Switch from Senvelgo to insulin for acro kitty?

[Bob's Staff]

Our 13 year old male Bob has been diagnosed with diabetes in January 2025. Because of his acromegaly (diagnosed a few months earlier), the vets decided to put him on Senvelgo instead of insulin therapy. His blood sugars have always been under control with Senvelgo, but I have also always had the impression his body was never thriving on these meds. From the beginning, he is slowly losing weight and has frequent episodes of diarrhea, but these side effects were never 'worse enough' yet to switch to insulin and take the risk of insulin-resistence. The last couple of weeks, however, the weight loss is accelerating (blood has been completely checked but nothing could be found) and we have reached the point where we have nothing to loose anymore. Which is why we are thinking of making the switch to insulin anyway, hoping it will make him feel better as soon as the Senvelgo is out of his system, but we have a few concerns.

His BUN/ureum and creatinine levels are too high (might be or might not be because of Senvelgo, fact is they were OK before Senvelgo ...), other kidney values and SDMA are still OK. He is on Royal Canin Early Renal dry food, but we are wondering if the insulin will be able to compensate the high level of energy contained in this food? Because of his kidney values but also a history of urinary tract problems, he will have to stay on this food and will not be able to switch to diabetic diet.

Can we keep his access to dry food all day long or will he have to eat on more regular moments when he is on insulin?

Thanks in advance for your precious help!

 

[Wendy&Neko]

Hello and welcome. Might be time to update your signature that says "no diabetes yet". Sorry he's gotten to that stage.

Have you seen this post from our Feline Health forum: New Treatments for Feline Diabetes. A couple of quotes from it talking about the potential use of Bexacat or Senvelgo:

• Laboratory values or physical assessment that indicates the presence of ketones, DKA, kidney or liver disease, or recurrent urinary tract infection (UTI) would preclude the use of either of these medications.

• Cats with symptoms of loss of or no appetite, weight loss (i.e., anorexia), dehydration, or lethargy at the time diabetes is diagnosed need to be very carefully screened. The presence of these symptoms require immediate discontinuation of Bexacat or Senvelgo and assessment for DKA regardless of blood glucose levels.

It sounds like a switch to insulin is a good idea. I hope the vet is considering Lantus (preferred) or Prozinc as the insulin.

Regarding food, what is his history of urinary tract problems? Dry food is the absolute worst thing for both kidneys and urinary issues. Lots of good information on this website by a vet specializing in feline nutrition: Cat Urinary Tract Diseases: Cystitis, Urethral Obstruction, Urinary Tract Infection. Another good website for kidney disease is Tanya's Comprehensive Guide to Feline Chronic Kidney Disease – Everything You Need to Know to Help Your Cat. Most cats with early stage kidney disease do not need special kidney diets. Similarly, diabetics don't need special diabetic food.

A good option for him may be a low carb/lower phosphorus wet food. What you want for early kidney disease is a good quality protein diet. Urinary issues do well with low carb wet or raw and low phosphorus. For what it's worth, one week after my acro Neko got her diabetes diagnosis, my other cat had his first idiopathic cystitis episode. His vet recommended raw as the solution for both cats. Neko's IM vet call raw the best food for her, and that was when she was stage 3 kidney disease, so further along than Bob. It doesn't need to be raw, but it is an example of low carb and low phosphorus moist food.

If you stay with the high dry food, it'll be a lot harder to regulate him. You'll need higher doses of insulin that if giving a low carb diet. But it is fine if he grazes.