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Diabetes in Cats
Chromuium picolinate and vandium used in treating feline diabetes
Diabetic neuropathy
Vomiting in Diabetic cat
Diabetes in elderly cat
Purina DM Formula (tm) diet for diabetic cats
Taking blood from a diabetic cat
Licking behavior in Diabetic cat
Diabetic cat
Diabetes and hairloss
Possible Diabetic mimics- Acromegaly and Hyperadrenocorticism
New symptoms in diabetic cat
Bowel problem in diabetic cat
Diabetes, insulin and neuropathy
Diabetic neuropathy possible
Feline Diabetes
Feeding schedule and regulating diabetes
Xanthomas and diabetes
Increased surgical riskPlease note: The most recent medical information is at the top of the page to least current at the bottom.also see Diabetes with other disorders and problems
also see Diabetes and other medications and
also see Testing and glucose meters
also see Insulin and regulating diabetes
also see Cushing's
also see Medication
also see Acromegaly
Cats can sometimes be maintained for long periods of time using dietary changes and medical treatment, although it may be preferable to start treatment for diabetes with insulin in all cats and then to try to maintain the cat later without insulin if it looks like that might be possible.
There is absolutely no question in my mind that the best way to monitor pets with diabetes to aid in regulating insulin levels is for the veterinary client to learn to monitor blood sugar at home using a blood glucose meter. It appears that about 50% of veterinary clients can manage this task readily and most can manage it with encouragement from their vet and the vet's staff. Some vets are not yet ready to take on this task, though. If your vet is one of those who discourages clients from attempting home glucose monitoring I personally think that you ought to change vets, at least for the pet with diabetes, unless there is a really compelling reason to stay for reasons other than the diabetes treatment.
Purchasing one of the newer blood glucose meters that require very small blood samples is best. It can be hard at times to get blood from a pet and they tend to move around a lot during the blood drawing process, making it critical that whatever blood you can get can be utilized quickly. Spend a little extra to get a good glucose meter, such as the One Touch (tm) glucometers and it will pay off over the long run in ease of use.
Regulating insulin dosages and blood glucose levels requires a lot of communication between the veterinary client and the vet. It can be a frustrating process that can take months in some cases. There are a few patients who are just extremely difficult to regulate. Despite this most insulin regulation failures are the result of insufficient communication between the veterinarian and the client or insufficient effort on the part of either the vet or the client, or both. It is nearly always possible to regulate insulin with adequate effort on everyone's part.
Choosing the type of insulin to use can be confusing. We almost always start with human NPH insulin, either Humalin N (Rx) or Novalin NPH (Rx) because these insulins are widely available and seem to work well for us. It is important to try to stick with an insulin type once good regulation is achieved so it is helpful to use an insulin that is likely to be available when you need it. Some vets prefer PZI insulin and there is now an insulin approved for use in dogs ( Vetsulin Rx) that is pork based and may work more consistently for dogs since pork insulin is closer to dog insulin than the human products. In addition, glargine (Lantus Rx) seems to work better for some cats than other types of insulin. Since it is also a human product there is a good chance that it will be available at all times, as well. Don't change insulin types willy-nilly, but remember that there are alternatives if regulation is proving to be very difficult.
A blood glucose curve is a plot of blood sugar levels during the day. It is generally done by obtaining a blood glucose level at the time of the morning meal and every 2 to 4 hours afterwards for at least 12 to 16 hours. Plotting the blood glucose numbers on a chart allows visualization of when the level is too high, too low or just right. The pattern of rises and falls in blood glucose allow the veterinarian or the client to see if the problem is an overdose of insulin, an underdose of insulin or resistance to the effects of insulin. This is valuable information that is essential to really good regulation of insulin levels.
Even though I strongly believe in the value of blood glucose monitoring at home, it is possible to monitor sugar levels using urine testing when abolutely necessary. Monitoring urine levels doesn't work as well as monitoring blood sugar levels but is better than not monitoring at all for those who are challenged by drawing blood from their cat.
This is probably veterinary heresy but I treat pets with insulin when the owners are willing to give the insulin injections twice a day but unwilling to pay for additional lab testing or won't attempt getting blood or urine for testing at home. I am willing to do this because the pet is going to die much more quickly, in most cases, if insulin is not used. We explain how to monitor behaviors such as drinking, urinating, appetite and attitude to evaluate whether blood sugar is too low or too high and hope for the best. People get pretty good at recognizing signs of high and low blood sugar over time. If their pet makes it to a stable situation there is a good chance of long term survival as long as insulin continues to be provided. Sometimes, when there is early success, these folks start to believe their pet might make it and go ahead and purchase home glucose monitors or work with us in other ways to monitor their pet's diabetes.
Mike Richards, DVM
08/2005
Chromuium picolinate and vandium used in treating feline diabetes
Question: Hi Dr Richards: I have a 7 yr old neutered male with serious eye problems (herpes, uveitis, glaucoma, corneal ulcers) who is also FIV+. I dont know if it was all the prednisone orally and via eye drops he was/is on (now no
drops and 5 mg every other day) but he developed diabetes. He is now on
Glipizide 5mg am and 2.5 mg pm. My usual vet is retiring and the new one is
recommending chromium picolinate 200 ug per day and also vanadium. The
literature I have read indicates vanadium is not widely used and a study in
India in rats showed it caused death in a large number of cases. Could you
tell me if I should start the cr picolinate at 200 ug right off the bat or
should I start at a low divided dose(50 ug a day) and work up from there??
COuld you tell me when in 2000 there was an article in JAVMA about cr and
vanadium? It might have been 4 2000 0r 5 /2000. I have also purchased a
glucose meter and am slowly learning how to use it(practicing on myself) in
the hopes it will be less stressful for BIg TOm to have his glucose measured
at home. Do you recommend the use of vanadium?? Is it OK to start with the
cr picolinate at 200 ug or should i start at a lower dose and work up?? I
have discovered the website feline diabetes, are there any others?? thanks,
catwoman.
Answer: C-
Both chromuium picolinate at 200ug/day per cat and vanadium have been recommended for cats to aid in control of blood sugar levels when insulin is being used, but I don't think that there is supporting evidence for the usefulness of
chromium. I do not know of any reason not to use these products with the
oral hypoglycemic agents. Vanadium at a dosage of 0.2mg/kg/day was used in
one study and Drs. Greco and Behrend recommended using 1/2 of a Super
Vanadyl Fuel (tm) capsule per day per cat in an article in the Compendium
on Continuing Education in May 2000. There was also an article in the
March 2000 Veterinary Medicine about this use by Patricia Dowling. I was
unable to find a reference from the AVMA Journal during the time period
that you mentioned by searching the AVMA database but sometimes I have a
hard time matching keywords on the AVMA site. The Compendium had a really
complete review of feline diabetes. They did not recommend starting the
dosage of the medications gradually. I think that there have been problems
with vomiting and inappetance associated with vanadium use and one case of
kidney failure in a cat that seemed to reverse on withdrawal of the
vanadium, based on postings on the Veterinary Information Network (tm).
Mike Richards, DVM
3/5/2002
Question: Dear Dr. Mike,
Wow! Thanks for your quick response. That was just great.
I took my cat to the vet's again yesterday, after I freaked out on the phone
This time, I saw an associate I had never met before. He said to put Victor
on the Purina DM immediately. (Only 3/4s of a cup a day! Victor will be one
hungry kitty!) The cat's bsg was close to 500 yesterday, at what was
supposedly the peak time for the PZI. This vet likes PZI and wants to
continue its use. He kept the dose at 11 units twice daily. He also gave me
the Glucotest granules to put in the litter. I am to monitor urine output for
the week. I am to call everyday with the Glucotest results. Then the vet will
determine if the insulin needs to be adjusted.
Victor will now be fed only twice a day, with his shot. I thought this would
be a major problem, but, so far, he is really a lot livelier and not
urinating as much. I can tell he's hungry because he keeps following me
around. But he seems to be doing ok. He even jumped onto the bed this morning
to be petted, which he hasn't done in a long time. He couldn't knead with his
front paws, though. I sure hope that comes back.
The neuropathy seems a little bit better this morning as well. At least
Victor can walk more than 4 feet. Is it possible that he can look better and
act livelier and the neuropathy can persist? My vet said the neuropathy
damage was completely reversible. Right?
As to stress, yes, Victor is the original scaredy cat. He has always
flinched at everything and hisses easily. I asked the vet if I could do the
blood monitoring at home, and he said it would be very difficult for me.
Maybe I can push that some.
Its interesting that you say you rely on the bsg testing. My first vet held
this opinion, but vet 2 liked fructosamine levels. Even though Victor's
fructosamine level was a 4, his sugar was way out of whack. The vet did
mention that he would do another curve soon. He took blood for a CBC work-up
yesterday. He is concerned about liver and kidney functions. Victor had been
given a cortisol test a while back. The results were normal.
I told the vet that when the PZI had arrived by FedEx it was not cold at all.
We were in the middle of a heat wave. The lab sent it overnight, but it still
wasn't cold. It has arrived before with the ice packs still a little frozen.
I wondered it this could have affected the PZI's potency, but the vet felt it
would not be a significant factor. Especially since Victor had had one bsg
test under 300 while he was on that batch of PZI.
So, I will observe and treat for another week. If there is no improvement, I
will ask for a referral, as you suggest. I am just so upset that more than 3
months have gone by without any improvement.
Thanks for your help. I'll keep you posted.
Irene
Answer: Irene-
It often takes diabetic neuropathy some time to completely go away after blood glucose is well controlled. I am guessing, but I think there is usually some residual signs of this for 4 to 6 weeks after we get glucose levels well controlled in moderate to severely affected cats.
The clinical signs are very meaningful so the way he feels is a good sign. Hopefully that will continue.
I would be concerned about the insulin but not overly concerned if it seemed to be working. I can't remember the exact duration that insulin can go unrefrigerated but I think it is something like 30 days based on the package insert from HumalinN (which I am recalling totally from memory).
Good luck with this.
Mike Richards, DVM
8/8/2002
Question: Hi Dr. Mike:
I have a 12 year old spayed female cat who has been diabetic now for 5 years.
I currently give her 3 units twice a day of PZI insulin. I recently came
across a problem that's stumping me and her vet. Every night for the past 2
months, she has been vomiting anywhere from 4:00 to 6:00 in the morning.
Then about 3 to 4 days a week, she vomits up all her breakfast. She never
vomits up her dinner. Her vet took all kinds of tests imaginable and they
all appear normal. So he recommended that I only feed her canned WD and give
her 2 full syringes of Laxatone every night before I go to sleep (which by
the way surprisingly doesn't effect her blood sugar). The only thing he
feels he can come up with is that she has furballs. Well, that isn't
working, she still vomits at that hour of the morning. She doesn't vomit up
any food, just a white foamy kind of substance or a yellowish substance. The
only thing I could think of is that she becomes nautious when her stomach
gets empty. So I feed her some WD before I go to sleep about 11:00 p.m., but
that doesn't work either -- she still vomits at that weird hour. Her feeding
schedule is 6:30 a.m. for breakfast and 5:30 p.m. for dinner. Dr. Mike, can
you figure out why she is vomiting only in the morning? I appreciate any
help you can offer.Janice
Answer: Janice-
It can help a great deal to go to four feedings a day for cats with diabetes, but that is hard to keep up all the time. The recommended way to do this is to feed 1/3rd of the daily feeding with the morning injection, 1/6th midway between the morning and evening insulin, then 1/3 with the evening insulin and then 1/6 of the total intake prior to bedtime. This helps to even out the sugar levels. We have had
one or two cats who seemed to do a lot better on Purinas DM (tm) food. This food is much different than w/d. Higher fiber, complex carbohydrate diets seem to be helpful for diabetes in dogs (and probably people) but the higher protein and fat in the Purina diet is supposed to help cats with diabetes more, at least according to studies by Purina and some independent investigators. The biggest problem that vets seem to have with this food is palatability-- cats don't always seem to like
it.There is also a reasonable probability of concurrent inflammatory bowel disease, pancreatitis or liver disease as a cause of the vomiting. Checking for these conditions with lab work would be good idea. In some cases, X-rays, ultrasound examination or endoscopic examination of the digestive tract might
be necessary to make a diagnosis but you can determine the extent to which you wish to pursue these things based on what is happening. It is possible to treat most for these problems. In some cases kidney failure that is developing independently of the diabetes can lead to vomiting.We also see some cats with diabetes that seem to have vomiting due to high blood pressure. We can't measure blood pressure accurately in our practice so we are basing this assumption on clinical signs of high blood pressure and response to therapy. It is possible that the medications might have some other beneficial effect or that the vomiting has cleared up for other reasons in these patients
since we haven't done anything like a controlled study. But just in case your vet sees any other signs of high blood pressure it would be worthwhile to consider this possibility.I would try the additional meals first, just as your vet suggested. It seems to work for some patients. After that I think I'd want to do a serum chemistry panel and look for problems that just aren't obvious clinically. Then I think it gets harder to decide what direction to go in. I guess we probably treat for inflammatory bowel disease to see if there is a response most often at this time but we
change that approach frequently based on the clinical exam findings.Good luck with this.
Mike Richards, DVM
7/2/2001
Question: Dear Dr. Mike Richards, DVM,
My cat Willie is almost 18 years old. In December of 2000, she became
diabetic while I was on vacation. When I returned in January, I noticed that
she had lost a lot of weight. She has always decreased her eating while I
was away in the past, and she was happy to eat now that I was home so I let
it be. However, I noticed after about a week she wasn't getting better. I
took her to the vet, and they did some blood tests. That night she became
very ill, and the next day when the vet notified me of the results of the
blood tests, we started her on 1 unit of Humulin Ultralente. That night I
ended up taking her to the emergency vet as she was breathing hard and
moaning. She had become keto-acidoic. She spent the next four days on IV's
and stayed in the hospital. We started her on 1 unit of Ultra-lente in the
morning, and 2 units at night. I was having to force feed her, and she had
neuropathy very bad. After several weeks, she started eating again and her
neuropathy began to disappear. I have gotten her on a feeding schedule of
eating 1 Tbsp of W/d wet at 7:00am and 7:00pm, with 1/2 cup dry W/d in the
morning to eat all day, and 1/4 cup in the evening. We have since had to
change to Humulin NPH insulin, as we weren't having any results with the
Ultralente. Until last week, we were all the way up to 6 units 2X a day, but
she was always over 500 when tested (8:00 am and 5:00pm). She recently had a
urinary tract infection, and had severe diarrhea from the antibotic for over
a week. On March 5 when taking her in for testing, she was at 74, so my vet
wanted to keep her for the day since Willie wouldn't eat. 2 hours later she
was at 8. She didn't show very many signs of being hypoglycemic, which made
me think that maybe she was always going too low, and that's why she was
always so high at the times we were testing her, since they were towards the
end of her injections. She went down again on March 8 to 16. Again, the
only symptom she showed was being tired. We reduced her insulin to 3units in
the morning and 2 at night. I suggested to my vet that we test around
2:30pm, when her shot was approximately 7 hours old. We did so on March 9,
and she was at 164. We went through the weekend, and we stopped the
antibiotic to help her stomach feel better. She began eating better, and the
diarrhea went away. Monday when I brought her in at 2:30pm she was back up
to 360, and at 5:00pm, she was at 541. She has already been tested for
Cushing's disease, (back in the very beginning when we were having problems
with the Ultralente, my vet worried about this being a contributing factor),
however, she tested negative. She has never been ill in her life, and other
then feeling bad at the beginning hours and ending hours of her shot, she
seems fine. She drinks a lot of water, and she eats compulsively at the
beginning of her injections (while she is really high) or she won't eat at
all. I really want to get her regulated because she is old, and I know this
puts so much strain on her body, especially her kidneys. I feel that my vet
is out of ideas, and I am not sure what to do. I thought at first that maybe
she was insulin resistant, but then she was crashing. However, it seems
whenever she starts to eat again, she skyrockets. I have read that things
such as cinnamon and brewer's yeast have been known to help with lowering
blood glucose levels in humans, but my vet would rather we did not try
"supplements". I really don't know what else to do. When she crashed the
first time, my vet ran some tests and found reticulocytes in her urine, and
that she was low on potassium. My vet stated that this could be the
beginning of kidney failure, but that the anemia could also be from her
losing blood from her urinary infection. Couldn't the low potassium be from
the dehydration and the diarrhea? Her original blood work from January came
back with her kidneys being at normal levels, showing only mild signs of
aging. Also, I had read that high fiber diets inhibit iron absorption in
humans, and Willie is eating only W/d. I mentioned this to my vet and she
said it wouldn't happen in cats, though. I feel as though I am at a dead
end, and that my vet is beginning to think that regulating Willie will not be
possible, as she told me the other day that I need to start thinking about
what we are doing. I do not want to make Willie suffer, but she only acts
like she isn't feeling good during the time when the insulin is wearing off,
and I feel that if we were able to attack this more aggressively, we could go
>somewhere. She would rather I did not do any glucose monitoring at home as
she stated it is difficult, but Willie growls now when I bring her to the vet
2X a day, 2-3X's per week. I bought some Chemstrip urinalysis sticks from my
vet, but they always show that the glucose is over 1000 (Specific gravity
1.020, and pH5). Any ideas or suggestions you may have will be deeply
appreciated.
Thank you, JenniferAnswer: Jennifer-
I hope that you have had a little more success over the last two weeks than your
were having but just in case, these are the things that I can think of to do.The first thing is to keep in mind that you are helping Willie a lot by
giving some insulin, even if you are not ever able to get her fully
regulated. I have had diabetic patients whose owners we had difficulty
communicating with or who would not make much of an effort to regulate the
insulin whose cats lived for several years just because it is better to be
helping some than not helping at all. So if it takes a while to regulate
Willie, that is OK.The next thing is that I disagree very strongly with your vet about home
testing for diabetes. This works very well in our practice and I think that
it is much more likely to be an accurate assessment of the glucose levels
at home because the stress of traveling to the vet's and perhaps even
staying there for the day, is eliminated. We use the following technique to
obtain the blood for testing and almost all cats will allow this testing.1) We use a 27 gauge needle as our "stylet" to prick a vein with. This is a
very small gauge needle and it is not usually uncomfortable for the cat
when the artery or vein is poked with the needle.2) We shine a flashlight through the ear with the flashlight held against
the unhaired portion of the ear. It is almost always possible to see the
little arteries and veins along the edge of the ear.3) We prick directly into one of the visible blood vessels. This produces a
small drop of blood that is easy to pick up with the siphoning blood sticks
or with a disposable dropper and then placed on the test strip. For long
haired cats it may be helpful to spread a very thin layer of Vaseline over
the edge of the ear prior to making the stick into the blood vessel.4) I think that any of the blood sugar monitors (glucometers) that you can
buy at your favorite pharmacy will work. Some are easier to use than
others, though. I think that ones in which the test strip siphons up the
blood are good but remember that the price of testing over the long run is
most affected by the price of the test strips, so check out prices of these
for the glucometers when considering them. It might be better to be a
little inconvenienced to save on costs, if cost is a factor in your
decision making.Almost all of our clients can learn this technique. Some cats aren't
friendly enough to allow any testing and some clients are a little too
squeamish but most can do this.The major advantage of home testing is that it allows a blood glucose curve
to be evaluated. If a blood sugar test is done every two to four hours for
twelve to sixteen hours, it is usually possible to tell if there is an
overdosage of insulin leading to very low lows and very high highs, or if
there just isn't adequate insulin being administered at any time during the
day. Once this is known, it is possible to adjust the insulin dose accordingly.I think that most of our diabetic cats need between six and twelve units of
NPH insulin twice a day, but some do require less and some more. Our record
low was a patient who only needed 1/2 unit of insulin twice a day but would
become symptomatic of diabetes without this dosage and our record high for
a cat is 22 units twice a day.If you can't work out home blood testing with your vet you could try to do
more systematic urine testing. If there is sugar in the urine throughout
the day, it is likely that you are not ever reaching an adequate dosage. If
there are times when there is no sugar at all in the urine and other times
when the sugar levels are very high in the urine, it is more likely that
you are over dosing the insulin or underdosing it (and the timing might
help in distinguishing these two events). Personally, I think that blood
testing is much more accurate as it gives "up to the minute" blood sugar
information while sugar in the urine just tells you there was a time during
the day when the blood sugar was not being adequately controlled.In cats, it may be better to use a low fiber diet that is higher in protein
and fat calories than to use a high fiber diet. It also helps a great deal
if you can spread the calorie intake out over as much of the day as
possible -- so several small meals is better than two big ones.Supplementing potassium may be helpful in making your cat feel better and
is usually safe even if it isn't necessary. Vanadium may help to stabilize
insulin dosing, as well. I am on the road (literally -- working on my
laptop in the car) and I don't have the vanadium information with me, but I
think it is on the web site. This has been written up recently in the
Compendium for Continuing Education and I think in Veterinary Medicine (the
journal), so your vet might have access to these articles if she needs some
persuasion to consider this supplement.Mike Richards, DVM
3/28/2001
Purina DM Formula (tm) diet for diabetic cat
Question: Dr. Richards,
Thank you for your thorough responses to my previous questions. Your
advice on the insulin dosage versus weight appears correct, as our cat has responded wonderfully to 9 units of insulin, twice per day. (I noticed you
indicated this was a hot topic recently) In fact, she has gained all her weight back and is as playful as ever.My question concerns the recent "breakthrough" that Purina claims for its
new DM formula cat food for diabetic cats. (Is it dry or wet?) I thought I would ask your opinion on the product before investing in it. Here is the company
link for the product, if you are interested.
http://www.purina.com/institute/news.asp?article=232Thanks again for all your help. John
Answer: John-
The Purina DM Formula (tm) diet is made to conform to some of the more
recent information on cats and their abilities (or inabilities) to utilize
complex carbohydrates. Cats are different than dogs and have less ability
to utilize carbohydrates, making the usual dietary recommendations for
dogs, of increasing complex carbohydrates and fiber, less ideal for cats.
So, in theory, the higher protein and fat percentages in the Purina DM
Formula should be a better diet for diabetic cats based on this information.We have not tried this diet in our practice but I have seen several posts
about it on the Veterinary Information Network (tm) and have discussed it
with other vets. The general experience seems to be that the diet is not
very palatable (cats don't like it much) but if they will eat it, there
does seem to be a decrease in insulin requirements and at least one or two
cats that I have heard of have been able to maintain normal blood sugar
levels on the diet without insulin. The decrease in insulin requirement
does mean that the blood sugar has to be watched very carefully as the diet
is initiated and that it is a good idea to make a very gradual transition
to this diet.This diet is not appropriate for cats with kidney failure or liver failure
due to the high protein levels.The diet is available in canned formulation only (or at least that was the
case as of Oct. 1, 2000, which is the last feeding guide I have from Purina.Hope this helps.
Mike Richards, DVM
1/24/2001
Taking blood from a diabetic cat - also treating rodent ulcers
Question: Dear Dr. Richards,
Did not know how to post a question without replying to your wonderful
overviews of pet problems. I don't think you will remember that you did
answer me once before about a depo induced diabetic cat. This one incident
cleared up and I was so stupid to give her not one, but two more shots to
give her some relief from her very, very, very virulent rodent ulcer.
Voila, she is now a diabetic again. The first depo shot is now 8 weeks
gone, and the second 4. We have a new vet now (and maybe unfortunately),
but she is taking blood from the jugular, which is another question, is that
the norm? We have been giving this 12 year old cat PZI (5 units) for about
4 weeks now, and with this jugular blood in this vet's machine, we are only
getting higher, and higher BG results. Today it was above 500, but Medley
is acting quite normally. Would appreciate an opinion as soon as you can.
Anita
Answer: Anita-
I don't know if drawing blood from the jugular vein is the most common
method, but it is a method that many vets favor in cats. This will have
some impact on the glucose measured using hand-held glucometers, since they
are calibrated with capillary blood in mind, but that is also true of blood
drawn from other veins. I think this is why glucometers tend to read a
little low (around 10% less than typical in-office blood machines) when
used for pets. If your cat objects strongly to the blood drawing procedure,
that may be influencing the blood glucose results. Cats can raise their
glucose levels significantly when they are stressed. We have one cat in our
practice whose blood sugar is typically 275 in our office, but who never
has glucose in the urine when tested at home. Since glucose should spill
into the urine when serum levels are about 180 gm/dl we are certain that
this cat is just releasing glucose into the blood stream due to stress.If you are only drawing blood once a day, it is also possible that the
blood values are falling below normal and then rising rapidly due to this.
Varying the time of day the blood is taken can help to point out a problem
like this, but doing a blood glucose curve (several samples from the same
day) is the best way to figure this sort of problem out.
I have seen some anecdotal reports of success treating eosinophilic
granulomas ( a cause of rodent ulcers) using ceterizine (Zyrtec Rx), 2.5 to
5mg twice a day. This is an antihistamine. We have had success in some
cats using chlopheniramine maleate (Chlortrimeton Rx) and essential fatty
acid supplementation (DermCaps tm or 3V Capsules tm -- and others). Once
in a while these are due to contact allergies (wool, plastic) or due to
food allergies. An elimination diet or the new hypoallergenic foods (Hills
z/d tm) might be helpful if this is the case. These would interfere less
with diabetes than the corticosteroids.Hope this helps some.
Mike Richards, DVM
11/21/2000
Licking behavior in diabetic cat
Question: Dear Dr. Mike,
I wrote to you a while back after I learned my 18 year old male cat had
diabetes. We finally got his sugar levels somewhat under control and are in
contact with the vet frequently. My question: On two or three occasions, my
cat will begin to lick the walls, furniture, etc. At these times he was
waiting for me to feed him and I just thought he was excited about wanting to
eat and was exhibiting some anticipatory behavior, although very atypical for
him. A few days ago, after being fed, he began licking the chair legs,
wallpaper, glass cabinet and was difficult to redirect for approximately 20
minutes. He then took a nap and awoke to go back into the room and begin
licking everything in sight including the floors as he was walking. I spoke
to my vet today and he feels that it is probably some sort of seizure and
that if it happens again, to call and possibly get blood work done. Have you
heard of this type of behavior? Is it common in older cats? I asked the vet
if his sugar levels may be contributing to the behavior, but he didn't feel
that it did. I would appreciate any thoughts you may have regarding this.Thank you very much, Barbara
Answer: Barbara-
There is a condition referred to as a partial complex seizure, in which
pets exhibit a behavior such as licking the floor and are hard (or
impossible) to distract from the behavior. This is a hard problem to
distinguish from a behavioral problem. It is also hard to be certain that
it is not occurring for behavioral reasons other than a seizure. In the
case of a diabetic pet, I would be most comfortable if I could do a blood
glucose curve and make sure that there was not a portion of the day when
the blood sugar was lower than it should be or much higher than it should
be, since this does seem to affect behavior in some patients. I can't
actually remember one licking the floor as a behavior associated with
hypoglycemia in any of our patients, but I would still like to rule it out.
If that is not the problem, and a general chemistry panel and complete
blood cell count also seems normal, I think that it may be really difficult
to figure out if there is an underlying cause or to treat the problem. It
is really hard to be certain whether partial complex seizures are
occurring, so it may be worth a visit to a veterinary neurologist if the
behavior continues and if you have a neurologist in your area so the trip
isn't too hard on you or your cat. In all honesty, this is a hard
condition to treat even if it can be confirmed, so if it is difficult to
get a neurologist's opinion, I don't think I'd go to extraordinary lengths
to get your cat to a neurologist. It might help if it is easy to arrange,
though.Mike Richards, DVM
10/9/2000
Question: Dear Dr. Richards,
This question pertains to our 6.5 year old indoor cat Lucia. Here's a not so
brief case history.On returning from a week long trip several years ago, we found Lucia to have
difficulty breathing, so much so we brought her to an emergency room where she
stayed overnight. At this point she was diagnosed with asthma and given
Prednesone and a bronchidilater. All was well for several years (we
stopped the medicine after a week or two and used as needed) until this spring, when her asthma reappeared with a vengeance. She was given Prednesone again for a two week period and again her asthma subsided. After returning from a weekend away this June, we noticed that Lucia had lost weight, was not eating much, and was very lethargic. We brought her to the Vet and was told that she had very high glucose levels and keytones in her urine, so much so that she stayed the weekend for IV treatment and glucose curves. After several weeks on Insulin and Cipro (for the asthma) she seemed well on her way to recovery. Her eating habits, however, changed significantly. She would no longer eat her Nine Lives
that she had eaten all her life. In fact she would cycle through different types
of food that she would or wouldn't eat. At one point she ate 4 cans of fancy feast a
day, but will not eat that anymore. She incessantly begs for table scraps,
something she never did before. She seems to cycle between times of not
eating at all and eating quite a bit. After her Insulin shot, her ears tend to
get very warm and she likes to lay down on cool surfaces (tile, hardwood), as
opposed to our bed, where she used to sleep. When we leave for a weekend, she seems to not want to eat at all. At this point, I don't think she has been completely
regulated for the correct Insulin level (we're doing 5 units per day of
Insulin U), but I can't help but feel there is something else wrong with her. Having
read about Pancreatisis, it seems like she might have several of the symptoms.
We are bringing her to the Vet for more blood work tomorrow, but so far, they
can't find any other problems, aside from the diabetes. Her brother does not
have anything wrong with him, so we've ruled out any infectious diseases. Any
guidance would be greatly appreciated.Thanks, John
Answer: John-
Pancreatitis is subtle and difficult to diagnose in cats. It is possible
that it is present. Considering the other medical history it is probably
more likely that the signs you are seeing are due to the diabetes and/or
asthma, though. It is particularly difficult to deal with asthma in a
diabetic cat due to the problems with regulating cats when corticosteroids,
like prednisone, must be used to treat a secondary condition.It is a good idea to try to use alternative therapies to limit the amount
of prednisone that is necessary to control the asthma. Cyproheptadine is a
good thing to try. Bronchodilators help some cats. Having terbutaline
(Brethine Rx) on hand to deal with crisis situations might also be a good
idea. In most cats with asthma, occasional use of prednisone or some other
corticosteroid is likely to be necessary, though.During the initial few weeks to months of insulin therapy there are often
problems with variable appetite and cats will often eat a food one day and
then refuse it the next. Over time, as it is possible to adjust the insulin
dosage to more closely control the glucose levels, there is usually a point
where the cat goes back to a normal eating pattern. Cyproheptadine is an
appetite stimulant in cats but it causes depression in the first week or so
that it is used in a lot of cats, so that might be part of the problem
with the eating pattern, to.We have not had to deal with sensitivity to insulin very often, but it does
occur. We usually have seen pain at the injection site that is consistent,
but it would be possible for other signs to occur, such as flushing of the
skin, which might be what you are seeing with the ears. Your vet probably
would notice this during the time when Lucia is there but do remember to
tell him or her about it, too.One of the hardest problems to deal with in diabetic cats is the effect of
things like leaving them at the vets or even when leaving them at home with
someone looking out for them. This stresses cats, which makes them release
more sugar, changes their eating habits and just makes it generally hard to
keep their insulin regulated. This becomes less of a problem over time, as
everyone adjusts to the use of insulin, but it is really tough early on
when trying to establish the correct insulin dosages.This is just something that you have to work through and it does take a lot
of coordination between you and your vet, so keep in close contact and
don't be afraid to ask questions and point out problems. This is going to
be doubly true in Lucia's case since asthma requires the same sort of
relationship with the vet. Hang in there and things should improve with time.Mike Richards, DVM
9/14/2000
Question: We have been dealing with feline diabetes for a couple of years.
Initially, when our 9 year old female was diagnosed, she was regulated
on Iletin. I can't recall her dosage, but after 10 months, she had 6
months where she didn't need any insulin at all (confirmed by our vet).
At the conclusion of the six months, she showed signs of diabetes again
and we headed back to the vet. Unfortunately, at that time, Iletin was
being discontinued, so we started on Humulin-U. We do not do blood
glucose curves any longer, although until this summer we took her to
the vet for them monthly. We did that for a year with no progress on a
curve. Her numbers were always very high throughout the day (400+) with
an evening crash (under 100)- every time. From her behavior and water
consumption, she seems to need around 4 units, but she has really high
numbers in her urine sample just before her morning shot. So now we give
her 4.5 units of Humulin twice a day. Her evening numbers still are low,
but when we have reduced insulin responsive to that, her water input and
urine output are extreme. Lastly, she has begun to really gain weight
recently and lose hair. Can you offer any advice about the hair loss?
My guess is that the weight gain is related to too much insulin, but the
hair loss has me baffled. And, any advice (other than ear sticks at
home - we don't want to do that to her) you can give us about regulating
her?Thanks. Helen
Answer: Helen-
It sounds to me like you are probably doing OK at this time. The most
realistic goal for insulin therapy is to keep the blood glucose level in
the recommended range for about 20 hours of the day. The odds seem pretty
good that you are achieving this level of control if you are only getting
high glucose sample in the urine just prior to the insulin injections.Depending on what you are already doing and what is practical for you to
do, there are some things that do help to control swings in blood glucose
levels. Some cats require different levels of insulin in the two injections
when using twice daily insulin. We have a patient that does best on three
units in the morning and two at night, for instance. Other patients do
better if insulin is given three times a day, but that is pushing the
limits of practicality for many people. Other cats do better if a fast
acting insulin (like regular insulin) is mixed with the longer acting NPH
insulin so that the there is a quick effect and then a slower effect.
Sometimes, feeding four times a day instead of three times a day will help
-- although most of our diabetic cat patients have food available all day.Doing a glucose curve to see exactly what is happening is the best thing to
do. You don't have to do them too often if you have a good idea of what
works for you and your cat, but checking every now and then is still a
really good idea. We do "mini" curves where we only check the blood from
8AM to 5PM and most of the time this gives us sufficient information to
successfully adjust insulin dosages.Weight gain sometimes accompanies good regulation of insulin levels.
I can't help much with the hair loss except to point out one possible
complicating factor that would explain the difficulty in regulating her
insulin and the hair loss, which would be hyperadrenocorticism. This is not
a common problem in cats but it is more common in diabetic cats than in the
general cat population and it is a cause of difficulty regulating insulin
levels. Actually, I can think of two problems --- acromegaly might also
cause both problems, although hair loss is not commonly listed as a sign
with it, either. It is definitely a complicating factor in cats as far as
insulin resistance goes, though. It can be a little hard to definitively
test for these conditions in cats but your vet can give you an estimation
of their likelihood based on a physical exam, checking for current signs of
insulin resistance with a glucose curve and through lab testing.At this point, a recheck with your vet is probably the first step. You
might want to ask about the possibility of a secondary problem like
hyperadrenocorticism (Cushing's disease) or acromegaly, if your vet doesn't
discuss them with you.Good luck with this.
Mike Richards, DVM
9/26/2000
Possible Diabetic mimics - Acromegaly and Hyperadrenocorticism in cats
Question: Hope all goes well with you! Days are passing faster than the human mind can comprehend here, but with "God willin' and the creek don't rise",
we're getting thru them one at a time!Many thanks, as always, for the monthly newsletter. It is still the
highlight of my month!Two questions, please?
Could you tell me, in general, what feline disorders would mimic diabetes
exactly except the massive weight loss is major weight gain?
and What readings on a full blood, chem, and T3 & T4 test would be indicative
to the disorder?With Gratitude, Lyn
Answer: Lyn-
I don't think that I know of a disease that mimics diabetes exactly except
produces weight gain. However, acromegaly sometimes causes symptoms similar
to diabetes and is sometimes a complicating factor in diabetes.
Hyperadrenocorticism can have most of the signs of diabetes, especially the
increase in drinking and urinating. This is not a common problem in cats
but it does occur.Acromegaly is a disorder in which excessive growth hormone is produced. It
produces many of the signs of diabetes, such as haircoat changes, exercise
intolerance and increased drinking and urinating (polyuria/polydipsia or
PU/PD). In this case the PU/PD behavior usually occurs due to insulin
resistance that eventually does lead to actual diabetes mellitus as a
complication of the acromegaly. It would be unusual, in a cat, to detect
this condition prior to the time that diabetes was already present. It is
possible to measure growth hormone, but it is usually reasonable to
diagnose acromegaly in a cat when there is an increase in blood sugar,
signs of bone growth such as widening of the gaps between the teeth,
increase in the size of the head or face, heart murmur, long thick hair
coat or some combination of these signs and there is no evidence of
hyperadrenocorticism or hyperthyroidism.Hyperadrenocorticism (HAC, Cushing's disease) is a disorder in which there
is excessive production of cortisol, as the result of pituitary gland
disorders (hypertrophy, cancer) or adrenal gland cancer. This can be hard
to confirm in cats but the current thinking is that low dose dexamethasone
testing is the best test for detecting hyperadrenocorticism in cats but it
sometimes has to be done twice, once at the usual low dose and once with a
higher dosage of dexamethasone since up to 20% of cats with
hyperadrenocorticism won't have the suppression in cortisol levels that the
test normally causes at the lower dosage. Cats do not have much change in
serum chemistry values when they have HAC, except that many cats with this
condition do have increased sugar levels or diabetes and sometimes
cholesterol or alanine transferase (ALT ) may be high, as well.There are probably some other possibilities but these are the two that I
can think of.Mike Richards, DVM
8/21/2000
Question: Dr. Mike: Am confused on this one. I usually can piece everything
together, but it can't seem to get a handle on it this time. Can you
explain: Bear with me, this all ties in, somehow.Every since Jake came off the "honeymoon", I've been able to keep his
glucose level between 120-175 with 1 to 2u of PZI 2bid. I do his
glucose test every 7 days & more often if symptoms occur in
between. They've always been the normal increase in drinking AND eating
at the same time.During the past week, I've had to take him up from 1 to 4u 2bid. I won't
know until Sunday morning's reading if the 8 is working. The readings
were at 104-110 & shot up to 408.Regular Maintenance things I do:
1) With his PM dose I give him a Vitamin supplement called Cataplex GTF
(order this thru a vet in Colorado) crushed & mixed in 3cc of liquid aloe
formulated for stomach ailments (again all natural ingredients.) We've
been doing this for 4 years & I've proven 4 times that it is critical to
his levels & temperament. I've he's off it more than 5 days, the sugar
goes sky hi & he becomes extremely aggressive (even attacking me if I try
to break up his skirmishes with his brother). During these spiking
episodes, I give it to him with both shots.2) Both he and his brother have severe constipation problems, so every 6
weeks or so, I grate raw carrots & mix it in their meals for a week. It
work & there has been no significant change in Jake's glucose levels.This time the sugar levels soared about 4 days into the carrot mix.
Too much natural sugar in the carrots this time?3) For the same reason, roughly 1x week, I mix a high-fiber powder named
BoodaMix 10 into their canned food. It's all natural ingredients (a few
surprise me: diatomaceous earth & montmorillonite clay). Same response
as No. 1.4) This is a first-timer, but the problem started before it: I picked up
a bag of Iams Hairball Remedy dry food. They love it - unbelievably
so. They've even stopped bugging me for their wet food which was a 5x
daily thing.Symptoms:
1) He's increased his water intake by at least 60% AND decreased the food
intake by about 40%. He's voiding what I estimate to be 90% of what he's
drinking & "pooping" better than he has in months.2) He's taken to sleeping on the kitchen floor - an ABSOLUTE FIRST.
3) He gets just a tad more disorientated from time to time.
His sleep habits remain normal, I do an "alert check" regularly & he
responds well, his coat remains silky (it always turns greasy when his
levels go up), he has no apparent signs of fever, his hind quarter started
to stiffen up about a year ago & he walks like a penguin, but that doesn't
seem to be any worse, and he also started to loose his balance a little
when he shakes his head, but that doesn't seem to be any worse either.I really don't want to know where this is leading to, but I have to.
Your thoughts, please.
My Best Regards,
Lyn
Answer: Lynn
I think that there are six problems mentioned in your note -- loss of
control of blood glucose regulation, stiffness of the rear legs, loss of
balance, constipation, decreased appetite and behavioral changes. Of these
problems, stiffness of the rear limbs, loss of balance and constipation are
long standing problems. The loss of control of the blood glucose level and
behavioral changes (sleeping on the kitchen floor) are new.The list of differentials for these conditions (at least the ones I can
think of) are as follows:stiffness of the rear limbs:
degenerative joint disease (arthritis)
low blood potassium
diabetic neuropathy
myositis, polymyositis
polyneuropathy
spinal disc problems
feline polioencephalomyelitisconstipation:
megacolon
inflammatory bowel disease
colitis
loss of balance:
toxoplasmosis
brain tumors
inner ear disease
high or low blood sugar levels
liver disease causing encephalopathy
feline infectious peritonitis (FIP)
feline polioencephalomyelitisdecreased appetite:
inflammatory bowel disease
low or high blood glucose
systemic illness (liver, kidney, heart disease)
hypophosphatemia (low phosphorous levels in the blood)
hypokalemia (low potassium levels in the blood)
hyperthyroidism, in a small number of cases
pancreatitisdifficulty regulating insulin: improper administration or handling of insulin
hyperadrenocorticism
acromegaly
insulin resistance
interference from other medications (especially cortisones)infections (bacterial cystitis is common in diabetics)
behavioral changes:
hyperthyroidism
brain tumors
hormonal illnesses
pain
inability to jump as well as in the past may be causing the new tendency to sleep on the floor.These are some things to think about.
PZI insulin as it is currently
available, through compounding, has a reputation for being inconsistent in
its effect, making regulation with it difficult at times. I am not sure
that this is a problem with the source of PZI insulin you have, but I think
you have to keep this problem in mind, as a potential cause of the current
problems. I would worry about this more if you recently got a new bottle
of insulin or if it is taking a long time to go through a bottle of insulin.We have had several clients who are very happy with the hairball food from
Science Diet. It seems to help cats with constipation, regardless of the
cause. I do not know what its effect on diabetes regulation might be.I would tend to worry about the hormonal illnesses first since they can
cause the majority of the problems you are seeing. Hyperthyroidism
commonly complicates insulin regulation, hyperadrenocorticism is less
common but does sometimes cause problems with insulin regulation and
acromegaly is uncommon but really screws up insulin regulation.It is always a good idea to think about bacterial infections of the bladder
(cystitis) as a complication in cats with diabetes.There are times when it is best to seek the help of an internal medicine
specialist with an interest in endocrinology. If it is not possible to get
some regulation of the insulin soon, that would be a good thing to consider.Hope this helps some.
Mike Richards, DVM
5/13/2000
Bowel problem in diabetic catQ: Dr. Mike,
Calico measured about 230 on glucose tests last week,
Thurs, Fri, Sat. However she hadn't eaten since the Tues before
the Thurs, and had thrown up all Wed am. She last had glucose
last Wed am before throwing up.
On Mon my regular vet had a sub who anethesized her,
and manipulated her for about a half hour , with enema. Nothing
passed , nor that night. He was so negative about her, that
on Tues I went to a different vet.
This vet was successful at removing most of it. He kept
her all night. Reported that she ate and peed. But no bm
Wed pm I picked her up.
Since home, she had done little peeing and no bm.
She is straining again.
The last vet and the regular vet were worried about
mega colon. (I don't yet know what it was, since they said
it in passing, and there was so much going on I didn't follow
up on it).
I fear she has lost elasticity ... (maybe this is mega
colon).
She is on wd with vetasyl. The last vet, Dr. M. also
thought she was low on potassium, and she is on Tumil-K.Now Dr. M is out of town til Mon, he has a sub, but
I don't want to deal with another new person on this.
The sub to my regular vet mentionned Metamucil.
What do you think of this?
It seems like I need to get her feces very loose to
get her colon back to operation ...
Any ideas?
What about lactulose and cisapride?
She is off insulin for now.
Thank you.
A: Jill-
I think that it is worth considering cisapride (Propulsid Rx), based on the
information available on it. Many vets have had good success with it. We
have been very lucky in our practice and have been able to control most
cases of constipation with either lactulose or metamucil type products
(same basic ingredients as Vetsyl -- so no advantage I know of to
switching). If the constipation is treated early and consistently, many
cats seem to avoid developing the large colons that can't contract well
that typify megacolon in cats. It is definitely worth being somewhat
aggressive in therapy for this condition, if that is what it takes. It is
safe to supplement oral potassium within the usual dosing guidelines, even
if she doesn't need it. And it can be beneficial in helping with muscle
contractility, so if it is low there is good reason to supplement it.I am very worried about the fact that she is off insulin. Unless she didn't
need it, which should be apparent pretty quickly if blood or urine sugar
values are monitored, then it is also an important medication for the
prevention of megacolon. Everything in the body, just about, requires sugar
and the only way to get it into cells properly is with adequate insulin.Please do check with your regular vet in the morning (Monday) and keep in
working at this. I really think you have a good chance of warding off the
worst possibilities if you keep working with your vet to resolve these
problems.Good luck with this.
Mike Richards, DVM
8/10/99
Diabetes, insulin and neuropathy
Q: Hi. My cat has diabetes, is not responding well to Humulin
Ultralente. Will be switching to Lente very soon.
The neuropathy is very serious, in all her legs. She cannot
jump, and walks with difficulty.
1. Is this neuropathy reversible? What is it exactly.
It seems to me that due to the large volume of urine she
must be losing all the water soluble vitamins. She started on some
vitamin pills last week Vet a Mix.
2. Do you think this neuropathy might be due to vitamin and
mineral deficiency?
3. Where might I get PZI? My vet used to use it and is
familiar with it.A: Jill-
PZI insulin was briefly off the market again, recently. However, a new
manufacturer is currently making it, although it is not fully FDA approved.
It can be ordered on an experimental basis with the proper forms. To order
PZI insulin, your vet should call Blue Ridge Pharmaceuticals at
1-800-374-8006.If your vet has had previous experience with PZI insulin then he or she
should be comfortable with dosing and use of PZI insulin.Due to the recent "on again, off again" availability of PZI insulin, we
have not been using it. We have used Humulin NPH insulin with good success,
as long as our clients are willing to dose twice daily. This insulin
should continue to be available in the future. We have not used Humulin
Ultralente or Humulin Lente insulin so I am not able to give you any
information based on personal experience with these insulins. The major
reason that I can see to try them is if once daily dosing is absolutely
necessary.Diabetic neuropathy is caused by metabolic changes induced by the diabetes.
It occurs due to a combination of factors, including changes in blood
supply to the nerves, utilization of sugars that are not normally utilized
by the nervous system and swelling associated with the by-products of those
sugars and the changes in the blood supply. At present, the best treatment
for this condition is aggressive control of the diabetes. It usually takes
several weeks to even several months for the weakness caused by the nerve
damage to resolve. Our experience has been that in most cases it will
resolve if the diabetes can be controlled.It wouldn't hurt to supplement vitamins and it may be a good idea.
I hope this helps some. Keep working closely with your vet to resolve this
situation. Diabetes takes a real team effort to control well.Mike Richards, DVM
6/16/99
Q: Dear Dr. Mike
A long story will follow. First ; excuse my following mistakes, I'm not a
native english speaker. We live at Germany and we are german. So I have to
please you to understand what I'm trying to say.
My female cat is an 13 ½ european shorthair. Since many years she has an
marked ( ? ) Foodallergie, and she is feeded by Hills Prescription d/d.
Since Apr.98 Hyperthroisdism is diagnosed. But we could not get the medicine
inside of her. For month's we tryed everythinmg you could thing about to get
the pills inside her mouse. Nothing.
At July the Diabetes was also diagnosed. We started with injektion of 1/
0,075 ml caninsulin. That was a very hard job for both, my cat and me.
However at least since Aug. 31st we are giving two injections a day every by
0,1ml. And after we did not allow her any interruption, she started to eat,
and from this moment she started to eat, we started some new food and within
there for two times a day a methimazole pill of 0,2mg. Great!
We thought now everything is absolutely ok., the cat ist getting better,
well, she's in a good condition.
But now, after 15 days with two pills, all the types of side effects are
coming at once!
She got only one injection at the 20th oct. morning and no pills.
At 21st she got insulin at morning with one pill. The hole day she was
sleeping, no food, no drink no walk around.
In the evening we saw her getting up in a unasually way. Her walk was very
insecure.
It did not better the next 2 hours. We watched her and I gave her insulin,
but it did not went better.
So I waited and give her some Glucose, it also did'nt change anything.
At 9.pm I asked my vet what this will be. We met in the clinic at night, and
it was diagnosed as to low sugar, and to dry. She got an electrolyte
infusion and some Vitamin inj.
The doctor made a checkup - no unknown results.
I put her home and she could not walk any more. Not a step! She only could
crawl, like an soldier, by using her front legs. It was terrible to look and
to realize, that this will not change anymore.
But next morning it seemed to be a little, little bit better. That day no
insuline, no pills.
We went to the vet and she made an bloodcheck. The Results , so I've been
told, are not good.
Liver problems, to high results of the thyroid.
We thought to put her into sleep. That was Thursday Noon, 22nd oct.
But she was by good appetite and I could stimulate her for drinking. It
seems to get very little better and better with her back legs, Thursday afternoon.
On Friday she got her insulin as normal, in the morning, but reduced to 0,075ml.
It seemed to get better again, by eating and drinking an watching as normal.
But very difficult and hard job for her to walk. It looks as her backlegs are
paralyzed, not real, but it reminds on this.
And my feeling was all the time that there went something absolutely wrong
with the methimazole.
So my husband was searching on internet to find something about this
problem.
He found, not in German, but in Switzerland and over the Atlantic.
And I was very excited to read all this about cats and Hyperthroisdism,
and as much as I could understand, I found out that there a lot of side effects,
which all seemed that they happened to my cat.
So here we are.The Question is: do you know what we could do to help her to get her on her
backlegs, or is there any possibility to do something for it? Medicine, or what?
It is not possible to get an radiotherapie here.
We will be thankfull for any answering, also by other catholders. Thank you
all! Carola & Andrew and Purzelcat.A: Dear Carola-
I can not be certain of this advice but I would be most concerned about
diabetic neuropathy causing the weakness in the back legs or possibly a
circulatory problem such as embolisms (blood clots) that can occur when
hyperthyroidism causes cardiomyopathy or problems due to high blood
pressure. Circulatory problems sometimes occur as a direct result of
diabetes, as well.Diabetic neuropathy is a decrease in function of nerves due to the changes
that occur in them with uncontrolled diabetes. Often this leads to weakness
in the rear legs but most cats can walk. Instead of walking on their toes
they may walk with much of the back part of their legs contacting the
ground, though. This will sometimes clear up slowly if good insulin
regulation can be achieved.Methimazole can't be used for all cats and you may have to consider other
ways to deal with the hyperthyroidism, such as surgical removal of the
affected thyroid gland or both glands if both are involved. It is more
complicated to do surgery such as this in a diabetic patient and so the
decision will be a hard one to make. Let your vet help you to understand
the options and the risks and then do what seems best.Mike Richards, DVM
Q: Sorry to bother you again but my mother's cat has been diagnosed with diabetes. Her vet is refusing insulin but both my books on cats says that insulin is the standard treatment for this? The glucose level is 20.88. Could he not be mentioning this because of the cost. I have told her to get a second opinion but any info would help best wishes
A: Mal- Vets often sound discouraging when talking to clients about the use of insulin (but few refuse to use it). The problem with insulin usage is that it is very confining for the pet owner due to the injection schedule, feeding schedule and need to monitor the success of the insulin dosages in some manner. This is especially true with cats because they often require twice daily insulin injections.
Some cats will respond at least temporarily to glipizide, the oral treatment for diabetes. Unfortunately, only about 30% of cats respond long term.
I couldn't tell much from the blood sugar value you sent. Blood glucose levels are normally between 60 and 120 in a normal cat. A value of 20.88 would be very low and the problem would actually be hypoglycemia rather than diabetes (hypergylcemia). I suspect you may have misplaced the decimal point or made an error in transcribing the value.
Find out from your mom if the vet is just being discouraging or actually refusing to help with insulin regulation and administration. I think that is probably the case but if not, it might be a good idea to get a second opinion.
Mike Richards DVM
Feeding schedule and regulating diabetes
Q: Dear Dr. Mike, First, thank you and Michal for your wonderful, informative site. It's terrific that you put so much time and expertise into helping people who love their pets. I read the section on cats and diabetes, and it was helpful (even just to know it's hard to regulate insulin in cats). My neutered male cat, Mr. Kitty (age unknown, but maybe 8-10 -- he was a stray) was recently diagnosed and is on 12 units of Lilly Iletin I, mornings only. We're having trouble regulating him (after only four weeks) and he's still eating and drinking like mad. I know it will take time to find the right dose. Knowing little about diabetes, I'm having trouble understanding his food requirements. His vet says he should only eat 15 minutes after the insulin injection, then again about 3 pm (based on when he "peaked" during testing). I can't get home at 3 pm, so I feed him at 5:00 instead. My first question is: shouldn't he eat when his body tells him he needs to? That is, shouldn't I leave food out all day? I stopped leaving food out for a while (I have 8 cats and they were all mad about it), but Mr. Kitty occasionally became desperate and anxious, even combative. My second question is: Why does he need to eat and drink so ravenously? My third question: Is it necessary that he eat only prescription Science Diet C/D? Is the *type* of food much help in regulating blood sugar? Dr. Mike, I really appreciate your help with my questions. I'm feeling my way along in the dark through unknown territory, and Mr. Kitty is very important to me. Thank you so much for your answers, and for your Web site. Kimberly
A: Kimberly-There are two considerations when giving advice for diabetes control that you should be aware of. The first is that vets develop a routine that works for them and even though there may be a theoretical "best" approach, it may not work well for your vet. The second is that someone has tried and probably recommended in writing, almost anything you can think of as a method of helping control insulin in diabetics. Therefore, even though I think the rest of the information in this email is correct from my point of view it is very likely other vets disagree and can produce some literature references to support their position. That said....
The ideal situation for feeding would be a cat who eats very small amounts very frequently throughout the course of the day, probably. We recommend leaving dry food out for cats all day and feeding three supplemental meals of a canned food to entice them to eat, one when the insulin injection is given, one later in the afternoon and then one in the evening. The total calories consumed should stay approximately the same each day, if possible. Many cats are cooperative about this and will consume roughly the same amount from day to day.
The ideal diet is controversial but currently the moderate fiber diets seem to be the most favored by nutritionists and endocrinologists. Hill's version of this is w/d and there are similar diets available from Purina, I think. Consistency is important and if it is easiest to get this using c/d I think that would be OK, personally. I don't use it for my diabetic patients simply because most of them already have favorite foods that they have taught their owners to use and I want the cat to want to eat and to eat consistently -- so feeding its favorite foods when they don't seem harmful seems best to me.
If you can get his insulin requirements regulated the increased hunger and thirst will lessen or even disappear. Insulin "unlocks" the cell's ability to transport glucose (the sugar the body uses for energy) into the cell. When it is not present in sufficient quantities the effect is a little like stacking up a ton of food just out of reach of a person in a cell -- they have all the food they need but they can't reach it. In diabetes there is plenty of sugar in the bloodstream but the cells have no way of getting it. The thirst comes because the sugar causes diuresis and dehydration, leading to thirst.
I can't tell for sure from your message, but I am guessing your vet is using Ultralente Iletin 1) insulin. When ultralente insulin given once a day does not work to control diabetes well, it is best to go to twice daily injection of the insulin. In some cases switching types of insulin is helpful, too. Lente insulin (Lente Iletin 1 or Humulin L, rx) given twice daily is more successful in some cats and NPH insulin is also used in some resistant cases. It takes a lot of cooperation between the cat owner, the vet and even the cat to regulate insulin well. Keep working with your vet to get this right!
Mike Richards, DVM
Q: Dear Dr. Mike: My cat has been diagnosed with chronic xanthogranulomatous interstitial dermatitius. Blood testing has shown it is not due to excess fat in the blood, hence dietary changes will not eliminate symptoms (itching and red, puffy, fat collections near ears). I'm wondering if you know where I can find out further information about this disease, and hopefully find a way to alleviate my cat's irritation. Any suggestions? Thanks. ELenkert
A: E- I have searched the electronic databases available to me and can not find an exact reference to "My cat has been diagnosed with chronic xanthogranulomatous interstitial dermatitus" (I corrected the spelling to dermatitis when searching). However, xanthomas are granulometous lesions often associated with excessive lipids in the blood stream so I am assuming this is the condition being referred to. Xanthomas also occur in cats who have diabetes and has been seen in cats as a side effect of administering megestrol acetate (Ovaban Rx), presumably because it causes diabetes. It would be a good idea to recheck blood glucose values if there is any question about the possibility of diabetes when xanthomas are present. There is some chance that hepatic lipidosis may contribute to this problem as well. If your cat is not eating well or shows any other signs of liver disease this may be worth looking into. If diabetes or hepatic lipidosis are present controlling the underlying disease will usually resolve the symptoms.
Mike Richards, DVM
Michal Response: There is an excellent site dedicated to cats with diabetes - http://www.felinediabetes.com
Last edited 06/05/07