# Newly Diagnosed Feline Diabetes



## emilyatl (Sep 9, 2013)

Hi everyone! It's been AGES since I've been on this forum, but I have a new issue with one of my cats.

Scout (12 year old neutered male), was recently diagnosed with diabetes. A little over 2 weeks ago, I noticed he was obsessing over the water dish (drinking for 5 minutes each time) to the point where his chest would be wet from water. He also seemed uninterested in food, and what little he did eat, he would vomit up (completely undigested). The next day, he had completely liquid diarrhea and was sitting in front of his water dish just staring into it (almost trancelike) So, a trip to the vet was in order. Just based on the symptoms, I was fearful of kidney failure, hyperthyroidism, or diabetes.

He has not lost/gained any weight since his last trip to the vet (his previous weight was 17.2 pounds, and this visit was 17.4). His blood glucose was at 301, potassium was 5.4 mmoL, T4 was 1.1 ug/dL (ruling out hyperthyroidsim), anion gap was 28 mmol/L, unine pH was 6.5, and urine gravity was 1.016. Also interesting is his monocytes were elevated at 1.17 K/uL. So the vet diagnosed diabetes. She gave him fluids, and prescribed lantis insulin, 1 unit twice a day as well as diabetic food (Royal Canin glucobalance). This was on September 1st, and he was started on insulin on September 2nd. 

After getting fluids and starting on insulin, he seemed to feel a lot better, his appetite was back, and he wasn't drinking water excessively. But he still had diarrhea, so I took him back to the vet on September 3rd. They measured his BG and it was 230 about 1 hour after eating and having a dose of insulin. The vet prescribed Metronidazole for 7 days, which cleared up his diarrhea the next day, and everything seemed back to normal until yesterday.

Yesterday, he was not interested in breakfast at all (which is quite unusual for him) so I didn't give him his insulin. He was kind of gagging and licking his lips (like he was very nauseaous), and swallowing a lot, then he vomitted up clear/mucousy liquid (no bile or food). It wasn't "normal" vomitting for him - normally if he eats something that doesn't agree with him, he'll make this loud meow/howl noise, and then start retching, and I can actually see his abdomen contract - that did not happen here. A few minutes later, he had completely liquid diarrhea again. So, I went back to the vet, and they gave him more fluids and a shot of Cerenia for the vomitting. Shortly later, they offered him food, and he ate well, so he got a dose of insulin. At this point, my vet was suspecting pancreatitis, IBD, triad disease, or possibly intestinal cancer, so she referred me to a specialist for an abdominal imaging.

This morning, Scout was completely normal. He was not gagging or vomitting and his poop was normal. He was ready and waiting for his breakfast this morning, so he ate his usual amount and got a dose of insulin before heading to the specialist. 

The specialist needed to wait a few hours after he digested his breakfast to do the ultrasound, but in the meantime plapated his abdomen and he didn't seem to be in pain, and he appeared adequately hydrated. So a few hours later, they did the abdominal radiographs and ultrasounds. The pancreas, liver, kidneys, adrenal glands, bladder, medial iliac lymph nodes all look normal. THe spleen was slightly enlarged, but did not appear abnormal. The only notable finding was what is described as "very mild, mucosal wall thickening identfied in the duodenum and at least one focal loop of the jejunum." She said this could be indicative of IBD or intestinal cancer. She ordered a GI panel and check of his fPL, which we won't get the results from until Monday/Tuesday next week. Pending the results of that, we may have to do an endoscopy to biopsy the small intestine.  She also gave me 4 Cerenia pills in the event he seems nauseous again.

Obviously, I'm terrified of intestinal cancer, but the prospect of IBD in a diabetic cat isn't exactly good news either since the typical treatment is steroids, which won't be feasible with a diabetic cat. But, I've read that IBD in diabetic cats is not all that uncommon. Does anyone have experience with this? 

I'm also wondering if the vomiting and diarrhea are just symptoms of being on a new food, newly being on insulin, etc. Thoughts? Any suggestions/recommendations of any other tests that should be run? 

He's still doing fine tonight, he ate dinner well, and pooped normally. He is still kind of swallowing a lot like he may still be a bit nauseous, but no vomitting so far...

Thanks in advance (and sorry for the crazy long post!).


----------



## emilyatl (Sep 9, 2013)

Forgot to mention, a week after he was started on insulin, he went in for a BG curve. He was there from 8AM (right after his breakfast/insulin) until 6PM getting his BG checked every 2 hours. The vet was very pleased with his curve - his BG was stead at around 230 the entire day (the highest it got was 235). So she wanted to monitor his BG and not make any adjustments in his insulin dosage for now.


----------



## doodlebug (May 13, 2006)

There is a bunch of junk in the Royal Canin food that could very well be causing digestive issues (corn, wheat & soy to name a few). I would ditch it and put him on a high quality, grain free, low carb wet food.


----------



## emilyatl (Sep 9, 2013)

I am not a fan of RC in general either. But he is VERY picky about wet food (I've been trying for years to get him completely off of dry food, but he's so finicky and will always cry for dry food after eating just a few bites of his wet food). There are few varieties he likes (mostly fish-based), in particular the Fussie Cat and Tiki Cat tuna varieties, and all of the ones he likes are less than .5% carbs, which is great, but I'm worried about an all fish diet. Should that be a concern or should I just let him have it since it's high protein and low carb?

I had gotten him down to 1/4 cup of TOTW dry food before this (he was doing pretty well on that and had lost several pounds over the course of 18 months) in addition to his wet food. So I've been giving him 1/4 cup of the Royal Canin glucobalance. Guess I'll need to get him off of it. I'm just worried about him eating enough wet food and possibly slipping into hepadic lipidosis.


----------



## NebraskaCat (Jan 15, 2013)

Oh wow, welcome back Emilyatl. I don't have any good input to your topic, but it's really good to hear from you and Scout again, even if it isn't good news that brought you here. Hope Monkey's doing well.


----------



## emilyatl (Sep 9, 2013)

Thanks Jeff! Monkey is doing great. He and Scout are like long-lost brothers. 

There is a new addition to the family too, Olive. She's 5 months old from the shelter I volunteer at (totally not planned, but fell in love and all of her littermates were adopted in a couple of weeks, and she was left for 2 months).


----------



## emilyatl (Sep 9, 2013)

Doodlebug - I've been reading a lot on the yourdiabetic cat site and forum (pretty much all night) and I think you're right about the RC dry. I'm really angry right now for not questioning this food, but 2 vets recommended it. So this morning, I decided to just give him wet food and not supplement with dry. Before eating, his BG was 194 (after no food for ~10 hours). After eating ~ 1.5 oz of wet food and getting his unit of insulin, I retested, and his BG was 77! That's the lowest it's been (by far) after eating and getting insulin. And he hasn't had any gagging yet today and drinking, pee, poop, etc. is all normal. So I guess I'll just continue testing him today to make sure he doesn't have any big dips in his BG. So if nothing else, the RC is definitely spiking his BG because he's eating the same exact wet food he ate for the past 3 days, the only thing that's changed is I took him off the RC (and he's eaten less as a result). Hopefuly I don't see any further GI issues. We'll see...


----------



## doodlebug (May 13, 2006)

Well, that makes sense. The RC dry is about 25% carbs whereas the canned foods you mentioned barely have any carbs at all.

Regarding your concerns about fish...there are 3 main reasons for avoiding fish. First is the concern that it contributes to urinary issues. That applies more to pate foods than chunky shredded. When they make pate they use whole ground fish which means a lot of bone goes into it...making the ash content higher. Foods like Tiki and Fussie Cat do not grind the fish, they are using cuts of meat. Just stay away from things like the Tiki sardines. 

The second reason for avoiding fish is the heavy metal content. I know that Weruva minimizes this by using smaller fish with shorter lifespans. For example instead of albacore tuna they use skipjack. So choose flavors made from smaller fish. You might want to give Tiki and Fussie Cat a call and ask if they are doing the same. Or try some Weruva.

And the 3rd major reason for avoiding fish is that cats will often become addicted to it and refuse everything else. You already have that problem, so it's not a consideration anymore. 

If you really need to use a dry food because he's not eating enough wet, I suggest Orijen which is certified low glycemic and has a lower carb level than RC and much better ingredients.


----------



## emilyatl (Sep 9, 2013)

There are a few non-fish ones he likes. Weruva Paw Lickin Chicken is one of his favorites too - which only has 3.3% carbs (YAY!). I've never tried their fish varieties, but I'll give those a try too. He prefers ones that are in a lot of liquid (like Paw Licken Chicken), or gelee/aspic (like the Fussie Cat varieties). He will eat pate, he's just a bit more picky about it (he does not like rabbit or duck, and will vomit up anything with beef). Also,he will not eat anything that's in those fake "nugget", "morsel" or "slice" forms (at least none that he's ever tried), which is fine because it looks like those tend do be higher in carbs anyhow? 

There's always the kitty crack. He does like Fancy Feast Chicken classic pate (this was about the only food I could get Jem to eat towards the end and Scout would always try to get it), but I usually don't by FF. After reading around, it looks like a lot of diabetic cats do really well on the FF classic pates and they are surprisingly low in carbs. So I may have to add this one back to the rotation. 

Thanks for all of the recommendations!


----------



## TabbCatt (Mar 26, 2014)

Have you tried Dave's canned food? It's pate, but someone mentioned they were able to wean off FF addicts using it. 

Besides weruva, there's also tiki cat in poultry flavors. I buy the chicken, turkey, and duck flavors, it's quite similar to paw lickin' chicken, but tiki has zero carbs and higher calories than weruva, which can be better than drastically reducing kcals all at once for a chunky cat. Their carnivore line has more liquid, but my two cats definitely lick their bowls clean and it's always a great way to ensure they're hydrydated. I'd recommend trying other brands that have low carbs before resorting to FF, but I quite understand if finances are a concern.

With a consistent low carb diet, I'm pretty optimistic your kitty will lose weight and be in diabetic remission. Remember, cats are carnivores, so in the end, he will be a much happier and healthier kitty if he's completely weaned off dry.

Good luck.


----------



## emilyatl (Sep 9, 2013)

Scout used to love Dave's, but he stopped eating it. My other cats still eat it, so I'll try adding it back into his rotation.

My local specialty pet store doesn't carry the Tiki non-fish varieties, so I've never tried them. Chewy has them (I'd just have to buy a case), and the prices are definitely cheaper than Weruva. The price isn't so much a concern, it's just finding stuff he'll eat consistently (usually once I buy a case of something, he stops eating it). :| Once I get him stable and used to the all wet diet, I'll try adding some variety, new brands, etc. My other 2 cats are not picky at all, so nothing goes to waste!

I rechecked his insulin this AM after breakfast, and it was 94.  That's 24 hours after his last insulin dose!!! So I'm hopeful too that I can get him off the insulin all together. He's really not thrilled about all of the ear pricks and has been hiding under the bed most of the day. 

He hasn't vomited or had diarrhea since Thursday. His poop was very soft today, but I'd expect that after being taken off the dry food. It certainly wasn't completely liquid and explosive like it was when all of this started. And he hasn't been gagging at all like he was.


----------



## TabbCatt (Mar 26, 2014)

I'm pretty sure your local independent store will be able to order it for you if you ask. It's strange that they don't carry this flavors, I'd think those would be the most popular, but maybe it's because it's also similar to weruva? If you order tiki online, make sure it's the 6 oz can, not the 2.8 oz. One case is 8 six ounce cans, not 12 or 24...


----------



## emilyatl (Sep 9, 2013)

Chewy carries a "carnivore" sampler, but half of them are beef, and he vomits up beef (he loves it, but his tummy doesn't). I'll check with my pet store to see if they can order it - I'm sure they would, I've just never even thought about it.


----------



## doodlebug (May 13, 2006)

If they have other Tiki flavors they can certainly get the chicken ones. They just may require that you buy the case. 

If you're not using a digestive supplement I suggest you start. I've had the best luck with Animal Essentials Probiotics and Digestive Enzymes. As far as I can tell it has absolutely no taste or smell. Holly is pretty picky and she eats it mixed in her canned food with no problem. And Maggie was the pickiest cat I've ever had and she ate fine too. Refrigerate it after opening.


----------



## emilyatl (Sep 9, 2013)

My pet store is going to order the Tiki Puka Puka Luai and Koolina Luai and let me buy just a few cans. They also had the Weruva Cat's in the Kitchen Chicken Frika-Zee, which is almost identical to the Paw Lickin Chicken, but a bit cheaper. I tried one of these, and he liked it. 

The pates are proving to be a bit more difficult. He doesn't like the really hard/dense texture (like EVO - I've tried those before and he wouldn't even touch them). I tried a can of Dave's turkey formula yesterday and he ate a couple of bites, then walked away. I'll try some different varieties of theirs since they tend to be a bit looser/wetter.

I've been checking his BG 3 - 4 times a day, and yesterday the highest it got was 142! So far, he hasn't gotten above 160 (which is technically still high, but barely), so I'm really excited that he hasn't gotten insulin in almost 4 days. 

Thanks for all of the recommendations!


----------



## doodlebug (May 13, 2006)

Just goes to show what an oxymoron "diabetic dry food" is.


----------



## emilyatl (Sep 9, 2013)

Yep. I wish I had never put him on the prescription food dry food to begin with!


----------



## TabbCatt (Mar 26, 2014)

How's his weight now? I'd be a bit concerned about that more than his BG numbers right now. If he was a chunky cat, I'd want him to lose weight at a very controlled, slow process. 

Wish humans were as easy to deal with the diabetes, but we're omnivores, so carbs are a must. Felines do best on a "Catkins diet" :mrgreen:


----------



## emilyatl (Sep 9, 2013)

According to my baby scale, he's lost 4 ounces since Saturday. With that small of a number, I'm not really considering that weight loss just yet. I usually just weigh him weekly, so I'm definitely keeping an eye on it. He has the metabolism (and activity level) of an inanimate object, so he loses weight VERY slowly. He is a bigger cat, but he really needs to lose ~ 2 pounds (he's lost 4 in the past 2 years). He does have a bit of flappy skin now under his belly (I call it his doodle  ), so he may not be able to get down to his "ideal" weight. We'll see...


----------



## doodlebug (May 13, 2006)

4 oz. is a lot. He should lose about a pound a month. So if he continues at this rate he would end up losing 1.5 pounds per month.


----------



## emilyatl (Sep 9, 2013)

Sorry, not 4 ounces, .04 pounds. He went from 17.42 to 17.38. So I think that may actually less than an ounce? I'll weigh him again on Saturday AM (when I weighed him last week).


----------

