can be weakness in the back legs. (https://felinecrf.org/potassium.htm#low)
 
I’m my experience older cars, if treated with insulin and monitored well do just as well as younger cats.
Every cat is different so one cat might live x number of years and another cat might live y number of years. You have done well having him on insulin for so long.
What about trying him with a freestyle libre monitor which is put on at the vet and lasts 2 weeks. That would give you an idea of how he’s going.
Have you been reducing the dose whenever he has had a symptomatic hypo? How much insulin is he in now?
 
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Another consideration is that diabetes is hard on a variety of organ systems. If you're not already doing so, I'd encourage you to make sure Cheshire has regular, twice a year vet visits and the vet runs a senior blood panel. It's a good way to know if there's any kind of medical condition brewing. Kidney issues are common in older cats and especially common in diabetics (cats and humans!).

The other issue with aging is that the response to medications may differ. Medications have a tendency to build up because the liver and kidneys don't work as efficiently with age. So, checking Cheshire's blood glucose may be important to make sure numbers aren't reacting in unpredictable ways.

In additions to what Daphne suggested, Cosequin can be helpful with arthritis. It's not a prescription -- it's a supplement and is a glucosamine and chondroitin product.
 
Daphne, Bron, Sienne - thank you so much! I couldn't have dreamed of more helpful responses. Arthritis, potassium, liver / kidney, senior blood panel, libre monitor, the senior care quide... exactly what I was hoping to learn.

Bron, to the question about reducing insulin: He's at 1.5 units twice per day now. I do make small adjustments when he goes low (1/4 unit, as precisely as possible). Over the years, he's gotten very wise to what's going on; he knows when it's time for a shot and will come pester me if I've lost track of time. He'll do the same if he's not feeling well, and keeps going to the fridge. I notice if he is urinating more and loses a little weight, so sometimes we inch back up on insulin, too.

I wasn't aware of the libre monitor for cats at all... that could be a great resource.
 
Just an FYI - The Libre can truly be an asset. However, members have noted that it runs lower than a hand held glucometer if the numbers are in a lower range. There's also a Facebook group for pet Libre users.
 
I've had several old cats including some diabetics. The snagging claw thing is true for all seniors and it helps to trim them so they don't get stuck somewhere and panic or worse, curl around and grow into the pads which makes walking painful and can cause infection. Hind leg weakness is not uncommon as they lose muscle. There can be several reasons for pooping outside of the litter box - weakness, mobility issues, constipation, etc., but spite isn't one of them. One of mine always went in front of the box so I just put puppy pads there and was grateful it was at least in the cat room.

I have noticed with my older diabetics that blood sugar seems to fluctuate more and have to be careful about testing and dosing. Some had to have their insulin reduced and others have gone off it entirely. Maybe an age-related slower metabolism thing. Chance is a former stray, age unknown (maybe 16) and his sugar has been very unpredictable lately. He only gets a drop of insulin anyway but I still have to skip shots 2-3 times a week. You really don't want a cat having repeated hypoglycemia episodes, with or without symptoms, as each one can increase the risk of brain damage.
 
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