Toby's internal medicine consult

[Susan and Toby]

There is still no conclusion on what systemic underlying issue is causing his insulin resistance. Negative for acromegaly.
It seems that we are getting closer to an answer though.
His new ultrasound showed persistent thickening of his small intestines. This is indicative of IBD or gastrointestinal lymphoma. Internist said it was more likely to be IBD. He would need biopsies to differentiate the two. His vet said we could take a chance and treat him for IBD with cyclosporine but if he had cancer it would make it worse. I would like to avoid having the biopsies. Plus I would have to wait for some time to get an appointment and leave Toby untreated. His vet is leaving this decision up to me.
Also the internist also suggested switching him from Lantus to Toujeo. He said that it has a basal action and doesn't cause big dips in glucose. He said that the change is recommended due to Toby's variable appetite and pets like him seem to respond
to this better than other types of insulin if they aren't doing well on Lantus.
There were no results on Toujeo when I searched for it on your forum.
Again his vet is leaving this decision up to me.
So that's his story. Any help making these decisions would be welcome but I understand if it is not reasonable for me to ask this.

 

[Wendy&Neko]

I'll start with the Toujeo. It's a U-300 insulin, meaning 3 times more concentrated than Lantus. There are no U-300 syringes in existence so you would have to use the pen needles to inject, which means you can only change the dose by 1 unit at a time. There is very little research on Toujeo in cats. When I searched I found one study that looked at only 9 cats for a total of 8 weeks. This is what the paper's conclusion said.

IGla-U300 seems effective and safe for the treatment of feline diabetes, but more long- term and comparative clinical trials are needed.

We have very little experience with it here, one of those cats was an acrocat being fostered and the caregiver got given the wrong insulin. She went back to Lantus when she figured out the error. We don't have dosing methods for Toujeo so won't be able to help as much with it. Maybe ask the internist if he knows of any dosing methods for it? It may be that this is something we have to look into.

Tresiba/degludec is another longer term insulin some people have used.

Can you tell me the IGF-1 test numbers for the acromegaly test? I'm just curious as I like to see what non acros test at. MSU recently changed their testing mechanism so I'm just data gathering.

I have experience with both IBD and small cell lymphoma - the latter one in three cats now. Actually, third kitty has both conditions, but thankfully has been in remission from SCL for for 6 years now. It really is a good idea to know what condition you are dealing with. The treatments are not the same for the two conditions. Ask the IM vet if an endoscopy or colonscopy (other end) is an option. It depends where in the intestines the thickening is. Most recent SCL kitty had an endoscopy and it was a pretty quick recovery.

If IBD, there are other treatments, one being a novel protein diet and a good probiotic (Visbiome). A couple good sites that tell you more:

• Raw Feeding for IBD Cats
• IBD Kitties

Rather than cyclosporine (uncommon treatment) cats here often get budesonide for IBD.

 

[Susan and Toby]

Thank you so much for your message!
I just saw it. I have cut and pasted most of it to his vet. How do vets feel about receiving input from you?

 

[Wendy&Neko]

Unless it's my vet, they don't know me. I'd prefer not to be quoted. Vets might not like hearing that you are listening to someone on the internet over them. I'm open to learning more about Toujeo, just haven't seen much. If you want the link to the paper, here it is. It is 2022, maybe there is something newer now?

Regarding learning more about his GI system, small cell lymphoma is a slow moving condition. You have time to decide how you will treat. You can always try a novel protein diet first and see if he responds. My novel, I mean a type of meat he hasn't had before, such as maybe rabbit, venison, lamb. There are many others. If the novel protein helps, he could have IBD. There are low carb, novel protein options, just not Fancy Feast.

 

[Susan and Toby]

I am very sorry to have sent your message to my vet.
Both for upsetting you and to annoy my vet.
I acted impulsively.

 

[Susan and Toby]

I am very sorry to have sent your message to my vet.
Both for upsetting you and to annoy my vet.
I acted impulsively.

BTW your name was not included in the paste.

 

[Wendy&Neko]

It's fine if you didn't mention my name.

 

[Susan and Toby]

Actually I think that your message was well received.
She even referred to it a couple of times.

 

[Lisa and Witn (GA)]

I have an IBD cat. If you are willing to make your own food, here is the recipe I use. I do cook my meat in an instant pot with water and after everything has cooled, mix the supplements in using the cooking water. I also use dried egg powder instead of fresh eggs. It works so well with him, I also feed it to my other cats. All of the supplements I buy from Amazon.

https://www.rawfeedingforibdcats.org/balanced-recipe-for-use-with-raw-or-cooked-proteins.html

 

[Susan and Toby]

I have an IBD cat. If you are willing to make your own food, here is the recipe I use. I do cook my meat in an instant pot with water and after everything has cooled, mix the supplements in using the cooking water. I also use dried egg powder instead of fresh eggs. It works so well with him, I also feed it to my other cats. All of the supplements I buy from Amazon.

https://www.rawfeedingforibdcats.org/balanced-recipe-for-use-with-raw-or-cooked-proteins.html

Thank you for the recommendations and the recipes!
I was wondering, before he was treated or diagnosed
with IBD was he insulin resistance?

 

[Lisa and Witn (GA)]

Thank you for the recommendations and the recipes!
I was wondering, before he was treated or diagnosed
with IBD was he insulin resistance?

Simon was never diabetic. But since this recipe is high in protein, it should still be good for diabetic cats also. I also like knowing what ingredients are really in their food.